EuroSurg Session Round-up - Part 1
What Is Eurosurg & Updates On Compass & Cascade Results Panel: Aya Riad (UK), Adam Turna (UK), Daoud Chaudhry (UK)
One of the many brilliant sessions that took place on day one of our 17th annual congress #ESCP2022 was a Scientific Session on EuroSurg.
Part One of the session, What Is EuroSurg? & Updates On Compass & Cascade Results Panel, kicked off with Ruth Blanco-Colino (Spain), who introduced EuroSurg – a pan-European students and trainee-led surgical research collaborative.
First established as a European organisation, EuroSurg’s success means it now reaches an international network of over 1,000 medical students and surgeons. The collaborative has been running for seven years and has three studies under its belt: euroSURG (2016), imagine (2018) and COMPASS Study (2020).
Ruth emphasised that participation in initiatives like EuroSurg offers huge opportunities for students, noting that learning how research works, as well as understanding how to start-up research projects at different units and hospitals, is an important part of becoming a good surgeon.
Following on from Ruth, Niall Brindl (Germany) shared update on the results of the COMPASS (Management of COMPlicAted intra-abdominal collectionS after colorectal Surgery) study, which successfully gained the involvement of 1,239 collaborators across 180 hospitals in 22 countries, and had its first paper published this year.
Niall started off by stating that prophylactic drain placement following colorectal surgery occurs routinely in one-third of colorectal resections, in spite of current evidence suggesting that this brings no significant clinical benefit. COMPASS therefore set out to audit international compliance with enhanced recovery after surgery (ERAS) guidelines in relation to the use of postoperative drains.
Presenting the visual abstract of the paper, Niall told the audience that the COMPASS study found that routine drain placement remains widespread, despite guidelines. He also noted that drains did not detect intraperitoneal collections earlier, but prolonged the length of stay and were associated with an increased risk of surgical site infections (SSIs). The talk was praised for the valuable and impactful research that brings with to surgery.
Next up Esther Matey (UK) took to the stage to deliver a much-celebrated overview of the Results from the multicentre international CASCADE (CArdiovSCulAr outcomes after major abdominal surgery) study. The aims of the study were to improve understanding around the variability and adherence to risk reduction measures for postoperative cardiovascular complications following major abdominal surgery.
Esther focused primarily on the preliminary results with regards to Venous Thromboembolism (VTE) in her talk.
After anticipating getting 6,000 patients involved in the study, CASCADE ended up reaching an impressive 24,000 patients over 300 centres taking part in Europe.
Of the 24,000 patients, the CASCADE study found that 185 patients (less than 1%) had VTE events following major abdominal or pelvic surgery.
In order to understand the cause of the VTE events, these patients were further classified into patients that had Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE), or patients that had both.
The findings were clear and interesting. Esther shared that patients are more likely to have VTEs in an in-patient setting (81%), rather than in an out-patient setting (19%), and this tended to be within the first 10 days post-operation. They also found that PE is more prevalent than DVTs post-operatively too.
Investigating these results, the CASCADE team looked to see if there was a difference between elective and emergency operations, but there didn’t appear to be one. Neither did they find a difference in benign or malignant cases.
They also found that some centres were giving maximum amounts of VTE prophylaxis, while others were giving minimal amounts. The reason behind this high degree of variability wasn’t clear, however.
Concluding the talk, Esther raised some poignant questions, including:
- Why does such variability exist in the provision of VTE prophylaxis?
- Do patients actually need to be on prophylaxis for such a long amount of time given that VTE events are minimal?
- How can we prevent that 0.7% of VTEs that take place in hospital settings?
With audience members commenting on the “fantastic work” that was “too good to put down”, some discussion and Q&A then took place to discuss where the study could go next to achieve a practice changing edict, as well as what should be investigated next to take into account surgical teams’ decision-making around administration of prophylaxis influenced by fear of bleeding.
Following on from what Esther’s talk, her colleagues Setthasorn Ooi (UK) and Iva Jakaitytė (UK), shared the Results of the CASCADE study with regards to postoperative cardiac complications (PCCs).
The study analysed the PCCs 30 days post-surgery and determined that the overall adjusted preliminary results rate was 2.38%.
Iva highlighted that the highest rates of PCCs tended to be from Atrial Fibrillation within the first 10 days post-surgery.
The study also found that there is substantial variation in adherence to preoperative preventative measures, but noted that there is ongoing analysis of the CASCADE data set to explore associations between interventions and PCC rates.
The audience praised the study for providing a clear point estimate of risk of serious heart complications after colorectal surgery – something that will assist surgeons in consenting patients properly as they discuss the risks of a potential operation.
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