bluuebunny/crossref_metadata_2025 huggingface dataset:
Transfusion-Associated Circulatory Overload (Taco) Presentations In Pediatric Patients
Authors: Sallagonda A , Andrzejewski C
Published: October 2021

Introduction/Objective

Limited literature exists regarding Transfusion Associated Circulatory Overload(TACO) in children. Its clinical expressions compared to those in adults remains to be fully explored. We report two TACO cases in children <18 months of age describing their clinical presentations compared to those in older patients.

Methods/Case Report

Case series

Results (if a Case Study enter NA)

Case 1: 1.13 kg 18 day old male neonate (27 weeks premature) with anemia requiring hemotherapy(HT). He received 35 ml aliquot of Red Blood Cells(RBCs) which he tolerated well on postoperative day(POD) 1 after bowel surgery. On POD 2, he was transfused RBCs(18 mls). Within 15 minutes of HT initiation, marked elevations in blood pressure(BP) were noted. Workup for a suspected transfusion reaction(STR) was initiated. Blood Bank studies revealed vital sign value(VSV) changes similarly seen in adults with TACO(Transfusion: 52; 2311, 2012). NT-proBNP levels post HT were markedly elevated (8,000 and 64,000 pg/ml).Case 2: 17 month old(11 kg) female with a three weeks prior history of COVID-19 admitted with fever/dehydration and subsequently diagnosed with multisystem inflammatory syndrome in children (MIS-C). Intravenous immunoglobulin(IVIG) infusion ordered and within 20 minutes of starting IVIG, she developed grunting. STR workup showed post HT BP/temperature elevations/chest X-ray with increased interstitial markings. Of note she had also received 1070 ml of intravenous fluids within 48 hours prior to HT. Elevated NT-proBNP levels pre/post HT were measured(17,121 pg/ml and 19, 824 pg/ml respectively). Symptoms improved with diuretics.

Conclusion

Children experiencing TACO can clinically manifest similarly as in adults with respect to BP elevations and pulmonary changes. Grunting may be an underappreciated manifestation of TACO in pts < 18 months of age. IVIG infusions used in the treatment of patients with MIS-C may present problematic fluid challenges. Recognition of and mitigation strategies for TACO risk factors in such patients may enhance HT safety in this vulnerable patient population.
Comparison of Polybrene DAT and Conventional DAT in Cases of Suspected DAT Negative Autoimmune Hemolytic Anemia (AIHA)
Authors: Sultana S , Balbuena-Marle R , Tormey C , Gollan J , Skeret R
Published: October 2021

Introduction/Objective

A negative Direct Antiglobulin Test (DAT) is seen in approximately 1-5% of patients presenting with signs and symptoms of immune hemolysis. A well-performed ‘standard’ DAT detects ~100-500 molecules of bound IgG per red cell. A more sensitive polybrene DAT may be helpful in order to confirm a diagnosis of AIHA in patients whose samples have tested negative via standard DAT. However, there has been little reported on utility of the polybrene DAT in evaluating such cases with modern DAT reagents. We hypothesized that the polybrene DAT would not contribute substantially to the analysis of Coombs-negative hemolytic anemia (C-NHA), based primarily on our anecdotal observation. As such, we undertook a study to assess results of polybrene DAT in cases evaluated for possible (C-NHA).

Methods/Case Report

Two study sites were used for data analysis (Yale-New Haven Hospital, Site A, and VA Connecticut, Site B) over a five year period (2016-2021). During this time, standard DATs were performed at both study sites by the tube method using polyspecific antiglobulin and, if positive, reflex to anti-IgG and -C3. For cases of suspected C-NHA (which are reported to Blood Bank via a consult mechanism), conventioned DAT- samples are referred to our regional immunohematology laboratory (American Red Cross, Farmington, CT) for manual hexadimethrine bromide (Polybrene) DAT. Polybrene DAT is reported as negative with two sources of polyspecific AHG. Subsets of patients also underwent acid elution studies (Gamma ELU-KITII) as part of a C-NHA algorithm developed during the study period. Results of standard DAT, acId elution, and polybrene DAT were extracted from Blood Bank electronic records at both study sites.

Results (if a Case Study enter NA)

Evaluation for C-NHA was performed in 32 patients/cases over the study period. Amongst these individuals, 96.8% (31/32) underwent polybrene DAT assessment and none (0%; 0/31) demonstrated a positive polybrene DAT result. Notably, acid elution studies were performed in 90.6% (29/32) of traditional DAT negative cases. Of these, 10.3% (3/29) had reactive eluates.

Conclusion

Performance of the polybrene DAT appeared to be of no value in the assessment of suspected C-NHA. Given that nearly 10% of individuals with a negative conventional DAT had a positive acid elution, this testing step appears to be of greater value in potentially identifying an autoantibody in suspected cases of C-NHA.
RhD negative women transfused RhD positive blood: Alloimmunization prophylaxis protocol and experiences
Authors: Alkhateb R , Prajapati V , Daniels J , Greebon L
Published: October 2021

Introduction/Objective

Preventing allomiunization from D-mismatched transfusions, i.e., transfusion RhD positive (RhD+) red blood cells (RBC) to an RhD negative (RhD–) individual, is not well established. We describe our hospital protocol and experiences managing RhD– young women who received emergency release D-mismatched transfusions.

Methods/Case Report

The pathologists evaluate all patients who received D-mismatched blood transfusions. The inclusion criteria for alloimmunization prophylaxis protocol include: RhD– females; <50 years old; No current or historical Anti-D; and received ≥1 unit of RhD+ blood.

The prophylaxis protocol depends on the RBC volume (RBCV) transfused. Patients who receive RBCV <20% of their total blood volume (TBV) are eligible to receive high dose RhIg, calculated based on the volume transfused. Those who received RBCV ≥20% of TBV would be eligible for red cell exchange (RBCX) followed by RhIg.

Results (if a Case Study enter NA)

Since 2016, four eligible patients received RhIg prophylaxis protocol and none met the criteria for RBCX. All the patients started the prophylaxis protocol within 24 hours of transfusion and completed it within 72 hours. One patient developed post treatment hemolysis and significant drop in hemoglobin requiring blood transfusion. Passive anti-D post treatment was confirmed in three patients, and one had passive anti C. Three of the four patients had follow up antibody screens >6 months post treatment that were negative for RhD alloimmunization.

Conclusion

Our therapeutic plan, the first well established protocol, involves identifying eligible patients based on set criteria and protocols. Our experience demonstrates that this protocol is effective in reducing/preventing RhD alloimmunization.
Effect of Severe Acute Respiratory Syndrome Coronavirus 2 on Blood Product Utilization in the Community Hospital Setting
Authors: Messersmith L , Mack M , Cordell J
Published: October 2021

Introduction/Objective

Blood products are a major expense for the laboratory, with an intricate balance between maintaining adequate supply and expiring products. Blood product wastage rates are typically less than 2%. The SARS-CoV-2 (SARS-CoV-2) pandemic has created a multifaceted challenge in blood utilization. Difficulties in predicting product usage, decreased supply, and transportation delays put hospitals at risk of increased blood product destruction. In this study, we analyze the effect of the SARS-CoV-2 pandemic on blood utilization in the community hospital setting, in order to develop improved laboratory management strategies for decreasing unit wastage.

Methods/Case Report

Quality indicators of blood utilization from 2012 to 2021 were retrospectively reviewed. Data was collected for packed red blood cells (pRBCs), platelets, and plasma. Units transfused, expired/destroyed, and total percent discarded were recorded for each month. Average transfusion and destruction rates were calculated for each product. Blood product utilization from 2020 was compared to years 2012-2019 using Pearson correlation, linear regression, and student paired t-tests.

Results (if a Case Study enter NA)

1,042 units were reviewed. For pRBCs, there was a strong correlation between 2020 and increased destruction compared to 2012-2019 (R= 0.8, p=0.005). There was no significant change in pRBC transfusions in 2020 compared to 2018 and 2019 (p= 0.3, p= 0.2). There were fewer pRBC transfusions in 2020 compared to 2016 and 2017 (p= 0.006, p=0.01). For platelets, there was increased destruction in 2020 compared to 2012-2019 (p= 0.01-0.04) and no significant change in usage (p= 0.3-0.5).

Conclusion

During the 2020 SARS-CoV-2 pandemic, there was a significant increase in blood product wastage. There was no significant increase in transfused pRBCs or platelet units, suggesting the increased destruction was not due to an overall increase in transfusions. Blood products are a major cost for laboratory and further investigation of these findings is warranted to mitigate continued wastage.
Massive Transfusion Protocol Over-Activation
Authors: Abdelmonem M , Wasim H , Abdelmonem M
Published: October 2021

Introduction/Objective

Massive blood transfusion protocol (MTP) is revealed in many cases, such as massive hemorrhage after surgeries, trauma settings, and labor and delivery. Patients who require blood transfusion of more than ten units of packed red blood cells in 24 hours or transfusion of more than four units of packed red blood cells (PRBCs) in one hour are the massive blood transfusion protocol candidates.

Methods/Case Report

A retrospective study was performed at a 225-bed level III trauma center in California. The overall massive blood transfusion protocol utilization, blood product emergency release, and blood product waste were recorded twelve months before and after launching an educational and collaboration program between blood banks and clinicians about the difference between massive transfusion protocol and blood emergency release.

Results (if a Case Study enter NA)

MTP utilization for the 12 months (June 2017 to June 2018) was demonstrated as 59 MTP activations: 32 MTPs from the emergency department, 4 MTPs from inpatient floors, 3 MTPs from labor and delivery, and 4 MTPs from operating rooms while the blood product emergency releases were 7 emergency releases. MTP utilization from (June 2018 to June 2019) was demonstrated as 15 MTP activations: 11 MTPs from the emergency department, 2 MTPs from inpatient floors, 1 MTPs from labor and delivery, and 1 MTPs from operating rooms, while the blood product emergency releases were 43 emergency releases. The blood product waste was reduced by 44.6% in 2018.

Conclusion

There was a significant reduction in MTP activation and blood product waste after implementing the educational program for the clinicians. The collaboration between the blood bank and the clinicians and coordinating educational sessions for clinicians about the difference between MTP and emergency release and the negative impact of the MTP over-activation on the blood product waste and the clinical laboratory scientists in the blood bank is vital in MTP utilization.
20(S)-Ginsenoside Rh2-induced apoptosis and protective autophagy in cervical cancer cells by inhibiting AMPK/mTOR pathway
Authors: Bian Shuai , Liu Meichen , Yang Song , Lu Shuyan , Wang Siming , Bai Xueyuan , Zhao Daqing , Wang Jiawen
Published: October 2021

20(S)-Ginsenoside Rh2 (GRh2) has various biological activities including anticancer effects. However, no reports have investigated the connection between autophagy and apoptosis in HeLa cells treated with 20(S)-GRh2. In this study, we found that 20(S)-GRh2 suppressed proliferation and induced apoptosis in HeLa cells by activating the intrinsic apoptotic pathway and causing mitochondrial dysfunction. 20(S)-GRh2 enhanced cell autophagy through promoting the phosphorylation of AMPK, depressed the phosphorylation of AKT, and suppressed mTOR activity. Furthermore, treatment with the autophagy inhibitor 3-methyladenine (3-MA) enhanced 20(S)-GRh2-induced apoptosis, while the autophagy inducer rapamycin promoted cell survival. Moreover, the apoptosis inhibitor Z-VAD-FMK significantly restrained the apoptosis and autophagy induced by 20(S)-GRh2 in HeLa cells. We found that 20(S)-ginsenoside Rh2-induced protective autophagy promotes apoptosis of cervical cancer cells by inhibiting AMPK/mTOR pathway.
EP.WE.1Hybrid Surgical Hot Clinic (HSHC): evaluation of Surgical Hot Clinic services during COVID-19 lockdown
Authors: Dhahri Adeel Abbas , Ahmad Raheel , Shaikh Bilal Fazal , Sajinyan Olubunmi , Warrag Ibrahim , Ivanov Bogdan
Published: October 2021

Aims

Surgical Hot Clinic (SHC) is an acute emergency service for management provided on an outpatient basis in the United Kingdom. Following the start of global Novel Coronavirus (COVID-19) pandemic and as per the statement released by the Association of Surgeons of Great Britain and Ireland (ASGBI), we modified SHC service to mainly provide telephonic follow-up with an occasional face-to-face service.

Methods

After developing a local pathway for SHC services during COVID-19 lockdown, a quality improvement audit was conducted from 30th March till 26th May 2020. Through this pathway, telephonic consultation carried out in most patients while for selective face-to-face consultation designated Medical Ambulatory area used. The analysis then performed using SPSS version 20 to assess the serviceability of modified hybrid SHC.

Results

Among 149 patients, 54(36.2%) were male, and 95(63.8%) were female, referred during Coronavirus lockdown. Out of these 149, 87(58.3%) referred from Accident & Emergency (A&E), 2(1.3%) from GP, 9(6.04%) after scan through radiology department while 51(34.2%) after discharge from hospital. Out of those who have telephonic consultation (n = 98), 12 patients were called in for review with either blood tests or further clinical examination. In total, only 10 out of 149 patients required admission to the hospital, either for intervention or symptomatic treatment.

Conclusion

Hybrid surgical hot clinic (HSHC) with both telephonic & face-to-face consultation, as per requirement, is flexible, effective and safe patient-focused acute surgical service during COVID-19 like a crisis.
EP.WE.14Prognostic significance of metabolic syndrome in patients undergoing carotid artery revascularisation: A systematic review and meta-analysis
Authors: Hajibandeh Shahab , Hajibandeh Shahin
Published: October 2021

Aims

to evaluate prognostic significance of metabolic syndrome (MetS) in patients undergoing carotid artery revascularisation.

Methods

A systematic review and meta-analysis was performed in compliance with PRISMA standards to evaluate prognostic significance of MetS in patients undergoing carotid endarterectomy or carotid stenting. Short-term (<30 days) postoperative outcomes (all-cause mortality, stroke or transient ischaemic attack (TIA), myocardial infarction, major adverse events) and long-term outcomes (restenosis, all-cause mortality, stroke or TIA, myocardial infarction, major adverse events) were considered as outcomes of interest. Random effects modelling was applied for the analyses.

Results

Analysis of 3721 patients from five cohort studies showed no difference between the MetS and no MetS groups in terms of the following short-term outcomes: all-cause mortality (OR: 1.67,P=0.32), stroke or TIA (OR: 2.44,P=0.06), myocardial infarction (OR: 1.01,P=0.96), major adverse events (OR: 1.23, P = 0.66). In terms of long-term outcomes, MetS was associated with higher risk of restenosis (OR: 1.75,P=0.02), myocardial infarction (OR: 2.12,P=0.04), and major adverse events (OR: 1.30, P = 0.009) but there was no difference between the two groups in terms of all-cause mortality (OR: 1.11, P = 0.25), and stroke or TIA (OR: 1.24, P = 0.33). The quality and certainty of the available evidence were judged to be moderate.

Conclusions

The best available evidence suggest that although MetS may not affect the short-term postoperative morbidity and mortality outcomes in patients undergoing carotid revascularisation, it may result in higher risks of restenosis, myocardial infarction and major adverse events in the long-term. Evidence from large prospective cohort studies are required for more robust conclusions.
EP.WE.17Surgical Telemedicine Clinics during the Covid-19 Pandemic – Patient-Reported Outcomes Report
Authors: Ekowo Onyekachi , Elgabry Ahmed , Gouveia nuno , Dighe Shwetal , Khan Aftab
Published: October 2021

Aims

The primary aim was to obtain patient feedback about surgical telemedicine clinics. The secondary endpoint was to investigate any factors influencing the patient’s feedback.

Methods

A retrospective qualitative study was undertaken, during the period between June – September 2020, at Darent Valley Hospital in West Kent. Telephone and online feedback were obtained using a 5 point questionnaire designed to assess their experience and preference for future consultations. Variables such as ‘demographics’, ‘first or follow-up clinic appointment’ and ‘physician-grade’, were analysed for any influence on patients feedback.

Results

A total of 200 patients responded to the questionnaire (telephone = 133, online = 77). The median age was 67 years (IQR 44 – 79) and male: female ratio 1. About 35.9% were a new referral and 42.7% has had some face-to-face appointment in the hospital before the pandemic. During the period of the study, about 42.7% had more than one telemedicine appointments. About 83.2% were consulted by surgical registrars. A rating from good to excellent for ‘overall experience’, ‘opportunity to express own concern’ and ‘how well the doctor addressed their concerns’ was given at 90%, 93.1% and 89.4%, respectively. About 80.2% felt reassured and 21.7% would prefer telemedicine for future consultations. There was no association between the variables studied and patient responses.

Conclusions

A high percentage of patients reported satisfactory service provision via telemedicine clinics. A majority of patients felt reassured. However, given the option, the face-to-face clinic would be the prefered option for the majority.
EP.WE.52Telephone Pre-Surgical Assessments in Renal Transplant Surgery
Authors: Porter Lucy
Published: October 2021

Aims

Patients listed for renal transplant require a pre-surgical assessment. This has traditionally involved an in-person appointment. During the Coronavirus Pandemic, these began to be offered as telephone appointments to reduce the number of hospital visits.

This study aims to assess the effectiveness of these new telephone assessments and whether they should continue to be offered.

Methods

20 patients from one renal transplant centre who had a telephone pre-transplant assessment between May and September 2020 were contacted and successfully completed a 12-question questionnaire. It was entirely voluntary and responses were anonymised.

Results

80% of patients built a great rapport with their doctor and all felt able to ask questions. All patients received a set appointment time, although some occurred late and 75% received information leaflets through the post. Most patients received adequate information on the topics specified. Not enough information was given in 20-26% of cases on medications and follow-up post-transplant and SARS-COV-2 risks. 40% preferred a telephone appointment, mainly due to less SARS-COV-2 risk and less hassle. Whereas 55% would rather a face-to-face appointment, due to better abilities to communicate and build relationships. Ideas for improvements were suggested.

Conclusions

Telephone assessments provide a good alternative to in-person pre-transplant assessments. Many patients prefer them, especially with SARS-COV-2 risks, however many still favour face-to-face appointments. Telephone assessments should therefore continue to be offered, but patient preference should be prioritised.

They can be improved by ensuring patients always receive enough information and leaflets, an appointment time window and a contact for further questions.
EP.WE.78Variation in the Branching Pattern of the Anterior Branches of the External Carotid Artery
Authors: Elsllabi Mohamed
Published: October 2021

Aims

The external carotid artery (ECA) shows a variable branching pattern of its stemming vessels. The aim of this study is to investigate the origin of the three primary anterior branches of the external carotid artery (ECA): the superior thyroid (STA), lingual (LA), and facial arteries (FA).

Methods

The branching pattern of the external carotid artery was studied on 15 Thiel embalmed cadavers of Scottish population (7 males and 8 females). The carotid triangle was dissected bilaterally in order to uncover the common carotid (CCA), internal carotid (ICA) and external carotid arteries (ECA). Moreover, the origin sites of the main anterior branches of the ECA (STA, LA and FA) were assessed in relation to the carotid bifurcation (CB) and with regard to sex and side.

Results

The STA was found to arise more frequently from the ECA (60%) than from the CCA (40%). Regarding the assessment of the branching patterns of the external carotid artery, the specimens where the STA, LA and FA emerged as individual branches were 90% of cases. The distances from the vessel origin site to the CB were found to be (8.11 ± 2.77), (19.38 ± 8.85) and (27.95 ± 10.15), for the STA, LA, and FA respectively.

Conclusions

In-depth knowledge of the branching pattern of the external carotid artery is of great importance. The current findings have confirmed that the ECA branching pattern is highly variable. Therefore, considering some radiological imaging before conducting any invasive procedure in the neck region could be vital to prevent iatrogenic injuries.
EP.WE.82Positive impact of COVID-19 pandemic on future of Surgery in the NHS
Authors: Kimura Shiori , Gambhir Raghvinder
Published: October 2021

Aim

To assess how surgical units innovated and adapted to meet the Lockdown challenges and highlight best practice development

Methods

Look at the Royal Surgical Colleges and national surgical society Guidelines during the pandemic and recovery phase of the Lockdowns. To assess how to local trust level modifications made in the first lockdown were reinforced during the second lockdown.

Results

During the first lockdown all elective surgical activity was suspended from 14th March. Day case urgent elective work restarted after 6 weeks, during this period only life and limb saving emergencies were performed on CEPOD theatres. Full PPE, aerosol generating precautions and thorough cleaning between cases ensured that no healthcare worker developed COVID-19 from occupational exposure in Theatres. Remote access from home has been a boon. The outpatients rapidly moved to online appointments. No routine follow up scans were done. Endovascular interventions increased. The telephonic clinics have reduced footfall, allowed routine follow-ups to be permanently put on telephonic clinics and patients too seem to be satisfied that they do not have to waste a day for a 10 minute appointment to come and be told that we will see you again in 12months time. Non-essential surgery has stopped,

Conclusion

Pandemic has been a time for surgeons to reflect on their practice. Instead of going back to old ways-outpatient clinics, day surgery units and main theatres have seen rapid adaptation of newer ideas. Pandemic has fast forwarded innovation in the NHS.
EP.WE.105Hand trauma during COVID pandemic: a tertiary trauma centre experience
Authors: Ghareib Amir , Oniska Sylwia , Karran Laura , Moledina Jamil
Published: October 2021

Introduction

St. George’s University Hospitals NHS Foundation Trust is a tertiary trauma centre. We receive a high volume of hand referrals from all over the south West London region. Closed hand fractures represent a significant number of our referrals. COVID-19 has put more burden in all health service endangering poor management of these trauma patients.

Aim

To assess management of close hand trauma patients during COVID pandemic.

Methods

Retrospective evaluation of closed hand fracture referrals during June, July, and August 2020. Clinical documentations, operative details and follow up visit notes have been reviewed.

Results

106 patients have been included. 47 patients treated surgically with 81% of them were in need for metalwork insertion. Most of operations were done within 8 days. Number of hospital visits was variable with a mean of six days for adult and two days for children. Patient who was in need for hand therapy have been seen within the first 8 days of their surgery. At three months follow up, only three cases had infection. Only one case had osteomyelitis and the other two case had infected metalwork. Most of the patents reported good movement in ASSH Total Active Movement of Hand score (TAM) at the end of the three months.

Conclusion

Despite COVID 19 pandemic our service managed to achieve acceptable results in dealing with these cases. Yet, securing a reasonable number of operating sessions and clinic appointments remains a challenge.
EP.WE.127Outcomes of colorectal cancer resections performed within Modified Enhanced Recovery After Surgery (M-ERAS) pathway during the first peak of COVID-19 pandemic
Authors: Liyanage Aloka Suwanna Danwaththa , Gokul Krishnan , Babu Bheemakone Harish , Ainsworth Paul
Published: October 2021

Aim

Enhanced Recovery After Surgery (ERAS) pathway has shown to reduce pulmonary complications and length of stay (LoS). However, the impact of pandemic on the care of patients in the ERAS pathway is unknown. Certain ERAS elements (i.e. Laparoscopic surgery) were considered un-safe at the outset of the current pandemic and therefore avoided. We present our experience of implementation of Modified ERAS (M-ERAS) pathway in a small cohort of colorectal cancer resections performed in our hospital during the first peak of the pandemic.

Methods

We analysed all colorectal cancer resections performed from 11th March to 31st June 2020 in our hospital. Those who admitted via emergency pathway and managed outside M-ERAS were excluded from the analysis. Primary outcome measures were LOS, pulmonary complications and 30-day mortality rate. Secondary outcome measures were short term complications (including post-op SARS-CoV-2 infections) and 30-day re-admission rate.

Results

All resections were performed in a non-COVID light setting (i.e. acute hospital). We performed 8 elective resections during the pandemic and 1 of them managed outside M-ERAS. All resections were performed via open access. All tumours were locally advanced (T3 and above) and one patient had neo-adjuvant chemotherapy. Two patients had metastatic disease. Average LOS was 8.1 day. One patent developed post-operative minor pulmonary embolism and required re-admission within 30 days post op. There was no 30-day mortality.

Conclusions

Implementation of M-ERAS elements may be COVID safe. More robust data are required to ascertain the safety and efficacy of ERAS/M-ERAS pathway in COVID risk ambience.
EP.WE.197Feasibility of a remotely supervised exercise programme
Authors: Machin Matthew , Hayward Laura , Harris Lindsey , Gadhvi Vijay , Thapar Ankur
Published: October 2021

Aim

To assess feasibility of a novel remotely-supervised exercise programme at a vascular hub during the COVID-19 lockdown.

Methods

Participants with arterial claudication (ABPI <0.90) who were able to walk 50m were enrolled into a 3-month programme by a vascular specialist nurse. The initial appointment addressed smoking cessation and best medical therapy. Baseline walking distance, ABPI and quality of life (QoL) were measured using the Intermittent Claudication Questionnaire. Following this, up to 8 WhatsApp video calls with a vascular specialist physiotherapist were undertaken to provide a tailored exercise programme. The Mapmywalk© App, or a pedometer, were used to monitor walking distances. Participants were instructed to record their daily longest walk and email results to their physiotherapist before each consultation.

Results

12 participants were enrolled, of these 2 participants were unsuitable. Median age was 63 years and 2 (20%) were female. Baseline median ABPI was 0.7 (IQR 0.5-0.8), median baseline absolute walking distance was 75m (IQR 50-140) and median baseline QoL was 51/80 (IQR 15-79). 7 participants (70%) successfully completed the programme and were discharged. Their median daily longest walk was 2000m (IQR 200-4000) and QoL scores improved to 6/80 (IQR 2-20) (p = 0.02). Remaining 3 participants required revascularisation for disease progression. Reimbursement tariffs for the supervised exercise programme were £700 per patient, whereas for revascularisation were £2000 - £5000.

Conclusion

Remotely supervised exercise was feasible and improved walking distance and quality of life in 70% of participants. Approximately £3000 per patient was saved from a reduction in revascularisation procedures in our unit.
EP.WE.231Emergency Presentations of Colorectal Cancer during the COVID-19 Era
Authors: Davidson S , Armstrong L , McElvanna K , McKay D
Published: October 2021

Aims

COVID-19 has reduced the ability to provide red flag investigations for colorectal patients. The aim of this study is to assess the number of emergency presentations of new colorectal malignancy during the COVID-19 era and if there is an increase in palliative cases.

Methods

A retrospective review of all patients presenting to unscheduled care with a new diagnosis of colorectal malignancy from 31st March 2020 - 25th January 2021 in a single UK Trust. An institutional data base and electronic care records were used to review patient demographics, management and curative intent. Data points for the same period in 2019-2020 were recorded for comparison.

Results

45 patients diagnosed with new colorectal malignancy during an unscheduled admission to hospital within the study timeframe. 22% (10/45) presented in January 2021. 29 diagnosed during the same time interval 2019-2020. Median age at presentation was 77.5 and 79 respectively.

40% (18/45) of patients in 2020-2021 proceeded to emergency surgery, compared to 58% (17/29) in 2019-2020 (p = 0.12).

10.3% (3/29) of 2019-2020 patients were managed with colonic stenting. This increased in 2020-2021 to 17.8% (8/45) (p = 0.38).

77.8% (35/45) patients in 2020/2021 presented at a palliative stage of disease compared to 62.1% (18/29) in 2019-2020 (p = 0.15).

Conclusions

Overall the data has not shown a statistically significant difference in patients presenting as an emergency with new colorectal malignancy. However, there was a rise in admissions noted in January 2021; should this trend continue, alongside the persistent pressures of COVID-19 ongoing research is needed to assess the true impact.
EP.WE.268Impact of COVID-19 on surgical services in a District General Hospital in the UK: benefits versus drawbacks
Authors: El-Abbassy Islam , El-Hakim Hesham , Wong Mei Kei , McIntyre Robert
Published: October 2021

Background

COVID-19 outbreak led to significant changes in health services worldwide. This study aims to assess the impact of this outbreak on the surgical services in a small District General Hospital and to highlight any benefits that we can take forward.

Methods

Data were collected retrospectively comparing the surgical service activity during the two months (April and May 2020) around the peak of COVID-19 first wave in the UK and the similar two-month period the year before when activity was at its usual pre-COVID level. A short questionnaire on the use and satisfaction of remote consultation was circulated to all hospital consultants.

Results

The total number of patients presenting to the emergency department in all specialities almost halved during the COVID-19 crisis. The number of emergency surgical admissions decreased. All elective lists were cancelled and more patients were managed conservatively.

In April and May 2020, 156 patients had outpatient surgical consultations. Only 14 of them were face-to-face, whereas the rest were done either by telephone or video calls. This is compared to 472 patients who had face-to-face consultations in April and May 2019. The results of the questionnaire showed that over 90% of the consultants felt telemedicine consultations were satisfactory and that they would have an important role in the future.

Conclusion

COVID-19 had serious impacts on surgical services regarding cancellation of elective lists and prolongation of waiting time. Despite these drawbacks, the increased confidence with telemedicine services was a significant benefit.
EP.WE.347An Audit On Our Procedural Consent Forms For Complication Of COVID-19 During The Pandemic
Authors: Najdawi Amal , Chaudhary Osman , Noureldin Khaled , Adedeji Janine , Dworkin Michael
Published: October 2021

Introduction

Aims

Methods

Conclusion
EP.WE.351Changes in social behaviour during the COVID-19 pandemic and consequences on hospital admissions from acute alcoholic related pancreatitis
Authors: Mak Wai Kin , Duckworth Jessica , Myintmo Aye Myat , Orabi Amira , Lane Rebekah , Holloway Sophie , Karran Laura , Pearce Ellie , Manzelli Antonio , Mossadegh Somayyeh
Published: October 2021

Background

Shifts in social behaviours as a consequence of the COVID-19 pandemic may make people more prone to alcohol use as a coping mechanism. This study aims to investigate whether there was an impact on acute alcohol-related pancreatitis cases given potential changes in alcohol consumption during the first COVID-19 lockdown period in the United Kingdom. It considers the time period since social establishments re-opened in July 2020, to evaluate whether increase alcoholic pancreatitis cases, as a proxy for altered drinking habits, persisted.

Methods

All codes relating to pancreatitis were used to identify cases between March to September (2016 to 2020). Inclusion criteria: acute alcohol-related pancreatitis only. These cases were screened by a group of independent medical juniors and analysed using Excel.

Results

A total of 1905 patients with pancreatitis were identified in the initial search, of which 136 were admitted with acute alcoholic pancreatitis. There was an increase in absolute number of new cases in 2020 compared to previous years (27 compared to a mean of 16 in the previous 4 years). When shops and pubs reopened, cases reduced by 37.5%.

Conclusion

This study highlights the issue of increased admission with acute pancreatitis relating to alcohol in the COVID-19 lock down period. During which, this group of patients are likely socially isolated with a lack of support. This calls for an increase in community support for such patients with emphasis on admission avoidance. This is especially important in an era when there is increased hospital admission due to COVID-19.
EP.WE.385A retrospective audit reviewing current practice on managing the incidence of anaemia and iron deficiency in pre-operative oesophagogastric resection patients
Authors: Bhatti Sumbal , Evans Laith
Published: October 2021

Aims

NICE guidelines state patients with anaemia should be offered iron therapy before and after surgery. An audit was undertaken at a tertiary care centre to assess compliance in patients undergoing oesophagogastric resection.

Methods

Retrospective audit looking at oesophagogastric resections over a period 12 months at a tertiary care centre. Data is being gathered from ORSOS and ICE to record pre, peri and post-operative haemoglobin and MCV, amongst other metrics, including whether iron therapy was prescribed. Data is also being gathered on post-operative outcomes. An intervention aiming to increase pre-operative haemoglobin levels will be implemented and then a repeat audit cycle will be carried out.

Results

Preliminary results from cycle 1 suggest that despite 71% of patients undergoing oesophagogastric resection having a haemoglobin<130g/l in men and <120g/l in women, only 6.7% are receiving preoperative iron therapy of any kind (i.e. oral or intravenous). 42.8% of all patients included suffered a post-operative complication. We predict implementation of changes in pre-operatively will reduce the post-operative complication rate.

Conclusions

The majority of patients undergoing oesophagogastric resection are not receiving adequate iron therapy prior to surgery and are being put at an increased risk of post-operative complications. Ongoing auditing will highlight the scope of the problem and reduce the risk of post-operative complications. Data is preliminary at this stage but due to the novelty of the audit (only one relevant paper was returned upon completing a structured literature search) we are submitting this abstract now as we believe it to be of clinical significance.
EP.WE.406Adherence to operative standards for ulnar polydactyly excision in times of COVID-19 pandemic
Authors: Eiben Inez , Bahadori Darab Payam , Eiben Paola , Filson Simon
Published: October 2021

Aims

Simple ulnar polydactyly excision is a very common surgical procedure ideally performed within the first 6 months of infants life and under local anaesthetic. In conditions preceding COVID-19 pandemic this procedure was performed in controlled environment of operating theatres on a weekly basis. Increase in pressure on the NHS and operating theatre reorganisation meant elective procedures had to be cancelled with no alternatives in sight. We have suggested therefore, it be performed in a clinic environment instead under strict supervision and guidelines. No recommendations however, have been implemented when considering completion of WHO checklist and standard operation documentation. We investigated therefore adherence to typical Evelina Hospital theatre guidelines when considering documentation.

Methods

Completed documentation for each patient undergoing ulnar polydactyly excision in clinic room was reviewed between May 2020 and December 2020. Categories of WHO checklist completion, operation note present and legible, appropriate local anaesthetic information and instrument count correct were reviewed.

Results

92% of procedures did not have WHO checklist completed. Furthermore, as many as two thirds of the documents were completed illegibly and did not contain required information.

Conclusions

Following the transfer of ulnar polydactyly excision procedure to clinic rooms we found the quality of documentation to be substandard. This provides opportunity for error and cause for concern. We introduced therefore standardised operative documentation pack to be completed at each polydactyly excision procedure in clinic room. Re-audited results showed improved compliance with standard operative rules and regulations and therefore improved quality of care.
EP.WE.409Stoma forming surgery – has lockdown changed our operative practice during COVID 19
Authors: Manson Ross , Tallo Tracy , Robertson Isabell , Anderson John , Sharma Praveen , MacDonald Angus
Published: October 2021

Aims

This study aimed to establish whether the initial lockdown resulted in a shift towards emergency surgery, changes in stoma formation and in rate of surgery with curative intent.

Methods

A retrospective data collection was performed. Patients were identified using a local database of all patients with stomas. Data was collected from 16/03/20 to 16/09/20. A comparison data set was taken (16/03/19 to 16/09/19). Data was collected on whether the case was performed as an emergency; the type of stoma formed and whether the operation was performed with curative intent.

Results

Seventeen patients were identified in the 2020 cohort (age: 51-84, mean age: 67.6, M:F 10:7). Fourteen cases (82.4%) were performed as emergencies, three electively (17.6%). Six (35.3%) had end colostomies, three (17.6%) had loop colostomies, one (5.9%) had a caecostomy, four (23.5%) had an end ileostomy and three (17.6%) had a loop ileostomy. Ten operations were for patients with cancer, three (30%) were performed with curative intent.

38 patients were identified in the 2019 cohort (age: 28-85, mean age: 63.0, M:F 17:21). 23 (60.5%) were emergencies, fifteen (39.5%) were performed electively. Nine (23.7%) had end colostomies, eight (21.1%) had loop colostomies, three (7.9%) had caecostomies, ten (26.3%) had end ileostomies and nine (23.7%) had loop ileostomies. There were nineteen operations for cancer, eight (42.1%) were with curative intent.

Conclusions

Cessation of elective activity caused a shift towards emergency operating, with an associated shift towards surgery with non-curative intent. The distribution of stomas formed has not changed.
EP.WE.412An unusual case of a 13.8cm Gastric Schwannoma invading into Transverse Mesocolon: A case report and literature review
Authors: Sharma Sameera , Milani Marika , Oglesby Stuart , Walsh Shaun
Published: October 2021

Gastric Schwannomas (GS) are benign, slow-growing, Sub-mucosal tumours (SMT’s) that constitute 0.2% of all gastric tumours. They usually have a homogenous appearance on contrast enhanced computed tomography of the abdomen (CECT Abdomen) and rarely show malignant features such as irregular borders, calcification, local invasion and mucosal ulceration. Due to lack of mucosal changes and poor yield during Oesophago-Gastro-Duodenoscopy (OGD) and biopsy, they are often misdiagnosed as Gastro-Intestinal Stromal tumours (GISTs), a malignant SMT.

Treatment options range from conservative management to major open resections and are dependent on the size and clinical presentation. Histologically, GS are spindle cells tumours with lymphoid cuffing. On Immunohistochemistry, they test positive for S100 but negative for DOG1, Smooth muscle actin and Desmin which are markers of GISTs.

Here we present the case of a 61-year-old female with a 15-year history of epigastric fullness that turned out to be a 13.8cm GS originating from the greater curvature of the stomach. On CECT Abdomen, the tumour appeared heterogeneous, with multiple calcium deposits and local invasion into the transverse mesocolon. The patient underwent a Sub-total gastrectomy with en-bloc transverse colectomy.

Symptoms from GS can be vague and can pose a significant diagnostic and investigative dilemma. Physicians and Surgeons should have a low threshold to investigate prolonged symptoms with CECT Abdomen. Despite their benign nature, if left undiagnosed, GS can grow to significant sizes and mimic malignant gastric tumours on conventional imaging resulting in unconventionally major resections.
EP.WE.429Surgery during the COVID-19 pandemic: Are we obtaining informed consent?
Authors: Robinson Emily , Ayathamattam Joseph , Harris Holly , McFall Malcolm
Published: October 2021

Background

It was estimated that 1 in 4 inpatients with COVID-19 acquired the virus whilst admitted in December 2020. Surgical patients that contract COVID-19 have poor outcomes, with mortality rates as high as 24% and risk of pulmonary complications as high as 50%. The Royal College of Surgeons of England published COVID-19 consenting guidelines in June 2020.

Aims

To identify the proportion of surgical patients who were informed of the risk of acquiring COVID-19 during the consenting process at two District General Hospitals.

Methods

The consent forms of 220 surgical patients who had either elective or emergency surgery during the second COVID-19 lockdown were reviewed retrospectively (1/11/2020-20/11/2020). This included General Surgery, Trauma and Orthopaedics and Urology. Patients with incomplete notes or who lacked capacity were excluded.

Results

In total, 193 patients were included. We found that 41.5% of patients were consented for the risk of acquiring COVID-19 peri-operatively. This did not vary significantly between elective and non-elective patients.

Conclusions

Our study shows that current practice does not meet national recommendations. In order to provide informed consent, surgeons must engage in emerging research regarding the local prevalence of COVID-19 and the implications of infection during the peri-operative period. Only with this knowledge, will surgeons be able to balance the risks and benefits on a case by case basis, to provide the patient with necessary information for consent. We recommend that trusts adopt a COVID-19 consenting policy, as part of the pre-operative assessment.
EP.WE.434Impact Of COVID-19 Pandemic On Approach To Patients With Suspected Appendicitis Pre-Covid V/S Early Covid V/S Late Covid
Authors: Alhabsha Osama , Kudchadkar Shantata J , Sinclair Elizabeth , Sagar Jayesh
Published: October 2021

Introduction

COVID-19 brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures. As a consequence, intercollegiate guidelines recommended Computed Tomography to confirm the diagnosis of acute appendicitis and open surgical approach to minimize aerosol generation.

Aims

To identify the impact of COVID-19 on the diagnostic and management approach for patients with acute appendicitis.

Method

A single-centre, retrospective study. Data of patients suspected/confirmed, clinically/radiologically with acute appendicitis was collected over 3 periods of 6.4 weeks. Pre-COVID (11/02/2020 – 22/03/2020), Early COVID (25/03/2020 – 10/05/2020) and Late COVID (23/10/2020 – 06/12/2020), number of patients is 44,22 and 30, respectively. Outcomes included patient demographics, COVID status, management plan, surgical approach (open v/s laparoscopic), imaging modality, admission to critical care, 30-day complication, mortality and length of stay.

Results

During late COVID, number of patients with acute appendicitis slightly increased as compared to initial phase. Interestingly, number of males were consistent throughout all 3 phases. Only 10% presented with perforation during late versus 50% in Early COVID phase. Imaging decreased significantly during late (33.3%), as compared to early phase (72.7%). Open approach was performed in only 1/30 in late, versus 20/21 in early group. There was no 30-day mortality in all 3 groups.

Conclusion

COVID-19 disrupted the usual surgical management plan of acute appendicitis in UK, during initial phase of lockdown. With the use of appropriate strategies and adherence to latest national guidelines, we were better prepared during the second lockdown. Construction of pathways for such pandemic events is helpful.
EP.WE.467A Snapshot Audit on the Compliance of Postoperative ERAS Protocol Following the Resumption of Elective Colorectal Surgical Operations in the COVID-19 era
Authors: Roslan Farah , Balsom Stephanie , Rajangam Akshaya , Evans John , Ihedioha Ugo
Published: October 2021

Aim

The COVID-19 pandemic has put a pause on most elective surgical procedures nationally. Although the efficacy of ERAS protocol has been well established, its compliance following the resumption of elective services is unknown. Our study aims to assess the level of adherence in the postoperative arm of ERAS in a large district general hospital (DGH).

Methods

Patients who underwent elective colorectal surgery were audited prospectively between 1st September 2020 and 15th October 2020.

Results

The mean age (SD) of the 23 patients audited [11(48%) male] was 65 (16) years. Of the cases audited, 17 (74%) had malignant pathology and 6 (26%) were benign. The overall mean compliance score was 4.91 out of 7 (70%). Nasogastric tube was not used in most patients [22(96%)]. However, compliance was poor with regards to opioid avoidance [2(8%)]. Majority of cases complied with early discontinuation of intravenous fluids administration and catheter removal, 14 (61%) and 13 (57%) respectively. 18 patients (78%) resumed oral intake by the first day after surgery and 21 patients (91%) mobilised by the third postoperative day. Higher compliance was significantly associated with decreased length of stay (p = 0.01) but did not reveal significant association with 30-day morbidity.

Conclusion

Although the compliance to postoperative ERAS protocol is generally good, our study highlighted a strong need to improve the postoperative practice of opioid avoidance. Stricter adherence should be aimed for as it is associated with shorter hospital stay which is particularly important in the COVID-19 pandemic era.