bluuebunny/crossref_metadata_2025 huggingface dataset:
SP9.3 - Introducing Frailty Assessment into The Suspected Lower GI Cancer Pathway – Results of a 2 Year Pilot
Authors: Sargsyan Narek , Bernardo Janice , Sreekanth Sakthi , Aruachalam Ganesh , Humphries Francesca , Vijay Vardhini
Published: September 2024

Introduction & Aim

An Increasing number of patients with suspected lowerGI cancer are being sent Straight-To-Test to achieve the 28 Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have been piloting a frailty pathway incorporated into the protocol for secondary care management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes.

Methods

A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-January2024 was analysed. Patients aged>75 with a frailty score of >=5 or performance status>=3, dementia, poly-pharmacy or from care home were referred straight to the frailty unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard-pathway.

Results

Over a 24-month period, 228patients with suspected cancer were seen on the frailty pathway. 49.5%(113patients) were found to be unfit for further investigations or declined/self-discharged. The 2ww standard was met in80%of frail patients compared to55% in>75s who were sent straight-to-test on the standard pathway. The 28day-FDS standard was met in50%of frail patients compared with18%in the other>75s.The average number of investigations per referral was0.5for frail patients compared to 1 for patients on the standard-pathway. 5patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer.

Conclusion

The frailty pathway is an effective initiative in reducing unnecessary invasive investigations, whilst providing timely investigations on the suspected cancer pathway.
SP9.5 - Peri-operative Comprehensive Geriatric Assessment (CGA): A new benchmark for Acute General Surgery patients
Authors: Sabbagh Hadi , Abu Al-Ryan , Reese George , Hudson Murray , Koizia Louis
Published: September 2024

Aims

More than 50% of patients undergoing emergency general surgery are over 65 years of age. NICE guidelines emphasise frailty assessment in acute surgical settings, particularly in the preoperative period. Similarly, the Emergency Laparotomy and Frailty (ELF) study showed associations between frailty (CFS ≥ 5) and 90-day mortality, increased complication and length of hospital stay in older emergency laparotomy patients. NELA best practice tariff (BPT) April 2023 heavily focuses on perioperative team involvement in frailer, older patients. This is an audit from a city teaching hospital, with a surgical liaison team against standards set by NELA.

Methods

Review of patients aged ≥ 65 undergoing emergency laparotomies between August and November 2023 (pre-intervention) then December and January 2024 (post-intervention). Data collected includes whether patients had a documented frailty score, a clearly documented CPR decision & treatment escalation plan (TEP), pre- or post-operative medical review, and advanced-care planning (ACP) post-operatively. Intervention included dedicated members of surgical liaison team following patients throughout admission, weekly meetings to discuss laparotomy patients, older patient template being created capturing ceilings of care, frailty score, and social history.

Results

Post intervention, improvement in clear documentation regarding escalation, frailty level. Greater level of MDT collaboration with regards to older patients undergoing laparotomies.

Conclusion

Changes in NELA BPT emphasise the importance of comprehensive geriatric assessment in the management of older laparotomy patients. Even a basic surgical liaison service can achieve high levels of compliance with a few simple strategies, resulting in better outcomes for patients as well as financial benefits for Trusts.
WP1.4 - Iliac Crest Bone Grafts and Hernia Formation: Insights from a Case Series And Review of Literature
Authors: Kirengo Thomas , Rafiq Sarmad , Maraqa Abdelrahman , Azhar Zubair , Ramanand Bangalore
Published: September 2024

Introduction

Hernias following iliac bone grafting are a rare but significant complication, with the earliest case reported in 1945. Repair of these hernia is challenging. There is a need for appropriate repair techniques to minimize morbidity and recurrence. We present our experience with 3 cases of post-iliac graft hernia repair and a systematic review of current literature.

Method

We conducted a systematic review of literature in two online databases, PubMed®/ MEDLINE and EMBASE) February 2024, following PRISMA guidelines. Keywords used were “Hernia”, “iliac”, and “Graft”. Data on demographics, initial pathology, time to presentation, type of hernia repair, and outcome were collected. Studies not in English and related to other types of hernia were excluded.

Results

31 studies, spanning from 1975-2023, were included of 751 results. There were 41 reported cases of hernias post iliac bone grafting. Age distribution ranged from 37-88 years, with an average age of 59 years. Average time of presentation was 4 years. 8 cases (25.8%) of recurrence were reported. The main indication for bone grafting was fracture with delayed/ non-union in 20 cases (64.5%). Mesh repair was performed in 70% of cases. Average follow-up period was approximately 17 months.

Conclusion

Hernias post iliac bone grafting should be suspected as a probable complication. If identified, most can be managed with mesh, however patients need to be followed up due to risk of recurrence.
WP2.14 - Lung Mycetoma - Chronicles from the Pandemic
Authors: Bhatti Hamza Waqar , Farooqui Marryam Riaz , Shafique Muhammad Salman , Hanif Muhammad
Published: September 2024

Introduction

COVID-19 is a global pandemic which obeys no geographical borders. Post Covid pneumonia sequalae is still an unpredictable course especially with patients with a pre-existing lung compromise. In such scenario, a cohort of patients must also be looked for a fungal infection.

Case Study

A 31-year-old male presented with history of fever, hemoptysis, and weight loss for 1 month. He suffered from Covid-19 pneumonia 3 months back. He was also diagnosed with Pulmonary tuberculosis 4 years back. Examination revealed right sided tracheal deviation with dull percussion note on the upper and middle zones of the right side of chest. Pulmonary function tests showed a restrictive pattern with a FEV1/FVC ratio of 0.9 (FEV1=2.02, FVC=2.22). Transthoracic echocardiography revealed dextrocardia, moderate TR, and a pulmonary arterial systolic pressure of 25 mm Hg. Contrast enhanced CT scan of thoracic cavity showed reduced right hemithorax, well-defined thick-walled cavities in the upper and lower lobe of the right lung and a ground glass appearance in the bilateral lower lobes. A diagnosis of Lung mycetoma was made along with post covid-19 pneumonia changes. Right posterolateral thoracotomy and right pneumonectomy was performed. Per-operatively, a collapsed lower lobe and stony hard upper and middle lobes of right lung with associated fungal balls were found. Patient was clinically well after a 30-day follow-up period.

Conclusion

Covid-19 patients with pre-existing pulmonary co-morbidities should be followed with caution and pulmonary symptoms in the post pneumonia patient should raise the suspicion of fungal infections as well.
WP3.1 - Retrospective analysis of gallbladder polyps: correlation between ultrasound imaging and histology findings – a single center study
Authors: Khalid Muhammad Abdullah , Azaini Wan , Aktas Mikail , Kassem Ahmed , Junkin Amy , Marzouk Ahmed
Published: September 2024

Aims

To investigate ultrasound imaging findings in patients with gallbladder polyps requiring cholecystectomy and compare them with histopathological results.

Methods

Patients with ultrasound diagnosis of gallbladder polyps who underwent cholecystectomy between January 2019 and September 2023 were included.

Results

A total of 701 patients’ records who had cholecystectomy were reviewed, 45 patients were included as per the inclusion criteria, of whom 73% were women. Mean age was 52±15 years. Average size of the polyps on ultrasound was 7.26mm and approximately 26.7% of polyps were noted to be bigger than 10mm. Histopathological findings confirmed the presence of polyps in only 46.7%. Out of these, size of the polyps was documented in 62% of histology reports which was compared with ultrasound findings. Mean size on USG was 9.13±2.73mm in comparison to histological size of 6±2.94mm. Mean difference in measurements was 3.13mm.

Conclusion

This study examines the relationship between ultrasound imaging and histological findings of gallbladder polyps. From our 45 patients identified with gallbladder polyps the majority were women. Larger sized polyps are more likely to be confirmed on histology and our findings suggest that ultrasound can overestimate polyp-size by up to 3mm. Finally, 53.3% of polyps diagnosed via ultrasound were not confirmed on histological examination. Further studies on larger cohorts are required to validate above findings and refine diagnostic protocols.
WP3.4 - Partial gastrectomy as a day case procedure for the treatment of Gastrointestinal Stromal Tumours – a single centre experience
Authors: James Stuart , Carey Charles , Richardson Gemma , Jaunoo Shameen
Published: September 2024

Aims

Gastrointestinal stromal tumours (GISTs) are malignant growths that may be managed effectively with radical surgery if diagnosed at an early stage. The majority of GISTs are found in the stomach and many may be managed effectively via a laparoscopic partial gastrectomy (PG). Day case surgery is becoming a more feasible option for patients undergoing laparoscopic PG. This study examined the outcomes of patients who underwent laparoscopic PG as a day case procedure at a UK tertiary centre.

Methods

The records of patients who underwent a partial gastrectomy to treat extra-luminal gastric GISTs between January 2021 to December 2023 were retrospectively reviewed. The rates of readmission and post-operative complications were noted for the patients were assessed. Patients with tumours near the gastro-oesophageal junction, lesser curve or with a significant intraluminal component were excluded.

Results

42 patients aged between 52 - 81 years were ultimately included in this analysis and 31 (73.8%) underwent surgery as a day case procedure. There were no readmissions, peri- or post-operative complications and none of the patients required a conversion from a laparoscopic to an open approach.

Conclusions

This single centre analysis suggests that laparoscopic day case PG is a safe option for selected patients. Overall this experience suggests that day case surgery should be carefully considered in those deemed likely to be able to recover well post-operatively. Additional larger studies are required to further evaluate the safety of day case laparoscopic PG.
WP3.8 - Estimating the Disease Burden and Epidemiological Characteristics of Burn Injuries in the United Kingdom: a systematic analysis of the global burden of disease study 2019
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu
Published: September 2024

Background

Burn injuries pose a substantial public health challenge globally, with profound physical, psychosocial, and financial consequences for individuals, households, and communities. This study aims to assess the disease burden and epidemiological characteristics of burn injuries in the United Kingdom (UK).

Methods

Utilising data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019, we estimated the prevalence, age-standardised incidence, and years lived with disability (YLD) for burn injuries in the UK. Burn injuries were further classified based on the total burn surface area (TBSA), distinguishing between <20% and >= 20% TBSA.

Result

In 2019, the age-standardised incidence rate of burn injuries in the UK was estimated at 330.65 per 100,000 (268.59-409.52). Incidence rates have demonstrated a stable downtrend since 1990. Over 90% of burn injuries in the UK were categorised as <20% TBSA. Younger age groups experienced a higher disease burden. England exhibited the highest age-standardised incidence rate of burn injuries (344.98 per 100,000), along with a threefold higher rate of burn injuries >20% TBSA (29.64 per 100,000) compared to Wales, Northern Ireland, and Scotland. The burden of disability attributed to burn injuries in the UK was estimated at 84.38 YLD per 100,000 (49.16-139.56), with the highest burden observed in England (88.90 per 100,000).

Conclusion

This study underscores the substantial disease burden imposed by burn injuries in the UK, alongside disparities in their distribution and warrant further studies in addressing the social and economic determinants of burn injuries.
WP3.9 - Characteristics and outcomes of an emergency hot clinic in a district general hospital - are they still a useful resource?
Authors: Martinez Alison Infante , Mapara Rahee , Leung Edward
Published: September 2024

Introduction

Hot clinics with ambulatory imaging have become integral to service provision in emergency general surgery, reducing admissions and expediting diagnoses. However they can come under criticism over a lack of senior decision making and perceived unnecessary reviews.

Aims

We aimed to evaluate the service in our department, by characterising the seniority level of the decision makers and assessors in the hot clinic, and outcomes of patients seen.

Methods

Retrospective analysis over a 3 month period of patients seen in the hot clinic of a district general hospital was performed.

Results

Total number of patients seen was 128. Median time from referral to appointment was 1 day. Abdominal pain formed 70.3% original presenting complaints. Over half of patients (52.3%, n=67) had review arranged by a registrar, and 46.9% (n=60) of patients were seen by a registrar at their appointment. 7% (n=9) had their hot clinic review arranged by a consultant. 63.3% (n=81) of patients had imaging performed as part of their review, and 53.1% (n =43) of these patients had pathology identified. 13.3% (n=17) of patients seen at the clinic required admission, and 43.0% (n=55) were discharged. 21.4% (n=3) of those brought back for a further hot clinic review had been seen by a consultant, versus 64.3% (n=9) seen by a registrar.

Discussion

Hot clinics are a valuable resource, and in our department a senior decision maker at a registrar level is involved in majority of decision making. The admission rate is low, demonstrating that the service is effective in helping to avoid admissions. Consultant input can help avoid repeated reviews.
WP4.6 - Reducing Unnecessary Transfusion of Blood Products – A Quality Improvement Project in a General Surgical Department in a District General Hospital
Authors: Arbis Alexander , Hamawandi Aveen , Donnellan Imelda
Published: September 2024

Aims

To audit adherence of transfusion of blood products against NICE guideline thresholds. To reduce unnecessary blood transfusions following departmental teaching sessions and installation of posters on surgical wards.

Methods

We retrospectively audited all patients receiving packed red cells transfusions consecutively across two consecutive four-month periods in a general surgery department. Departmental teaching sessions were held after the first audit cycle, supplemented by installation of posters including NICE guideline thresholds on surgical wards. The medical notes for each patient were assessed for pre-transfusion haemoglobin, indication for transfusion, and whether each transfusion was prescribed according to NICE guidelines.

Results

A total of 112 units of packed red blood cells in 42 patients and 133 units in 43 patients were transfused, respectively, before and after intervention. 45 units (40.2%) were prescribed according to NICE guidelines on first audit, improving to 67 units (50.4%) following intervention. 23 units of blood (20.5% of total) were transfused back-to-back inappropriately on first audit, reducing to 6 units (4.51% of total) after intervention. There were 2 self-limiting transfusion-related reactions (1.79%) on first audit, both in patients transfused above guidance thresholds, and no reactions following intervention. At a raw cost of approximately £135 per unit of donated blood, savings of £1830 were made over a four-month period (£5493pa), not including nursing and administration costs

Conclusions

Through simple local interventions and stricter adherence to transfusion thresholds, we reduced inappropriate above-threshold blood product transfusions in our hospital. This corresponded to a reduction in unnecessary blood-transfusion reactions and significant hospital savings.
WP4.14 - Association of Socioeconomical Status and Disparity In Paediatric Burn: Results From The Global Burden Of Disease Study 2019
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu
Published: September 2024

Background

Burn represents a significant contributor to both morbidity and mortality in the paediatric population and is closely related to socioeconomic and geographic factors but is often overlooked. This study aims to estimate the unbalanced distributions, temporal trends and quality of care in paediatric burn.

Methods

Data focusing on paediatric population (<20 years old) was sourced from the Global Burden of Disease (GBD) Study 2019 stratified by Socio-demographic Index (SDI) and WHO region, including incidence, mortality and disability-adjusted life-years (DALYs). Joinpoint regression analysis and principal component analysis were conducted to compute the temporal trend and quality of care (QCI) index respectively.

Result

In 2019, 3,719,806 paediatric burn cases were reported, resulting in 23,986 deaths and 2,240,311 DALYs globally. Over 40% of deaths and DALYs attributable to burn occur in the African region, despite the region accounting for around 20% of the total incidence. The age-standardised incidence rate (ASIR) from 2010-2019 was 0.419 per 100,000 but death (ASDR) and DALYs (ASDALYs) were reduced at the rate of 3.04 per 100,000 and 2.92 per 100,000 respectively. The global QCI for paediatric burn was 88 with a proportional trend observed across SDI quintiles Significant association in between SDI scores and gender disparity and quality of care was observed.

Conclusion

This study highlights the significant burden of paediatric burn and its disproportionate global distribution. Preventive measures, enhancing access to quality healthcare, and addressing the social and economic determinants of burn should be addressed in future studies.
WP4.17 - Laparoscopic versus open repair of perforated peptic ulcer: a systematic scoping review and in-depth evaluation of existing evidence
Authors: Chalmers Katy , Lee Matthew , Cousins Sian , Peckham-Cooper Adam , Coe Peter , Blencowe Natalie
Published: September 2024

Background

Perforated peptic ulcer remains a common cause of morbidity and mortality worldwide. Surgical treatment includes a trend towards minimally invasive surgery. To safely implement this, it is important to understand the key steps that have been assessed in clinical trials. The aim of this review is to assess the reporting of intervention steps in laparoscopic and open ulcer repair.

Methods

A systematic search was performed of the MEDLINE, EMBASE, & clinical trial databases (PROSPERO (CRD42023404537)). Randomised trials on laparoscopic vs open repair of peptic ulcer were included. Data extracted included study metadata, as well as technical aspects of interventions, use of co-interventions. Study design was assessed using the PRECIS-2 tool, to explore whether trials were predominantly pragmatic or explanatory, and also using the Cochrane Risk of Bias tool.

Results

408 studies were screened for eligibility, and nine full-texts were included. This included six studies from China, two from India, and one from the Netherlands. Incision, ulcer closure details, and lavage, were the best reported aspects of laparoscopic repair (n=7). Method of access, incision, and ulcer closure were well described in 8 studies. Co-interventions such as antibiotic use, analgesia, and H pylori eradication were poorly described. Interventions were delivered by high volume laparoscopic surgeons. Studies were considered at high risk of bias. PRECIS-2 assessment found studies were neither fully pragmatic nor explanatory.

Conclusions

Laparoscopic repair of perforated peptic ulcer is a poorly defined intervention. Standardisation of key steps and co-interventions is required to facilitate a well designed randomised trial.
WP5.1 - An audit of Escherichia coli bacteraemia from a hepatobiliary origin
Authors: Holmes Paul , Narula Shaima , Payne Christopher
Published: September 2024

Aims

Gallstone disease is the commonest cause of biliary sepsis, which in turn is a frequent source of Escherichia coli bacteraemia (ECB). In 2022, our health board was an outlier for ECB infection rates. It was hypothesized that this may be related to extended waiting times to be seen at the surgical clinic or rising numbers on the waiting list for cholecystectomy, caused by the COVID-19 backlogs. This study aims to assess the prevalence and characteristics of ECB infections associated with hepatobiliary conditions in a tertiary centre in Scotland, and review any associations with waiting lists.

Methods

A retrospective analysis of ECB cases linked to hepatobiliary conditions between 01/01/2022 and 31/12/2022 was conducted. Parameters studied included infection acquisition (community, hospital, healthcare-associated), biliary disease history, inpatient/outpatient status, waiting list status, admission specialty and treatment modalities.

Results

Of the 71 cases analysed, 68% were community-acquired, while only 15% were healthcare or hospital-associated. Non-malignant biliary disease was present in 43% of patients, and 39% had prior inpatient history. The majority were not on clinic (89%) or surgery (92%) waiting lists. General surgery was the commonest admitting speciality (51%). Mortality rate was 17%.

Conclusions

This audit did not identify an association between increases in ECB rates and waiting lists for clinic review or surgery, and very few patients were awaiting cholecystectomy. The study confirms the clinical significance of hepatobiliary-associated ECB infection, with mortality rates similar to that of previously published reports.
WP5.2 - Acute Pancreatitis: challenging the relevance of the modified Glasgow score and bridging the gap to optimise management
Authors: Manku Bhagat , O’Sullivan Arun , Bleehen Laura , Ramcharan Sean , Marriott Paul , Singh Sandeep
Published: September 2024

Aims

Acute pancreatitis is a frequently encountered emergency surgical presentation, with an incidence of 56 cases per 100,000 per year. 10%- 20% of patients develop a rapidly progressive inflammatory response with an overall mortality rate of 5%. Deciding the need for intervention during pancreatitis is variable. Predicting severity is challenging and multifactorial. Scoring systems aid in standardisation of treatment, however they do not factor in the evolving knowledge on factors that predict mortality in severe acute pancreatitis. The aim of this audit was to identify any gaps in optimising the management of acute pancreatitis.

Methods

Prospective data was collected between January 2023 – May 2023 and analysed against current NICE and UK working Party on Acute Pancreatitis guidelines.

Results

41 patients were identified with a median age of 60 (53.7% male, 46.3% female). No cases required admission to intensive care. Gallstones (56.2%) and alcohol (19.6%) were identified as leading causes. Key gaps in management were identified: 12.2% of patients were scored via the modified Glasgow score, 24.4% received antibiotics without a clinical indication, 34% received aggressive fluid therapy and 19.5% received education on disease diagnosis and management.

Conclusion

Supportive management can be optimised, with a significant need to address patient education to minimise recurrence. Our data supports the use of targeted scoring systems in patients who are already critically ill. As the majority of cases were mild, we propose that the Modified Glasgow score is a useful aide but should not replace clinical judgment and careful monitoring of patients. Potential ambulatory pathways could be considered for mild acute pancreatitis.
WP5.9 - Emergency laparotomies in the elderly: a patient perspective
Authors: Hale Emily , Davis Heather , Sert Sena , Bowling Kirk
Published: September 2024

Aims

Emergency laparotomy is known to convey worse morbidity and mortality for elderly patients. Despite a growing elderly population, there is a limited understanding of the patient experience in emergency laparotomy. This study aims to assess patient satisfaction following emergency laparotomy.

Methods

Patients were identified from the National Emergency Laparotomy Audit (NELA) database, who were aged 80 and above, and underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Of the patients who survived to discharge, a telephone-based interview was undertaken in January 2024. Exclusion criteria included: confusion, severe illness and relook laparotomy. Data were collected on functional status and satisfaction with the procedure. Patients were also asked what they wished they known prior to the operation. Post-operative outcomes were assessed in a separate study.

Results

132 cases were undertaken in this period. 72 cases met inclusion criteria. We achieved a 61% response rate. 59% of respondents were living independently post operatively and 61% had no functional decline. 93% of respondents were happy to have had the operation and if given the opportunity again would still have had the procedure. Patients were overall very happy with the information offered prior to the procedure, 7% felt they had no alternative option. One patient was not satisfied with the follow up received.

Conclusions

Although emergency laparotomy in the elderly is high risk, our data demonstrate excellent patient satisfaction. This study provides a better understanding of what is important to patients; this should be considered in the consent process and communication.
WP5.12 - Assessing the safety of managing and discharging appendicitis patients within 24 hours of presentation to hospital
Authors: James Stuart , Carey Charles , Richardson Gemma , Jaunoo Shameen
Published: September 2024

Aims

Acute appendicitis (AA) has an incidence of 81 per 100,000 person-years and is a common reason for admission in acute general surgery units. Laparoscopic appendicectomy (LA) is well established as the main treatment method for patients with AA and many are deemed fit for discharge soon after this operation. This study aimed to assess the proportion of AA patients who underwent LA who were able to be successfully discharged within 24 hours of their surgery.

Methods

The notes from AA patients admitted to Royal Sussex County Hospital between December 2021 and December 2023 were retrospectively analysed for their time to post-operative discharge. Within this group, cases who were uncomplicated and who could be discharged within 8 hours of surgery were noted. The notes were further assessed for patients who required readmission within 24 hours of surgery.

Results

462 cases of AA admitted were identified and of these, 152 (32.9%) underwent LA and were discharged within 24 hours of admission. 91 (59.8%) of this subgroup were discharged within 8 hours and 81 (53.3%) had uncomplicated appendicitis. None of these cohorts of patients were readmitted within 24 hours.

Conclusions

Discharging patients within 8 hours of LA was shown to be a safe option for patients who underwent surgery. The findings in this study suggest that pathways encouraging the prompt assessment and management of appendicitis cases should be considered in all hospitals to facilitate effective patient flow.
WP6.5 - Setting Up For Success: Supporting New General Surgical Registrars' Non-Operative Technical Skills Development
Authors: Kuligowska Anna , Clarke Rory , Biyani Shekhar , Peckham-Cooper Adam , Ng Oliver
Published: September 2024

Aim

Entry into Higher Surgical Training is associated with new challenges to trainees’ clinical, technical, professional and inter-personal skills. A three-day modular “bootcamp” course was designed for new General Surgery ST3s transitioning from Core Surgical Training to bridge the gap and support areas of developmental need.

Methods

Four varied modules were undertaken by candidates; one focussed on non-operative technical skills in surgery (NOTSS). Following pre-interviews with all stakeholders, immersive scenarios were developed. The programme encompassed operating in a stressful environment with a focus on crisis resource management principles, ward round leadership, theatre prioritisation, difficult communication, and a further workshop on managing bullying and sexual harassment. A multi-professional faculty included anaesthetists, theatre staff, psychiatrists and geriatricians alongside surgeons.

Results

All 26 trainees were invited to self-rate confidence using a 5-point Likert scale, as well as free text annotation. 13 (50%) completed both pre- and post-course confidence questionnaires. Data showed significant improvement in self-rated confidence across all NOTSS domains, particularly for operating in a stressful environment ("Confident"/ "Strongly Confident" = 69% pre-course to 100% post-course). Free text responses included highly positive feedback for high faculty to trainee ratio allowing detailed personalised feedback, exposure to multi-professional perspectives and opportunities to reflect on difficult professional scenarios.

Conclusion

Following the success of this course, it has now become part of ST3 Induction in Yorkshire - an opportunity to promote a positive working culture and strengthen professional relationships. A multi-specialty faculty allows for sharing of transferable inter-specialty skills. We recommend all transitional training stages would benefit from embedded induction courses.
WP6.9 - Essential Surgery Skills Course: A One Week Training Program to Prepare Surgeons for Humanitarian Deployment
Authors: Sherif Youmna , Pham Kala , Davis Rachel
Published: September 2024

Background

Medical students, surgical trainees, and surgical faculty are increasingly interested in incorporating global surgery into their clinical practices and professional careers. However, many concerns remain about the preparation of surgeons for operating in resource-limited settings and their exposure to critical procedures such as cesarean sections, hysterectomies, or fracture reductions. In an attempt to address these concerns, academic institutions have developed advanced professional training programs for the global surgeon.

Methods

A six-day essential surgery skills conference was created at a large academic institution that provides trainees and surgeons with an overview of common surgical scenarios across orthopedics, urology, obstetrics, gynecology, general surgery, anesthesia and ultrasound in the form of didactics, simulations, and wet labs.

Results

11 surgical trainees from four large academic institutions attended the essential surgery skills conference. Trainees attended sessions on point of care ultrasound, regional anesthesia, general anesthesia, hysterectomies, cesarean sections, post-partum hemorrhage, fracture reduction and fixation, ureteral injuries, and humanitarian deployment. A pre and post-test was administered. Improvement was noted in the trainees scores on the post-test in their knowledge of surgical subspecialty care. Trainees also reported feeling better prepared for humanitarian deployment.

Conclusion

Global surgery conferences can be designed to provide a networking and collaboration forum for improving access to surgical services worldwide. One-week predeparture conferences that discuss essential technical skills and relevant global surgery knowledge may better prepare surgeons to operate in resource-limited settings.
WP7.5 - Primary Repair of Obstetric Anal Sphincter Injuries (OASIS): a Survey of Surgeons’ Experience
Authors: Elsaid Nada , Thomas Gregory , Carrington Emma , Vaizey Carolynne
Published: September 2024

Purpose

OASIS is associated with devastating consequences; namely incontinence. Timely, satisfactory repair of OASIS is necessary to mitigate the risk of maternal morbidity. Primary repair is typically undertaken by an obstetrician. In cases of profound anatomical disruption, the on-call surgeon may be called. The aim was to explore the experience and current practice of surgeons in the acute repair of OASIS.

Methods

A cross-sectional, observational study was performed. Registrars and consultants who participate in an on-call rota in the UK were included. The survey was disseminated to members of ASGBI and ACPGBI. It was also advertised via social media platforms, including Twitter and LinkedIn. A chain-sampling method was advocated. A descriptive analysis of the data was undertaken.

Results

318 responses have been recorded so far. 32% of surgeons had been contacted to assist in an acute repair, of which 23% had a specialist interest in pelvic floor surgery. Of those who were contacted, 53% would typically be called for a 3c or 4 tear. Of these, 73% had not performed any primary repairs over the preceding year. 77% of all respondents had not received any training. Of those awarded the FRCS, 36% were not confident at all in performing an acute repair.

Conclusion

There remains a lack of consensus on who is responsible for the repair of these injuries. Surgeon involvement should only occur if adequate exposure and training is assured. Involvement may be reserved for cases where secondary repair is considered, when specialist pelvic floor opinion should be sought.
WP7.6 - Unplanned Re-admisisons - How are we doing; Phase 1 study
Authors: Laulloo Sufia , Connell Benedict , Barnes Stephanie , Laulloo Faqih , Ilayaraja Rajendran
Published: September 2024

Introduction

30-day unplanned re-admissions provide an indicator of performance in the NHS Framework. Average readmission rate is around 15 to 17%, however surgical re-admission is less published. Therefore, a study was set up to assess the factors influencing surgical re-admissions in a Tertiary Centre.

Methods

Retrospective study of prospectively collected data from the tertiary centre database including all ‘Unplanned Re-admissions’(URA) aged >15 years in general surgery between January and December 2022. URA <15 years old and to other surgical specialties were excluded. ANOVA test and descriptive statistics were used to analyse the data.

Results

289 (58%) of 498 readmissions were URA with 150 (52%) female and 139 (48%) male. 57 (19%) were aged 15-30 years, 121 (42%) 31-60 years, 109 (38%) 61-90 years and 2 > 90 years (Median age 54 years; p<0.05). 191 (66%) were from ED, 84 (29%) were GP referrals, 10 (3%) from clinics and 4 (2%) transferred from network. 178 (62%) URA were within 10 days of discharge, 72 (25%) between 11-20 days and 39 (13%) > 20 days (p < 0.05). The commonest cause of URA was biliary diseases (n = 40, 14%) followed by lower (n=32, 11%) and upper abdominal pain (n=17, 5%) and nonspecific abdominal pain (n=22, 7%). Other causes included appendicitis (n=8, 3%), pancreatitis (n=8, 3%), post-op complications (n=14, 5%) and obstruction (n=24, 8%).

Conclusions

URA significantly impacts health care provision and patients’ confidence. An initial study has identified reasons and patterns of re-admissions, the next phase involves analysing specific reasons to mitigate factors leading to URA.
WP7.7 - TRUST: Transvaginal Ultrasound for Surgery Evaluation and Treatment. The use of invasive tests in the right iliac fossa surgical pathway
Authors: Rankin Sally , Badminton Rebecca , Saia Laura , Tudball Daisy , Gurung Fiona , Taylor Lucy , Slim Naim , Okocha Michael
Published: September 2024

Transvaginal ultrasound (TVUS) is an invasive intimate test with strict guidance on its utilisation. This tool is commonly used in General surgery (GS) as a decision aid for operative or non-operative management.

Aims

Ensure patient selection for TVUS was equivalent in Gynae and GS pathways. Determine the influence of TVUS on the decision to operate. Ensure patients were consented adequately comparatively between general surgery and gynaecology.

Methods

This was a mixed methods study with retrospectively collected data from 1400 woman undergoing TVUS for RIF pain presenting to Gynae or GS in a DGH. Interviews were conducted with 50 GS and 50 Gynae patients. Ultrasound, blood, and histology results were reviewed. A positive GS TVUS was defined as free fluid or appendicitis, Gynae pathology was excluded. Interviews consisted of 8 likert scale questions on the process. Ethical approval was given by the hospital ethics committee.

Results

A total of 1445 patients were included (825 admitted under GS and 620 under gynae). Median age for the GS cohort was 28 and gynae 31 with no statistical difference in baseline characteristics. TVUS was positive in 14.8% of GS patients. Positive patients were more likely to proceed to laparoscopy (OR 2.43, 95% CI 1.46-4.03, p <.05). 50% of these had histologically confirmed appendicitis. Similarly, patients with raised WCC or CRP were more likely to proceed to laparoscopy (OR 1.87, 95% CI 1.26-2.76, p <.05); 56% had histologically confirmed appendicitis. There were no significant differences interviews.

Conclusion

TVUS remains an invasive tool, with similar diagnostic profile to blood tests. Careful consideration should be given to its use.
WP7.14 - The change of a DGH emergency surgical service leads to marked improvements in timing of cholecystectomy for gallstone pancreatitis, in line with international guidance
Authors: Ainley Paul , Kerr Barry , Davis Helen , Gallagher Charles , Byrnes Colman , McAree Barry
Published: September 2024

Background

International Association of Pancreatology (IAP) guidelines recommend that cholecystectomy should be performed on patients with mild biliary pancreatitis during their index admission. This retrospective study compares how a paradigm shift in the provision of emergency surgical services in one district general hospital (DGH) significantly improved ability to follow this guideline. With input from the surgical ambulatory emergency care network (SAEC), our team transformed care via an Emergency Surgery Unit (EmSU) system. This includes surgical assessment with ambulation, linked radiology slots, semi-emergency theatre lists twice weekly in addition to NCEPOD theatre and the emergency take divided in two according to sex of patient ensuring appropriate patient load for each of the surgeons of the week.

Methods

A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean + SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests.

Results

The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P < 0.01).

Days to surgery saw a 10.1-fold reduction (332.5 + 41.1 to 32.9 + 6.3 days; P < 0.0001).

Conclusions

Adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, now closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.
WP8.5 - Operative Documentation of Laparoscopic Appendicectomies at FVRH based on GIRFT - An Audit
Authors: Ng Alvin Yuan Liang , Macpherson Laura , Mehta Arnav , Graves-Morris Katie , Wilson Michael
Published: September 2024

Introduction

Laparoscopic appendicectomy (LA) is the most performed abdominal surgery in the UK. Clear documentation is required to ensure safe and effective patient care.

Aims

To assess compliance with LA operative documentation at Forth Valley Royal Hospital using Getting It Right First Time (GIRFT) guidelines.

Methods

27 data points selected from GIRFT Guidelines were examined retrospectively for 172 LA procedures between 01/08/2022 and 29/09/2023. Completed numbers and percentages for each data point were calculated.

Results

Most consistently documented data points were intra-operative findings 168 (98%), details of closure 168 (98%) and method to secure appendix stump 161 (94%). Least consistently documented were drain insertion 7 (4%), estimated blood loss 5 (3%) and instructions for suture removal 6 (3%). 6 (37%) operative notes explicitly confirmed whether the appendix was removed in those with a macroscopically normal appendix.

Conclusion

Many data points had a high completion rate, whilst others had a low completion rate. We have highlighted discrepancies in documentation between surgeons which the department is hoping to streamline to avoid any gaps that could have patient care, legal or cost implications in the future.
WP8.7 - Systematic review and meta-analysis of interventions to improve the informed consent process for patients undergoing invasive interventions
Authors: Clements Joshua , Clements Jake , Convie Liam , Clarke Mike , Kirk Stephen
Published: September 2024

Aims

This systematic review and meta-analysis aimed to assess the impact of various information based interventions used during the informed consent process for adults (over 18 years) with capacity undergoing invasive procedures.

Methods

The systematic review was conducted according to the predefined protocol developed and registered on PROSPERO (CRD42023380406). The Cochrane risk of Bias (ROB) tool was used to assess study quality. Effect measurements were assessed using standard mean differences and risk ratios for continuous variables and dichotomous variables respectively. Meta- analyses were performed using Review Manager (RevMan) version 5.4.

Results

127 studies contributing 15022 patients met the inclusion criteria from 22 countries. 120 studies were conducted in an elective setting across a variety of surgical, radiological, endoscopic, oncological, and medical disciplines. Statistically significant improvement was demonstrated in objective (SMD 0.45, (95% CI 0.14 to 0.77) I2=86% and subjective understanding (SMD 0.62, (95% CI 0.28 to 0.96) I2=74%, immediate (SMD 0.68 (95% CI 0.53 to 0.83) I2=81%, short (SMD 0.70, (95% CI 0.43 to 0.97) I2=83% and long-term knowledge (SMD 0.57, (95% CI 0.30 to 0.84) I2=82% and satisfaction with the informed consent process (SMD 0.32, (95% CI 0.19 to 0.45) I2=78%.

Conclusions

This review provides a global overview of the impact of various intervention modalities employed to enhance the informed consent process with demonstrable improvement in a variety of outcomes measures. Where available, consideration should be given by clinicians to the use of such adjuncts during the informed consent process.
WP8.10 - Ultrasound Cannulation Training Programme: Quality Improvement Project
Authors: Horner Nathan , Bruce Nikki , Dornan Ronnie
Published: September 2024

Aim

Familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts and preserves venous access. In our District General Hospital (DGH), no teaching on ultrasound-guided venous access was available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors.

Methods

Discussions were held with the medical education team at our DGH to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation, and usefulness of the session (out of 5).

Results

Of the 49 participants, only 65% (n=32) filled in the course forms. Data was only analysed from these individuals. 47% (n=15) had previous experience using an ultrasound machine. Of the 32 participants analysed, 87.5% (n=28) felt the session was very useful and the other 12.5% (n=4) found the session to be useful. 100% (n=32) felt more confident performing ultrasound-guided access after the session. The average confidence score pre vs post-session was 1.59/5 vs 3.88/5, respectively.

Conclusions

This programme can improve confidence in procedural skills amongst junior doctors, whilst also minimising stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results obtained will be critical in continuing this programme in our hospital and hopefully roll out to a wider audience.
WP8.11 - Perception of Patients, Physicians, and Chaperones Regarding the Use of Chaperones During Patient Examinations for Plastic Surgery: A Systemic Review
Authors: Wong Zhen Yu , Ou Kai Qi , Wong Zhen Ning
Published: September 2024

Aim

There is a scarcity of information related to the use of chaperones during patient examinations of body areas where plastic and reconstructive surgery is performed.

Methods

In this systematic review, we searched electronic databases for literature addressing physician use of chaperones during examinations of patients undergoing plastic surgery from the perspective of the patient, physician, and chaperone from inception of the database until April 2023. We conducted an inductive thematic analysis of four domains (physician perspective, patient perspective, chaperone perspective, and chaperone documentation.

Result

The results of the analysis showed that surgeons who are experienced, are men, or have received education related to using chaperones are more likely to provide chaperones during patient examinations for medico-legal protection and patient comfort. A small percentage of surgeons have faced accusations from patients of inappropriate behavior. Most of these incidents have occurred without a chaperone present. Patients who have long associations with a particular plastic surgery practice are less likely to want a chaperone. When physicians examine nonsensitive areas, most patients prefer having no chaperone. However, young patients and patients undergoing reconstructive procedures are more likely to request chaperones. Patients prefer having family members or friends serve as chaperones. Notably, despite the presence of a chaperone, we found that documentation of the presence of a chaperone was inadequate.

Conclusion

Further research, including qualitative studies and multinational approaches, is warranted to gain deeper insights and develop comprehensive guidelines for chaperone use that empowers both patients and healthcare providers.