Danny JN Wong

Guy's and St Thomas' NHS Foundation Trust · Department of Anaesthetics

Background Critical care beds are a limited resource, yet research indicates that recommendations for postoperative critical care admission based on patient‐level risk stratification are not followed. It is unclear how prioritisation decisions are made in real‐world settings and the effect of this prioritisation on outcomes. Methods This was a pre...

The future and sustainability of the anaesthetic workforce is a growing concern with a projected shortfall of 11,000 anaesthetists by 2040. The supply of anaesthetists able to provide safe anaesthesia care does not meet the rising demand of surgical waiting lists. In recent years, changes to recruitment and curricula for anaesthetic specialty train...

The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID‐19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri‐operative airway complications has no...

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful. We surveyed applicants to investigate their experience of the recruitment process (response rate 536/1056; 51%). Approximately 61% of respondents were not offered...

The most recent ST3 Anaesthetic recruitment for posts commencing in August 2021 saw larger numbers of applicants (n = 1,056) compared to previous years, with approximately 700 applicants failing to secure an ST3 post. We surveyed 536 anaesthetic junior doctors who applied for ST3 posts during this application round with the aim of investigating the...

Intra‐operative hypotension frequently complicates anaesthesia in older patients and is implicated in peri‐operative organ hypoperfusion and injury. The prevalence and corresponding treatment thresholds of hypotension are incompletely described in the UK. This study aimed to identify prevalence of intra‐operative hypotension and its treatment thres...

Objective To describe success rates of respiratory protective equipment (RPE) fit testing and factors associated with achieving suitable fit. Design Prospective observational study of RPE fit testing according to health and safety, and occupational health requirements. Setting A large tertiary referral UK healthcare facility. Population 1443 hea...

Background: Tracheal intubation for patients with COVID-19 is required for invasive mechanical ventilation. The authors sought to describe practice for emergency intubation, estimate success rates and complications, and determine variation in practice and outcomes between high-income and low- and middle-income countries. The authors hypothesized t...

Purpose: Regional anesthesia techniques may improve patient recovery beyond treating postoperative pain alone and may facilitate patients in their return to functional, psychological as well as emotional baselines. We hypothesized that the quality of recovery (QoR) experienced by patients following breast surgery was associated with the type of an...

Objective To establish the prevalence, risk factors and implications of suspected or confirmed coronavirus disease 2019 (COVID-19) infection among healthcare workers in the United Kingdom (UK). Design Cross-sectional observational study. Setting UK-based primary and secondary care. Participants Healthcare workers aged ≥18 years working between 1...

2020 The Authors. Anaesthesia published by John Wiley & Sons Ltd on behalf of Association of Anaesthetists Postoperative critical care is a finite resource that is recommended for high-risk patients. Despite national recommendations specifying that such patients should receive postoperative critical care, there is evidence that these recommendation...

Background Preoperative risk prediction is important for guiding clinical decision-making and resource allocation. Clinicians frequently rely solely on their own clinical judgement for risk prediction rather than objective measures. We aimed to compare the accuracy of freely available objective surgical risk tools with subjective clinical assessmen...

Purpose: Because of the anticipated surge in cases requiring intensive care unit admission, the high aerosol-generating risk of tracheal intubation, and the specific requirements in coronavirus disease (COVID-19) patients, a dedicated Mobile Endotracheal Rapid Intubation Team (MERIT) was formed to ensure that a highly skilled team would be deploye...

Objective To establish the prevalence and risk factors for the development of suspected or confirmed coronavirus disease 2019 (COVID-19) infection among healthcare workers (HCWs) in the United Kingdom (UK). Design Cross-sectional observational study. Setting UK-based primary and secondary care. Participants HCWs aged ≥18 years working between 1 Feb...

Although intended for benefit, surgery exposes patients to potential complications. Critical care is thought to protect against the development of these complications, and is recommended for patients at higher risk. However, previous literature suggests that high-risk patients do not consistently receive postoperative critical care. In this PhD the...

Although intended for benefit, surgery exposes patients to potential complications. Critical care is thought to protect against the development of these complications, and is recommended for patients at higher risk. However, previous literature suggests that high-risk patients do not consistently receive postoperative critical care. In this Ph...

Healthcare workers involved in aerosol‐generating procedures, such as tracheal intubation, may be at elevated risk of acquiring COVID‐19. However, the magnitude of this risk is unknown. We conducted a prospective international multicentre cohort study recruiting healthcare workers participating in tracheal intubation of patients with suspected or c...

Graphical models have emerged as a tool to map out the interplay between multiple measured and unmeasured variables, and can help strengthen the case for a causal association between exposures and outcomes in observational studies. In Part 1 of this methods series, we will introduce the reader to graphical models for causal inference in perioperati...

While randomized-controlled studies (RCTs) represent the gold standard in clinical research, most clinical questions cannot be answered using this technique, due to ethical considerations, time, and cost. The goal of observational research in clinical medicine is to gain insight into the relationship between a clinical exposure and patient outcome,...

The recent development of electronic logbooks with secure off‐device data storage provides a rich resource for research. We present the largest analysis of anaesthetic logbooks to date, with data from 494,235 cases logged by 964 anaesthetists over a 4‐year period. Our analysis describes and compares the annual case‐load and supervision levels of di...

( Anaesthesia . 2018;73:825–831) In the United Kingdom, cesarean deliveries (CD) are classified based on a system that defines the urgency of the surgery. A category 1 CD is one in which there is an immediate threat to the life of the mother or fetus while a category 4 CD has no urgency and can be done at a time convenient to the patient and obstet...

Background: Decisions to admit high-risk postoperative patients to critical care may be affected by resource availability. We aimed to quantify adult ICU/high-dependency unit (ICU/HDU) capacity in hospitals from the UK, Australia, and New Zealand (NZ), and to identify and describe additional 'high-acuity' beds capable of managing high-risk patient...

p>Background: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for...

Background: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. Methods: We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons fo...

We conducted a 5‐year retrospective cohort study on women undergoing caesarean section to investigate factors influencing the operating room‐to‐incision interval. Time‐to‐event analysis was performed for category‐1 caesarean section using a Cox proportional hazards regression model. Covariates included: anaesthetic technique; body mass index; age;...

Introduction The admission of high-risk patients to critical care after surgery is a recommended standard of care. Nevertheless, poor compliance against this recommendation has been repeatedly demonstrated in large epidemiological studies. It is unclear whether this is due to reasons of capacity, equipoise, poor quality clinical care or because hos...

Background The cause of adverse weekend clinical outcomes remains unknown. In 2013, the “NHS Services, Seven Days a Week” project was initiated to improve access to services across the seven-day week. Three years on, we sought to analyse the impact of such changes across the English NHS. Methods Aggregated trust-level data on crude mortality rates,...

Background: The Surgical Outcome Risk Tool (SORT) is a risk stratification instrument used to predict perioperative mortality. We wanted to evaluate and refine SORT for better prediction of the risk of postoperative morbidity. Methods: We analysed prospectively collected data from a single-centre cohort of adult patients undergoing major electiv...

Postoperative recovery is a complex process depending on multiple factors, with no standardised definition. The postoperative morbidity survey (POMS) is a validated 9-domain composite measure of inpatient morbidity [1]. Patients with prolonged length of stay (LoS) have increased burdens of illness with economic repercussions at the individual level...

INTRODUCTION: Two of the Four hospitals designated as Major Trauma Centres in London, United Kingdom, currently operate on-site helicopter landing pads. King's College Hospital (KCH) is constructing a third. We evaluate current trauma services at KCH, prior to the helipad entering service, establishing baseline workload and mortality measures. METH...

Introduction: Two of the 4 hospitals designated as major trauma centers in London, UK, currently operate on-site helicopter landing pads. King's College Hospital (KCH) is constructing a third. We evaluate current trauma services at King's College Hospital, before the helipad entering service, establishing baseline workload and mortality measures....

Critically ill patients may require interhospital transfer for specialist care or because of a lack of local ICU capacity. Harm is assumed from delays that result, but it is not clear whether these delays are due to transfer distances or deficiencies in the organisation of care.

Donze and colleagues found a clinically relevant increased thrombosis complication rate in patients with preoperative systemic inflammation or sepsis.1 However, they used the “risk” of postoperative arterial and venous thromboses interchangeably with the odds ratio, which may …

This survey into intensive care unit (ICU) discharge communication practices presents data from 60 responding units in the UK. Of these, 95% provide some form of written or verbal information to ward teams and 86.7% have Critical Care Outreach Teams, which provide the majority of post-discharge follow-up. Very little information is provided to pati...

Small proline-rich repeat protein 1A (SPRR1A) is expressed in dorsal root ganglion (DRG) neurons following peripheral nerve injury but it is not known whether SPRR1A is differentially expressed following injury to peripheral versus central DRG projections and a detailed characterization of expression in sensory neuron subpopulations and spinal cord...