bluuebunny/crossref_metadata_2025 huggingface dataset:
351 A Service Evaluation of Emergency Laparotomy and Total Parenteral Nutrition at a Single Teaching Hospital
Authors: Ashmore D , Lee M , Wilson T
Published: August 2023

Aim

Malnourished patients undergoing emergency general surgery (EGS) have a greater risk of mortality than those not malnourished. There is often a need for nutritional support in EGS. This study investigated the risk factors for total parenteral nutrition (TPN) in patients undergoing emergency laparotomy, and whether there is an association with the NELA risk score.

Method

A five-year review (June 2016-2021) of the local NELA database and referrals to the Nutrition Support Team was performed. Pre-operative, operative and post-operative data for patients who received TPN and those who did not was collected. Associations between risk factors including NELA score and TPN use were examined using chi squared test and Mann Whitney U, as appropriate.

Results

There were 931 NELA patients, of which 22.8% (n = 173) received TPN. Intestinal obstruction was the commonest indication for surgery at 51.3% (n = 478) with no difference in age or sex. Despite patients receiving TPN being more likely to be frail (0.004), have higher ASA scores (0.001), lower albumin levels (<0.001), and worse pre- and post-operative NELA scores (both 0.002), stoma formation (0.002) and mortality (<0.001) was half that in patients without TPN. Sub-analysis reveals this was irrespective of when TPN was administered.

Conclusions

Two mutually exclusive explanations exist. TPN may be a predictor of disease severity and subsequent clinical intervention, or it may indeed improve the nutritional and clinical outcomes in this high risk EGS group. Further studies are needed to clarify this, in addition to the most appropriate method of identifying malnutrition in NELA-eligible patients.
508 Appendicoliths – Time to Operate: The Temporal Relationship Between Pre-Operative CT Confirmed Appendicolith and Time to Develop Complicated Appendicitis
Authors: Prayle M , Taib A , Kler A , Kanakalingam D , Asaad P
Published: August 2023

Aim

Evidence suggests delaying an appendicectomy for up to 24 hours does not increase the risk of complicated appendicitis. Appendicoliths are a risk factor for perforation. However, no study has explored the temporal relationship between appendicolith presence and time to perforation. This study aims to review pre-operative Computer Tomography (pCT) confirmed appendicoliths and their correlation with a shorter time to complicated appendicitis.

Method

Retrospective single centre study of patients admitted between 2018-2020. Inclusion criteria: age ≥18 years, appendicitis on histopathology following an operation and pCT scan. Complicated appendicitis was defined intra-operatively as an appendicular abscess, gangrenous or perforated appendix.

Results

310 patients were included in the study (45.5% with complicated appendicitis). Appendicoliths were present in 79 (25.5%) patients. Multivariate logistic regression identified an appendicolith as a significant risk factor for perforation (Odds Ratio 4.2, 95% Confidence Interval [CI] 1.3-13.6, p = 0.018). Within the first 12 hours of admission, those with an appendicolith accounted for a significantly greater proportion of patients with complicated appendicitis intra-operatively than those without (57.7% vs 42.3% respectively, p = 0.039). Within 12 hours of admission, those with an appendicolith were 2.2 times more likely to suffer from complicated appendicitis than those without (95% CI 1.4-3.7).

Conclusions

Patients with an appendicolith found on CT should be prioritised for theatre within 12 hours of admission.
895 A Retrospective Analysis of National Emergency Laparotomy Audit (NELA) Data at a Tertiary Hospital
Authors: Omran K , Aftab M , Wheatstone S
Published: August 2023

Aim

To audit emergency laparotomy outcomes in a tertiary hospital and identify areas for improvement.

Method

Retrospective analysis of 148 cases from Year 8 (12/2020-11/2021) of NELA patient data. Categorical and continuous data were analysed through chi-squared and t-tests, using R (version:4.2.2).

Results

Our NELA patient length-of-stay (LOS) was 2.2x the national mean (33.59 vs.15.1 days). 14 statistical outliers in LOS were identified which compounded the discrepancy between our median (15 days) and mean (33.59 days). Patients with stomas formed had a significantly higher mean LOS compared to those without (42 vs 26 days). Frail patients did not have a higher LOS, and much higher mean rates of review by geriatricians was noted (87% vs. 24% nationally).

A greater percentage of our patients had high pre-operative mortality risk scores compared to nationally (51.5% vs. 43.5%). A higher percentage of our patients had ischaemia (20.8% vs. 8.9%) and haemorrhage (5.6% vs. 2.6%) as indications for surgery. However, our 30-day mortality rate was lower on average (5.5% vs. 9.7%).

Conclusions

Our hospital's high rates of complicated cases and low mortality rates suggest a high-quality of patient care. Length of stay has been identified as an area for improvement, and we propose implementation of special discussion of long-staying patients in weekly ward round meetings as a potential intervention. While there may be various factors contributing to our higher mean LOS, we postulate that our status as a major stoma centre and tertiary referral centre for complicated cases as likely the primary cause.
905 To Operate or Not to Operate? a Clinical Audit in the Management of Adhesional Small Bowel Obstruction
Authors: Karagiannidis G , Khaliq T , El-Farran M , Youssef F
Published: August 2023

Aim

To compare our current management of adhesional small bowel obstruction (ASBO) with the National audit for small bowel obstruction 2017 and Bologna guidelines, to produce a flow chart which will indicate:First line management should be with intravenous fluids, analgesia, anti-emetics, and nasogastric tube (NGT).Patients diagnosed with ASBO should first undergo a trial conservative management with a water-soluble contrast.Operative management should be considered after 72 hours of non-resolving SBO.

Method

The medical records of all SBO patients admitted to Ipswich Hospital NHS trust between 1/4/2020 and 1/4/2021 were screened. All patients above 16 years of age and with a clinical diagnosis of ASBO were included in the audit.

Results

43 patients were diagnosed with ASBO.All patients were prescribed IV fluids. 38 (88.4%)and 36 patients (83.7%)received analgesia and anti-emetics respectively.21 patients(72.1%) had a NG tube inserted.24 patients (53.5%) were treated conservatively while 19 patients were taken to theater.37% of the ASBO patients, who were managed conservatively, were given a water-soluble contrast(Gastrograffin),which caused resolution of the obstruction in 20 patients(83.3%),while the rest were taken to theater.The average time to theater was 4 days(96 hours).

Conclusions

Our results are in line with the comparing standards. Our first line management for ASBO could be improved.The use of a water-soluble contrast should be used more regurarly in the conservative management of ASBO. A step-by-step ASBO flow chart could help the admitting surgical team follow the appropriate steps for the better management of ASBO.
1011 Chemical VTE Prophylaxis for Adults with Abdominal Trauma: A Systematic Review
Authors: Virdee P K , Walsh U , Ibrahim M
Published: August 2023

Aim

The increased incidence of VTE following blunt and penetrating abdominal trauma is well documented due to trauma induced coagulopathy and immobility. Whilst guidance often advocates early chemical thromboprophylaxis with low molecular weight heparin, clinical practice varies. This systematic review aims to evaluate evidence regarding VTE chemical prophylaxis in the adult trauma population (16+) presenting with blunt and penetrating abdominal trauma.

Method

A search of MEDLINE, EMBASE and PubMed databases was conducted, and additional references were identified from a review of literature citations. Search results were limited to English language and human studies. Co-existing severe head injuries defined as AIS>3 was excluded. Data was summarised in data extraction tables, along with level of evidence and bias scores for each study.

Results

A total of 9 retrospective trials exploring the timings of VTE chemoprophylaxis were included. All but 3 studies showed late VTE chemoprophylaxis initiation (>48hrs) was linked with a higher incidence of VTE, with significant results in 4 studies. Early VTE chemoprophylaxis was not associated with increased risk of NOM failure. Early VTE chemoprophylaxis was also not found to be associated with an increased risk in bleeding in most studies, with non-significant differences in blood transfusion requirements.

Conclusions

Research favours early initiation of VTE chemoprophylaxis in the abdominal trauma population, without significant risk of complications and supports results from other trauma populations. Further prospective studies are needed in the abdominal trauma population, as well as its sub-populations, to directly compare VTE agents and dosing regimens and provide higher quality evidence to support chemical thromboprophylaxis.
1068 Are There Delays to Emergency CEPOD Theatre Times? a Closed-Loop Audit Before and After Having a Dedicated CEPOD Registrar
Authors: Datta U , Ahmad A , Kamal M , Richardson T
Published: August 2023

Aim

To evaluate delays to Emergency Theatre (CEPOD) start times, “knife-to-skin” times, turnover between cases, and whether having a separate Registrar for CEPOD has improved theatre flow.

Method

This was a closed-loop retrospective audit at Walsall Manor Hospital with data collected using the electronic system, in two 4-week blocks; from 13/06/2022 – 10/07/2022 and then again from 18/07/22 – 14/08/22. 4 days were excluded due to external factor delays which could not be attributed to the theatre team. The target for patients being sent for was 08:40 AM, and arrival was 09:00 AM as per hospital policy.

Results

90.4% (47/52) of patients who were the first case of each day were sent for after 08:40 AM. 88.5% (46/52) arrived in the anaesthetic room after 09:00 AM. 94.2% (49/52) had “knife-to-skin” after 09:30 AM and 71.2% (37/52) after 10:00 AM. 36.5% (19/52) had a turnover time of more than 30 mins between cases. There were statistically significant differences between the mean times for the following categories when there was a single on-call Registrar vs when there was a dedicated CEPOD registrar: Time sent for (09:33 vs 09:08, p-value 0.015), Arrival Time (10:00 vs 09:32, p-value 0.010) and turnover time between cases (00:39 vs 00:11, p-value 0.018).

Conclusions

There are significant delays to CEPOD start times, anaesthetic times, “knife-to-skin times, and turnover times. Having a separate dedicated CEPOD registrar made a difference to the flow of emergency cases.
1079 SARC-F Questionnaire: A New Predictive Tool in Emergency Laparotomy Patients
Authors: Brzeszczyński F , Brzeszczyński M , Kusiński M
Published: August 2023

Introduction

Sarcopenia is associated with increased morbidity and mortality after emergency laparotomy skeletal muscle mass index (SMI) has been previously used to diagnose sarcopenia preoperatively. SARC-F (Strength, assistance, rising from a chair, climbing stairs, and falls) questionnaire is a new tool used to assess sarcopenia presence. The aim of this study was to evaluate the predictive role of SARC-F questionnaire on postoperative outcomes.

Method

This prospective observational single center study recorded SARC-F questionnaire scores in patients undergoing emergency laparotomy between September and November 2022. SMI scores were also recorded by dividing CT derived psoas muscle area by patient’s height2. Postoperative mortality rates and severity of complications were graded using Clavien–Dindo classification. SARC-F score and SMI were correlated to postoperative outcomes.

Results

A total of 20 patients were recruited with a mean age of 60. Indications for emergency laparotomy included: perforated viscus, bowel obstruction, spleen injury and appendicitis. Median SARC-F score was 3 (IQR: 6) and median SMI was 13.7 cm2/m2 (IQR: 5.8). The mortality rate was 20% and 50% of patients had post-operative complications. Results of multivariate regressions show that SARC-F score has a statistically significant positive relation and statistically significant effect on post operative complications (p value = 0.04) and mortality (p value = 0.03), while SMI has no statistically significant effect on post operative complications (p value = 0.08) and mortality (p value = 0.59).

Conclusions

SARC-F questionnaire may be a more accurate method of assessing sarcopenia in patients undergoing emergency laparotomy and may be a useful prognostic tool.
1202 National Emergency Laparotomy Audit (NELA): Difficulties Achieving the Best Practice Tariff (BPT) Criteria
Authors: Chkir B , Patel P , Peris R , Lee G , Handa S
Published: August 2023

Aim

BPT is granted to trusts if “80% of their NELA-high-risk-patients have a Consultant Surgeon (CS) and a Consultant Anaesthetist (CA) present during surgery and were admitted directly to critical care–the same patient needs to have received both elements of care.” The aim is to assess the difficulties in achieving the BPT &compare outcomes of high-risk-NELA-patients in a DGH.

Method

Retrospective review of all emergency laparotomy admissions from April 2019-August 2021.Only high-risk patients included. Data extracted from NELA-website &various sections across the hospital’s e-system.

Results

Total of 166 cases;99 of which were classified as high-risk. 48-males & 51-female patients (age range 40-95). 100% of cases had CS present in theatre. 63% of cases had CA in theatre compared to 37% which had SAS-grade-anaesthetist. 87% were admitted to critical-care,9% to Patient-Progression-Unit (PPU/HDU) & 4% to wards. 82% of patients survived the admission:63% had CA in theatre compared to 37% which had SAS-grade-anaesthetist.86% patients admitted to critical-care,11% to PPU/HDU & 3% to wards.

Conclusions

57% of high-risk cases have met the BPT criteria compared to 43% which didn't:29-cases had no CA in theatre,6-cases were not admitted to critical-care & 8-cases were not admitted to critical-care & had no CA in theatre.

18-total mortalities:9 met BPT & 9 didn't meet BPT (7 had no CA in theatre and 2 were not transferred to ICU post-op).

81% of total cases supervised by SAS-grade-anaesthetist survived.82% of total cases supervised by CA survived.

The survival outcomes of both anaesthetist-grades are almost identical but isn't audited in NELA-reports (Changes to criteria if otherwise).
1085 The Core Surgical Training Attainment (CoSTA) Study: Analysis of Differential Attainment in Early Surgical Training Using the UK Medical Education Database (UKMED)
Authors: Vinnicombe Z , Smith D , Little M , Super J , Gunnee M , Anakwe R
Published: August 2023

Aim

Core Surgical Training (CST) represents the earliest rung of the surgical training ladder. The CoSTA study aims to outline demographic differences in attainment in this cohort of applicants using the UK Medical Education database (UKMED).

Method

As part of a retrospective, longitudinal cohort study, using data available from UKMED, CST applications for 3,365 doctors who were F2 between 2013 and 2016 were analysed. Univariate analyses were conducted, followed by a logistic regression model that included the statistically significant variables from the univariate analyses. The outcome measure was successfully obtaining a place on a CST programme.

Results

Univariate analysis found that a lower proportion of black candidates had successful applications (54% compared to 68% for white N = 3,365, P <0.001). Applicants whose parents had attended university were more likely to be successful (67% compared to 59% N = 3,365, P <0.001). Logistic regression found that white applicants were 1.26 times more likely to be successful and applicants whose parents went to university were 1.20 times more likely to be successful (N = 1,935). The model controlled for other relevant variables including applicant behaviour (only applying to CST), medical school attended and performance at medical school (deciles in the Educational Performance Measure).

Conclusions

There is evidence of differential attainment in those applying for the CST programme. It is vital that this information is highlighted to those responsible for the training pathway so these issues can be addressed.
685 Consent for Emergency Laparotomy - Factors Affecting Discussion of Risk of Mortality With Patients and Their Families, and Use of NELA Preoperative Risk Scores as a Tool for Enabling Informed Consent
Authors: Geary G , Waterman J , Shah P
Published: August 2023

Introduction

Emergency Laparotomy (EL) carries a high risk of morbidity and mortality. Preoperative predictive tools can be a useful means of calculating and communicating this risk. Patients and their families should understand the risk of mortality during the consent process for an EL; clinicians are legally and ethically obliged to provide them with such information. Our aim was to assess whether discussions with patients and their family’s surrounding mortality are adequately documented as part of providing informed consent, and factors affecting this.

Method

A retrospective cohort study was performed in a single district general hospital between July 2020 and December 2021. All adult patients undergoing EL of any indication were included. The NELA mortality risk tool was used to estimate the risk of postoperative mortality. Binary logistic regression analysis was performed to investigate the predictors of documented discussion regarding the risk of mortality with patients and their families. All statistical tests were two-tailed and statistical significance was assumed at P < 0.05.

Results

There were a total of 111 patients. Documented discussion regarding NELA risk score with patients and their families were seen in 42% and 32% of cases, respectively. NELA mortality risk score was an independent predictor of documented discussion regarding the risk of mortality with patients (OR: 1.04, 95% CI 1.00, 1.09, P = 0.039) and their families (OR: 1.05, 95% CI 1.01, 1.09, P = 0.014).

Conclusions

There is a need to improve discussions regarding the risk of mortality during the consent process in patients undergoing EL whether such risk is high or low.
154 A Scoping Review of the Management of Benign Prostate Hyperplasia in Africa
Authors: Zubair A
Published: August 2023

Aim

Benign prostatic hyperplasia (BPH) is a non-malignant prostate gland enlargement of unknown cause that affects more than 50% of men over 60 and is the most common cause of bladder outlet obstruction and voiding symptoms. BPH is treated primarily with watchful waiting, phytotherapy, and medical or surgical options. In this study, we sought to examine the different management practices in African urological centres, outcomes of management, and complications.

Method

A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding the management of BPH from inception till date. Articles were selected based on their relevance to the management of benign prostatic enlargement in Africa. Results are reported according to the PRISMA extension for scoping reviews.

Results

Exactly 2999 patients were included in the study. Seventy-three (73.49%) percent of these patients totalling 2204, underwent surgical management of BPH, 124 (4.13%) patients were treated with phytomedicines, and 684 (22.80%) patients were treated with medical therapy. A total of 808 patients opted for non-surgical treatment for BPH in the included studies. In this group, 124 were treated using phytochemicals or natural herbs, and 648 were treated with standard prescription medications.

Conclusions

While surgical treatment for benign prostatic enlargement is shifting towards minimally invasive procedures in the developed world, open prostatectomy is still quite popular in Africa. Further research should focus not only on the reason for these disparities in management but also on the rationale for the selection of medical, surgical, or phytotherapy in African urological centres.
275 The Declining Elective Workload of a Consultant Surgeon
Authors: Blake I , Mason P F
Published: August 2023

Aim

The elective workload of a consultant surgeon has changed considerably over time. We aimed to describe these changes and explore possible reasons behind them.

Method

All elective procedures performed by a single consultant vascular and general surgeon at a district general hospital were identified for the years 2000 and 2019. Cases were classified by complexity (major, moderate or minor) and specialty (general, vascular, colorectal, upper GI, plastics, endocrine, breast, urology or other).

Results

In 2000 there were 41 full and 50 half day theatre lists compared to 24 full and 47 half day lists in 2019. The total number of procedures fell by 39.25% (400 in 2000 versus 243 in 2019). The mean number of procedures per full and half day list was 5.46 and 3.50 in 2000 compared to 4.67 and 2.80 in 2019.

There were 51 major (12.75%), 189 moderate (47.25%) and 160 minor (40%) procedures compared to 8 major (3.29%), 99 moderate (40.74%) and 137 minor (56.37%) in 2019. Most cases were general or vascular (82.5% in 2000, 97.53% in 2019) but the breadth was greater in 2000 (9 versus 4 specialties).

Conclusions

The number of lists, total procedures performed and mean cases per list are lower despite increasing demand. The breadth and complexity of cases has also decreased. The reasons for this are likely multi-factorial but may include the use of varying anaesthetic and scrub teams, the introduction of checklists, changes to consent procedures, centralisation of services, the presence of a trainee in theatre and changes to specialty training.
1228 Predictors of Re-Intervention Following Index Cholecystectomy
Authors: Kuan J Y , Kho J , Shetty V , Date R , Rajendran I
Published: August 2023

Aim

Index Cholecystectomy (IC) is safe and reduces patient morbidity. However, IC can be challenging due to inflammation of hepatocystic triangle, increasing the risk of postoperative complications. Study was conducted to evaluate factors influencing postoperative complications following IC.

Method

Retrospective review of consecutive IC performed as a primary procedure was carried out between February 2021 and July 2022 in our trust. Primary outcome was postoperative Grade 3 Clavien-Dindo (CDC) complication, in comparison to patients with uncomplicated recovery. Pre-operative factors including age, CRP, WBC, LFT, surgeon grade, modality (laparoscopic/open) and number of previous admissions were included for analysis. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value <0.05 was statistically significant.

Results

100 IC were included. Most IC were consultant-led [80/100(80%)]. 11/100(11%) patients developed Grade 3 CDC complication; 4/100(4%) bile leak requiring ERCP and stent insertion, 3/100(3%) post-operative collection requiring radiological-assisted drainage, 2/100(2%) retained bile duct stones requiring ERCP, 1/100(1%) incision and drainage of port site seroma and 1/100(1%) biloma requiring laparoscopic washout. Re-intervention was common in older patients (61±18years vs 55±22years,p = 0.04) and higher median peak CRP levels (312±178 vs 154±284,p = 0.01). There were no differences in LFT parameters, number of previous admissions or timing of operation from day of admission between the two groups.

Conclusions

Age>65 and higher pre-operative CRP were associated with increased risk of postoperative procedural intervention. Larger prospective studies are needed to confirm these findings. Surgeons should consider these factors for consenting and risk assessment purposes.
1301 What Can Be Done to Minimise the Mucosal Complications of Surgical Intervention Involved in the Treatment of Corneal Blindness Through Osteo-Odonto-Keratoprosthesis
Authors: Bukhari S R
Published: August 2023

Introduction

Osteo-odonto-keratoprosthesis (OOKP), “tooth-in-eye surgery”, is a rare, complex surgery offered to certain patients with bilateral corneal blindness. Indications for the surgery include and range from: Steven-Johnson syndrome to end-stage ocular surface diseases. OOKP consists of two stages undertaken four months apart. Surgical complications can be divided into intraoperative and following stages 1 and 2. The most common postoperative complications include: Mucosal thinning/ulceration, mucosal overgrowth, and infection. We discuss, preventive methods which can be considered before the stage 2 intervention to minimise the rate of complications post OOKP surgery.

Method

A literature search was conducted in PubMed and Research gate to determine the main complications following involvement of maxillofacial surgery. Our key search criteria included mucosal complications post maxillofacial and oculoplastic surgical involvement. We selected for complications, post harvestation and transfer of the buccal mucosa onto the eye surface in OOKP.

Results

Three studies were selected, with a total of 130 patients. 58% experiencing surgical complications following stage 2. Study 1 demonstrated mucosal graft complications (22%), mucosal overgrowth(28%), mucosal thinning and ulceration(22%). Notably, 38% experienced no complications following the second stage. In the remaining studies, post-operative complications were divided into mucosal necrosis (33%) and mucosal overgrowth(13%), showing how complications can often interplay.

Conclusions

OOKP is a complex and laborious multi-disciplinary surgery, amenable to postoperative complications. Mucosal complications occur in a significant number of cases; therefore, it is important to anticipate these and endeavour to avert them. We outline how through prudent patient selection and pre-operative patient care (promotion and correction of dentition and oral health, examination of oral mucosa and maintenance of good mucosal graft health), outcomes for this surgery can be significantly improved.
34 Susceptibility Vessel Sign (SVS) for Assessment of Intra-Arterial Thrombus and Thrombus Burden in Patients with Acute Ischemic Stroke: An Institutional Study
Authors: Paudel S , Phuyal S
Published: August 2023

Background

SWI can help in the diagnosis of thrombus within the vessel in acute ischemic stroke (AIS) known as susceptibility vessel sign (SVS) and detection of SVS within the vessel can predict treatment modality and outcome. In this study, the purpose is to correlate the SVS on SWI with different parameters of stroke.

Method

It was a retrospective cross-sectional study, where consecutive stroke patients with vessel occlusion on magnetic resonance angiography (MRA) were included for the study for one year. The relation of SVS on SWI with risk factors and territory involved and length of thrombus was correlated with the NIH stroke scale (NIHSS).

Results

A total of one hundred and five patients were enrolled for this study. 62% (66 out of 105) of patients showed SVS on SWI with MRA positive occlusion. A positive correlation was observed between SVS on SWI with the risk factor (p = 0.003) with 86% of heart disease and 47% of hypertension had SVS. A positive correlation was also observed between the SVS on SWI with territorial occlusion (p = 0.000). There was moderate positive correlation was observed between the NIHSS and thrombus length (p = 0.002) with a Pearson coefficient of 0.367.

Conclusions

SWI can be useful in identifying the location of the thrombus, and NIHSS can determine the thrombus length in acute stroke. A higher incidence of SVS can be associated with risk factors and it also depends upon the site of occlusion of the vessel.
146 WHO Surgical Checklist Compliance and Attention Rates Among Different Specialties and Years
Authors: Ng W H , Yeatman W , Kim D , Molyneux M
Published: August 2023

Aim

This study aims to evaluate the compliance of surgical staff to the WHO surgical safety checklist, excluding sign-out. The quality of surgical marks and inattentive rates of surgical staff during me-out were also investigated.

Method

Data was collected over 3 weeks using a fixed criteria in September 2022 within 3 hospitals consisting of 5 sites. A total of 105 procedures were observed. Mean and confidence intervals were calculated using SPSS.

Results

The mean compliance rate of the checklist was 97%. Sign-in (97%), Time-Out (96%), and Surgical mark rates (98%) all scored similarly.

Among specialties observed, interventional cardiology scored the highest compliance rates, at 100%, while cardiothoracic surgery scored the lowest at 91%. In 38% of procedures observed, surgical staff were found to be inattentive during me-out. Among the inattentive surgical staff, 73% of surgical staff had mild inattentiveness (e.g. filling up drug charts), 18% had moderate inattentiveness (e.g. talking to other staff), 9.1% of them had severe inattentiveness (e.g. scrubbing in).

Among the audit cycles from 2014 to 2022, there was an increase in sign-in rates from the previous cycle held in 2019 to 2022 from 82% to 97%. Inattentive rates increased from 33% in 2019 cycle to 38% in 2022 cycle.

Conclusions

This study reports high compliance rates and improvement with the checklist among all specialties, but also high inattentive rates by surgical staff. Improvements such as fostering a good culture among surgical staff on the WHO checklist and paying attention are key in never reducing events.
209 Cochlear Implant Referral Time in Deaf Children: Are They Different Due to Parental Deafness?
Authors: Shukla J , Adegboye O , Oremulé T
Published: August 2023

Aim

95% of deaf children are born to hearing parents (DCHP) and 5% are born to Deaf parents (DCDP). Traditionally, Deaf parents have opposed cochlear implants (CIs) in deaf children as they believe CIs medicalise deafness. Delayed referral and implantation owing to parental hesitation may affect linguistic and educational outcomes. There is a lack of literature regarding the factors that may affect care provision for DCDP. Consequently, this study aimed to investigate whether DCDP were referred for cochlear implantation and underwent surgery at an older age compared to DCHP.

Method

This was a retrospective study carried out at a tertiary referral centre. 22 DCDP who underwent cochlear implantation between 1999 to 2021 were identified and matched to 22 DCHP. An unpaired t-test compared the differences between the age at referral and age at implantation between the 2 groups. A Pearson’s correlation determined the relationship between months till referral and months between referral and implant. SPSS v28.0 was used for statistical analysis.

Results

DCDP had an older mean age at referral (22.5 months) than DCHP (17.5 months, p = 0.552) and had an older mean age at implantation (33.4 months) than DCHP (31.0 months, p = 0.767) albeit this was statistically insignificant. DCDP had a significant negative correlation with the months till referral and the months between referral and implantation (r = -0.514, p = 0.017).

Conclusions

Future research should aim to use a larger patient sample and consider the effect of delayed referral and surgery on clinical outcomes between DCDP and DCHP.
557 Adherence and Factors Related to Completion of SRS22 PROM Scores in Patients Undergoing Surgical Correction for Adolescent Idiopathic Scoliosis
Authors: Bellamy M , Tung W S , Courtney E , Jayasuriya R , Cole A , Bayley E
Published: August 2023

Aim

The Scoliosis Research Society Health-Related Quality of Life Questionnaire (SRS22) allows clinicians insights into the challenges patients with scoliosis face. This study aims to assess compliance with SRS22 questionnaires, identifying key factors impacting adherence.

Method

This retrospective cohort study of the British Spine Registry included 216 patients who underwent surgery for Adolescent Idiopathic Scoliosis between 2018 and 2022 at a single institution. Completed SRS22s at 5 timepoints were collected with contact and deprivation data.

Results

SRS22 completion averaged 44.0% across time points. Contact information was available in 84.1%. There was a significant drop in completion from 2018 (60.4%) to 2021 (30.6%) at follow up. Binary logistic regression demonstrated preoperative and 6-week SRS22s were significant predictors of completed 6-month and 1-year questionnaires (OR: 2.46; p = 0.037, OR: 3.31; p = 0.0041). Six-month completion and telephone numbers were significant predictors of 1-year completion (OR: 6.29; p < 0.001, OR: 5.55, p = 0.048). One year completion was the only significant predictor for 2-year completion (OR: 10.29; p < 0.001). Index of multiple deprivation was not significant to SRS22 completion.

Conclusions

With lowering rates of engagement, input at the beginning of care may provide an effective strategy to maximise long-term collection. With incomplete preliminary questionnaires, later questionnaire completion is unlikely. Long term completion does not seem to directly correspond to email availability or area deprivation. Clinical initiative and funding, maximising completion at early patient visits, could lead to significantly greater engagement.
608 Oral Antibiotic Bowel Preparation in Elective Anterior Resection
Authors: Newey H
Published: August 2023

Aim

A single centre retrospective cohort study investigating the impact of oral antibiotic prophylaxis (OAP) for lower anterior resections on length of hospital stay and post-operative complications.

Method

The pre-intervention group were all elective anterior resections between 2015 and 2016. They received mechanical bowel preparation only. The intervention group were patients undergoing elective anterior resection between 2020 and 2021. These patients were given OAP in addition to standard mechanical bowel preparation. Outcomes investigated were surgical site infections, overall length of hospital stay, anastomotic leak and return to theatre. These were then compared between the two cohorts and statistical analysis was conducted.

Results

The pre-intervention group consisted of 221 patients and there were 201 patients in the intervention group. 61% of patients were male, whilst other patient demographics were comparable between cohorts. The mean length of hospital stay was reduced by 26.4% (p = 0.002) and the median length of stay was reduced by one day. There was a 1.5% decrease (p = 0.50) in post-operative infections, a decrease of 26.7% (p = 0.25) in anastomotic leaks and a decrease of 45% (p = 0.13) in patients who returned to theatre.

Conclusions

There was a statistically significant reduction in length of hospital stay with OAP alongside mechanical preparation. Although post-operative complications such as anastomotic leaks and return to theatre were reduced, these were not statistically significant, but may still have clinical and economic importance. There is strong evidence towards the benefit of OAP reducing length of stay, which reduces cost and improves patient flow and bed capacity.
743 Intraoperative Outcomes Using Infrahepatic Inferior Vena Cava Clamping During Hepatectomy: A Meta-Analysis
Authors: Tan J , Patel A , Kitching S , Iqbal A , Satyadas T
Published: August 2023

Aim

The aim of this meta-analysis is to determine the effect of infrahepatic inferior vena cava clamping (IIVCC) with Pringle maneuver (PM) compared to only PM during hepatectomy on intraoperative outcomes.  

Method

Medline, Cochrane Library, Scopus, Web of Science, and EMBASE were searched from inception till 23.11.2021 using a predefined search strategy. The initial search resulted in 615 unique articles. After screening, eight studies including 755 patients (358 in IIVCC+PM, 397 in PM group) met the inclusion criteria for this meta-analysis. Of these, two were randomized controlled trials, one prospective and five retrospective cohort studies. Data on patient demographics, surgical technique and intraoperative outcomes was collected. Summary estimates using the appropriate effect models were generated with Review Manager 5.0.  

Results

Patients who underwent IIVCC + PM during hepatectomies experienced significantly less total intraoperative blood loss (mean difference (MD), 95% confidence interval (CI) = -233.03, -360.48 to -105.58; p = 0.0003), less blood loss during transection (MD, 95% CI = -172.91, -308.94 to -36.88; p = 0.01), and had significantly less intraoperative blood transfusion requirement (Odds ratio, 95% CI = 0.38, 0.25 to 0.57; p<0.0001) compared to patients who had only PM. Additionally, the total operative time was comparable between the two groups (MD, 95% CI = 8.06, 4.29 to 11.82; p<0.0001). There were no difference in the parenchymal transection time and total intraoperative fluid infusion between the two groups.

Conclusions

IIVCC + PM is beneficial in reducing intraoperative blood loss and need for transfusion without significantly affecting operative times in comparison to PM during hepatectomy.
1023 The Changing Indication and Outcomes of Patients Undergoing Pancreatectomy for Malignancy
Authors: Jackson S , Dreyer S , Bryce A , Thomas R , Duthie F , Coats M , Carter R , McKay C , Dickson E , Chang D , Holroyd D , Jamieson N
Published: August 2023

Aim

Pancreatic surgery has evolved significantly in terms of indications and peri-operative management to improve long term outcomes for patients. The aim of this study is to assess the change in indication and long-term outcome for patients undergoing pancreatectomy for malignancy.

Method

Patients who underwent pancreatectomy at the West of Scotland Pancreatic Unit, Glasgow Royal Infirmary between 2000 – 2020 for malignancy were included. Clinicopathological variables, survival and recurrence data were collected from patient notes and electronic patient records.

Results

594 patients were identified. The majority were for pancreatic ductal adenocarcinoma (PDAC) n = 325 (54.7%). There was a significant increase in overall survival for all indications (28.6 months vs 41.8 months, P = 0.001), completion of adjuvant therapy and the use of neoadjuvant therapy (P<0.001) over the first and second decades in the study period. After adopting a neoadjuvant strategy for PDAC in the unit from 2013, the overall median survival increased from 24.6 months to 34.5 months (P<0.001). The overall survival for PDACs was higher for those receiving neoadjuvant chemotherapy compared to upfront resection (41.9 months vs 38.9 months, P = 0.151). For patients with PDAC who received upfront surgery, median survival increased from 24.2 to 40.3 months (P = 0.004) once a neoadjuvant strategy was adopted.

Conclusions

There has been significant changes to the indications and long-term outcomes for patients undergoing pancreatectomy. A neoadjuvant strategy improved survival even in those patients who received upfront surgery.
389 Spinal Fusion in Parkinsons Disease – Surgery, Radiography and Complications
Authors: Toor K
Published: August 2023

Aim

To understand the effectiveness of spinal fusion in PD, this review will focus on the surgical and radiological outcomes of this specific patient group using spinal fusion, within the background of pre- and post-operative complications.

Method

This literature review was conducted using PubMed, Embase and Medline databases. The selection criteria included studies with patients who are undergoing primary spinal fusion surgery, excluding any other neuromuscular disorders. We identified and reviewed twenty-eight studies in which spinal fusion was conducted in PD patients, encompassing clinical, radiographic outcomes and perioperative complications.

Results

A total of 363 patients with PD who underwent primary spinal fusion surgery were reviewed with an average age of 64 and a 3:4 male to female ratio. With average follow up at 52 months, 69 out of 97 patients were judged to have a satisfactory outcome with the remaining 29% reporting worsening Visual Analog Score (VAS) post-surgically. 84 out of 121 patients showed an improved Sagittal Vertical Axis (SVA) at follow up. 134 patients out of 145 displayed greater overall total complications when compared to non-PD patients.

Conclusions

Spinal fusion within PD patients has shown to be of benefit clinically with radiographic measures showing improvement post-surgically which is sustained at follow up. However, what limits its efficacy is the development of complications in this complex patient group. Continued prospective research is required and perhaps the advent of minimally invasive approaches may further benefit these patients and minimise complications.
417 Factors Associated with the Development of Post-Traumatic Hydrocephalus Following a Decompressive Craniectomy: A Single Centre Experience
Authors: Jesuyajolu D , Moti T , Abdulahi Z , Alnaser A , Zanaty A , Grundy T , Evans J
Published: August 2023

Introduction

A decompressive craniectomy (DC) is a surgical procedure sometimes utilised to manage refractory intracranial hypertension following severe traumatic brain injury (sTBI). Previous studies have established a relationship between DC and post-traumatic hydrocephalus (PTH). This study aimed to identify the factors responsible for developing shunt-amenable post-traumatic hydrocephalus in patients who underwent DC following sTBI.

Method

A review of a prospectively collected database of all patients admitted with severe TBI in a tertiary neurosurgical centre in northwest England between January 2012 and May 2022 was performed. Post-traumatic hydrocephalus was defined as evidence of progressive ventricular dilatation, clinical deterioration, and/or the eventual need for CSF diversion (i.e. a ventriculoperitoneal shunt). Statistical analysis was carried out using IBM SPSS vs 28.0.1.

Results

65 patients met the eligibility criteria and were included in the study. The mean age of the PTH group was 31.38+/-14.67, while the mean age of the non-PTH group was slightly higher at 39.96 +/- 14.85. No statistically significant difference was observed between the two groups' mechanisms of traumatic injury (MOI) (P = 0.945). Of the predictors investigated, cerebellar hematoma (and contusions) was significantly associated with post-traumatic hydrocephalus (p = 0.006).

Conclusions

This study concludes that cerebellar hematoma (and contusions) are associated with developing post-traumatic hydrocephalus in patients undergoing decompressive craniectomy.
643 A Review of the Screening Protocols Investigating Intracranial Aneurysms in Polycystic Kidney Disease
Authors: Abualnaja S , Rehman U , McKenna G
Published: August 2023

Aim

Intracranial aneurysms (ICA) are a common complication of polycystic kidney disease (PKD). Due to the lack of screening protocols that exist for PKD patients, without the appropriate preventative measures ICA rupture leads to significant morbidity and mortality. The aim is to analyse existing screening protocols by referencing the lead time between ICA diagnosis and rupture in PKD patients, the purpose and importance of screening, the types of imaging modalities used, and patient outcomes. We will also consider cost-effectiveness and its relation in establishing a screening protocol.

Method

A literature search was conducted in April 2022 for articles published between 1990-2022 with special interest in ICA, PKD, and screening protocols. Only exclusion criteria were patients who were diagnosed with PKD <30 years of age. An independent reviewer screened the relevant full papers prior to inclusion.

Results

Our findings suggest that if a PKD presents with either a positive family history of ICA and/or cerebrovascular events and/or is above 40 years of age, then they should have a magnetic resonance angiography (MRA) scan every 5 years to monitor ICA development with annual follow-ups. This will significantly decrease patient morbidity and mortality in PKD positive patients.

Conclusions

While there is significant evidence proving that screening protocols decrease the morbidity and mortality of PKD patients, none have been suggested. The screening protocol suggested in this review should be used as a guideline for future studies that will try and establish a national or international guidelines that can be used by nephrologists and neurosurgeons worldwide.
1216 Epidemiology, Management, and Outcome of Traumatic Spinal Cord Injury at Two Hospitals in the South-West Region of Cameroon: A Five-Year Retrospective Review
Authors: Takoutsing B D , Esene I , Chichom A M
Published: August 2023

Aim

To determine the prevalence, patterns, management, and outcome of traumatic spinal cord injury (TSCI) at the Buea Regional Hospital (BRH) and Limbe Regional Hospital (LRH).

Method

We performed a descriptive cross-sectional study with a retrospective data collection of cases of TSCI admitted from January 1st, 2017, to December 31st, 2021. Chi-square was used for bivariate analysis assessing correlation between various patterns and outcome of TSCI. The p-value was considered statistically significant if <0.05.

Results

TSCI represented 1% of hospital admissions. The majority were males (79.2%), and within the 25-44 years age group (55.6%). Referred patients represented 48.6% of cases. The most prevalent etiology was falls (43.7%). More than half (66.7%) had an incomplete SCI which correlated with the level of spine injury (p = 0.018). A spine CT scan was the neuroimaging modality of choice (65.3%). The treatment modalities varied, and the majority (92.3%) of those requiring surgery were operated on greater than 48 hours after injury. The morbidity rate was 36.1%, the severity of neurological injury improved in 23.6%, and the mortality rate was 16.9%. The level of spine injury and the initial severity of neurological injury correlated with the neurological outcome (p = 0.017; p = 0.007), and survival post-injury (p = 0.029; p = 0.006).

Conclusions

Males of the working age group are most at risk of TSCI. Most causes of TSCI at the are preventable, and their management deviates from recommendations. Their morbidity and mortality rates are high reflecting the realities of TSCI in sub-Saharan Africa.
1249 A Single Centre Analysis of Cauda Equina Referrals Since the ENTICE National Audit
Authors: Choudhry H , Vasilla A , Richards O , Schramm M , Kalra N , Sheikh A
Published: August 2023

Aim

To analyse changes in the referral patterns of Cauda Equina Syndrome (CES) following the publication of the national ENTICE study.

Method

A retrospective analysis was conducted of all 933 patients referred to Leeds Neurosurgery department in a 6- month period (1st October 2019- 1st February 2020) for suspected CES. The referrals were analysed to assess compliance with the updated national BASS/ SBNS guidelines, primarily to determine if an MRI had been performed prior to referral. This was compared with data prior to the national ENTICE study.

Results

933 patients were referred to Leeds Neurosurgery department for suspected CES in the 6-month period. This is a 31% increase prior to the ENTICE study. Of these referrals, 65 had radiologically confirmed CES. 15% of those referred had an MRI prior to referral. 15.5% of referrals in hours had an accompanying scan compared with 14.5% of referrals out of hours. 8% of referrals from centres with access to out of hours scanning did not have an MRI prior to referral.

Conclusions

Referrals should only be sent after CES has been radiologically confirmed, according to national guidelines. Despite changes in the referral system, the number and quality of referrals has not improved since the ENTICE national audit. A lack of out of hours MRI provision has little effect on referrals without a scan. Only 7% of CES referrals had confirmed CES, thus it is imperative that guidelines are followed to reduce delays in neurosurgical care.