The lessons of the National Confidential Enquiry into Perioperative Deaths

Ingram, Gabrielle

doi:10.1053/bean.1999.0028

Cited by 4 publications

(3 citation statements)

References 2 publications

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“…In surgery, the National Confidential Enquiry into Peri-Operative Deaths (N-CEPOD) addressed the issue of where a baseline for risk might lie (8,11). There are between 2.8 million and 3.3 million operations per year in England, Wales, and Northern Ireland.…”

Section: The High-risk Thoracic Surgical Patientmentioning

confidence: 99%

“…The risk of death within 30 days of any operation has been estimated at between 0.7% and 1.7%. The N-CEPOD enquiry also showed that as a group, surgeons did not identify one third of patients who died as being high-risk for peri-operative death, suggesting that our perception of what is "high-risk" is somewhat inaccurate (11). Boyd et al have intimated that high risk should be defined as an individual's risk of mortality is either >5% or twice the risk of the general population undergoing the same procedure (8).…”

Section: The High-risk Thoracic Surgical Patientmentioning

confidence: 99%

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Lung cancer resection in high-risk patients: a narrative review

Patel¹,

Bishay²,

Naidu³

2022

Shanghai Chest

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Background and Objective: The National Lung Cancer Audit (NLCA) 2022 report showed that for England in 2019, the curative treatment rates of non-small cell lung cancer (NSCLC) patients with stage I/II disease and good performance status were 81%, this metric fell to 73% in 2020 with resection rates falling from 20% to 15%. The impact of COVID-19 could well have influenced this and indeed lung cancer patients diagnosed in 2020 were more likely to have a worse performance status, diagnosed as emergency presentations and less likely to have a pathological diagnosis. Assessing risk in the current era and defining which patients are high-risk needs formal exploration and definition if we are to improve resection rates in a safe and equitable manner. Methods:We conducted a narrative literature review to explore the paradigm of risk in thoracic surgery and in particular address the concept of what is considered to be "high risk" for surgery. We searched MEDLINE, EMBASE and Cochrane Library databases using the OVID interface. We reviewed articles between January 1, 2000, and December 31, 2021 and restricted this to full text papers only in the English language. Conference abstracts were not considered.

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Section: The High-risk Thoracic Surgical Patientmentioning

confidence: 99%

Section: The High-risk Thoracic Surgical Patientmentioning

confidence: 99%

Lung cancer resection in high-risk patients: a narrative review

Patel¹,

Bishay²,

Naidu³

2022

Shanghai Chest

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“…Lucas and colleagues [15] developed the classification of caesarean delivery based on urgency approved by the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of Anaesthetists in the UK after it was developed further into the most consistent method recommended by National Confidential Enquiry into Perioperative Deaths [16].…”

Section: Classification Of Caesarean Sectionmentioning

confidence: 99%

Caesarean Section in Low-, Middle- and High-Income Countries

Byamugisha¹,

Adroma²

2020

Recent Advances in Cesarean Delivery

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Caesarean section (CS) refers to delivery of a foetus through surgical incisions made through abdominal and uterine walls. It's a life-saving procedure when complications arise during pregnancy. It may be an emergency or a planned procedure. Although desirable, CS may be medically unnecessary. CS is a major procedure associated with imme diate and long-term maternal and perinatal risks and may have implications for future pregnancies. Since 1985, international healthcare community considers ideal rate for CS to be 10-15%. However, in the last decade, there has been concern about the rising rates of CS from as low as 2% in Africa to as high as 50-60% in Dominican Republic and Latin America. To this effect, there have been attempts to regulate the rates, and the Ten Group Classification System under the Robson criteria is such an attempt. CS rates are on the increase due to varying reasons ranging from patient, institutional, care provider and societal factors. There have been modifications in the CS technique and the drugs used postoperatively from Pitocin to addition of Misoprostol. Need has developed from Reproductive Health Specialists to review indications, rates and terminologies used and evaluate practices in low-, middle-and high-income countries regarding CS.

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Awake tracheal intubation with the intubating laryngeal mask in a patient with diffuse idiopathic skeletal hyperostosis

Palmer

Ball

2000

Anaesthesia

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SummaryDiffuse idiopathic skeletal hyperostosis, otherwise known as Forestier's disease or ankylosing hyperostosis, is a relatively common condition that is distinguished from ankylosing spondylitis by the relative preservation of spinal function and the characteristic 'candle flame' lipping of the vertebrae. We report a patient with this condition and a well-recorded history of impossible intubation who presented for emergency laparotomy. The patient was intubated awake using the intubating laryngeal mask and sedation and anaesthesia were provided by a target-controlled infusion of propofol. Awake fibreoptic intubation has become a key technique in dealing with the anticipated difficult intubation. The recent National Confidential Enquiry into Perioperative Deaths (NCEPOD) [1] has recommended that a fibrescope and personnel skilled in its use are available in all sites where anaesthesia is performed. However, fibreoptic intubation is not a panacea, and difficult fibreoptic intubation is an ever-present problem. The intubating laryngeal mask (ILM), a purpose designed modification of the familiar laryngeal mask airway with a curved steel inlet tube and integral introducing handle, has been used successfully to intubate the trachea in cases of fixed neck deformity [2]. We report its successful use in an awake patient, with diffuse idiopathic skeletal hyperostosis (DISH) and an acute abdominal emergency, in whom there was a recorded history of difficult fibreoptic intubation. Case historyA 48-year-old woman, BMI 34.2, complaining of diarrhoea, vomiting and lower abdominal pain, was presented for anaesthetic assessment and urgent laparotomy. She was reported by the surgical registrar as being 'an anaesthetic nightmare'. Previous medical history included endometriosis, low back pain, migraine and an alaplasty to enlarge her nares. Anaesthetic notes were available from 1994 and 1995 when she had laparoscopies. Three failed intubations were recorded. On one occasion anaesthesia had been abandoned, in another a laryngeal mask airway had been used to maintain the airway during surgery and in a third case an ENT consultant had used a fibrescope to intubate the trachea after induction of anaesthesia. This procedure had been reported as being extremely difficult. View at direct laryngoscopy had been graded as Cormack and Lehane IV by one anaesthetist and another had noted 'impossible direct laryngoscopy due to a small mouth, full set of teeth, large tonsils and a rigid cervical spine'.On examination she appeared well hydrated and, apart from a flushed appearance and a sinus tachycardia of 100 beat.min À1 , not unduly unwell. Examination of the airway revealed that she had a short neck with almost no extension and rotation limited to 30Њ in either direction. She had an interincisor gap of 31 mm, her modified Mallampati score was 4 and thyromental distance 5 cm (Fig. 1). She was hyperteloric and her posterior hairline was only 2.5 cm above the vertebra prominens. Lateral cervical spine radiographs showed a short cervical sp...

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The lessons of the National Confidential Enquiry into Perioperative Deaths

Cited by 4 publications

References 2 publications

Lung cancer resection in high-risk patients: a narrative review

Lung cancer resection in high-risk patients: a narrative review

Caesarean Section in Low-, Middle- and High-Income Countries

Awake tracheal intubation with the intubating laryngeal mask in a patient with diffuse idiopathic skeletal hyperostosis

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