bluuebunny/crossref_metadata_2025 huggingface dataset:
MOY 3 Management of acute cholecystitis in Scotland: A population wide cohort study
Authors: Rajan Sendhil , Bekheit Mohamed , Wohlgemut Jared , Watson Angus , Ramsay George
Published: August 2023

Aims

Acute cholecystitis (AC) is a common Emergency General Surgery presentation, and is managed either by a cholecystectomy or conservatively. Surgery during the acute inflammatory phase has been shown to be safe and superior, however, operative rates vary widely. Also, medium-long term survival rates with each approach are still not definitively established. This real-world population analysis aims to describe the current management and outcomes of patients with AC across Scotland.

Methods

This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for AC were included. Patient level data were used to identify all patients admitted to Scottish hospitals between 1997-2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was mapped to mortality data to establish date and cause of death.

Results

47558 patients diagnosed with AC, admitted in one of 46 hospitals were included. These patients accounted for 58824 episodes (27.2% of patients encountered >1 episode). The study population had a median age of 58 years (IQR=43-71), 64.4% were female, and most had no comorbidities. 28741(60.4%) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared to non-operative management (OR 0.62, 95% CI 0.55-0.70).

Conclusions

In this comprehensive analysis of AC in Scotland, 60% of patients had an index cholecystectomy. Patients undergoing surgery had a superior survival to those managed conservatively, further advocating for an operative approach in this cohort.
NELA 1 Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: A retrospective cohort study
Authors: Saji Alwin Puthiyakunnel , Hughes Ioan , Mitra Kalyan , Hajibandeh Shahin , Hajibandeh Shahab
Published: August 2023

Aims

To compare predictive significance of sarcopenia and clinical frailty scale in terms of postoperative mortality in patients undergoing emergency laparotomy.

Methods

In compliance with STROCSS statement standards a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and clinical frailty scale were compared using the Receiver Operating Characteristic (ROC) curve analysis and multivariable binary logistic regression analysis.

Results

A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs 0.70, P<0.0001), in-hospital mortality (AUC: 0.79 vs 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs 0.67, P=0.0009) compared with clinical frailty scale. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality (coefficient: 4.22119, P<0.0001) but did not identify clinical frailty score as independent predictor (coefficient: 0.066311, P=0.5544).

Conclusions

Sarcopenia is a stronger predictor of postoperative mortality compared with clinical frailty score in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.
SP1.3 Implementation of a care bundle to sustainably reduce surgical site infection after emergency laparotomy
Authors: Thornton James , Swain Cara , Brewster Oliver , Gane Dawn , Rogers Jodie , Pullyblank Anne
Published: August 2023

Introduction

Surgical site infection (SSI) after emergency laparotomy (EL) is reported in up to 35% of patients. Implementation of the PreciSSIon bundle; 2% chlorhexidine preparation, second-dose antibiotics after 4 hours operating, wound protector (WP), antibacterial sutures for deep and superficial layers, halved SSI after elective colorectal surgery. This project aimed to implement an adapted bundle for EL.

Method

For patients in hospital at 30 days, notes were reviewed. For those discharged before 30 days patient-reported 30-day SSI was measured using the Public Health England Questionnaire. Baseline data was collected for 1 year with bundle implemented 2020. Additions to bundle were glove change and betadine wound wash.

Results

677 patients had EL over 4 years. Average mortality was 10%. A further 10% had laparostomy and temporary VAC dressing. Average response rate to questionnaire was 71%. Compliance with bundle elements were 100% for chlorhexidine, 96% for antibiotic 2nd dose, 83% and 90% for deep and superficial antibacterial sutures, 85% for glove change and betadine. Use of WPs was only 50%. After implementation of the bundle at the beginning of 2020, both patient-reported and in-patient SSI reduced, and total SSI has halved.

Conclusion

We have demonstrated reliable implementation of a care bundle (excluding WPs) sustainably reduced SSI after emergency laparotomy.
SP1.8 Comparing the efficacy of povidone-iodine versus normal saline in laparotomy wound irrigation to prevent surgical site infections: A meta-analysis
Authors: Magsi Abdul Malik , Shafique Muhammad Salman , Sains Parv , Baig Mirza Khurrum , Singh Krishna K , Sajid Muhammad S
Published: August 2023

Objective

Surgical site infections (SSIs) are associated with increased mortality, morbidity and cost to provide healthcare in patients undergoing laparotomy and abdominal surgery. The objective of this study is to evaluate the role of laparotomy wound irrigation either by povidone-iodine (PVI) or normal saline (NS) in patients undergoing laparotomy for various gastrointestinal operations and assess their role to reduce SSIs.

Materials and methods

Randomized controlled trials (RCTs) reporting the role of laparotomy wound irrigation with PVI versus NS in patients undergoing laparotomy for various gastrointestinal operations and assess their role to reduce the risk of SSIs were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results

The search of medical databases yielded 13 RCTs on 3816 patients undergoing laparotomy for various gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations prior to the laparotomy skin wound closure. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk [odds ratio 0.54, 95%, CI (0.30, 0.98), Z = 2.04, P=0.04] of SSIs. However, there was significant heterogeneity (Tau2 = 70; Chi2 = 40.19, df = 12; (P = 0.0001; I2 = 70 %) among included studies.

Conclusion

Laparotomy wound irrigation with PVI has shown clinically proven advantage of reducing the risk of SSIs.
SP2.8 AnTIcoaGulation afteR pancreatic surgery with vEnouS reSection (TIGRESS): what should we do? Results from an international survey
Authors: Russell Thomas , Ciprani Debora , Aroori Somaiah
Published: August 2023

Aims

Patients who undergo pancreatic surgery with venous resection/reconstruction (PSVRR) have high rates of morbidity/mortality and are at risk of postoperative venous thromboembolism (VTE). It is unknown if this group should be routinely anticoagulated. We developed a survey to establish current anticoagulation practices among pancreatic surgeons.

Methods

A JotForm.com survey was sent to members of various hepatopancreatobiliary societies. Questions covered: centre volume, venous resection/reconstruction techniques, and anticoagulation policies.

Results

Sixty-five centres from 17 seventeen countries responded. Following a “side-bite” venous resection and patch repair, 40% use an autologous vein patch, 27% use peritoneum and 27% use a bovine patch. When formally resecting a segment of vein, 17% of centres use an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (PTFE, 73%) grafts are the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a “side-bite” resection with patch repair, 59%, 28%, and 19% of centres provide therapeutic anticoagulation (TAG), respectively. Among the units that provide TAG, most (66%) use low molecular weight heparin. The duration of therapy provided varies from inpatient stay only (14%) to six months (32%).

Conclusions

Our global survey indicates that anticoagulation practices following PSVRR are highly variable. The centres do not agree on when or how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity on these issues.
SP3.5 Trends in systematic reviews of kidney transplantation: a 10-year analysis of the evidence base
Authors: Salih Sarah , Knight Simon , O'Callaghan John , Salih Marwah , Walker James , Pengel Liset
Published: August 2023

Background

Systematic reviews (SRs) are the highest form of evidence for all types of clinical questions in evidence-based practice. For the first time in 2018, the number of SR publications in transplantation outstripped those from randomised controlled trials (RCTs). This raises concerns of duplication or increased use of poor-quality evidence. We aimed to analyse the trends, strength and quality of evidence in SRs in kidney transplantation over a 10-year period.

Methods

Systematic reviews in kidney transplantation were identified from the Transplant Library, without language restriction. All full-text citations were exported to a custom Research Electronic Data Capture (REDCap) database prior to evaluation. The quality of evidence in all included SRs was assessed using AMSTAR-2.

Results

We included 454 reviews, of which, only 3 scored as ‘high quality’. We found 96.70% of SRs were identified as ‘critically low quality’, which increased in number over time. The number of reviews comprising non-RCT data increased in the most recent 5 years. Only 14.12% of SRs had made a clear recommendation for practice.

Conclusions

This review highlights several concerning statistics that need to be addressed. In the last 10 years, only 3 SRs in kidney transplantation were ‘high-quality’. The weaknesses identified in critical domains, alongside the increased use of non-RCT data and lack of conclusive recommendations, undermines the confidence in the results of the reviews and purpose of publication. As these reviews are instrumental to clinical decision-making and patient care, we advocate for improved reporting quality among SRs in the field of kidney transplantation.
SP3.9 The role of urinary biomarkers in predicting post operative kidney function
Authors: Dirie Jamal , Singh Rishabh , Singh Toolika , Rockall Timothy , Forni Lui
Published: August 2023

Aims

Post-operative Acute Kidney Injury (AKI) has implications on recovery, conferring a significant risk of morbidity and mortality. A previous study of 488 major abdominal surgery patients demonstrated that urinary biomarkers could predict peri-operative AKI. The aim of this follow-up study was to assess the biomarkers (NGAL, KIM-1, DKK-3 and IGFBP-7*TIMP-2) for their ability to predict long-term changes in renal function.

Methods

Predictive ability for long term renal function derangement was assessed by classifying the participants change in their ‘CKD’ stage from the pre-operative status, determined by the measured eGFR at follow up as per the KDIGO criteria (at least 6 months from their operation). Biomarker performance was assessed utilising AUROC analysis. Biomarkers were also interrogated for their ability to predict mortality at one year.

Results

Follow up measurement of renal function was obtained in 446 of 488 patients. 40 patients died within 1 year of their operation. Median time of follow up renal function measurement was 398 days post operatively (IQR: 366 – 490 days).

169 patients developed an increase in their CKD stage. No biomarker showed good predictive ability for such a rise – all displayed AUC values of <0.6. Similarly, AUC values for the prediction of mortality within one year were low, with all AUC values <0.65.

Discussion

This study has determined that urinary AKI biomarkers are poor predictors for long term derangement in renal function and mortality at one year in the surgical patient. Such evidence suggests that biomarkers are best suited to detect changes in the immediate post operative period.
SP4.4 A Prospective Diagnostic study investigating Urinary Biomarkers of AKI in Major Abdominal Surgery (The AKI-BioMAS Study)
Authors: Singh Rishabh , Maclean William , Singh Toolika , Mackenzie Paul , Rockall Timothy , Forni Lui
Published: August 2023

Aims

To characterize biomarker performance in predicting Acute Kidney Injury (AKI) in Major Abdominal Surgery using both the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine (AKISCr) and urine output (AKIUO) criteria. Post-operative AKI is associated with increased morbidity and mortality. Research assessing AKI biomarkers has focussed on cardiac, vascular and transplant surgery cohorts. Few studies have addressed Major Abdominal Surgery.

Methods

This prospective observational diagnostic study was conducted on 488 major abdominal surgery patients. Urine was collected four hours post-surgery. Biomarkers measured were NGAL, KIM-1, DKK-3 and IGFBP-7*TIMP-2. Diagnostic performance was assessed utilizing Receiver Operating Characteristic (ROC) curve analysis.

Results

242 participants developed AKIUO (49.5%) and 43 AKISCr (8.8%). The area under the receiver operating characteristic curve (AUC) values for stage 1 AKISCr using NGAL was 0.741 (95%CI 0.699-0.770, p<0.001) and 0.871 (95%CI 0.838-.899, p<0.001) for stage 2. AUC values for IGFBP-7*TIMP-2 for stage 1 were 0.655 (95% CI 0.611-0.697, p0.003) and stage 2 0.803 (95%CI 0.764-0.837 p0.002). The AUC for KIM-1 was statistically significant for stage 1 (0.68, 95%CI 0.637-0.722) but not for stage 2. No AUC values for DKK-3 were statistically significant. Biomarkers performed poorly for stage 1 and 2 AKIUO with AUC values of <0.65.

Conclusions

AKI rates following Major Abdominal Surgery are dependent on criteria used. Given the numerous confounders affecting urine output post-operatively it may be that current AKIUO criteria in patients undergoing Major Abdominal Surgery may be inappropriate. This is reflected in poor diagnostic performance of biomarkers in this context. Biomarkers performed better when assessing AKISCr, with NGAL returning the highest AUC values.
SP4.5 Expression of trans-membrane mucins is associated with poor outcomes after chemotherapy in breast cancer
Authors: Hebden Sophie , Jones Stacey , Al Amri Waleed , Maisey Tom , Verghese Eldo , Hughes Thomas
Published: August 2023

Aims

Chemoresistance is a key barrier to breast cancer cures, particularly in the triple-negative subtype. Mucins are O-glycosylated proteins that may drive therapeutic resistance and oncogenic progression in carcinomas. Somatic mutations in mucin 3 (MUC3), 12 (MUC12) and 16 (MUC16) have been identified in breast tumour samples, however their impacts on chemoresponse are poorly explored. We aimed to explore whether breast cancer cell expression of transmembrane mucins MUC3, MUC12 and MUC16 correlates with chemotherapy outcomes.

Methods

Immunohistochemistry was performed on tissue microarrays of primary breast tumours resected from patients subsequently treated with adjuvant chemotherapy (n=303). Tumour cores were semi-quantitively scored based on proportion and intensity of tumour cells staining for MUC3, MUC12 and MUC16. Receiver Operating Characteristic curves were used to dichotomize into relatively high and low expressing groups. Kaplan-Meier analyses were used to determine correlations with disease-free or overall survival.

Results

Relatively high expression of MUC3 was significantly associated with poor outcomes after adjuvant cytotoxic chemotherapy, in terms of shorter disease-free (p=0.001) and overall survival (p=0.016). Interestingly, higher expression of MUC3 was also associated with this apparent chemoresistance in the triple-negative breast cancer subtype specifically, with reduced disease-free (p=0.041) and overall survival (p=0.032). High expression of structurally-related mucins MUC12 or MUC16 also showed possible weak trends towards poor outcomes after chemotherapy, although significance was not reached.

Conclusions

In the future, mucins may offer promise as novel predictive biomarkers, or as targets for inhibition using monoclonal antibodies, for example, to enhance chemoresponse and improve survival outcomes in breast cancer patients.
SP4.6 12 months analysis of the PROM-Q study: Comparison of Patient Reported Outcome Measures using the BREAST-Q questionnaire in pre- versus sub-pectoral implant based immediate breast reconstruction
Authors: Rampal Ritika , Jones Stacey , Young Clare , Hartup Sue , Savage Jessica , Kim Baek
Published: August 2023

Introduction

There is a lack of comparative data on clinical and patient perceived outcomes on pre- versus sub-pectoral implant-based breast reconstruction (IBR). We investigated whether these different surgical approaches influenced clinical or patient perceived outcomes.

Methods

This prospective non-randomised longitudinal cohort study (ClinicalTrials.gov identifier: NCT04842240) recruited patients undergoing immediate IBR (Sep 2019-Sep 2021). Data collection included patient characteristics and post-operative complications. Patients completed BREAST-Q questionnaire at baseline, 2 weeks, 3 and 12 months post-surgery.

Results

We recruited 78 patients (46 pre-pectoral; 59% vs. 32 sub-pectoral; 41%). Patient characteristics were comparable (Table 1). Similar complication rates were observed (15.2% pre-pectoral vs. 9.4% sub-pectoral; p=0.44). Overall implant loss rate was 3.8% (6.5% pre-pectoral vs. 0% sub-pectoral; p=0.14).

Median Breast-Q scores were similar between pre- and sub-pectoral IBR at 3 months; breast satisfaction (58 vs. 48; p=0.12), psychosocial well-being (60 vs. 57; p=0.9), physical well-being (68 vs. 76; p=0.53), and Animation Q scores (73 vs. 76; p=0.45). Similar findings were observed at 12 months; breast satisfaction (58 vs. 53; p=0.3), psychosocial well-being (59 vs. 60; p=0.9), physical well-being (68 vs. 78; p=0.18), and Animation Q scores (69 vs. 73; p=0.4).

Conclusions

This study demonstrates equivalent clinical and patient perceived outcomes between pre- and sub-pectoral IBR, thereby aiding informed decision making regarding either surgical option.
SP4.7 Improving the documentation of breast surgery operation notes: Closing the loop on a quality improvement project
Authors: Wu Fiona , Atkins William , Ghurahoo Linsley , Abdelmawla Ahmed , Trapszo Pawel , Seetharam Seema
Published: August 2023

Aims

The operative note is an important document for ensuring patient safety and effective communication between the MDT. This quality improvement project (QIP) audited the completeness of the breast surgery operative note against the recommendations outlined in the Association of Breast Surgery (ABS) Summary Statement (2015). We developed an operative note proforma to address the deficiencies identified and evaluated the effectiveness of this tool.

Methods

31 operative notes were retrospectively reviewed in our baseline audit (cycle 1) against the recommendations. We audited 17 parameters per note. Questionnaires were also circulated amongst 8 of our nursing colleagues to gather their feedback on the current operative note. An electronic proforma was devised from published recommendations and MDT feedback. We performed a prospective re-audit (cycle 2) of 33 notes following our intervention.

Results

Our baseline audit (cycle 1) identified that 7/17 of the parameters failed to meet the audit standard. 61% (19/31) of the operative notes were electronic. 63% (5/8) of our nursing colleagues agreed the handwritten operative notes were often illegible and all preferred an electronically written document. 1/17 of the parameters failed to meet the audit standard in the re-audit (cycle 2) post-intervention. 97% (32/33) of the notes were electronic and 52% (17/33) was documented using the proforma.

Conclusions

This QIP has demonstrated that improvements in the operative note documentation can be achieved through simple interventions. The proforma has been uploaded onto the local intranet for universal access. The outcome of this QIP is likely to be sustained by our departmental surgeons as documentation now meets recommended standards.
SP5.3 The risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury: A meta-analysis and meta-regression analysis
Authors: Carrington-Windo Eliot , Hajibandeh Shahab , Alessandri Georgio , Duncan Trish , Kumar Nagappan , David O'Reilly
Published: August 2023

Aims

To determine the risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury.

Methods

We performed a systematic review and meta-analysis in compliance with PRISMA statement standards. A search of electronic information sources was conducted to identify all studies reporting the risk of hepatic pseudoaneurysm after liver trauma. The JBI assessment tool was used to assess the risk of bias of the included studies. Random-effects models were applied to calculate pooled outcome data.

Results

A total of 2030 patients from six studies were included. Based on the American Association for the Surgery of Trauma classification system, 21% had grade I injury; 33% grade II injury; 28% grade III injury; 12% grade IV injury; 5% grade V injury. The pooled risk of hepatic pseudoaneurysm was 1.8% (95% CI 1.1-2.5%). The risk was 0.4% (0-1.2%) in patients with grade I injury, 0.7% (0-1.7%) in patients with grade II injury; 1.5% (0.4-2.7%) in patients with grade III injury; 4.6% (1.4-7.7%) in patients with grade IV injury; 10.6% (1.8-22.9%) in patients with grade V injury. The average time between liver injury and detection of hepatic pseudoaneurysm was 6 days (1-10).

Conclusions

The risk of hepatic pseudoaneurysm after liver trauma increases as the severity of liver injury increases. Hepatic pseudoaneurysms are rare after grade I or grade II injuries, and increasingly common after grades III, IV and V injuries. We do not hesitate to recommend routine surveillance imaging in patients with grade III to V injuries.
SP5.7 Prognostic Value of ‘Cachexia Index’ in Patients with Colorectal Cancer Undergoing Surgical Resection
Authors: Brown Leo R , Gardner Ellen , Thompson Josh J , McGovern Josh , Dolan Ross D , Hendry Paul O
Published: August 2023

Aim

Numerous phenotypical features of cachexia have been associated with poorer outcomes in patients with cancer. However, at present, very few of these markers are routinely considered during the shared decision-making process. This study aims to assess the prognostic value of a novel composite marker of cachexia, termed ‘Cachexia Index’, in patients with colorectal cancer.

Method

Consecutive patients who underwent resection of a newly diagnosed colorectal cancer, between Jan 2019 and December 2020, were identified from prospectively maintained databases across two sites. Cachexia index was calculated as (L3 skeletal muscle index) x (serum albumin) / (neutrophil-lymphocyte-ratio). The sex-stratified, cut-off values for cachexia index were determined using area under receiver operating characteristic curves (AUC) and Youden’s Index. The primary outcome of interest was overall survival.

Results

Overall 273 patients (53% male, median 67 years) underwent resection of a colon (n=178) or rectal (n=95) cancer across the study period. Optimum cut-off values for a low cachexia index were defined as <50 for males (AUC=0.792, sensitivity = 0.821, specificity = 0.727) or <35 for females (AUC=0.744, sensitivity = 0.700, specificity = 0.756). Patients with a low cachexia index were older (median 71 vs. 66 years, p=0.029) and had a higher proportion of cT4 (p=0.035) or cN1/2 tumours (p=0.044). Tumour site and ASA grade were comparable between groups. Following adjustment for confounders, using cox-multivariable regression, low cachexia index was associated with decreased overall survival (HR: 3.77, 95% CI: 1.93-7.37, p<0.001).

Conclusion

Cachexia index may be a clinically useful marker for poor prognosis in patients undergoing surgical resection of a colorectal cancer.
SP7.5 Should we analyse all cholecystectomy specimens? An analysis of the features of incidentally discovered gallbladder cancers
Authors: Scicluna Chiara , McElroy Luke , Roberts Fiona , Gough Vivienne , Kohnen Gabriele
Published: August 2023

Aims

Gallbladder cancer is the commonest form of malignancy of the biliary tract, but is rare in Western countries. A large proportion of cases are incidentally diagnosed at surgery or from the cholecystectomy specimen. The analysis of gallbladder specimens costs our health board around £42,000 per year. The aim was to identify any predictive factors in incidentally discovered gallbladder cancers.

Methods

All gallbladder specimen reports at our health board between May 2012 and September 2022 were analysed and filtered so incidental cancer cases could be analysed for any predictive features. Outcomes with only dysplasia were removed.

Results

16,695 eligible reports were analysed of which 32 had malignant outcomes. The median age for malignancy was 71 vs 50 for benign. 30 were adenocarcinoma and 2 were adenosquamous carcinoma. 14 presented with cholecystitis, 9 with biliary colic, 6 with choledocholithiasis and 3 with gallstone pancreatitis. Intraoperatively, 7 had normal appearances, 20 were reported at being ‘thickened’, 2 ‘contracted’, 2 with empyema and 1 with a mucocoele. 6 patients had a subtotal cholecystectomy and in all cases this was due to intraoperative difficulty.

Conclusions

We could not identify any single feature that predicted or excluded the presence of cancer. Given that the lower age limit for malignancy was 51, a consideration could be made for not processing specimens from patients under the age of 45 as the likelihood of diagnosing incidental carcinoma is extremely unlikely and would reduce the yearly processing by 37% with a cost saving of £15,500 per year.
SP8.1 Patient perception of the informed consent process: A single centre cohort study comparing paper and digital consent
Authors: Hussain Mohammad Iqbal , Coombs Alex , Lameirinhas Claudia , Agrawal Avi , Toh Simon , John Edward St
Published: August 2023

Aims

NHS Digital set eConsent as a priority for 2021-2022 and digital consent is now being adopted by many hospitals. This study aims to compare how patients perceive the consenting process on both paper and digital platforms.

Methods

A prospective service evaluation was conducted in a university hospital (May 2022-December 2022), across 9 specialities, to compare paper with digital consent. as a part of an SBRI-granted project (SBRIH19P3055) to identify the economic benefits of digital consent. The digital consent solution was provided by Concentric Health. Time-motion study assessing the consultation time required to consent a patient was conducted in clinics. Patient feedback was obtained through structured questionnaires, including the CollaboRATE score (validated to measure shared decision-making, SDM).

Results

Patient feedback was compared for 151 responders from each group. 92 (60.9%) responders in the digital group scored the CollaboRATE Topscore (representative of gold standard SDM) in comparison to 71 (47%) responders in the paper consent group. 113 patients had experienced both paper and digital consent, of which 73 (64.6%) patients prefer digital consent and 40 (35.3%) prefer paper consent. Sub-analysis of consultation time (including both consent and clinic time) revealed no significant difference P=0.102 between the use of paper (n=21) and digital (n=26) consent.

Conclusion

Digital consent is favoured by patients perhaps because it enables more meaningful and detailed discussion of information before surgery. Patient satisfaction regarding their involvement in SDM is higher with digital consent than with paper consent. Further studies are needed to evaluate the value of digital consent.
SP8.10 Auditing periprocedural antibiotic prophylaxis (PAP) in emergency surgery using NAPS surgical ™
Authors: Shamiyah Khalid Adnan , Yu Hans , Yan Helen , Bond-smith Giles , Jones Nicola
Published: August 2023

Aim

The study aimed to investigate the compliance with guidelines and the appropriateness of periprocedural antibiotic prophylaxis (PAP) in emergency surgery at the John Radcliffe Hospital. The study also aimed to determine the usefulness of NAPS surgical™ in monitoring and evaluating PAP usage.

Methods

The study conducted a retrospective analysis of medical charts for 97 consecutive emergency general surgical operations in August 2022. Data collected included the type of surgery, antibiotics administered, and compliance with local guidelines. The data was analyzed using NAPS surgical™.

Results

In 97 cases, 40 patients did not receive PAP, 26 of which were deemed appropriate. 57 patients received 76 doses of antibiotics, 51 of which were deemed inappropriate, mainly due to the administration of PAP to low-risk cases or outside of the recommended timing. Cefazolin was the most commonly used drug and no adverse effects were reported.

Conclusions

The study highlights the value of NAPS surgical™ in monitoring prophylactic antibiotic usage and the need for ongoing monitoring and education. NAPS surgical™ provides a comprehensive evaluation of antibiotic use, is cost-effective, and allows for direct comparison with other hospitals, providing insight into best practices. The hospital found NAPS surgical™ useful in assessing antibiotic stewardship and monitoring stewardship interventions.
SP9.2 Penthrox Is Effective but Is It Patient Approved?
Authors: Dias Ana , Zeidan Ziad , Copp Matt , Eslabra Francis , Hassan Rawan , Middleton Rory
Published: August 2023

Aim

Penthrox is a handheld inhaler that administers methoxyflurane. Its use is approved for analgesia in moderate-to-severe trauma-related pain in adults in emergency department (ED). The literature currently lacks methodologically robust qualitative data on individual patient experience. Using a structured qualitative study, we set out to address this shortcoming.

Methods

Focus group: Five patients were selected to identify key themes they felt important to explore and these were included in the questionnaire design.

Study Design

We retrospectively identified all uses of Penthrox in ED from June to August 2021. Qualitative data was gathered using the Trickett short interview method and responses grouped into positive and negative descriptors. In addition, quantitative data concerning their experience using 5-point Lickert scales were also gathered.

Results

Questionnaires: 101 responded to the questionnaire. Penthrox® was utilised mainly for the manipulation of fractures, most commonly for that of the Ankle and Wrist. 90% reported an overall satisfaction of ‘≥ Good’. 97% reported ease-of-use ‘≥ Good’. Its analgesic effectiveness was rated as ‘Excellent’ by 52%, and ‘≥ Good’ by 89%. The most reported side-effects were drowsiness (13%) and nausea (7%). The majority reported no side-effects (74%). 94% would take it again if required. A NVIVO word cloud was created visually confirming an overall positive experience amongst the patients.

Conclusions

This study shows that Penthrox is a well-tolerated and user-friendly means of alleviating trauma-related pain in ED. It highlights the importance of taking into consideration the individual patient journey alongside robust evidence-based data on safety and efficacy for the development of a holistic treatment.
SP9.8 An Audit of Intraoperative Hypothermia Rates in Adults Undergoing Emergency Surgery in a Tertiary General Surgical Unit and Evaluation of the Efficacy of Preoperative and Intraoperative Forced-Air Warming on Achieving Intraoperative Normothermia
Authors: Foran Daniel , Bramer Solange , Pledge Alexandra , Bond-Smith Giles
Published: August 2023

Aims

Surgical site infections (SSIs) inflict significant economic burden on the NHS. Preoperative and intraoperative hypothermia are risk factors for SSIs. Evidence shows that maintenance of intraoperative normothermia significantly reduces SSI rates. Perioperative SSI bundles addressing factors including hair removal, antibiotic prophylaxis, skin preparation, drape positioning, and hypothermia are critical to improving SSI rates. We aim to audit rates of intraoperative hypothermia in our surgical caseload and evaluate the efficacy of preoperative and intraoperative forced-air warming through bespoke gowns in achieving intraoperative normothermia.

Methods

We conducted a retrospective audit of the intraoperative core temperatures of all adult patients undergoing surgical procedures on the emergency theatre list of a general surgery department and who had a temperature at knife-to-skin recorded (n=88). We then ran a prospective trial, outfitting patients listed for surgery (n=15) with forced-air warming gowns. Patients underwent forced-air warming with the gowns for 45 minutes on the surgical ward, throughout anaesthetic induction, and intraoperatively. Patient core temperature was measured at baseline, upon arrival at the anaesthetic room, and at knife-to-skin.

Results

Baseline audit data showed over 18% of patients were hypothermic at knife-to-skin. Contrastingly, 100% of patients wearing forced-air warming gowns were normothermic at knife-to-skin. The mean core temperature at knife-to-skin was significantly higher in patients wearing warming gowns (p=0.012).

Conclusions

Forced-air warming gowns are superior to traditional hospital gowns, blankets and surgical access forced-air warming devices in achieving intraoperative normothermia. They are an effective, sustainable, and cost-neutral, ‘all-in-one’ alternative to current perioperative protocol and will reduce SSI rates.
SP9.16 An international consensus for mitigation of the detrimental effects of the COVID-19 pandemic on laparoscopic training
Authors: De Veciana Anna Jimenez , Kwan Jing Yi , Long Judith , Sedman Peter , Chetter Ian , Yiasemidou Marina
Published: August 2023

Aim

Achieve an international consensus on how to recover lost training opportunities.

Background

A global survey conducted by our team revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conducted a survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic.

Methods

A questionnaire was proposed; this was based on the results of expert semi-structured interviews. After validation, the questionnaire was disseminated to trainers across the globe.

Results

208 international surgeons replied (M:80.29%). Most were 35-44y.o. (71/208) and worked in teaching hospitals (75.96%). The topics of the questionnaire were: (1)causes of impact, with lack of theatre time (108/164) and management pressures to finish cases quickly (102/164) being identified, (2)availability of guidelines, highlighting lack thereof (93/164) and highlighting the importance of training recovery specific guidelines (112/155) (3)impact of COVID-19 on trainer’s morale, with 87/164 feeling demoralised (4)mentorship; mentorship should be provided (139/155) (5)curriculum changes; opportunities for training in each list (138/155), dedicated training lists (120/155), pairing junior to senior trainees (130/155), training should be individualised to address different levels of needs (134/155) (6)simulation training; should be integrated in the curriculum (127/155), with individualised targets (129/155) and supervised.

Conclusion

This international survey provides a straightforward guide for the recovery of training after the COVID-19 pandemic.
SP10.1 Post operative complications and functional outcome after ventral mesh and suture rectopexy for rectal prolapse: a single centre observational study
Authors: Anand Easan , Ravi Prabhu , Satti Suren , Sidhom Mark , Venkatasubramanian Arcot
Published: August 2023

Aims

Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. The aim of this study was to evaluate post op complications (early, late and mesh) and functional outcomes after a standardized LVMR.

Methods

All patients who underwent Rectopexy from February 2008 to April 2021 were included into the study. The patients were evaluated preoperatively, at 3 months and 1 year postoperatively. Surgical complications, mesh complications (mesh detachment, erosion and infection) and functional results in terms of faecal incontinence, recurrence and ODS were analysed.

Results

95 patients (88 – LVMR; 7 - suture Rectopexy) who underwent Rectopexy were included in the study with a mean age of 68 and female predominance of 90 patients. 30 patients had external rectal prolapse (ERP), 45 patients had internal rectal prolapse (IRP) or intussusception, 20 patients had both ERP and IRP (Table 3). 53 patients had preoperative MRI scan and 15 patients had preoperative proctogram. (Table 4).

92 patients did not have any early complications. 13 patients had late postoperative complications including recurrent prolapse, stoma formation, suture migration and incisional hernia. Mesh complications were seen in 2 patients with mesh erosion and mesh detachment, both of whom had non-absorbable stitches used. There were no post op deaths documented. During the follow up period, 12 patient developed symptoms of ODS.

Conclusion

LVMR is a safe and effective treatment for rectal prolapse. Careful patient selection, appropriate preoperative workup, and meticulous surgical technique undoubtedly transforms postoperative outcomes.
SP10.3 Colectomy for Inflammatory Bowel Disease (IBD) – use of the National Consultant Information Programme (NCIP) to highlight colorectal surgical practice in England
Authors: Galla Aashlesha , Maxwell-Armstrong Charles , Booth Matthew , Young Lucy , Bogovac Marina , Williams Norman
Published: August 2023

Introduction

The NCIP tool uses HES data from Trusts to understand the spread and variation of a range of surgical procedures. There are two forms of IBD; Crohn’s and Ulcerative Colitis (UC). This work uses NCIP to contextualise data and understand Covid-19’s impact and the current practice of colectomy for IBD in England.

Method

Pseudonymised data was extracted from NCIP dashboards by NHS England Improvement data analysts. Various metrics were analysed including surgical approach, frequency of cases, length of stay (LOS), incidence of stoma maturation and readmission, and mortality.

Results

3907 Crohn’s and 1942 UC cases performed from April 2019-March 2022. Decrease observed in frequency during Covid-19.

Crohn’s: 47.76% laparoscopic cases. 17.42% of total providers did <10 cases in 4-year period. Average LOS was 9.01 days ± 0.16 with 95% CI [8.70, 9.32], p<0.001. Mean stoma rate was 31.73% in units performing ≥20 cases. 30-day readmission was 17.33%. 90-day mortality was 0.23%.

UC: 56.54% laparoscopic cases. 47.29% of total providers did <10 cases in the 4-year period. Average LOS was 10.39 days ± 0.29 with 95% CI [9.82,10.96], p<0.001. Mean stoma rate was 87.09% in units performing ≥20 cases. 30-day readmission was 21.94%. 90-day mortality was 0.82%.

Conclusion

Covid-19 decreased current practice for IBD colectomies, possibly due to RCS guidance recommending temporary suspension of non-cancer surgery during the pandemic. Lower laparoscopy rates than expected. Significant centre variation and variation in stoma rate observed. Data suggests stoma creation within episode is a contributor to higher average LOS and readmission rate (p<0.05).
SP10.12 Would You Like a Pus Swab Sent?
Authors: Lingam Gita , Hu Kylin , Pamma Aarondeep , Kirmani Naveed
Published: August 2023

Aim

The Association of Coloproctology of Great Britain and Ireland (ACPGBI) consensus guidelines in emergency colorectal surgery states that microbiology sampling is of limited value in the management of anorectal abscesses. Several centres continue to send intra-operative swabs routinely for microbiology. This study aims to identify (1) if sampling changed postoperative management and (2) quantify the financial cost of sending unnecessary swabs within a district general hospital setting.

Methods

Retrospective study investigating intraoperative clinician use of microbiology swabs. Study sample included patients who underwent an incision and drainage of an anorectal abscess from 1st October 2021 to 1st October 2022 in a district general hospital setting.

Results

A review of patient data obtained 59 patients who underwent an incision and drainage of an anorectal abscess. Swabs were taken in 54 (91.5%) cases. At 2 months, 40.7% of the swab results had not been reviewed by a clinician. 89% of swab results were reported after the patient was discharged. No documentation mentioned reviewing microbiology results in a follow-up clinic. There was no documented change of antibiotics nor correlation found between swab results and magnetic resonance imaging (MRI) requests/findings. Each microbiology swab costs £3 and labour costs are a minimum of £10 per swab analysed by a band 6 biomedical scientist. Total cost incurred per year was therefore estimated at £702.

Conclusions

Surgeons tend not to review microbiology results at follow-up appointments. Furthermore, there was no evidence that microbiology sampling resulted in change in patient management. Unnecessary use of swabs contributes to the NHS economic burden with no additional clinical benefit.
SP11.9 A Vascular Surgeon's Dilemma - Biodegradable Versus Non-Biodegradable Drug Eluting Stents: A Systematic Review and Meta Analysis
Authors: Shah Aishwarya , Kumar Niraj
Published: August 2023

Aims

Vascular stents are the best-known interventional treatment for cardiovascular disease, with variation in available stents increasing significantly over time. Despite the rapidity of new prototype releases, critical cross-comparisons fail to maintain the same rate, therefore causing confusion for vascular surgeons. Research is most notably lacking between biodegradable-polymer sirolimus-eluting stents (BP-SESs) and permanent-polymer sirolimus-eluting stents (PP-SESs). Therefore, a systematic review with meta-analysis was conducted evaluating clinical outcomes.

Methods

Using relevant synonyms of “biodegradable”, “sirolimus” and “stent”, the databases Medline, Embase, and Scopus were searched, with the final search being conducted on the 4th of November 2022. Reference lists were also screened. The clinical outcomes investigated were stent thrombosis (ST), myocardial infarction (MI), target vessel revascularisation (TVR), target lesion revascularisation (TLR), and death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

Five clinical trials directly comparing clinical outcomes between BP-SESs and PP-SESs were ultimately identified for inclusion. For all five outcomes investigated, no statistically significant difference (p>0.05) was found between the BP-SES and the PP-SES recipients. Pooled odds ratios of 0.86 (95% CI:0.44-1.65), 0.75 (95% CI:0.32-1.74), 1.12 (95% CI:0.54-2.32), 1.14 (95% CI:0.38-3.38) and 0.95 (95% CI:0.51-1.77) were calculated for ST, MI, TVR, TLR and death respectively.

Conclusions

Although there is some evidence to suggest BP-SESs are noninferior to PP-SESs, concrete conclusions cannot yet be drawn due to the paucity of research in this field. Further clarity from randomised control trials will aid additional examination and improvement in stent materials and outcomes.
SP11.10 Assessment of Heart Rate Variability as A Marker of Stress and Cognitive Load During Vascular Surgery: Surgical Training
Authors: Mandal Manish , De Louche Calvin , Fernandes Lee , Lawson Jason , Pouncey Anna Louise , Bicknell Colin D
Published: August 2023

Introduction

Decreased heart rate variability (HRV) correlates with subjective stress (STAI-6 score) and demonstrates increased stress at challenging steps during vascular surgery. This observational study aimed to examine HRV utility as an objective measure of stress and satisfaction during intra-operative vascular surgical training; hypothesising detrimental HRV change is associated with: (1) low training satisfaction, (2) operating compared to assisting, and (3) lower surgical experience.

Methods

Change from baseline (%) in HRV (SDNN - overall variability and LFHF - sympathetic tone) was calculated during arterial cutdown and arterial closure training points in 7 trainers and 10 trainees during 9 femoral vascular procedures. Pearson’s correlation coefficient was used to investigate association between training satisfaction and operative HRV in trainees, and overall operative experience and training point HRV. Mann-Whitney-U was used to investigate HRV difference in operating trainees with high versus average training satisfaction and operating versus assisting/supervising training points.

Results

Data (median (IQR)) included 13 cutdowns and 12 closures. Training satisfaction did not relate to STAI-6 or HRV. LFHF was significantly lower in trainers when operating (n=2) compared to supervising (n=10) cutdown (-18.96(-27.87--10.05) vs 36.96(10.83-147.2) p=0.0409*). No difference was seen during closure or in trainees. Operative LFHF non-significantly decreased with experience overall (r=-0.342, p=0.0944) and during cutdown (r=-0.498, p=0.0833), no association existed for assisting.

Conclusion

HRV may objectively measure stress during in-theatre training. This study suggests trainers may experience more stress when supervising rather than operating. Larger studies are required to demonstrate a more definitive relationship between training, stress and HRV.