East Cheshire NHS Trust runs Congleton War Memorial Hospital, Knutsford and District Community Hospital and Macclesfield District General Hospital, in Cheshire, England. It provides both acute hospital services and community services as is rated 'Good' by the Care Quality Commission (CQC), with the most recent inspection outcome announced in 2019.Macclesfield District General Hospital was purpose built in the early 1980s replacing a much older traditional infirmary. Congleton War Memorial Hospital opened in 1924, paid for by public subscription after years of fundraising by local people as a memorial to those who died in the first world war.In April 2012 it made an unsuccessful bid to become an NHS Foundation Trust. The Casualty Department in Macclesfield has been under threat for some years, but in August 2013 it was said to be under no immediate threat.The Trust had a contract with Arvato services for human resource services. 60 of the trust's staff were transferred to Arvato in 2013. In May 2016 Arvato said the contract was no longer commercially viable, demanding £2.4 million a year (more than double the contract price of £1.1 million a year) to continue after the end of the contractual period in April 2017. The contract is to be brought back in-house.The Trust gained a contract for sexual health services when Cheshire West and Chester Council decided to transfer it from Countess of Chester Hospital NHS Foundation Trust in December 2014.It spent £1.7 million on agency staff in 2014/5. In February 2016 it was expecting a deficit of £18.3 million for the year 2015/6.In July 2016 the board announced that it no longer believed the organisation is sustainable in its current form, forecasting a deficit in 2016/7 of £20m.The sustainability and transformation plan for Merseyside and Cheshire proposed to downgrade the emergency department at Macclesfield District General Hospital to a minor injuries and illnesses unit, but within a fortnight, after widespread opposition it was altered to read "“The clear view is that the best model of care will include an A&E department at Macclesfield staffed by hospital doctors and clinicians.”.
Abstract Aims In-hospital-appendicectomy-delays >24 hours from admission is believed to be associated with increased complications (perforations, SBO, SSI’s, collections) & mortality. Aim-of-study is to assess outcomes of in-hospital delayed (>24hrs) appendicectomy. Methods Cohort-study was carried-out from Jan’2020 to Jan’2026 at single-institution. Descriptive-demography & outcomes were-evaluated for in-hospital delayed-appendicectomies caried-out after-24hrs from-admission. Appendicectomies-carried-out within-24hrs of-admission were-controls. Results <24 hrs-appendicectomy(n=616) >24 hrs appendicectomy(n=276) Mann-Whitney-U test(p-value) Age(yrs) 35.9±0.8 36.0 ±1.3 NS Sex(M:F) 309:307 116:160 <0.05 BMI(kg/m2) 25.8±0.3 25.2±0.4 NS WCC(x109/L) 13.9±0.2 12.0±0.2 <0.0001 CRP(mg/L) 80.7±4.0 64.8±5.0 <0.01 Neut(x109/L) 11.3±0.2 9.6±0.2 <0.0001 Uncomplicated-AA (n) 270 144 <0.05 Complicated-AA (n) 346 132 <0.05 ASA 1±0.5 1±0.5 NS Clinical(n) 99 18 <0.05 USS-scan(n) 126 92 <0.005 CT-scan(n) 420 194 NS Op-time(mins) 73.8±1.2 76.9±2.2 NS LOS(days) 2±0.5 3±1 <0.0001 Inpatient-AB(days) 2±0.5 3±1 <0.0001 Discharge-AB(days) 3±2.5 0±2.5 <0.05 Complications (n) 20 17 NS Washout(n) 436 161 <0.005 Drain(n) 121 46 NS Conclusions In-hospital-delayed-appendectomy-cases had prolonged-inpatient-antibiotics, longer LOS. Urgency of surgical-intervention is dependent: pre-operative appendicitis classification: complicated appendicitis predominately performed as class 2 NCEPOD, whereas uncomplicated appendicitis carried out as NCEPOD class 3 (this was more apparent in appendectomies carried out after 24 hrs admission). Appendicectomy performed > 24 hours from admission were not associated with increased complication or mortality. Antibiotics is advocated at time of diagnosis as interim therapy until surgical intervention.
Abstract Aims Postoperative-ITU-support-in-CRC-resections reported <10% (11.9%-readmission & 10%-return-to-theatre: NBOCA-2025), serves critical tool for managing high-risk patients, reducing-mortality, & managing-severe-complications, comes with high-costs-&-resource-implications. Aim of study: review CRC-resections that-received-post-operate-ITU-care (direct & indirect ITU-transfers). Methods Cohort-study of CRC-resections that-received post-operative ITU-care from: -Jan’2007-to-Jan’2026 at single institution. INARC (intensive care national audit & research centre) ITU scores were used. CRC-resections not requiring ITU-care were controls. Results Direct-CRC(n=392) Indirect-CRC(n=76) non-ITU-CRC(n=1525) Kruskall-Wallis(p-value) ANOVA Age(yrs) 74.8±0.6 73.9±1.3 68.8 ± 0.3 <0.0001 Sex(M:F) 233:159 47:29 807:718 NS ASA 3±0.5 2±0.5 2±0 <0.0001 BMI(kg/m2) 27.5±0.3 27.6±0.7 26.3±0.2 <0.005 Laparoscopy(n) 189 38 981 <0.0001 Emergency(n) 131 21 277 < 0.0001 Op-time(mins) 200.1±4.8 170.3±8.8 170.9±2.2 <0.0001 LOS(days) 10±5.5 19±7 7±3.5 <0.0001 90-D-mortality(n) 44 16 59 <0.0001 ITU-stay(days) 2±0.5 4±2.5 Mann-Whitney-U<0.0001 APACHE-II 13.5±0.3 14.1±0.7 NS INARC-score(%) 10.1±0.5 13.1±0.7 <0.0001 INARC-mortality (%) 8.6±0.5 17.5±1.5 < 0.0001 Complications (n) AL 12 11 52 < 0.0001 POI 74 23 218 0.0002 HAP 52 28 122 < 0.0001 SSI’s 41 13 111 0.0022 Sepsis 46 8 66 < 0.0001 Survival Rate(%) 1styear 78.0 72.0 88.1 Logrank 5thyear 48.7 50.3 66.8 p = NS 10thyear 30.4 36.3 51.2 15thyear 15.4 27.1 35.6 Conclusion ITU-support occurred 23.5% CRC-resections: 83.8% direct-ITU & 16.2% indirect-ITU transfers. Factors affecting ITU-transfers: - emergency-surgery, patient-factors (multiple-comorbidity, high-ASA) & complexity-of-surgery (e.g prolonged-operations). ITU-care is limited-resource & costly. There is added benefit of direct-ITU-transfers, thereby reduces indirect-ITU transfers which is-associated with increased mortality & morbidity.
Lymphedema is usually approached as a survivorship complication; yet, many of the injuries that produce lymphatic failure begin during cancer treatment planning. Regional nodal irradiation, chemoradiation, lymph-node surgery, systemic therapy, obesity, infection history, and baseline lymphatic reserve can converge to produce chronic swelling, fibrosis, cellulitis risk, functional limitation, and an impaired quality of life. Despite this, lymphatic drainage pathways are rarely contoured, constrained, or prospectively monitored as organs at risk in radiotherapy practice. This commentary argues that the lymphatic system should enter radiotherapy-planning discussions as a candidate toxicity structure, while cautioning against premature universal dose constraints. Evidence signals are clinically meaningful but not yet protocol-defining: in the MA.20 breast cancer trial, regional nodal irradiation increased lymphedema from 4.5% to 8.4%; in nasopharyngeal carcinoma, mean doses of approximately 58.7 Gy to level IV and 58.6 Gy to levels I–VII were proposed as thresholds associated with moderate/severe facial lymphedema; and gynecological cancer studies report wide lower-limb lymphedema incidence ranges, with radiotherapy, lymphadenectomy, number of nodes removed, and body mass index repeatedly implicated as risk factors. The immediate priority is not mandatory lymphatic sparing, but lymphatic-aware planning: a baseline risk assessment, reproducible candidate contours, dose–volume reporting, selective sparing where oncologically safe, and prospective toxicity monitoring. The author proposed a framework to reflect this argument. Making lymphatic toxicity visible, measurable, and modelled may help shift lymphedema from an accepted late effect to a potentially preventable planning endpoint.
