bluuebunny/crossref_metadata_2025 huggingface dataset:
345 A Novel Study Exploring the Hidden Cost of Insufficient Investment in Computer Technology in a District General Hospital
Authors: Rogers A , Ramasubbu R , Ramasubbu B
Published: May 2021

Introduction

The NHS’ move towards increasing digitisation is limited by inadequate resourcing. It is estimated 70% of a junior doctor’s time is spent completing computer-based administrative work. Aging and insufficient equipment leads to inefficiency. The objective of this study is to investigate the hidden cost of insufficient and poorly performing computer technology.

Method

Surveys were disseminated to doctors and data was collected regarding designation, ward, salary and estimated ‘minutes-waiting’ for computers to become free (CF) and to load (CL).

Results

33 surveys were completed. The hospital-wide average CF and CL were 25 minutes and 31.06 minutes respectively, with a corresponding average daily cost per doctor of £10.16 (CF) and £12.63 (CL), totalling £22.79/doctor/day. In the highest-expense ward, CF (31.66 minutes) and CL (38.33 minutes) equated to £30.28/doctor/day. Following acquisition of new hardware and re-audit, CL was significantly reduced to 20.4 minutes (p = 0.0142).

Conclusions

This study highlights the hidden cost of insufficient, poorly performing hardware. Every day the total cost of time-wasted greatly surpasses the cost of a single computer unit, illustrating the false economy of reduced capital investment in computer technology.
498 The Bristol Sign - A Technical Tip to Confirm Skin Flap Vascularity
Authors: Schrire Timothy , Emam Ahmed , Colavitti Giulia , Khan Umraz
Published: May 2021

Introduction

In modern medicine, free flap reconstruction has become the gold standard when faced with soft tissue defects. The impressive cosmesis, and adaptability of free flaps means that we can securely state that we are in the era of Plastic Surgery defined by free flap reconstruction. However, as part of free flap reconstruction, clinical monitoring of the flap is a central tenet post-operatively. Different departments have different protocols for this.

Method

In our unit, it is practice to insert a single interrupted stitch overlying the Doppler site just before dressings. This localises the site of the pedicle for Doppler monitoring, and allows the surgeon to examine the quality of the blood droplets, demonstrating flap perfusion.

Results

The use of the stitch is considered practical, replicable, and safe, and aids in providing gold standard monitoring post-operatively. The additional analysis of the blood droplet is another sign, in itself, of a healthy flap, and excludes venous congestion.

Conclusions

The Bristol stitch is a useful adjunct to free flap reconstruction. It’s localisation of the Doppler signal allows medical and nursing staff to confidently approach post-operative monitoring, and the blood elicited by the stitch insertion is a useful sign of flap vascularity and venous status.
500 Tetraminos Flap
Authors: Schrire T , Din A , Khan U
Published: May 2021

30 year old male, who had been hit at 90mph whilst on a motorbike sustaining femoral, tibial and right foot open fractures. He underwent an open reduction and internal fixation (ORIF) of his right lateral femoral condyle, a right retrograde femoral nail, and ORIF of the tibia. He had 2 separate free flaps (a chimera scapular/parascapular and antero-lateral thigh-ALT) to his right lower leg, and split skin grafting to the remainder of the right lower limb. Upon regular post-operative review it was found that whilst healed the limb was showing a poor return of function and a major contributor was the lack of motion of the right knee joint. Patient had an excision of the split skin graft, with a quadriceps plasty, where the myofascial planes were released, and the contractures incised, with a chimeric scapular and parascapular free flap onto the defect. This resulted in coverage of large soft tissue defect with no need to skin graft donor sites and no functional implication of muscle harvest. Tetraminos in appearance, like the popular computer game, which has never before been described, compared with normal coverage, which would be latissimus dorsi free flap and graft.
504 Can Measuring Heart Rate Variability in The Operating Surgeon Provide Insight into Intra-Operative Stress? A Literature Review and Direction for Research
Authors: Pearson L , Narayanan A , Fisher J P , Khashram M
Published: May 2021

Introduction

Stress affects the internal environment of the operating surgeon. Examining ways to mitigate this could prove important to the health of both surgeon, and patients.

Heart rate variability (HRV) is emerging as a novel, validated measure of autonomic nervous system (ANS) function with developing accessible and non-invasive technologies. HRV parameters correlate to ANS function and can be used to measure responses to various stimuli.

Method

A search strategy was developed to identify 23 articles that matched inclusion criteria. These included data collected intra-operatively with ambulatory monitoring, in simulated settings and one systematic review.

Results

Several studies found increased sympathetic response in the operating surgeon – which correlates with subjective reporting of stress. Some studies compared variables; one study suggested that laparoscopic colorectal surgery caused higher mental strain than open, while another suggested higher stress in surgeons while teaching compared to when primary operator. There have been no comparative trials using HRV in surgeons.

Conclusions

We present a review of the growing literature regarding HRV measurement in surgeons. This novel tool is a promising avenue to provide psychophysiological insight into the operating surgeon. This could guide future research into optimising the theatre environment for intra-operative performance using controlled or in-situ design.
508 Conservative Management of Small Bowel Obstruction: A Local Experience
Authors: Gonzalez M , Aker M , Manjunath P , Mishra A , Ward N
Published: May 2021

Introduction

Post-operative intra-abdominal adhesions remain the leading cause of small bowel obstruction (SBO) representing one of the main diagnoses warranting emergency laparotomies. The National Audit in Small Bowel Obstruction advocates the use of water-soluble contrast agents (WSCA) as initial management of SBO. We aim to assess the role and outcomes of WSCA and its rate in successfully managing SBO non-operatively.

Method

We conducted a 2-year retrospective analysis including all patients admitted with adhesive SBO. Outcomes of patients who received WSCA were compared to those who hadn’t.

Results

118 patients were included, 27(23%) of which required immediate surgery while 91(77%) were initially managed conservatively. From the latter group, 53(58.2%) received WSCA whilst 38(41.8%) didn’t. Of the group that received WSCA, 36(39.5%) were successfully managed non-operatively, compared to 26(28.5%) that didn’t, this however lacked statistical significance. LOS didn’t differ between these two groups (5 days vs. 5.5 days, p = 0.805). 32% of the patients required eventual surgical intervention needing longer LOS regardless of receiving WSCA (6.6 days vs. 13.6 days p < 0.001).

Conclusions

Adhesive SBO can be managed conservatively in up to two-thirds of patients. WSCA usage has a positive impact but needs further assessment in larger studies.
550 “No One Told Me About This Side of The Job!” A Novel Method for Teaching Senior Surgical Trainees
Authors: Metcalfe K , Pollard J , Thomas I
Published: May 2021

Introduction

Higher surgical training is specifically geared towards preparation for working as a Consultant, but trainees typically get limited exposure to Consultant level administration tasks. Whilst Consultants are familiar with these tasks, registrars are often naïve to this side of clinical practice and new Consultants find it takes up a significant proportion of their time. We developed an “office admin” simulation session as a method for gaining further non-technical skills in surgery.

Method

A simulation based on a real Consultant General Surgeon’s workload was created, which included actioning pathology reports, vetting referrals, and planning a theatre list. Trainees were given 40 minutes to work through the tasks before debriefing with an experienced simulation facilitator.

Results

Six general surgical trainees took part in the pilot. All found it ‘useful’ or ‘very useful’ and stated that it will help prepare them for the role of Consultant. All felt it would make a useful regular addition to the regional teaching programme.

Conclusions

This novel simulation was well received and demonstrated a useful method to practise these skills in preparing for the role of Consultant. We aim to develop the simulation package further so it can augment the regional speciality training.
28 Diagnosed vs Undiagnosed Chronic Obstructive Pulmonary Disease: Short and Long-term Impact on Coronary Artery Bypass Surgery
Authors: Gatta F , Haqzad Y , Loubani M
Published: May 2021

Introduction

This study sought to compare clinical outcomes among non-COPD, diagnosed COPD, and undiagnosed COPD patients, in CABG surgery.

Method

A single-centred retrospective study, from January 2010 to December 2019. Primary outcomes were post-operative complications, lenght of ITU admission and in-hospital staying. Secondary outcomes were re-intervention rate, in-hospital and long-term mortality.

Results

4020 patients were divided into: non-COPD – Group A (74.55% n = 2997), diagnosed COPD – Group B (14.78% n = 594), and undiagnosed COPD – Group C (10.67% n = 429). The rate of respiratory complications was noted in this order: Group B > Group C > Group A (p 0.00000002). Perioperative Acute Kidney Injury, wound complications, and in-hospital staying were higher in Group B (p 0.0004, p 0.03, and p 0.0009, respectively). Long-term mortality resulted greater in Group B and C (p 0.0004). No difference in long-term mortality was noted in relation to the expected FEV1% in Group B (p 0.29) and Group C (p 0.82).

Conclusions

In CABG surgery, patients with diagnosed COPD carry a prolonged in-hospital staying and greater peri-operative complications. Both diagnosed and undiagnosed COPD predispose to respiratory complications and higher long-term mortality rate. Consequently, undiagnosed COPD should be included in the EuroSCORE. Finally, the expected FEV1% appears not to correlate with long-term survival.
689 Silac (Sinus Laser-Assisted Closure) For Pilonidal Sinus: Our NHS Experience
Authors: Kalaskar S , Adamek J
Published: May 2021

Introduction

The accepted treatment of pilonidal disease still consists of surgical excision with primary wound closure. This treatment has complications such as excessive pain, delayed wound healing, and recurrence. We introduced this technique using a radial laser probe (SiLaCTM, Biolitec, Germany). Previous studies have shown encouraging results with respect to safety, patient satisfaction, and minimal recurrence rates.

Method

The pilot project was planned with the objectives to assess postoperative complications and reoperation rates. All operations were performed as day case procedures under general anaesthesia. We studied the data of our first 25patients operated with this technique between January 2019 and December 2019 using a prospective database and outpatient clinic follow up.

Results

The median follow up duration was 13 months. The initial success rate was 64%(16/25), reoperation was required in 32%(8/25) and one patient was lost to follow up. one patient returned with abscess formation in the postoperative period.

Conclusions

SiLaC is a safe and minimally invasive technique for the destruction of the pilonidal cyst and sinus. The success rate is modest, making this new therapy a minimally invasive option for the majority of the patients with pilonidal disease but it should be offered with caution.
711 Atypical Presentation of a Ruptured Thyroid Cyst
Authors: Sahib Y , Aziz M , Benamer M
Published: May 2021

Introduction

Thyroid cysts are a common finding with the bulk of cases being benign and approximately only 5% being malignant. The majority of these cysts are managed conservatively in the absence of malignancy or compressive symptoms.

Case

presentation

A middle-aged female patient presented with sudden onset anterior neck bruising but minimal specific symptomatology. On examination, the patient had bruising around the anterior neck and chest wall. CT and MRI scanning of the neck revealed the bruising was attributed to a ruptured thyroid cyst. On follow up, an ultrasound guided fine-needle aspirate revealed the histology to be inflammatory follicular thyroid tissue.

D

iscussion

The case demonstrated a rare presentation, given the lack of trauma in her history nor the presence of more sinister conditions as demonstrated by the fine-needle aspirate. Normally hemorrhage of thyroid cysts are due to trauma or abnormal thyroid vasculature. There are a few previous case reports of similar presentations where ruptured thyroid cysts led to life-threatening airway compromise requiring intubation. Early recognition of these thyroid cyst complications is crucial.

Conclusion

Neck and anterior chest wall hematoma can be a sign of thyroid cyst rupture/hemorrhage. It is important to recognize this sign to prevent life-threatening airway compromise.
743 Inflammatory Pseudotumor (IPT) Of the Liver, A Diagnostic Dilemma with Therapeutic Uncertainty in A cohort of Bangladeshi patients (Observational Cohort Study)
Authors: Rabbi H , Chowdhury A Q , Sarder M M , Islam R
Published: May 2021

Background

IPT a benign lesion seldom encountered in clinical practice. It’s mysterious in origin & remains ambiguous.Infection, stone,autoimmune disease,systemic inflammatory response,trauma,foreign body and neoplasm attributes to etiological factors.Advanced imaging modalities help in increased detection of focal liver lesion.

Aim

To analyze its clinical significance. 33 patients with focal liver lesions were evaluated and treated surgically as hepatic neoplasm consecutively from July 2013 to January 2020.

Method

Retrospective observational cohort study.

Results

14 male & 19 female were studied, mostly in 3rd decade of life. Clinically only 21% of them presented with fever.In 24 patients the lesions were located in left lobe of liver.The operative procedures were: wedge resection in 3 patients,limited resection in 5 patients,Left Hepatectomy 7 patients,Left lateral hepatic segmentectomy in 17 patients, right hepatectomy in 2 patients & central hepatectomy in 1 patient. 8patients required bilioenteric anastomosis as additional procedure.Histopathological study revealed Tuberculosis in 7 patients(21.21%),fungal granuloma in 3 patients, foreign body granuloma in 3 patients, Ductal calculi with abscess in 9 patients and idiopathic in 7 patients.

Conclusions

IPT of liver represents a rare entity usually mistaken as malignant lesion.Despite the low prevalence, it often creates a diagnostic dilemma resulting into therapeutic uncertainty.
768 The Role of MRI Texture Analysis in Predicting Outcomes in Locally Advanced Rectal Cancer After Chemoradiotherapy
Authors: Alrahawy M , Aker M , Zeinaldin A , Arulampalam T
Published: May 2021

Background

Locally advanced rectal cancer (LARC) is treated by neoadjuvant chemoradiotherapy(NCRT) followed by surgery after restaging by magnetic resonance imaging(MRI). Texture analysis(TA) is a novel imaging biomarker that can assess heterogeneity in MRIs. This study hypothesizes that TA has the ability to predict the complete response(CR), survival, local recurrence, and distant metastasis.

Method

This is a retrospective analysis of all patients diagnosed with LARC who received NCRT and who have had MRI scans. Six parameters were systematically extracted from Textural histograms of post-treatment scans. Correlation between TA and CR was tested. These parameters were then examined to determine their ability in predicting local recurrence, distant metastases, and survival by means of Kaplan-Meier survival curves and log-rank tests.

Results

Four out of the six parameters extracted significantly identified CR. Utilising the same cut-off values across all parameters, three parameters significantly predicted local recurrence: Entropy(p = 0.033), mean of positive pixels(MPP)(p = 0.045), and Skewness(p = 0.018). Four parameters significantly predicted distant metastases: SD(p = 0.015), entropy(p = 0.017), MPP(p = 0.005), and skewness (p < 0.001). Four texture parameters significantly predicted survival: SD(p = 0.002), entropy(p = 0.001), MPP(p < 0.001), and skewness(p = 0.017).

Conclusions

MRI textural features are potentially significant imaging biomarkers in predicting survival, local recurrence, or liver metastases in LARC.
837 The Identification of Gaze Behaviour and Physiological Markers Associated With Making An Error During Laparoscopic Cholecystectomy
Authors: Ashraf H , Sodergren M , Mylonas G , Darzi A
Published: May 2021

Introduction

Adverse surgical events remain at an unacceptably high level despite multiple global safety initiatives being introduced. As yet, however there is no conclusive evidence to identify whether physiological markers can be used to predict whether a surgeon will make an error

Method

Surgeons were asked to complete a simulated laparoscopic cholecystectomy task while physiological metrics and gaze behaviour was tracked. LightGBM and CatBoost were used to predict the physiological metric most useful in predicting whether a surgeon was about to make an error. The binary task used a boolean value of “does an error occur in the next 5 seconds” as the dependent variable, while the multiclass task classified the severity of error (0, 1, 2, 3).

Results

Autocorrelation with lag (eventually calculated with a lag of timestep 2) measured the tendency of this timeseries to correlate with itself. The degree of correlation, or lack of correlation, and sudden changes in correlation over time were gleaned from this feature.

Conclusions

Skin conductance was most likely to successfully predict impending error. However when gaze features were added, overall model performance improved by 6.4%. The potential for reduction in surgical error rate and improvement in patient safety are important factors to consider.
875 Use of Oriented Priors Through Magnetic Tractography (MAGNET) In Deliniation Of Meyer's Loop and Correlation with Visual Field Deficit In Temporal Lobe Epilepsy (TLE) Surgery: A Pilot Study
Authors: Bhatia S , Shastin D , Tax C , Parker G , Shwartz S , Hamandi K , Gray W , Jones D , Chamberland M
Published: May 2021

Introduction

Pre-operative white matter tract reconstruction of the Meyer’s loop (ML) of the optic radiation using diffusion MRI (tractography) can be used to prevent post-operative visual-field deficit. Due to its complex anatomy, precise reconstruction of the ML is challenging and often underestimated. Previous work has suggested that an innovative tractography technique using oriented priors called MAGNET better approximates reconstruction to reported histological prosections. This proof-of-context study validates the MAGNET methodology in predicting visual-field deficits in patients undergoing TLE surgery.

Method

Diffusion MRI datasets were used to reconstruct pre-operative ML using MAGNET in five patients. These were overlaid on post-operative T2-MRI series demonstrating the surgically resected area to measure overlap between resection and reconstructed ML. A correlation with post-operative visual-field defects was established.

Results

There was no evidence of visual field deficit in the cases where there was no overlap between the reconstructed ML and the resected region. In the cases with overlap with reconstructed ML and resection, there was visual deficit found. There was no correlation between proportion of resected ML and visual deficit.

Conclusions

This pilot demonstrates that MAGNET accurately reconstructs ML in pre-surgical TLE cases compared to standard tractography techniques and can be used to augment neurosurgical planning and resection.
923 Accuracy of Assessment in Hand Trauma; Pre COVID-19 Face to Face Assessment Compared to Virtual Assessment During COVID-19 Lockdown
Authors: Westley S , Creasy H , Mistry R
Published: May 2021

Introduction

The Queen Victoria Hospital (QVH) was designated a cancer and trauma hub during the COVID-19 pandemic. With this, a new virtual hand trauma clinic was set up.

We assess accuracy of assessment within this virtual set-up with comparison to pre COVID-19 face-to-face assessment.

Method

Two weeks of clinic sessions during and pre lockdown were analysed. Initial assessment was compared with the patient's operation note.

Results

In the pre COVID-19 two-week period 129 face-to-face appointments were analysed. Of 99 patients that required surgery 77 (78%) had an accurate assessment. 6 were overestimated, 12 were underestimated.

189 patients were seen over two weeks during lockdown via telephone or video call. Accuracy of assessment increased with seniority of the clinician. Of 126 patients that required an operation 109 (87%) had an accurate assessment; all structures injured were correctly predicted. 12 were overestimated, 5 had their injury underestimated.

Conclusions

The new virtual clinic allowed patients to be remotely assessed during lockdown, reducing footfall and unnecessary journeys.

We found that virtual clinic assessments are accurate, and no patient underwent an unnecessary procedure. Using a telephone call plus photo gave similar accuracy as a video call.

Virtual assessment was more accurate than face-to-face assessment.
38 Adapting an Emergency General Surgery Service in Response to the COVID-19 Pandemic
Authors: Hickland P , Clements J , Convie L , McKay D , McElvanna K
Published: May 2021

Introduction

In response to the COVID-19 pandemic, our emergency general surgery (EGS) service established an enhanced ambulatory service and undertook non-operative management of selected pathologies. This study compares the activity of our service before and after these changes.

Method

Patients referred by the emergency department were prospectively identified over a four-week period beginning from the date of reconfiguration (COVID) and compared to patients retrospectively identified from the same period the previous year (Pre-COVID) and followed up for 30 days. Data was extracted from handover documents and electronic care records.

Results

There were 281 and 283 patients during the Pre-COVID and COVID periods, respectively. Rates of admission decreased (78.1% to 41.7%) whilst there were increased rates of ambulation (7.1% to 17.3%) and discharge (6% to 22.6%). Duration of admission decreased (6.9 to 4.8 days), and there were fewer operative and endoscopic interventions (78 to 40). There were increased ambulatory investigations (11 to 39), telephone reviews (0 to 39), and use of early CT to facilitate discharge (5% to 34.7%). There were no differences in 30-day readmission or mortality in any group.

Conclusions

Restructuring of our EGS service in response to COVID-19 facilitated an increased use of ambulatory services and imaging, whilst maintaining patient safety.
107 COVID 19 - Developing A Second Brain for Axillary Conservation During the Pandemic By Extrapolating Evidence On Technical Trends Of Sentinel Node Staging Of Axilla Into A Streamlined Recommendation
Authors: Arif T , Absar M S
Published: May 2021

Introduction

Axillary conservation is the way forward after game changing trials like ACOSOG Z0011, surrogate trials like IBCSG,AMAROS, ALMANAC, on-going POSNOC, and newbie ATNEC have decreased the need to fiddle with the axilla. Current standard is the utilisation of double technique with radioisotope and blue dye to decrease false negative rates for true sentinel node retrieval.

Method

Literature search on the topic in the last two decades.

Results

The search yielded 197 publications which were subjected to a meticulous review.

Conclusions

Single agent radioisotope is recommended in palpable and good biology breast tumours. Use of single agent blue dye can be standardised in axillary tail tumours. It is also recommended when isotope mapping is logistically not feasible or during pandemics like COVID 19 where looming infrastructure challenges are prevalent. Dual agent technique should be considered in previously treated breast and axilla, neoadjuvant chemotherapy cohort, bad tumour biology, high BMI and macromastia groups for true nodal retrieval. Optimal number of nodes taken out should not be more than three (n = 3). Lower axillary sampling of not more than 3 nodes is recommended for troubleshooting. Magnetic tracing can be used as an adjunct to either single agent (RI/BD) technique when there is failure to localise the sentinel node.
141 The COVID-19 Pandemic: A Disproportionate Impact on Pregnant Surgical Trainees?
Authors: Pendegast H
Published: May 2021

Introduction

Despite increases in the female surgical trainee workforce over the last decade male trainees still dominate the surgical specialties. It is well recognised that there is strong gender disparity in surgery. The wider challenges further experienced by pregnant surgical trainees are also well documented.

Method

NHS digital data on the surgical workforce and the Royal College of Obstetricians and Gynaecologists COVID-19 guidance for pregnant healthcare workers was reviewed.

Results

Women account for 27% of the surgical workforce and the average time taken to complete training is longer for female trainees. Current guidelines for pregnant healthcare workers advise strict social distancing measures up to 28 weeks gestation with avoidance of high-risk areas including operating theatres. A non-patient facing role is advised from 28 weeks onward.

Conclusions

The COVID-19 pandemic has created additional barriers for women in surgery. Restrictions for pregnant trainees, whilst vital for their wellbeing, has denied access to some essential training opportunities necessary for progression. It will likely further isolate them from the workforce and hinder their advancement into senior roles where they are already underrepresented. Although it is recognised that surgical training in general has been impacted by COVID-19 there is an argument that this disproportionately affects pregnant trainees.
147 A Meta-Analysis Comparing the Diagnostic Accuracy of Initial RT-PCR And CT Scan in Suspected COVID-19 Patients
Authors: Siddiqui S , Mair M , Hussain M , Das S
Published: May 2021

Introduction

Reverse transcriptase Polymerase chain reaction(RT-PCR) is considered as the gold standard diagnostic test for COVID-19 infection. It’s accuracy has been doubted and subsequently had effects on planning, performing operations causing. Research has suggested the use of Computed Tomography Scan instead. In this study we performed a meta-analysis comparing the diagnostic accuracy of CT compared to RTPCR.

Method

Our systematic review and meta-analysis were undertaken as per PRISMA guidelines. The methodological quality of each included study was assessed using the QUADAS-2 tool on RevMan 5.3. We performed data analyses using Stata version 12.

Results

Sensitivity estimates for CT scan ranged from 0.69 to 1.00 and for RT-PCR varied ranging from 0.47 to 1.00. The pooled estimate of sensitivity for CT was 0.95 (95% CI – 0.88-0.98) and specificity was 0.31 (95% CI – 0.035-0.84). It was found that specificity of initial RT-PCR(100%) was higher than CT(31%). With respect to sensitivity, CT(95%) was superior to RT-PCR(91%) p (0.000)

Conclusions

Sensitivity of CT is significantly higher than RT-PCR for detecting COVID-19 infection, however as CT findings are not specific. Since CT scans are readily available, protocols can be developed to utilise it to minimalize delay in planning surgery.
167 The Experience and Outcomes of Elective Urgent and Cancer Surgery in A District General Hospital in The United Kingdom During Covid-19 Pandemic
Authors: Tam A , Elhadi M , Ong C T , Bhat A , Akhtar M
Published: May 2021

Background

Many urgent and elective surgeries were postponed to cope with the Coronavirus disease (COVID-19) pandemic, with latest data found a substantial postoperative mortality risk (25·6%, 18.9%) after emergency and elective surgery, respectively.

Our institution was one of the first trust to offer essential elective surgery using a “COVID-free” designated site during the start of the pandemic.

The aim of this study is to analyse the clinical outcomes of patients who underwent essential elective procedures during the virus outbreak in the UK.

Method

Retrospective analysis of outcomes all patients who had undergone urgent elective and cancer surgery, from 30th March 2020 to 21st May 2020, using an implemented “Super Green Pathway”.

The primary endpoints were 30 days mortality and COVID related morbidities, and the secondary endpoints were surgical related complications and oncological outcomes.

Results

92 patients (Male:45%; Female:55%) across 5 surgical specialties were identified. There was no record of mortality in our cohort. Only 1 patient was tested positive for SARS-CoV-2, 18 days after the initial operation without any pulmonary complications.

Conclusions

It is possible to mitigate the high mortality risk of postoperative complications associated with COVID-19, with no delay to essential surgeries for cancer patients, thus delivering safe practice during the pandemic.
197 Acute Management of Traumatic Anterior Shoulder Dislocations During COVID-19: Are We Meeting Published National Standards for Treatment During the Pandemic?
Authors: Donovan R , Abdelmalek A , Crowther M , Packham I
Published: May 2021

Background

BESS/BOA Patient Care Pathways provide national guidelines for acute management of traumatic anterior shoulder dislocations with respect to emergency reduction and clinic follow-up. COVID-19 posed challenges in terms of analgesia choice for reductions and altered follow-up arrangements. This study aimed to assess variance from the care pathway.

Method

We performed a retrospective case note analysis of all emergency presentations with acute traumatic anterior shoulder dislocations at the MTC in Bristol from 01/04/2019-31/05/2019 to the same period in 2020 to analyse the effects of COVID-19 on management of these injuries.

Results

We identified 32 patients in 2019, and 24 in 2020. Entonox usage fell, in favour of Penthrox. Use of conscious sedation (requiring full PPE) remained around 20%. Pre- and post-reduction imaging was near 100% throughout. Referral to follow-up was 88% in 2019 but 38% in 2020. Those assessed in clinic during COVID-19, fewer were mobilised early or referred to outpatient physiotherapy compared to 2019.

Conclusions

Acute management of anterior shoulder dislocations during COVID-19 was challenged by choice of suitable analgesia that limits AGPs, and limiting access to ’face-to-face’ follow-up. A key concern was a significant decrease in patient follow-up, thus limiting the access to optimal aftercare such as physiotherapy and further imaging.
258 Increase in Cycling Injuries During COVID-19: Unintended Consequences of Lockdown Restrictions in The United Kingdom
Authors: Ansari S A , Al-Jader B , Khan N , Younis F
Published: May 2021

Introduction

Higher number of cycling injuries were observed during the COVID-19 period in the United Kingdom at our institution. Many were serious injuries requiring hospitalisation and some requiring surgery. We investigated whether the lockdown led to a legitimate increase in incidence of cycling related injuries, resulting in a higher number of aerosol generating procedures (AGPs). This would assess whether the guidance on exercise during lockdown was appropriate, shaping future regulation in the case of cyclical lockdowns.

Method

Records were screened retrospectively for cycling related injuries between April 1st and May 12th (lockdown) 2020 and for same period in 2019 as a control group. Injury severity, distribution and number of surgical procedures resulting from these were assessed.

Results

The proportion of injuries due to cycling rose threefold (n = 55) during the COVID-19 lockdown. Injuries included fractures, soft tissue injuries and mixed injuries. An increase in the number of operative procedures (n = 13) and AGPs was also noted.

Conclusions

Vague guidance and allowance of one form of outdoor exercise per day may have unintentionally contributed to rise in cycling injuries as many took to cycling for recreation. To make the guidance appropriate, usual forms of exercise should be encouraged, risk taking behaviours discouraged and safe cycling practices endorsed.
283 Laparoscopic Surgery During Covid-19 Pandemic: A Systematic Review of Recommendations
Authors: Boghdady M El , Ewalds-Kvist B
Published: May 2021

Introduction

Aerosol generating procedures such as laparoscopic surgery are known to be associated with increased risks of viral transmission to the healthcare workers. The safety of laparoscopy during the COVID-19 pandemic was therefore debated. We aimed to systematically review the literature regarding the safe use of laparoscopy during COVID-19.

Method

We performed a systematic search using PubMed and ScienceDirect databases from inception to 1st May 2020. The following search terms were used: ‘’laparoscopic surgery and COVID-19’’; ‘’minimally invasive surgery and COVID-19’’. The study protocol was registered with PROSPERO register.

Results

Altogether, 174 relevant citations were identiﬁed and reviewed for this study, of which 22 articles were included. The analysis of the findings was presented in tabular form. We scrutinized the common recommendations for performing laparoscopy during the COVID-19 pandemic in forms of pre-, intra- and postoperative phases.

Conclusions

There is no scientific evidence to date for the transmission of COVID-19 by means of laparoscopic surgery. If safe, conservative management is the primary alternative during the pandemic. If indicated, laparoscopic surgery can be used with precautions because of supplementary benefits compared to open surgery. We concluded that recommended precautions should be respected while performing laparoscopy during the pandemic.
287 COVID-19 and Surgical Specialties – Lessons Learnt: A Rural DGH Perspective
Authors: Zahari F , Shahrokhi N , Byrne H C , Gurung G , Hughes G , Navaratnam D M , Rambani R , Rao M
Published: May 2021

Introduction

The COVID-19 pandemic has seen the restructuring of surgical services worldwide. We aimed to evaluate pre-operative planning and post-operative outcomes in expedited colorectal surgery (ECRS), emergency general surgery (EGS), and emergency orthopaedic surgery (EOS) during the COVID-19 era at our rural hospital.

Method

This was a prospective observational cohort study. Electronic hospital systems identified adult patients who underwent ECRS, major EGS or EOS at our site, from the start of the UK lockdown.

Results

Following exclusion criteria, 98 patients were included in data analysis. Post-operative respiratory complications were seen in 27.8% of ECRS patients, 13.3% of EGS patients and 4% of EOS patients. 2 patients were diagnosed with COVID-19, with 1 COVID-19 associated mortality. Length of hospital stay was reduced for EOS in the COVID-19 setting and this was found to be statistically significant (p value <0.001).

Conclusions

When compared to the literature, COVID-19 related complications in surgical patients were found to be lower at our rural hospital. This could be due to regional variation in the prevalence of COVID-19. If there were to be a second surge, we suggest NHS Trusts should be given the autonomy to make local decisions on modifying their elective caseload, rather than following a national ‘one-size-fits-all’ guideline.
333 Management of Distal Radius Fractures During The COVID-19 Crisis
Authors: East J , Tahir M , Bose D , Quraishi H
Published: May 2021

Introduction

Distal radius fractures are common. Treatment depends on a multitude of factors including the pattern / displacement of the fracture, patient age, pre-morbid function, and surgeon preference. We aim to investigate the effect of the pandemic on the management and short-term outcomes of patients with DRF’s.

Method

Retrospective review of all adult DRF’s two months before and after BOA released emergency standards on trauma management. The primary outcome measure was the proportion of patients managed non-operatively before and during COVID-19. Data extracted: demographics, comorbidities, cognitive baseline, treatment, and follow-up. Radiographs were reviewed for displacement [dorsal tilt (>10o), ulnar variance (>3mm), intra-articular step (>2mm)].

Results

Pre-COVID (n = 29), COVID (n = 35). Characteristics were comparable in terms of median age (66 and 72 years, p = 0.41), %aged ≤65 (48% and 37%, p = 0.37), dominant side fracture (36% and 40%, p = 0.52), presence ≥ 2 co-morbidities (41% and 43%, p = 0.91). More patients were managed non-operatively during COVID (86% vs. 69%, p = 0.11), 2 of whom had unstable fracture pattern and developed malunion, compared to none in pre-COVID period.

Conclusions

Management of DRF’s remains a controversial topic, particularly in age <65 years. Long term follow up of patients with significant fracture displacement managed conservatively during COVID pandemic could help guide future practice.
387 Plastic Surgery Workload During The COVID-19 Pandemic
Authors: Gohil K , Al-Himdani S , Walkden A , Price G
Published: May 2021

Introduction

COVID-19 has been a formidable opponent to every aspect of the NHS. A comparative study examined referral workload at a regional Plastic Surgery Unit, Major Trauma Centre & Burns Facility during the initial stages of the lockdown period. Lessons learnt can then help prepare for the future.

Method

From initial lockdown (24/03/2020), all Plastic Surgery referrals were documented for 28 days. This data was compared to the same period in 2019. Demographics, diagnosis, mechanism of injury and time to presentation and surgery were noted.

Results

A total of 525 patients were managed, with a 48% reduction in referrals during lockdown. Hand trauma referrals reduced by 16% but increases in deliberate self-harm (100%), DIY injury (75%), lower limb trauma (250%) and burns (64%) were seen. Fewer work and school related injuries were managed in keeping with lockdown rules. Notably, access to surgical management did not alter.

Conclusions

The COVID-19 pandemic significantly affected the workload of our service. Social behaviours and psychological impact were common contributing factors. As Plastic Surgeons this should be acknowledged and consideration of optimising mental health services and health education should be prioritised for the future.
416 Prospective Multicentre Study of Impact of COVID-19 on Colorectal Cancer Resections
Authors: Kumar L , Mahfooz Buksh M , Merali N , Hammer C , Nagendram S , Kenny R , Chakravartty S , Madan R
Published: May 2021

Introduction

COVID-19 pandemic has posed a major challenge to healthcare systems globally. In NHS, around 36,000 cancer operations have been estimated to be cancelled during the peak time alone. This regional study evaluated the risk of COVID-19 in patients undergoing surgery for colorectal cancer during the peak time.

Method

This prospective multicentre observational study conducted in four busy district hospitals included 52 patients with colorectal cancer who underwent surgery during the COVID lockdown period (23rd March to 5th May). PCR swab testing was used to detect COVID. Data was collected from patient notes, MDT files and pathology results.

Results

73% (38/52) underwent elective procedures, 90% with curative intent. Overall, mean (SD) age was 70 (12.2) years, 50% were female. 60% (32/52) had left sided cancers and a total of 48% (25/52) patients had stage 3 or above. 27% (14/52) had post-operative complications, with 4% (2/52) being Grade 3 Clavien-Dindo. Total mortality was 6% (3/52) of which 1 was elective patient. Only one patient developed COVID infection during the inpatient stay.

Conclusions

Data suggests, local policies to prevent COVID spread have been effective. Local lockdown in case of second peak may be a reasonable option. Improvement in COVID testing could have major impact on outcomes.
484 Early Orthopaedic Input in Trauma Patients During COVID Times And Its Importance in The Post-COVID Era
Authors: Saleem S , Parikh S , Loeffler M
Published: May 2021

The Pandemic made way for interdepartmental collaborative efforts to action an early orthopaedic review of all trauma patients bypassing AnE, during the COVID pandemic.

Retrospective, single centre collection of data including 55 wrist and 40 ankle injuries that presented to the hospital in the month of January and April, marking pre-COVID and COVID times respectively. Data was gathered under following parameters: 1-Number of hospital visits, 2-Number of fracture clinic appointments, 3-Number of admissions and 4- Time to definite management. Simple data analysis was done to calculate means of all the parameters.

The average time to definite Management for distal radius fractures dropped from 2.78 to 0.86 days. For the same cases a dip in number of hospital visits was noted, from 2.72 to 2.09. Mean admissions for these patients dropped from 0.12 to 0.09.

The results quiet evidently show that early orthopaedic input reduced hospital visits, hospital admissions and time to definite management for distal radius fracture cases. A decrease in patient exposure to the hospital translates to reduced chance of contracting the COVID-19 virus. These results can prove very useful in setting guidelines, as we navigate patient care in uncertain COVID times.
491 Clinical Characteristics and Outcomes of Patients Undergoing Emergency Appendicectomy During the Pandemic Of COVID-19 Infection – A Single Centre Experience
Authors: Aladeojebi A , Salgaonkar H , Murcott D , Cheruvu C
Published: May 2021

Introduction

In March 2020, the World Health Organisation declared a global pandemic with the outbreak of a novel coronavirus. As the morbidity and mortality rates increased, the healthcare system was burdened with grave challenges including decisions on how to manage patients who needed emergency surgery during the pandemic. In the absence of clear guidelines and undetermined effects of peri-operative COVID-19 infection on surgical patient outcomes; our aim was to publish our surgical outcomes for emergency appendicentomies done during the pandemic.

Method

Prospective data was collated from 1st of March to 5th of June 2020 (n = 132) had appendicectomies over the period stated. Patient demographics, presenting symptoms, peri-operative events, investigations, and post-operative results and complications were documented and analysed. The results were then compared with outcomes of retrospective analysis at the same centre (n = 206) carried out from 1st March to 30th June 2019.

Results

The incidence of complications of appendicitis were similar without any significant differences. The negative appendix rate was significantly lesser in 2020 group, which may correlate to strict patient selection criteria for surgery.

Conclusions

Under strict selection protocols to reduce transmission of COVID- 19 and best surgical practice emergency appendicectomy is safe and feasible. However these observations warrant further well-designed future studies.
505 A Single Center Cohort Observational Study to Assess The Surgical Admissions During COVID-19 And Recommendations For Redeployment Of The Surgical Workforce
Authors: Abdalla M l , Connolly T , Bujoreanu I , Stylianides N A
Published: May 2021

Introduction

The redeployment of the surgical workforce to support other frontline specialties was an integral part of the nationwide response to the COVID-19 pandemic. The R number is gradually increasing in different parts of the UK suggesting a second wave is imminent. Aimed to analyze the surgical emergency workload and provide recommendations for future redeployments.

Method

Three separate cohorts of adult emergency admissions; emergency admissions prior to lockdown (23rd of February to 22nd of March), 1 month after (23rd of March to 22nd of April) and 2 months after (23rd of April to 22nd of May). Data was collected regarding patient characteristics, duration of symptoms prior to presentation, clinical outcomes and compared between these groups.

Results

Notable initial decrease in admission per day (4.3 to 2.5) and interventional management (30%) during the 1st month of lockdown. A marked increase in 24-hour discharge rate (50%). These parameters begun to normalize by the 2nd month. The rate of overall conservative management gradually increased from 36.7% pre-lockdown to 60.9% at the 2nd month.

Conclusions

Providing elective work is cancelled, surgical teams could safely tolerate working with 30%-40% of original staffing level, which will need to be gradually increased to 50%-70% after 1 month.
531 COVID-19 and Patients with Congenital Heart Disease: Are the Risk Higher? A Systematic Review
Authors: Haiduc A , Ogunjimi M , Shammus R , Mahmood S , Harky A
Published: May 2021

Introduction

We aimed to determine if patients with CHD are at a higher risk of poor outcomes if they have COVID-19, compared to those without CHD.

Method

A systematic review was executed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. To identify articles related to COVID-19 and CHD, an extensive literature search was performed on EMBASE, Medline, Scopus and Global Health databases using keywords and MeSH terms.

Results

12 articles met the inclusion criteria and were included for analysis in this systematic review. Two themes were identified for data extraction: [1] evidence supporting higher risks in CHD patients and [2] evidence against higher risks in CHD patients. After combining the data, there were 99 patients with CHDs out of which 12 required admission to ICU.

Conclusions

This systematic review suggests that CHD may increase the risk of poor outcomes for those with COVID-19, but also highlights the necessity for more research with larger sample sizes in order to make a more justified conclusion, as the majority of papers that were analysed were case series and case reports. Future research should aim to quantify the risks if possible while accounting for various confounding factors such as age and treatment history.
537 Implications of Covid-19 on Vitreoretinal and Cataract Surgery
Authors: Kabbani J , Kabbani J
Published: May 2021

Introduction

The coronavirus pandemic (COVID-19) has greatly impacted ophthalmic surgery, including changes to surgical protocols and training. We explored the effects on vitreoretinal and cataract surgeries, which constitute the commonest areas of ophthalmic surgery.

Method

Literature searches were performed for the terms “vitreoretinal”, and “cataract”, each in combination with “surgery” and “Covid-19”. Relevant results were assessed to determine perceived impact on ophthalmic theatres.

Results

36 search results were analysed; 25 and 11 for cataract and vitreoretinal surgery respectively. Efforts to reduce infection rates have significantly reduced non-urgent operations, with reports of just 5.7% of ophthalmologists in certain areas performing cataract surgeries. Furthermore, surgeons have been advised to perform bilateral cataract surgery, and to combine phacoemulsification with vitreoretinal surgery, thereby avoiding deferred operations and further exposure. Other recommended changes in surgical strategies to enhance safety include three-dimensional heads-up displays for vitreoretinal surgeries, novel microscope drapes, and virtual consultations for surgery follow-up. Various reports indicate a negative impact on junior surgeon training and mental well-being; indeed, The Royal College of Ophthalmology has recommended assigning operations to experienced surgeons.

Conclusions

Ophthalmic surgery rates and protocols have been impacted in the effort to reduce Covid-19 spread. Trainee surgeon education and well-being warrant further attention.