bluuebunny/crossref_metadata_2025 huggingface dataset:
O025 The epidemiology of gastroenteropancreatic neuroendocrine tumours (GEP-NETS) in the north-east of England and a systematic review of literature
Authors: Chu GHC , Etherson KJ , McNally R , Robinson SM
Published: November 2022

Introduction

Gastroenteropancreatic neuroendocrine tumours (GEP-NETs) are rare, indolent malignancies with unknown aetiology and an increasing incidence was observed globally. With limited research on GEP-NET epidemiology, the reasons behind incidence disparities between countries remain unclear. Whether this increase was a true phenomenon or was confounded by factors including diagnostics advancement and classification evolution needs further enquiry. The aims are to evaluate all available literature on GEP-NET incidence rates (IR), and to determine GEP-NET incidence in the North-East and the association between survival and age, gender, grade, stage, and socioeconomic status (SES).

Methods

Systematic review of relevant literature using MEDLINE, Embase, Scopus and Web of Science. Quality of methodology was assessed using the Newcastle-Ottawa Scale. (2) 140 GEP-NET patients from 1996 to 2019 were identified. Crude IR, age-standardised IR and overall survival (OS) were determined. Outcome parameters were identified from Cox-proportional Hazard analysis.

Results

GEP-NET global incidence increased in the last decades, whereas Asia and various European countries reported no significant changes. Ethnic and gender differences were observed. (2) Over 23 years, IR increased by 40.5% per annum (0.08–5.94/1,000,000). 5- and 10-year OS were 71.0% and 28.9% respectively. SES had non-significant associations with the covariates. Age >70 yrs (HR=5.48 [2.20–13.66], p<0.001) and middle SES (HR=2.23 [1.05–3.75], p=0.038) were independent predictors for worse prognosis.

Conclusion

GEP-NETs continue to rise despite differences in reporting methods across the literatures and underlying factors not being captured in this population-based study. A prospective NET registry is necessary to elucidate accurate GEP-NET epidemiology in the UK.

Take-home message

GEP-NET incidence rates are evidently increasing both in the North-East and globally; yet, the reasons behind such increase remain unclear. This highlights the establishment of a prospective neuroendocrine tumour (NET) registry is imperative in the North-East or in the UK so that all GEPNETs can be captured and detect subtle incidence changes over time.
O028 Multi-centre UK analysis after simultaneous pancreas and kidney transplantation in recipients with type 2 diabetes mellitus
Authors: Owen RV , Carr HJ , Counter C , Thompson EJ , Shaw JA , Wilson CH , White SA
Published: November 2022

Introduction

Only 3.4% of simultaneous pancreas and kidney transplants (SPKT) in the UK are performed for recipients with T2DM. The aim of this study was to compare outcomes after SPKT for recipients with either T1DM or T2DM.

Methods

Data on all UK SPKTs from 2003–2019 were obtained from the NHSBT UK Transplant Registry (n=2,236). Current SPKT selection criteria for T2DM requires insulin treatment and recipient BMI<30kg/m2 at listing. Cases where the aetiology of diabetes was missing and recipients who had received a re-transplant were excluded, resulting in a final cohort of n=2,154. Graft (GS) and patient (PS) survival analyses were conducted using Kaplan-Meier plots and Cox regression models. Complications were compared using chi-squared analyses.

Results

The majority of SPKTs were performed in recipients with T1DM (95.6%, n=2,060), and 3.4% (n=94) were performed in T2DM recipients. Recipients with T2DM were statistically significantly more likely to be older (p<0.0001), male (p<0.0001), with a higher BMI (p=0.0191), and not requiring dialysis (p<0.0001). Univariate analysis showed comparable outcomes for GS and PS at 1yr (GS p=0.120; PS p=0.886) and 3yrs (GS p=0.316; PS p=0.237). Multi-variate analysis also showed comparable outcomes in GS (p=0.564, HR 1.221, 95%CI 0.619, 2.406) and PS (p=0.556, HR 1.280, 95%CI 0.563, 2.911). Common complications after SPKT were analysed and no statistically significant differences were seen between recipients.

Conclusion

This is the largest European study evaluating outcomes after SPKT comparing recipients with T1DM or T2DM. Carefully selected recipients with T2DM were shown to have comparable graft survival, patient survival and rates of complications.

Take-home message

Carefully selected recipients with T2DM were shown to have comparable graft survival, patient survival and rates of complications.
O032 Simultaneous liver and thoracic transplantation: outcomes in a specialist centre in the United Kingdom
Authors: Malik AK , Dark J , Wilson CH , Sen G , Talbot D , Masson S , Hassan A , White SA , Manas DM
Published: November 2022

Introduction

Operative and logistical complexity of combined heart-liver (HLTx) and combined lung-liver (LLTx) transplantation limit the wider adoption of such a specialist procedure. We report a consecutive series of patients who underwent simultaneous liver and thoracic transplants

Methods

We performed a retrospective review of patients undergoing combined liver and thoracic transplantation from 2001–2021. Patients were discussed at a joint liver-thoracic multi-disciplinary team meeting Perioperative care was managed jointly by liver and thoracic anaesthetic teams. Immunosuppression was guided by cardiothoracic protocols.

Results

Seven patients (5M:2F, age range 21–54) underwent HLTx/LLTx. Four underwent HLTx transplantation whereas 3 underwent LLTx, all combined with a simultaneous liver transplant. Indications for HLTx were failing Fontan circulations with associated liver cirrhosis (n=3) and failing Fontan circulation with solitary 6.6 cm hepatocellular carcinoma treated with 5 rounds of trans-arterial chemoembolization pre-transplantation (n=1). Indications for LLTx were cystic fibrosis with associated cirrhosis (n=2) and alpha-1 antitrypsin deficiency (n=1). The following complications were also managed; for HLTx biliary stricture needing hepaticojejunostomy (n=1), sternal debridement (n=1), re-sternotomy for haemodynamic compromise (n=1), and for LLTx endoscopic management of a biliary stricture (n=1). There was one mortality in the series in a HLTx who was highly sensitised and developed acute rejection with multiorgan failure and died on day 12. The remaining six patients are alive and well following transplantation, with follow-up ranging from 8 months to 15 years.

Conclusion

Combined liver and thoracic transplants are a high-risk intervention, but can produce acceptable outcomes in selected patients despite the complexity and logistical issues.

Take-home message

Combined liver and thoracic transplantation is a complex procedure, suitable for selected patients and performed in a specialist centre to achieve acceptable outcomes.
O034 Incidentally enlarged iliac lymph nodes in renal transplantation – a sting in the tail!
Authors: Malik AK , Moulding S , Manas DM , Rix D , Sen G , Amer A , White SA , Figuiereido R , Talbot D , Wilson CH
Published: November 2022

Introduction

During renal transplant, lymphadenectomy around the iliac vessels is performed to provide adequate access. Enlarged iliac lymph nodes have unclear clinical significance and standard guidance. We audited lymph node histopathology to evaluate their significance.

Methods

Two audit cycles (January to August 2020 and September 2020 to October 2021, respectively) were performed. Following the first cycle, recommendation was that all enlarged lymph nodes should be biopsied. We reviewed patient histopathology and subsequent follow-up of patients with enlarged lymph nodes.

Results

241 patients underwent renal transplantation, with 19 Patients having enlarged lymph nodes (median 35mm, range 12–77mm, figure 1) sent for histopathology. Specimens from 16 patients showed benign/reactive changes (7 patients CMV positive, 14 EBV positive). Two specimens contained no lymph node. One patient (CMV and EBV positive) demonstrated evidence of chronic lymphocytic leukaemia, followed up with a bone trephine biopsy and staging CT. Staging revealed lymphadenopathy on both sides of the diaphragm and an incidental 19mm renal cell carcinoma in the native right kidney. A watch and wait strategy was employed. All 19 patients who underwent lymph node sampling were alive at last follow up.

Conclusion

A literature review revealed no study into the best practice for managing incidentally enlarged lymph nodes. They are of unclear significance but may represent significant pathology requiring further follow up and management. We recommend that all lymph nodes with suspicious features and/or measuring >30mm are sampled for histopathology.

Take-home message

Enlarged lymph nodes (>30mm) should be biopsied, as they may be associated with significant pathology requiring follow up and/or intervention.
O037 Future informed consent research – a step in the wrong direction!
Authors: Clements JM , Convie LJ , Kirk SJ , Clarke M
Published: November 2022

Introduction

Over 300 million invasive procedures occur globally every year, each requiring patient informed consent. No single outcome measure exists for measurement of the informed consent process. A core outcome set (COS) for informed consent for therapy consisting of 9 outcomes has been developed to define what outcomes matter to key stakeholders in the informed consent process. We aimed to identify the frequency of uptake of the COS consent outcomes in future randomised control trials.

Methods

A systematic review of prospectively registered randomised control trial protocols was performed. The online trial registries World Health Organisation (WHO) International Clinical Trials Registry Platform (ICTRP) and the US National Library of Medicine ClinicalTrials.gov were searched. All studies assessing interventions designed to improve the informed consent process were considered.

Results

627 registered protocols were identified of which 22 met the inclusion criteria. Only two core outcomes were reported in any prospective interventional consent trial protocols. Patient satisfaction with the consent process and patient satisfaction with the amount of information were observed which employed unvalidated tools. Patient knowledge was the predominant primary outcome measure (n=20). Unvalidated measurement tools were used in all cases. Patient anxiety, decisional regret and decisional conflict were the only outcomes consistently measured using validated measurement tools.

Conclusion

The use of unvalidated outcome measurement tools in future consent trials are widespread. This review has highlighted the clear disconnect between chosen outcomes in future consent trial protocols and an established informed consent COS, limiting the potential value of outputs in future consent trials.

Take-home message

A clear disconnect exists between the outcome measures used in prospective consent randomised trials and an established core outcome set for informed consent for therapy.
O040 Patient reported outcomes and experiences following emergency laparotomy: a mixed methods patient survey
Authors: Silva L , Mohammed SA , Strong P , Watts T , Torkington J , Cornish J
Published: November 2022

Introduction

Emergency laparotomy (EmLap) is a “life-saving” procedure, but little is known about how “life-changing” it can be. This study aims to establish the impact of EmLap on PROMs and PREMs.

Methods

All surviving patients who had an EmLap from 2016–2019 were included. Eligible patients were invited to complete a postal questionnaire. Responses underwent qualitative and logistical regression analysis.

Results

Response rate was 42.6% (n=310). 11.3% reported that they had not resumed intimacy post-op. Patients were less likely to resume intimacy if they were >80 years (OR 10.500, p0.003), had a return to theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR 4.906, p0.003). Patients were more likely to change employment if female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had a stoma (OR 4.006, p<0.001), or incisional hernia (OR 4.228, p<0.001). Qualitative analysis revealed deconditioning, lack of employer support, and delays to reconstructive surgery were the main reasons for not returning to work. Qualitative analysis of experience exposed a number of unmet needs: surgical “debrief” and “what to expect” (33.6%), surgical aftercare (25.2%), mental-health support (22.6%) and timely restorative surgery (11.7%). 88.1% felt a specialist nurse would have improved their experience. Patients were more likely to have reported a negative experience if they had benign disease (p0.010).

Conclusion

This is the first study to describe PROMS and PREMS following EmLap, and also to identify patients at risk of poor outcome. It advocates the need for an EmLap specialist nurse to facilitate holistic care.
O041 Utilising digital follow-up after elective laparoscopic cholecystectomy: a feasibility study
Authors: Daliya P , Carvell J , Rozentals J , Lobo DN , Parsons SL
Published: November 2022

Introduction

Cholecystectomy is one of many operations performed nationally for which routine postoperative follow-up is no longer offered. National guidelines recommend patients are offered a postoperative helpline or telephone follow-up (TFU) appointment at discharge. Whilst the benefits of TFU are well documented, the use of digital modalities is less so. The objective of this study was to identify if digital follow-up (DFU) using an online platform, was equivalent to TFU.

Methods

Patients listed for elective laparoscopic cholecystectomy between August 2016 and March 2018 were given free choice to opt for postoperative DFU or routine postoperative care (TFU or no follow-up) at a tertiary referral centre in Nottingham. Primary objectives were to identify the incidence of 30-day postoperative complications identified by DFU compared with TFU. Secondary objectives were identifying the incidence of readmissions at 30-days, reoperations at 30-days, the incidence of missed complications at 30-days, and compliance with follow-up between groups.

Results

Of 597 patients undergoing laparoscopic cholecystectomy, 199 (33.3%) opted for TFU, and 98 for (16.4%) DFU. DFU was completed for 85 (86.7%) participants and TFU for 125 (62.8%), p<0.0001. Over 5 times as many patients who chose TFU missed their appointment compared with choosing DFU (5.6% vs. 30.9%, p < 0.001). DFU was completed earlier than TFU (median 6 days vs. 13.5 days, p=0.001) with high patient acceptability, identifying complications and alerting clinicians to those patients requiring early review.

Conclusion

This feasibility study has demonstrated that DFU is an acceptable alternative to TFU after elective laparoscopic cholecystectomy.
O042 Risk of postoperative venous thromboembolism following benign colorectal surgery: systematic review and meta-analysis
Authors: Leow TW , Rashid A , Lewis-Lloyd CA , Crooks CJ , Humes DJ
Published: November 2022

Introduction

Venous thromboembolism (VTE) is a well-established complication after colectomy. VTE prophylaxis guidelines for benign colorectal disease is scarce, partly due to the paucity of studies reporting post-operative VTE rates of benign disease. This meta-analysis aimed to quantify the VTE risk after benign colorectal resection and determine its variability.

Methods

Embase, Medline, and 4 other registered medical databases were searched from database inception to 21 June 2021. Inclusion criteria: RCTs and large population-based database cohort studies reporting 30-day and 90-day VTE rates after benign colorectal resection in patients aged ≥18 years. Exclusion criteria: Patients undergoing colorectal cancer surgery. Studies were grouped for meta-analysis according to post-operative follow-up duration, admission type and indication for surgery.

Results

17 studies were eligible for meta-analysis reporting on 250,170 patients. Pooled 30-day and 90-day VTE incidence rates after benign colorectal resection were 284 (95%CI, 224–360) and 84 (95%CI, 33–218) per 1,000 person-years. Stratified by admission type, 30-day VTE incidence rates per 1,000 person-years were 532 (95% CI, 447–664) for emergency and 213 (95% CI, 100–453) for elective colorectal resections. 30-day VTE incidence rates per 1,000 person-years postcolectomy were 485 (95%CI, 411–573) for ulcerative colitis, 228 (95%CI, 181–288) for Crohn's disease and 208 (95%CI, 152–288) for diverticulitis patients.

Conclusion

VTE rates remain high up to 90-days after colectomy. Emergency compared to elective benign resections have higher rates of post-operative VTE. Further studies reporting VTE rates by type of benign disease need to stratify rates by admission type to more accurately define postcolectomy VTE risk.

Take-home message

VTE risk following benign colorectal surgery is high, especially among those who underwent emergency surgery. Extended venous thromboprophylaxis should be considered for these group of patients.
O043 The outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England
Authors: Adiamah A , Rashid A , Crooks C.J , Hammond JS , Jepsen P , West J , Humes DJ
Published: November 2022

Introduction

The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections, and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis.

Methods

Adult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink, and hospital episode statistics data. Length of stay, re-admission, Case fatality, and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex, and co-morbidity using logistic regression.

Results

A total of 40353 patients underwent appendicectomy and of these 75(0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p <0.0001) and have comorbidities (p<0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90-days (20% vs 11%, p=0.019). Most importantly, their odds of death at 90-days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49)

Conclusion

Patients with cirrhosis have a 3-fold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis.

Take-home message

Patients with cirrhosis have a 3-fold increased mortality risk than those without cirrhosis. They also have longer hospital stays and higher risk of readmissions.
O045 A systematic review of observational management of cutaneous basal cell carcinoma
Authors: Goodall R , Chicco M , Wietek N , Borsky K , Harrison C , Rodrigues J
Published: November 2022

Background

Cutaneous basal cell carcinoma (BCC) is the commonest cancer in the United Kingdom. Surgical excision is the most common treatment. This review summarises all published outcomes of observational/non-interventional management of BCC.

Methods

This PRISMA-compliant systematic review searched MEDLINE, EMBASE and CENTRAL databases from inception-June 2021. All studies reporting outcomes of observational management for BCC were included.

Results

From 2529 titles, four full-text articles reporting on 2298 individuals were eligible. Two studies were randomised controlled trials (RCTs) comparing histological clearance rates and adverse events following treatment with an inactive strategy (placebo cream) versus topical 5%-imiquimod (at different frequencies) for 6–12 weeks. Clearance rates ranged from 52–100% for imiquimod and 2–19% for placebo, with more adverse events associated with imiquimod. The other two studies used prospective cohort designs. One study assessed the natural history of BCCs managed expectantly in 39 individuals aged ≥80years. During the 15.8-month follow-up, 46.2% of lesions did not increase in size and 10.3% resolved. The remaining study compared treatment patterns of 1360 patients with non-melanoma skin cancer (NMSC) in individuals with or without limited life-expectancy (LLE). The LLE subgroup had a 5-year mortality rate of 43.3%, with no deaths attributed to NMSC. Only 3.3% of individuals with LLE underwent observational treatment. No study examined quality-of-life or cost-effectiveness.

Conclusion

There has been limited investigation of observational management of BCC, despite possible advantages of this strategy. Future RCTs should compare quality-of-life outcomes and utility adjusted survival following interventional or observational management of BCC.

Take-home message

This systemic review identifies a lack of data reporting outcomes following observational management of BCC, despite possible advantages of this treatment strategy. Future RCTs should compare quality of life outcomes and utility-adjusted survival following interventional or observational management of BCC.
O046 Incidental appendicectomy in pancreas transplantation: a single-centre study
Authors: Hussein A , Gill-Barman B , Karydis N , Callaghan C
Published: November 2022

Introduction

Pancreas transplantation is associated with a significant rate of surgical complications, some of which have similar clinical features to acute appendicitis. An incidental appendicectomy (IA) at the time of pancreas transplantation could reduce future diagnostic uncertainty. This study aimed to establish the number of IA undertaken during pancreas transplantation in our unit and examine outcomes. Of those patients that did not undergo an IA, we identified those that subsequently required intervention for their appendix.

Methods

A database of patients who underwent a pancreas transplant in our unit from 01/01/2012 to 10/12/2020 was obtained and patients were followed up until 01/03/2021. Electronic records were examined. Standard statistical analyses were undertaken and death-censored graft survivals were compared using the log-rank test.

Results

243 patients underwent a pancreas transplant. Of the 227 (93%) patients that had not previously had an appendicectomy, 53 (23%) underwent an IA during transplantation. There were no complications and 2 carcinoid tumours were identified. Of the 174 (77%) patients that did not undergo an IA, 3 (2%) patients required subsequent intervention for the appendix. There was no statistically significant difference in operative time (p=0.06), index inpatient length of stay (p=0.50), ICU stay (p=0.80), pancreatic graft survival (p=0.50), or kidney graft survival (p=0.70) between patients who had an IA and those who did not.

Conclusion

IA during pancreas transplantation appears to be safe, and does not significantly prolong pancreas transplantation or adversely affect other outcomes. Surgeons should consider whether incidental appendicectomy should become standard practice.

Take-home message

Appendiceal complications after pancreas transplantation can be challenging and surgeons should consider whether incidental appendicectomy should become standard practice.
O049 FRAX score assessment of long term follow up thyroid cancer patients
Authors: Chauhan V , Mohamed E , Lee M , Gouni R , Alasttal S , Fouad M , Chadwick D , Christakis I
Published: November 2022

Introduction

Thyroid stimulating hormone (TSH) suppression with Levothyroxine (LT4) following thyroid cancer surgery is recommended in some patients under long term follow up. However, LT4 may cause reduced bone mineral density. We aimed to assess patients in our long-term thyroid cancer follow up clinic for risk to bone health.

Methods

We conducted a review of all patients in the thyroid cancer follow-up clinic and calculation of FRAX score for those that are >40 years old who are followed up in the Endocrine Surgical Service of NUH. Subsequently patients were categorised into risk groups according to the Osteoporosis Group Guideline (2017) and managed accordingly.

Results

78 patients were identified and had ongoing follow up. 23 patients were excluded as they were <40 years old. 10 patients did not want to participate in the study. 45 patients were assessed with the FRAX score. There were 31 female and 14 male patients, mean age 60.8 (±12.3) years. The mean follow up was 75.0 (±78.9) months. 11% (five patients) were found to require treatment for Osteoporosis without a bone mineral density (BMD) scan, 38% (17 patients) were recommended to assess their BMD, 4% had borderline risk to measure BMD, and 47% required lifestyle and dietary modification.

Conclusion

Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

Take-home message

Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.
O052 A retrospective analysis of a single-centre experience with administration of neoadjuvant chemotherapy prior to surgical removal of breast tumour
Authors: Reveendran D , Tait C , Hogan B
Published: November 2022

Introduction

Neoadjuvant chemotherapy (NACT) is increasingly used to aid breast preservation surgery for patients with non-conservable disease at presentation. NICE guidelines recommend offering primary systemic therapy to patients with ER- disease and/or HER2+ disease and for those with ER+ disease to reduce tumour size. This retrospective study aimed to analyse the incidence of local and systemic recurrence post NACT.

Methods

A retrospective analysis of NACT usage was conducted from January 2011 to December 2020 at the breast surgery unit. Clinical data of patients who received NACT were collected using the local Breast Unit database, Electronic Patient Record (EPR) and Systm1. Data included patient demographics, type of breast and axillary surgical procedure, histopathology of breast tumour, pathological response to NACT and time to local and/or systemic recurrence.

Results

202 patients received NACT for breast cancer between January 2011 to December 2020. Analysis showed an increasing use of NACT ranging from 2.19% of all cancers in 2013 to 14.5% in 2020. 89/202 patients underwent breast preservation surgery. 1 patient developed local recurrence at median follow up of 26 months. 42 patients developed systemic recurrence, and 40 of them had residual disease found at surgery post NACT at median follow up of 24 months.

Conclusion

Our unit has been increasingly using NACT over the last 8 years in line with guidance. Breast conserving surgery post NACT is associated with a low risk of local recurrence. The risk of systemic disease progression post NACT is very low for patients who have complete pathological response.

Take-home message

Breast conserving surgery post NACT is associated with a low risk of local recurrence. The risk of systemic disease progression post NACT is very low for patients who have complete pathological response.
O054 A novel hyaluronic acid hydrogel as an extracellular matrix to improve adipose tissue graft survival in autologous transfer for breast cancer reconstruction
Authors: Bechar J , Bastie C , Dallmann R , Worch J , Gharanei S , Shabir S , Dove A , Hardwicke J
Published: November 2022

Introduction

Adipose tissue transfer is used for correcting breast contour defects after cancer surgery. Graft survival can be as poor as 15% at four years follow-up. Hyaluronic acid (HA) hydrogels can be used to suspend adipocytes to aid survival.

Methods

A unique HA gel with cross-linked aldehyde and hydrazine groups allowing self-healing around cells after injection was engineered. The gel's rheology and degradation properties in vitro were characterised. 3T3-L1, murine and human adipocytes were encapsulated within HA hydrogel, with survival and gene expression interrogated. A murine animal model underwent subcutaneous injection of primary murine adipocytes mixed with HA gel, with survival and gene expression examined.

Results

The novel HA hydrogel can be degraded by tissue hyaluronidases in 4–5 days. Self-healing occurred in 30 minutes and the gel is robust enough to be injected through a needle. 3T3-L1, murine and human adipocytes were encapsulated within HA hydrogel and showed a <15% deduction in survival compared to control. Mature adipocyte gene expression markers compared to control showed no difference. Primary murine adipocytes injected in vivo showed no difference in survival at higher gel volumes compared to control.

Conclusion

The novel engineered HA hydrogel has suitable mechanical characteristics for injection and can support adipocyte survival in vitro and in vivo and is ready for a pilot human trial.

Take-home message

Our novel HA gel can support adipocytes in vivo and in vitro, and offers a potential method for augmentation of adipose tissue transfer.
O056 Achieving optimal clinical outcomes in autologous fat grafting (AFG): a systematic review of processing techniques
Authors: Langridge B , Khan H , Awad L , Mosahebi A , Butler PEM
Published: November 2022

Introduction

AFG is an increasingly popular technique in reconstructive and cosmetic surgery but significant variability in long-term graft retention continues to be a limitation. This results in unreliable clinical outcomes and revision procedures. There is no consensus on the optimal methodology of graft processing. This systematic review identifies the latest evidence base supporting different processing techniques.

Methods

A systematic literature search was conducted using PubMed, SCOPUS, and the Cochrane electronic databases. Studies comparing AFG processing techniques and reporting long-term patient outcomes (≥3 months) were identified. Data collected included the technical aspects of techniques, cohort characteristics, complication rates, volume retention. Systematic assessment of study quality was also performed.

Results

Twenty-four studies (2928 patients) providing at least level three evidence were included. Processing techniques evaluated included centrifugation, decantation, washing, filtration, gauze rolling, as well as commercial devices and ASC enrichment methods. There was variable reporting of complications and volume retention rates. Complications were infrequent; palpable cysts (0–18%), cellulitis (0–8%) and fat necrosis (0–36.4%) were the most commonly reported. No significant differences in long-term volume retention between techniques were found in AFG in the breast. In head and neck patients, greater volume retention were documented in ASC enrichment (64.8–95.8%) and commercial devices (41.2%) compared to centrifugation (31.8–76%).

Conclusion

The quality of AFG research has improved significantly in recent years but has heterogeneity in reporting outcomes. ASC (adipose derived stem/stromal cells) enrichment methods and commercial devices results in superior long-term volume retention in facial but not breast fat grafting.

Take-home message

Adipose derived stem/stromal cell enrichment methods and commercial devices have superior long term volume retention in facial but not breast autologous fat grafting [level of evidence II]. Randomised control trials are necessary to identify if certain processing methods are superior to others in volume retention and complication rates.
O057 The association between computed tomography-based body composition metrics and outcomes after aortic aneurysm repair
Authors: Koh AL-Y , Yang QZC , Hanna L , Boshier P , Gibbs R
Published: November 2022

Introduction

Computed tomography-based body composition (CTBC) metrics can provide a reliable measure of muscle and fat distribution. Their role in predicting outcomes following abdominal aortic aneurysm (AAA) repair has yet to be investigated. This study explored the associations between CTBC and short-term postoperative outcomes after AAA repair.

Methods

This single-centre retrospective study included patients who had undergone either elective or emergency AAA repair, via open or endovascular routes, from 2015 to 2020. The cross-sectional surface areas of skeletal muscle (SMI), and intramuscular (IMAT), visceral (VAT), and subcutaneous (SAT) adipose tissues were measured at the L3 vertebral level of a preoperative CT scan. Sarcopaenia was defined as SMI ≤38.5cm2 in women and ≤52.4cm2 in men. Cut-points for IMAT, VAT, and SAT were defined as the sex-specific median or mean for this study population.

Results

In total, 265 patients were included. SMI was higher in the open surgery group compared to the endovascular group (p=0.011). For infrarenal aneurysms, IMAT was higher in the endovascular group (p=0.021), however, for juxtarenal aneurysms, it was higher in the open surgery group (p=0.002). 76.6% of all patients had sarcopaenia but this was not associated with mortality (p=0.259), Clavien-Dindo class ≥2 complications (p=0.559), or length of stay (p=0.920). IMAT, VAT, and SAT were not associated with any measured outcomes.

Conclusion

Body composition differences between open and endovascular patients highlight the potential for CTBC as a tool for patient stratification. However, at present, CTBC cannot predict short-term postoperative outcomes.

Take-home message

There are significant differences in body composition between patients undergoing open and endovascular aortic aneurysm repair, highlighting the potential for CTBC to be used as a tool for patient stratification. However, at present, CTBC cannot predict short term postoperative outcomes.
O059 Efficacy and safety of embolo-sclerotherapy of arteriovenous malformation based on the experience from a single specialist centre
Authors: Pang C , Arasakumar DRB , Evans N , Papadopoulou A , Khalifa M , Hamilton G , Lim CS , Brookes J
Published: November 2022

Introduction

To evaluate the efficacy and safety of EST, particularly foamed STS 3% in the treatment of arteriovenous malformations (AVMs) in a single specialist centre.

Methods

All patients with AVMs who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. Types of AVM were grouped into Schobinger's classification. All ESTs were performed either with foam sclerosants (STS 3% and polidocanol), ethanol, coils and/or other substances including Onyx and Gelfoam. Outcome measures included treatment effects and complications. Continuous variables were compared using ANOVA F test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at p<0.05.

Results

A total of 65 patients with AVMs, with a mean age of 36 years (range 1–74 years) were included. The age of patients with Type IV AVM were significantly (p=0.014) higher than others. The use of EST with foam STS was significantly lower for type IV AVM (0.0%) (p=0.003). Complications were significantly higher in type III AVM (21.1%)) (p=0.009). A total of 6 (9.2%) patients experienced complications for example, upper lip necrosis and partial facial weakness. The number of days in follow-up was not significantly different across all types of AVM. However, type II AVM showed a significantly lower number of days in follow-up (p=0.038).

Conclusion

EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs.

Take-home message

EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs.
O060 Staged hybrid single lumen reconstruction (TIGER) in management of chronic symptomatic complex type B aortic dissection
Authors: Sultan S , Acharya Y , Hynes N
Published: November 2022

Introduction

We aim to report an innovative technique - Staged Hybrid Single Lumen Reconstruction (TIGER) in the management of chronic symptomatic complex type B aortic Dissection (CS -TBAD). TIGER technique was adopted as a tool for total aortic remodelling with true lumen expansion, false lumen regression and complete thrombosis with stabilization of overall aortic diameter.

Methods

Aortic dissection cases (n = 5) were managed by the TIGER technique, which included creating a single lumen from the supra celiac, infra-diaphragmatic aorta to both common iliac arteries with open surgical patching of the visceral arteries; followed by TEVAR three months later (mean follow-up 16 months). All had aneurysmal dilation, while 60% had acute pan aortic dissection and 40% CS-TBAD.

Results

Sixty percentages of the patients required a left subclavian artery chimney graft, while 20% required bilateral subclavian to carotid artery transposition. No spinal drainage was needed and all patients had intra-operative trans-oesophageal ECHO for wire guidance. There was no aortic rupture or retrograde type A dissection, and renal, visceral, cardiac, pulmonary, or spinal complications. All, but one patient, went off their antihypertensive medication. 100% of the patients maintained normal eGFR postoperatively with accelerated aortic modulation.

Conclusion

Our experience showed that TIGER is effective at the semi acute stage to initiate remodelling and prevent malperfusion, facilitating straightforward TEVAR at stage two, which was made easier by avoiding visceral branch stenting. Moreover, the stented aortic segment's length was decreased, avoiding critical shattering, branch dislodgment, and visceral compromise, including spinal ischaemia and negative cardiovascular consequences.

Take-home message

Staged Hybrid Single Lumen Reconstruction (TIGER) is an effective technique in the management of chronic symptomatic complex type B aortic dissection at the semi acute stage to initiate remodelling and prevent malperfusion, facilitating a straightforward thoracic endovascular aortic repair (TEVAR) made easier by avoiding visceral branch stenting.
O061 A single-centre retrospective study in a large tertiary renal centre on the management of infected arteriovenous grafts
Authors: Chow BJ , Chowdary P , Khurram MA , Mohamed IH
Published: November 2022

Introduction

Prosthetic arteriovenous grafts (AVGs) are often used as tertiary vascular access for haemodialysis in patients with exhausted autogenous options. AVGs are associated with an increased risk of infection which can lead to excess morbidity and life-threatening complications. Infected AVGs are challenging to manage, and the current evidence remains unclear on optimal strategy with arguments for conservative management, salvaging with revision or surgical excision (subtotal or total). This study sought to evaluate the management of infected AVGs by examining the clinical outcomes of patients with infected AVGs managed in our institution.

Methods

We conducted a single-centre retrospective study of all AVG infections managed (conservative management via antibiotics; graft revision; surgical excision) between June 2016 to May 2021. Primary outcome was mortality at 1 year. Secondary outcome was functional vascular access at 6 months and 1 year. Data were extracted from electronic patient records, radiology imaging and reporting.

Results

34 patients were included in our study (14.7% conservatively managed; 14.7% revision; 70.6% surgical excision) with a mean age of 60.4 ± 14.4 years (67.6% males). Average time from AVG placement to presentation was 11.8 months. 1 year mortality was 14.7%. Functional vascular access at 6 months in the three groups was 60%, 60% and 10% and 1-year functional vascular access was 60%, 75% and 42% respectively.

Conclusion

Surgically excised infected AVGs are associated with poor 6-month and 1-year vascular access outcomes. The findings suggest that conservative management and/or revision are more prudent given their higher probability of subsequent functional access.

Take-home message

Provision of a definite vascular access within the first year of graft infection is highly challenging. As such, conservative management and graft revision present as superior options to manage infected arteriovenous grafts.
O062 Acquired carotid-jugular fistulas following carotid endarterectomy: a narrative review
Authors: Narroway H , Bourke B , Tchen A
Published: November 2022

Introduction

Acquired arterio-venous fistulas (AVF) involving the carotid artery are most commonly the result of trauma and catheterisation of the neck vessels. Left untreated, carotid-jugular fistulas (CJF) may precipitate ischaemic neurological symptoms due to thromboembolism or shunting of blood through the AVF.

Methods

A literature review was performed to determine the incidence and outcomes of acquired carotid-jugular AVFs following carotid endarterectomy (CEA). Electronic searches were performed using three databases, PubMed, EMBASE, and Google Scholar.

Results

Three case studies met inclusion criteria for analysis. The first case occurred 4-months following a left CEA. CT-angiography and duplex ultrasound identified a pseudoaneurysm arising from the proximal internal carotid artery. A CJF was identified on re-intervention and carotid ligation was performed following unsuccessful attempts to repair the defect. The patient has ongoing mild dysphonia with no other complications at 18 months follow-up. The second case occurred 6 years following right CEA. Catheter angiography revealed an AVF between the right external carotid artery (ECA) and internal jugular vein, treated with coil embolization. The patient made complete neurological recovery and had no further complications at 2 years follow-up. The third case occurred 4 years following right CEA. Catheter angiography identified fistulisation between the lingual branch of the right ECA and right retromandibular vein, treated with transarterial particle embolization. The patient made a complete neurological recovery.

Conclusion

Carotid-jugular AVFs are rare following CEA. This review proposes that carotid-jugular AVFs may be amenable to both open and endovascular intervention with durable outcomes. Proceduralists should be cognisant of this complication.

Take-home message

Carotid-jugular arteriovenous fistulas are rare following carotid endarterectomy and may be amenable to both open and endovascular intervention with durable outcomes.
O063 Use of MRSA screening to discontinue teicoplanin on a tertiary vascular surgical firm
Authors: Deans K , Kansagra A , Chokkarapu P , Curtis S
Published: November 2022

Introduction

The aim of this study was to determine whether the implementation of new educational

interventions could reduce the use of teicoplanin in Diabetic Foot Infections (DFI) on a Vascular surgical firm and prevent potential toxicity. Local trust guidelines state that DFI should be treated with piperacillin-tazobactam and teicoplanin. Following a groin/nasal swab, teicoplanin can then be withdrawn if the patient has a negative screen for MRSA (methicillin-resistant Staphylococcus aureus).

Methods

Interventions were undertaken to reduce overuse of teicoplanin. These consisted of Ward Pharmacist teaching, updating the Vascular Doctor Handbook and sending an email to the Ward Juniors explaining current antibiotic guidelines. Alongside these interventions was the pre-existing weekly microbiology Consultant-led ward rounds. Teicoplanin prescribing was compared in patient groups identified pre (n=44) and post intervention (n=36). Inclusion criteria were diabetes/ prediabetes, no allergies to penicillin or teicoplanin and no prosthetic material grafts in situ.

Results

The mean number of excess doses of teicoplanin decreased from 4.84 (pre-intervention) to 1.00 (post-intervention). Largest excess doses received by one patient was reduced from 11 to 6. One 400 mg teicoplanin vial costs £9.30, resulting in an average saving of £35.71 per patient.

Conclusion

The described interventions reduced the number of excess teicoplanin doses for DFI on the Vascular firm. This resulted in a more cost-effective practice, drug administration rounds becoming more time efficient and resulting in less waste thus facilitating more sustainable practice. Future research could further explore the impact on sustainability by calculating carbon emissions of antibiotic usage on the ward.

Take-home message

Educational interventions have helped reduce excess use of teicoplanin in Diabetic Foot Infections for patients under the care of a vascular surgical firm. This has led to a reduction in time and expenses, thus promoting a more sustainable practice.
O064 Early follow-up quality of life and mental health of patients with congenital vascular malformations cared for in a multi-disciplinary specialist center
Authors: Pang C , Nisbet R , Gibson M , Evans N , Khalifa M , Papadopoulou A , Tsui J , Hamilton G , Brookes J , Lim CS
Published: November 2022

Introduction

To evaluate the early follow-up quality of life (QoL), pain and mental health of patients with congenital vascular malformation (CVM) receiving care by a single multi-disciplinary specialist centre

Methods

All patients with CVM who received care (supportive treatment only, open surgery, targeted pharmacological therapy, embolosclerotherapy), and had follow-up, between 1 February 2018 and 31 January 2020 were included. The health-related QoL, pain, and mental health were assessed with validated questionnaires: SF-36, VAS-P and HADS. The CVM were categorized into types – low-flow (LFVM) and high-flow (HFVM), and anatomical locations. Paired t-test was used for all analyses. Differences were considered significant at P<0.05.

Results

110 patients (85 LFVM and 25 HFVM) with a mean age of 36.9 years were included. Significant improvement was found in the bodily pain domain of SF-36 and VAS-P (both P = 0.01) in all patients. However, only patients with HFVM reported significant improvement in the bodily pain domain of SF-36 (P=0.002) and VAS-P (P = 0.02). Patients who received supportive treatment only reported significant improvement in mental health (P=0.004) and social functioning (P=0.03) domains of SF-36. Meanwhile, patients treated with embolosclerotherapy reported significant improvement only in VAS-P (P=0.02). Patients who received targeted pharmacological therapy reported no significant early changes.

Conclusion

The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.

Take-home message

The effects of care on early follow-up QoL, pain and mental health of patients with CVM were heterogenous. Future research is required to understand the various factors that affect the QoL and mental health of these patients, as well as the holistic approaches to manage them.