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Article ; Online: Impact of COVID-19 on vascular patients worldwide: analysis of the COVIDSurg data.

Hitchman, Louise / Machin, Matthew

2022 Volume 62, Issue 6, Page(s) 558–570

Abstract: Background: The COVIDSurg collaborative was an international multicenter prospective analysis of perioperative data from 235 hospitals in 24 countries. It found that perioperative COVID-19 infection was associated with a mortality rate of 24%. At the ... ...

Abstract	Background: The COVIDSurg collaborative was an international multicenter prospective analysis of perioperative data from 235 hospitals in 24 countries. It found that perioperative COVID-19 infection was associated with a mortality rate of 24%. At the same time, the COVER study demonstrated similarly high perioperative mortality rates in vascular surgical patients undergoing vascular interventions even without COVID-19, likely associated with the high burden of comorbidity associated with vascular patients. This is a vascular subgroup analysis of the COVIDSurg cohort. Methods: All patients with a suspected or confirmed diagnosis of COVID-19 in the 7 days prior to, or in the 30 days following a vascular procedure were included. The primary outcome was 30-day mortality. Secondary outcomes were pulmonary complications (adult respiratory distress syndrome, pulmonary embolism, pneumonia and respiratory failure). Logistic regression was undertaken for dichotomous outcomes. Results: Overall, 602 patients were included in this subgroup analysis, of which 88.4% were emergencies. The most common operations performed were for vascular-related dialysis access procedures (20.1%, N.=121). The combined 30-day mortality rate was 27.2%. Composite secondary pulmonary outcomes occurred in half of the vascular patients (N.=275, 45.7%). Conclusions: Mortality following vascular surgery in COVID positive patients was significantly higher than levels reported pre-pandemic, and similar to that seen in other specialties in the COVIDSurg cohort. Initiatives and surgical pathways that ensure vascular patients are protected from exposure to COVID-19 in the peri-operative period are vital to protect against excess mortality.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; COVID-19/diagnosis ; COVID-19/mortality ; COVID-19/therapy ; Child ; Child, Preschool ; Female ; Global Health/trends ; Humans ; Infant ; Male ; Middle Aged ; Outcome and Process Assessment, Health Care/trends ; Patient Safety ; Prospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; Vascular Diseases/diagnosis ; Vascular Diseases/mortality ; Vascular Diseases/surgery ; Vascular Surgical Procedures/adverse effects ; Vascular Surgical Procedures/mortality ; Vascular Surgical Procedures/trends ; Young Adult
Language	English
Publishing date	2022-01-15
Publishing country	Italy
Document type	Journal Article ; Multicenter Study ; Observational Study
ZDB-ID	80143-4
ISSN	1827-191X ; 0021-9509
ISSN (online)	1827-191X
ISSN	0021-9509
DOI	10.23736/S0021-9509.21.12024-5
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Article ; Online: Extracorporeal Shockwave for Intermittent Claudication and Quality of Life: A Randomized Clinical Trial.

Cai, Paris / Pymer, Sean / Ibeggazene, Said / Raza, Ali / Hitchman, Louise / Chetter, Ian / Smith, George

JAMA surgery

2024

Abstract: Importance: Intermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed.: Objective: To assess extracorporeal corporeal shockwave therapy in ...

Abstract	Importance: Intermittent lower limb claudication limits function and quality of life. Supervised exercise programs are not readily available, and a noninvasive alternative is needed. Objective: To assess extracorporeal corporeal shockwave therapy in improving quality of life in patients with claudication. Design, setting, and participants: In this double-blind, placebo-controlled randomized clinical trial, patients in the outpatient setting at a single tertiary center for vascular surgery were randomized in a 1:1 ratio to extracorporeal shockwave therapy or placebo therapy with no shockwaves delivered. Recruitment was between June 2015 and January 2020, with 12-week follow-up ending in March 2020. A convenience sample of patients with claudication and conservative treatment requirements who refused or were unable to participate in supervised exercise were eligible. Patients receiving anticoagulation therapy or with an active cancer were excluded. Of 522 patients screened, 389 were eligible, 138 were enrolled, and 110 completed follow-up and were included in the primary analysis. Statistical analysis was completed by May 2021. Intervention: In the intervention group, patients received 100 impulses of 0.1mJ/mm/cm2 in an area of the gastrocnemius muscle 3 times weekly for 3 weeks. The steps for treatment were replicated for the control group without delivering the treatment. Main outcomes and measures: The primary outcome was the Physical Functioning domain of the 36-item Short-Form Quality of Life Questionnaire at 12-week follow-up. Secondary outcomes included walking distances, ankle brachial pressure index, and other quality-of-life measures. Results: Of 138 patients recruited and randomized, 92 (67%) were male, and the mean (SD) age of the study population was 67 (9.6) years. The intervention group had a significantly higher physical function score at 12 weeks (estimated median difference 3.8; 95% CI, 0.0-7.7; P = .03). However, this significance did not remain when adjusting for covariates. At 12 weeks, the intervention group had significantly longer pain-free and maximum walking distances (pain-free estimated median difference, 34.1, 95% CI, 11.4-56.8; P = .004; maximum estimated median difference, 51.4; 95% CI, 10.7-86.5; P = .01). Conclusions and relevance: To our knowledge, this is the first double-blind, placebo-controlled, randomized clinical trial to consider extracorporeal shockwave therapy for the management of intermittent claudication. It demonstrated efficacy for walking distances, may have a positive effect on quality of life, and may provide a safe, noninvasive alternative therapy for patients with intermittent claudication. Trial registration: ClinicalTrials.gov Identifier: NCT02652078.
Language	English
Publishing date	2024-04-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2701841-6
ISSN	2168-6262 ; 2168-6254
ISSN (online)	2168-6262
ISSN	2168-6254
DOI	10.1001/jamasurg.2024.0625
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Article: Telemedicine for sustainable postoperative follow-up: a prospective pilot study evaluating the hybrid life-cycle assessment approach to carbon footprint analysis.

Lathan, Ross / Hitchman, Louise / Walshaw, Josephine / Ravindhran, Bharadhwaj / Carradice, Daniel / Smith, George / Chetter, Ian / Yiasemidou, Marina

Frontiers in surgery

2024 Volume 11, Page(s) 1300625

Abstract: Introduction: Surgical site infections (SSI) are the most common healthcare-associated infections; however, access to healthcare services, lack of patient awareness of signs, and inadequate wound surveillance can limit timely diagnosis. Telemedicine as ... ...

Abstract	Introduction: Surgical site infections (SSI) are the most common healthcare-associated infections; however, access to healthcare services, lack of patient awareness of signs, and inadequate wound surveillance can limit timely diagnosis. Telemedicine as a method for remote postoperative follow-up has been shown to improve healthcare efficiency without compromising clinical outcomes. Furthermore, telemedicine would reduce the carbon footprint of the National Health Service (NHS) through minimising patient travel, a significant contributor of carbon dioxide equivalent (CO Methods: Patients who underwent a lower limb vascular procedure were reviewed remotely at 30 days following the surgery, with a combined outcome measure (photographs and Bluebelle Wound Healing Questionnaire). A hybrid life-cycle assessment approach to carbon footprint analysis was used. The kilograms of carbon dioxide equivalent (kgCO Results: Altogether 31 patients (M:F 2.4, ±11.7 years) were included. The median return distance for patient travel was 42.5 (7.2-58.7) km. Median reduction in emissions using remote follow-up was 41.2 (24.5-80.3) kgCO Discussion: This model shows that the hybrid life-cycle assessment approach is achievable and reproducible. Implementation of an asynchronous digital follow-up model is effective in substantially reducing the carbon footprint of a tertiary vascular surgical centre. Further work is needed to corroborate these findings on a larger scale, quantify the impact of telemedicine on patient's quality of life, and incorporate kgCO
Language	English
Publishing date	2024-03-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2024.1300625
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Article ; Online: Protocol: The role of defunctioning stoma prior to neoadjuvant therapy for locally advanced colonic and rectal cancer-A systematic review.

Mesri, Mina / Hitchman, Louise / Yiaesemidou, Marina / Quyn, Aaron / Jayne, David / Chetter, Ian

PloS one

2022 Volume 17, Issue 9, Page(s) e0275025

Abstract: Defunctioning stomas (ileostomy and colostomy) may be used prior to commencement of neoadjuvant therapy in patients with locally advanced colon or rectal cancer, in order to prevent clinical large bowel obstruction caused by radiotherapy associated ... ...

Abstract	Defunctioning stomas (ileostomy and colostomy) may be used prior to commencement of neoadjuvant therapy in patients with locally advanced colon or rectal cancer, in order to prevent clinical large bowel obstruction caused by radiotherapy associated oedema or progression of disease in patients who are not obstructed. However, the exact rate of clinical obstruction in patients undergoing neoadjuvant therapy who do not receive a defunctioning stoma is not known. Furthermore, it is not clear which factors predispose patients to developing clinical large bowel obstruction. Given that defunctioning stomas are associated with post operative and intra-operative risks, it is not currently possible to tailor defunctioning stomas to patients who have the greatest risk of developing obstruction. This systematic review which is in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA), aims to define the role of defunctioning stomas in prevention of obstruction patients with locally advanced colon or rectal cancer while undergoing neoadjuvant therapy. Two researchers will perform the literature search which will include all published and "in process" articles published in the English language between 2002-2022 in the following databases: EMBASE (OVID), MEDLINE (EBSCO), CINHAL complete, Web of Science, Cochrane Central Registry of Controlled Trials, Clinical Trials Registry. The full text of the selected articles will be independently screened by two researchers against the inclusion criteria. Data will be extracted from each article regarding: study design, participants, type of intervention and outcomes. The effect size will be expressed in incidence rates and when appropriate in relative risk with 95% confidence intervals. If possible, we will perform a meta-analysis. Heterogeneity will be assessed using I2 statistics. We will pool the data extracted from the randomised controlled trials to perform a meta-analysis using the Review Manager 5 software (RevMan 5). The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system will be used to assess the certainty of the evidence.
MeSH term(s)	Anastomosis, Surgical/adverse effects ; Colon/surgery ; Humans ; Meta-Analysis as Topic ; Neoadjuvant Therapy ; Rectal Neoplasms/surgery ; Surgical Stomas/adverse effects ; Systematic Reviews as Topic
Language	English
Publishing date	2022-09-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	2267670-3
ISSN	1932-6203 ; 1932-6203
ISSN (online)	1932-6203
ISSN	1932-6203
DOI	10.1371/journal.pone.0275025
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Article ; Online: Extracorporeal shockwave therapy compared with standard care for diabetic foot ulcer healing: An updated systematic review.

Hitchman, Louise / Totty, Joshua / Smith, George E / Carradice, Daniel / Twiddy, Maureen / Iglesias, Cynthia / Russell, David / Chetter, Ian C

International wound journal

2022 Volume 20, Issue 6, Page(s) 2303–2320

Abstract: Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched for ... ...

Abstract	Emerging evidence suggests that extracorporeal shockwave therapy (ESWT) may improve time to DFU healing. The aim of this review was to appraise the evidence on role of ESWT in DFU healing and impact of different ESWT doses. Databases were searched for trials comparing ESWT plus standard care to standard care alone in participants with DFUs. Search results were reviewed by two independent reviewers. The Cochrane Risk of Bias 2 tool and GRADE approach was used to assess bias and certainty. The primary outcome was time to healing. The search identified 345 papers after duplicates removed. Six trials consisting of 471 participants were included. There was unclear or high risk of bias across all domains. Time to ulcer healing was probably shorter in patients treated with ESWT compared with standard ulcer care alone (GRADE: low certainty). Patients treated with ESWT were more likely to heal at 20 weeks post-ESWT compared with those treated with standard ulcer care alone (GRADE: low certainty). There was significant heterogeneity. ESWT remains a promising new treatment but the translation into routine clinical practice is still limited by the low certainty of evidence surrounding its effectiveness, case selection and optimum dose.
MeSH term(s)	Humans ; Diabetic Foot/therapy ; Extracorporeal Shockwave Therapy/methods ; Treatment Outcome ; Wound Healing ; Diabetes Mellitus
Language	English
Publishing date	2022-12-03
Publishing country	England
Document type	Systematic Review ; Journal Article ; Review
ZDB-ID	2170920-8
ISSN	1742-481X ; 1742-4801
ISSN (online)	1742-481X
ISSN	1742-4801
DOI	10.1111/iwj.14035
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Article: PRESS survey: PREvention of surgical site infection-a global pan-specialty survey of practice protocol.

Heinz, J / Walshaw, J / Kwan, J Y / Long, J / Carradice, D / Totty, J / Kontouli, K M / Lainas, P / Hitchman, L / Smith, G / Huo, B / Guadalajara, H / Garcia-Olmo, D / Sharma, D / Biyani, C S / Tomlinson, J / Loubani, M / Galli, R / Lathan, R /

Chetter, I / Yiasemidou, M

Frontiers in surgery

2023 Volume 10, Page(s) 1251444

Abstract: Background: Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different ... ...

Abstract	Background: Surgical site infections (SSI) complicate up to 40% of surgical procedures, leading to increased patient morbidity and mortality. Previous research identified disparities in SSI prevention guidelines and clinical practices across different institutions. The study aims to identify variations in SSI prevention practices within and between specialties and financial systems and provide a representation of existing SSI preventative measures to help improve the standardization of SSI prevention practices. Methods: This collaborative cross-sectional survey will be aimed at pan-surgical specialties internationally. The study has been designed and will be reported in line with the CROSS and CHERRIES standards. An international study steering committee will design and internally validate the survey in multiple consensus-based rounds. This will be based on SSI prevention measures outlined in the CDC (2017), WHO (2018), NICE (2019), Wounds UK (2020) and the International Surgical Wound Complications Advisory Panel (ISWCAP) guidelines. The questionnaire will include demographics, SSI surveillance, preoperative, peri-operative and postoperative SSI prevention. Data will be collected on participants' surgical specialty, operative grade, of practice and financial healthcare system of practice. The online survey will be designed and disseminated using Qualtrics Discussion: Current SSI prevention practice in UK Vascular surgery varies considerably, with little consensus on many measures. Given the inconsistency in guidelines on how to prevent SSIs, there is a need for standardization. This survey will investigate the disparity in SSI preventative measures between different surgical fields and countries.
Language	English
Publishing date	2023-09-25
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2773823-1
ISSN	2296-875X
ISSN	2296-875X
DOI	10.3389/fsurg.2023.1251444
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Article: Rotational vertebral artery occlusion secondary to completely extraosseous vertebral artery.

Rendon, Rachel / Mannoia, Kristyn / Reiman, Steven / Hitchman, Louise / Shutze, William

Journal of vascular surgery cases and innovative techniques

2018 Volume 5, Issue 1, Page(s) 14–17

Abstract: Rotational vertebral artery (VA) occlusion is a possible cause of reduced blood flow through the posterior circulation of the brain due to compression of the VA on head turning when blood flow from the contralateral VA is compromised. When compression ... ...

Abstract	Rotational vertebral artery (VA) occlusion is a possible cause of reduced blood flow through the posterior circulation of the brain due to compression of the VA on head turning when blood flow from the contralateral VA is compromised. When compression occurs in the V2 segment of the VA, it is usually due to compression from the longus colli muscle or cervical osteophytes. We present a unique case of a patient with a completely extraosseous course of the V2 segment of her dominant right VA that resulted in symptomatic rotational VA occlusion.
Language	English
Publishing date	2018-12-31
Publishing country	United States
Document type	Case Reports
ISSN	2468-4287
ISSN	2468-4287
DOI	10.1016/j.jvscit.2018.09.006
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Article ; Online: A prospective observational cohort study of concomitant versus sequential phlebectomy for tributary varicosities following axial mechanochemical ablation.

Mohamed, Abduraheem / Leung, Clement / Hitchman, Louise / Wallace, Tom / Smith, George / Carradice, Daniel / Chetter, Ian

Phlebology

2019 Volume 34, Issue 9, Page(s) 627–635

MeSH term(s)	Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Postoperative Complications/prevention & control ; Prospective Studies ; Quality of Life ; Thrombophlebitis/prevention & control ; Varicose Veins/therapy ; Vascular Surgical Procedures
Language	English
Publishing date	2019-03-13
Publishing country	England
Document type	Clinical Trial ; Comparative Study ; Journal Article ; Observational Study
ZDB-ID	645172-x
ISSN	1758-1125 ; 0268-3555
ISSN (online)	1758-1125
ISSN	0268-3555
DOI	10.1177/0268355519835625
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Article ; Online: Compliance with NICE guidelines when commissioning varicose vein procedures.

Carradice, D / Forsyth, J / Mohammed, A / Leung, C / Hitchman, L / Harwood, A E / Wallace, T / Smith, G E / Campbell, B / Chetter, I

BJS open

2018 Volume 2, Issue 6, Page(s) 419–425

Abstract: Background: Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning ...

Abstract	Background: Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168. Methods: Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes. Results: Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated. Discussion: The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.
Language	English
Publishing date	2018-08-29
Publishing country	England
Document type	Journal Article
ISSN	2474-9842
ISSN (online)	2474-9842
DOI	10.1002/bjs5.95
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Article ; Online: Editor's Choice - Systematic Review and Meta-Analysis of Wound Adjuncts for the Prevention of Groin Wound Surgical Site Infection in Arterial Surgery.

Gwilym, Brenig L / Dovell, George / Dattani, Nikesh / Ambler, Graeme K / Shalhoub, Joseph / Forsythe, Rachael O / Benson, Ruth A / Nandhra, Sandip / Preece, Ryan / Onida, Sarah / Hitchman, Louise / Coughlin, Patrick / Saratzis, Athanasios / Bosanquet, David C

European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery

2021 Volume 61, Issue 4, Page(s) 636–646

Abstract: Objective: Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to ... ...

Abstract	Objective: Groin incision surgical site infections (SSIs) following arterial surgery are common and are a source of considerable morbidity. This review evaluates interventions and adjuncts delivered immediately before, during, or after skin closure, to prevent SSIs in patients undergoing arterial interventions involving a groin incision. Data sources: MEDLINE, EMBASE, and CENTRAL databases were searched. Review methods: This review was undertaken according to established international reporting guidelines and was registered prospectively with the International prospective register of systematic reviews (CRD42020185170). The MEDLINE, EMBASE, and CENTRAL databases were searched using pre-defined search terms without date restriction. Randomised controlled trials (RCTs) and observational studies recruiting patients with non-infected groin incisions for arterial exposure were included; SSI rates and other outcomes were captured. Interventions reported in two or more studies were subjected to meta-analysis. Results: The search identified 1 532 articles. Seventeen RCTs and seven observational studies, reporting on 3 747 patients undergoing 4 130 groin incisions were included. A total of seven interventions and nine outcomes were reported upon. Prophylactic closed incision negative pressure wound therapy (ciNPWT) reduced groin SSIs compared with standard dressings (odds ratio [OR] 0.34, 95% CI 0.23 - 0.51; p < .001, GRADE strength of evidence: moderate). Local antibiotics did not reduce groin SSIs (OR 0.60 95% CI 0.30 - 1.21 p = .15, GRADE strength: low). Subcuticular sutures (vs. transdermal sutures or clips) reduced groin SSI rates (OR 0.33, 95% CI 0.17 - 0.65, p = .001, GRADE strength: low). Wound drains, platelet rich plasma, fibrin glue, and silver alginate dressings did not show any significant effect on SSI rates. Conclusion: There is evidence that ciNPWT and subcuticular sutures reduce groin SSI in patients undergoing arterial vascular interventions involving a groin incision. Local antibiotics did not reduce groin wound SSI, although the strength of this evidence is lower. No other interventions demonstrated a significant effect.
MeSH term(s)	Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/adverse effects ; Arteries/surgery ; Groin/blood supply ; Humans ; Negative-Pressure Wound Therapy/adverse effects ; Observational Studies as Topic ; Randomized Controlled Trials as Topic ; Risk Assessment ; Risk Factors ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/microbiology ; Surgical Wound Infection/prevention & control ; Suture Techniques/adverse effects ; Treatment Outcome ; Vascular Surgical Procedures/adverse effects
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-01-07
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	1225869-6
ISSN	1532-2165 ; 1078-5884
ISSN (online)	1532-2165
ISSN	1078-5884
DOI	10.1016/j.ejvs.2020.11.053
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