Infective endocarditis: do we have an effective risk score model? A systematic review

Background Infective endocarditis (IE) is a rare, highly morbid condition with 17% in-hospital mortality. 25-30% require surgery and there is ongoing debate with regard to markers predicting patient outcomes and guiding intervention. This systematic review aims to evaluate all IE risk scores currently available. Methods Standard methodology (PRISMA guideline) was used. Papers with risk score analysis for IE patients were included, with attention to studies reporting area under the receiver-operating characteristic curve(AUC/ROC). Qualitative analysis was carried out, including assessment of validation processes and comparison of these results to original derivation cohorts where available. Risk-of-bias analysis illustrated according to PROBAST guidelines. Results Of 75 articles initially identified, 32 papers were analysed for a total of 20 proposed scores, (range 66-13,000 patients), 14 of which were specific for IE. The number of variables per score ranged from 3 to 14 with only 50% including microbiological variables and 15% including biomarkers. The following scores had good performance (AUC>0.8) in studies proposing the score (often the derivation cohort); however fared poorly when applied to a new cohort: PALSUSE, DeFeo, ANCLA, RISK-E, EndoSCORE, MELD-XI, COSTA, SHARPEN. DeFeo score demonstrated the largest discrepancy with initial AUC of 0.88, compared to 0.58 when applied to different cohorts. The inflammatory response in IE has been well documented and CRP has been found to be an independent predictor for worse outcomes. There is ongoing investigation on alternate inflammatory biomarkers which may assist in IE management. Of the scores identified in this review, only 3 have included a biomarker as a predictor. Conclusion Despite the variety of available scores, their development has been limited by small sample size, retrospective collection of data and short-term outcomes, with lack of external validation, limiting their transportability. Future population studies and large comprehensive registries are required to address this unmet clinical need

Preoperative systemic inflammation and perioperative myocardial injury: prospective observational multicentre cohort study of patients undergoing non-cardiac surgery

Medical Research Council and British Journal of Anaesthesia clinical research training fellowship (grant reference MR/M017974/1) to T.E.F.A.; UK National Institute for Health Research Professorship to R.P.; British Journal ofAnaesthesia/Royal College of Anaesthetists basic science Career Development award, British Oxygen Company research chair grant in anaesthesia from the Royal College of Anaesthetists, and British Heart Foundation Programme Grant (RG/14/4/30736) to G.L.A

Major surgery in a minor way

Poster presentationBackground: Hysterectomy is one of the most common gynaecology operations performed in the UK and is often the chosen management in benign conditions that has not responded to conservative or medical treatment . This is commonly the case in the treatment of large uterine fibroids where the size of the fibroid uterus is a major factor for consideration in the determination of hysterectomy technique. Objective: The aim of this study is to evaluate the relevance of laparoscopic subtotal hysterectomy (LSH) in the treatment of large uterine fibroids as a safe alternative to total laparoscopic (TLH) and abdominal hysterectomy (AH). Method: A retrospective collection of all patients who underwent a LSH under one surgeon between 2009 and 2011 was analysed. Patients with a uterus which clinically measured as ‡16 weeks and a uterus weight of ‡240 g also confirmed on histology were included. Data was collected for intra-operative complications, operation duration, estimated blood loss and length of hospital stay, which includes the time the patient is admitted to the time she is discharged. Results: Fifty-three patients were included, 52 patients had successful LSH and one patient was converted to AH due to a large broad ligament fibroid (775 g). Mean weight of the uterus was 467 g (%) [245–410 g: 28 (53%), 450–649 g: 13 (25%), 650–849 g: 7 (13%), 850–1400 g: 5 (9%)]. Mean operation time was 83.83 min (40–117 min). There were no significant major intra-operative complications recorded. Fifty-two (98.1%) patients had insignificant blood loss and 1 (1.8%) had significant blood loss requiring blood transfusion. Mean hospital stay was 1.45 days [1 day: 36 (67.9%), 2 days (22.6%): 12, 3 days: 3 (5.6%), 4 days: 2 (3.8%)]. Conclusion: In the case of large uterine fibroids, LSH provide a safe and better alternative to TLH and A