Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56-1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion.
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study / Glasbey, Jc; Bibi, S; Pata, F; Ozkan, Bb; Van Straten, S; Hodson, J; Chapman, Sj; Blanco???colino, R; Chapman, Sj; Glasbey, Jc; Pata, F; Pellino, G; Sgr??, A; Soares, A; Elst, T; Van Straten, S; Nepogodiev, D; Hodson, J; Borakati, A; Bath, Mf; Yasin, Ih; Mclean, K; Arthur, T; Kovacevic, M; Delibegovic, S; Karamanliev, M; Swamad, M; ??ebr??k, R; Paramasivam, R; Martensen, A; Larsen, Hm; R??deker, L; Frey, Pe; Kechagias, A; Venara, A; Duchalais, E; Ioannidis, A; Pata, F; Pellino, G; Pasquali, S; Sgr??, A; Simioni, A; Farina, V; Podda, M; Lorenzon, L; (Italia), Itsurg; Schaeff, V; Otto, A; Jakubauskas, M; Elst, Tr; Chu, M; Fagan, Pvb; Wells, Ci; Alagoa Jo??o, A; Soares, A; Juloski, J; Blanco???colino, R; P??rez???ajates, S; Anabitarte Bautista, O; El Kasmy, Y; Espin???basany, E; Clerc, D; Ciubotaru, C; Popescu, S; Yanishev, A; Lee, S; Ozkan, Bb; Yag??z Sen, A; Aktas, Mk; 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[10.1111/codi.15311]
Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study
JC Glasbey; S Bibi; F Pata; BB Ozkan; S Van Straten; J Hodson; SJ Chapman; R Blanco???Colino; SJ Chapman; JC Glasbey; F Pata; G Pellino; A Sgr??; A Soares; T Elst; S Van Straten; D Nepogodiev; J Hodson; A Borakati; MF Bath; IH Yasin; K Mclean; T Arthur; M Kovacevic; S Delibegovic; M Karamanliev; M Swamad; R ??ebr??k; R Paramasivam; A Martensen; HM Larsen; L R??deker; PE Frey; A Kechagias; A Venara; E Duchalais; A Ioannidis; F Pata; G Pellino; S Pasquali; A Sgr??; A Simioni; V Farina; M Podda; L Lorenzon; ItSURG (Italia); V Schaeff; A Otto; M Jakubauskas; TR Elst; M Chu; PVB Fagan; CI Wells; A Alagoa Jo??o; A Soares; J Juloski; R Blanco???Colino; S P??rez???Ajates; O Anabitarte Bautista; Y El Kasmy; E Espin???Basany; D Clerc; C Ciubotaru; S Popescu; A Yanishev; S Lee; BB Ozkan; A Yag??z Sen; MK Aktas; BE Baki; B Y??ksek; JC Glasbey; S Kamarajah; K Mclean; A Borakati; IH Yasin; RA Khaw; E Mills; R Goodson; N Thakral; STARSurg Collaborative; AD Ablett; M Adra; I Kwek; SM Khan; P Quinn; LR Manley; A Badran; A Ramjeeawon; A Campbell; HL Tan; DS Rye; N Rajaraman; JG Norman; K Vutipongsatorn; G Solomou; M Akhbari; A Ali; V Murray; DM Baker; BD Brandao; B Stainer; R Thavayogan; D Jones; OO Onafowokan; A Gharooni; N Dabab; S Carlton???Carew; G Kungwengwe; M Gabriel; E Sewart; TC Shortland; S Lawday; P Pockney; A Dawson; T Arthur; CD Brumfitt; P Stewart; B Ng; JK Luong; S Delibegovic; V Ivanov; A Borisova; V Neykov; K Kun??arov??; B Kolo??ov??; T Antonova; M Farka??ov??; R ??ebr??k; JL Harbjerg; S Brandsborg; S Brinck; MD Kjaer; A Mark???Christensen; KP Unbehaun; P Dalsgaard; KD Lycke; A Kechagias; P LeNaoures; E Duchalais; C Brigand; E Dumange; M Gout; C Moehwald; M Prem; O Alhalabi; S Sliwinski; J Krupp; E Gablenz; L Schmitzer; A Kopp; J Steinle; J Gsenger; LJ Pohl; M Riccardi; IM Christodoulou; M Konstantinidis; N Machairas; A Zoikas; D Balalis; DK Manatakis; ML Aguilera; A Sgr??; A Simioni; L Marano; F Fleres; F Lovisetto; D Sasia; E Segalini; G Pata; A Lucchi; A Sagnotta; T Campagnaro; F Petrelli; G Gallo; M Papandrea; V Testa; G Sinibaldi; F Di Candido; F Colombo; G Perrone; A Biancafarina; G Canonico; M Pagnanelli; G Curletti; R Bini; A Manzoni Garberini; H Impellizzeri; N Cillara; R Tutino; A Picciariello; D Coletta ;G Savino; F Ferrara; N Tamini; G Talamo; D Parini; P Giamundo; A lo Conte; G Pagano; V Ripetti; A Pesce; N Menduni; G Pellino; R Giudicissi; M Podda; E Goldin; D Rega; A Belli; V Andriola; L Gordini; F Pata; C Foppa; G Piccolo; A Birindelli; C Ferrari; Z Ballarini; F Tirelli; M Milone; M De Rosa; NS Pipitone Federico; B Molteni; PL Tilocca; G Sancini; GN Piozzi; A Lauretta; G Poillucci; S Mulas; V Schaeff; A Otto; M Jakubauskas; D Simcikas; L Portelli; JWM Wijnbergen; TL Dinger; SFH ten Doesschate; ASHM Dalen; DD den Bos; M Hansmann; J Medina Feliz; SZ Kuiper; Z Abdulrahman; SR Pruijssers; S Farik; BM Elliott; VP Geneta; M Chu; S Wilton; H Kandelaki; SL Peng; S Campbell; YK Lim; SS Yassaie; M Murray; PVB Fagan; C Haran; J Tan; J Castro; A Laranjeira; S Catarino; C Neves???Marques; JG Correia; BN Vieira; AC Quintela; ML Serra; J Maciel; M Cunha; DJ Apar??cio; J Neves; J Azevedo; M Romano; F Eir??; J Romano; C Monteiro; M Claro; MR Almeida; M Peyroteo; ND Machado; H Capote; M Ferreira; X Sousa; H Devesa; D Cavadas; I Guerreiro; M Costa; M Rosete; M Salman; C English; N Mohammed; S Popescu; A Yanishev; A Litvin; VV ??uk; K M??sz??rosov??; S Van Straten; R Jaich; H De Lima; S Brooks; M Marx; M Nshalati Salvation; J Garc??a Cardo; I Mora???Guzm??n; J Sancho Muriel; U Andres Olabarria; P Muriel; C Jimenez Vi??as; F Alconchel; O Esteban Sinovas; A G??mez del Pulgar; Y El Kasmy; C Fair??n Oro; S P??rez???Ajates; M L??pez Otero; S Figueroa Jim??nez; O Claramonte Bellmunt; J Mart??nez Caballero; I Rubio???P??rez; MM Aguilar???Mart??nez; JJ Segura???Sampedro; C Olmedo Moreno; D Negre Parra; AM Est??vez Diz; R Mart??n???Balbuena; C Bustamante Recuenco; RE Licardie Bola??os; P Fern??ndez; A D??az Padillo; A Forero???Torres; I Alberdi San Rom??n; H Salvador Ros??s; M Merayo ??lvarez; P Villarejo Campos; CC Lopes Moreira; P Uriol Peralta; M Serrano Navidad; J Ripoll??s???Melchor; A Garcea; H G??mez Facundo; O Anabitarte Bautista; P Troncoso Pereira; C V P??rez Guarinos; D Clerc; B Blaser; G Piazza; B Gagliardi; H Serin; A Yag??z Sen; SS Yurdaor; MK Aktas; E Arslan; O Kopac; A Uyanik; BB Ozmen; E Tiftik; B Aksoy; A Yalcinkaya; F Ozoglu; MD Kocer; G Bilicen; EN Cinar; ?? Uslu; Y Kaya; K Demirci; J Wong; MMH Farhan???Alanie; G Suresh; A Asif; BJ Finch; Y Bhahirathan; J Herron; Z Yi Tew; R Obukofe; C Russell; I Suchett???Kay; T Netke; L Williams; A Kisiel; FY Liu; H Claireaux; P James; A Mondal; R Kalderon; HH Nadama; Z Al???Saraff; JPH Tam; A Powell???Chandler; F Wood; A Campbell; Rebecca Gorgievska; A Ragavoodoo; C Thakrar; D Rojoa; C Palmer; K Davidson; L Giacci; J Hale; FW Gan; R Makin???Taylor; CY Hey; C Toh; JM Findlay; N Griffiths; S Ganesananthan; S Jasionowska; M Poustie; C Wong; T Turner; W Pyc; W Sloper; C Warner; J Coey; D Mason; S Sait; M Kowal; TC Shortland; M Owen; A Saiyed; I Ashworth; K Akbari; M Curran; P Martin; D Parker; A Dawson; K Kwok; C Lye; P Pockney; M Ghaly; T Sammour; D Lewis; R Mundasad; A Wilkes; G Ctercteko; P Stewart; S Delibegovic; S Maslyankov; R Dimov; S Iliev; D Dimitrov; F Marek; J ??rhalmi; P Skalick??; T Skalick??; K Chrz; P Christensen; J Wors??e; ES Kristensen; KJ Emmertsen; US Loeve; E Duchalais; AL Mihaljevic; F Herrle; KM Konstantinidis; DK Manatakis; D Korkolis; I Karanikas; ML Aguilera; L Vincenti; G Anania; F Borghi; F Agresta; I Maretto; A Parisi; L Bucci; G De Palma; A Guglielmi; E Cucinotta; F La Torre; F Cianchi; M Guerrieri; A Lauretta; M Trompetto; R Persiani; G Micheletto; P Delrio; A Belli; S Cantafio; F Lovisetto; M Ronconi; PAG Bisagni; M De Prizio; N Tamini; G Sinibaldi; A Franceschi; R Galleano; M Cavallini; A Brescia; L D'Ambra; A Benevento; P Niolu; M Calgaro; E Colangelo; T Grottola; DF Altomare; S Puleo; G Salamone; A Pietrabissa; G Poggioli; V Ripetti; E Erdas; R Ottonello; G Canonico; V Tonini; F Selvaggi; G Sammarco; G. Ceccarelli; C De Nisco; D Surgo; L. Taglietti; A Ozolins; A Sivin??; T Poskus; J Psaila; WA Bemelman; LJ Graat; B Langenhoff; BPL Wijnhoven; AHW Ven; M Poelman; LPS Stassen; G Slooter; YIZ Acherman; C Hoff; MF Gerhards; MWJ Stommel; EJ Hazebroek; AAW Geloven; RA Schasfoort; BL Leeuwen; JB Tuynman; MWA Tilburg; EG Boerma; P Sharma; B Jenkins; IP Bissett; SL Peng; A Herd; A Gordon; D Vernon; M Omundsen; J Ly; A Reddy; G Bonnet; C Harmston; M Morales; V Francisco; S Costa; A Manso; E Amorim; J Pereira; J Cardoso; S Our??; M Carat??o; C Nascimento; B Ribeiro da Silva; V Taranu; R Dias; H Devesa; J Mendes; M Allen; A Silva; S Carlos; E Barbosa; C Carneiro; L Ramos; J Maciel; L Lencastre; R Martins; P Silva???Vaz; PF Ridgway; DA McNamara; R Cahill; A Hogan; J Larkin; PR O'Connell; I Negoi; A Abelevich; VM ??uk; M Vician; C Ede; I Sardiwalla; S Mulira; D Montwedi; M Oyomno; D Sabia; V Portugal Porras; V Vigorita; G Sanz Ortega; J Garc??a; A Esp?? Mac??as; F Blanco Antona; JA Luj??n Mompe??n; S Salvans Ruiz; P Villarejo???Campos; M Romero Sim??; L S??nchez???Guill??n; LM Jim??nez???G??mez; A S??nchez L??pez; T Golda; D Juli?? Bergkvist; C Nevado; JF Noguera Aguilar; B cRicardo Felipe; J Septiem; A Rodr??guez S??nchez; J Ca??ete???G??mez; I Ruiz Montesinos; J Ripoll??s???Melchor; M Mill??n???Scheiding; I Prieto???Nieto; JJ Segura???Sampedro; E Espin???Basany; M Frasson; I Alberdi San Rom??n; D Garc??a Olmo; M H??bner; D Petermann; MO Sauvain; V Ozben; IE Ge??im; E Dis??i; A Rencuzogullari; A Kurt; T Bisgin; M Pehlivan; A Isik; E Onur; S Leventoglu; MC Haksal; MS Erturk; M Keskin; A Guner; S Tutcu Sahin; GS Ozbalci; A Pergel; D Albayrak; D Bruce; N Fearnhead; J Arthur; M Harron; G Beattie; L Titu; A Ali; M Saunders; J Phillips; S Dindyal; B Cresswell; Y Gercek; J Lee; T Linn; G Faulkner; S Lockwood; J Rees; A Charalabopoulos; B Campbell; C Kontovounisios; T Amarnath; M Johnson; E Epanomeritakis; S Vigs; P Nastro; A Gilliam; S Smolarek; T Wilson; J Orbell; R McIntyre; T Agarwal; P Hainsworth; P Patel; J Vijay; B Liu; P Dhruva Rao; C Roxburgh; M Vipond; H Youssef; C Thorn; A Schizas; S Denley; D Bowley; K Das; T Cuming; A Saha; L Chung; J Pitt; P Davis; O Jones; M Taylor; A Bhargava; A Haji; N Watson; I Bloom; B Singh; M Norwood; S Gurjar; N Stylianides; S Mirza; M Evans; G Williams; P Patil; J Hernon; G Finch; S Green; K Chapple; O Fafemi; J Warusavitarne; A Samee; C Carden; L Ong; K Verma; A Joseph; N Rawat; T Pinkney; O Oke; P Glen; C Maxwell???Armstrong; R Oliphant; J Garner; SJ Moug; S Middleton; JN Lund; NJ Smart; G Osborn; T Moore; T Raymond; CH Knowles; TS Hany; R Clarke; G Khera; R Brady; C Sellahewa; C Mason; A Torrance; K Lasithiotakis; J Knight; A Pullybank; P Ainsworth; F Reid; A Ramwell; S Maslekar; R George; A Skull; S Holtham; K Muhammad; R Lal; M Varcada; FM Smith; M Howlader; D Defriend; S Kirk; T Richards; C Evans; CM Borg; K Telford; N Sarfraz; K Busby; J Hollingshead; D Speake; N Pawa; D West; M Chadwick; O Komolafe; S Richardson; M Thornton; A Goede; C Osborne; D Bandyopadhyay; J Foong; YJ Lee; P Liebenberg; D Mijalkov; A Wells; N Bull; A Ajmera; T Warburton; S Morgan; A Mahmoud; M Schachtel; B Mikhail; I Fomin; B Mekaeil; N Taylor; C Stevenson; A Drane; U Pahalawatta; LT Lai; A Debiasio; J Wong; HJS Jun; R Hengpoonthana; DM Mendis; PM Robb; HJ Lee; AAB Wyche; LT Davis; HJ Lee; A Chrimes; A Agarwal; J Zhao; S Williams; JMSN Jayalath; P Liebenberg; S Khor; T Muddasani; S Childs; S Ridgway; NDA Blefari; H Tam; N Puchalski; C Ngai; J Mackenzie; N Johnson; M Holmes; R Zuzek; T Saluja; T Gould; YK Goh; T Selvaraj; CD Brumfitt; YZ Beh; NN Dudi???Venkata; D Horne; JL Borrow; C Campbell; G Cousins; L Jackson; K Maheepala; S Zhao; E Holden; L Tutt; B Thompson; H Collins; F Louie; B Buckland; D Smith; C Chong; TH Chua; C Nayak; J Redmond; RR Tan; M Gramlick; JS Teh; SY Ng; P Britten???Jones; R Mohd Rosli; HDV Pham; T Jegathees; SMCJ Coulter???Nile; MP Gosselink; JK Luong; YL Wang; M Maciaszek; PS Chrapko; A Nair; V Thirugnanasundralingam; K Muir; M Salibasic; V Pavlov; T Paycheva; A Borisova; E Lyulenina; N Kolev; V Ivanov; D Nguen; Y Mitkov; E Mitkov; P Vladova; V Dimitrov; M Hussain; A Gabarski; T Ivanov; T Yotsov; I Ilieva; M Karamanliev; A Akisheva; M Shoshkova; E Nawaz; H Feradova; T Mladenov; V Neykov; V Jozaf; M Farka??ov??; T Klail; M P??s; A Adel; O Sotona; M Barto??; T Amjad; O Mal??; S Berec; M Hanu??ov??; M Hurn??; J Ri??ko; M Ludvik; M Stercz; R Tresko??; M Posp????il; L Hlav????ov??; K Kun??arov??; D Tomanov??; S Chodora; O Houdek; R Novick??; T Antonova; K Sobotkov??; S Cha; K ??uta Kimle; K Jirankova; M Bujda; A Pacl??k; A Trap; J J??rgens???Lahnstein; M Storm; P Dalsgaard; I Damgaard; F Olawi; F Ehlern; M Raos; FP Kristensen; KD Lycke; K B??nnerup; KP Unbehaun; MD Kjaer; S Brandsborg; S Amiri; M Enevoldsen; JL Harbjerg; J H??jgaard Pedersen; BN Jepsen; TK Hillgaard; SB Erichsen; CV Nielsen; CP Madsen; J Bjerke; CD Skej??; RR Aabling; JS S??rensen; A Mark???Christensen; A Kechagias; A Turunen; J Katunin; M Niskakangas; T Vignaud; S Frey; C Ricolleau; F Chanut; J Magnin; M Gout; T Seiboldt; L Beck; LJ Pohl; K Zamzow; F Betge; A Poncelet; M Truant; H Hauschild; N Neugebauer; L Sch??ning; S CS Simon; C Galata; I Karampinis; T Th??wel; AM Seckler; C Kerem; S Durdevic; A Ioannidis; F Antonakopoulos; M Konstantinidis; A Mathioulaki; P Chrysoheris; PG Athanasopoulos; V Kalles; I Spyrou; C Barkolias; A Paspala; N Machairas; D Papaconstantinou; E Spartalis; N Arkadopoulos; A Prodromidou; Z Garoufalia; D Balalis; A Zoikas; IM Christodoulou; D Mendez; J Rosales; M Flores; M Garcia; A Garcia; M Garcia; Z Noriega; D Torselli; ML Aguilera; J Rodriguez; S Lafranceschina; E Artioli; S Giaccari; V Nevoso; A Schimera; S Marino; P Geretto; L Pellegrino; B Borghi; D Sasia; A Marano; C Corino; G Cannata; MC Giuffrida; F Landra; G Pata; D Ongaro; G Baronio; S Raimondo; S Casiraghi; R Salvadori; G Savino; E Finotti; E Ciccioli; A Galgano; M Zuin; A Simioni; A Bettella; A Barina; E Vendramin; G Palano; D Schiavone; A Di Cintio; A Gemini; S Trastulli; M De Luca; A Sagnotta; J Desiderio; F Gubbiotti; M Cigognini; G Zaffaroni; A Maffioli; S Colombo; A Bondurri; G Sampietro; D Foschi; F Colombo; M Manigrasso; M Danzi; R Amato; L Anastasio; F Mastella; R Basile; R Peltrini; E Marra; G Luglio; G Pagano; M Giglio; M Manigrasso; P Anoldo; S Vertaldi; L Grimaldi; N Tammaro; C Pedrazzani; T Campagnaro; G Turri; E Lazzarini; C Conti; I Vulcano; E Bertilone; G Pintabona; F Viscosi; S Cerasari; G Galiffa; P Lapolla; D Coletta; C Del Basso; B CirilloMembro del Collaboration Group G De Toma; K Fazzi; S Bini; F Coratti; P Montanelli; S Grandi; T Nelli; N Ben Khaled; F Cammelli; E Ferrini; ME Billo; PL Tilocca; AG Marrosu; F Scognamillo; C Pala; F Attene; L Carboni; MW Ruggiu; G Gabbas; I Marziali; S Mazzocato; F Petrelli; R Vergari; F Piazzai; I Kubolli; A Aggiusti; A Paolucci; M Ortenzi; M Olivieri; C Belluco; AD Antona; S Basso; M Morino; M Mistrangelo; V Testa; G Gallo; G Clerico; G De Santi; MF Bitonti; M Trompetto; NS Pipitone Federico; M Frattalone; F Tirelli; V Fico; F Santullo; F Belia; A Spinelli; M Marco; F Di Candido; M Bevilacqua; 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R Scaramuzzo; A Larcinese; C Fioriti; E Picone; M Nardi; L Marano; G Castagnoli; A Bartoli; R Bellochi; A Spaziani; D Conti; V Poponesi; M Trippetti; S Amicucci; G Tazza; P Procacci; F Giovannini; E Basile; A Franceschi; G Caristo; M Pagnanelli; P De Nardi; R Rosati; G Marcocci; A Vignali; G Curletti; R Galleano; A Badran; M Malerba; A Percivale; O Ghazouani; L Reggiani; C Spirito; G Moschetta; F Cosmi; G Romeo; M Gasparrini; F Sucameli; A Gennai; E Moggia; C Bianchi; P Bonfante; S Macina; C Feleppa; G Talamo; M Imperatore; SM Tenconi; S Rausei; D Maioli; V Marchionini; F Pata; C Sparta; FA Mura; M Barmina; A Lorettu; C Rettaroli; G Mastino; GV Ruggiu; GA Mura; BA Perrone; M De Angelis; A Mereu; V Adamo; C Bianco; A Manzoni Garberini; M Ricciardiello; C Campanaro; P Panaccio; LM Esposito; F D'Ascanio; R Pietroletti; A Picciariello; N Chetta; F Aquilino; F Di Marco; A Amico; E Schembari; S Puglisi; L Licari; S Campanella; G Profita; N Falco; G Rotolo; P Venturelli; R Tutino; P De Marco; M Marcian??; A Sgr??; F Argenti; MS Milani; S Malabarba; G Giambartolomei; I Vella; F Gronchi; A Ruggieri; G Sancini; A Roggiani; F Balsamo; A Gori; D Cuicchi; R D'Alessio; D Benvenuto; L Gordini; E Erdas; F Podda; F Cappellacci; C Salaris; S Sanna; J Marcialis; L Mosino; M Peddis; S Melis; G De Donno; AC Aru; E Falsetti; D Parini; J Lanari; U D'Errico; S Bianchini; A Birindelli; F Fig??; A Caiazzo; L Selvaggi; A Capozzolo; C Cerra; M Pirillo; M Papandrea; S Cravano; I Libri; N Laquatra; A Isabello; A Tru??kovs; A Bartnick; E Malcevs; MJ Machatschek; J Alm; S Lapsa; M Delorme; F Zeynalov; J Larnovskis; J Sauka; D Bodrov; R Gailumsis; AM Wiemann; NL M??ller; I Jelovskis; D Deksnis; O Bauermeister Potts; T Slimbajevs; NE Samalavicius; D Simcikas; V Nutautiene; P Zeromskas; J Jurgaitis; O Aliosin; A Slepavicius; V Eismontas; M Kybransiene; A Dulskas; J Kuliavas; P Kavaliauskas; R Kavaliauskaite; E Po??kus; D Danys; M Kry??auskas; S Mikalauskas; R Rackauskas; M Drungilas; T Po??kus; V Jotautas; K Strupas; C Cachia; C Cefai; L Portelli; Y Youssef; D Degaetano; S Debono; M Sammut; J Cassar; K Sammut; RC Looijen; ASHM Dalen; MAJ Becker; D Comert; L te Molder; J Tromp; E Matthee; YM Tissen; E Brinkhuis; HS Vries; E 't Hart; K Beckers; Y Bekker; S Kakar; SFH ten Doesschate; TC Smaalen; OC Veen; SA Dingemans; LC den Brink; GHEJ Vijgen; EMF Voort; A Pool; KLC Rest; T Haak; NRF Sluijpers; SR Pruijssers; CJL Molenaar; MC Gordinou de Gouberville; S Saleh; MA Mens; EM Hoeks; S Nieuwenhuizen; EM Praag; E Westerduin; MPCM Smit; SJ Lely; B Nasimi; M Gerdsen; RCH Stijns; TYS Leow; G Penningnieuwland; A Ruiter; T Ribbers; CAM Aarts; MS Tulek; J Jonge; S Kocak; HJ Alqethami; R Constansia; PC Elst; MW Tissink; A Gr??ter; Y Vroom; DM Voeten; T Feenstra; J Azzahhafi; S Bofarid; M Kip; W Saleh; S Franssen; CL Boon; RJM Franssen; I Romaen; MTF Jense; J D'Souza; R Pascoe; A Scott; E Stark; K Mulholland; WK Lau; B Smith; SIB Adams; N Shah; E Ling; J Young; SL Peng; A Jacobson; H Macfater; S Farik; SY Chen; 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A Amado; M Leite; P Miranda; C Cunha; M Ferreira; D Cavadas; R Silva; S Pina; I Paix??o; L Orelhas; J Santos; A Pacheco; AF Rocha; MJ Jervis; V Pedro; V Paix??o; A Guerreiro; D Melo; D Correia; V Capella; T Moinhos; C Monteiro; M Silva; BN Vieira; AG Silva; D Galv??o; A Mora; R Bettencourt; F Costa; I Gil; J Morgado; J Neves; I M??nica; S Oliveira; H Ribeiro; M Ferreira; N Guimar??es; M Duarte; J Miranda; SF Martins; MR Almeida; R Parreira; A Faustino; N Medeiros; R Castro; B Soares; M Resendes; P Almeida; A Cruz; M Claro; G Vaz Pinto; D Sousa; D Costa Santos; A Silva; F Silva; G Fialho; M Reia; N Pratas; H Capote; C Costa; J Costa; S Morais; A Machado; V Horta; M Rocha???Melo; J Patr??cio; M Pereira; R Lima; AM Cinza; J Oliveira; C Velez; M Ferreira; F Borges; J Sim??es; F Eir??; P Botelho; B Cismasiu; D Alves; B Dias; C Costa; JP Gon??alves; P Valente; J Oliveira; L Freire; R Saraiva; M Moreira; M Fragoso; J Guimar??es; G Cruz; DJ Apar??cio; J Ribeiro; I Borges da Ponte; S Almeida; AR Martins; T Louro; M Morgado; AS Ferreira; M Alves; N Oliveira; R L??rias; C Neves???Marques; I Estalagem; C Botelho; J B??rtolo; C Fidalgo Antunes; F Cabral; F Brito Silva; A Dias Matos; M Santos; R Cunha; M Duarte; M Sousa; R Canotilho; M Peyroteo; AM Correia; PC Martins; JAM Jardim; SP Domingos; JM Bai??o; BS Rocha; NMRO Lopes; DM Jord??o; JG Correia; MD ??ngelo; T Caro??o; M Romano; JR Gomes; RG Monteiro; S Varghese; E Boyle; L Aljohmani; J Alexander; V Graziadei; C McCaughey; A Jain; J Lee; H Ramanayake; R Sabnani; LF Colon; N Bansal; I Stephens; R Tan; S Sharma; G Doherty; S Fenn; E Mulhare; M Walsh; C Leavey; O Costigan; S Griffin; ?? Dockry; E Khogali; AK Aly; R McPhedran; D O'Gorman; D Vermeulen; L Dervan; SJ Kang; O Dixon; E Morrissey; M Compton; AR Pentony; CL Piong; R Nossier; J Hanna; K Sabir; SY Eow; N Ladak; D Boersma; PJ Kamath; TBW Soh; AH Dyer; SY Chee; IXH Tan; A Kelliher; L Adeusi; N Howarth; N McCawley; A O'Neill; MR Jones; R Saleh; A Singh; R Senaratne; P Kakodkar; I Balasubramanian; A Hogan; A Al???Salihi; V Vyas; A Vedadi; SS Popescu; K Piras; CI Ciubotaru; A Litvin; E Romanova; N Ponomarev; A Savchenko; A Yanishev; R Luzan; E Lutovinova; A Gavrilina; A Barkovskaya; N Kudelkina; D Topchubaev; R Radulovi??; K Milo??evic; VV ??uk; J Boji??i??; J Juloski; M Gen??i??; U Jankovi??; M Zubowicz; PK Such????; J Gerstmeier; K M??sz??rosov??; E Brazitikou; E Fytrou; M Celik; M Dubovsk??; J Schmalenbeck; SC Sautter; H Ceyran; R Jaich; N Fitchat; S Mathebula; J Chauke; W Mculu; Z Ngwenya; K Withey; A Piperidis; Y Toyi; A Nicolaides; T Jaffer; A Sparke; N Van Staden; CR McDuling; L Claassen; C Kruger; J Weyers; M Marx; J Lecler; A Yebes; O Anabitarte Bautista; OC Mana; H Gomez; L Riba; J Perez; L Casaval Cornejo; I Vicente Rodr??guez; F Jim??nez Escovar; U Andres Olabarria; M Calvo Fern??ndez; A Portugal Mart??nez; I Badiola Bergara; A Landaluce Olavarria; E Pozo Andr??s; M L??pez Otero; C Samart??n Toimil; JC Primo ??lvarez; L Rodriguez Fernandez; A Yebes; C Ortega; ME Ossola; E Camarero; M Mart??nez Ill??n; L Aranda Garc??a; M L??zaro Cardona; C Montalvo Olmedo; P Livianos Arias???Camis??n; S Figueroa Jim??nez; JM Nieto Arranz; MJ Mateos Sexmero; E Diego Alonso; C Fair??n Oro; A Izquierdo Moreno; A Margarida; B Pando; L Liquete Mar??n; M P??rez Calle; MJ Ramos Cordero; A Sagredo Cuartango; E S??nchez; A Marcos Rodrigo; JM Mart??nez D??az; JJ Ruiz Manzanera; ?? Navarro Barrios; L Rodr??guez Pedre??o; F Alconchel; P Garc??a Moreno; M Garc??a G??mez; K Rodrigues; J Platero Diago; M Veras Lista; S Rif?? Terricabras; L Butler Sanz; E Alberch Camprub??; M Rico Ferr??ndez; E Puig Lao; M De Pablo Mir??; A Alberca???Paramo; T Alia Verdejo; J Ca??ete???Manzanares; M Molina???Florez; LC Garc??a Hern??ndez; S Orozco Nu??ez; M Suarez???Sanchez; J Martin???Fernandez; MM Soriano Li??bana; D Negre Parra; CF Campo Betancourth; S Sevila Mico; A Fernandez; C Curtis; M Bosch; D Triguero; M Bosch Ram??rez; N Ramayo D??az; I Gonz??lez Caraballo; T Pascual Vicente; MI Orue???Echebarria; L S??nchez???Calvo; D Wang; C Trueba???Collado; JT Morales Bernaldo de Quir??s; P Uriol Peralta; F Lima Pinto; S N????ez O??Sullivan; FA Ramos Jim??nez; I Alberdi San Rom??n; A P??rez Ortega; A Trujillo Barbadillo; E Romero Pujana; MV Fernandez Illera; O Claramonte Bellmunt; A De La Llave Serralvo; P Muriel; N Mestres; E Cuello; M Merichal; JE Sierra; J Escoll; M Rufas; AI Pinillos; J Ortega; M Serrano Navidad; P Vivas Angeles; R Vives Figueras; E Baena Sanfeliu; B Campillo Alonso; M Alberich Prats; J Duran Arrocha; N Cornell?? Garceso; C Uribe Galeano; O Delisau Puig; A Castro; H Salvador Ros??s; C Codony Bassols; N Fernandes; J Garc??a ??damez; C Caula Freixa; MJ S??nchez; P Mart??n???Borreg??n; A Quevedo; J Mart??nez; JM Mar??n; P Rodr??guez; JJ Garcia Orozco; DA Ferrusola Diaz; RE Licardie Bola??os; ML Garcia Jimenez; L Castro Diez; C Mosquera Fernandez; M Merayo Alvarez; E Alonso Batanero; I Cifri??n Canales; MG Calzada; CB Recuenco; MC Martin; I Esteban Avenda??o; C Jim??nez Relimpio; P Lancho Lavilla; I Blanco Bartolom??; I G??mez Cano; C Blasco Andr??s; A Forero???Torres; A Alonso???Poza; B Dieguez; M Losada; C Gilsanz; A Garc??a???Vico; A Roman???Rando; M?? S??nchez???G??lvez; IM Bersabe???Alonso; A Vadillo???Bohorquez; RD Gutierrez Rios; M Eizaguirre Ubegun; I Novo Sukia; M Uribe Isado; M Iba??ez Alda; CC Lopes Moreira; C Olmedo Moreno; C Pastor Idoate; A Abad???Motos; E Mar??nez???Hurtado; R Salvachua???Fern??ndez; ED Padilla Zegarra; M Franco; A Martinez; P Ramos Martin; P Mate Mate; C Marcano Chavez; I Rubio???Perez; H Ayllon; S Jer?????McFarlane; C Soldevila???Verdeguer; C Pine??o???Flores; D Ambrona???Zafra; L Fern??ndez???Vega; A Gil???Catal??n; A Craus???Miguel; N Pujol???Cano; F Sena???Ruiz; MJ G??mez Jurado; P Alberti Delgado; A Bordanova Reverter; Y El Kasmy; JF Belzunce???Cap??; M Verdaguer Tremolosa; Q Lin; C Muniesa; L Avelino; H Cholewa; J Sancho???Muriel; M Navasquillo; A Nav??o; D Abell??; M De Jesus; E Alvarez; P Troncoso Pereira; JM Garcia; A Gil; HE Giordano; G Mignon; A Vanoni; A Henkens; G Jarrar; M Odovic; M Willemin; O Milliet; D Hahnloser; D Clerc; N Demartines; G Piazza; H Teixeira; O Pittet; ML Haller; B Gagliardi; A Huot; B Blaser; A Kefleyesus; A Bugmann; LM Piotet; L Meijers; GK Kurtoglu; EK Sel; VC Isler; BS Yilmaz; C Adiyaman; M Kara; HC Demirkaya; HK Korkmaz; AM Pektas; B G??ner; EC ????lek; HB Tombul; CY Boztu??; A T??naz; M Y??lmaz; Y Karaman; FA Ak??n; S Dansuk; M Ba????avu??; M Kaya; B Kutlu; MC Seker; V Erten; U Memis; ZB Ko??ak; YE Karapinar; M Fakirullahoglu; ?? Uslu; E K??seoglu; M Yeni; MK Aktas; N Aykun; MH Agca; C Bilen; I Kilinc; C Atar; V Kilic; C Aktuna; M Aba; YE Alim; M Binbuga; ?? 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Yumurtaci; A Emin; ??agri Girit; MK Yildirak; E Senyigit; A G??ldag; B S??yleyici; YE Aytin; FE Akay; NG Iskan; B Mutlu; AO Sunay; AD Ablett; T Tie???Gill; G Ramsay; L De Paola; S McGuckin; A Alshakhs; A Ahmeidat; J Wong; N Goergen; Z Ali; L Mullarkey; MF Bath; R Walshe; E Lewis; B Berry; J Moneim; S Mookerjee; S Christy; O Ojofeitimi; L Carroll; A Hylands; LP Delaugere; D Reveendran; C Coulter; C Ralston; L Laverty; P Gallagher; A Ahmed; YQ Yeo; D Elliott; J Bennett; M Mcnamara; S Sivarajah; C Dunmore; G Aitken; M Nair; MH Aly; M Buari; MMH Farhan???Alanie; K Ahmed; Z Sheikh; M Monks; J Lehmann; O Rotimi; T Bell; D Limnatitou; S Gormley; P Taleongpong; V Patel; L Macgregor; S Amini; C Turner; L Dwyer???Hemmings; A Busuttil; J Powell; C Hensher; F Vivian; K Wcislo; Z Millar; S Hirosue; I Ogunmwonyi; D Nakakande; I Kwek; H Gaze; A Nirmalanantha; MA Bin Amran; A Foulkes; N Jones; S Pillai; G Khoury; T Powell; I Maleyko; A Sangheli; M Ransome; M Isse; O Aromolaran; H Bholah; J Anbarasan; 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R Polson; D Mason; E Mackenzie; C Russell; N Doyle; Z Habib; M Zardab; F Sartaj; H Farooq; M Tabibi; DJ Drury; SJ James; R Barnett; AB Teasdale; ETJ Richardson; DA Thomas; S Ahmed; RL Williams; HF Najabat???Lattif; E Cahya; G Lou; M Coyle; K Homyer; LY Zhu; M Woods; J Chang; H O'Callaghan; I Suchett???Kaye; TH Mihailidis; H Alawattegama; E Seite; A Barrett; E Riordan; W Lam; M Dowdeswell; C Mulvenna; T Netke; O Awokoya; L Gurowich; K Dhera; S Hayat; L Williams; L Tincknell; M Spazzapan; F Teeling; K Sysum; J Latter; M Latter; S Khan; M Guruswamy; W Beedham; E Brazier; M Elghobashy; M Bajaj; H Mann; E Etel; M Woodmass; H Hayden; A Kisiel; Y Ali; S Husain; A Arnold; AC Pedersen; P Cunha; M Ahmed; S Al Zawawi; V Kudva; FY Liu; K Theodoropoulou; M Miscampbell; AV Robinson; J Johnston; A Dharni; S Lamb; T Westerman; E Evans; L Campbell; M Gillespie; CM Cheong; K Kulathevanayagam; A Varghese; SI Ike; TSM Chu; B Baljer; JAW Mogg; P Rai; HA Claireaux; M Williams; R Smillie; J Goetz; E Appleby; T Fadipe; S Vaughan???Burleigh; G Puri; P Hussain; P James; R Flather; A Cutler; S Pathak; J Sheldon; T Collicott; M al???Ausi; A Mondal; A Jovaisaite; SM Shah; N Khalid; D Gutmann; S Davison; YJ Alame; L Syed; WJ Owen; SD Ahsan; R Kalderon; U Anthony???Uzoeto; C Macleod Hall; S Zheng; K Wynter; C James; D Sapre; R Ghosh; J Baird; L Cockburn; O Blackwood; HH Nadama; W Simpson; S Jeong; S Bishop; R Bate; C Hobson; AH Adam; C Redclift; J Do; O Adeleye; F Poli; A Batterham; S Brown; JN Parekh; W Clay; K Pieri; A Jackson; S Brown; A Saxena; B Gurung; T Oyebola; F O'Brien; B Djeugam; S Gardezi; S Ul???Hasan; MP Martin???Hernandez; M Sisley; S Modi; R Antakia; A Elbayouk; YJ Soh; J Mather; Z Yusuf; Z Al???Sarraf; M Naja; SB Rassool; J Convill; Y Nikookam; A Warsame; JPH Tam; C Pace; M Kiandee; R Ridwan; C Carey; F Hirri; MJA McMillan; JJ Ling; A Powell???Chandler; L Pendelbury; K Kerimzade; A Tang; EO Howard; S Humayun; OJ Wadsworth; K Tan; F Abdelhameed; C Haglund; I Radnaeva; N Hu; S Rambhatla; D Waldron; P Madahar; S Malik; A Campbell; LC Meney; I Ibrahim; CK Kang; JZJ Chiu; V Livie; B Ibrahim; M Khalil; G Pooley; B Shishkin; R Gorgievska; J Docherty; A Southgate; A Coomes; F McGee; S Flanagan; C Thakrar; QJ Tan; H Anwar; R Clough; B Chrisp; J Cassels; GWV Cross; A Ragavoodoo; L Mercer; C Mercer; A Refalo; R Hadley; A McTighe; F Farrow; A Brodie; G Davis; DR Shah; C Bowers; S Patel; O Morice; A Burzic; J Cheung; A Shashidhara; G Theodoraki; J Birk; A Ong; MPE Ng; RTW Wong; S Maese; B Yeap; Z Iqbal; DM Rojoa; C Cabaleiro Barciela; M Hussain; CM Ruddy; S Lindwe; Y Qamar; S Chuita; T Melaugh; JD Hall; C Palmer; O Kouli; ASI Hassane; AW Azhar; TK Tan; W Perchard; T Scurr; K Davidson; E Campbell; L Kelk; A Ghosh; A Gibbins; D Mala; A Loizidou; O Hall; L Mecia; C Hew; K Varathan; L Tong; B Chandrasekar; L Giacci; E Buchanan; M O'Connell; SY Kwak; EH Ong; S Gardner; J Lim; C Maden; M Illahi; J Hale; Z Xuan Tan; S Edwards; R Stahl; J Stahl; A Hickman; D Collett; Z Goolam???Mahomed; B Allen; A Atiyah; H Ahmad; J Jones; O McGregor; E Ogundiya; FW Gan; A Boulbadaoui; O Kirnon???Jackman; QX Lim; H Peckham; T Yeoh; SQ Yong; JY Chen; S Siva; ZH Sam; M Gilani; YN Goh; MG Muthukumar; S Phillips; R Makin???Taylor; J Tjoakarfa; A Giri; S Suresan; R Thavayogan; CY Hey; P Thomas; TA Johnson; RI Williams; A Rashid; A Kushairi; A Rais; A James; M Bugelli; Y Chechelnitskaya; N Sandhu; C Toh; R Tandon; M Gray; A Kumar; C Ciurleo; I Nyamali; S Hiremath; S Sinha; M Chowdhary; E Bradley; M McTiernan; S Macdonald; S Sharkey; N McLaughlin; C Amey; L Kraria; O Skan; C Kind; JM Findlay; P Tupper; C Van Rhee; SI Honeyman; G Menon; M Ahmed; L Jegatheeswaran; N Griffiths; A Madhavan; M Warne; FL Malcolm; T Lessware; HT Wilkerson; S Chatterjee???Woolman; A Yoong; WUR Ahmed; A Longshaw; O Flannery; R Green; M Leaning; J Cragg; H Sharriff; C Doherty; S Ganesananthan; KWL Kwan; L Sanders???Crook; S Bhatia; S Eames; F Lewis; P Kirupananthan; ZY Boh; S Dass; A Soma; A Newton; M Hill; Y Shafiq; M Brkljac; L Boyce; S Jasionowska; WJ English; S Lam; C Chipeta; D Yilmaz; C Jain; T Garofalidou; SA Novotny; S Locke; C Bowman; A Begaj; C Murphy; K Radcliffe; JT Chong; M Poustie; E Jeffrey; N Chaudhury; K Rajendran; Z Akbar; B Walters; B Kulendrarajah; N Tran; S Shrestha; S Parmar; C Gallagher; L Hennessy; E Pentti; S Badhrinarayanan; A Fung; M Mansoor; R Kenny; P Kan; DE Lee; S Khosla; M Samake; F Shaban; R Aftab; M Gough; B Woodburn; S Vayalapra; K McMurrugh; C Wong; D Jimulia; S Deol; S Pike; Y Embury???Young; T Turner; M Patel; E Kilgallon; R Keating; A Walsh; H Khan; G Logue; M Orekoya; M Alasmar; M Charalambides; A Clav?? Llavall; E Williamson; Y Bharwada; S Zearmal; H Evans; M Panikkar; G Cruz; J Caplan; A Ruparelia; T Tanvir; C Soare; YL Pang; J Trotter; A Zaidi; V Thakrar; P Pulickal; H Ahmed; J Parnell; H Khan; S Lennock; V Ford; W Pyc; R Brignall; D O'Neill; R Hanna; R Kane; M Nicola; K Rajput; Y Xiao; C Warner; S Michael; E Wright; S Juniper; E Thompson; L Hoskyns; A Kanitkar; C Ross; A Unsworth; H Rshaidat; K Demarre; A Chiang; A Bareh; J Dellen; C Faqihinejad; A Gadhvi; R Grant; J Lewsey; A Morris; H Martin; C McClarty; S Sanyal; A Alsaif; A Palkhi; S Bhopal; S Vishnu K; A Papanikolaou; A Mitra; A Nur; F Ali; C Burford; T Huq; W Sloper; E Irwin; L Matthews; WS Ngu; T Hosfield; F Muneeb; O Page; E Zeb; J Coey; A Al???Azzawi; J McIntosh; A Vucicevic; M Hughes; L Brooks; B Fanibi; M Dixon; P Njoku; D Morris; J Jobson; H Chowdhury; DOT Alawode; W Wynell???Mayow; V Udayachandran; D Alsoof; J Ekert; N Joseph; N Zulkefley; G Hunt; T Christodoulou; O Wright; S Soman; M Jamal; S Beqiri; P Borgas; S Christie; F Pereira; S Browne; J Yiu; A Dworkin; J Brayley; A Palmer; M Charalambos; CS Jones; S Toner; R Cowden; L Lee; P Nicol; O Holman; M Imtiaz; V Albert; SP Leung; M Erotocritou; J Wong; R Stroud; D Mason; R Wilkin; W Thomson; L Mackee; N G; Y Bei; S Sait; S Mckenna Favier; A Ibrahim; A Kler; L Reynolds; SH Mohamed; Y Majeed; B Fakim; A Jones; M Kowal; G Liversedge; Z Carrington; J Windebank; A Izzarina; U Akbani; J Craven; A Aldarragi; S Harding; A Millward; TC Shortland; M Bedford; R Stroud; R Obukofe; E Mackenzie; V Gopalan; A Midgen; P Khadka; O Cheng; S Taneja; N Manobharath; JY Kok; DWE Lim; T Buick; M Boland; S Piya; R Devlin; CJ Fairfield; RJ George; M Rahi; S Zaman; S Hajiev; T Ross; M Owen; E Crisp; C Thompson; A Charalambous; JL Hollywood; A Saiyed; RFL Hammond; J Matthews; V Mendonca; J Spinty; K Khan; J Cheng; N Glynn; U Muhammad; M Khan; L Anderson; K Mccormack; J Mak; S Patrawala; N Milinkovic; R Schofield; M Chauhan; L Hartley; J Hind; I Ashworth; L Nelson; D Ratnasingham; K Akbari; T Whitehead; S Dimitriadis; K Marshall; EJ Flint; M Curran; C Horner; A Heybourne; H Morgan; C Wickstone; D Panagiotou; E O'Connell; K Dean; R Iqbal; L Walsh; N Yu; N Rana; E Massie; J Ng; M Jung; YD Lee; M Harris; S White; S Delibegovic; B Boev; P Tonchev; V Prochazka; J ??rhalmi; J Ri??ko; A Skalick??; K Chrz; S Ravn; A Ojak????r; E Duchalais; C D??rr???Harim; F Herrle; C Koutserimpas; G Giraudo; A Armellini; A Ruzzenente; C Mazzeo; C De PaduaMembro del Collaboration Group A Realis Luc; A Maroli; I Giani; ME Cufari; M Vitali; G Ceccarelli; GP Gusai; R Quattromani; E Virgilio; S Berti; S Mulas; FF Di Mola Ospedale SS Annunziata; V Papagni; F Tuminello; M Magnoli; L Vittori; A Longheu; GA Loche; B Braccio; E De Luca; G Resta; G Ancans; A Tamosiunas; M Petrulionis; P Andrejevic; ME Stellingwerf; N Abdulrahman; KGH Pas; G Thomas; AM Brandsma; J Davids; SJ Rottier; D de Roy van Zuidewijn; R Hawkins; HI Ong; Y Li; B Desmond; J Winstanley; M Martins; M Rosete; M Americano; M Santos; S Frade; R Senhorinho; R Peixoto; A Alagoa Jo??o; C Alves???Vale; M Lamas; DB O'Connor; M Hoo; A Gopaul; K Scanlon; N O'Dwyer; I Negoi; M Jovanovi??; A Panyko; H De Lima; S Van Vuuren; A Centeno; IR Bernado; M Paniagua Garcia Se??orans; L Gonz??lez Amor; A Cuenca Ram??rez; J Abrisqueta; M Estaire Gomez; A Arroyo; C Cerd??n; N G??mez Romeu; A Forero???Torres; JM Enriquez???Navascues; F Collado???Roura; P Curchod; S Gaspar; L Imadalou; D Mutlu; C Akyol; FA Uygur; IC Eray; O Biyiklioglu; MF ??etin; AE Isik; B Karip; H Dogan; L Sar??g??l; E Tunc; T Aydin; S Bodur; K Karabulut; AA Francis; A Al???hadithi; N To; ISF Lau; E Smith; S Mahapatra; O McAuliffe; AA Francis; L Imam; B Akram; S Hossaini; R Davies; M Ko; J Collins; A Pandya; S Reilly; J Archer; C Auty; CD Roche; J Livie; FA Chaudhry; E Ntakomyti; R Diallo; T Bylinski; J Wright; S Lawday; E Masiha; J Tung; B Shirazi; A Neilson; S Epton; N Patel; S Trussell; A Couldrey; C Donnelly; S Eftychiou
2020
Abstract
Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56-1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion.
Citazione
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[10.1111/codi.15311]
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Il report seguente simula gli indicatori relativi alla propria produzione scientifica in relazione alle soglie ASN 2023-2025 del proprio SC/SSD. Si ricorda che il superamento dei valori soglia (almeno 2 su 3) è requisito necessario ma non sufficiente al conseguimento dell'abilitazione.
