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181 results on '"Sharples, L. D."'

4. Effect Of Receiving A Heart Transplant

Author

Satchithananda, D. K., Stoica, S. C., Parameshwar, J., Large, S. R., Wallwork, J., Sharples, L. D., MacGowan, Guy A., Murali, Srinivas, MacFadyen, Robert J., Deng, Mario C., De Meester, Johan M. J., Smits, Jacqueline M. A., Heinecke, Joachim, and Scheld, Hans H.

Published
2001

24. The contribution of the anaesthetist to risk‐adjusted mortality after cardiac surgery

Author

Papachristofi, O., Sharples, L. D., Mackay, J. H., Nashef, S. A. M., Fletcher, S. N., Klein, A. A., Lau, G, Woodward, D, Hillier, J, Ware, M, Agarwal, S, Bill, M, Gill, R, Duthie, D, and Skinner, H

Subjects
Male, Risk, Surgical results, medicine.medical_specialty, Patient risk, 03 medical and health sciences, Postoperative Complications, 0302 clinical medicine, Primary outcome, Anesthesiology, 030202 anesthesiology, Physicians, health services administration, medicine, Humans, Hospital Mortality, Prospective Studies, 030212 general & internal medicine, Cardiac Surgical Procedures, Intensive care medicine, Prospective cohort study, Aged, Risk adjusted, business.industry, General surgery, EuroSCORE, Original Articles, United Kingdom, Cardiac surgery, surgical procedures, operative, Anesthesiology and Pain Medicine, Original Article, Female, Clinical Competence, business
Abstract

Summary It is widely accepted that the performance of the operating surgeon affects outcomes, and this has led to the publication of surgical results in the public domain. However, the effect of other members of the multidisciplinary team is unknown. We studied the effect of the anaesthetist on mortality after cardiac surgery by analysing data collected prospectively over ten years of consecutive cardiac surgical cases from ten UK centres. Casemix‐adjusted outcomes were analysed in models that included random‐effects for centre, surgeon and anaesthetist. All cardiac surgical operations for which the EuroSCORE model is appropriate were included, and the primary outcome was in‐hospital death up to three months postoperatively. A total of 110 769 cardiac surgical procedures conducted between April 2002 and March 2012 were studied, which included 127 consultant surgeons and 190 consultant anaesthetists. The overwhelming factor associated with outcome was patient risk, accounting for 95.75% of the variation for in‐hospital mortality. The impact of the surgeon was moderate (intra‐class correlation coefficient 4.00% for mortality), and the impact of the anaesthetist was negligible (0.25%). There was no significant effect of anaesthetist volume above ten cases per year. We conclude that mortality after cardiac surgery is primarily determined by the patient, with small but significant differences between surgeons. Anaesthetists did not appear to affect mortality. These findings do not support public disclosure of cardiac anaesthetists' results, but substantially validate current UK cardiac anaesthetic training and practice. Further research is required to establish the potential effects of very low anaesthetic caseloads and the effect of cardiac anaesthetists on patient morbidity.

Published
2015
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34. Disease-specific survival benefit of lung transplantation in adults : a national cohort study.

Author

Titman, Andrew C., Rogers, C. A., Bonser, R. S., Banner, N. R., Sharples, L. D., Titman, Andrew C., Rogers, C. A., Bonser, R. S., Banner, N. R., and Sharples, L. D.

Abstract

The lung transplantation candidate population is heterogeneous and survival benefit has not been established for all patient groups. UK data from a cohort of 1997 adult (aged ≥ 16), first lung transplant candidates (listed July 1995 to July 2006, follow-up to December 2007) were analyzed by diagnosis, to assess mortality relative to continued listing. Donor lungs were primarily allocated according to local criteria. Diagnosis groups studied were cystic fibrosis (430), bronchiectasis (123), pulmonary hypertension (74), diffuse parenchymal lung disease (564), chronic obstructive pulmonary disease (COPD, 647) and other (159). The proportion of patients in each group who died while listed varied significantly (respectively 37%, 48%, 41%, 49%, 19%, 38%). All groups had an increased risk of death at transplant, which fell below waiting list risk of death within 4.3 months. Thereafter, the hazard ratio for death relative to listing ranged from 0.34 for cystic fibrosis to 0.64 for COPD (p < 0.05 all groups except pulmonary hypertension). Mortality reduction was greater after bilateral lung transplantation in pulmonary fibrosis patients (p = 0.049), but not in COPD patients. Transplantation appeared to improve survival for all groups. Differential waiting list and posttransplant mortality by diagnosis suggest further use and development of algorithms to inform lung allocation.

Published
2009

38. EuroSCORE II

Author

Nashef, S. A. M., primary, Roques, F., additional, Sharples, L. D., additional, Nilsson, J., additional, Smith, C., additional, Goldstone, A. R., additional, and Lockowandt, U., additional

Published
2012
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41. Clinical and cost-effectiveness analysis of an open label, single-centre, randomised trial of spinal cord stimulation (SCS) versus percutaneous myocardial laser revascularisation (PMR) in patients with refractory angina pectoris: The SPiRiT trial

Author

Dyer, M T, primary, Goldsmith, K A, additional, Khan, S N, additional, Sharples, L D, additional, Freeman, C, additional, Hardy, I, additional, Buxton, M J, additional, and Schofield, P M, additional

Published
2008
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