bluuebunny/crossref_metadata_2025 huggingface dataset:
ThTP2.3 Value of staging laparoscopy in patients with oesophageal and junctional cancers – Single centre retrospective observational study
Authors: Liyanage Nanayakkara Kushan Dhanuja , Khateeb Basim , Ng James , Sengupta Paulomi , Savadia Krishna , El-Sharkawy Ahmed
Published: August 2023

Introduction

The role of staging laparoscopy in oesophageal and junctional cancer remains controversial due to lack of robust evidence leading to heterogenous practice nationally and globally. The purpose of this study was to identify the value of staging laparoscopy in patients with oesophageal and junctional cancer.

Methods

A retrospective review of all consecutive patients who underwent staging laparoscopy for oesophageal and junctional cancer over 7-year period at Royal Derby Hospital, Derby was conducted using hospital database. Patient demographics, histology, staging, location, and findings of staging laparoscopy were analysed.

Results

A total of 278 of patients underwent staging laparoscopy from July 2015 to September 2022 were included. All patients with gastric cancer histology were excluded. Majority of the patients were having adenocarcinoma histology (N=248, 89.2%) and 236 (84.8%) cancers were involving lower oesophagus/ GOJ. Additionally, nearly three-quarters of patients (N=203, 73%) were having T3 staging before the procedure. Overall, staging laparoscopy had changed the management in 22 patients (7.9%) due to positive cytology (N=12, 4.3%) and other findings (N=10, 3.5%) such as cirrhosis liver, large bulky tumour, and peritoneal deposits. Out of patients who were having positive cytology, all had adenocarcinoma histology, located in the lower oesophagus, and had T3 or above pre-operative staging.

Conclusion

This study identified the value of staging laparoscopy in patients with certain risk factors who are at risk of having peritoneal disease. Therefore, selective approach would be more appropriate when selecting patients for staging laparoscopy in oesophageal and junctional cancer.
ThTP3.2 Introducing a ward round template to improve the quality of documentation on the general surgery ward round
Authors: Davenport Matthew , Chan Chetying , Suhail Shameel , Davies Emma
Published: August 2023

Aims

We aimed to improve documentation on general surgical ward rounds, through the introduction of a ward round template at a single UK surgical unit.

Methods

The structure of the template was adapted from the ‘Surgical Assessment for Emergencies Ward Round Tool’ produced by the RCSEd, with modifications based on local requirements. A retrospective audit was performed of 4 weeks of electronic ward round notes prior to, and 4 weeks after the introduction of the template. Ward round notes on 2 chosen days (Wednesdays and Saturdays) during the 4 week study periods were included for analysis. We observed how frequently specific important clinical information was documented.

Results

378 electronic ward round notes were analysed (176 before, and 202 after the introduction of the template). The ward round template was used, either in part or in full, in 72% of ward round notes following it’s introduction. An pre-existing structured electronic ward round note had previously been used in only 1% of cases. How frequently each of the following components was documented when using the template was: important admission events (86%), VTE prophylaxis (93%), nutritional status (76%), review of prescribed antibiotics (91%) and ceiling of care (65%). We demonstrated statistically significant improvements for each of these components (p<0.05) from pre-template rates (73%, 16%, 63%, 51% and 2% respectively).

Conclusion

The introduction of a ward round template vastly improved the frequency with which a structured approach to ward round was taken. In doing so, significantly improving the documentation of important clinical information.
ThTP3.6 Patient-Reported Experience Measures: the impact of In-Person Surveys
Authors: Gouaalla Hafsah , Riyazati Mahta , Nyantakyi Maame , Ali Fizza , Gambhir Raghvinder Pal Singh
Published: August 2023

Aims

This study aimed to identify the impact of actively administering a survey to aid patients in completing patient-reported experience measure (PREM) surveys. We aimed to compare key domains' results to the national UK kidney PREM 2021 report and determine whether there is a difference between surveys administered by an in-person volunteer and self-administered surveys.

Methods

Our volunteers visited hospital renal and satellite dialysis units weekly from Aug to Oct 2022. All haemodialysis patients were offered to complete a 38-item survey covering 14 domains on their renal care experience using a 1-7 rating scale, 1 being the lowest rating and 7 the highest. We then compiled and compared our results to the 2021 report.

Results

49 out of 82 patients completed the PREM survey. The completion rate increased from the previous year in hospital dialysis and satellite units. The patients’ experience domain score was lower than the 2021 report, with an average score of 5.66 compared to 6.24. A higher percentage of patients in our study (36.7%) reported never being asked about their emotions compared to 14.4% in 2021. This has led to a new referral pathway for seeking emotional counselling.

Conclusions

This year’s survey identified a felt need for emotional support and creation of a new referral pathway for the same. Administering surveys in person through volunteers increases patient engagement and receptiveness to engage, especially for patient groups that may have barriers such as language, disabilities and lack of access to technology.
ThTP3.9 Perceptions and priorities of perioperative staff and the public for sustainable surgery: a validated questionnaire study
Authors: Gadi Nishita , Lam Kyle , Beatty Jasmine Winter , Acharya Amish , Purkayastha Sanjay
Published: August 2023

Aims

To determine the attitudes and beliefs of perioperative staff and the public to sustainability initiatives in surgery, and whether differences exist between the two groups. Despite a drive to improve surgical sustainability, few interventions have been adopted. Stakeholder engagement is considered a key barrier to implementation.

Methods

Validated healthcare questionnaires were developed using a stepwise process. A systematic review was undertaken to identify key domains pertaining to sustainability, and ensure content validity. Initial questionnaires were refined using an iterative process of feedback from focus groups. Psychometric validation was conducted to remove question ambiguity. The final validated questionnaire was distributed to perioperative staff and the public using a multi-modal approach.

Results

Only 37.1% of perioperative staff reported implementation of sustainability initiatives in their departments. Yet, staff (45.7%) and the public (48.2%) somewhat agreed that sustainability should influence a surgeon’s procedural decision-making. Insufficient staff education regarding sustainability was a potential cause for lack of adoption, with 71.4% reporting they had no formal training. Staff and the public agreed outcomes (38.6% v. 42.7% p=0.767) and surgeon experience with a technique (28.6% v. 40.0%, p=0.082) were more important than sustainability. However, 40.9% of the public did not consider operative time an important factor compared to sustainability, whilst 45.7% staff would only tolerate procedures 25% longer.

Conclusions

Engaging stakeholders is central to implementing long-term environmentally sustainable initiatives in surgery, without compromising patient outcomes. More work is needed to understand the relative trade-offs considered by perioperative staff and the public, as well as providing both groups with more education on ecological outcomes.
ThTP4.3 Single Incision Laparoscopy (SIL) Versus Conventional Multi-port laparoscopy (CL) for Colorectal Surgery: A Systematic Review and Meta-analysis
Authors: Sherbiney Mohammed El , Khawaja Amir Hassan , Noureldin Khaled , Issa Mohamed , Varma Aarti
Published: August 2023

Background

There is an increase in colorectal cancer resections worldwide and in the UK. The surgical resections were conducted open initially and replaced later with the conventional multiport technique. Laparoscopic colectomy became the standard surgical technique in 1991. With the innovation in surgical technology, single-incision laparoscopy is stated to attract more attention to the possible next step in colorectal resection. This project aimed to compare the outcome between the two techniques and detect if one technique is superior to the other.

Methods

According to the PRISMA guidelines, A detailed literature survey using PubMed, MEDLINE, and EMBASE databases was carried out to extract Randomised Controlled Trials published between January 2000 and May 2021 and using Revman for statistical analysis.

Results

Eleven RCTs were extracted with a total of 1370 with 686patients (50.07%) underwent SIL and 684pateints (49.92%) underwent CL.There was no significant difference between SIL and CL in terms of operative time (SMD=0.01; 95% CI=-0.19 to 0.22; Z= 0.11; P=0.91), length of hospital stays, (SMD= -0.10; 95% CI=-0.22 to 0.02; Z= 1.61; P=0.11), overall complication (OR=0.99; 95% CI= 0.75 to 1.30; Z=0.09; P=0.93). SIL showed shorter length incision (SMD= -0.99; 95% CI=-1.35 to -0.62; Z= 5.25; P<0.00001). SIL showed more intra operative complication (OR=1.80; 95% CI= 0.92 to 3.51; Z=1.72; P=0.09) and conversion to other technique or open (OR=3.10; 95% CI= 0.95 to 10.14; Z=1.87; P=0.06) but was not statistically significant.

Conclusion

SIL can be considered a safe alternative to CL if performed by experienced surgeons.
ThTP5.9 Are readmission rates in a new surgical SDEC department acceptable? A service evaluation of a Healthboard’s new department
Authors: White Angus , Wong Eleanor , Anwar Salman , Koonara Kalhar , Thomas Charlotte
Published: August 2023

Aims

Unplanned patient readmission after discharge is a costly and potentially preventable occurrence, which can negatively impact both the patient’s experience and overall outcomes. Readmission rates across the country vary depending on location, population demographics and presenting complaint, but most departments have rates between 4 – 10%.

Our health board has recently implemented a new surgical Same Day Emergency Care (SDEC) department in response to rising pressures on beds. There have already been promising drops in patient waiting times since its inception, however patient readmission rates have not been formally evaluated.

We aimed to investigate 30 day unplanned patient readmission rates in this new SDEC department.

Methods

All patients that came in to the SDEC department in October 2022 were placed on a prospective database. We used the healthboard’s Clinical Workstation (CWS) database application to track whether they had re-presented to the Emergency or surgical departments within 30 days of their discharge from SDEC.

Results

344 patients were seen in SDEC over the course of 31 days. Of these 238 were discharged, 34 were planned readmissions and 71 were admitted. Of the discharged patients 13 came back as unplanned readmissions within 30 days. This gives an unplanned readmission rate of 5.5%.

Conclusion

SDEC is providing an excellent surgical service, with low unplanned readmission rates. SDEC has proven to be an effective way to divert patients from the Surgical Assessment Unit and ease the acute on call surgical take pressures.
ThTP5.10 A clinical audit of assessment of the risk of malnutrition and the subsequent nutritional support prescribed for older emergency laparotomy patients
Authors: Windle Angela , Burke Dermot , Ispoglou Theocharis , Nair Sherena
Published: August 2023

Aims

Patients should have assessment of the risk for malnutrition on admission using a Malnutrition Universal Screening Tool (MUST) and this should trigger a response if patients are categorised as high risk (National Institute for Health Care and Excellence, 2017). This clinical audit sought to identify if older patients undergoing emergency laparotomy were identified as at risk of malnutrition with subsequent interventions to address protein and energy deficiencies.

Methods

Patients entered onto the National Emergency Laparotomy Audit (NELA) database who were over 65 years of age during 1/1/21 to 31/12/22 were included. The patient records were screened for the MUST score on admission and whether nutritional supplementation was prescribed, or dietetic referral made, following the recording of a high-risk MUST score.

Results

Three hundred patients were included in the audit with 99.3% of the patients having a MUST score recorded on admission. One hundred and fourteen patients recorded a high MUST score, with 35% of the high MUST patients not receiving a dietetic review and 24% receiving neither oral nor parenteral supplementation. Mortality at 30 days was 13.9%. The wide variety of supplementation prescribed was changed to a protein and energy-based supplement upon dietetic review.

Conclusions

MUST scores are available to surgical teams, but high-risk scores do not always trigger an intervention to address deficiencies in older NELA patients. A protocol to ensure consistent approaches to supplementation before dietetic review would reduce variation and education of prescribers is needed to address the importance of prescribing protein-based supplements is needed.
ThTP7.4 Role of transanal irrigation in the management of low anterior resection syndrome: an evidence synthesis by meta-analysis
Authors: Shafique Muhammad Salman , Umair Musab Bin , Tahir Irtesam , Sains Parv , Baig Mirza Khurrum , Sajid Muhammad S
Published: August 2023

Objective

Low anterior resection syndrome (LARS) may be a debilitating postoperative anorectal dysfunction causing negative impact on the health-related quality of life in patients undergoing low anterior resection for rectal diseases. The objective of this review is to evaluate the role of transanal irrigation (TAI) in patients with LARS.

Methods

Randomized controlled trials (RCTs) comparing the effectiveness of TAI against baseline conventional therapies in patients with diagnosed LARS were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4.

Results

Three RCTs reported the effectiveness of TAI on 109 patients with LARS. Two RCTs compared TAI against conventional conservative therapies whereas one RCT reported the comparison of TAI versus tibial nerve stimulation. There were 53 patients in the TAI group and 56 patients were in no-TIA group. In the random effects model analysis, TAI was associated with the reduced low anterior resection score [standardised mean difference -2.32, 95%, CI (-3.98, -0.67), Z = 2.75, P=0.006] and lower faecal incontinence score [standardised mean difference -1.62, 95%, CI (-3.06, -0.17), Z = 2.19, P=0.03] compared to other therapies. There was significant heterogeneity (Tau2 = 1.85; Chi2 = 20.78, df = 2; (p < 0.0001; I2 = 90 %) among included studies.

Conclusion

TAI has shown clinically proven advantage to improve LARS related anorectal dysfunction. However, due to paucity of the randomised trials, and significant clinical as well methodological diversity among included studies, these findings should be taken cautiously.
ThTP7.7 Anastomotic leakage in colorectal cancer resections: A 15 year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A
Published: August 2023

Aims

Anastomotic leakage is serious event in restorative colorectal cancer resections, reported incidence of < 10%. Aim of study is to assess management of anastomotic leakage at single centre.

Methods

Single-centre cohort study was carried out: Jan' 08 to Feb' 23. Descriptive demographics + post-op outcomes were analysed for colorectal cancer resections with “non-leaks” as controls.

Results

Conclusion

Anastomotic leakage rate 3.5 % of colorectal cancer resections, surgical intervention in 1.5 %. Type C leakage are believed to have worst prognosis (recurrence & shorter survival). Despite prolonged hospital stay (p < 0.0001), there was no reduced survival or increased mortality rate with anastomotic leaks. Early diagnosis & intervention is crucial in the management of anastomotic leakage. A diversion stoma reduces the adversity of anastomotic leakage.
ThTP7.12 Effect of COVID-19 lockdown on surgical outcomes of patients undergoing colorectal surgeries
Authors: Gowda Manoj Srinivas , Mesut Erel , Peter Bennett , Venkatesan Gowtham , Thulasiraman Sri , Jha Madan
Published: August 2023

Aims

When the UK entered the lockdown, the referral pathways and hospital policies changed in order to deal with the pandemic and protect healthcare staff and patients from the virus. The objective of our study is to compare the surgical outcomes of patients having colorectal (CR) surgeries during and after lockdown.

Methods

Patients who underwent CR surgeries between Feb-2020 to Aug-2022 were included in the study. All patient related, disease specific and surgical details were obtained from the prospectively collected database. Patients were divided in to two groups: Surgeries before (group-A: during lockdown) and after 22/2/21(group-B: after lockdown). Patient demographics, surgical details and postoperative complications were collected and analysed using standard statistical tests.

Results

A total of 528 patients underwent surgeries during this period, of which 422 had cancer resections. During lockdown 230 patients had surgery (Group-A) and 298 patients had surgery after lockdown (Group-B). The median age of patients is 72 and 73 years in group A and B respectively (p-value 0.29). In group-A, 16% of patients had emergency presentation and in group-B,10% had emergency presentation (p-value:0.039). Emergency operations were undertaken in 21.74% of patients in group-A compared to 14.43% in group-B (p value:0.028). Minimal invasive surgery was done in 189 (82.17%) patients during lockdown compared with 253 (84.90%) after lockdown (p-value:0.102). The complications rate was higher in group-A compared to group-B (19.56% in group-A vs 12.75% in group-B, p- value:0.032).

Conclusions

Emergency presentation, emergency operations and postoperative complications were higher during lockdown compared with post lockdown. There was no difference with respect to mode of surgery.
ThTP8.1 Improving Adherence to NCEPOD Guidelines in a District General Hospital
Authors: Mactier Mhairi , Shahid Mishal , Chung Lucia
Published: August 2023

Background

NCEPOD classification defines urgency for appropriate surgical intervention. Use of this classification ensures patient safety, clinical governance, and promotes communication and teamwork. NCEPOD advises classification is allocated at time of the decision to operate; classification should be recorded both in the patient casenotes and on the theatre management system.

Aim

To assess use of NCEPOD classification in a district general hospital and improve adherence to national guidelines.

Methods

Retrospective data review of theatre management system (OPRA) for all emergency cases performed at a district general hospital between 01-14/09/2021. Data reviewed included procedure performed, NCEPOD classification and adherence to selected classification (time of booking ◊ time to theatre). Theatre booking form was amended to include NCEPOD classification and distributed throughout the department. Further data collection 14-28/01/2022 to assess for improvement, and 02-13/05/2022 to assess for sustained change.

Results

Cycle 1

Cycle 2

Cycle 3

Conclusion

Introduction of new theatre booking form has improved adherence to NCEPOD guidelines. There is scope to improve this further. Ongoing efforts include more departmental education and introduction of a WHO surgical sign-out.
FTP1.1 Using the STUMBL score to assess blunt chest wall trauma - does improving accuracy lead to improved patient care?
Authors: Clymo Jonathon , Perikleous Yianna , Wickham Alex
Published: August 2023

The STUMBL score is widely used to assess risk of complications in patients with blunt chest wall trauma. We audited its use in guiding the management of patients with rib fractures at a London major trauma centre.

Methods

This was a closed-loop audit. Data were collected retrospectively from electronic patient records for a period of one month (October 2021). Results were disseminated at the Regional Major Trauma Network Governance meeting. Educational updates were provided for the multidisciplinary team. After this intervention, a second one month audit cycle was completed (December 2021).

Results

Thirty-nine patients were included in cycle 1, of whom 41% (n=16) had care stratified using the STUMBL score. Calculation accuracy was poor: 0% had a correct score and 56.3% (n=9) had a score calculated within ±3 of the correct figure. Post-intervention, there was a significant improvement in STUMBL use in the 34 patients assessed in cycle 2: 85.3% (n=29; p=0.0001) had a documented score. Accuracy also improved, with 44.8% (n=13) within ±3 of correct and 31.0% (n=9) correct. There was no significant difference in the proportion of patients who were treated according to guidelines (74.3% vs 53.8%) or who were under-treated (23.1% vs. 38.2%) following our intervention (p=0.18).

Conclusions

We found a number of barriers to implementing the STUMBL score. Its use and calculation accuracy was improved by education, but this did not result in more patients following the suggested treatment pathway. Further evaluation is required to understand this discrepancy.
FTP1.4 Computer Blast wave and Shrapnel Simulation in Unity
Authors: Hutton Michael
Published: August 2023

Aims

A computer simulation to show the effects of an explosive device's blast wave and shrapnel injuries to humans.

Methods

Unity 3D project written in C# with real time physics showing the effects on people and listing probable injuries sustained.

Results

An explosive mass of 0.1kg to 100kg PTEN can be simulated showing the evolving blast wave and up to 100,000 shrapnel particles. The blast wave can show the maximum overpressure, velocity of the shock front and temperature Video: https://youtu.be/ICH2xHR6678. The shrapnel is simulated with the physics engine including velocity, energy of injury and body/limb hit points to calculate their effect. A model of the Manchester Arena is used as an example. Example blastwave data:

Conclusions

This novel approach to simulation showcases what is possible with computer simulation. Next steps are verification of data and building of more models. A higher detailed human model is being worked on which includes organs and bones.
FTP1.7 Critical decision analysis of pre-hospital major haemorrhage protocol activation
Authors: Wohlgemut Jared , McMullen Heather , Marsden Max , Marsh William , Perkins Zane , Tai Nigel
Published: August 2023

Aims

Major haemorrhage protocol activation (MHPA) facilitates immediate blood product availability and institutional capacity readiness for bleeding trauma patients. MHPA is a difficult decision pre-hospital, where two thirds of MHPAs occur. We aimed to identify the determinants and influences of the pre-hospital MHPA decision.

Methods

This prospective qualitative study had Health Research Authority approval (REC 22/PR/0089). Physicians from one helicopter emergency medical service (HEMS) were purposively sampled. Written informed consent was obtained. Cases representing difficult MHPA decisions within the previous six months were included. Semi-structured interviews were conducted via Microsoft Teams, following the critical decision analysis method. Interviews were transcribed and analysed using a 6-step inductive thematic analysis method on NVivo.

Results

Twelve interviews were conducted with nine participants: median age 37 years (range 34-45), median post-graduate experience 12 years (IQR 10.5-14.8), and median HEMS experience 1 year (IQR 0.5-4.9). Cues for (and against) the MHPA decision included: hard evidence of bleeding (or bleeding judged to be non-severe); initial information fit their mental model of a bleeding patient (or did not); patient deterioration (or response to resuscitation); acknowledgement that injuries and bleeding can be missed (or uncertainty of clinical findings); and alternative diagnoses were considered less likely (or more likely). Other influences of the MHPA decision were heuristics (especially anchoring bias), situational awareness, previous experience, colleagues on-scene, time- and task-pressure, and the desire for diagnostic accuracy and professional reputation.

Conclusions

Multiple determinants and influences affect the pre-hospital MHPA decision. Acknowledging these cognitive processes will inform efforts to improve decision-making in trauma.
FTP1.8 Thoracic spine stab injury with a retained knife: a rare case and the lessons learnt
Authors: Ingram-Walpole Shannon , Shah Shaneel , Campana Luca , Griffiths Ben , Almerie Qutayba
Published: August 2023

A 52-year-old female patient was admitted to the Emergency Department with an isolated thoracic spinal stabbing with a retained knife. She was haemodynamically stable a normal peripheral neurological examination. CT scan with 3D image reconstruction showed the blade had collided and lodged into the T11 vertebrae with the tip in close proximity but missing the spinal cord, aorta and inferior vena cava. A multidisciplinary team, including anaesthetists and vascular, neuro, and general surgeons, agreed upon the treatment strategy. The lodged knife was safely withdrawn in the operating theatre with the patient in prone position and under sedation and local anaesthesia. Following the procedure, neurological examination remained normal, and MRI scan revealed no spinal cord injuries.

In this case report we discuss the initial approach to managing patients with a penetrating spinal injury. We elaborate on the role of pre-operative imaging using CT scan with 3D reconstruction, where possible, to assess the extent of injuries, as well as, the importance of timely input from multidisciplinary specialties based on the extent of the injuries. In case of a retained foreign body, we discuss how to extract it and importance of having contingency planning for any potential post withdrawal complications.
FTP2.5 Clinical audit following initial experience from a dedicated botox clinic for the treatment of anal fissure
Authors: Brandie Emma , Jabbar Salman Ahmed Abdul , Nicholson Gary
Published: August 2023

Background and Aims

Chronic anal fissure is a common and debilitating disease. Intersphincteric injection of Botulinum Toxin A during examination under anaesthesia (EUA) is an established treatment option following failed conservative management. The aim of this study was to investigate the effectiveness of clinic-based Botox injection for treatment of chronic anal fissure as an alternative to injection under anaesthesia. Feasibility was evaluated in terms of cost, safety and sustainability.

Methods

This was a retrospective single centre study of prospectively collected data between August 2021 and August 2022. Demographic data, treatment protocols and follow-up outcomes at three months were collated. The relative costs were provided by the regional financial department.

Results

Sixty-four patients were referred to clinic in the first year. Anal fissure was confirmed in 63% of patients with 89% receiving Botox injection in the clinic setting with no major complications. Healed fissure was induced in 85% of patients reviewed at a three-month follow-up. Five patients required referral for EUA with injection of botox. An estimated cost saving of £1,308.50 per case was achieved for clinic-based Botox versus Botox administered via EUA. Clinic-based administration of Botox reduced theatre resource utilisation during the study period.

Conclusion

Clinic-based Botox administration is feasible, safe and effective in the treatment of chronic anal fissure. This treatment approach not only provides a clinically effective, cost-efficient alternative to surgery but reduces resource utilisation and waste which is environmentally beneficial.
FTP3.3 Pelvic intraoperative neuromonitoring during anterior or abdominoperineal resections: a critical appraisal of published studies by meta-analysis
Authors: Singh Anurag , Kaur Mandeep , Sains Parv , Baig Mirza , Swaminathan Christi , Sajid Muhammad
Published: August 2023

Objective

Anorectal, urinary and sexual dysfunction following rectal resections (RR) is a clinical problem influencing the health related quality of life significantly. The objective of this review is to evaluate the role of intraoperative neuromonitoring (pIONM) to prevent pelvic nerve damage leading to urogenital dysfunction in patients undergoing RR.

Materials and methods

All types of comparative studies reporting the role of pIONM to avoid pelvic nerve damage leading to urogenital dysfunction in patients undergoing RR were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results

The search of medical databases yielded 6 comparative studies (one randomised trial and 3 retrospective and 2 prospective studies) on 489 patients undergoing RR. In the random effects model analysis, pIONM failed to reduce the incidence of erectile dysfunction (p = 0.27), urinary dysfunction (p = 0.78), and sexual dysfunction (p = 0.18). However, the risk of anorectal dysfunction [standardised mean difference -0.57, 95%, CI (-0.81, -0.34), Z = 4.85, P=0.00001] reduced significantly by use of pIONM during open/laparoscopic or robotic RR. There was no heterogeneity (Tau2 = 0.0; Chi2 = 1.48, df = 3; (p < 0.48; I2 = 0 %) among included studies.

Conclusion

pIONM may reduce the risk of anorectal dysfunction following RR but the outcomes related to urinary and sexual dysfunction seem to be unchanged. However, due to paucity of the randomised trials, these findings should be taken cautiously.
FTP3.4 Robotic bladder-sparing exenterations for advanced rectal cancers - Short term outcomes
Authors: Kazi Mufaddal , Desouza Ashwin , Sharma Vivekanand , Saklani Avanish
Published: August 2023

Introduction

Pelvic exenterations are the standard of care for anterior urogenital invasion from advanced rectal cancers. In select cases, bladder preservation is possible. The present study aims to report the surgical and short-term oncological outcomes for the largest series of robotic bladder-sparing exenterations for locally-advanced rectal cancers.

Methods

Single-centre, retrospective analysis of patients that underwent robotic bladder-sparing exenterations for primary advanced rectal cancers between December 2019 and November 2022. Primary outcomes were major morbidity rate (≥ grade IIIA), R0 resections, and local recurrences.

Results

Sixteen patients underwent robotic bladder-sparing exenterations. The median hospital stay was 8.5 days and six patients (38%) experienced grade IIIA or more morbidity. There was no operative mortality. Five patients had a urinary leak; four from the bladder neck and one from the posterior wall of the bladder secondary to necrosis. A pathologically involved circumferential margin was observed in one patient and one patient had a local recurrence.

Conclusions

Robotic bladder-sparing exenterations are technically feasible for select locally-advanced rectal cancers with prostatic or urethral invasion. Operative morbidity is largely related to bladder neck leaks. Short-term oncological outcomes appear favourable in terms of R0 resections and local recurrence rates.
FTP4.1 Compliance With Antimicrobial Prescribing Guideline Recommendations
Authors: Ayantunde Boluwatife , Opaluwa Abdu , Vaghela Devan , Zach Rudolf
Published: August 2023

Aims

Due to concerns regarding the quality of antimicrobial prescribing in the General Surgery department at a District General Hospital, a prospective quality improvement project was undertaken to guide local antimicrobial stewardship.

To assess the compliance of the General Surgery department with local antimicrobial prescribing guidelines and policies, and recommendations in the BNF and electronic medicines compendium (EMC).

The aim was to evaluate the extent of change in compliance of the General Surgery junior doctors during after intervention.

Methodology

Prospectively collected data on the patients admitted and started on antimicrobial agents over two 3-week periods under the General Surgery department. Educational interventions were initiated in the interval between the periods of data collection.

Results

91 patients were audited in Cycle 1 with a median age of 57 (9-93) years including 36 males and 55 females. Cycle 2 involved 89 patients with a median age of 60 (9-87) with 48 males and 41 females.

After intervention, there was an increase in correct prescribing regime (51.6 to 56.2%), correct dose (91.2 to 98.9%), correct frequency (59.3 to 79.8%), and correct duration; when included (78.8 to 83.3%). There was a decrease in the duration being included on the prescription (36.3 to 33.7%). The increases in correct antimicrobial dosing and correct antimicrobial frequency prescriptions were statistically significant at p ≤ 0.05.

Conclusion

Areas for improvement in the compliance to prescribing guidelines in the department could be influenced successfully through appropriate intervention. The audit highlighted particular areas to be targeted by education.
FTP5.3 The Use of High Risk MDT in Assessing Patients for Elective Surgery
Authors: Dunlop Hannah
Published: August 2023

Aims

The High-Risk MDT is an opportunity for patients to meet with consultants in surgery, medicine and anaesthetics who are involved in their care and come to a joined decision about their care. The aim of this audit was to review the patients referred and their outcomes over a year, particularly the mortality of those recommended for surgery verses those not and use of objective risk scores.

Methods

Data was collected for all patients referred to the MDT from March 2021 to February 2022, including patient demographics, comorbidities, if there was an objective morbidity or mortality risk documented to be explained to the patient, as well as the MDT recommendation and subsequent mortality. 65 patients were referred; one repeat referral was excluded as were eight patients where no notes from the MDT meeting could be found and two that were referred to tertiary centre, leaving 54 patients for analysis.

Results

17% of patients had a documented risk of morbidity or mortality, with 4 patient notes documenting a validated objective risk score (POSSUM, SORT, NSQIP). 54% of those referred to the high-risk MDT were deemed not fit for surgery, with a mortality rate of 33%. 46% of those referred to the high-risk MDT were recommended for surgery, with a 2% mortality rate.

Conclusions

The high risk MDT is a helpful process for patients and staff but there is a lack of standardisation in the risk assessment used and documentation at these meetings, meaning that there is much variation in patient experience.
FTP5.5 Zinc and Copper Deficiency in Bariatric Patients: Time to Revise Guidelines?
Authors: Kainth Rupinder , Burton Katarina , Sufi Pratik
Published: August 2023

Aim

The number of bariatric surgeries performed is increasing due to the rising incidence of obesity. It is known that mineral deficiencies can occur in the postoperative period for these procedures. We examined the prevalence of zinc and copper deficiencies before and after various bariatric procedures, with the aim of assessing the relevance of current recommendations, specifically the American Society for Metabolic & Bariatric Surgery (ASMBS) and the British Obesity and Metabolic Surgery Society (BOMSS) guidelines, regarding monitoring and supplementation.

Method

We retrospectively analysed data of 327 patients who underwent one of three bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and mini-gastric bypass (MGB) between January 2018 and December 2019. Copper and zinc serum levels prior to surgery, and at 3, 6, and 12 months post-operation were collected.

Results

Preoperatively, 56.7% of patients undergoing bariatric surgery were zinc deficient and 32.4% had hypercupraemia. Twelve months post-surgery, 42.9% of RYGB, 35.3% of SG, and 57.7% of MGB patients with preoperative zinc deficiency presented again with a zinc deficiency requiring supplementation. Only 1 patient displayed copper deficiency preoperatively, and 6 postoperatively.

Conclusion

Screening for zinc and copper deficiencies at 6 and 12 months postoperatively, rather than at 3 months, is a more clinical and cost-effective strategy.
FTP5.9 A review of post-operative outcomes following Cholecystectomy - Emergency vs Elective
Authors: Kuan Jen Yee , Kho Jason , Shetty Vinutha , Date Ravindra , Rajendran Ilayaraja
Published: August 2023

Aim

NICE (CG188) 2014 recommends index cholecystectomy (IC) for patients admitted with gallstone disease, particularly “acute cholecystitis”, within one week of diagnosis. Conversely, elective cholecystectomy (EC) patients are pooled via various pathways, from elective to emergency. Safety of ICs is well-established. A study was conducted to investigate difference in outcomes between IC and EC.

Methods

Retrospective study of prospective database of cholecystectomies performed as primary procedure was carried out between February 2021 and July 2022 in our trust. The primary outcome was hospital readmission, while secondary outcomes included postoperative complications graded by Clavien-Dindo classification (CDC), length of stay (LoS) and intensive care (ICU) admission. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value <0.05 was statistically significant.

Results

202 patients underwent cholecystectomy. There were similar numbers in the studied groups; IC-49.8% (n=100/202) and EC-50.2% (n=102/202). Hospital readmission rates were higher in the IC – 11/100(11%) vs EC – 3/102(2.9%), p=0.02. Postoperative interventions (grade-3-CDC) (IC-11.0%, n=11 vs EC-2.9%, n=3, p=0.02) and ICU admission rates (IC-7.0%, n=7 vs EC-1.0%, n=1, p=0.03) were higher in IC compared to EC. Uncomplicated recovery (grade-1-CDC) was significantly higher in EC (p<0.0001). Postoperative LoS was significantly longer in IC (p<0.0001). There was no recorded mortality in either group.

Conclusion

Study confirms that IC is safe. However, postoperative procedural interventions were more common in IC, which is highly indicative of complex pathology (perforated/necrotic gallbladder/inflamed hepatocystic triangle) and may be contributed by timing of procedure. Further studies to assess underlying factors contributing to these outcomes are warranted.
FTP5.11 Consenting for Elective Surgical Procedures
Authors: Nishijo Mai , Sivasothy Niroshan , Gurunaidu Subramaniam
Published: August 2023

Background

Guidelines by the Royal College of Surgeons, Department of Health and General Medical Council state that consenting for surgical procedures should be a process, rather than a one-off event, for patients with capacity to make a fully informed decision. Consent should be gained well in advance and this decision reconfirmed on the day. This audit aimed to investigate whether patients undergoing elective surgeries at a hospital were consented sufficiently in advance to surgery.

Method

Over a two-week period, consent forms for patients undergoing elective surgeries in General Surgery and Urology in a hospital were reviewed prospectively. Consent was defined as formal consent form signed by the patient and surgeon.

Results

Total of 76 consent forms were reviewed (n=38 for General Surgery, n=38 for Urology). Only 26.32% of patients overall were consented in advance to surgery. 52.63% of General Surgery patients were consented prior to day of surgery and reconsented on the day, whereas 0% of Urology patients were consented prior to day of surgery. 0% of patients overall were provided written information when consented, and 2.63% consented with an interpreter.

Conclusion

All patients seen in outpatient clinic or ward with plan for elective surgery should be formally consented when the procedure is initially proposed, to allow sufficient time for reflection on the decision. Adequate time should be provided in clinic to accommodate this. Patients’ understanding should be maximised with written information and interpreter if required. Consent forms may be stored online if patients are consented months prior to surgery.
FTP6.3 In Hospital Delay to Laparoscopic Appendicectomy in CT Proven Appendicitis
Authors: Farrow Emily , Phillips Simon , Arvind Nitin
Published: August 2023

Aims

The ability to deliver emergency general surgery (EGS) is often limited by access to emergency theatres. The Royal College of Surgeons suggests that clinical audit of EGS activity will establish evidence that can contribute to service change. Laparoscopic appendicectomy is one of the most frequent EGS operations performed. The aim of this study is to quantify in hospital delay to theatre for CT proven appendicitis and examine clinical outcomes.

Methods

In a large major trauma and transplant centre, where emergency theatre space is shared with several specialties, data were collected on patients admitted with CT proven appendicitis over a 6-month period (01/06/2022 to 01/12/2022). Details of CT findings, intra-operative findings, as well as time of booking, operation and discharge were recorded.

Results

65 patients presented with CT proven appendicitis. The average time to theatre from time of booking was 16.7 hours. 60.0% (39/65) patients took >12 hours to get to theatre. Of these, 7.7% (3/39) had perforated appendicitis on CT. 33.3% (13/39) had perforated appendicitis at the time of surgery. The average stay of patients with perforated appendicitis at the time of surgery was 4.1 days longer than those with uncomplicated appendicitis.

Conclusions

In hospital delay of more than 12 hours has previously been shown to be an independent risk factor for perforation. A large proportion of our patients took more than 12 hours to get to theatre and those with perforated appendicitis had an increased length of stay. Delays in delivering EGS results in increased length of stay, exacerbating the bed crisis.
FTP7.8 Has Endoscopic retrograde cholangiopancreatography (ERCP) management of acute biliary obstruction due to gallstones been affected during the Covid-19 pandemic? – A single unit experience
Authors: Yang Peiming , Singh Gautam , Peter Mark
Published: August 2023

Introduction

British Society of Gastroenterology (BSG) guidelines advised for ERCP procedures to be continued for emergency biliary pathologies during the Covid pandemic. We aim to compare the performance and outcomes of ERCP for acute gallstone biliary obstruction before, during, and post first and second covid waves at our unit.

Methods

Retrospective study of all patients with acute biliary obstruction secondary to gallstones who underwent ERCP from January to December 2020 (covid), compared with those between January to December 2019 (pre-covid), and between January to December 2021 (post-covid).

Results

65 patients underwent ERCP for obstructed gallstones in the covid group, compared to 64 in pre-covid and 64 in post-covid group. Higher proportion of patients presented with severe jaundice (bilirubin >100) in the covid group, compared to pre-covid (P=0.031) and post-covid (P=0.028) groups. Proportion of patients with biliary sepsis requiring antibiotics was higher in covid group compared to pre-covid (P=0.031) and post-covid groups (P=0.047).

The median waiting time for ERCP was 3 days in covid group, 4 days in pre-covid, and 5 days in post-covid. Compared to both pre-covid and post-covid groups respectively, there was no statistically significant reduction in the covid group in any of: proportion of complete CBD clearance (P=0.26 P=0.40), sphincterotomies performed (P=0.22, P=0.49), or successful CBD stent insertion (P=085. P=0.52).

There was no statistical difference in post-ERCP complication rates comparing Covid with pre-covid (P=0.47), or post-covid (P=0.24) groups.

Conclusions

Quality of ERCP management of acute gallstone biliary obstruction has been maintained throughout the covid pandemic at our unit.
FTP8.4 Trends in Exception Reporting (ER): Medicine vs Surgery
Authors: Richardson Tom , Naqvi Mushal
Published: August 2023

Aim

ER was introduced with the new junior doctor contract in 2016. This was a mechanism to ensure compensation for all work performed and to uphold all educational opportunities. Literature regarding ER is limited and focuses on barriers to reporting. The aim of this study was to assess how ER practices have changed over 5 years and to highlight differences between grade and speciality.

Methods

A retrospective cohort study was carried out. 5 years of reports from 1/1/2017 to 31/12/2021 were downloaded from Medic Online, Allocate Software. Quantitative and qualitative data were analysed in Microsoft Excel.

Results

125 doctors submitted 549 reports. The number of reports submitted per year have decreased over time whilst the number of doctors submitting at least one report has increased. The number of male doctors submitting reports has not changed in contrast to female doctors which has increased with a correlation of 0.76. Overall there is no difference in number of reports submitted by sex (p=0.1). F1s are more likely to report than any other grade (p<0.001) and are most likely to report for hours worked rather than educational opportunity lost. ER in medicine has remained constant whilst it has declined within surgery.

Conclusions

Numbers of reports are declining but more doctors, especially females, are prepared to report. This suggests working conditions are improving and suggested barriers to ER are being broken down. Hospital specialties should learn from each other’s ER data to improve patient care as well as working conditions and educational opportunities for junior doctors.
FTP8.10 Impact of COVID-19 vaccination-based triaging on recovery of services for Plastic Surgery Hand Trauma in a Plastic Surgery Tertiary Referral Centre
Authors: Ishak Lisa , Bramhall Russell , Murphy Adrian
Published: August 2023

Aim

Evaluate the impact vaccination-based-triaging on recovery of operative services.

Method

Data was collected retrospectively on 120 patients who underwent surgical management for closed hand fractures, nerve injuries, and tendon injuries. Forty were in the pre-covid group (Jan-Mar 2019), 40 in the post-covid pre-vaccine group (Jan-Mar 2022), and 40 in the post-covid post-vaccine group (Jul-Sep 2022).

Outcome measures:

Results

In the post-covid post-vaccine group, operative delay was shorter than in the post-covid pre-vaccine group for hand fractures (3.6 vs 3.9) nerve injuries (3.8 vs 2.5), and tendon injuries (2.1 vs 2.2). Overall, the difference was not statistically significant (3.3 vs 2.7, p=0.2526).

BSSH operative timing requirements were met in a higher proportion of patients for hand fractures (93% vs 85%), nerve repairs (100% vs 87%), tendon repairs (89% vs 85%) and overall (89% vs 85%).

In the pre-covid group, operative delay was shorter than both post-covid groups for hand fractures (2.5), nerve injuries (1.8), and tendon injuries (1.4). Overall, the difference was statistically significant compared to the post-covid pre-vaccine (1.9 vs 3.3, p=0.0024) and pre-covid post-vaccine groups (2.7 vs 1.9, p=0.0238).

Overall, BSSH operative timing requirements were met for a higher proportion of patients than both pre-covid groups (100% vs 89%)

Conclusions

Plastic surgery hand trauma services have not yet fully recovered. Further interventions are required to aid recovery to pre-pandemic standards.