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3. Predictors of Severe Graft Dysfunction After DCD Heart Transplantation with Direct Procurement and Preservation

Author

Martinez Marin, L., primary, Smail, H., additional, Bhagra, S., additional, Hogg, R., additional, Jenkins, D., additional, Kaul, P., additional, Kydd, A., additional, Large, S., additional, Lewis, C., additional, Messer, S., additional, Nunes, J., additional, Parameshwar, J., additional, Rafiq, M., additional, Simmonds, L., additional, Tsui, S., additional, Pettit, S., additional, and Berman, M., additional

Published
2024
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4. 8-Year Single-Centre Experience of DCD Heart Transplantation: Temporal Trends in Outcomes, Procedural and Recipient Characteristics

Author

Martinez Marin, L., primary, Smail, H., additional, Bhagra, S., additional, Hogg, R., additional, Jenkins, D., additional, Kaul, P., additional, Kydd, A., additional, Large, S., additional, Lewis, C., additional, Messer, S., additional, Nunes, J., additional, Parameshwar, J., additional, Rafiq, M., additional, Simmonds, L., additional, Tsui, S., additional, Berman, M., additional, and Pettit, S., additional

Published
2024
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8. Organ Care System (OCS) Perfusion Time During Donation After Circulatory Death (DCD) Heart Transplantation: Not Too Little, Not Too Much: There Safety Lie

Author

Smail, H., primary, Martinez Marin, L., additional, Pettit, S., additional, Kaul, P., additional, Rafiq, M., additional, Tsui, S., additional, Jenkins, D., additional, Large, S., additional, Bhagra, S., additional, Kydd, A., additional, Simmonds, L., additional, Hogg, R., additional, Parameshwar, J., additional, Lewis, C., additional, Nunes, J., additional, Messer, S., additional, Page, A., additional, Al-Adhami, A., additional, and Berman, M., additional

Published
2024
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13. Hypotension-Avoidance Versus Hypertension-Avoidance Strategies in Noncardiac Surgery : An International Randomized Controlled Trial.

Author

Marcucci, M, Painter, TW, Conen, D, Lomivorotov, V, Sessler, DI, Chan, MTV, Borges, FK, Leslie, K, Duceppe, E, Martínez-Zapata, MJ, Wang, CY, Xavier, D, Ofori, SN, Wang, MK, Efremov, S, Landoni, G, Kleinlugtenbelt, YV, Szczeklik, W, Schmartz, D, Garg, AX, Short, TG, Wittmann, M, Meyhoff, CS, Amir, M, Torres, D, Patel, A, Ruetzler, K, Parlow, JL, Tandon, V, Fleischmann, E, Polanczyk, CA, Lamy, A, Jayaram, R, Astrakov, SV, Wu, WKK, Cheong, CC, Ayad, S, Kirov, M, de Nadal, M, Likhvantsev, VV, Paniagua, P, Aguado, HJ, Maheshwari, K, Whitlock, RP, McGillion, MH, Vincent, J, Copland, I, Balasubramanian, K, Biccard, BM, Srinathan, S, Ismoilov, S, Pettit, S, Stillo, D, Kurz, A, Belley-Côté, EP, Spence, J, McIntyre, WF, Bangdiwala, SI, Guyatt, G, Yusuf, S, Devereaux, PJ, POISE-3 Trial Investigators and Study Groups, Marcucci, M, Painter, TW, Conen, D, Lomivorotov, V, Sessler, DI, Chan, MTV, Borges, FK, Leslie, K, Duceppe, E, Martínez-Zapata, MJ, Wang, CY, Xavier, D, Ofori, SN, Wang, MK, Efremov, S, Landoni, G, Kleinlugtenbelt, YV, Szczeklik, W, Schmartz, D, Garg, AX, Short, TG, Wittmann, M, Meyhoff, CS, Amir, M, Torres, D, Patel, A, Ruetzler, K, Parlow, JL, Tandon, V, Fleischmann, E, Polanczyk, CA, Lamy, A, Jayaram, R, Astrakov, SV, Wu, WKK, Cheong, CC, Ayad, S, Kirov, M, de Nadal, M, Likhvantsev, VV, Paniagua, P, Aguado, HJ, Maheshwari, K, Whitlock, RP, McGillion, MH, Vincent, J, Copland, I, Balasubramanian, K, Biccard, BM, Srinathan, S, Ismoilov, S, Pettit, S, Stillo, D, Kurz, A, Belley-Côté, EP, Spence, J, McIntyre, WF, Bangdiwala, SI, Guyatt, G, Yusuf, S, Devereaux, PJ, and POISE-3 Trial Investigators and Study Groups

Abstract

BACKGROUND: Among patients having noncardiac surgery, perioperative hemodynamic abnormalities are associated with vascular complications. Uncertainty remains about what intraoperative blood pressure to target and how to manage long-term antihypertensive medications perioperatively. OBJECTIVE: To compare the effects of a hypotension-avoidance and a hypertension-avoidance strategy on major vascular complications after noncardiac surgery. DESIGN: Partial factorial randomized trial of 2 perioperative blood pressure management strategies (reported here) and tranexamic acid versus placebo. (ClinicalTrials.gov: NCT03505723). SETTING: 110 hospitals in 22 countries. PATIENTS: 7490 patients having noncardiac surgery who were at risk for vascular complications and were receiving 1 or more long-term antihypertensive medications. INTERVENTION: In the hypotension-avoidance strategy group, the intraoperative mean arterial pressure target was 80 mm Hg or greater; before and for 2 days after surgery, renin-angiotensin-aldosterone system inhibitors were withheld and the other long-term antihypertensive medications were administered only for systolic blood pressures 130 mm Hg or greater, following an algorithm. In the hypertension-avoidance strategy group, the intraoperative mean arterial pressure target was 60 mm Hg or greater; all antihypertensive medications were continued before and after surgery. MEASUREMENTS: The primary outcome was a composite of vascular death and nonfatal myocardial injury after noncardiac surgery, stroke, and cardiac arrest at 30 days. Outcome adjudicators were masked to treatment assignment. RESULTS: The primary outcome occurred in 520 of 3742 patients (13.9%) in the hypotension-avoidance group and in 524 of 3748 patients (14.0%) in the hypertension-avoidance group (hazard ratio, 0.99 [95% CI, 0.88 to 1.12]; P = 0.92). Results were consistent for patients who used 1 or more than 1 antihypertensive medication in the long term. LIMITATION: Adherence to the as

Published
2023

29. Hypertensive disorders in women with peripartum cardiomyopathy: insights from the ESC EORP PPCM Registry

Author

Jackson, Alice M., Petrie, Mark C., Frogoudaki, Alexandra, Laroche, Cécile, Gustafsson, Finn, Ibrahim, Bassem, Mebazaa, Alexandre, Johnson, Mark R., Seferovic, Petar M., Regitz‐Zagrosek, Vera, Mbakwem, Amam, Böhm, Michael, Prameswari, Hawani Sasmaya, Abdel Gawad, Doaa Ahmed Fouad, Goland, Sorel, Damasceno, Albertino, Karaye, Kamilu, Farhan, Hasan Ali, Hamdan, Righab, Maggioni, Aldo P., Sliwa, Karen, Bauersachs, Johann, Meer, Peter, Favaloro, R., Favaloro, L., Carballo, M., Peradejordi, M., Renedo, M.F., Absi, D., Bertolotti, A., Ratto, R., Talavera, M.L., Gomez, R., Lockwood, S., Barton, T., Austin, M‐A., Arstall, M., Aldridge, E., Chow, Y.Y., Dekker, G., Mahadavan, G., Rose, J., Wittwer, M., Hoppe, U., Sandhofer, A., Bahshaliyev, A., Gasimov, Z., Babayev, A., Niftiyev, P., Hasanova, I., AlBannay, R., AlHaiki, W., Husain, A., Mahdi, N., Kurlianskaya, A., Lukyanchyk, M., Shatova, O., Troyanova‐Shchutskaia, T., Anghel, L., De Pauw, M., Gevaert, S., De Backer, J., De Hosson, M., Vervaet, P., Timmermans, P.J., Janssen, A., Yameogo, N.V., Kagambega, L.J., Cumyn, A., Caron, N., Cote, A‐M., Sauve, N., Nkulu, D. Ngoy, Lez, D. Malamba, Yolola, E. Ngoy, Krejci, J., Poloczkova, H., Ersboll, A., Gustafsson, F., Elrakshy, Y., Hassanein, M., Hammad, B., Eldin, O. Nour, Fouad, D., Salman, S., Zareh, Z., Abdeall, D., Elenin, H. Abo, Ebaid, H., El Nagar, A., Farag, S., Saed, M., El Rahman, Y H Abd, Ibrahim, B.S., Abdelhamid, M., Hanna, R.N. W., Youssef, G., Awad, R., Botrous, O.L. I., Halawa, S. Ibrahim, Nasr, G., Saad, A., El Tahlawi, M., Abdelbaset, M., El‐saadawy, M., El‐shorbagy, A., Shalaby, G., Anttonen, O., Tolppanen, H., Hamekoski, S., Menez, T., Noel, A., Lamblin, N., Mouquet, F., Coulon, C., Groote, P., Langlois, S., Schurtz, G., Cohen‐Solal, A., Mebazaa, A., Fournier, M‐C., Louadah, B., Akrout, N., Logeart, D., Leurent, G., Jovanova, S., Arnaudova‐Dezulovicj, F., Livrinova, V., Bauersachs, J., Hilfiker‐Kleiner, D., Berliner, D., Jungesblut, M., Koenig, T., Moulig, V.A., Pfeffer, T.J., Böhm, M., Kindermann, I., Schwarz, V., Schmitt, C., Swojanowsky, P., Pettit, S., Petrie, M., McAdam, M., Patton, D., Bakhai, A., Krishnamurthy, V., Lim, L., Clifford, P., Bowers, N., Clark, A. L., Witte, K., Cullington, D., Oliver, J., Simms, A., Mcginlay, M., McDonagh, T., Shah, A. M., Amin‐Youssef, G., De Courcey, J., Martin, K., Shaw, S., Vause, S., Wallace, S., Malin, G., Wick, C., Nikolaou, M., Rentoukas, I., Chinchilla, H., Andino, L., Iyengar, S., Chandra, S., Yadav, D.K., Babu, R. Ravi, Singh, A.K., Kumar, S., Karunamay, B.B., Chaubey, S.K., Dhiman, S.R., Jha, V.C., Singh, S.K., Kodati, D., Dasari, R., Sultana, S., Dewi, T.I., Prameswari, H. Sasmaya, Al‐Farhan, H.A., Al‐Hussein, A., Yaseen, I.F., Al‐Azzawi, Falah, Al‐Saedi, Ghazi, Mahmood, G.M., Mohammed, M.K., Ridha, A.F., Shotan, A., Vazan, A., Goland, S., Biener, M., Senni, M., Grosu, A., Martin, E., Esposti, D. Degli, Bacchelli, S., Borghi, C., Metra, M., Sciatti, E., Orabona, R., Sani, F., Brunetti, N.D., Sinagra, G., Bobbo, M., D'Agata Mottolese, B., Gesuete, V., Rakar, S., Ramani, F., Kamiya, C., Barasa, A., Ngunga, M., Bajraktari, G., Hyseni, V., Lleshi, D., Pllana, E., Pllana, T., Noruzbaeva, A., Ismailov, F., Mirrakhimov, E., Abilova, S., Lunegova, O., Kerimkulova, A., Osmankulova, G., Duishenalieva, M., Kurmanbekova, B., Turgunov, M., Mamasaidova, S., Bektasheva, E., Kavoliuniene, A., Muckiene, G., Vaitiekiene, A., Celutkiene, J., Balkevicine, L., Barysiene, J., Chee, K.H., Damasceno, A., Machava, M., Veldhuisen, D.J., Meer, P., Berg, M., Roos‐Hesselink, J., Hagen, I., Baris, L., Hurtado, P., Ezeonu, P., Isiguzo, G., Obeka, N., Onoh, R., Asogwa, F., Onyema, C., Otti, K., Ojji, D., Odili, A., Nwankwo, A., Karaye, K., Ishaq, N., Sanni, B., Abubakar, H., Mohammed, B., Sani, M., Kehinde, M., Mbakwem, A., Afolabi, B., Amadi, C., Kilasho, M., Qamar, N., Furnaz, S., Gurmani, S., Kayani, M.G.A. Mahmood, Munir, R., Hussain, S., Malik, S., Mumtaz, S., Saligan, J.R., Rubis, P., Biernacka‐Fijalkowska, B., Lesniak‐Sobelga, A., Wisniowska‐Smialek, S., Kasprzak, J.D., Lelonek, M., Zycinski, P., Jankowski, L., Grajek, S., Oko‐Sarnowska, Z., Rutkowska, A. Bartczak, Kaluzna‐Oleksy, M., Plaskota, K., Demkow, M., Dzielinska, Z., Henzel, J., Kryczka, K., Moiseeva, O., Irtyuga, O., Karelkina, E., Zazerskaya, I., Seferovic, P.M., Milinkovic, I., Živkovic, I., Ristic, A.D., Milasinovic, D., Kong, W. KF, Tan, L.K., Tan, J.L., Thain, S., Poh, K.K., Yip, J., Sliwa, K., Azibani, F., Hovelmann, J., Viljoen, C., Briton, O., Zamora, E., Orcajo, N. Alonso, Carbonell, R., Pascual, C., Muncharaz, J. Farre, Alonso‐Pulpon, L., Cubero, J. Segovia, Urquia, M. Taibo, Garcia‐Pavia, P., Gomez‐Bueno, M., Cobo‐Marcos, M., Briceno, A., Galvan, E. De Teresa, Garcia‐Pinilla, J.M., Robles‐Mezcua, A., Morcillo‐Hildalgo, L., Elbushi, A., Suliman, A., Ahamed, N., Jazzar, K., Murtada, M., Schaufelberger, M., Goloskokova, V., Hullin, R., Yarol, N., Arrigo, M., Cavusoglu, Y., Eraslan, S., Fak, A.S., Enar, S. Catirli, Sarac, L., Cankurtaran, B., Gumrukcuoglu, H., Ozturk, F., Omagino, J., Mondo, C., Lwabi, P., Ingabire, P., Nabbaale, J., Nyakoojo, W., Okello, E., Sebatta, E., Ssinabulya, I., Atukunda, E., Kitooleko, S., Semu, T., Salih, B.T., Komaranchath, A.M., Almahmeed, W.A.R., Gerges, F., Farook, F.S. Mohamed, Albakshy, F., Mahmood, N., Wani, S., Freudenberger, R., Islam, N., Quinones, J., Sundlof, D., Beitler, C., Centolanza, L., Cornell, K., Huffaker, S., Matos, L., Marzo, K., Paruchuri, V., Patel, D., Abdullaev, T., Alyavi, B., Mirzarakhimova, S., Tsoy, I., Bekbulatova, R., and Uzokov, J.

Abstract

Aims: \ud Hypertensive disorders occur in women with peripartum cardiomyopathy (PPCM). How often hypertensive disorders co-exist, and to what extent they impact outcomes, is less clear. We describe differences in phenotype and outcomes in women with PPCM with and without hypertensive disorders during pregnancy.\ud \ud Methods: \ud The European Society of Cardiology PPCM Registry enrolled women with PPCM from 2012-2018. Three groups were examined: 1) women without hypertension (‘PPCM-noHTN’); 2) women with hypertension but without pre-eclampsia (‘PPCM-HTN’); 3) women with pre-eclampsia (‘PPCM-PE’). Maternal (6-month) and neonatal outcomes were compared.\ud \ud Results: \ud Of 735 women included, 452 (61.5%) had PPCM-noHTN, 99 (13.5%) had PPCM-HTN and 184 (25.0%) had PPCM-PE. Compared to women with PPCM-noHTN, women with PPCM-PE had more severe symptoms (NYHA IV in 44.4% and 29.9%, p

Published
2021

30. A Machine Learning Algorithm to Identify Patients at Risk of Unplanned Subsequent Surgery After Intramedullary Nailing for Tibial Shaft Fractures

Author

Bhandari, M., Bulstra, A.E.J., Bzovsky, S., Doornberg, J.N., Goslings, J.C., Hendrickx, L.A.M., Jaarsma, R.L., Jeray, K.J., Kerkhoffs, G.M.M.J., Petrisor, B., Ring, D., Schemitsch, E.H., Swiontkowski, M., Sanders, D., Sprague, S., Tornetta, P., Walter, S.D., Heels-Ansdell, D., Buckingham, L., Leece, P., Viveiros, H., Mignott, T., Ansell, N., Sidorkewicz, N., Agel, J., Bombardier, C., Berlin, J.A., Bosse, M., Browner, B., Gillespie, B., Jones, A., O'Brien, P., Poolman, R., Macleod, M.D., Carey, T., Leitch, K., Bailey, S., Gurr, K., Konito, K., Bartha, C., Low, I., MacBean, L.V., Ramu, M., Reiber, S., Strapp, R., Tieszer, C., Kreder, H.J., Stephen, D.J.G., Axelrod, T.S., Yee, A.J.M., Richards, R.R., Finkelstein, J., Gofton, W., Murnaghan, J., Schatztker, J., Ford, M., Bulmer, B., Conlan, L., Laflamme, G.Y., Berry, G., Beaumont, P., Ranger, P., Laflamme, G.H., Gagnon, S., Malo, M., Fernandes, J., Poirier, M.F., McKee, M.D., Waddell, J.P., Bogoch, E.R., Daniels, T.R., McBroom, R.R., Vicente, M.R., Storey, W., Wild, L.M., McCormack, R., Perey, B., Goetz, T.J., Pate, G., Penner, M.J., Panagiotopoulos, K., Pirani, S., Dommisse, I.G., Loomer, R.L., Stone, T., Moon, K., Zomar, M., Webb, L.X., Teasdall, R.D., Birkedal, J.P., Martin, D.F., Ruch, D.S., Kilgus, D.J., Pollock, D.C., Harris, M.B., Wiesler, E.R., Ward, W.G., Shilt, J.S., Koman, A.L., Poehling, G.G., Kulp, B., Creevy, W.R., Stein, A.B., Bono, C.T., Einhorn, T.A., Brown, T.D., Pacicca, D., Sledge, J.B., Foster, T.E., Voloshin, I., Bolton, J., Carlisle, H., Shaughnessy, L., Obremskey, W.T., LeCroy, C.M., Meinberg, E.G., Messer, T.M., Craig, W.L., Dirschl, D.R., Caudle, R., Harris, T., Elhert, K., Hage, W., Jones, R., Piedrahita, L., Schricker, P.O., Driver, R., Godwin, J., Kregor, P.J., Tennent, G., Truchan, L.M., Sciadini, M., Shuler, F.D., Driver, R.E., Nading, M.A., Neiderstadt, J., Vap, A.R., Vallier, H., Patterson, B.M., Wilber, J.H., Wilber, R.G., Sontich, J.K., Moore, T.A., Brady, D., Cooperman, D.R., Davis, J.A., Cureton, B.A., Mandel, S., Orr, R.D., Sadler, J.T.S., Hussain, T., Rajaratnam, K., Drew, B., Bednar, D.A., Kwok, D.C.H., Pettit, S., Hancock, J., Cole, P.A., Smith, J.J., Brown, G.A., Lange, T.A., Stark, J.G., Levy, B.A., Garaghty, M.J., Salzman, J.G., Schutte, C.A., Tastad, L., Vang, S., Seligson, D., Roberts, C.S., Malkani, A.L., Sanders, L., Dyer, C., Heinsen, J., Smith, L., Madanagopal, S., Frantz-Bush, L., Coupe, K.J., Tucker, J.J., Criswell, A.R., Buckle, R., Rechter, A.J., Sheth, D.S., Urquart, B., Trotscher, T., Anders, M.J., Kowalski, J.M., Fineberg, M.S., Bone, L.B., Phillips, M.J., Rohrbacher, B., Stegemann, P., Mihalko, W.M., Buyea, C., Augustine, S.J., Jackson, W.T., Solis, G., Ero, S.U., Segina, D.N., Berrey, H.B., Agnew, S.G., Fitzpatrick, M., Campbell, L.C., Derting, L., McAdams, J., Ponsen, K.J., Luitse, J., Kloen, P., Joosse, P., Winkelhagen, J., Duivenvoorden, R., Teague, D.C., Davey, J., Sullivan, J.A., Ertl, W.J.J., Puckett, T.A., Pasque, C.B., Tompkins, J.F., Gruel, C.R., Kammerlocher, P., Lehman, T.P., Puffinbarger, W.R., Carl, K.L., Weber, D.W., Jomha, N.M., Goplen, G.R., Masson, E., Beaupre, L.A., Greaves, K.E., Schaump, L.N., Goetz, D.R., Westberry, D.E., Broderick, J.S., Moon, B.S., Tanner, S.L., Powell, J.N., Buckley, R.E., Elves, L., Connolly, S., Abraham, E.P., Steele, T., Ellis, T., Herzberg, A., Crawford, D.E., Hart, R., Hayden, J., Orfaly, R.M., Vigland, T., Vivekaraj, M., Bundy, G.L., Miclau, T., Matityahu, A., Coughlin, R.R., Kandemir, U., McClellan, R.T., Lin, C.H.H., Karges, D., Cramer, K., Watson, J.T., Moed, B., Scott, B., Beck, D.J., Orth, C., Puskas, D., Clark, R., Jones, J., Egol, K.A., Paksima, N., France, M., Wai, E.K., Johnson, G., Wilkinson, R., Gruszczynski, A.T., Vexler, L., Mallee, W.H., Schipper, I.B., and SPRINT Investigators

Subjects
prediction model, intramedullary nailing, machine learning, subsequent surgery, tibia shaft fracture, Orthopedics and Sports Medicine, Surgery, General Medicine
Abstract

Objectives: In the SPRINT trial, 18% of patients with a tibial shaft fracture (TSF) treated with intramedullary nailing (IMN) had one or more unplanned subsequent surgical procedures. It is clinically relevant for surgeon and patient to anticipate unplanned secondary procedures, other than operations that can be readily expected such as reconstructive procedures for soft tissue defects. Therefore, the objective of this study was to develop a machine learning (ML) prediction model using the SPRINT data that can give individual patients and their care team an estimate of their particular probability of an unplanned second surgery. Methods: Patients from the SPRINT trial with unilateral TSFs were randomly divided into a training set (80%) and test set (20%). Five ML algorithms were trained in recognizing patterns associated with subsequent surgery in the training set based on a subset of variables identified by random forest algorithms. Performance of each ML algorithm was evaluated and compared based on (1) area under the ROC curve, (2) calibration slope and intercept, and (3) the Brier score. Results: Total data set comprised 1198 patients, of whom 214 patients (18%) underwent subsequent surgery. Seven variables were used to train ML algorithms: (1) Gustilo-Anderson classification, (2) Tscherne classification, (3) fracture location, (4) fracture gap, (5) polytrauma, (6) injury mechanism, and (7) OTA/AO classification. The best-performing ML algorithm had an area under the ROC curve, calibration slope, calibration intercept, and the Brier score of 0.766, 0.954, -0.002, and 0.120 in the training set and 0.773, 0.922, 0, and 0.119 in the test set, respectively. Conclusions: An ML algorithm was developed to predict the probability of subsequent surgery after IMN for TSFs. This ML algorithm may assist surgeons to inform patients about the probability of subsequent surgery and might help to identify patients who need a different perioperative plan or a more intensive approach.

Published
2021

31. Conditional recurrence-free survival of clinical complete responders managed by watch and wait after neoadjuvant chemoradiotherapy for rectal cancer in the International Watch & Wait Database: a retrospective, international, multicentre registry study

Author

Fernandez, L. M., Sao Juliao, G. P., Figueiredo, N. L., Beets, G. L., van der Valk, M. J. M., Bahadoer, R. R., Hilling, D. E., Meershoek-Klein Kranenbarg, E., Roodvoets, A. G. H., Renehan, A. G., van de Velde, C. J. H., Habr-Gama, A., Perez, R. O., Abdelrazeq, A., Asoglu, O., Barroca, R., Beveridge, J., Bhowmick, A., Blower, A., Braun, M., Bujko, K., Carter, P., Carvalho, C., Coco, C., Cunningham, C., D'Hoore, A., Dimofte, G., Ding, P., Duff, S., Dwyer, S. T., Epstein, J., Evans, D., Fulford, P., Gaertner, W., Gerard, J. -P., Gollins, S., Harris, R., Harrison, J., Heat, J., Hill, J., Hobbiss, J., Huertas, E., Huq, Z., Iseas, S., Jakobsen, A., Jones, D., Jones, L., Khan, U., Kushwaha, R., Lees, N., Linn, T. Y., Loganathan, S., Lopez Campos, F., Madoff, R., Mamedli, Z. Z., Martling, A., Matzel, K. E., Melenhorst, J., Mitchell, P., Murad-Regadas, S. M., O'Dwyer, S. T., Pairola, A., Paraoan, M., Pares, O., Peeters, K. C. M. J., Pettit, S. H., Pranesh, N., Rajaganeshan, R., Ravi, S., Rawat, S., Richards, D., Riyad, K., Rossi, G., Rutten, H. J. T., Saeed, M., Salaman, J., Sanchez Loria, F., Van der Sande, M. E., Santiago, I., Selvasekar, C., Siddiqui, K. H., Smart, C., Solkar, M. H., Sun Myint, A., Taylor, B., Telford, K., Scott, N., Vaccaro, C. A., Vailati, B. B., Verberne, C., Vieira, P., Vimalchandran, D., Ward, S., Wilson, M. S., Winter, D. C., Witjes, C., Wolthuis, A. M., Zhang, J., Zhang, Z., Coco C. (ORCID:0000-0002-4713-7093), Fernandez, L. M., Sao Juliao, G. P., Figueiredo, N. L., Beets, G. L., van der Valk, M. J. M., Bahadoer, R. R., Hilling, D. E., Meershoek-Klein Kranenbarg, E., Roodvoets, A. G. H., Renehan, A. G., van de Velde, C. J. H., Habr-Gama, A., Perez, R. O., Abdelrazeq, A., Asoglu, O., Barroca, R., Beveridge, J., Bhowmick, A., Blower, A., Braun, M., Bujko, K., Carter, P., Carvalho, C., Coco, C., Cunningham, C., D'Hoore, A., Dimofte, G., Ding, P., Duff, S., Dwyer, S. T., Epstein, J., Evans, D., Fulford, P., Gaertner, W., Gerard, J. -P., Gollins, S., Harris, R., Harrison, J., Heat, J., Hill, J., Hobbiss, J., Huertas, E., Huq, Z., Iseas, S., Jakobsen, A., Jones, D., Jones, L., Khan, U., Kushwaha, R., Lees, N., Linn, T. Y., Loganathan, S., Lopez Campos, F., Madoff, R., Mamedli, Z. Z., Martling, A., Matzel, K. E., Melenhorst, J., Mitchell, P., Murad-Regadas, S. M., O'Dwyer, S. T., Pairola, A., Paraoan, M., Pares, O., Peeters, K. C. M. J., Pettit, S. H., Pranesh, N., Rajaganeshan, R., Ravi, S., Rawat, S., Richards, D., Riyad, K., Rossi, G., Rutten, H. J. T., Saeed, M., Salaman, J., Sanchez Loria, F., Van der Sande, M. E., Santiago, I., Selvasekar, C., Siddiqui, K. H., Smart, C., Solkar, M. H., Sun Myint, A., Taylor, B., Telford, K., Scott, N., Vaccaro, C. A., Vailati, B. B., Verberne, C., Vieira, P., Vimalchandran, D., Ward, S., Wilson, M. S., Winter, D. C., Witjes, C., Wolthuis, A. M., Zhang, J., Zhang, Z., and Coco C. (ORCID:0000-0002-4713-7093)

Abstract

Background: Watch and wait is a novel management strategy in patients with rectal cancer who have a clinical complete response after neoadjuvant chemoradiotherapy. Surveillance of these patients is generally intensive, because local regrowth (with the potential for salvage) occurs in 25% of patients, and distant metastases occur in 10% of patients. It is unclear for how long these patients should be followed up. To address this issue, we did conditional survival modelling using the International Watch & Wait Database (IWWD), which is a large-scale registry of patients with a clinical complete response after neoadjuvant chemotherapy who have been managed by a watch-and-wait strategy. Methods: We did a retrospective, multicentre registry study using a dataset from the IWWD, which includes data from 47 clinics across 15 countries. We selected patients (aged ≥18 years) with rectal cancer who had a clinical complete response after neoadjuvant chemotherapy, and who were subsequently managed by a watch-and-wait strategy between Nov 25, 1991, and Dec 31, 2015. Patients who had not achieved a clinical complete response or who had undergone any surgical procedure were excluded. The criteria used for defining a clinical complete response and the specific surveillance strategies were at the discretion of each participating centre. We used conditional survival modelling to estimate the probability of patients remaining free of local regrowth or distant metastasis for an additional 2 years after sustaining a clinical complete response or being distant metastasis-free for 1, 3, and 5 years from the date of the decision to commence watch and wait. The primary outcomes were conditional local regrowth-free survival at 3 years, and conditional distant metastasis-free survival at 5 years. Findings: We identified 793 patients in the IWWD with clinical complete response who had been managed by a watch-and-wait strategy. Median follow-up was 55·2 months (IQR 36·0–75·6). The probabilit

Published
2021

35. Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture: a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled trial

Author

Borges, F.K., Devereaux, P.J., Cuerden, M., Bhandari, M., Guerra Farfan, Ernesto., Patel, A., Sigamani, A., Umer, M., Neary, J., Tiboni, M., Tandon, V., Ramokgopa, M.T., Sancheti, P., John, B., Lawendy, A., Balaguer-Castro, Mariano, Jenkinson, R., Ś Lȩczka, P., Nabi Nur, A., Wood, G.C.A., Feibel, R., McMahon, J.S., Biccard, B.M., Landoni, G., Szczeklik, W., Wang, C.Y., Tomas-Hernandez, Jordi, Abraham, V., Vincent, J., Harvey, V., Pettit, S., Sontrop, J., Garg, A.X., Universitat Autònoma de Barcelona, [Borges FK] Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada. [Devereaux PJ] Department of Perioperative Medicine, Population Health Research Institute, Hamilton, Ontario, Canada. Departments of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, Ontario, Canada. [Cuerden M] Division of Nephrology, Department of Medicine, Western University, London, Ontario, Canada. [Bhandari M] Department of Surgery, McMaster University, Hamilton, Ontario, Canada. [Guerra-Farfán E, Tomas-Hernandez J] Servei de Cirurgia Traumatològica i Ortopèdica, Vall d'Hebron Hospital Universitari, Barcelona, Spain. [Patel A] Department of Medicine, McMaster University, Hamilton, Ontario, Canada, Vall d'Hebron Barcelona Hospital Campus, Borges, F. K., Devereaux, P. J., Cuerden, M., Bhandari, M., Guerra-Farfan, E., Patel, A., Sigamani, A., Umer, M., Neary, J., Tiboni, M., Tandon, V., Ramokgopa, M. T., Sancheti, P., John, B., Lawendy, A., Balaguer-Castro, M., Jenkinson, R., Sleczka, P., Nabi Nur, A., Wood, G. C. A., Feibel, R., Mcmahon, J. S., Biccard, B. M., Landoni, G., Szczeklik, W., Wang, C. Y., Tomas-Hernandez, J., Abraham, V., Vincent, J., Harvey, V., Pettit, S., Sontrop, J., and Garg, A. X.

Subjects
Male, Therapeutics::Patient Care::Time-to-Treatment [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], accelerated surgery, 030232 urology & nephrology, Patient Care Planning, law.invention, Hip fracture, Fractures - Tractament, 0302 clinical medicine, Postoperative Complications, Randomized controlled trial, law, Fracture Fixation, Risk Factors, Protocol, Medicine, 030212 general & internal medicine, Surgical treatment, Acute kidney injury, Cirurgia ortopèdica, General Medicine, Acute Kidney Injury, 3. Good health, Insuficiència renal aguda, Therapeutics::Orthopedic Procedures [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], terapéutica::procedimientos ortopédicos [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], hip fracture, Female, Risk Adjustment, Adult, medicine.medical_specialty, enfermedades urogenitales masculinas::enfermedades urológicas::enfermedades renales::insuficiencia renal::lesión renal aguda [ENFERMEDADES], Risk Assessment, Time-to-Treatment, 03 medical and health sciences, Standard care, Humans, In patient, Surgical repair, Protocol (science), business.industry, Hip Fractures, medicine.disease, Male Urogenital Diseases::Urologic Diseases::Kidney Diseases::Renal Insufficiency::Acute Kidney Injury [DISEASES], Surgery, terapéutica::asistencia al paciente::tiempo hasta el tratamiento [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Accelerated surgery, business
Abstract

Accelerated surgery; Acute kidney injury; Hip fracture Cirugía acelerada; Lesión renal aguda; Fractura de cadera Cirurgia accelerada; Lesions renals agudes; Fractura de maluc Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. Ethics and dissemination: We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. Trial registration number: NCT02027896; Pre-results. This work was supported by the following grants: Canadian Institute of Health and Research (CIHR) Foundation Award, CIHR’s Strategy for Patient Oriented Research (SPOR), through the Ontario SPOR Support Unit, which is supported by the CIHR and the Province of Ontario, as well as the Ontario Ministry of Health and Long-Term Care, and a grant from Smith & Nephew to recruit 300 patients in Spain. Grants to support this substudy were provided by the Department of Medicine at Western University. Dr Devereaux was supported by a Tier 1 Canada Research Chair in Perioperative Medicine. Dr Amit Garg was supported by the Dr Adam Linton Chair in Kidney Health Analytics and a CIHR Clinician Investigator Award.

Published
2019

36. Surgical Palpation to Exclude Donor Transmitted Coronary Disease: A Single Centre Experience

Author

Vokshi, I., primary, Ali, J., additional, Ansaripour, A., additional, Woolcock, E., additional, Cheshire, C., additional, Parameshwar, J., additional, Kydd, A., additional, Lewis, C., additional, Jenkins, D., additional, Tsui, S., additional, Kaul, P., additional, Large, S., additional, Berman, M., additional, Pettit, S., additional, and Bhagra, S., additional

Published
2021
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39. Donation after Circulatory Death Heart Transplantation - The First 5 Years a Successful Leap in Activity

Author

Cernic, S., primary, Messer, S., additional, Page, A., additional, Berman, M., additional, Kaul, P., additional, Osman, M., additional, Nachum, E., additional, Parameshwar, J., additional, Pettit, S., additional, Lewis, C., additional, Kydd, A., additional, Bhagra, S., additional, Goddard, M., additional, Quigley, R., additional, Baxter, J., additional, Jenkins, D., additional, Tsui, S., additional, Catarino, P., additional, and Large, S., additional

Published
2021
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42. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial

Author

Ponikowski, P. Kirwan, B.-A. Anker, S.D. McDonagh, T. Dorobantu, M. Drozdz, J. Fabien, V. Filippatos, G. Göhring, U.M. Keren, A. Khintibidze, I. Kragten, H. Martinez, F.A. Metra, M. Milicic, D. Nicolau, J.C. Ohlsson, M. Parkhomenko, A. Pascual-Figal, D.A. Ruschitzka, F. Sim, D. Skouri, H. van der Meer, P. Lewis, B.S. Comin-Colet, J. von Haehling, S. Cohen-Solal, A. Danchin, N. Doehner, W. Dargie, H.J. Motro, M. Butler, J. Friede, T. Jensen, K.H. Pocock, S. Jankowska, E.A. Azize, G. Fernandez, A. Zapata, G.O. Garcia Pacho, P. Glenny, A. Ferre Pacora, F. Parody, M.L. Bono, J. Beltrano, C. Hershson, A. Vita, N. Luquez, H.A. Cestari, H.G. Fernandez, H. Prado, A. Berli, M. García Durán, R. Thierer, J. Diez, M. Lobo Marquez, L. Borelli, R.R. Hominal, M.Á. Ameri, P. Agostoni, P. Salvioni, A. Fattore, L. Gronda, E. Ghio, S. Turrini, F. Uguccioni, M. Di Biase, M. Piepoli, M. Savonitto, S. Mortara, A. Terrosu, P. Fucili, A. Boriani, G. Midi, P. Passamonti, E. Cosmi, F. van der Meer, P. Van Bergen, P. van de Wetering, M. Al-Windy, N.Y.Y. Tanis, W. Meijs, M. Groutars, R.G.E.J. The, H.K.S. Kietselaer, B. van Kesteren, H.A.M. Beelen, D.P.W. Heymeriks, J. Van de Wal, R. Schaap, J. Emans, M. Westendorp, P. Nierop, P.R. Nijmeijer, R. Manintveld, O.C. Dorobantu, M. Darabantiu, D.A. Zdrenghea, D. Toader, D.M. Petrescu, L. Militaru, C. Crisu, D. Tomescu, M.C. Stanciulescu, G. Rodica Dan, A. Iosipescu, L.C. Serban, D.L. Drozdz, J. Szachniewicz, J. Bronisz, M. Tycińska, A. Wozakowska-Kaplon, B. Mirek-Bryniarska, E. Gruchała, M. Nessler, J. Straburzyńska-Migaj, E. Mizia-Stec, K. Szelemej, R. Gil, R. Gąsior, M. Gotsman, I. Halabi, M. Shochat, M. Shechter, M. Witzling, V. Zukermann, R. Arbel, Y. Flugelman, M. Ben-Gal, T. Zvi, V. Kinany, W. Weinstein, J.M. Atar, S. Goland, S. Milicic, D. Horvat, D. Tušek, S. Udovicic, M. Šutalo, K. Samodol, A. Pesek, K. Artuković, M. Ružić, A. Šikić, J. McDonagh, T. Trevelyan, J. Wong, Y.-K. Gorog, D. Ray, R. Pettit, S. Sharma, S. Kabir, A. Hamdan, H. Tilling, L. Baracioli, L. Nigro Maia, L. Dutra, O. Reis, G. Pimentel Filho, P. Saraiva, J.F. Kormann, A. dos Santos, F.R. Bodanese, L. Almeida, D. Precoma, D. Rassi, S. Costa, F. Kabbani, S. Abdelbaki, K. Abdallah, C. Arnaout, M.S. Azar, R. Chaaban, S. Raed, O. Kiwan, G. Hassouna, B. Bardaji, A. Zamorano, J. del Prado, S. Gonzalez Juanatey, J.R. Ga Bosa Ojeda, F.I. Gomez Bueno, M. Molina, B.D. Sim, D. Yeo, T.J. Loh, S.Y. Soon, D. Ohlsson, M. Smith, J.G. Gerward, S. Khintibidze, I. Lominadze, Z. Chapidze, G. Emukhvari, N. Khabeishvili, G. Chumburidze, V. Paposhvili, K. Shaburishvili, T. Parhomenko, O. Kraiz, I. Koval, O. Zolotaikina, V. Malynovsky, Y. Vakaliuk, I. Rudenko, L. Tseluyko, V. Stanislavchuk, M. AFFIRM-AHF investigators

Abstract

Background: Intravenous ferric carboxymaltose has been shown to improve symptoms and quality of life in patients with chronic heart failure and iron deficiency. We aimed to evaluate the effect of ferric carboxymaltose, compared with placebo, on outcomes in patients who were stabilised after an episode of acute heart failure. Methods: AFFIRM-AHF was a multicentre, double-blind, randomised trial done at 121 sites in Europe, South America, and Singapore. Eligible patients were aged 18 years or older, were hospitalised for acute heart failure with concomitant iron deficiency (defined as ferritin

Published
2020

43. Ferric carboxymaltose for iron deficiency at discharge after acute heart failure: a multicentre, double-blind, randomised, controlled trial

Author

Ponikowski, Piotr, primary, Kirwan, Bridget-Anne, additional, Anker, Stefan D, additional, McDonagh, Theresa, additional, Dorobantu, Maria, additional, Drozdz, Jarosław, additional, Fabien, Vincent, additional, Filippatos, Gerasimos, additional, Göhring, Udo Michael, additional, Keren, Andre, additional, Khintibidze, Irakli, additional, Kragten, Hans, additional, Martinez, Felipe A, additional, Metra, Marco, additional, Milicic, Davor, additional, Nicolau, José C, additional, Ohlsson, Marcus, additional, Parkhomenko, Alexander, additional, Pascual-Figal, Domingo A, additional, Ruschitzka, Frank, additional, Sim, David, additional, Skouri, Hadi, additional, van der Meer, Peter, additional, Lewis, Basil S, additional, Comin-Colet, Josep, additional, von Haehling, Stephan, additional, Cohen-Solal, Alain, additional, Danchin, Nicolas, additional, Doehner, Wolfram, additional, Dargie, Henry J, additional, Motro, Michael, additional, Butler, Javed, additional, Friede, Tim, additional, Jensen, Klaus H, additional, Pocock, Stuart, additional, Jankowska, Ewa A, additional, Azize, G, additional, Fernandez, A, additional, Zapata, GO, additional, Garcia Pacho, P, additional, Glenny, A, additional, Ferre Pacora, F, additional, Parody, ML, additional, Bono, J, additional, Beltrano, C, additional, Hershson, A, additional, Vita, N, additional, Luquez, HA, additional, Cestari, HG, additional, Fernandez, H, additional, Prado, A, additional, Berli, M, additional, García Durán, R, additional, Thierer, J, additional, Diez, M, additional, Lobo Marquez, L, additional, Borelli, RR, additional, Hominal, MÁ, additional, Metra, M, additional, Ameri, P, additional, Agostoni, P, additional, Salvioni, A, additional, Fattore, L, additional, Gronda, E, additional, Ghio, S, additional, Turrini, F, additional, Uguccioni, M, additional, Di Biase, M, additional, Piepoli, M, additional, Savonitto, S, additional, Mortara, A, additional, Terrosu, P, additional, Fucili, A, additional, Boriani, G, additional, Midi, P, additional, Passamonti, E, additional, Cosmi, F, additional, van der Meer, P, additional, Van Bergen, P, additional, van de Wetering, M, additional, Al-Windy, NYY, additional, Tanis, W, additional, Meijs, M, additional, Groutars, RGEJ, additional, The, HKS, additional, Kietselaer, B, additional, van Kesteren, HAM, additional, Beelen, DPW, additional, Heymeriks, J, additional, Van de Wal, R, additional, Schaap, J, additional, Emans, M, additional, Westendorp, P, additional, Nierop, PR, additional, Nijmeijer, R, additional, Manintveld, OC, additional, Dorobantu, M, additional, Darabantiu, DA, additional, Zdrenghea, D, additional, Toader, DM, additional, Petrescu, L, additional, Militaru, C, additional, Crisu, D, additional, Tomescu, MC, additional, Stanciulescu, G, additional, Rodica Dan, A, additional, Iosipescu, LC, additional, Serban, DL, additional, Drozdz, J, additional, Szachniewicz, J, additional, Bronisz, M, additional, Tycińska, A, additional, Wozakowska-Kaplon, B, additional, Mirek-Bryniarska, E, additional, Gruchała, M, additional, Nessler, J, additional, Straburzyńska-Migaj, E, additional, Mizia-Stec, K, additional, Szelemej, R, additional, Gil, R, additional, Gąsior, M, additional, Gotsman, I, additional, Halabi, M, additional, Shochat, M, additional, Shechter, M, additional, Witzling, V, additional, Zukermann, R, additional, Arbel, Y, additional, Flugelman, M, additional, Ben-Gal, T, additional, Zvi, V, additional, Kinany, W, additional, Weinstein, JM, additional, Atar, S, additional, Goland, S, additional, Milicic, D, additional, Horvat, D, additional, Tušek, S, additional, Udovicic, M, additional, Šutalo, K, additional, Samodol, A, additional, Pesek, K, additional, Artuković, M, additional, Ružić, A, additional, Šikić, J, additional, McDonagh, T, additional, Trevelyan, J, additional, Wong, Y-K, additional, Gorog, D, additional, Ray, R, additional, Pettit, S, additional, Sharma, S, additional, Kabir, A, additional, Hamdan, H, additional, Tilling, L, additional, Baracioli, L, additional, Nigro Maia, L, additional, Dutra, O, additional, Reis, G, additional, Pimentel Filho, P, additional, Saraiva, JF, additional, Kormann, A, additional, dos Santos, FR, additional, Bodanese, L, additional, Almeida, D, additional, Precoma, D, additional, Rassi, S, additional, Costa, F, additional, Kabbani, S, additional, Abdelbaki, K, additional, Abdallah, C, additional, Arnaout, MS, additional, Azar, R, additional, Chaaban, S, additional, Raed, O, additional, Kiwan, G, additional, Hassouna, B, additional, Bardaji, A, additional, Zamorano, J, additional, del Prado, S, additional, Gonzalez Juanatey, JR, additional, Ga Bosa Ojeda, FI, additional, Gomez Bueno, M, additional, Molina, BD, additional, Pascual Figal, DA, additional, Sim, D, additional, Yeo, TJ, additional, Loh, SY, additional, Soon, D, additional, Ohlsson, M, additional, Smith, JG, additional, Gerward, S, additional, Khintibidze, I, additional, Lominadze, Z, additional, Chapidze, G, additional, Emukhvari, N, additional, Khabeishvili, G, additional, Chumburidze, V, additional, Paposhvili, K, additional, Shaburishvili, T, additional, Parhomenko, O, additional, Kraiz, I, additional, Koval, O, additional, Zolotaikina, V, additional, Malynovsky, Y, additional, Vakaliuk, I, additional, Rudenko, L, additional, Tseluyko, V, additional, and Stanislavchuk, M, additional

Published
2020
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45. Heart Transplantation from Donation after Circulatory Determined Death: The Royal Papworth Experience

Author

Page, A., primary, Messer, S., additional, Berman, M., additional, Kaul, P., additional, Pavlushkov, E., additional, Parameshwar, J., additional, Abu-Omar, Y., additional, Goddard, M., additional, Dunning, J., additional, Pettit, S., additional, Lewis, C., additional, Kydd, A., additional, Bhagra, S., additional, Ali, A., additional, Sudarshan, C., additional, Jenkins, D., additional, Tsui, S., additional, Catarino, P., additional, and Large, S., additional

Published
2020
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48. Association between complications and death within 30 days after noncardiac surgery

Author

Spence, J., LeManach, Y., Chan, M.T.V., Wang, C.Y., Sigamani, A., Xavier, D., Pearse, R., Alonso-Coello, P., Garutti, I., Srinathan, S.K., Duceppe, E., Walsh, M., Borges, F.K., Málaga Rodríguez, Germán Javier, Abraham, V., Faruqui, A., Berwanger, O., Biccard, B.M., Villar, J.C., Sessler, D.I., Kurz, A., Chow, C.K., Polanczyk, C.A., Szczeklik, W., Ackland, G., Garg, A.X., Jacka, M., Guyatt, G.H., Sapsford, R.J., Williams, C., Cortes, O.L., Coriat, P., Patel, A., Tiboni, M., Belley-Côté, E.P., Yang, S., Heels-Ansdell, D., McGillion, M., Schünemann, H.J., Parlow, S., Patel, M., Pettit, S., Yusuf, S., Devereaux, P.J., and VISION Investigators

Subjects
Male, surgical mortality, patient monitoring, Kaplan-Meier Estimate, mortality rate, noncardiac surgery, sepsis, Postoperative Complications, Prospective Studies, Prospective cohort study, risk reduction, Mortality rate, adult, Hazard ratio, General Medicine, Middle Aged, cohort analysis, aged, female, Surgical Procedures, Operative, multicenter study (topic), Female, Cohort study, prospective study, early diagnosis, medicine.medical_specialty, Postoperative Hemorrhage, surgical technique, Article, Sepsis, male, Internal medicine, medicine, operative blood loss, Humans, controlled study, human, outcome assessment, Aged, Proportional hazards model, business.industry, disease association, heart muscle injury, Perioperative, medicine.disease, major clinical study, Confidence interval, purl.org/pe-repo/ocde/ford#3.02.00 [https], hospital discharge, peroperative complication, hospital admission, early intervention, Commentary, mortality risk, business
Abstract

BACKGROUND: Among adults undergoing contemporary noncardiac surgery, little is known about the frequency and timing of death and the associations between perioperative complications and mortality. We aimed to establish the frequency and timing of death and its association with perioperative complications. METHODS: We conducted a prospective cohort study of patients aged 45 years and older who underwent inpatient noncardiac surgery at 28 centres in 14 countries. We monitored patients for complications until 30 days after surgery and determined the relation between these complications and 30-day mortality using a Cox proportional hazards model. RESULTS: We included 40 004 patients. Of those, 715 patients (1.8%) died within 30 days of surgery. Five deaths (0.7%) occurred in the operating room, 500 deaths (69.9%) occurred after surgery during the index admission to hospital and 210 deaths (29.4%) occurred after discharge from the hospital. Eight complications were independently associated with 30-day mortality. The 3 complications with the largest attributable fractions (AF; i.e., potential proportion of deaths attributable to these complications) were major bleeding (6238 patients, 15.6%; adjusted hazard ratio [HR] 2.6, 95% confidence interval [CI] 2.2–3.1; AF 17.0%); myocardial injury after noncardiac surgery [MINS] (5191 patients, 13.0%; adjusted HR 2.2, 95% CI 1.9–2.6; AF 15.9%); and sepsis (1783 patients, 4.5%; adjusted HR 5.6, 95% CI 4.6–6.8; AF 12.0%). INTERPRETATION: Among adults undergoing noncardiac surgery, 99.3% of deaths occurred after the procedure and 44.9% of deaths were associated with 3 complications: major bleeding, MINS and sepsis. Given these findings, focusing on the prevention, early identification and management of these 3 complications holds promise for reducing perioperative mortality. Study registration:ClinicalTrials.gov, no. NCT00512109.

Published
2019

50. Holistic primary health care for Aboriginal and Torres Strait Islander prisoners: exploring the role of Aboriginal Community Controlled Health Organisations

Author

Pettit, S, Simpson, P, Jones, J, Williams, M, Islam, MM, Parkinson, A, Calabria, B, Butler, T, Pettit, S, Simpson, P, Jones, J, Williams, M, Islam, MM, Parkinson, A, Calabria, B, and Butler, T

Abstract

© 2019 The Authors Objective: Aboriginal and Torres Strait Islander Community Controlled Health Organisations (ACCHOs) have been identified as having an important role in improving the health and wellbeing of individuals in prison; however, a lack of information exists on how to strengthen this role. This paper explores the experiences of ACCHO staff in primary health care to individuals inside or leaving prison. Methods: Nineteen staff from four ACCHOs were interviewed. ACCHO selection was informed by proximity to prisons, town size and/or Local Government Area offending rates. Thematic analysis of the interviews was undertaken. Results: While most ACCHOs had delivered post-release programs, primary health care delivery to prisoners was limited. Three themes emerged: i) a lack of access to prisoners; ii) limited funding to provide services to prisoners; and iii) the need for a team approach to primary health care delivery. Conclusion: A holistic model of care underpinned by a reliable funding model (including access to certain Medicare items) and consistent access to prisoners could strengthen ACCHOs’ role in primary health care delivery to people inside or leaving prison. Implications for public health: ACCHOs have an important role to play in the delivery of primary health care to prisoners. Existing models of care for prisoners should be examined to explore how this can occur.

Published
2019

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