Enhanced recovery after surgery

The NHS is continually striving to improve patient care. Enhanced Recovery after Surgery (ERAS) initiatives have been proven to benefit patient care, reduce complication rates and shorten length of stay. The drive is efficacy and equity of care for all patients. Originally developed in colorectal surgery and established in three other surgical specialities (gynaecological, urological and musculoskeletal surgery) the Department of Health, through the NHS Improvement framework, is driving the wider adoption of ERAS. The adoption of enhanced recovery principles in thoracic surgery is gathering pace. Birmingham Heartlands Hospital is at the forefront of driving the development of ERAS in thoracic surgery. This project will establish the evidence base for key thoracic interventions on the ERAS pathway, show the results of the first national survey of thoracic ERAS practice and highlight the preliminary achievements on patient outcomes. The project will also show the results of visits to other thoracic surgical units and the gap analyses performed on their ERAS pathways. The project will also highlight the construction of the first manual for ERAS in thoracic surgery and patient information booklet. The resulting ERAS pathway can thus be used by others within the speciality of thoracic surgery to promote and enhance the care of their patients

Does the revised cardiac risk index predict cardiac complications following elective lung resection?

Background: Revised Cardiac Risk Index (RCRI) score and Thoracic Revised Cardiac Risk Index (ThRCRI) score were developed to predict the risks of postoperative major cardiac complications in generic surgical population and thoracic surgery respectively. This study aims to determine the accuracy of these scores in predicting the risk of developing cardiac complications including atrial arrhythmias after lung resection surgery in adults. Methods: We studied 703 patients undergoing lung resection surgery in a tertiary thoracic surgery centre. Observed outcome measures of postoperative cardiac morbidity and mortality were compared against those predicted by risk. Results: Postoperative major cardiac complications and supraventricular arrhythmias occurred in 4.8% of patients. Both index scores had poor discriminative ability for predicting postoperative cardiac complications with an area under receiver operating characteristic (ROC) curve of 0.59 (95% CI 0.51-0.67) for the RCRI score and 0.57 (95% CI 0.49-0.66) for the ThRCRI score. Conclusions: In our cohort, RCRI and ThRCRI scores failed to accurately predict the risk of cardiac complications in patients undergoing elective resection of lung cancer. The British Thoracic Society (BTS) recommendation to seek a cardiology referral for all asymptomatic pre-operative lung resection patients with > 3 RCRI risk factors is thus unlikely to be of clinical benefit

Erratum : Does the revised cardiac risk index predict cardiac complications following elective lung resection?

No abstrac

Land-use and land-cover dynamics in response to changes in climatic, biological and socio-political forces: The case of southwestern Ethiopia

Few studies of land-use/land-cover change provide an integrated assessment of the driving forces and consequences of that change, particularly in Africa. Our objectives were to determine how driving forces at different scales change over time, how these forces affect the dynamics and patterns of land use/land cover, and how land-use/land-cover change affects ecological properties at the landscape scale. To accomplish these objectives, we first developed a way to identify the causes and consequences of change at a landscape scale by integrating tools from ecology and the social sciences and then applied these methods to a case study in Ghibe Valley, southwestern Ethiopia. Maps of land-use/land-cover change were created from aerial photography and Landsat TM imagery for the period. 1957-1993. A method called `ecological time lines' was developed to elicit landscape-scale explanations for changes from long-term residents. Cropland expanded at twice the speed recently (1987-1993) than two decades ago (1957-1973), but also contracted rapidly between 1973-1987. Rapid land-use/land cover change was caused by the combined effects of drought and migration, changes in settlement and land tenure policy, and changes in the severity of the livestock disease, trypanosomosis, which is transmitted by the tsetse fly. The scale of the causes and consequences of land-use/land-cover change varied from local to sub-national (regional) to international and the links between causes and consequences crossed scales. At the landscape scale, each cause affected the location and pattern of land use/land cover differently. The contraction of cropland increased grass biomass and cover, woody plant cover , the frequency and extent of savanna burning, and the abundance of wildlife. With recent control of the tsetse fly, these ecological changes are being reversed. These complex patterns are discussed in the context of scaling issues and current conceptual models of land-use/land-cover change

Venous thromboembolism in patients undergoing operations for lung cancer: a systematic review.

BACKGROUND The risk of venous thromboembolism is perceived to be high in patients with lung cancer. However, existing studies in patients undergoing operations for lung cancer draw inconsistent conclusions and recommendations in terms of thromboprophylaxis. The aim of this study was to perform a systematic review of the risk of perioperative and postoperative venous thromboembolism for patients undergoing potential curative surgical procedures for primary lung cancer METHODS This was a systematic review including studies of patients with primary lung cancer undergoing operations with curative intent. RESULTS We included 19 studies with a total of 10,660 patients. All studies, except 1, were observational in design. Marked heterogeneity was found between the studies in terms of methodologic aspects, patient characteristics, and findings. The mean risk of venous thromboembolism (VTE) was estimated at 2.0% (range, 0.2%-19%), with a mean observation period of 16 months (range, 0.1-22), and the risk was nearly identical in studies with 1 month of follow-up and studies with a longer follow-up. CONCLUSIONS The evidence for using thromboprophylaxis after lung cancer operations is relatively sparse, and the use is based predominantly on clinical consensus. However, the risk of VTE seems to occur predominantly within the initial postoperative period, and subsequently the risk falls. Future research should focus on identifying patients and surgical procedures that increase the risk of VTE. This could be accomplished by large observational studies in addition to randomized controlled trials evaluating different thromboprophylaxis strategies