bluuebunny/crossref_metadata_2025 huggingface dataset:
EP-100 Skin Graft Versus Local Flaps in Management of Post-Burn Elbow Contracture
Authors: Noureldin Khaled , Issa Mohamed , Badawi Marwa , Darwish Mariam , Makram Mahmoud , Abdelazizi Ayyat
Published: November 2022

Introduction

Contracture is a pathological scar tissue resulting from local skin tissue damage, secondary to different local factors. It can restrict joint mobility, resulting in deformity and disability. This study aimed to investigate the outcomes of skin grafts compared to local flaps to reconstruct post-burn elbow contractures. These parameters included regaining function, range of movement, recurrence, and local complications.

Methodology

A retrospective study reviewed twenty-one patients for elbow reconstruction over 12 months. Only patients with post-burn elbow contracture were included. Other causes, including previous corrective surgery, any resultant elbow stiffness, and patients who opted out of postoperative physiotherapy, were excluded. Subdivision was according to the method of coverage into three groups: graft alone(G1), local flap(G2), or combined approach(G3).

Results

Females were three times at higher risk to suffer a burn injury, while almost half of the cases were children. Scald injury represented 81% of burn causes. G1,2,3 were used in 47.6%, 42.9% and 9.5% of cases retrospectively. Overall rate of infection was 28.5%. 100% graft taken was recorded in 81.8% of cases; however, flap take was in 90%. After 12 months of follow-up,re-contracture was 60% and 22.8% in G1 and G2; however, the satisfaction rate was 70% and 100% in both groups retrospectively. The overall satisfaction was 85.7% in all groups.

Conclusion

Grafts and local flaps are reasonable options for post contracture release; however, flaps are superior. Coverage selection depends on the lost tissue area and exposure of underlying deep structures. Physiotherapy and patient satisfaction are crucial in the outcomes.
EP-116 Family and Next of Kin (NOK) Communication - Time for a new NELA standard?
Authors: Ahmed Salma , Hassan Karim , Abubaker Malaz , Wilson Jeremy , Magee Conor
Published: November 2022

Introduction

The Covid-19 pandemic highlighted the importance of communication between patients, families, and the surgical team. Covid left many patients bereft of personal contact with loved ones and NOK were often left without information due to overwhelming, challenging situations for surgical teams. These challenges may not be unique to Covid- e.g team shift-working, late-night operating are ongoing barriers to NOK communication following emergency laparotomy (EmLap).

Methods

Twenty random EmLap patients during the pandemic were identified. Qualitative data on NOK discussion were obtained including telephone follow-up to confirm whether discussions took place.

Results

Only 50% of patients had documented NOK discussion- of these seven were held prior to surgery, 4 post-operatively and 5 during admission. Communication with families was mainly carried out by nurses while consultant/registrar discussions were documented on 7 occasions only.

Conclusion

Communication with the NOK of patients undergoing emergency laparotomy needs improving. Patient-centred care must involve the NOK. We would suggest that NOK should be informed of surgical outcomes and prognosis by a senior surgical team member. Notwithstanding the usual caveats of confidentiality and patient wishes- the importance of this facet of surgical care to many patients and their relatives cannot be understated and could be considered as a potential NELA standard of care.
EP-125 A rare case of abdominal wall necrotizing fasciitis caused by Actinomyces europaeus—a novel pathogen
Authors: Allen Neill , James Georgina , Jain Yogesh
Published: November 2022

Actinomyces europaeus is a sub-species of actinomyces first isolated in humans in 1997. It is commensal bacteria found within the genitourinary and gastrointestinal tract. Although it is known to cause soft tissue infection and has been known to cause abscesses, it has never been identified as the primary pathogen in a case of necrotizing fasciitis. We present the case of a 59-year-old man with recurrent groin infections, poorly controlled Type 2 diabetes and obesity who developed necrotizing fasciitis of his lower abdominal wall secondary to Actinomyces europaeus. We discuss the clinical course and the value of early identification of the pathogen and specialist microbiologist advice.
EP-148 Acute appendicitis complicated by COVID-19: an unexpected postsurgical sequela, Case Presentation
Authors: Ahmed Salma , Zaver Vasudev , Shafi Adil , Al-Hamid Zaid
Published: November 2022

Background

This is a case in which we explore the presentation and management of a 62-year-old gentleman, who attended a UK based surgical unit with appendicitis and a positive COVID-19 on admission. Following an urgent appendicectomy, he suffered a morbid and protracted postoperative period, complicated by an upper gastrointestinal bleed and prolonged ileus. The virus has been recognised to increase the risk of micro-thromboembolic events and gastrointestinal complications. We discuss the possibility of COVID-19 causing the patient's presentation and his post-surgical recovery. We aim to demonstrate our experience of the relationship between acute appendicitis and the morbidity associated with COVID-19.

Discussion

The case demonstrates a unique sequela following an otherwise routine emergency appendicectomy. In concurrence with a radiologically and microbiologically evident COVID-19 infection, it raises the question of whether the appendicitis was caused or at least complicated by the virus. This hypothesis is supported by a similar discovery in a case series carried out in Wuhan, in which a paediatric patient acutely presented with a perforated appendix in parallel with a SARSCoV-2 infection, which required urgent surgery. Contrastingly, a case which involved a COVID-19 positive adult male with a non-perforated and non-suppurative appendix demonstrated no complications post-operatively.

Conclusion

It is possible to postulate that the severe presentation outlined in our case could also have been caused by a delayed COVID-19 presentation. However, there is currently no formal research to support this and the approach has not been exemplified in a complex case such as ours.
EP-157 Pyocystis: A silent complication of a supravesical urinary diversion
Authors: Anwar Baseerat , Khalil Waqas , Rao Praveen , Ghiblawi Salaheddin , Ul Islam Jawad
Published: November 2022

Aim

Pyocystis is an important yet overlooked rare complication of a non-functioning urinary bladder. It is due to collection, liquefaction and decomposition of shed bladder epithelium, resulting in accumulation of pus in the bladder causing sepsis. We describe a case of Pyocystis in a patient with bilateral nephrostomies who presented with urosepsis multiple times due to this complication.

Case Report

A 78-year-old man, known case of Ca Prostate wit bilateral nephrostomies warranted multiple subsequent hospital admissions in one month due to urosepsis presenting with fever, urethral discharge, suprapubic pain and very high inflammatory markers. He underwent a CT Abdomen & Pelvis which revealed markedly distended bladder despite nephrostomies in place. Upon catheterization, no urine output was observed which raised concerns. An attempt at bladder washout displayed a large amount of thick foul-smelling pus which was aspirated. This was sent for culture and patient was commenced on appropriate IV antibiotics. After a thorough bladder wash out under flexible cystoscopy, patient was eventually discharged on a long-term catheter with regular bladder washouts in community as required. Patient was successfully managed on conservative treatment.

Conclusion

Pyocystis can sometimes be a missed complication of urinary diversion or a non-functioning bladder that can present silently under sepsis and should therefore be considered as a differential diagnosis of sepsis in patient with supravesical urinary diversion.

We wanted to highlight this condition which if left undiagnosed will progress to severe sepsis and possible death. Hence prompt intervention and aggressive management is vital.

Treatment for this complication requires catheterization, bladder irrigation and antibiotics.
EP-168 A rare encounter of “Forgotten disease”
Authors: Sengupta Shreya , Bose Sayantan
Published: November 2022

With the advent and prompt use of antibiotics after throat infections, the rare entity of Necrobacillosis has almost disappeared in clinical practice. Here we present a case of a fit and well 27 year old lady who was brought into A&E with septic shock, DIC and MODS after initial diagnosis of a sore throat 4 days ago which was treated by oral antibiotics. She was found to have bilateral patchy consolidations which later became necrotic cavities, empyema thoracis, peritonitis and abscess cavities in abdomen with evolving splenic abscess, prolonged QT and ectopics and type 2 respiratory failure. She was resuscitated, intubated and transferred to the ICU. With an isolate of Fusobacterium necrophorum from blood culture Meropenem, clindamycin and metronidazole were started. However, over the next few days of treatment, lack of clinical response prompted antibiotics changing, and surgical drainage of abscesses in chest and abdomen. Eventually after a considerable period of abdominal abscess drainage and about 3 weeks of metronidazole and other antibiotics followed by Piperacillin and tazobactam for another 3 weeks the patient recovered from sepsis and was stepped down to ward. This case though rare is a good example of the benefits of surgical drainage and prolonged antibiotics for septic patients with collections. A rapid weaning only results in re-collection and clinical deterioration or recurrent collection as happened to this patient. This is a rare case of Lemierre's syndrome which depicts the surgical difficulties faced due to recurrent abscess cavities formed in this condition.
EP-180 Analysis of two-week wait referrals to a colorectal surgery department for iron deficiency anaemia in a rural DGH
Authors: Anderson Catherine , Chituku Tsitsi , Rao Milind
Published: November 2022

Iron deficiency anaemia (IDA), defined as low haemoglobin and ferritin levels, affects 2–5% of adults in the developed world. Asymptomatic malignant gastrointestinal pathology must be excluded in all patients.

Patients referred on a two-week wait Colorectal pathway with IDA between 4/1/2018–28/2/2021 were recruited (n=566). 92.4% of patients were investigated, only 45.2% had true IDA. Although screening for coeliac disease was a prerequisite in the referral pro forma, 63.2% were referred without.

NICE guidance recommends upper and lower gastrointestinal investigations in all patients with confirmed IDA. 61.6% of patients had both investigations performed. 65.1% patients were diagnosed with benign conditions- diverticular disease (37.6%), polyp (31%) and hiatus hernia (28.5%). Age was the strongest predictor for pathology in patients with IDA (p=0.001), not specifically for cancer (p=0.111).

4.4% (n=23) patients were diagnosed with colorectal cancer. Low haemoglobin was significantly correlated with cancer (p=0.002), however only 60.9% had low ferritin.

Guidelines suggest that only post-menopausal women should be investigated for IDA unless symptomatic or risk factors. Although only 80% had symptoms; the entire cohort had investigations and only 60% returned a positive test.

This study highlighted variability in investigations in addition to lack of adherence by primary care physicians to referral guidelines resulting in avoidable referrals and potentially inappropriate investigations in pre-menopausal women by secondary care physicians, thus overwhelming an exceedingly burdened two- week wait pathway.
EP-182 The predictive significance of neutrophil-to-lymphocyte ratio in cholecystitis: a systematic review and meta-analysis
Authors: Millward Alex , Kler Aaron , Taib Adnan , Hajibandeh Shahab , Hajibandeh Shahin , Asaad Peter
Published: November 2022

Aims

The aim of this review was to examine whether neutrophil-to-lymphocyte ratio (NLR) can predict the presence of cholecystitis and distinguish between simple and severe cholecystitis.

Methods

A systematic literature search was performed. Risk of bias was assessed using the Newcastle-Ottawa Scale. Random effects model was used to calculate mean difference (MD) in two situations: (a) no cholecystitis versus cholecystitis and (b) simple versus severe cholecystitis. Receiver operating characteristic (ROC) curve analysis was performed to determine cut-off values of NLR for the above situations.

Results

Ten retrospective studies comprising of 2827 patients were included. 327 had no cholecystitis, 2100 had simple cholecystitis and the remaining 400 had severe cholecystitis. NLR was significantly higher in acute cholecystitis compared to “no cholecystitis” (MD = 8.05 (95% CI 7.71–8.38), p < 0.01) and severe cholecystitis when compared with simple cholecystitis (MD = 3.14 (95% CI 1.26–5.02), p < 0.01). For patients with cholecystitis compared to those without cholecystitis, an NLR cut-off value of 2.98 was identified (AUC = 0.90). Logistic regression analysis confirmed NLR > 2.9 was an independent predictor of cholecystitis (OR 36.0, p = 0.006). In simple versus severe cholecystitis, an NLR cut-off value of 8.5 was identified (AUC = 0.73). Binary logistic regression analysis suggested an NLR > 8.5 was not an independent predictor of severe cholecystitis (OR 6.5 p = 0.090).

Conclusion

NLR is significantly higher in patients with cholecystitis of any severity compared to patients without cholecystitis. Moreover, NLR can predict acute cholecystitis. However, NLR cannot predict the severity of disease due to inadequately powered studies.
EP-192 The effect of surgical case-based discussions in confidence levels in surgical intravenous fluid prescribing
Authors: Rees Chantal Olivia Blanch , George Jayan
Published: November 2022

Aims

Methods

FY1 doctors were surveyed throughout July 2021 and December 2021 across two sites. Eight questions used Likert scales (1 to 5: not at all confident to very confident) to assess surgical IV fluid prescribing. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

44 FY1 doctors completed the initial questionnaire.

19 FY1 doctors completed the questionnaire post rotation. (8 attended teaching and 11 did not.)

Confidence levels in surgical intravenous (IV) fluid prescribing were greater in FY1 doctors who had received CBD across 7 of the 8 questions than in those who did not.

Confidence levels were similar between those who had received CBD or not in surgical IV fluid prescribing in diagnosing a chest infection (as opposed to fluid overload).

Conclusions

Confidence levels in surgical IV fluid prescribing were mostly higher in those FY1 doctors who received surgical CBD teaching. Further research is required for the use of CBD in its potential to improve FY1 doctor education.
EP-193 The effect of surgical case-based discussions in confidence levels managing general surgical patients
Authors: George Jayan , Rees Chantal Olivia Blanch
Published: November 2022

Aims

Methods

FY1 doctors were surveyed throughout July 2021 and December 2021 across two sites. Seven questions used Likert scales (1 to 5: not at all confident to very confident) to assess managing general surgical patients. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

44 FY1 doctors completed the initial questionnaire.

19 FY1 doctors completed the questionnaire post rotation. (8 attended teaching and 11 did not.)

Confidence levels in managing the unwell general surgical patient and prescribing antiemetics was greater in FY1 doctors who had received CBD as opposed to those who did not.

Confidence levels were similar in managing gallstone disease, appendicitis, diverticulitis and prescribing analgesia for those who had received CBD and those that did not.

Conclusions

Confidence levels in managing general surgical patients were mostly higher in those FY1 doctors who received surgical CBD teaching. Further research is required for the use of CBD in its potential to improve FY1 education.
EP-194 The effect of surgical case-based discussions in confidence level in end of life patient management
Authors: George Jayan , Rees Chantal Olivia Blanch
Published: November 2022

Aims

Methods

FY1 doctors were surveyed throughout July 2021 and December 2021 across two sites. Six questions used Likert scales (1 to 5: not at all confident to very confident) to assess end of life management. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

44 FY1 doctors completed the initial questionnaire.

19 FY1 doctors completed the questionnaire post rotation. (8 attended teaching and 11 did not.)

Confidence levels in end of life patient management were greater in FY1 doctors who had received CBD across 5 of the 6 questions as opposed to those who did not.

Confidence levels were similar for end of life patient management for prescribing oral morphine for breakthrough pain when a patient is on a Fentanyl patch, for those who had received CBD and those who did not.

Conclusions

Confidence levels in end of life care management were mostly higher in those FY1 doctors who received surgical CBD teaching. Further research is required for the use of CBD in its potential to improve FY1 doctor education.
EP-196 The effect of medical and surgical rotations in confidence in managing surgical patients
Authors: George Jayan , Rees Chantal Olivia Blanch
Published: November 2022

Aims

Methods

FY1 doctors were surveyed throughout July – August 2021 and December 2021 across two sites. Seven questions used Likert scales (1 to 5: not at all confident to very confident) to assess general surgical patient management. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

44 FY1 doctors (27 Surgery, 17 Medicine) completed the initial questionnaire.

19 FY1 doctors (13 Surgery, 6 Medicine) completed the questionnaire post rotation.

Confidence levels were greater for FY1 doctors in surgery when managing the unwell general surgical patient and prescribing antiemetics.

Confidence levels in managing analgesia, diverticulitis, gallstone disease and appendicitis were similar for FY1 doctors in either group.

Conclusions

Confidence levels are similar post first rotation in managing surgical conditions between medical and surgical specialties. Confidence levels are higher for surgical FY1 doctors. Further research is required in this area to improve FY1 doctor education in managing surgical patients.
EP-198 Is Primary surgical treatment of anal carcinoma safe and cost-effective in low resource settings?
Authors: Weledji Elroy
Published: November 2022

Aims

The aim of the study is to debate if primary surgical treatment (abdominoperineal (AP) resection remains safe and effective in low resource settings especially when considering the cost, availability, protracted treatment and complications of radiotherapy+/- chemotherapy.

Methods

An electronic literature search were performed to identify original published studies on anal carcinoma and management.

Results

The oncological outcome of primary surgical treatment is equivalent to chemoradiotherapy. The arguments for surgery as primary treatment are (1) Surgery is the primary treatment modality for small perianal lesions that can be locally excised, (2) a 55% 5-yr survival after a potentially curable AP resection of early locally advanced cancer, (3) 50% relapse after complete remission using chemoradiation and many can be salvaged by AP resection. (4) Four situations may require surgery after primary chemoradiotherapy (a) residual tumour, (b) complications of treatment, (c) incontinence or fistula after tumour resolution, (d) subsequent tumour recurrence. (5) Only a generous biopsy will reveal if a residual ulcer contains residual disease for which a salvage AP resection may be the only option as further radiotherapy cannot be given. (6) Salvage AP resection carries a high morbidity. The main arguments against surgery as primary treatment are the increased tumour radiosensitivity in the undisturbed pelvis with well oxygenated tissues and less small bowel in the radiation field limiting toxicity, (2) radiation therapy will reduce local recurrence better than after surgery (3) 20% are incurable surgically at presentation.

Conclusions

Primary surgical treatment of anal cancer may remain safe and cost-effective in low resource settings
EP-210 Routine colonoscopy after acute diverticulitis – appraising an age-old practice
Authors: Elsaid Nada , Paxton Benjamin , Ismail Adam , Oshowo Ayo
Published: November 2022

The standard of care for patients with diverticulitis is to perform a colonoscopy following resolution of the acute episode, to exclude occult malignancy. But how often does malignancy masquerade as diverticulitis? Further, when deciding whether or not to investigate these patients, there does not appear to be a consensus for those who have had a previous colonoscopy confirming diverticulosis only. We examined this cohort to assess the outcomes of their endoscopic screening. Historically, tests, including barium studies, yielded a lower sensitivity but since the advent of CT colonography, the results are more accurate with the added benefit of reduced procedure-related morbidity and burden on the NHS. We consider whether routine endoscopic colonic evaluation post diverticulitis should, to all intents and purposes, become obsolete. A total of 34 patients (identified from a series of 457) were coded with a diagnosis of diverticulitis between September and December 2021. Of these, 21 underwent subsequent endoscopic evaluation post inflammatory episode. 0 patients had cancer. 2 patients had tubular adenomatous polyps, displaying low grade dysplasia. Interestingly, technical difficulty and/or poor patient tolerance meant that 4 of these patients underwent a flexible sigmoidoscopy only. 1 patient developed diverticulitis a month after their scope. 2 patients had repeat colonoscopies within 2 years, the indication being diverticulitis. The authors acknowledge that the sample used is small and robust conclusions could not be drawn thus far. Our aim is to evoke interest in the reader with this study serving as a precursor to a larger project that is underway.
EP-215 COVID-19: Influence on Stoma Outcomes & Post-Operative Mortality
Authors: Mactier Mhairi , Tallo Tracey , Robertson Isobel , MacDonald Angus
Published: November 2022

Introduction

The COVID-19 pandemic resulted in cessation of elective surgery and a shift towards emergency surgery, often non-curative with stoma formation. Our hospital stoma database scores surgical complications (retraction, prolapse, stenosis and hernia) and patient symptoms (leakage, soiling, skin changes and odour), recorded by the specialist nurse at varying post-operative points.

Aim

To compare stoma scores and post-operative mortality pre- and mid-pandemic.

Methods

The stoma database (Microsoft Access) was interrogated for two periods: 16/03/19–16/09/19 (pre-pandemic) and 16/03/20–16/09/20 (mid-pandemic). Mortality at 6 and 12 months was extracted from electronic patient records (Clinical Portal).

Results

Pre-pandemic, 28 patients underwent stoma formation. Median stoma score at post-operative day 3, day 10, 6 months and 12 months was 0(0–4), 0(0–4), 1(0–8) and 1(0–3) respectively. Post-operative mortality was 21% at 6 months and 36% at 12 months.

Mid-pandemic, 19 patients underwent stoma formation. Median stoma score at equivalent time intervals was 0(0–2), 1(0–8), 0(0–5) and 4 (n=1 patient score recorded). There was a relative paucity of data recorded mid-pandemic with a maximum of 9 patient scores recorded at any one time. Post-operative mortality was 16% at 6 months and 26% at 12 months.

Conclusions

While acute surgery during the pandemic does not appear to be associated with increased stoma complications and post-operative mortality was less during the pandemic, limited data recording makes true comparison of pre- and mid-pandemic stoma outcomes difficult. Assessing the impact of the COVID-19 pandemic on surgical outcomes may be limited by poor quality of data collected.
EP-221 Outcome of early cholecystectomy compared to percutaneous drainage of gallbladder and delayed cholecystectomy for patients with acute cholecystitis: systematic review and meta-analysis
Authors: Nassar Ahmed , Elshahat Ibrahim , Forsyth Katharine , Shaikh Shafaque , Ghazanfar Mudassar
Published: November 2022

Aim

Compare outcomes of ELC and PTGBD as an initial intervention for AC and to compare operative outcomes of ELC and delayed laparoscopic cholecystectomy (DLC).

Methods

English-language studies published until December 2020 were searched. Randomised controlled trials (RCTs) and observational studies compared EC and PTGBD with delayed cholecystectomy for patients presented with acute cholecystitis were considered. Main outcomes were mortality, conversion to open, complications and length of hospital stay.

Results

Out from 1347 records,14 studies were included. 205,361(94.7%) patients had EC and 11,565 (5.3%) patients had PTGBD as an initial intervention for AC. Risk of mortality was considerably higher in PTGBD compared to EC group; HR,95% CI: [3.68 (2.13, 6.38)]. In contrast, complication rate was significantly higher in EC group (47%) vs 8.7% in PTGBD group in patients admitted to ICU for sepsis related to AC; P-value=0.011. ELC group had more intra-operative blood loss than DLC group; MD (95%CI): 34.2 (4.15, 64.25) ml. There was no difference in mortality between the two groups; HR (95% CI): 1.30 [0.60, 2.83] Patients had ELC are at higher risk of post-operative complications compared to DLC; RR [95% CI]: 2.88 [1.78, 4.65]. Risk of bile leak or bile duct injury was six folds more in ELC; RR [95% CI]: 6.07 [1.67, 21.99].

Conclusion

ELC should be considered for all patients with acceptable surgical risk admitted with AC regardless its severity. PTGBD can be considered for patients admitted to the ICU for organ support. Future studies needed to assess the validity of this approach.
EP-245 A snapshot review of the use of prophylactic antibiotics for emergency gastrointestinal surgeries: a tertiary care centre experience
Authors: Nour Hussameldin Mohamed , Peristeri Dmitria V , Shafique Shehram , Khan Prof Mansoor , Singh Krishna K , Sajid Mr Muhammad S
Published: November 2022

Aim

The administration of recommended prophylactic antibiotics on time for emergency gastrointestinal surgery (GIS) is effective in reducing surgical site infections (SSI) and expediting post-operative recovery. This audit aims to assess the optimum use of prophylactic antibiotics in patients undergoing emergency GIS.

Methods

The data of all patients undergoing emergency GIS over a 1-month period was reviewed according to UH Sussex NHS trust (microguide) guidelines. The data was extracted, transferred and analysed using Microsoft Excel.

Results

Forty-one patients underwent emergency GIS during the study period. Emergency GIS procedures included laparoscopic appendicectomy (n=20), open colorectal resections (n=5), laparoscopic colorectal resections (n=3), perforated duodenal ulcer repair (n=2), inguinal hernia repair (n=2), diagnostic laparoscopy (n=2), defunctioning ileostomy (n=2) and other (n=5). Recommended antibiotics were administered in 17 (41.5%) patients and 29 (70.8%) patients were administered antibiotics at the correct time. Surgical site infections (SSI) were seen in 6 (14.5%) patients, of which 2 (11%) patients were in the recommended-antibiotics group and 4 (16.5%) in the non-recommended antibiotics group (p= 0.05). Two patients (2/29; 6.8%) contracted SSI in the group which received antibiotics on time. The major factor behind using non-recommended antibiotics and not administering antibiotics at the recommended time was the continuation of antibiotics commenced at the time of admission.

Conclusion

A significantly higher proportion of patients undergoing emergency GIS were not administered the recommended antibiotics. Moreover, almost one third of patients were not administered antibiotics on time. Use of non-recommended antibiotics results in higher incidence of SSI in patients undergoing emergency GIS.
EP-250 A closed-loop clinical audit on the impact of implementing the STAR Score at a tertiary level hospital in India: Where do we stand?
Authors: Sinha Akatya Vidushi , Kadam Sameer
Published: November 2022

Aim

To perform an audit to check Quality & Compliance of Surgical documentation using STAR Score at a tertiary hospital in India.

Method

A total of 90 case files were studied and assessed in detail from all surgical departments. The audit was done for a period of 1 month at a tertiary hospital in India. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. A series of departmental training and implementation meetings were carried out. After 2 weeks, a re-audit was performed.

Result

The overall compliance score of the hospital was found to be 74%. While the departments of General surgery and orthopaedics showed a higher rate of compliance, each constituting 82%, Neurosurgery showed the least compliance of 62%. It was also seen that the maximum percentage of missing information constituted of anaesthetic records and subsequent entries. After the re-audit, a considerable improvement was observed, with the compliance rate improving to 90% in all departments.

Conclusion

We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
EP-254 Do not forget about bowel ischemia: a thematic review at Bedford Hospital
Authors: Muscara Francesca , Mwendauya Abigail , Kattaria Khaled , Soriano Jose , Bevan Katharine
Published: November 2022

Introduction

Bowel ischaemia (BI) is a life-threatening emergency with a mortality rate of 60–80%, which requires early diagnosis and surgical intervention. Clinical presentation is nonspecific, being characterised by initial discrepancy between severe abdominal pain and minimal clinical findings, abdominal CT has poor sensitivity and specificity. BI remains a diagnostic challenge for clinicians and often is an autopsy finding (1–1.5% of all adults’ autopsy). We conducted a thematic review to identify major issues which led to fail to recognise BI.

Methods

Data was collected retrospectively from NELA database on 626 patients who underwent emergency laparotomy, between 2013–2021 at Bedford Hospital, including preoperative clinical-radiological data, operation details, postoperative complications according to Clavien-Dindo (CD) classification and mortality.

Results

A total of 68 (10.8%) patients had BI as intra-operative finding, average age 71.3 (37–99), 35 (51.4%) female and 33 (48.5%) male. 25 (36.7%) had BI as indication for emergency laparotomy. 65 (95.5%) presented as emergency versus 3 (0.5%) as elective admission. The average waiting time for surgery was 8.9 hours. 53 (77.9%) patients received CT AP (46 triple phase, 4 angiogram, 3 without contrast), presence of BI was highlighted in 11 (21.1%) cases. In 14 (20.5%) patients a stoma was fashioned during laparotomy. 28 (41.2%) complications were recorded, of which 8 (28.5%) CD grade I, 5 (17.8%) CD grade 3b and 13 (46.4%).

Conclusions

Our results showed a mortality rate of 19.1% at 30 days postoperatively. We recommend strong clinical suspicion and aggressive approach should be adopted to improve the clinical outcome of BI.
EP-269 An Audit of Carbon Emissions Generated by Virtual and In-Person Clinic Appointments During The COVID-19 Pandemic
Authors: McKay Ellen , Singh-Ranger Gupreet , Schimp-Manuel Krystal
Published: November 2022

Background/Introduction

Virtual appointments have been considered in our department for many years, as a strategy to lower carbon emissions. The advent of COVID-19 prompted urgent implementation as in person appointments were limited.

We performed a prospective audit to assess the effectiveness of this approach in lowering carbon footprint.

Method

Audit study of all surgical clinic appointments from 18/03/20–31/03/21at the Upper River Valley Hospital, New Brunswick. Mileage calculated based on a round trip from patient postcode to hospital address.

CO2 / CO2 equivalents (CO2-e) emitted calculated from previously published data - mobile phone CO2-e; 0.0092751142 g/minute, laptop; 0.269216134 g/minute, standard car emissions 128.002 g/km.

Results were analysed statistically.

Results

Discussion

Implementation of virtual appointments significantly lowered the carbon footprint of our surgery clinic.

This has the potential to be a positive development in the efforts against climate change. Factors such as quality assurance, patient and physician satisfaction need to be determined however.
EP-271 Assessing the Impact of Implementing the STAR Score at a Tertiary Level Hospital in India: A Closed-loop Clinical Audit
Authors: Sinha Akatya Vidushi , Kadam Sameer
Published: November 2022

Aim

To perform an audit to check Quality & Compliance of Surgical documentation using STAR Score in the general surgery department of a tertiary hospital in India.

Method

A total of 20 case files were studied and assessed in detail from the general surgery department. The audit was done for a period of 1 month at a tertiary hospital in India. The “STAR: Surgical tool for auditing records” tool was used to collect data accordingly. The results were compared with standard guidelines and further analyzed. Interventions were carried out by a series of departmental training and meetings. After 2 weeks, a re-audit was performed.

Result

The overall compliance score of the general surgery department was seen to be 82% in the first cycle. While the initial clerking constituted 21% compliance, operative records, and discharge summaries, showed compliance of 33% and 22% respectively. Consent and Anesthetic records showed the least compliance of 7% and 14%. The highest compliance was seen in subsequent entries, constituting 35%. In the second cycle, a significant change was reported as the overall compliance score increased to 95%. All sections showed a statistically significant increase. Consent and anesthetic records demonstrated an increase of 75% and 70% compliance, respectively.

Conclusion

We believe that compliance and implementation of the STAR Score is mandatory, as it can significantly improve the quality of documentation and can be implemented universally.
EP-273 Magnetic nanoparticle administration to a model of penetrating neurotrauma in vitro
Authors: Basit Raja Haseeb , Wiseman Jessica , Chari Divya Maitreyi
Published: November 2022

Introduction/Aims

Functional recovery in penetrating traumatic brain injury (pTBI) is hampered due to the lack of clinically approved regenerative therapies. Although a surgical emergency, pTBI management is largely supportive, with no targeted neuroregenerative therapies. Reactive gliotic and neuroinflammatory responses with a lack of spontaneous axonal regeneration represent a major barrier to repair. Emergent nanotechnologies including magnetic nanoparticles (MNPs) show promise to attenuate such responses through immunomodulation, with potential of delivery of neurotherapeutic molecules to lesion sites during surgical intervention. However, there is a lack of high throughput, neuropathomimetic, models for nano/biomaterial testing in experimental neurology. Our group recently showed glial cell interactions with a surgical biomaterial scaffold (DuraGen PlusTM) in a novel in vitro model of pTBI.

Methods

Mice cerebral cortices were extracted and cultured 8–10 days in vitro (DIV) using previous methodology (Basit et al, Mat Sci Eng C, 2021) with a modified chemical medium. At 8 DIV, a sterile pipette was used for transection of the culture simulating penetrating injury in vitro with injection of carboxymethyl dextran-coated magnetic nanoparticles and polyethylene glycol-coated magnetic nanoparticles into the lesion site. MNP-neural cell responses were evaluated using immunocytochemistry methods.

Results

Our model demonstrates hallmark reactive gliotic responses, immune cell infiltration and axonal transection in injury sites. We demonstrate preferential and competitive microglial uptake of delivered MNPs versus other neural cell types (p<0.05, n=5).

Conclusion

The model is adaptable to study neural cell responses to range of materials, offering high versatility for testing promising surgical neuromaterial based therapeutic interventions in experimental clinically relevant research.
EP-277 Emphysematous cholecystitis: A diagnostic dilemma and treatment challenge
Authors: Matias Mariana Rita Afonso , Elnabil-Mortada Ahmed , Ackroyd Roger
Published: November 2022

Background

Emphysematous cholecystitis (EC) is a rare life-threatening variant of acute cholecystitis. It is commonly seen in elderly men who are immunocompromised, known diabetes mellitus or peripheral vascular disease. EC is caused by gas-forming organisms such as Escherichia coli, Clostridium perfringens and Bacteroides fragilis and has a reported mortality of up to 25%. Computed Tomography is the most sensitive diagnostic imaging study for the detection of intraluminal or intramural gallbladder gas.

Methods

We report a diagnostic dilemma and multidisciplinary management of a case of emphysematous cholecystitis with unusual presentation in a young, healthy patient with no risk factors.

Results

A 47-year-old male chef, otherwise fit and well, presented with a clinical picture of sepsis and abdominal pain. Initial investigations were normal apart from bilateral basal atelectasis, hence he was treated for pneumonia, although without clinical improvement. Due to persistent fever, patient underwent further investigations that established the diagnosis of emphysematous cholecystitis. His clinical condition improved dramatically after urgent laparoscopic cholecystectomy with patient being safely discharged home 6 days post-op, with an uneventful postoperative recovery.

Conclusion

A high index of clinical suspicion and multidisciplinary team management including surgery, radiology, and microbiology is crucial for early diagnosis of the rare life-threatening condition of EC. Our clinical case highlights that EC is not limited to elderly morbid patients and urgent laparoscopic cholecystectomy is the best treatment when feasible.
EP-279 Impact of a Subspecialty Emergency Service on Emergency Laparotomy Workload
Authors: Farrow EZ , Cook TA
Published: November 2022

Aims

Subspecialist emergency surgical care, shared between Upper GI (UGI) and Colorectal (CR), can bring clinical benefits. Currently subspecialist emergency care is provided in around 20% of units but is likely to become more common in larger units with a view to driving improvement in outcomes. A subspecialty emergency service was introduced in our Trust in April 2020. The purpose of this study was to assess the impact of the subspecialty emergency service on emergency laparotomy workload for each team.

Methods

Data recorded on the NELA Database over an 18-month period (April 2020 - September 2021) were reviewed. Consultant involvement and subspecialty team were recorded

Results

There were 14 surgeons (7 UGI, 7CR) participating equally in the emergency service (two consultants available 24/7). There were 589 emergency laparotomies (mean 33/month) performed in the 18-month period, 6 were excluded from analysis due to incomplete data. A consultant surgeon was present for 94% of all cases. 357 cases (51 per surgeon) were performed under a CR consultant compared with 226 (32.3 per surgeon) under an UGI consultant. CR consultants performed more laparotomies out of hours then their UGI colleagues.

Conclusions

There was good consultant involvement for all emergency laparotomies. CR surgeons performed 61.2% of emergency laparotomies reflecting the presenting pathology of emergency patients. This had an impact on the amount of out of hours operating for individuals within the service as a whole. These differences should be taken into consideration in units looking to establish a subspecialty emergency service.
EP-283 A rare cause of headache – cerebral sinus venous thrombosis after COVID-19 vaccination
Authors: Kam Cheuk Tung , Rait Jaideep
Published: November 2022

Introduction

Cerebral sinus venous thrombosis (CSVT) is a rare complication of COVID-19 vaccination. There is an incidence of 0.55 per 100,000 person-months. We describe a case of CSVT post COVID-19 vaccine.

Case description

A 58-year-old male presented to a district general hospital after being involved in an RTC with a 3 month history of left sided headache which had followed his first COVID-19 vaccine (AstraZeneca). No focal neurological deficits were elicited. Blood results were unremarkable. Radiological workup suggested left transverse and sigmoid sinus thrombosis with no other intracranial complications. The patient was admitted and managed with low molecular weight heparin with an uneventful recovery.

Discussion

CSVT is a rare and sometimes fatal disease. An increased risk of CSVT after COVID-19 vaccination has been suggested. An underlying immunological mechanism is suspected with the involvement of platelet factor-4 (PF4) antibody. Headache is the most common presenting symptom with onset within one week of vaccination. Positive D-dimer, PF4 IgG assay and thrombocytopenia may also support the diagnosis. CSVT may progress to major complications including intracranial haemorrhage and even death. Prompt diagnosis and appropriate treatment prevents neurosurgical intervention such as decompressive craniotomy and may improve neurological outcome.

Conclusion

This case describes an important and rare finding of complications following COVID-19 vaccine. Consideration should be made in management for patients with a recent history of COVID 19 vaccination presenting with features of headache. A high level of clinical suspicion is needed to investigate and manage these patients appropriately with potential CSVT.
EP-295 Mentoring Scheme for Medical Students Interested in a Career in Surgery
Authors: Bowerman Kathryn , Agarwal Reena
Published: November 2022

Aim

A career in surgery requires dedication and commitment from medical school onwards. Having a mentor is proven to help facilitate career progression and improve self-confidence as well as providing supportive, non-biased, non-judgemental career advice. Mentors report increased job satisfaction and self-esteem when mentoring junior colleagues.

Method

The senior author, along with the local medical school's surgical society, launched a pilot scheme for medical students and volunteering consultant surgeons in April 2021. 46 students were recruited, and 28 consultant surgeon mentors. Mentees were then paired with mentors, with some mentors taking on multiple mentees.

Results

Feedback forms were sent out 6 months later to establish perceptions on progress and any suggestions for improvement. We had a low return rate of the feedback forms with 19 returns from mentees, 13 of which had met their mentors. 8 forms were returned by mentors, 5 of whom had met their mentees. 82.35% of mentees who returned the form said the pilot scheme had either ‘met or exceeded their expectations’.

Conclusion

This pilot scheme was launched just as Covid-19 pandemic recovery work started, with surgical specialities trying to clear the back log, which may be the reason of the meetings not taking place or the feedback forms not being completed. In the future, we hope to recruit surgical trainees to help with the mentorship programme and by time constraining the programme, trying to ensure that all mentees get the benefit of limited number of mentors.
EP-296 Introduction of an Information Leaflet for Patients Presenting with Hand Injuries
Authors: Bowerman Kathryn , Frost Stephen , Agarwal Reena
Published: November 2022

Aim

Patient Information Leaflets (PILs) are an effective way to educate patients, involve them in their care, and improve communication between patient and clinician. Our department did not have a PIL covering all hand injuries in single leaflet, therefore we decided to make one.

Method

We created a PIL to give to all patients with hand injuries that were seen in the Emergency Department by Plastic Surgery. The PIL explains what will happen if they need surgical intervention, or if the injury can be managed conservatively. In our hospital, Plastic Surgery covers hand injuries on Fridays, Saturdays, and Sundays and then patients are either planned for dedicated trauma lists during the week or for follow up in the Hand Trauma Review Clinic.

Results

The leaflet detailed the follow up patients could expect, as well as red flag symptoms to look out for, and who to contact should any problems arise. The PIL enabled us to emphasise the importance of adherence to advice given by healthcare professionals, particularly on any dressings and splints provided to the patients.

Conclusion

While the leaflet is generic in nature to cover all injuries, specific advice is given in addition to the leaflet to ensure that patients have the best possible care. In the future, we would like to make the leaflet electronic in order to reduce waste and risk of infection. Ideally, patients could scan a QR code taking them directly to the relevant part of the leaflet.
EP-313 Timeliness of ultrasound investigation in patients presenting with acute abdominal pain – single-centre audit
Authors: Mateescu Daniela Ioana , Hakeem Abdul , Chedid Youssef , Chattopadhyay Dipankar
Published: November 2022

Aim

To identify patients delays in ultrasound investigation in patients who present with acute abdominal pain; patients who require ultrasound investigation to decide if they require admission or can be safely discharged home.

Methods

Patients who presented to our hospital's Accident and Emergency department with acute abdominal pain and an ultrasound was requested were included in the analysis. The indication was divided into 3 main categories (Upper abdominal pain, post-cholecystectomy and other pathology). Data were analysed in relation to admission and discharge. Patients who had outpatient ultrasounds were excluded from the study. Mean and standard deviations were used for the delays.

Results

A total of 322 patients were included in the study, 160 (49.7%) patients were due to cholelithiasis or upper abdominal pain, 158 (49.1%) were due to other pathologies, 4 (1%) were post-cholecystectomy ultrasounds. The mean admission to ultrasound request was 1.77 (±5.48) with 290 (90.1%) being requested within 2 days of admission. Mean days from request to ultrasound being performed was 1.37 (±4.04) with 299 (93.1%) performed within 2 days.

Conclusions

The study concluded that the average time from ultrasound being requested to being performed in patients with acute abdominal pain was 0–2 days, this shows that the ultrasound is performed appropriately and there are minimal delays.