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4. Periprosthetic Joint Infection in an Immunocompetent Patient: A Case Report

Author

Blane C. Kelly MD, David S. Constantinescu BS, and William Foster MD

Subjects
Orthopedic surgery, RD701-811, Geriatrics, RC952-954.6
Abstract

Introduction: A periprosthetic joint infection (PJI) is a potentially devastating complication following an arthroplasty procedure. There are many organisms that commonly cause this complication; in this case report, we will discuss a PJI caused by an unusual bacteria found in the mouths of domestic pets. Objective: To present a case report of a patient with a periprosthetic hip infection from Capnocytophaga canimorsus and review the literature. Methods: We present a case of C canimorsus PJI in an immunocompetent woman who had undergone a total hip arthroplasty. The patient was doing well postoperatively for many years until she was bitten on the foot by a domestic canine. Patient diagnosed using Musculoskeletal Infection Society criteria, then treated with explant of the hip prosthesis, irrigation and debridement, placement of an antibiotic cement spacer, and a 6-week course of intravenous antibiotics. Results: Unfortunately, while awaiting replant, this patient had a massive myocardial infarction and died. Discussion: Current literature suggests treating canine bites with amoxicillinas well as a discussion with patients pre-/postoperatively from a lower extremity arthroplasty specialist. Conclusion: Capnocytophaga canimorsus is a rare cause of infection, even more unusual in an immunocompetent patient. This study highlights the importance of considering C canimorsus as a cause of PJI, regardless of the immunologic status of the patient.

Published
2019
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5. Cost‐effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology

Author

Sutton, A. J., Vohra, R. S., Hollyman, M., Marriott, P. J., Buja, A., Alderson, D., Pasquali, S., Griffiths, E. A., Vohra, R. S., Spreadborough, P., Hollyman, M., Marriott, P. J., Kirkham, A., Pasquali, S., Alderson, D., Griffiths, E. A., Fenwick, S., Elmasry, M., Nunes, Q. M., Kennedy, D., Khan, R. B., Khan, M. A. S., Magee, C. J., Jones, S. M., Mason, D., Parappally, C. P., Mathur, P., Saunders, M., Jamel, S., Ul Haque, S., Zafar, S., Shiwani, M. H., Samuel, N., Dar, F., Jackson, A., Lovett, B., Dindyal, S., Winter, H., Fletcher, T., Rahman, S., Wheatley, K., Nieto, T., Ayaani, S., Youssef, H., Nijjar, R. S., Watkin, H., Naumann, D., Emesih, S., Sarmah, P. B., Lee, K., Joji, N., Heath, J., Teasdale, R. L., Weerasinghe, C., Needham, P. J., Welbourn, H., Forster, L., Finch, D., Blazeby, J. M., Robb, W., McNair, A. G. K., Hrycaiczuk, A., Charalabopoulos, A., Kadirkamanathan, S., Tang, C.‐B., Jayanthi, N. V. G., Noor, N., Dobbins, B., Cockbain, A. J., Nilsen‐Nunn, A., de Siqueira, J., Pellen, M., Cowley, J. B., Ho, W.‐M., Miu, V., White, T. J., Hodgkins, K. A., Kinghorn, A., Tutton, M. G., Al‐Abed, Y. A., Menzies, D., Ahmad, A., Reed, J., Khan, S., Monk, D., Vitone, L. J., Murtaza, G., Joel, A., Brennan, S., Shier, D., Zhang, C., Yoganathan, T., Robinson, S. J., McCallum, I. J. D., Jones, M. J., Elsayed, M., Tuck, E., Wayman, J., Carney, K., Aroori, S., Hosie, K. B., Kimble, A., Bunting, D.M., Fawole, A. S., Basheer, M., Dave, R. V., Sarveswaran, J., Jones, E., Kendal, C., Tilston, M. P., Gough, M., Wallace, T., Singh, S., Downing, J., Mockford, K. A., Issa, E., Shah, N., Chauhan, N., Wilson, T. R., Forouzanfar, A., Wild, J. R. L., Nofal, E., Bunnell, C., Madbak, K., Rao, S. T. V., Devoto, L., Siddiqi, N., Khawaja, Z., Hewes, J. C., Gould, L., Chambers, A., Rodriguez, D. U., Sen, G., Robinson, S., Carney, K., Bartlett, F., Rae, D. M., Stevenson, T. E. J., Sarvananthan, K., Dwerryhouse, S. J., Higgs, S. M., Old, O. J., Hardy, T. J., Shah, R., Hornby, S. T., Keogh, K., Frank, L., Al‐Akash, M., Upchurch, E. A., Frame, R. J., Hughes, M., Jelley, C., Weaver, S., Roy, S., Sillo, T. O., Galanopoulos, G., Cuming, T., Cunha, P., Tayeh, S., Kaptanis, S., Heshaishi, M., Eisawi, A., Abayomi, M., Ngu, W. S., Fleming, K., Bajwa, D. S., Chitre, V., Aryal, K., Ferris, P., Silva, M., Lammy, S., Mohamed, S., Khawaja, A., Hussain, A., Ghazanfar, M. A., Bellini, M. I., Ebdewi, H., Elshaer, M., Gravante, G., Drake, B., Ogedegbe, A., Mukherjee, D., Arhi, C., Iqbal, L. G. N., Watson, N. F., Aggarwal, S. K., Orchard, P., Villatoro, E., Willson, P. D., Mok, J., Woodman, T., Deguara, J., Garcea, G., Babu, B. I., Dennison, A. R., Malde, D., Lloyd, D., Satheesan, S., Al‐Taan, O., Boddy, A., Slavin, J. P., Jones, R. P., Ballance, L., Gerakopoulos, S., Jambulingam, P., Mansour, S., Sakai, N., Acharya, V., Sadat, M. M., Karim, L., Larkin, D., Amin, K., Khan, A., Law, J., Jamdar, S., Smith, S. R., Sampat, K., Oʼshea, K. M., Manu, M., Asprou, F. M., Malik, N. S., Chang, J., Johnstone, M., Lewis, M., Roberts, G. P., Karavadra, B., Photi, E., Hewes, J., Gould, L., Chambers, A., Rodriguez, D., OʼReilly, D. A., Rate, A. J., Sekhar, H., Henderson, L. T., Starmer, B. Z., Coe, P. O., Tolofari, S., Barrie, J., Bashir, G., Sloane, J., Madanipour, S., Halkias, C., Trevatt, A. E. J., Borowski, D. W., Hornsby, J., Courtney, M. J., Virupaksha, S., Seymour, K., Robinson, S., Hawkins, H., Bawa, S., Gallagher, P. V., Reid, A., Wood, P., Finch, J. G., Parmar, J., Stirland, E., Gardner‐Thorpe, J., Al‐Muhktar, A., Peterson, M., Majeed, A., Bajwa, F. M., Martin, J., Choy, A., Tsang, A., Pore, N., Andrew, D. R., Al‐Khyatt, W., Taylor, C., Bhandari, S., Chambers, A., Subramanium, D., Toh, S. K. C., Carter, N. C., Tate, S., Pearce, B., Wainwright, D., Mercer, S. J., Knight, B., Vijay, V., Alagaratnam, S., Sinha, S., Khan, S., El‐Hasani, S. S., Hussain, A. A., Bhattacharya, V., Kansal, N., Fasih, T., Jackson, C., Siddiqui, M. N., Chishti, I. A., Fordham, I. J., Siddiqui, Z., Bausbacher, H., Geogloma, I., Gurung, K., Tsavellas, G., Basynat, P., Shrestha, A. K., Basu, S., Mohan, A. C., Harilingam, M., Rabie, M., Akhtar, M., Kumar, P., Jafferbhoy, S. F., Hussain, N., Raza, S., Haque, M., Alam, I., Aseem, R., Patel, S., Asad, M., Booth, M. I., Ball, W. R., Wood, C. P. J., Pinho‐Gomes, A. C., Kausar, A., Obeidallah, M. R., Varghase, J., Lodhia, J., Bradley, D., Rengifo, C., Lindsay, D., Gopalswamy, S., Finlay, I., Wardle, S., Bullen, N., Iftikhar, S. Y., Awan, A., Ahmed, J., Leeder, P., Fusai, G., Bond‐Smith, G., Psica, A., Puri, Y., Hou, D., Noble, F., Szentpali, K., Broadhurst, J., Date, R., Hossack, M. R., Goh, Y. L., Turner, P., Shetty, V., Riera, M., Macano, C. A.W., Sukha, A., Preston, S. R., Hoban, J. R., Puntis, D. J., Williams, S. V., Krysztopik, R., Kynaston, J., Batt, J., Doe, M., Goscimski, A., Jones, G. H., Smith, S. R., Hall, C., Carty, N., Ahmed, J., Panteleimonitis, S., Gunasekera, R. T., Sheel, A. R. G., Lennon, H., Hindley, C., Reddy, M., Kenny, R., Elkheir, N., McGlone, E. R., Rajaganeshan, R., Hancorn, K., Hargreaves, A., Prasad, R., Longbotham, D. A., Vijayanand, D., Wijetunga, I., Ziprin, P., Nicolay, C. R., Yeldham, G., Read, E., Gossage, J. A., Rolph, R. C., Ebied, H., Phull, M., Khan, M. A., Popplewell, M., Kyriakidis, D., Hussain, A., Henley, N., Packer, J. R., Derbyshire, L., Porter, J., Appleton, S., Farouk, M., Basra, M., Jennings, N. A., Ali, S., Kanakala, V., Ali, H., Lane, R., Dickson‐Lowe, R., Zarsadias, P., Mirza, D., Puig, S., Al Amari, K., Vijayan, D., Sutcliffe, R., Marudanayagam, R., Hamady, Z., Prasad, A. R., Patel, A., Durkin, D., Kaur, P., Bowen, L., Byrne, J. P., Pearson, K. L., Delisle, T. G., Davies, J., Tomlinson, M. A., Johnpulle, M. A., Slawinski, C., Macdonald, A., Nicholson, J., Newton, K., Mbuvi, J., Farooq, A., Mothe, B. S., Zafrani, Z., Brett, D., Francombe, J., Spreadborough, P., Barnes, J., Cheung, M., Al‐Bahrani, A. Z., Preziosi, G., Urbonas, T., Alberts, J., Mallik, M., Patel, K., Segaran, A., Doulias, T., Sufi, P. A., Yao, C., Pollock, S., Manzelli, A., Wajed, S., Kourkulos, M., Pezzuto, R., Wadley, M., Hamilton, E., Jaunoo, S., Padwick, R., Sayegh, M., Newton, R. C., Hebbar, M., Farag, S. F., Spearman, J., Hamdan, M. F., DʼCosta, C., Blane, C., Giles, M., Peter, M. B., Hirst, N. A., Hossain, T., Pannu, A., El‐Dhuwaib, Y., Morrison, T. E. M., Taylor, G. W., Thompson, R. L. E., McCune, K., Loughlin, P., Lawther, R., Byrnes, C. K., Simpson, D. J., Mawhinney, A., Warren, C., McKay, D., McIlmunn, C., Martin, S., MacArtney, M., Diamond, T., Davey, P., Jones, C., Clements, J.M., Digney, R., Chan, W. M., McCain, S., Gull, S., Janeczko, A., Dorrian, E., Harris, A., Dawson, S., Johnston, D., McAree, B., Ghareeb, E., Thomas, G., Connelly, M., McKenzie, S., Cieplucha, K., Spence, G., Campbell, W., Hooks, G., Bradley, N., Hill, A. D. K., Cassidy, J. T., Boland, M., Burke, P., Nally, D. M., Hill, A. D. K., Khogali, E., Shabo, W., Iskandar, E., McEntee, G. P., OʼNeill, M. A., Peirce, C., Lyons, E. M., OʼSullivan, A. W., Thakkar, R., Carroll, P., Ivanovski, I., Balfe, P., Lee, M., Winter, D. C., Kelly, M. E., Hoti, E., Maguire, D., Karunakaran, P., Geoghegan, J. G., McDermott, F., Martin, S. T., Cross, K. S., Cooke, F., Zeeshan, S., Murphy, J. O., Mealy, K., Mohan, H. M., Nedujchelyn, Y., Ullah, M. F., Ahmed, I., Giovinazzo, F., Milburn, J., Prince, S., Brooke, E., Buchan, J., Khalil, A. M., Vaughan, E. M., Ramage, M. I., Aldridge, R. C., Gibson, S., Nicholson, G. A., Vass, D. G., Grant, A. J., Holroyd, D. J., Jones, M. A., Sutton, C. M. L. R., OʼDwyer, P., Nilsson, F., Weber, B., Williamson, T. K., Lalla, K., Bryant, A., Carter, C. R., Forrest, C. R., Hunter, D. I., Nassar, A. H., Orizu, M. N., Knight, K., Qandeel, H., Suttie, S., Belding, R., McClarey, A., Boyd, A. T., Guthrie, G. J. K., Lim, P. J., Luhmann, A., Watson, A. J. M., Richards, C. H., Nicol, L., Madurska, M., Harrison, E., Boyce, K. M., Roebuck, A., Ferguson, G., Pati, P., Wilson, M. S. J., Dalgaty, F., Fothergill, L., Driscoll, P. J., Mozolowski, K. L., Banwell, V., Bennett, S. P., Rogers, P. N., Skelly, B. L., Rutherford, C. L., Mirza, A. K., Lazim, T., Lim, H. C. C., Duke, D., Ahmed, T., Beasley, W. D., Wilkinson, M. D., Maharaj, G., Malcolm, C., Brown, T. H., Shingler, G. M., Mowbray, N., Radwan, R., Morcous, P., Wood, S., Kadhim, A., Stewart, D. J., Baker, A. L., Tanner, N., Shenoy, H., Hafiz, S., De Marchi, J. A., Singh‐Ranger, D., Hisham, E., Ainley, P., OʼNeill, S., Terrace, J., Napetti, S., Hopwood, B., Rhys, T., Downing, J., Kanavati, O., Coats, M., Aleksandrov, D., Kallaway, C., Yahya, S., Weber, B., Templeton, A., Trotter, M., Lo, C., Dhillon, A., Heywood, N., Aawsaj, Y., Hamdan, A., Reece‐Bolton, O., McGuigan, A., Shahin, Y., Ali, A., Luther, A., Nicholson, J. A., Rajendran, I., Boal, M., and Ritchie, J.

Published
2017
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6. Arthroscopic Versus Open Rotator Cuff Repair: Fellowship-Trained Orthopaedic Surgeons Prefer Arthroscopy and Self-Report a Lower Complication Rate

Author

Alexander R. Vap, William Pavlis, David S. Constantinescu, and Blane C. Kelly

Subjects
medicine.medical_specialty, Intraoperative Complication, Sports medicine, medicine.diagnostic_test, business.industry, General surgery, Rehabilitation, Elbow, Arthroscopy, education, Public Health, Environmental and Occupational Health, Physical Therapy, Sports Therapy and Rehabilitation, medicine.anatomical_structure, Orthopedic surgery, Medicine, Current Procedural Terminology, Original Article, Orthopedics and Sports Medicine, Rotator cuff, business, Complication, RC1200-1245
Abstract

Purpose: To evaluate whether fellowship training had an effect on the practice pattern and complication rates among Part II examinees of the American Board of Orthopaedic Surgery (ABOS) for rotator cuff repair (RCR) from 2007-2017. Methods: The ABOS database was queried for arthroscopic (Current Procedural Terminology [CPT] code 29827) and open/mini-open (CPT codes: 23410, 23412) RCR performed from 2007-2017. Excluded were procedures that did not included CPT codes 29827, 23410, 23412. A comparison between arthroscopic and open/mini-open use as well as self-reported complications were assessed based on recorded fellowship training. Results: A total of 31,907 RCR were reported over the past 10 years (2007-2017). The percentage of RCR procedures performed using arthroscopic technique vs open/mini-open varied among surgeons who completed one fellowship: Sports Medicine (92.5 % arthroscopy; 7.5 % mini/open), Shoulder & Elbow (91.3 % arthroscopy; 8.7% mini/open), and Hand & Upper Extremity (69.6 % arthroscopy; 30.4 % open). Total complication rates varied among surgeons who completed one fellowship: Sports Medicine (11.5 %), Shoulder & Elbow (13.5 %), and Hand & Upper Extremity (13.4 %). Surgeons completing one fellowship in either Sports Medicine, Shoulder & Elbow, Hand & Upper Extremity all reported significantly lower complication rates using arthroscopic over mini/open technique (P < .001). Conclusions: Among ABOS Part II examinees completing a Sports Medicine, Shoulder and Elbow or Hand and Upper Extremity fellowship, Sports Medicine trained surgeons had significantly greater rates of performing arthroscopic over open RCR and significantly lower self-reported intraoperative complication rates. Clinical Relevance: Understanding the effects of fellowship training may guide mentors and future trainees.

Published
2021

7. Predicting the difficult laparoscopic cholecystectomy: development and validation of a pre-operative risk score using an objective operative difficulty grading system

Author

Nassar, A. H. M., Hodson, J., H. J., Ng, Vohra, R. S., Katbeh, T., Zino, S., Griffiths, E. A., Kirkham, A. J., Pasquali, S., Marriott, P., Johnstone, M., Spreadborough, P., Alderson, D., Fenwick, S., Elmasry, M., Nunes, Q. M., Kennedy, D., Khan, R. B., Khan, M. A. S., Magee, C. J., Jones, S. M., Mason, D., Parappally, C. P., Mathur, P., Saunders, M., Jamel, S., Haque, S. U., Zafar, S., Shiwani, M. H., Samuel, N., Dar, F., Jackson, A., Lovett, B., Dindyal, S., Winter, H., Fletcher, T., Rahman, S., Wheatley, K., Nieto, T., Ayaani, S., Youssef, H., Nijjar, R. S., Watkin, H., Naumann, D., Emesih, S., Sarmah, P. B., Lee, K., Joji, N., Lambert, J., Heath, J., Teasdale, R. L., Weerasinghe, C., Needham, P. J., Welbourn, H., Forster, L., Finch, D., Blazeby, J. M., Robb, W., Mcnair, A. G. K., Hrycaiczuk, A., Charalabopoulos, A., Kadirkamanathan, S., Tang, C. -B., Jayanthi, N. V. G., Noor, N., Dobbins, B., Cockbain, A. J., Nilsen-Nunn, A., de Siqueira, J., Pellen, M., Cowley, J. B., W. -M., Ho, Miu, V., White, T. J., Hodgkins, K. A., Kinghorn, A., Tutton, M. G., Al-Abed, Y. A., Menzies, D., Ahmad, A., Reed, J., Khan, S., Monk, D., Vitone, L. J., Murtaza, G., Joel, A., Brennan, S., Shier, D., Zhang, C., Yoganathan, T., Robinson, S. J., Mccallum, I. J. D., Jones, M. J., Elsayed, M., Tuck, L., Wayman, J., Carney, K., Aroori, S., Hosie, K. B., Kimble, A., Bunting, D. M., Fawole, A. S., Basheer, M., Dave, R. V., Sarveswaran, J., Jones, E., Kendal, C., Tilston, M. P., Gough, M., Wallace, T., Singh, S., Mockford, J. D. K. A., Issa, E., Shah, N., Chauhan, N., Wilson, T. R., Forouzanfar, A., Wild, J. R. L., Nofal, E., Bunnell, C., Madbak, K., Rao, S. T. V., Devoto, L., Siddiqi, N., Khawaja, Z., Hewes, J. C., Gould, L., Chambers, A., Rodriguez, D. U., Sen, G., Robinson, S., Bartlett, F., Rae, D. M., Stevenson, T. E. J., Sarvananthan, K., Dwerryhouse, S. J., Higgs, S. M., Old, O. J., Hardy, T. J., Shah, R., Hornby, S. T., Keogh, K., Frank, L., Al-Akash, M., Upchurch, E. A., Frame, R. J., Hughes, M., Jelley, C., Weaver, S., Roy, S., Sillo, T. O., Galanopoulos, G., Cuming, T., Cunha, P., Tayeh, S., Kaptanis, S., Heshaishi, M., Eisawi, A., Abayomi, M., Ngu, W. S., Fleming, K., Bajwa, D. S., Chitre, V., Aryal, K., Ferris, P., Silva, M., Lammy, S., Mohamed, S., Khawaja, A., Hussain, A., Ghazanfar, M. A., Bellini, M. I., Ebdewi, H., Elshaer, M., Gravante, G., Drake, B., Ogedegbe, A., Mukherjee, D., Arhi, C., Giwa, L., Iqbal, N., Watson, N. F., Aggarwal, S. K., Orchard, P., Villatoro, E., Willson, P. D., Mok, K. W. J., Woodman, T., Deguara, J., Garcea, G., Babu, B. I., Dennison, A. R., Malde, D., Lloyd, D., Satheesan, S., Al-Taan, O., Boddy, A., Slavin, J. P., Jones, R. P., Ballance, L., Gerakopoulos, S., Jambulingam, P., Mansour, S., Sakai, N., Acharya, V., Sadat, M. M., Karim, L., Larkin, D., Amin, K., Khan, A., Law, J., Jamdar, S., Smith, S. R., Sampat, K., O'Shea, K. M., Manu, M., Asprou, F. M., Malik, N. S., Chang, J., Lewis, M., Roberts, G. P., Karavadra, B., Photi, E., Hewes, J., Rodriguez, D., O'Reilly, D. A., Rate, A. J., Sekhar, H., Henderson, L. T., Starmer, B. Z., Coe, P. O., Tolofari, S., Barrie, J., Bashir, G., Sloane, J., Madanipour, S., Halkias, C., Trevatt, A. E. J., Borowski, D. W., Hornsby, J., Courtney, M. J., Virupaksha, S., Seymour, K., Hawkins, H., Bawa, S., Gallagher, P. V., Reid, A., Wood, P., Finch, J. G., Guy Finch, J., Parmar, J., Stirland, E., Gardner-Thorpe, J., Al-Muhktar, A., Peterson, M., Majeed, A., Bajwa, F. M., Martin, J., Choy, A., Tsang, A., Pore, N., Andrew, D. R., Al-Khyatt, W., Taylor, C., Bhandari, S., Subramanium, D., Toh, S. K. C., Carter, N. C., Tate, S., Pearce, B., Wainwright, D., Mercer, S. J., Knight, B., Vijay, V., Alagaratnam, S., Sinha, S., El-Hasani, S. S., Hussain, A. A., Bhattacharya, V., Kansal, N., Fasih, T., Jackson, C., Siddiqui, M. N., Chishti, I. A., Fordham, I. J., Siddiqui, Z., Bausbacher, H., Geogloma, I., Gurung, K., Tsavellas, G., Basynat, P., Shrestha, A. K., Basu, S., Chhabra, A., Harilingam, M., Rabie, M., Akhtar, M., Kumar, P., Jafferbhoy, S. F., Hussain, N., Raza, S., Haque, M., Alam, I., Aseem, R., Patel, S., Asad, M., Booth, M. I., Ball, W. R., Wood, C. P. J., Pinho-Gomes, A. C., Kausar, A., Obeidallah, M. R., Varghase, J., Lodhia, J., Bradley, D., Rengifo, C., Lindsay, D., Gopalswamy, S., Finlay, I., Wardle, S., Bullen, N., Iftikhar, S. Y., Awan, A., Ahmed, J., Leeder, P., Fusai, G., Bond-Smith, G., Psica, A., Puri, Y., Hou, D., Noble, F., Szentpali, K., Broadhurst, J., Date, R., Hossack, M. R., Goh, Y. L., Turner, P., Shetty, V., Riera, M., Macano, C. A. W., Sukha, A., Preston, S. R., Hoban, J. R., Puntis, D. J., Williams, S. V., Krysztopik, R., Kynaston, J., Batt, J., Doe, M., Goscimski, A., Jones, G. H., Hall, C., Carty, N., Panteleimonitis, S., Gunasekera, R. T., Sheel, A. R. G., Lennon, H., Hindley, C., Reddy, M., Kenny, R., Elkheir, N., Mcglone, E. R., Rajaganeshan, R., Hancorn, K., Hargreaves, A., Prasad, R., Longbotham, D. A., Vijayanand, D., Wijetunga, I., Ziprin, P., Nicolay, C. R., Yeldham, G., Read, E., Gossage, J. A., Rolph, R. C., Ebied, H., Phull, M., Khan, M. A., Popplewell, M., Kyriakidis, D., Henley, N., Packer, J. R., Derbyshire, L., Porter, J., Appleton, S., Farouk, M., Basra, M., Jennings, N. A., Ali, S., Kanakala, V., Ali, H., Lane, R., Dickson-Lowe, R., Zarsadias, P., Mirza, D., Puig, S., Al Amari, K., Vijayan, D., Sutcliffe, R., Marudanayagam, R., Hamady, Z., Prasad, A. R., Patel, A., Durkin, D., Kaur, P., Bowen, L., Byrne, J. P., Pearson, K. L., Delisle, T. G., Davies, J., Tomlinson, M. A., Johnpulle, M. A., Slawinski, C., Macdonald, A., Nicholson, J., Newton, K., Mbuvi, J., Farooq, A., Mothe, B. S., Zafrani, Z., Brett, D., Francombe, J., Barnes, J., Cheung, M., Al-Bahrani, A. Z., Preziosi, G., Urbonas, T., Alberts, J., Mallik, M., Patel, K., Segaran, A., Doulias, T., Sufi, P. A., Yao, C., Pollock, S., Manzelli, A., Wajed, S., Kourkulos, M., Pezzuto, R., Wadley, M., Hamilton, E., Jaunoo, S., Padwick, R., Sayegh, M., Newton, R. C., Hebbar, M., Farag, S. F., Spearman, J., Hamdan, M. F., D'Costa, C., Blane, C., Giles, M., Peter, M. B., Hirst, N. A., Hossain, T., Pannu, A., El-Dhuwaib, Y., Morrison, T. E. M., Taylor, G. W., Thompson, R. L. E., Mccune, K., Loughlin, P., Lawther, R., Byrnes, C. K., Simpson, D. J., Mawhinney, A., Warren, C., Mckay, D., Mcilmunn, C., Martin, S., Macartney, M., Diamond, T., Davey, P., Jones, C., Clements, J. M., Digney, R., Chan, W. M., Mccain, S., Gull, S., Janeczko, A., Dorrian, E., Harris, A., Dawson, S., Johnston, D., Mcaree, B., Ghareeb, E., Thomas, G., Connelly, M., Mckenzie, S., Cieplucha, K., Spence, G., Campbell, W., Hooks, G., Bradley, N., Hill, A. D. K., Cassidy, J. T., Boland, M., Burke, P., Nally, D. M., Khogali, E., Shabo, W., Iskandar, E., Mcentee, G. P., O'Neill, M. A., Peirce, C., Lyons, E. M., O'Sullivan, A. W., Thakkar, R., Carroll, P., Ivanovski, I., Balfe, P., Lee, M., Winter, D. C., Kelly, M. E., Hoti, E., Maguire, D., Karunakaran, P., Geoghegan, J. G., Mcdermott, F., Martin, S. T., Cross, K. S., Cooke, F., Zeeshan, S., Murphy, J. O., Mealy, K., Mohan, H. M., Nedujchelyn, Y., Ullah, M. F., Ahmed, I., Giovinazzo, F., Milburn, J., Prince, S., Brooke, E., Buchan, J., Khalil, A. M., Vaughan, E. M., Ramage, M. I., Aldridge, R. C., Gibson, S., Nicholson, G. A., Vass, D. G., Grant, A. J., Holroyd, D. J., Jones, M. A., Sutton, C. M. L. R., O'Dwyer, P., Nilsson, F., Weber, B., Williamson, T. K., Lalla, K., Bryant, A., Carter, C. R., Forrest, C. R., Hunter, D. I., Nassar, A. H., Orizu, M. N., Knight, K., Qandeel, H., Suttie, S., Belding, R., Mcclarey, A., Boyd, A. T., Guthrie, G. J. K., Lim, P. J., Luhmann, A., Watson, A. J. M., Richards, C. H., Nicol, L., Madurska, M., Harrison, E., Boyce, K. M., Roebuck, A., Ferguson, G., Pati, P., Wilson, M. S. J., Dalgaty, F., Fothergill, L., Driscoll, P. J., Mozolowski, K. L., Banwell, V., Bennett, S. P., Rogers, P. N., Skelly, B. L., Rutherford, C. L., Mirza, A. K., Lazim, T., Lim, H. C. C., Duke, D., Ahmed, T., Beasley, W. D., Wilkinson, M. D., Maharaj, G., Malcolm, C., Brown, T. H., Al-Sarireh, B., Shingler, G. M., Mowbray, N., Radwan, R., Morcous, P., Wood, S., Kadhim, A., Stewart, D. J., Baker, A. L., Tanner, N., Shenoy, H., Hafiz, S., De Marchi, J. A., Singh-Ranger, D., Hisham, E., Ainley, P., O'Neill, S., Terrace, J., Napetti, S., Hopwood, B., Rhys, T., Downing, J., Kanavati, O., Coats, M., Aleksandrov, D., Kallaway, C., Yahya, S., Templeton, A., Trotter, M., Lo, C., Dhillon, A., Heywood, N., Aawsaj, Y., Hamdan, A., Reece-Bolton, O., Mcguigan, A., Shahin, Y., Aymon, Luther, A. A., Nicholson, J. A., Rajendran, I., Boal, M., and Ritchie, J.

Subjects
Adult, Male, operative difficulty, medicine.medical_specialty, medicine.medical_treatment, Difficulty grading, difficult cholecystectomy, predictive score, surgery, laparoscopic, cholecystectomy, Surgical planning, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Preoperative Care, Humans, Medicine, Laparoscopic cholecystectomy, Framingham Risk Score, business.industry, General surgery, Reproducibility of Results, Middle Aged, medicine.disease, Pre operative, Single surgeon, Cholecystectomy, Laparoscopic, ROC Curve, 030220 oncology & carcinogenesis, Multivariate Analysis, Cholecystitis, Female, 030211 gastroenterology & hepatology, Surgery, Cholecystectomy, business, Abdominal surgery
Abstract

The prediction of a difficult cholecystectomy has traditionally been based on certain pre-operative clinical and imaging factors. Most of the previous literature reported small patient cohorts and have not used an objective measure of operative difficulty. The aim of this study was to develop a pre-operative score to predict difficult cholecystectomy, as defined by a validated intra-operative difficulty grading scale. Two cohorts from prospectively maintained databases of patients who underwent laparoscopic cholecystectomy were analysed: the CholeS Study (8755 patients) and a single surgeon series (4089 patients). Factors potentially predictive of difficulty were correlated to the Nassar intra-operative difficulty scale. A multivariable binary logistic regression analysis was then used to identify factors that were independently associated with difficult laparoscopic cholecystectomy, defined as operative difficulty grades 3 to 5. The resulting model was then converted to a risk score, and validated on both internal and external datasets. Increasing age and ASA classification, male gender, diagnosis of CBD stone or cholecystitis, thick-walled gallbladders, CBD dilation, use of pre-operative ERCP and non-elective operations were found to be significant independent predictors of difficult cases. A risk score based on these factors returned an area under the ROC curve of 0.789 (95% CI 0.773–0.806, p

Published
2019
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8. A DEMATEL Approach to Analyzing Barriers to Implementing Integrated Biorefineries in the Philippines.

Author

Castro, Yaselyn Kaye G., Manalo, Bianca P., Saunar, Nicolle Blane C., Belmonte, Beatriz A., Andiappan, Viknesh, and Benjamin, Michael Francis D.

Subjects
AGRICULTURAL wastes, BIOMASS energy, LOCAL government, STAKEHOLDERS
Abstract

An integrated biorefinery (IBR) is a multi-process facility that uses agricultural waste to produce valuable bioenergy products. Several studies already have shown the potential economic, environmental, and social benefits of setting up IBRs. However, planning is crucial in the development of IBRs since several stakeholders are involved in its operation and the entire biomass-bioenergy supply chain. As an initial step, it is essential to identify the potential barriers to implementing IBRs at the local level prior to its nationwide scale-up. In this preliminary work, a Decision-Making Trial and Evaluation Laboratory (DEMATEL) framework was used in analyzing barriers to implementing IBRs on a municipality level. DEMATEL-based methods determine the relation between cause-effect factors in a given problem. Based on the results, the primary causal barrier is the "Lack of potential feedstocks due to climate change and other factors (B6)" and the "Lack of technology and infrastructure readiness (B1)" is the highly-correlated barrier. The results from this preliminary study can be used to develop a more robust assessment of establishing IBRs. Farmers, investors, local government units, and policymakers can then use such analysis to create mechanisms to address the barriers and formulate policies in developing IBRs. [ABSTRACT FROM AUTHOR]

Published
2022
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9. A Biomechanical Comparison of the Effect of Baseplate Design and Bone Marrow Fat Infiltration on Tibial Baseplate Pullout Strength

Author

Gregory J. Golladay, Shalin C. Shah, Blane C. Kelly, Stephen L. Kates, John R. Owen, and Aaron J. Johnson

Subjects
musculoskeletal diseases, Fat infiltration, Total knee arthroplasty, Prosthesis Design, 03 medical and health sciences, 0302 clinical medicine, Bone Marrow, Load to failure, medicine, Animals, Humans, Orthopedics and Sports Medicine, Tibia, Arthroplasty, Replacement, Knee, Orthodontics, 030222 orthopedics, business.industry, Bone Cements, Pullout strength, medicine.anatomical_structure, Tibial baseplate, Cattle, Implant, Bone marrow, business, Knee Prosthesis
Abstract

Background Early clinical results of a new total knee arthroplasty (TKA) implant design show promise for improved outcomes and patellofemoral function scores. However, reports of early tibial component-cement interface debonding requiring revision have been published. This study investigated the biomechanical properties of three different tibial baseplates to understand potential causes of failure. Methods PFC Sigma (control), Attune (1st generation) and Attune S+ (2nd generation) tibial baseplates were implanted into 4th generation sawbone tibia models using a standardized technique. Three of each baseplate were cemented with and without additional bovine bone marrow fat. All models were tested to failure with measured axial distraction force. Implant type, presence or absence of bovine marrow and load to failure were all recorded and compared. Two-way ANOVA followed by post-hoc pairwise comparisons were used to determine statistical significance, which was set to P Results The 2nd generation tibial baseplates required significantly more force to failure. The presence of bovine marrow significantly reduced the pullout force of the implant designs overall. No significant difference was detected between the 1st generation and control baseplates. Failure mode for each model was also noted to be different irrespective of the presence or absence of bone marrow fat. Conclusion The 2nd generation baseplates required significantly more force to failure compared with older designs. The presence of bone marrow during cementation of a tibial base plate significantly decreased axial pullout strength of a tibial baseplate in this laboratory model. All 1st generation baseplates exhibited debonding at the cement-implant interface.

Published
2020

15. Correction to: Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Author

Griffiths, E. A., Hodson, J., Vohra, R. S., Marriott, P., Katbeh, T., Zino, S., Nassar, A. H. M., Kirkham, A. J., Pasquali, S., Johnstone, M., Spreadborough, P., Alderson, D., Fenwick, S., Elmasry, M., Nunes, Q. M., Kennedy, D., Khan, R. B., Khan, M. A. S., Magee, C. J., Jones, S. M., Mason, D., Parappally, C. P., Mathur, P., Saunders, M., Jamel, S., Haque, S. U., Zafar, S., Shiwani, M. H., Samuel, N., Dar, F., Jackson, A., Lovett, B., Dindyal, S., Winter, H., Fletcher, T., Rahman, S., Wheatley, K., Nieto, T., Ayaani, S., Youssef, H., Nijjar, R. S., Watkin, H., Naumann, D., Emesih, S., Sarmah, P. B., Lee, K., Joji, N., Lambert, J., Heath, J., Teasdale, R. L., Weerasinghe, C., Needham, P. J., Welbourn, H., Forster, L., Finch, D., Blazeby, J. M., Robb, W., Mcnair, A. G. K., Hrycaiczuk, A., Charalabopoulos, A., Kadirkamanathan, S., Tang, C. -B., Jayanthi, N. V. G., Noor, N., Dobbins, B., Cockbain, A. J., Nilsen-Nunn, A., de Siqueira, J., Pellen, M., Cowley, J. B., W. -M., Ho, Miu, V., White, T. J., Hodgkins, K. A., Kinghorn, A., Tutton, M. G., Al-Abed, Y. A., Menzies, D., Ahmad, A., Reed, J., Khan, S., Monk, D., Vitone, L. J., Murtaza, G., Joel, A., Brennan, S., Shier, D., Zhang, C., Yoganathan, T., Robinson, S. J., Mccallum, I. J. D., Jones, M. J., Elsayed, M., Tuck, L., Wayman, J., Carney, K., Aroori, S., Hosie, K. B., Kimble, A., Bunting, D. M., Fawole, A. S., Basheer, M., Dave, R. V., Sarveswaran, J., Jones, E., Kendal, C., Tilston, M. P., Gough, M., Wallace, T., Singh, S., Mockford, J. D. K. A., Issa, E., Shah, N., Chauhan, N., Wilson, T. R., Forouzanfar, A., Wild, J. R. L., Nofal, E., Bunnell, C., Madbak, K., Rao, S. T. V., Devoto, L., Siddiqi, N., Khawaja, Z., Hewes, J. C., Gould, L., Chambers, A., Rodriguez, D. U., Sen, G., Robinson, S., Bartlett, F., Rae, D. M., Stevenson, T. E. J., Sarvananthan, K., Dwerryhouse, S. J., Higgs, S. M., Old, O. J., Hardy, T. J., Hornby, R. S. S. T., Keogh, K., Frank, L., Al-Akash, M., Upchurch, E. A., Frame, R. J., Hughes, M., Jelley, C., Weaver, S., Roy, S., Sillo, T. O., Galanopoulos, G., Cuming, T., Cunha, P., Tayeh, S., Kaptanis, S., Heshaishi, M., Eisawi, A., Abayomi, M., Ngu, W. S., Fleming, K., Bajwa, D. S., Chitre, V., Aryal, K., Ferris, P., Silva, M., Mohamed, S. L. S., Khawaja, A., Hussain, A., Ghazanfar, M. A., Bellini, M. I., Ebdewi, H., Elshaer, M., Gravante, G., Drake, B., Ogedegbe, A., Mukherjee, D., Arhi, C., Iqbal, L. G. N., Watson, N. F., Aggarwal, S. K., Orchard, P., Villatoro, E., Willson, P. D., Mok, K. W. J., Woodman, T., Deguara, J., Garcea, G., Babu, B. I., Dennison, A. R., Malde, D., Lloyd, D., Satheesan, S., Al-Taan, O., Boddy, A., Slavin, J. P., Jones, R. P., Ballance, L., Gerakopoulos, S., Jambulingam, P., Mansour, S., Sakai, N., Acharya, V., Sadat, M. M., Karim, L., Larkin, D., Amin, K., Khan, A., Law, J., Jamdar, S., Smith, S. R., Sampat, K., O'Shea, K. M., Manu, M., Asprou, F. M., Malik, N. S., Chang, J., Lewis, M., Roberts, G. P., Karavadra, B., Photi, E., Hewes, J., Rodriguez, D., O'Reilly, D. A., Rate, A. J., Sekhar, H., Henderson, L. T., Starmer, B. Z., Coe, P. O., Tolofari, S., Barrie, J., Bashir, G., Sloane, J., Madanipour, S., Halkias, C., Trevatt, A. E. J., Borowski, D. W., Hornsby, J., Courtney, M. J., Virupaksha, S., Seymour, K., Hawkins, H., Bawa, S., Gallagher, P. V., Reid, A., Wood, P., Finch, J. G., Guy Finch, J., Parmar, J., Stirland, E., Gardner-Thorpe, J., Al-Muhktar, A., Peterson, M., Majeed, A., Bajwa, F. M., Martin, J., Choy, A., Tsang, A., Pore, N., Andrew, D. R., Al-Khyatt, W., Bhandari, C. T. S., Subramanium, D., Toh, S. K. C., Carter, N. C., Tate, S., Pearce, B., Wainwright, D., Mercer, S. J., Knight, B., Vijay, V., Alagaratnam, S., Sinha, S., El-Hasani, S. S., Hussain, A. A., Bhattacharya, V., Kansal, N., Fasih, T., Jackson, C., Siddiqui, M. N., Chishti, I. A., Fordham, I. J., Siddiqui, Z., Bausbacher, H., Geogloma, I., Gurung, K., Tsavellas, G., Basynat, P., Shrestha, A. K., Basu, S., Harilingam, A. C. M., Rabie, M., Akhtar, M., Kumar, P., Jafferbhoy, S. F., Hussain, N., Raza, S., Haque, M., Alam, I., Aseem, R., Patel, S., Asad, M., Booth, M. I., Ball, W. R., Wood, C. P. J., Pinho-Gomes, A. C., Kausar, A., Obeidallah, M. R., Varghase, J., Lodhia, J., Bradley, D., Rengifo, C., Lindsay, D., Gopalswamy, S., Finlay, I., Wardle, S., Bullen, N., Iftikhar, S. Y., Awan, A., Ahmed, J., Leeder, P., Fusai, G., Bond-Smith, G., Psica, A., Puri, Y., Hou, D., Noble, F., Szentpali, K., Broadhurst, J., Date, R., Hossack, M. R., Goh, Y. L., Turner, P., Shetty, V., Riera, M., Macano, C. A. W., Sukha, A., Preston, S. R., Hoban, J. R., Puntis, D. J., Williams, S. V., Krysztopik, R., Kynaston, J., Batt, J., Doe, M., Goscimski, A., Jones, G. H., Hall, C., Carty, N., Panteleimonitis, S., Gunasekera, R. T., Sheel, A. R. G., Lennon, H., Hindley, C., Reddy, M., Kenny, R., Elkheir, N., Mcglone, E. R., Rajaganeshan, R., Hancorn, K., Hargreaves, A., Prasad, R., Longbotham, D. A., Vijayanand, D., Wijetunga, I., Ziprin, P., Nicolay, C. R., Yeldham, G., Read, E., Gossage, J. A., Rolph, R. C., Ebied, H., Phull, M., Khan, M. A., Popplewell, M., Kyriakidis, D., Henley, N., Packer, J. R., Derbyshire, L., Porter, J., Appleton, S., Farouk, M., Basra, M., Jennings, N. A., Ali, S., Kanakala, V., Ali, H., Lane, R., Dickson-Lowe, R., Zarsadias, P., Mirza, D., Puig, S., Amari, K. A., Vijayan, D., Sutcliffe, R., Marudanayagam, R., Hamady, Z., Prasad, A. R., Patel, A., Durkin, D., Kaur, P., Bowen, L., Byrne, J. P., Pearson, K. L., Delisle, T. G., Davies, J., Tomlinson, M. A., Johnpulle, M. A., Slawinski, C., Macdonald, A., Nicholson, J., Newton, K., Mbuvi, J., Farooq, A., Mothe, B. S., Zafrani, Z., Brett, D., Francombe, J., Barnes, J., Cheung, M., Al-Bahrani, A. Z., Preziosi, G., Urbonas, T., Alberts, J., Mallik, M., Patel, K., Segaran, A., Doulias, T., Sufi, P. A., Yao, C., Pollock, S., Manzelli, A., Wajed, S., Kourkulos, M., Pezzuto, R., Wadley, M., Hamilton, E., Jaunoo, S., Padwick, R., Sayegh, M., Newton, R. C., Hebbar, M., Farag, S. F., Spearman, J., Hamdan, M. F., D'Costa, C., Blane, C., Giles, M., Peter, M. B., Hirst, N. A., Hossain, T., El-Dhuwaib, A. P. Y., Morrison, T. E. M., Taylor, G. W., Thompson, R. L. E., Mccune, K., Loughlin, P., Lawther, R., Byrnes, C. K., Simpson, D. J., Mawhinney, A., Warren, C., Mckay, D., Mcilmunn, C., Martin, S., Macartney, M., Diamond, T., Davey, P., Jones, C., Clements, J. M., Digney, R., Chan, W. M., Mccain, S., Gull, S., Janeczko, A., Dorrian, E., Harris, A., Dawson, S., Johnston, D., Mcaree, B., Ghareeb, E., Thomas, G., Connelly, M., Mckenzie, S., Cieplucha, K., Spence, G., Campbell, W., Hooks, G., Bradley, N., Hill, A. D. K., Cassidy, J. T., Boland, M., Burke, P., Nally, D. M., Khogali, E., Shabo, W., Iskandar, E., Mcentee, G. P., O'Neill, M. A., Peirce, C., Lyons, E. M., O'Sullivan, A. W., Thakkar, R., Carroll, P., Ivanovski, I., Balfe, P., Lee, M., Winter, D. C., Kelly, M. E., Hoti, E., Maguire, D., Karunakaran, P., Geoghegan, J. G., Mcdermott, F., Martin, S. T., Cross, K. S., Cooke, F., Zeeshan, S., Murphy, J. O., Mealy, K., Mohan, H. M., Nedujchelyn, Y., Ullah, M. F., Ahmed, I., Giovinazzo, F., Milburn, J., Prince, S., Brooke, E., Buchan, J., Khalil, A. M., Vaughan, E. M., Ramage, M. I., Aldridge, R. C., Gibson, S., Nicholson, G. A., Vass, D. G., Grant, A. J., Holroyd, D. J., Angharad Jones, M., Sutton, C. M. L. R., O'Dwyer, P., Nilsson, F., Weber, B., Williamson, T. K., Lalla, K., Bryant, A., Ross Carter, C., Forrest, C. R., Hunter, D. I., Nassar, A. H., Orizu, M. N., Knight, K., Qandeel, H., Suttie, S., Belding, R., Mcclarey, A., Boyd, A. T., Guthrie, G. J. K., Lim, P. J., Luhmann, A., Watson, A. J. M., Richards, C. H., Nicol, L., Madurska, M., Harrison, E., Boyce, K. M., Roebuck, A., Ferguson, G., Pati, P., Wilson, M. S. J., Dalgaty, F., Fothergill, L., Driscoll, P. J., Mozolowski, K. L., Banwell, V., Bennett, S. P., Rogers, P. N., Skelly, B. L., Rutherford, C. L., Mirza, A. K., Lazim, T., Lim, H. C. C., Duke, D., Ahmed, T., Beasley, W. D., Wilkinson, M. D., Maharaj, G., Malcolm, C., Brown, T. H., Al-Sarireh, B., Shingler, G. M., Mowbray, N., Radwan, R., Morcous, P., Wood, S., Kadhim, A., Stewart, D. J., Baker, A. L., Tanner, N., Shenoy, H., Hafiz, S., De Marchi, J. A., Singh-Ranger, D., Hisham, E., Ainley, P., John Terrace, S. O. N., Napetti, S., Hopwood, B., Rhys, T., Downing, J., Kanavati, O., Coats, M., Aleksandrov, D., Kallaway, C., Yahya, S., Templeton, A., Trotter, M., Lo, C., Dhillon, A., Heywood, N., Aawsaj, Y., Hamdan, A., Reece-Bolton, O., Mcguigan, A., Shahin, Y., Aymon, Luther, A. A., Nicholson, J. A., Rajendran, I., Boal, M., and Ritchie, J.

Subjects
Adult, Male, operative difficulty, medicine.medical_specialty, MEDLINE, cholecystectomy, difficulty grading, laparoscopic, Surgery, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, Internal medicine, medicine, Humans, Prospective Studies, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), Laparoscopic cholecystectomy, Aged, business.industry, General surgery, Correction, Hepatology, Length of Stay, Middle Aged, Conversion to Open Surgery, Cholecystectomy, Laparoscopic, ROC Curve, 030220 oncology & carcinogenesis, Multivariate Analysis, 030211 gastroenterology & hepatology, Female, business, Grading scale, Abdominal surgery
Abstract

A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets.Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall's tau for dichotomous variables, or Jonckheere-Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis.A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p 0.001).We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty.

Published
2018

20. The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Author

Bharamgoudar, R., Sonsale, A., Hodson, J., Griffiths, E., Vohra, R.S., Kirkham, A.J., Pasquali, S., Marriott, P., Johnstone, M., Spreadborough, P., Alderson, D., Griffiths, E.A., Fenwick, S., Elmasry, M., Nunes, Q.M., Kennedy, D., Khan, R.B., Khan, M.A.S., Magee, C.J., Jones, S.M., Mason, D., Parappally, C.P., Mathur, P., Saunders, M., Jamel, S., Haque, S.U., Zafar, S., Shiwani, M.H., Samuel, N., Dar, F., Jackson, A., Lovett, B., Dindyal, S., Winter, H., Fletcher, T., Rahman, S., Wheatley, K., Nieto, T., Ayaani, S., Youssef, H., Nijjar, R.S., Watkin, H., Naumann, D., Emesih, S., Sarmah, P.B., Lee, K., Joji, N., Lambert, J., Heath, J., Teasdale, R.L., Weerasinghe, C., Needham, P.J., Welbourn, H., Forster, L., Finch, D., Blazeby, J.M., Robb, W., McNair, A.G.K., Hrycaiczuk, A., Charalabopoulos, A., Kadirkamanathan, S., Tang, C.-B., Jayanthi, N.V.G., Noor, N., Dobbins, B., Cockbain, A.J., Nilsen-Nunn, A., de Siqueira, J., Pellen, M., Cowley, J.B., Ho, W.-M., Miu, V., White, T.J., Hodgkins, K.A., Kinghorn, A., Tutton, M.G., Al-Abed, Y.A., Menzies, D., Ahmad, A., Reed, J., Khan, S., Monk, D., Vitone, L.J., Murtaza, G., Joel, A., Brennan, S., Shier, D., Zhang, C., Yoganathan, T., Robinson, S.J., McCallum, I.J.D., Jones, M.J., Elsayed, M., Tuck, L., Wayman, J., Carney, K., Aroori, S., Hosie, K.B., Kimble, A., Bunting, D.M., Fawole, A.S., Basheer, M., Dave, R.V., Sarveswaran, J., Jones, E., Kendal, C., Tilston, M.P., Gough, M., Wallace, T., Singh, S., Mockford, J.D.K.A., Issa, E., Shah, N., Chauhan, N., Wilson, T.R., Forouzanfar, A., Wild, J.R.L., Nofal, E., Bunnell, C., Madbak, K., Rao, S.T.V., Devoto, L., Siddiqi, N., Khawaja, Z., Hewes, J.C., Gould, L., Chambers, A., Rodriguez, D.U., Sen, G., Robinson, S., Bartlett, F., Rae, D.M., Stevenson, T.E.J., Sarvananthan, K., Dwerryhouse, S.J., Higgs, S.M., Old, O.J., Hardy, T.J., Shah, R., Hornby, S.T., Keogh, K., Frank, L., Al-Akash, M., Upchurch, E.A., Frame, R.J., Hughes, M., Jelley, C., Weaver, S., Roy, S., Sillo, T.O., Galanopoulos, G., Cuming, T., Cunha, P., Tayeh, S., Kaptanis, S., Heshaishi, M., Eisawi, A., Abayomi, M., Ngu, W.S., Fleming, K., Bajwa, D.S., Chitre, V., Aryal, K., Ferris, P., Silva, M., Lammy, S., Mohamed, S., Khawaja, A., Hussain, A., Ghazanfar, M.A., Bellini, M.I., Ebdewi, H., Elshaer, M., Gravante, G., Drake, B., Ogedegbe, A., Mukherjee, D., Arhi, C., Giwa, L., Iqbal, N., Watson, N.F., Aggarwal, S.K., Orchard, P., Villatoro, E., Willson, P.D., Mok, K.W.J., Woodman, T., Deguara, J., Garcea, G., Babu, B.I., Dennison, A.R., Malde, D., Lloyd, D., Satheesan, S., Al-Taan, O., Boddy, A., Slavin, J.P., Jones, R.P., Ballance, L., Gerakopoulos, S., Jambulingam, P., Mansour, S., Sakai, N., Acharya, V., Sadat, M.M., Karim, L., Larkin, D., Amin, K., Khan, A., Law, J., Jamdar, S., Smith, S.R., Sampat, K., O?shea, K.M., Manu, M., Asprou, F.M., Malik, N.S., Chang, J., Lewis, M., Roberts, G.P., Karavadra, B., Photi, E., Hewes, J., Rodriguez, D., O?Reilly, D.A., Rate, A.J., Sekhar, H., Henderson, L.T., Starmer, B.Z., Coe, P.O., Tolofari, S., Barrie, J., Bashir, G., Sloane, J., Madanipour, S., Halkias, C., Trevatt, A.E.J., Borowski, D.W., Hornsby, J., Courtney, M.J., Virupaksha, S., Seymour, K., Hawkins, H., Bawa, S., Gallagher, P.V., Reid, A., Wood, P., Finch, J.G., Guy Finch, J., Parmar, J., Stirland, E., Gardner-Thorpe, J., Al-Muhktar, A., Peterson, M., Majeed, A., Bajwa, F.M., Martin, J., Choy, A., Tsang, A., Pore, N., Andrew, D.R., Al-Khyatt, W., Taylor, C., Bhandari, S., Subramanium, D., Toh, S.K.C., Carter, N.C., Tate, S., Pearce, B., Wainwright, D., Mercer, S.J., Knight, B., Vijay, V., Alagaratnam, S., Sinha, S., El-Hasani, S.S., Hussain, A.A., Bhattacharya, V., Kansal, N., Fasih, T., Jackson, C., Siddiqui, M.N., Chishti, I.A., Fordham, I.J., Siddiqui, Z., Bausbacher, H., Geogloma, I., Gurung, K., Tsavellas, G., Basynat, P., Shrestha, A.K., Basu, S., Chhabra, A., Harilingam, M., Rabie, M., Akhtar, M., Kumar, P., Jafferbhoy, S.F., Hussain, N., Raza, S., Haque, M., Alam, I., Aseem, R., Patel, S., Asad, M., Booth, M.I., Ball, W.R., Wood, C.P.J., Pinho-Gomes, A.C., Kausar, A., Obeidallah, M.R., Varghase, J., Lodhia, J., Bradley, D., Rengifo, C., Lindsay, D., Gopalswamy, S., Finlay, I., Wardle, S., Bullen, N., Iftikhar, S.Y., Awan, A., Ahmed, J., Leeder, P., Fusai, G., Bond-Smith, G., Psica, A., Puri, Y., Hou, D., Noble, F., Szentpali, K., Broadhurst, J., Date, R., Hossack, M.R., Goh, Y.L., Turner, P., Shetty, V., Riera, M., Macano, C.A.W., Sukha, A., Preston, S.R., Hoban, J.R., Puntis, D.J., Williams, S.V., Krysztopik, R., Kynaston, J., Batt, J., Doe, M., Goscimski, A., Jones, G.H., Hall, C., Carty, N., Panteleimonitis, S., Gunasekera, R.T., Sheel, A.R.G., Lennon, H., Hindley, C., Reddy, M., Kenny, R., Elkheir, N., McGlone, E.R., Rajaganeshan, R., Hancorn, K., Hargreaves, A., Prasad, R., Longbotham, D.A., Vijayanand, D., Wijetunga, I., Ziprin, P., Nicolay, C.R., Yeldham, G., Read, E., Gossage, J.A., Rolph, R.C., Ebied, H., Phull, M., Khan, M.A., Popplewell, M., Kyriakidis, D., Henley, N., Packer, J.R., Derbyshire, L., Porter, J., Appleton, S., Farouk, M., Basra, M., Jennings, N.A., Ali, S., Kanakala, V., Ali, H., Lane, R., Dickson-Lowe, R., Zarsadias, P., Mirza, D., Puig, S., Al Amari, K., Vijayan, D., Sutcliffe, R., Marudanayagam, R., Hamady, Z., Prasad, A.R., Patel, A., Durkin, D., Kaur, P., Bowen, L., Byrne, J.P., Pearson, K.L., Delisle, T.G., Davies, J., Tomlinson, M.A., Johnpulle, M.A., Slawinski, C., Macdonald, A., Nicholson, J., Newton, K., Mbuvi, J., Farooq, A., Mothe, B.S., Zafrani, Z., Brett, D., Francombe, J., Barnes, J., Cheung, M., Al-Bahrani, A.Z., Preziosi, G., Urbonas, T., Alberts, J., Mallik, M., Patel, K., Segaran, A., Doulias, T., Sufi, P.A., Yao, C., Pollock, S., Manzelli, A., Wajed, S., Kourkulos, M., Pezzuto, R., Wadley, M., Hamilton, E., Jaunoo, S., Padwick, R., Sayegh, M., Newton, R.C., Hebbar, M., Farag, S.F., Spearman, J., Hamdan, M.F., D?Costa, C., Blane, C., Giles, M., Peter, M.B., Hirst, N.A., Hossain, T., Pannu, A., El-Dhuwaib, Y., Morrison, T.E.M., Taylor, G.W., Thompson, R.L.E., McCune, K., Loughlin, P., Lawther, R., Byrnes, C.K., Simpson, D.J., Mawhinney, A., Warren, C., McKay, D., McIlmunn, C., Martin, S., MacArtney, M., Diamond, T., Davey, P., Jones, C., Clements, J.M., Digney, R., Chan, W.M., McCain, S., Gull, S., Janeczko, A., Dorrian, E., Harris, A., Dawson, S., Johnston, D., McAree, B., Ghareeb, E., Thomas, G., Connelly, M., McKenzie, S., Cieplucha, K., Spence, G., Campbell, W., Hooks, G., Bradley, N., Hill, A.D.K., Cassidy, J.T., Boland, M., Burke, P., Nally, D.M., Khogali, E., Shabo, W., Iskandar, E., McEntee, G.P., O?Neill, M.A., Peirce, C., Lyons, E.M., O?Sullivan, A.W., Thakkar, R., Carroll, P., Ivanovski, I., Balfe, P., Lee, M., Winter, D.C., Kelly, M.E., Hoti, E., Maguire, D., Karunakaran, P., Geoghegan, J.G., McDermott, F., Martin, S.T., Cross, K.S., Cooke, F., Zeeshan, S., Murphy, J.O., Mealy, K., Mohan, H.M., Nedujchelyn, Y., Ullah, M.F., Ahmed, I., Giovinazzo, F., Milburn, J., Prince, S., Brooke, E., Buchan, J., Khalil, A.M., Vaughan, E.M., Ramage, M.I., Aldridge, R.C., Gibson, S., Nicholson, G.A., Vass, D.G., Grant, A.J., Holroyd, D.J., Jones, M.A., Sutton, C.M.L.R., O?Dwyer, P., Nilsson, F., Weber, B., Williamson, T.K., Lalla, K., Bryant, A., Carter, C.R., Forrest, C.R., Hunter, D.I., Nassar, A.H., Orizu, M.N., Knight, K., Qandeel, H., Suttie, S., Belding, R., McClarey, A., Boyd, A.T., Guthrie, G.J.K., Lim, P.J., Luhmann, A., Watson, A.J.M., Richards, C.H., Nicol, L., Madurska, M., Harrison, E., Boyce, K.M., Roebuck, A., Ferguson, G., Pati, P., Wilson, M.S.J., Dalgaty, F., Fothergill, L., Driscoll, P.J., Mozolowski, K.L., Banwell, V., Bennett, S.P., Rogers, P.N., Skelly, B.L., Rutherford, C.L., Mirza, A.K., Lazim, T., Lim, H.C.C., Duke, D., Ahmed, T., Beasley, W.D., Wilkinson, M.D., Maharaj, G., Malcolm, C., Brown, T.H., Al-Sarireh, B., Shingler, G.M., Mowbray, N., Radwan, R., Morcous, P., Wood, S., Kadhim, A., Stewart, D.J., Baker, A.L., Tanner, N., Shenoy, H., Hafiz, S., De Marchi, J.A., Singh-Ranger, D., Hisham, E., Ainley, P., O?Neill, S., Terrace, J., Napetti, S., Hopwood, B., Rhys, T., Downing, J., Kanavati, O., Coats, M., Aleksandrov, D., Kallaway, C., Yahya, S., Templeton, A., Trotter, M., Lo, C., Dhillon, A., Heywood, N., Aawsaj, Y., Hamdan, A., Reece-Bolton, O., McGuigan, A., Shahin, Y., Aymon, Luther, A.A., Nicholson, J.A., Rajendran, I., Boal, M., and Ritchie, J.

Subjects
Adult, Male, Scoring tool, medicine.medical_specialty, Patient factors, medicine.medical_treatment, Operative Time, Operative duration, 030230 surgery, Logistic regression, Article, patient factors, 03 medical and health sciences, Laparoscopic cholecystectomy, 0302 clinical medicine, Patient satisfaction, 030202 anesthesiology, Interquartile range, medicine, Humans, theatre utilisation, Propensity Score, Aged, Framingham Risk Score, Receiver operating characteristic, business.industry, prediction, Middle Aged, operative duration, Cholecystectomy, Laparoscopic, ROC Curve, scoring tool, Centre for Surgical Research, Elective Surgical Procedures, Theatre utilisation, Emergency medicine, Cohort, Propensity score matching, Female, Surgery, Cholecystectomy, Prediction, business
Abstract

Background The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p 90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care.

Published
2018
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23. Population-based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Author

Vohra, RS, Pasquali, S, Kirkham, AJ, Marriott, P, Johnstone, M, Spreadborough, P, Alderson, D, Griffiths, EA, Fenwick, S, Elmasry, M, Nunes, Q, Kennedy, D, Khan, RB, Khan, MAS, Magee, CJ, Jones, SM, Mason, D, Parappally, CP, Mathur, P, Saunders, M, Jamel, S, Ul Haque, S, Zafar, S, Shiwani, MH, Samuel, N, Dar, F, Jackson, A, Lovett, B, Dindyal, S, Winter, H, Fletcher, T, Rahman, S, Wheatley, K, Nieto, T, Ayaani, S, Youssef, H, Nijjar, RS, Watkin, H, Naumann, D, Emeshi, S, Sarmah, PB, Lee, K, Joji, N, Heath, J, Teasdale, RL, Weerasinghe, C, Needham, PJ, Welbourn, H, Forster, L, Finch, D, Blazeby, JM, Robb, W, McNair, AGK, Hrycaiczuk, A, Kadirkamanathan, S, Tang, C-B, Jayanthi, NVG, Noor, N, Dobbins, B, Cockbain, AJ, Nilsen-Nunn, A, de Siqueira, J, Pellen, M, Cowley, JB, Ho, W-M, Miu, V, White, TJ, Hodgkins, KA, Kinghorn, A, Tutton, MG, Al-Abed, YA, Menzies, D, Ahmad, A, Reed, J, Khan, S, Monk, D, Vitone, LJ, Murtaza, G, Joel, A, Brennan, S, Shier, D, Zhang, C, Yoganathan, T, Robinson, SJ, McCallum, IJD, Jones, MJ, Elsayed, M, Tuck, L, Wayman, J, Carney, K, Aroori, S, Hosie, KB, Kimble, A, Bunting, DM, Fawole, AS, Basheer, M, Dave, RV, Sarveswaran, J, Jones, E, Kendal, C, Tilston, MP, Gough, M, Wallace, T, Singh, S, Downing, J, Mockford, KA, Issa, E, Shah, N, Chauhan, N, Wilson, TR, Forouzanfar, A, Wild, JRL, Nofal, E, Bunnell, C, Madbak, K, Rao, STV, Devoto, L, Siddiqi, N, Khawaja, Z, Hewes, JC, Gould, L, Chambers, A, Rodriguez, DU, Sen, G, Robinson, S, Bartlett, F, Rae, DM, Stevenson, TEJ, Sarvananthan, K, Dwerryhouse, SJ, Higgs, SM, Old, OJ, Hardy, TJ, Shah, R, Hornby, ST, Keogh, K, Frank, L, Al-Akash, M, Upchurch, EA, Frame, RJ, Hughes, M, Jelley, C, Weaver, S, Roy, S, Sillo, TO, Galanopoulos, G, Cuming, T, Cunha, P, Tayeh, S, Kaptanis, S, Heshaishi, M, Eisawi, A, Abayomi, M, Ngu, WS, Fleming, K, Bajwa, DS, Chitre, V, Aryal, K, Ferris, P, Silva, M, Lammy, S, Mohamed, S, Khawaja, A, Hussain, A, Ghazanfar, MA, Bellini, MI, Ebdewi, H, Elshaer, M, Gravante, G, Drake, B, Ogedegbe, A, Mukherjee, D, Arhi, C, Iqbal, LGN, Watson, NF, Aggarwal, SK, Orchard, P, Villatoro, E, Willson, PD, Wa, K, Mok, J, Woodman, T, Deguara, J, Garcea, G, Babu, BI, Dennison, AR, Malde, D, Lloyd, D, Satheesan, S, Al-Taan, O, Boddy, A, Slavin, JP, Jones, RP, Ballance, L, Gerakopoulos, S, Jambulingam, P, Mansour, S, Sakai, N, Acharya, V, Sadat, MM, Karim, L, Larkin, D, Amin, K, Khan, A, Law, J, Jamdar, S, Smith, SR, Sampat, K, O'Shea, KM, Manu, M, Asprou, FM, Malik, NS, Chang, J, Lewis, M, Roberts, GP, Karavadra, B, Photi, E, Hewes, J, Rodriguez, D, O'Reilly, DA, Rate, AJ, Sekhar, H, Henderson, LT, Starmer, BZ, Coe, PO, Tolofari, S, Barrie, J, Bashir, G, Sloane, J, Madanipour, S, Halkias, C, Trevatt, AEJ, Borowski, DW, Hornsby, J, Courtney, MJ, Seymour, K, Hawkins, H, Bawa, S, Gallagher, PV, Reid, A, Wood, P, Finch, JG, Parmar, J, Stirland, E, Gardner-Thorpe, J, Al-Muhktar, A, Peterson, M, Majeed, A, Bajwa, FM, Martin, J, Choy, A, Tsang, A, Pore, N, Andrew, DR, Al-Khyatt, W, Taylor, C, Bhandari, S, Subramanium, D, Toh, SKC, Carter, NC, Mercer, SJ, Knight, B, Tate, S, Pearce, B, Wainwright, D, Vijay, V, Alagaratnam, S, Sinha, S, El-Hasani, SS, Hussain, AA, Bhattacharya, V, Kansal, N, Fasih, T, Jackson, C, Siddiqui, MN, Chishti, IA, Fordham, IJ, Siddiqui, Z, Bausbacher, H, Geogloma, I, Gurung, K, Tsavellas, G, Basynat, P, Shrestha, AK, Basu, S, Harilingam, ACM, Rabie, M, Akhtar, M, Kumar, P, Jafferbhoy, SF, Hussain, N, Raza, S, Haque, M, Alam, I, Aseem, R, Patel, S, Asad, M, Booth, MI, Ball, WR, Wood, CPJ, Pinho-Gomes, AC, Kausar, A, Obeidallah, MR, Varghase, J, Lodhia, J, Bradley, D, Rengifo, C, Lindsay, D, Gopalswamy, S, Finlay, I, Wardle, S, Bullen, N, Iftikhar, SY, Awan, A, Ahmed, J, Leeder, P, Fusai, G, Bond-Smith, G, Psica, A, Puri, Y, Hou, D, Noble, F, Szentpali, K, Broadhurst, J, Date, R, Hossack, MR, Goh, YL, Turner, P, Shetty, V, Riera, M, Macano, CAW, Sukha, A, Preston, SR, Hoban, JR, Puntis, DJ, Williams, SV, Krysztopik, R, Kynaston, J, Batt, J, Doe, M, Goscimski, A, Jones, GH, Hall, C, Carty, N, Panteleimonitis, S, Gunasekera, RT, Sheel, ARG, Lennon, H, Hindley, C, Reddy, M, Kenny, R, Elkheir, N, McGlone, ER, Rajaganeshan, R, Hancorn, K, Hargreaves, A, Prasad, R, Longbotham, DA, Vijayanand, D, Wijetunga, I, Ziprin, P, Nicolay, CR, Yeldham, G, Read, E, Gossage, JA, Rolph, RC, Ebied, H, Phull, M, Khan, MA, Popplewell, M, Kyriakidis, D, Henley, N, Packer, JR, Derbyshire, L, Porter, J, Appleton, S, Farouk, M, Basra, M, Jennings, NA, Ali, S, Kanakala, V, Ali, H, Lane, R, Dickson-Lowe, R, Zarsadias, P, Mirza, D, Puig, S, Al Amari, K, Vijayan, D, Sutcliffe, R, Marudanayagam, R, Hamady, Z, Prasad, AR, Patel, A, Durkin, D, Kaur, P, Bowen, L, Byrne, JP, Pearson, KL, Delisle, TG, Davies, J, Tomlinson, MA, Johnpulle, MA, Slawinski, C, Macdonald, A, Nicholson, J, Newton, K, Mbuvi, J, Farooq, A, Mothe, BS, Zafrani, Z, Brett, D, Francombe, J, Barnes, J, Cheung, M, Al-Bahrani, AZ, Preziosi, G, Urbonas, T, Alberts, J, Mallik, M, Patel, K, Segaran, A, Doulias, T, Sufi, PA, Yao, C, Pollock, S, Manzelli, A, Wajed, S, Kourkulos, M, Pezzuto, R, Wadley, M, Hamilton, E, Jaunoo, S, Padwick, R, Sayegh, M, Newton, RC, Hebbar, M, Farag, SF, Spearman, J, Hamdan, MF, D'Costa, C, Blane, C, Giles, M, Peter, MB, Hirst, NA, Hossain, T, Pannu, A, El-Dhuwaib, Y, Morrison, TEM, Taylor, GW, Thompson, RLE, McCune, K, Loughlin, P, Lawther, R, Byrnes, CK, Simpson, DJ, Mawhinney, A, Warren, C, Mckay, D, McIlmunn, C, Martin, S, MacArtney, M, Diamond, T, Davey, P, Jones, C, Clements, JM, Digney, R, Chan, WM, McCain, S, Gull, S, Janeczko, A, Dorrian, E, Harris, A, Dawson, S, Johnston, D, McAree, B, Ghareeb, E, Thomas, G, Connelly, M, McKenzie, S, Cieplucha, K, Spence, G, Campbell, W, Hooks, G, Bradley, N, Hill, ADK, Cassidy, JT, Boland, M, Burke, P, Nally, DM, Khogali, E, Shabo, W, Iskandar, E, McEntee, GP, O'Neill, MA, Peirce, C, Lyons, EM, O'Sullivan, AW, Thakkar, R, Carroll, P, Ivanovski, I, Balfe, P, Lee, M, Winter, DC, Kelly, ME, Hoti, E, Maguire, D, Karunakaran, P, Geoghegan, JG, Martin, ST, McDermott, F, Cross, KS, Cooke, F, Zeeshan, S, Murphy, JO, Mealy, K, Mohan, HM, Nedujchelyn, Y, Ullah, MF, Ahmed, I, Giovinazzo, F, Milburn, J, Prince, S, Brooke, E, Buchan, J, Khalil, AM, Vaughan, EM, Ramage, MI, Aldridge, RC, Gibson, S, Nicholson, GA, Vass, DG, Grant, AJ, Holroyd, DJ, Jones, MA, Sutton, CMLR, O'Dwyer, P, Nilsson, F, Weber, B, Williamson, TK, Lalla, K, Bryant, A, Carter, CR, Forrest, CR, Hunter, DI, Nassar, AH, Orizu, MN, Knight, K, Qandeel, H, Suttie, S, Belding, R, McClarey, A, Boyd, AT, Guthrie, GJK, Lim, PJ, Luhmann, A, Watson, AJM, Richards, CH, Nicol, L, Madurska, M, Harrison, E, Boyce, KM, Roebuck, A, Ferguson, G, Pati, P, Wilson, MSJ, Dalgaty, F, Fothergill, L, Driscoll, PJ, Mozolowski, KL, Banwell, V, Bennett, SP, Rogers, PN, Skelly, BL, Rutherford, CL, Mirza, AK, Lazim, T, Lim, HCC, Duke, D, Ahmed, T, Beasley, WD, Wilkinson, MD, Maharaj, G, Malcolm, C, Brown, TH, Shingler, GM, Mowbray, N, Radwan, R, Morcous, P, Wood, S, Kadhim, A, Stewart, DJ, Baker, AL, Tanner, N, Shenoy, H, Hafiz, S, De Marchi, JA, Singh-Ranger, D, Hisham, E, Ainley, P, O'Neill, S, Terrace, J, Napetti, S, Hopwood, B, Rhys, T, Kanavati, O, Coats, M, Aleksandrov, D, Kallaway, C, Yahya, S, Templeton, A, Trotter, M, Lo, C, Dhillon, A, Heywood, N, Aawsaj, Y, Hamdan, A, Reece-Bolton, O, McGuigan, A, Shahin, Y, Ali, A, Luther, A, Nicholson, JA, Rajendran, I, Boal, M, Ritchie, J, Grp, CS, and Collaborative, WMR

Subjects
Male, medicine.medical_treatment, 030230 surgery, outcomes, 0302 clinical medicine, Postoperative Complications, 80 and over, Prospective Studies, Prospective cohort study, Aged, 80 and over, education.field_of_study, Middle Aged, Conversion to Open Surgery, medicine.anatomical_structure, Treatment Outcome, Cholecystectomy, Laparoscopic, Centre for Surgical Research, Elective Surgical Procedures, 030220 oncology & carcinogenesis, Cohort, Female, Elective Surgical Procedure, Adult, medicine.medical_specialty, Population, Gallbladder disease, Gallbladder Diseases, Aged, Ambulatory Surgical Procedures, Cholecystectomy, Emergency Treatment, Humans, Ireland, Patient Readmission, Time-to-Treatment, United Kingdom, Surgery, benign disease, 03 medical and health sciences, Laparoscopic, medicine, education, business.industry, General surgery, Gallbladder, medicine.disease, business, Complication
Abstract

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all-cause 30-day readmissions and complications in a prospective population-based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all-cause 30-day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics.

Published
2016
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24. Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Author

Vohra, R. S., Pasquali, S., Kirkham, A. J., Marriott, P., Johnstone, M., Spreadborough, P., Alderson, D., Griffiths, E. A., Fenwick, S., Elmasry, M., Nunes, Q., Kennedy, D., Basit Khan, R., Khan, M. A. S., Magee, C. J., Jones, S. M., Mason, D., Parappally, C. P., Mathur, P., Saunders, M., Jamel, S., Ul Haque, S., Zafar, S., Shiwani, M. H., Samuel, N., Dar, F., Jackson, A., Lovett, B., Dindyal, S., Winter, H., Fletcher, T., Rahman, S., Wheatley, K., Nieto, T., Ayaani, S., Youssef, H., Nijjar, R. S., Watkin, H., Naumann, D., Emeshi, S., Sarmah, P. B., Lee, K., Joji, N., Heath, J., Teasdale, R. L., Weerasinghe, C., Needham, P. J., Welbourn, H., Forster, L., Finch, D., Blazeby, J. M., Robb, W., Mcnair, A. G. K., Hrycaiczuk, A., Charalabopoulos, A., Kadirkamanathan, S., Tang, C. -B., Jayanthi, N. V. G., Noor, N., Dobbins, B., Cockbain, A. J., Nilsen-Nunn, A., de Siqueira, J., Pellen, M., Cowley, J. B., W. -M., Ho, Miu, V., White, T. J., Hodgkins, K. A., Kinghorn, A., Tutton, M. G., Al-Abed, Y. A., Menzies, D., Ahmad, A., Reed, J., Khan, S., Monk, D., Vitone, L. J., Murtaza, G., Joel, A., Brennan, S., Shier, D., Zhang, C., Yoganathan, T., Robinson, S. J., Mccallum, I. J. D., Jones, M. J., Elsayed, M., Tuck, L., Wayman, J., Carney, K., Aroori, S., Hosie, K. B., Kimble, A., Bunting, D. M., Fawole, A. S., Basheer, M., Dave, R. V., Sarveswaran, J., Jones, E., Kendal, C., Tilston, M. P., Gough, M., Wallace, T., Singh, S., Downing, J., Mockford, K. A., Issa, E., Shah, N., Chauhan, N., Wilson, T. R., Forouzanfar, A., Wild, J. R. L., Nofal, E., Bunnell, C., Madbak, K., Rao, S. T. V., Devoto, L., Siddiqi, N., Khawaja, Z., Hewes, J. C., Gould, L., Chambers, A., Urriza Rodriguez, D., Sen, G., Robinson, S., Bartlett, F., Rae, D. M., Stevenson, T. E. J., Sarvananthan, K., Dwerryhouse, S. J., Higgs, S. M., Old, O. J., Hardy, T. J., Shah, R., Hornby, S. T., Keogh, K., Frank, L., Al-Akash, M., Upchurch, E. A., Frame, R. J., Hughes, M., Jelley, C., Weaver, S., Roy, S., Sillo, T. O., Galanopoulos, G., Cuming, T., Cunha, P., Tayeh, S., Kaptanis, S., Heshaishi, M., Eisawi, A., Abayomi, M., Ngu, W. S., Fleming, K., Singh Bajwa, D., Chitre, V., Aryal, K., Ferris, P., Silva, M., Lammy, S., Mohamed, S., Khawaja, A., Hussain, A., Ghazanfar, M. A., Bellini, M. I., Ebdewi, H., Elshaer, M., Gravante, G., Drake, B., Ogedegbe, A., Mukherjee, D., Arhi, C., Giwa Nusrat Iqbal, L., Watson, N. F., Kumar Aggarwal, S., Orchard, P., Villatoro, E., Willson, P. D., Wa, K., Mok, J., Woodman, T., Deguara, J., Garcea, G., Babu, B. I., Dennison, A. R., Malde, D., Lloyd, D., Satheesan, S., Al-Taan, O., Boddy, A., Slavin, J. P., Jones, R. P., Ballance, L., Gerakopoulos, S., Jambulingam, P., Mansour, S., Sakai, N., Acharya, V., Sadat, M. M., Karim, L., Larkin, D., Amin, K., Khan, A., Law, J., Jamdar, S., Smith, S. R., Sampat, K., M O'shea, K., Manu, M., Asprou, F. M., Malik, N. S., Chang, J., Lewis, M., Roberts, G. P., Karavadra, B., Photi, E., Hewes, J., Rodriguez, D., O'Reilly, D. A., Rate, A. J., Sekhar, H., Henderson, L. T., Starmer, B. Z., Coe, P. O., Tolofari, S., Barrie, J., Bashir, G., Sloane, J., Madanipour, S., Halkias, C., Trevatt, A. E. J., Borowski, D. W., Hornsby, J., Courtney, M. J., Virupaksha, S., Seymour, K., Hawkins, H., Bawa, S., Gallagher, P. V., Reid, A., Wood, P., Finch, J. G., Parmar, J., Stirland, E., Gardner-Thorpe, J., Al-Muhktar, A., Peterson, M., Majeed, A., Bajwa, F. M., Martin, J., Choy, A., Tsang, A., Pore, N., Andrew, D. R., Al-Khyatt, W., Taylor, C., Bhandari, S., Subramanium, D., Toh, S. K. C., Carter, N. C., Mercer, S. J., Knight, B., Tate, S., Pearce, B., Wainwright, D., Vijay, V., Alagaratnam, S., Sinha, S., El-Hasani, S. S., Hussain, A. A., Bhattacharya, V., Kansal, N., Fasih, T., Jackson, C., Siddiqui, M. N., Chishti, I. A., Fordham, I. J., Siddiqui, Z., Bausbacher, H., Geogloma, I., Gurung, K., Tsavellas, G., Basynat, P., Kiran Shrestha, A., Basu, S., Chhabra Mohan Harilingam, A., Rabie, M., Akhtar, M., Kumar, P., Jafferbhoy, S. F., Hussain, N., Raza, S., Haque, M., Alam, I., Aseem, R., Patel, S., Asad, M., Booth, M. I., Ball, W. R., Wood, C. P. J., Pinho-Gomes, A. C., Kausar, A., Rami Obeidallah, M., Varghase, J., Lodhia, J., Bradley, D., Rengifo, C., Lindsay, D., Gopalswamy, S., Finlay, I., Wardle, S., Bullen, N., Iftikhar, S. Y., Awan, A., Ahmed, J., Leeder, P., Fusai, G., Bond-Smith, G., Psica, A., Puri, Y., Hou, D., Noble, F., Szentpali, K., Broadhurst, J., Date, R., Hossack, M. R., Li Goh, Y., Turner, P., Shetty, V., Riera, M., Macano, C. A. W., Sukha, A., Preston, S. R., Hoban, J. R., Puntis, D. J., Williams, S. V., Krysztopik, R., Kynaston, J., Batt, J., Doe, M., Goscimski, A., Jones, G. H., Hall, C., Carty, N., Panteleimonitis, S., Gunasekera, R. T., Sheel, A. R. G., Lennon, H., Hindley, C., Reddy, M., Kenny, R., Elkheir, N., Mcglone, E. R., Rajaganeshan, R., Hancorn, K., Hargreaves, A., Prasad, R., Longbotham, D. A., Vijayanand, D., Wijetunga, I., Ziprin, P., Nicolay, C. R., Yeldham, G., Read, E., Gossage, J. A., Rolph, R. C., Ebied, H., Phull, M., Khan, M. A., Popplewell, M., Kyriakidis, D., Henley, N., Packer, J. R., Derbyshire, L., Porter, J., Appleton, S., Farouk, M., Basra, M., Jennings, N. A., Ali, S., Kanakala, V., Ali, H., Lane, R., Dickson-Lowe, R., Zarsadias, P., Mirza, D., Puig, S., Al Amari, K., Vijayan, D., Sutcliffe, R., Marudanayagam, R., Hamady, Z., Prasad, A. R., Patel, A., Durkin, D., Kaur, P., Bowen, L., Byrne, J. P., Pearson, K. L., Delisle, T. G., Davies, J., Tomlinson, M. A., Johnpulle, M. A., Slawinski, C., Macdonald, A., Nicholson, J., Newton, K., Mbuvi, J., Farooq, A., Sidhartha Mothe, B., Zafrani, Z., Brett, D., Francombe, J., Barnes, J., Cheung, M., Al-Bahrani, A. Z., Preziosi, G., Urbonas, T., Alberts, J., Mallik, M., Patel, K., Segaran, A., Doulias, T., Sufi, P. A., Yao, C., Pollock, S., Manzelli, A., Wajed, S., Kourkulos, M., Pezzuto, R., Wadley, M., Hamilton, E., Jaunoo, S., Padwick, R., Sayegh, M., Newton, R. C., Hebbar, M., Farag, S. F., Spearman, J., Hamdan, M. F., D'Costa, C., Blane, C., Giles, M., Peter, M. B., Hirst, N. A., Hossain, T., Pannu, A., El-Dhuwaib, Y., Morrison, T. E. M., Taylor, G. W., Thompson, R. L. E., Mccune, K., Loughlin, P., Lawther, R., Byrnes, C. K., Simpson, D. J., Mawhinney, A., Warren, C., Mckay, D., Mcilmunn, C., Martin, S., Macartney, M., Diamond, T., Davey, P., Jones, C., Clements, J. M., Digney, R., Chan, W. M., Mccain, S., Gull, S., Janeczko, A., Dorrian, E., Harris, A., Dawson, S., Johnston, D., Mcaree, B., Ghareeb, E., Thomas, G., Connelly, M., Mckenzie, S., Cieplucha, K., Spence, G., Campbell, W., Hooks, G., Bradley, N., Hill, A. D. K., Cassidy, J. T., Boland, M., Burke, P., Nally, D. M., Khogali, E., Shabo, W., Iskandar, E., Mcentee, G. P., O'Neill, M. A., Peirce, C., Lyons, E. M., O'Sullivan, A. W., Thakkar, R., Carroll, P., Ivanovski, I., Balfe, P., Lee, M., Winter, D. C., Kelly, M. E., Hoti, E., Maguire, D., Karunakaran, P., Geoghegan, J. G., Martin, S. T., Mcdermott, F., Cross, K. S., Cooke, F., Zeeshan, S., Murphy, J. O., Mealy, K., Mohan, H. M., Nedujchelyn, Y., Fahad Ullah, M., Ahmed, I., Giovinazzo, F., Milburn, J., Prince, S., Brooke, E., Buchan, J., Khalil, A. M., Vaughan, E. M., Ramage, M. I., Aldridge, R. C., Gibson, S., Nicholson, G. A., Vass, D. G., Grant, A. J., Holroyd, D. J., Jones, M. A., Sutton, C. M. L. R., O'Dwyer, P., Nilsson, F., Weber, B., Williamson, T. K., Lalla, K., Bryant, A., Carter, C. R., Forrest, C. R., Hunter, D. I., Nassar, A. H., Orizu, M. N., Knight, K., Qandeel, H., Suttie, S., Belding, R., Mcclarey, A., Boyd, A. T., Guthrie, G. J. K., Lim, P. J., Luhmann, A., Watson, A. J. M., Richards, C. H., Nicol, L., Madurska, M., Harrison, E., Boyce, K. M., Roebuck, A., Ferguson, G., Pati, P., Wilson, M. S. J., Dalgaty, F., Fothergill, L., Driscoll, P. J., Mozolowski, K. L., Banwell, V., Bennett, S. P., Rogers, P. N., Skelly, B. L., Rutherford, C. L., Mirza, A. K., Lazim, T., Lim, H. C. C., Duke, D., Ahmed, T., Beasley, W. D., Wilkinson, M. D., Maharaj, G., Malcolm, C., Brown, T. H., Shingler, G. M., Mowbray, N., Radwan, R., Morcous, P., Wood, S., Kadhim, A., Stewart, D. J., Baker, A. L., Tanner, N., Shenoy, H., Hafiz, S., De Marchi, J. A., Singh-Ranger, D., Hisham, E., Ainley, P., O'Neill, S., Terrace, J., Napetti, S., Hopwood, B., Rhys, T., Kanavati, O., Coats, M., Aleksandrov, D., Kallaway, C., Yahya, S., Templeton, A., Trotter, M., Lo, C., Dhillon, A., Heywood, N., Aawsaj, Y., Hamdan, A., Reece-Bolton, O., Mcguigan, A., Shahin, Y., Ali, A., Luther, A., Nicholson, J. A., Rajendran, I., Boal, M., and Ritchie, J.

Subjects
Adult, Male, medicine.medical_specialty, medicine.medical_treatment, Gallbladder disease, Population, Gallbladder Diseases, 030230 surgery, Biliary colic, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Emergency cholecystectomy, benign gallbladder disease, hospital care, 80 and over, Medicine, Humans, Cholecystectomy, Prospective Studies, Prospective cohort study, education, Emergency Treatment, Aged, Aged, 80 and over, education.field_of_study, Endoscopic retrograde cholangiopancreatography, medicine.diagnostic_test, business.industry, General surgery, Gallbladder, Middle Aged, medicine.disease, Hospitals, United Kingdom, Hospitalization, medicine.anatomical_structure, Centre for Surgical Research, 030220 oncology & carcinogenesis, Female, Ireland, Surgery, medicine.symptom, business, Cohort study
Abstract

Background The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals. Methods Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals. Conclusion Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

Published
2016
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28. Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology

Author

Sutton, A J, primary, Vohra, R S, additional, Hollyman, M, additional, Marriott, P J, additional, Buja, A, additional, Alderson, D, additional, Pasquali, S, additional, Griffiths, E A, additional, Spreadborough, P, additional, Kirkham, A, additional, Fenwick, S, additional, Elmasry, M, additional, Nunes, Q M, additional, Kennedy, D, additional, Khan, R B, additional, Khan, M A S, additional, Magee, C J, additional, Jones, S M, additional, Mason, D, additional, Parappally, C P, additional, Mathur, P, additional, Saunders, M, additional, Jamel, S, additional, Ul Haque, S, additional, Zafar, S, additional, Shiwani, M H, additional, Samuel, N, additional, Dar, F, additional, Jackson, A, additional, Lovett, B, additional, Dindyal, S, additional, Winter, H, additional, Fletcher, T, additional, Rahman, S, additional, Wheatley, K, additional, Nieto, T, additional, Ayaani, S, additional, Youssef, H, additional, Nijjar, R S, additional, Watkin, H, additional, Naumann, D, additional, Emesih, S, additional, Sarmah, P B, additional, Lee, K, additional, Joji, N, additional, Heath, J, additional, Teasdale, R L, additional, Weerasinghe, C, additional, Needham, P J, additional, Welbourn, H, additional, Forster, L, additional, Finch, D, additional, Blazeby, J M, additional, Robb, W, additional, McNair, A G K, additional, Hrycaiczuk, A, additional, Charalabopoulos, A, additional, Kadirkamanathan, S, additional, Tang, C-B, additional, Jayanthi, N V G, additional, Noor, N, additional, Dobbins, B, additional, Cockbain, A J, additional, Nilsen-Nunn, A, additional, de Siqueira, J, additional, Pellen, M, additional, Cowley, J B, additional, Ho, W-M, additional, Miu, V, additional, White, T J, additional, Hodgkins, K A, additional, Kinghorn, A, additional, Tutton, M G, additional, Al-Abed, Y A, additional, Menzies, D, additional, Ahmad, A, additional, Reed, J, additional, Khan, S, additional, Monk, D, additional, Vitone, L J, additional, Murtaza, G, additional, Joel, A, additional, Brennan, S, additional, Shier, D, additional, Zhang, C, additional, Yoganathan, T, additional, Robinson, S J, additional, McCallum, I J D, additional, Jones, M J, additional, Elsayed, M, additional, Tuck, E, additional, Wayman, J, additional, Carney, K, additional, Aroori, S, additional, Hosie, K B, additional, Kimble, A, additional, Bunting, D M, additional, Fawole, A S, additional, Basheer, M, additional, Dave, R V, additional, Sarveswaran, J, additional, Jones, E, additional, Kendal, C, additional, Tilston, M P, additional, Gough, M, additional, Wallace, T, additional, Singh, S, additional, Downing, J, additional, Mockford, K A, additional, Issa, E, additional, Shah, N, additional, Chauhan, N, additional, Wilson, T R, additional, Forouzanfar, A, additional, Wild, J R L, additional, Nofal, E, additional, Bunnell, C, additional, Madbak, K, additional, Rao, S T V, additional, Devoto, L, additional, Siddiqi, N, additional, Khawaja, Z, additional, Hewes, J C, additional, Gould, L, additional, Chambers, A, additional, Rodriguez, D U, additional, Sen, G, additional, Robinson, S, additional, Bartlett, F, additional, Rae, D M, additional, Stevenson, T E J, additional, Sarvananthan, K, additional, Dwerryhouse, S J, additional, Higgs, S M, additional, Old, O J, additional, Hardy, T J, additional, Shah, R, additional, Hornby, S T, additional, Keogh, K, additional, Frank, L, additional, Al-Akash, M, additional, Upchurch, E A, additional, Frame, R J, additional, Hughes, M, additional, Jelley, C, additional, Weaver, S, additional, Roy, S, additional, Sillo, T O, additional, Galanopoulos, G, additional, Cuming, T, additional, Cunha, P, additional, Tayeh, S, additional, Kaptanis, S, additional, Heshaishi, M, additional, Eisawi, A, additional, Abayomi, M, additional, Ngu, W S, additional, Fleming, K, additional, Bajwa, D S, additional, Chitre, V, additional, Aryal, K, additional, Ferris, P, additional, Silva, M, additional, Lammy, S, additional, Mohamed, S, additional, Khawaja, A, additional, Hussain, A, additional, Ghazanfar, M A, additional, Bellini, M I, additional, Ebdewi, H, additional, Elshaer, M, additional, Gravante, G, additional, Drake, B, additional, Ogedegbe, A, additional, Mukherjee, D, additional, Arhi, C, additional, Iqbal, L G N, additional, Watson, N F, additional, Aggarwal, S K, additional, Orchard, P, additional, Villatoro, E, additional, Willson, P D, additional, Mok, J, additional, Woodman, T, additional, Deguara, J, additional, Garcea, G, additional, Babu, B I, additional, Dennison, A R, additional, Malde, D, additional, Lloyd, D, additional, Satheesan, S, additional, Al-Taan, O, additional, Boddy, A, additional, Slavin, J P, additional, Jones, R P, additional, Ballance, L, additional, Gerakopoulos, S, additional, Jambulingam, P, additional, Mansour, S, additional, Sakai, N, additional, Acharya, V, additional, Sadat, M M, additional, Karim, L, additional, Larkin, D, additional, Amin, K, additional, Khan, A, additional, Law, J, additional, Jamdar, S, additional, Smith, S R, additional, Sampat, K, additional, O'shea, K M, additional, Manu, M, additional, Asprou, F M, additional, Malik, N S, additional, Chang, J, additional, Johnstone, M, additional, Lewis, M, additional, Roberts, G P, additional, Karavadra, B, additional, Photi, E, additional, Hewes, J, additional, Rodriguez, D, additional, O'Reilly, D A, additional, Rate, A J, additional, Sekhar, H, additional, Henderson, L T, additional, Starmer, B Z, additional, Coe, P O, additional, Tolofari, S, additional, Barrie, J, additional, Bashir, G, additional, Sloane, J, additional, Madanipour, S, additional, Halkias, C, additional, Trevatt, A E J, additional, Borowski, D W, additional, Hornsby, J, additional, Courtney, M J, additional, Virupaksha, S, additional, Seymour, K, additional, Hawkins, H, additional, Bawa, S, additional, Gallagher, P V, additional, Reid, A, additional, Wood, P, additional, Finch, J G, additional, Parmar, J, additional, Stirland, E, additional, Gardner-Thorpe, J, additional, Al-Muhktar, A, additional, Peterson, M, additional, Majeed, A, additional, Bajwa, F M, additional, Martin, J, additional, Choy, A, additional, Tsang, A, additional, Pore, N, additional, Andrew, D R, additional, Al-Khyatt, W, additional, Taylor, C, additional, Bhandari, S, additional, Subramanium, D, additional, Toh, S K C, additional, Carter, N C, additional, Tate, S, additional, Pearce, B, additional, Wainwright, D, additional, Mercer, S J, additional, Knight, B, additional, Vijay, V, additional, Alagaratnam, S, additional, Sinha, S, additional, El-Hasani, S S, additional, Hussain, A A, additional, Bhattacharya, V, additional, Kansal, N, additional, Fasih, T, additional, Jackson, C, additional, Siddiqui, M N, additional, Chishti, I A, additional, Fordham, I J, additional, Siddiqui, Z, additional, Bausbacher, H, additional, Geogloma, I, additional, Gurung, K, additional, Tsavellas, G, additional, Basynat, P, additional, Shrestha, A K, additional, Basu, S, additional, Mohan, A C, additional, Harilingam, M, additional, Rabie, M, additional, Akhtar, M, additional, Kumar, P, additional, Jafferbhoy, S F, additional, Hussain, N, additional, Raza, S, additional, Haque, M, additional, Alam, I, additional, Aseem, R, additional, Patel, S, additional, Asad, M, additional, Booth, M I, additional, Ball, W R, additional, Wood, C P J, additional, Pinho-Gomes, A C, additional, Kausar, A, additional, Obeidallah, M R, additional, Varghase, J, additional, Lodhia, J, additional, Bradley, D, additional, Rengifo, C, additional, Lindsay, D, additional, Gopalswamy, S, additional, Finlay, I, additional, Wardle, S, additional, Bullen, N, additional, Iftikhar, S Y, additional, Awan, A, additional, Ahmed, J, additional, Leeder, P, additional, Fusai, G, additional, Bond-Smith, G, additional, Psica, A, additional, Puri, Y, additional, Hou, D, additional, Noble, F, additional, Szentpali, K, additional, Broadhurst, J, additional, Date, R, additional, Hossack, M R, additional, Goh, Y L, additional, Turner, P, additional, Shetty, V, additional, Riera, M, additional, Macano, C A W, additional, Sukha, A, additional, Preston, S R, additional, Hoban, J R, additional, Puntis, D J, additional, Williams, S V, additional, Krysztopik, R, additional, Kynaston, J, additional, Batt, J, additional, Doe, M, additional, Goscimski, A, additional, Jones, G H, additional, Hall, C, additional, Carty, N, additional, Panteleimonitis, S, additional, Gunasekera, R T, additional, Sheel, A R G, additional, Lennon, H, additional, Hindley, C, additional, Reddy, M, additional, Kenny, R, additional, Elkheir, N, additional, McGlone, E R, additional, Rajaganeshan, R, additional, Hancorn, K, additional, Hargreaves, A, additional, Prasad, R, additional, Longbotham, D A, additional, Vijayanand, D, additional, Wijetunga, I, additional, Ziprin, P, additional, Nicolay, C R, additional, Yeldham, G, additional, Read, E, additional, Gossage, J A, additional, Rolph, R C, additional, Ebied, H, additional, Phull, M, additional, Khan, M A, additional, Popplewell, M, additional, Kyriakidis, D, additional, Henley, N, additional, Packer, J R, additional, Derbyshire, L, additional, Porter, J, additional, Appleton, S, additional, Farouk, M, additional, Basra, M, additional, Jennings, N A, additional, Ali, S, additional, Kanakala, V, additional, Ali, H, additional, Lane, R, additional, Dickson-Lowe, R, additional, Zarsadias, P, additional, Mirza, D, additional, Puig, S, additional, Al Amari, K, additional, Vijayan, D, additional, Sutcliffe, R, additional, Marudanayagam, R, additional, Hamady, Z, additional, Prasad, A R, additional, Patel, A, additional, Durkin, D, additional, Kaur, P, additional, Bowen, L, additional, Byrne, J P, additional, Pearson, K L, additional, Delisle, T G, additional, Davies, J, additional, Tomlinson, M A, additional, Johnpulle, M A, additional, Slawinski, C, additional, Macdonald, A, additional, Nicholson, J, additional, Newton, K, additional, Mbuvi, J, additional, Farooq, A, additional, Mothe, B S, additional, Zafrani, Z, additional, Brett, D, additional, Francombe, J, additional, Barnes, J, additional, Cheung, M, additional, Al-Bahrani, A Z, additional, Preziosi, G, additional, Urbonas, T, additional, Alberts, J, additional, Mallik, M, additional, Patel, K, additional, Segaran, A, additional, Doulias, T, additional, Sufi, P A, additional, Yao, C, additional, Pollock, S, additional, Manzelli, A, additional, Wajed, S, additional, Kourkulos, M, additional, Pezzuto, R, additional, Wadley, M, additional, Hamilton, E, additional, Jaunoo, S, additional, Padwick, R, additional, Sayegh, M, additional, Newton, R C, additional, Hebbar, M, additional, Farag, S F, additional, Spearman, J, additional, Hamdan, M F, additional, D'Costa, C, additional, Blane, C, additional, Giles, M, additional, Peter, M B, additional, Hirst, N A, additional, Hossain, T, additional, Pannu, A, additional, El-Dhuwaib, Y, additional, Morrison, T E M, additional, Taylor, G W, additional, Thompson, R L E, additional, McCune, K, additional, Loughlin, P, additional, Lawther, R, additional, Byrnes, C K, additional, Simpson, D J, additional, Mawhinney, A, additional, Warren, C, additional, McKay, D, additional, McIlmunn, C, additional, Martin, S, additional, MacArtney, M, additional, Diamond, T, additional, Davey, P, additional, Jones, C, additional, Clements, J M, additional, Digney, R, additional, Chan, W M, additional, McCain, S, additional, Gull, S, additional, Janeczko, A, additional, Dorrian, E, additional, Harris, A, additional, Dawson, S, additional, Johnston, D, additional, McAree, B, additional, Ghareeb, E, additional, Thomas, G, additional, Connelly, M, additional, McKenzie, S, additional, Cieplucha, K, additional, Spence, G, additional, Campbell, W, additional, Hooks, G, additional, Bradley, N, additional, Hill, A D K, additional, Cassidy, J T, additional, Boland, M, additional, Burke, P, additional, Nally, D M, additional, 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additional, Vass, D G, additional, Grant, A J, additional, Holroyd, D J, additional, Jones, M A, additional, Sutton, C M L R, additional, O'Dwyer, P, additional, Nilsson, F, additional, Weber, B, additional, Williamson, T K, additional, Lalla, K, additional, Bryant, A, additional, Carter, C R, additional, Forrest, C R, additional, Hunter, D I, additional, Nassar, A H, additional, Orizu, M N, additional, Knight, K, additional, Qandeel, H, additional, Suttie, S, additional, Belding, R, additional, McClarey, A, additional, Boyd, A T, additional, Guthrie, G J K, additional, Lim, P J, additional, Luhmann, A, additional, Watson, A J M, additional, Richards, C H, additional, Nicol, L, additional, Madurska, M, additional, Harrison, E, additional, Boyce, K M, additional, Roebuck, A, additional, Ferguson, G, additional, Pati, P, additional, Wilson, M S J, additional, Dalgaty, F, additional, Fothergill, L, additional, Driscoll, P J, additional, Mozolowski, K L, additional, Banwell, V, additional, 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C, additional, Dhillon, A, additional, Heywood, N, additional, Aawsaj, Y, additional, Hamdan, A, additional, Reece-Bolton, O, additional, McGuigan, A, additional, Shahin, Y, additional, Ali, A, additional, Luther, A, additional, Nicholson, J A, additional, Rajendran, I, additional, Boal, M, additional, and Ritchie, J, additional

Published
2016
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33. Use of abdominal ultrasonography to assess pediatric splenic trauma. Potential pitfalls in the diagnosis

Author

Krupnick, A S, Teitelbaum, D H, Geiger, J D, Strouse, P J, Cox, C S, Blane, C E, and Polley, T Z

Subjects
Radiography, Abdominal, Predictive Value of Tests, Humans, Abdominal Injuries, Child, Tomography, X-Ray Computed, Wounds, Nonpenetrating, Spleen, Research Article, Ultrasonography
Abstract

OBJECTIVE: The purpose of this study was to evaluate the accuracy of abdominal ultrasonography (US) for screening and grading pediatric splenic injury. SUMMARY BACKGROUND DATA: The use of abdominal US has increased rapidly as a method of evaluating organ damage after blunt abdominal trauma. Despite US's increasing use, little is known about its accuracy in children with splenic injury. METHODS: Children (N = 32) suffering blunt abdominal trauma who were diagnosed with splenic injury by computerized tomography (CT) scan prospectively were enlisted in this study. Degree of splenic injury was evaluated by both CT and US. The ultrasounds were evaluated by an initial reading as well as by a radiologist who was blinded as to the results of the CT. RESULTS: Twelve (38%) of the 32 splenic injuries found on CT were missed completely on the initial reading of the US. When the ultrasounds were graded in a blinded fashion, 10 (31%) of the splenic lacerations were missed and 17 (53%) were downgraded. Seven (22%) of the 32 splenic fractures were not associated with any free intraperitoneal fluid on the CT scan. CONCLUSIONS: This study has shown that US has a low level of sensitivity (62% to 78%) in detecting splenic injury and downgrades the degree of injury in the majority of cases. Reliance on free intraperitoneal fluid may be inaccurate because not all patients with splenic injury have free intra-abdominal fluid. Based on these findings, US may be of limited use in the initial assessment, management, and follow-up of pediatric splenic trauma.

Published
1997

34. Doppler ultrasonography in the early postoperative evaluation of renal transplants in children

Author

Blane, C. E., Gagnadoux, M. F., Brunelle, F., Argyropoulou, M., and Lallemand, D.

Subjects
Adult, Kidney Tubular Necrosis, Acute/etiology/ultrasonography, Male, Renal Artery/physiology/ultrasonography, Kidney Transplantation, Adolescent, Postoperative Complications/ultrasonography, Child, Preschool, Graft Rejection/ultrasonography, Humans, Kidney/*ultrasonography, Female, Vascular Resistance, Child
Abstract

The renal ultrasonography (US) scans of 23 children who had recently undergone kidney transplantation were reviewed; the studies included Doppler US scanning of the arterial vessels at several levels. There were 43 studies for children whose postoperative course was normal; 16 studies were obtained during episodes of acute tubular necrosis and 21 during episodes of acute rejection. The upper limit of normal for the resistive index (RI) at the arcuate artery is higher (up to 0.79) for a pediatric renal transplant patient than for adults with normal kidneys, regardless of the age of the kidney donor. Therefore, elevation of the RI to 0.80 or higher or complete loss of diastolic flow always indicates a complication of transplantation. Abnormally high RI values were seen in patients with both acute tubular necrosis and acute rejection; however, the RI value as determined by US did not distinguish these two entities. In addition, in 7 cases of acute tubular necrosis and 12 of acute rejection the RI was normal (0.58 to 0.79). Can Assoc Radiol J

Published
1993

35. Old renal transplants examined by Doppler ultrasonography

Author

Blane, C. E., Gagnadoux, M. F., Brunelle, F., Argyropoulou, M., and Lallemand, D.

Subjects
Adult, Male, Renal Artery/ultrasonography, Kidney Transplantation, Adolescent, Humans, Kidney/*ultrasonography, Female, Vascular Resistance, Middle Aged, Child, Aged, Follow-Up Studies
Abstract

Twenty-four ultrasonography (US) studies of 21 renal transplants that had been in place for 1 to 19 (median 3) years were evaluated. The absolute resistive indices (RIs) determined during Doppler US at various arterial levels and the differences in RI between the levels did not correlate with the clinical diagnosis of chronic rejection. This study suggests that measuring RI values with Doppler US in people who received renal grafts as children does not currently contribute additional information for diagnosis or management. Can Assoc Radiol J

Published
1993

36. Development of an Operations Research Software Package for Army Divisions.

Author

AIR FORCE INST OF TECH WRIGHT-PATTERSONAFB OH SCHOOL OF ENGINEERING, Wilson, Blane C., AIR FORCE INST OF TECH WRIGHT-PATTERSONAFB OH SCHOOL OF ENGINEERING, and Wilson, Blane C.

Abstract

There exists great potential for applying operations research techniques to solve specific problems in the areas of operations, installation support, and training at the Army division level. Because of the operational tempo of today's active-duty and reserve component units, command must focus on accomplishing the daily missions. Also, due their limited knowledge of the field, planners may not be aware of how operations research can be used to enhance planning and operations. Time, training funds, resources, safety, personnel, and equipment are all critical factors in this process. Operations research techniques could be used to improve division-level operations by saving time, managing resources more efficiently, and helping leaders make sound decisions. This thesis research is designed to increase the awareness of how the use of operations research at the division level, can aid planners and decision-makers in solving real problems encountered on a daily basis, thus improving unit operations. By using Microsoft Excel, Visual Basic, and Microsoft Access, a software package was developed to assist division planners in solving problems encountered in such areas as transportation, risk management, fuel service, dining facilities, and shelf storage. Using the software package can result in division planners managing time and resources more effectively.

Published
1998

43. The role of arthrography in the management of dysplasia epiphysealis hemimelica.

Author

Ho, Angelena, Blane, Caroline, Kling, Thomas, Ho, A M, Blane, C E, and Kling, T F Jr

Abstract

Dysplasia epiphysealis hemimelica can be diagnosed on plain radiographs of the affected areas. However, double contrast arthrography in three new cases provided additional information. The cartilaginous portions of the lesion at the articular surface of the bone were precisely demonstrated, aiding the orthopedic surgeon in deciding which patients should have surgery and planning the extent of operation necessary. [ABSTRACT FROM AUTHOR]

Published
1986
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44. True heterotopic bone in the paralyzed patient.

Author

Blane, Caroline, Perkash, Inder, Blane, C E, and Perkash, I

Abstract

In past years the clinical and radiologic presentation of true heterotopic bone in the paralyzed patient has been confused with osteomyelitis, neoplasm, trauma, and thrombophlebitis. We reviewed 376 paralyzed patients' roentgenographic files and found 78 patients with soft tissue ossification unassociated with infection, neoplasm, or underlying fractures, which we called true heterotopic bone. From this population the usual spectrum of radiologic findings is described, so that the radiologist may separate roentgenographically a group of patients from other types of ectopic ossification. [ABSTRACT FROM AUTHOR]

Published
1981
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45. Effect of intravascular surveillance and education program on rates of nosocomial bloodstream infections

Author

Cohran, J., Larson, E., Roach, H., Blane, C., and Pierce, P.

Abstract

Background: Because of high proportions of central line-related bloodstream infections (BSIs), an intravascular surveillance and education program (IVSP) was instituted in the study institution in 1987. Methods: A 61/2-year historical prospective study was conducted to evaluate the effects of the IVSP on incidence of nosocomial BSIs. With use of Centers for Disease Control and Prevention criteria, concurrent data on nosocomial BSIs were collected by two infection control professionals before, during, and for 3 years afte the IVSP. Results: Hospital-wide BSIs during the 3-year IVSP and for 3 years after were 0.9% and 0.9% (p=0.58) or 1.4 and 1.2/1000 patient-days (p=0.24). Central line-related BSIs represented 29%, 24%, and 29% of the total BSIs 6 months before, 3 years during, and 6 months after the intervention, respectively (p=0.62). Conclusions: The IVSP resulted neither in a reduction in the total intravascular catheter-related BSIs nor in a change in the proportion of potentially preventable central line-related BSIs. To be successful, an intervention must include the authority to mandate practice changes; education and feedback without such authority were inadequate.

Published
1996
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