Preoperative investigations of open heart surgical patients: our current institutional protocol (1)

Background: Open heart surgery is one of the complex procedures physicians undertake in modern medicine. It requires high tech equipment, special infrastructure and highly skilled manpower, especially in the areas of cardiology, cardiac surgery, anaesthesiology and cardiac perfusion. Preoperative diagnosis must be accurate and patients’ safety determined in order that appropriate informed consent is given. In open heart surgery, our institution developed preoperative assessment protocol. They are clinical evaluation and preoperative investigations.The objective of this study is to highlight our institutional preoperative investigative protocol and compare same with what is available in the literature.Materials and Method: In our institution, the first open heart surgery was done in 1974. We performed a retrospective review of the preoperative investigation protocols from 1974 to 2016, spanning a period of 42 years noting the changes and outcome of the changes. The 42 years of cardiac surgery activity occurred in 3 phases: 1. from 1974 – 2000; 2. 2003; 3. 2013 – 2016. Data were obtained from our hospital Record Department. The types of the preoperative investigative protocol and outcome of the changes were analyzed using Microsoft excel and results expressed in arithmetic percentages and presented in tables and bar chart.Results: These investigations are broadly divided into diagnostic and patient’s fitness assessment investigations. The diagnostic investigations aid proper clinical evaluations and are used in evaluating congenital heart defects and acquired heart diseases. In addition, fitness assessment tests have two functions and they are 1. determining the risks of postoperative morbidity and mortality from patients’ co-morbidities and the systemic effects of the cardiac disease(s). 2. Predicting the postoperative support that may be required in order to maximize the chances of uneventful surgery. The diagnostic and fitness investigations guide the quartet (cardiologist, cardiac surgeon, cardiac anaesthetist and cardiac perfusionist) in making appropriate management decisions especially with regard to complex congenital heart defects and complex cardiac cases in the elderly, discussed in the setting of cardiac team meetings.Conclusion: Preoperative investigations form part of an intrinsic preoperative checklist to ensure where possible uneventful surgery. When they are holistically done and accurate diagnosis is made including patients properly worked up via-a-vis the results of the investigations, the outcome is bound to be favourable.Keywords: complex, congenital, diagnostic, preoperative, investigatio

Histology types of chest wall tumours: Fifteen year single center experience

Background/Objective: Chest wall tumours are not uncommon.They are regarded as malignant until otherwise proven.The objective of this study is to analyze the histological variants in our institution and compare same with relevant data available in the literature.Materials and Methods: We performed a retrospective study of chest wall tumours at our institution(NCTCE, UNTH, Enugu, Nigeria), for a period of 15 years, spanning October, 2001 to September, 2015.The pathologic reports were retrieved from the hospital pathology archives and correlated with patients' copies in the hospital record.The lesions were classified as primary and secondary based on the clinical and radiological data as well as the histological reports.Results:A total of 158 chest wall tumours were identified in 158 patients with a mean age range of (45 +/- 6). The male to female ratio was  1:1.1(male = 74,46.84% and female =84, 53.16%). There were 81  primary chest wall tumours, out of which benign soft chest wall tumour was 50(61.73%) and malignant soft chest wall tumour was 13(16.05%).The benign bone and cartilage chest wall tumour accounted for 1(1.23%) and malignant component was 17(20.99%).The secondary chest wall tumours studied were 77, out of which 30(38.96%) were  invasive and 47(61.04%) were metastatic Conclusion:The commonest primary malignant chest wall tumour was malignant fibrous histocytoma while the most common secondary chest wall tumours seen in this study was mostly metastatic epithelial  neoplasms.Key words: chest wall,tumour,histology,malignant

Multiorgan MRI findings after hospitalisation with COVID-19 in the UK (C-MORE): a prospective, multicentre, observational cohort study

Introduction: The multiorgan impact of moderate to severe coronavirus infections in the post-acute phase is still poorly understood. We aimed to evaluate the excess burden of multiorgan abnormalities after hospitalisation with COVID-19, evaluate their determinants, and explore associations with patient-related outcome measures. Methods: In a prospective, UK-wide, multicentre MRI follow-up study (C-MORE), adults (aged ≥18 years) discharged from hospital following COVID-19 who were included in Tier 2 of the Post-hospitalisation COVID-19 study (PHOSP-COVID) and contemporary controls with no evidence of previous COVID-19 (SARS-CoV-2 nucleocapsid antibody negative) underwent multiorgan MRI (lungs, heart, brain, liver, and kidneys) with quantitative and qualitative assessment of images and clinical adjudication when relevant. Individuals with end-stage renal failure or contraindications to MRI were excluded. Participants also underwent detailed recording of symptoms, and physiological and biochemical tests. The primary outcome was the excess burden of multiorgan abnormalities (two or more organs) relative to controls, with further adjustments for potential confounders. The C-MORE study is ongoing and is registered with ClinicalTrials.gov, NCT04510025. Findings: Of 2710 participants in Tier 2 of PHOSP-COVID, 531 were recruited across 13 UK-wide C-MORE sites. After exclusions, 259 C-MORE patients (mean age 57 years [SD 12]; 158 [61%] male and 101 [39%] female) who were discharged from hospital with PCR-confirmed or clinically diagnosed COVID-19 between March 1, 2020, and Nov 1, 2021, and 52 non-COVID-19 controls from the community (mean age 49 years [SD 14]; 30 [58%] male and 22 [42%] female) were included in the analysis. Patients were assessed at a median of 5·0 months (IQR 4·2–6·3) after hospital discharge. Compared with non-COVID-19 controls, patients were older, living with more obesity, and had more comorbidities. Multiorgan abnormalities on MRI were more frequent in patients than in controls (157 [61%] of 259 vs 14 [27%] of 52; p5mg/L, OR 3·55 [1·23–11·88]; padjusted=0·025) than those without multiorgan abnormalities. Presence of lung MRI abnormalities was associated with a two-fold higher risk of chest tightness, and multiorgan MRI abnormalities were associated with severe and very severe persistent physical and mental health impairment (PHOSP-COVID symptom clusters) after hospitalisation. Interpretation: After hospitalisation for COVID-19, people are at risk of multiorgan abnormalities in the medium term. Our findings emphasise the need for proactive multidisciplinary care pathways, with the potential for imaging to guide surveillance frequency and therapeutic stratification. Funding: UK Research and Innovation and National Institute for Health Research

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries