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  • 1
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    P130 Timing of nasogastric tube insertion and risk of postoperative pneumonia: international, prospective cohort study
    Oxford University Press (OUP) ; 2021
    In:  BJS Open Vol. 5, No. Supplement_1 ( 2021-04-08)
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 5, No. Supplement_1 ( 2021-04-08)
    Abstract: This study aims to assess whether Prophylactic NGT insertion was associated with reduced rates of pneumonia, in comparison to Reactive NGT after colorectal surgery. Methods Pre-planned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January and April 2018 were included. Those receiving NGT were divided into three groups, based on the timing of the placement: Routine (at the time of surgery); Prophylactic (after surgery, before vomiting); and Reactive (after surgery, after vomiting). Pneumonia within 30 postoperative days was considered as primary outcome measure and it was compared between the three groups using multivariable regression analysis. Results 4,715 patients were included in the analysis. 1,536 (32.6%) received an NGT corresponding to 926 (60.3%) Routine, 461 (30%) Reactive and 149 (9.7%) Prophylactic. 200 patients (4.2%) developed pneumonia (No NGT: 2.7%; Routine NGT: 5.2%; Reactive NGT: 10.6%; Prophylactic NGT: 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the Prophylactic and Reactive NGT groups (OR: 1.03, 95% CI: 0.56 – 1.87, p = 0.932). Conclusion In patients who required NGT insertion after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery in comparison to reactive insertion.
    Type of Medium: Online Resource
    ISSN: 2474-9842
    URL: Article
    DOI: 10.1093/bjsopen/zrab032.129
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2902033-5
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  • 2
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    Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery
    Oxford University Press (OUP) ; 2020
    In:  British Journal of Surgery Vol. 107, No. 2 ( 2020-01-05), p. e161-e169
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 107, No. 2 ( 2020-01-05), p. e161-e169
    Abstract: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P & lt; 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1002/bjs.11326
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2006309-X
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  • 3
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    Validation of the OAKS prognostic model for acute kidney injury after gastrointestinal surgery
    Oxford University Press (OUP) ; 2022
    In:  BJS Open Vol. 6, No. 1 ( 2022-01-06)
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 6, No. 1 ( 2022-01-06)
    Abstract: Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies. Methods The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI. Results In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899). Conclusion The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity. Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK).
    Type of Medium: Online Resource
    ISSN: 2474-9842
    URL: Article
    DOI: 10.1093/bjsopen/zrab150
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 4
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    P4: EXTERNAL VALIDATION OF THE OUTCOMES AFTER KIDNEY INJURY IN SURGERY (OAKS) PROGNOSTIC SCORE TO PREDICT POSTOPERATIVE ACUTE KIDNEY INJURY IN PATIENTS UNDERGOING MAJOR ELECTIVE COLORECTAL SURGERY
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. Supplement_1 ( 2021-04-27)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. Supplement_1 ( 2021-04-27)
    Abstract: Postoperative Acute Kidney Injury (AKI) is associated with significant morbidity and mortality following major gastrointestinal surgery. The Outcomes After Kidney injury in Surgery (OAKS) prognostic score risk stratifies patients undergoing major gastrointestinal surgeries for 7-day postoperative acute kidney injury (AKI). This study aimed to perform external validation of an international elective colorectal cohort. Method The Ileus MAnagement INternational (IMAGINE) audit (January to April 2018) included consecutive adults undergoing elective colorectal resection or stoma reversal across Europe and Australasia. Multivariate logistic regression was performed using data on 7-day AKI and the OAKS prognostic variables (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery, and preoperative use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers). Discrimination and calibration (Hosmer–Lemeshow test) were assessed on prediction of patients at high-risk ( & gt;20%) of postoperative AKI. Result Of 4046 patients included across 338 centres, 13.4% (n=542) developed 7-day AKI. The model discrimination was 0.67 (95% CI = 0.65-0.70), identifying high-risk patients with low sensitivity (0.28, 95% CI: 0.25-0.32) but high specificity (0.90, 95% CI = 0.89-0.91). Furthermore, the model demonstrated good calibration (p=0.518). Conclusion Discrimination of the OAKS score for patients at high-risk of postoperative AKI in this cohort is good, and remains consistent with the derivation cohort. High-risk patients identified may represent a feasible target for interventions aimed at mitigating AKI. Take-home message Prognostic risk scores may be helpful in predicting risk of postoperative acute kidney injury in patients undergoing major abdominal surgery.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab117.089
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2006309-X
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  • 5
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    P7: ACUTE KIDNEY INJURY AFTER ELECTIVE COLORECTAL SURGERY: RESULTS OF A NATIONAL CLOSED-LOOP AUDIT
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. Supplement_1 ( 2021-04-27)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. Supplement_1 ( 2021-04-27)
    Abstract: The aim of this study was to re-audit the rates of acute kidney injury (AKI) after elective colorectal surgery, following local presentations of results. Method Outcomes After Kidney injury in Surgery (OAKS) and Ileus Management International (IMAGINE), were prospective multicentre audits on consecutive elective colorectal resections, in the UK and Ireland. These were performed over 3-month periods in 2015 and 2018 respectively. During the interim period, results were presented at participating centres to stimulate local quality improvement initiatives. Risk-adjusted 7-day postoperative AKI rates were calculated through multilevel logistic regression based on the OAKS prognostic score. Result Of the 4,917 patients included, 3,133 (63.7%) originated from OAKS and 1,784 (36.3%) from IMAGINE. On univariate analysis, there was no significant difference (p=0.737) in the 7-day AKI rate between OAKS (n=346, 11.8%) and IMAGINE (n=205, 11.5%). However, the risk-adjusted AKI rate in IMAGINE was significantly lower compared to OAKS (-1.8%, 95% CI: -2.3% to -1.3%, p & lt;0.001). Of 47 centres (40.1%) with a recorded local presentation, there was no significant difference in the subsequent AKI rate in IMAGINE (-0.7%, -2.0% to 0.6%, p=0.278). Conclusion Rates of AKI after elective colorectal surgery significantly reduced on re-audit. However, this may be related to increased awareness from participation or national quality improvement initiatives, rather than local presentation of results. Abbrev. AKI - Acute Kidney Injury, OAKS - Outcomes After Kidney injury in Surgery, IMAGINE - Ileus Management International Take-home message Risk-adjusted AKI rates significantly reduced on re-audit, however, this was most likely due to factors separate from the local presentation of initial results.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab117.092
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 6
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    Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries
    Elsevier BV ; 2022
    In:  The Lancet Vol. 400, No. 10363 ( 2022-11), p. 1607-1617
    Details
    In: The Lancet, Elsevier BV, Vol. 400, No. 10363 ( 2022-11), p. 1607-1617
    Type of Medium: Online Resource
    ISSN: 0140-6736
    URL: Article
    DOI: 10.1016/S0140-6736(22)01846-3
    RVK:
    XA 10000
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2022
    detail.hit.zdb_id: 2067452-1
    detail.hit.zdb_id: 3306-6
    detail.hit.zdb_id: 1476593-7
    SSG: 5,21
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  • 7
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    Correction to: EuroSurg-1 study: an opportunity to encourage student-driven surgical research in Italy
    Springer Science and Business Media LLC ; 2019
    In:  Techniques in Coloproctology Vol. 23, No. 3 ( 2019-3), p. 299-299
    Details
    In: Techniques in Coloproctology, Springer Science and Business Media LLC, Vol. 23, No. 3 ( 2019-3), p. 299-299
    Type of Medium: Online Resource
    ISSN: 1123-6337 , 1128-045X
    URL: Article
    DOI: 10.1007/s10151-019-01958-3
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2019
    detail.hit.zdb_id: 2011444-8
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  • 8
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    IMAGINE: Ileus management international
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  International Journal of Surgery Vol. 55 ( 2018-07), p. S40-
    Details
    In: International Journal of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 55 ( 2018-07), p. S40-
    Type of Medium: Online Resource
    ISSN: 1743-9191
    URL: Article
    DOI: 10.1016/j.ijsu.2018.05.171
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2201966-2
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  • 9
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    Body mass index and complications following major gastrointestinal surgery: A prospective, international cohort study and individual patient data meta-analysis
    Ovid Technologies (Wolters Kluwer Health) ; 2018
    In:  International Journal of Surgery Vol. 55 ( 2018-07), p. S48-
    Details
    In: International Journal of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 55 ( 2018-07), p. S48-
    Type of Medium: Online Resource
    ISSN: 1743-9191
    URL: Article
    DOI: 10.1016/j.ijsu.2018.05.214
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2018
    detail.hit.zdb_id: 2201966-2
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  • 10
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    Intraperitoneal drain placement and outcomes after elective colorectal surgery: international matched, prospective, cohort study
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. 6 ( 2022-05-16), p. 520-529
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. 6 ( 2022-05-16), p. 520-529
    Abstract: Many surgeons routinely place intraperitoneal drains after elective colorectal surgery. However, enhanced recovery after surgery guidelines recommend against their routine use owing to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice. Methods COMPASS (COMPlicAted intra-abdominal collectionS after colorectal Surgery) was a prospective, international, cohort study which enrolled consecutive adults undergoing elective colorectal surgery (February to March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time to diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time to discharge; and 30-day major postoperative complications (Clavien–Dindo grade at least III). After propensity score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement. Results Overall, 1805 patients from 22 countries were included (798 women, 44.2 per cent; median age 67.0 years). The drain insertion rate was 51.9 per cent (937 patients). After matching, drains were not associated with reduced rates (odds ratio (OR) 1.33, 95 per cent c.i. 0.79 to 2.23; P = 0.287) or earlier detection (hazard ratio (HR) 0.87, 0.33 to 2.31; P = 0.780) of collections. Although not associated with worse major postoperative complications (OR 1.09, 0.68 to 1.75; P = 0.709), drains were associated with delayed hospital discharge (HR 0.58, 0.52 to 0.66; P & lt; 0.001) and an increased risk of SSIs (OR 2.47, 1.50 to 4.05; P & lt; 0.001). Conclusion Intraperitoneal drain placement after elective colorectal surgery is not associated with earlier detection of postoperative collections, but prolongs hospital stay and increases SSI risk.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac069
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2006309-X
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