SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Background: Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased ... more Background: Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased risk of colorectal cancer. Advances in endoscopy have rendered most previously invisible dysplasia visible, leading to changes in guidelines around surveillance and management of dysplasia. This study aims to assess New Zealand endoscopists' (i) understanding of current guidelines, (ii) uptake of advanced techniques and (iii) management of dysplasia. Methods: A digital survey of New Zealand endoscopists was undertaken. Invitations were sent to members of New Zealand gastroenterology and surgical societies. Questions were asked regarding demographics, surveillance interval, risk stratification, endoscopic technique and dysplasia management. Results: Fifty of the 322 invitees completed the survey (15.5%). Over 80% used techniques meeting the guideline recommendations. The majority (77%) of endoscopists take random biopsies in addition to targeted. Endoscopically resectable polypoid low-grade dysplasia was typically managed with surveillance (93%) but this dropped to less than half for high-grade dysplasia and less than a third for non-polypoid high-grade dysplasia (inconsistent with guidelines). Conclusions: Current New Zealand endoscopists' practice appears to be aligned with international guidelines in terms of screening interval, risk stratification and technique. However, New Zealand endoscopists are less likely to offer a patient surveillance for endoscopically resectable dysplasia.
Abstract Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and p... more Abstract Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18–89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic–perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1–8 and 2–10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5–71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.
BACKGROUND Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased r... more BACKGROUND Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased risk of colorectal cancer. Advances in endoscopy have rendered most previously invisible dysplasia visible, leading to changes in guidelines around surveillance and management of dysplasia. This study aims to assess New Zealand endoscopists' (i) understanding of current guidelines, (ii) uptake of advanced techniques and (iii) management of dysplasia. METHODS A digital survey of New Zealand endoscopists was undertaken. Invitations were sent to members of New Zealand gastroenterology and surgical societies. Questions were asked regarding demographics, surveillance interval, risk stratification, endoscopic technique and dysplasia management. RESULTS Fifty of the 322 invitees completed the survey (15.5%). Over 80% used techniques meeting the guideline recommendations. The majority (77%) of endoscopists take random biopsies in addition to targeted. Endoscopically resectable polypoid low-gr...
We congratulate the New Zealand government for the unprecedented steps taken to protect our popul... more We congratulate the New Zealand government for the unprecedented steps taken to protect our population from the potentially catastrophic threat to public health posed by the COVID-19 pandemic In recent weeks, we have witnessed the capacity of government to enact sweeping changes which alter the day-to-day lives, economic fortunes and civic freedoms of all New Zealanders As citizens, most of us have followed the new rules, buying into the premise that by doing so, we're saving lives The medical community has been unanimous in supporting the need for action against the novel coronavirus COVID-19 Modelling provided to the Government by Prof Wilson from The University of Otago suggests that, without intervention, up to 3 32 million New Zealanders could be infected with Covid-19, 146,000 requiring hospital admission, 36,600 requiring ICU-level care, and 27,600 potential deaths 1 For context, in 2017 there were 33,599 deaths from all causes in New Zealand 2We should not simply aim to ...
SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critica... more SummarySARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was no...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Background: Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased ... more Background: Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased risk of colorectal cancer. Advances in endoscopy have rendered most previously invisible dysplasia visible, leading to changes in guidelines around surveillance and management of dysplasia. This study aims to assess New Zealand endoscopists' (i) understanding of current guidelines, (ii) uptake of advanced techniques and (iii) management of dysplasia. Methods: A digital survey of New Zealand endoscopists was undertaken. Invitations were sent to members of New Zealand gastroenterology and surgical societies. Questions were asked regarding demographics, surveillance interval, risk stratification, endoscopic technique and dysplasia management. Results: Fifty of the 322 invitees completed the survey (15.5%). Over 80% used techniques meeting the guideline recommendations. The majority (77%) of endoscopists take random biopsies in addition to targeted. Endoscopically resectable polypoid low-grade dysplasia was typically managed with surveillance (93%) but this dropped to less than half for high-grade dysplasia and less than a third for non-polypoid high-grade dysplasia (inconsistent with guidelines). Conclusions: Current New Zealand endoscopists' practice appears to be aligned with international guidelines in terms of screening interval, risk stratification and technique. However, New Zealand endoscopists are less likely to offer a patient surveillance for endoscopically resectable dysplasia.
Abstract Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and p... more Abstract Retrorectal tumors are rare tumors that require resection for symptoms, malignancy and potential malignant transformation. Traditional approaches have included laparotomy, perineal excision or a combination. Multiple minimally invasive techniques are available which have the potential to minimize morbidity and enhance recovery. We performed a systematic review of the literature to determine the feasibility and surgical outcomes of retrorectal tumors approached using minimally invasive surgical techniques. Publications in which adult patients (≥ 18 years) had a minimally invasive approach (laparoscopic or robotic) for resection of a primary retrorectal tumor were included. Data were collected on approach, preoperative investigation, size and sacral level of the tumor, operating time, length of stay, perioperative complications, margins and recurrence. Thirty-five articles which included a total of 82 patients met the inclusion criteria. The majority of patients were female (n = 65; 79.2%), with a mean age of 41.7 years (range 18–89 years). Seventy-three patients (89.0%) underwent laparoscopic or combined laparoscopic–perineal resection, and 9 (10.8%) had a robotic approach. The conversion rate was 5.5%. The overall 30-day morbidity rate was 15.7%, including 1 intraoperative rectal injury (1.2%). Ninety-five percent (n = 78) of the retrorectal tumors were benign. Median length of stay was 4 days for both laparoscopic and robotic groups, with ranges of 1–8 and 2–10 days, respectively. No tumor recurrence was noted during follow-up [median 28 months (range 5–71 months)]. A minimally invasive approach for the resection of retrorectal tumors is feasible in selected patients. Careful patient selection is necessary to avoid incomplete resection and higher morbidity than traditional approaches.
BACKGROUND Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased r... more BACKGROUND Patients with inflammatory bowel disease (IBD) undergo surveillance for an increased risk of colorectal cancer. Advances in endoscopy have rendered most previously invisible dysplasia visible, leading to changes in guidelines around surveillance and management of dysplasia. This study aims to assess New Zealand endoscopists' (i) understanding of current guidelines, (ii) uptake of advanced techniques and (iii) management of dysplasia. METHODS A digital survey of New Zealand endoscopists was undertaken. Invitations were sent to members of New Zealand gastroenterology and surgical societies. Questions were asked regarding demographics, surveillance interval, risk stratification, endoscopic technique and dysplasia management. RESULTS Fifty of the 322 invitees completed the survey (15.5%). Over 80% used techniques meeting the guideline recommendations. The majority (77%) of endoscopists take random biopsies in addition to targeted. Endoscopically resectable polypoid low-gr...
We congratulate the New Zealand government for the unprecedented steps taken to protect our popul... more We congratulate the New Zealand government for the unprecedented steps taken to protect our population from the potentially catastrophic threat to public health posed by the COVID-19 pandemic In recent weeks, we have witnessed the capacity of government to enact sweeping changes which alter the day-to-day lives, economic fortunes and civic freedoms of all New Zealanders As citizens, most of us have followed the new rules, buying into the premise that by doing so, we're saving lives The medical community has been unanimous in supporting the need for action against the novel coronavirus COVID-19 Modelling provided to the Government by Prof Wilson from The University of Otago suggests that, without intervention, up to 3 32 million New Zealanders could be infected with Covid-19, 146,000 requiring hospital admission, 36,600 requiring ICU-level care, and 27,600 potential deaths 1 For context, in 2017 there were 33,599 deaths from all causes in New Zealand 2We should not simply aim to ...
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Papers by Tamara Glyn