bluuebunny/crossref_metadata_2025 huggingface dataset:
483 A Quality Improvement Project: Novel Electronic Operative Note Templates to Improve the Continuity of Post-Operative Patient Care
Authors: Abdeen B , Alaaraj M , Alkilani Y , Ahmad S B , Ahmed U , Kumar G
Published: October 2021

Introduction

Good Surgical Practice from RCS England encourages the use of e-health records and detailed typed operative notes. The Covid-19 pandemic has led to multi-site operating. ENT operations in our trust were split over three sites including the private sector leading to potential disruption in continuity of patient care. Physical operation notes are difficult to access in emergencies, telephonic clinics or for audit purposes. We aim to have operative notes available on patients’ e-records which adhere to RCSEng guidelines.

Method

In this QIP, we reviewed all ENT operations over a retrospective one-month period recording percentage of notes uploaded to patient e-record and the number of surgeons in theatre. We created two novel RCSEng compliant e-operative notes with a user guide, generic and tonsillectomy-specific, and prospectively collected data to complete the cycle.

Results

261 patients were included in both study periods. Only 36/134(27%) had e-operative pre-intervention improving to 71/127(56%) post-intervention. In the latter period, 76% of operations included a registrar and were more likely to have e-operative notes(72%) compared to when a consultant was operating alone(6%). There was low uptake of our tonsillectomy e-proforma(33%).

Conclusions

Our QIP has already proved effective with our templates increasing operative documentation on e-records. Increased use of e-template was more likely with the presence of a registrar in theatre. Room for improvement remains and we will re-audit after the introduction of further user-friendly operative templates and IT training. This QIP has also revealed additional operative training opportunities of which registrars can take advantage.
744 A Quality Improvement Project on Timely Removal of Central Venous Catheters
Authors: Devarakonda S , Korula P J , Kandasamy S
Published: October 2021

Introduction

Central Line-Associated Blood Stream Infections are associated with high morbidity and mortality. It is essential to ensure quality in insertion, maintenance, and timely removal of central lines. Our ICU follows a protocol to remove unused lines after five days. We have an electronic alert system to monitor these lines, and we wanted to audit its usage and improve its efficacy.

Method

This project was designed using QI methodology and was carried out in a Level III Surgical ICU. We implemented two PDSA cycles in August and December 2020. After the first cycle, an online survey was performed among ICU doctors to gauge their knowledge of the alert system and local protocols. Based on the above results, an educational session was carried out, showing a step-by-step guide to using the alert system, and a re-audit was done in December.

Results

The first cycle showed that alerts were created for only 17 (25%) of 68 lines. Also, the survey revealed that about 30% of doctors were unfamiliar with the alert system. After the intervention, adherence to the alert system increased to 65% (alerts for 41 of 63 lines). There was also a significant improvement in the mean number of central line days from 6.4 (SD = 3.1) to 4.2 (SD = 2.8) [P <  .05].

Conclusions

It is crucial to monitor central lines, and simple educational sessions about local protocols can bring success in implementing sustainable change in quality. We suggest hospitals have systems to monitor the central lines and regularly audit their effectiveness.
886 Healing Hands and Thrifty Plans! A Prospective, Cost-Effective Trial in Abscess Management
Authors: Saiyed S , Ahmed M , Winfield M , Briggs C , Amr B
Published: October 2021

Aim

Cutaneous abscesses are ubiquitous presentations requiring surgical drainage in most cases. There is a wide variation across the UK in the surgical practice dealing with such common problem. The aim of this study was to reduce the costs incurred in surgical drainage of acute skin and soft tissue abscess.

Method

This was a prospective, cost-effective study of the expenses incurred in surgical drainage of acute cutaneous and subcutaneous abscesses treated under the general surgeons' care over one year.

Results

A consequential saving of £13,962 was achieved during the study period. Between October 2019 and October 2020, 322 patients with soft tissue abscesses were treated by incision and drainage in general surgery. We calculated a total cost of £55.26 per patient for this routine operation. These expenses were based on basic surgical drapes pack, standard surgical gowns, sterile gloves and obtaining and processing the microbiology specimens. We have designed and implemented a new theatre protocol specifically for this procedure, resulting in a substantial reduction of the costs to £11.90 per patient. The total savings of £13,962 do not include savings caused by abscess drainage under local anaesthesia and does not calculate the savings that occurred due to shorter inpatient stay. These extra savings will be calculated and added later.

Conclusions

Considering the increasing financial burden on the NHS, we could make significant savings of nearly 80% of the operative costs of surgical drainage of a cutaneous abscess. We could achieve that by implementing simple modifications in the current surgical pathways without compromising patients' safety.
928 Current Practice in The Investigation and Management of Post-Operative Ileus
Authors: English C , Jakes A , Wheatstone S
Published: October 2021

Introduction

Post-operative ileus is non-obstructive impairment of gastrointestinal motility after surgery. Treatment involves nil-by-mouth, correction of electrolytes and stopping aggravating medications. There is no current national/trust guideline for investigation and management of post-operative ileus.

Aim

To assess current practice in investigation and management of post-operative ileus on surgical wards at St Thomas’s Hospital.

Method

All patients with a diagnosis of post-operative ileus on surgical wards between November - December 2020 were identified. Their clinical notes were reviewed, and common themes explored.

Results

16 patients were diagnosed with post-operative ileus. 12 (75%) patients were male, with a median age of 60 (IQR: 28). 10 (63%) were open procedures, majority being colorectal (10; 63%), cardiothoracic (3; 19%), urological (2; 13%), vascular (1; 6%) operations. Average time between operation and diagnosis was 5.2 (range: 2-14) days. Bowel sounds were auscultated in only 2 (12.5%) patients at initial assessment. 8 (50%) patients had imaging to confirm diagnosis (AXR; 5, CT scan; 4). Majority (15; 94%) of patients had serum magnesium and potassium checked at diagnosis. All patients with serum potassium <4.0mmol/L (5) and magnesium <0.7mmol/L (2) had intravenous supplementation. 14 (88%) were administered Hartmann’s solution. 10 (63%) patients were made nil-by-mouth and 15 (94%) had a Ryles tube inserted. 2 (12.5%) patients were prescribed a prokinetic, and only 2 had either opioids or laxatives stopped. No patients were offered gum.

Conclusions

There is apparent clinical variation in investigation and management of post-operative ileus. We plan to develop an evidence-based trust guideline to reduce unwarranted clinical variation.
948 Feasibility Study of a Drive-Through Influenza Vaccination Clinic for Patients-At-Risk & Their Contacts
Authors: Curtin G , McCarthy S , Cooney C , Spencer K , Thompson M
Published: October 2021

Background

There are 3-5 million cases of severe influenza-like illness globally each year, and up to 650,000 related deaths. This high prevalence rate proves to be a heavy burden on the healthcare system with >3,000 hospitalisations and >150 ICU admissions annually. Immunisation is gold-standard for the prevention of influenza outbreaks. The HSE Influenza Immunisation Strategy allocates vaccines to be administered in primary care to patients at-risk and their contacts. However, due to the COVID-19 pandemic, this has become a logistical challenge. We aimed to design and test a drive-through influenza vaccine clinic at a large GP practice in Cork.

Method

We designed and implemented an online booking system for at-risk patients and their contacts. 1-minute drive-through time slots were available to book for up to 6 people per vehicle. The primary measurement was the number of patients vaccinated with a secondary measurement of time spent vaccinating these patients.

Results

The pilot clinic occurred on 10/10/2020 with over 600 patients-at-risk & their contacts receiving the influenza vaccination over a time period of 10 hours. The capacity of this clinic was limited by the supply of vaccines. We estimate that 1,800 people could be vaccinated over the same time period with adequate vaccine supply.

Conclusions

A drive-through influenza vaccination clinic can be efficiently run using an online booking system and serves as a safe, efficient, and convenient way for patients-at-risk & their contacts to receive vaccinations. This system can be rolled out efficiently each winter for influenza vaccination and could be expanded to deliver mass vaccination for SARS-CoV-2.
963 Management of Acute Gallstone-Related Complications at Great Western Hospital (GWH): Re-Audit
Authors: Castelhano R , Bartlett J , Wooler H , Theofilis A , Mahmoud A , Shamali A
Published: October 2021

Aim

Gallstone related disease accounts for a third of the admissions to the Surgical Department. In June 2019, a clinical audit was undertaken at Great Western Hospital assessing the number of patients who underwent cholecystectomy, following initial diagnosis, in accordance to current guidelines. The results demonstrated a very low number of patients had cholecystectomy, within the targeted time frame, which led to the implementation of a dedicated operative “hot gallbladder” list weekly. In June 2020, we re-audit the service to evaluate the impact of the change implemented.

Method

A retrospective observational analysis of patients admitted to the Hospital in June 2020 with gallstone related disease. Data was collected using the Surgical on-call lists, these were analysed and patients selected according to the reason for admission, only gallstone related issues were considered in this analysis. Finally, via Medway, the time from admission to surgery was assessed.

Results

Despite the disruption in service provision due to COVID-19, the implementation of the “hot gallbladder” list led to a 10.7% increase in timely cholecystectomies, bringing the overall compliance to 14%. There was also a significant reduction in biliary relate re-admissions, from 58% to 37%. Despite 47.3% of patients were still awaiting surgery, the waiting list was reduced by 5.2% in only 1 year.

Conclusions

This study demonstrated that the implementation of the “hot gallbladder” list has improved the compliance with the current guidelines. The change has brought us in line with the national average of 15%, as estimated by RCSEng, therefore demonstrating the efficacy of the weekly list.
1037 Early Detection and Management of Preoperative Anaemia in An Elective Vascular Surgery Cohort
Authors: Tanna S , Walker J
Published: October 2021

Introduction

Iron deficiency anaemia is the most common cause of anaemia in the surgical population. Patients receiving transfusions during major surgery encounter more adverse outcomes compared to those that do not, indicating the early management of pre-operative anemia is likely to reduce major surgical patient morbidity and mortality. Previous studies have demonstrated that 33% of patients undergoing major vascular surgery operations are anaemic (haemaglobin, Hb, <130g/L).

Aim

We aim to reduce the proportion of anaemic patients undergoing major vascular surgery by 50%.

Method

A point-of-care HemoCue machine was used to measure Hb in patients who were referred for elective major surgery in 11 vascular clinics. Patients with Hb < 130g/L were prescribed a 1-month course of Ferrous Sulfate (200mg TDS), and a letter was sent to their GP requesting iron function tests. Post-intervention Hb levels were rechecked following the preoperative anaesthetics review.

Results

11 patients were referred for major surgery, of which 4 were identified as anaemic (36%). The mean Hb concentration was 121.3g/L, which increased to 137.3g/L following oral iron therapy. The mean duration of follow up was 36 days (range 0-94 days).

Conclusions

The implementation of a HemoCue machine to identify and manage preoperative anaemia was successful in our pilot study. Further work should include full integration of our pathway into current vascular clinics without student support. This will enable evaluation of the impact of our intervention on a wider scale.
1054 A Simple Intervention to Minimise the Incidence of The Forgotten Ureteric Stent: Updating the Surgical Discharge Summary
Authors: Wong S , Sehgal R , Goyal A , Allen D
Published: October 2021

Introduction

Ureteric stents are routinely used in ureteric obstruction, however, have considerable morbidity with major complications, such as encrustation, obstruction, urosepsis, and renal failure if left in situ for longer than six months. Despite an electronic stent register, there are still multiple emergency admissions of complications from forgotten stents, as well as those presenting with significant stent symptoms. Often stents are inserted as an emergency procedure with minimal information given on their discharge summary. A discharge template was therefore introduced that could also serve as a patient information leaflet to help minimise the incidence of forgotten stents.

Method

A discharge template was designed based off the trust-endorsed and British Association of Urological Surgeons (BAUS) patient leaflet and distributed amongst the juniors. A total of 28 patients were interviewed via telephone questionnaires – 21 randomly selected pre-intervention and 7 post-intervention from a one-month scale either side of the intervention. The template included: information on stents, common stent symptoms, indications to seek healthcare advice, and contact details to use in the event they are lost to follow-up.

Results

Patients aware that stents should be changed within six months went from 52% to 100%. Awareness of stent symptoms and red-flag symptoms went from 52% to 91%, and 57% to 100% respectively. Those who felt they had sufficient information on the discharge letter to understand their stent increased from 52 to 89%.

Conclusions

Significant improvement in patient understanding of stents and therefore hopefully in appropriate health-seeking behaviour, patient rapport, safety, and improvement in stents removed within target.
1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy
Authors: Adnan A , Sange S , Ahmed M , Kanchustambam S
Published: October 2021

Introduction

Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI).

Method

A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded.

Results

In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%).

Conclusions

The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.
1145 Achilles Tendon Rupture Management: Improving Our Pathway
Authors: Onubogu I K , Al-Janabi M , Southgate C , Dhinsa B
Published: October 2021

Background

Achilles tendon ruptures are the most common tendon injury which affect predominantly middle age males. The yearly incidence is 31/100,000, with a rising incidence due to an increasingly active older generation1. Conservative versus operative management options shows no significant difference in rates of re-rupture or length of rehabilitation2. Delays in imaging have been found to delay definitive treatment and led to multiple attendances in the outpatient clinic.

Method

A retrospective analysis was performed patients diagnosed with an Achilles tendon rupture from September 2016 to February 2017 throughout the East Kent Trust. Patients were identified via clinical coding of ED attendance. Following implementation of the pathway in October 2018, a second retrospective analysis of patients identified between October 2018 and March 2019 was performed. Patients with re-ruptures or < 16 years old were excluded from the study.

Results

Following introduction of the pathway, there has been a 100% increase in the number of ultrasound scans performed, with the rupture gap size documented in 50% of these. The time to decision for conservatively managed patients dropped from 8 to 2 days. The number of clinic appointments also dropped from 3 to 2 with the management of patients predominantly in the plaster room.

Conclusions

The pathway has streamlined the process for patients following their injury. The majority of patients are seen by a senior clinician within 72 hours and a treatment plan clarified. The use of surgical care practitioner led clinics have allowed continuity of care for these patients and swift escalation when required.
1159 Ring-Fenced Arthroplasty Unit: The Need of The Hour During Winter and A Pandemic Crisis
Authors: Srikumar B , Perianayagam G R , Narayan P , Pawar R , Antapur P
Published: October 2021

Aim

Winter pressures along with the COVID-19 pandemic, have caused cancellation of elective services, prolonged waiting times, patient dissatisfaction and financial implications. Length of stay (LOS) following joint replacements is variable. The availability of ring-fenced beds and enhanced recovery protocol (ERP) can improve these outcomes. The performance of a stand-alone arthroplasty unit in an acute NHS Trust was assessed regarding safety, LOS and complications.

Method

Patient data was collected for total hip & knee replacements (TJAs) between the months of December to March of 2018-19 and 2019-20. Demographics, ASA, transfusion rates, LOS and 90-day reattendance was analysed. Modified ERP implemented in late 2019 included changes in analgesia and early post-operative mobilisation. The performance was then compared with DGHs within the region.

Results

In 2019-20, of 280 TJAs performed, there was a mean LOS of 43 hours. This shows a reduction compared with LOS of 69 hours in 2018-19, where 288 TJAs were performed. In 2019-20, 74% of cases had early discharge within 36 hours of surgery, versus 24% in 2018-19. This accumulates to 333 inpatient days saved. Note that following ERP modification, 6 patients were discharged on the day of surgery. Surgery related complications within 3 months which required reattendance, were seen in only 2 patients. This unit performed an average of 335 TJA’s in these winter months, the highest average in comparison to other DGHs in the East Midlands region, which had an overall average of 165 cases.

Conclusions

A ring-fenced arthroplasty service with adherence to ERP significantly decreases LOS and increases productivity.
1176 Paediatric Patients Presented with Right Iliac Fossa Pain: Is the Ultrasound Scan Conducted in A Timely Manner?
Authors: Barghash M , Iskandar A , Fawzy S , Ali B
Published: October 2021

Aim

Ultrasound scan is a crucial clinical tool in the management of acute appendicitis in children. That is because it can aid in the diagnosis without exposing the patient to potentially harmful ionising radiation from computed tomography scans. In this project, we were assessing whether children presented with right iliac fossa pain receive their scans on time. In addition, we were exploring whether definitive management and hospital length of stay were affected by the scan delay.

Method

This was a retrospective project in which we assessed case notes of paediatric patients who had an ultrasound scan between September 2019 and September 2020 in one of the district general hospitals in the UK. The project included notes of patients who were below 16, admitted with right iliac fossa pain, and had an inpatient ultrasound scan.

Results

A total of 33 patients met the inclusion criteria. The waiting time ranged from 1 hour to 89 hours with a mean of around 19.5 hours and a median of 14.5 hours. The hospital length of stay ranged from 1 day to 21 days with a mean of around 2.5 days and a median of 1 day.

Conclusions

An ultrasound scan should be conducted within the same day of admission for all paediatric patients presented with right iliac fossa pain.
1250 Introduction of a New Electronic System in Surgery during the COVID-19 Pandemic
Authors: Jacob N , Chaudhary O , Darwish N , Pardoe H
Published: October 2021

Aim

The ongoing COVID-19 pandemic has impacted all aspects of clinical practice. Preventative measures to avoid spread of the virus has included maintaining social distancing, thus making surgical handovers and ward care particularly challenging. The surgical department at PAH were able to reflect on what improvements could be made to the current system during this time, with a particular focus on efficiency and information governance, while also maintaining social distancing. Due to the advancement in information technology, electronic systems have become widely used throughout the NHS and a quality improvement project was introduced to try and improve our department using an electronic handover

Method

A quality improvement project was carried out, with questionnaires sent out pre- and post-implementation to evaluate the impact of the new electronic handover.

Results

Implementation of the electronic handover improved the safety and efficiency of the surgical department, particularly with information governance (p < 0.001), efficiency of ward rounds (p = 0.002) and social distancing. Less doctors were taking lists home (p < 0.001) and fewer doctors needed to return to the MDT room during ward rounds to check key clinical information (p < 0.001). Close to 50% of doctors said that the implementation of an electronic system reduced the need to be in crowded MDT rooms to check patient information.

Conclusions

There were clear benefits to using an electronic healthcare system both for satisfaction of workers and for patient care. The project used pre-existing IT software that was modified through collaboration with the IT department and is something that will continue to be improved in the future.
1368 TED Talks and Fragmin Shots: Venous Thromboembolism Prophylaxis (VTEP) in a busy Emergency Surgical Unit (ESU) - A Quality Improvement Project
Authors: Sharma A , Siddique H , Oyeyipo Y , Sajorda L , Nadeem U , Watfah J , Qurashi K
Published: October 2021

VTE results in > 30,000 deaths/ year. Surgical inpatients are at 25% risk of developing VTE. National guidelines state all surgical admissions must be risk assessed for VTE within 24 hours.

Aim

Evaluate our current practice of VTEP. Create and disseminate interactive tutorials for healthcare professionals (HCPs). Improve patient understanding and adherence to VTEP.

Method

A baseline audit analysed existing VTEP measures. Inclusion criteria: all ESU admissions, age >18. Parameters included ensuring completion of VTE risk assessment (VTERA) proformas; scrutinizing low-molecular-weight heparin (LMWH) and TED stockings (TEDs) prescriptions; observing patients’ TEDs use and reasons for non-adherence. Subsequently, plan-do-study-act (PDSA) cycles were performed.

Results

Baseline [September 2020] (n = 93): VTERA complete: 54%; LMWH (57%) and TEDs (37%) prescribed; 26% wearing TEDs; 42% deemed TEDs unnecessary. PDSA Cycle 1 [October 2020] (n = 68): Educational poster displayed in clinical areas. VTERA complete (73.5%), LMWH (75%) and TEDs (53%) prescribing improved. Only 29% wearing TEDs. PDSA Cycle 2 [November 2020] (n = 55): Implementation of VTE e-learning module and inter-professional educational tutorials. HCPs (n = 25) felt more knowledgeable (pre:3.4/5, post:5/5) and confident (pre: 3.2/5, post: 4.7/5) on VTEP. All parameters improved, except patients wearing TEDs (31%). PDSA Cycle 3 [December 2020]: Initial patient questionnaire (n = 30) revealed - 33% misconstrued LMWH use; >50% deemed TEDs unnecessary. A patient information leaflet was created and distributed alongside TEDs. Upon re-audit (n = 72), we noted significant improvement in patient adherence to TEDs (64%), alongside sustained improvement in all other parameters.

Conclusions

Our initiative highlights the necessity of empowering both patients and the multidisciplinary team in achieving optimum rates of VTEP.
1372 Thrombocytosis and Malignancy: Management in Primary Care
Authors: Choi B , Jegatheeswaran L , Platt E
Published: October 2021

Introduction

The diagnosis of cancer relies within primary care to recognise this possibility in patients. Studies have shown an association of thrombocytosis with cancer, in particular lung, renal, uterine and colorectal cancer. Subsequently, suspected cancer pathways incorporate thrombocytosis in stratifying risk. This quality improvement project aimed to evaluate and improve the approach of GPs at a West London practice in managing thrombocytosis.

Method

A retrospective study evaluated patients with a most recent platelet count of > 450x109/L. Furthermore, a survey was sent to all GPs within the practice to establish their understanding and concerns. Results were presented locally, and intervention applied following the end of the first cycle.

Results

The survey showed 75% (n = 9) of staff were aware of the association of thrombocytosis and malignancy. In absence of specific symptoms, 64% would consider a chest X-ray, 41% a faecal occult blood test and 16% would consider transvaginal USS in women. 28 patients were identified with thrombocytosis. Of these, 4 had underlying malignancy, 3 had an underlying haematological condition. 2 cases had a concurrent inflammatory process. Of the remaining 19 patients, 5 were referred on for specialist service. In the remaining 14, although filed as “to repeat blood test” or “speak to doctor”, 12 had yet to be actioned.

Conclusions

The management of thrombocytosis at a local level in primary care has room for improvement. An alert was designed and created on the online system used by the practice to safeguard missed recalls for blood tests and prompts to consider the possibility of malignancy.
1564 Not all roads lead to Rome! – A Retrospective Insight into a Young Adult Hip Pain Referral Pathway
Authors: Krzak A M , Millar Z , Doran C , Ferreira Bruco M E , Purohit K , Nagrodzki J , van Loggerenberg A , Khanduja V
Published: October 2021

Introduction

Young adult hip pain is increasingly recognized as an early warning sign for development of debilitating arthritis later in life. Two common causes for young adult hip pain are femoroacetabular impingement (FAI) and dysplasia. Yet, no universal referral pathway exists in the UK for young patients experiencing hip pain. Our aim was to investigate the timeline and journey of patients seen in a specialist young adult hip clinic at a tertiary orthopaedic centre.

Method

We conducted a case series using a two-part open question questionnaire given to 40 patients at a young adult hip clinic at a tertiary orthopaedic centre between March and November 2019.

Results

Average time from onset of symptoms to appointment in specialist clinic was 2.9 (± 3.9) years, with range between 1 month and 23 years. Average time between first GP appointment and appointment at a tertiary centre was 2.1 (±2.4) years. A total of 33 (83%) patients were seen in secondary care prior to referral to a specialist clinic at a tertiary centre. Imaging modalities prior to attendance were as follows: 23 (58%) patients had a hip X-ray, 15 (38%) a CT scan, 30 (75%) an MRI scan and 6 (15%) an ultrasound scan of their hip. A total of 23 (58%) patients had corticosteroid injections prior to referral to a specialist clinic.

Conclusions

Large variation seen in our results highlights an opportunity for service improvement and development of a universal referral pathway to improve patient care and reduce burden on other services.
1580 Introduction of Dedicated Boarder’s Bleep and Registrar for Improved Clinical Communication, Management, And Care of Boarder Surgical Patients
Authors: Khan J S , Ekpete N , Elsllabi M , Payne C
Published: October 2021

Aim

Surgical patients are often placed within non-surgical wards due to shortage of beds, however the care of these patients remains under the parent surgical team. Unfortunately, patients outwith surgical areas can frequently feel neglected, with staff often unsure who to contact for reviews. This project aims to improve communication between boarding wards and the surgical team, as well as improving patient care and management.

Method

This prospective study was based on the Model for Improvement Framework approach to quality improvement. Data was gathered using questionnaires from various staff members on non-surgical wards. Outcomes were measured on a qualitative basis.

Results

Qualitative data was collected from 45 nursing staff (NS). Prior to introduction of a designated boarder’s bleep, 25% of NS felt they knew who to contact for queries and reviews, whereas 46% contacted the parent ward and 29% contacted the on-call surgical registrar. Only 46% of boarded patients received daily reviews. Following introduction of a dedicated surgical registrar for boarders, 62% of NS felt they knew who to contact with 48% aware of surgical boarder’s bleep. Daily reviews of patients increased to 65% over the course of the cycles of this project.

Conclusions

Bed shortages can play a vast role in patient care and treatment. This study has effectively demonstrated an improvement in provision of patient care, demonstrating an increase in NS knowing who to contact, as well as a 19% increase in daily patient reviews. Introduction of a dedicated boarder’s bleep-holder has shown improvement in clinical communication and management.
1682 Association between Obesity and Chronic Laryngitis in Women and Their Effects on Phonation
Authors: Al Houssari A
Published: October 2021

Introduction

“Phonation” is the physical process by which the vocal folds produce certain sounds. According to laryngology, there are different factors that can affect our larynx (voice box) negatively, such as: Obesity, benign vocal cord lesions, sex hormones, head and neck surgeries and patients who are suffering from health complications recovered from COVID-19 after a prolonged intubation. These factors could show difficulties in voice, airway, and swallowing.

Aim

This study aimed to investigate the relationship between obesity and chronic laryngitis in which this inflammation hinders phonation and voice/sound output. This investigation in South Korea using data from Korea National Health and Nutrition Examination Survey (KNHANES) collected during 2008 – 2010.

Method

(KNHANES) was a cross-sectional survey of the civilian, non-institutionalized population of South Korea (n = 13,819) aged 19 years or older. Obesity status was measured by using BMI and waist circumference.

Conclusions

Obese women in Korea have an elevated risk for developing chronic laryngitis. Chronic laryngitis itself is a misfortune. Chronic laryngitis (CL) causes excess mucus, a sore throat, a persistent dry cough, loss of voice and phonation and difficulty swallowing. Moreover, obese women will suffer from hormonal imbalances that show changes in their voice tones. Elevated estrogen levels cause gastric acid secretion and GERD in women. To help those patients, it is better to shift into a healthy lifestyle, manage their weight by healthy diet and exercises. In this way, a lot of complications will be lessened such as: GERD that is responsible for benign vocal cord lesions possibility. Some women who suffer from chronic laryngitis and turns into cancer decide to do neck surgery. Otolaryngologists stated common side effects from head and neck surgery include temporary or permanent loss of normal voice, impaired speech, and hearing loss.
679 Introduction of A Robotic Rectopexy Programme with Benchmarking to International Standards in Published Randomised Controlled Trials
Authors: Wilkinson G , Fleming C , Brannigan A
Published: October 2021

Aim

With the evolution of robotic surgery, the adoption of a robotic approach to perform rectopexy, in particular ventral mesh repair (VMR), is gaining popularity. We aimed to audit clinical outcomes following introduction of a robotic rectopexy (RR) programme and compare outcomes to internationally published randomised controlled trials (RCTs).

Method

Consecutive patients undergoing RR from July to December were included. The daVinci Xi surgical system (Intuitive, California) was used for all procedures using a modified left lower abdominal approach. Where VMR was performed, a 4 x 18cm Permacol mesh was used as standard and posterior fixation using ethibond. We compared operative times and 30-day clinical outcomes to international data.

Results

Over a six-month period, thirteen RR were performed (n = 1 sutured, n = 2 resection sutured, n = 10 VMR). All patients were female with a mean age of 60.4 years (SD 14.12). Mean time from 1st consultation to surgery was 10.7 months. Three patients had an external rectal prolapse and ten patients a rectocoele confirmed on dynamic MRI. Seven patients had co-existing urinary symptoms impacting on quality of life. Median docking time was 23 minutes and median robotic operative time was 194 minutes (156 minutes reported). There were no conversions (2.5% reported). Average length of stay was 5 days (4 days reported) and there were no 30-day morbidities (8.6% reported) or readmissions.

Conclusions

Robotic rectopexy can be performed with appropriate operative times and clinical outcomes and offers a superior operative platform for critical operative steps including rectal mobilisation and VMR mesh placement and suturing.
858 Transoral Robotic Surgery: Comparing the Geography of Research Publications with The Global Burden of Disease
Authors: Jones C S , Higginbotham G , Gormley A , Jones K , Main B G
Published: October 2021

Introduction

Transoral robotic surgery (TORS) is increasingly used for the resection of oropharyngeal tumours. It is unclear if there is equitable access to this innovative technique worldwide, specifically in areas of greatest need. This study aimed to map the geographic distribution of publications on TORS and compare this to global disease burden.

Method

Systematic searches identified all studies of TORS from inception to 2018. The country of origin of each study was identified. The incidence and age standardised rate (ASR) of oropharyngeal cancer for each country was obtained from The Global Cancer Observatory (GLOBOCAN) database. World Bank classifications of countries by income level were obtained.

Results

A total of 132 studies were identified. The majority (96%) were published in high-income countries, 2% in lower-middle, and 2% in upper-middle income countries. Eighty-nine were published in the USA, the country with the second-highest incidence of oropharyngeal cancer worldwide (13% of total), but 20th by ASR. The greatest incidence was in India (21%), however this was the source of only 2% of studies. Of the ten countries with the highest incidence, eight were represented in published studies, in comparison to four of the top 10 by ASR.

Conclusions

There is evident disparity in the geographical distribution of published studies of TORS. This disparity may represent unequal access to surgical technologies, or a lack of evaluation of the technology in different healthcare settings. This may impact the generalisability of research findings. Equitable access to novel surgical technologies is ethical and can help address global disease burden.
1019 Quantified Learning Curves for Robotic Gastrointestinal Surgery
Authors: Huttman M , Kiandee M , Lawrence R , Paynter L , Lawday S , Smith A , Ranat R , Scroggie D
Published: October 2021

Aim

Robotic techniques are increasingly being adopted by gastrointestinal surgeons. It is important to understand the learning curves (LCs) for robotic surgery, to protect patients from harm caused by surgeon inexperience.

The aim of this study was to summarise reports of the LC for three robotic gastrointestinal procedures: cholecystectomy, oesophagectomy and Roux-en-Y gastric bypass (RYGB).

Method

Three systematic reviews were conducted by the trainee led RoboSurg Collaborative. Systematic searches identified reports of primary clinical research involving robotic cholecystectomy, oesophagectomy and RYGB. Articles were screened in duplicate by title, abstract and then full text. References to the LC were extracted and coded. Quantifications of the learning curve were summarised using descriptive statistics.

Results

259 articles were identified: 56 measured the LC, with 23 (9%) of these calculating the number of cases required to complete the LC. The mean reported number of cases at which the LC plateaued was: 16 for oesophagectomy (N = 6, SD = 3.7), 18 for cholecystectomy (N = 5, SD = 15.1), 34 for RYGB (N = 12, SD = 24.6). The reported LCs often incorporated equipment setup times, and so represents learning of the team as well as the surgeon. These values represent points on the LC that authors deemed their surgeons to have ‘completed’ learning. Definitions for when these points occurred varied greatly but largely fell in to two categories: ‘plateau of operative time’ or ‘matching operating time of laparoscopic control procedure’.

Conclusions

The heterogeneity in how LCs are defined, measured, and reported highlights the need for a more standardised approach when evaluating novel techniques such as robotics.
1028 How Has the Learning Curve Been Measured in Robotic Gastrointestinal Surgery?
Authors: Huttman M , Kiandee M , Lawrence R , Paynter L , Lawday S , Ranat R , Smith A , Scroggie D
Published: October 2021

Aim

Robotic surgery is increasingly being adopted by gastrointestinal surgeons. The IDEAL Collaboration has recommended evaluation of the learning curve (LC) for such surgical innovations. It is not known how learning curves have been reported for robotic gastrointestinal procedures. The aim of this study was to summarise how the LCs were measured for three robotic gastrointestinal procedures: cholecystectomy, oesophagectomy and Roux-en-Y gastric bypass (RYGB).

Method

Three systematic reviews conducted by the trainee led RoboSurg Collaborative identified primary clinical research involving robotic cholecystectomy, oesophagectomy and RYGB. Articles were screened in duplicate by title, abstract and then full text. References to the LC were extracted and coded. The techniques used to measure the LC were summarised using descriptive statistics.

Results

259 articles were identified, of which 56 (22%) actively measured the LC. The commonest surrogate marker for performance was operative time (N = 34, 63%). Several evaluated performances using the cumulative sum of the operative times (N = 8, 14%). Complications (N = 5, 8%) and time to complete a specific surgical step (N = 4, 7%) were also used. Some authors used multiple markers (N = 4, 7%). Cases were reported individually in 48 (81%) of the LCs, whereas they were grouped in 11 (19%). 19 authors (34%) provided graphical representation of the LC.

Conclusions

The reporting of LCs for robotic gastrointestinal surgery was heterogeneous and lacked standardisation. There was variation in choice of surrogate markers for performance, individual versus grouped case reporting, and graphical representations. To improve the utility of LC reports, the recommendations of the IDEAL Collaboration should be implemented.
1045 Summarising the Reporting of Regulatory Procedures in Robotic Cholecystectomy: A Systematic Review and Narrative Synthesis
Authors: Higginbotham G , Gull E , Henshall D , Handa I , Brewster O , Jones C S , Kirkham E N ,   On behalf of the RoboSurg Collaborative
Published: October 2021

Introduction

Robotic cholecystectomy (RC) represents the most recent innovation in the management of gallstones. Whilst RC is becoming increasingly widespread, the evidence base surrounding its introduction has not been characterised. When evaluating innovative surgical techniques, adherence to regulatory and governance procedures is essential in maintaining patient safety. This study aims to appraise the reporting of studies of RC, focussing on regulatory procedures.

Method

Systematic searches identified all published studies reporting RC. Data collection was based on the IDEAL (Idea, Development, Exploration, Assessment, Long-term follow-up) framework, and included general study characteristics, governance approvals, trial registration, study funding, conflicts of interests, and information communicated to patients.

Results

Systematic searches identified 1425 abstracts. Of the 90 full-text papers included, only three were randomised controlled trials. The majority (71%) were single-centre studies. Conflicts of interest were common, with 11 (12%) studies funded by the robot manufacturer, and 23 (26%) reporting conflicts related to authors. Ethical approval was confirmed in 51 (57%) studies; four reported prior registration with a register. Only forty-two studies (47%) documented obtaining patient consent for study participation. Only four documented discussions regarding the innovative nature of RC. In ten, modifications to the robot or technique were described, but it was not apparent if patients were informed of these.

Conclusions

This comprehensive review highlights multiple deficiencies in the reporting of regulatory procedures in the evaluation of RC. Improved reporting is required in studies of RC to ensure transparency, interpretability, and the safe, evidence-based adoption of new technologies into clinical practice.
1079 Analysis of Human Papilloma Virus (HPV) Status in Metastatic Oropharyngeal Squamous Cell Carcinoma (OPSCC)
Authors: Kathiravelupillai A , Arora A , Jeannon J P , Brunet-Garcia A , Faulkner J , Sandison A
Published: October 2021

Introduction

OPSCC often (80%) presents with ipsilateral neck metastasis. Presentation may be as carcinoma of unknown primary (CUP). Sampling via ultrasound guided Fine Needle Aspiration Cytology (FNAC) and/or Core Biopsy (CB) from nodal metastases is required for diagnosis, comparison with primary tumour and to assess human papilloma virus (HPV) status. HPV positive biopsy from CUP may indicate oropharynx primary. HPV positive OPSCC has better prognosis. HPV association is ascertained by p16 immunocytochemistry (p16- IHC) and HPV DNA in situ hybridization (HPV-ISH). In a cohort of OPSCC patients from a single referral centre 68% had metastatic disease. Core biopsy was optimal for HPV testing.

Method

Retrospective review of records from Transoral Robotic Surgery (TORS) patients treated for OPSCC between December 2017-2019 was conducted. Cohort included patients undergoing TORS for diagnostic purposes and with curative intent.

Results

Data was available from 23 patients who had TORS for OPSCC. 47.8% (n = 11) presented with lymphadenopathy. 82.6% (n = 19) underwent FNAC. 68.4% (n = 13) were diagnosed with metastatic OPSCC and 56.5% (n = 13) underwent neck dissections. 52.2% (n = 12) had confirmed HPV positive metastases, 75% (n = 9) had 1 node positive, 25% (n = 3) had >1 node positive. FNAC yielded enough tissue for p16 IHC and HPV-ISH in 10.5% (n = 2). CB yielded sufficient tissue for analysis in all cases 39.1% (n = 9).

Conclusions

The study confirms high incidence of neck metastases in HPV associated OPSCC patients. Needle core biopsy appears superior to FNAC for tissue sampling to assess HPV status in tumours metastatic to neck.
1096 Robot-Assisted Minimally Invasive Oesophagectomy: Comparing the Geography of Research Publication with The Global Burden of Disease
Authors: Higginbotham G , Zucker B , Ramirez J , Kirkham E N , Jones C S ,   On behalf of the RoboSurg Collaborative
Published: October 2021

Introduction

Robot-assisted minimally invasive oesophagectomy (RAMIE) is increasingly used in the management of oesophageal tumours. It is unclear if there is equitable access to this innovative technique worldwide, specifically in areas of greatest need. This study aimed to map the geographic distribution of publications on RAMIE and compare this to global disease burden.

Method

Systematic searches identified all studies of RAMIE from inception to 2020. The country of origin of each study was identified. The incidence and age standardised rate (ASR) of oesophageal cancer for each country was obtained from The Global Cancer Observatory (GLOBOCAN) database. World Bank classifications of countries by income level were obtained.

Results

A total of 103 studies were identified. The majority (81%) were published in high-income countries, 15% in upper-middle, and 5% in lower-middle income countries. Thirty-four were published in the USA, the country with the fifth-highest incidence of oesophageal cancer worldwide, but 90th by ASR. The greatest incidence was in China (54% of global incidence) but was the source of only 15% of studies. Of the ten countries with the highest incidence, five were represented in published studies, in comparison to one of the top 10 by ASR.

Conclusions

There is evident disparity in the geographical distribution of published studies of RAMIE. This disparity may represent unequal access to surgical technologies, or a lack of evaluation of the technology in different healthcare settings. This may impact the generalisability of research findings. Equitable access to novel surgical technologies is ethical and can help address global disease burden.