9 results on '"Michalis Koullouros"'
Search Results
2. Cost of postoperative ileus following colorectal surgery: A cost analysis in the Australian public hospital setting
- Author
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Luke Traeger, Michalis Koullouros, Sergei Bedrikovetski, Hidde M. Kroon, Michelle L. Thomas, James W. Moore, and Tarik Sammour
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Male ,Ileus ,Postoperative Complications ,Hospitals, Public ,Australia ,Costs and Cost Analysis ,Gastroenterology ,Humans ,Length of Stay ,Colorectal Surgery ,Aged ,Retrospective Studies - Abstract
Postoperative ileus (POI) following surgery results in significant morbidity, drastically increasing hospital costs. As there are no specific Australian data, this study aimed to measure the cost of POI after colorectal surgery in an Australian public hospital.A cost analysis was performed, for major elective colorectal surgical cases between 2018 and 2021 at the Royal Adelaide Hospital. POI was defined as not achieving GI-2, the validated composite measure, by postoperative day 4. Demographics, length of stay and 30-day complications were recorded retrospectively. Costings in Australian dollars were collected from comprehensive hospital billing data. Univariate and multivariate analyses were performed.Of the 415 patients included, 34.9% (n = 145) developed POI. POI was more prevalent in males, smokers, previous intra-abdominal surgery, and converted laparoscopic surgery (p 0.05). POI was associated with increased length of stay (8 vs. 5 days, p 0.001) and with higher rates of complications such as pneumonia (15.2% vs. 8.1%, p = 0.027). Total cost of inpatient care was 26.4% higher after POI (AU$37,690 vs. AU$29,822, p 0.001). POI was associated with increased staffing costs, as well as diagnostics, pharmacy, and hospital services. On multivariate analysis POI, elderly patients, stoma formation, large bowel surgery, prolonged theatre time, complications and length of stay were predictive of increased costs (p 0.05).In Australia, POI is significantly associated with increased complications and higher costs due to prolonged hospital stay and increased healthcare resource utilisation. Efforts to reduce POI rates could diminish its morbidity and associated expenses, decreasing the burden on the healthcare system.
- Published
- 2022
3. Surgical publications: detecting and preventing fraud
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Michalis Koullouros and Guy Maddern
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Fraud ,Humans ,Surgery ,General Medicine - Published
- 2022
4. Appendicitis and ganglioneuroma—an unusual co-existence
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Michalis Koullouros, Sarah Candler, Caroline Smith, and Santosh Olakkengil
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AcademicSubjects/MED00910 ,Case Report ,Surgery ,jscrep/0160 - Abstract
Ganglioneuromas are benign, fully differentiated mature tumours related to neuronal tissues and usually seen in the gastrointestinal tract, retroperitoneum and mediastinum. The few cases of appendiceal ganglioneuromas that were previously described in the literature belong to the paediatric population and were associated with genetic mutations and syndromes. We present a unique case of an Aboriginal Australian adult with acute appendicitis and concurrent ganglioneuroma diagnosed using histopathology and immunohistochemistry using Neu-N, S100 and Sox-10. The patient had no history of any of the syndromes associated with ganglioneuromatosis and had no other relevant family history.
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- 2022
5. Bilateral Versus Single Internal Mammary Artery Use in Coronary Artery Bypass Grafting: A Propensity Matched Analysis
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Michael P. Vallely, Ying Yan Zhu, Paul G. Bannon, Stella R. Harris, Michael Seco, Michalis Koullouros, Fabio Ramponi, and Michael K. Wilson
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Bypass grafting ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,03 medical and health sciences ,Coronary artery bypass surgery ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Blood product ,Humans ,Medicine ,030212 general & internal medicine ,Coronary Artery Bypass ,Mammary Arteries ,Propensity Score ,Retrospective Studies ,business.industry ,Surgery ,Survival Rate ,medicine.anatomical_structure ,Cohort ,Propensity score matching ,Mammary artery ,Morbidity ,New South Wales ,Cardiology and Cardiovascular Medicine ,business ,Wound healing ,Artery - Abstract
BACKGROUND Bilateral internal mammary artery (BIMA) grafts have demonstrated superior long-term outcomes compared with single internal mammary artery (SIMA) grafts. Despite this, BIMA remains widely underutilised due to perceived technical challenges and concerns regarding wound healing. We sought to examine the morbidity and mortality associated with BIMA use in a propensity-matched cohort of patients. METHODS From 2009 to 2016, 3,594 consecutive patients underwent coronary artery bypass surgery at three affiliated institutions. Thirty-day (30) mortality and morbidity data were collected prospectively. Propensity-score matched analyses were performed for BIMA versus SIMA use controlling for a number of preoperative characteristics. RESULTS Overall, 29% of procedures were performed off pump, with a greater proportion in the BIMA group (43% vs. 21%, p
- Published
- 2019
6. Should Total Hip Arthroplasty be Performed Acutely in the Treatment of Acetabular Fractures in Elderly or Used as a Salvage Procedure Only?
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Tarak Chouari, Katharine Hamlin, Gabija Lazaraviciute, Steven W Hamilton, Iain M Stevenson, and Michalis Koullouros
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musculoskeletal diseases ,medicine.medical_specialty ,total hip arthroplasty ,mesh: replacement ,hip ,posttraumatic osteoarthritis ,medicine.medical_treatment ,Osteoarthritis ,replacement ,elderly ,03 medical and health sciences ,0302 clinical medicine ,lcsh:Orthopedic surgery ,Fracture fixation ,Symposium - Total Hip Arthroplasty ,medicine ,Orthopedics and Sports Medicine ,030212 general & internal medicine ,mesh: hip ,total hip arthroplasty MeSH terms: Fracture fixation ,Acetabular fracture ,030222 orthopedics ,business.industry ,medicine.disease ,Acetabulum ,Arthroplasty ,Surgery ,osteoarthritis ,lcsh:RD701-811 ,mesh: acetabulum ,surgical procedures, operative ,Systematic review ,mesh: osteoarthritis ,Harris Hip Score ,Orthopedic surgery ,Physical therapy ,arthroplasty ,acetabulum ,mesh: Fracture fixation ,business ,mesh: arthroplasty - Abstract
Background: Total hip arthroplasty (THA) is now an increasingly common procedure for people sustaining acetabular fractures. The incidence of acetabular fractures among the elderly population is increasing, and contemporary treatment aims to avoid the risks of prolonged incumbency associated with poor bone stock for fixation or inability to comply with limited weightbearing in this patient group. The concept of acute hip arthroplasty as a treatment for acetabular fracture is, therefore, becoming more topical and relevant. Our systematic review investigates whether THAs for acetabular fractures should be performed acutely, with a short delay, or as a late procedure for posttraumatic osteoarthritis (PTOA) if it develops. Materials and Methods: Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed when undertaking this systematic review. Detailed searches were performed on three different databases, using keywords, such as “acetabular fracture,” “acetabular trauma,” “total hip arthroplasty,” “hip arthroplasty,” and “hip prosthesis.” Studies from 1975 to September 2016 were included in the study. All studies included in the review were independently critically appraised by two of the authors. Results: Forty three studies were included in this review. Only two of them actually compared acute and delayed THAs for acetabular fractures with the rest focusing on one or the other. Results were comparable between acute and late THAs in terms of aseptic loosening, operative time, blood loss, Harris Hip Score, and ability to mobilize postoperatively without aid. Complication rates, however, were much higher in the acute group. Conclusion: Evidence based on this topic is scarce and therefore we have to be cautious about drawing a definitive conclusion. The findings of this systematic review do suggest, however, that acute THAs should be considered in elderly patients, where fixation is not possible, or when their health and ability to rehabilitate are poor. It should also be considered in patients where PTOA is very likely, or where there is already some preexisting degenerative osteoarthritis.
- Published
- 2017
7. Is Liver Ultrasound Useful as Part of the Surveillance Strategy following Potentially Curative Colorectal Cancer Resection?
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C. Mackay, JR Schneider, George Ramsay, Michalis Koullouros, Craig Parnaby, and Lynn Stevenson
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Male ,medicine.medical_specialty ,Colorectal cancer ,Disease ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Surveillance monitoring ,Neoplasm Metastasis ,Pelvis ,Aged ,Retrospective Studies ,Ultrasonography ,business.industry ,Mortality rate ,Ultrasound ,Gastroenterology ,General Medicine ,Middle Aged ,medicine.disease ,medicine.anatomical_structure ,Liver ,030220 oncology & carcinogenesis ,Radiological weapon ,030211 gastroenterology & hepatology ,Female ,Radiology ,Neoplasm Recurrence, Local ,business ,Colorectal Neoplasms ,Tomography, X-Ray Computed - Abstract
Background: Optimal surveillance monitoring following curative resection of colorectal cancer remains unclear. Guidelines recommend computed tomography (CT)-based imaging for the initial 3 years following surgical intervention due to the high rates of local and distant recurrence. However, there is currently limited supporting evidence for this strategy. Our current follow-up practice is to offer annual interval abdominal ultrasound and abdominal/pelvis CT scans starting at 6 and 12 months with the sequence of radiological follow-up remaining at the discretion of each clinician. We aim to establish the additional diagnostic benefit of abdominal ultrasound to CT scans in colorectal cancer surveillance follow-up. Methods: All patients who underwent colorectal resection with curative intent in our region during a single year were included. Patients were detected from a prospectively collected pathology database and supplemented retrospectively with patient demographics, imaging reports, and mortality data. Results: A total of 243 patients (male n = 135, 55.6%) were included. There was a mortality rate of 31.3% over the study period. Patients who received abdominal ultrasound as their initial imaging modality (n = 64, 26.3%) were significantly older, had less severe disease, and a significantly lower mortality rate when compared to CT patients (n = 148, 60.9%). All patients with new hepatic disease detected by ultrasound scans had their management discussed in multi-disciplinary team meetings before their next scheduled CT. Conclusion: In an era where cross-sectional imaging of colorectal cancer is commonplace, abdominal ultrasound offers additional benefit to CT as a postoperative imaging adjunct for the detection of hepatic disease recurrence.
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- 2018
8. Isolated cardiac desminopathy
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Michalis Koullouros, Keith M. Kerr, Tarak Chouari, Dana Dawson, and Andrew Stewart
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Adult ,medicine.medical_specialty ,Cardiac Catheterization ,Treatment outcome ,MEDLINE ,Muscular Dystrophies ,Electrocardiography ,Biopsy ,medicine ,Edema ,Humans ,Radiology, Nuclear Medicine and imaging ,Pulmonary Wedge Pressure ,Pulmonary wedge pressure ,medicine.diagnostic_test ,business.industry ,Biopsy, Needle ,General Medicine ,Immunohistochemistry ,Defibrillators, Implantable ,Echocardiography, Doppler, Color ,Dyspnea ,Treatment Outcome ,Female ,Radiology ,Cardiology and Cardiovascular Medicine ,business ,Cardiomyopathies - Published
- 2017
9. The role of oral antibiotics prophylaxis in prevention of surgical site infection in colorectal surgery
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Michalis Koullouros, Nadir Khan, and Emad H Aly
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Male ,medicine.medical_specialty ,Quality Assurance, Health Care ,medicine.drug_class ,Antibiotics ,MEDLINE ,Administration, Oral ,Cochrane Library ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Surgical Wound Infection ,Antibiotic prophylaxis ,Intensive care medicine ,Randomized Controlled Trials as Topic ,business.industry ,Gastroenterology ,Hepatology ,Middle Aged ,Colorectal surgery ,Anti-Bacterial Agents ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Administration, Intravenous ,Female ,business ,Surgical site infection ,Colorectal Surgery ,Publication Bias ,Cohort study - Abstract
Surgical site infection (SSI) continues to be a challenge in colorectal surgery. Over the years, various modalities have been used in an attempt to reduce SSI risk in elective colorectal surgery, which include mechanical bowel preparation before surgery, oral antibiotics and intravenous antibiotic prophylaxis at induction of surgery. Even though IV antibiotics have become standard practice, there has been a debate on the exact role of oral antibiotics. The primary aim was to identify the role of oral antibiotics in reduction of SSI in elective colorectal surgery. The secondary aim was to explore any potential benefit in the use of mechanical bowel preparation (MBP) in relation to SSI in elective colorectal surgery. Medline, Embase and the Cochrane Library were searched. Any randomised controlled trials (RCTs) or cohort studies after 1980, which investigated the effectiveness of oral antibiotic prophylaxis and/or MBP in preventing SSIs in elective colorectal surgery were included. Twenty-three RCTs and eight cohorts were included. The results indicate a statistically significant advantage in preventing SSIs with the combined usage of oral and systemic antibiotic prophylaxis. Furthermore, our analysis of the cohort studies shows no benefits in the use of MBP in prevention of SSIs. The addition of oral antibiotics to systemic antibiotics could potentially reduce the risk of SSIs in elective colorectal surgery. Additionally, MBP does not seem to provide a clear benefit with regard to SSI prevention.
- Published
- 2016
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