bluuebunny/crossref_metadata_2025 huggingface dataset:
1006 Hot Biliary Telephone Follow-Up Clinic Patient Satisfaction QIP
Authors: Murugan V , Wong T , Fouad M , Sanyal S
Published: August 2023

Aim

Current evidence notes associations between gallstone disease and increased hepato-pancreato-biliary complications in the general population, signifying the importance to optimise the services provided for patients in this group; for instance, telephone follow-up hot biliary clinics that cater to relatively healthy patients with gallstone disease. This QIP aims to increase patient satisfaction rates in these clinics.

Method

A Likert-scale, 13-item questionnaire ranging from 1-5 (1 = strongly disagree, 5 = strongly agree), was developed to assess patient satisfaction with telephone follow-ups. An average score of 4 across all questionnaire items was fixed as the satisfactory cut-off point. 100 patients who had had telephone follow-ups were then retrospectively identified to fill out the questionnaire. The data was then analysed to identify the overall satisfactory rate, and rates according to sex and age groups.

Results

On overall, 75% of patients were satisfied with telephone follow-ups. Breakdown of data according to sex revealed that 79.4% of females and 67.6% of males were satisfied by telephone follow-ups (p-value: 0.19). As for age groups, 72.2% of patients below the age of 50, 88.9% of patients between the ages of 50-59, 71.4% of patients between the ages of 60-69 and 72% of patients above the age of 70 were satisfied (p-value: 0.52).

Conclusions

Despite positive initial findings, these numbers can be improved by implementing measures like providing clinicians with a model teleconsultation template for use in clinics and providing patients the options of choosing either face-to-face appointments or telephone follow-ups.
1076 Staff Perceptions on Electronic Patient List Management: Introducing the General Surgery Care Teams to Improve Patient Safety
Authors: Hinchcliffe Z , Bruggemann N , Hague O , Low J , Sohrabi C , Kenworthy W , Sengupta N
Published: August 2023

Aim

Electronic patient lists are widely used across NHS England and commonly rely on staff manually updating lists to guide inpatient ward-rounds, creating potential for human errors. Locally, lists are extracted from Electronic Patient Record (EPR), whereby doctors are responsible for ‘coding’ patients under ‘general surgeon’ at admission. Errors in this process lead to “missed” patients, raising concerns for patient safety. This study aimed to assess staff perceptions surrounding this system to help implement the new EPR General Surgery Care Team.

Method

Perceptions were analysed using an online anonymous questionnaire, distributed via a messaging group. Questions were categorised into ‘ease of use’, ‘time-efficiency’ and ‘safety’, and assessed using a Likert Scale (1-5). Open questions screened for list-related examples of poor patient care and areas for improvement.

Results

Twelve responses were analysed: 7 (58.3%) Foundation Year 1, 4 (33.4%) Senior House Officers and 1 (8.3%) Registrar. Eleven (91.7%) responses reported the system to be inefficient and 7/12 (58.3%) difficult to use (scoring Likert 4-5). 100% believed the system disturbed patient care (Likert 3-5), describing it as “complicated”, “time-consuming” and “messy to use”. This “compromises patient safety” and “increases junior workload”. Nine (75%) responses identified specific examples where the system directly affected care, including patients “missed” from ward-rounds, delayed management, and adverse outcomes.

Conclusions

The ‘old’ list management system was complex and slow to use, directly compromising patient care. Further qualitative data is required to continue improving the General Surgery Care Team List, implemented using this feedback, to optimise patient safety.
1078 Assessing the Compliance & Adherence to the Emergency General Surgery Admission Proforma via ‘Take 10’ Principles - a Complete Clinical Audit
Authors: Akhtar M A B , Varzgalis M
Published: August 2023

Aim

To assess the adherence and compliance to the emergency general surgery admission proforma, based on the ‘Take 10’ principles which includeObservationsExaminationsImpressionInvestigationsAntibioticsIV FluidsVTE RiskNutritional AssessmentEstimated Length of StayCeiling of Care

Method

Retrospective review of the admission proformas of 20 random patients was done - without prompting the admitting team to strictly comply to the ‘Take 10” principles. Education was provided to the next surgical on-call team, who were encouraged to fill out the proforma and carry out the post-take ward round using ‘Take 10’ principles. A relook retrospective review was carried out on a subsequent 20 random patients after 4 weeks. The results from both weeks were compared.

Results

Percentage adherence Observations:25% in 1st week and 95 % in 2nd week Examinations:100% in 1st week and 100 % in 2nd week Impression:100% in 1st week and 100 % in 2nd week Investigations:95% in 1st week and 100 % in 2nd week Antibiotics:63% in 1st week and 90 % in 2nd week IV Fluids:25% in 1st week and 95 % in 2nd week VTE Risk:45% in 1st week and 100 % in 2nd week Nutritional Assessment:48% in 1st week and 100 % in 2nd week Estimated Length of Stay:10% in 1st week and 85 % in 2nd week Ceiling of Care:12% in 1st week and 78 % in 2nd week

Conclusions

The implementation of the Take 10 checklist during the post take surgical ward round, resulted in improved documentation on the emergency general surgery admission proforma.
1141 Good Medical Practice: Patient's Right to the Information - an Audit of the Patient's Understanding and Satisfaction with the Information Provided to the Patients with Acute Pancreatitis
Authors: Jamal Z , Zafar N , Khawaja Z , Haider I , Adnan N
Published: August 2023

Aim

The aim of this audit was to find out if adequate information regarding acute pancreatitis as per the NICE guidelines was being provided to the patients and their family members and to assess patients’ satisfaction in terms of the provided information.

Method

30 patients were admitted in the department of general surgery with acute pancreatitis were provided with a questionnaire containing 10 questions asking about the information provided to them about their condition by healthcare professionals.

Results

Overall, 60% of the patients were not satisfied with the information provided. None of the patients were provided written information and more than 90% were not explained condition with the help of a diagram. The other areas where the patients were not provided information were investigations done (40%), treatment (60%), provision of verbal information (26%), and alcohol as the potential cause of the condition (27%).

Conclusions

This audit emphasized the need of a proper explanation of acute pancreatitis to the patients and their family members. It was also found that no leaflets were available for the patients. Results were shared in the surgical team group and a leaflet has been designed and distributed to every patient with acute pancreatitis.

Second Cycle

After the introduction of the leaflet, improvement has been seen in almost all the areas of the information provided to the patients. Overall, satisfaction has improved from 60% to 92% in the patients admitted with acute pancreatitis.
1160 Improving Operative Notes and Consent Forms in a Urology Department Working Across Four Hospitals; a Quality Improvement Project
Authors: Vaidya A , Bourdoumis A
Published: August 2023

Aim

Consenting patients appropriately and well-written operative notes are essential for patient care. Anecdotal evidence highlighted that both of these areas could be improved in a urology directorate working across four hospitals. This QIP aimed to assess if consent forms included the risks stated by the British Association of Urological Surgeons (BAUS) leaflet for each operation and compliance with Royal College of Surgeons (RCS) guidelines for operative notes.

Method

A QIP using PSDA methodology. Cycle one: a retrospective assessment of one week’s operations assessing compliance of consent forms and operation notes. Cycle two: creating electronic templates for common operative notes which meet all RCS standards and consent forms as per the BAUS leaflets, followed by assessing their implementation for one week’s operating.

Results

Cycle one: 7% of consent forms were filled out appropriately. 0% of operative notes met all the RCS guidelines; 6 sections had 0% compliance. Cycle two: 33% of patients were consented using the templates; 13% of patients underwent an operation for which no template existed. 29% of operations were filled out using the templates and met all RCS criteria. Qualitative assessment found that surgeons did not use the template as they did not know they existed or how to use them; surgeons using the templates reported they saved time.

Conclusions

Premade templates save time and improve the quality of documentation when employed appropriately. However, their uptake requires buy-in from colleagues and teaching to ensure people know how to use them. Additional cycles are required to improve standards further.
1246 High Output Stoma Management Audit
Authors: Mollier J , Jenkinson M , Serisier A , Gurung P , Jacob M
Published: August 2023

Aim

High output stomas lead to a myriad of complications for patients including dehydration, electrolyte imbalances, poor skin integrity & altered bowel function. However, this issue is not well recognised amongst junior doctors. This audit’s aim was to improve awareness of high output stomas including their implications and management according to the Association of Stoma Care Nurses’ (ASCN) national guidelines amongst junior doctors.

Method

An electronic survey was distributed to 20 junior doctors working in General Surgery at Southend University Hospital, assessing their knowledge on recognition and management of high output stomas. A checklist summarising the ASCN guidelines was then created. A post-intervention survey was then distributed to assess for improvement in knowledge and application of ASCN guidelines as well as use of the checklist.

Results

Overall, 51% answers were correct in the first survey compared to 72% answers correct in the post-intervention survey, and 83% of participants used the checklist. There was improvement in use of IV fluids (50% to 100%), monitoring fluid balance (80% to 91%), fibre restriction (37% to 70%), fluid restriction (50% to 70%), checking & replacing Mg (65% to 87%) & use of regular codeine (70% to 77%), as well as moderate improvement in appropriate doses of loperamide being given (5% to 30%).

Conclusions

The above audit resulted in an improvement of knowledge and application of evidence-based guidance provided by ASCN, with ultimate intent to improve patient outcomes. Further work includes distribution of the checklists throughout the hospital and to other hospitals.
1251 A Project Aimed at Improving the Completeness and Quality of Admission Clerking in the ENT Department
Authors: Nowinka Z , Benjamin E
Published: August 2023

Aim

Admissions notes are essential in communicating information regarding patients. The project aimed to improve the proportion of completed admission clerking and the quality of the recorded data for the ENT patients admitted to the ward.

Method

We have included emergency presentations and elective admissions for moderate and major head and neck surgery. Patients were identified from handover lists. Baseline data were collected across a period of six weeks, and 103 admission notes were included. Following the intervention, the data collection lasted another six weeks, and 93 documents were identified. Documents were compared against The Royal College of Surgeons of England Guidelines for Clinicians on Medical Records and Notes. Interventions to improve the standard of admission clerking included: a short departmental presentation, educational posters, and an introduction of the electronic clerking proforma.

Results

Following the intervention, the proportion of completed admission clerking has increased and the quality of recorded data has improved.The proportion of completed admission clerking increased from 95.4% to 100% for emergency presentations, and from 2.6% to 68.2%for elective admissions. Data completeness has improved across all documentation domains. For emergency presentations, the most notable improvement was recorded for the medication history (76.9% vs 93.0%) and allergy status (73.9% vs 87.3%). For elective admissions, the greatest improvement was noted for past medical history (2.6% vs 65.6%) and social history (0% vs. 56.5%).

Conclusions

In conclusion, the use of clerking proforma alongside educational presentation and posters increased the completeness and quality of admission clerking, for both emergency and elective presentations in the ENT department.
757 Indocyanine Green Colonic Perfusion Demonstration Following Robotic Da Vinci X Inferior Mesenteric Artery Ligation for the Treatment of Type II Endoleak
Authors: Lambert J , Al Majid S , Salaman R , Gavan D , Sheikh A , Gill M
Published: August 2023

Background

We describe the technical operative details of the robotic repair of a type II endoleak (T2E) following endovascular abdominal aortic aneurysm repair (EVAR). We demonstrate that indocyanine green (ICG) can be used intra-operatively to demonstrate perfusion of the colon following ligation of the inferior mesenteric artery (IMA) vessel feeding the aneurysm sac.

Method

A 74-year old male underwent EVAR for a 5.8 cm infra-renal abdominal aortic aneurysm using an E-Tegra, Jotec Device (JOTEC Gmb, Lotzenäcker 23,D-72379 Hechingen). Surveillance contrast CT (CTA) over the ensuing 30 months confirmed progressive sac expansion.

Results

ICG confirmed colonic perfusion via the marginals after IMA ligation. Total operative time 56 min < 50 mls blood loss and 1-day hospital stay. 3-month follow-up: CTA and ultrasound demonstrated complete resolution of T2E and adequately perfused colon.

Conclusions

A total robotic approach can be performed safely with intra-operative ICG used to demonstrate colonic perfusion as an added safety measure.
890 Surgical Multidisciplinary Team Meetings Are Enhanced by Collaboration in the Metaverse
Authors: Ghaderi R , Edwards T , Cobb J , Logishetty K
Published: August 2023

Aim

Multidisciplinary team meetings (MDT-Ms) are utilised as a clinical decision-making tool. Currently, these are in-person or remote, using screen-sharing of patient health records including clinical findings, numerical data, and imaging (2D/3D). Immersive Virtual Reality (IVR) is an emerging technology allowing multiple care-providers to remotely interact with patient data in the metaverse. Our aim was to develop an IVR metaverse for MDT-M and test its feasibility and efficacy in the orthopaedic trauma setting.

Method

Interviews of users attending existing orthopaedic trauma MDT-Ms at a regional major trauma centre identified strengths, weaknesses, opportunities, and threats (SWOT analysis) for a novel platform. Iterative testing allowed feature development and curation of twenty-four simulated cases from previous admissions. User experience in pilot MDT-Ms was measured using the NASA Task Load Index (NASA-TLX) and System Usability Scale (SUS).

Results

An IVR metaverse platform was developed and four MDT-Ms were successfully conducted with healthcare professionals (n = 13). Participants found ‘data visualisation’ and ‘clinical decision-making’ effective in IVR: median 5 (IQR 4-5); and 5 (IQR 4-5) respectively. Ratings on ‘ease of communication’ in the metaverse were varied with a median of 3 (IQR 2-4.5). Qualitative analysis highlighted the strength of IVR for collaborative interrogation of 3D anatomy and injury patterns. The NASA-TLX domain ‘task performance’ was rated consistently highly.

Conclusions

Healthcare professionals can conduct MDT-Ms using a novel platform on commercially available IVR headsets. Participants were able to collaboratively interrogate clinical data, facilitating enhanced discussion, decision-making, and perceived task performance. Future iterations will focus on role designation to improve communication in MDT-Ms.
931 Minimising Surgical Inpatient Bed Use and Maximising Patient Flow in Plastic Surgery: Proposal for Combined Acute Trauma Clinic with Attached Local Anaesthetic Theatre and Ambulatory Care with IV Therapy Service
Authors: Jawad A , Kadhum M
Published: August 2023

Background

The majority of hand trauma referrals to plastic surgery consist of minor injuries that ideally require initial washout and exploration under local anaesthetic, during which repair of most damaged structures can also be undertaken. Meanwhile, a significant proportion of acute admissions to plastic surgery are for infected wounds requiring washout, intravenous antibiotics, limb elevation, and daily wound review to ensure resolution. These occupy surgical beds of often-limited capacity, and confine otherwise generally mobile, independent patients.

Literature

Trauma clinics are well-established, often being utilised as see-and-treat services (Rea-et-al 2004), reducing the wait for a potentially unpredictable main trauma theatre, with proven cost benefit (Cullen-et-al 2021). This is further aided by patient counselling regarding waiting times for surgery (Khan & Iqbal 2021), and the model has been augmented to incorporate virtual reviews (Westley-et-al 2020). Infected wounds amenable to local anaesthetic or wide-awake-local-anaesthetic-no-tourniquet (Lalonde 2015) could similarly be managed in this environment, but may necessitate admission for intravenous antibiotics, nevertheless. However, soft-tissue infections are increasingly being managed in outpatient settings through using single/twice-daily dosed antibiotics with daily review (Ektare et al 2015).

Proposal

An ideal configuration would therefore consist of a trauma clinic space with assessment bays, local anaesthetic minor theatre, and IV infusion chair(s), staffed by a receptionist, an assessing doctor/nurse practitioner, an operating surgeon with scrub nurse/trained healthcare assistant, and an IV-trained nurse.

Conclusions

We believe that this cost-effective setup would ensure patients receive timely adequate care for acute limb trauma and infections while reducing inpatient presence and improving efficiency.
449 Carbon Fibre Versus Titanium Implant Construct in Separation Surgery with Post Adjuvant Stereotactic Ablative Radiotherapy for Spinal Oligometastatic Disease
Authors: Saha P , Uthayanan L , Cox K , Tsang E , Hwang Z , Ajayi B , Khan U , Singh Alg V , Minhas P , Lui D
Published: August 2023

Aim

Radical treatment for Spinal Oligometastatic Disease (OMD) was often traditionally treated with morbid Tomita En Bloc Spondylectomy. Now, Stereotactic Ablative Radiosurgery (SABR) provides curative tumour ablation without open surgery, reduced cord toxicity and better pain management. SABR delivered postoperatively to Separation Surgery (SS) has shown excellent mortality rates, infection control, maximum local-control, and better pain management. This study is the first to compare clinical safety of carbon-fibre implantation (CFI) comparing to titanium implantation (TI).

Method

Retrospective review of OMD/OPD cases that underwent separation surgery with postoperative SABR investigating tumour histology, OMD type, instrumentation used for SS (CFI versus TI), mortality, local recurrence (LR), pain management, infection, complications, hospital length of stay, ICU length of stay and palliative outcomes at a quaternary level-1 spinal unit.

Results

79 patients were in the OMD pathway, 36 patients underwent SS with/without SABR. 20 patients had SS with TI. 16 patients had SS with CFI. SS with TI±SABR: 30-day mortality-10%, 12-month mortality-15%. SS with TI+SABR: 30-day mortality-0% 12-month mortality-0%, 12-month LR-0% TI: Infection-4% SS with CFI±SABR: 30-day mortality-6%, 3-year mortality-12.5%. SS with CFI+SABR: 30-day mortality-0% 12-month mortality-0%, 12-month LR-0% CFI: Infection-0% Pain in both groups were associated with PD cases only.

Conclusions

SS with postoperative SABR regardless of construct material demonstrated excellent outcomes. CFI demonstrated to be superior to TI. When postoperative SABR was absent from treatment, patients had complications and was demoted to palliative decompression with neurological symptom management. This highlights the importance of SABR in conjunction to SS.
450 Anterior Separation Surgery to Allow for Stereotactic Ablative Radiotherapy: A Novel Approach Permiting Radical Oncological Treatment of Spinal Oligometastastc Disease
Authors: Saha P , Ajayi B , Minhas P , Lui D
Published: August 2023

Background

A paradigm shift in the treatment of spinal metastases has allowed surgeons to deliver curative results utilising radical oncological treatment. In oligometastatic disease (OMD), Stereotactic Ablative Radiotherapy (SABR) as a primary modality or adjuvant treatment to surgery has shown excellent survival outcomes, lower morbidities, and better pain management. The novel use of carbon fibre (CF) vertebral body replacement (VBR) allows optimal SABR planning, less reflection and better future surveillance imaging. CF reinforced PEEK has mechanical properties that allow high resistance to ionising radiation and low wear particles, which is better suited for planned SABR as opposed to titanium VBR and screws.

Case presentation

A 48-year-old female presented with a recurrent solitary metachronous oligometastatic breast T2 lesion. Her systemic suitability indicated for separation surgery (SS) with post-operative SABR to avoid morbid excision surgery. This case report illustrates novel treatment for spinal oligometastatic disease utilising anterior separation surgery with custom CF VBR with postoperative SABR. Due to several contraindications of posterior separation surgery, anterior surgery was opted for utilising the philosophy of Enneking radical surgery despite Enneking inappropriate resection.

Results

There were no intra-operative and post-operative complications. 30-months postoperative follow-up and imaging demonstrated that the patient was tumour-free, mobile, pain-free and living independently.

Conclusions

Utilising this novel approach, Anterior Spinal SS and SABR has shown maximum local control and can deliver curative, radical oncological control. The use of CF has properties allowing high resistance to ionizing radiation and low wear particles, which is better for planned SABR as opposed to titanium VBR and screws.
486 Virtual Reality and Surgical Oncology: Where Are We?
Authors: Ng C P Y
Published: August 2023

Aim

Less than 5% of patients from low- and middle-income countries (LMICs) have access to basic cancer surgery. Virtual reality (VR) is heralded as the novel tool to build surgical capacity and capabilities, yet its adoption in surgical oncology is poorly understood. The systematic review aimed to scope the utility of VR across surgical specialities and modalities and identify gaps.

Method

The systematic review was carried out by means of a search on the Web of Science, including all articles and reviews on virtual reality and surgical oncology published between January 2011 and January 2020 following the PRISMA guidance. Of 95 papers initially identified, 24 studies were included.

Results

The review revealed gaps in application, accessibility and clinical evaluation of VR. VR was applied the most in open (58.3%), followed by in endoscopic (20.8%) and robotic (20.8%) cancer surgeries. Neurosurgery led in the use of VR (n = 13, 54.2%), followed by urology (n = 8, 33.3%) and gynaecology (n = 2, 8.3%). In terms of the characteristics, 11 (57.9%) articles described VR tools with high fidelity; and 12 (63.2%), with haptic feedback. While all VR illustrated face and content validity, only 12 (63.2%) exhibited construct validity and one (5.3%) demonstrated predictive validity.

Conclusions

VR is disproportionately developed for complex, high risk cancer surgeries. The asynchrony between its development and actual global cancer surgery demand means the technology is not effectively, efficiently, and equitably utilised to realise its surgical capacity-building potential. Future research should prioritise in affordable, clinically evaluated VR technology for high demand, common cancer surgeries required in LMICs.
832 Analysis of Surgical Outcomes and Survival Benefit of Simultaneous Resection of the Primary Colonic Tumour and Liver Metastasis – Experience of a UK Tertiary Centre Between 2013-2022
Authors: Lakshmanan V , Kane E , Hughes J , Kaul A , Arthur J , Mann K , James E , Skaife P , Malik H , Fenwick S , Jones R , Diaz-Nieto R , Hale J , McAvoy A
Published: August 2023

Introduction

22% of patients with colorectal cancer present with synchronous metastases. Traditionally, surgical management for these patients is performed separately although increasingly these are being done as simultaneous resections as supported by NICE, UK. Large-scale data to support this is limited and heterogeneous.

Aim

We aimed to analyse the experience of simultaneous resection at a UK tertiary centre with attention to surgical, oncological outcomes, and survival benefits.

Method

A prospective database between 2013-2022 was analysed, and clinical data were collared. Statistics performed using R.

Results

Ninety-six simultaneous resections were reviewed. 71% were left-sided including rectal and 29% were right-sided, while 69% and 31% of patients underwent minor and major liver resections respectively. The majority of cases were performed as open (77%), laparoscopic (16%), or converted to open (6.5%). 30-day mortality was 1% and morbidity rate was 55.4% (Clavien Dindo III 39.2%, IV 4%). Stoma formation rate was 34%. To date, 62% had recurrent disease, 55% received further chemotherapy and 29% had further resections. Median time to recurrence was 31.2 weeks. Median total survival was 34 months. Left-sided and minor liver resections tended towards improved survival, but this was non-significant; survival was significantly improved for those patients diagnosed via the bowel cancer screening program (BSCP).

Conclusions

Simultaneous resection of colorectal cancer and liver metastases is safe with low mortality and an acceptable morbidity rate. Overall survival of 34 months is promising with further analysis required into oncological strategies and improving uptake of the BSCP.
979 Radiofrequency Ablation a Novel Method in Radical Oncological Treatment of Spinal Oligometastatic Disease
Authors: Saha P , Tsang E , Hwang Z , Ajayi B , Minhas P , Lui D
Published: August 2023

Aim

Radiofrequency Ablation (RFA) is a curative novel addition to the armamentarium of radical oncological treatment. RFA as an adjunct to separation surgery may be a new technique that may have a beneficial compound effect of cytoreduction. The novel use of RFA in conjunction to radical treatment or independently for the treatment of oligometastatic disease (OMD) is investigated at a quaternary level 1 spinal center.

Method

Retrospective review of spinal OMD patients between 01/01/2017-01/12/2022. Patient demographic data, tumour histology, OMD type, surgery type and instrumentation, RFA, local recurrence (LR), infection and mortality data were analysed.

Results

15 cases of RFA. 11 out 26 separation surgeries (SS) performed for patients in the OMD/OPD pathway had adjunct RFA ± cement. Titanium SS with RFA ± cement (n = 4): 2-year LC– 0%; 2 years mortality–0% Titanium separation surgery without RFA ± cement (n = 16)–1 year LC–6% (n = 1); 30-day mortality – 12.5% There were 7 cases with independent RFA and cement, 1 case with RFA + biopsy and 3 cases with cement only. LR–0% at 6 months(n = 9), 12 months (n = 7) and 24 months (n = 5), the pain was well managed, no infection, and mortality–0% at 6 months(n = 11), 12 months (n = 7) and 24 months (n = 5).

Conclusions

RFA is promising for OMD pathway which can potentially deliver radical oncological control. As an adjunct to SS and SABR, it may offer improved cytoreductive control. The authors believe they are the first to describe this technique used in conjunction with SS where we show local recurrence of 0% at 2 years.
1047 Local Recurrence and Functional Outcomes After Metastatic Spinal Cord Compression Surgery
Authors: Yoon W Y , Lam T C
Published: August 2023

Aim

Metastatic Spinal Cord Compression (MSCC) is one of the most important complications of cancer. Surgical decompression is an important treatment for MSCC with proven benefits in overall survival, yet it is highly invasive and carries a significant morbidity and mortality risk. This study aims to review the outcome of MSCC decompression surgery, including local recurrence, overall survival, and post-operative ambulatory function.

Method

A retrospective review of data of 121 patients who underwent MSCC surgery at Lancashire Teaching Hospitals over 8 years and Blackpool Victoria Hospital over 5 years was performed. Competing risk regression analysis, log-rank test and multiple variable regression were used for the analysis of local recurrence, overall survival and post-operative ambulatory function at 3 months.

Results

The crude local recurrence risk was 9/121 (7.4%), and median time to recurrence was 94 days (range = 7-416 days). Previous radiotherapy to the MSCC site was strongly associated with higher local recurrence risk after MSCC surgery (SHR = 10.490, p = 0.000). Poor pre-operative ambulatory status (OR:12.347, p = 0.001) was associated with worse functional outcomes at 3rd month. Decompression surgery with instrumentation (OR = 0.186, p = 0.033), post-operative radiotherapy (OR = 0.143, p = 0.010) and higher post-operative radiotherapy dose (OR: 0.923, p = 0.006) were associated with better post-operative functional outcomes at 3rd month. The use of post-operative Systemic Anti-Cancer Therapy (HR = 0.346, p = 0.000) and haematological cancers (HR = 0.341, p = 0.006) predicted longer overall survival.

Conclusions

Our findings indicate previous irradiation to the MSCC site predicts local recurrence after MSCC surgery. Surgery with instrumentation and post-operative radiotherapy is important for the preservation of ambulatory function in the early post-operative period.
1187 A Study of Outcomes in Patients with Gastrointestinal Tract Lymphomas Who Require Inadvertent Surgery
Authors: Sarodaya V , Liemangow H , Eiswai A , Lim M
Published: August 2023

Aim

Patients may present with acute surgical symptoms from their lymphoma. We aimed to study postoperative outcomes and 3-year overall survival in patients who had inadvertent surgery as primary management of their gastrointestinal tract lymphomas.

Method

Suitable patients were identified using electronic records from January 2013 to December 2022. Demographics, clinicopathological characteristics and survival outcomes of these patients were collected retrospectively.

Results

A total of 25 patients were identified. The most common clinical symptom was abdominal pain (n = 18, 72%) with demonstration of an obstruction (n = 16, 64%) or perforation (n = 4, 16%) by a mass on CT scan. Small bowel was the most common site, followed by colon and stomach (55%, 24% and 21% respectively) Diffuse large B-cell lymphoma was the most common subtype (66.7%). Immunohistochemistry revealed B-lymphocyte antigen CD20 to be positive in most patients (n = 17, 68%) and Ki 67% to be high (>70%) in a third (n = 8, 32%).

Upon discharge, two thirds of patients were well enough to have systemic chemotherapy (n = 19, 76%). Two patients died from surgical complications while the rest succumbed to disease progression (n = 10, 76%). The overall 3-year survival rate was 56%.

Conclusions

Patients with gastrointestinal tract lymphoma who do not die in the postoperative period after inadvertent surgery are likely to be alive at 3 years with the use of systemic chemotherapy.
326 Cardiopulmonary Exercise Test as Predictor of Postoperative Ileus in Elective Colorectal Surgery – a Prospective Cohort Study
Authors: Tay T , Fleet B , Golder U , Legga A , Davies E , Raymond T , Hawkin P , Janta E , Ryska O
Published: August 2023

Aim

Postoperative ileus (POI) is a complication where there is abnormal pattern of slow or absent gastrointestinal motility after surgery. Elderly, frail, and comorbid patients often undergo cardiopulmonary exercise test (CPET) to determine their risks and suitability for major surgery. A literature review on Pubmed and Web of Science reveal no studies have been published on whether CPET variables can act as a predictor of POI. Hence, we aim to investigate whether there is a correlation between CPEX and post-operative ileus or major complications after colorectal surgery.

Method

All patients with stage I-IV Colorectal cancer who underwent CPET test between January 2013-June 2021 before elective major colorectal surgery were enrolled. Anaerobic threshold (AT) was used as a marker of cardiopulmonary fitness on CPET. POI was defined in any patient with NGT inserted postoperatively. Major complications were classified using Clavien-Dindo Classification≥Grade 3. Fisher’s exact test was used for categorical variables and independent sample t-test for continuous variables.

Results

In total, 115 patients were included - 64% were males and median age was 78(51-95) years old. Mean Anaerobic threshold was 10.4(6.4-15.6) mg/kg/min. Thirty-three(29%) and fifteen(13%) patients experienced POI and major complications respectively. There were no significant differences in mean AT for those who had POI versus without (10.9 vs 10.2, p = 0.13) and those with major complications versus without (10.7 vs 10.4, p = 0.62).

Conclusions

The overall incidence of POI was relatively high. Our study did not confirm level of cardiorespiratory fitness as a predictor of postoperative ileus or major complications.
1239 Microbiology, Culture and Sensitivity Analysis During Drainage of Non-Perianal Soft-Tissue Abscesses: Do We Review the Results and How Often Do They Change Management?
Authors: Rashid S , Pizanias M , Ezzat C
Published: August 2023

Aim

The utility in obtaining microbiology, culture, and sensitivity (MC&S) specimens during drainage of soft-tissue abscesses is controversial. This study aimed to determine if routine MC&S analysis changed management after drainage of non-perianal abscesses.

Method

A retrospective review was undertaken of consecutive patients undergoing drainage for non-perianal superficial abscesses between July and November 2021. Data recorded included whether an MC&S specimen was taken, the result, any antimicrobial treatment and clinical outcome. Using the Auditing functions inbuilt to the software, whether the surgical team had subsequently reviewed the result was also determined.

Results

76 patients underwent abscess drainage, located in the pilonidal region (32%), axillary (24%), buttock (24%), groin (11%), neck (5%) and trunk (5%). MC&S was sent from 52 cases (69%). Results were reviewed by the surgical team in 6 cases (11%). Samples were positive in 34 cases (65%). Mixed organisms were the most common positive finding (28 cases) and sensitivity was not performed on these samples. Methicillin-sensitive S aureus was cultured from 4 cases (8%), Methicillin-resistant S aureus from 1 case (2%) and Staphylococcus lugdenensis from 1 case (2%). Post-operative antibiotics were prescribed for 25 patients. 4 patients required a further course of antibiotics postoperatively and in all these cases MC&S was taken but showed no growth.

Conclusions

Few MC&S results were reviewed by the surgical team and MC&S results did not guide management in any case. These results support the hypothesis that routine MC&S sampling is not required for typical abscesses in low-risk patients.
292 Augmented Reality: A Novel Approach T­­o Surgical Simulation, a Objective & Subjective Validation, Health Economics Study & Systematic Review
Authors: Rawaf D , ElBahnasawi M , Toms J , Harris M , Ludick C , Sheikh M , Beghal G , Tenang L , Van Flute J , Street E
Published: August 2023

Aim

To validate the novel LapAR for surgical simulation.

Method

Utilising a high-fidelity simulator (LapAR1), we validated efficacy alongside health economics evaluation with an appropriate systematic review analysing the various styles of training.

Results

A pilot benchmarked two appendicectomies or vaginal cuffs with two rounds of intervening LapPass2. One hour on the simulator found ‘time’ savings of 19% and 36.9%, and ‘distance(m)’ savings of 25% and 56.5% respectively. A multi-centre has shown that 10 appendectomy benchmarks, with three LapPass rounds in two weeks can reduce ‘time’ by 55-66% and ‘distance’ by 39-72%. All figures are statistically significant following multiple-regression analyses.

Self-confidence scores on a day course indicated that all areas improved by a mean of 3.82 (likert, p = 0.018).

A BMJ peer-reviewed health economics review4 was then performed using estimated costs. The potential Return on Investment (ROI) for the NHS was deduced. At 100% translation rate alongside validation data, we save £455 per patient through reduced anaesthetic time and shorter inpatient stay.

Finally, a SR (n = 26) of literature on the main four (AR vs VR vs traditional vs cadaveric) demonstrated that AR is preferred, improves procedural success & provides faster skill acquisition.

Conclusions

Reduced complication rates, anaesthetic time and ability to reduce waiting list burden would form future scopes of study. However, we can now infer that AR-based laparoscopic training with the LapAR is not only preferred, but it is more effective at providing clinically translatable, and scalable cost-effective laparoscopic training as a potential new gold standard.
399 The MDT Game: Implementation of a Novel Simulation Exercise to Improve Multidisciplinary Care Teaching to Medical Students
Authors: Chong S , West L , Khera G
Published: August 2023

Background

Multidisciplinary team (MDT) medicine is the national gold standard for cancer care. Medical students are often encouraged to observe MDTs, however such meetings discuss a high volume of complex cases at rapid pace. This presents limited opportunities for learning or engagement for a student observer. We describe a novel teaching exercise which assigns students to roles on a simulated MDT, with the aim of improving understanding of collaborative MDT working.

Method

A simulation exercise was devised which assigned individual students to one of ten roles on a gastrointestinal cancer MDT. Each student was given information about a fictional patient which pertained to their role and encouraged to discuss management options as a group. Student feedback was sought to assess understanding of MDTs and teaching quality of both the simulation exercise and observation of a formal MDT meeting.

Results

Sixty-five students provided feedback on both the simulation exercise and the facilitated MDT observation session. Most students (78%) rated the simulation exercise as either “good” (40%) or “excellent” (38%), with a statistically significant improvement in mean score for the role-play compared to formal MDT observation (mean difference 0.46, p<0.001, 95% CI 0.23-0.69). Fifty-three students (82%) reported that participation in the simulation exercise improved their understanding of MDTs.

Conclusions

Multidisciplinary care teaching can be delivered to medical students in an acceptable form using principles of simulation-based training. Potential further developments for simulated MDTs include use of anonymised patient data to create more authentic vignettes and use of parallel pre- and post-test questions to assess learning.
1156 The Effectiveness of Augmented Reality for Medical Students’ Surgical Training: A Systematic Review
Authors: Shah A , Kaka A , Kumar N , Patel A , Yunus A , Patel A
Published: August 2023

Aim

Interest in augmented reality (AR) technologies within an educational setting have surged in recent years. Few studies evaluate the use of AR in a primarily medical student population. This systematic review with meta-analysis intended to evaluate the existing literature on this topic.

Method

This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using relevant synonyms for the terms “augmented reality”, “surgery” and “medical students”, the databases Medline, Embase, and Scopus were searched. Data was extracted for outcome measures such as time for task completion, errors/fails, attempts/retries, motion sickness/nausea and focus shifts.

Results

826 records were initially retrieved; 19 studies were included in our review, with a total of 485 participants. The AR group performed better than the comparator group in 84% of the statistically significant main outcomes. The AR groups were less likely to fail assessment, with a pooled odds ratio of 1.76 (95% CI:0.06-51.71, p = 0.74, I2 = 81%). One study reported 57% fewer critical errors than the comparator group. Only two studies reported nausea/motion sickness as an outcome (12% (n = 3) and mean Likert-scale score of 3 (of 10) in the AR groups).

Conclusions

AR can be an effective surgical teaching and training tool for medical students. However, the limitations of AR have not been explored extensively by primary studies, so gradual integration of AR is proposed until further studies elucidating benefits and risks can be undertaken.
97 Evaluating the impact of virtual collaborative teaching methods on educating and increasing interest in general surgery in medical students
Authors: Vyas R , Baskaran R , Naguib A , Raj D , Mukopadhyay S , Dalavaye N , Gamage M
Published: August 2023

Aim

This study investigated the effectiveness of a multi-collaboration (OSCEazy, NSTS, INCISION UK, NANSIG, WEDNS, BIMA, BURST Urology) General Surgical teaching session, in evaluating the educational impact of large-scale collaborative virtual teaching and increasing student’s interest in pursuing a surgical career.

Method

The General Surgery sessions were held virtually in early 2021, with participants voluntarily completing a post-session feedback form. A 10-point Likert scale (1- Strongly Disagree, 10- Strongly Agree) was used to collect student responses based on various domains. Confidence, knowledge, interest/commitment, and worries/concerns with regards to General Surgical content was surveyed. Furthermore, perceptions of General Surgery as a doable career and availability of research opportunities. In addition, final questions included the effects of collaborative events (added value, impact of attendance). A Wilcoxon signed-rank test was conducted, and median values were reported.

Results

We received 72 responses from the General Surgery Part 2 session. Results showed an increase in confidence (median: 9, SD: 1.576), knowledge (median: 9, SD: 1.172), interest/commitment (median: 8, SD: 2.106) and decreased worries/concerns (median: 8, SD: 1.771). Positive results were seen for General Surgery as a doable career (median: 8, SD: 2.197) and research availability (median:8, SD: 1.986). In terms of the collaboration, results showed an increased teaching value (median: 9, SD: 1.610) and attendance (median: 9, SD: 1.985).

Conclusions

The results demonstrate that online collaborative courses influence the knowledge and inspiration of students pursuing surgical specialties. In addition, large-scale collaborations increase the added value of the event and increases outreach in medical students.
201 The Surgical Hour: Improving the Surgical Footprint of Undergraduate Surgical Teaching
Authors: Kerdegari N , Sahai A , Zakri R
Published: August 2023

Aim

To deliver an online surgical teaching programme for medical students to enhance undergraduate surgical education and evaluate its effectiveness. The drive was for increasing the surgical footprint in a curriculum surgeons felt lacked exposure during the COVID-19 pandemic.

Method

Surgical speakers across 9 different surgical specialties were recruited via email. Topics included basic surgical principles, common pathologies, the surgical portfolio and surgical innovation. The programme was advertised to students via social media and a newsletter. Quantitative and qualitative feedback was collected via attendee feedback forms. Attendees’ knowledge in topics covered before and after each lecture was measured via self-assessment using a 5-point Likert scale. A paired t-test was performed to measure pre- and post-session knowledge.

Results

17 lectures were delivered between October 2021 and May 2022. 463 feedback forms were completed across the series by students across all years. Mean knowledge ratings improved after each session. 16/17 teaching sessions produced a statistically significant improvement in surgical knowledge (p<0.05). The most statistically significant improvement was seen following the acute abdomen lecture (p = 0.00) Vascular surgery showed an increase from 2.8 to 4 (p = 0.07). Common themes in written feedback were relevance to clinical practice, enthusiastic speakers, and exposure to content not otherwise taught in the curriculum.

Conclusions

Supplementary surgical series successfully address the demand for increased surgical teaching within the undergraduate curriculum. They improve insight into a career in surgery with exposure to positive role models, significant improvement in knowledge and practical advice on career development, empowering students to pursue surgery.
218 Entrepreneurship in Plastic Surgery – a Single Departmental Experience
Authors: Campos M , Brady C , Ponniah A
Published: August 2023

Aim

The specialty of Plastic and reconstructive surgery has long been at the forefront of innovation. However, perceptions of individuals focusing on entrepreneurship, particularly at a junior level, remain unclear. Anecdotally, trainees can be discouraged from participating in entrepreneurial efforts for fear of seniors’ disapproval.

Method

A questionnaire was circulated amongst doctors at the Royal Free Plastic Surgery department aiming to establish knowledge and perceptions of entrepreneurship. It included 10 questions to be answered anonymously.

Results

18 individuals responded, including Foundation doctors (n = 2), Junior clinical fellows (n = 2), Core surgical trainees (n = 3), Specialty registrars (n = 5), Senior clinical fellows (n = 2) and Consultants (n = 4). All respondents (n = 18) understood the meaning of the term “entrepreneurship” and 44.4% (n = 8) had prior entrepreneurship experience. Perceptions of the connotations of the word “entrepreneurship” in surgery varied. 33% (n = 6) reported “strongly negative” and 33% (n = 6) “strongly positive” connotations. Notably, of those reporting “strongly negative” connotations, 80% (n = 4) were junior trainees at Core surgical training or below, and 20% (n = 1) were specialty registrars. Amongst the 4 consultants, mean perception on a 5-point scale was 3.75, indicating an overall “positive” connotation. Furthermore, 83.3% (n = 15) of respondents felt their surgical career had not provided them with opportunities to develop entrepreneurship skills and 94.4% (n = 17) would like further opportunities to develop entrepreneurship skills.

Conclusions

Perceptions on involvement in entrepreneurship in surgery are predominantly positive. Those associating entrepreneurial efforts with negative connotations seem to be predominantly junior. This result will hopefully encourage Plastic surgeons at all levels to become involved in entrepreneurial efforts.