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1. A neglected priority? The importance of surgery in tackling global health inequalities

Author

Ewan D. Kennedy, Cameron J. Fairfield, and Stuart J. Fergusson

Subjects
surgery, global health, inequalities, Medicine, Public aspects of medicine, RA1-1270
Abstract

"I was thinking that I was already dead... now I can talk with you people, I’m so happy! ” These words, spoken quietly but with great warmth by a young woman devastated by a vesicovaginal fistula and restored to dignity through compassionate operative treatment, cut cleanly through divides of geography, culture, and class. More eloquently than any statistic she speaks of the life–changing and life–saving importance of surgical services in all health care systems. The woman’s testimony features in Jaymie Ang Henry’s film, ‘The Right to Heal’, a deeply moving piece of advocacy that makes a clear case for focusing far greater global attention on the huge need to achieve more equitable access to essential surgery. This is the case we take up here, with a particular focus on the needs of sub–Saharan Africa.

Published
2015
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2. Changes in Emergency General Surgery During Covid-19 in Scotland: A Prospective Cohort Study

Author

Lachlan Dick, Jasmine Brown, Richard Cassidy, Martin Berlansky, Salasiah Othman, James Green, and Ewan D. Kennedy

Subjects
Adult, Male, medicine.medical_specialty, Original Scientific Report, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, 030230 surgery, Hospitals, General, Patient Readmission, Betacoronavirus, 03 medical and health sciences, COVID-19 Testing, Patient Admission, 0302 clinical medicine, medicine, Operating time, Humans, Prospective Studies, Practice Patterns, Physicians', Prospective cohort study, Pandemics, Aged, Clinical Laboratory Techniques, SARS-CoV-2, business.industry, General surgery, COVID-19, Middle Aged, Vascular surgery, Hospitals, District, medicine.disease, Appendicitis, Cardiac surgery, Scotland, Cardiothoracic surgery, General Surgery, Surgical Procedures, Operative, 030220 oncology & carcinogenesis, Female, Surgery, Emergencies, Coronavirus Infections, business, Abdominal surgery
Abstract

Introduction Covid-19 has had a significant impact on all aspects of health care. We aimed to characterise the trends in emergency general surgery at a district general hospital in Scotland. Methods A prospective cohort study was performed from 23/03/20 to 07/05/20. All emergency general surgery patients were included. Demographics, diagnosis and management were recorded along with Covid-19 testing and results. Thirty-day mortality and readmission rates were also noted. Similar data were collected on patients admitted during the same period in 2019 to allow for comparison. Results A total of 294 patients were included. There was a 58.3 per cent reduction in admissions when comparing 2020 with 2019 (85 vs 209); however, there was no difference in age (53.2 vs 57.2 years, p = 0.169) or length of stay (4.8 vs 3.7 days, p = 0.133). During 2020, the diagnosis of appendicitis increased (4.3 vs 18.8 per cent, p = grade 1 vs 58.3 per cent > grade 1, p =

Published
2020

3. Meta-analysis of the effect of perioperative intravenous lidocaine on return of gastrointestinal function after colorectal surgery

Author

Ewan D. Kennedy, Irwin Foo, Nicholas T. Ventham, Doug Speake, C. Cooke, Hugh Paterson, and Susan M Nimmo

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Lidocaine, Ileus, Nausea, Review, 030230 surgery, Placebo, Colonic Diseases, Young Adult, 03 medical and health sciences, Laparoscopic, 0302 clinical medicine, Colorectal surgery, medicine, Humans, Postoperative Period, Anesthetics, Local, Defecation, Randomized Controlled Trials as Topic, Pain, Postoperative, business.industry, Gastroenterology, Colonoscopy, Recovery of Function, Perioperative, Middle Aged, medicine.disease, Analgesics, Opioid, Intravenous lidocaine, Anesthesia, Administration, Intravenous, Female, Laparoscopy, 030211 gastroenterology & hepatology, Surgery, medicine.symptom, Gastrointestinal function, business, medicine.drug, Abdominal surgery
Abstract

Background Return of normal gastrointestinal (GI) function is a critical determinant of recovery after colorectal surgery. The aim of this meta-analysis was to evaluate whether perioperative intravenous (IV) lidocaine benefits return of gastrointestinal function after colorectal resection. Methods A comprehensive search of Ovid Medline, PubMed, Embase, Cochrane library, and clinicaltrials.org was performed on 1st July 2018. A manual search of reference lists was also performed. Inclusion criteria were as follows: randomized controlled trials (RCTs) of intravenous (IV) lidocaine administered perioperatively compared to placebo (0.9% saline infusion) as part of a multimodal perioperative analgesic regimen, human adults (> 16 years), and open or laparoscopic colorectal resectional surgery. Exclusion criteria: non-colorectal surgery, non-placebo comparator, children, non-general anaesthetic, and pharmacokinetic studies. The primary endpoint was time to first bowel movement. Secondary endpoints were time to first passage of flatus, time to toleration of diet, nausea and vomiting, ileus, pain scores, opioid analgesia consumption, and length of stay. Results One hundred and ninety one studies were screened, with 9 RCTs meeting inclusion criteria (405 patients, four laparoscopic and five open surgery studies). IV lidocaine reduced time to first bowel movement compared to placebo [seven studies, 325 patients, mean weighted difference − 9.54 h, 95% CI 18.72–0.36, p = 0.04]. Ileus, pain scores, and length of stay were reduced with IV lidocaine compared with placebo. Conclusions Perioperative IV lidocaine may improve recovery of gastrointestinal function after colorectal surgery. Large-scale effectiveness studies to measure effect size and evaluate optimum dose/duration are warranted. Electronic supplementary material The online version of this article (10.1007/s10151-019-1927-1) contains supplementary material, which is available to authorized users.

Published
2019

4. Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

Author

T. Yang, T. Pitts-Tucker, Daron Smith, S. Suresh, A.A. Khetarpal, C. Brathwaite-Shirley, Justine Davies, Sayinthen Vivekanantham, A. A. Adebayo, T. Sorah, N. Yim, H.R. Jackson, Salim Tayeh, R.H. Bremner, A. Piquet, L. Higgs, R. Yuen, P. Fergurson, N.K. Sim, A. Hibberd, A. Mehdi, N. Moody, D. Maru, C. Joyner, I. Hindle Fisher, Vartan Balian, N. Wetherall, Siyin Liu, P.N. Phan, S. Mallick, C. Lek, B. Oremule, S. Nelaj, M. Williams, Maqsood Qamar, A. Menon, M. Mohamud, H. Cheema, C. Chan, H.M. Omer, S.J. Cole, E. Craig, K.E. Leslie, S.S. Talukdar, R.B.S. Holliday, J. Heskin, A. Cody, Syed Shumon, S. McAleer, S. Abburu, P. Deekonda, S.F. Ashraf, R. Bose, AE Cotton, C. McGowan, S. Rashid, K. Theodoropoulou, A. MacAskill, Vishal Narwani, R. Maamari, S. Stokes, L.N. Harris, Peng Yong Sim, Evie Gardner, Leo Ng, N. Chandan, J.W. Lockey, M. Acres, H. Jhala, M.L. Kwan, A. Abdulmajid, A.E. Cardwell, P. Buakuma, C.P. Keane, M. Ahmed, N.J. Chilvers, E. Semple, J. Meek, A.K. Clarke, K. Koysombat, A. Hague, E.J.H. Turner, N. Keelty, P. Karunakaran, K.D. Clement, Mansoor Khan, Y. Cao, O. Prys-Jones, S.L. Walsh, C.N. McKerr, Sanjay Shah, S. Peroos, A. Dhanji, Joseph M. Norris, Neil Smith, M. Lakhani, M. Wijesekera, M. Bhatti, Midhun Mohan, C.Y. Luk, M. Elkawafi, S. Wadanamby, Jameel Mushtaq, Jonathan C. M. Wan, A. Ghaffar, M. Siddiqui, S. Naqib, Michaeline Kelly, J.W. Duncumb, F. Hughes, H.E.M. Jordan, R. Callan, G. Hung, C.F. Brewer, E.M. Ruiz, A. Higgins, C. Horst, C. Roberts, S. Kanabar, C. Wall, A.M. Buchan, A. Luhishi, R.P. Watson, D. Xylas, A. McBride, A. Bell, G. Heppenstall-Harris, A. Pericleous, Akanksha Chhabra, N. Hitchen, P. Raut, Shahzada Ahmed, M. Mirza, C.H. Archer, G. Russell, C.T. Francescon, D.T. Robertson, N. Gardiner, K. Cheng, A. Mishra, E. Webb, L. Rothwell, Dee A. Carter, V. Gupta, M. Johnstone, M.E. Kelly, R.D.C. Moon, E. Woin, K. Nadanakumaran, U. White, J. Empey, F. Bulley, R. Morley, G. Charalambous, L. Turner, S. Angelov, D. Coffey, S. Hartley, S. Pronin, E. Seager, R.K. Varma, Sharifullah Khan, S.B. Husnoo, R.K. Sethi, H.M. Chang, A. Duffy, Hew D.T. Torrance, P. Cunha, L. Kimani, W. Din, E.G. Heywood, C. O'Connell, D. Wylam, L. Anderson, N. Ahern, A.J. Trist, D. Burke, A. He, M. Sundar-Singh, A. Odeleye, G. Kumaran, N.L. Salloum, T.M. Brooks, A.S. Lynch, R. Debenham, Howard Gardner, M. Nielsen, M. Das, G. Bingham, S. Qureshi, Aditya Borakati, J. Wylie, Z. Kazmi, J.H. Park, P. Gill, A.R. Craig, M. Chen, Jonathan Wild, S.J. Lim, K.P. Choo, G. Culleton, G. Deas, E.Y. Chua, D. Vanniasegaram, A.H. Amphlett, N. Rajan, J.H. Chen, M. Hameed, Paul Ziprin, C. Toale, D. Gold, N. Keane, Jacob H Matthews, E. Palkhi, Nick Watson, C.M. Hewitt, A. Yousif, Faheem Ahmed, D. Wilkinson, John Mason, C. Reeder, R. Sagar, Deirdre A. Collins, S. Sandhu, S. Singh, J. Herron, A.Y.L. Ng, K. Brennan, K.A. Hoban, V. Navayogaarajah, A.S. Jawad, J.Y.L. Low, Julian R. Johnston, J. Wye, Inge Bernstein, John Parkin, A.D. Henson, Y.H. Soo, C. Topham, M. Steel, Priyank Patel, C.M. Lankage, U. Ashfaq, E.J. Brown, N.L. Foster, C.W. Rookes, R.J. Greig, K.L. McKevitt, N. Jathanna, J.M. Geraghty, M. Karia, S. Cumming, H. Holyoak, S. Parthiban, R.B. Karsan, V.C. Wing, T.E. Glover, R.D. Adams, B.H. Miranda, S. Gaffney, S. Rogers, G.E. Torlot, J.J. Filby, S. Sii, N.M. Rafiq, M. Shoa, S. Singagireson, N. Ungcharoen, Jennie Parker, B.F. Chong, N.M. Shafiq, V. Wong, E. Shakweh, A. Al-Mousawi, J. Pearce, S. Botchey, L. Horne, L. Fletcher, B. Singh, E.A. Whatling, K. Duke, A. Mastan, A.L. Frank, S. Verma, Humaira Shaheen, W. Liew, J. Turner, R. Rampal, T. Filipescu, R.M. Markham, B.A. Patel, S. Lim, A. Atayi, S. Yoganathan, N. Ramsay, M. Khattak, O. Amin, E. McAleer, K. Gohil, H. Shufflebotham, George S Bethell, M. Dhar, J.E. Davies, A.F. Carroll, E. Cornish, S. Omara, J. Bartlett, D. Loughran, A. Iqbal, L.R. Springford, D.R. McCormack, S. Leong, R. Ingham, D. Tan, A. Khajuria, M. Tonkins, M. Petrarca, A.M. Bucko, L.L. McKelvey, C. Gill, C.E. Thakker, K. Mohan, J. Turnbull, G. Cuthbert, W. Dean, R.D.J. Whitham, D.M. Lees, N. Chan, D. Osei-Kuffour, A. Sahathevan, K. Ng, L.B. Anderson, J. Eraifej, A. O'Connor, O.J. Cundy, C. Kong, R.K. Hughes, Bryan Paul Traynor, P. Keane, C. Liu, E. Canning, E.D. Mills, C. Gouldthrope, S. Patel, M.J.V. Holmes, C. Cullen, Lisa McNamee, Alberto Pizzolato, P. Harries, M. Elseedawy, R. Varley, C. Whacha, S.G. Ratu, A. Wright, S. Parsons, Pishoy Gouda, A. Mian, R. Bhudia, R. Adams, N. Bell, Talisa Ross, R. Reid, J.P. Shah, Sarah Dean, C. Neophytou, Alex Ward, J.D. Thompson, M. Seedat, A. Ramnarine, R.T. Harris, A. Qureshi, C. Major, Y. Sinha, A.S. Rocke, C.S. Yong, P. Kwang, David Neil Cooper, L. Aildasani, R.W. Goh, A.R. Dyal, L. Braganza, L. Healy, N. Davies, T. Reakes, N. Patel, S. Sng, C. Brennan, Z.R. Bakewell, S.L. Jenkin, Ahmed Daoub, I.A. Rhema, R.A. Walford, O. Spence, L. Yow, E.J. Roberts, W. Cymes, Y. Liew, E. Segall, June A. Sullivan, K.K. Sandhu, L. Satterthwaite, G.X. Xu, R.M. Waldron, S. McGarvie, D. Brown, M. Alizadeh, J.A. Syeed, H.F. Roberts, P. Dawson, H.R. Abdikadir, S. O'Connor, Y. Maheswaran, B.A. Hughes, B.A. Atraszkiewicz, K. Singh, C. Mcgenity, A.D. Wood, Ewan D. Kennedy, S.X. Poo, S. Mitrasinovic, Max Marsden, A. Ibrahim, Daniel F. McAuley, M. Attalla, S. Govinden, Siti Asma' Hassan, T. Raghvani, T. Bloomfield, R. Heminway, M. Ali, K.L. Robertson, P. Lalor, T. Dogra, I. Antoniou, A. Tahmina, Markus L. Sagmeister, Ronan McMullan, J. Matthams, Richard J. Egan, Elspeth Cumber, M. Dolaghan, P. Sritharan, S. Sarwar, E.S.M. Tan, S.E. Murray, S. Morris, S. Mansoor, M. King, Randall V. Martin, P. Williams, G. Brent, N.B. Reid, S. Collinson, T. Sarvanandan, R. Ratnakumaran, R.E. Keeling, M.A. Sherif, D. Thomas, I.J. Clark, R. Coulson, T.P. Bemand, A. Abid, A.L. Martin, J.C.K. Ng, P. Avery, Y. Narang, R. Manson, H. Petra, J.E. Giles, A.E. Lim, N.A. Vithanage, S. Osman, D. Elf, Panagis M. Lykoudis, A. Ang, Debra Salmon, A. Croall, T. Sale, S. Bonsu, Y.P. Mogan, G.E. Cooper, J. Lamont, S.T. Marchal, P. Naran, A.N. Kumar, R. Owasil, F. Koumpa, J.Q. Ng, P.N. Nesargikar, J. Boyle, Ryan Preece, E. Sewart, S. Lee, S. Kosasih, N. Jamal, Stephen J Chapman, N.A. Redgrave, C. Holmes, A.E. Barthorpe, S. Mistry, J.A. Yates, Robin Wilson, E. Prakash, J.Y. Kee, S.M. Anderson, R.S. Suresh, N. Hussain, S. Gentry, S. Darr, H. Heneghan, H.D. McRobbie, S. Assadullah, Shivam Bhanderi, C. Weston, A. Delport, A. Winarski, M.M. Li, T. Tharmachandirar, N. Canning, P.R. Forrest, Adam J Boulton, A. Ponweera, G.E. Stewart, J.S. Ahn, J. Hartley, A. Isaac, J.L.Y. Allen, R. Carr, S. Gokani, J. Zhao, C. Player, D. Sim, W. English, R.J. McGalliard, S. Cullen, R. Thethi, A. Livesey, K.N. Lwin, M. K. Abd Ghaffar, C.L. Knight, P.C. Hurst, A.Y. Tay, Devender Mittapalli, F. Winslow, G. Bhaskaran, L. Gauntlett, W. Leung, D.M. Golding, A. Wali, D.C. Marshall, H. Ross, K.P. Raman, P.J. Teoh, C. Allan, I. Nehikhare, C.M. Ventre, M. Venn, J.A. Crewdson, A. Shukla, N. Ramjeeawon, S. Shahid, P. Mithrakumar, J. Fern, Y. Tan, H. Haq, S. Turaga, U. Hayat, C. Palmer, H. Goradia, T. Ramtoola, J. Bloomer, C. Chhina, Z. Momoh, W.M. Wynell-Mayow, N. Jayakody, M. Bravo, J. Gabriel, R. Khanijau, L. Esteve, A. Malik, R.D. Obute, S. Sheth, S. Lunawat, U. Qureshi, C. Rees, A. Kerai, M. Peters, A.Y. Tsui, K. Kow, M. Trail, A. Coates, F. Long, V. Paraoan, M.T. Stoddart, N. Li, M. Bright, W.W. Chaudhry, M.K. Malys, S. Owczarek, C.L. Jubainville, E. Brennan, M. Hanrahan, A. Wang, A. Burgess, S. Dutt, N. Varma, R.P. Williams, A. Ledsam, R.T. Buckle, W. Ho, U. Sajjad, B. Goh, M.R. Hardy, E. Lim, L.J. Burney, C.S.D. Roy, Thomas M Drake, Harry J. Gilbert, A. Yener, A. Trimble, Archana Shah, H. Ahmed, E.C. Barton, K. Eparh, C. McCrann, F. Harding, J. Mah, D. Kotecha, A. Al-Robeye, J. MacDonald, S. Kim, Andrew Logan, C. McLaughin, H. Collier, O. Brewster, J. Loveday, L. Tung, S. Dindyal, O. Al-Obaedi, A. Simpson, M. Sirakaya, F. Morgan, G.S. Ng, S. Mahboob, D. FitzPatrick, A. Jindal, O. O'Carroll, Y. Devabalan, T. Axelson, D. Rojoa, K. Sasapu, Kirsty Davies, J. Moradzadeh, Ewen M Harrison, K. Gandhi, S. Beecroft, G. McCabe, C.P. Chilima, T. Goldsmith, H.Z. Bazeer, N. Kalra, P. Morrison, T.C. Hoskins, J.J. Wiltshire, A. Narain, D. Joshi, D. Horth, H.C.P. Wilson, Y.F. Dennis, M. Mills, C. Diaper, J.A. Sanders, S.M. Chiu, J. Coffin, V. Elangovan, K.S. Dolbec, H.L. Warwick, R.H. Shuttleworth, T. Patel, R. Goodson, F.S. Brown, Jane Lim, O. Ziff, M. Rashid, V. Mirdavoudi, K.G. Reid, A. Broyd, E. Woon, M. Zuhair, A.D. Greenhalgh, L.R. Wingfield, S. Stevens, O. Hussain, G. Pandey, A. Bakhsh, I.B. Ptacek, J. Dobson, L. Bolton, A.L. Kerr, T.M.P. Fung, P. Narayan, T. Ward, Ruth Lyons, C. Robinson, Buket Gundogan, S. Akhtar, P. Vanmali, L. Austreng, N. Kelly, M. Kadicheeni, H Ali, P. Holton, H. Turley, C.J. Morrison, L. Hu, M. Sukkari, D.A. O'Sullivan, J. Brecher, C.J. White, M.A. Charalambos, William Bolton, M. Tahir, L. Grundy, T.P. Pezas, Ewan Brown, Nicholas Bullock, A.M.A. Shafi, A. Aslanyan, Michael F. Bath, H. Wilson, P.C. Copley, S.E. Scotcher, Heather Kennedy, N. Bassam, A. Omar, G.D. Stott, S. Ashraf, E. Galloway, R.D. Bartlett, H. Amin, Y.N. Neo, W.C. Soon, S. Rabinthiran, C. Phillips, L.A. Henderson, K. Whitehurst, A. Kahar, S. Sukumar, M.R. Williams, W.A. Gatfield, C. Ntala, K. Dear, A.R. Chitnis, M. Eragat, H.C. Huang, K. O'Sullivan, N. Yong, J. Robson, A. Valli, A. Mohite, G.J. Salam, F. Tongo, S. Lopes, R.A. O'Loughlin, S.L. Hickling, J. Fong, A. Chung, Kathy Nicholls, H. Abid, S. Balaji, J. Hardie, T. Reeves, H.R. Paine, M. Hayat, H. Nayee, Y.N. Suleman, S. Tan, M. Sharifpour, X. Chen, I. Barai, A. Yan, M.A. Gillies, T.W. Tilston, A. Kreibich, Y.H. Tan, A. Murtaza, Chris Dunn, P. Jull, J.W. Kim, A.D. Semana, N. Abuhussein, P. Shepherd, L. Derbyshire, P.M. McEnhill, J.B. Patel, C. Toh, T. Arif, B.W. Matthews, D. Shanahan, N. Seneviratne, L. Carr, A. Curran, A. Batho, L.D. O'Flynn, R. McAllister, A. Durr, Rahul Bhome, S. Mackin, K. Ahmad, R. Shaunak, S. Bassiony, H.A. Khokhar, R. Chin, R. Priestland, G.X.J. Sherliker, J.H. Entwisle, C. Anandarajah, H. Aziz, M. Chaudhary, A. Kishore, H. Adjei, M. Minhas, S.W. McLure, T. Kane, E. Ingram, T. Fautz, D. Chrastek, R. Singh, B.N. Shurovi, A. Asmadi, N. Ansari, J. Mahmood, K. Patel, A.N. Street, A. Thacoor, C. Girling, L. Cheskes, V. Shatkar, B. Ali, A. McGrath, Shaun Trecarten, J.D. Farmer, R. Dean, R.C. McLean, P.L.M. Harrison, S. Iqbal, S. Hirani, R. Fleck, S. Pope, C.Y. Kong, A.M. Demetri, H. Selvachandran, M. Malaj, H.K. Blege, B.D. Mistry, C.M. Grossart, R. Slade, S.A. Stanger, A.J. Dhutia, A. Amajuoyi, Ased Ali, M. Robinson, R. Punj, Jane Dickson, J. Lucas de Carvalho, Jessica Harvey, L.M. Bullman, D Nepogodiev, H.L. Joyce, Catrin Morgan, J. Paul, R. Vaughan, A. Prabhudesai, C. Egerton, A. Sheldon, C. Holloway, K. Brzyska, J. Ashwood, Christine McGarrigle, S. Pal, H. Rosen O'Sullivan, A. Rangedara, A. Hill, A. Szczap, S. Hudson-Phillips, J. Lavery, Harriet Mitchell, J.D.B. Hayes, M. Salem, F.A. Bamgbose, J. Bassett, V. Raghuvir, R. Dennis, S.E. Cox, C.J. Dewdney, N. Mitha, A.W. Roberts, Brij Patel, J. Wills, R. Goodier, R.M. Koshy, D. Weinberg, E.J. Griffin, Harriet L. Mills, A. Marsh, Z. Khonat, Kenneth A. McLean, E. Hester, T. Spencer, A.H.Y. Lee, J. Chong, L.R. Bookless, Michael J. Raphael, P. Sangal, M. McMenamin, H. Khalid, G.S. Harbhajan Singh, F.I. Chaudhry, N. Favero, J.E.F. Fitzgerald, Chetan Khatri, J. Remedios, A. Charania, Daniel J. George, S. Jackson, C. Murkin, R. Dawar, I. Kisyov, E. Wong, R.J. Pearse, A.N. Baker, L. Carthew, N. Warren, I. Adeleja, M. McCann, C. Drislane, R. Tan, S. Ho, K. Hulley, L. Doan, E.M. O'Neill, R. Gratton, M. Srikantharajah, C. Henderson, L. Puan, H. Whittingham, A. Johnston, E. Mckean, A.K. Tear, D. Varma, H. McFarlane, C.N. Lou, E.M. Cumber, Aneel Bhangu, Z.H. Siddiqui, J. Cleere, M. Chamberlain, James Glasbey, Sarah Ali, M. Masood, A. Linton, G. Chillarge, M. Davis-Hall, A. Anilkumar, U. Khan, A. Tai, R. Shepherd, Joshua Burke, W. Loke, M. Edison, A. Mortimer, N. Anim-Addo, R.S. Reehal, R. Blessed, Daniyal J. Jafree, M.S. Sait, H.C. Copley, N. Ward, M. Wells, K. Raji, J. Gulati, H. Keevil, C.A. Asbjoernsen, A. White, Nikita R. Bhatt, J. Barnes, S. Wang, F. Cheung, Clive Graham, K. Dynes, C. Dorman, E. Strange, A. Radotra, A. Reed, R. Nachiappan, I. Ibrahim, F. Acquaah, P. Jalota, S. Stezaker, J.E. Rogers, MI Perera, R. Kiff, T. Rangan, R. Weaver, E. Mazumdar, J. Beckett, Rowena McGregor, E.V. Wright, N. Punjabi, V. Charavanamuttu, Stephen O'Neill, S. Majid, Zulfiqarali G. Abbas, S.M. Lakhani, G. Rattan, J. Lua Boon Xuan, K. Joshi, HE Whewell, M. Patel, T.M. Schulz, O.K. Vernon, L.F. McClymont, N. Woodcock, L. Gray, Reena Shah, H. Thakur, F.S. Peck, P. Karia, L. Ashken, S. Rinkoff, M. McDowell, L. Chew, C.D. Blore, A.C.D. Smith, E. Auyoung, L.M. Sabine, O. Parker, S.M. Choi, V. Thirumal, J. Pickard, L. Murphy, C.J. Coffey, P. Dube, M.H. Abul, T. Khan, J. Campbell, M.T. Turner, Adam Gwozdz, K.K. Ong, B. Durrani, A. O'Kane, A.S. North, Najeeb Ahmed, C. Xiao, D. Maclennan, Nora Abdul Aziz, S.A. Semnani, L. Bell, Amy Ashton, L. Crozier, V. Teng, M. O'Bryan, K. Clesham, Vanisha Patel, L. Kretzmer, T. Lo, G.H. Stanley, M.D. Theodoreson, J.K. Mehta, F. Morris, L. Howells, R. Pinto, T. Bergara, J. Matheson, E. Devlin, E.T. Tan, E. Toner, L. Jacob, Sher Ahmad, J. Sellathurai, Catherine Doherty, J. Norton, C. Maxwell-Armstrong, S. Ng, T.R. Barrow, N. Boxall, A.A. Thevathasan, M. Ryan, E. Uppal, C. Jenvey, G.E. Aidoo-Micah, Karan Verma, U. Datta, F. Hirst, H. Woodward, J. Khangura, J. Chervenkoff, F. Edozie, E. Burke, M.G. Rasiah, A. Jaitley, Thomas L. Lewis, D. Lazenby, A. Lotfallah, A. Khan, E. McCance, Henry A. Claireaux, A.S. Fawaz, P.D. Jewell, R.G. Tharakan, R. Narramore, E. Heathcote, G. Nixon, H. Chin, E. Sun, L.S. Chew, K. Lim, G. Lakshmipathy, R. Telfer, B.A. Shuker, H. Kitt, O.D. Thompson, N. Behar, H. Naveed, R. Allot, E. Batt, E.J. Stone, J.M. Aithie, I. Henderson, Rakesh Heer, C. Deall, C.J. McIntyre, L. Dinsmore, S. Milne, Bhavik Anil Patel, N. Cody, A. Pandey, A. Kaushal, M.C. Sykes, N. Maple, R. Simpson, S. Lynne, S. Shahidi, M.I. Zegeye, B. Forte, P. Khonsari, G. Thomas, O. Sitta, V. Robertson, K. Mazan, J. Prest-Smith, D. O'Reilly, A. Sreh, A.E. Salih, Anna Craig-Mcquaide, Vandana Agarwal, E.G. Chisholm, Z. Afzal, G.L. de Bernier, P.W. Stather, Lucy Elliott, A. Collins, D. Lim, M. Abdelhadi, Q. Lu, and J. Stein

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, Critical Care, medicine.medical_treatment, Patient Care Planning, Young Adult, 03 medical and health sciences, Patient Admission, 0302 clinical medicine, 030202 anesthesiology, Laparotomy, Intensive care, medicine, Humans, Hospital Mortality, Prospective Studies, Prospective cohort study, Digestive System Surgical Procedures, Aged, Aged, 80 and over, Postoperative Care, business.industry, Patient Selection, Professional Practice, Odds ratio, Middle Aged, United Kingdom, Confidence interval, Anesthesiology and Pain Medicine, Cohort, Emergency medicine, Female, Observational study, Emergencies, business, Ireland, Abdominal surgery
Abstract

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Published
2019

5. The progression of non-small cell lung cancer from diagnosis to surgery

Author

N A Bradley, Ewan D. Kennedy, Alan Kirk, Iain McPherson, Rohith Govindraj, and M. Asif

Subjects
0301 basic medicine, Male, medicine.medical_specialty, Lung Neoplasms, Adenocarcinoma of Lung, Disease, Disease-Free Survival, Resection, Time-to-Treatment, 03 medical and health sciences, 0302 clinical medicine, Carcinoma, Non-Small-Cell Lung, Positron Emission Tomography Computed Tomography, medicine, Humans, Neoplasm Invasiveness, Lung cancer, Pneumonectomy, Aged, Neoplasm Staging, Retrospective Studies, Aged, 80 and over, Lung, business.industry, Margins of Excision, General Medicine, Middle Aged, medicine.disease, Surgery, Tumor Burden, Survival Rate, 030104 developmental biology, medicine.anatomical_structure, Oncology, Chemotherapy, Adjuvant, 030220 oncology & carcinogenesis, Radiological weapon, Carcinoma, Squamous Cell, Disease Progression, T-stage, Lymph Node Excision, Histopathology, Female, Non small cell, Lymph Nodes, business, Tomography, X-Ray Computed
Abstract

The IASLC 8th TNM Staging 8th differentiates between a greater number of T-stages. Resection remains the mainstay of curative treatment with often significant waiting times. This study aims to quantify the T-stage progression and growth of non-small cell lung cancers (NSCLCs) between radiological diagnosis and resection, and its impact on disease recurrence and survival.A retrospective analysis of NSCLC resections (289) in a high-volume centre between July 01, 2015 and June 30, 2016. Baseline demographics, time from diagnostic CT to surgery, tumour size (cm) and T-stage from diagnostic CT, PET-CT and post-operative histopathology reports were recorded. The primary outcome was increase in T-stage from diagnostic CT to resection. Kaplan-Meier and cox proportional hazard analyses were used to determine recurrence-free survival and survival.Median increase in tumour size between diagnosis and resection was 0.3 cm (p 0.0001). Median percentage increase in size was 13%. T-stage increased in 133 (46.0%) patients. N stage increased in 51 patients (17.7%), 32 (11.1%) to N2 disease. Mean survival in those upstaged was 43.5 (39.9-47.1) months versus 53.4 (50.0-56.8) months in patients not upstaged (p = 0.025). Mean recurrence-free survival in those upstaged was 39.1 (35.2-43.0) months versus 47.7 (43.9-51.4) months in patients not upstaged (p = 0.117). Upstaging was independently associated with inferior survival (HR 1.674, p = 0.006) and inferior recurrence-free survival (HR 1.423, p = 0.038).A significant number of patients are upstaged between diagnostic and resection resulting in reduced survival and recurrence-free survival. A change in management pathways are required to improve outcomes in NSCLC.

Published
2020

6. Efficacy of Intravenous Lidocaine for Postoperative Analgesia Following Laparoscopic Surgery: A Meta-Analysis

Author

Doug Speake, Ewan D. Kennedy, Nicholas T. Ventham, Hugh Paterson, Richard R. W. Brady, Irwin Foo, and Kenneth C. H. Fearon

Subjects
Laparoscopic surgery, medicine.medical_specialty, Lidocaine, Vomiting, Nausea, medicine.medical_treatment, Analgesic, Placebo, Eating, medicine, Humans, Anesthetics, Local, Pain Measurement, Randomized Controlled Trials as Topic, Pain, Postoperative, business.industry, Surgery, Analgesics, Opioid, Regimen, Anesthesia, Administration, Intravenous, Laparoscopy, Analgesia, medicine.symptom, business, Abdominal surgery, medicine.drug
Abstract

Intravenous (IV) lidocaine has analgesic and anti-inflammatory properties. This study aims to evaluate the efficacy of IV lidocaine in controlling postoperative pain following laparoscopic surgery. A meta-analysis of randomised controlled trials (RCTs) comparing IV lidocaine versus placebo/routine treatment for postoperative analgesia following laparoscopic surgery. The primary outcome was opiate requirement at 24 h. Secondary outcomes included cumulative opiate requirement, numerical pain scores (2, 12, 24, 48 h at rest and on movement), recovery indices (nausea and vomiting, length of stay, time until diet resumption, first flatus and bowel movement) and side effects (cardiac/neurological toxicity). Subgroup analyses were performed according to operation type and to compare IV lidocaine with intraperitoneal lidocaine. Fourteen RCTs with 742 patients were included. IV lidocaine was associated with a small but significant reduction in opiate requirement at 24 h compared with placebo/routine care. IV lidocaine was associated with reduced cumulative opiate requirement, reduced pain scores at rest at 2, 12 and 24 h, reduced nausea and vomiting and a shorter time until resumption of diet. The length of stay did not differ between groups. There was a low incidence of IV lidocaine-associated toxicity. In subgroup analyses, there was no difference between IV and intraperitoneal lidocaine in the measured outcomes. IV lidocaine has a multidimensional effect on the quality of recovery. IV lidocaine was associated with lower opiate requirements, reduced nausea and vomiting and a shorter time until resumption of diet. Whilst IV lidocaine appears safe, the optimal treatment regimen remains unknown. Statistical heterogeneity was high.

Published
2015

7. Diurnal Variation in Blood Pressure and Arterial Stiffness in Chronic Kidney Disease

Author

Vanessa Melville, Robert Kimmitt, David J. Webb, Iain M. MacIntyre, Ewan D. Kennedy, Wilna Oosthuyzen, Kayleigh E. Brown, Jane Goddard, Neeraj Dhaun, and Rebecca Moorhouse

Subjects
Adult, Endothelin Receptor Antagonists, Male, medicine.hormone, medicine.medical_specialty, Blood Pressure, Thiophenes, Essential hypertension, Endothelins, Vascular Stiffness, Internal medicine, Sitaxentan, Internal Medicine, Humans, Medicine, Renal Insufficiency, Chronic, Pulse wave velocity, Endothelin-1, business.industry, Isoxazoles, Middle Aged, medicine.disease, Circadian Rhythm, Pulse pressure, Blood pressure, Endocrinology, Case-Control Studies, Arterial stiffness, Cardiology, Female, business, Kidney disease, medicine.drug
Abstract

Abstract— Hypertension and arterial stiffness are important independent cardiovascular risk factors in chronic kidney disease (CKD) to which endothelin-1 (ET-1) contributes. Loss of nocturnal blood pressure (BP) dipping is associated with CKD progression, but there are no data on 24-hour arterial stiffness variation. We examined the 24-hour variation of BP, arterial stiffness, and the ET system in healthy volunteers and patients with CKD and the effects on these of ET receptor type A receptor antagonism (sitaxentan). There were nocturnal dips in systolic BP and diastolic BP and pulse wave velocity, our measure of arterial stiffness, in 15 controls (systolic BP, −3.2±4.8%, P P =0.001; pulse wave velocity, −5.8±5.2%, P P P P Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifiers: NCT01770847 and NCT00810732.

Published
2014

8. Cognitive Outcome After On- and Off-Pump Coronary Artery Bypass Grafting Surgery: A Systematic Review and Meta-Analysis

Author

Shaoyun Chen, Robert Sykes, Kevin C.C. Choy, Jamie Anderson, Ewan D. Kennedy, Sam A. MacKenzie, R. Peter Alston, Yun Lin Ang, Deborah E. Moore, and Muhamed M Farhan-Alanie

Subjects
medicine.medical_specialty, Psychometrics, Endpoint Determination, medicine.medical_treatment, Trail Making Test, Coronary Artery Bypass, Off-Pump, Neuropsychological Tests, law.invention, Coronary artery disease, Cognition, Randomized controlled trial, Memory, law, Cardiopulmonary bypass, medicine, Humans, Learning, Postoperative Period, Cognitive decline, Randomized Controlled Trials as Topic, Off-pump coronary artery bypass, business.industry, Publication bias, medicine.disease, Surgery, Treatment Outcome, surgical procedures, operative, Anesthesiology and Pain Medicine, Meta-analysis, Anesthesia, Cognition Disorders, Cardiology and Cardiovascular Medicine, business, Publication Bias
Abstract

Objective The aim of this study was to compare cognition following coronary artery bypass grafting (CABG) surgery with or without cardiopulmonary bypass (CPB) (on- or off-pump). Design Systematic review and meta-analysis of randomized control trials comparing cognitive outcome in patients undergoing CABG surgery on- or off-pump as assessed by continuous measures from a battery of 7 psychometric tests. Setting Multi-institutional centers performing CABG surgery. Participants Patients with coronary artery disease requiring CABG surgery. Interventions CABG surgery with or without CPB. Measurements and main results A structured literature search identified 13 randomized control trials that included a total of 2,405 patients. Results from 7 psychometric tests were grouped into early (≤3 months) and late (6-12 months) postoperative periods. No significant differences were found between on- and off-pump groups in any of the 7 psychometric tests in either the early (p range 0.21-0.78) or late (p range 0.09-0.93) postoperative period. Conclusion The results suggested that CPB may not be associated with cognitive decline that is associated with CABG surgery.

Published
2013

9. Patients unfit for neoadjuvant therapy may still undergo resection of locally advanced esophageal or esophagogastric junctional cancer with acceptable oncological results

Author

J. Robert O’Neill, Richard J E Skipworth, Vicki Save, Barbara Langdale-Brown, Simon Paterson-Brown, Ewan D. Kennedy, and Lucy Wall

Subjects
medicine.medical_specialty, medicine.medical_treatment, Esophageal cancer, Locally advanced, Neoadjuvant chemotherapy, 03 medical and health sciences, 0302 clinical medicine, Mandard, medicine, Stage (cooking), Neoadjuvant therapy, Cohort Study, Cisplatin, Chemotherapy, business.industry, Cancer, General Medicine, medicine.disease, Comorbidity, Surgery, Esophagogastric junctional cancer, 030220 oncology & carcinogenesis, ComputingMethodologies_DOCUMENTANDTEXTPROCESSING, 030211 gastroenterology & hepatology, business, medicine.drug
Abstract

Supplemental Digital Content is available in the text., Introduction: Neoadjuvant chemotherapy (NA) is routinely offered to patients undergoing resection for locally advanced (≥cT3Nx or cTxN+) esophageal or esophagogastric junctional (EGJ) cancer in the United Kingdom. Patients with comorbidity precluding the use of NA can be considered for resection yet the effect of omitting NA on survival is unclear. Methods: Retrospective review of prospectively collected clinical data from patients undergoing attempted curative therapy for ≥cT3Nx or cTxN+ esophageal or EGJ (Siewert type I-III) cancer between 2001 and 2013. Results: NA was commenced in 289 patients and primarily comprised 2 cycles of cisplatin and 5-fluorouracil (264 patients, 91%). Surgery alone was planned for 82 patients with NA omitted due to comorbidity. Patients undergoing surgery alone were matched for clinical variables and stage with those undergoing NA but were significantly older (mean=8 y, P

Published
2016

10. A neglected priority? The importance of surgery in tackling global health inequalities

Author

Stuart J. Fergusson, Cameron J Fairfield, and Ewan D. Kennedy

Subjects
medicine.medical_specialty, Inequality, business.industry, lcsh:Public aspects of medicine, Health Policy, media_common.quotation_subject, lcsh:R, Public Health, Environmental and Occupational Health, global health, lcsh:Medicine, lcsh:RA1-1270, medicine.disease, Vesicovaginal fistula, Surgery, Viewpoints, surgery, Dignity, Geography, inequalities, Health care, Global health, medicine, business, media_common
Abstract

“I was thinking that I was already dead… now I can talk with you people, I’m so happy!” These words, spoken quietly but with great warmth by a young woman devastated by a vesicovaginal fistula and restored to dignity through compassionate operative treatment, cut cleanly through divides of geography, culture, and class. More eloquently than any statistic she speaks of the life–changing and life–saving importance of surgical services in all health care systems. The woman’s testimony features in Jaymie Ang Henry’s film, ‘The Right to Heal’ [1], a deeply moving piece of advocacy that makes a clear case for focusing far greater global attention on the huge need to achieve more equitable access to essential surgery. This is the case we take up here, with a particular focus on the needs of sub–Saharan Africa.

Published
2015

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