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Darbyshire AR, Kostakis I, Meredith P, Kovacs C, Prytherch D, Briggs J, Toh S. Operative and non-operative management for intestinal emergencies: findings from a single-centre retrospective cohort study. Ann R Coll Surg Engl 2023. [PMID: 38037957 DOI: 10.1308/rcsann.2023.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Patients with an intestinal emergency who do not have surgery are poorly characterised. This study used electronic healthcare records to provide a rapid insight into the number of patients admitted with an intestinal emergency and compare short-term outcomes for non-operative and operative management. METHODS A single-centre retrospective cohort study was conducted at a tertiary NHS hospital (from 1 December 2013 to 31 January 2020). Patients were identified using diagnosis codes for intestinal emergencies, based on the inclusion criteria for the National Emergency Laparotomy Audit. Relevant data were extracted from electronic healthcare records (n=3,997). RESULTS Nearly half of patients admitted with an intestinal emergency received nonoperative management (43.7%). Of those who underwent surgery, 63.7% were started laparoscopically. The non-operative group had a shorter hospital stay (median: 5.4 days vs 8.2 days [started laparoscopically] or 16.8 days [started open]) and fewer unintended intensive care admissions than the surgical group (2.4% vs 8.7% [started laparoscopically] 21.1% [started open]). However, 30-day mortality for non-operative treatment was double that for surgery (22.4% vs 10.1%). The 30-day mortality rate was found to be even higher for non-operative management (50.3%) compared with surgery (19.5%) in a sub-analysis of patients with admission National Early Warning Score ≥4 (n=683). CONCLUSION The proportion of patients with intestinal emergencies who do not have surgery is greater than expected, and it appears that many respond well to non-operative treatment. However, 30-day mortality for non-operative management was high, and the low number of admissions to intensive care suggests that major invasive treatment was not appropriate for most in this group.
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Affiliation(s)
| | - I Kostakis
- Portsmouth Hospitals University NHS Trust, UK
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK
| | - P Meredith
- Portsmouth Hospitals University NHS Trust, UK
| | - C Kovacs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK
| | - D Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK
| | - J Briggs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK
| | - Skc Toh
- Portsmouth Hospitals University NHS Trust, UK
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Darbyshire AR, Kostakis I, Briggs J. Early warning scores to assess risk before emergency laparotomy: a reply. Anaesthesia 2023; 78:1303. [PMID: 37387194 DOI: 10.1111/anae.16083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/01/2023]
Affiliation(s)
- A R Darbyshire
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - I Kostakis
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - J Briggs
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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Darbyshire AR, Kostakis I, Meredith P, Toh SKC, Prytherch D, Briggs J. Novel predictors of mortality in emergency bowel surgery: a single-centre cohort study. Anaesthesia 2023; 78:561-570. [PMID: 36723442 DOI: 10.1111/anae.15966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2022] [Indexed: 02/02/2023]
Abstract
Pre-operative risk stratification is a key part of the care pathway for emergency bowel surgery, as it facilitates the identification of high-risk patients. Several novel risk scores have recently been published that are designed to identify patients who are frail or significantly unwell. They can also be calculated pre-operatively from routinely collected clinical data. This study aimed to investigate the ability of these scores to predict 30-day mortality after emergency bowel surgery. A single centre cohort study was performed using our local data from the National Emergency Laparotomy Audit database. Further data were extracted from electronic hospital records (n = 1508). The National Early Warning Score, Laboratory Decision Tree Early Warning Score and Hospital Frailty Risk Score were then calculated. The most abnormal National or Laboratory Decision Tree Early Warning Score in the 24 or 72 h before surgery was used in analysis. Individual scores were reasonable predictors of mortality (c-statistic 0.699-0.740) but all were poorly calibrated. A National Early Warning Score ≥ 4 was associated with a high overall mortality rate (> 10%). A logistic regression model was developed using age, National Early Warning Score, Laboratory Decision Tree Early Warning Score and Hospital Frailty Risk Score as predictor variables, and its performance compared with other established risk models. The model demonstrated good discrimination and calibration (c-statistic 0.827) but was marginally outperformed by the National Emergency Laparotomy Audit score (c-statistic 0.861). All other models compared performed less well (c-statistics 0.734-0.808). Pre-operative patient vital signs, blood tests and markers of frailty can be used to accurately predict the risk of 30-day mortality after emergency bowel surgery.
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Affiliation(s)
- A R Darbyshire
- Department of General Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - I Kostakis
- Research Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - P Meredith
- Research Department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - S K C Toh
- Department of General Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - D Prytherch
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK
| | - J Briggs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, UK
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Chatzimavroudis G, Kotoreni G, Kostakis I, Voloudakis N, Christoforidis E, Papaziogas B. Outcomes of posterior component separation with transversus abdominis release (TAR) in large and other complex ventral hernias: a single-surgeon experience. Hernia 2021; 26:1275-1283. [PMID: 34668108 DOI: 10.1007/s10029-021-02520-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Over the last years, great advances in the repair of abdominal wall hernias have dramatically improved patients' outcomes. Especially for large and other complex ventral hernias, the application of component separation techniques has been a landmark in their successful management. The aim of this study is to present our experience with the posterior component separation with transversus abdominis release (TAR) in patients with these demanding ventral hernias. METHODS A retrospective analysis of prospectively collected data of all patients who underwent elective ventral hernia repair with TAR between January 2016 and December 2019 was performed. Preoperative, intraoperative, and postoperative data were analyzed. RESULTS A total of 125 patients with large and other complex ventral hernias were included in the final analysis. More than 80% of patients had one or more comorbidities. Of all patients, 116 (92.8%) had a history of previous abdominal surgery, 27 (21.6%) had a history of SSI and nine (7.2%) had active fistulas. Postoperatively, SSOs were presented in 11 patients (8.8%), including three cases of SSI. Neither mesh infection occurred, nor mesh excision required. With a mean follow-up of 2.5 years, only one recurrence was observed. CONCLUSIONS With a wound complication rate of less than 9% and a recurrence rate of less than 1%, our results show that TAR is a reliable, safe and effective technique for the repair of massive and other complex ventral hernias. The combination of knowledge of the abdominal wall anatomy at a proficient level, proper training, and adoption of a strict prehabilitation program are considered prerequisites for the successful management of such demanding hernias.
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Affiliation(s)
- G Chatzimavroudis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece. .,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece.
| | - G Kotoreni
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece.,Complex Hernia and Abdominal Wall Reconstruction Center, European Interbalkan Medical Center, Thessaloniki, Greece
| | - I Kostakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - N Voloudakis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - E Christoforidis
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - B Papaziogas
- 2nd Surgical Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, G. Gennimatas General Hospital, Thessaloniki, Greece
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Darbyshire AR, Kostakis I, Pucher PH, Toh S, Mercer SJ. The impact of laparoscopy on emergency surgery for adhesional small bowel obstruction: prospective single centre cohort study. Ann R Coll Surg Engl 2021; 103:255-262. [PMID: 33682461 DOI: 10.1308/rcsann.2020.7079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Laparoscopic adhesiolysis is increasingly being used to treat adhesional small bowel obstruction (ASBO) as it has been associated with reduced postoperative length of stay (LOS) and faster recovery. However, concerns regarding limited working space, iatrogenic bowel injury and failure to relieve the obstruction have limited its uptake. This study reports our centre's experience of adopting laparoscopy as the standard operative approach. METHODS A single-centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; January 2015 to December 2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and inhospital outcomes data were compared between different surgical approaches. Linear regression analysis was performed for LOS. RESULTS A total of 299 cases were identified. Overall, 76.3% of cases were started laparoscopically and 52.2% were completed successfully. Patients treated laparoscopically had lower Portsmouth - Physiological and Operative Severity Score for the enuMeration of Mortality and morbidity (P-POSSUM) predicted mortality (median 2.1 (interquartile range (IQR) 1.3-5.0) vs 5.7 (IQR 2.0-12.4), p=<0.001) and shorter postoperative LOS compared with open (median 4.2 days (IQR 2.5-8.2) vs 11.3 days (IQR 7.3-16.6), p=0.000). Inhospital mortality was lower in the laparoscopic group (2 vs 7 deaths, p=<0.001). In regression analysis, laparoscopic surgery was found to have the strongest association with postoperative LOS (β -8.51 (-13.87 to -3.16) p=0.002) compared with open surgery. CONCLUSIONS Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is associated with reduced LOS with no impact on complications or mortality.
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Affiliation(s)
| | | | - P H Pucher
- Portsmouth Hospitals University NHS Trust, UK
| | - Skc Toh
- Portsmouth Hospitals University NHS Trust, UK
| | - S J Mercer
- Portsmouth Hospitals University NHS Trust, UK
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Orkney A, Platt T, Narayanaswamy BE, Kostakis I, Bouman HA. Bio-optical evidence for increasing Phaeocystis dominance in the Barents Sea. Philos Trans A Math Phys Eng Sci 2020; 378:20190357. [PMID: 32862820 PMCID: PMC7481673 DOI: 10.1098/rsta.2019.0357] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Increasing contributions of prymnesiophytes such as Phaeocystis pouchetii and Emiliania huxleyi to Barents Sea (BS) phytoplankton production have been suggested based on in situ observations of phytoplankton community composition, but the scattered and discontinuous nature of these records confounds simple inference of community change or its relationship to salient environmental variables. However, provided that meaningful assessments of phytoplankton community composition can be inferred based on their optical characteristics, ocean-colour records offer a potential means to develop a synthesis between sporadic in situ observations. Existing remote-sensing algorithms to retrieve phytoplankton functional types based on chlorophyll-a (chl-a) concentration or indices of pigment packaging may, however, fail to distinguish Phaeocystis from other blooms of phytoplankton with high pigment packaging, such as diatoms. We develop a novel algorithm to distinguish major phytoplankton functional types in the BS and apply it to the MODIS-Aqua ocean-colour record, to study changes in the composition of BS phytoplankton blooms in July, between 2002 and 2018, creating time series of the spatial distribution and intensity of coccolithophore, diatom and Phaeocystis blooms. We confirm a north-eastward expansion in coccolithophore bloom distribution, identified in previous studies, and suggest an inferred increase in chl-a concentrations, reported by previous researchers, may be partly explained by increasing frequencies of Phaeocystis blooms. This article is part of the theme issue 'The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.
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Affiliation(s)
- A. Orkney
- Department of Earth Sciences, University of Oxford, 3 South Parks Road, Oxford OX1 3AN, UK
- e-mail:
| | - T. Platt
- Plymouth Marine Laboratory, Prospect Place, Plymouth PL1 3DH, UK
| | - B. E. Narayanaswamy
- Scottish Association for Marine Science, Scottish Marine Institute, Oban PA37 1QA, UK
| | - I. Kostakis
- School of Computing, University of Portsmouth, Portsmouth PO1 3HE, UK
- Physics Department, University of Strathclyde, Glasgow G4 ONG, UK
| | - H. A. Bouman
- Department of Earth Sciences, University of Oxford, 3 South Parks Road, Oxford OX1 3AN, UK
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Kostakis I, Röttgers R, Orkney A, Bouman HA, Porter M, Cottier F, Berge J, McKee D. Development of a bio-optical model for the Barents Sea to quantitatively link glider and satellite observations. Philos Trans A Math Phys Eng Sci 2020; 378:20190367. [PMID: 32862821 PMCID: PMC7481666 DOI: 10.1098/rsta.2019.0367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
A bio-optical model for the Barents Sea is determined from a set of in situ observations of inherent optical properties (IOPs) and associated biogeochemical analyses. The bio-optical model provides a pathway to convert commonly measured parameters from glider-borne sensors (CTD, optical triplet sensor-chlorophyll and CDOM fluorescence, backscattering coefficients) to bulk spectral IOPs (absorption, attenuation and backscattering). IOPs derived from glider observations are subsequently used to estimate remote sensing reflectance spectra that compare well with coincident satellite observations, providing independent validation of the general applicability of the bio-optical model. Various challenges in the generation of a robust bio-optical model involving dealing with partial and limited quantity datasets and the interpretation of data from the optical triplet sensor are discussed. Establishing this quantitative link between glider-borne and satellite-borne data sources is an important step in integrating these data streams and has wide applicability for current and future integrated autonomous observation systems. This article is part of the theme issue 'The changing Arctic Ocean: consequences for biological communities, biogeochemical processes and ecosystem functioning'.
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Affiliation(s)
- I. Kostakis
- Physics Department, University of Strathclyde, Glasgow, UK
- e-mail:
| | - R. Röttgers
- Remote Sensing Department, Helmholtz-Zentrum Geesthacht, Geesthacht, Germany
| | - A. Orkney
- Department of Earth Sciences, University of Oxford, Oxford, UK
| | - H. A. Bouman
- Department of Earth Sciences, University of Oxford, Oxford, UK
| | - M. Porter
- Scottish Association for Marine Science, Oban, UK
| | - F. Cottier
- Scottish Association for Marine Science, Oban, UK
- Department Arctic and Marine biology, Faculty for Bioscience, Fisheries and Economy, UiT The Arctic University of Norway, Tromsø, Norway
| | - J. Berge
- Department Arctic and Marine biology, Faculty for Bioscience, Fisheries and Economy, UiT The Arctic University of Norway, Tromsø, Norway
- Department of Arctic Biology, University Center on Svalbard, Longyearbyen, Norway
- Department of Biology, NTNU AMOS—Center of Autonomous Marine Operations and Systems, Norwegian University of Technology and Science, Trondheim, Norway
| | - D. McKee
- Physics Department, University of Strathclyde, Glasgow, UK
- Department Arctic and Marine biology, Faculty for Bioscience, Fisheries and Economy, UiT The Arctic University of Norway, Tromsø, Norway
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Tsoukalas N, Aravantinou E, Tsapakidis K, Giaginis C, Tolia M, Binas I, Baxevanos P, Galanopoulos M, Kiakou M, Kostakis I, Nikolaou C, Litos I, Liontos M, Tsiambas E, Gioulbasanis I, Sfiniadakis I, Karameris A, Kyrgias G, Theocharis S, Tsiatas M. Clinical significance of RCAS1 and CD3 expression in non-small cell lung cancers in immunotherapy era. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Tsapakidis K, Tsoukalas N, Giaginis C, Gioulbasanis I, Tolia M, Aravantinou E, Galanopoulos M, Kiakou M, Kostakis I, Litos I, Liontos M, Sogka E, Tzouda V, Liaskonis K, Theocharis S. Systematic inflammation and histologic grade in non-small cell lung carcinoma. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx380.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Korogiannos A, Aravantinou-Fatorou E, Papadopoulos V, Kamposioras K, Kostakis I, Lazaridis G, Nikolaou M, Voulgaris E, Bournakis E, Chatzifoti N, Zaxaropoulou P, Tsoukalas N. 1235 Education and career development in oncology: Results from a european survey conducted by the Hellenic Group of Young Oncologists (HEGYO). Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30539-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Michailidou M, Giannouli V, Kostakis I, Kotsikoris V, Marakos P, Pouli N, Loutrari H. Novel pyrazolopyrimidine derivatives inhibit angiogenesis and tumor growth in a mouse Lewis lung carcinoma model. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv098.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kostakis I, Ghirtis K, Pouli N, Marakos P, Skaltsounis AL, Leonce S, Caignard DH, Atassi G. Synthesis and cytotoxic activity of 2-dialkylaminoethylamino substituted xanthenone and thioxanthenone derivatives. Farmaco 2000; 55:455-60. [PMID: 11204746 DOI: 10.1016/s0014-827x(00)00068-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The synthesis and biological evaluation of some new pyranoxanthenones and pyranothioxanthenones, substituted with flexible amino side-chains, and their evaluation as potential antitumor agents is described. The cytotoxic activity of the compounds and their eventual selective effect on a phase of the cell cycle were evaluated in vitro, using the murine lymphocytic L1210 leukemia cell line. The new aminoderivatives exhibited highly potent cytotoxicity against the leukemia L1210 cell line when compared to acronycine. All the compounds induced a partial accumulation of cells in the G2 + M phase of the cell cycle.
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Affiliation(s)
- I Kostakis
- University of Athens, Department of Pharmacy, Greece
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