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  1. Article ; Online: Loss of muscle mass in the immediate post-operative period is associated with inadequate dietary protein and energy intake.

    Hardy, E J / Deane, C S / Lund, J N / Phillips, B E

    European journal of clinical nutrition

    2023  Volume 77, Issue 4, Page(s) 503–505

    Abstract: Despite the implementation of 'Enhanced Recovery After Surgery' (ERAS) protocols, major abdominal surgery is still associated with significant and detrimental losses of muscle mass and function in the post-operative period. Although ERAS protocols ... ...

    Abstract Despite the implementation of 'Enhanced Recovery After Surgery' (ERAS) protocols, major abdominal surgery is still associated with significant and detrimental losses of muscle mass and function in the post-operative period. Although ERAS protocols advocate both early mobility and dietary intake, dietary composition in the immediate post-operative period is poorly characterised, despite muscle losses being greatest in this period. Herein, we show in 15 patients (66 ± 6 y, 12:3 M:F) who lost ~10% m. vastus lateralis muscle mass in the 5 days after open colorectal resective surgery, mean energy intake was only ~25% of the minimum ESPEN recommendation of 25 kcal/kg/d and daily dietary protein intake was only ~12% of the ESPEN recommended guidelines of 1.5 g/kg/d. Given the known importance of nutrition for muscle mass maintenance, innovative dietary interventions are needed in the immediate post-operative period, accounting for specific patient dietary preference to maximise compliance (e.g., soft-textured foods).
    MeSH term(s) Humans ; Dietary Proteins ; Energy Intake ; Nutritional Status ; Diet ; Muscles
    Chemical Substances Dietary Proteins
    Language English
    Publishing date 2023-01-26
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 639358-5
    ISSN 1476-5640 ; 0954-3007
    ISSN (online) 1476-5640
    ISSN 0954-3007
    DOI 10.1038/s41430-023-01264-0
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  2. Article ; Online: The Impact of Surgeon Speciality Interest on Outcomes of Emergency Laparotomy in IBD.

    Bunce, J A / Doleman, B / Lund, J N / Tierney, G M

    World journal of surgery

    2023  Volume 47, Issue 9, Page(s) 2287–2295

    Abstract: Introduction: Emergency laparotomy may be required in patients with inflammatory bowel disease (IBD). NELA is the largest prospectively maintained database of adult emergency laparotomies in England and Wales and includes clinical urgency of the cases. ... ...

    Abstract Introduction: Emergency laparotomy may be required in patients with inflammatory bowel disease (IBD). NELA is the largest prospectively maintained database of adult emergency laparotomies in England and Wales and includes clinical urgency of the cases. The impact of surgeon subspeciality on outcomes after emergency laparotomy for IBD is unclear. We have investigated this association, according to the degree of urgency in IBD emergency laparotomy, including the effect of minimally invasive surgery (MIS).
    Methods: Adults with IBD in the NELA database between 2013 and 2016 were included. Surgeon subspeciality was colorectal or non-colorectal. Urgencies are 'Immediate', '2-6 h', '6-18 h' and '18-24 h'. Logistic regression was used to investigate in-patient mortality and post-operative length of stay (LOS).
    Results: There was significantly reduced mortality and LOS in IBD patients who were operated on by a colorectal surgeon in the least urgent category of emergency laparotomies; Mortality adjusted OR 2.99 (CI 1.2-7.8) P = 0.025, LOS IRR 1.18 (CI 1.02-1.4) P = 0.025. This association was not seen in more urgent categories. Colorectal surgeons were more likely to use MIS, P < 0.001, and MIS was associated with decreased LOS in the least urgent cohort, P < 0.001, but not in the other urgencies.
    Conclusions: We found improved outcomes in the least urgent cohort of IBD emergency laparotomies when operated on by a colorectal surgeon in comparison to a non-colorectal general surgeon. In the most urgent cases, there was no benefit in the operation being performed by a colorectal surgeon. Further work on characterising IBD emergencies by urgency would be of value.
    MeSH term(s) Adult ; Humans ; Laparotomy ; Surgeons ; England ; Medical Audit ; Retrospective Studies
    Language English
    Publishing date 2023-05-24
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-023-07051-z
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  3. Article ; Online: A call for clarity: a scoping review of predictors of poor outcome after emergency abdominal surgery for inflammatory bowel disease.

    Bunce, J A / Wall, J J S / Lund, J N / Tierney, G M

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2023  Volume 25, Issue 12, Page(s) 2317–2324

    Abstract: Aim: The medical management of inflammatory bowel disease (IBD) is rapidly progressing; however, many patients with the disease still require surgery. Often this is done as an emergency. Initiatives such as the National Emergency Laparotomy Audit have ... ...

    Abstract Aim: The medical management of inflammatory bowel disease (IBD) is rapidly progressing; however, many patients with the disease still require surgery. Often this is done as an emergency. Initiatives such as the National Emergency Laparotomy Audit have shown how evidence-based emergency surgery improves outcomes for the patient. The aim of this scoping review is to describe the current evidence base on risk stratification in emergency abdominal surgery for IBD.
    Methods: A literature search, abstract and full paper screening resulted in 17 articles representing 63 472 patients from seven countries.
    Results: It is likely that age, the American Society of Anesthesiologists grade, comorbidity and organ dysfunction play a similar role in risk stratification in IBD patients as in other emergency abdominal surgery cohorts. However, the reporting of what is considered an IBD emergency is variable. Six studies include clear definitions of emergency in our study. The range of what is considered an emergency is within 12 h of admission to any time within an unplanned admission.
    Conclusion: To have data driven, evidence-based emergency surgical practice in IBD we need consistency of reporting, including the definitions of emergency and urgency. Core descriptor sets in IBD would be valuable.
    MeSH term(s) Humans ; Colitis, Ulcerative/surgery ; Inflammatory Bowel Diseases/surgery ; Laparotomy
    Language English
    Publishing date 2023-10-23
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.16783
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  4. Article ; Online: The evidence base for pilonidal sinus surgery is the pits.

    Brown, S R / Lund, J N

    Techniques in coloproctology

    2019  Volume 23, Issue 12, Page(s) 1173–1175

    MeSH term(s) Evidence-Based Medicine ; Humans ; Outcome Assessment, Health Care ; Pilonidal Sinus/classification ; Pilonidal Sinus/surgery ; Randomized Controlled Trials as Topic ; Recurrence ; Surgical Procedures, Operative/adverse effects ; Surgical Procedures, Operative/methods ; Surgical Wound Infection/etiology ; Wound Closure Techniques ; Wound Healing
    Language English
    Publishing date 2019-11-21
    Publishing country Italy
    Document type Journal Article ; Review
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-019-02116-5
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    Zs.A 5842: Show issues Location:
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  5. Article ; Online: Quantitative futility in emergency laparotomy: an exploration of early-postoperative death in the National Emergency Laparotomy Audit.

    Javanmard-Emamghissi, H / Doleman, B / Lund, J N / Frisby, J / Lockwood, S / Hare, S / Moug, S / Tierney, G

    Techniques in coloproctology

    2023  Volume 27, Issue 9, Page(s) 729–738

    Abstract: Background: Quantitative futility is an appraisal of the risk of failure of a treatment. For those who do not survive, a laparotomy has provided negligible therapeutic benefit and may represent a missed opportunity for palliation. The aim of this study ... ...

    Abstract Background: Quantitative futility is an appraisal of the risk of failure of a treatment. For those who do not survive, a laparotomy has provided negligible therapeutic benefit and may represent a missed opportunity for palliation. The aim of this study was to define a timeframe for quantitative futility in emergency laparotomy and investigate predictors of futility using the National Emergency Laparotomy Audit (NELA) database.
    Methods: A two-stage methodology was used; stage one defined a timeframe for futility using an online survey and steering group discussion; stage two applied this definition to patients enrolled in NELA December 2013-December 2020 for analysis. Futility was defined as all-cause mortality within 3 days of emergency laparotomy. Baseline characteristics of this group were compared to all others. Multilevel logistic regression was carried out with potentially clinically important predictors defined a priori.
    Results: Quantitative futility occurred in 4% of patients (7442/180,987). Median age was 74 years (range 65-81 years). Median NELA risk score was 32.4% vs. 3.8% in the surviving cohort (p < 0.001). Early mortality patients more frequently presented with sepsis (p < 0.001). Significant predictors of futility included age, arterial lactate and cardiorespiratory co-morbidity. Frailty was associated with a 38% increased risk of early mortality (95% CI 1.22-1.55). Surgery for intestinal ischaemia was associated with a two times greater chance of futile surgery (OR 2.67; 95% CI 2.50-2.85).
    Conclusions: Quantitative futility after emergency laparotomy is associated with quantifiable risk factors available to decision-makers preoperatively. These findings should be incorporated qualitatively by the multidisciplinary team into shared decision-making discussions with extremely high-risk patients.
    MeSH term(s) Humans ; Aged ; Aged, 80 and over ; Laparotomy/adverse effects ; Medical Futility ; Risk Factors ; Lactic Acid ; Databases, Factual ; Retrospective Studies
    Chemical Substances Lactic Acid (33X04XA5AT)
    Language English
    Publishing date 2023-01-07
    Publishing country Italy
    Document type Journal Article ; Comment
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02747-1
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    Zs.A 5842: Show issues Location:
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  6. Article ; Online: Beyond high-risk: analysis of the outcomes of extreme-risk patients in the National Emergency Laparotomy Audit.

    Javanmard-Emamghissi, H / Doleman, B / Lund, J N / Lockwood, S / Hare, S / Pearce, L / Moug, S / Tierney, G M

    Anaesthesia

    2023  Volume 78, Issue 11, Page(s) 1376–1385

    Abstract: Patients who require emergency laparotomy are defined as high risk if their 30-day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are ... ...

    Abstract Patients who require emergency laparotomy are defined as high risk if their 30-day predicted risk of mortality is ≥ 5%. Despite a large difference in the characteristics of patients with a mortality risk score of between 5% and 50%, these outcomes are aggregated by the National Emergency Laparotomy Audit (NELA). Our aim was to describe the outcomes of the cohort of patients at extreme risk of death, which we defined as having a NELA-predicted 30-day mortality of ≥ 50%. All patients enrolled in the NELA database between December 2012 and 2020 were included. We compared patient characteristics; length of hospital stay; rates of unplanned return to the operating theatre; and 90-day survival in extreme-risk groups (predicted ≥ 50%) and high-risk patients (predicted 5-49%). Of 161,337 patients, 5193 (3.2%) had a predicted mortality of ≥ 50%. When patients were further subdivided, 2437 (47%) had predicted mortality of 50-59% (group 50-59); 1484 (29%) predicted mortality of 60-69% (group 60-69); 840 (16%) predicted mortality of 70-79% (group 70-79); and 423 (8%) predicted mortality of ≥ 80% (group 80+). Extreme-risk patients were significantly more likely to have been admitted electively than high-risk patients (p < 0.001). Length of stay increased from a median (IQR [range]) of 26 (16-43 [0-271]) days in group 50-59 to 35 (21-56 [0-368]) days in group 80+, compared with 17 (10-30 [0-1136]) days for high-risk patients. Rates of unplanned return to the operating theatre were higher in extreme-risk groups compared with high-risk patients (11% vs. 8%). The 90-day survival was 43% in group 50-59, 34% in group 60-69, 27% in group 70-79 and 17% in group 80+. These data underscore the need for a differentiated approach when discussing risk with patients at extreme risk of mortality following an emergency laparotomy. Clinicians should focus on patient priorities on quantity and quality of life during informed consent discussions before surgery. Future work should extend beyond the immediate postoperative period to encompass the longer-term outcomes (survival and function) of patients who have emergency laparotomies.
    MeSH term(s) Humans ; Laparotomy ; Quality of Life ; Medical Audit ; Risk Factors ; Forecasting ; Retrospective Studies ; Emergencies
    Language English
    Publishing date 2023-09-29
    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.16130
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  7. Article ; Online: A systematic review of the impact of postoperative aerobic exercise training in patients undergoing surgery for intra-abdominal cancers.

    Paul, M / Smart, T F / Doleman, B / Toft, S / Williams, J P / Lund, J N / Phillips, B E

    Techniques in coloproctology

    2023  Volume 27, Issue 12, Page(s) 1169–1181

    Abstract: Introduction: Enhanced recovery after surgery (ERAS) programmes which advocate early mobility after surgery have improved immediate clinical outcomes for patients undergoing abdominal cancer resections with curative intent. However, the impact of ... ...

    Abstract Introduction: Enhanced recovery after surgery (ERAS) programmes which advocate early mobility after surgery have improved immediate clinical outcomes for patients undergoing abdominal cancer resections with curative intent. However, the impact of continued physical activity on patient-related outcomes and functional recovery is not well defined. The aim of this review was to assess the impact of postoperative aerobic exercise training, either alone or in conjunction with another exercise modality, on patients who have had surgery for intra-abdominal cancer.
    Methods: A literature search was performed of electronic journal databases. Eligible papers needed to report an outcome of aerobic capacity in patients older than 18 years of age, who underwent cancer surgery with curative intent and participated in an exercise programme (not solely ERAS) that included an aerobic exercise component starting at any point in the postoperative pathway up to 12 weeks.
    Results: Eleven studies were deemed eligible for inclusion consisting of two inpatient, one mixed inpatient/outpatient and eight outpatient studies. Meta-analysis of four outpatient studies, each reporting change in 6-min walk test (6MWT), showed a significant improvement in 6MWT with exercise (MD 74.92 m, 95% CI 48.52-101.31 m). The impact on health-related quality of life was variable across studies.
    Conclusion: Postoperative exercise confers benefits in improving aerobic function post surgery and can be safely delivered in various formats (home-based or group/supervised).
    MeSH term(s) Humans ; Infant ; Quality of Life ; Exercise ; Exercise Tolerance ; Inpatients ; Neoplasms
    Language English
    Publishing date 2023-08-07
    Publishing country Italy
    Document type Systematic Review ; Meta-Analysis ; Journal Article ; Review
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-023-02844-9
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  8. Article ; Online: Clinically significant reductions in morphine consumption need to take account of baseline risk: presentation of a novel meta-analysis methodology.

    Doleman, B / Lund, J N / Williams, J P

    British journal of anaesthesia

    2018  Volume 120, Issue 2, Page(s) 414–415

    MeSH term(s) Acute Pain ; Analgesics, Opioid ; Humans ; Morphine ; Pain, Postoperative ; Pregabalin
    Chemical Substances Analgesics, Opioid ; Pregabalin (55JG375S6M) ; Morphine (76I7G6D29C)
    Language English
    Publishing date 2018-01-08
    Publishing country England
    Document type Letter ; Comment
    ZDB-ID 80074-0
    ISSN 1471-6771 ; 0007-0912
    ISSN (online) 1471-6771
    ISSN 0007-0912
    DOI 10.1016/j.bja.2017.12.012
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  9. Article ; Online: Random duodenal biopsy to exclude coeliac disease as a cause of anaemia is not cost-efective and should be replaced with universally performed pre-endoscopy serology in patients on a suspected cancer pathway.

    Herrod, P J J / Lund, J N

    Techniques in coloproctology

    2018  Volume 22, Issue 2, Page(s) 121–124

    Abstract: Background: Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron deficiency anaemia remains a common procedure, but is expensive and time-consuming. Serological investigation for coeliac ...

    Abstract Background: Random duodenal biopsy to exclude coeliac disease during upper gastrointestinal endoscopy for the investigation of iron deficiency anaemia remains a common procedure, but is expensive and time-consuming. Serological investigation for coeliac disease is also recommended, having excellent accuracy with the added benefit of lower cost. This study sought to examine the utility of duodenal biopsy and coeliac serology in the diagnosis of coeliac disease.
    Methods: A prospectively maintained database was interrogated to identify all patients having upper gastrointestinal endoscopy for the investigation of anaemia between January 01, 2016, and December 31, 2016.
    Results: Of the 1131 patients having an endoscopy, coeliac serology was measured in only 412 (36%) and was positive in 9 cases (2%), leading to 6 histological diagnoses of coeliac disease and 3 false positives. Two-hundred and seventy-four patients with negative serology had biopsies taken which were all negative. Only 2/451 (0.4%) patients who had biopsies performed in the absence of a serology test were histologically positive for coeliac disease. The cost per diagnosis of a case of coeliac disease in those with either negative or absent coeliac serology was £18,839 (US$25,244, €21,196).
    Conclusions: Random duodenal biopsy is not a cost-effective method of diagnosing coeliac disease and should be replaced with pre-endoscopy coeliac serology.
    MeSH term(s) Anemia/diagnosis ; Anemia/etiology ; Biopsy/economics ; Biopsy/methods ; Celiac Disease/complications ; Celiac Disease/diagnosis ; Celiac Disease/pathology ; Cost-Benefit Analysis ; Databases, Factual ; Duodenum/pathology ; Duodenum/surgery ; Endoscopy, Gastrointestinal/economics ; Endoscopy, Gastrointestinal/methods ; False Positive Reactions ; Humans ; Prospective Studies ; Serologic Tests/economics ; Serologic Tests/methods
    Language English
    Publishing date 2018-02-23
    Publishing country Italy
    Document type Evaluation Studies ; Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-018-1756-7
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  10. Article ; Online: CT-derived measures of muscle quantity and quality predict poorer outcomes from elective colorectal surgery: a UK multicentre retrospective cohort study.

    Blackwell, J E M / Herrod, P J J / Doleman, B / Boyd-Carson, H / Dolan, D / Wheldon, L / Brown, S R / Banerjea, A / Moug, S / Lund, J N

    Techniques in coloproctology

    2023  Volume 27, Issue 11, Page(s) 1091–1098

    Abstract: Purpose: To assess whether preoperative radiologically defined lean muscle measures are associated with adverse clinical outcomes in patients undergoing elective surgery for colorectal cancer.: Methods: This retrospective UK-based multicentre data ... ...

    Abstract Purpose: To assess whether preoperative radiologically defined lean muscle measures are associated with adverse clinical outcomes in patients undergoing elective surgery for colorectal cancer.
    Methods: This retrospective UK-based multicentre data collection study identified patients having had colorectal cancer resection with curative intent between January 2013 to December 2016. Preoperative computed-tomography (CT) scans were used to measure psoas muscle characteristics. Clinical records provided postoperative morbidity and mortality data.
    Results: This study included 1122 patients. The cohort was separated into a combined group (patients with both sarcopenia and myosteatosis) and others group (either sarcopenia or myosteatosis, or neither). For the combined group, anastomotic leak was predicted on univariate (OR 4.1, 95% CI 1.43-11.79; p = 0.009) and multivariate analysis (OR 4.37, 95% CI 1.41-13.53; p = 0.01). Also for the combined group, mortality (up to 5 years postoperatively) was predicted on univariate (HR 2.41, 95% CI 1.64-3.52; p < 0.001) and multivariate analysis (HR 1.93, 95% CI 1.28-2.89; p = 0.002). A strong correlation exists between freehand-drawn region of interest-derived psoas density measurement and using the ellipse tool (R
    Conclusion: Measures of lean muscle quality and quantity, which predict important clinical outcomes, can be quickly and easily taken from routine preoperative imaging in patients being considered for colorectal cancer surgery. As poor muscle mass and quality are again shown to predict poorer clinical outcomes, these should be proactively targeted within prehabilitation, perioperative and rehabilitation phases to minimise negative impact of these pathological states.
    MeSH term(s) Humans ; Sarcopenia/diagnostic imaging ; Sarcopenia/etiology ; Retrospective Studies ; Colorectal Surgery ; Postoperative Complications/etiology ; Risk Factors ; Colorectal Neoplasms/diagnostic imaging ; Colorectal Neoplasms/surgery ; Psoas Muscles/diagnostic imaging ; Psoas Muscles/pathology ; Tomography, X-Ray Computed/methods ; United Kingdom ; Muscle, Skeletal/diagnostic imaging ; Muscle, Skeletal/pathology
    Language English
    Publishing date 2023-05-03
    Publishing country Italy
    Document type Multicenter Study ; Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-023-02769-3
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