scholarly journals A District General Hospital Experience of Patients Receiving Apixaban, Dabigatran, Rivaroxaban or Warfarin for Anticoagulation

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4733-4733 ◽  
Author(s):  
Lewis Raiman ◽  
Richard H Antbring ◽  
Abed Abu-Sitta ◽  
Faris N Al-Refaie
Keyword(s):  
United Kingdom ◽  
General Hospital ◽  
Conflicts Of Interest ◽  
Oral Anticoagulants ◽  
District General Hospital ◽  
Bleeding Complications ◽  
Published Data ◽  
Complication Rates ◽  
Common Causes ◽  
The Impact

Abstract Introduction Novel oral anticoagulants (NOACs) are becoming increasingly more prevalent as a preventative measure for venous thromboembolism and stroke prevention in atrial fibrillation (AF)1. NOACs are considered non inferior to Vitamin K antagonists (VKAs) in terms of efficacy and clinical trial evidence has suggested lower rates of complications with the use of NOACs2. There is limited published literature on the complication rates of NOAC use in the district general hospital setting. In this retrospective study, the bleeding rates amongst patients on oral anticoagulants in a district general hospital in the United Kingdom were established. Methods All patients prescribed a NOAC (Rivaroxaban, dabigatran or apixaban) or a VKA at the Princess Alexandra Hospital, a district general hospital in Harlow, United Kingdom, between 01/01/2015 and 31/12/2015 were identified from hospital pharmacy records. Electronic patient hospital records of these individuals were reviewed to identify indication for anticoagulation and any subsequent bleeding complications after initiating therapy as classified according to ICD-10 up until 31st of June 2016. Results A total of 521 patients were prescribed a NOAC. 283 patients were prescribed Rivaroxaban, 217 patients Apixaban and 21 patients were prescribed Dabigatran. 969 patients were prescribed a VKA. From 1st of January 2015 to June 31st 2016, 5.9% of NOAC patients suffered a bleed requiring a hospital visit during this time, versus 7.1% patients on a VKA. Amongst patients prescribed a NOAC, common causes of bleeding included GI haemorrhage (34.5%), epistaxis (38.0%), haemoptysis (13.8%). Amongst patients prescribed a VKA, common causes of bleeding included gastrointestinal bleeding (57.0%), epistaxis (25.2%), haemoptysis (11.9%). Rates of cerebral haemorrhage were low in both groups (0.77% of patients prescribed a NOAC and 0.61% of patients prescribed a VKA). Conclusion This data illustrates real-world experience of bleeding rates requiring hospital admission of patients on NOACs and VKA. The data suggests a lower bleeding complication rate amongst a district general hospital patient population taking NOAC compared to VKA, in keeping with previously published data. References 1. Beyer-Westendorf J, Förster K, Pannach S, Ebertz F, Gelbricht V, Thieme C, Michalski F, Köhler C, Werth S, Sahin K, Tittl L. Rates, management, and outcome of rivaroxaban bleeding in daily care: results from the Dresden NOAC registry. Blood. 2014 Aug 7;124(6):955-62. 2. Chai-Adisaksopha C, Crowther M, Isayama T, Lim W. The impact of bleeding complications in patients receiving target-specific oral anticoagulants: a systematic review and meta-analysis. Blood. 2014 Oct 9;124(15):2450-8. Disclosures No relevant conflicts of interest to declare.

scholarly journals O33 Outcomes of patients undergoing emergency surgery during the first phase of national lockdown in the United Kingdom due to COVID-19 pandemic: experience at a district general hospital

2021 ◽  
Vol 108 (Supplement_5) ◽  
Author(s):  
W Luo ◽  
R Limb ◽  
A Aslam ◽  
R Kattimani ◽  
D Karthikappallil ◽  
...  
Keyword(s):  
United Kingdom ◽  
Length Of Stay ◽  
General Hospital ◽  
Postoperative Mortality ◽  
District General Hospital ◽  
National Guidelines ◽  
Fractured Neck Of Femur ◽  
The United Kingdom ◽  
Significant Difference ◽  
The Impact

Abstract Introduction This study aimed to assess the impact of the COVID-19 pandemic on emergency operations during the first phase of lockdown in the United Kingdom, compared to the equivalent population in the same calendar period in 2019. Method We retrospectively reviewed patients undergoing surgery in emergency theatres at our district general hospital between March 23rd and May 11th in 2019 and 2020. Data collected included demographics, National Confidential Enquiry into Patient Outcome and Death (NCEPOD) category and procedure. The primary outcome was 90-day post-operative mortality; secondary outcomes included time to intervention and length of inpatient stay. Result 132 patients (2020) versus 141 (2019) patients were included with no significant difference in age (P = 0.676), sex (P = 0.230), or overall 90-day postoperative mortality (P = 0.196). Notably, time to intervention was faster for NCEPOD code 3 patients in 2020 than 2019 (P = 0.027). Time to intervention in 2020 was longer for those dying within 90 days post-operatively compared to survivors (P = 0.02). There was no difference in length of stay between years, both overall and when comparing subgroups by NCEPOD category or procedures (fractured neck of femur (P = 0.776), laparoscopies (P = 0.866), laparotomies (P = 0.252)), except for upper limb trauma (P = 0.007). Conclusion This study is amongst the first describing the general case mix in emergency theatres in the UK. Patient pre-operative characteristics and demographics did not change. Our data confirms patient prioritisation according to NCEPOD recommendations and streamlining of surgical services, with no difference in overall mortality, time to intervention or length of stay compared to 2019. Take-home Message At this district general hospital, patients were appropriately prioritised, and our results show adaptation of hospital practice to emerging national guidelines during the first phase of lockdown. A national validation audit assessing morbidity and mortality outcomes for all NCEPOD patients may be facilitate further understanding of risks posed to patients requiring urgent surgery during these unprecedented times.

scholarly journals 822 Lessons Learnt During the COVID-19 Pandemic on Emergency Surgical Admissions in A District General Hospital

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Ahn ◽  
N Khan ◽  
N Desai ◽  
M Abdu ◽  
L Hiddema ◽  
...  
Keyword(s):  
General Hospital ◽  
Public Health Intervention ◽  
District General Hospital ◽  
Lifestyle Changes ◽  
Severe Respiratory Distress ◽  
Surgical Services ◽  
Record Data ◽  
Efficacious Vaccine ◽  
Severe Respiratory Distress Syndrome ◽  
The Impact

Abstract Introduction Coronavirus disease (COVID-19) is an acute severe respiratory distress syndrome which resulted in an unprecedented impact on NHS service provision. We aimed to assess the impact of COVID-19 on general surgical services in a district general hospital. Method Electronic health care record data was retrospectively collected from 6th of April to 6th of May for both 2019 and 2020. Results Despite fewer referrals and admissions in 2020 (133 vs 177 admissions in 2019), there were more failed discharges (29 vs 17 in 2019) and higher associated costs. Higher numbers of biliary related pathologies and pancreatitis (50 in 2020 vs 25 in 2019), and fewer complaints of non-specific abdominal pain (10 in 2020 vs 22 in 2019) were observed. The use of outpatient investigations decreased by approximately 40% in 2020; however, utilisation of inpatient investigations was comparable. Conclusions Better utilisation of outpatient investigations and virtual clinic services may surmount pressures from further peaks of COVID-19. The increase in biliary related cases and pancreatitis may be consequent upon lifestyle changes during lockdown. This merits further investigation and if appropriate, public health intervention. In the absence of an efficacious vaccine, further research would be essential to streamline general surgical services based on clinical risk stratification.

scholarly journals Open Appendicectomy under Spinal Anesthesia—A Valuable Alternative during COVID-19

2021 ◽  
Vol 07 (02) ◽  
pp. e69-e72
Author(s):  
Dinh Van Chi Mai ◽  
Alex Sagar ◽  
Oliver Claydon ◽  
Ji Young Park ◽  
Niteen Tapuria ◽  
...  
Keyword(s):  
United Kingdom ◽  
Patient Satisfaction ◽  
Spinal Anesthesia ◽  
Stated Preference ◽  
Case Series ◽  
District General Hospital ◽  
Complication Rates ◽  
Open Appendicectomy ◽  
Surgical Department ◽  
The United Kingdom

Abstract Introduction Concerns relating to coronavirus disease 2019 (COVID-19) and general anesthesia (GA) prompted our department to consider that open appendicectomy under spinal anesthesia (SA) avoids aerosolization from intubation and laparoscopy. While common in developing nations, it is unusual in the United Kingdom. We present the first United Kingdom case series and discuss its potential role during and after this pandemic. Methods We prospectively studied patients with appendicitis at a British district general hospital who were unsuitable for conservative management and consequently underwent open appendicectomy under SA. We also reviewed patient satisfaction after 30 days. This ran for 5 weeks from March 25th, 2020 until the surgical department reverted to the laparoscopic appendicectomy as the standard of care. Main outcomes were 30-day complication rates and patient satisfaction. Results None of the included seven patients were COVID positive. The majority (four-sevenths) had complicated appendicitis. There were no major adverse (Clavien-Dindo grade III to V) postoperative events. Two patients suffered minor postoperative complications. Two experienced intraoperative pain. Mean operative time was 44 minutes. Median length of stay and return to activity was 1 and 14 days, respectively. Although four stated preference in hindsight for GA, the majority (five-sevenths) were satisfied with the operative experience under SA. Discussion Although contraindications, risk of pain, and specific complications may be limiting, our series demonstrates open appendicectomy under SA to be safe and feasible in the United Kingdom. The technique could be a valuable contingency for COVID-suspected cases and patients with high-risk respiratory disease.

661 Improving Antibiotic Prescribing in a District General Hospital: A Closed Loop Audit

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
Z H Ng ◽  
T Kamran
Keyword(s):  
General Hospital ◽  
District General Hospital ◽  
Educational Interventions ◽  
Correct Choice ◽  
Antibiotic Prescribing ◽  
Surgical Team ◽  
Abdominal Abscesses ◽  
Antibiotic Efficacy ◽  
The Impact ◽  
Local Antibiotic

Abstract Aim Broad-spectrum antibiotics are effective in decreasing wound infection and postoperative intra-abdominal abscesses for patients undergoing appendicectomy. Compliance with local hospital antibiotic guidelines is important in ensuring antibiotic efficacy and reducing potential for toxicity and antibiotic resistance. The aim was to assess the impact of educational interventions on the adherence to local antibiotic guidelines in patients undergoing appendicectomy at a Scottish district general hospital. Method Preoperative antibiotic prescribing in consecutive adult patients aged ≥ 16 years undergoing appendicectomy were audited against hospital guidelines over a four-month period between March 2019 and July 2019. We implemented change through antibiotic prescribing teaching for doctors in the surgical team and anaesthetic team. This change was subsequently evaluated through a re-audit over a three-month period between December 2019 and February 2020. Results The baseline audit demonstrated 68.8% (n = 11/16) compliance to local antibiotic guidelines among patients undergoing appendicectomy. The remaining patients had the correct choice of antibiotics, but gentamicin was prescribed in different doses. Gaps in prescriber awareness of antibiotic guidelines were identified. Following departmental teaching sessions regarding antibiotic prescribing and use of the gentamicin dosing calculator, the re-audit showed 93.8% (n = 15/16) compliance with local antibiotic guidelines among prescribers in the surgical team and anaesthesic team. Conclusions Education interventions were instrumental in improving adherence to antibiotic prescribing guidelines. This highlights the importance of regular audit and prescriber education in the promotion of antibiotic stewardship in hospitals.

Endoscopic pituitary surgery: a systematic review and meta-analysis

2009 ◽  
Vol 111 (3) ◽  
pp. 545-554 ◽  
Author(s):  
Abtin Tabaee ◽  
Vijay K. Anand ◽  
Yolanda Barrón ◽  
David H. Hiltzik ◽  
Seth M. Brown ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Pituitary Surgery ◽  
Small Sample ◽  
Csf Leak ◽  
Tumor Control ◽  
Published Data ◽  
Complication Rates ◽  
Short Term ◽  
The Impact

Object Surgery on the pituitary gland is increasingly being performed through an endoscopic approach. However, there is little published data on its safety and relative advantages over traditional microscope-based approaches. Published reports are limited by small sample size and nonrandomized study design. A meta-analysis allows for a description of the impact of endoscopic surgery on short-term outcomes. Methods The authors performed retrospective review of data from their institution as well as a systematic review of the literature. The pooled data were analyzed for descriptive statistics on short-term outcomes. Results Nine studies (821 patients) met inclusion criteria. Overall, the pooled rate of gross tumor removal was 78% (95% CI 67–89%). Hormone resolution was achieved in 81% (95% CI 71–91%) of adrenocorticotropic hormone secreting tumors, 84% (95% CI 76–92%) of growth hormone secreting tumors, and 82% (95% CI 70–94%) of prolactin secreting tumors. The pooled complication rates were 2% (95% CI 0–4%) for CSF leak and 1% (95% CI 0–2%) for permanent diabetes insipidus. There were 2 deaths reported in the literature that were both related to vascular injury, giving an overall mortality rate of 0.24%. Conclusions The results of this meta-analysis support the safety and short-term efficacy of endoscopic pituitary surgery. Future studies with long-term follow-up are required to determine tumor control.

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