Safety of Nonsteroidal Anti-inflammatory Drugs in Major Gastrointestinal Surgery: A Prospective, Multicenter Cohort Study
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Significant safety concerns remain surrounding the use of nonsteroidal anti-inflammatory drugs (NSAIDs) following gastrointestinal surgery, leading to wide variation in their use. This study aimed to determine the safety profile of NSAIDs after major gastrointestinal surgery.
Consecutive patients undergoing elective or emergency abdominal surgery with a minimum one-night stay during a 3-month study period were eligible for inclusion. The administration of any NSAID within 3 days following surgery was the main independent variable. The primary outcome measure was the 30-day postoperative major complication rate, as defined by the Clavien–Dindo classification (Clavien–Dindo III–V). Propensity matching with multivariable logistic regression was used to produce odds ratios (OR) and 95 % confidence intervals.
From 9264 patients, 23.9 % (n = 2212) received postoperative NSAIDs. The overall major complication rate was 11.5 % (n = 1067). Following propensity matching and adjustment, use of NSAIDs were not significantly associated with any increase in major complications (OR 0.90, 0.60–1.34, p = 0.560).
Early use of postoperative NSAIDs was not associated with an increase in major complications following gastrointestinal surgery.
KeywordsAnastomotic Leak Ketorolac Major Complication Rate Anastomotic Leak Rate Propensity Match
STARSurg received INSPIRE funding from the Academy of Medical Sciences and the Wellcome Trust. The Royal College of Surgeons of England provided meeting facilities for a collaborator training day and the Association of Surgeons in Training (http://www.asit.org) supported this meeting with an ASiT Regional Event Grant.
Writing and Steering Group (asterisk indicates joint first author)
T. M. Drake*, D. Nepogodiev*, S. J. Chapman*, J. C. Glasbey*, C. Khatri*, C. Y. Kong*, H. A. Claireaux, M. F. Bath, M. Mohan, L. McNamee, M. Kelly, H. Mitchell, J. E. Fitzgerald, E. M. Harrison, A. Bhangu (overall guarantor). Statistical analysis T. M. Drake, A. Bhangu, E. M. Harrison (statistical guarantor). Local leads H. A. Claireaux (University of Bristol, Bristol); I. Antoniou (Hull York Medical School, Hull); R. Dean (Leicester Medical School, Leicester); N. Davies (University of East Anglia, Norwich); S. Trecarten, I. Henderson (University of Nottingham, Nottingham); C. Holmes (University of Sheffield, Sheffield); J. Wylie, R. H. Shuttleworth (Queen’s University Belfast, Belfast); A. Jindal (University of Limerick, Limerick); F. Hughes, P. Gouda (National University of Ireland, Galway); L. McNamee (Royal College of Surgeons in Ireland, Dublin); R. Fleck (Trinity College, Dublin); M. Hanrahan (University College Cork, Cork); P. Karunakaran (University College Dublin, Dublin); J. H. Chen, M. C. Sykes (Imperial College, London); R. K. Sethi, S. Suresh (King’s College, London); P. Patel, M. Patel (Queen Mary University, London); R. K. Varma, J. Mushtaq (St George’s University of London, London); B. Gundogan (University College London, London); W. Bolton (University of Leeds, Leeds); M. Mohan, T. Khan (University of Liverpool, Liverpool); J. Burke, R. Morley (University of Manchester, Manchester); N. Favero (Newcastle University Medical School, Newcastle upon Tyne); R. Adams (University of Aberdeen, Aberdeen); V. Thirumal (University of Dundee, Dundee); E. D. Kennedy (University of Edinburgh, Edinburgh); K. K. Ong, Y. H. Tan (University of Glasgow, Glasgow); J. Gabriel (Brighton and Sussex Medical School, Brighton); A. Bakhsh, J. Y. L. Low (Peninsula, Exeter and Plymouth); A. Yener (Southampton Medical School, Southampton); V. Paraoan (University of Cambridge, Cambridge); R. Preece, T. W. Tilston (Cardiff University, Cardiff); E. Cumber (University of Oxford, Oxford); S. Dean (Swansea University, Swansea); T. Ross, E. McCance (University of Birmingham, Birmingham); H. Amin (Keele University, Keele); L. Satterthwaite (University of Warwick, Coventry). Other collaborators K. D. Clement, R. Gratton, E. D. Mills, S. M. Chiu, G. Hung, N. M. Rafiq, J. D. B. Hayes, K. L. Robertson, K. Dynes (Aberdeen Royal Infirmary, Aberdeen); H. C. Huang, S. Assadullah, J. W. Duncumb, R. D. C. Moon, S. X. Poo, J. K. Mehta, K. R. Joshi, R. Callan, J. M. Norris, N. J. Chilvers, H. Keevil, P. Jull (Addenbrooke’s Hospital, Cambridge); S. Mallick, D. Elf, L. Carr (Airedale General Hospital, Steeton); C. Player, E. C. Barton, A. L. Martin, S. G. Ratu, E. J. Roberts, P. N. Phan, A. R. Dyal, J. E. Rogers, A. D. Henson (Alexandra Hospital, Redditch); N. B. Reid, D. Burke, G. Culleton, S. Lynne, D. Burke (Antrim Area Hospital, Antrim); S. Mansoor, C. Brennan, R. Blessed, C. Holloway, A. Hill, T. Goldsmith, S. Mackin (Arrowe Park Hospital, Wirral); S. Kim, E. Woin, G. Brent, J. Coffin, O. Ziff (Barnet Hospital, Barnet); Z. Momoh, R. Debenham, M. Ahmed (Basingstoke and North Hampshire Hospital, Basingstoke); C. S. Yong, J. C. Wan, H. C. Copley, P. Raut, F. I. Chaudhry (Bedford Hospital, Bedford); R. H. Shuttleworth, G. Nixon, C. Dorman, R. Tan, S. Kanabar, N. Canning, M. Dolaghan, N. Bell, M. McMenamin (Belfast City Hospital, Belfast); A. Chhabra, K. Duke, L. Turner, T. Patel, L. S. Chew, M. Mirza, S. Lunawat, B. Oremule (Blackpool Victoria Hospital, Blackpool); N. Ward, M. Khan (Bolton Royal Hospital, Bolton); E. T. Tan, D. Maclennan, R. J. McGregor, E.G. Chisholm, E. J. Griffin, L. Bell (Borders General Hospital, Melrose); B. A. Hughes, J. Davies, H. Haq, H. Ahmed, N. Ungcharoen, C. Whacha, R. Thethi (Bradford Royal Infirmary, Bradford); R. M. Markham, A. H. Y. Lee, E. Batt, N. P. Bullock, C. T. Francescon, J. E. Davies, N. M. Shafiq (Bristol Royal Infirmary, Bristol); J. Zhao, S. Vivekanantham, I. Barai, J. L. Y. Allen, D. C. Marshall, C. J. McIntyre, H. C. P. Wilson, A. J. Ashton, C. Lek (Charing Cross Hospital, London); N. Behar, M. Davis-Hall, N. Seneviratne, S. Kim, L. Esteve, M. Sirakaya, S. Ali, S. Pope, J. S. Ahn, A. Craig-McQuaide (Chelsea and Westminster Hospital, London); W. A. Gatfield, S. Leong, A. M. Demetri, A. L. Kerr (Cheltenham General Hospital, Cheltenham); C. Rees, J. Loveday, S. Liu, M. Wijesekera, D. Maru, M. Attalla, N. Smith (Chester Hospital, Chester); D. Brown, P. Sritharan, A. Shah, V. Charavanamuttu, G. Heppenstall-Harris, K. Ng, T. Raghvani, N. Rajan, K. Hulley (Colchester Hospital, Colchester); N. Moody, M. Williams, A. Cotton (Conquest Hospital, Hastings); M. Sharifpour, K. N. Lwin, M. Bright, A. R. Chitnis, M. Abdelhadi, A. D. Semana (County Hospital, Stafford); F. Morgan, R. Reid, J. Dickson, L. Anderson, R. McMullan, J. Dickson, N. Ahern, A. Asmadi, L. B. Anderson (Craigavon Area Hospital, Craigavon); J. Lua Boon Xuan, L. Crozier, S. McAleer (Daisy Hill Hospital, Newry); D. M. Lees, A. A. Adebayo, M. Das, A. H. Amphlett (Derriford Hospital, Plymouth); A. Al-Robeye, A. Valli, J. Khangura, A. Winarski, A. Ali, J. Khangura (Dewsbury Hospital, Dewsbury); H. Woodward, C. Gouldthrope, M. Turner, K. Sasapu (Diana Princess of Wales Hospital, Grimsby); M. Tonkins, J. R. L. Wild, M. Robinson, J. Hardie, R. Heminway, R. Narramore, N. Ramjeeawon, A. Hibberd (Doncaster Royal Infirmary, Doncaster); F. Winslow, W. Ho, B. F. Chong, K. Lim, S. Ho (Dumfries and Galloway Royal Infirmary, Dumfries); J. A. Crewdson, S. Singagireson, N. Kalra, F. Koumpa, H. Jhala, W. C. Soon, M. Karia, M. G. Rasiah, D. Xylas (Ealing Hospital, Southall); H. Gilbert, M. Sundar-Singh, J. Wills (Eastbourne District General Hospital, Eastbourne); J. Mushtaq, S. Akhtar, S. Patel, L. Hu, C. Brathwaite-Shirley, H. Nayee, O. Amin, T. Rangan, E. J. H. Turner (East Surrey Hospital, Redhill); C. McCrann, R. Shepherd, N. Patel, J. Prest-Smith, E. Auyoung, A. Murtaza, A. Coates (Epsom Hospital, Epsom); O. Prys-Jones, M. King, S. Gaffney, C. J. Dewdney, I. Nehikhare, J. Lavery (Forth Valley Royal Hospital, Larbert); J. Bassett, K. Davies, K. Ahmad, A. Collins, M. Acres, C. Egerton, T. Khan (Furness General Hospital, Barrow-in-Furness); K. Cheng, X. Chen, N. Chan, A. Sheldon, S. Khan, J. Empey, E. Ingram, A. Malik, M. Johnstone (Gartnavel General Hospital, Glasgow); R. Goodier, J. P. Shah, J. E. Giles, J. A. Sanders, S. W. McLure, S. Pal, A. Rangedara, A. N. Baker, C. A. Asbjoernsen (George Eliot Hospital, Nuneaton); C. Girling, L. Gray, L. Gauntlett, C. Joyner, S. Qureshi, S. Dean (Glangwili General Hospital, Carmarthen); Y. P. Mogan, J. C. K. Ng, A. N. Kumar, J. H. Park, D. Tan, K. P. Choo, K. P. Raman, P. Buakuma, C. Xiao, S. Govinden (Glasgow Royal Infirmary, Glasgow); O. D. Thompson, M. A. Charalambos, E. Brown, R. B. Karsan, T. Dogra, L. M. Bullman, P. M. Dawson (Gloucestershire Royal Hospital, Gloucester); A. L. Frank, H. Abid, L. Tung, U. Qureshi, A. Tahmina, B. W. Matthews (Good Hope Hospital, Sutton Coldfield); R. T. Harris, A. O’Connor, K. Mazan, S. Iqbal, S. A. Stanger, J. D. Thompson (Great Western Hospital, Swindon); J. A. L. Sullivan, E. Uppal, A. MacAskill, F. A. Bamgbose, C. Neophytou, A. F. Carroll, C. W. Rookes, U. Datta, A. J. Dhutia (Hammersmith Hospital, Hammersmith); S. Rashid, N. Ahmed, T. Lo (Harrogate District Hospital, Harrogate); S. Bhanderi, C. D. Blore, S. Ahmed, H. Shaheen, S. Abburu, S. Majid, Z. Abbas, S. S. Talukdar, S. Ahmed (Heartlands Hospital, Birmingham); L. J. Burney, J. B. Patel, O. Al-Obaedi, A. W. Roberts, O. Al-Obaedi, S. Mahboob (Hereford County Hospital, Hereford); B. Singh, S. Sheth, P. Karia, A. Prabhudesai, K. Kow, K. Koysombat, S. Wang, P. Morrison, Y. Maheswaran, P. Keane (Hillingdon Hospital, Uxbridge); P. C. Copley, O. Brewster, G. X. Xu, P. Harries, C. Wall (Hinchingbrooke Hospital, Huntingdon); A. Al-Mousawi, S. Bonsu, P. Cunha, T. Ward, J. Paul, K. Nadanakumaran, S. Tayeh, T. Ward, H. Holyoak, J. Remedios, K. Theodoropoulou, T. Ward (Homerton University Hospital, London); A. Luhishi, L. Jacob, F. Long, A. Atayi, S. Sarwar, O. Parker (Huddersfield Royal Infirmary, Huddersfield); J. Harvey, H. Ross, R. Rampal, G. Thomas, P. Vanmali, C. McGowan, J. Stein (Hull Royal Infirmary, Hull, and Castle Hill Hospital, Cottingham); V. Robertson, L. Carthew, V. Teng, J. Fong (Inverclyde Royal Hospital, Greenock); A. N. Street, C. E. Thakker (Ipswich Hospital, Ipswich); D. O’Reilly, M. Bravo, A. Pizzolato, H. A. Khokhar, M. Ryan, L. Cheskes, R. Carr, A. E. Salih (James Connolly Hospital, Dublin); S. Bassiony, R. Yuen, D. Chrastek, H. Rosen O’Sullivan, A. Amajuoyi, A. Wang, O. Sitta, J. Wye (James Paget University Hospital, Great Yarmouth); M. A. Qamar, C. Major, A. Kaushal (Kent and Canterbury Hospital, Canterbury); C. Morgan, M. Petrarca, R. Allot, K. Verma, S. Dutt, R. Allot, C. P. Chilima, S. Peroos, R. Allot (King George Hospital, Ilford); S. R. Kosasih, H. Chin, L. Ashken, R. J. Pearse, R. A. O’Loughlin, A. Menon, K. Singh, J. Norton (King’s College Hospital, London); R. Sagar, N. Jathanna, L. Rothwell, N. Watson, F. Harding, P. Dube (King’s Mill Hospital, Sutton-in-Ashfield); H. Khalid, N. Punjabi, M. Sagmeister, P. Gill, S. Shahid, S. Hudson-Phillips, D. George, J. Ashwood, T. Lewis (Kingston Hospital, Kingston upon Thames); M. Dhar, P. Sangal, I. A. Rhema, D. Kotecha, R. Dean, Z. Afzal, J. A. Syeed, E. Prakash, P. Jalota, R. Dean (Leicester Royal Infirmary, Leicester); J. Herron, L. Kimani, A. Delport, A. Shukla (Lincoln County Hospital, Lincoln); V. Agarwal, S. Parthiban, H. Thakur, W. Cymes, S. Rinkoff (Lister Hospital, Stevenage); J. A. Turnbull, M. Hayat, S. Darr, U. Khan, J. Lim, A. Higgins (Manchester Royal Infirmary, Manchester); G. Lakshmipathy, B. Forte, E. Canning, A. Jaitley, J. Lamont, E. Toner, A. Ghaffar, M. McDowell, D. Salmon (Mater Infirmorum Hospital, Belfast); P. Gouda, O. O’Carroll, A. Khan, M. E. Kelly, K. Clesham, C. Palmer, R. Lyons, M. E. Kelly, A. Bell, R. Chin, R. M. Waldron, M. E. Kelly (Mayo General Hospital, Castlebar); A. Trimble, S. E. Cox, U. Ashfaq, J. Campbell, R. B. S. Holliday, G. McCabe (Monklands Hospital, Airdrie); F. Morris, R. Priestland, S. Dean, O. K. Vernon, A. Ledsam, R. Vaughan (Morriston Hospital, Swansea); D. Lim, Z. R. Bakewell, R. K. Hughes (Musgrove Park Hospital, Taunton); R. M. Koshy, H. R. Jackson, P. Narayan, A. E. Cardwell, C. L. Jubainville, T. Arif, L. E. Elliott, V. Gupta, T. Arif (New Cross Hospital, Wolverhampton); G. Bhaskaran, K. Singh, A. Odeleye, F. Ahmed, R. Shah, A. Odeleye, J. Pickard, Y. N. Suleman, A. Odeleye (Newham University Hospital, London); A. S. North, L. F. McClymont, N. Hussain, I. Ibrahim, G. S. Ng, V. Wong, A. E. Lim, L. N. Harris, T. Tharmachandirar, D. Mittapalli (Ninewells Hospital, Dundee); V. Patel, M. Lakhani (Nobles Hospital, Isle of Man); N. Davies, H. Z. Bazeer, V. Narwani, K. K. Sandhu, L. R. Wingfield, S. Gentry, H. Adjei, M. Bhatti, L. Braganza (Norfolk and Norwich University Hospital, Norwich); J. Barnes, S. Mistry, G. Chillarge, S. Stokes, J. Cleere, S. Wadanamby, A. M. Bucko, J. Meek, N. Boxall, E.G. Heywood, J. J. Wiltshire, C. Toh, A. E. Ward, B. N. Shurovi, T. M. Drake (Northern General Hospital, Sheffield); D. Horth, B. Y. Patel, B. Ali, T. Spencer, T. Axelson, L. Kretzmer, C. Chhina (North Manchester General Hospital, Manchester); C. Anandarajah, T. Fautz, C. Horst (North Middlesex University Hospital NHS Trust, Edmonton); A. A. Thevathasan, J. Q. Ng, F. Hirst (North Tyneside General Hospital, North Shields); C. F. Brewer, A. E. Logan, J. W. Lockey, P. R. Forrest, N. Keelty, A. D. Wood, L. R. Springford, P. Avery, T. M. Schulz, T. P. Bemand, L. Howells (Northwick Park Hospital, Harrow); H. Collier, A. Khajuria, R. G. Tharakan, S. Parsons (Nottingham City Hospital, Nottingham); A. M. Buchan, R. J. McGalliard, J. D. Mason, O. J. Cundy, N. Li, N. A. Redgrave, R. P. Watson, T. P. Pezas, Y. F. Dennis, E. Segall, M. Hameed, A. S. Lynch (John Radcliffe and Churchill Hospitals, Oxford); M. Chamberlain, F. S. Peck, Y. N. Neo, G. Russell, M. Elseedawy, S. Lee, N. L. Foster, Y. H. Soo, L. Puan (Perth Royal Infirmary, Perth); R. Dennis, H. Goradia, A. Qureshi (Peterborough City Hospital, Peterborough); S. Osman, T. Reeves, L. Dinsmore, M. Marsden, Q. Lu, T. Pitts-Tucker (Portsmouth Hospitals NHS Trust Queen Alexandra Hospital, Portsmouth); C. E. Dunn, R. A. Walford, E. Heathcote, R. Martin, A. Pericleous, K. Brzyska, K. G. Reid, M. R. Williams, N. Wetherall (Prince Charles Hospital, Merthyr Tydfil); E. McAleer, D. Thomas, R. Kiff, C. Gouldthrope (Princess of Wales Hospital, Bridgend); S. Milne, M. J. V. Holmes, S. Stokes, J. Bartlett, J. Lucas de Carvalho, T. Bloomfield (Princess Royal Hospital, Haywards Heath); F. Tongo, R. H. Bremner, N. Yong, B. A. Atraszkiewicz, A. Mehdi, M. Tahir, G. X. J. Sherliker, A. K. Tear, A. Pandey (Princess Royal University Hospital, Bromley); A. Broyd, H. M. Omer, M. Raphael, W. W. Chaudhry, S. Shahidi, A. S. Jawad, C. K. Gill, I. Hindle Fisher, I. Adeleja, I. J. Clark, G. E. Aidoo-Micah (Queen Elizabeth Hospital, Birmingham); P. W. Stather, G. J. Salam, T. E. Glover, G. Deas, N. K. Sim, R. D. Obute, W. M. Wynell-Mayow (Queen Elizabeth Hospital, King’s Lynn); M. S. Sait, N. Mitha, G. L. de Bernier, M. Siddiqui, R. Shaunak, A. Wali, G. Cuthbert (Queen Elizabeth Hospital, Woolwich); R. Bhudia, E. Webb, S. Shah, N. Ansari, M. Perera, N. Kelly (Queen’s Hospital, Romford); R. McAllister, G. H. Stanley, C. P. Keane, V. Shatkar, C. Maxwell-Armstrong (Queen’s Medical Centre, Nottingham); L. A. Henderson, N. Maple, R. Manson, R. D. Adams, E. Brown, E. Semple (Raigmore Hospital, Inverness); M. Mills, A. Daoub, A. Marsh, A. Ramnarine, J. Hartley, M. Malaj (Rotherham General Hospital, Rotherham); P. D. Jewell, E. A. Whatling, N. Hitchen, M. Chen (Royal Berkshire Hospital, Reading); B. Goh, J. Fern, S. Rogers, L. Derbyshire (Royal Blackburn Hospital, Blackburn); D. T. Robertson, N. Abuhussein, P. Deekonda, A. Abid, A. Bakhsh (Royal Devon and Exeter Hospital, Exeter); P. L. M. Harrison, L. Aildasani, H. Turley (Royal Glamorgan Hospital, Ynysmaerdy); M. A. Sherif, G. Pandey, J. J. Filby, A. Johnston, E. Burke, M. Mohamud, K. Gohil, A. Y. Tsui, R. Singh (Royal Gwent Hospital, Newport); S. J. Lim, K. O’Sullivan, L. L. McKelvey, S. O’Neill, H. F. Roberts, F. S. Brown, Y. Cao, R. T. Buckle, Y. Liew, S. Sii, C. M. Ventre, C. J. Graham, T. Filipescu (Royal Infirmary of Edinburgh, Edinburgh); A. Yousif, R. Dawar, A. Wright, M. Peters, R. Varley, S. Owczarek, S. Hartley (Royal Lancaster Infirmary, Lancaster); M. Khattak, A. Iqbal, M. Ali, B. Durrani, Y. Narang, G. S. Bethell, L. Horne, R. Pinto (Royal Liverpool Hospital, Liverpool); K. Nicholls, I. Kisyov, H. D. Torrance, P. Patel, M. Patel, W. English, S. M. Lakhani, S. F. Ashraf, M. Venn (Royal London Hospital, London); V. Elangovan, Z. Kazmi, J. Brecher, S. Sukumar, A. Mastan, A. Mortimer, J. Parker, J. Boyle (Royal Preston Hospital, Preston); M. Elkawafi, J. Beckett, A. Mohite, A. Narain, E. Mazumdar, A. Sreh, A. Hague, D. Weinberg, L. Fletcher (Royal Shrewsbury Hospital, Shrewsbury); M. Steel, H. Shufflebotham, M. Masood, Y. Sinha, H. Amin, C. Jenvey, H. Kitt, R. Slade, A. R. Craig, C. Deall, Y. Sinha (Royal Stoke University Hospital, Stoke-on-Trent); J. Gabriel, T. Reakes, J. Chervenkoff, E. Strange, M. O’Bryan, C. Murkin, D. Joshi, E. Strange, T. Bergara, S. Naqib, D. Wylam, E. Strange (Royal Sussex County Hospital, Brighton); S. E. Scotcher, C. M. Hewitt, M. T. Stoddart, A. Kerai, A. J. Trist, S. J. Cole, C. L. Knight, S. Stevens, G. E. Cooper (Royal United Hospital, Bath); R. Ingham, J. Dobson, J. Wylie, A. O’Kane, J. Moradzadeh, A. Duffy, C. Henderson, S. Ashraf, C. McLaughin (Royal Victoria Hospital, Belfast); T. C. Hoskins, R. S. Reehal, L. R. Bookless, R. C. McLean, E. J. Stone (Royal Victoria Infirmary, Newcastle upon Tyne); E. V. Wright, H. R. Abdikadir, C. Roberts, O. Spence, M. Srikantharajah, M. Patel, E. M. Ruiz, J. H. Matthews, E. Gardner, C. Roberts (Russell’s Hall Hospital, Dudley); E. Hester, P. Naran, R. Simpson, M. Minhas, E. Cornish, S. A. Semnani, D. Rojoa (Salford Royal Hospital, Salford); A. Radotra, J. Eraifej, K. Eparh, D. N. E. Smith, B. D. Mistry, S. L. Hickling, A. Bhangu (Sandwell General Hospital, West Bromwich); W. Din, C. Liu, P. Mithrakumar, V. Mirdavoudi (Scarborough Hospital, Scarborough); M. Rashid, C. Mcgenity, O. Hussain, M. Kadicheeni, H. Gardner, N. Anim-Addo, J. Pearce, A. Aslanyan, C. Ntala, T. Sorah, J. Parkin, M. Alizadeh (Scunthorpe Hospital, Scunthorpe); A. White, F. Edozie, J. Johnston, A. Kahar, V. Navayogaarajah, B. Patel, D. Carter, P. Khonsari, A. Burgess, B. Patel (Southend Hospital, Westcliff-on-Sea); C. Kong, A. Ponweera, A. Cody, Y. Tan, A. Y. L. Ng, A. Croall, C. Allan, S. Ng, V. Raghuvir (Southern General Hospital, Glasgow); R. Telfer, A. D. Greenhalgh, C. N. McKerr, M. A. Edison, B. A. Patel, K. Dear, M. R. Hardy (Southmead Hospital, Bristol); P. Williams, S. Hassan, U. Sajjad (Southport Hospital, Southport); E. M. O’Neill, S. Lopes, L. Healy (South Tipperary Hospital, Tipperary); N. Jamal, S. Tan, D. Lazenby, S. B. Husnoo, S. Beecroft, T. Sarvanandan (Stepping Hill Hospital, Stockport); C. Weston, N. Bassam, S. Rabinthiran, U. Hayat, L. Ng, D. Varma (St George’s Hospital, London); M. Sukkari, A. Mian, A. Coates, A. Omar, J. W. Kim, A. Coates, J. Sellathurai, J. Mahmood (St Helier Hospital, Carshalton); C. O’Connell, R. Bose, H. Heneghan, P. Lalor, J. Matheson, C. Doherty, C. Cullen, D. Cooper, S. Angelov, C. Drislane (St James’ Hospital, Dublin); A. C. D. Smith, A. Kreibich, E. Palkhi, A. Durr, A. Lotfallah, D. Gold, E. Mckean, A. Durr, A. Dhanji, A. Anilkumar, A. Thacoor, A. Durr (St James’s University Hospital, Leeds); Z. H. Siddiqui, S. Lim, A. Piquet, S. M. Anderson, A. Jindal, D. R. McCormack, J. Gulati, A. Ibrahim, A. Jindal, S. E. Murray, S. L. Walsh, A. McGrath (St Luke’s Hospital, Limerick); P. Ziprin, E. Y. Chua, C. N. Lou, J. Bloomer, H. R. Paine, D. Osei-Kuffour, C. J. White, A. Szczap, S. Gokani, K. Patel (St Mary’s Hospital, London); M. K. Malys, A. Reed, G. E. Torlot, E. M. Cumber (Stoke Mandeville Hospital, Aylesbury, and High Wycombe Hospital, High Wycombe); A. Charania, S. Ahmad, N. Varma, H. Cheema, L. Austreng, H. Petra, M. Chaudhary (St Peter’s Hospital, Chertsey); M. I. Zegeye, F. Cheung, D. Coffey, R. S. Heer, S. Singh, E. Seager, S. Cumming, R. S. Suresh, S. Verma, I. B. Ptacek, A. M. Gwozdz (St Thomas’ Hospital, London); T. Yang, A. A. Khetarpal, S. Shumon, T. M. P. Fung, W. Leung, P. Kwang, L. Chew, W. Loke, A. Curran (Sunderland Royal Hospital, Sunderland); C. Chan (Tameside General Hospital, Ashton-under-Lyne); C. McGarrigle, K. Mohan, S. Cullen, E. Wong, C. Toale, D. Collins, N. Keane, B. P. Traynor, D. Shanahan (The Adelaide and Meath Hospital, Dublin); A. Yan, D. J. Jafree, C. Topham S. Mitrasinovic, S. Omara, B. Gundogan, G. Bingham, P. M. Lykoudis, B. H. Miranda (The Royal Free Hospital, London); K. Whitehurst, G. Kumaran, Y. Devabalan, H. Aziz, M. Shoa, S. Dindyal (The Whittington Hospital, London); J. A. Yates, I. Bernstein, G. Rattan, J. A. Yates (Tullamore Hospital, Tullamore); R. Coulson, S. Stezaker, A. Isaac, M. Salem, A. McBride, A. Isaac, H. McFarlane, L. Yow, J. MacDonald (Ulster Hospital, Belfast); R. D. Bartlett, S. Turaga, U. White, W. Liew, N. Yim (University College London Hospital, London); A. Ang, A. Simpson, D. McAuley, E. Craig, L. Murphy, P. Shepherd, J. Y. Kee, A. Abdulmajid, A. Chung (University Hospital Ayr, Ayr); H. L. Warwick, A. Livesey, P. Holton, M. D. Theodoreson, S. L. Jenkin, J. Turner, J. H. Entwisle, S. T. Marchal, S. O’Connor, H. K. Blege (University Hospital Coventry and Warwickshire, Coventry); J. M. Aithie, L. M. Sabine, G. E. Stewart, S. Jackson (University Hospital Crosshouse, Crosshouse); A. Kishore, C. M. Lankage, F. Acquaah, H. L. Joyce (University Hospital Lewisham, Lewisham); A. Jindal, K. L. McKevitt, C. J. Coffey, A. S. Fawaz, K. S. Dolbec, D. A. O’Sullivan, J. M. Geraghty (University Hospital Limerick, Limerick); E. Lim, L. Bolton, D. FitzPatrick, C. Robinson, T. Ramtoola, S. Collinson (University Hospital of South Manchester, Manchester); L. Grundy, P. M. McEnhill, G. S. Harbhajan Singh, D. Loughran, D. M. Golding, R. E. Keeling, R. P. Williams, R. D. J. Whitham, S. Yoganathan, R. Nachiappan, R. J. Egan (University Hospital of Wales, Cardiff); R. Owasil, M. L. Kwan, A. He, R. W. Goh, R. Bhome, H. Wilson, P. J. Teoh, K. Raji, T. Reeves, N. Jayakody, J. Matthams (University Hospital Southampton NHS Foundation Trust, Southampton); J. Chong, S. Tan, C. Y. Luk, R. J. Greig, M. Trail, G. Charalambous, V. Thirumal, A. S. Rocke, N. Gardiner (Victoria Hospital, Kirkcaldy); F. Bulley, N. Warren, E. Brennan, P. Fergurson, R. Wilson, H. Whittingham (Victoria Infirmary, Glasgow); E. J. Brown, R. Khanijau, K. Gandhi, S. Morris, A. J. Boulton, N. Chandan, A. E. Barthorpe, R. Maamari, S. Sandhu (Walsall Manor Hospital, Walsall); M. McCann, L. Higgs, V. Balian, C. Reeder, C. Diaper, V. Balian, T. Sale, H. Ali, V. Balian (Warrington Hospital, Warrington); C. H. Archer, A. K. Clarke, J. Heskin, P. C. Hurst, J. D. Farmer, L. D. O’Flynn, L. Doan, B. A. Shuker, G. D. Stott (Warwick Hospital, Warwick); N. A. Vithanage, K. A. Hoban, P. N. Nesargikar, H. R. Kennedy, C. M. Grossart, E. S. M. Tan, C. S. D. Roy, P. Sim, K. E. Leslie (Western General Hospital, Edinburgh); D. Sim, M. H. Abul, N. Cody, A. Y. Tay, E. Woon, S. Sng, J. Mah, J. Robson (Western Infirmary, Glasgow); E. Shakweh, V. C. Wing, H. Mills, M. M. Li, T. R. Barrow, S. Balaji, H. E. M. Jordan, C. Phillips, H. Naveed (West Middlesex Hospital, Isleworth); S. Hirani, A. Tai, R. Ratnakumaran, A. Sahathevan, A. M. A. Shafi, M. Seedat, R. Weaver (Whipps Cross Hospital, London); A. Batho, R. Punj, H. Selvachandran, N. Bhatt, S. Botchey, Z. Khonat, K. Brennan (Whiston Hospital, Prescot); K. K. Ong, C. J. Morrison, E. Devlin, A. Linton, E. Galloway, S. McGarvie, N. Ramsay (Wishaw General Hospital, Wishaw); H. D. McRobbie, H. Whewell, W. Dean (Wrexham Maelor Hospital, Wrexham); S. Nelaj, M. Eragat, A. Mishra, T. Kane, M. Zuhair, M. Wells, D. Wilkinson, N. Woodcock (York Hospital, York); E. Sun, N. Aziz, M. K. Abd Ghaffar (Ysbyty Gwynedd, Bangor).
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