7 research outputs found
Enhancement of MTC Performance in LTE Networks by Maximizing Random Access Procedure Throughput
No full text
Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
No full textnone5203openGlasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; McLean, Kenneth; Nepogodiev, Dmitri; Harrison, Ewen; Bhangu, Aneel A; Nepogodiev, Dmitri; Siaw-Acheampong, Kwabena; Benson, Ruth A; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E; Evans, Jonathan P; Glasbey, James C; Gujjuri, Rohan R; Heritage, Emily; Jones, Conor S; Kamarajah, Sivesh K; Khatri, Chetan; Khaw, Rachel A; Keatley, James M; Knight, Andrew; Lawday, Samuel; Li, Elizabeth; Mann, Harvinder S; Marson, Ella J; McLean, Kenneth A; Mckay, Siobhan C; Mills, Emily C; Pellino, Gianluca; Picciochi, Maria; Taylor, Elliott H; Tiwari, Abhinav; Simoes, Joana FF; Trout, Isobel M; Venn, Mary L; Wilkin, Richard JW; Bhangu, Aneel; Glasbey, James C; Smart, Neil J; Minaya-Bravo, Ana; Evans, Jonathan P; Gallo, Gaetano; Moug, Susan; Pata, Francesco; Pockney, Peter; Di Saverio, Salomone; Vallance, Abigail; Vimalchandran, Dale; Griffiths, Ewen A; Kamarajah, Sivesh K; Evans, Richard PT; Townend, Philip; Roberts, Keith; McKay, Siobhan; Isaac, John; Satoi, Sohei; Edwards, John; Coonar, Aman S; Marchbank, Adrian; Caruana, Edward J; Layton, Georgia R; Patel, Akshay; Brunelli, Alessandro; Ford, Samuel; Desai, Anant; Gronchi, Alessandro; Fiore, Marco; Almond, Max; Tirotta, Fabio; Dumitra, Sinziana; Kolias, Angelos; Price, Stephen J; Fountain, Daniel M; Jenkinson, Michael D; Hutchinson, Peter; Marcus, Hani J; Piper, Rory J; Lippa, Laura; Servadei, Franco; Esene, Ignatius; Freyschlag, Christian; Neville, Iuri; Rosseau, Gail; Schaller, Karl; Demetriades, Andreas K; Robertson, Faith; Alamri, Alex; Shaw, Richard; Schache, Andrew G; Winter, Stuart C; Ho, Michael; Nankivell, Paul; Rey Biel, Juan; Batstone, Martin; Ganly, Ian; Vidya, Raghavan; Wilkins, Alex; Singh, Jagdeep K; Thekinkattil, Dinesh; Sundar, Sudha; Fotopoulou, Christina; Leung, Elaine YL; Khan, Tabassum; Chiva, Luis; Sehouli, Jalid; Fagotti, Anna; Cohen, Paul; Gutelkin, Murat; Ghebre, Rahel; Konney, Thomas; Pareja, Rene; Bristow, Rob; Dowdy, Sean; Shylasree, TS; Kottayasamy Seenivasagam, Rajkumar; Ng, Joe; Fujiwara, Keiichi; Stewart, Grant D; Lamb, Benjamin; Narahari, Krishna; McNeill, Alan; Colquhoun, Alexandra; McGrath, John S; Bromage, Steve; Barod, Ravi; Kasivisvanathan, Veeru; Klatte, Tobias; Simoes, Joana FF; Abbott, Tom EF; Abukhalaf, Sadi; Adamina, Michel; Ademuyiwa, Adesoji O; Agarwal, Arnav; Akkulak, Murat; Alameer, Ehab; Alderson, Derek; Alakaloko, Felix; Albertsmeier, Markus; Alser, Osaid; Alshaar, Muhammad; Alshryda, Sattar; Arnaud, Alexis P; Augestad, Knut Magne; Ayasra, Faris; Azevedo, José; Bankhead-Kendall, Brittany K; Barlow, Emma; Beard, David; Benson, Ruth A; Blanco-Colino, Ruth; Brar, Amanpreet; Minaya-Bravo, Ana; Breen, Kerry A; Bretherton, Chris; Buarque, Igor Lima; Burke, Joshua; Caruana, Edward J; Chaar, Mohammad; Chakrabortee, Sohini; Christensen, Peter; Cox, Daniel; Cukier, Moises; Cunha, Miguel F; Davidson, Giana H; Desai, Anant; Di Saverio, Salomone; Drake, Thomas M; Edwards, John G; Elhadi, Muhammed; Emile, Sameh; Farik, Shebani; Fiore, Marco; Fitzgerald, J Edward; Ford, Samuel; Garmanova, Tatiana; Gallo, Gaetano; Ghosh, Dhruva; Gomes, Gustavo Mendonça Ataíde; 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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
No full textnone5203siSummary
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19
outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of
elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.
Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in
61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were
followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19
Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the
period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full
lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not
undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between
lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government
response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.
Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up
of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were
associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted
hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11827; HR 0·51,
0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate
lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained
independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without
neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in
moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability
rates observed with longer delays.
Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in
regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although
short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations
might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience
of elective surgery systems requires strengthening, which might include protected elective surgical pathways and longterm investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great
Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper
Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European
Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and
Ireland, and Yorkshire Cancer Research.openGlasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; McLean, Kenneth; 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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
No full textnone5203siBackground: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.
Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.
Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.
Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.openGlasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; 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Global Incidence and Risk Factors Associated With Postoperative Urinary Retention Following Elective Inguinal Hernia Repair
No full textImportance: Postoperative urinary retention (POUR) is a well-recognized complication of inguinal hernia repair (IHR). A variable incidence of POUR has previously been reported in this context, and contradictory evidence surrounds potential risk factors. Objective: To ascertain the incidence of, explore risk factors for, and determine the health service outcomes of POUR following elective IHR. Design, Setting, and Participants: The Retention of Urine After Inguinal Hernia Elective Repair (RETAINER I) study, an international, prospective cohort study, recruited participants between March 1 and October 31, 2021. This study was conducted across 209 centers in 32 countries in a consecutive sample of adult patients undergoing elective IHR. Exposure: Open or minimally invasive IHR by any surgical technique, under local, neuraxial regional, or general anesthesia. Main Outcomes and Measures: The primary outcome was the incidence of POUR following elective IHR. Secondary outcomes were perioperative risk factors, management, clinical consequences, and health service outcomes of POUR. A preoperative International Prostate Symptom Score was measured in male patients. Results: In total, 4151 patients (3882 male and 269 female; median [IQR] age, 56 [43-68] years) were studied. Inguinal hernia repair was commenced via an open surgical approach in 82.2% of patients (n = 3414) and minimally invasive surgery in 17.8% (n = 737). The primary form of anesthesia was general in 40.9% of patients (n = 1696), neuraxial regional in 45.8% (n = 1902), and local in 10.7% (n = 446). Postoperative urinary retention occurred in 5.8% of male patients (n = 224), 2.97% of female patients (n = 8), and 9.5% (119 of 1252) of male patients aged 65 years or older. Risk factors for POUR after adjusted analyses included increasing age, anticholinergic medication, history of urinary retention, constipation, out-of-hours surgery, involvement of urinary bladder within the hernia, temporary intraoperative urethral catheterization, and increasing operative duration. Postoperative urinary retention was the primary reason for 27.8% of unplanned day-case surgery admissions (n = 74) and 51.8% of 30-day readmissions (n = 72). Conclusions: The findings of this cohort study suggest that 1 in 17 male patients, 1 in 11 male patients aged 65 years or older, and 1 in 34 female patients may develop POUR following IHR. These findings could inform preoperative patient counseling. In addition, awareness of modifiable risk factors may help to identify patients at increased risk of POUR who may benefit from perioperative risk mitigation strategies.
Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries
No full textBackground: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries.Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761)
