bluuebunny/crossref_metadata_2025 huggingface dataset:
MOY 1 Variation in decision making around high-risk emergency laparotomy over time
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Lund Jon , Hare Sarah , Moug Susan , Tierney Gillian
Published: August 2023

Background

There have been huge improvements in the ten years of the National Emergency Laparotomy Audit (NELA), notably in the assessment and recognition of high-risk emergency laparotomy patients, with associated improvements in outcomes. However, guidance around emergency laparotomy multi-disciplinary decision making remains sparse. The aim of this work was to examine the NELA database for variation in emergency laparotomy patient demographics over time.

Method

All patients enrolled in the NELA database December 2012-2020 were included. Patients were grouped according to their year of entry into the database (Years 1-7) and were assessed for NELA score, futile surgery (death in <72 hours of emergency laparotomy), and their admitting hospital.

Results

A total of 161,337 patient enrolled in the database had a documented NELA risk score. The mean NELA score decreased over time: 11.6% in Year 1 compared to 8.9% in Year 7. The number of extreme-risk patients decreased accordingly; overall 3.2% (n=5196) had a 30-day mortality risk of ≥50%, accounting for 4.3% of surgeries in Year 1, and only 2.2% in Year 7 (p<0.001). Although extreme-risk laparotomies were carried out in 183 hospitals, 1 in 5 were carried out in just 16 participating hospitals. The number of futile surgeries also decreased over time from 5% (n=1034) in Year 1 to 3.2% (n=705) in Year 7 (p<0.001).

Conclusion

High-risk, extreme risk and futile surgeries have decreased significantly annually since NELA began auditing surgical outcomes, however the missing puzzle piece remains patients that do not have emergency laparotomy.
SP2.7 Is routine nasogastric tube placement following pancreatoduodenectomy really necessary?
Authors: Muhammad Qazi Rahim , Bledge Henry Kwami , Russell Thomas , Ahmad Jawad , Khan Saboor , Marangoni Gabriele ,   RAW Study Collaborators
Published: August 2023

Background

Traditionally, pancreatoduodenectomy (PD) patients would leave theatre with a nasogastric tube (NGT) in situ. Recent evidence has suggested that the potential drawbacks of routine placement may outweigh the potential gains. This study aimed to compare the outcomes of PD patients who received a NGT intra-operatively to those did not.

Methods

Data taken from Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres from 8 countries, n=1484). The following outcome measures were used: median length of stay (LoS), incidence of delayed gastric emptying (DGE), incidence of grade B/C DGE, and the provision of postoperative nutritional support. Analyses were performed using Fisher’s exact test and the Mann-Whitney U test.

Results

Out of 1484 patients who underwent PD for malignancy, 1098 (74.0%) had data on their NGT status. 91.6% of patients received an intra-operative NGT. The median length of time until tube removal was four days (range: 1-64, interquartile range: 3). in comparison to the group with no NG tube, median length of stay (both 14 days, p=0.9), as well as incidence of DGE (14.3% vs 7.6%, p=0.08) grade B/C DGE (8.3% vs 4.3%, p=0.2) were similar. Patients who did not receive a tube less often received postoperative nutritional support (any form, 30.4% vs 49.8%, p=0.0004).

Conclusion

Most patients underwent PD had NG placed intraoperatively. Had no affect length of stay or incidence of DGE. Patients who received a NGT more often received postoperative nutritional support. NGTs should only be placed when they are clinically indicated.
SP3.2 Where are all the nurses in the UK?
Authors: Bhatnagar Meghna , Gambhir Raghvinder Pal Singh
Published: August 2023

Aim

There is a worldwide shortage of nurses and midwifes according to World Health Organisation (WHO). Aim of the present study was to analyse the nursing crisis in the UK.

Methods

Google search was done for the number of nurses registered with Nursing medical council UK. NHS England and NMC reports on workforce were accessed and analysed.

Results

WHO recommends a minimum nurse to population of ratio of 3: 1000. Among the OECD countries, UK has 8.2 nurses per 1000 compared to 18/1000 in Switzerland and 1.1/1000 in south Africa. NMC has 771500 registered nurses but all are not practising full time. Around 40 % of these have been registered for < 10 and are probably in Band 5 or 6 and still in near full time active direct clinical nursing roles. The remaining 60% who have been on the register for >10 years would probably be doing more managerial roles. That makes it even worse. In addition a large number of registered nurses are in administrative roles in regulatory bodies like GMC. NMC, CQC etc.

In addition what the nurses do with their time also has changed. It is estimated that only <40% of the nursing time is spent in direct clinical care.

Conclusion

If all the registered nurses were available to do Direct clinical care we would be one of the best resourced country among OECD but where are these registered practitioners is the question.
SP3.3 Digital Consent: a review of two years of implementation & its impact on the perioperative workflow
Authors: Hart Patrick , Moore Connor , Loughran Dafydd , John Edward St
Published: August 2023

Aims

Paper consent processes have been demonstrated to contain errors of omission, illegibility and unwarranted variation. Missing paper-consent forms can cause delays, cancellations and poor theatre efficiency. Digital consent is known to reduce errors, empower patients in clinical decision discussions and improve patient perception of Shared Decision Making. This study evaluates the roll-out of Concentric Health’s digital consent application over a two year period.

Methods

Consent episode data was assessed from a two year period (27th January 2021 - 26th January 2023) using Concentric analytics. Qualitative data was obtained via optional patient satisfaction surveys.

Results

96,710 consent episodes were created during the period, amounting to 79,476 completed consent episodes for 3029 unique procedures by 1193 clinicians, across 27 specialties from 43 healthcare providers. Of the completed episodes, 44.1% were completed in advance of the day-of-surgery. 22.5% of episodes were remote. Patients were aged 0-105 years, (median 60, IQR 43). Treatment information was shared digitally with 77.1% of patients. The average patient satisfaction rating was 4.61 out of 5 (1 very poor - 5 very good, n = 10007).

Conclusions

Concentric is being used in practice across multiple hospitals and clinical environments, with patients reporting high satisfaction scores. Digital consent enables consent in advance of the day-of-surgery, affording patients sufficient time for consideration, and possibly optimising theatre efficiency. Remote consent is feasible, used by over a fifth of patients. Digital consent applications can be considered for adoption in all units to capitalise on these benefits.
SP3.6 Does a novel preservation solution improve organ performance in an ex-vivo perfusion of porcine liver?
Authors: Williams Paul , Quyn Aaron , Corps Claire , Lodge Peter
Published: August 2023

Aims

This project aims to compare LS-A (Leeds solution for abdomen) to a gold standard solution, IGL-1 (Institute George-Lopez solution) at clinically acceptable CIT (Cold ischaemic time) in a DCD (Donation after cardiac death) model of porcine liver transplant. An ex-vivo Perfusion device will then provide normothermic machine perfusion to simulate the immediate post-transplant stage.

Methods

DCD livers retrieved from landrace pigs, were preserved at 4-hours CIT in LS-A or IGL-1. They were re-perfused on a normothermic machine perfusion device, using autologous blood as a perfusate. Biochemical analysis was performed hourly for various markers of tissue and hepatocyte damage.

Results

Livers stored in LS-A (n=6) and IGL-1 (n=6) have no significant differences when compared for ALT, AST, ALP, LDH and glucose. Perfusate lactate was significantly lower in the LS-A group (p=0.008) as was the perfusate potassium(p=0.001) across the perfusion period.

Conclusions

Analysis has shown significantly lower lactate and potassium in LS-A preserved livers, in DCD retrieval, with 4-hours CIT. There are no other observed significant differences between LS-A and IGL-1 when comparing liver function tests and LDH production. This suggests better tissue preservation with LS-A in the setting of very high risk donor livers. The next stage of the project will look at LS-A vs IGL-1 in an extended preservation period (>14 hours) in a DBD (Donation after brainstem death) model.
SP3.7 Regional Outcomes of Paediatric Renal Transplantation in the UK. A Machine Learning Analysis: An Epidemiology In Transplant Study Group (ETrSG) Initiative
Authors: Sharma Hemant , Khoo Rebecca , Ohia Ernest , Whitley Sarah , Mehra Sanjay , Sharma Abhishek
Published: August 2023

Purpose

<25%of UK children commencing RRT receive a pre-emptive transplant in the UK. Paediatric patients on the waiting list have increased over the last 5 years. This study assesses the paediatric renal transplant rates in the UK since the year 2000 and the regional graft outcomes of paediatric renal transplant in the UK and determine the predictors of survival at 1, 3, and 5 years.

Methods

We harmonized the NHSBT-Data to shortlist the paediatric renal transplants performed in the UK from the year 2000-2019. The Predictors of Transplant outcomes were evaluated by five classifiers including logistic regression, SVM, random forest, K-Nearest neighbour matching, and adaptive boosting. Random Forest Model had the best performance validated by RMSE. Rattle R/ JASP was used to derive Variables of importance. Survival outcomes and predictors data mined from MLA were further mined with Cox-Regression.

Results

A total of 2610 paediatric transplants were reported to NHSBT (the year 2000-2019). London region did the maximum transplants (N= 854) followed by Northern & Yorkshire (N=347) and North-West region (N= 340). High-Volume center doing living donors had considerably better survival compared to others. On Regression-analysis, the better graft survival was correlated to recipient age group >8 years (p <0.001), CIT <12 hr (p= 0.02), Transplant year -2010 onwards (p <0.01), ethnically matched donor-recipient (p= 0.01), HLA NHSBT group 1 and 2 (p=0.04) and high volume centers (> 15 paediatric transplants/annually).

Conclusions

Superior outcomes were reported from high-volume centers and transplants done after the year 2010. Immunologically well-matched kidneys and low Cold-Ischemia-time (CIT) predict better survival.
SP4.1 Outcomes of Patient Reported Experience Measures (PREM) in Diabetic foot clinic
Authors: Singh Gambhir Raghvinder Pal , Sreeramulu Pradhay , Bates Maureen , Manu Chris , Slim Hani , Vas Prash
Published: August 2023

Aims

No PREMs exist for diabetic foot (DF) patients. The aim of the study was to develop and validate a DF PREM questionnaire and assess the outcomes in a Diabetic foot clinic.

Methods

PREM Questionnaire was developed through consensus using pre validated questionnaire from other specialty PREMS. Suitable questions were chosen and modified for use in the DF care. The questionnaire was piloted on 10 patients in the multi disciplinary Diabetic foot clinic (DFC) and results were evaluated and presented to the core group and trust Patient experience and involvement team. The suggested changes were incorporated and again piloted on 10 patients and the results were re-presented to the core team. The final version was then approved for use among patients.

The questionnaire consisted of 12 sections and had 37 questions with 7 point grading system (1 being the lowest and 7 being the highest ranking). The patients attending the DFC were then offered the questionnaire.

Results

Among those offered, 85% (68/80) accepted to fill the questionnaire either themselves or with help. Majority were aged 41-74 years, with 60% White British ethnicity. The M:F ratio was 1.3:1. Among the 12 domains the highest scoring domains were ‘Access to the clinic’, ‘information provided’, ‘privacy and dignity’ and ‘scheduling and planning’. The worst scoring domains were ‘hospital parking’ and ‘provision of transport’ over which the clinic had no direct control.

Conclusions

The DF treatment process is long and tedious and patients are required to make multiple visits to the DFC. PREMs allow us to measure their experience and target service improvement.
SP4.2 Saving inpatient beds: Are day-case total parathyroidectomies possible and safe?
Authors: Sultana Emiko , McDonald Sophie , Al-Saadi Nina , Chang Jessica , Sandhu Kanwaljit , Houghton Andrew
Published: August 2023

Introduction

Total parathyroidectomy on patients with hyperparathyroidism traditionally required an inpatient hospital stay to monitor patients for postoperative hypocalcaemia. Our centre developed a safe protocol in 2015 which enables total parathyroidectomies to be carried out as a day-case procedure. This protocol, developed in conjunction with the renal physicians, involves giving the patient oral alfacalcidol preoperatively for 5 days and close monitoring of the calcium levels postoperatively to permit safe same day discharge.

Methods

A single centre retrospective study was carried out on all patients who underwent a total parathyroidectomy for hyperparathyroidism between 2005 and 2022. A comparison study was done before and after the protocol was introduced in 2015. Data were collected regarding the patient comorbidities, peri-operative calcium level, post-operative calcium, potassium and parathyroid levels, length of hospital stay, operative procedure details, hospital readmission, and 30-day morbidity.

Results

57 patients underwent total parathyroidectomy during the study period (22 before protocol and 35 after the protocol). After introduction of the protocol, 40% of patients were discharged on the same day, compared to only 4.54% previously. The duration of inpatient hospital stay was reduced from 0-13 days to 0-3 days. Reasons for prolonged hospital stay in the remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patient required readmission during the 30-day post-operative period.

Conclusions

Day-case surgery for total parathyroidectomy can be achieved safely in patients with a preoperative regimen of alfacalcidol and close monitoring of calcium levels post-operatively, emulating a virtual ward round.
SP5.5 Peri-operative, Oncological and Functional Outcomes of Robotic versus Transanal Total Mesorectal Excision in patients with Rectal Cancer: A Systematic Review and Meta-analysis
Authors: Mohamedahmed Ali Yasen , Zaman Shafquat , Wuheb Ali Ahmed , Yassin Nuha
Published: August 2023

Background

To evaluate comparative outcomes of robotic low anterior resection (RTME) and spinal Trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer.

Methods

A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing RTME versus TaTME for low rectal cancer were included. Primary outcomes were post-operative complications namely, anastomosis leak, SSI, overall complications rate, and Clavien-Dindo complications rate. Operative time, conversion to open, Intra-operative blood loss, ITU and hospital length of stay (LOS), post-operative complications, oncological outcomes, and functional outcomes were the evaluated outcome parameters.

Results

Twelve studies with a total number of 3025 patients divided between the Robotic group (n=1881) and TaTME group (n=1144) were included. There was a significant difference between the two groups regarding Operative time (P=0.39), conversion to open (P=0.29) and intra-operative blood loss (P= 0.62). Clavien-Dindo ≥ 3 complications rate (P=0.25), anastomosis leak (P= 0.89), re-operation (P=0.62), re-admission rate (P=0.92), R0 resection (P= 0.52), ITU LOS (P= 0.63) and total LOS (P=0.30) showed similar results between the two groups. RTME group showed a higher rate of harvested lymph nodes (P= 0.04) and completed TME (P=0.05). Wexner and LARS scores showed significantly better functional results in the RTME group compared to the TaTME group (P= 0.0009) and (P= 0.00001), respectively.

Conclusion

Compared to TaTME, RTME provides significantly better functional outcomes, a higher number of harvested lymph and complete TME with a similar postoperative complications rate.
SP5.6 A UK-wide audit on peri-operative practices during deceased donor kidney transplantation: Results from a prospective National Transplant ACcess to Theatre (NTACT) Audit
Authors: Borbas Balint , Mujeeb Mariyam , Tanase Andrei , Aroori Somaiah
Published: August 2023

Background

The outcomes of deceased donor kidney transplants are mainly affected by donor and recipient factors. There is little data on standard perioperative practices across the UK and whether variations in perioperative practices could affect the outcomes. This national audit aims to identify current perioperative practices.

Methods

We conducted a multicentre, prospective audit of adult deceased donor kidney-only transplants across 14 UK transplant centres between February and September 2022. Data was collected on pre-operative antibiotic use, clinician’s grade, fluid management, central/arterial line insertion, post-operative destination, crossmatch and advanced haemodynamic monitoring use. Data was recorded on RedCap and analysed using descriptive statistics.

Results

476 kidney-only transplants were recorded (59 were excluded for incomplete/incorrect data), leaving 417 transplants. In 98.6% of transplants, patients received antibiotics pre-operatively. A wide range of antibiotics were given; the three most used were co-amoxiclav (n=135), ciprofloxacin (n=92) and amikacin (n=62). Most operations were led by a consultant surgeon (91.1% n=380). However, only 60.1% of cases were led by consultant anaesthetists. Central lines were used in 65.5% (273/417) of patients, 41.0% (171/417) used an arterial line, and 25.4% (106/417) had advanced haemodynamic monitoring. A total of 289 cases (69.3%) received goal-directed fluid therapy, of which 74.4% (215/289) used static parameters. Most common post-operative destinations were the transplant ward, 75.3% (n=314), ICU, 9.4% (n=39) and HDU, 10.1% (n=42).

Conclusions

We identified wide variations in certain perioperative practices. In the future, we would like to assess whether there is any relationship between the variations in practice and postoperative outcomes, such as graft function and mortality.
SP5.12 Pancreas Graft Outcome dictates the Renal Graft outcomes and overall patient survival in Simultaneous Kidney Pancreas (SPK) Transplant recipients. A UNOS/OPTN Transplant Registry Big Data Analysis over the last 20 years. An Epidemiology In Transplant Study Group (ETrSG) Initiative
Authors: Sharma Hemant , Mehra Sanjay , Kapoor Kunal , El-Bakry Adham , Devkaran Bhavesh , Sharma Abhishek
Published: August 2023

Purpose

Pancreatic graft outcomes affect the cumulative outcomes of SPK transplant, yet the impact of pancreas graft loss on renal graft and overall patient survival is yet to be reported.

Methods

We harmonized the UNOS/OPTN SPK Transplant data (1996-2019) reported to the U.S. Dept. of Health and Human Services to analyze survival outcomes of recipients who had all cause pancreas graft loss. The demographics report and survival analysis (renal graft/ patient survival) at 1,3, and 5 years post-transplant were data mined. Logistic Regression was done to identify predictors of survival.

Results

N=7036 all-cause pancreatic graft losses were reported from a cohort of N=64815 SPK Transplant recipients during the first five years of transplant. The renal graft survival was 99%, 97%, and 95% in functioning SPK transplant; 77%, 68%, and 54% in recipients with pancreatic graft loss at 1,3, and 5 years respectively. (Log-rank <0.001). The overall patient survival was 84%, 75%, and 66% in recipients with pancreatic graft loss at 1,3, and 5 years, respectively (Log-rank <0.001). Recipient age >45 years (p=0.008), recipient smoking history ( p<0.001), recipient history of hypertension ( p< 0.001), Recipient BMI >30 (p=0.01), cardiac events ( p=0.02) were the variables of importance on univariate analysis affecting renal graft and patient survival. Recipients with functioning Pancreas had a renal transplant survival benefit (0.22; 0.45) at 1 and 5 years & overall patient survival (0.15; 0.33) at 1 and 5 years respectively.

Conclusions

Functioning pancreas graft confers survival benefit to renal graft and overall patient survival. The survival deteriorates over time since pancreas graft failure.
SP6.3 Prognostic significance of Socio-Economic Deprivation on OGD outcome
Authors: Eley Catherine , Hawkes Neil , Barlow Emma , Herbert Geraint , Egan Richard , Lewis Wyn
Published: August 2023

Introduction

Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on OesophagoGastroDuodenoscopy (OGD) findings has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of OGD irrespective of referral reason.

Method

Two-thousand consecutive patients presenting to four Health Boards in Wales (June 2019-) were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into Quintiles for analysis (Q1 most, Q5 least Deprived).

Results

Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Oesophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Oesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC) referral (n=35, 4.6%) with three diagnosed after routine OGD (0.6%, p<0.001). Deprivation was associated more advanced radiological perceived Stage III Cancer (Q1 16.1% v Q2 55.6% v Q5 5.6%, OR 0.007, p=0.005).

Conclusion

Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe oesophagitis, which correlated with up to 10-fold more advanced cancer stage at diagnosis.
SP7.8 Qualitative exploration of gastrointestinal recovery following surgical admission: Phase I of the PRO-diGI study
Authors: Baker Daniel ,   PRO-DIGI Steering Group
Published: August 2023

Background

Patients admitted to hospital for abdominal surgery often experience gastrointestinal dysfunction. Recovery of gastrointestinal function is poorly measured and only briefly assessed by clinicians. There is a need for a patient reported outcome measure to assess gastrointestinal recovery. The first stage of development requires qualitative methodology to identify key concepts.

Methods

Adult patients admitted to hospital for major gastrointestinal, urological, or gynaecological surgery, in an emergency or elective setting were eligible to participate. Patients treated non-operatively for small bowel obstruction were also eligible. Interviews were conducted by telephone, audio-recorded and transcribed. Interviews were coded and analysed in the NVivo software by two researchers and reviewed by lay members of the steering group. Interviews continued until saturation was reached. Ethical approval was gained prior to interviews (21/WA/0231).

Results

Twenty-nine interviews were completed (17 male, median age 64) across three specialties (20 gastrointestinal, 6 gynaecological, 3 urological). Two overarching themes of ‘general recovery’ and ‘gastrointestinal symptoms’ were identified. General recovery included 3 themes of; ‘life impact’, ‘mental impact’ including anxiety, and ‘physical impact’ including fatigue. Gastrointestinal symptoms included 3 themes of; ‘abdominal symptoms’ such as pain, ‘diet and appetite’, and ‘expulsory function’ such as stool frequency. A total of 18 gastrointestinal symptoms were identified during patient recovery – many of which lasted several weeks following discharge.

Discussion

This study highlights a broad range of gastrointestinal and non-gastrointestinal symptoms experienced by patients during their gastrointestinal recovery. Patients remain symptomatic following discharge. Clinicians should consider assessing recovery thoroughly at discharge and follow up.
SP8.7 Long-term outcomes after stoma siting in emergency surgery – a retrospective multi-centre cohort study
Authors: MacDonald Scott , Ng Jene , Clark Maggie , Quasim Tara , Moug Susan
Published: August 2023

Pre-operative stoma siting has been shown to reduce stoma-related complications in the elective setting and may improve patient quality of life (QoL). However, there is less evidence regarding the effect of stoma siting in patients undergoing Emergency Laparotomy (EmLap), when stoma siting rates may be lower due to time constraints of emergency surgery. This retrospective multi-centre cohort study aimed to compare the long-term outcomes of patients undergoing EmLap who had pre-operative stoma siting with those who didn’t.

A retrospective review of a prospectively maintained database of EmLap patients from 3 hospitals across 2 years (Dec ’19-’21) was performed in Dec ’22. Patients with emergency stoma formation per NELA criteria were included and clinical notes were reviewed, including prospectively maintained follow-up from stoma practitioners. Any patients lost to follow-up within a year were excluded.

n=381 patients were identified (Mean age-65years, Median follow up-21 months). n=185(48.6%) were marked for a stoma pre-operatively (89.2% by stoma nurse; 10.8% by surgeon). Those not marked pre-operatively had a higher incidence of 30-day overall morbidity (77% v 67%, p=0.0388), stoma-related skin problems (28.1%v18.9%, p=0.0357), ischaemia/necrosis (16v1%, p<0.005) and muco-cutaneous separation (12v3%, p=0.044). There was no significant difference in stoma-related complications between those marked by a stoma nurse compared with those marked by a surgeon (79.4%v66.7%, p=0.1851).

Stoma siting in emergency laparotomy is associated with reduced early stoma complications. There are similar outcomes whether the patient is sited by a stoma CNS or a surgeon. Additional education and training should be aimed at surgeons in order to improve frequency of stoma siting in order to improve patient outcomes.
SP9.5 Outcomes after Emergency Cholecystectomy: A Multicentre Retrospective Cohort Study
Authors: Borakati Aditya , Hughes Frances , Kocher Hemant , Malik Humza
Published: August 2023

Aims

Gallstone disease affects 10-15% of the UK population and represents a significant proportion of emergency general surgical admissions. Consensus international guidelines recommend cholecystectomy for all stable patients within 7 days of admission for emergency biliary pathology. This study sought to evaluate the outcomes of emergency cholecystectomy at a regional level over a 5 year period.

Methods

Retrospective multicentre study of all patients undergoing cholecystectomy at 4 acute hospitals in East London, UK, covering a population of 2.9 million, between 2016 and 2021. All previous hospital attendances with biliary pathology were retrieved to 2010 from prospectively maintained electronic patient records. The primary outcomes were time to surgery (TTS) from index attendance and total length of stay (TLOS) stratified by timing of surgery. Multivariable linear regression was used to identify independent predictors of TTS and TLOS.

Results

2056 patients were identified. 1786 (86.9%) underwent elective cholecystectomy and 270 (13.1%) cholecystectomy during an emergency admission. Median TTS was 108.3 days overall with 5.8 days for emergency cholecystectomy, median TLOS was 5.0 days overall and 7.6 days for emergency cholecystectomy. After adjustment with linear regression, emergency cholecystectomy reduced TTS by 112.3 days (95% CI 140.2-84.4), whilst each year of age increased TTS by 0.80 days and male gender was associated with 38.1 days greater TTS. For TLOS, emergency cholecystectomy was associated with an increase in admission time by 3.54 days (95% CI 2.04-5.03).

Conclusions

Emergency cholecystectomy significantly reduces time to cholecystectomy from index attendance with biliary pathology at the cost of increased overall time admitted.
SP9.6 Effectiveness and safety of prophylactic mesh closure in emergency Gastrointestinal surgery
Authors: Albendary Mohamed , Mohamedahmed Ali Yasen Y , Alamin Amin , Rout Shantanu , George Anil , Zaman Shafquat
Published: August 2023

Background

Wound complications are frequent in emergency Gastro-Intestinal (GI) surgery increasing morbidity and cost of care. Although laparotomy closure using a prophylactic mesh has been proven to limit Incisional Hernia (IH) occurrence, the literature lacked a high-quality assessment in the setting of emergency GI laparotomy. This review offers an up-to-date evaluation of the prophylactic mesh closure in these conditions.

Methods

A systematic review was executed via literature database: PubMed, Cochrane database, Science Direct and Google Scholar. Studies were examined for eligibility and included if they managed to compare prophylactic mesh closure to the conventional laparotomy closure in GI emergency surgeries. Both early postoperative fascial dehiscence and late incisional hernia were examined as primary endpoints. Secondary outcomes incorporate Surgical Site Infection (SSI), seroma/hematoma formation, complications of Clavien-Dindo score ≥3, operative time, and hospital stay.

Results

2 Randomised controlled trials (RCTs)(1, 2) and 2 comparative studies,(3, 4) which studied 562 patients, met the inclusion criteria. The hernia rate was significantly reduced in the mesh group (Odds Ratio 0.14 [0.05, 0.36], P value < 0.0001), while there was no statistically significant difference in fascial dehiscence between the studied groups (Odds Ratio 0.49 [0.01, 47.02], P value= 0.76). In addition, there was no significant outcome favouring one group over the other in terms of SSI and rest of the screened endpoints.

Conclusion

Despite the promising reduction in IH rate, a solid outcome was not obtained due to the limited number of relevant studies, paucity of RCTs and diversity in surgical techniques and mesh positions. A wider-scale RCTs may offer reliable results.
SP9.12 The Global Practice of Inguinal Hernia Repair Study (GLACIER): A survey of 1014 hernia surgeons
Authors: Liyanage Nanayakkara Kushan Dhanuja , Viswanath Nakul , Madhok Brijesh , Mahawar Kamal , Sheen Aali , Wilson Michael
Published: August 2023

Introduction

There are many variations in practices and preferences for inguinal hernia repair among surgeons globally. The purpose of the Global Practice of Inguinal Hernia Repair Study (GLACIER) was to capture these variations related to open, laparoscopic, and robotic inguinal hernia repair.

Method

A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms, personal email network of authors and email to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC).

Results

A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were equally preferred (43% and 47% respectively). Transabdominal pre-peritoneal repair (TAPP) is the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for minimally invasive approach. Repair with a mesh was preferred by 98% of the surgeons and synthetic monofilament light weight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and, 1% after minimally invasive repair. Only 10% of surgeons preferred open repair with local anaesthesia.

Conclusion

This survey identified similarities and variations in practice globally along with some discrepancies in inguinal hernia repair compared to best practice guidelines. It also identifies several key areas where more focus future research is required.
SP10.4 Pre-operative use of exclusive enteral nutrition in adult patients with Crohn’s disease: a single centre experience
Authors: Goh Ee Teng , Luthra Pavit , Syme Graeme , Kok Klaartje , Hancorn Kate , Mehta Shameer
Published: August 2023

Introduction

Exclusive enteral nutrition (EEN) in the management of adult patients with Crohn’s disease (CD) is thought to reduce post-operative complications but is under-utilised. This study aims to assess the use of EEN and post-operative outcomes in patients undergoing surgery for CD.

Methods

Consecutive adult patients at a single NHS Trust with CD undergoing surgery for stricturing, penetrating and medication-refractory disease from January 2018 to December 2021 were included. Patients prescribed at least 6 weeks of EEN prior to surgery (EEN) were compared to those who were not (non-EEN). Outcomes included intestinal failure (IF) requiring parenteral nutrition, post-operative complications, length of stay (LOS), unplanned readmission at 3 months and disease recurrence at 6 months.

Results

142 patients were included, comprising 22 EEN and 120 non-EEN patients. There were no cases of postoperative IF in the EEN cohort, whilst 18.3% of non-EEN patients (22/120; p=0.04) developed type one IF. The mean LOS (days) was significantly less in the EEN group (8.3±3.6 vs. 15.9±17.3, p=0.04), as were the complication rates when using a Clavien Dindo score of ≥2 (13.6% vs. 36.7%, p=0.04). Outcomes for unplanned admission at 3 months (OR 0.44, p= 0.3) and disease recurrence at 6 months (OR 0.45, p= 0.3) favoured the EEN cohort but were not significant.

Conclusion

Consistent with other studies, our study demonstrated a potential benefit in post-operative outcomes in adult patients treated with at least 6 weeks of EEN. To fully utilize the benefits of EEN, potential candidates for surgery who will benefit from EEN need to be identified early.
SP11.5 Maximising Efficient Endoscopy Training: a MEET tool initiative
Authors: Eley Catherine , Hawkes Neil , Egan Richard , Lewis Wyn
Published: August 2023

Background

Endoscopy training is sub-optimal (two thirds of dedicated training lists fall short of demand) and if competency trajectories are to improve, capacity must amplify. The aim was to develop a semi-automated web-based Application (App) to maximise training.

Methods

A blended Clinical and Digital Services App team used integrated list planning, built with open-source PHP framework Laravel and TALL Stack, and cloud hosted with Microsoft Azure. User profiles were aligned with Joint Advisory Group on Endoscopy (JAG) Training terminology - six users with diverse functionality (Planner, Training Lead, Trainer, Trainee, Viewer, and Administrator) supplying endoscopy list planning linked to e-invitation, to create a prototype MEET tool.

Results

Real time prototype testing proved MEET was accessible on all modern web browser platforms (on-line wired, Wi-Fi and broadband) with an App icon available on iOS and Android. Endoscopy list use was assessed prospectively over two months, one before (114 lists, 22.8% training dedicated) and one after MEET tool introduction (108 lists, 22.2% training dedicated). MEET could improve full training list use from 19.2% (5 lists) before, to 41.7% (10 lists) after introduction (Chi2 46.4, p<0.001; Cramer’s V 0.457, p<0.001). Moreover, the potential for ad-hoc training improved from 10.4% (10 lists) to 48.9% (44 lists, p<0.01).

Conclusion

MEET tool assessment within a development test area was workable with two- to four-fold better training opportunity. MEET has important promise and roll-out potential to all medical training - an opportune COVID recovery tool.
WTP1.1 Ruptured AAA pathway time audit within East Kent Hospitals University foundation trust (EKHUFT)
Authors: Ashoor Yasser , Senaratne Jawaharlal
Published: August 2023

Background

With ruptured abdominal aortic aneurysms (rAAA) without rapid intervention, there is almost 100% mortality. Even with intervention mortality remains high and It is intuitive that more rapid access to specialist care might reduce this, though the choice of which patients are transferred lacks evidence. Kent and Canterbury hospital (K&CH) is the vascular hub for rAAAs in Kent, serving 4 spoke hospitals.

Aim

To assess the current speed of management of rAAA within Kent Hospitals.

Methods

An audit of 50 rAAA patients from 11/2019-10/2021 was conducted. 26 patients (52%) died without intervention, 10 of them after the transfer to the vascular facility. 11 patients (22%) underwent open surgical repair and 13 patients (26%) underwent EVAR. Of those who underwent intervention (24 patients), only 11 survived. From hospital attendance to CTA and from CTA clinching diagnosis to transfer to K&CH, the median times were 95(9-1140) and 70(27-370) minutes, respectively. Median time from arrival to K&CH to theatre was 90(11-190) minutes.

Conclusions

There are no current explicit UK guidelines on the emergency management of rAAA, with variation in practice and our audit shows room for improvement, including patient selection for referral, diagnostic tools and the conditions under which the transfer is made. Thus, we have created a pathway to improve the rapid diagnosis and transfer between the Kent hospitals. A re-audit will be conducted to assess the effectiveness of this.
WTP1.5 The Effect of Health Literacy and Socio-Economic Deprivation on Outcomes After Lower Limb Revascularisation for Chronic Limb Threatening Ischaemia - The HeaLTHI Study
Authors: Bishop Chloe , Wunnava Sai , El-Sayed Tamer , Nandhra Sandip
Published: August 2023

Aims

Health literacy is the ability to obtain, process and understand health-information needed to make health-related decisions. Research has suggested a relationship between health literacy, socio-economic status, and health-related outcomes. This study aimed to assess how health literacy and socio-economic status interact for patients undergoing bypass surgery for chronic limb threatening ischaemia (CLTI).

Methods

Patients with CLTI undergoing lower limb surgical bypass graft operations were included in a cross-sectional observational study. The HLS19-Q12 questionnaire categorised participant’s Health Literacy as inadequate, problematic, sufficient, or excellent. Socio-economic status was assess using the Index of Multiple Deprivation. Primary outcomes were major adverse cardiovascular and limb events.

Results

Fifty patients (mean age±SD: 70±8.7 years) were included. Participant’s health literacy was inadequate (28%), problematic (38%), sufficient (24%) and excellent (10%). 40% lived in areas of highest deprivation. All health literacy groups were comparable for post-operative outcomes, but poorer health literacy was associated with a lower socio-economic status (r = 0.308 (P = 0.029)) which was also a significant predictor for amputation (P = 0.017).

Conclusions

This study suggests that a lower health literacy is associated with greater social deprivation which in turn maybe a predictor for amputation following bypass surgery. Health Literacy is a potentially modifiable factor and improving it could have a mediating role in health inequalities created by social deprivation, addressing a vascular James-Lind Alliance priority.
WTP2.1 Predictors Of Non -Adherence To Immunosuppression In Transplant Patients At A University Teaching Hospital
Authors: Devkaran Bhavesh , Ohia Ernest , Koufopoulos Georgios , Bandara Chameera , Mehra Sanjay , Sharma Hemant
Published: August 2023

Introduction

To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine the predictors of non-adherence.

Methods

From a total of 106 KTPs treated at the RLBUHT (Jan 2020- June 2021), N= 20 (18%) patients were identified as being non-adherent on two or more hospital incident episodes identified by the continued care clinic, clinicians, and pharmacy. Statistical analysis was performed using the Student t-test. The predictors were data mined with Cox Regression, with the time-variable being time to graft dysfunction or Tacrolimus level abnormality > 50% variance of average trough level (6-8 ng/ml).

Results

Non-Adherence was observed in 20 (18.6%) patients; the estimated glomerular filtration rate was significantly lower in the no-adherence group (28.52 ± 17.62 ml/min) than in the adherence group (62.43 ± 11.72 ml/min, p < 0.05). About the Tacrolimus trough level, a significant difference was found between the adherers and the Nonadherers (5.10 ± 2.19 vs. 3.06 ± 1.04 ng/ml, p < 0.05). Non-adherers were interrogated during clinical encounters by clinicians and interpreter requirements. Polypharmacy (N=15), (Interpreter requirement) (N=11), young patients age 18-21 (N=05), and old age>70 (N=04) were the predictors of non-adherence. The patients were re-counseled and social services were involved to minimize recurrence.

Conclusion

The KTPs in this study demonstrated that non-adherence was associated with worse graft function and a lower Tacrolimus level. Knowledge about the degree of adherence could help identify non-adherent patients early and develop strategies to improve outcomes.
WTP2.3 Incidence of intrathyroid parathyroid adenoma - last 9 years in a teaching hospital
Authors: Kho Jason , Kuan Jen Yee , Turner Paul , Shetty Vinutha
Published: August 2023

Aim

The incidence of intrathyroid parathyroid adenoma (iTPA) is estimated to be 0.7-5.7% of hyperparathyroidism cases. Thyroid lobectomies may be performed when an adenoma cannot be clearly identified and isolated. We aimed to review the incidence of iTPA and outcomes after surgery within our practice.

Methods

We retrospectively reviewed consecutive parathyroidectomies performed by two experienced upper gastrointestinal surgeons (VS and PT) in a teaching hospital between April 2013 and December 2022. Preoperative radiological imaging was reviewed, and cases of iTPAs were diagnosed intraoperatively and on histopathology. These were further evaluated to review the outcomes after surgery.

Results

Total of 211 parathyroidectomy surgeries were performed, 11 (5.2%) of which were found to be iTPAs. These were confirmed on histopathology. Median age of patient cohort was 57±13 years. Patients were predominantly female (n=10, 90.9%). None underwent previous neck exploration. There was radiological (SPECT and Ultrasound) suspicion of iTPAs in 3 (1.4%) cases; peri-operative decision was made to explore for iTPA in the remaining 8 cases. 9/11 (81.8%) patients had hemithyroidectomy performed; in the remaining two cases, adenoma was successfully isolated from thyroid tissue and resected. Preoperative methylene blue infusion was utilised in all cases, of which uptake was evident in 8 (72.7%) cases. Calcium normalised in all patients postoperatively and none required further neck exploration.

Conclusion

Our 9-year series of parathyroid surgery revealed 5.2% incidence of iTPA, the majority of which was diagnosed intraoperatively. Diagnosis of iTPA should be considered if there is suspicion on radiological imaging and where no obvious adenoma is identified after full neck exploration.
WTP3.6 Comparison of complications and benefits of retrieval of gall bladder with and without bag
Authors: Ayubi Azaz , Rauf Sidra , Mujahid Sheeza , Ajaz Hamda , Akhtar Fahad , Sakhizada Fahim
Published: August 2023

Aim

To compare the outcomes of gallbladder extraction with versus without using retrieval bag in laparoscopic cholecystectomy.

Methods

The duration of the study was six months after approval of synopsis. After meeting the inclusion criteria a total of 130 patients were enrolled. Informed consent and demographic detail were noted. Patients were randomly assorted in two groups by lottery method. In group A, the gallbladder was extracted using an endobag. In group B, extraction of the gallbladder was done without using endobag. All patients were followed-up in OPD after one week and were evaluated for postoperative wound infection at port site.

Results

The mean age of the patients was 40.44±10.884 years, 52(40%) patients were male and 78 (60%) patients were females. In patients with bag retrieval group the port site infection was not noted in comparison with those without bag retrieval group the port site infection was found in 9 (13.8%) patients (p-value=0.002).

Conclusion

Gallbladder extraction with retrieval bag showed significantly better outcome in terms of port site infection as compared to without retrieval bag patients in laparoscopic cholecystectomy.
WTP4.5 An Evaluation of the Introduction of a Perioperative Care Bundle to Reduce Surgical Site Infections after Bowel Resection Surgery in a DGH Setting
Authors: Audei Wafa , Peck Mariska , Lal Nikhil , Hamdan Mohammed
Published: August 2023

Background

The surgical site infection (SSI) rate for colonic resections at a District General Hospital (DGH) in South-Central England was 25.3%. The UK national average is 8.6%. The aim of this study was to evaluate if the implementation of a perioperative care bundle based on NICE guidance improved SSI rates.

Methods

Retrospective data was collected prior to the bundle implementation (Group 1) and prospective data following bundle introduction (Group 2). Inclusion criteria were all emergency and elective bowel resections. The primary outcome assessed was the development of an SSI within the 30-day postoperative period. The secondary outcomes were related to confounding variables, such as diabetes and immunosupression. Data was collected from the electronic patient record system and follow-up telephone consultations using a standardised questionnaire.

Results

The SSI rate in Group 1 (n=55) was 30.9% (95% CI,19.0%-43.1%) as opposed to 19.2% (95 CI, 8.5%-30.0%) in Group 2 (n=52), p=0.16. Interestingly, for patients of a BMI >30 the SSI rate dropped from 45.5% (95% CI, 16.7%-76.6%) to 20.0% (95% CI, 4.3%- 48.1%).

Conclusion

The 10-step perioperative care bundle did not significantly reduce the SSI rate. However, bundle uptake was moderate (73%), and only 65.4% of prospective cases achieved complete bundle compliance. Further research is required to investigate the effectiveness of this bundle on high-risk groups, as well as implementation barriers.