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2. Outcomes Following Vascular and Endovascular Procedures Performed During the First COVID-19 Pandemic Wave

Author

Panagiota Birmpili, Ruth A. Benson, Brenig Gwilym, Sandip Nandhra, Nina Al-Saadi, Graeme K. Ambler, Robert Blair, David Bosanquet, Nikesh Dattani, Louise Hitchman, Katherine Hurndall, Matthew Machin, Sarah Onida, Athanasios Saratzis, Joseph Shalhoub, Lauren Shelmerdine, Aminder A. Singh, Lauren, Shelmerdine, Aminder Anthony Singh, David C. Bosanquet, Rachael O. Forsythe, George Dovell, Ryan Preece, Chris Imray, Sonia Kandola, Adam Johnson, Andrew Choong, Jun Jie Ng, Sarah Aitken, Jana-Lee Moss, Efthymios Beropoulis, Konstantinos Stavroulakis, Fabrico Santiago, Amr Abdelhaliem, Aseel Abuduruk, Thomas M. Aherne, Hazem Ahmed, Sarah J. Aitken, Tasleem Akhtar, Bekir B. Akkaya, Julien Al Shakarchi, Abdeljawad J. Algasi, Musaad AlHamzah, Ahmed A. Alhumiad, Bernard Allard, Meshal Almeshal, Faris Alomran, Reem N. AlRakaf, Mohamed Altabal, Nishath Altaf, Abdulmajeed H. Altoijry, Talal Altuwaijri, Nasser Alwehaibi, Sara J. Anderson Baker, Domenico Angiletta, Afroditi Antoniou, George A. Antoniou, Libnah L. Areias, James Ashcroft, Noel Atkinson, Doaa Attia, Lukas Attwell, Mohammed A. Azab, Omar Aziz, Ahmed Y. Azzam, Christos Bakoyiannis, Hashem Barakat, Khalid Bashar, Ruth Battersby, K.S. Benaragama, Ahmed T.S. BenGhatnsh, Nikolaos Bessias, Resya Bhakthavalsalan, Shagran Binkhamis, Roshan Bootun, Emily Boyle, Ion Buga, Martin Catterson, Jennifer L. Chambers, Karishma Chandarana, Alexandros Charalabopoulos, Gabriella Charlton, Stephen W.K. Cheng, Natasha Chinai, Asad J. Choudhry, Annie Clothier, Tina U. Cohnert, Chloe Coleman, Michael Costanza, Patrick A. Coughlin, James Coulston, James Cragg, Katy Darvall, Emma M. Davies, Huw Davies, Claire Dawkins, Joseph A. Dawson, Anastasia Dean, Bedanta S. Dhal, Andrew Duncan, Mark Edwards, Bridget Egan, Mehdi El Amrani, Ahmed Elhadi, Muhammed Elhadi, Mohamed S. Eljareh, Ramy Elkady, Mohamed Elkawafi, Fatimah S. Elkhafeefi, Maysoon Elkwahad, Ibrahim A. Ellojli, Kareem ElSanhoury, Hazem Elsantawy, Khaled Elsayed, Raed M. Ennab, Owain Fisher, Robert Fitridge, Ronald L.G. Flumignan, Amy L. Fowler, Richard F. Galloway, John Gan, Andrew Garnham, Sotirios Georgopoulos, Tamer M.H. Ghatwary Tantawy, Ravi R. Goel, Mingzheng A. Goh, Tabitha Grainger, Nalaka Gunawansa, Eric Hammond, Joseph Hanna, Simon C. Hardy, Thomas J. Hardy, Gareth J. Harrison, Ahmed Hassanin, Andrew T. Hattam, Martin Hein, Hytham K.S. Hmaid, Kay Hon, Kaisor Iqbal, Hakkı Z. Iscan, Arda Isik, Doireann P. Joyce, Maciej Juszczak, Kiriaki Kakavia, Stavros Kakkos, Christos D. Karkos, Emmanuel Katsogridakis, Rana Khalil, Andrew I. Khallaf, Aazeb Khan, Manar Khashram, Samantha Khoo, Joseph Kilby, Beatrice Kuang, Ioanna Kyrou, Pierfrancesco Lapolla, Kai W. Leong, Eunice Lim, Ju-wei N. Liu, Dafydd Locker, Xun Luo, Oliver T.A. Lyons, Ragai R. Makar, Dimitris Maras, Emmeline A. Martin, Hayrettin L. Mavioglu, Dennis Mazingi, James McCaslin, David N. McClure, Kevin McKevitt, Lewis Meecham, Shreya Mehta, Fabrizio Minelli, Andrea Mingoli, Afroditi M. Mitka, Farag S. Mohamed, Hayley M. Moore, Rachael L. Morley, Konstantinos G. Moulakakis, Eustratia Mpaili, Ahmed Msherghi, Kamel Muhammad, Juanita Muller, Korana Musicki, Luis C.U. Nakano, Craig Nesbitt, Jonathan Nicholls, Andrew Nickinson, Thamer Nouh, Jose M.S. Nunag, Isaac K. Nyamekye, Michael J. Papanikolas, Theofanis T. Papas, Konstantinos O. Papazoglou, Sharath Paravastu, Noala Parr, Ketino Pasenidou, Fernando Picazo Pineda, Franklin Pond, Matthew A. Popplewell, Katarzyna Powezka, Daniela Prce, Sivaram Premnath, Raffaele Pulli, Hussein M.M. Rabee, Habibur P. Rahman, Nandhini Ravintharan, Andrés Reyes Valdivia, Toby Richards, Konstantinos Roditis, Alexander E.S. Rolls, Iain N. Roy, Hani Saeed, Prakash Saha, Alberto Saltiel, Paolo Sapienza, Emma Scott, Christopher N. Selvaraj, Atif Sharif, Simona Sica, Justinas Silickas, Gurkirat Singh, Ashwin Sivaharan, Yogeesan Sivakumaran, Pranav Somaiya, Gerry Stansby, Bethany M. Stavert, Abhilash Sudarsanam, Elizabeth Suthers, Helen Suttenwood, Ahmed Taha, Mohamed A.H. Taha, Siu C. Tam, Alethea M. Tang, Robert Tang, Dana Taran, Lawrence Tarusan, Myat S. Thet, Jacqueline Thomas, Sean Tierney, Konstantinos Tigkiropoulos, Giovanni Tinelli, Mahmoud M.H. Tolba, Hannah C. Travers, Ioannis Tsagkos, Yamume Tshomba, Paraskevi Tsiantoula, Christopher P. Twine, Berkay Ulker, Serap Ulusoy, Ertekin U. Unal, Vincent C. Varley, Thodur M. Vasudevan, Uyen G. Vo, Timothy Wagner, Stewart R. Walsh, Judy Wang, Jackie Wong, Sarah A. Warren, Chun L.P. Yih, Sergio Zacà, Adeel S. Zafar, Shady Zaki, and Ewa M. Zywicka

Subjects
Vascular surgery, COVID-19, Coronavirus, Mortality, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objective: The first COVID-19 pandemic wave was a period of reduced surgical activity and redistribution of resources to only those with late stage or critical presentations. This Vascular and Endovascular Research Network COVID-19 Vascular Service (COVER) study aimed to describe the six-month outcomes of patients who underwent open surgery and or endovascular interventions for major vascular conditions during this period. Methods: In this international, multicentre, prospective, observational study, centres recruited consecutive patients undergoing vascular procedures over a 12-week period. The study opened in March 2020 and closed to recruitment in August 2020. Patient demographics, procedure details, and post-operative outcomes were collected on a secure online database. The reported outcomes at 30 days and six months were post-operative complications, re-interventions, and all cause in-hospital mortality rate. Multivariable logistic regression was used to assess factors associated with six-month mortality rate. Results: Data were collected on 3 150 vascular procedures, including 1 380 lower limb revascularisations, 609 amputations, 403 aortic, 289 carotid, and 469 other vascular interventions. The median age was 68 years (interquartile range 59, 76), 73.5% were men, and 1.7% had confirmed COVID-19 disease. The cumulative all cause in-hospital, 30-day, and six-month mortality rates were 9.1%, 10.4%, and 12.8%, respectively. The six-month mortality rate was 32.1% (95% CI 24.2–40.8%) in patients with confirmed COVID-19 compared with 12.0% (95% CI 10.8–13.2%) in those without. After adjustment, confirmed COVID-19 was associated with a three times higher odds of six-month death (adjusted OR 3.25, 95% CI 2.18–4.83). Increasing ASA grade (3–5 vs. 1–2), frailty scores 4–9, diabetes mellitus, and urgent and or immediate procedures were also independently associated with increased odds of death by six months, while statin use had a protective effect. Conclusion: During the first wave of the pandemic, the six-month mortality rate after vascular and endovascular procedures was higher compared with historic pre-pandemic studies and associated with COVID-19 disease.

Published
2024
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4. Outcomes Following Vascular and Endovascular Procedures Performed During the First COVID-19 Pandemic Wave

Author

Birmpili, Panagiota, Benson, Ruth A., Gwilym, Brenig, Nandhra, Sandip, Al-Saadi, Nina, Ambler, Graeme K., Blair, Robert, Bosanquet, David, Dattani, Nikesh, Hitchman, Louise, Hurndall, Katherine, Machin, Matthew, Onida, Sarah, Saratzis, Athanasios, Shalhoub, Joseph, Lauren, Shelmerdine, Singh, Aminder Anthony, Bosanquet, David C., Forsythe, Rachael O., Dovell, George, Preece, Ryan, Imray, Chris, Kandola, Sonia, Johnson, Adam, Choong, Andrew, Ng, Jun Jie, Aitken, Sarah, Moss, Jana-Lee, Beropoulis, Efthymios, Stavroulakis, Konstantinos, Santiago, Fabrico, Abdelhaliem, Amr, Abuduruk, Aseel, Aherne, Thomas M., Ahmed, Hazem, Aitken, Sarah J., Akhtar, Tasleem, Akkaya, Bekir B., Al Shakarchi, Julien, Algasi, Abdeljawad J., AlHamzah, Musaad, Alhumiad, Ahmed A., Allard, Bernard, Almeshal, Meshal, Alomran, Faris, AlRakaf, Reem N., Altabal, Mohamed, Altaf, Nishath, Altoijry, Abdulmajeed H., Altuwaijri, Talal, Alwehaibi, Nasser, Anderson Baker, Sara J., Angiletta, Domenico, Antoniou, Afroditi, Antoniou, George A., Areias, Libnah L., Ashcroft, James, Atkinson, Noel, Attia, Doaa, Attwell, Lukas, Azab, Mohammed A., Aziz, Omar, Azzam, Ahmed Y., Bakoyiannis, Christos, Barakat, Hashem, Bashar, Khalid, Battersby, Ruth, Benaragama, K.S., BenGhatnsh, Ahmed T.S., Bessias, Nikolaos, Bhakthavalsalan, Resya, Binkhamis, Shagran, Bootun, Roshan, Boyle, Emily, Buga, Ion, Catterson, Martin, Chambers, Jennifer L., Chandarana, Karishma, Charalabopoulos, Alexandros, Charlton, Gabriella, Cheng, Stephen W.K., Chinai, Natasha, Choudhry, Asad J., Clothier, Annie, Cohnert, Tina U., Coleman, Chloe, Costanza, Michael, Coughlin, Patrick A., Coulston, James, Cragg, James, Darvall, Katy, Davies, Emma M., Davies, Huw, Dawkins, Claire, Dawson, Joseph A., Dean, Anastasia, Dhal, Bedanta S., Duncan, Andrew, Edwards, Mark, Egan, Bridget, El Amrani, Mehdi, Elhadi, Ahmed, Elhadi, Muhammed, Eljareh, Mohamed S., Elkady, Ramy, Elkawafi, Mohamed, Elkhafeefi, Fatimah S., Elkwahad, Maysoon, Ellojli, Ibrahim A., ElSanhoury, Kareem, Elsantawy, Hazem, Elsayed, Khaled, Ennab, Raed M., Fisher, Owain, Fitridge, Robert, Flumignan, Ronald L.G., Fowler, Amy L., Galloway, Richard F., Gan, John, Garnham, Andrew, Georgopoulos, Sotirios, Ghatwary Tantawy, Tamer M.H., Goel, Ravi R., Goh, Mingzheng A., Grainger, Tabitha, Gunawansa, Nalaka, Hammond, Eric, Hanna, Joseph, Hardy, Simon C., Hardy, Thomas J., Harrison, Gareth J., Hassanin, Ahmed, Hattam, Andrew T., Hein, Martin, Hmaid, Hytham K.S., Hon, Kay, Iqbal, Kaisor, Iscan, Hakkı Z., Isik, Arda, Joyce, Doireann P., Juszczak, Maciej, Kakavia, Kiriaki, Kakkos, Stavros, Karkos, Christos D., Katsogridakis, Emmanuel, Khalil, Rana, Khallaf, Andrew I., Khan, Aazeb, Khashram, Manar, Khoo, Samantha, Kilby, Joseph, Kuang, Beatrice, Kyrou, Ioanna, Lapolla, Pierfrancesco, Leong, Kai W., Lim, Eunice, Liu, Ju-wei N., Locker, Dafydd, Luo, Xun, Lyons, Oliver T.A., Makar, Ragai R., Maras, Dimitris, Martin, Emmeline A., Mavioglu, Hayrettin L., Mazingi, Dennis, McCaslin, James, McClure, David N., McKevitt, Kevin, Meecham, Lewis, Mehta, Shreya, Minelli, Fabrizio, Mingoli, Andrea, Mitka, Afroditi M., Mohamed, Farag S., Moore, Hayley M., Morley, Rachael L., Moulakakis, Konstantinos G., Mpaili, Eustratia, Msherghi, Ahmed, Muhammad, Kamel, Muller, Juanita, Musicki, Korana, Nakano, Luis C.U., Nesbitt, Craig, Nicholls, Jonathan, Nickinson, Andrew, Nouh, Thamer, Nunag, Jose M.S., Nyamekye, Isaac K., Papanikolas, Michael J., Papas, Theofanis T., Papazoglou, Konstantinos O., Paravastu, Sharath, Parr, Noala, Pasenidou, Ketino, Pineda, Fernando Picazo, Pond, Franklin, Popplewell, Matthew A., Powezka, Katarzyna, Prce, Daniela, Premnath, Sivaram, Pulli, Raffaele, Rabee, Hussein M.M., Rahman, Habibur P., Ravintharan, Nandhini, Valdivia, Andrés Reyes, Richards, Toby, Roditis, Konstantinos, Rolls, Alexander E.S., Roy, Iain N., Saeed, Hani, Saha, Prakash, Saltiel, Alberto, Sapienza, Paolo, Scott, Emma, Selvaraj, Christopher N., Sharif, Atif, Sica, Simona, Silickas, Justinas, Singh, Gurkirat, Sivaharan, Ashwin, Sivakumaran, Yogeesan, Somaiya, Pranav, Stansby, Gerry, Stavert, Bethany M., Sudarsanam, Abhilash, Suthers, Elizabeth, Suttenwood, Helen, Taha, Ahmed, Taha, Mohamed A.H., Tam, Siu C., Tang, Alethea M., Tang, Robert, Taran, Dana, Tarusan, Lawrence, Thet, Myat S., Thomas, Jacqueline, Tierney, Sean, Tigkiropoulos, Konstantinos, Tinelli, Giovanni, Tolba, Mahmoud M.H., Travers, Hannah C., Tsagkos, Ioannis, Tshomba, Yamume, Tsiantoula, Paraskevi, Twine, Christopher P., Ulker, Berkay, Ulusoy, Serap, Unal, Ertekin U., Varley, Vincent C., Vasudevan, Thodur M., Vo, Uyen G., Wagner, Timothy, Walsh, Stewart R., Wang, Judy, Wong, Jackie, Warren, Sarah A., Yih, Chun L.P., Zacà, Sergio, Zafar, Adeel S., Zaki, Shady, Zywicka, Ewa M., Shelmerdine, Lauren, and Singh, Aminder A.

Published
2024
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5. Evaluating pharmacological THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment across NHS and private clinics in the UK: a multi-centre, assessor-blind, randomised controlled trial—THRIVE trial

Author

John Norrie, Rebecca Lawton, Joseph Shalhoub, Beverley J Hunt, Annya Stephens-Boal, Tamara Everington, Joanne Dunbar, Sarah Onida, Layla Bolton, Manjit Gohel, A H Davies, Laura Burgess, Matthew Machin, Steven Rogers, Sarah Whittley, Sandip Nandhra, Daniel Carradice, Benedict Turner, Mark S Whiteley, and Carolyn Singer

Subjects
Medicine
Abstract

Introduction Endovenous therapy is the first choice management for symptomatic varicose veins in NICE guidelines, with 56–70 000 procedures performed annually in the UK. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a known complication of endovenous therapy, occurring at a rate of up to 3.4%. Despite 73% of UK practitioners administering pharmacological thromboprophylaxis to reduce VTE, no high-quality evidence supporting this practice exists. Pharmacological thromboprophylaxis may have clinical and cost benefit in preventing VTE; however, further evidence is needed. This study aims to establish whether when endovenous therapy is undertaken: a single dose or course of pharmacological thromboprophylaxis alters the risk of VTE; pharmacological thromboprophylaxis is associated with an increased rate of bleeding events; pharmacological prophylaxis is cost effective.Methods and analysis A multi-centre, assessor-blind, randomised controlled trial (RCT) will recruit 6660 participants from 40 NHS and private sites across the UK. Participants will be randomised to intervention (single dose or extended course of pharmacological thromboprophylaxis plus compression) or control (compression alone). Participants will undergo a lower limb venous duplex ultrasound scan at 21–28 days post-procedure to identify asymptomatic DVT. The duplex scan will be conducted locally by blinded assessors. Participants will be contacted remotely for follow-up at 7 days and 90 days post-procedure. The primary outcome is imaging-confirmed lower limb DVT with or without symptoms or PE with symptoms within 90 days of treatment. The main analysis will be according to the intention-to-treat principle and will compare the rates of VTE at 90 days, using a repeated measures analysis of variance, adjusting for any pre-specified strongly prognostic baseline covariates using a mixed effects logistic regression.Ethics and dissemination Ethical approval was granted by Brent Research Ethics Committee (22/LO/0261). Results will be disseminated in a peer-reviewed journal and presented at national and international conferences.Trial registration number ISRCTN18501431.

Published
2024
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6. Understanding the current acute aortic syndrome (AAS) pathways-The Collaborative Acute Aortic Syndrome Project (CAASP) protocol.

Author

Jim Zhong, Ganesh Vigneswaran, Nawaz Z Safdar, Indrajeet Mandal, Aminder A Singh, Sandip Nandhra, and CAASP steering committee

Subjects
Medicine, Science
Abstract

BackgroundAcute aortic syndrome (AAS) is an emergency associated with high peri-hospital mortality rates. Variable clinical presentation makes timely diagnosis challenging and such delays in diagnosis directly impact patient outcomes.Aims and objectivesThe aims of the Collaborative Acute Aortic Syndrome Project (CAASP) are to characterise and evaluate the current AAS pathways of a cohort of hospitals in the UK, USA and New Zealand to determine if patient outcomes are influenced by the AAS pathway (time to hospital admission, diagnosis and management plan) and demographic, social, geographic and patient-specific factors (clinical presentation and comorbidities). The objectives are to describe different AAS pathways and time duration between hospital admission to diagnosis and management plan instigation, and to compare patient outcomes between pathways.MethodsThe study is a multicentre, retrospective service evaluation project of adult patients diagnosed on imaging with AAS. It will be coordinated by the UK National Interventional Radiology Trainee Research (UNITE) network and Vascular and Endovascular Research Network (VERN) in conjunction with The Aortic Dissection Charitable Trust (TADCT). All AAS cases diagnosed on imaging between 1st January 2018 to 1st June 2021 will be included and followed-up for 6 months. Eligibility criteria include aortic dissection (AD) Type A, Type B, non A/B, penetrating aortic ulcer, and intramural haematoma. Exclusion criteria are non-AAS pathology, acute on chronic AAS, and age

Published
2024
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8. Global impact of the first coronavirus disease 2019 (COVID‐19) pandemic wave on vascular services

Author

Benson, Ruth A, Nandhra, Sandip, Shalhoub, Joseph, Dattani, Nikesh, Ambler, Graeme K, Banquet, David C, Bosanquet, David C, Forsythe, Rachael, Onida, Sarah, Dovell, George, Hitchman, Louise, Preece, Ryan, Saratzis, Athanasios, Imray, Chris, Johnson, Adam, Choong, Andrew, Ng, Jun Jie, Aitken, Sarah, Moss, Jana-Lee, Sudarsanam, Abhilash, Tam, Adam, Beck, Adam W, Barkat, Adel, Bajwa, Adnan, Elbasty, Ahmed, Awopetu, AI, Kodama, Akio, Rivera, Aksim G, Munoz, Alberto, Saltiel, Alberto, Russo, Alejandro, Rolls, Alex, Kafetzakis, Alexandros, Kimyaghalam, Ali, Kordzadeh, Ali, Shepherd, Amanda, Singh, Aminder, Mingoli, Andrea, Lazaris, Andreas M, Isaak, Andrej, Marin, Andres, Valdivia, Andrés Reyes, Batchelder, Andrew, Duncan, Andrew, Argyriou, Angeliki, Jaipersad, Anthony S, Freyrie, Antonio, Pereira-Neves, António, Mahomed, Anver, Isik, Arda, Jawien, Arkadiusz, Choudhry, Asad J, Sivaharan, Ashwin, Giannoukas, Athanasios, Papaioannou, Athanasios, Abbas, Ayman, Christos, Bakoyiannis, Akkaya, Bekir Bogachan, Huasen, Bella, Patrice, Bibombe, Mwipatayi, Azhar, Bilal, Keldiyorov, Boboyor, Ullery, Brant W, Pratesi, Carlo, Hinojosa, Carlos A, Bechara, Carlos F, Parra, Carolina Salinas, Alexandros, Charalabopoulos, Bezard, Charlotte, Lee, Cheong Jun, Davies, Chris, Behrendt, Christian-Alexander, Lowe, Christopher, Karkos, Christos D, Yih, Chun Ling Patricia, McDonnell, Ciarán, Ordonez, Claudia, Nesbitt, Craig, Alexander, Croo, Guglielmone, Daniel, Doherty, Daniel T, Riding, David M, Esposito, Davide, Harkin, Denis, Lui, Dennis H, and Kamal, Dhafer M

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Neurodegenerative, Good Health and Well Being, COVID-19, Global Health, Health Care Surveys, Health Services Accessibility, Humans, Pandemics, Practice Patterns, Physicians', Prospective Studies, Vascular Surgical Procedures, Vascular and Endovascular Research Network (VERN) COVER study collaborative*, Medical and Health Sciences, Surgery, Clinical sciences
Abstract

This online structured survey has demonstrated the global impact of the COVID-19 pandemic on vascular services. The majority of centres have documented marked reductions in operating and services provided to vascular patients. In the months during recovery from the resource restrictions imposed during the pandemic peaks, there will be a significant vascular disease burden awaiting surgeons. One of the most affected specialties.

Published
2020

9. Social deprivation does not impact on acute pancreatitis severity and mortality: a single-centre study

Author

Linda Sharp, Sanjay Pandanaboyana, Manu K Nayar, Wei Boon Lim, Francis P Robertson, and Sandip Nandhra

Subjects
Diseases of the digestive system. Gastroenterology, RC799-869
Abstract

Background and aims The incidence of acute pancreatitis (AP) is increasing in the UK. Patients with severe AP require a significant amount of resources to support them during their admission. The ability to predict which patients will develop multiorgan dysfunction remains poor leading to a delay in the identification of these patients and a window of opportunity for early intervention is missed. Social deprivation has been linked with increased mortality across surgical specialties. Its role in predicting mortality in patients with AP remains unclear but would allow high-risk patients to be identified early and to focus resources on high-risk populations.Methods A prospectively collected single-centre database was analysed. English Index of Multiple Deprivation (IMD) was calculated based on postcode. Patients were grouped according to their English IMD quintile. Outcomes measured included all-cause mortality, Intestive care unit (ITU) admission, overall length of stay (LOS) and local pancreatitis-specific complications.Results 398 patients with AP between 2018 and 2021 were identified. There were significantly more patients with AP in Q1 (IMD 1–2) compared with Q5 (IMD 9–10) (156 vs 38, p

Published
2023
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11. Whole Gut Motility Patterns in Patients with Chronic Nausea and Vomiting.

Author

Klinge, Mette W., Haase, Anne Mette, Rolighed, Nanna Sutter, Krogh, Klaus, Scott, Mark, Schlageter, Vincent, Mark, Esben Bolvig, Nandhra, Gursharan Kaur, Drewes, Asbjørn Mohr, and Loedrup, Anders Bergh

Abstract

Background/Objectives: Chronic nausea and vomiting (N/V) disorders are common in clinical practice. Our primary aim was to compare total and segmental gastrointestinal transit times as well as gastric contraction patterns in patients with chronic N/V syndrome to those of healthy volunteers (HVs). In the patient group, our secondary aim was to explore how symptoms and motility patterns were affected by a serotonin HT4 receptor agonist (Prucalopride). Methods: Patients with chronic N/V syndrome and HVs underwent baseline assessment of regional gastrointestinal (GI) motility/transit using the Motilis 3D-Transit system. Patients were then treated with Prucalopride 2 mg daily for 28 days, with the 3D-transit examination repeated within 10–20 days after treatment onset. Two self-administered questionnaires (the Gastrointestinal Symptom Rating Scale [GSRS] and Gastroparesis Cardinal Symptom Index [GCSI]) were used to assess patients' symptoms. Results: A total of 19 patients (13 F; median age 25 years (IQR 22–39) and 55 HVs (25 F; median age 28 (24–35) were included. At baseline, no differences in regional GI transit times were found between groups. However, patients had a significantly lower gastric contraction amplitude than HVs (9 mmHg (IQR 8–11) vs. 12 (10–15: p < 0.001). In response to Prucalopride treatment, gastric emptying time was reduced from a median of 3.1 h to 1.6 h (p < 0.005). Further, the GCSI was significantly reduced from GCSI 3.0 (IQR 2.3–3.7) at baseline to GCSI 1.9 (IQR 1.3–3.2) with Prucalopride. Conclusions: Patients with chronic N/V syndrome have significantly lower gastric contraction amplitude than HVs and may symptomatically benefit from prokinetics. They do not, however, have evidence of panenteric dysmotility. [ABSTRACT FROM AUTHOR]

Published
2024
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12. Evaluating current acute aortic syndrome pathways: Collaborative Acute Aortic Syndrome Project (CAASP).

Author

Zhong, Jim, Singh, Aminder A, Safdar, Nawaz Z, Nandhra, Sandip, Vigneswaran, Ganesh, and Collaborators, CAASP

Subjects
DELAYED diagnosis, FAMILY history (Medicine), DIAGNOSTIC imaging, INTERVENTIONAL radiology, AORTA, AORTIC dissection
Abstract

Background Diagnosis of acute aortic syndrome is challenging and associated with high perihospital mortality rates. The study aim was to evaluate current pathways and understand the chronology of acute aortic syndrome patient care. Method Consecutive patients with acute aortic syndrome imaging diagnosis between 1 January 2018 and 1 June 2021 were identified using a predetermined search strategy and followed up for 6 months through retrospective case note review. The UK National Interventional Radiology Trainee Research and Vascular and Endovascular Research Network co-ordinated the study. Results From 15 UK sites, 620 patients were enrolled. The median age was 67 (range 25–98) years, 62.0% were male and 92.9% Caucasian. Type-A dissection (41.8%) was most common, followed by type-B (34.5%); 41.2% had complicated acute aortic syndrome. Mode of presentation included emergency ambulance (80.2%), self-presentation (16.2%), and primary care referral (3.6%). Time (median (i.q.r.)) to hospital presentation was 3.1 (1.8–8.6) h and decreased by sudden onset chest pain but increased with migratory pain or hypertension. Time from hospital presentation to imaging diagnosis was 3.2 (1.3–6.5) h and increased by family history of aortic disease and decreased by concurrent ischaemic limb. Time from diagnosis to treatment was 2 (1.0–4.3) h with interhospital transfer causing delay. Management included conservative (60.2%), open surgery (32.2%), endovascular (4.8%), hybrid (1.4%) and palliative (1.4%). Factors associated with a higher mortality rate at 30 days and 6 months were acute aortic syndrome type, complicated disease, no critical care admission and age more than 70 years (P < 0.05). Conclusions This study presents a longitudinal data set linking time-based delays to diagnosis and treatment with clinical outcomes. It can be used to prioritize research strategies to streamline patient care. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Groin Wound Infection after Vascular Exposure (GIVE) Risk Prediction Models: Development, Internal Validation, and Comparison with Existing Risk Prediction Models Identified in a Systematic Literature Review

Author

Stather, Philip, Singh, Aminder, Mancuso, Enrico, Arifi, Mohedin, Altabal, Mohamed, Elhadi, Ahmed, Althini, Abdulmunem, Ahmed, Hazem, Davies, Huw, Rangaraju, Madhu, Juszczak, Maciej, Nicholls, Jonathan, Platt, Nicholas, Olivier, James, Kirkham, Emily, Cooper, David, Roy, Iain, Harrison, Gareth, Ackah, James, Mittapalli, Devender, Barry, Ian, Richards, Toby, Elbasty, Ahmed, Moore, Hayley, Bajwa, Adnan, Duncan, Andrew, Batchelder, Andrew, Vanias, Tryfon, Brown, Matthew, Saratzis, Athanasios, Yap, Trixie, Green, Lucy, Smith, George, Hurst, Katherine, Rodriguez, Daniel U., Schofield, Ella, Danbury, Hannah, Wallace, Tom, Forsyth, James, Stimpson, Amy, Hopkins, Luke, Mohiuddin, Kamran, Nandhra, Sandip, Mohammadi-Zaniani, Ghazaleh, Tigkiropoulos, Konstantinos, Shalan, Ahmed, Bashar, Khalid, Sam, Rachel, Forrest, Craig, Debono, Samuel, Hussey, Keith, Falconer, Rachel, Korambayil, Salil, Brennan, Ciaran, Wilson, Thomas, Jones, Aled, Hardy, Tom, Burton, Hannah, Cowan, Andrew, Contractor, Ummul, Townsend, Elaine, Grant, Olivia, Cronin, Michelle, Rocker, Michael, Lowry, Danielle, Clothier, Annie, Locker, Dafydd, Forsythe, Rachael, McBride, Olivia, Eng, Calvin, Jamieson, Russell, Altaf, Nishath, Picazo, Fernando, Sieunarine, Kishore, Benson, Ruth A., Crichton, Alexander, Dattani, Nikesh, Akhtar, Tasleem, Suttenwood, Helen, Guest, Francesca, Wardle, Bethany, Dovell, George, Chinai, Natasha, Ambler, Graeme K., Bosanquet, David, Hinchliffe, Robert, Beckitt, Timothy, Wafi, Arsalan, Thapar, Ankur, Moxey, Paul, Lane, Tristan, Preece, Ryan, Naidoo, Kamil, Patterson, Benjamin, Perrott, Claire, Shalhoub, Joseph, Aherne, Thomas, Hassanin, Ahmed, Boyle, Emily, Egan, Bridget, Tierney, Sean, Patel, Shaneel, Birmpili, Panagiota, Kandola, Sandhir, Neequaye, Simon, Elhadi, Muhammed, Msherghi, Ahmed, Khaled, Ala, Meecham, Lewis, Fisher, Owain, Mahmood, Asif, Milgrom, David, Burke, Kerry, Saleh, Faris, Al-Samarneh, Tariq, Gwilym, Brenig L., and Bosanquet, David C.

Published
2021
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21. Evaluating pharmacological THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment across NHS and private clinics in the UK: a multi-centre, assessor-blind, randomised controlled trial—THRIVE trial

Author

Machin, Matthew, primary, Whittley, Sarah, additional, Norrie, John, additional, Burgess, Laura, additional, Hunt, Beverley J, additional, Bolton, Layla, additional, Shalhoub, Joseph, additional, Everington, Tamara, additional, Gohel, Manjit, additional, Whiteley, Mark S, additional, Rogers, Steven, additional, Onida, Sarah, additional, Turner, Benedict, additional, Nandhra, Sandip, additional, Lawton, Rebecca, additional, Stephens-Boal, Annya, additional, Singer, Carolyn, additional, Dunbar, Joanne, additional, Carradice, Daniel, additional, and Davies, A H, additional

Published
2024
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24. Evaluating the feasibility and acceptability of an exercise and behaviour change intervention in socioeconomically deprived patients with peripheral arterial disease: The textpad study protocol.

Author

Gabriel Cucato, Chris Snowden, Emma McCone, Craig Nesbitt, Sandip Nandhra, Mackenzie Fong, Eileen Kane, Maisie Rowland, Nawaraj Bhattarai, Paul Court, Oliver Bell, John Michael Saxton, and James Prentis

Subjects
Medicine, Science
Abstract

This pilot randomised controlled trial aims to assess the feasibility and acceptability of a 12-week home-based telehealth exercise and behavioural intervention delivered in socioeconomically deprived patients with peripheral artery disease (PAD). The study will also determine the preliminary effectiveness of the intervention for improving clinical and health outcomes. Sixty patients with PAD who meet the inclusion criteria will be recruited from outpatient clinic at the Freeman Hospital, United Kingdom. The intervention group will undergo telehealth behaviour intervention performed 3 times per week over 3 months. This program will comprise a home-based exercise (twice a week) and an individual lifestyle program (once per week). The control group will receive general health recommendations and advice to perform unsupervised walking training. The primary outcome will be feasibility and acceptability outcomes. The secondary outcomes will be objective and subjective function capacity, quality of life, dietary quality, physical activity levels, sleep pattern, alcohol and tobacco use, mental wellbeing, and patients' activation. This pilot study will provide preliminary evidence of the feasibility, acceptability and effectiveness of home-based telehealth exercise and behavioural intervention delivered in socioeconomically deprived patients with PAD. In addition, the variance of the key health outcomes of this pilot study will be used to inform the sample size calculation for a future fully powered, multicentre randomized clinical trial.

Published
2022
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25. Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

Author

T Richards, S Shaikh, S Rehman, A Khan, J Shah, C Smith, A Brown, S Singh, A P Arnaud, A Young, D Bowen, P Patel, S Williams, J Dunn, J John, M Loubani, A Hainsworth, A Kolias, PJ Hutchinson, R Singh, S Sinha, S Shaw, J Edwards, S Mukherjee, AAB Jamjoom, A Singh, S Saeed, J Martin, S Smith, S Ross, M Mohan, P Hutchinson, G James, RDC Moon, P Brennan, A Williams, S Brown, A Ward, M Lee, K Thompson, S Ali, J Williams, S Reid, U Khan, J Lambert, A Smith, B Singh, M Hassan, N Sharma, J Reynolds, N Wright, T Williams, H Smith, M Ng, M Rahman, A Taylor, P Shah, D Saxena, J Evans, I Omar, M Ali, A Hanson, Z Li, R Andrade, P Cardoso, H Jeong, P Sharma, M Arrieta, J Clark, L Pearce, J McVeigh, V Sharma, B Kim, J Singh, S Newman, J Byrne, A Hassan, A Persad, A Gardner, H Liu, K Shah, I Hughes, S Davison, A Balakrishnan, K Patel, J Hall, S Mistry, J Parry, R Baumber, N McGrath, E Ross, R Mannion, S Murphy, FL Wright, A Rogers, B Rai, M Thomas, R Ribeiro, E Hamilton, J Teixeira, B Davidson, L Carvalho, R Garrido, A Puppo, A Guimarães, E Santos, M Kamal, M Denning, M Elhadi, J E Fitzgerald, D Miller, M Gowda, C Morris, A Phillips, H Yang, Y Zhang, N Machairas, A Fisher, A Kaufmann, A Aggarwal, L Hansen, M Otify, H Soleymani Majd, A Jones, M Rodrigues, S Sundar, C Jones, R Edmondson, A Sharkey, L Smith, G Williams, J Dunning, E Belcher, D Stavroulias, V Zamvar, M Patel, M Baker, R Evans, M Sherif, J Hopkins, R Mohammed, A Hill, H Jackson, G Jones, K George, J Dixon, A Tong, S Jallad, Deborah S Keller, A Pereira, L Elliott, D Ford, A Sermon, M Almond, Andrew Metcalfe, C Peluso, T White, S Shah, A Witek, Chetan Khatri, A Tiwari, T Lo, K Agarwal, C Sweeney, C Hart, T Holme, S Green, I Ahmed, A Sobti, C Anderson, N Modi, R Campbell, C Magee, M Mirza, D Jones, N Stylianides, X Luo, C Kang, J Ribeiro, L Kumar, J Diaz, A Bhalla, R Young, C Perkins, A James, A Walters, J Reid, R Pereira, C McDonald, A Aujayeb, K Jackson, M Allen, D Ghosh, M Chan, C Price, K Khan, R Moore, M Ibrahim, A Marchbank, M Silva, M Baig, J De Coster, J Castellanos, S Saxena, M Duque, E Li, E Martin, A Isik, J González, RJ Davies, B Smith, R Owen, K Lakhoo, M Rogers, MA Akhtar, K Mellor, S Agrawal, L Foster, G Harris, J McIntyre, M Garner, R West, R Cuthbert, D Johnson, H Gomes, C Roy, N Spencer, D Mehta, J Freedman, J Blair, K Rajput, K Williams, J Wall, A Soliman, F Chen, A Mokhtari, I Mohamed, J Pascoe, M Khalifa, R Das, A Lara, M Costa, A Mahmoud, K Roberts, J Lane, S Robertson, J P Evans, E Krishnan, I Haq, S Rogers, J Knowles, M Chowdhury, A Ghanbari, L Macdonald, S Powell, J Hunt, J Cornish, J Engel, S Page, I Blake, A Rolls, H Ross, D Simpson, J Hammond, A Goyal, K Parkins, A Desai, A Gaunt, A Salim, Y Yousef, A Schache, H Mohan, SR Brown, R Nair, M Flatman, J Lord, RJ Egan, R Harries, N Judkins, K Sugand, T Hine, J Luck, C Johnson, G Salerno, AW Phillips, R Houston, A Volpe, C Walker, C Steele, M Rela, C Barry, R Alves, L Ramsay, A Turnbull, A Daniele, C S Jones, P Gallagher, G Gradinariu, A Oliveira, C Hardie, H Ferguson, S Bhattacharya, E Davies, P Joshi, C Mellor, E Griffiths, A Bhangu, R Mahoney, F Kashora, G Ruiz, K Wong, G Hill, V Testa, S Ford, C Park, P Gomez, C Lopes, A Lázaro, A Shabana, A Agarwal, C Chung, C Politis, G Martin, E Chung, M Ismail, C Cunha, S Correia, I Santos, A Tang, A Robson, T Collier, G Baltazar, M Quintana, C English, M Ip, K Newton, J Kahn, C Tan, D Cheng, R Woods, M Ho, A ABBAS, A Henry, F Rivas, M Mohammed, N Parsons, T Board, S Madan, A Osorio, M Jarvis, M Hashem, A Egglestone, E Halliday, A Ridgway, G Gallo, J Gilliland, W Marx, R Shaw, A Mahmood, K Gohil, B Gallagher, D Alderson, A Karim, G D Stewart, G Peck, L Majkowski, J Carter, H Ishii, L HUMPHREYS, J Khan, S Abbott, C Newton, F Borghi, A Sud, K Bhatia, H Cao, V Vijay, L Sanderson, E Holler, N Hanna, D Ferguson, P Miranda, L Pickering, T Singhal, T Newman, K Ghosh, C Camacho, D Manning, C Lipede, R Clifford, S Higgs, C Menakaya, S Shankar, K Booth, M Abdalla, T Nelson, T Farrell, H Naseem, J Johnstone, A Wilkins, A Brunt, A Nogués, A Patience, D Jeevan, M Vatish, G Stables, S Adegbola, I Hunt, K Dickson, W Matthews, N Dunne, M Maher, G Faulkner, E Hernandez, R Sofat, K Sahnan, A Brunelli, M Raza, K Chui, C Brennan, P Vaughan, H Chu, R Hagger, ASD Liyanage, R Perkins, S Duff, C Gill, H Dean, S Bandyopadhyay, K Ragupathy, Y Cunningham, A Bateman, V Brown, B Ho, E Britton, H Ikram, R Hasan, A Colquhoun, S Handa, A Maqsood, M Caputo, J Torkington, G Fusai, N Hossain, DJ Lin, S Stefan, IR Daniels, D Pournaras, A Askari, P Nisar, S Moug, J Sagar, N Yassin, G Minto, Z Hamady, JR O'Neill, S Chowdhury, R Cresner, D Vimalachandran, FD Mcdermott, RP Jones, P Zerbib, L Sreedharan, S Wahed, SS Gisbertz, MI van Berge Henegouwen, R Preece, I Liew, S McCluney, D Watts, D Nehra, B Dean, D Chaudhry, L Ross, F Solari, S Chatterji, B Barmayehvar, S Lourenco, L Onos, F Mansour, A Radhakrishnan, M Varcada, M Richmond, I Hernández, A Spinelli, H Pham, J Shalhoub, F Wells, K Bevan, A Peckham-Cooper, N Campain, J Steinke, R Wilkin, K McEvoy, S Mastoridis, N Fine, J Bayer, Y Joshi, A Yener, S C McKay, NS Kalson, S Horvath, H Fu, A Parente, SE Lewis, Y Ahmad, G Seidel, M Dunstan, U von Oppell, J Vatish, H Hirsch, K Breen, C Dott, D Mathieu, J Hardie, K Aldridge, A Doorgakant, P Petrone, R Tansey, M El Amrani, C Branco, Y Viswanath, A Meagher, B Keeler, N Tewari, A Gabr, J Kinross, M Longhi, E M Harrison, P Daliya, P Asaad, F Langlands, N Misra, S Kristinsson, S Di Saverio, C Conso, H Roy, E Massie, L Masterson, D Baskaran, A Hannah, O Ismail, S URBAN, J Domenech, S Ranjit, L Massey, S Mannan, D Rutherford, F Colombo, R Kulkarni, D Kearney, Neil J Smart, G Bourke, D Shrestha, P Nankivell, O Breik, R Exley, D Zakai, AK Abou-Foul, P Naredla, R Vidya, G Mundy, H Marin, A E Ward, A Sudarsanam, W Singleton, M Ganau, F Moura, J Blanco, R Myatt, S Sousa, H Zahid, S Garrido, A Fell, E Caruana, D Nepogodiev, F Dhaif, B Bankhad-Kendall, H Kaafarani, C Bretherton, L Marais, K Siaw-Acheampong, B E Dawson, J C Glasbey, R R Gujjuri, E Heritage, S K Kamarajah, J M Keatley, S Lawday, G Pellino, J F F Simoes, I M Trout, M L Venn, R J W Wilkin, A O Ademuyiwa, E Al Ameer, O Alser, K M Augestad, B Bankhead-Kendall, R A Benson, S Chakrabortee, R Blanco-Colino, A Brar, A Minaya Bravo, K A Breen, I Lima Buarque, M F Cunha, G H Davidson, S Farik, M Fiore, G M A Gomes, C Halkias, I Lawani, H Lederhuber, S Leventoglu, M W Loffler, H Mashbari, D Mazingi, D Moszkowicz, J S Ng-Kamstra, S Metallidis, M Niquen, F Ntirenganya, O Outani, F Pata, T D Pinkney, P Pockney, D Radenkovic, A Ramos-De la Medina, A Schnitzbauer, S Shu, K Soreide, S Tabiri, P Townend, G Tsoulfas, G van Ramshorst, Mak JKC, F Tirotta, A Kisiel, LD Cato, AM Pathanki, A Chebaro, K Lecolle, S Truant, FR Pruvot, E Surmei, L Mattei, J Dudek, S El-Hasani, J Cuschieri, GH Davidson, RG Wade, H Elkadi, C Pompili, JR Burke, E Bagouri, Z Abual-Rub, S Munot, M Kowal, SC Winter, F Di Chiara, K Wallwork, A Qureishi, M Lami, S Sravanam, S Chidambaram, R Smillie, AV Shaw, C Cernei, D Jeyaretna, RJ Piper, E Duck, C Jelley, SC Tucker, G Bond-Smith, XL Griffin, GD Tebala, N Neal, TM Noton, H Ghattaura, OBF Risk, H Kharkar, C Verberne, A Senent-Boza, A Sánchez-Arteaga, I Benítez-Linero, F Manresa-Manresa, L Tallón-Aguilar, L Melero-Cortés, MR Fernández-Marín, VM Durán-Muñoz-Cruzado, I Ramallo-Solís, P Beltrán-Miranda, F Pareja-Ciuró, BT Antón-Eguía, AC Dawson, A Drane, F Oliva Mompean, J Gomez-Rosado, J Reguera-Rosal, J Valdes-Hernandez, L Capitan-Morales, del Toro Lopez, A Alanbuki, O Usman, AJ Beamish, D Bosanquet, D Magowan, H Nassa, G Mccabe, D Holroyd, NB Jamieson, NM Mariani, V Nicastro, D Motter, C Jenvey, T Minto, DR Sarma, C Godbole, W Carlos, A Khajuria, H Connolly, G Di Taranto, S Shanbhag, J Skillman, M Sait, H Al-omishy, B Heer, R Lunevicius, ARG Sheel, M Sundhu, AJA Santini, Fathelbab MSAT, KMA Hussein, QM Nunes, K Shahzad, Baig MMAS, JL Hughes, A Kattakayam, SB Shah, AL Clynch, N Georgopoulou, HM Sharples, AA Apampa, IC Nzenwa, D Podolsky, NL Coleman, MP Callahan, P Beak, I Gerogiannis, A Ebrahim, A Alwadiya, C Demetriou, E Grimley, E Theophilidou, E Ogden, FL Malcolm, G Davies-Jones, Ng JCK, N Elmaleh, Z Chia, J A'Court, A Konarski, R Talwar, P S Jambulingam, A Maity, C Hatzantonis, S Kudchadkar, N Cirocchi, CH Chan, H Eberbach, B Erdle, R Sandkamp, G Velmahos, LR Maurer, M El Moheb, A Gaitanidis, L Naar, MA Christensen, C Kapoen, K Langeveld, M El Hechi, B Main, T Maccabe, NS Blencowe, DP Fudulu, D Bhojwani, M Baquedano, F Rapetto, O Flannery, D Tadross, C Blundell, S Forlani, S Guha, CJ Kelty, G Chetty, G Lye, SP Balasubramanian, N Sureshkumar Shah, A Al-mukhtar, E Whitehall, A Giblin, A Adamec, J Konsten, M Van Heinsbergen, A Sou, J Jimeno Fraile, D Morales-Garcia, M Carrillo-Rivas, E Toledo Martínez, Pascual À, A Landaluce-olavarria, M Gonzalez De miguel, Fernández Gómez Cruzado L, E Begoña, D Lecumberri, A Calvo Rey, GM Prada hervella, L Dos Santos Carregal, MI Rodriguez Fernandez, M Freijeiro, S El Drubi Vega, J Van den Eynde, W Oosterlinck, R Van den Eynde, A Boeckxstaens, A Cordonnier, J Jaekers, M Miserez, M Galipienso Eri, JD Garcia Montesino, J Dellonder Frigolé, D Noriego Muñoz, V Lizzi, F Vovola, A Arminio, A Cotoia, AL Sarni, M Bekheit, BS Kamera, M Elhusseini, A Ahmeidat, W Cymes, G Mignot, J Agilinko, A Sgrò, MM Rashid, K Milne, KE Stewart, MSJ Wilson, K McGivern, BC Brown, B Wadham, IA Aneke, J Collis, H Warburton, DM Fountain, R Laurente, KV Sigamoney, M Dasa, Z Naqui, M Galhoum, MT Hasan, R Kalenderov, O Pathmanaban, R Chelva, K Subba, M Khalefa, F Hossain, T Moores, J Anthoney, O Emmerson, R Makin-Taylor, CS Ong, R Callan, O Bloom, G Chauhan, J Kaur, A Burahee, S Bleibleh, N Pigadas, D Snee, S Bhasin, A Crichton, A Habeebullah, AS Bodla, M Mondragon, V Dewan, MC Giuffrida, A Marano, S Palagi, S Di Maria Grimaldi, A Simonato, M D'Agruma, R Chiarpenello, L Pellegrino, F Maione, D Cianflocca, Pruiti Ciarello, G Giraudo, E Gelarda, E Dalmasso, A Abrate, V Ciriello, F Rosato, A Garnero, L Leotta, M Chiozza, G Anania, A Urbani, M Koleva Radica, P Carcoforo, M Portinari, M Sibilla, JE Archer, A Odeh, N Siddaiah, H Carmichael, CG Velopulos, RC McIntyre, TJ Schroeppel, EA Hennessy, L Zier, C Parmar, JM Muñoz Vives, CJ Gómez Díaz, CA Guariglia, C Soto Montesinos, L Sanchon, M Xicola Martínez, N Guàrdia, P Collera, R Diaz Del Gobbo, R Sanchez Jimenez, R Farre Font, R Flores Clotet, CEM Brathwaite, H Hakmi, AH Sohail, R Heckburn, D Townshend, N McLarty, A Shenfine, K Madhvani, M Hampton, AP Hormis, V Miu, K Sheridan, C Luney, MA Williams, A Alqallaf, A Ben-Sassi, R Crichton, J Sonksen, GR Layton, B Karki, S Pankhania, S Asher, A Folorunso, J Winyard, J Mangwani, BHB Babu, C Weerasinghe, M Ballabio, P Bisagni, T Armao, M Madonini, A Gagliano, P Pizzini, A Älgå, M Nordberg, G Sandblom, J El Kafsi, K Logishetty, A Saadya, R Midha, H Subbiah Ponniah, T Stockdale, T Bacarese-Hamilton, N Anjarwalla, D Marujo Henriques, R Hettige, C Baban, A Tenovici, F Anazor, SD King, S Kazzaz, S HKruijff, De Vries JPPM, PJ Steinkamp, PKC Jonker, WY Van der Plas, W Bierman, Y Janssen, ABJ Borgstein, D Enjuto, M Perez Gonzalez, P Díaz Peña, M Marqueta De Salas, P Martinez Pascual, L Rodríguez Gómez, R Garcés García, A Ramos Bonilla, N Herrera-Merino, P Fernández Bernabé, EP Cagigal Ortega, García de Castro Rubio E, I Cervera, MH Siddique, C Barmpagianni, A Basgaran, A Basha, V Okechukwu, A Bartsch, CA Leo, HK Ubhi, N Zafar, H Abdul-Jabar, F Mongelli, M Bernasconi, M Di Giuseppe, D Christoforidis, D La Regina, M Arigoni, A Al-Sukaini, S Mediratta, O Brown, M Boal, S Stanger, H Abdalaziz, J Constable, G Dovell, R Gopi reddy, A Dehal, HB Shah, GWV Cross, P Seyed-Safi, YW Smart, A Kuc, M Al-Yaseen, B Jayasankar, D Balasubramaniam, K Abdelsaid, N Mundkur, RE Soulsby, O Ryska, T Raymond, P Hawkin, G Kinnaman, I Sharma, K Freystaetter, JN Hadfield, A Hilley, S Arkani, M Youssef, I Shaikh, K Seebah, V Kouritas, D Chrastek, G Maryan, DF Gill, F Khatun, J Parakh, V Sarodaya, A Daadipour, KD Bosch, V Bashkirova, LS Dvorkin, VK Kalidindi, A Choudhry, M Espino Segura-Illa, G Sánchez Aniceto, AM Castaño-Leon, L Jimenez-Roldan, J Delgado Fernandez, A Pérez Núñez, A Lagares, D Garcia Perez, M Santas, I Paredes, O Esteban Sinovas, L Moreno-Gomez, E Rubio, V Vega, A Vivas Lopez, M Labalde Martinez, O García Villar, PM Pelaéz Torres, J Garcia Borda, E Ferrero Herrero, C Eiriz Fernandez, C Ojeda-Thies, JM Pardo Garcia, H Wynn Jones, H Divecha, C Whelton, E Powell-Smith, M Alotaibi, A Maashi, A Zowgar, M Alsakkaf, O Izquierdo, D Ventura, D Escobar, U Garcia de cortazar, Villamor Garcia, A Cioci, K Rakoczy, W Pavlis, R Saberi, A Khaleel, A Unnithan, K Memon, RR Pala Bhaskar, F Maqboul, F Kamel, A Al-Samaraee, R Madani, H Llaquet Bayo, N Duchateau, C De Gheldere, A Fayad, ML Wood, G Groot, I Hakami, C Boeker, J Mall, AF Haugstvedt, ML Jönsson, P Caja Vivancos, Villalabeitia Ateca, M Prieto Calvo, P Martin Playa, A Gainza, EJ Aragon Achig, A Rodriguez Fraga, Melchor Corcóstegui, G Mallabiabarrena Ormaechea, JJ Garcia Gutierrez, L Barbier, MA Pesántez Peralta, M Jiménez Jiménez, JA Municio Martín, J Gómez Suárez, G García Operé, LA Pascua Gómez, M Oñate Aguirre, A Fernandez-Colorado, M De la Rosa-Estadella, A Gasulla-Rodriguez, M Serrano-Martin, A Peig-Font, S Junca-Marti, M Juarez-Pomes, S Garrido-Ondono, L Blasco-Torres, M Molina-Corbacho, Y Maldonado-Sotoca, A Gasset-Teixidor, J Blasco-Moreu, V Turrado-Rodriguez, AM Lacy, FB de Lacy, X Morales, A Carreras-Castañer, P Torner, M Jornet-Gibert, M Balaguer-Castro, M Renau-Cerrillo, P Camacho-Carrasco, M Vives-Barquiel, B Campuzano-Bitterling, I Gracia, R Pujol-Muncunill, M Estaire Gómez, D Padilla-Valverde, S Sánchez-García, D Sanchez-Pelaez, E Jimenez Higuera, R Picón Rodríguez, Fernández Camuñas À, C Martínez-Pinedo, EP Garcia Santos, V Muñoz-Atienza, A Moreno Pérez, CA Cano, D Crego-Vita, M Huecas-Martinez, A Roselló Añón, MJ Sangüesa, JC Bernal-Sprekelsen, JC Catalá Bauset, P Renovell Ferrer, C Martínez Pérez, O Gil-Albarova, J Gilabert Estellés, K Aghababyan, R Rivas, J Escartin, JL Blas Laina, B Cros, Talal El-Abur, J Garcia Egea, C Yanez, JH Kauppila, E Sarjanoja, S Tzedakis, PA Bouche, S Gaujoux, D Gossot, A Seguin-Givelet, D Fuks, M Grigoroiu, R Sanchez Salas, X Cathelineau, P Macek, Y Barbé, F Rozet, E Barret, A Mombet, N Cathala, E Brian, F Zadegan, AJ Baldwin, E Gammeri, A Catton, S Marinos Kouris, J Pereca, M Kaushal, A Kler, V Reghuram, S Tezas, V Oktseloglou, F Mosley, MFI De La Cruz Monroy, P Bobak, S Ahad, E Lostis, GK Ambler, J Manara, M Doe, T Jichi, GD Stewart, J Ramzi, AA Singh, J Ashcroft, OJ Baker, P Coughlin, Durst AZED, A Abood, A Habeeb, VE Hudson, B Lamb, L Luke, S Mitrasinovic, Ngu AWT, S Waseem, F Georgiades, XS Tan, J Pushpa-rajah, I Abu-Nayla, S Rooney, E Irune, MHV Byrne, A Durrani, A Sethuraman Venkatesan, T Combellack, G Tahhan, M Kornaszewska, V Valtzoglou, I Deglurkar, M Koutentakis, Syed Nong Chek SAH, M Shinkwin, F Ayeni, H Tustin, M Bordenave, N Manu, N Eardley, OL Serevina, S Roy Mahapatra, K Mohankumar, I Khawaja, A Palepa, T Doulias, Y Premakumar, Y Jauhari, Z Koshnow, A Uberai, F Hirri, BM Stubbs, J Manickavasagam, S Dalgleish, R Kanitkar, CJ Payne, Ng CE, DE Henshall, T Drake, EM Harrison, A Tambyraja, RJE Skipworth, G Linder, R McGregor, J Mayes, R Pasricha, A Razik, S Thrumurthy, D Howden, Z Baxter, L Osagie, M Bence, GE Fowler, N Rajaretnam, A Goubran, JS McGrath, JRA Phillips, DA Raptis, JM Pollok, F Soggiu, S Xyda, C Hidalgo Salinas, H Tzerbinis, T Pissanou, R Mirnezami, N Angamuthu, T Shakir, H Capitelli-McMahon, L Hitchman, A Andronic, A Aboelkassem Ibrahim, J Totty, S Tayeh, T Chase, J Ayorinde, T Cuming, A Trompeter, C Hing, P Tsinaslanidis, MW Benjamin, A Leyte, J Smelt, G Santhirakumaran, A Labib, O Lyons, S Onida, KM Sarraf, S Erridge, S Yalamanchili, A Abuown, D Davenport, S Wheatstone, SM Andreani, MF Bath, A Sahni, L Rigueros Springford, C Sohrabi, J Bacarese-Hamilton, FG Taylor, P Patki, C Tanabalan, ME Alexander, CJ Smart, L Abdeh, M Zeiton, R Advani, S Nikolaou, T Oni, N Ilahi, K Ballantyne, Z Woodward, R Merh, B Robertson-Smith, P Ameerally, JG Finch, C Gnanachandran, I Pop, D Dass, G Thiruchandran, Toh SKC, A Allana, C Bellis, O Babawale, YC Phan, U Lokman, T Koc, L Duggleby, S Shamoon, H Clancy, A Mansuri, A Thakrar, L Wickramarachchi, S Sivayoganathan, E Karam, HV Colvin, A Badran, A Cadersa, A Cumpstey, R Aftab, F Wensley, V Morrison-Jones, GK Sekhon, H Shields, Z Shakoor, T Talbot, A Alzetani, J Rooney, M Rudic, A Aladeojebi, M Kitchen, R Lefroy, P Nanjaiah, AD Rajgor, RJ Scurrah, LJ Watson, T Royle, B Steel, Luk ACO, VG Thiruvasagam, W Marlow, C Konstantinou, D Yershov, A Denning, E Mangos, T Nambirajan, I Flindall, V Mahendran, J De Marchi, NF Davis, A Picciariello, V Papagni, DF Altomare, S Granieri, C Cotsoglou, A Cabeleira, P Serralheiro, T Teles, C Canhoto, J Simões, AC Almeida, O Nogueira, R Athayde Nemésio, MJ Amaral, A Valente da Costa, R Martins, P Guerreiro, A Ruivo, D Breda, JM Oliveira, AL De Oliveira Lopez, M Colino, J De Barros, AP Soares, H Morais, T Revez, MI Manso, JC Domingues, P Henriques, Cardoso N Ribeiro VI, G Martins dos Santos, M Peralta Ferreira, J Ascensão, B Costeira, L Rio Rodrigues, M Sousa Fernandes, P Azevedo, I Lourenço, G Mendinhos, A Nobre Pinto, H Taflin, H Abdou, L O'Meara, Z Cooper, SA Hirji, BU Okafor, V Roxo, CP Raut, JS Jolissaint, DA Mahvi, C Reinke, S Merola, A Ssentongo, P Ssentongo, Oh JS, J Hazelton, J Maines, N Gusani, RCG Martin, N Bhutiani, R Choron, F Soliman, MD E Dauer, E Renza-Stingone, E Gokcen, E Kropf, H Sufrin, J Sewards, J Poggio, K Sanserino, L Rae, M Philp, M Metro, P McNelis, R Petrov, T Pazionis, DB Lumenta, SP Nischwitz, E Richtig, M Pau, P Srekl-Filzmaier, N Eibinger, B Michelitsch, M Fediuk, A Papinutti, TU Cohnert, E Kantor, J Kahiu, S Hosny, A Sultana, M Taggarsi, L Vitone, OP Vaz, I Sarantitis, S Timbrell, A Shugaba, GP Jones, SS Tripathi, MS Greenhalgh, H Emerson, K Vejsbjerg, W McCormick, K Singisetti, Y Aawsaj, R Vanker, M Ghobrial, S Kanthasamy, H Fawi, M Awadallah, J Cheung, S Tingle, F Abbadessa, A Sachdeva, CD Chan, I McPherson, F Mahmoud Ali, S Pandanaboyana, T Grainger, S Nandhra, N Dawe, C McCaffer, J Riches, J Moir, H Elamin Ahmed, C Saleh, RM Koshy, LJ Rogers, PL Labib, N Hope, K Emslie, P Panahi, E Clough, I Enemosah, J Natale, N Raza, JI Webb, M Antar, J Noel, R Nunn, F Eriberto, R Tanna, S Lodhia, C Osório, J Antunes, P Balau, and M Godinho

Subjects
Medicine
Abstract

Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis.Setting Prospective, international, multicentre, observational cohort study.Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative).Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality.Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787).Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups.Trial registration number NCT04323644

Published
2021
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26. THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment: a multi-centre, assessor blind, randomised controlled trial (THRIVE trial)

Author

Machin, Matthew, primary, Whittley, Sarah, additional, Norrie, John, additional, Burgess, Laura, additional, Hunt, Beverley J., additional, Bolton Saghdaoui, Layla, additional, Shalhoub, Joseph, additional, Everington, Tamara, additional, Gohel, Manjit, additional, Whiteley, Mark, additional, Rogers, Steven, additional, Onida, Sarah, additional, Turner, Benedict, additional, Nandhra, Sandip, additional, Lawton, Rebecca, additional, Stephens-Boal, Annya, additional, Singer, Carolyn, additional, Dunbar, Joanne, additional, Davies, Alun Huw, additional, and Carradice, Daniel, additional

Published
2023
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27. The Impact of Pre-Operative Anaemia on One Year Amputation Free Survival and Re-Admissions in Patients Undergoing Vascular Surgery for Peripheral Arterial Disease: A National Vascular Registry Study

Author

Birmpili, P., primary, Cromwell, D.A., additional, Li, Q., additional, Johal, A.S., additional, Atkins, E., additional, Waton, S., additional, Pherwani, A.D., additional, Williams, R., additional, Richards, T., additional, and Nandhra, S., additional

Published
2023
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29. Is a primer needed for orthodontic bonding? : a randomised controlled trial

Author

Nandhra, Sarabijit Singh, Littlewood, S., Houghton, N., Luther, F., and Wood, S.

Subjects
617.6
Abstract

Is a primer needed for orthodontic bonding? A Randomised controlled trial Objective: To evaluate the clinical performance of APC Victory IITM (3M Unitek) brackets in direct orthodontic bonding with and without the use of primer. Design: A single operator two centre prospective randomised controlled clinical trial. Setting: The orthodontic departments at the Leeds Dental Institute and St.Luke’s hospital, Bradford. Subjects and methods: 92 patients requiring orthodontic treatment with fixed appliances. 46 Patients randomly allocated to control (with primer) or test (without primer). Patients bonded using a standardised procedure. Main outcome measures: Number of bracket failures, time to bond-up appliances and the adhesive remnant index (ARI) when bracket failure occurred, over a six month period Results: Failure rate with primer 8.8%, without primer 13.8%, no statistically significant difference- P value 0.051. Mean difference in bondup time per bracket was 0.068 minutes which was not statistically significant (P =0.402). Statistically significant difference in the ARI – ARI 0 with primer 55.9%, no primer 81.5%, (P= 8.1622e-008). Conclusion: There is no statistically significant difference in the bracket failure rate with or without primer when bonding APC Victory IITM (P=0.051). No significant difference in bond-up times. Statistically significant difference in the ARI, bonding without primer providing a lower ARI.

Published
2012

31. INSIGHTS FROM FRANCHISEES IN THE CHILDREN'S SERVICES INDUSTRY

Author

Nandhra, Indi

Subjects
Franchises, Advertising, marketing and public relations, Business, Economics
Abstract

Warning: If your passion leads you to children's service brands where diversity, equity and inclusion are a primary focus within the brand offerings then read on. If this is not [...]

Published
2023

32. Aligner orthodontics: a literature review

Author

Nikhil Gogna, Murray Irving, and Kieran Nandhra

Subjects
General Medicine
Abstract

Many studies have been undertaken to understand the limitations and benefits of aligners, including systematic reviews with meta-analyses. However, there are very few comprehensive reviews of the current evidence. This literature review provides an up-to-date summary of various aspects of clear aligner therapy, including patient compliance, clinical effectiveness, social interactions and iatrogenic effects. CPD/Clinical Relevance: Clear aligners are a popular choice and the article provides an up-to-date summary of various aspects of clear aligner therapy.

Published
2023
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33. Study protocol for COvid-19 Vascular sERvice (COVER) study: The impact of the COVID-19 pandemic on the provision, practice and outcomes of vascular surgery.

Author

Ruth A Benson, Sandip Nandhra, and Vascular and Endovascular Research Network

Subjects
Medicine, Science
Abstract

BackgroundThe novel Coronavirus Disease 2019 (COVID-19) pandemic is having a profound impact on global healthcare. Shortages in staff, operating theatre space and intensive care beds has led to a significant reduction in the provision of surgical care. Even vascular surgery, often insulated from resource scarcity due to its status as an urgent specialty, has limited capacity due to the pandemic. Furthermore, many vascular surgical patients are elderly with multiple comorbidities putting them at increased risk of COVID-19 and its complications. There is an urgent need to investigate the impact on patients presenting to vascular surgeons during the COVID-19 pandemic.Methods and analysisThe COvid-19 Vascular sERvice (COVER) study has been designed to investigate the worldwide impact of the COVID-19 pandemic on vascular surgery, at both service provision and individual patient level. COVER is running as a collaborative study through the Vascular and Endovascular Research Network (VERN), an independent, international vascular research collaborative with the support of numerous national and international organisations). The study has 3 'Tiers': Tier 1 is a survey of vascular surgeons to capture longitudinal changes to the provision of vascular services within their hospital; Tier 2 captures data on vascular and endovascular procedures performed during the pandemic; and Tier 3 will capture any deviations to patient management strategies from pre-pandemic best practice. Data submission and collection will be electronic using online survey tools (Tier 1: SurveyMonkey® for service provision data) and encrypted data capture forms (Tiers 2 and 3: REDCap® for patient level data). Tier 1 data will undergo real-time serial analysis to determine longitudinal changes in practice, with country-specific analyses also performed. The analysis of Tier 2 and Tier 3 data will occur on completion of the study as per the pre-specified statistical analysis plan.

Published
2020
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38. Premature deciduous tooth loss: a rare case of detrimental sequelae to the permanent dentition

Author

Kirandeep Nandhra and Andrew Flett

Subjects
General Medicine
Abstract

Early loss of deciduous teeth can be associated with loss of space, tooth displacement, centreline disturbance, tooth impaction and ectopia. Its inevitability, unless monitored accordingly, among patients makes it pivotal that practitioners are aware of the detrimental effects, so they are able to consider these in the patient's management. This report presents the case of an 18-year-old patient who experienced tooth impaction and significant first premolar root resorption following the premature loss of deciduous second molars. CPD/Clinical Relevance: The orthodontist should be aware of the potential for detrimental sequelae of early primary tooth loss and subsequent tooth impaction, and ensure these are appropriately assessed and investigated in order to incorporate these into a patient's management plan.

Published
2023
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40. Understanding the current acute aortic syndrome (AAS) pathways—The Collaborative Acute Aortic Syndrome Project (CAASP) protocol.

Author

Zhong, Jim, Vigneswaran, Ganesh, Safdar, Nawaz Z., Mandal, Indrajeet, Singh, Aminder A., and Nandhra, Sandip

Subjects
PENETRATING atherosclerotic ulcer, AORTA, DELAYED diagnosis, SYMPTOMS, AORTIC dissection, COMORBIDITY
Abstract

Background: Acute aortic syndrome (AAS) is an emergency associated with high peri-hospital mortality rates. Variable clinical presentation makes timely diagnosis challenging and such delays in diagnosis directly impact patient outcomes. Aims and objectives: The aims of the Collaborative Acute Aortic Syndrome Project (CAASP) are to characterise and evaluate the current AAS pathways of a cohort of hospitals in the UK, USA and New Zealand to determine if patient outcomes are influenced by the AAS pathway (time to hospital admission, diagnosis and management plan) and demographic, social, geographic and patient-specific factors (clinical presentation and comorbidities). The objectives are to describe different AAS pathways and time duration between hospital admission to diagnosis and management plan instigation, and to compare patient outcomes between pathways. Methods: The study is a multicentre, retrospective service evaluation project of adult patients diagnosed on imaging with AAS. It will be coordinated by the UK National Interventional Radiology Trainee Research (UNITE) network and Vascular and Endovascular Research Network (VERN) in conjunction with The Aortic Dissection Charitable Trust (TADCT). All AAS cases diagnosed on imaging between 1st January 2018 to 1st June 2021 will be included and followed-up for 6 months. Eligibility criteria include aortic dissection (AD) Type A, Type B, non A/B, penetrating aortic ulcer, and intramural haematoma. Exclusion criteria are non-AAS pathology, acute on chronic AAS, and age<18. This project will evaluate patient demographics, timing of presentation, patient symptoms, risk factors for AD, physical examination findings, timing to imaging and treatment, hospital stay, and mortality. Univariate and multivariate analysis will be used to identify predictors associated with prolonged time to diagnosis or treatment and mortality at 30 days. [ABSTRACT FROM AUTHOR]

Published
2024
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45. The persistent challenges faced by vascular surgery services during the UK coronavirus pandemic: a snapshot qualitative survey

Author

Ruth A. Benson and S Nandhra

Subjects
medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), SARS-CoV-2, business.industry, COVID-19, General Medicine, Vascular surgery, Northern ireland, medicine.disease, Qualitative survey, United Kingdom, Abdominal aortic aneurysm, Emergency medicine, Pandemic, Humans, Medicine, Surgery, business, Venous disease, Pandemics, Vascular Surgical Procedures, Personal protective equipment
Abstract

Introduction The coronavirus (COVID-19) pandemic continues to affect the NHS. The Vascular and Endovascular Research Network (VERN) COvid Vascular sERvice (COVER) study has prospectively shown the significant global impact of the COVID-19 pandemic on vascular surgery. The aim of this study is to investigate the way in which this second wave has affected surgeons’ ability to treat patients with urgent vascular conditions, using contemporaneous snapshot data from 30 UK vascular centres. Methods This is a contemporary (18–28 January 2021) re-run of the Tier 1 COVER survey. This used closed and open questions, related to centres’ provision of common vascular services, threshold for treatment, imaging, screening, staff and theatre availability, multidisciplinary team input, clinics, personal protective equipment, vaccination policies and case-backlogs. The survey was disseminated to clinicians via email. A service reduction score was calculated. Results Forty-two complete responses were received from 30 vascular centres (England, Northern Ireland, Scotland and Wales). Overall, 56.7% of units are performing only urgent procedures. The threshold for abdominal aortic aneurysm (AAA) repair has increased in the majority of UK centres (60%). One in six AAA screening programmes have stopped all screening activity: 30% having a significantly reduced programme and only half running as normal. Waiting lists are increasing for AAA, lower limb revascularisation and venous disease. Conclusion Overall, these data suggest that vascular care in the NHS is facing unprecedented pressures due to COVID-19. Vascular stakeholders will have to urgently address these issues in the coming months. Study registration number ISRCTN 80453162 (registered prospectively).

Published
2022
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46. Social Deprivation and the Association With Survival Following Fenestrated Endovascular Aneurysm Repair

Author

Ehsanul Choudhury, James Rammell, James McCaslin, Nikesh Dattani, Sandip Nandhra, Robin Williams, and James Prentis

Subjects
medicine.medical_specialty, medicine.medical_treatment, Endovascular aneurysm repair, Blood Vessel Prosthesis Implantation, Postoperative Complications, Primary outcome, Risk Factors, Internal medicine, Humans, Medicine, In patient, Retrospective Studies, Procedure time, Aortic aneurysm repair, business.industry, Endovascular Procedures, General Medicine, medicine.disease, Abdominal aortic aneurysm, Treatment Outcome, Social deprivation, Surgery, Social Deprivation, Cardiology and Cardiovascular Medicine, business, Complication, Aortic Aneurysm, Abdominal
Abstract

Introduction : Social deprivation is associated with poor clinical outcomes. It is known to have an impact on length of stay and post-operative mortality across a number of other surgical specialties. This study evaluates the impact of social deprivation on outcomes following fenestrated endovascular aneurysm repair (FEVAR). Methods : All elective FEVARs performed between 2010-2018 at a tertiary vascular centre were analysed. Deprivation (index of multiple deprivation (IMD)) data was sourced from the English indices of deprivation 2019, by postcode. Primary outcome was overall survival by Kaplan-Meier. Secondary outcomes included length of hospital stay (LOS) and complications. Cox-proportional hazard analyses were conducted. Results : Some 132 FEVAR patients were followed-up for 3.7 (SD 2.2) years. Fifty-seven patients lived in areas with high levels of deprivation (IMD 1-3), 34 in areas with moderate deprivation (IMD 4-6) and 41 in areas with the lowest level (IMD 7-10) of deprivation. Groups were comparable for Age, BMI, AAA diameter and co-morbidity. A higher proportion of patients from deprived areas had renal failure (15% (26.3%) vs. 9% (11.8%) p=0.019) but no overall difference in procedure time was observed (200 mins (155-250) vs. 180 mins (145-240) p=0.412). Kaplan-Meier analysis demonstrated significantly poorer survival for patients living in areas with high levels of deprivation (IMD 1-3) (p=0.03). Mortality was comparable for IMD 4-6 and 7-10 groups. Patients from the most deprived areas had longer hospital stay (6 days ( 4 , 5 , 6 , 7 , 8 , 9 ) vs. 5 ( 3 , 4 , 5 , 6 , 7 ) p=0.005) and higher all-cause complication rates (21 (36.8%) vs. 14 (18.4%) p=0.02). Decreasing IMD was associated with worse survival (HR -0.85 (0.75-0.97) (p=0.02)). Conclusions : Social deprivation was associated with increased mortality, length of stay and all-cause complication rates in patients undergoing FEVAR for complex abdominal aortic aneurysm (AAA). These results may help direct pre-optimisation measures to improve outcomes in higher risk sub-groups.

Published
2022
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47. The Vascular and Endovascular Research Network (VERN): A multidisciplinary collaborative for vascular surgeons in training.

Author

Hitchman, Louise, Gwilym, Brenig, Al-Saadi, Nina, Birmpili, Panagiota, Singh, Aminder, Machin, Matt, Blair, Robert, Hurndall, Kathern, Shelmerdine, Lauren, Shalhoub, Joseph, Bosanquet, Dave, Dattani, Nikesh, Saratzis, Athanasios, Onida, Sara, Benson, Ruth, Nandhra, Sandip, and Ambler, Graeme

Abstract

Copyright of Gefaesschirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Published
2023
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