The Society of British Neurological Surgeons

Neurosurgical National Audit Programme

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Surgeon

Mr Alexander L Green MD FRCS(SN)
Professional Title Neurosurgeon
GMC Number 4424585
Personal Email
Secretary Vicky Ford 01865 234605 vicky.ford@ouh.nhs.uk
SBNS Member? Yes

Hospitals

Training


BSc(hons) Neuroscience, University College London - 1994

MB BS, University College London - 1997

MD, University of London - 2007

FRCS (SN), RCS Engl - 2007

2009

University College London: 1991-1997

North Thames Deanery Specialist Training (Neurosurgery): 2001-2002

Oxford Deanery Specialist Training (Neurosurgery): 2002-2007

Oxford Deanery NIHR Academic Clinical Lecturer: 2007-2009

Professional Activity


Spalding Senior Lecturer, University of Oxford, 2009 - present

President, British Society of Stereotactic and Functional Neurosurgery, 2011-2016

Associate Editor, Annals of the Royal College of Surgeons of England, 2015 - present

Extraordinary Junior Research Fellow, The Queen's College, Oxford, 2007-2012

 

British Society of Stereotactic and Functional Neurosurgery

Society of British Neurological Surgeons

Neuromodulation Society of UK and Northern Ireland

International Neuromodulation Society

I have attended a court room skills course and provide medicolegal opinions on personal injury and clinical negligence cases.

Clinical Activity


Functional Neurosurgery including pain and movement disorders

Pain, including dorsal root ganglion stimulation, occipital nerve stimulation and spinal cord stimulation

Training Programme Director (Neurosurgery, Oxford Deanery)

Research


My main focus is on the higher control of the autonomic nervous system. I use Deep Brain Stimulation to both record from the brain and also stimulate brain areas whilst looking at autonomic control. This allows me to elucidate brain pathways involved in the autonomic nervous system with potential for future treatments of blood pressure related disorders, breathing and bladder dysfunction. I am also involved in a number of clinical trials related mainly to neuromodulation. These include a trial of intraventricular platelet-derived growth factor for advanced Parkinson's disease, two DBS registries, an observational cohort study of dorsal root ganglion stimulation for pain and other smaller studies. I also conduct research into non-functional neurosurgical treatments and was the chief investigator for the Evicel study (a dural sealant RCT) and a current study comparing two dural sealants. My work on the autonomic nervous system has also allowed me to research into the domains of pain (related to autonomic activity) as well as cognitive function. 

  1. Hyam JA, Kringelbach ML, Silburn PA, Aziz TZ, Green ALThe autonomic effects of deep brain stimulation-a therapeutic opportunity. Nat Rev Neurol. 2012; 8(7):391-400
  2. Green AL, Stone E, Sitsapesan H, Turney BW, Coote JH, Aziz TZ, Hyam JA, Lovick TA. Switching off micturition using deep brain stimulation at midbrain sites. Ann Neurol. 2012 Jul;72(1):144-7
  3.  Antoniades CA, Bogacz R, Kennard C, FitzGerald JJ, Aziz T, Green AL.Deep brain stimulation abolishes slowing of reactions to unlikely stimuli.J Neurosci. 2014 34(33):10844-52
  4. Green AL, Wang S, Purvis S, Owen SLF, Bain PG, Stein JFS, Guz A, Aziz TZ, Paterson DJ. Identifying cardiorespiratory neurocircuitry involved in central command during exercise in humans. J Physiol 2007; 578:605-12
  5. Alexander L. Green, Shouyan Wang, Sarah L.F.Owen, Kangning Xie, Xuguang Liu, David J Paterson, John F Stein, Peter G Bain, Tipu Z Aziz. Deep Brain Stimulation can Regulate Arterial Blood Pressure in Awake Humans. Neuroreport 2005. 16: 1741-5

Outcome Report

SBNS
Understanding activity pie charts


What does the Consultant activity pie chart show?

The Consultant activity pie charts represent the total number of elective (planned) finished consultant episodes (FCEs) and non-elective (emergency) finished consultant episodes. A finished consultant episode usually represents the care of a single patient from admission to discharge.

Please note that for Consultants who provide both adult services for patients older than 17 years and paediatric services for patients 16 years old and younger there are two outcome reports.

Elective Procedural Case-mix and Case Volume
Image

SBNS
Understanding mortality funnel plot charts

What does the Consultant funnel plot chart show?

The Hospital Consultant mortality funnel plot represent the total number of elective (planned) finished consultant episodes (FCEs) and non-elective (emergency) finished consultant episodes. A finished consultant episode usually represents the care of a single patient from admission to discharge.

The mortality presented here is for three years: April 2014 – March 2017. Please note that for Consultant who provide both adult services for patients older than 17 years and paediatric services for patients 16 years old and younger there are two outcome reports.

The horizontal yellow line represents the national average mortality. The solid black lines above and below the yellow line are the control limits. The upper control limit represents the highest expected mortality rate. The Consultant's outcome is highlighted in magenta.

30 Day Risk Adjusted Elective Procedural Mortality
Image

The outcomes of this consultant are within the expected range

Understanding the risk-adjusted mortality rate

Risk adjustment (or case-mix adjustment) takes into account patient risk factors to calculate a predicted mortality rate. This means that hospitals or consultants who see higher risk patients have their mortality rate adjusted to account for the factors that put these patients at greater risk.

Understanding the 'funnel plot' diagram

The funnel plot displays the risk-adjusted elective procedural mortality ratio for each consultant plotted against the expected number of mortalities for that consultant. The expected number of mortalities for each consultant will vary depending on the number of procedures they have performed and the risk profile of the patients they have treated. The horizontal yellow line represents the expected ratio. The solid black line above the chart is known as a ‘control limit’. This control limit represents the highest expected mortality rate. Risk-adjusted rates appearing beneath this line are within the normal range.

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