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Article ; Online: The impact of perioperative non-steroidal anti-inflammatory drugs use on pleurodesis following thoracic surgery.

Kutywayo, Kudzayi / Habib, Akolade A / Caruana, Edward J

Interdisciplinary cardiovascular and thoracic surgery

2023 Volume 37, Issue 5

Abstract: A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: in patients who have had {visceral and parietal pleural symphysis}, {do NSAIDs reduce} {the efficacy of pleurodesis}? Sixteen papers ... ...

Abstract	A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was: in patients who have had {visceral and parietal pleural symphysis}, {do NSAIDs reduce} {the efficacy of pleurodesis}? Sixteen papers were discovered in the search. Of these, 3 human studies were included in the analysis. None showed a significantly higher rate of pleurodesis failure in patients given perioperative NSAIDs. The results from the largest study met criteria for noninferiority. Within the constraints of the study, the results suggest that systemic administration of nonsteroidal anti-inflammatory medication in the perioperative period does not necessarily attenuate effective pleurodesis. However, further study is needed as there is a clear paucity of human-based studies.
Language	English
Publishing date	2023-09-04
Publishing country	England
Document type	Journal Article
ISSN	2753-670X
ISSN (online)	2753-670X
DOI	10.1093/icvts/ivad107
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Article ; Online: A systematic review of the quality of abstracts reporting on randomized controlled trials presented at major international cardiothoracic conferences.

Gysling, Savannah / Khan, Amreen / Caruana, Edward J

Seminars in thoracic and cardiovascular surgery

2022 Volume 35, Issue 2, Page(s) 437–446

Abstract: Conference proceedings are widely available and may represent the only report of given research. Poor reporting of randomized controlled trials (RCTs) in conference abstracts may impede interpretability. In 2008, the Consolidating Standards of Reporting ... ...

Abstract	Conference proceedings are widely available and may represent the only report of given research. Poor reporting of randomized controlled trials (RCTs) in conference abstracts may impede interpretability. In 2008, the Consolidating Standards of Reporting Trials group published minimum standards for RCT reporting in conference abstracts (CONSORT-A). We sought to evaluate the reporting quality of abstracts presented at major international cardiothoracic conferences. Abstracts were retrieved for the annual meetings of 5 cardiothoracic societies over 3 consecutive years (2016 to 2018). After screening, those reporting on RCTs were scored by 2 independent reviewers against the 17-item CONSORT-A checklist. The primary endpoint was the total number of checklist criteria reported in individual abstracts. Statistical analysis was performed using STATA ICv16. Of 3233 screened abstracts, 100 (3.1%) reported on RCTs. Average checklist adherence was 35% (median 6/17 items, IQR 2-15) across abstracts. Author contact (n = 0), funding disclosures (n = 3, 2.9%) and randomization methodology (n = 5, 4.8%) were the least-frequently reported. There was no statistically-significant difference in terms of reporting quality between conferences (n = 0.07) or years (p = .06). Trial registration, word count (>300), multicentre trial design and mention of CONSORT in the abstract were associated with higher reporting quality. Reporting quality was not associated with successful full-length publication within 2 years (p = .33). The reporting quality of abstracts of RCTs presented at international cardiothoracic conferences is poor when benchmarked against the CONSORT-A standards. This highlights an area for targeted improvement.
MeSH term(s)	Humans ; Treatment Outcome ; Randomized Controlled Trials as Topic ; Checklist ; Multicenter Studies as Topic
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Systematic Review ; Journal Article
ZDB-ID	1038278-1
ISSN	1532-9488 ; 1043-0679
ISSN (online)	1532-9488
ISSN	1043-0679
DOI	10.1053/j.semtcvs.2021.11.022
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Article ; Online: In patients undergoing video-assisted thoracic surgery for lung resection, does three-dimensional endoscopic vision provide superior clinical outcomes?

Chandarana, Karishma / Caruana, Edward J

Interactive cardiovascular and thoracic surgery

2019 Volume 30, Issue 4, Page(s) 588–592

Abstract: A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the use of 3-dimensional endoscopic vision provides superior clinical outcomes to patients undergoing video-assisted thoracic ... ...

Abstract	A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether the use of 3-dimensional endoscopic vision provides superior clinical outcomes to patients undergoing video-assisted thoracic surgery for lung resection. Altogether 231 unique papers were found using the reported search, of which 6 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Four of the 6 papers demonstrated a statistically significant reduction in operative time, although this difference may not be of sufficient magnitude to be relevant clinically. There was no difference in any other outcomes assessed. We therefore conclude that, in patients undergoing video-assisted thoracic surgery for lung resection, 3-dimensional endoscopic vision has no demonstrable impact on perioperative or oncological outcomes, or cost, although it may reduce operative time.
MeSH term(s)	Endoscopy/methods ; Humans ; Imaging, Three-Dimensional/methods ; Lung Neoplasms/diagnosis ; Lung Neoplasms/surgery ; Pneumonectomy/methods ; Surgery, Computer-Assisted/methods ; Thoracic Surgery, Video-Assisted/methods ; Treatment Outcome
Language	English
Publishing date	2019-12-04
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2095298-3
ISSN	1569-9285 ; 1569-9293
ISSN (online)	1569-9285
ISSN	1569-9293
DOI	10.1093/icvts/ivz293
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Zs.A 5730: Show issues

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Article ; Online: Validation of NEWS2, SIRS, and qSOFA in Postoperative Cardiac Patients: A Retrospective Cohort Study.

Gysling, Savannah / Shanmuganathan, Selvaraj / Szafranek, Adam / Stewart, Iain D / Caruana, Edward J

The Journal of surgical research

2023 Volume 293, Page(s) 364–372

Abstract: Introduction: The 'quick Sepsis Related Organ Failure Assessment' (qSOFA), 'Systemic Inflammatory Response Syndrome' (SIRS), and 'National Early Warning Score' 2 (NEWS2) scores are yet to be comparatively validated in ward-based cardiac surgical ... ...

Abstract	Introduction: The 'quick Sepsis Related Organ Failure Assessment' (qSOFA), 'Systemic Inflammatory Response Syndrome' (SIRS), and 'National Early Warning Score' 2 (NEWS2) scores are yet to be comparatively validated in ward-based cardiac surgical patients despite widespread routine use in clinical practice. We sought to assess the predictive validity of NEWS, SIRS, and qSOFA in identifying postoperative, ward-level cardiac surgical patients at risk of poor short-term mortality. Methods: All adult patients who underwent cardiac surgery at a single tertiary center between November 2014 and October 2017 were identified. Data for bedside observations, hematological results, and microbiology requests were obtained from electronic health records. Survival data were acquired from a national registry. The primary outcome was the discriminatory ability, measured by the area under the receiver operating characteristic (AUROC), of each score for in-hospital mortality. Results: One thousand five hundred forty three (male n = 1101, 71%) patients were included. Overall in-hospital mortality was 2.4%. There was no significant difference in discriminatory ability of NEWS (AUROC 0.5060), SIRS (AUROC 0.4874), and qSOFA (AUROC 0.5139) for in-hospital mortality (P = 0.881). Sensitivity for this outcome was ubiquitously low (13.51-40.54%). Conclusions: Current illness-severity scores show a low discriminatory ability for in-hospital mortality in ward-based cardiac surgical patients. Caution should be used in the application of these prognostic screening tools for early detection of poor outcomes in this population.
MeSH term(s)	Adult ; Humans ; Male ; Female ; Systemic Inflammatory Response Syndrome/diagnosis ; Systemic Inflammatory Response Syndrome/epidemiology ; Systemic Inflammatory Response Syndrome/etiology ; Organ Dysfunction Scores ; Retrospective Studies ; Early Warning Score ; Sepsis/diagnosis ; Sepsis/etiology ; ROC Curve ; Hospital Mortality ; Prognosis ; Emergency Service, Hospital
Language	English
Publishing date	2023-10-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2023.08.044
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Zs.A 178: Show issues

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Article ; Online: Do older surgeons have safer hands? A retrospective cohort study.

Rizzo, Victoria / Caruana, Edward J / Freystaetter, Kathrin / Parry, Gareth / Clark, Stephen C

Journal of cardiothoracic surgery

2022 Volume 17, Issue 1, Page(s) 223

Abstract: Background: For complex surgical procedures a volume-outcome relationship can often be demonstrated implicating multiple factors at a unit and surgeon specific level. This study aims to investigate this phenomenon in lung transplantation over a 30-year ... ...

Abstract	Background: For complex surgical procedures a volume-outcome relationship can often be demonstrated implicating multiple factors at a unit and surgeon specific level. This study aims to investigate this phenomenon in lung transplantation over a 30-year period with particular reference to surgeon age and experience, cumulative unit activity and time/day of transplant. Methods: Prospective databases identified adult patients undergoing isolated lung transplantation at a single UK centre between June 1987 and October 2017. Mortality data was acquired from NHS Spine. Individual surgeon demographics were obtained from the General Medical Council. Student t-test, Pearson's Chi-squared, Logistic Regression, and Kaplan-Meier Survival analyses were performed using Analyse-it package for MicrosoftExcel and STATA/IC. Results: 954 transplants (55.9% male, age 44.4 ± 13.8 years, 67.9% bilateral lung) were performed, with a median survival to follow-up of 4.37 years. There was no difference in survival by recipient gender (p = 0.661), between individual surgeons (p = 0.224), or between weekday/weekend procedures (p = 0.327). Increasing centre experience with lung transplantation (OR1.001, 95%CI: 1.000-1.001, p = 0.03) and successive calendar years (OR1.028, 95%CI: 1.005-1.052, p = 0.017) was associated with improved 5-year survival. Advancing surgeon age at the time of transplant (mean, 48.8 ± 6.6 years) was associated with improved 30-day survival (OR1.062, 95%CI: 1.019 to1.106, p = 0.003), which persisted 5 years post-transplant (OR1.043, 95%CI: 1.014-1.073, p = 0.003). Individual surgeon experience, measured by the number of previous lung transplants performed, showed a trend towards improved outcomes at 30 days (p = 0.0413) with no difference in 5-year survival (p = 0.192). Conclusions: Our study demonstrates a relationship between unit volume, increasing surgeon age and survival after lung transplantation. A transplant volume: outcome relationship was not seen for individual surgeons.
MeSH term(s)	Adult ; Female ; Humans ; Kaplan-Meier Estimate ; Lung ; Lung Transplantation ; Male ; Middle Aged ; Retrospective Studies ; Surgeons ; Treatment Outcome
Language	English
Publishing date	2022-09-01
Publishing country	England
Document type	Journal Article
ZDB-ID	2227224-0
ISSN	1749-8090 ; 1749-8090
ISSN (online)	1749-8090
ISSN	1749-8090
DOI	10.1186/s13019-022-01943-2
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Article ; Online: Impact of coronavirus 2019 (COVID-19) on training and well-being in subspecialty surgery: A national survey of cardiothoracic trainees in the United Kingdom.

Caruana, Edward J / Patel, Akshay / Kendall, Simon / Rathinam, Sridhar

The Journal of thoracic and cardiovascular surgery

2020 Volume 160, Issue 4, Page(s) 980–987

Abstract: Objectives: The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of ... ...

Abstract	Objectives: The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity. We sought to establish the impact of the COVID-19 pandemic on the well-being, practice, and progression of all trainees in cardiothoracic surgery in the United Kingdom. Methods: A 31-item questionnaire was designed, validated, and disseminated via e-mail and an instant-messaging platform. Results: In total, 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programs nationally; 48 (63%) and 24 (32%) were concerned about their physical and mental health, respectively, 25 (33%) had taken time off work due to COVID-19, 65 (86%) had treated patients with COVID-19, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time, 41 (54%) remain concerned about personal protective equipment provision at their institution, 42 (55%) had been redeployed to cover other specialties, and 23 (30%) had encountered ethical dilemmas related to care of patients. There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction), and operating theaters (78% reduction). In total, 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time. Conclusions: The duration and impact of the current pandemic is, as yet, uncertain. Timely sharing of experiences, concerns, and expectations will inform health care and education policy and influence practice in the pandemic era and beyond.
MeSH term(s)	Adult ; Attitude of Health Personnel ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/therapy ; Coronavirus Infections/transmission ; Education, Medical, Graduate ; Humans ; Occupational Health ; Occupational Stress/diagnosis ; Occupational Stress/etiology ; Occupational Stress/psychology ; Pandemics ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/therapy ; Pneumonia, Viral/transmission ; SARS-CoV-2 ; Students, Medical/psychology ; Surgeons/psychology ; Surveys and Questionnaires ; Thoracic Surgery/education ; United Kingdom
Keywords	covid19
Language	English
Publishing date	2020-06-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	3104-5
ISSN	1097-685X ; 0022-5223
ISSN (online)	1097-685X
ISSN	0022-5223
DOI	10.1016/j.jtcvs.2020.05.052
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Article ; Online: Role of vitamin D supplementation in modifying outcomes after surgery: a systematic review of randomised controlled trials.

Patel, Akshay / Caruana, Edward J / Hodson, James / Morrison, Rory / Khor, Bo / Gysling, Savannah / Trevis, Jason / Mangel, Tobin / Benson, Ruth / Zakeri, Roxanna / Manders, Jennifer / Vaja, Ricky / Rogers, Luke / Baker, Paul / Pournaras, Dimitri J / Thickett, David / Hewison, Martin / Naidu, Babu / Lim, Eric

BMJ open

2024 Volume 14, Issue 1, Page(s) e073431

Abstract: Background: There is increasing evidence to suggest vitamin D plays a role in immune and vascular function; hence, it may be of biological and clinical relevance for patients undergoing major surgery. With a greater number of randomised studies being ... ...

Abstract	Background: There is increasing evidence to suggest vitamin D plays a role in immune and vascular function; hence, it may be of biological and clinical relevance for patients undergoing major surgery. With a greater number of randomised studies being conducted evaluating the impact of vitamin D supplementation on surgical patients, it is an opportune time to conduct further analysis of the impact of vitamin D on surgical outcomes. Methods: MEDLINE, EMBASE and the Cochrane Trials Register were interrogated up to December 2023 to identify randomised controlled trials of vitamin D supplementation in surgery. The risk of bias in the included studies was assessed using the Cochrane Risk of Bias tool. A narrative synthesis was conducted for all studies. The primary outcome assessed was overall postoperative survival. Results: We screened 4883 unique studies, assessed 236 full-text articles and included 14 articles in the qualitative synthesis, comprising 1982 patients. The included studies were highly heterogeneous with respect to patient conditions, ranging from open heart surgery to cancer operations to orthopaedic conditions, and also with respect to the timing and equivalent daily dose of vitamin D supplementation (range: 0.5-7500 mcg; 20-300 000 IU). No studies reported significant differences in overall survival or postoperative mortality with vitamin D supplementation. There was also no clear evidence of benefit with respect to overall or intensive care unit length of stay. Discussion: Numerous studies have reported the benefits of vitamin D supplementation in different surgical settings without any consistency. However, this systematic review found no clear evidence of benefit, which warrants the supposition that a single biological effect of vitamin D supplementation does not exist. The observed improvement in outcomes in low vitamin D groups has not been convincingly proven beyond chance findings. Trial registration number: CRD42021232067.
MeSH term(s)	Humans ; Dietary Supplements ; Randomized Controlled Trials as Topic ; Vitamin D/therapeutic use ; Vitamins/therapeutic use
Chemical Substances	Vitamin D (1406-16-2) ; Vitamins
Language	English
Publishing date	2024-01-17
Publishing country	England
Document type	Systematic Review ; Journal Article
ZDB-ID	2599832-8
ISSN	2044-6055 ; 2044-6055
ISSN (online)	2044-6055
ISSN	2044-6055
DOI	10.1136/bmjopen-2023-073431
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Article: Hybrid video-assisted thoracoscopic surgery lobectomy and en-bloc chest wall resection for non-small cell lung cancer.

Caruana, Edward J / Solli, Pierogiorgio / Coonar, Aman S

Journal of thoracic disease

2016 Volume 8, Issue 9, Page(s) E935–E937

Abstract: Chest wall invasion is seen in 5% to 8% of patients presenting with lung cancer. We report a case of complete resection of a 14 cm × 9 cm pT3N0M0 squamous cell carcinoma arising from the right lower lobe and invading the lower chest wall posteriorly, in ... ...

Abstract	Chest wall invasion is seen in 5% to 8% of patients presenting with lung cancer. We report a case of complete resection of a 14 cm × 9 cm pT3N0M0 squamous cell carcinoma arising from the right lower lobe and invading the lower chest wall posteriorly, in a 75 years old male, via a hybrid thoracoscopic [video-assisted thoracoscopic surgery (VATS)] approach. Following conventional VATS lobectomy, a targeted 10 cm incision was performed to allow wide resection of the 7
Language	English
Publishing date	2016-07-04
Publishing country	China
Document type	Case Reports
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd.2016.08.24
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Article: Impact of Covid-19 on training and wellbeing in subspecialty surgery: a national survey of cardiothoracic trainees in the United Kingdom

Caruana, Edward J. / Patel, Akshay / Kendall, Simon / Rathinam, Sridhar

Journal of Thoracic and Cardiovascular Surgery

Abstract: OBJECTIVES: The Covid-19 pandemic has overwhelmed healthcare systems and disrupted routine care internationally Healthcare workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity ...

Abstract	OBJECTIVES: The Covid-19 pandemic has overwhelmed healthcare systems and disrupted routine care internationally Healthcare workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity We sought to establish the impact of the Covid-19 pandemic on the wellbeing, practice and progression of all trainees in cardiothoracic surgery in the United Kingdom METHODS: A 31-item questionnaire was designed, validated, and disseminated via email and an instant-messaging platform RESULTS: 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programmes nationally 48 (63%) and 24 (32%) were concerned about their physical and mental health respectively 25 (33%) had taken time off work due to Covid-19 65 (86%) had treated Covid-19 patients, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time 41 (54%) remain concerned about PPE provision at their institution 42 (55%) had been redeployed to cover other specialties 23 (30%) had encountered ethical dilemmas related to care of patients There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction) and operating theatres (78% reduction) 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time CONCLUSIONS: The duration and impact of the current pandemic is, as yet, uncertain Timely sharing of experiences, concerns and expectations will inform healthcare and education policy, and influence practice in the pandemic era and beyond
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #823363
Database	COVID19

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Article: Impact of coronavirus 2019 (COVID-19) on training and well-being in subspecialty surgery: A national survey of cardiothoracic trainees in the United Kingdom

Caruana, Edward J / Patel, Akshay / Kendall, Simon / Rathinam, Sridhar

J Thorac Cardiovasc Surg

Abstract: OBJECTIVES: The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of ... ...

Abstract	OBJECTIVES: The coronavirus 2019 (COVID-19) pandemic has overwhelmed health care systems and disrupted routine care internationally. Health care workers face disruption to their work routines and professional development, as well as an elevated risk of infection and morbidity. We sought to establish the impact of the COVID-19 pandemic on the well-being, practice, and progression of all trainees in cardiothoracic surgery in the United Kingdom. METHODS: A 31-item questionnaire was designed, validated, and disseminated via e-mail and an instant-messaging platform. RESULTS: In total, 76 (of 118, 64%) cardiothoracic surgical trainees responded, representing all training grades and programs nationally; 48 (63%) and 24 (32%) were concerned about their physical and mental health, respectively, 25 (33%) had taken time off work due to COVID-19, 65 (86%) had treated patients with COVID-19, 36 of whom (55%) were wearing satisfactory personal protective equipment at the time, 41 (54%) remain concerned about personal protective equipment provision at their institution, 42 (55%) had been redeployed to cover other specialties, and 23 (30%) had encountered ethical dilemmas related to care of patients. There was a significant impact on time spent in outpatient clinics (44% reduction), multidisciplinary team meetings (79% reduction), and operating theaters (78% reduction). In total, 67 (88%) of respondents were concerned about the impact on their training, and 54 (71%) felt that the deviation may require an extension in their planned training time. CONCLUSIONS: The duration and impact of the current pandemic is, as yet, uncertain. Timely sharing of experiences, concerns, and expectations will inform health care and education policy and influence practice in the pandemic era and beyond.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #625190
Database	COVID19

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