bluuebunny/crossref_metadata_2025 huggingface dataset:
1558 Epiglottic Abscess: A Rare Complication of Adult Epiglottitis
Authors: Teklay S , Green F , Prasai A , Moor J
Published: October 2021

This report summarises a case of a 23-year-old female who was found to have an epiglottic abscess, an unusual complication of epiglottitis not commonly reported in the literature. Despite the reduced incidence of childhood epiglottitis following widespread Haemophilus Influenzae vaccination, the adult incidence is nonetheless increasing, which would lead to expected higher numbers of resultant complications.

Abscess formation should form part of the differential diagnosis when epiglottitis fails to adequately respond to medical management. In these cases, cross-sectional imaging is often required in order to guide surgical management. This involves endoscopic transoral incision and drainage under general anaesthesia, which here brought rapid resolution. Perioperative support of the anaesthetic team is vital: if endotracheal intubation is not possible, a surgical tracheostomy may be required.

We reaffirm that endoscopic examination by experienced personnel is appropriate in the initial and ongoing investigation of supraglottic laryngeal infections in order to make a diagnosis and evaluate an airway in stable patients. Such patients must be managed on a ward with airway trained nursing staff and an escalation plan in case of airway compromise. In patients that present in airway obstruction, airway stabilization, with early input from ENT surgeons and anaesthetists, is the priority.
1640 Stridor in An Infant with Double Aortic Arch
Authors: Aladham Y , Ahmed O
Published: October 2021

An eleven-month-old infant presented to our casualty with stridor that had been noticed by the parents a few weeks earlier and became increasingly evident lately. They did not recall a specific event when the infant “chocked”, but they denied any recent history of respiratory tract infection. The infant had no relevant medical or surgical history, and he was born full term with normal vaginal delivery.

Examination of the infant showed moderate biphasic stridor with both suprasternal and intercostal recessions. Oxygen saturation on room air was 94% and temperature was 37.1°. Chest auscultation revealed bilateral equal air entry, though decreased, with transmitted stridor. No lung crepitations were appreciated.

Suspicion of unwitnessed foreign body aspiration arose, and a decision of diagnostic rigid bronchoscopy was taken. Rigid bronchoscopy revealed no foreign body along the tracheobronchial tree, but evident circumferential constriction of the lower trachea was noted with tendency of the tracheal wall to collapse upon withdrawal of the bronchoscope.

Following recovery, computed tomography with contrast of the neck and chest was done and a vascular ring, consisting of double aortic arch, was found compressing and narrowing the trachea.

Further follow up over the following 6 months showed marked improvement of his distress, and active observation was continued.

Conclusions

Although foreign body aspiration is the commonest cause of stridor in infants and young children, external compression of the trachea, particularly with vascular rings, should be considered in children with otherwise unexplained stridor.
1647 A Rare Case of Segmental Testicular Infarct and Subsequent Investigations
Authors: Horn C
Published: October 2021

Segmental testicular infarction (STI) is a very rare condition, with less than 70 cases reported since 1909. It generally presents with testicular pain and may be confused clinically with testicular torsion and radiologically with testicular cancer. However, it can be managed conservatively, unlike those diagnoses, so in order to avoid unnecessary treatment it should be considered as a differential in presentations of testicular pain. The etiology of STI is most commonly idiopathic (70% of cases), but it is important to rule out underlying infection, clotting disorders or vasculitis. As a result, whenever this diagnosis is made, it is vital to carry out further investigations.

This case concerns a 36-year-old chef, with no significant past medical history, who presented with a 24-hour history of severe testicular pain. Due to the length of time from onset of symptoms, he underwent routine blood tests, urinalysis and an ultrasound rather than proceeding to scrotal exploration. This showed a wedge-shaped hypoechoic area in keeping with segmental infarct. As a result, he was managed conservatively, but subsequently had further specialist blood tests, as well as computed tomography imaging and several interval ultrasounds. No cause was found and after several months, while the hypoechoic area seen on ultrasound was still present, his pain had resolved.

While this a rare cause of testicular pain, it is important to consider it as a diagnosis, as it may avoid an unnecessary operation. Subsequent investigations are complex, so it is important to appreciate their necessity.
1666 An Isolated Maxillary Sinus Fracture Associated with Extensive Subcutaneous Emphysema and Pneumomediastinum
Authors: Dhillon D , Teklay S , Abela C
Published: October 2021

Subcutaneous emphysema is a common entity following facial trauma. However, pneumomediastinum secondary to isolated facial fractures is a rare and potentially life-threatening complication.

We present a case of a 26-year-old female that presented with sudden onset left sided facial swelling over the left periorbital and zygomaticomaxillary region and some bruising overlying the left maxilla. In addition to palpable crepitus that was present over the left temporal and left supraclavicular regions following blunt trauma. There was no associated difficulty breathing or dysphagia and it was unclear whether she had blown her nose earlier that day. Computed tomography confirmed the diagnosis and extension of the pneumomediastinum.

In conclusion, pneumomediastinum is a rare complication of blunt facial trauma. Prophylactic antibiotics should be considered to reduce the risk of mediastinitis and nose blowing should be avoided. Due to a lack of clear guidelines when managing this condition, sound clinical judgement with a high index of suspicion is recommended.
476 The Role of Medical Students in an International, Collaborative, Multi-Centre Global Surgery Study
Authors: Gandhi S , Raj R , Dominic C , Taylor E H , Politis M , Hussain S. Namayah F , Bandyopadhyay S , Peter N , Lakhoo K
Published: October 2021

Introduction

The gaps in formal education caused by the pandemic have provided medical students with opportunities to redefine their role in settings across clinical medicine, education and research. This task shifting could provide avenues for students to engage with global surgery, where the cultivation of research skills, networking, and global collaboration amongst students is imperative for sustainable progress.

COVIDPaedsCancer is an international collaborative cohort study assessing the impact of the pandemic on paediatric cancer services. We aimed to trial a student and junior doctor-lead team to perform the day-to-day running of this research.

Method

An operations team of 47 students and junior doctors across 11 countries was assembled. Sub-teams were created for social media, network management, email communications, REDCap, research support and graphics. Together, they ran the study under guidance from the steering committee.

Results

To date, the operations team has coordinated study collaborators in collecting data for 1252 patients from 78 centres across 39 countries. Cooperation between sub-teams enabled the recruitment of collaborators from 558 hospitals in total. They also identified 2 errors in the protocol and resolved them with steering committee input, and continuously managed hospital leadership issues and general queries throughout the course of the study. The team was able to adapt in response to the evolving needs of collaborators and the steering committee.

Conclusions

Medical students were able to aid the delivery of an international, multicentre, collaborative, global surgery research study while benefiting from learning opportunities, networking opportunities, and developing interest and understanding of global surgery.
689 A Service Evaluation of Colonic Stent Procedures Over A 10 Year Period at University Hospital Bristol
Authors: Embury-Young Y , Caslake Holding F , Wates E , Shabbir J
Published: October 2021

Introduction

The National Institute of Clinical Excellence (NICE) updated guidance in January 2020 and recommend colonic stent insertion for acute left-sided bowel obstruction as either palliative treatment or a bridge to elective surgery. Colonic stent insertion has shown improved outcomes in reducing hospital stay and stoma rate when compared to emergency surgery in patients presenting with large bowel obstruction.

Objectives

This service evaluation aimed to identify indications, complications, and outcomes of colonic stent insertion at University Hospital Bristol(UHB).

Method

Retrospective analysis of all colonic stent procedures performed at UHB between 1st January 2010 to 31st May 2020.

Results

87 patients had a colonic stent procedure. 60(69%) were performed as an emergency and 27(33%) electives. Obstruction was secondary to a tumour in 84(97%) patients and diverticular strictures in 3(3%). 19(22%) had stent insertion as a bridge to elective surgery. 64(74%) stents were successfully deployed. 15(75%) required emergency surgery where the stent was unsuccessful. Complications occurred in 9(14%) successfully deployed stents, including: perforation(1;1%); per-rectal bleed(1;1%); dislodgement(1:1%); bacterial translocation(1;1%); tenesmus(2;2%); more than one stent required(3;3%). 30-day mortality was 11%.

Conclusions

The majority of colonic stent procedures at UHB were for patients presenting with acute large bowel obstruction secondary to malignancy. Few of these patients were suitable for surgery and stent insertion primarily for symptom relief. Where stent insertion is unsuccessful there is a high conversion (75%) to emergency surgery. Complications were observed in 14% of stent procedures and 30-day mortality was 11%.
719 Colovaginal Fistula from Neglected Vaginal Pessary; Fallouts from the COVID-19 Pandemic
Authors: Oyewole B , Elzaafarany A , Tawfik A , Campbell-Smith T
Published: October 2021

An 86-year-old lady was admitted with a one-week history of feeling unwell, polyuria, dysuria, urinary and faecal incontinence. She had previously been treated for recurrent UTIs by her GP. On examination she had suprapubic tenderness but no peritonism. Observations revealed tachycardia of 122bpm with a temperature of 36.3*C. Inflammatory markers were raised with a white cell count of 22.0x106 /L and CRP 129 mg/L. Urine cultures grew Pseudomonas aeruginosa. She was managed for urosepsis with intravenous antibiotics.

Past medical history included vaginal pessary for uterine prolapse, congestive cardiac failure, hypertension, polymyalgia and osteoporosis She lived alone with no package of care.

On admission she improved with intravenous antibiotics however she had a perineal examination due to ongoing faecal and urinary incontinence and was noticed to be passing faeces per vaginam. A colo-vaginal fistula was suspected, and she was reviewed by the gynaecologist who noted her pessary had been in-situ for up to a year and her routine appointment to have it changed was cancelled due to the COVID-19 pandemic.

An MRI Pelvic scan confirmed a 3x2cm rectovaginal fistula.

She was reviewed by the general surgery team and the decision was made for her to be defunctioned to prevent her episodes of recurrent UTIs and improve her quality of life. She successfully had a laparoscopic end colostomy with an uneventful post-operative period.

This case highlights the harms caused from the cancellation of appointments and demonstrates a rare cause of rectovaginal fistula.
867 A Novel Use for Silicone Expanders: Reducing Pelvic Dead Space and Preventing Bowel Herniation When Managing Radical Exenterative Surgery Complications
Authors: Hadjikyriacou E
Published: October 2021

Aim

To date, there is no clear consensus regarding the best way to obliterate the pelvic dead space, as seen in patients treated for recurrent perineal herniation and entero-cutaneous fistuli following total pelvic exenteration (TPE) for locally advanced rectal cancer. We present a novel technique using saline-filled breast expander to fill the dead space and create an artificial pelvic floor using the implant capsule, thus preventing intestinal herniation and fistuli formation in the multi-operated and irradiated pelvis scenario.

Method

We present 2 patients who initially had TPE, IGAP flap perineal reconstruction and neoadjuvant chemoradiotherapy. Patient 1 had 2 laparotomies for persistent enteroperineal fistulae in the 2-year postoperative period. Patient 2 had persistent wound discharge 2 years post TPE and underwent an enterocutaneous fistula repair and wound debridement. Both cases were complicated by perineal herniation and re-presented with persistent fistulation. A Becker 25 breast expander was placed into the pelvis and inflated with 150 ml of saline, to help contain the small bowel in the abdomen and reduce the risk of perineal re-herniation and fistulae.

Results

The silicone device was removed at 7-12 months, preserving its capsule, by the time the wound had healed. The wounds remained healed at post-operative follow up without any further perineal wound complications, herniation or fistuli

Conclusions

Addressing the dead pelvic space by using a breast expander may treat this particular TPE complication. The capsule created following placement of breast implant, facilitates artificial pelvic floor.
1069 Diverticular Disease: An Audit of Adherence to NICE Guidelines
Authors: Lesi O , Iqbal M R , Khan L
Published: October 2021

Introduction

Diverticular disease is a common surgical problem ranging from diverticulosis to uncomplicated diverticulitis to complicated diverticulitis. The NICE Guidelines for diverticular disease recommended that antibiotics should only be given in patients who are systemically unwell, background of immunosuppression or have complicated diverticulitis. We aimed to access the compliance to these guidelines with regards to the use of antibiotics at our local institute.

Method

This was a retrospective audit reviewing the management of patients with Computed Tomography Scan findings of uncomplicated acute diverticulitis (Hinchey Ia) at the surgical emergency unit at Basildon University Hospital between August 2018 and May 2020. Data obtained included demographic data, presenting symptoms (fever, abdominal pain), haematological investigations (full blood count and c-reactive protein) and use of intravenous/oral antibiotics.

Results

Twenty patients were included, the M:F ratio was 1:1.9, the age range was between 36-80 years. 13 patients (65%) had left iliac fossa pain as part of their presenting symptom while only three (15%) had pyrexia. Seventeen patients(85%) had NEWS score between 0-1 with 60% of the patients presenting with elevated white blood cell count and 75% with c-reactive protein >5. All our patients were prescribed antibiotics.

Conclusions

There was no discrimination in the use of antibiotics/admission for uncomplicated diverticulitis as all patients had antibiotics and as such there is need for increased awareness about the guidelines among the surgical team and adherence to the protocol to prevent indiscriminate use of antibiotics.
1118 The Role of Emergency Surgery in Diverticular Strictures of Those Who Were Initially Managed Conservatively
Authors: Jayawardena P , Jayawardena O , Peris R , Rafie A
Published: October 2021

Aim

The presence of diverticulosis can lead to several different complications including formation of strictures. However, the literature concerning management of diverticular strictures is poor. The purpose of this study is to evaluate the patients who were initially treated non surgically and had to undergo emergency surgery.

Method

A retrospective study was performed using a cohort of patients between 2016 and 2020 where 84 patients with diverticular strictures were identified and followed up. Data on the management of diverticular stricture was captured using the hospital’s electronic medical records.

Results

Out of 84 patients with diverticular strictures, 9 had elective surgery without any medical treatment while 75 had medical treatment first. Out of the 75 patients who were medically treated, 12 underwent emergency surgery while 2/75 underwent elective surgery after receiving medical treatment due to ongoing symptoms. Out of the 12 patients that underwent emergency surgery, 9 patients presented with obstruction while 3 had a bowel perforation. 6 patients had Hartmann’s procedure, 5 had defunctioning colostomy and 1 patient had adhesiolysis. No patient deaths were recorded at 12 months.

Conclusions

Although medical management remains the preferred method of managing diverticular strictures in the UK, it is not without its complications. 1 in 5 patients had an acute surgical admission requiring emergency surgery. This raises the importance of a good ‘safety net’ in those managed non-surgically, to reduce delays associated with seeking medical advice. We also appreciate the importance of carrying out more extensive studies to establish the best way to manage diverticular strictures.
1146 Use of Prophylactic Oral Antibiotics in Preventing Postoperative Surgical Site Infections in Elective Colorectal Surgery – A Review
Authors: Arumuga Jothi A
Published: October 2021

Aim

To prevent postoperative surgical site infections (SSIs), prophylactic oral antibiotics (OA) administration in combination with mechanical bowel preparation (MBP) and prophylactic parenteral (IV) antibiotics have been a preoperative procedure in elective colorectal surgery. Hence, the aim of this article is to review the effectiveness of prophylactic OA in preventing SSIs in elective colorectal surgery.

Method

PubMed and Scopus databases were searched. Search criteria included keywords such as antibiotic prophylaxis, oral antibiotic prophylaxis, parenteral antibiotic prophylaxis, postoperative surgical site infection and colorectal surgery. Selection criteria included any randomised controlled trials (RCTs) which investigated the effectiveness of prophylactic OA, with or without prophylactic IV antibiotics in preventing SSIs in elective colorectal surgery in adult population, published from the years 2010 onwards. Only full text studies and papers published in English language were chosen.

Results

Ten RCTs were included in this study. Studies indicated that OA alone could significantly reduce the risk of postoperative SSIs (p < 0.05). Further analysis of these studies showed that in the presence of IV antibiotic prophylaxis, there is an even greater reduction in the risk of SSIs (P < 0.05). However, an article by Hjalmarsson et al. showed that there was a significantly greater rate of incisional SSIs in prophylactic OA group in comparison to prophylactic IV antibiotics group (P < 0.022).

Conclusions

These studies indicate that OA in combination with IV antibiotic prophylaxis is superior to either IV antibiotic prophylaxis or OA prophylaxis respectively. Hence, it is advisable to administer a combined OA and IV antibiotic prophylaxis in elective colorectal surgery.
1266 Digital Rectal Examination: Do You Still Put Your Foot in It If You Don’t Put Your Finger in It?
Authors: Marlow N , McNamara J , Ali R , Bentley T , James M , Bond-Smith G
Published: October 2021

Introduction

Most surgical trainees are familiar with the aphorism ‘if you don’t put your finger in it, you put your foot in it’, with regards to digital rectal examination (DRE). This commonly taught maxim, attributed to Bailey and Love in their Short Practice of Surgery, was coined to highlight the folly of neglecting DRE in patients with histories suggestive of malignant anorectal pathology. However, data are lacking on the diagnostic yield of DRE for detecting anorectal cancer in patients with lower gastrointestinal bleeding (LGIB), whilst advances in biomarker and imaging technology beg the question: is there still a role for DRE in the assessment of patients with LGIB?

Method

We designed a clinical coding search strategy to identify all adult patients with acute LGIB referred to general surgery at a UK university hospital from January to July 2020. Electronic patient records were interrogated to identify history and examination findings, diagnoses and clinical outcomes.

Results

169 patients (median age 63 (16-94) years, 54.4% male) were identified, 74.6% (126/169) with bright red bleeding, 23.7% (40/169) with altered blood and 1.8% (3/169) with melaena. DRE was performed in 91.1% (154/169) of patients, identifying blood in 42.9% (66/154) of cases and suspicious lesions, which were subsequently confirmed as anorectal malignancy, in 1.3% (2/154).

Conclusions

DRE represents a possibly stigmatising and uncomfortable examination for patients and clinicians alike. These data support the utility of DRE in patients with LGIB and may inform the discussion at the bedside to facilitate the timely diagnosis of anorectal malignancy.
445 Review of Restarting Elective Surgical Service in District General Hospital Post COVID 19
Authors: Singh N , Chin Y F , Hajiesmaeili H , Rahman E , Vidya R
Published: October 2021

Aim

National Health Service (NHS) has massively reduced non-urgent elective surgical service as COVID-19 hit the UK.This study aims to evaluate the measures taken by our trust to restart elective surgical work which was suspended due to the COVID-19 pandemic.

Method

This is a single centre, retrospective, observational study. We analysed records of the first 100 patients who underwent any type of elective General Surgical operative procedure since June 2020.

Results

Our cohort included 51 female, and 49 male patients. Youngest patient was 19 years old and the eldest was of 86 years with mean age of 55.5. In our group, 16 patients were ASA grade 1, 57 were ASA 2, 26 ASA 3 and 1 patient was ASA grade 4. The median ASA grade among our patient group was 2. In this study shortest hospital stay was of 1 day and longest of 53 days with average stay of 5.2 days and SD of 7.6. In our cohort, 18 patients developed Grade 2 Clavein-Dindo(CD) Complications,6 patients developed Grade 3 and none developed complications of CD Grade 4 or beyond. Repeat COVID-19 tests for all patients staying over 7 days were negative.

Conclusions

In conclusion, through appropriate isolation and with adhering to trust guidelines, restarting of elective surgery in non-covid free hospital compound via separate pathways are feasible and should be reflected upon before stopping all elective surgical services in the future considering the threat of further waves of covid-19 or the new variant of the virus looks very real.
489 Assessing the Impact Of COVID-19 On Head and Neck Cancer Treatment and Preparing for The Next Wave
Authors: Daga K , Argus L , Goswami J
Published: October 2021

Introduction

As of 11th of March 2020, the World Health Organization (WHO) declared the novel coronavirus 2019 (COVID-19) a pandemic. It is estimated that urgent cancer referrals have reduced 70-89% across hospitals in England during the COVID-19 pandemic, in addition to reductions in attendance for the different treatment arms. The aim of our investigation is to assess the impact of COVID-19 on MDT outcomes and patients attending/receiving treatment as compared to before for head and neck cancer.

Method

Data was collected retrospectively over a period of 203 days (7th January to 28th July 2020), including 66 patients prior to COVID-19 being declared a pandemic and 116 patients since, at a regional cancer centre. A total of 182 patients undergoing treatment were identified. These patients were assessed by TNM staging, MDT outcomes and final initial treatment intents, which were compared to pre-COVID outcomes.

Results

With respect to MDT outcomes, there was an increase in the number of patients decided for surgery from 10.61% to 23.28% (p = 0.78) during the first wave of the pandemic. Patients decided for radiotherapy and chemotherapy increased by 12.49% and 4.31% respectively. Notably, there was a decrease in further investigations and referrals from 37.88% to 18.10%. Moreover, an increase in palliative treatment intent by 10.55% was noted during the pandemic.

Conclusions

As the UK enters into the next peak of the pandemic, with reduced capacity for elective surgery and outpatient clinics, it is essential to consider its impact on the standard of care delivered to current cancer patients.
638 The Implication of Telephone Consultations During COVID-19 Pandemic on Informed Consent
Authors: Ayoub N , Gareb F , Akhtar M
Published: October 2021

Aim

Is to find whether telephone consultations have affected patient’s comprehension of the proposed surgical management and possible risks until the day of surgery and accordingly ability for informed consent.

Method

This study included a sample of patients admitted to QEQM hospital for elective day case surgery during November 2020 and had only telephone consultation when referred for surgery. A feedback survey assessing quality of information given to patients before and on day of surgery was filled by the patients after the procedure.

Results

The sample included 40 patients undergoing different procedures [cholecystectomy (25), inguinal hernia repair (25), rectal examination under anaesthesia (5), ventral hernia repair (2), incisional hernia (2), inguinal lymph node biopsy (1)]. It was found that 27.5% of patients didn’t have thorough explanation of possible risks and no explanation about postoperative care in 35%.20% were not provided a leaflet about procedure, 57.5% had concerns before surgery and 75% of patients wished for a leaflet with illustrative diagrams, explanation of risks with their management to be able to take the right decision and majority of these patients were from cholecystectomy subgroup.

Conclusions

The lack of face-face appointment affected greatly the informed consent process resulting in patient dissatisfaction which raised the need for new leaflets containing diagrammatic explanation of procedures and possible risks with their management to ensure fulfilment of autonomy principle.
743 Establishing COVID-Secure Surgery: Maintaining Urgent Elective Surgery During The COVID-19 Pandemic
Authors: Phelan L , Digne-Malcolm H , Hassett D , Naumann D N , Dilworth M P , Bowley D M
Published: October 2021

Introduction

The COVID-19 pandemic continues to impose significant direct burdens on secondary healthcare services in the UK and around the world. Maintaining timely and safe delivery of major urgent elective surgery throughout the pandemic is essential if we are to continue to treat cancer and other time-critical surgical conditions. Our Trust established a COVID-secure hospital within the Trust to deliver urgent elective surgical care.

Method

Basic demographics, operative interventions and 30-day outcomes of consecutive patients undergoing major surgery at our COVID-secure site were collected between June-November 2020. Major surgery was defined as patients requiring admission to the Post Anaesthetic care unit (PACU). PACU provides Level 2 care for 23 hours before discharging patients to the ward.

Results

279 consecutive patients were included. PACU admission >23 hours were associated with increased total length of stay (LOS) (p = 0.004), 30-day complications (p < 0.0001), higher rate of transfer to a ‘COVID-hot’ hospital (p = 0.01) and nosocomial COVID-19 infection (p = 0.051). Compared to spinal anaesthesia, epidural anaesthesia was associated with PACU admission breach (p = 0.02), increased total LOS (p = 0.01), increased transfer to the ‘hot’ sites (p = 0.03) and 30-day complications (p = 0.06).

Conclusions

Establishing a COVID-secure site enabled continuation of major urgent elective surgery within a viral pandemic. Level 2 support is essential to ensure safe delivery of complex surgery at ‘cold’ sites. This study has identified clinically relevant advantage with the use of adjuvant spinal anaesthesia in preference to epidural. Enhancing critical care services is essential to minimise patient transfer to ‘hot sites’ and limit nosocomial COVID infection.
839 Patterns of Management of Acute Cholecystitis during the COVID 19 Pandemic
Authors: Brown B , Varley R , Reynolds E , Galloway S
Published: October 2021

Aim

The poor outcomes described by CovidSurg in patients with Covid-19 undergoing surgical intervention and the unknown safety of laparoscopic surgery initially led to increased conservative management in acute cholecystitis (AC). As the number of cases continues to rise, we aim to assess how the coronavirus pandemic has affected our service and adherence to AUGIS guidelines.

Method

We retrospectively analysed all adult admissions with radiologically confirmed AC from defined 2-month periods (pre-pandemic (PP), wave-1 (W1) and wave-2 (W2)) at an acute general surgical service without dedicated hot gallbladder lists where the prevalence of coronavirus has remained high throughout. Primary outcome was rate of index admission (acute) cholecystectomy.

Results

93 patients were included in total (PP 35, W1 33, W2 24). Demographic details were similar across all groups. Tokyo grade I (mild) cholecystitis was more commonly admitted PP (63.9% versus 48.5% and 50.0%). Conservative management was trialed in 91.7%, 100.0% and 62.5% and failed in 18.2%, 21.2% and 21.1%. Cholecystectomy rates were 13.9%, 12.1% and 29.2%. Increased use of CT in W1 has returned to PP imaging pattern in W2. 30-day readmission rates were 5.6%, 18.2% and 4.2%. Two patients in W1 tested positive for Covid-19 and were managed conservatively. No post-operative pulmonary complications were recorded and no difference in biliary complications was observed.

Conclusions

Operative management of AC as per AUGIS guidelines during the pandemic in Covid-19 negative patients is safe and improves outcomes compared to conservative management with no appreciable increase in biliary complications.
845 Diabetic Foot Care Services in COVID-19 Era – A University Hospital Multi specialty Team Experience
Authors: Ain Q , Solanki P , Georgi T , Gala T , Ashraf H , Kelleher D , Vig S
Published: October 2021

Introduction

Multidisciplinary foot care services contribute to the reduction in amputations from foot ulceration secondary to diabetes. The COVID-19 pandemic pressurised services and required a pause of elective care. This study reports the patient’s experience of foot care provision during the first wave where self-care, virtual appointments and patient directed appointments were utilised.

Method

Diabetic foot patients were retrospectively identified over a one-month period booked for MDT care (in hospital, OPD, diabetic foot clinic, community podiatry clinic or at home). All patients>16 years of age diagnosed with a new or previous diabetic foot ulcer or post-operative foot wound were included. Data was collated via a patient survey form and descriptive statistics were used to characterize the study population and responses.

Results

63 patients were identified (1/10 – 30/10) with data collated from 51 respondents (81%). 78% (40/51) were male. Median age was 69 years (IQR 59–76). 86% were comfortable attending a hospital appointment. 92% reported continuing to receive an appropriate level of care. All of the patients felt well supported and knew how to access the foot care service. 29% utilised virtual care. 82% (42/51) considered face to face appointments were more suitable for follow up rather than virtual/phone appointments.

Conclusions

It was possible to continue to provide safe diabetic foot care despite the COVID-19 pandemic but careful patient selection and communication is the key.
888 The Impact Of COVID-19 Pandemic on Orthopaedic Trauma Workload In QEH-Gateshead
Authors: Mousa A , Zhang M , Hinsche A
Published: October 2021

Aim

To assess the impact of COVID-19 pandemic on Trauma workload after the social distancing and lockdown measures from mid-March 2020.

To review the evidence of local experience to support our trauma management during this pandemic to learn for the next time.

Method

Retrospective

Acute referrals and Trauma theatre cases between:

Results

Total acute referrals for T&O dropped significantly from 302 to 168 cases over the course of the same 6 weeks period in 2019 (Pre-COVID) and 2020 (Post-COVID). A significant drop in performing ORIF as definitive management of fractures from 33% to only 15% with more reliance on conservative management. During the pandemic, 26% of the fractures were NOF cases in the elderly population which was nearly half this size (15%) last year. This reflects the effect of the national lockdown on reducing the trauma workload of other injuries such as RTC, sports, and leisure activities. Mortality rates doubled postoperatively; 6 cases (2019) and 12 (2020) with 7 cases were COVID negative and 5 cases were positive. With 67 years old median age, the postoperative complications were COVID-19 respiratory infection or cohort-age-related.

Conclusions

COVID-19 virus pandemic has hit the world in March 2019. This has dropped Trauma workload significantly due to the lockdown measures which reduced accidents rates and fractures requiring fixation. Unavoidable NOF injuries remain static, regardless of the pandemic measures. Few learning points were absorbed from the first pandemic wave made us prepared for the second and third waves.
925 Maintenance of Elective Surgical Care During Covid-19 Pandemic
Authors: Digne-Malcolm H , Kanwal A , Puventhiranathan P , Phelan L , Hamid M , Hendrickse C , Dilworth M P
Published: October 2021

Introduction

Recent publications demonstrate significant morbidity in surgical patients with concurrent COVID-19 infection. This, combined with the redistribution of resources to support the pandemic, led to abrupt cessation in planned operating. COVID-19-free ‘cold’ sites were established to enable elective surgery to resume with reduced risk. We evaluate the outcomes and limitations of a newly established cold site.

Method

Data were collected retrospectively for all patients operated between June and September 2020 by either General Surgery or Urology. Primary outcomes were 30-day COVID-19 infection and 30-day mortality. Secondary outcomes included length of stay, 30-day complications, and need for transfer to ‘hot’ hospital sites.

Results

881 patients were included. No patients had a positive COVID-19 test within 30 days of their operation. 30-day mortality was 0.01% (n = 1). The mean (+/-SD) length of stay was 1.69+/-3.42 days. 12.15% (n = 107) of patients experienced a complication within 30 days and 11.7% (n = 103) were readmitted within 30 day of discharge. 3.3% (n = 29) of patients required transfer to a ‘hot’ hospital site. 44.8% of these were admitted to level 2 or level 3 care, 17.2% required total parenteral nutrition, and 20.7% returned to theatre.

Conclusions

‘Cold’ surgical sites are effective in preventing peri-operative COVID-19 infection. Elective surgery can therefore continue safely through the pandemic with such precautions. Further development of on-site resources, including provision for total parenteral nutrition and access to higher level care, will help to minimise the need for patient transfers to COVID-19 exposed sites.
927 Epistaxis Management in COVID-19
Authors: Chandrasekar B , Oremule B , de Carpentier J
Published: October 2021

Aim

Traditional management of epistaxis include endoscopic examination of the nasal cavity and/or cautery requiring close contact between doctor and patient. We aimed to reduce the length of in-patient stay for patients with epistaxis whilst maintaining patient safety during the COVID-19 pandemic.

Method

A retrospective and prospective audit was performed to assess the management of patients and their outcomes prior to and after new COVID-19 epistaxis guidelines were introduced in our unit. A PDSA cycle was undertaken.

Results

27 patients presented to our ENT department in each 3-month audit cycle. 20 patients in each group were packed. More patients were packed bilaterally in group 2. The admission rate reduced from 100% to 25%. Packing duration increased from 1.8 (in group 1) to 3 days in group 2. 1 patient in each group required surgical management. The 30-day re-bleed rate increased from 11% to 30% All re-bleeds in group 1 were admitted. Only 1 patient (3.7%) with a re-bleed in group 2 required admission. The mortality rate was unchanged. The length of time during the initial visit decreased. Hospital visits per patient (for removal of pack, pain, and re-bleeding) increased from 1.1 in group 1 to 2.7 in group 2.

Conclusions

Our COVID-19 epistaxis guidelines reduced close contact, in-patient admissions, and length of stay. However, there is an increase number of visits per patient and increase re-bleed rate (suggesting that cautery plays an important role). The next cycle plans to introduce a patient leaflet and a virtual clinic.
955 Management of A Progressed SCC Case in the COVID-19 Era
Authors: Gkorila A , Mastronikoli S
Published: October 2021

We herein report the case of an elderly patient who underwent amputation of their hand for a squamous cell carcinoma (SCC) due to lack of timely treatment during the COVID-19 pandemic.

The patient had a biopsy-proven SCC of the dorsum of their left hand, first diagnosed in March 2020, before the first lockdown. The lesion was 3cm, mobile, easily excisable, and the defect routinely reconstructable. Unfortunately, a number of appointments were missed and when the patient was eventually seen back in the clinic, the lesion was bigger and firmly fixed to the deeper structures. An urgent wide excision of the lesion with split skin graft reconstruction was planned. Intraoperatively, axillary lymph nodes were identified and a FNAB reported metastatic disease. After a failed attempt to fully resect the hand lesion and salvage the surrounding structures, a joint consultant decision was made that an amputation would give the patient the best chance of survival. Since the patient was lacking capacity, and following a discussion with the family, an above wrist amputation was performed in the patient’s best interests.

This case sheds light on the unseen and unrecorded victims of COVID-19. Due to the pandemic, most outpatient follow-up appointments were cancelled, and operating waiting times were significantly increased. National research studies showed that all skin cancer treatments were negatively affected by the COVID-19 pandemic. During this lockdown, there is an urgent need to continue the provision of these services as the risk of untreated skin cancer is even greater.
985 Improving the Accessibility and Quality of Junior Doctor's Rotas During the Covid19 Pandemic
Authors: Gowda A , Smith K
Published: October 2021

Introduction

Rotas are an important part of a Junior Doctors working life. Having an up to date and accessible rota is important in enhancing Junior Doctor’s working lives in addition to being vital for work force planning and patient safety. During the Covid19 pandemic, rotas have changed several times making it difficult to track changes. Prior to our project, Junior Doctors found it neither difficult nor easy to access rotas at work (2.84 out of 5), found it fairly difficult to access rotas at home (2.38 out of 5) and the rotas they had access to were only average in being up to date (2.69 out of 5). Our project looked to improve this.

Method

Data was collected by surveys sent to Junior Doctors in the surgical department. PDSA Cycle 1 involved implementing surgical rotas on Microsoft Teams. PDSA Cycle 2 involved having other speciality rotas on Microsoft Teams. Our aims were to improve accessibility of rotas both at home and in the workplace whilst improving how up to date the available rota is.

Results

After the surgical rotas were on Microsoft Teams, rotas were easy to access at work (4.64 out of 5), fairly easy to access at home (4.24 out of 5) and were mostly up to date (4.41 out of 5). This has led to an improved satisfaction amongst Junior Doctors.

Conclusions

Currently the surgical department in Derby is using our solution for rotas. Medical staffing is in the midst of implementing this in the Medical speciality.
1038 Patient’s Experiences and Lessons Learned Following Establishment of a New Regional Day Procedure Centre in Response To COVID-19 Pandemic
Authors: Gilmore C , Coulson R , Graham V , McAllister I
Published: October 2021

Aim

Due to the impact of COVID-19 on elective services an exclusive day procedure centre has been established for the region. This study aims to review the patient experiences of the service.

Method

A 26-question feedback survey assessed patient outcomes, complications, and experiences. All patients who underwent hernia repair from September to November 2020 were contacted 6 weeks postoperatively by telephone to participate.

Results

Over 10 weeks, 55 patients underwent unilateral inguinal hernia repair. 49 patients completed the survey, 5 patients were not contactable, and 1 patient declined to participate. Overall high levels of patient satisfaction were reported, when asked the question “Rate the overall experience (out of 10) from the time you were contacted to proceed with surgery to now?” The average patient reported score was 9.5. Results indicated excellent use of written patient information leaflets. 92% (N = 46) of participants had a travel time of less than 60 minutes and 94% (N = 45) of those contacted reported the centre as a convenient location. Qualitative responses described pain at 48-72hrs following the procedure when local anaesthetic had worn off, to the detriment of overall patient satisfaction.

Conclusions

A dedicated site for day-surgery can be successful during the period of COVID-19 restrictions. High levels of patient satisfaction reported. However, lessons learned include need for improved education regarding postoperative analgesia; the effects of local anesthesia and patient directed follow up via the well-established local surgical hub.
1077 TELP In Urology: Hindrance or A Help During Covid-19 Pandemic? A Closed Loop Audit
Authors: Henderson L , Birse E , Nalagatla S , Reid S
Published: October 2021

Aim

TELP (Treatment Escalation/Limitation Plan) form is a novel clinical decision-making tool introduced during the COVID-19 pandemic in our health board to provide a standardised patient management plan in case of patient deterioration. A closed loop audit of its compliance in Urology patients was performed.

Method

Patient medical records were analysed over two periods (Cycle 1: 5/10/20 - 11/10/20 and Cycle 2: 23/11/20 – 29/11/20) for all Urology patients in our institution. Cycle 1 audit findings were presented at the Departmental Education Meeting. During Cycle 1, an anonymous questionnaire was sent to all Urology Medical and Nursing staff to gather their opinion on TELP.

Results

In total 100 patients were analysed. 66 were male and 34 females. Age ranged from 15 to 91 years. TELP form completion rate improved from 48% (Cycle 1) to 68% (Cycle 2), however, correct completion remained poor at 11.1% and 16.7% in Cycle 1 and Cycle 2 respectively. Commonly, there was no reporting of ‘discussion with patient or family’ or ‘patient capacity’. Majority of patients with a completed TELP had one to four underlying co-morbidities and were emergency admissions (65%). The questionnaire reported barriers to compliance including, time for completion, document size, and the feeling it was inappropriate for certain patient groups. Most felt it did not represent patients’ wishes (73%) or improved discussion regarding escalation status (50%).

Conclusions

TELP forms have sub-optimal correct completion rates and may not always represent patient’s wishes. Inherent barriers to its use need to be addressed, given limited resources during the COVID pandemic.
1219 Patient Satisfaction with Virtual Orthopaedic Clinics During the COVID-19 Pandemic
Authors: Shah Y , Shah K
Published: October 2021

Background

The COVID-19 pandemic has elicited the need to deliver consultation appointments remotely due to social-distancing measures, as well as some individuals having to shield. Virtual clinics are not a familiar setting for orthopaedic surgeons or their patients, but it is a necessity in the current climate and potentially also in the future.

Aim

This study aims to determine patient satisfaction of virtual orthopaedic consultations, during the COVID-19 pandemic and for the future.

Method

A 10-question survey assessed the satisfaction level of both new and follow-up patients towards virtual clinics for consultations with orthopaedic surgeons.

Results

Based on 100 patients who completed the surveys in a 6-month study during the pandemic, it was found that a majority (90%) of patients reported being satisfied (either very satisfied or satisfied) with the telephone clinics and would be content on having virtual clinics in the future.

Conclusions

Many patients view virtual clinics as an acceptable substitute for face-to-face appointments, specifically during the pandemic. However, it was also reported that a majority of patients would still prefer a physical examination as well. If virtual consultations are to persist beyond the COVID-19 pandemic, further exploration would need to be carried out to determine the efficacy.
1342 Screening Patients’ Temperature in COVID-era Outpatient Clinics: An Overreliance on Unreliable Devices?
Authors: Allman M , McKenna M , Leopard D , Backhouse S
Published: October 2021

Aim

The Covid-19 pandemic continues to impair patient access to hospital clinics. One way of enabling outpatient services to continue safely is to screen for pyrexia by checking patients’ temperature prior to their clinic appointment. Infrared tympanic thermometers (ITT) are commonly used as a surrogate marker of core temperature. Non-contact infrared cutaneous thermometers (NICT) are increasingly favoured as they require no direct contact with patients. The aim was to measure the concordance of temperature readings between ITT and NICT on patients attending ENT outpatient clinic at one hospital.

Method

Body temperature was recorded using ITT and NICT on 63 sequential patients. Agreement was tested using a Bland-Altman plot with 95% confidence interval and paired T-tests.

Results

Mean body temperature was significantly lower (p < 0.05) for the NICT [36.3 °C (95% CI 36.2 °C-36.4 °C)] compared with the ITT [36.6 °C (95% CI 36.5 °C-36.7 °C)]. The NICT measured on average 0.34 °C (95% CI 0.33 °C-0.35 °C) lower than the ITT. The Bland-Altman plot showed moderate agreement of the two methods (SD 0.46 °C; limits -1.25 °c to 0.57 °c); however, disagreement was greater at higher and lower temperature extremes.

Conclusions

Screening patients for pyrexia aims to help prevent spread of COVID-19. False negatives result in a missed opportunity to break the chain of transmission. A significant proportion of false negatives may reverse any intended benefit. NICT are convenient but may be more susceptible to false negatives when assessing for pyrexia and may provide little more than false reassurance when used for pyrexia screening.