C G Moran

University of Nottingham, Nottigham, England, United Kingdom

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Publications (40)109.83 Total impact

  • I K Moppett · M Rowlands · A Mannings · C G Moran · M D Wiles
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    ABSTRACT: Background: Hip fracture is a condition with high mortality and morbidity in elderly frail patients. Intraoperative fluid optimization may be associated with benefit in this population. We investigated whether intraoperative fluid management using pulse-contour analysis cardiac monitoring, compared with standard care in patients undergoing spinal anaesthesia, would provide benefits in terms of reduced time until medically fit for discharge and postoperative complications. Methods: Patients undergoing surgical repair of fractured neck of femur, aged >60 yr, receiving spinal anaesthesia were enrolled in this single-centre, blinded, randomized, parallel group trial. Patients were allocated to either anaesthetist-directed fluid therapy or a pulse-contour-guided fluid optimization strategy using colloid (Gelofusine) boluses to optimize stroke volume. The primary outcome was time until medically fit for discharge. Secondary outcomes included postoperative complications, mobility, and mortality. We updated a systematic review to include relevant trials to 2014. Results: We recruited 130 patients. Time until medically fit for discharge was similar in both groups, mean [95% confidence interval (CI)] 12.2 (11.1-13.5) vs 13.1 (11.9-14.5) days (P=0.31), as was total length of stay 14.2 (12.9-15.8) vs 15.3 (13.8-17.2) days (P=0.32). There were no significant differences in complications, function, or mortality. An updated meta-analysis (four studies, 355 patients) found non-significant reduction in early mortality [relative risk 0.66 (0.24-1.79)] and in-hospital complications [relative risk 0.80 (0.61-1.05)]. Conclusions: Goal-directed fluid therapy during hip fracture repair under spinal anaesthesia does not result in a significant reduction in length of stay or postoperative complications. There is insufficient evidence to either support or discount its routine use. Clinical trial registration: ISRCTN88284896.
    BJA British Journal of Anaesthesia 12/2014; DOI:10.1093/bja/aeu386 · 4.85 Impact Factor
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    ABSTRACT: The major trauma team relies on an efficient, communicative team to ensure patients receive the best quality care. This requires a comprehensive handover, rapid systematic review, and early management of life- and limb-threatening injuries. These multiple injured patients often present with complex conditions in a dynamic situation. The importance of team work, communication, senior decision-making, and documentation cannot be underestimated. © 2014 The Author 2014. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved.
    BJA British Journal of Anaesthesia 08/2014; 113(2):234-241. DOI:10.1093/bja/aeu235 · 4.85 Impact Factor
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    O. Salar · J. Holley · B. Baker · B.J. Ollivere · C.G. Moran
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    ABSTRACT: Background Coagulation screening continues as a standard of care in many hip fracture pathways despite the 2011 guidelines from the Association of Anaesthetists of Great Britain and Ireland (AAGBI) which recommend that such screening be performed only if clinically indicated. This study aims to evaluate the use of pre-operative coagulation screening and explore its financial impact. Methods Prospective data was collected in accordance with the “Standardised Audit of Hip Fractures in Europe” (SAHFE) protocol. All patients admitted to our hospital with hip fractures during a 12-month period from November 2011 to November 2012 were analysed. Data including coagulation results and the use of vitamin K or blood products were collected retrospectively from the hospital computer system. Patient subgroup analysis was performed for intraoperative blood loss, post-operative blood units transfused, haematoma formation and gastrointestinal haemorrhage. Results 814 hip fractures were analysed. 91.4% (n = 744) had coagulation tests performed and 22.0% (n = 164) had an abnormal result. Of these, 55 patients were taking warfarin leaving 109 patients who had abnormal results and were not taking warfarin. When this group (n = 109) was compared to those who had normal test results (n = 580) and to all other patients (n = 705) there was no difference in intraoperative blood loss (p = 0.79, 0.78), postoperative transfusion (p = 0.38, 0.30), postoperative haematoma formation (p = 0.79, 1.00), or gastrointestinal haemorrhage (p = 0.45, 1.00) respectively. In those who were not taking warfarin, but had abnormal results, none had treatment to reverse their coagulopathy with either vitamin K or blood products. By omitting pre-operative coagulation tests in patients who are not taking warfarin, we estimate a financial saving of between £66,500 and £432,250 per annum. Conclusions This study supports the hypothesis that routine pre-operative coagulation screening is unnecessary in hip fracture patients unless they take warfarin or have a known coagulopathy. Moreover, its omission represents significant cost-saving potential.
    Injury 08/2014; 45(12). DOI:10.1016/j.injury.2014.08.032 · 2.14 Impact Factor
  • BJA British Journal of Anaesthesia 08/2014; 113(2):202-6. DOI:10.1093/bja/aeu204 · 4.85 Impact Factor
  • O Salar · B Baker · T Kurien · A Taylor · C Moran
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    ABSTRACT: Immunosuppressants have been the mainstay of treatment for certain inflammatory joint conditions for many years. Developments in this field, namely biological treatments, have led to a change in the classical presentation of acute bone, joint and soft tissue infections. The normal findings of severe pain and tenderness on examination may be absent or simply mimic a typical exacerbation of the chronic joint condition. A minimally raised white cell count and elevated C-reactive protein in the absence of systemic signs of infection may be interpreted as further evidence for the diagnosis of an exacerbation of inflammatory arthritis. We present a unique case of recurrent polyarticular septic arthritis in a patient treated with immunosuppression for refractory rheumatoid arthritis. We hope this article will enable doctors to appreciate and recognise the changing face of septic arthritis in the modern era of immunosuppressant treatments.
    Annals of The Royal College of Surgeons of England 03/2014; 96(2):11-12. DOI:10.1308/003588414X13814021678196 · 1.27 Impact Factor
  • P Kodumuri · B Ollivere · J Holley · C G Moran
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    ABSTRACT: We evaluated the top 13 journals in trauma and orthopaedics by impact factor and looked at the longer-term effect regarding citations of their papers. All 4951 papers published in these journals during 2007 and 2008 were reviewed and categorised by their type, subspecialty and super-specialty. All citations indexed through Google Scholar were reviewed to establish the rate of citation per paper at two, four and five years post-publication. The top five journals published a total of 1986 papers. Only three (0.15%) were on operative orthopaedic surgery and none were on trauma. Most (n = 1084, 54.5%) were about experimental basic science. Surgical papers had a lower rate of citation (2.18) at two years than basic science or clinical medical papers (4.68). However, by four years the rates were similar (26.57 for surgery, 30.35 for basic science/medical), which suggests that there is a considerable time lag before clinical surgical research has an impact. We conclude that high impact journals do not address clinical research in surgery and when they do, there is a delay before such papers are cited. We suggest that a rate of citation at five years post-publication might be a more appropriate indicator of importance for papers in our specialty. Cite this article: Bone Joint J 2014;96-B:414-19.
    Bone and Joint Journal 03/2014; 96-B(3):414-9. DOI:10.1302/0301-620X.96B3.32279 · 1.96 Impact Factor
  • O Salar · JM Holley · BG Baker · B Ollivere · CG Moran
    Edinburgh International Trauma Symposium.; 08/2013
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    International Journal of Surgery 12/2012; 10(8):S89. DOI:10.1016/j.ijsu.2012.06.472 · 1.53 Impact Factor
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    ABSTRACT: Unlabelled: Hip fracture is associated with considerable morbidity and mortality and occurs in an elderly and infirm group of patients. Periprosthetic fracture after hip hemiarthroplasty is a serious complication. In this study, we have reviewed our experience of this injury. The outcome measures used were fracture union, mortality, infection and requirement for further surgery. Method: We identified a cohort of 79 patients who sustained periprosthetic fractures after hip hemiarthroplasty from a prospective hip fracture database of 8354 patients (3611 were treated with hemiarthroplasty). Seventy-two percent were female and the mean age was 86 years at time of periprosthetic fracture. Results: Sixty-two fractures occurred around uncemented prostheses (Austin Moore n=61); the remainder occurred around cemented prostheses. The mean time from hip fracture surgery to periprosthetic fracture was 35 months (median time 5 months). Fractures were classified according to the Vancouver system. Fifteen percent (n=12) were type A fractures, 26% (n=21) were type B1 fractures, 41% (n=32) were type B2 fractures, 9% (n=7) were type B3 fractures and 9% (n=7) were type C fractures. Twenty-eight patients underwent open reduction internal fixation (ORIF), 36 required revision surgery, one required fixation and simultaneous revision and 14 were treated non-operatively. Eleven percent (n=9) died within 1 month of periprosthetic fracture, 23% had died by 3 months, 34% by 1 year and 49% by 2 years. Nineteen patients (24%) died before fracture union had occurred. Fracture union occurred in 97% of the remaining cases (58/60). Two patients developed nonunion requiring revision surgery (3%), and three patients developed deep infection requiring debridement (4%), one patient had an infection at the time of the periprosthetic fracture requiring a planned two-stage revision, one patient sustained a second periprosthetic fracture and two patients underwent superficial wound debridement (3%). The incidence of periprosthetic fracture at our institution since 1999 is 1.7% (62 of 3611 patients). The incidence rate after uncemented Austin Moore stem was 2.3% (54/2378) and cemented Exeter stem was 0.5% (4/812); Fisher's exact test p=0.004. Conclusions: This article reports satisfactory outcomes in this complex group of patients. We have established the incidence of 1.7%, with relatively low rates of nonunion, infection and other complications. The mortality rate has been established, and survivorship analysis has identified an increased rate of fracture around the Austin Moore prosthesis.
    Injury 10/2012; 44(6). DOI:10.1016/j.injury.2012.09.015 · 2.14 Impact Factor
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    P. Kodumuri · B. Ollivere · C.G. Moran
    Injury Extra 10/2012; 43(10):116. DOI:10.1016/j.injury.2012.07.329
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    Injury 10/2012; 43(10):1623. DOI:10.1016/j.injury.2012.06.017 · 2.14 Impact Factor
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    R. Berber · C.P. Lewis · D.P. Forward · C.G. Moran
    Injury Extra 10/2012; 43(10):75. DOI:10.1016/j.injury.2012.07.205
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    B.J. Ollivere · T. Kurien · C. Morris · D. Forward · C.G. Moran
    Injury Extra 10/2012; 43(10):79. DOI:10.1016/j.injury.2012.07.219
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    ABSTRACT: /st> The Nottingham Hip Fracture Score (NHFS) was developed and validated in a single centre in 2007 as a predictor of 30 day mortality. It has subsequently been shown to predict longer term and functional outcomes. We wished to assess the ability of NHFS to predict outcomes in other centres and to investigate the change in outcome after hip fracture over time. /st> The NHFS was calculated for all patients with data from three UK hip fracture units: Peterborough (1992-2009), Brighton (2008-9), and Nottingham (2000-9) including 4804, 585, and 1901 patients, respectively. The logistic regression was used to recalibrate the NHFS to 30 day mortality across the three units using a random selection of 50% of the data set. Calibration was assessed using the Hosmer-Lemeshow goodness of fit. /st> The median (inter-quartile range) NHFS values were Peterborough [4.0 (1-6)], Brighton [5.0 (3-7)], and Nottingham [5.0 (3-7)]. There was no correlation between 30 day mortality and time (R(2)=0.05, P=0.115). The proportion of patients with NHFS≥4 showed a weak correlation with time (R(2)=0.2, P=0.003). The original NHFS equation overestimates mortality in the higher-risk groups. A modified equation shows good calibration for all three centres {30 day mortality (%)=100/1+e([(5.012×(NHFS×0.481)])}. The hospital was not a predictor of 30 day mortality. /st> The NHFS, with an updated equation, is a robust predictor of 30 day mortality after hip fracture repair in geographically distinct UK centres.
    BJA British Journal of Anaesthesia 06/2012; 109(4):546-50. DOI:10.1093/bja/aes187 · 4.85 Impact Factor
  • C G Moran · D P Forward
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    ABSTRACT: There have been many advances in the resuscitation and early management of patients with severe injuries during the last decade. These have come about as a result of the reorganisation of civilian trauma services in countries such as Germany, Australia and the United States, where the development of trauma systems has allowed a concentration of expertise and research. The continuing conflicts in the Middle East have also generated a significant increase in expertise in the management of severe injuries, and soldiers now survive injuries that would have been fatal in previous wars. This military experience is being translated into civilian practice. The aim of this paper is to give orthopaedic surgeons a practical, evidence-based guide to the current management of patients with severe, multiple injuries. It must be emphasised that this depends upon the expertise, experience and facilities available within the local health-care system, and that the proposed guidelines will inevitably have to be adapted to suit the local resources.
    The Bone & Joint Journal 04/2012; 94(4):446-53. DOI:10.1302/0301-620X.94B4.27786 · 3.31 Impact Factor
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    ABSTRACT: We performed a retrospective review of all patients admitted to two large University Hospitals in the United Kingdom over a 24-month period from January 2008 to January 2010 to identify the incidence of atypical subtrochanteric and femoral shaft fractures and their relationship to bisphosphonate treatment. Of the 3515 patients with a fracture of the proximal femur, 156 fractures were in the subtrochanteric region. There were 251 femoral shaft fractures. The atypical fracture pattern was seen in 27 patients (7%) with 29 femoral shaft or subtrochanteric fractures. A total of 22 patients with 24 atypical fractures were receiving bisphosphonate treatment at the time of fracture. Prodromal pain was present in nine patients (11 fractures); 11 (50%) of the patients on bisphosphonates suffered 12 spontaneous fractures, and healing of these fractures was delayed in a number of patients. This large dual-centre review has established the incidence of atypical femoral fractures at 7% of the study population, 81% of whom had been on bisphosphonate treatment for a mean of 4.6 years (0.04 to 12.1). This study does not advocate any change in the use of bisphosphonates to prevent fragility fractures but attempts to raise awareness of this possible problem so symptomatic patients will be appropriately investigated. However, more work is required to identify the true extent of this new and possibly increasing problem.
    The Bone & Joint Journal 03/2012; 94(3):385-90. DOI:10.1302/0301-620X.94B3.27999 · 3.31 Impact Factor
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    Al-Ataasi Talaat · Daud Tai Shan Chou · Mohammad Ali · Chris Boulton · Christopher Gerrard Moran
    International Journal of Surgery (London, England) 12/2011; 9(7):542. DOI:10.1016/j.ijsu.2011.07.235 · 1.53 Impact Factor
  • John Findlay · Chris Boulton · Daren Forward · Christopher Moran
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    ABSTRACT: The UK Hospital at Night (H@N) programme is hypothesised to improve efficiency of out-of-hours care. No studies have assessed a surgical programme or mechanisms of effect. This prospective study aimed to do so in a trauma and orthopaedic department over 10 weeks. Senior house officers recorded night shift activity. Mean time to attend referrals reduced from 29 to 15 minutes as a result of the programme (p = 0.007). Workload and 30 day mortality and morbidity for hip fracture remained unchanged. The mechanisms underlying improvements are unclear, but may represent central organisation of workload.
    Journal of perioperative practice 10/2011; 21(10):346-51.
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    T. Al-Atassi · D.T.S. Chou · C. Boulton · C.G. Moran
    Injury Extra 09/2011; 42(9):104. DOI:10.1016/j.injury.2011.06.226
  • O Sahota · N Morgan · C G Moran
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    ABSTRACT: Data on the true acute care costs of hip fractures for patients admitted from care homes are limited. Detailed costing analysis was undertaken for 100 patients. Median cost was £9,429 [ 10,896], increasing to £14,435 [ 16,681], for those requiring an upgrade from residential to nursing home care. Seventy-six percent of costs were attributable to hospital bed days, and therefore, interventions targeted at reducing hospital stay may be cost effective. Previous studies have estimated the costs associated with hip fracture, although these vary widely, and for patients admitted from care homes, who represent a significant fracture burden, there are limited data. The primary aim of this study was to perform a detailed assessment of the direct medical costs incurred and secondly compare this to the actual remuneration received by the hospital. One hundred patients presenting from a care home in 2006 were randomly selected and a detailed case-note costing analysis was undertaken. This cost was then compared to the actual remuneration received by the hospital. Median cost per patient episode was £9,429 [ 10,896] (all patients) range £4,292-162,324 [ 4,960-187,582] (subdivided into hospital bed day costs £7,129 [ 8,238], operative costs £1,323 [ 1,529] and investigation costs £977 [ 1,129]). Twenty-two percent of the patients admitted from a residential home required upgrading to a nursing home. In this group, the median length of stay was 31 days (mean 38, range 10-88) median cost £14,435 [ 16,681]. Average remuneration received equated to £6,222 [ 7,190] per patient. This represents a mean loss in income, compared to actual calculated costs of £3,207 [ 3,706] per patient. The median cost was £9,429 [ 10,896], increasing to £14,435 [ 16,681], for those requiring an upgrade from residential to nursing home care at discharge. Significant cost differences were seen comparing the actual cost to remuneration received. Interventions targeted at reducing length of stay may be cost effective.
    Osteoporosis International 05/2011; 23(3):917-20. DOI:10.1007/s00198-011-1651-9 · 4.17 Impact Factor

Publication Stats

822 Citations
109.83 Total Impact Points


  • 2006–2014
    • University of Nottingham
      • Centre for Sports Medicine
      Nottigham, England, United Kingdom
  • 2010–2012
    • Nottingham University Hospitals NHS Trust
      • Department of Trauma and Orthopaedics
      Nottigham, England, United Kingdom
  • 2011
    • Royal Berkshire NHS Foundation Trust
      Reading, England, United Kingdom