ObjectivesAdministrative databases with dedicated coding systems in healthcare systems where providers are funded based on services recorded have been shown to be useful for clinical research, although their reliability is still questioned. We devised a custom classification of procedures and algorithms based on OPCS, enabling us to identify open heart surgeries from the English administrative database, Hospital Episode Statistics, with the objective of comparing the incidence of cardiac procedures in administrative and clinical databases.DesignA comparative study of the incidence of cardiac procedures in administrative and clinical databases.SettingData from all National Health Service Trusts in England, performing cardiac surgery.ParticipantsPatients classified as having cardiac surgery across England between 2004 and 2015, using a combination of procedure codes, age >18 and consultant specialty, where the classification was validated against internal and external benchmarks.ResultsWe identified a total of 296 426 cardiac surgery procedures, of which majority of the procedures were coronary artery bypass grafting (CABG), aortic valve replacement (AVR), mitral repair and aortic surgery. The matching at local level was 100% for CABG and transplant, >90% for aortic valve and major aortic procedures and >80% for mitral. At national level, results were similar for CABG (IQR 98.6%–104%), AVR (IQR 105%–118%) and mitral valve replacement (IQR 86.2%–111%).ConclusionsWe set up a process which can identify cardiac surgeries in England from administrative data. This will lead to the development of a risk model to predict early and late postoperative mortality, useful for risk stratification, risk prediction, benchmarking and real-time monitoring. Once appropriately adjusted, the system can be applied to other specialties, proving especially useful in those areas where clinical databases are not fully established.

Diabetes mellitus (DM) is considered as a risk of cardiovascular diseases due to the expression of certain pathological factors, including hormones, such as serotonin. The aim of the current study was to evaluate the bridging role of serotonin between DM and cardiac valvulopathy via reactive oxygen species (ROS) generation. Eighty diabetic patients and 50 healthy individuals along with experimental models were studied. DM was induced in the rat model via intraperitoneal alloxan injection and subsequently treated with serotonin. ROS, superoxide dismutase and brain natriuretic peptide (BNP) expressions analyses as well as histopathologies were also performed. An increase in ROS concentration and down-regulation of antioxidant enzyme activities in diabetic patients as well as serotonin-treated diabetic experimental models were observed. The heart valves of the serotonin-treated diabetic rats were impaired along with BNP expression when compared to the normal subjects. The current study suggested that endogenous enhanced serotonin level may contribute as a bridge between diabetes and cardiovascular diseases via acceleration of free radical generation in diabetic conditions.

Patients with diabetes mellitus (DM) develop tendencies toward heart disease. Hyperglycemia induces the release of serotonin from enterochromaffin cells (EC). Serotonin was observed to elevate reactive oxygen species (ROS) and downregulate antioxidant enzymes. As a result, elevated levels of serotonin could contribute to diabetic complications, including cardiac hypertrophy. In the present study, diabetes mellitus was induced in rats by alloxan administration; this was followed by the administration of serotonin to experimental animals. ROS, catalase (CAT), superoxide dismutase (SOD), B-type natriuretic peptide (BNP) expression, and histopathological assessments were performed. Elevated ROS concentrations and decreased antioxidant enzyme activities were detected. Further, we observed an increase in cell surface area and elevated BNP expression which suggests that events associated with cardiac hypertrophy were increased in serotonin-administered diabetic rats. We conclude that serotonin secretion in diabetes could contribute to diabetic complications, including cardiac hypertrophy, through enhanced ROS production.

Background Up to 25% of colorectal cancers present with bowel obstruction. Metal stents (MS) can provide a bridge to surgery by relieving obstruction and allowing the subject's condition to improve pre-operatively. Methods Hospital Episode Statistics (HES) is a database of all NHS funded secondary care episodes in England. Subjects admitted with bowel obstruction secondary to colorectal cancer without metastases were identified and subdivided into two groups: MS insertion prior to surgery and surgery only. Due to demographic differences between the groups, propensity score matching was used to analyse procedural outcomes, mortality and readmission within 30 days in left-sided cancers based upon age, sex and Charlson co-morbidity score. Results Over 10 years, 4571 subjects were identified; 401 received a MS and 4170 underwent surgery only. Median age of MS subjects was 71 (IQR 62-79) years; 226 (56.4%) were male. Median age of surgery-only subjects was 73 (64-81); 2165 (51.9%) were male. Following propensity matching 375 MS and 375 surgery-only subjects remained; MS had fewer readmissions within 30 days (28 (7.5%) versus 44 (11.7%), p = 0.047), fewer respiratory complications (< 6 (< 1.5%) versus 28 (7.5%), p < 0.001), lower stoma rates (49 (13.1%) versus 159 (42.4%), p < 0.001) and higher rates of laparoscopic surgery (154 (41.1%) versus 25 (6.7%), p < 0.001). Mortality was lower in the MS group at 30 days (7 (1.9%) versus 33 (8.8%), p < 0.001) and 1 year (37 (9.9%) versus 71 (19.0%), p < 0.001). Conclusions In subjects presenting with obstructing colorectal cancer outcomes including respiratory complications, readmission and mortality appear to be better in subjects undergoing MS as a bridge to surgery compared to surgery alone.

For patients with pre-existing diabetes, the risk of death, cardiovascular events, and cancer after bariatric surgery was higher than for those without diabetes, whose mortality risk after surgery remains 35% higher than that of the general population.