The Impact of Pre-Operative Biologic Therapy on Post-Operative Surgical Outcomes in Ulcerative Colitis – A Systematic Review and Meta-Analysis
Jasmine Zanelli | University of Warwick
Biologic therapy has emerged as an effective modality amongst the medical treatment options available for ulcerative colitis (UC). However, its impact on post-operative care in patients with UC is still up for debate.
This review attempted to evaluate the risk of having post-operative complications following biologic therapy in patients with UC.
A systematic search of the relevant databases was conducted with the aim of identifying studies which compared the post-operative complication rates of UC patients, who were either exposed or not exposed to a biologic therapy, prior to their surgery. Outcomes of interest included both the infectious and the total complication rates. Pooled odds-ratios and 95% confidence intervals were calculated.
19 studies, reviewing a total of 12,308 patients with UC, were included in the meta-analysis. 2199 of those had had an exposure to a biologic therapy prior to surgery. The pooled OR for the infectious complications and the total complications were 0.95 (95% CI 0.62-1.45) and 1.14 (95% CI 1.04-1.28) respectively, which suggests that there was no significant association between the pre-operative biologic therapy and post-operative infectious or total complications. Moreover, the duration between the last dose of biologic therapy and surgery did not influence the risk of having a post-operative infection.
This meta-analysis suggests that the pre-operative biologic therapy does not increase the overall risk of having a post-operative infection or any complication. Being on biologic therapy should not delay an abdominal surgery in patients with ulcerative colitis.
Changes to Surgical Procedure in COVID-Positive and Suspected Patients
Joshua Clayton | Swansea University
The last few days have seen the dissemination of the infection disease known as COVID-19, with confirmed cases climbing daily. Having spread rapidly to all corners of the globe this virus can lead to respiratory distress and even failure (1). Despite being unprepared for an outbreak of this magnitude, healthcare professionals have been quick to implement a series of measure to reduce infection rates (2).
Due to the changes in normal operating procedure during this trying time, a number of surgical specialties have laid out a series of guidelines regarding changes in elective operating procedures. As such the European journal of Trauma and emergency medicine (3) have produced a series of recommendations for preparing staff for operating in the current climate. These recommendations have been subdivided into 8 sections:
1) General recommendations.
2) Operating on COVID positive patients.
3) Operating theatre set up.
4) The transport of COVID positive patients.
5) Surgical staff preparation, including the use of personal protective equipment.
6) Considerations taken into account with regards to the anaesthesia used.
7) Surgical approach.
8) Case completion and post-operative care.
Today’s clinicians will be leading the way within the pandemic. With everyday life being drastically changed we must maintain the standards that are expected for patients and uphold safety standards staff require. Due the unprecedented times we have been forced to learn from our experiences and others, ensuring that we limit the speed and maximise our ability to treat patients with COVID-19.
Get into The Digital Age: A Patient Satisfaction Survey Investigating Pre- and Post-Operative Information Provision in Lower Limb Surgery
Maxwell Renna | University of Warwick
Planned lower limb surgery is common, with over 90,000 hip and 95,000 knee replacements performed in the UK yearly. Patient satisfaction is an important element of healthcare provision, usually measured by functional outcomes but influenced by many other factors. Few studies have assessed patients’ views on the information given to them pertaining surgery and patients are infrequently consulted when designing information packs which can lead to confusion during the recovery period and poorer long-term outcomes. We aimed to assess if patients were satisfied with the information they received around their operations and identify potential improvements.
Set in a major trauma centre in the West Midlands, a survey was administered to patients who used the orthopaedic service over the course of one month. Surveys were designed in Qualtrics and administered face-to-face on paper. Thematic content analysis was performed.
Eighty patients completed the survey, of which 88.8% of patients were satisfied with the information they received. Discussions with surgeons were the most useful resource and 53% of patients requested more internet resources. Post-operative patients more likely to be dissatisfied with information provision. Over 20% of patients requested more information on post-op pain and recovery timelines.
Although patients were generally satisfied, areas for change were identified. Suggested improvements take the form of webpages, a mobile platform or forum for asking healthcare professionals questions. Extra resources could contain educational videos, patient experiences and an interactive recovery timeline. These suggestions may enable NHS Trusts to “get into the digital age”.