DR. DAVID MCEVOY CROMWELL, M.D.

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This research studied patients in England who had external ventricular drains (EVDs) placed between April 2013 and March 2020, looking at how the timing of the procedure affected mortality and other outcomes. Out of 10,239 patients, 26.7% died within 90 days of the procedure; the highest mortality rate was 43.2% for those who had the EVD alone, compared to 19.7% for those who also underwent a surgical procedure at the same time. This is important because it highlights significant differences in patient outcomes based on how and when EVDs are placed, which can help improve treatment practices in neurosurgery. Who this helps: This benefits patients undergoing neurosurgical procedures, doctors, and hospitals aiming to improve treatment outcomes.

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This study looked at surgical patients in the UK who are at high risk of dying after surgery, analyzing data from over 12 million patients between 2015 and 2019. They found that 13.9% of high-risk patients died within 90 days of surgery, compared to only 1.1% in low-risk patients, and about 27.1% of high-risk patients died within a year after surgery. This matters because it highlights the significant health care needs of high-risk patients and may inform better surgical management and support for this vulnerable group. Who this helps: This helps patients undergoing surgery, especially those identified as high-risk, by highlighting the need for better care and resources.

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This study looked at how well England's hospitals managed emergency surgeries during the COVID-19 pandemic, particularly in the second and third waves of infections. They found that while there were 1,308 deaths (3.8% of admissions) during the second wave and 1,235 deaths (3.4%) during the third, these rates were similar to or better than historical rates before the pandemic, suggesting that hospitals improved their responses over time. This is important because it highlights how lessons from the early pandemic helped hospitals maintain care standards and support patient recovery. Who this helps: Patients needing emergency surgical care.

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This study looked at how to better identify cases of colorectal cancer returning after patients had surgery to remove it. Researchers examined data from nearly 35,000 patients and found that about 18.7% (or 6,556 patients) experienced recurrence. The new method they developed is based on hospital records and can help address gaps in existing cancer registries, which often fail to fully capture recurrence data, allowing for better tracking and management of this serious condition. Who this helps: This helps patients and doctors by providing more accurate information about cancer recurrence.

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This study looked at how the COVID-19 pandemic affected neurosurgery services in 24 hospitals in England from 2019 to 2022. They found a significant drop in surgical procedures, with about 39,000 procedures recorded in 2022 compared to nearly 46,000 in 2019, and a backlog of nearly 25,000 surgeries. This decline is concerning because it means patients are waiting longer for essential treatments, with the time to see a doctor increasing from 17 to 24 weeks. Who this helps: This helps patients needing neurosurgery, as well as their doctors who are managing delayed treatments.

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This research looked at how different features of general practices in the UK relate to their performance in a pay-for-performance program called the Quality and Outcomes Framework (QOF). The study found that practices serving older and poorer populations, along with larger practices and those with older doctors, often perform worse on these measures. In contrast, group practices with more full-time doctors and those that train new doctors typically perform better, which raises concerns about fairness in how this program rewards practices. Who this helps: This helps patients, especially those in older and low-income communities, by highlighting potential inequities in healthcare delivery.

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This study reviewed 52 research articles on neurosurgery from a trusted database to see how well treatments are backed by rigorous trials. It found that only 28 of these reviews were published recently, and many common surgeries lack solid evidence, with nine reviews showing no relevant trials at all. Overall, the quality of evidence for neurosurgery was mostly rated as low, meaning doctors and patients may not have reliable data to make informed treatment choices. Who this helps: This helps patients and doctors by highlighting the need for better research in neurosurgery.

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This study looked at the presence of harmful bacterial biofilms in normal colon tissue and polyps during screenings for colorectal cancer. Researchers found higher levels of these biofilms in normal tissues of people with colorectal cancer, with bacterial levels increasing as polyps grew larger; 2,051 people were tested, and 21 had polyp tissues examined. Understanding these relationships helps identify risk factors for colorectal cancer, which can improve screening and treatment strategies. Who this helps: This research benefits patients at risk for colorectal cancer and doctors involved in screenings and treatment.

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This study looked at how well hospital records can help identify patients with advanced colorectal cancer (CRC) at the time of their initial diagnosis, using data from a national cancer registry in England. It found that among over 186,000 patients, about 21.7% were identified as having metastatic cancer through hospital data, which is a slight increase from 23% using the cancer registry alone. This is important because knowing whether a cancer has spread can significantly affect treatment decisions and survival rates, with patients having metastatic disease facing a 59.3% chance of dying within a year compared to just 7.4% for those without. Who this helps: This benefits patients with colorectal cancer and their doctors by providing clearer information about disease severity at diagnosis.

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The National Cancer Audit Collaborating Centre (NATCAN) started on October 1, 2022, to improve cancer care in England and Wales by conducting ten national audits. These audits gather regular data from hospitals to assess the quality of care, allowing them to see how well they are performing and where they can improve. By providing timely feedback and supporting hospitals in making necessary changes, NATCAN aims to ensure safer and more effective cancer treatment. Who this helps: This benefits patients receiving cancer care and the hospitals that treat them.

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This study looked at how different countries treat abdominal aortic aneurysms (AAAs) in patients under 65 years old. Out of nearly 95,000 patients, about 13.4% were under 65, and there were big differences in treatment approaches—like endovascular repair (EVAR), which was used in 59.6% of cases, ranging from 24.9% in Denmark to 74.0% in the USA. Having better consistency in treatment could lead to better outcomes for younger patients facing these surgeries, as some are treated even when their aneurysms are smaller than recommended. Who this helps: Patients under 65 with abdominal aortic aneurysms.

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This study looked at changes in English general practice from 2013 to 2023, focusing on the number of practices, the staff available, and patient appointments. During this time, the number of general practices dropped by 20%, but the average number of patients each practice serves increased by 40%, rising from about 6,967 to 9,724 patients. Additionally, while the overall number of healthcare staff in general practice grew by 20%, the number of qualified GPs decreased by 15%, indicating a shift towards larger practices with more diverse healthcare teams. Who this helps: Patients benefit from more collaborative care, although they face longer wait times due to fewer GPs.

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This study looked at how effective emergency surgery is compared to non-emergency surgery for five common emergency conditions: appendicitis, gallstone disease, diverticular disease, abdominal wall hernia, and intestinal obstruction. The researchers examined data from over a million patients and found that, on average, patients who had emergency surgery spent a similar number of days alive and out of the hospital as those who had non-emergency surgery, with differences ranging from -21 days for frail patients with appendicitis to an increase of 18.2 days for non-frail patients with intestinal obstruction. This matters because understanding the effectiveness of surgery types can help guide treatment decisions for patients with these urgent health conditions. Who this helps: Patients facing emergency surgery decisions.

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This study looked at how effective and cost-friendly emergency surgery is for common conditions like appendicitis and hernias using data from electronic health records (EHRs) from 2010 to 2019. It analyzed over 500,000 hospital admissions and found that while traditional methods suggested emergency surgery wasn’t cost-effective, the new method used indicated it could be for certain groups but there was uncertainty in the results. This matters because it highlights that emergency surgery may benefit some patients more than others, especially those who are not very frail. Who this helps: Patients needing emergency surgery and their doctors.

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This study looked at how the first wave of COVID-19 in England affected patients who were admitted for common surgical emergencies like appendicitis, gallstones, and intestinal obstructions. Researchers found that from March to June 2020, there were fewer emergency admissions (12,231) compared to the same timeframe in 2019 (18,428), but the death rate within 90 days was higher in 2020, especially for those with gallstone disease (a 2.66 times greater risk of death) and diverticular disease (a 1.99 times greater risk). This is important because it highlights the risks patients faced during the pandemic, suggesting that delays in treatment may have contributed to worse outcomes. Who this helps: This research helps patients and healthcare providers understand the risks associated with emergency surgeries during pandemics.

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This study looked at how COVID-19 affected lung cancer care in the UK NHS from 2014 to 2020. It found that the pandemic disrupted early diagnosis, surgery access, and treatment for lung cancer patients, leading to worse outcomes. For example, there was a decrease in timely treatments, which means patients were not receiving the care they needed when they needed it most. Who this helps: This helps lung cancer patients who need better support and care following disruptions caused by the pandemic.

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This study looked at patients who needed emergency surgery for a large bowel perforation and analyzed why some of them died while in the hospital. Out of over 6,400 patients, 1,029 (16.0%) died; many of these deaths were linked to complications, with a failure to rescue rate of 24.3% for those who experienced complications. The findings indicate that hospitals' ability to prevent in-hospital deaths did not differ significantly, so efforts should focus on minimizing complications to improve patient outcomes. Who this helps: This research benefits patients undergoing emergency surgery and their healthcare providers.

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This study looked at how quickly patients with chronic limb-threatening ischaemia (CLTI) received revascularization treatments in the UK. Out of 11,398 patients studied, 50.6% received their treatment within 5 days, with an average wait time of 5 days. Factors like older age, more health issues, and the day of the week patients were admitted affected how fast they were treated, showing that those admitted later in the week were less likely to be treated promptly. Who this helps: This information benefits patients with CLTI and healthcare providers working to improve treatment timelines.

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This study looked at how often patients ended up having emergency surgery for five common conditions—appendicitis, gallstones, diverticular disease, hernias, and intestinal obstruction—across hospitals in England. They analyzed data from over 1.3 million emergency admissions and found that the rate of emergency surgery varied widely depending on the hospital, with 92.3% of appendicitis patients receiving surgery compared to only 11.0% of those with diverticular disease. The findings highlight that older patients are less likely to receive emergency surgery for most conditions, which raises concerns about equitable treatment. Who this helps: This benefits patients by highlighting potential disparities in emergency surgical care based on age and hospital location.

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This study looked at how a national program aimed at improving care for emergency abdominal surgery was applied across 93 hospitals and whether it led to better patient outcomes. The researchers found that most hospitals did not consistently follow all the recommended care processes, with only 3 processes improved on average per hospital. However, hospitals that used at least five implementation strategies were more successful, with 30% showing significant improvements in care processes. Who this helps: This helps patients undergoing emergency abdominal surgery by identifying better care practices in hospitals.

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This study looked at how delays in surgery for patients with a perforated peptic ulcer affect their chances of survival. Researchers found that for every hour a patient waited for surgery, their risk of dying increased by 6% after 90 days. The average wait time for surgery was about 7.5 hours, and overall, 10.61% of the patients died within 90 days after their operation. Who this helps: This helps patients with perforated peptic ulcers and their doctors by highlighting the importance of prompt surgical treatment.

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This study looked at the costs associated with treating early invasive breast cancer in England, focusing on women aged 50 and older diagnosed between 2014 and 2015. Researchers found that the average hospital costs for treatment were £5,167 for stage I, £7,613 for stage II, and £13,330 for stage IIIA. The costs were higher for younger patients and varied by region and other factors, highlighting how these costs rise significantly with the stage of the disease. Who this helps: This information benefits patients, healthcare providers, and policymakers by revealing how treatment costs are influenced by disease stage and demographics.

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This study looked at how often infants were taken to the emergency hospital in Ontario, Canada, and England between 2010 and 2013. Researchers found that only 7.9% of infants in Ontario were admitted to the hospital after an emergency visit, compared to 19.6% in England. Although the rate of any unplanned hospital visits was similar in both places, infants in Ontario had fewer admissions and usually stayed longer when they did. Who this helps: This helps infants and their parents by highlighting differences in hospital care between countries.

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This study looked at how long newborns stay in the hospital after birth and whether that affects their chances of being readmitted within 30 days. Out of nearly 4.7 million babies, 5.2% were readmitted, but hospitals with longer stays didn't have lower readmission rates overall, although longer stays seemed beneficial for late preterm babies (born between 34-36 weeks). This research matters because it suggests that longer hospital stays may help some vulnerable newborns get the extra support they need, potentially leading to fewer readmissions. Who this helps: Late preterm babies and their families.

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This study looked at how the number of surgeries performed by hospitals and surgeons affects outcomes for patients undergoing surgery for oesophago-gastric cancer in England from 2011 to 2013. It found that hospitals with higher surgery volumes had lower 30-day death rates (2.3%) and fewer cases of serious complications (anastomotic leakage at 6.3%). The impact of the surgeon’s experience was less significant, mainly reducing the risk of complications rather than death. Who this helps: This benefits patients undergoing oesophago-gastric cancer surgery by highlighting the importance of choosing high-volume hospitals and surgeons for better outcomes.

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This study looked at how healthcare professionals in England use findings from national audits of cancer care to improve their practices and services. Out of nearly 600 professionals surveyed, over 90% found the audit results relevant, with 42% changing their clinical practices and 56% making service improvements based on the findings. However, the effectiveness of these audits could be improved by providing better-quality data and clearer comparisons of local performance. Who this helps: This helps healthcare providers improve cancer care for their patients.

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The study looked at a program from The Royal College of Surgeons of England that supports surgeons in training to do research. Of the 502 recipients of this fellowship, 361 responded to a survey, and the results showed that 62% worked on laboratory research, 96% pursued a higher degree, and 91% of those in the first 15 years completed their degree. Additionally, many recipients went on to publish their work, with a median of 3 articles each, and 60% secured further research funding. Who this helps: This benefits trainee surgeons and the medical community by enhancing their research skills and career opportunities.

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This study looked at how to connect health records for mothers and their babies using secure and anonymous data from hospitals in England. Researchers found that they could successfully link 42% of baby records to their mothers’ records directly, and an additional 56% using a more flexible method that considered various factors like admission dates and location. These connections improved over time and managed to cover about 97% of births in England, which helps ensure better quality data for research and healthcare services. Who this helps: This benefits researchers and healthcare providers working with maternal and infant health.

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This study looked at how many patients with advanced oesophagogastric cancer in England complete their palliative chemotherapy treatment and what factors affect their ability to finish it. Out of nearly 10,000 patients analyzed, only 24% received palliative chemotherapy, and of those, about 53% completed their treatment. Notably, only 9% of patients aged 75 and older received chemotherapy, highlighting that elderly patients with poor health are less likely to complete treatment. Who this helps: This research helps doctors and patients make informed decisions about chemotherapy options and potential outcomes.

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This study looked at whether the number of percutaneous nephrolithotomy (PCNL) surgeries performed at a hospital affects patient safety and outcomes. They found that it didn't make much difference; for example, 9.7% of patients at low-volume hospitals were readmitted to the hospital after surgery, compared to 8.4% at high-volume hospitals. The only notable difference was that patients stayed in the hospital for an average of 5.3 days at low-volume hospitals, while those at medium and high-volume hospitals stayed for about 5 days. Who this helps: This research benefits patients undergoing PCNL as it shows that they can expect similar safety outcomes regardless of the hospital's surgery volume.

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This study compared two treatments for dysplastic Barrett's esophagus (a precancerous condition) to see which was more effective and safer: complete endoscopic resection (EMR) and radiofrequency ablation (RFA). Both methods were found to be quite effective, with dysplasia eradicated in 95% of patients after EMR and 92% after RFA, but EMR had a higher rate of complications, affecting 12% of patients compared to only 2.5% for RFA. This matters because it helps doctors choose a safer treatment option for patients at risk of esophageal cancer. Who this helps: Patients with dysplastic Barrett's esophagus.

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This study looked at how women with lower urinary-genital tract fistulas were treated in NHS hospitals from 2000 to 2009. It found that out of 905 women who had surgery to repair these fistulas, about 12% had unsuccessful repairs, and those treated at hospitals that did more than 30 repairs were less likely to need a second surgery (7.4% compared to 13.2% at hospitals with fewer repairs). This matters because it highlights the importance of having experienced hospitals handle more cases to reduce failure rates. Who this helps: This helps patients by ensuring they receive better care from skilled teams.

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This study looked at how hospitals in England and Wales provide services for women with heavy menstrual bleeding (HMB) two to three years after new guidelines were issued in 2007-2008. The research found that most hospitals offer good diagnostic services like ultrasound (80%) and hysteroscopy (87%), but only 38% have a specialized clinic for menstrual bleeding, and just 30% have a written plan for handling HMB care. These findings matter because while there are resources available, many hospitals still struggle to organize effective treatment for women suffering from HMB. Who this helps: Patients with heavy menstrual bleeding.

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This study examined how well diagnosis and treatment codes are used to track patients who had surgery for abdominal aortic aneurysms (AAA) in English hospitals from 2003 to 2008. It found that out of 20,290 patients, 94.9% had accurate coding for their condition, with 79.3% of those needing emergency surgery correctly recorded as having a ruptured AAA. This consistency in coding is important because it helps ensure that hospitals can identify and group patients effectively for better treatment and outcomes. Who this helps: This helps patients and doctors by ensuring accurate tracking of patient data for better care.

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This study looked at how well UK maternity units followed national guidelines for preventing a serious infection called Group B Streptococcus (GBS) in newborns. Out of 227 units, 171 provided their protocols, and while 134 of these protocols aimed to follow the recommendations, only 34 were fully consistent with the national guidelines. This inconsistency means some high-risk mothers might not get the necessary antibiotics during labor, while others without risk factors might receive unnecessary treatments. Who this helps: This helps pregnant women and their newborns by ensuring proper guidelines are followed for preventing infections.

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This study looked at the risk of bleeding after tonsil surgery in over 40,000 patients across hospitals in England and Northern Ireland. It found that 3.5% experienced bleeding after surgery, with a significant increase in risk when using diathermy tools compared to traditional methods; specifically, the risk was 2.47 times greater with bipolar diathermy and 3.20 times greater with bipolar diathermy scissors compared to cold steel techniques. This matters because understanding these risks can lead to safer tonsillectomy practices and better patient outcomes. Who this helps: This helps patients undergoing tonsillectomy and their doctors.

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This study looked at how to define "primary care patients" in emergency departments (ED) and identified that many patients who go to the ED might not actually need emergency care. Researchers reviewed 34 papers and proposed that a primary care patient in the ED is someone who comes for a new health issue, likely doesn't need to stay in the hospital, and wasn't sent there by a doctor. This matters because it helps clarify the role of the emergency department and how to use healthcare resources effectively. Who this helps: This helps patients and healthcare providers by improving care and managing resources better in emergency situations.