An investigation into perioperative outcome following gastrointestinal resection in England

This thesis represents research from Hospital Episode Statistics data and provides an insight into gastrointestinal resectional surgery in England. It examines national outcomes following major colorectal resection, oesophagectomy and gastrectomy. Having established these outcomes, I ventured to investigate the commonly used mortality measures in the literature. I also studied the timing and causes of deaths following colorectal resection in English NHS Trust hospital. I was able to demonstrate that a significant number of adverse outcomes occur beyond the initial hospital stay. I evaluated the role of two key factors - minimally invasive surgery and surgeon volume in trying to mitigate these adverse outcomes. I found that national outcome following elective or planned colorectal resection are comparable with other published cancer registry reports in England. For upper gastrointestinal resection for cancer, however, outcome are significantly worse than those from Far East, but superior to studies from the States. I derived 'medical morbidity' by studying secondary codes for medical complications. Surgical complications were quantified by using surrogates such as unplanned re-operation and re-intervention following the initial procedure. I undertook a review of the literature for published outcomes following planned colorectal resection in the elderly. This demonstrated heterogeneity in studies with regards to sample size and type of study. The most commonly used measure of post-operative risk was in-hospital or 30-day mortality. In the elderly population, we demonstrated high mortality up to one year following emergency colorectal resection. To understand this excess mortality that is not taken into account by short term metrics, we studied the causes of deaths in these patients. Significant deaths occur in the young and elderly due to cardiac causes, up to one year following major colorectal resection. This calls for further research to define a new intermediate term metric that accurately quantifies the mortality risk. The uptake of minimally invasive gastrointestinal resection in England has been promising. During the study period there has been a steady rise in number of resections undertaken laparoscopically. In colorectal surgery, laparoscopic resection has been associated with shorter length of stay, reduced morbidity and mortality. Outcome following minimally invasive oesophagectomy and gastrectomy have shown this technique to be safe and potentially beneficial in reducing pulmonary complications and length of stay. However further research is needed into this. Oesophagectomy, gastrectomy and pancreatectomy for cancer have all demonstrated a positive volume-outcome relationship. With increasing surgeon caseload, risk of 30-day mortality is lower. These structure and process measures may be utilised by policy makers to improve outcome following gastrointestinal resection in England.Open Acces

An investigation into perioperative outcome following gastrointestinal resection in England

This thesis represents research from Hospital Episode Statistics data and provides an insight into gastrointestinal resectional surgery in England. It examines national outcomes following major colorectal resection, oesophagectomy and gastrectomy. Having established these outcomes, I ventured to investigate the commonly used mortality measures in the literature. I also studied the timing and causes of deaths following colorectal resection in English NHS Trust hospital. I was able to demonstrate that a significant number of adverse outcomes occur beyond the initial hospital stay. I evaluated the role of two key factors - minimally invasive surgery and surgeon volume in trying to mitigate these adverse outcomes. I found that national outcome following elective or planned colorectal resection are comparable with other published cancer registry reports in England. For upper gastrointestinal resection for cancer, however, outcome are significantly worse than those from Far East, but superior to studies from the States. I derived 'medical morbidity' by studying secondary codes for medical complications. Surgical complications were quantified by using surrogates such as unplanned re-operation and re-intervention following the initial procedure. I undertook a review of the literature for published outcomes following planned colorectal resection in the elderly. This demonstrated heterogeneity in studies with regards to sample size and type of study. The most commonly used measure of post-operative risk was in-hospital or 30-day mortality. In the elderly population, we demonstrated high mortality up to one year following emergency colorectal resection. To understand this excess mortality that is not taken into account by short term metrics, we studied the causes of deaths in these patients. Significant deaths occur in the young and elderly due to cardiac causes, up to one year following major colorectal resection. This calls for further research to define a new intermediate term metric that accurately quantifies the mortality risk. The uptake of minimally invasive gastrointestinal resection in England has been promising. During the study period there has been a steady rise in number of resections undertaken laparoscopically. In colorectal surgery, laparoscopic resection has been associated with shorter length of stay, reduced morbidity and mortality. Outcome following minimally invasive oesophagectomy and gastrectomy have shown this technique to be safe and potentially beneficial in reducing pulmonary complications and length of stay. However further research is needed into this. Oesophagectomy, gastrectomy and pancreatectomy for cancer have all demonstrated a positive volume-outcome relationship. With increasing surgeon caseload, risk of 30-day mortality is lower. These structure and process measures may be utilised by policy makers to improve outcome following gastrointestinal resection in England.Open Acces

Case Report - Abdominal CSF pseudocyst in a pateint with ventriculo-peritoneal shunt

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication of ventriculo-peritoneal shunts. We report a case of a large lesser sac CSF pseudocyst in a 63-year-old male operated for fibroblastic meningioma of the cerebello-pontine angle ten years earlier. During the initial surgery a ventriculo-peritoneal catheter was inserted for associated hydrocephalus. He presented with epigastric pain and swelling since 4 weeks. A CT scan of the abdomen revealed a large cystic mass in the lesser sac with thin enhancing walls. An exploratory laparotomy was performed and the cyst drained externally with revision of the shunt. The patient had a rapid and uneventful recovery. We report this uncommon occurrence with a brief review of the literature

Neuroprotective effects of vitamin E in cold induced cerebral injury in guinea pigs

180-184Significant reduction in hemorrhage (10 v/s 13), necrosis (2 v/s 4), cavitations (7 v/s 13), neuronal degeneration, perivascular and parenchymal inflammatory infiltrate (7 v/s 11) were observed in Vitamin E treated cold induced head injury in guinea pigs, evaluated post injury using the modified Benderson’s scale. The results suggest that Vitamin E is highly effective in promoting clinical and histopathological recovery in cold induced head injury in guinea pigs

Abdominal CSF pseudocyst in a pateint with ventriculoperitoneal shunt

Abdominal cerebrospinal fluid (CSF) pseudocyst is an uncommon complication of ventriculo-peritoneal shunts. We report a case of a large lesser sac CSF pseudocyst in a 63-year-old male operated for fibroblastic meningioma of the cerebello-pontine angle ten years earlier. During the initial surgery a ventriculo-peritoneal catheter was inserted for associated hydrocephalus. He presented with epigastric pain and swelling since 4 weeks. A CT scan of the abdomen revealed a large cystic mass in the lesser sac with thin enhancing walls. An exploratory laparotomy was performed and the cyst drained externally with revision of the shunt. The patient had a rapid and uneventful recovery. We report this uncommon occurrence with a brief review of the literature

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age >= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients >= 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those >= 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups