Groin wound infection after vascular exposure ( GIVE ) multicentre cohort study

Surgical site infections (SSIs) of groin wounds are a common and potentially preventable cause of morbidity, mortality, and healthcare costs in vascular surgery. Our aim was to define the contemporaneous rate of groin SSIs, determine clinical sequelae, and identify risk factors for SSI. An international multicentre prospective observational cohort study of consecutive patients undergoing groin incision for femoral vessel access in vascular surgery was undertaken over 3 months, follow‐up was 90 days. The primary outcome was the incidence of groin wound SSI. 1337 groin incisions (1039 patients) from 37 centres were included. 115 groin incisions (8.6%) developed SSI, of which 62 (4.6%) were superficial. Patients who developed an SSI had a significantly longer length of hospital stay (6 versus 5 days, P = .005), a significantly higher rate of post‐operative acute kidney injury (19.6% versus 11.7%, P = .018), with no significant difference in 90‐day mortality. Female sex, Body mass index≥30 kg/m2, ischaemic heart disease, aqueous betadine skin preparation, bypass/patch use (vein, xenograft, or prosthetic), and increased operative time were independent predictors of SSI. Groin infections, which are clinically apparent to the treating vascular unit, are frequent and their development carries significant clinical sequelae. Risk factors include modifiable and non‐modifiable variables

Effectiveness of a quality improvement collaborative in reducing time to surgery for patients requiring emergency cholecystectomy.

BACKGROUND: Acute gallstone disease is a high-volume emergency general surgery presentation with wide variations in the quality of care provided across the UK. This controlled cohort evaluation assessed whether participation in a quality improvement collaborative approach reduced time to surgery for patients with acute gallstone disease to fewer than 8 days from presentation, in line with national guidance. METHODS: Patients admitted to hospital with acute biliary conditions in England and Wales between 1 April 2014 and 31 December 2017 were identified from Hospital Episode Statistics data. Time series of quarterly activity were produced for the Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) and all other acute National Health Service hospitals (control group). A negative binomial regression model was used to compare the proportion of patients having surgery within 8 days in the baseline and intervention periods. RESULTS: Of 13 sites invited to join Chole-QuIC, 12 participated throughout the collaborative, which ran from October 2016 to January 2018. Of 7944 admissions, 1160 patients had a cholecystectomy within 8 days of admission, a significant improvement (P < 0·050) from baseline performance. This represented a relative change of 1·56 (95 per cent c.i. 1·38 to 1·75), compared with 1·08 for the control group. At the individual site level, eight of the 12 Chole-QuIC sites showed a significant improvement (P < 0·050), with four sites increasing their 8-day surgery rate to over 20 per cent of all emergency admissions, well above the mean of 15·3 per cent for control hospitals. CONCLUSION: A surgeon-led quality improvement collaborative approach improved care for patients requiring emergency cholecystectomy

Current medical management of patients with peripheral arterial disease and potential benefits of risk-factor optimization: findings from a prospective national cohort by the Vascular and Endovascular Research Network (VERN) collaboration

Background: Previous research suggests patients with Peripheral Arterial Disease (PAD) are not offered adequate risk-factor modification, despite their high cardiovascular risk. We aimed to assess the cardiovascular profiles of patients with PAD in the UK and quantify the survival benefits of target-based risk-factor modification. Methods: The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April - June 2018) to assess practice against UK and European goal-directed BMT guidelines. Risk and benefits of risk-factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. Results: Overall, 440 patients (mean age: 70±11 years, 24% female) were included. Mean cholesterol (4.3±1.2 mmol/L) and LDL (2.7±1.1 mmol/L) levels were above recommended levels; 319 (73%) patients were hypertensive and 343 (78%) were smokers. Only 12% of patients were prescribed high-dose statin therapy and 39% an antithrombotic agent. The median risk of a major cardiovascular event over 10-years was 53% [Interquartile Range (IQR): 44-62%]. Controlling all modifiable cardiovascular risk-factors based on UK and European guidance targets (LDL<2mmol/L, SBP<140mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29% (range: 20-38%) with 6.3 cardiovascular disease-free years gained (range: 4.0-9.3 years). Conclusion: The medical management of patients with PAD is suboptimal. Controlling modifiable risk-factors to guideline-based targets confers a large therapy-benefit from both a 10-year and a lifetime perspective