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Article ; Online: Dental Surgical Activity in Hospitals during COVID-19: A Nationwide Observational Cohort Study.

Booth, J / Fowler, A J / Pearse, R / Dias, P / Wan, Y I / Witton, R / Abbott, T E F

2024 , Page(s) 23800844231216356

Abstract: Introduction: The number of surgical extractions performed in hospitals in England remains unclear. This study reports the volume of surgical extractions conducted in hospitals and change in activity during the COVID-19 pandemic.: Methods: We ... ...

Abstract	Introduction: The number of surgical extractions performed in hospitals in England remains unclear. This study reports the volume of surgical extractions conducted in hospitals and change in activity during the COVID-19 pandemic. Methods: We conducted a nationwide observational cohort study using Hospital Episode Statistics (HES) in England for patients undergoing surgical removal of a tooth (defined using OPSC-4 code F09) between April 1, 2015, and December 31, 2020. Procedures were stratified by age, gender, and urgency (elective or nonelective), reported using descriptive statistics, number, and percentage. We conducted post hoc modeling to predict surgical activity to December 2023. In addition, we contrasted this with aggregate national data on simple dental extraction procedures and drainage of dental abscesses in hospital as well as dental activity in general practice. Results: We identified a total of 569,938 episodes for the surgical removal of a tooth (females 57%). Of these, 493,056/569,938 (87%) were for adults and 76,882/569,938 (13%) children ≤18 years. Surgical extractions were most frequent in adult females. Elective cases accounted for 96% ( Conclusions: The number of surgical extractions taking place in hospitals during the pandemic fell by 56%. The true impact of this reduction is unknown, but delayed treatment increases the risk of complications, including life-threatening infections. Knowledge transfer statement: The result of this study provides an evidence-based overview of the trends relating to surgical extractions of teeth in England taking place in hospitals. This information can be used to inform service and workforce planning to meet the needs of patients requiring surgical extractions. The data also provide an insight into the oral health needs of the population in England.
Language	English
Publishing date	2024-01-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2842304-5
ISSN	2380-0852 ; 2380-0844
ISSN (online)	2380-0852
ISSN	2380-0844
DOI	10.1177/23800844231216356
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Article ; Online: Elevated heart rate after noncardiac surgery: post hoc analysis of a prospective observational cohort study.

Patel, A B U / May, S M / Reyes, A / Martir, G / Abbott, T E F / Brealey, D / Stephens, R C M / Ackland, G L

British journal of anaesthesia

2024 Volume 124, Issue 4, Page(s) e207–e208

Language	English
Publishing date	2024-02-21
Publishing country	England
Document type	Journal Article
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2019.11.015
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Article ; Online: Functional decline after major elective non-cardiac surgery: a multicentre prospective cohort study.

Ladha, K S / Cuthbertson, B H / Abbott, T E F / Pearse, R M / Wijeysundera, D N

Anaesthesia

2021 Volume 76, Issue 12, Page(s) 1593–1599

Abstract: Self-reported postoperative functional recovery is an important patient-centred outcome that is rarely measured or considered in research and decision-making. We conducted a secondary analysis of the measurement of exercise tolerance before surgery (METS) ...

Abstract	Self-reported postoperative functional recovery is an important patient-centred outcome that is rarely measured or considered in research and decision-making. We conducted a secondary analysis of the measurement of exercise tolerance before surgery (METS) study for associations of peri-operative variables with functional decline after major non-cardiac surgery. Patients who were at least 40 years old, had or were at risk of, coronary artery disease and who were scheduled for non-cardiac surgery were recruited. Primary outcome was a reduction in mobility, self-care or ability to conduct usual activities (EuroQol 5 dimension) from before surgery to 30 days and 1 year after surgery. A decline in at least one function was reported by 523/1309 (40%) participants at 30 days and 320/1309 (24%) participants at 1 year. Participants who reported higher pre-operative Duke Activity Status indices more often reported functional decline 30 days after surgery and less often reported functional decline 1 year after surgery. The odds ratios (95%CI) of functional decline 30 days and 1 year after surgery with moderate or severe postoperative complications were 1.46 (1.02-2.09), p = 0.037 and 1.44 (0.98-2.13), p = 0.066. Discrimination of participants who reported functional decline 30 days and 1 year after surgery were poor (c-statistic 0.61 and 0.63, respectively). In summary, one quarter of participants reported functional decline up to one postoperative year.
MeSH term(s)	Adult ; Aged ; Coronary Artery Disease/pathology ; Elective Surgical Procedures/adverse effects ; Female ; Health Status ; Humans ; Male ; Middle Aged ; Odds Ratio ; Patients/psychology ; Physical Functional Performance ; Postoperative Complications/physiopathology ; Postoperative Period ; Prospective Studies ; Quality of Life ; Risk Factors ; Self Care ; Surveys and Questionnaires
Language	English
Publishing date	2021-07-13
Publishing country	England
Document type	Journal Article
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.15537
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Article ; Online: IL-1ra polymorphisms and risk of epidural-related maternal fever (EPIFEVER-2): study protocol for a multicentre, observational mechanistic cohort study.

Ali, A / Weber, V / Thompson, S J / Abbott, T E F / Harmston, R / David, A L / Ackland, G L

International journal of obstetric anesthesia

2022 Volume 50, Page(s) 103540

Abstract: Background: Laboratory data suggest that insufficient circulating levels of the anti-inflammatory cytokine interleukin-1 receptor antagonist (IL-1ra) are associated with intrapartum inflammation and epidural-related maternal fever, both of which ... ...

Abstract	Background: Laboratory data suggest that insufficient circulating levels of the anti-inflammatory cytokine interleukin-1 receptor antagonist (IL-1ra) are associated with intrapartum inflammation and epidural-related maternal fever, both of which increase the rate of obstetric interventions and antibiotic use during labour. Genetic polymorphisms strongly influence IL-1ra levels in the general population. We aim to examine the association between IL-1ra polymorphisms and epidural-related maternal fever using Mendelian randomization analysis. Methods: EPIFEVER-2 is a multicentre UK trial enrolling 637 women receiving epidural analgesia for labour. Blood samples obtained no later than four hours after epidural insertion will provide deoxyribonucleic acid for Taqman single-nucleotide polymorphism genotyping for presence/absence of rs6743376, rs1542176 alleles for IL-1ra, to establish the genetic score. The absence of both alleles is associated with the lowest IL-1ra levels. The primary outcome is pyrexia (>38°C) or intrapartum antibiotic administration. Secondary outcomes include mode of delivery, maternal and neonatal healthcare interventions. Results: The EPIFEVER-2 study was prospectively registered (ISRCTN99641204) following ethical approval. Participant recruitment began in May 2021, with 221 women recruited across three centres as of November 21, 2021. Conclusions: EPIFEVER-2 will generate the largest prospective dataset detailing the incidence and consequences of epidural-related maternal fever. Using Mendelian randomisation analysis, a causative role for lower IL1-ra levels in determining the risk of epidural-related maternal fever and/or antibiotic administration before delivery will be examined.
MeSH term(s)	Analgesia, Epidural/adverse effects ; Analgesia, Epidural/methods ; Analgesia, Obstetrical/methods ; Anti-Bacterial Agents/therapeutic use ; Cohort Studies ; Female ; Humans ; Infant, Newborn ; Interleukin 1 Receptor Antagonist Protein/genetics ; Multicenter Studies as Topic ; Observational Studies as Topic ; Polymorphism, Genetic ; Pregnancy ; Prospective Studies
Chemical Substances	Anti-Bacterial Agents ; Interleukin 1 Receptor Antagonist Protein
Language	English
Publishing date	2022-03-18
Publishing country	Netherlands
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	1086024-1
ISSN	1532-3374 ; 0959-289X
ISSN (online)	1532-3374
ISSN	0959-289X
DOI	10.1016/j.ijoa.2022.103540
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Article ; Online: Age of patients undergoing surgery.

Fowler, A J / Abbott, T E F / Prowle, J / Pearse, R M

The British journal of surgery

2019 Volume 106, Issue 8, Page(s) 1012–1018

Abstract: Background: Advancing age is independently associated with poor postoperative outcomes. The ageing of the general population is a major concern for healthcare providers. Trends in age were studied among patients undergoing surgery in the National Health ...

Abstract	Background: Advancing age is independently associated with poor postoperative outcomes. The ageing of the general population is a major concern for healthcare providers. Trends in age were studied among patients undergoing surgery in the National Health Service in England. Methods: Time trend ecological analysis was undertaken of Hospital Episode Statistics and Office for National Statistics data for England from 1999 to 2015. The proportion of patients undergoing surgery in different age groupings, their pooled mean age, and change in age profile over time were calculated. Growth in the surgical population was estimated, with associated costs, to the year 2030 by use of linear regression modelling. Results: Some 68 205 695 surgical patient episodes (31 220 341 men, 45·8 per cent) were identified. The mean duration of hospital stay was 5·3 days. The surgical population was older than the general population of England; this gap increased over time (1999: 47·5 versus 38·3 years; 2015: 54·2 versus 39·7 years). The number of people aged 75 years or more undergoing surgery increased from 544 998 (14·9 per cent of that age group) in 1999 to 1 012 517 (22·9 per cent) in 2015. By 2030, it is estimated that one-fifth of the 75 years and older age category will undergo surgery each year (1·49 (95 per cent c.i. 1·43 to 1·55) million people), at a cost of €3·2 (3·1 to 3·5) billion. Conclusion: The population having surgery in England is ageing at a faster rate than the general population. Healthcare policies must adapt to ensure that provision of surgical treatments remains safe and sustainable.
MeSH term(s)	Adolescent ; Adult ; Age Factors ; Aged ; Child ; Child, Preschool ; England/epidemiology ; Forecasting ; Health Care Costs/statistics & numerical data ; Humans ; Infant ; Infant, Newborn ; Middle Aged ; State Medicine/statistics & numerical data ; Surgical Procedures, Operative/economics ; Surgical Procedures, Operative/statistics & numerical data ; Surgical Procedures, Operative/trends ; Young Adult
Language	English
Publishing date	2019-05-22
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1002/bjs.11148
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Article ; Online: Saving money: An ideal driver for improved perioperative care?

Abbott, T E F / Pearse, R M

Anaesthesia, critical care & pain medicine

2017 Volume 36, Issue 3, Page(s) 147–148

MeSH term(s)	Humans ; Perioperative Care ; Postoperative Complications
Language	English
Publishing date	2017-01-30
Publishing country	France
Document type	Editorial ; Comment
ISSN	2352-5568
ISSN (online)	2352-5568
DOI	10.1016/j.accpm.2017.01.006
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Article ; Online: Cardiac vagal dysfunction and myocardial injury after non-cardiac surgery: a planned secondary analysis of the measurement of Exercise Tolerance before surgery study.

Abbott, T E F / Pearse, R M / Cuthbertson, B H / Wijeysundera, D N / Ackland, G L

British journal of anaesthesia

2018 Volume 122, Issue 2, Page(s) 188–197

Abstract: Background: The aetiology of perioperative myocardial injury is poorly understood and not clearly linked to pre-existing cardiovascular disease. We hypothesised that loss of cardioprotective vagal tone [defined by impaired heart rate recovery ≤12 beats ... ...

Abstract	Background: The aetiology of perioperative myocardial injury is poorly understood and not clearly linked to pre-existing cardiovascular disease. We hypothesised that loss of cardioprotective vagal tone [defined by impaired heart rate recovery ≤12 beats min Methods: We conducted a pre-defined, secondary analysis of a multi-centre prospective cohort study of preoperative cardiopulmonary exercise testing. Participants were aged ≥40 yr undergoing non-cardiac surgery. The exposure was impaired HRR (HRR≤12). The primary outcome was postoperative myocardial injury, defined by serum troponin concentration within 72 h after surgery. The analysis accounted for established markers of cardiac risk [Revised Cardiac Risk Index (RCRI), N-terminal pro-brain natriuretic peptide (NT pro-BNP)]. Results: A total of 1326 participants were included [mean age (standard deviation), 64 (10) yr], of whom 816 (61.5%) were male. HRR≤12 occurred in 548 patients (41.3%). Myocardial injury was more frequent amongst patients with HRR≤12 [85/548 (15.5%) vs HRR>12: 83/778 (10.7%); odds ratio (OR), 1.50 (1.08-2.08); P=0.016, adjusted for RCRI). HRR declined progressively in patients with increasing numbers of RCRI factors. Patients with ≥3 RCRI factors were more likely to have HRR≤12 [26/36 (72.2%) vs 0 factors: 167/419 (39.9%); OR, 3.92 (1.84-8.34); P<0.001]. NT pro-BNP greater than a standard prognostic threshold (>300 pg ml Conclusions: Impaired HRR is associated with an increased risk of perioperative cardiac injury. These data suggest a mechanistic role for cardiac vagal dysfunction in promoting perioperative myocardial injury.
MeSH term(s)	Aged ; Aged, 80 and over ; Cohort Studies ; Exercise Test ; Exercise Tolerance ; Female ; Heart/innervation ; Heart Injuries/physiopathology ; Heart Rate ; Humans ; Male ; Middle Aged ; Natriuretic Peptide, Brain/blood ; Peptide Fragments/blood ; Postoperative Complications/physiopathology ; Predictive Value of Tests ; Preoperative Care ; Prospective Studies ; Surgical Procedures, Operative ; Treatment Outcome ; Vagus Nerve/physiopathology
Chemical Substances	Peptide Fragments ; pro-brain natriuretic peptide (1-76) ; Natriuretic Peptide, Brain (114471-18-0)
Language	English
Publishing date	2018-12-17
Publishing country	England
Document type	Journal Article ; Multicenter Study
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2018.10.060
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Article ; Online: Elevated preoperative heart rate is associated with cardiopulmonary and autonomic impairment in high-risk surgical patients.

Abbott, T E F / Minto, G / Lee, A M / Pearse, R M / Ackland, G L

British journal of anaesthesia

2017 Volume 119, Issue 1, Page(s) 87–94

Abstract: Background: Elevated preoperative heart rate (HR) is associated with perioperative myocardial injury and death. In apparently healthy individuals, high resting HR is associated with development of cardiac failure. Given that patients with overt cardiac ... ...

Abstract	Background: Elevated preoperative heart rate (HR) is associated with perioperative myocardial injury and death. In apparently healthy individuals, high resting HR is associated with development of cardiac failure. Given that patients with overt cardiac failure have poor perioperative outcomes, we hypothesized that subclinical cardiac failure, identified by cardiopulmonary exercise testing, was associated with elevated preoperative HR > 87 beats min -1 (HR > 87). Methods: This was a secondary analysis of an observational cohort study of surgical patients aged ≥45 yr. The exposure of interest was HR > 87, recorded at rest before preoperative cardiopulmonary exercise testing. The predefined outcome measures were the following established predictors of mortality in patients with overt cardiac failure in the general population: ventilatory equivalent for carbon dioxide ( V˙E/V˙co2 ) ratio ≥34, heart rate recovery ≤6 and peak oxygen uptake ( V˙o2 ) ≤14 ml kg -1 min -1 . We used logistic regression analysis to test for association between HR > 87 and markers of cardiac failure. We also examined the relationship between HR > 87 and preoperative left ventricular stroke volume in a separate cohort of patients. Results: HR > 87 was present in 399/1250 (32%) patients, of whom 438/1250 (35%) had V˙E/V˙co2 ratio ≥34, 200/1250 (16%) had heart rate recovery ≤6, and 396/1250 (32%) had peak V˙o2 ≤14 ml kg -1 min -1 . HR > 87 was independently associated with peak V˙o2 ≤14 ml kg -1 min -1 {odds ratio (OR) 1.69 [1.12-3.55]; P =0.01} and heart rate recovery ≤6 (OR 2.02 [1.30-3.14]; P <0.01). However, HR > 87 was not associated with V˙E/V˙co2 ratio ≥34 (OR 1.31 [0.92-1.87]; P =0.14). In a separate cohort, HR > 87 (33/181; 18.5%) was associated with impaired preoperative stroke volume (OR 3.21 [1.26-8.20]; P =0.01). Conclusions: Elevated preoperative heart rate is associated with impaired cardiopulmonary performance consistent with clinically unsuspected, subclinical cardiac failure. Clinical trial registration: ISRCTN88456378.
MeSH term(s)	Aged ; Autonomic Nervous System/physiopathology ; Cohort Studies ; Exercise Test ; Female ; Heart Failure/etiology ; Heart Rate/physiology ; Humans ; Logistic Models ; Male ; Middle Aged ; Stroke Volume
Language	English
Publishing date	2017-09-21
Publishing country	England
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1093/bja/aex164
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Article ; Online: Resource requirements for reintroducing elective surgery during the COVID-19 pandemic: modelling study.

Fowler, A J / Dobbs, T D / Wan, Y I / Laloo, R / Hui, S / Nepogodiev, D / Bhangu, A / Whitaker, I S / Pearse, R M / Abbott, T E F

The British journal of surgery

2021 Volume 108, Issue 1, Page(s) 97–103

Abstract: Background: The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled.: Methods: This was a ... ...

Abstract	Background: The COVID-19 response required the cancellation of all but the most urgent surgical procedures. The number of cancelled surgical procedures owing to Covid-19, and the reintroduction of surgical acivirt, was modelled. Methods: This was a modelling study using Hospital Episode Statistics data (2014-2019). Surgical procedures were grouped into four urgency classes. Expected numbers of surgical procedures performed between 1 March 2020 and 28 February 2021 were modelled. Procedure deficit was estimated using conservative assumptions and the gradual reintroduction of elective surgery from the 1 June 2020. Costs were calculated using NHS reference costs and are reported as millions or billions of euros. Estimates are reported with 95 per cent confidence intervals. Results: A total of 4 547 534 (95 per cent c.i. 3 318 195 to 6 250 771) patients with a pooled mean age of 53.5 years were expected to undergo surgery between 1 March 2020 and 28 February 2021. By 31 May 2020, 749 247 (513 564 to 1 077 448) surgical procedures had been cancelled. Assuming that elective surgery is reintroduced gradually, 2 328 193 (1 483 834 - 3 450 043) patients will be awaiting surgery by 28 February 2021. The cost of delayed procedures is €5.3 (3.1 to 8.0) billion. Safe delivery of surgery during the pandemic will require substantial extra resources costing €526.8 (449.3 to 633.9) million. Conclusion: As a consequence of the Covid-19 pandemic, provision of elective surgery will be delayed and associated with increased healthcare costs.
MeSH term(s)	COVID-19/diagnosis ; COVID-19/epidemiology ; COVID-19 Testing ; Elective Surgical Procedures/economics ; Elective Surgical Procedures/statistics & numerical data ; England/epidemiology ; Facilities and Services Utilization/economics ; Hospital Costs ; Hospitalization/statistics & numerical data ; Humans ; Models, Statistical ; Pandemics ; Personal Protective Equipment ; Preoperative Care ; SARS-CoV-2 ; Time-to-Treatment/economics
Language	English
Publishing date	2021-02-26
Publishing country	England
Document type	Journal Article
ZDB-ID	2985-3
ISSN	1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
ISSN (online)	1365-2168
ISSN	0263-1202 ; 0007-1323 ; 1355-7688
DOI	10.1093/bjs/znaa012
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Article ; Online: Mortality after surgery with SARS-CoV-2 infection in England: a population-wide epidemiological study.

Abbott, T E F / Fowler, A J / Dobbs, T D / Gibson, J / Shahid, T / Dias, P / Akbari, A / Whitaker, I S / Pearse, R M

British journal of anaesthesia

2021 Volume 127, Issue 2, Page(s) 205–214

Abstract: Background: The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated mortality ... ...

Abstract	Background: The COVID-19 pandemic has heavily impacted elective and emergency surgery around the world. We aimed to confirm the incidence of perioperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated mortality after surgery. Methods: Analysis of routine electronic health record data from NHS hospitals in England. We extracted data from Hospital Episode Statistics in England describing adult patients undergoing surgery between January 1, 2020 and February 28, 2021. The exposure was SARS-CoV-2 infection defined by International Classification of Diseases (ICD)-10 codes. The primary outcome measure was 90 day in-hospital mortality. Data were analysed using multivariable logistic regression adjusted for age, sex, Charlson Comorbidity Index, Index of Multiple Deprivation, presence of cancer, surgical procedure type and admission acuity. Results are presented as n (%) and odds ratios (OR) with 95% confidence intervals (CI). Results: We identified 2 666 978 patients undergoing surgery of whom 28 777 (1.1%) had SARS-CoV-2 infection. In total, 26 364 (1.0%) patients died in hospital. SARS-CoV-2 infection was associated with a much greater risk of death (SARS-CoV-2: 6153/28 777 [21.4%] vs no SARS-CoV-2: 20 211/2 638 201 [0.8%]; OR=5.7 [95% CI, 5.5-5.9]; P<0.001). Amongst patients undergoing elective surgery, 2412/1 857 586 (0.1%) had SARS-CoV-2, of whom 172/2412 (7.1%) died, compared with 1414/1 857 586 (0.1%) patients without SARS-CoV-2 (OR=25.8 [95% CI, 21.7-30.9]; P<0.001). Amongst patients undergoing emergency surgery, 22 918/582 292 (3.9%) patients had SARS-CoV-2, of whom 5752/22 918 (25.1%) died, compared with 18 060/559 374 (3.4%) patients without SARS-CoV-2 (OR=5.5 [95% CI, 5.3-5.7]; P<0.001). Conclusions: The low incidence of SARS-CoV-2 infection in NHS surgical pathways suggests current infection prevention and control policies are highly effective. However, the high mortality amongst patients with SARS-CoV-2 suggests these precautions cannot be safely relaxed.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; COVID-19/mortality ; COVID-19/surgery ; Elective Surgical Procedures/mortality ; Elective Surgical Procedures/trends ; England/epidemiology ; Epidemiologic Studies ; Female ; Hospital Mortality/trends ; Humans ; Male ; Middle Aged ; Population Surveillance/methods
Language	English
Publishing date	2021-06-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	80074-0
ISSN	1471-6771 ; 0007-0912
ISSN (online)	1471-6771
ISSN	0007-0912
DOI	10.1016/j.bja.2021.05.018
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