Michael J Stechman

Michael J Stechman
Cardiff and Vale University Health Board | UHW · Surgery

MD, FRCS

About

117
Publications
8,247
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2,003
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Introduction
Michael J Stechman currently works in the Department of Surgery, Cardiff and Vale University Health Board. Michael does research in Surgery. His current project is 'Older Persons Surgical Outcomes Collaboration (OPSOC)'.
Additional affiliations
June 2012 - present
Cardiff University
Position
  • Director of Year 5, Undergraduate MBBCh
September 2010 - present
Cardiff and Vale University Health Board
Position
  • Consultant Surgeon
April 2007 - August 2010
Oxford University Hospitals NHS Trust
Position
  • Higher Surgical Trainee

Publications

Publications (117)
Article
Background In response to the COVID-19 pandemic, many countries mandated staying at home to reduce transmission. This study examined the association between living arrangements (house occupancy numbers) and outcomes in COVID-19. Methods Study population was drawn from the COPE Study, a multicentre cohort study. House occupancy was defined as: livi...
Article
Our increasingly aging population is associated with older people being admitted to surgical wards at a rate surpassing population growth. 1 Although frailty is not exclusive to older adults, its prevalence is positively associated with age. 2 Hewitt et al. observed frailty to independently predict increased length of hospital stay (LOS), 30-day an...
Article
Full-text available
Background Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods The study population was drawn from the COPE Study (COVID-19...
Chapter
There has been a paradigm shift in the approach to primary hyperparathyroidism (PHPT), from bilateral cervical exploration (BCE) to focused parathyroidectomy facilitated by preoperative localization scans. This has resulted in fewer four-gland explorations. Conversely, patients with negative localization are more likely to have smaller parathyroid...
Article
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Background The United Kingdom Registry of Endocrine and Thyroid Surgeons is a national database holding details on > 28,000 parathyroidectomies. Methods An extract (2004–2017) of the database was analysed to investigate the reported efficacy, safety and use of intra-operative surgical adjuncts in targeted parathyroidectomy (tPTx) and bilateral nec...
Article
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Objective: During the COVID-19 pandemic the continuation or cessation of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin receptor blockers (ARBs) has been contentious. Mechanisms have been proposed for both beneficial and detrimental effects. Recent studies have focused on mortality with no literature having examined length of hosp...
Article
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Background The COVID-19 pandemic has placed significant pressure on health and social care. Survivors of COVID-19 may be left with substantial functional deficits requiring ongoing care. We aimed to determine whether pre-admission frailty was associated with increased care needs at discharge for patients admitted to hospital with COVID-19. Methods...
Article
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Background: The impact of surgery compared to non-surgical management of older general surgical patients is not well researched. Methods: We examined the association between management and adverse outcomes in a cohort of emergency general surgery patients aged > 65 years. This multi-center study included 727 patients (mean+/-SD, 77.1 ± 8.2 years, 5...
Article
Thyroid nodules are common and a frequent reason for referral to secondary care. Clinical assessment and investigation should aim to address the possibility of malignancy, functional status of the thyroid and compressive symptoms. A combination of neck ultrasound and fine needle aspiration cytology (FNAC) can usually help establish a plan of manage...
Article
Introduction: This protocol describes an observational study which set out to assess whether frailty and/or multimorbidity correlates with short-term and medium-term outcomes in patients diagnosed with COVID-19 in a European, multicentre setting. Methods and analysis: Over a 3-month period we aim to recruit a minimum of 500 patients across 10 ho...
Article
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Frailty assessed using Clinical Frailty Scale (CFS) is a good predictor of adverse clinical events including mortality in older people. CFS is also an essential criterion for determining ceilings of care in people with COVID-19. Our aims were to assess the prevalence of frailty in older patients hospitalised with COVID-19, their sex and age distrib...
Article
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Coronavirus disease 2019 (COVID-19) infection causes acute lung injury, resulting from aggressive inflammation initiated by viral replication. There has been much speculation about the potential role of non-steroidal inflammatory drugs (NSAIDs), which increase the expression of angiotensin-converting enzyme 2 (ACE2), a binding target for severe acu...
Preprint
Full-text available
Background: Whilst there is literature on impact of the SARS viruses in the severely immunosuppressed, and those who develop exaggerated immune response, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study...
Article
Full-text available
Introduction Hospital admissions for non-COVID-19 pathology have significantly reduced. It is believed that this may be due to public anxiety about acquiring COVID-19 infection in hospital and the subsequent risk of mortality. There is an urgent need for clarity regarding patients who acquire COVID-19 in hospital (nosocomial COVID-19 infection [NC]...
Article
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on behalf of the COPE Study Collaborators* Summary Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed...
Article
Full-text available
Background The COVID-19 pandemic has placed unprecedented strain on health-care systems. Frailty is being used in clinical decision making for patients with COVID-19, yet the prevalence and effect of frailty in people with COVID-19 is not known. In the COVID-19 in Older PEople (COPE) study we aimed to establish the prevalence of frailty in patients...
Article
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Background: Trainee research collaboratives (TRCs) have pioneered high quality, prospective 'snap-shot' surgical cohort studies in the UK. Outcomes After Kidney injury in Surgery (OAKS) was the first TRC cohort study to attempt to collect one-year follow-up data. The aims of this study were to evaluate one-year follow-up and data completion rates,...
Article
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Background/purpose A key measure to maintain and improve the quality of healthcare is the formal accreditation of provider units. The European Society of Endocrine Surgeons (ESES) therefore proposes a system of accreditation for endocrine surgical centers in Europe to supplement existing measures that promote high standards in the practice in endoc...
Article
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Background: With an ageing population, an increasing number of older adults are admitted for assessment to acute surgical units. Older adults have specific factors that may influence outcomes, one of which is delirium (acute cognitive impairment). Objectives: To establish the prevalence of delirium on admission in an older acute surgical populat...
Article
p>Background: This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes between benign and malignant disease. Methods: Data on adrenalectomies were extracted from a national surgeon-reported registry. Preoperative diagn...
Article
Background: This study investigated the indications, procedures and outcomes for adrenal surgery from the UK Registry of Endocrine and Thyroid Surgery database from 2005 to 2017, and compared outcomes between benign and malignant disease. Methods: Data on adrenalectomies were extracted from a national surgeon-reported registry. Preoperative diag...
Article
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Background: In 2018, AJCC TNM staging changed for differentiated (DTC) and anaplastic (ATC) thyroid carcinoma. The impact of this change on mortality rates was investigated and compared with the MACIS prognostic score. Methods: Analysis of a prospective database of DTC/ATC was undertaken. Patients were staged according to TNM7 and TNM8 criteria,...
Article
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Nephrolithiasis (NL) and nephrocalcinosis (NC), which comprise renal calcification of the collecting system and parenchyma, respectively, have a multifactorial etiology with environmental and genetic determinants and affect $10% of adults by age 70 years. Studies of families with hereditary NL and NC have identified >30 causative genes that have in...
Chapter
Managing patients with adrenal disease requires a detailed knowledge of endocrinology, pathology, radiology as well as both laparoscopic and major resectional surgery. It is important that patients are managed in a multidisciplinary setting. The principle tenets of adrenal surgery are to establish the presence or absence of endocrine dysfunction, d...
Article
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Renal calcification (RCALC) resulting in nephrolithiasis and nephrocalcinosis, which affects ∼10% of adults by 70 years of age, involves environmental and genetic etiologies. Thus, nephrolithiasis and nephrocalcinosis occurs as an inherited disorder in ∼65% of patients, and may be associated with endocrine and metabolic disorders including: primary...
Article
Background: Cognitive impairment is prevalent in older surgical patients; however, the condition is greatly under-recognized, and outcomes associated with it are poorly understood. Methods: This is a prospective multicenter cohort study of unselected consecutive older adults admitted to 5 emergency general surgical units across the United Kingdom...
Article
Background: Low albumin is a prognostic factor associated with poor surgical outcomes. We aimed to examine the predicative ability of easily obtainable point-of-care variables in combination, to derive a practical risk scale for predicting older adults at risk of poor outcomes on admission to the emergency general surgical setting. Methods: This i...
Article
Aims Post-operative acute kidney injury (AKI) is a common and independent mortality risk factor carrying high clinical and economic cost. This study aimed to establish the incidence of AKI in patients undergoing emergency laparotomy (EL), to determine patients’ risk profile and consequent mortality. Methods Consecutive 239 patients of median age 6...
Data
Table S1 Information box of the criteria used to quantify conditions to define multimorbidity in the current study. Table S2 The Canadian Study of Health and Aging (CSHA) frailty scale used to define the level of frailty of each patient during hospital admission. Figure S1 The Confusion Assessment Method Diagnostic Algorithm used to define the pr...
Article
Background: Sarcoidosis is a multiorgan idiopathic inflammatory disease that involves the thyroid gland in 1 to 4.6% of the cases. Case report: We report a case of a 36-year-old man who was diagnosed with Graves’ disease and initially treated with block and replace regimen followed by radioactive iodine (RAI), both of which were unsuccessful. The p...
Article
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Background: Parathyroid hormone (PTH) has a short half-life and is cleared by the liver and kidneys. This study examined whether declining estimated glomerular filtration rate (eGFR) affects application of the Miami criterion for intraoperative PTH (ioPTH) decline during parathyroidectomy for primary hyperparathyroidism (pHPT). Methods: A retros...
Article
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Aim: The determinants of cognitive impairment and delirium during acute illness are poorly understood, despite being common among older people. Anemia is common in older people, and there is ongoing debate regarding the association between anemia, cognitive impairment and delirium, primarily in non-surgical patients. Methods: Using data from the...
Chapter
Pheochromocytoma is a rare tumour that arises from catecholamine-secreting cells of the adrenal medulla or extra-adrenal chromaffin tissue. The extra-adrenal tumours are known as a paragangliomas. Both tumours are extremely rare in children with a reported incidence of less than 0.3 cases per million. Most of PHEO and sympathetic PGL secrete catech...
Article
Introduction The incidence of thyroid cancer has increased worldwide, whether a real or apparent increase is debated. Literature from the USA suggests greater diagnostic scrutiny, environmental and genetic factors may all play a part. This increase will result in a greater number of referrals for surgical assessment. This study examined the trend...
Article
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Evidence from clinical and experimental data suggests that thyrotropin receptor (TSHR) signaling is involved in energy expenditure through its impact on white adipose tissue (WAT) and brown adipose tissue (BAT). TSHR expression increases during mesenchymal stem cell (MSC) differentiation into fat. We hypothesize that TSHR activation [TSHR*, elevate...
Article
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Evidence from clinical and experimental data suggests that thyrotropin receptor (TSHR) signalling is involved in energy expenditure through its impact on white (WAT) and brown (BAT) adipose tissues. TSHR expression increases during mesenchymal stem cell (MSC) differentiation into fat. We hypothesize that TSHR activation (TSHR*, elevated TSH, thyroi...
Article
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Introduction Focused parathyroidectomy for primary hyperparathyroidism (pHPT) in patients with a single positive localizing scan may have an unacceptably high recurrence rate unless intraoperative parathyroid hormone (ioPTH) is used. The CaPTHUS score was previously developed to predict singlegland disease in such instances. We evaluated the accura...
Article
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Introduction Impaired preoperative kidney function is associated with an increase in post-procedural major complications and mortality in older elective surgical population. However, little is known about the impact of poor kidney function on outcomes in emergency surgical setting in this age group. This study aimed to quantify the effect of impair...
Article
Introduction: Ultrasound and Tc99mMIBI scans are used to localise parathyroid tumours in sporadic primary hyperparathyroidism (pHPT). Intra-operative PTH (ioPTH) assay facilitates unilateral neck exploration (UNE). When both ultrasound and MIBI are negative, it is our policy to explore the left side of the neck and only proceed to bilateral neck e...
Poster
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Introduction: It is unclear whether older surgical patients who undergo emergency operation have higher prevalence of mortality and readmission than those managed conservatively. We therefore examined the prevalence of emergency operations during emergency surgical admission of older people (≥65 years) and its association with mortality at 90 days...
Article
Background The purpose of the study is to examine the prevalence of hyperglycaemia in an older acute surgical population and its effect on clinically relevant outcomes in this setting. Methods Using Older Persons Surgical Outcomes Collaboration (OPSOC) multicentre audit data 2014, we examined the prevalence of admission hyperglycaemia, and its effe...
Article
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Objectives Multimorbidity is the presence of 2 or more medical conditions. This increasingly used assessment has not been assessed in a surgical population. The objectives of this study were to assess the prevalence of multimorbidity and its association with common outcome measures. Design A cross-sectional observational study. Setting A UK-based m...
Article
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Introduction: Older patients (>65 years of age) admitted as general surgical emergencies increasingly require improved recognition of their specific needs relative to younger patients. Two such needs are frailty and cognitive impairment. These are evolving research areas that the emergency surgeon increasingly requires knowledge of to improve shor...
Article
Introduction: Major surgery is associated with acute kidney injury (AKI). This study examines associations between elective parathyroid surgery and post-operative renal impairment. Methods: Consecutive patients undergoing elective parathyroidectomy were evaluated, and demographic data and relevant blood parameters collected. A renal risk score w...
Article
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A 42-year-old man arrived at the emergency department in severe respiratory distress, requiring immediate intubation and ventilation. An emergency computed tomography (CT) neck scan identified a substantial haematoma within a multinodular goitre, necessitating an emergency total thyroidectomy. It was later discovered that the patient had been the v...
Data
Video 1: Intraoperative video demonstrating the right-sided thyroid nodule responsible for the arterial bleeding.
Article
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Background: Laparoscopic surgery is being increasingly offered to the older person. Objective: To systematically review the literature regarding laparoscopic colorectal cancer surgery in older people and compare to younger adult populations. Study selection: We included randomized controlled trials that compared open to laparoscopic colorectal canc...