Morriston Hospital (Welsh: Ysbyty Treforys) is a 750-bed hospital located in Cwmrhydyceirw near Morriston in Swansea, Wales. It is managed by Swansea Bay University Health Board. Alongside its role as a district general hospital, Morriston is a teaching hospital for medical students of Swansea University Medical School.
Introduction To evaluate the association between interhospital transfer and postoperative mortality after emergency general surgery operations. Methods In compliance with Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement standards, a systematic review including random-effects meta-analysis was conducted. All adult patients undergoing emergency general surgery operations were eligible for inclusion. Interhospital transfer was the prognostic factor of interest and direct admission without transfer was the comparison. Postoperative mortality was the primary outcome and postoperative morbidity was the secondary outcome. Results Seven studies (n = 2,863,773) were included. Transferred patients were older (mean difference: 5.91 y, P = 0.010) and more patients in the transferred group were classed as American Society of Anesthesiologists ≥3 (odds ratio [OR]: 2.45, P < 0.001). Although transferred patients underwent more complex procedures such as small bowel resection (OR: 1.49, P = 0.002), colectomy (OR: 1.72, P = 0.002), and perforated peptic ulcer repair (OR: 1.69, P < 0.001), less complex operations such as appendicectomies (OR: 0.60, P = 0.003) were more common in the direct admission group. Pooled unadjusted 30-d mortality was significantly higher in transferred patients (OR: 2.55, P < 0.001) which persisted even after adjustment (OR: 1.26, P = 0.008). Interhospital transfer was associated with higher risk postoperative morbidity (unadjusted OR: 2.06, P = 0.0003; adjusted OR: 1.31, P = 0.003). Conclusions Interhospital transfer is associated with increased risks of postoperative mortality and morbidity in emergency general surgery and should be considered as a negative prognostic factor. The poor prognosis may be due to more severe disease, more complex operation, and transfer-related delays.
Background:Mastopexy is a technique that repositions the nipple-areolar complex to a more aesthetically desirable position within the profile of the breast. The BREAST-Q is a vital tool that can be used to assess patient-reported outcome measures (PROMs). Given the known importance of PROM following mastopexy surgery, we aim to provide a systematic review of the literature to summarize the available information and provide direction for further optimization of patient care and research. Methods:A systematic review was performed using the Ovid (MEDLINE/PubMed) database in accordance with the preferred reporting items for systematic reviews and meta-analyses checklist. The inclusion criteria comprise studies in the English language from 1976 to 2024, female patients only, and studies reporting patient satisfaction following mastopexy or augmentation mastopexy. Case reports, studies without validated PROMs, animal studies, conference proceedings, and bariatric patients were excluded. Risk of bias was assessed using the Critical Appraisal Skills Programme checklist. Results:A total of 10 studies qualified for qualitative synthesis of data, and meta-analysis was performed where possible. A total of 510 patients underwent mastopexy procedures. The mean ages across studies ranged from 31 to 54 years. Mean body mass index values were reported in 6 studies, ranging from 20 to 27 kg/m². The mean follow-up duration varied from 6 to 38 months. Inconsistent data across all studies significantly limited the meta-analysis. Conclusions:Mastopexy procedure leads to higher rates of patient satisfaction and quality of life. This analysis has highlighted the need for more consistent PROM reporting in mastopexy surgery.
To evaluate the effect of Enhanced Recovery After Surgery (ERAS) protocols on mortality and morbidity after trauma and non-trauma emergency laparotomies. A PRISMA-compliant meta-analysis using random-effects modelling was conducted. All studies comparing outcomes of ERAS with no ERAS in adult patients undergoing emergency laparotomies in either trauma or non-trauma settings were included. Thirty-day mortality and morbidity were the outcomes. Trauma and non-trauma patients were analysed separately. Nine studies comprising 707 patients were included (ERAS group: 336; no ERAS group: 371). The ERAS components were preoperative counselling in 67
BACKGROUND:Surgical ventricular reconstruction (SVR) is not always feasible in patients with ischaemic cardiomyopathy and left ventricular (LV) aneurysm, due to high surgical risk. The Revivent-TC Transcatheter Ventricular Enhancement System is a less invasive alternative option. METHODS:We conducted a systematic literature search using PubMed, Ovid Medline and Google Scholar between January 2013 up to May 2025 to assess the effectiveness and safety of Revivent-TC System. Inclusion criteria included symptomatic patients with ischaemic left ventricular (LV) systolic impairment and anterior or anteroseptal scar, with appropriate anatomy confirmed by cardiac magnetic resonance (CMR), who were treated with the device. Outcomes included echocardiographic parameters, procedural data, adverse events and survival. RESULTS:Eight studies (276 patients) were included: seven observational and the prospective non-randomised dual-arm ALIVE trial. Mean age was 61.8 years; 73% were male with LV ejection fraction (EF) ranging from 22.8% to 35.6%. Procedural success ranged from 96 to 100%, with procedure-related mortality of 2.5%. Conversion to full median sternotomy was required in 1.4% due to complications such as right ventricular (RV) perforation, acute mitral regurgitation and right ventricular (RV) failure. Surgical re-intervention was required in 4.3% of patients. Overall mortality during follow-up was 6.5%. Statistically significant improvement in LVEF and LV volumes was observed across observational studies, persisting up to 5 years post-operatively. Improvements in exercise tolerance, NYHA functional class and quality of life were also observed. However, the ALIVE trial did not demonstrate a significant clinical benefit over guideline-directed medical therapy (win ratio 1.13; p = 0.32), with cardiovascular mortality and HF hospitalisation numerically favouring the control group. CONCLUSIONS:The Revivent-TC system is associated with LV volume reduction and functional improvements in selected patients, offering a less invasive alternative to surgical ventricular reconstruction. However, the evidence base consists predominantly of small observational studies, and the only controlled trial did not demonstrate significant benefit on hard clinical endpoints. Longer-term randomised data, including a guideline-directed medical therapy comparator arm, are needed before definitive conclusions about efficacy can be drawn.
IntroductionAcross sub-Saharan Africa, there is a growing burden of vascular disease amid a paucity of training opportunities. In Kenya, most vascular care is delivered by cardiothoracic, general and orthopedic surgeons with limited access to specialist vascular training. We aim to build capacity to recognize, assess, and manage patients with foot sepsis and limb- or life-threatening vascular disease through structured fundamentals and advanced vascular skills courses supported by a network of local trainers to ensure long-term sustainability. Methods The inaugural Fundamentals in Vascular Surgery course was held in September 2024, followed in September 2025 by Advanced Skills in Vascular Surgery alongside the second “Fundamentals” course. Structured surveys were administered to participants in both years, with a 1-y follow-up survey distributed to the 2024 cohort to assess application of skills and longer-term impact. Results Fifty-six participants were trained across the three courses, with all courses oversubscribed. Faculty numbers increased through a faculty development scheme alongside new regional trainers from Ethiopia and South Africa. All participants rated the courses as relevant to their practice and would recommend them to colleagues. At 1-y follow-up, all respondents reported improved perceived ability to assess and manage urgent vascular presentations and to perform fasciotomies, minor, and major amputations. 91.7% had referred patients to a vascular surgeon; 33.3% attended the 2025 Advanced course, with the remainder planning to do so in the future. Conclusions The program has demonstrated sustained engagement, faculty growth, and oversubscription, underscoring unmet training needs. In collaboration with Surgical Society of Kenya, College of Surgeons of East, Central and Southern Africa, and Royal College of Surgeons, Edinburgh, these courses show potential to strengthen regional capacity in vascular surgery, with Kenya emerging as a training hub.
