bluuebunny/crossref_metadata_2025 huggingface dataset:
WTP6.3 Evolution of a Five-Year, Multi-Specialty Surgical Course for Foundation Doctors Transitioning into Surgical Training: An Educational Paradigm
Authors: Kwan Jing Yi , Banks Philippa , Biyani Chandra Shekhar , Phillipson Mark , Palit Victor , Yiasemidou Marina
Published: August 2023

Background

The Essential Surgical Skills Course (ESSC) is a multi-specialty surgical stimulation embedded course that has been run successfully for five years, acting as an educational paradigm for bridging the gap between two levels of training. This report aims to describe the evolving process of designing and delivering a successful ‘hands-on’ course and assess its validity through trainee feedback.

Methods

The face validity of the course was assessed through the cumulative (free-text and quantitative) five-year feedback from trainees. The design and process of content adjustment according to feedback is described in detail to allow for easy replication by other educators.

Results

Face validity of the different sessions of the course ranged from 8.17-9.42 out of 10. Feedback driven changes to the curriculum with positive reception. Key themes identified as beneficial including teaching style, course structure and responsiveness.

Conclusion

The ESSC has demonstrated good face validity and was well received by trainees. The key factors contributing to the success of the course include the structured method of curriculum design, outstanding teaching delivery methods, the availability of appropriate faculty and infrastructure and the willingness to learn from trainee feedback and adjust the content of the course accordingly. It acts as a paradigm for courses aimed to prepare surgical trainees for a ‘step-up’ in their careers.
WTP6.6 The Major Trauma TIG Fellowship: lessons learned. Perspectives of a paediatric surgeon training in adult trauma surgery
Authors: Morris Louise , Brooks Adam
Published: August 2023

Introduction

Major Trauma Training Interface Group (TIG) Fellowships were introduced in 2018 to formalise and enhance the training of surgeons and allied specialists in trauma care. Paediatric surgery is a non-traditional route to trauma surgery. Lessons learned from a fresh perspective may be relevant to surgeons who may not include trauma in their regular practice but may occasionally encounter seriously injured patients requiring emergency management.

Method

Training involves a 12 month placement; fellows are trained to deliver effective trauma team leadership and/or in the skills and decision making required to perform resuscitative trauma surgery. Important learning points were documented throughout the fellowship. A selection are described below.

Results

Conclusion

Integrated training is immensely valuable in trauma care. Collaboration between trauma units and the regional MTC could optimise shared learning outside formal fellowships.
WTP7.3 Advanced Clinical Practitioner (ACP) led Surgical Same Day Emergency Care (SSDEC) has transformed emergency surgical workflow with high levels of satisfaction
Authors: Hanley-Hine Rachael , Polisena Stephanie , Capozzi Patrizia , Duff Sarah
Published: August 2023

Aims

ACPs offer senior assessment to emergency general surgical patients and have changed the face of emergency surgical assessment and care.

To demonstrate success of SSDEC through increasing numbers seen though the service, less patients assessed through ED, more timely assessment, and expedited ward discharges within a competent and safe environment.

To demonstrate staff (ACP and Consultant) and patient confidence and satisfaction.

Methods

Data will be collected from service provision dashboards, locally collected data including Incident Reporting and the newly introduced electronic patient record. Surveys are used for patient, consultant and ACP feedback.

Results

The number of patients seen through SSDEC has increased from an average of 25 per week in 2017 to 125 per week in 2023. Patients dealt with in SSDEC alleviate pressure on ED and the surgical team.

Survey results demonstrate that surgical consultants feel that SSDEC has improved their emergency experience, patient experience and there is confidence in the ACPs competence.

Surgical ACPs felt clinically supported and had confidence in their own clinical autonomy.

93% of patients were very satisfied or satisfied with their practitioner and experience.

Conclusion

An ACP led surgical SDEC leads to high levels of patient satisfaction with consultants feeling confident in ACP competence to assess and manage emergency surgical patients.

Moreover, the ACPs report feeling autonomous, confident, supported and satisfied in their job.
WTP7.5 The shift in practice Toward Laparoscopic emergency surgery over period of 7 years in a district hospital
Authors: Jabri Yamen , Husain Elham , Ezeme Constantine , Pring Chris
Published: August 2023

Aim

Many studies showed the advantages of laparoscopic surgery when compared to open surgery both in elective and emergency surgery. The Aim of this study is to compare Laparoscopic and open surgical procedures in managing Emergency surgery in a district hospital over a period of 7 years.

Methods

We reviewed 1776 emergency cases in 2015 and 1836 cases in 2022 in the emergency theatre register. We included all the abdominal emergency surgeries that qualifies for the NELA inclusion/ exclusion criteria. We excluded all non-general surgery cases. We also excluded Appendectomies, Hernia repair and Laparoscopic cholecystectomies.

Results

We included 207 in 2015 and 234 in 2022. There was significant increase in Laparoscopic surgery performed between 2015 and 2022 (63%Vs40%).

Less open surgeries were performed (46%Vs24%) and no change in the conversion rate (13%vs12%).

Operating time was (89min) for Laparoscopic cases. Compared to open procedures (119min) and converted cases (141min).

Conclusion

There has been more than 50 % increase in laparoscopic cases. However, there was no significant reduction in conversion rate.

The laparoscopic surgery time was significantly less when compared to open or converted cases, however this might simply be sure to the complexity of those cases rather than the advantage of laparoscopic surgery.

Key statement

There has been significant shift toward laparoscopic surgery over the last few years due to better understanding of the benefit of laparoscopic surgery and increase confidence in performing laparoscopic surgery.

There is a room of improvement in case selection to decrease the conversion rate avoiding unnecessary increase of operating time.
WTP7.7 A novel sexually transmitted infection (STI) testing and screening programme in an Ambulatory Surgical Clinic (ASC) for female patients presenting with abdominal pain
Authors: Jones Sian , Ganesh Divolka , Mahon Ciara , Please Helen , Hughes Michael , Cooper Adam Peckham
Published: August 2023

Aims

Methods

Women aged 18-44 years presenting to ASC were offered a voluntary self-collected high vulvovaginal swab for chlamydia and gonorrhoea at triage. Data was collected over one year (Dec 2021-Dec 2022). Testing was offered to 299 patients, 20 declined to participate and 18 samples were rejected. Positive results were referred to the Sexual Health service for treatment and contact tracing as agreed on a pre-planned referral pathway.

Results

5.4% of swabs were positive (2 Gonorrhoea and 12 Chlamydia). The mean age of those testing positive was 24.5. All positive patients presented initially with lower abdominal pain. Of those testing positive 7 had further imaging (USS pelvis) and only 25% had a documented sexual history taken. 4 women had diagnostic imaging indicative of PID and 4 patients were treated for PID empirically. The remaining patients were treated for non-specific abdominal pain or unrelated pathology.

Conclusions

Undiagnosed sexually transmitted disease is prevalent and young females presenting with lower abdominal pain provide an excellent testing cohort. Given the high incidence of positive tests, further training of surgeons to consider and ask pertinent questions regarding an STI diagnosis is vital. The introduction of self-swab testing has been successful in assisting as a diagnostic tool and screening programme.
WTP8.2 How the healthcare system fails to provide continued care for patients
Authors: Mahalingam Praveena , Mantova Maria , Gambhir Raghvinder Pal Singh
Published: August 2023

Aims

In the current climate of dissatisfaction with the healthcare system due to oversaturation of outpatient services that has left around 7 million people waiting to be seen for the first time, we wanted to evaluate the number of post-surgical patients who have failed to receive appropriate follow-up.

Methods

We retrospectively looked at all patients admitted under the vascular department at a tertiary centre hospital over a 3-month period. We excluded the following patients from our data collection:

1. Those who passed away in hospital.

2. Those who did not require follow-up after discharge.

We looked at the Electronic Patient Records (EPR) to identify if they had been given a follow-up appointment.

Results

A total of 127 of the 150 patients admitted in the 3 month study period were advised a follow-up in their Electric discharge notifications (EDNs). Of these, 83 patients were admitted electively and 44 as emergencies.

For a follow-up appointment to be booked there are two steps:

For the elective admissions, 88% had follow-up booked compared to 86% for the emergency admissions.

Conclusions

Our study shows that the failure to follow up rate was 12-14% despite a dual notification method. This can have an adverse impact on both the quality and continuity of patient care. The system still continues to fail the patients.
WTP8.13 Expression of Integrin Subunit Alpha 7 (ITGA7) predicts survival from breast cancer following adjuvant chemotherapy
Authors: Jones Stacey
Published: August 2023

Aim

To investigate the relevance of ITGA7 expression with respect to clinical prognostic markers, disease-free survival (DFS) and disease-specific survival (DSS) after adjuvant chemotherapy in breast cancer.

Methods

Breast cancer tissue was obtained from a tissue microarray comprising all tumour subtypes in 305 women. Expression of ITGA7 was determined by immunohistochemistry. Relative expression of ITGA7 was assessed.

Results

Overall, it was concluded that ITGA7 levels were independent of the clinical prognostic markers, tumour grade, lymph node status, oestrogen receptor status and molecular subtype. Kaplan-Meier survival analyses showed, high ITGA7 nuclear protein expression was associated with longer DFS, mean 647 days; p=0.036 in the whole cohort. The same trend was visible for ITGA7 cytoplasmic protein expression albeit that this was not significant. Sub-analysis of ER-positive breast cancers also showed that high ITGA7 nuclear protein expression was associated with both a longer DFS and DSS, 682 days, p=0.05 and 604 days, p=0.005 respectively. Kaplan-Meier survival analysis was performed separately on the patients who received either taxanes with anthracyclines or anthracyclines without taxanes. This demonstrated a significant increase in DFS, 806 days; p=0.004 in primary breast cancers that had high ITGA7 nuclear protein expression in the group that received anthracycline-based chemotherapy alone. No statistically significant difference in DFS or DSS was noted between high and low ITGA7 expression in the group that received anthracycline and taxane based adjuvant chemotherapy.

Conclusion

ITGA7 has been identified as impacting upon DFS and DSS in breast cancer potentially via the modification of chemoresponse.
ThTP2.2 Correlation between conventional endoscopic and histopathological diagnosis of Barrett’s oesophagus
Authors: Verma Harsh , Asarbakhsh Mariam , Singh Gautum , Megson Tyler , Olejnik Hannah , Saha Arin
Published: August 2023

Introduction

The diagnosis of Barrett’s oesophagus is currently made with a combination of endoscopic appearances and presence of intestinal metaplasia (IM) on oesophageal biopsies. There have been minimum endoscopy and pathology reporting standards proposed by the British Society of Gastroenterologists and these include the use of high resolution endoscopy and the use of a comprehensive proforma for biopsies. This study compared the diagnosis of Barrett’s oesophagus between conventional endoscopy and histopathological analysis.

Methods

All patients who were due for surveillance endoscopy for Barrett’s oesophagus in 2022 were identified from a prospectively maintained waiting list. Endoscopy reports, biopsy results and outcomes were recorded. Correlation between endoscopic and histopathological results, with particular attention to the presence of intestinal metaplasia, was recorded.

Results

There were 192 patients identified for this study. All had endoscopic diagnosis of Barrett’s oesophagus (between 2016 and 2020) and were entered into a surveillance programme based on endoscopic diagnosis alone.

36 patients (19%) did not have a Prague classification (C and M grading) recorded on their primary endoscopy report and 55 patients (29%) did not have images available for review. None had HRE (all had conventional endoscopy). Only 127 patients (66%) had IM from original endoscopic biopsies and none had documentation of p53 status.

Conclusion

There was relatively poor compliance between current practice and gold-standard recommendations for endoscopy and pathology reporting. Just 66% of patients who had an endoscopic diagnosis of Barrett’s had IM on histopathology. These findings have implications for the accurate diagnosis and surveillance of Barrett’s oesophagus.
ThTP2.5 Diagnosis of intestinal metaplasia (IM) in the surveillance of Barrett’s oesophagus – a comparison between Cytosponge and endoscopic biopsy
Authors: Asarbakhsh Mariam , Singh Gautam , Verma Harsh , Megson Tyler , McDonald Claire , Saha Arin
Published: August 2023

Introduction

Regular endoscopy with oesophageal biopsies is recommended for the surveillance of Barrett’s oesophagus. Intestinal metaplasia (of all subtypes) carries the highest risk of progression to dysplasia and adenocarcinoma; thus, it is important for diagnosis of Barrett’s. Concerns exist about the accuracy of endoscopic diagnosis when obtaining biopsies and in ‘missing’ metaplasia between biopsies. Cytosponge is a novel, minimally invasive oesophageal cytology sampling device; this study assessed the correlation between endoscopic biopsies and Cytosponge cytology in the diagnosis of IM.

Methods

192 patients with endoscopic Barrett’s oesophagus who were due for surveillance endoscopy in 2022 were identified and screened for suitability for Cytosponge. If suitable, patients were offered a Cytosponge. Cytosponge cytology results were compared with previous histopathological biopsy results.

Results

127 patients (66%) had IM from original endoscopic biopsies. Many of these patients did not have images available for review to assess accuracy of original endoscopic diagnosis. Cytosponge detected IM in 88 cases (45%). Sensitivity was 67.77% (95% CI, 58.67%-75.98%) and specificity of 91.55% (95% CI, 82.51%-96.84%). The positive predictive value was 93.18% (95%CI, 86%-96%) and negative predictive value of 62.50% (95% CI, 56.04%-68.54%).

Conclusion

The accuracy of cytosponge is favourable and comparable to screening endoscopy. Cytosponge can be used as a screening tool and, potentially, as an alternative to endoscopy to identify IM. Further work is needed to determine accuracy of endoscopic diagnosis, given the high proportion (over one-third) of patients who are currently on a Barrett’s surveillance programme but do not have any histological diagnosis of IM.
ThTP2.9 Managing Choledochal Cysts in Adults at a DGH
Authors: Buksh Md-Mahfooz , Kerans George , Menezes Neville , Al Samaraee Ahmad
Published: August 2023

Aims

Choledochal Cycts (ChDCs) in adults are rare and mostly benign, although 7-11% can be associated with malignancy. This study explored a DGH experience in managing ChDCs.

Methods

Retrospective study from April 2019-April 2022. All patients ≥18 years diagnosed with ChDCs on MRCP/MRI-pancreas (regardless of MR indication) were included in the final analysis. HPB-MDT records were checked for relevant cases/management plans.

Results

2013 MRCP/MRI-pancreas scans were performed. 29 (1.4%) patients were found to have ChDCs with around half reported as Type I. The mean age was 48 years, with a female: male ratio of 2.6:1. 70% of patients were white. In 55% of cases the main symptom was upper abdominal pain, with 3.4% of ChDCs found incidentally. There were 33 hospital admissions in total (including readmissions), mainly for pain control, with an average duration of 72 hours. 9 patients with ChDC had symptomatic gallstones over the study period, with nearly all requiring laparoscopic cholecystectomy. No patients had objective evidence of malignancy warranting ChDC excision/hepatico-jejunostomy. The management and annual surveillance plans were decided at the regional HPB-MDT.

Conclusions

ChDCs management in adults is challenging, since it requires long-term clinical/radiological surveillance. This is the largest DGH study of ChDCs in our region. Our findings are close to other studies, although we found a higher prevalence of ChDCs in white patients (usually well reported in Asian populations). Due to the rarity of this condition and paucity in the literature regarding its management challenges, we propose the implementation of standardised national databases/guidelines.
ThTP2.11 Three-year follow up outcomes in mesh-augmented vs sutured cruroplasty in giant hiatal hernia repair
Authors: Hammett Felix , Fairbrass Dominic , Dexter Eloise , Pellen Michael , Wilkins Alexander
Published: August 2023

Aims

There is no consensus for indications on mesh-augmentation of crural repair in hiatus hernia. We evaluated outcomes following mesh-augmented versus suture repair of giant hiatus hernia.

Methods

Giant hiatus hernia was defined as a hernia containing at least 30% of the stomach in the thorax. We undertook a retrospective analysis of records for patients undergoing surgical repair of hiatus hernia in a tertiary centre between 2016 and 2019, with a minimum follow up of three years. Patients were identified using clinical coding. Pre-operative investigations (OGD, barium swallow, CT) and operative findings were used to identify those patients with giant hiatus hernias. Outcomes assessed included morbidity, recurrence and revisional surgery.

Results

58 patients of median age 72 (27-90) underwent repair of a giant hiatus hernia. 56 (97%) were performed laparoscopically (1 conversion, 1 open). All were primary procedures, 50 elective and 8 emergency. 20 had mesh-augmented suture repair (19 BIO-A, 1 Permacol) and 38 had primary suture repair alone. 26 (44.8%) had additional fundoplication.

By three years post-surgery 14/58 (24%) recurrent hiatus hernias were identified on further investigation, similar in both groups (5/20 vs 9/38). Symptomatic revisional surgery was undertaken in 2/20 (10%) mesh-augmented and 2/38 (5%) suture only repairs.

30-day mortality was 0%. Morbidity (Clavien-Dindo 3+) was recorded in 5 patients (8.6%).

Conclusion

Giant hiatal hernia repair complication and recurrence rates were comparable to published studies. Those patients with recurrence following mesh-augmented repair were more likely to require revision surgery. However mesh may be used in cruroplasty for perceived weaker or wider crura.
ThTP3.1 Development and early validation of ‘SuturePal’: a novel mixed reality laparoscopic suturing training module
Authors: Chidi-Egeolu Chibueze , Lam Kyle , Lawson Jason , Kinross James M
Published: August 2023

Aims

Laparoscopic suturing is a challenging skill to acquire, requiring extensive training. This study aims firstly to develop a novel self-directed mixed reality laparoscopic suturing training module using the Microsoft Hololens 2 headset and secondly to assess the feasibility of this training tool and advantages over conventional training methods.

Methods

SuturePal is a self-directed mixed reality training module which combines didactic videos, text, and bespoke interactive 3D models. Ten medical students and surgical trainees participated in a single-blinded prospective randomised feasibility study. Participants received baseline teaching for laparoscopic intracorporeal knot tying and were subsequently randomised to either SuturePal (n=5) or conventional training (n=5). Baseline and post-training knots were recorded and assessed by two blinded examiners for time taken, precision, errors, and proficiency according to two previously validated objective assessment tools. Cognitive load was measured via the validated NASA-TLX tool and participant feedback was recorded.

Results

SuturePal users reported higher confidence levels (p=0.0476) and lower mental demand (p=0.0397) following training compared to those taught by conventional means. No statistical differences, however, were shown between groups when comparing objective measures of knot tying performance.

Conclusions

SuturePal provides evidence for how mixed reality technology may enhance engagement in surgical skill acquisition by improving user experience and lowering mental demand. This contributes to the growing body of evidence that mixed reality may have a role in enhancing surgical training. However, further research in the form of larger scale studies is required to determine whether mixed reality improves objective performance of surgical trainees.
ThTP3.12 Green Surgery: Save the Suture, Save the Future
Authors: Ong Chon Sum , Rahman Khandakar Rezwanur , Saqib Muhammad Waleed , Jesudason Edwin
Published: August 2023

Aim

To reduce the number of unnecessary openings of suture packs and suture wastage to reduce environmental, social, and financial costs in general surgical procedures.

Method

A prospective audit was conducted at a District General Hospital by collecting data on the number of suture packs opened and unused for general surgical procedures for 2 weeks in November 2022. The intervention was done by raising awareness using posters and sustainability education. The data was collected again for 2 weeks and analysed using GraphPad Prism.

Results

For laparoscopic surgery, there was a reduction in redundant suture packs opened (P=0.86) and subsequently unused (P=0.86) but the result was insignificant. In contrast, for open surgery, the reduction in the suture pack opened (P=0.028) and subsequently unused (P=0.034) was significant. The financial savings were extrapolated to be £2799 yearly. The yearly environmental savings including transport and waste incineration totalled approximately 367kg CO2e. The survey used for social impact showed improved staff sustainability awareness and the development of new sustainable practices.

Conclusions

The health sector is pivotal to mitigate climate change due to its responsibility for 4-5% of global greenhouse gas emissions. The building of a global regime for the mitigation of climate change is vital but the small scales of positive action like reducing suture wastage need to also be encouraged. The emergence of a polycentric system to reduce greenhouse gas emissions will become the inspiration for the national ambition of delivering a net zero NHS.
ThTP4.2 Complications Following Emergency Colorectal Cancer Resections: A single centre cohort Study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A
Published: August 2023

Aims

Colorectal Cancer (CRC) is 3rd prevalent & 2nd lethal malignancy in UK. Emergency CRC presents < 30% cases (NBOCA 2022) & associated with high post-operative morbidity & mortality. Aim of study is to assess post-operative complications in emergency CRC resections.

Methods

A cohort study carried out from Jan'08 to Feb'23, post-operative surgical outcomes were evaluated in emergency CRC resections. Elective CRC resections recruited as controls.

Results

Conclusion

Emergency CRC resections had higher ASA 3. There was a greater early post operative mortality rate, but no difference in post operative complications & anastomotic leakage. However, emergency CRC resections was associated with prolonged hospital stay (p < 0.001) & poorer survival rates (Logrank p <0.0001) (worse in perforated cancers). Emergency CRC presentations remain a challenge, accounting for 20% of all CRC’s for the last decade. Therefore, our study supports prompt diagnosis and early intervention of emergency CRC mitigate the poor survival.
ThTP4.4 Textural Analysis as a Predictive Biomarker in Rectal Cancer
Authors: Alrahawy Mahmoud , Aker Medhet , Issa Mohamed , Noureldeen Khaled , Gaber Ahmed , Zeinaldine Ashraf
Published: August 2023

Background

Colorectal cancer (CRC) is common and accurate staging enhances a better prognosis. Pelvic MRI is the gold standard for Rectal cancer staging. Textural analysis (TA) is a radiomic process that quantifies lesions’ heterogenicity by measuring pixel distribution in digital imaging. MRI TA of rectal cancer images is considered a future predictor of its outcomes. This review summarizes the potential role of TA in rectal cancer’s prognosis.

Methods

Searches were done using Medline, Embase, and PubMed. Only English articles and human studies were included. Key findings and future research suggestions were highlighted to delineate the gap in TA use.

Review analysis

Some studies established a correlation between TA and rectal cancer outcomes, such as treatment response, survival, and distant spread.

Research showed that TA of MRI could differentiate complete from partial responders to Neo-adjuvant radio-chemotherapy. The response was higher in the mid-treatment MRI but lower in the pre-treatment.

The pre-and post-treatment MRIs were significant markers of overall survival, disease-free survival, and relapse-free survival in Locally Advanced Rectal Cancer patients.MR morphological features showed the ability to define either local or distant recurrence.

TA showed an ability to predict liver metastasis in CRC; Entropy and uniformity were significant predictors of patients’ liver metastases compared to patients with normal liver.

Conclusion

Medical images TA could predict important clinical outcomes in rectal cancer; eventually, this could change rectal cancer management into more personalized treatment options (watchful waiting). More prospective and randomized trials are mandatory to overcome TA standardization challenges.
ThTP4.6 Which FIT level is fit for purpose?
Authors: Oyewole Bankole , Sacaleanu Maria , Song Mosea , Elgharably Noura , Elwes Caitlin , Animasahun Victor
Published: August 2023

Aims

To assess the diagnostic performance of faecal immunochemical test (FIT) in patients referred under the two week-wait (2WW) pathway and to test colorectal cancer (CRC) detection thresholds.

Methods

All patients referred under the 2WW pathway for a study period of 2 months were identified; referring symptoms, FIT levels, investigations and final diagnosis were collected via the electronic patient records. Exclusion criteria were patients who were not under the 2WW pathway, patients without FIT, those that declined or unfit for further investigations. Data was anonymized and analysed using the SPSS software.

Results

438 patients were referred to the colorectal team during the study period, 335 patients (157 males and 178 females) met the inclusion criteria, age range 25-93 years, mean age 69.33 years (SD 12.66).

14 patients had a final diagnosis of colorectal cancer.

All 14 patients had a FIT >6.9 (p 0.012), that was also the case with a FIT of 10 and above (p 0.002) which had a stronger association, FIT test 11 and above, 15 and above and 20 and above being the positive threshold detected 13 of 14 patients with CRC with a p value 0.008, 0.002 and 0.001 respectively.

Conclusions

Our data shows that a FIT threshold of 10 and above detected all patients with CRC and even a slight increase of the threshold to 11 missed 7.1% (1/14) of patients with CRC. Hence patients with ‘slightly positive FIT’ should be considered for further investigations if appropriate.
ThTP4.8 Day 1 post-operative discharge following RAS Colorectal Cancer Resections; exciting potential in helping solve the NHS bed crisis
Authors: McGuire Carina , Khopekar Faid , Saldanha James , Komolafe Segun , Maxwell Fraser
Published: August 2023

Aims

The NHS is under significant bed strain. Optimising safe, early discharge of elective patients post-operatively should form part of the response to these pressures. We present the results of a single centre retrospective study looking at day 1 post operative (PO) discharge and 30 day readmission rate (RR) in patients who had undergone robotic assisted (RAS) colorectal cancer (CRC) surgical resection.

Methods

Using the hospital’s theatre database, we identified all RAS CRC resection patients from 2nd May 2022 until 17th January 2023. We documented PO LOS using data from ‘Trakcare’ and separated those patients discharged day 1 from those discharged >day 1 to compare RR.

Results

The median LOS for patients undergoing RAS CRC resections (n=56) was 3 days with a bimodal distribution (1,2). 19.3% (n=11) of patients were discharged on PO day one. 1 patient from this cohort was readmitted within 30 days representing a 9.1% RR. From those patients discharged after day 1 (n=45), 5 were readmitted representing a 11.1% RR. All readmissions from both cohorts were managed at ward level.

Discussion

Our study shows that PO day one discharge of RAS CRC resection patients results in a decreased rate of 30 day readmissions compared to those discharged later than day one. It has not traditionally been the practice within our heath board to consider discharge within 24 hours of CRC resection. We hope this practice, as demonstrated in our robotic patients, can be considered and may help increase bed availability at our hospital and elsewhere.
ThTP4.13 Discrepancy between preoperative MRI staging and post-operative histopathology staging in rectal cancer patients who had primary surgery. A retrospective study at a District General Hospital
Authors: Wani Ishfaq , Husain Namaj , Thomas Pradeep , Alam Abu , Narayanasamy Sangara
Published: August 2023

Aim

The aim of this retrospective study was to analyse the discrepancy between preoperative MRI staging and post-operative histopathology staging of rectal cancer patients who had primary surgery.

Methods

A retrospective cohort study analysed the records of 47 patients with histology confirmed rectal cancer over the period of 5 years from 2017 to 2022. Data was collected from the hospital database.

Results

Forty-seven patients were evaluated. The mean age of presentation was 72 years. Out of 47 patients 65.95% (n=31/47) were men; 34.05 % (n=16/47) were women. Discrepancy in T staging and N staging were found in 44% (n=21/47) and 49% (n=22/45) patients respectively. Two patients had inconclusive N staging on preoperative MRI. In T stage discrepancy, 86 % ( n=18/21) were upstaged and 14% (n=3/21) were downstaged. In N stage discrepancy, 73%(n=16/22) were upstaged and 27% (n=6/22) were downstaged.

Conclusion

There was significant discrepancy in preoperative MRI staging and post-operative histopathology staging in our study. Discrepancy in rectal cancer staging has critical effects on management, outcomes, and survival rates of patients. Appropriate and accurate clinical radiological staging enables multi-disciplinary teams to plan optimal management approaches.
ThTP5.1 Laparoscopic cholecystectomy on index admission – are we following AUGIS guidelines?
Authors: Reid Rebecca , Shahjahan Mohammed
Published: August 2023

Background

Laparoscopic cholecystectomy is the gold standard in management of acute cholecystitis, biliary colic and gallstone induced pancreatitis. AUGIS has produced guidelines recommending optimal timing during index presentation for surgery.

Aim

To identify if our local acute surgical unit was following AUGIS guideline recommendations and performing laparoscopic cholecystectomy on index admission for recurrent/ongoing biliary colic, mild gallstone pancreatitis and for acute cholecystitis within 72 hours of onset of symptoms.

Methods

Prospective review of surgical patients admitted to DGH in Northern Ireland with acute cholecystitis, biliary colic and gallstone pancreatitis over six-month period between April and September 2021.

Results

103 patients were admitted during 6 months with gallstone disease. Of these, only 20 underwent inpatient lap cholecystectomy during their admission. 21 patients were deemed unfit for surgery and 3 declined surgery. 10 patients with acute cholecystitis had surgery; only 4 had symptom onset within 72 hours as recommended.

Conclusion

This unit was not following AUGIS recommendations on the timing of laparoscopic cholecystectomy for patients presenting with gallstone disease. During this data collection a pathway was started for day case laparoscopic cholecystectomy at a satellite site to help expedite patients who were unable to have their operation as inpatient.
ThTP5.2 Outcome of polypharmacy in frail patients post emergency laparotomy
Authors: Ng Hwei Jene , Quasim Tara , Rattray Nicholas , Moug Susan
Published: August 2023

Aims

The causal effect relationship between frailty and polypharmacy is not clearly established. Medications are used to treat co- morbidities that cause frailty but the side effects of the drugs could also be the stressors leading to frailty. Moreover, high risk of mortality is associated with frail emergency laparotomy patients. We aim to explore the association between 30- day mortality and frailty with polypharmacy.

Methods

A prospective database of emergency laparotomy (EmLap) patients in a busy district hospital was analysed. Patients ≥40 years old who underwent EmLap as per NELA criteria were included. Frailty was assessed via Clinical Frailty Score with score ≥4 as frail. Polypharmacy was defined as ≥5 daily medications. Statistical analysis was performed using logistic regression and p value of <0.05 was considered significant.

Results

100 patients were included with 41% male and median age of 66 years. The overall 30- day mortality rate was 9%. Frailty was present in 49% and mortality rate was 16.3% (OR 79.76, p= 0.0121). Polypharmacy was found in 36% and mortality rate was 16.7% (OR 4.07, p= 0.045). There was significant association between frailty and polypharmacy (p=0.012). When both frailty and polypharmacy were present (25%), the mortality rate was 20% (OR 5.55, p= 0.026).

Conclusion

Frailty increases risk of polypharmacy and polypharmacy poses risk of worsening frailty, Mortality rate post EmLap is higher when EmLap patients are both frail and have polypharmacy. It is important to rationalise and review patient’s drug therapy in the community as well as in hospital.
ThTP5.4 Fasting times and medication administration in ‘nil by mouth’ emergency surgery patients
Authors: Oxley Catherine , Lingam Gita , Metcalfe Matthew
Published: August 2023

Aims

In ‘nil by mouth’ (NBM) emergency surgery patients, to 1) reduce the proportion of oral medications incorrectly administered/omitted and 2) reduce the proportion that are fasted for longer than the recommended 6 hours for food and 2 hours for clear fluids.

Methods

Medication administration and fasting data were collected prospectively on patients who received emergency surgery over two 2-week periods (n=169). Between these rounds of data collection, interviews were conducted with a range of staff members to understand reasons for poor compliance with guidelines. Based on this, local guidelines were updated to reflect a wider range of medications, and a range of methods were used to educate staff about best practice.

Results

In the first round of data collection, 45% of drug administration decisions were not compliant with guidelines. By the second round, these drug errors were reduced by 60%. On average fasting times were reduced by 25%, from 14.4 hours to 10.9 hours for clear fluids and from 24.2 hours to 18.5 hours for food. However, in both rounds, the range of times exceeded 110 hours.

Conclusions

Education about ‘NBM’ can significantly improve preoperative optimisation of patients and reduce the risk to patient safety associated with critical medications being omitted. The reduction in medication errors was so significant because lack of understanding of guidelines was highlighted as the major cause of non-compliance. Impact on fasting times was smaller, likely due to the other factors contributing to the prolonged times, such as patient choice, operation scheduling difficulties, and inadequate communication between teams.
ThTP5.5 The Emergency laparotomy – “scans, tubes and scalpels”. A report from the UK’s first collaborative National Emergency Laparotomy Audit (NELA) training meeting
Authors: Mitchell Robert , Govindarajah Narendranath , Loh Ee-Neng , Robson Michael , Tsironis Dimitrios , Wale Anita
Published: August 2023

Background & Aims

Time-critical emergency laparotomies are routinely performed nationally. These complex patients often require multi-disciplinary discussion of pre-operative imaging and intra-operative and post-operative status. NELA is designed to improve patient outcomes, encouraging regular audit and quality improvement.

We report the outcomes of the UK’s first collaborative NELA training meeting from a Major Trauma Centre in London

This unique meeting aimed to:

Methods

Three complex laparotomy patients were discussed using case-based discussions involving General Surgery, Anaesthetics and Radiology and involving imaging, intra-operative photographs and anaesthetic information. Pre- and post-meeting participant questionnaires were disseminated for comparative analysis.

Results

39 attended the evening (50% radiologists, 25% surgeons, 25% anaesthetists); two thirds’ trainees. 100% attendee satisfaction rate was recorded. 46% of attendees were not aware of NELA prior to the meeting.

Post meeting, 95% of attendees were confident in their understanding of the NELA process. There was a 25% increase in the knowledge of NELA reporting outcome measures (to 95%) and 90% correctly named the specialities involved.

96% of attendees reported interest in attending a subsequent meeting.

Conclusion

Complex emergency patients require expert cross-specialty input to drive improvements in patient outcomes. We believe this to be the first multidisciplinary NELA education meeting. Improvement in attendee understanding demonstrates the success of shared learning via case-based discussion to improve patient care. We aim to continue local meetings with aspirations to future national events.
ThTP5.7 Laparoscopic Management of Adhesional Small Bowel Obstruction: Is it Feasible?
Authors: Spyropoulou Liana Evangelia , Hadjicosta Olympia , Hamza Yasser , Ubaide Hassan , Aker Medhat , Arulampalam Tan
Published: August 2023

Despite advances in laparoscopic surgery, there is limited evidence on its application and outcomes for the management of adhesional small bowel obstruction(aSBO). Literature defines indications for surgery, without addressing the appropriate approach, traditionally involving laparotomy. This study investigated the feasibility of laparoscopic adhesiolysis for aSBO.

This retrospective cohort study included electronic data of patients admitted with aSBO, in a large laparoscopic centre over 3 years. Exclusion criteria applied to non-adhesional SBO, large bowel pathology and conservative treatment. Outcomes included the rate and reason for conversion to laparotomy, complications and length of stay (LOS).

85 patients with CT proven aSBO were included, over 3 years. 69(81.2%) of patients were approached laparoscopically and there was a 32%rate of conversion to laparotomy, due to technical difficulty(54.6%), planned “laparoscopy-first”(22.7%) or intraoperative emergency(18.2%).Those managed laparoscopically had 5 days median LOS compared to 9 in the converted subgroup.

Operation note review, revealed a standard operative approach using naso-gastric tube, right sided ports, and collapsed small bowel manipulation to identify the adhesion point. Enterotomy rate was 13.0% and 14.5%of patients required bowel resection from an extraction site. Post-operatively, 20.3%of patients suffered prolonged ileus, 5.8%anastomotic leak, 5.8%required re-operation, 8.7%were readmitted with recurrence and there were 10(14.5%) in-hospital deaths.

Our study indicated that laparoscopic adhesiolysis could be feasible for selected patients, with a CT proven transition point. Given the observational findings of this single centre study, further research in laparoscopic units is required, including direct comparison with laparotomy, and converted subgroups, aiming to generate standardised guidelines for the laparoscopic management of aSBO.
ThTP5.12 Assessment of malnutrition and nutritional interventions in patients presenting with acute small bowel obstruction – are we ‘getting it right first time’?
Authors: Yadu Shirley , Laouris Panayiotis , Bhandari Santosh , Makhija Rohit , Mallappa Sreelakshmi , Besali Mina
Published: August 2023

Aims

High levels of morbidity and mortality are associated with small bowel obstruction (SBO), a common general surgical emergency. Assessment of malnutrition and introduction of early nutritional interventions are of paramount importance in the management algorithm of these patients. We audited our practice of managing acute small bowel obstruction at a busy district general hospital comparing our practice against National Audit of Small Bowel Obstruction (NASBO) recommendations.

Methods

Data were gathered for all patients presenting with bowel obstruction to our Trust between 01/08/2022 and 30/11/2022. In depth review of patient case records was undertaken using electronic patient record systems (e-Track and Evolve).

Results

195 patients were admitted with acute bowel obstruction. 68 patients (35%) had acute SBO (M: F; 34:34). 58 (85%) had no documentation of duration for which they had been ‘nil by mouth’ (NBM) prior to hospitalisation. Malnutrition universal screening tool score (MUST score) was completed in 29 (43%) patients.

59% of patients had an emergency computed tomography (CT) which confirmed diagnosis of SBO. 60% of patients were managed non-operatively. On an average, patients were kept ‘NBM’ for two days (range; 1-16 days). Average waiting time for peripherally inserted central catheter (PICC) was 9.6 days.

Conclusions

Evaluating our practice of managing patients with acute SBO has highlighted multiple areas for improvement to ‘get it right first time’. We have included stakeholders; nursing staff, dieticians, surgeons, junior doctors and vascular access team to implement action plan to optimise management in this cohort of patients in line with NASBO guidelines.
ThTP6.4 A systematic review of the impact of postoperative aerobic exercise training in patients undergoing surgery for intra-abdominal cancers
Authors: Paul Melanie , Smart Thomas , Doleman Brett , Toft Suzanne , Phillips Bethan , Lund Jon
Published: August 2023

Introduction

Enhanced recovery after surgery (ERAS) programmes which advocate early mobility after surgery have improved immediate clinical outcomes for patients undergoing abdominal cancer resections with curative intent. However, the impact of continued physical activity on patient-related outcomes and functional recovery is not well-defined. This review aims to assess the impact of postoperative aerobic exercise training, either alone or in conjunction with another exercise modality, on patients who have had surgery for intra-abdominal cancer.

Methods

A literature search was performed of electronic journal databases. Eligible papers needed to report an outcome of aerobic capacity in patients >18 years of age, who underwent cancer surgery with curative intent and participated in an exercise programme (not solely ERAS) that included an aerobic exercise component starting at any point in the postoperative pathway up to twelve weeks.

Results

Ten studies were deemed eligible for inclusion consisting of one inpatient, one mixed inpatient/outpatient and eight outpatient studies. Meta-analysis of 4 outpatient studies, each reporting change in 6-minute walk test (6MWT), showed a significant improvement in 6MWT with exercise (MD: 74.92 m, 95% CI: 48.52 to 101.31m). The impact on health-related quality of life was variable across studies.

Conclusion

Postoperative exercise confers benefits in improving aerobic function post-surgery and can be safely delivered in various formats (home-based or group/supervised).
ThTP6.6 Improving Opioid Stewardship in General Surgical Practice
Authors: Reid Rebecca , Vijayagopal Kesav , Htet Win , Butler Rebecca , Wilson Jeremy , Magee Conor
Published: August 2023

Aim

The last 30 years has demonstrated a steady increase in drug-related deaths, with opioids implicated in at least 2,219 deaths in 2021 in England and Wales1. Inpatient opioid prescribing in surgery has been demonstrated to correlate with long-term use post-discharge2. We aim to improve opioid stewardship at our DGH to reduce ‘opioid-load’ in the community, thereby reducing likelihood of long-term post-operative use.

Method

Intervention included teaching for junior doctors, audit meeting presentation and posters designed collaboratively with acute pain team. Prospective data collected for 92 patients discharged from general surgery from October 2022 and compared to previous data pre-intervention from June 2020. Opioid prescriptions were converted to Milligrams of Morphine Equivalence (MMgEq) for analysis.

Results

Following intervention, max average 58.64 MMgEq/day compared to 85.88 MMgEq/day previously. Max PRN prescription now 49.77 MMgEq/day compared to 57.18 MMgEq/day. Increased involvement of acute pain team (15.9% to 20%) and improved use of multimodal analgesia (PCA - 3% to 13%, NSAIDS - 2% to 16.5%, rectus sheath blocks – 1% to 4.2%). Discharge prescribing also improved; only 57.6% discharged with opioids, 89% had documented plan for GP and 49% had specific duration.

Conclusions

Our results demonstrate marked improvement in surgical opioid prescribing. There is potential for further improvement including introduction of opioid misuse risk calculator and formalising opiate prescribing guidelines in surgery.

1 ONS. Deaths related to drug poisoning in England and Wales: 2021 registrations. August 2022

2 Vijayagopal et al. (2022). SP1.1.4 Caveat Chirurgicus - Opioid use following surgery. British Journal of Surgery. 109.