Emergency hernia surgery at a high‐volume tertiary centre: a 3‐year experience

2021 ◽  
Author(s):  
Thomas B. Russell ◽  
Hassan Elberm
Keyword(s):  
High Volume ◽  
Hernia Surgery ◽  
Tertiary Centre

The role of a trauma review system and development of intra-operative checklists in improving the quality of fracture fixations in a high volume tertiary centre

2020 ◽  
Author(s):  
Raja Bhaskara Rajasekaran ◽  
Dheenadhayalan Jayaramaraju ◽  
Devendra Agraharam ◽  
Ramesh Perumal ◽  
Arun Kamal ◽  
...  
Keyword(s):  
High Volume ◽  
Review System ◽  
Tertiary Centre

Excimer Laser Coronary Angioplasty: Clinical Applications and Procedural Outcome, in a Large-Volume Tertiary Centre

Cardiology ◽  
2021 ◽  
pp. 1-7
Author(s):  
Conor McQuillan ◽  
Mohamed Farag ◽  
Mohaned Egred
Keyword(s):  
Excimer Laser ◽  
Coronary Angioplasty ◽  
High Volume ◽  
Stent Insertion ◽  
Ageing Population ◽  
Chronic Total Occlusions ◽  
Tertiary Centre ◽  
Stent Restenosis ◽  
In Stent Restenosis ◽  
Excimer Laser Coronary Angioplasty

Excimer-laser coronary angioplasty can be used to modify undilatable and uncrossable lesions in native arteries and in-stent restenosis which are increasingly encountered with the ageing population undergoing coronary intervention. We present our laser experience over a 10-year period in a large cardiac tertiary centre. <b><i>Method:</i></b> Retrospective analysis of prospectively collected data on all procedures where laser was used from August 2008 to December 2019. Clinical presentation, demographics, and procedural details were all recorded. Successful procedures were defined as &#x3c;30% stenosis at the end. Periprocedural and in-hospital complications were recorded and verified. Results are presented as numbers and percentages. <b><i>Results:</i></b> A total of 331 patients were identified with 473 lesions treated with laser and an overall total of 637 lesions. Of the 473 lesions treated, 46 (9.9%) were in-stent restenosis, 146 (30.9%) were chronic total occlusions, and the rest were uncrossable or undilatable lesions. The vast majority of procedures (97.0%) were performed with the 0.9-mm laser catheter. The overall success rate was 81.6% (58–87%) from low- to high-volume user. Complications included dissection 3 (0.6%), no-reflow 3 (0.6%), coronary perforation 13 (2.7%), and tamponade in 1 (0.2%). Only 3 (0.6%) of the perforations were seen after the laser catheter passage, the rest were seen later following balloon preparation or stent insertion. <b><i>Conclusion:</i></b> Laser is a valuable tool for treating complex and resistant coronary lesions. Its efficacy and safety are well established and when applied appropriately, it helps to achieve optimal outcomes for our patients.

Morbidity and mortality in complex robot-assisted hiatal hernia surgery: 7-year experience in a high-volume center

2018 ◽  
Vol 33 (7) ◽  
pp. 2152-2161 ◽  
Author(s):  
Alexander C. Mertens ◽  
Rob C. Tolboom ◽  
Hana Zavrtanik ◽  
Werner A. Draaisma ◽  
Ivo A. M. J. Broeders
Keyword(s):  
Hiatal Hernia ◽  
High Volume ◽  
Morbidity And Mortality ◽  
Robot Assisted ◽  
Hernia Surgery ◽  
High Volume Center

scholarly journals DOP62 Morbidity after primary ileocecal resection for Crohn’s disease in the years of biologics: Lesson learned over 631 patients exclusively treated in a tertiary centre

2020 ◽  
Vol 14 (Supplement_1) ◽  
pp. S101-S102
Author(s):  
M Rottoli ◽  
M Tanzanu ◽  
G Vago ◽  
A Belvedere ◽  
D Parlanti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Medical Treatment ◽  
Univariate Analysis ◽  
Preoperative Assessment ◽  
High Volume ◽  
Ileocecal Resection ◽  
Tertiary Centre ◽  
Major Complications

Abstract Background Several risk factors for morbidity after surgery for Crohn’s disease of the terminal ileum have already been identified. However, the study population is rarely homogeneous, due to high-volume centres receiving patients treated in other hospitals with diverging medical protocols and different thresholds for surgical referral. A study including only patients undergoing homogeneous perioperative treatment in a single referral centre might reduce the selection bias. The aim of this study was to identify the risk factors for minor (Clavien-Dindo ≤2) and major (Clavien-Dindo ≥3) postoperative complications in patients who received medical treatment and surgery in a single centre. Methods Retrospective analysis of ileocecal resections for Crohn’s disease in biological era (2004–2019). Recurrence was excluded. Risk factors for minor and major complications were identified through univariate and multivariable logistic regression analyses. Variables were selected by univariate analysis with p &lt; 0.2 criteria, then a stepwise selection with entry criteria p = 0.05 and stay criteria p = 0.1. Results Of 631 patients included (59.4% male, median age 37 years), 214 (34%) had previous surgery and 152 (24.1%) biologics. Laparoscopy was feasible in 35.9% of cases, 285 patients (45.1%) required surgery on other bowel sites due to multiple locations or fistulae. 281 (44.5%) patients presented with fistulizing disease. Risk factors for 90-day minor complications (22.8%). Risk factors for 90-day major complications (6.8%). Conclusion Risk of minor complications was higher in younger patients, especially after a longer medical treatment. Fistulating disease increases the risks only if the rectum and sigmoid colon are involved. Major complications seem to be related to specific patient’s comorbidities, rather than disease characteristics. Onset of hypertension and neuro-vascular disease, known adverse events of chronic steroid use, should not be underestimated in the preoperative assessment of patients. Poor nutritional status greatly increased the risk of minor and major complications; therefore, any effort should be made towards the nutritional optimisation of Crohn’s patients

scholarly journals Survey of General Paediatric Surgery Provision in England, Wales and Northern Ireland

2008 ◽  
Vol 90 (3) ◽  
pp. 193-197 ◽  
Author(s):  
JK Pye
Keyword(s):  
Northern Ireland ◽  
Elective Surgery ◽  
High Volume ◽  
District General Hospital ◽  
Paediatric Surgery ◽  
Subtle Change ◽  
Tertiary Centre ◽  
The Future ◽  
Tertiary Hospitals ◽  
Current Provision

INTRODUCTION A survey was carried out to ascertain the current provision of general paediatric surgery (GPS) in all hospitals in England, Wales and Northern Ireland with 100% return rate. The provision of GPS is at a crossroads with a drift of these cases to the overstretched, tertiary referral hospitals. METHODS The regional representatives on the council of the Association of Surgeons of Great Britain and Ireland (ASGBI) obtained data from their regions. Any gaps in the data were completed by the author telephoning the remaining hospitals to ascertain their current provision. RESULTS A total of 325 acute hospitals are potentially available to admit elective and/or emergency paediatric patients, of which 25 hospitals provide a tertiary paediatric surgical service. Of the remaining ‘non-tertiary’ hospitals, 138 provide elective GPS and 147 provide emergency GPS. The ages at which GPS is carried out varies considerably, but 76% of non-tertiary hospitals provide elective GPS to those over the age of 2 years. The ages of emergency cases are 24% over the age of 2 years and 51.5% over the age of 5 years. The age at which surgery is carried out is dependent on the anaesthetic provision. Subspecialisation within each hospital has taken place with a limited number of surgeons providing the elective surgery. ‘Huband-spoke’ provision of GPS to a district general hospital (DGH) from a tertiary centre is embryonic with only 11 surgeons currently in post. An estimate of the annual elective case load of GPS based on the average number of cases done on an operation list works out at 23,000 cases done outwith the tertiary centres. DISCUSSION Almost 10 years ago, a change in the training of young surgeons took place. An increase in training posts in Tertiary centres was made available following advice from the British Association of Paediatric Surgeons (BAPS) but these posts were often not taken up. Many DGH surgeons became uncertain whether they should continue GPS training. A subtle change in the wording of the general guidance by the Royal College of Anaesthetists altered the emphasis on the age at which it was appropriate to anaesthetise children. Change in clinical practice, reducing need, and a drift towards tertiary centres has reduced DGH operations by 30% over a decade. Young surgeons are now seldom exposed to this surgery, and are not being trained in it. The large volume of these low-risk operations in well children cannot be absorbed into the current tertiary centres due to pressure on beds. The future provision of this surgery is at risk unless action is taken now. This survey was carried out to inform the debate, and to make recommendations for the future. The principal recommendations are that: (i) GPS should continue to be provided as at present in those DGHs equipped to do so; (ii) GPS training should be carried out in the DGHs where a high volume of cases is carried out; (iii) management of these cases should use a network approach in each region; (iv) hospital trusts should actively advertise for an interest in GPS as a second subspecialty; and (v) the SAC in general surgery develop a strategy to make GPS relevant to trainee surgeons.

scholarly journals 283 Salvage Versus Primary Robot-Assisted Radical Prostatectomy: A Propensity-Matched Comparative Effectiveness Study from A High-Volume Tertiary Centre

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
A Nathan ◽  
M Fricker ◽  
R De Groote ◽  
A Arora ◽  
Y Phuah ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
High Volume ◽  
Patient Characteristics ◽  
Primary Treatment ◽  
Complication Rates ◽  
Robot Assisted ◽  
Oncological Outcomes ◽  
Tertiary Centre ◽  
Comparative Effectiveness Study ◽  
Primary Groups

Abstract Aim Salvage Robot-Assisted Radical Prostatectomy (sRARP) is a potential treatment option for locally recurrent Prostate Cancer after non-surgical primary treatment. There are minimal data comparing outcomes between propensity-matched salvage and primary Robot-Assisted Radical Prostatectomy (RARP). We compare perioperative, oncological, and functional outcomes of sRARP with primary RARP and between sRARP post-whole and focal gland therapy. Method 1:1 propensity-matched comparison of 146 sRARP with primary RARP from a cohort of 3,852 consecutive patients from a high-volume tertiary centre. Results There were no significant differences in patient characteristics between the salvage and primary RARP groups. Grade III-V Clavien-Dindo complication rates were 1.3% and 0% in the salvage and primary groups, respectively (p = 0.310). Median (IQR) follow-up was 16 (10,30) and 21 (13,33) months in the salvage and primary groups, respectively. BCR rates were 30.8% and 13.7% in the salvage and primary groups, respectively (p &lt; 0.001). Pad-free continence rates were 79.1% and 85.4% at two years in the salvage and primary groups, respectively (p = 0.160). ED rates were 95.2% and 77.4% in the salvage and primary groups, respectively (p &lt; 0.001). Comparing the whole gland and focal gland groups, BCR rates were 33.3% and 29.1%, respectively (p = 0.687), pad-free continence rates were 66% and 89.3%, respectively (p = 0.001), and ED rates were 98.3% and 93%, respectively (p = 0.145). Conclusions SRARP has similar perioperative but inferior oncological outcomes to primary RARP. Continence rates are similar to primary RARP, but potency is worse. Perioperative and oncological outcomes of sRARP after focal gland therapy are similar but continence outcomes are superior compared to sRARP after whole gland therapy.

scholarly journals O09 CLINICAL FEASIBILITY OF THE Q1.6 INGUINAL HERNIA APPLICATION: A PROSPECTIVE COHORT STUDY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Ludo van Hout ◽  
Willem Bökkerink ◽  
Patrick Vriens
Keyword(s):  
Inguinal Hernia ◽  
Functional Limitations ◽  
High Volume ◽  
Patient Characteristics ◽  
Smartphone Application ◽  
Measuring Instruments ◽  
Hernia Surgery ◽  
Current Application ◽  
Inguinal Hernia Surgery ◽  
Patient Reported

Abstract Aim Patient Reported Outcomes (PROs) are essential for evaluating hernia surgery. Current measuring instruments for PROs have disadvantages: often lengthy and burdensome paper questionnaires, used at predetermined moments with low patient compliance and time-consuming data processing. The Q 1.6 Inguinal Hernia application was developed to overcome these challenges. This pilot study reports the first clinical feasibility results. Materials and Methods the ‘twitch crowdsourcing’ concept was applied: during the interval of unlocking a smartphone or tablet a short question is asked, multiple times a day. Questions from validated questionnaires were implemented. The adaptive question engine generates an individualized set of questions. Alerts are automatically generated when a complication is suspected. All inguinal hernia patients in a high-volume inguinal hernia center were eligible for inclusion. Patients signed informed consent. Results 229 patients answered over 50.000 pre- and postoperative questions of which 92% were answered. Pre- and postoperative patient characteristics and clinical outcomes confirmed a standard inguinal hernia population. Compliance was 91.7% after 14 days, 69.0% after 3 months and 28.8% after one year. Pain and functional limitations were measured with a numerical scale from zero to ten. After 3 and 7 days, 7.7% and 44.3% returned to work, respectively. Patients were highly satisfied (92.8% preferred the app to usual care). Conclusions this smartphone application shows promising results for clinical practice. Remote monitoring may become standard postoperative care after (inguinal) hernia surgery. The current application will be further improved and evaluated for cost-effectiveness, safety and validity.

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