Surgery

Mortality following acute native artery embolecotmy for arterial embolism unrelated to peripheral arterial disease (PAD): 18 year review (2014)

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Type of publication:
Conference abstract

Author(s):
*Lambert J., *Premaratne S., *Jaipersad A., *Houghton A., *Fox A., *Merriman K.

Citation:
International Journal of Surgery, November 2014, vol./is. 12/(S114)

Abstract:
Introduction: Arterial embolism unrelated to peripheral vascular disease (AEUPAD) is known to be associated with risk factors such as malignancy, atrial fibrillation and thrombophilias. This study aimed to determine survival following embolecotmy of native arteries for AEUPAD. Methodology: Retrospective analysis was performed of a prospectively maintained database in a single vascular centre for the past 18 years, for all native artery embolectomies. Patients with PAD and graft embolectomies were excluded. Kaplan-Meier survival analysis was performed to calculate overall survival. Relationship between death and known risk factors were also assessed. Results: From 1994 to 2012, 192 patients had 204 native artery embolectomies for AEUPAD. 11 had multiple embolectomies. 100(49%) were male, mean age 72.5 (range: 9-102) years. Embolectomies performed; femoral 115 (56%), popliteal 47(23%), brachial 40 (17%), iliofemoral 1(0.4 %) and tibial 2(0.8%). 80 (41.60%) of patients were alive at the time of analysis. Kaplan-Meier estimates 69.77% survival 12 months post embolecotmy, decreased to 46.42% and 18.61% within 2 and 5 years respectively. Age (p<0.0001) and male sex (p=0.0451) were associated with death. Smoking had a negative correlation with mortality (p=0.0080). Conclusions: There is high mortality following embolecotmy. Though basic investigations are performed, further assessment may be necessary to prevent high mortality.

Link to full-text:
http://www.journal-surgery.net/article/S1743-9191(14)00812-7/pdf

Is the negativity rate of laparoscopic appendicectomies on the increase? (2015)

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Type of publication:
Conference abstract

Author(s):
*Sukha A., *Packer H., *Taylor M., *Goodyear S.

Citation:
Surgical Endoscopy and Other Interventional Techniques, April 2015, vol./is. 29/(S313)

Abstract:
Aims: This study investigates the histological appearance of appendixes from laparoscopic and open appendicectomies. We propose that the negativity rate of laparoscopic appendicectomies is when compared to an open appendicectomy due to the advancements in laparoscopic equipment and surgeon skills. Methods Retrospective data collection of all appendicectomies between January – June 2014. Data was collected from Theatre logbooks and the Pathology and PACS computer systems, and analysed in Microsoft Excel. Results 226 appendectomies were performed on the emergency-operating list. 174 (77%) had a laparoscopic appendicectomy and 52(23%) had an open procedure. The negative appendix rate on histology was significantly higher in the laparoscopic group (28.2%, n = 49) versus the open group (11.5%, n = 6) p = 0.05. There was a 2% (n = 5) associated morbidity and 0% mortality. Conclusion Laparoscopic surgery is considered to be a minimally invasive surgical procedure with low associated risks. The appendix is removed when inflamed and often in right iliac fossa pain when no other pathology is found. Our study shows that laparoscopy may be overused resulting in higher than expected negativity rates. Key statement Laparoscopic surgery is fast becoming the preferred operative procedure for the suspected appendicitis diagnostic tool in the unclear presentation of right iliac fossa pain. The minimally invasive procedure is considered to be a safe procedure perhaps resulting in its overuse. We investigate the negativity rate in laparoscopic verses open appendicectomy.

How good are surgeons at identifying appendicitis? Results from a multi-centre cohort study (2015)

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Type of publication:
Journal article

Author(s):
Strong S., Blencowe N., Bhangu A., Panagiotopoulou I.G., Chatzizacharias N., Rana M., Rollins K., Ejtehadi F., Jha B., Tan Y.W., Fanous N., Markides G., Tan A., Marshal C., Akhtar S., Mullassery D., Ismail A., Hitchins C., Sharif S., Osborne L., Sengupta N., Challand C., Pournaras D., Bevan K., King J., Massey J., Sandhu I., Wells J.M., Teichmann D.A., Peckham-Cooper A., Sellers M., Folaranmi S.E., Davies B., Potter S., Egbeare D., Kallaway C., Parsons S., Upchurch E., Lazaridis A., Cocker D., King D., Behar N., Loukogeorgakis S.P., Kalaiselvan R., Marzouk S., Turner E.J.H., Kaptanis S., Kaur V., Shingler G., Bennett A., Shaikh S., Aly M., Coad J., Khong T., Nouman Z., Crawford J., Szatmary P., West H., MacDonald A., Lambert J., Gash K., Hanks K.A., Griggs E., Humphreys L., Torrance A., Hardman J., Taylor L., Rex D., Bennett J., Crowther N., McAree B., Flexer S., Mistry P., Jain P., Hwang M., Oswald N., Wells A., Newsome H., Martinez P., Alvarez C.A.B., Leon J., Carradice D., Gohil R., Mount M., Campbell A., Iype S., Dyson E., Groot-Wassink T., Ross A.R., Charlesworth P., Baylem N., Voll J., Sian T., Creedon L., Hicks G., Goring J., Ng V., Tiboni S., Palser T., Rees B., Ravindra P., Neophytou C., Dent H., Lo T., Broom L., O'Connell M., Foulkes R., Griffith D., Butcher K., Mclaren O., Tai A., Yano H., Torrance H.D.T., Moussa O., Mittapalli D., D.Watt, Basson S., Gilliland J., Pilgrim S., Wilkins A., Yee J., Cain H., Wilson M., Pearson J., Turnbull E., Brigic A., Yassin N.A., Clarke J., Mallappa S., Jackson P., Jones C., Lakshminarayanan B., Sharma A., Velineni R., Fareed K., Yip G., Brown A., Patel N., Ghisel M., Tanner N., Jones H., Witherspoon J., Phillips M., Ho M.F., Ng S., Mak T., Campain N., Mukhey D., Mitchell W.K., Amawi F., Dickson E., Aggarwal S., Satherley L.K., Asprou F., Keys C., Steven M., Johnstone M., Muhlschlegel J., Hamilton E., Yin J., Dilworth M., Wright A., Spreadborough P., Singh M., Mockford K., Morgan J., Ball W., Royle J., Lacy-Colson J., Lai W., Griffiths S., Mitchell S., Parsons C., Joel A.S., Mason P.F., Harrison G.J., Steinke J., Rafique H., Battersby C., Hawkins W., Gurram D., Hateley C.A., Penkethman A., Lambden C., Conway A., Dent P., Yacob D., Oshin O.A., Hargreaves A., Gossedge G., Long J., Walls M., Futaba K., Pinkney T., Puig.S, Boddy A., Jones A., Tennuci C., Battersby N., Wilkin R., Lloyd C., Sein E., McEvoy K., Whisker L., Austin S., Colori A., Sinclair P., Loughran M., Lawrence A., Horsnell J., Bagenal J., Pisesky A., Mastoridis S., Solanki K., Siddiq I., Merker L., Sarmah P., Richardson C., Hanratty D., Evans L., Mortimer M., Bhalla A., Bartlett D., Beral D., Cornish J., Haddow J.B., Hall N.J.

Citation:
International Journal of Surgery, March 2015, vol./is. 15/(107-112)

Abstract:
Background: Convincing arguments for either removing or leaving in-situ a macroscopically normal appendix have been made, but rely on surgeons' accurate intra-operative assessment of the appendix. This study aimed to determine the inter-rater reliability between surgeons and pathologists from a large, multicentre cohort of patients undergoing appendicectomy. Materials and methods: The Multicentre Appendicectomy Audit recruited consecutive patients undergoing emergency appendicectomy during April and May 2012 from 95 centres. The primary endpoint was agreement between surgeon and pathologist and secondary endpoints were predictors of this disagreement. Results: The final study included 3138 patients with a documented pathological specimen. When surgeons assessed an appendix as normal (n=496), histopathological assessment revealed pathology in a substantial proportion (n=138, 27.8%). Where surgeons assessed the appendix as being inflamed (n=2642), subsequent pathological assessment revealed a normal appendix in 254 (9.6%). There was overall disagreement in 392 cases (12.5%), leading to only moderate reliability (Kappa 0.571). The grade of surgeon had no significant impact on disagreement following clinically normal appendicectomy. Females were at the highest risk of false positives and false negatives and pre-operative computed tomography was associated with increased false positives. Conclusions: This multi-centre study suggests that surgeons' judgements of the intra-operative macroscopic appearance of the appendix is inaccurate and does not improve with seniority and therefore supports removal at the time of surgery.

Monckeberg's arteriosclerosis: Vascular calcification complicating microvascular surgery (2015)

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Type of publication:
Journal article

Author(s):
*Castling B., *Bhatia S., *Ahsan F.

Citation:
International Journal of Oral and Maxillofacial Surgery, January 2015, vol./is. 44/1(34-36)

Abstract:
Monckeberg's arteriosclerosis is often an incidental finding, identified either clinically or on plain radiography. It can occasionally be associated with diabetes mellitus or chronic kidney disease. It differs from the more common atherosclerosis in that the tunica intima remains largely unaffected and the diameter of the vessel lumen is preserved. Despite such vessels appearing hard and pulseless throughout their affected length, they deliver relatively normal distal perfusion, indeed there is often a bounding pulse at the end of the calcified zone. They appear unremarkable on magnetic resonance angiography but visibly calcified on plain radiography. Monckeberg's arteriosclerosis has a prevalence of < 1% of the population, but when it does occur it can cause consternation at the prospect of using these vessels for microvascular anastamosis. We report our experience of deliberately using these vessels in an osseocutaneous radial forearm free flap reconstruction. Although there are some technical considerations to bear in mind, we would suggest that unlike vessels affected by atherosclerosis, anastomosis of arteries affected by Monckeberg's arteriosclerosis has little or no impact on free flap survival.

 

Calcaneus osteotomy (2014)

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Type of publication:
Journal article

Author(s):
Tennant J.N., *Carmont M., Phisitkul P.

Citation:
Current Reviews in Musculoskeletal Medicine, 2014, vol./is. 7/4(271-276), 1935-973X;1935-9748 (2014)

Abstract:
Calcaneal osteotomy is an extra-articular, joint-sparing procedure that is used in the correction of cavovarus and planovalgus foot deformity. Careful indications and contraindications for the procedure, with meticulous surgical technique, should be followed to avoid complications and to achieve optimal outcomes. Multiple options of osteotomies exist, including translational (medializing and lateralizing calcaneal osteotomy, with ability to slide proximally or distally, closing wedge (Dwyer), and rotational type osteotomies (Evans, Z-osteotomy). Future directions for innovation include developments of both implants and surgical techniques.

Link to more details or full-text:

The Telford tonsillectomy tie trainer: an AirSim model modification (2014)

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Type of publication:
Journal article

Author(s):
*Douglas, JA; *Senior, AJ; *Scott, A

Citation:
Annals of The Royal College of Surgeons of England, Volume 96, Number 8, November 2014, pp. 634-634(1)

Abstract:

Link to more details or full-text: http://www.ingentaconnect.com/content/rcse/arcs/2014/00000096/00000008/art00042

Safety of short, in-hospital delays before surgery for acute appendicitis: Multicentre cohort study, systematic review, and meta-analysis (2014)

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Type of publication:
Journal article

Author(s):
Bhangu A., Panagiotopoulou I.G., Chatzizacharias N., Rana M., Rollins K., Ejtehadi F., Jha B., Tan Y.W., Fanous N., Markides G., Tan A., Marshal C., Akhtar S., Mullassery D., Ismail A., Hitchins C., Sharif S., Osborne L., Sengupta N., Challand C., Pournaras D., Bevan K., King J., Massey J., Sandhu I., Wells J.M., Teichmann D.A., Peckham-Cooper A., Sellers M., Folaranmi S.E., Davies B., Potter S., Egbeare D., Kallaway C., Parsons S., Upchurch E., Lazaridis A., Cocker D., King D., Behar N., Loukogeorgakis S.P., Kalaiselvan R., Marzouk S., H. Turner E.J., Kaptanis S., Kaur V., Shingler G., Bennett A., Shaikh S., Aly M., Coad J., Khong T., Nouman Z., Crawford J., Szatmary P., West H., MacDonald A., Lambert J., Gash K., Hanks K.A., Griggs E., Humphreys L., Torrance A., Hardman J., Taylor L., Rex D., Bennett J., Crowther N., McAree B., Flexer S., Mistry P., Jain P., Hwang M., Richardson J., Oswald N., Wells A., Newsome H., Martinez P., B. Alvarez C.A., Leon J., Carradice D., Gohil R., Mount M., Campbell A., Iype S., Dyson E., Groot-Wassink T., Ross A.R., Charlesworth P., Baylem N., Voll J., Sian T., Creedon L., Hicks G., Goring J., Ng V., Tiboni S., Palser T., Rees B., Ravindra P., Neophytou C., Dent H., Lo T., Broom L., O’Connell M., Foulkes R., Griffith D., Butcher K., McLaren O., Tai A., Yano H., T. Torrance H.D., Moussa O., Mittapalli D., Watt D., Basson S., Gilliland J., Wilkins A., Yee J., Cain H., Wilson M., Pearson J., Turnbull E., Brigic A., Yassin N.A., Clarke J., Mallappa S., Jackson P., Jones C., Lakshminarayanan B., Sharma A., Fareed K., Yip G., Brown A., Patel N., Ghisel M., Tanner N., Jones H., Witherspoon J., Phillips M., Ho M.F., Ng S., Mak T., Campain N., Mukhey D., Mitchell W.K., Amawi F., Dickson E., Aggarwal S., Satherley L.K., Asprou F., Keys C., Steven M., Muhlschlegel J., Hamilton E., Yin J., Dilworth M., Wright A., Spreadborough P., Singh M., Mockford K., Morgan J., *Ball W., *Royle J., *Lacy-Colson J., Lai W., Griffiths S., Mitchell S., Parsons C., Joel A.S., Mason P.F., Harrison G.J., Steinke J., Rafique H., Battersby C., Hawkins W., Gurram D., Hateley C.A., Penkethman A., Lambden C., Conway A., Dent P., Yacob D., Oshin O.A., Hargreaves A., Gossedge G., Long J., Walls M., Futaba K., Pinkney T., Puig S., Nepogodiev D., Marriott P., Boddy A., Jones A., Tennuci C., Battersby N., Wilkin R., Lloyd C., Sein E., McEvoy K., Whisker L., Austin S., Colori A., Sinclair P., Loughran M., Lawrence A., Horsnell J., Bagenal J., Pisesky A., Mastoridis S., Solanki K., Siddiq I., Merker L., Sarmah P., Richardson C., Hanratty D., Evans L., Mortimer M., Bhalla A., Bartlett D., Beral D., Blencowe N.S., Cornish J., Haddow J.B., Hall N.J., Johnstone M., Pilgrim S., Trong S., Velineni R.

Citation:
Annals of Surgery, May 2014, vol./is. 259/5(894-903), 0003-4932;1528-1140 (May 2014)

Abstract:
OBJECTIVE: To determine safety of short in-hospital delays before appendicectomy. BACKGROUND: Short organizational delays before appendicectomy may safely improve provision of acute surgical services. METHODS: The primary endpoint was the rate of complex appendicitis (perforation, gangrene, and/or abscess). The main explanatory variable was timing of surgery, using less than 12 hours from admission as the reference. The first part of this study analyzed primary data from a multicentre study on appendicectomy from 95 centers. The second part combined this data with a systematic review and meta-analysis of published data. RESULTS: The cohort study included 2510 patients with acute appendicitis, of whom 812 (32.4%) had complex findings. Adjusted multivariable binary regression modelling showed that timing of operation was not related to risk of complex appendicitis [12-24 hours odds ratio (OR) 0.98 (P = 0.869); 24-48 hours OR 0.88 (P = 0.329); 48+ hours OR 0.82 (P = 0.317)]. However, after 48 hours, the risk of surgical site infection and 30-day adverse events both increased [adjusted ORs 2.24 (P = 0.039) and 1.71 (P = 0.024), respectively]. Meta-analysis of 11 nonrandomized studies (8858 patients) revealed that delay of 12 to 24 hours after admission did not increase the risk of complex appendicitis (OR 0.97, P = 0.750). CONCLUSIONS: Short delays of less than 24 hours before appendicectomy were not associated with increased rates of complex pathology in selected patients. These organizational delays may aid service provision, but planned delay beyond this should be avoided. However, where optimal surgical systems allow for expeditious surgery, prompt appendicectomy will still aid fastest resolution of pain for the individual patient.

Link to more details or full-text:

Achieving standards for unscheduled surgical care (2014)

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Type of publication:
Journal article

Author(s):
McArdle, Kirsten, *Leung, Edmund, Cruickshank, Neil, Laloe, Veronique

Citation:
Clinical Governance: An International Journal, 01 March 2014, vol./is. 19/1(21-29), 14777274

Abstract:
Purpose — The Royal College of Surgeons published Standards for Unscheduled Surgical Care in response to variable clinical outcomes for emergency surgery. The purpose of this study is to assess for feasibility of a district hospital providing care in accordance to the recommendations. Design/methodology/approach — A total of 100 consecutive patient unscheduled episodes of care were prospectively included. Information regarding demographics, timeliness of investigations, operations, consultant input and clinical outcomes was collated. All patients were risk-adjusted for mortality. The data were compared to the guidelines. Findings — A total of 91 patients were included; 80 patients underwent surgery. There were 18 deaths (22.5 per cent), eight (10 per cent) post-operative within 30 days. There was no statistical difference between deaths and day of admission or surgery. There were 39 critically-ill patients, none were reviewed by a consultant within the recommended 30 minutes. Of the critically-ill patients, 23 underwent CT scanning, none within the recommended 30 minutes. All patients were operated within the recommended timeframe by urgency grading. For those predicted mortality rate .5 per cent, a consultant was present in theatre for 97 per cent of cases. All patients had a consultant review within 24 hours of admission. Originality/value — To the authors’ knowledge this is the first evaluation of the practical difficulties in achieving consultant delivered care in surgery in a district general hospital. These results are interesting to clinicians and service planners involved in developing emergency services. Adhering to these guidelines would require significant re-allocation of resources in most hospitals and may require centralisation of services.