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Sritharan R, Arya R, Abdelrahman A, Parmar S, Sharp I, Breeze J. Justifying the implementation of intraoperative computed tomography for midface fracture treatment in improving outcomes. Br J Oral Maxillofac Surg 2023; 61:315-319. [PMID: 37088595 DOI: 10.1016/j.bjoms.2023.03.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023]
Abstract
Intraoperative CT scanning is the international standard for treating midface fractures as it allows intraoperative assessment of reduction and fixation. To our knowledge, no NHS hospital in the UK has this facility yet due to the financial and logistical burden of its implementation. The aim of this study was to determine if complications including the requirement for a return to theatre (RTT) could have been predicted from the post-fixation CT scan. All treated midface fractures that had presented to a regionalised major trauma centre within two years (01 January 2020 - 31 December 2021) were identified. Those developing complications including RTT were determined. All postoperative CT scans (including those without complication or RTT) were re-analysed with the clinicians blinded to the outcomes to determine the positive predictive value (PPV) and negative predictive value (NPV) of requiring RTT to alter plate position intraoperatively based on CT scan alone. In all, there were eight episodes of unplanned return to theatre, resulting in an overall RTT rate of 8/119 (6.7%). When only analysing patients treated for orbital fractures this RTT rises to 8/40 (20%). Of those eight patients who had a postoperative CT and required RTT, this could have been predicted in 7/8 (87.5%). A total of 16/44 (36.4%) patients that did not have RTT would have additionally been recommended to have the plate position altered based on CT alone. Based upon those that had a CT, the PPV of CT alone being able to predict those requiring RTT was 40.6% and the NPV 96.2%. Our results would suggest intraoperative CT would likely have prevented eight patients requiring RTT in two years and could have improved outcomes in 16 cases. In preventing RTT as well as potentially improving the outcomes of a further 16 cases in maxillofacial surgery, the purchase of an intraoperative CT scanner could yield net savings of £75534-£114990 over two years.
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Affiliation(s)
- R Sritharan
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom.
| | - R Arya
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - A Abdelrahman
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - S Parmar
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - I Sharp
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - J Breeze
- Department of Oral & Maxillofacial Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2GW, United Kingdom; Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham B15 2TH, United Kingdom
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Zabel M, Schlögl S, Lubinski A, Svendsen JH, Bauer A, Arbelo E, Brusich S, Conen D, Cygankiewicz I, Dommasch M, Flevari P, Galuszka J, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Kenttä T, Kucejko T, Haarmann H, Harden M, Iovev S, Kääb S, Kaliska G, Katsimardos A, Kasprzak JD, Qavoq D, Lüthje L, Malik M, Novotný T, Pavlović N, Perge P, Röver C, Schmidt G, Shalganov T, Sritharan R, Svetlosak M, Sallo Z, Szavits-Nossan J, Traykov V, Vandenberk B, Velchev V, Vos MA, Willich SN, Friede T, Willems R, Merkely B, Sticherling C. Present criteria for prophylactic ICD implantation: Insights from the EU-CERT-ICD (Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators in EUrope) project. J Electrocardiol 2019; 57S:S34-S39. [PMID: 31526572 DOI: 10.1016/j.jelectrocard.2019.09.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/28/2019] [Accepted: 09/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. It is urgently needed to better identify patients who benefit from prophylactic ICD therapy. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU-CERT-ICD) completed in 2019 will assess this issue. SUMMARY The EU-CERT-ICD is a prospective investigator-initiated non-randomized, controlled, multicenter observational cohort study done in 44 centers across 15 European countries. A total of 2327 patients with heart failure due to ischemic heart disease or dilated cardiomyopathy indicated for primary prophylactic ICD implantation were recruited between 2014 and 2018 (>1500 patients at first ICD implantation, >750 patients non-randomized non-ICD control group). The primary endpoint was all-cause mortality, and first appropriate shock was co-primary endpoint. At baseline, all patients underwent 12‑lead ECG and Holter-ECG analysis using multiple advanced methods for risk stratification as well as documentation of clinical characteristics and laboratory values. The EU-CERT-ICD data will provide much needed information on the survival benefit of preventive ICD therapy and expand on previous prospective risk stratification studies which showed very good applicability of clinical parameters and advanced risk stratifiers in order to define patient subgroups with above or below average ICD benefit. CONCLUSION The EU-CERT-ICD study will provide new and current data about effectiveness of primary prophylactic ICD implantation. The study also aims for improved risk stratification and patient selection using clinical risk markers in general, and advanced ECG risk markers in particular.
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Affiliation(s)
- Markus Zabel
- Dept. of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.
| | - Simon Schlögl
- Dept. of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Andrzej Lubinski
- Dept. of Cardiology, Medical University of Lodz (MUL) WAM Hospital, Lodz, Poland
| | - Jesper Hastrup Svendsen
- Dept. of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Axel Bauer
- Dept. of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Germany
| | - Elena Arbelo
- IDIBAPS, Dept. of Cardiology, Hospital Clinic Barcelona, Spain
| | - Sandro Brusich
- Dept. of Cardiovascular Disease, KBC Rijeka, Rijeka, Croatia
| | - David Conen
- University Hospital, University of Basel, Switzerland; Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
| | - Iwona Cygankiewicz
- Dept. of Cardiology, Medical University of Lodz (MUL) CKD Hospital, Lodz, Poland
| | - Michael Dommasch
- Med. Klinik und Poliklinik I, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | - Panagiota Flevari
- 2nd Dept. of Cardiology, Attikon University Hospital, Athens, Greece
| | - Jan Galuszka
- Dept. of Cardiology, University Hospital, Olomouc, Czech Republic; Faculty of Medicine and Dentistry, Palacký University, Olomouc, Czech Republic
| | | | - Gerd Hasenfuß
- Dept. of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany; DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Robert Hatala
- Slovak Medical University, Bratislava, Slovakia; NUSCH, Bratislava, Slovakia
| | - Heikki V Huikuri
- Medical Research Center, Oulu University Hospital, Finland; University of Oulu, Finland
| | - Tuomas Kenttä
- Medical Research Center, Oulu University Hospital, Finland; University of Oulu, Finland
| | - Tomasz Kucejko
- Dept. of Cardiology, Medical University of Lodz (MUL) WAM Hospital, Lodz, Poland
| | - Helge Haarmann
- Dept. of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Markus Harden
- Dept. of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Svetoslav Iovev
- Dept. of Cardiology, St. Ekaterina University Hospital, Sofia, Bulgaria
| | - Stefan Kääb
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Jaroslaw D Kasprzak
- Chair and Dept. of Cardiology, Bieganski Hospital, Medical University of Lodz (MUL), Lodz, Poland
| | - Dariusz Qavoq
- Chair and Dept. of Cardiology, Bieganski Hospital, Medical University of Lodz (MUL), Lodz, Poland
| | - Lars Lüthje
- Dept. of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tomáš Novotný
- Dept. of Internal Medicine and Cardiology, University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Nikola Pavlović
- Dept. of Cardiology, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - Peter Perge
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Christian Röver
- Dept. of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Georg Schmidt
- Med. Klinik und Poliklinik I, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | | | - Rajeeva Sritharan
- Dept. of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Martin Svetlosak
- Slovak Medical University, Bratislava, Slovakia; NUSCH, Bratislava, Slovakia
| | - Zoltan Sallo
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Vassil Traykov
- Dept. of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | | | - Vasil Velchev
- Dept. of Cardiology, St. Anna Hospital, Sofia, Bulgaria
| | - Marc A Vos
- Dept. of Medical Physiology, University Medical Center Utrecht, Netherlands
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany; Dept. of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Rik Willems
- University Hospitals of Leuven, Leuven, Belgium
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Zabel M, Sticherling C, Willems R, Lubinski A, Bauer A, Bergau L, Braunschweig F, Brugada J, Brusich S, Conen D, Cygankiewicz I, Flevari P, Taborsky M, Hansen J, Hasenfuß G, Hatala R, Huikuri HV, Iovev S, Kääb S, Kaliska G, Kasprzak JD, Lüthje L, Malik M, Novotny T, Pavlović N, Schmidt G, Shalganov T, Sritharan R, Schlögl S, Szavits Nossan J, Traykov V, Tuinenburg AE, Velchev V, Vos MA, Willich SN, Friede T, Svendsen JH, Merkely B. Rationale and design of the EU-CERT-ICD prospective study: comparative effectiveness of prophylactic ICD implantation. ESC Heart Fail 2018; 6:182-193. [PMID: 30299600 PMCID: PMC6351896 DOI: 10.1002/ehf2.12367] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 08/30/2018] [Indexed: 01/10/2023] Open
Abstract
Aims The clinical effectiveness of primary prevention implantable cardioverter defibrillator (ICD) therapy is under debate. The EUropean Comparative Effectiveness Research to Assess the Use of Primary ProphylacTic Implantable Cardioverter Defibrillators (EU‐CERT‐ICD) aims to assess its current clinical value. Methods and results The EU‐CERT‐ICD is a prospective investigator‐initiated non‐randomized, controlled, multicentre observational cohort study performed in 44 centres across 15 European Union countries. We will recruit 2250 patients with ischaemic or dilated cardiomyopathy and a guideline indication for primary prophylactic ICD implantation. This sample will include 1500 patients at their first ICD implantation and 750 patients who did not receive a primary prevention ICD despite having an indication for it (non‐randomized control group). The primary endpoint is all‐cause mortality; the co‐primary endpoint in ICD patients is time to first appropriate shock. Secondary endpoints include sudden cardiac death, first inappropriate shock, any ICD shock, arrhythmogenic syncope, revision procedures, quality of life, and cost‐effectiveness. At baseline (and prior to ICD implantation if applicable), all patients undergo 12‐lead electrocardiogram (ECG) and Holter ECG analysis using multiple advanced methods for risk stratification as well as detailed documentation of clinical characteristics and laboratory values. Genetic biobanking is also organized. As of August 2018, baseline data of 2265 patients are complete. All subjects will be followed for up to 4.5 years. Conclusions The EU‐CERT‐ICD study will provide a necessary update about clinical effectiveness of primary prophylactic ICD implantation. This study also aims for improved risk stratification and patient selection using clinical and ECG risk markers.
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Affiliation(s)
- Markus Zabel
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | | | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Belgium
| | - Andrzej Lubinski
- Department of Cardiology, Medical University of Lodz (MUL) WAM Hospital, Lodz, Poland
| | - Axel Bauer
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - Leonard Bergau
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | | | - Josep Brugada
- IDIBAPS, Department of Cardiology, Hospital Clinic Barcelona, Barcelona, Spain
| | - Sandro Brusich
- Department of Cardiovascular Disease, KBC Rijeka, Rijeka, Croatia
| | - David Conen
- Department of Cardiology, University Hospital, Basel, Switzerland.,Population Health Research Institute, McMaster University, Hamilton, ON, Canada
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz (MUL), Lodz, Poland
| | - Panagiota Flevari
- 2nd Department of Cardiology, Attikon University Hospital, Athens, Greece
| | - Milos Taborsky
- Department of Cardiology, University Hospital, Olomouc, Czech Republic
| | | | - Gerd Hasenfuß
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany.,DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
| | - Robert Hatala
- Slovak Medical University NUSCH, Bratislava, Slovakia
| | - Heikki V Huikuri
- Medical Research Center, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Svetoslav Iovev
- Department of Cardiology, St. Ekaterina University Hospital, Sofia, Bulgaria
| | - Stefan Kääb
- Department of Cardiology, Klinikum Großhadern, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | | | - Jaroslaw D Kasprzak
- Chair and Department of Cardiology, Bieganski Hospital, Medical University of Lodz (MUL), Lodz, Poland
| | - Lars Lüthje
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Marek Malik
- National Heart and Lung Institute, Imperial College, London, UK
| | - Tomas Novotny
- Department of Internal Medicine and Cardiology, University Hospital Brno, Brno, Czech Republic
| | - Nikola Pavlović
- Department of Cardiology, KBC Sestre Milosrdnice, Zagreb, Croatia
| | - Georg Schmidt
- Med. Klinik und Poliklinik I, Technische Universität München, Klinikum rechts der Isar, Munich, Germany
| | | | - Rajeeva Sritharan
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | - Simon Schlögl
- Department of Cardiology and Pneumology, Heart Center, University Medical Center, Göttingen, Germany
| | | | - Vassil Traykov
- Department of Cardiology, Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria
| | - Anton E Tuinenburg
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Vasil Velchev
- Department of Cardiology, St. Anna Hospital, Sofia, Bulgaria
| | - Marc A Vos
- Department of Medical Physiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefan N Willich
- Institute for Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Tim Friede
- DZHK (German Center for Cardiovascular Research), partner site Göttingen, Göttingen, Germany.,Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Jesper Hastrup Svendsen
- Department of Cardiology, The Heart Centre, Rigshospitalet, Copenhagen University Hospital, and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Béla Merkely
- Department of Cardiology, Semmelweis University Heart Center, Budapest, Hungary
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