Browsing by Author "Apse, Ingus Arnolds"

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    Basal Cell Carcinoma. Analysis of 395 cases localized in the neck, ear and nose region
    (2020) Kornevs, Egils; Apse, Ingus Arnolds; Safronovs, Toms Janis; Krastiņa, Aija; Paparde, Arturs; Lauskis, Gunars; Salms, Girts; Department of Oral and Maxillofacial Surgery and Oral Medicine; Rīga Stradiņš University; Department of Human Physiology and Biochemistry
    BACKGROUND AND OBJECTIVES: To test if there are different outcomes in basal cell carcinoma for lesion size, histopathology, localization, and recurrence rates. MATERIALS AND METHODS: A total of 395 patients with BCC localized in the neck, nose and ear regions who were surgically treated in Latvian Oncology Centre between 2006-2011 were analyzed retrospectively. The data were analyzed using modified classification based on Clarks et al. (2014) and McKenzie et al. (2016). RESULTS: Three hundred and ninety-five cases of BCC that were surgically treated in head and neck region were reviewed. Results were tabulated in four categories: anatomical region, histopathology, lesion size, and recurrence rates. Classification by anatomical region: 228 cases in the nose region, 82 cases in the neck region, 82 cases in the ear region. Classification by histopathology: 259 cases presented as low risk BCC [nodular, pigmented, adenoid, keratotic and cystic], 21 cases presented as superficial, 94 cases presented as mixed, and 21 cases presented as high-risk BCC (metatypical, morphea form). Mann-Whitney U test was used to compare recurrent BCC cases to non-recurrent cases. Significantly higher recurrence rates were observed if BCC at the time of the excision was ≥10 mm (p<0.001). Significance was also noted in cases where histopathology was mixed BCC and in cases where mixed BCC was localized to the nose region (p<0.001). CONCLUSION: More attention should be brought to assessing classification and clinical treatment synergy. Higher recurrence rates are observed when lesions occur in high risk anatomical region (H zone), when lesion size reaches or exceeds 20 mm in diameter, and when lesion is subtyped as mixed BCC. It is crucial to evaluate risk factors such as BCC subtype and localization, as these are associated with a higher rate of recurrence when present in a single lesion. These risk factors, together with pre-treatment lesion evaluation will enable formulation of better treatment plan and prognostic aspects in each case.
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    Elective surgery system strengthening : development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries
    (2022-11-05) COVIDSurg Collaborative; NIHR Global Health Unit on Global Surgery; Apse, Ingus Arnolds; Pāvulāns, Jānis; Pčolkins, Andrejs
    Background: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings: In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation: The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding: National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.
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    Influence of Mucosal Tissue Thickness on Peri-Implant Bone Stability : Retrospective Radiological Study
    (2023-12) Apse, Ingus Arnolds; Lācis, Rihards; Gončarova, Alīna; Šalms, Ģirts; Akota, Ilze; Neimane, Laura; Faculty of Dentistry
    Gradual bone loss around the implants is an ongoing concern. Mucosal tissue thickness is considered as a contributing factor that influences bone remodelling after implantation. It has been suggested that tissue thickness thinner than 2.5 mm may contribute to more peri-implant bone loss, eventually affecting implant bone stability. Measuring mucosal thickness prior to surgery may be a predictor of the bone changes and could modify the surgical methods. In this study mucosal tissue thickness was measured retrospectively on radiographs before implant insertion, one year and at least three years after implantation. Within the limits of this study, no influence of initial mucosal tissue thickness on long term peri-implant bone stability was found.
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    SARS-CoV-2 infection and venous thromboembolism after surgery : an international prospective cohort study
    (2022-01) COVIDSurg Collaborative; GlobalSurg Collaborative; Apse, Ingus Arnolds; Ivanova, Anna
    SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3-6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
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    SARS-CoV-2 vaccination modelling for safe surgery to save lives : data from an international prospective cohort study
    (2021-09-27) COVIDSurg Collaborative, GlobalSurg Collaborative; Apse, Ingus Arnolds; Ivanova, Anna
    BACKGROUND: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. METHODS: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. RESULTS: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. CONCLUSION: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
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    Timing of surgery following SARS-CoV-2 infection : an international prospective cohort study
    (2021) COVIDSurg Collaborative; GlobalSurg Collaborative; Apse, Ingus Arnolds; Ivanova, Anna
    Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.