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Featured researches published by Babu Naidu.


Thorax | 2010

Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors?

Paula Agostini; H Cieslik; Sridhar Rathinam; Ehab Bishay; M. Kalkat; P. Rajesh; Richard Steyn; Sally Singh; Babu Naidu

Background Postoperative pulmonary complications (PPC) are the most frequently observed complications following lung resection, of which pneumonia and atelectasis are the most common. PPCs have a significant clinical and economic impact associated with increased observed number of deaths, morbidity, length of stay and associated cost. The aim of this study was to assess the incidence and impact of PPCs and to identify potentially modifiable independent risk factors. Methods A prospective observational study was carried out on all patients following lung resection via thoracotomy in a regional thoracic centre over 13 months. PPC was assessed using a scoring system based on chest x-ray, raised white cell count, fever, microbiology, purulent sputum and oxygen saturations. Results Thirty-four of 234 subjects (14.5%) had clinical evidence of PPC. The PPC patient group had a significantly longer length of stay (LOS) in hospital, high dependency unit (HDU) LOS, higher frequency of intensive care unit (ITU) admission and a higher number of hospital deaths. Older patients, body mass index (BMI) ≥30 kg/m2, preoperative activity <400 m, American Society of Anesthesiologists (ASA) score ≥3, smoking history, chronic obstructive pulmonary disease (COPD), lower preoperative forced expiratory volume in 1 s (FEV1) and predicted postoperative (PPO) FEV1 were all significantly (p<0.05) associated with PPC on univariate analysis. Multivariate analysis confirmed that age >75 years, BMI ≥30 kg/m2, ASA ≥3, smoking history and COPD were significant independent risk factors in the development of PPC (p<0.05). Conclusion The clinical impact of PPCs is marked. Significant independent preoperative risk factors have been identified in current clinical practice. Potentially modifiable risk factors include BMI, smoking status and COPD. The impact of targeted therapy requires further evaluation.


Thorax | 2015

Test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours

Holly Pattenden; Maria Leung; Emma Beddow; Michael Dusmet; Andrew G. Nicholson; Michael Shackcloth; Saifullah Mohamed; Adnan Darr; Babu Naidu; Swetha Iyer; Adrian Marchbank; Amy Greenwood; Doug West; Felice Granato; Alan Kirk; Priyadharshanan Ariyaratnam; Mahmoud Loubani; Eric Lim

Positron emission tomography-CT (PET-CT) is one of the initial mediastinal staging modality for non-small cell lung cancer; however, the clinical utility in carcinoid tumours is uncertain. We sought to determine the test performance of PET-CT for mediastinal lymph node staging of pulmonary carcinoid tumours. We collated data from seven institutions, performing a retrospective search on pathological databases for a consecutive series of patients who underwent thoracic surgery (with lymph nodal dissection) for carcinoid tumours with preoperative PET-CT staging. PET-CT results were compared with the reference standard of pathologic results obtained from lymph node dissection and test performance reported using sensitivity and specificity. From November 1999 to January 2013, 247 patients from seven institutions underwent surgery for carcinoid tumours with a corresponding preoperative PET-CT scan. The mean age of the patients was 61 (SD 15, range 73) and 84 were male patients (34%). The pathologic subtype was typical carcinoid in 217 patients (88%) and atypical carcinoid in 30 patients (12%). Results from lymph node dissection were obtained in 207 patients. The calculated sensitivity and specificity of PET-CT to identify mediastinal lymph node disease was 33% (95% CI 4% to 78%) and 94% (95% CI 89% to 97%), respectively. Our results indicate that PET-CT has a poor sensitivity but good specificity to detect the presence of mediastinal lymph node metastases in pulmonary carcinoid tumours. Mediastinal lymph node metastases cannot be ruled out with negative PET-CT uptake, and if the absence of mediastinal lymph node disease is a prerequisite for directing management, tissue sampling should be undertaken.


European Journal of Cardio-Thoracic Surgery | 2018

Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS)

T. Batchelor; Neil Rasburn; Etienne Abdelnour-Berchtold; Alessandro Brunelli; Robert J. Cerfolio; Michel Gonzalez; Olle Ljungqvist; René Horsleben Petersen; Wanda M. Popescu; Peter Slinger; Babu Naidu

Enhanced recovery after surgery is well established in specialties such as colorectal surgery. It is achieved through the introduction of multiple evidence-based perioperative measures that aim to diminish postoperative organ dysfunction while facilitating recovery. This review aims to present consensus recommendations for the optimal perioperative management of patients undergoing thoracic surgery (principally lung resection). A systematic review of meta-analyses, randomized controlled trials, large non-randomized studies and reviews was conducted for each protocol element. Smaller prospective and retrospective cohort studies were considered only when higher-level evidence was unavailable. The quality of the evidence base was graded by the authors and used to form consensus recommendations for each topic. Development of these recommendations was endorsed by the Enhanced Recovery after Surgery Society and the European Society for Thoracic Surgery. Recommendations were developed for a total of 45 enhanced recovery items covering topics related to preadmission, admission, intraoperative care and postoperative care. Most are based on good-quality studies. In some instances, good-quality data were not available, and subsequent recommendations are generic or based on data extrapolated from other specialties. In other cases, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention of hypothermia, short-acting anaesthetics to facilitate early emergence, regional anaesthesia, nausea and vomiting control, opioid-sparing analgesia, euvolemic fluid management, minimally invasive surgery, early chest drain removal, avoidance of urinary catheters and early mobilization after surgery. These guidelines outline recommendations for the perioperative management of patients undergoing lung surgery based on the best available evidence. As the recommendation grade for most of the elements is strong, the use of a systematic perioperative care pathway has the potential to improve outcomes after surgery.


Thorax | 2016

S65 Developing a multi-disciplinary thoracic surgery research team improves the recruitment into and quality of clinical trials

Amy Kerr; N Oswald; S Kadiri; H Bancroft; E Virgilio; Joanne Webb; M Bellamy; J Taylor; Ehab Bishay; M. Kalkat; Richard Steyn; P. Rajesh; Babu Naidu

Objectives Recruitment into surgical trials historically has been fraught with difficulty. We examine whether developing a multi-disciplinary research team has aided recruitment, data collection, patient retention and so success of clinical trials. In addition we look at effects on the patient experience of the surgical pathway. Methods We evaluated the development and impact of a specialist thoracic trained research team of nurses and allied health care professionals in a regional thoracic unit from 2009–2015. We assessed the impact on the recruitment into National Institute for Health Research Clinical Research Network (NIHR CRN) thoracic surgery portfolio trials. Patient experience was captured through a survey (n = 30) and research team feedback through interviews (n = 5). During the development, clear leadership and support networks were created, new members were trained by specialist thoracic research nurses to obtain competences in both research and thoracic surgery to enable confident valid informed consent and the collection of robust quality data. Results Since the development of a specialised thoracic surgery research team in 2010 the number trials have steadily increased and along with number of team members whilst clinical activity remained constant. The number of patient consented into clinical trials increased 7 fold (Table 1). From staff interviews a recurring theme was that a clear team structure and a specialist training aided them to be better patient advocate not only in research but in the clinical pathway. Patients universally agreed that involvement of the research team helped reduce their anxiety about their surgery and so enhanced patients experience. Conclusion The impact of a dedicated research team goes well beyond research but improves clinical care. Having a clear support system and a specialist trained team has increased recruitment and retention into thoracic surgical trials and enhanced the patient’s experience of research and the surgical pathway. Abstract S65 Table 1


Thorax | 2016

S63 Postoperative pulmonary complications and physiotherapy requirements after open thoracotomy versus vats lobectomy: a propensity score-matched analysis

Paula Agostini; Sebastian Lugg; Kerry Adams; N Vartsaba; M. Kalkat; P. Rajesh; Richard Steyn; Babu Naidu; Alison Rushton; Ehab Bishay

Introduction Video-assisted thoracoscopic surgical (VATS) lobectomy is increasingly used for curative intent lung cancer surgery compared to open thoracotomy due to its minimally invasive approach and associated benefits. However, the effect of the VATS approach on postoperative pulmonary complications (PPC), rehabilitation and physiotherapy requirements is unclear; our study aimed to use propensity score matching to investigate this. Methods Between January 2012 and January 2016 all consecutive patients undergoing lobectomy via thoracotomy or VATS were prospectively observed. Exclusion criteria included VATS converted to thoracotomy, re-do thoracotomy, sleeve/bi-lobectomy and tumour size >7 cm diameter (T3/T4). All patients received physiotherapy assessment on postoperative day 1 (POD1), and subsequent treatment as deemed appropriate. PPC frequency was measured daily using the Melbourne Group Scale.1 Postoperative length of stay (LOS), high dependency unit (HDU) LOS, intensive therapy unit (ITU) admission and in-hospital mortality were observed. Propensity score matching (PSM) was performed using previous identified PPC risk factors (age, ASA score, BMI, COPD, current smoking) and lung cancer staging. Results Over 4 years 736 patients underwent lobectomy with 524 remaining after exclusions; 252 (48%) thoracotomy and 272 (52%) VATS cases. PSM produced 215 matched pairs. VATS approach was associated with less PPC (7.4% Vs 18.6%; p < 0.001), shorter median LOS (4 days vs 6; p < 0.001), and a shorter median HDU LOS (1 day vs 2; p = 0.002) (Table 1). Patients undergoing VATS required less physiotherapy contacts (3 Vs 6; p < 0.001) and reduced therapy time (80 min vs 140; p < 0.001). More patients mobilised on POD1 (84% vs 81%; p = 0.018), and significantly less therapies to treat sputum retention and lung expansion were required (p < 0.05). Abstract S63 Table 1 Postoperative outcomes following open thoracotomy versus VATS. Thoracotomy(n = 215) VATS (n = 215) p value PPC (%) 40 (18.6) 16 (7.4) <0.001 Median Hospital LOS (IQR) 6 (4) 4 (3) <0.001 Median HDU LOS (IQR) 2 (2) 1 (1) 0.002 ITU admission (%) 9 (4.2) 6 (2.8) 0.599 Hospital mortality (%) 5 (2.3) 3 (1.4) 0.724 VATS, video-assisted thorascopic surgery; PPC, postoperative pulmonary complication; LOS, length of stay; HDU, high dependency unit; ITU, intensive therapy unit. Conclusions This study demonstrates that patients undergoing VATS lobectomy developed less PPC and had improved associated outcomes compared to thoracotomy. Patients were more mobile earlier, required half the physiotherapy resources, having fewer pulmonary and mobility issues. Reference Agostini P, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax 2010;65(9):815–8.


Thorax | 2016

S61 Risk factors and short-term outcomes of developing postoperative pulmonary complications after vats lobectomy

Paula Agostini; Sebastian Lugg; Kerry Adams; Tom Smith; M. Kalkat; P. Rajesh; Richard Steyn; Babu Naidu; Alison Rushton; Ehab Bishay

Introduction Postoperative pulmonary complications (PPC), such as pneumonia and atelectasis are associated with poor outcomes following thoracotomy and lung resection, with risk factors identified.1,2 Video-assisted thoracoscopic surgery (VATS) is increasingly performed, however, there are varying reports regarding the incidence of PPC with little is known about their effect on short-term outcomes or potential risk factors. Methods A prospective observational study of consecutive patients undergoing VATS lobectomy was performed in a regional centre (2012–2016). Exclusion criteria included re-do VATS/completion lobectomy. All patients received physiotherapy assessment/intervention as necessary from postoperative day 1 (POD1). The presence of PPC was determined daily using the Melbourne Group Scale. Outcomes included hospital length of stay (LOS), intensive therapy unit (ITU) admission and hospital mortality. Results 287 patients underwent VATS lobectomy, 2 patients undergoing completion lobectomy were excluded. Of 285 patients; 137 were male (48%), median (IQR) age of 69 years (13) and mean (±SD) FEV1 of 87% (±19). PPC developed in 21 patients (7.4%); the median day that PPC developed was postoperative day 3 (Figure 1). Patients who developed a PPC had a significantly longer hospital LOS (4 vs 3 days), higher rate of ITU admission (25% vs 0%) and higher hospital mortality (14% vs 0%) (p < 0.001). Current smoking and COPD diagnosis were significantly different on univariate analysis (p < 0.05), but on forward stepwise logistic regression, only current smoking was a significant independent risk factor for PPC (p = 0.015). Those with PPC required significantly more physiotherapy contacts/time, with more specific pulmonary therapy and emergency out-of-hours therapy. Abstract S61 Figure 1 Day PPC detected following surgery Conclusions Patients undergoing VATS remain at risk of developing a PPC associated with significantly worse short-term morbidity and mortality. Patients that develop a PPC following VATS required increased postoperative physiotherapy compared to non-PPC patients. Current smoking is an independent risk factor for PPC development following VATS, thus vigorous addressing of preoperative smoking cessation is urgently needed. References Agostini P, et al. Postoperative pulmonary complications following thoracic surgery: are there any modifiable risk factors? Thorax 2010;65(9):815–8. Lugg ST, et al. Long-term impact of developing a postoperative pulmonary complication after lung surgery. Thorax 2016;71(2):171–6.


Interactive Cardiovascular and Thoracic Surgery | 2007

Is incentive spirometry effective following thoracic surgery

Paula Agostini; Rachel Calvert; Hariharan Subramanian; Babu Naidu


Interactive Cardiovascular and Thoracic Surgery | 2013

A novel two-hit rodent model of postoperative acute lung injury: priming the immune system leads to an exaggerated injury after pneumonectomy

Robert G. Evans; Oscar B.A. Ndunge; Babu Naidu


Interactive Cardiovascular and Thoracic Surgery | 2016

In patients with resectable non-small-cell lung cancer, is video-assisted thoracoscopic segmentectomy an appropriate alternative to video-assisted thoracoscopic lobectomy?

Johnathan R. Lex; Babu Naidu


Journal of Thoracic Oncology | 2017

MA 08.09 Postoperative Mobilization and Rehabilitation Requirements for Lung Cancer Patients Undergoing Minimally Invasive Surgery

Paula Agostini; Sebastian Lugg; Kerry Adams; Tom Smith; M. Kalkat; P. Rajesh; Richard Steyn; Babu Naidu; Alison Rushton; Ehab Bishay

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Paula Agostini

Heart of England NHS Foundation Trust

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Ehab Bishay

Heart of England NHS Foundation Trust

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M. Kalkat

Heart of England NHS Foundation Trust

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P. Rajesh

Heart of England NHS Foundation Trust

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Richard Steyn

Heart of England NHS Foundation Trust

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Alison Rushton

University of Birmingham

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Kerry Adams

Heart of England NHS Foundation Trust

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Sebastian Lugg

University of Birmingham

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Amy Kerr

Heart of England NHS Foundation Trust

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Tom Smith

University of Birmingham

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