bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.WE.1015Management of Boerhaave Syndrome
Authors: Florance Charlotte , Jones Katie , Singh Krishna
Published: October 2021

Aim

Boerhaave’s Syndrome is a rare and fatal condition, characterised by a distal oesophageal tear induced by an abrupt rise in intra-luminal pressure. Treatment remains controversial; we present a recent case and review relevant literature.

Methods

A retrospective analysis of case-notes was performed, and a literature review undertaken on PubMed.

Results

A 58-year-old male presented as an emergency with severe chest pain, having choked and vomited following the ingestion of steak. Computed tomograpy scan of the thorax demonstrated a large pneumomediastinum associated with an oesophageal perforation on the anterior wall and bilateral pleural effusions. A primary laparoscopic repair was performed with jejunostomy placement for feeding. The post-operative period was complicated by a prolonged stay on intensive care with sepsis secondary to mediastinitis. A contrast swallow performed eleven days post-surgery confirmed no persistent leak and the patient was discharged five days later.

Boerhaave’s syndrome accounts for 10% of oesophageal perforations and is typically associated with a history of overindulgence and vomiting. Stable patients with a contained disruption and minimal contamination, can be managed conservatively. Endoscopic therapies include clipping small perforations, self-expanding stents for larger defects, and endoluminal vacuum therapy. Operative interventions comprise primary repair, debridement and drainage of thoracic cavity, diversion operations and single stage resection with or without primary reconstruction.

Conclusion

Boerhaave’s Syndrome is associated with significant morbidity and mortality, but with early recognition and prompt intervention, patients can be successfully managed. Options include conservative, endoscopic and surgical, depending upon the site and size of the perforation.
EP.WE.1048Weight Regain After Sleeve Gastrectomy More Common in Male and Less Common in Super-Obese Patients - Results of an 18-Month Follow-up Study
Authors: Bodla Ahmed Salman , Abraham Jenny , Shah Neha , Menon Vinod
Published: October 2021

Aims

Long-term success of Sleeve Gastrectomy (SG) is undermined by weight regain (WR). Several procedure- and patient-specific factors have been proposed in previous studies. Here we look at 18-month follow-up post-SG to investigate WR and patient-specific variables influencing this.

Methods

A single-centre study involving retrospective analysis of a prospectively-maintained database. Inclusion criteria: Primary non-revisional SG patients with adequate follow-up data to assess WL/WR trends. Patients were divided into two subgroups based on their %EWL between 6-to-12 and 12-to-18 months: weight regainers (WR) and weight losers/maintainers (WL/M).

Results

Out of 338 SG cases between 2012-2017, 180 met inclusion criteria of which 18.3% were men and 45% were super-obese. All patients lost weight during first 6 months (mean %EWL 52.3%, P < 0.0001). Between 6-to-12 months, 87.6% patients continued WL with a further mean %EWL of 10.35% (P < 0.0001). Between 12-to-18 months, a drastic deceleration/reversal of WL progress was observed with an average of only 0.76% EWL (P = 0.84), with 42% of patients regaining weight in this period (mean EWG 6.8%). Male patients encountered significantly higher WR rate (OR 3.27, P = 0.003), whereas it was much less frequent in pre-operatively super-obese patients (OR 0.48, P = 0.036). Moreover, there was no difference in the 6-month %EWL between WR and WL/M subgroups (P = 0.62), thus negating the possibility of WL burn-out phenomenon.

Conclusions

Different rates of WR in men and super-obese patients may indicate underlying behavioural and biological differences. More research is needed to investigate them in detail, having implications for revisional surgery and follow-up support.
EP.TH.104An interesting case of Post-ITU delirium
Authors: Bhat Srushti
Published: October 2021

A 75-year old golf-player underwent an open radical cystectomy for a grade 3 bladder carcinoma. His medical history was unremarkable. Post-operatively, he was admitted to the ITU for observation and transferred to the ward after 3 days. On the 5th day post-op, he developed sudden SOB, tachypnoea and hypotension. Blood gas analysis revealed T1 respiratory failure and lactate of 3.3. He was commenced on anticoagulants and a CTPA incidentally found multiple small pulmonary emboli- suspected to be chronic. He developed severe HAP and was transferred back to ITU. 10 days later after improvement he was stepped down. His oral intake had significantly reduced and his urine output was low. He was alert but ward nurses found him to be vacant and significantly confused after his second step down. A CXR was unremarkable. He reported hallucinations and was struggling with his memory. A week later, he was transferred to a community hospital for rehabilitation as his delirium was improving. In the community, he experienced ongoing confusion and hallucinations. Nurses noted hematochezia and jaundice and he was re-admitted with abdominal pain and pyrexia. His LFTs were severely deranged and he was initiated on antibiotics for possible cholangitis. USS abdomen, CT and MRCP revealed no obvious cause of obstruction. A probable diagnosis of viral hepatitis was made by the Gastroenterologist which spontaneously resolved. CT head for confusion screen revealed right frontal lobe ischaemia with severe gliosis- possibly post-operative. The psychiatric team reviewed the patient and he was diagnosed with post-ITU delirium.
EP.TH.208The need for speed: Reduced operative time in laparoscopic sleeve gastrectomy may reduce length of hospital stay
Authors: Lin Yi-Tzu Linda , Cheah Hock Ping , Wong Kenneth
Published: October 2021

Introduction

Length of stay (LOS) in laparoscopic sleeve gastrectomy (LSG) is affected by multiple factors, including gender, BMI >50, comorbidities, socioeconomic status and increased operative time (OT). This study aimed to evaluate the effect of reduced OT on LOS.

Methods

Analysis was conducted using a prospective database in patients who underwent LSG by a single surgeon at a single institution from January 2015 to December 2019. Patients receiving other operations (e.g. adhesiolysis, cholecystectomy, para-oesophageal hiatal hernia repair or ventral hernia repair) during LSG were excluded. All the patients were divided into two groups: OT ≤ 60 minutes and OT > 60 minutes. Patient demographics and outcome variables, including LOS, 30-day readmission, unexpected return to operating theatre, complications and mortality, were collected and analysed.

Results

A total of 1412 patients were included. In OT ≤ 60 minutes group (N = 804), the average LOS was 1.37 days and the average operative time was 51.31 minutes. In OT > 60 minutes group (N = 608), the average LOS was 1.66 days and the average operative time was 77.95 minutes. OT ≤ 60 minutes group showed a statistically significant decrease in LOS compared to OT > 60 minutes group (P-value <0.0001). The 30-day readmission rate was 0.97%. Complications included one gastric leak (0.07%), one postoperative bleeding requiring reoperation (0.07%), three (0.21%) portal vein thrombosis, and no mortality.

Conclusion

Our study demonstrated that reduced OT (≤60 minutes) in LSG was associated with reduced LOS but without increase in complication rates and mortality. This has implications for economic considerations for both hospitals and patients, especially in self-funded payer models.
EP.TH.239Outcomes and Complications After Sleeve Gastrectomy
Authors: Asad Sima Al , Khan Shujhat
Published: October 2021

Aim

The sleeve gastrectomy (SG) is a popular bariatric procedure that has beneficial effects that go beyond that of simply reducing obesity. It also has positive effects on diabetes, dyslipidaemia, and hypertension.

Method

The literature search was carried out using Ovid MEDLINE and PubMed databases to search for keywords and MeSH terms including “bariatric surgery”, “sleeve gastrectomy”, “complications”, “hypertension”, “diabetes”, “dyslipidaemia”, “cardiovascular” and “obesity”.

Result

SG leads to improvement in hypertension, type 2 diabetes, increased HDL levels, and reduction in uraemia levels that were present even after 10 years. Approximately 56-59% of patients experience type 2 diabetes mellitus remission after a year following a SG operation, and the beneficial effects of the operation on diabetes continue long after a year, with 84-86% of patients noting remission after a 5-year period. Approximately 78.5% who undergo SG will see improvements in hypertension, whilst 67.1% will report resolution. On the other hand, complications include formation of strictures (0.7-4% in patients), haemorrhage (1.5% of patients), and leakage (1.5-2.4%). Additional complications include alteration to bile flow, disruption to microbiota, and disruption to vagus nerve activity.

Conclusion

Complications from SG are uncommon but can be severe, and the involved mechanisms are only partially revealed. However, optimisation of risk factors in the months leading up to the operation can significantly improve outcomes in patients. This involves an early implementation of a healthy lifestyle including advising patients to exercise more regularly and adopt a low fat, low salt diet, limiting alcohol, and cessation of smoking.
EP.TH.243Western Australian Multicentre review of management of the axilla in breast cancer patients receiving neoadjuvant chemotherapy
Authors: MacConnell Suanne , Ballal Helen , Singh Vineeta , Saunders Christobel
Published: October 2021

Aim

De-escalation of treatment in early breast cancer is proposed to reduce morbidity to patients without compromising oncological outcomes. Use of SNB as gold standard in clinically node negative patients is an example of successful implementation. In patients receiving upfront chemotherapy, axillary management is more complex. We reviewed the axillary management of patients undergoing neoadjuvant chemotherapy (NAC) to assess nodal response.

Method

The MDT records of two centres were reviewed between January 2015 and May 2019 to identify patients receiving NAC. Clinical records were reviewed to collect demographics, radiological and clinicopathological results as well as follow up data.

Results

185 patients were identified as suitable, median age 49 (21-79). 49% were clinically node negative on presentation. 32% underwent a SNB prior to NAC; this decreased over the study period from 40.5% to 20.5%. Of the cN0 patients, 24% were upstaged to node positive disease at final surgery. None of these achieved a pCR in the breast. 18% of cN0 patients went straight to ALND, 50% were YpN0. 42% of cN1 patients achieved ypN0. 58% down-staged to ypN0 also achieved pCR in the breast. Only 1 patient with residual disease in axilla achieved pCR in the breast.

Conclusion

Use of pre-NAC SNB is declining with low rates of upfront ALND in cN0 patients. There is a 42% rate of down-staging axillary disease with NAC. Patients are unlikely to have nodal response without pCR in the breast. There is likely to be a role for targeted axillary dissection in carefully selected patients.
EP.TH.322Should a concurrent sentinel node biopsy be performed when the preoperative histopathological category of B5c in a breast cancer biopsy is identified?
Authors: Clark Dominic , Jenkins Stephanie
Published: October 2021

Aim

To assess the management of sentinel lymph node biopsy (SLNB) in patients with a pre-operative B5c histopathological diagnosis.

Method

A retrospective study of the decision for SLNB in 31 breast cancer patients with B5c biopsy and their final histology were reviewed between 2009-2019. Factors that determine concurrent SLNB (size of mass lesion > 1cm/increasing size, DCIS > 4cm, recurrence and abnormal lymph nodes on ultrasound) were assessed.

Results

15 patients (48%) with invasive disease and 7 patients (23%) with non-invasive disease had concurrent SLNB, whilst 9 (29%) patients with non-invasive disease did not receive concurrent SLNB and no patient (0%) with invasive disease failed to receive concurrent SLNB. Using the above inclusion and exclusion criteria 21 of 31 (68%) patients would have been managed correctly whilst 5 (16%) would of had unnecessary surgery and 5 (16%) would have required a second operation.

Discussion

In this study, 48% of patients with concurrent SLNB were identified as invasive and avoided a second operation. Although 23% of patients underwent unnecessary SNLB, no invasive disease SLNBs were missed. Solely using inclusion and exclusion criteria would not have improved results. This suggests that there must be other factors involved in correctly managing these patients.

Conclusion

Discussions with the patient about risk benefits of SLN complications vs repeat surgery, and patient comorbidity, in addition to radiological characteristics, may assist management decisions.
EP.TH.336Surgeons' Knowledge Of Characteristics of Mesh Used in Groin Hernia Repair- A Cross Sectional Survey
Authors: Patel Maitreyi , Kirmani Naveed
Published: October 2021

Aims

We aim to assess the surgeons’ awareness of mesh characteristics by way of an online survey.

Methods

A cross sectional survey of surgeons routinely performing groin hernia repairs was conducted across five NHS hospitals using an online questionnaire. Surgeon’s experience in groin hernia repair was taken in account. The data was analyzed using Microsoft Excel. Descriptive statistics was used.

Results

37 surgeons responded to the survey.6 surgeons had more than 20 years of experience. 8 (21.62%) performed >50 hernia repairs annually. When compared with years of experience, knowledge of material was 100% with >10 years experience. Knowledge of tensile strength was 50% in those with > 20 years experience, while 83% of respondents with >20 years experience were aware of the weight and pore size of the mesh they used. In comparison with the number of groin hernia repairs done annually, all respondents performing >50 repairs knew the material they used. Amongst these respondents, knowledge of tensile strength, weight and pore size was 38%, 75% and 63% respectively.

Conclusions

Our study suggests that the level of knowledge regarding mesh is inadequate among surgeons, falling short of the minimum expected of surgeons performing groin hernia repair.
EP.TH.341Creating and testing the online multimedia platform aboutmyop.org
Authors: Daliya Prita , Lobo Dileep , Parsons Simon
Published: October 2021

Introduction

The value of patient focused registries and the use of patient reported outcomes is well documented. However, despite the availability of technological advances the use of multimedia interfaces with patient interaction and real time digitalised data collection has yet to become routine practice. As a modern-day solution, aboutmyop.org was developed as a patient-facing website to improve patient-clinician communication and information sharing. The aim of this study was to pilot the platform in routine clinical care, to identify acceptability, strength and weaknesses.

Method

Patients identified with symptomatic gallstones and referred for consideration for elective laparoscopic cholecystectomy were invited to use aboutmyop.org by postal invitation. Patient demographics, and information on patient recruitment were collected prospectively.

Results

The process of approvals to implement and integrate aboutmyop.org with NHS systems took over 18 months. Due to difficulties with onboarding, 349 (38.9%) of the 898 eligible patients registered, and fewer continued to participate post-operatively (7 days: 46.5%, 30-days: 30.5%, 3-months: 27%, 6-months: 19%). Participants were significantly younger than non-participants (47.6 vs. 51.8 years, p < 0.05), but were otherwise equally matched for gender and comorbidities. Despite system and implementation issues, participants were accepting and supportive of aboutmyop.org.

Conclusion

The aboutmyop.org system demonstrates a method to improve information accessibility for patients, and a novel method for data-sharing between patients and clinicians. Despite difficulties with system access, users demonstrated a willingness to engage in virtual recruitment and digital surveys. Subsequent improvements in access to a aboutmyop.org should help to facilitate long-term patient engagement and quantify real world benefits.
EP.TH.447Simultaneous repair of bilateral Inguinal hernia under Local Anaesthetic - is it feasible?
Authors: Athisayaraj T , Olugbemi J , Sebastian B , Coveney E
Published: October 2021

Introduction

Local Anaesthetic repair of unilateral Inguinal hernia is well reported in the literature, as a safe, well tolerated and effective operation. However, there is not much literature on simultaneous repair of bilateral inguinal hernias under local anaesthetic. We are reporting our experience with simultaneous repair of bilateral inguinal hernias under local anaesthetic.

Methods

We did a retrospective analysis of prospectively collected data of patients, who had bilateral inguinal hernia repaired under local anaesthetic over a period of 2009 - 2019, looking at the patient demographics, patient reported pain score, operating time, volume of local anaesthetic used, patient satisfaction and complication rates.All the patients had Lichtenstein's hernioplasty. The LA mixture was made up of 30ml 0.5% Bupivacaine with adrenaline, 20 ml 2% Lignocaine with adrenaline, 50 ml of 0.9% Saline and 6 ml of 8.6% Sodium Bicarbonate. All these surgeries were performed on a day case basis.

Results

There were 24 patients, who underwent local anaesthetic repair of bilateral inguinal hernias, 22 Males and 2 Females. Age range was 35 - 81 years. The BMI varied from 18 - 30, with a mean of 24. The average operating time was 66.8 minutes (38 - 120 minutes, median 60 min). The mean pain score was 24, on a 0-100 scale. Patient satisfaction scores varied from 50-100 (Median 90, Mean 88.1)

Conclusion

We conclude that successful simultaneous repair of bilateral inguinal hernia under local anaesthetic is feasible, with a low level of patient discomfort, high satisfaction rate and using safe quantities of local anaesthetic
EP.TH.449Routine G&S in elective laparoscopic cholecystectomy and the impact on NHS resources
Authors: Kronberga Madara , Matias Mariana , Wiggins Tom
Published: October 2021

Aim

Current guidelines for routine pre-operative tests for elective surgery, don’t mention routine Group & Save (G&S). At present the need for G&S sample is dependent on the operative severity and the likelihood of blood loss. However, despite consistently low major bleeding rates in elective laparoscopic cholecystectomy (ELC) (0.1 – 0.46%) many hospitals, including ours, still hold local policies to have routine G&S pre-operatively and/or on the day of surgery. Our aim is to audit our hospitals local policy regarding G&S samples in ELC and establish its necessity and financial impact.

Methods

Retrospective study looking at adult patients undergoing ELC at University Hospitals Birmingham NHS Foundation Trust in 2020.

Results

344 ELC procedures were carried out in 2020. Of those 82 had no G&S, 137 had pre-op sample taken with no following samples, with a total of 182 samples sent on the day of surgery. Antibodies were identified in 5 patients (1,45%) however none were cross-matched before surgery. Only 1 patient needed transfusion in the peri-operative period and was cross-matched from sample sent after surgery.

Conclusion

Based on our results the likelihood of having peri-operative bleeding in ELC requiring blood transfusion is minimal (0.29%), therefore the need for routine G&S in this context is questionable. Arguably, diagnosing antibodies in itself would justify one G&S sample. In agreement with this our results show that in 2020 our Trust spent unnecessarily more that 2’431£, additionally adding workload to already stretched staff and delaying theatres.
EP.TH.632A single centre’s experience with bariatric surgery outcomes compared to UK NBSR third report 2020
Authors: James Georgina , Gopinath Bussa , Rao Milind
Published: October 2021

Bariatric Surgery has become a routine elective operation offered to patients with obesity (BMI >30) and obesity related diseases. The UK national Bariatric Surgery registry (NBSR) publishes data from record bariatric surgeries.

Aim

We compare one Bariatric service’s outcomes with the outcomes of the NBSR- Third Report 2020. Outcomes; 30-day mortality and complications, length of stay (LOS), 1-year weight loss for Gastric Sleeve (GS) and Roux-en-Y gastric bypasses.

Method

We collected data from one bariatric unit over a 98-month period. Data were taken from bariatric specialist nurses and electronic patient records. This was then compared with the NBSR report 2020.

Results

NBSR UK records 48.8% bypasses and 35.4% GS compared with our department (81.2% bypasses and 9.5% GS.)

The average weight-loss 1-year post op for GS 36.9kg (NBSR 40.3kg) and for bypass 60.2kg (NBSR 44.1 kg)

The average LOS for Bypass was 2.37 days (95%CI 2.3-.2.7) compared with the NBSR 2.6 (95% CI: 2.5-2.7). Whereas GS 2.9 (95%CI: 2.3-3.4) compared to NBSR 2.5 (95% CI: 2.4-2.6). 30-day mortality for primary procedures was 0% for Bypasses and GS compared with the NBSR 0.05%. 30 day complications at 1.74% compared with NBSR <2.38%.

Conclusion

Our unit proportionally performs more bypasses compared with the rest of UK and has greater 1-year weight-Loss with bypass procedures. This bariatric unit had less 30 day mortality and complications compared with NBSR. Our department is meeting the national outcomes when compared with the rest of the UK.
EP.TH.665Where’s the gallbladder? A rare case of gallbladder agenesis with cystic duct stone
Authors: Cheung Tiffany , Presa Roberto , Manzelli Antonio
Published: October 2021

Aims

Gallbladder agenesis is a rare congenital anatomical malformation with an incidence of 0.007-0.0027%. Although usually asymptomatic, clinically it may present similarly to biliary colic. There may be increased risk of de novo biliary duct stone formation due to biliary dyskinesia, subsequent duct dilatation and biliary stasis. We present a case of incidental gallbladder agenesis identified during intended laparoscopic cholecystectomy.

Methods

A 68 year-old female with no significant comorbidities presented with a 16 hour history of colicky right upper quadrant pain and vomiting. She had been awaiting cholecystectomy for increasingly symptomatic gallstones, most recently visualised within a contracted gallbladder on ultrasound two months prior. Recurrently obstructive LFT’s warranted urgent magnetic resonance cholangiopancreatography (MRCP), which identified a poorly-visualised contracted gallbladder and a 10mm common bile duct without filling defect. At index laparoscopic cholecystectomy, a very small thick-walled structure resembling the gallbladder was identified and safely excised in retrograde; a stone was seen within.

Results

Macroscopic examination revealed a 27 x 9 x 11mm piece of dark brown tissue containing soft orange material. Microscopic histological examination confirmed this to be cystic duct focally lined by mucinous epithelium with chronic inflammation. Findings were consistent with gallbladder agenesis.

Conclusions

Although rare, it is important for surgeons to maintain an index of suspicion for gallbladder agenesis, particularly if repeated imaging demonstrates a poorly-visualised or ‘contracted’ gallbladder despite adequate fasting. Furthermore, as in this case, the presence of ‘gallbladder’ stones radiologically does not preclude gallbladder agenesis. Anticipation of this malformation may aid interpretation of biliary anatomy, if incidentally found intra-operatively.
EP.TH.754One Year Experience of Laparoscopic Common Bile Duct Exploration in a District General Hospital Using Ambu Disposable Scope
Authors: Diab Alsarah , Kilkenny Jane , Eltayeb Omer
Published: October 2021

Aim

Common bile duct (CBD) stones are the most common cause of obstructive jaundice. Laparoscopic exploration of the CBD with laparoscopic cholecystectomy has been preferred to endoscopic treatment, as a single-stage modality of treatment for CBD stones. This procedure was started in a District General Hospital in May 2019 using the standard port sites and Ambu® aScope™ 2 single-use flexible scope.

Methods

Retrospective analysis of outcome of all laparoscopic CBD explorations done in a District General Hospital between May 2019 and September 2020.

Results

A total of ten laparoscopic CBD explorations were carried out during the identified period, the main indications were young patients (40%), referral by gastroenterologist (40%) and failed endoscopic retrograde cholangiopancreatography (ERCP) (20%). The mean age (±SD) was 54.7 (± 19.2) and 70% of patients were females. Two thirds of the operations were done in emergency setting, with choledochotomy approach being used in 60% of cases and primary closure in all cases. The average length of stay (±SD) after the operation was 3.1 (±1.9). Only one patient developed a haemoserous collection that required a laparoscopic washout, none of the patients required readmission.

Conclusion

Laparoscopic CBD exploration can be performed safely in a district general hospital, the disposable Ambu® aScope™ 2 is safe, feasible and cost-effective substitute to the reusable choledochoscope. Provision of this laparoscopic CBD exploration at district general hospital level is more convenient to patients and can reduce referrals to regional hepatobiliary units, and therefore provide a good training opportunity for surgical registrars in this setting.
EP.TH.855Hartmanns reversal - Laparoscopic Vs Open, UHNM experience over the last 3 years
Authors: Nair Nandu , Haneef Umar , Chen Zehong , Roy Sudipta
Published: October 2021

Aim

Reversal of hartmanns is still an operation associated with significant morbidity. Although various studies have tried to assess the best time for attempting reversal after the primary operation, there is still no consensus. The aim of our study was to look at our experience over the last three years to find any possible factors which determine the duration between primary operation and reversal and compare laparoscopic vs open approach.

Methods

Prospective cohort including consisting of patients who underwent hartmanns reversal in 3 years was analysed (January-2017 to December-2019). Data was collected retrospectively from clinical notes.

Results

Among the patients (n = 50) there was equal distribution of males (52%) and females (48%). Although the initial operation was open in 74% patients, reversal was attempted laparoscopically in 46% with a conversion rate of 43.4%. Median duration between initial operation and reversal was 433 days. There was no significant association between duration before reversal and patient comorbidities or the indication for the index procedure. Also there was no statistical difference in postoperative hospital stay or immediate postoperative morbidity between laparoscopic and open hartmanns reversal.

Conclusion

There was no difference in immediate postoperative outcomes between patients who had laparoscopic or open hartmanns reversal. There was no determining factor which made the surgeon prefer laparoscopic over open approach nor was there a difference in duration between primary operation and reversal based of patient factors or method of approach. Hence timing of hartmanns reversal and the method of approach still depends on surgeon preference and experience.
EP.TH.860Audit to review the post-operative blood transfusion rate in open hernia repairs in order to reduce the number of pre-operative Group and Save Tests obtained
Authors: Cormack Jonathan , Wong Nicholas
Published: October 2021

Aims

Open hernia repair is a common elective and emergency surgical procedure. The majority of hernia repairs are performed without complications. Current dogma dictates 2 pre-operative group and save tests must be obtained prior to hernia repair. Post-operative haemorrhage is rare and there is equipoise as to whether all patients must be group and saved pre-operatively.

Methods

Retrospective review of electronic patient records between April 2018 to March 2019 in a large district general hospital. Cross referencing of operative, blood transfusion and blood science records was performed.

Results

410 open hernia repairs including inguinal, femoral and all other abdominal wall hernias were performed. The hernia repairs were elective and emergency procedures with patients ASA 1 - 5.

A total of 820 pre-operative group and save test were obtained with a total cost of £7,978.60. The post-operative blood transfusion rate was 1.46%.

Conclusions

A large number of open hernia repairs were performed over a 12-month period with a very low post-operative blood transfusion rate. This small single centre study indicates that many pre-operative group and save tests may be unnecessary as the majority of hernia repairs were performed without post-operative blood transfusion. Abolishing unnecessary group and save tests could reduce clinical and financial burden without compromising patient safety. The study also suggests that a selective group and save policy be instituted for certain patient characteristics such as emergency repair, ASA ≥3 or abdominal wall reconstruction for incisional hernia. A selective group and save policy will be implemented and re-audit in 6 months.
EP.TH.955Surgical site Infection prevention Bundle- One Centres Experience
Authors: Thomas Rhys , Reeves Nicola , Torkington Jared
Published: October 2021

Aim

Surgical Site Infections (SSIs) affects the patient’s recovery following surgery. Within Wales the colorectal SSI rate for both emergency and elective patients is 13%, as per a prospective all Wales observational study. The study further demonstrated that elective colorectal SSI rate was 21.1%. In light of this, a single centre within Wales developed and implemented an SSI bundle to help prevent SSIs.

Methods

A bundle was designed based on the WHO and CDCs guidelines and was agreed on by all colorectal consultants within the centre. There were 3 elements to the bundle – pre-operative, intra-operative and post-operative. The bundle was implemented for 50 elective colorectal patients to assess its feasibility and effectiveness.

Results

50 patients had the SSI bundle from 1 st November to 20 th December 2019. Compliance with the bundle was assessed and the resultant SSI rate improved by 40% with an SSI rate of 20% in this centre reducing to 12%. Further analysis of the SSIs that developed demonstrated that 2 were secondary to intra-abdominal complications and the other 4 failed to have all elements of the bundle implemented.

Conclusion

An SSI bundle can by effectively implemented and become standard care for colorectal patients to effectively reduce the SSI rate.
BJS.02Graduates from different medical schools vary in their performance on the Intercollegiate Membership of the Royal College of Surgeons (MRCS) Examinations
Authors: Ellis Ricky , Scrimgeour Duncan , Cleland Jennifer , Lee Amanda , Brennan Peter
Published: October 2021

Aims

UK medical schools vary in their mission, curricula and pedagogy, but little is known of the effect of this on postgraduate examination performance. We explored differences in outcomes at the Membership of the Royal College of Surgeons examination (MRCS) between medical schools, course types, national ranking and candidate sociodemographic factors.

Methods

A retrospective longitudinal study of all UK medical graduates who attempted MRCS Part A (n = 9730) and MRCS Part B (n = 4645) between 2007 and 2017, utilising the UK Medical Education Database (https://www.ukmed.ac.uk). We examined the relationship between medical school and success at first attempt of the MRCS using univariate analysis. Logistic regression modelling was used to identify independent predictors of MRCS success.

Results

MRCS pass rates differed significantly between medical schools (P < 0.001). Russell Group graduates were more likely to pass MRCS Part A (Odds Ratio (OR) 1.79 [95% Confidence Interval (CI) 1.56-2.05]) and Part B (OR 1.24 [1.03-1.49])).  Trainees from Standard-Entry 5-year programmes were more likely to pass MRCS at first attempt compared to those from extended (Gateway) courses, Part A OR 3.72 [2.69-5.15]; Part B (OR 1.67 [1.02-2.76]. Non-graduates entering medical school were more likely to pass Part A (OR 1.40 [1.19-1.64]) and Part B (OR 1.66 [1.24-2.24]) than graduate-entrants.

Conclusion

Medical school, course type and socio-demographic factors are associated with success on the MRCS. This information will help to identify surgical trainees at risk of failing the MRCS in order for schools of surgery to redistribute resources to those in need.
BJS.03Markov Decision Analysis of Treatment Pathways for Resectable Malignancy of the Oesophagus or Gastrooesophageal Junction
Authors: Bradley Alison , Brown Leo
Published: October 2021

Aims

To perform decision-analysis of treatment options for resectable malignancy of the oesophagus or gastroesophageal junction including: surgery alone, neoadjuvant chemoradiotherapy, neoadjuvant chemotherapy and surgery followed by adjuvant therapy based on current highest-level evidence.

Methods

A Markov decision analysis model in an advanced decision-tree format was constructedand populated with data from existing randomised controlled trials. Markov model transition probabilities were based on weighted pooled estimates of proportions from included studies, calculated using Freeman-Tukey arcsine square root transformation under random effects model to account for heterogeneity.Each Markov cycle equated with one month and Markov states within the model included: alive without disease, alive with disease and dead. Extensive deterministic and Monte Carlo probabilistic sensitivity analysis was performed to test all parameters contained within the model.

Results

23 randomised controlled trials were included. Intention-to-treat analysis of the treatment pathways showed that neoadjuvant chemoradiotherapy was the superior pathway with an overall survival time of 50.52 months (42.26 QALMs). Monte Carlo sensitivity analysis run over 10000 iterations showed that neoadjuvant chemoradiotherapy was selected as the superior treatment pathway at a frequency of 93.21% followed by surgery followed by adjuvant therapy with a frequency of 6.79%. Subgroup analysis of only squamous cell carcinomas demonstrated that neoadjuvant chemoradiotherapy was the superior pathway with an overall survival time of 62.67 months (55.22 QALMs).

Conclusions

Based on current best available evidence this decision analysis supports neoadjuvant chemoradiotherapy as the treatment strategy of choice for resectable malignancy of the oesophagus or gastroesophageal junction.
EP.TU.23Impact of a multi-disciplinary team teaching programme on understanding of roles and communication among the multi-disciplinary team
Authors: Ishak Lisa
Published: October 2021

Background

Multidisciplinary teamwork is a critical aspect of patient care. It has a well recognised impact on patient healthcare outcomes. Communication among the multidisciplinary team (MDT) is paramount for effective collaboration, joint care planning and co-ordinated assessments of patients.

Aim

To evaluate the impact of an MDT teaching programme on understanding of roles, and communication among the MDT.

Methods

A questionnaire was distributed among ward staff who rated their understanding of roles and experience of communication for 8 teams within the MDT. An MDT teaching programme was designed and ran weekly over 6 weeks, aimed at improving understanding of roles and communication among the MDT. Sessions were attended by various members of staff including junior doctors, occupational therapy, physiotherapy, junior and senior nursing staff, consultants, and ward clark. The questionnaire was repeated and results were compared.

Results

Understanding of MDT roles was rated 15-32% higher after the teaching programme. For MDT teams not involved in the teaching programme, understanding of roles was rated the same or lower than before the programme. Staff experience of communication among the MDT was rated higher by 18% after the teaching programme. Additionally, the teaching programme provided an opportunity for MDT members to organise weekly MDT-based activities aimed at improving patient healthcare outcomes.

Conclusion

In conclusion, MDT teaching programmes are an effective way of improving understanding of roles and communication among the MDT.
EP.TU.292Role of varying cultural backgrounds on patient safety in modern health care (NHS)
Authors: Narayanasamy Sangara Narayanan , Thomas Pradeep
Published: October 2021

Introduction

Patient’s safety and quality health care are prime motive in today’s health system. To avoid incidents on the minority, safe health system has to function linking different cultures and diversity. Cultural competency is applying clinical skills, knowledge and attitude towards the betterment and clinical safety of minority patients.

Cultural competency

Culture is defined as traditions and norms within group of people, linked by similar beliefs, behaviour,food habits and moral values. Ethno-pharmacology is the branch of science analysing the variations and effect of medications on different group of people. Cultural competency expanded as multicultural education, including patient outcomes, provider outcomes and health service and organizational outcomes (Vega, 2005; Srivastava, 2008). Current debate is that could cultural competency reduce the racial discrimination (Drevdahl et al., 2008).

Cultural competency and outcomes

Patient outcomes are measured in terms of physiological parameters (Hawthrone et al., 2008) and organisational outcomes include multilingual health workers, translators and help desks. (Fisher et al., 2007). Workshop, conferences, and training programs, orientation programs, peer education, interpreters, and meetings improve health care delivery.

Conclusion

Provider and organizational outcomes show moderate improvements in health services, whereas weak evidence of improvements in patient outcome. Henderson et al and Fisher et al reported that health workers trained culturally are most effective in delivering care.

Recommendations

Appropriate terminology and methods of interventions has to be formulated. Periodic reviews and new assessment tools has to be done. Systematic and organizational approach with cost effectiveness to be handled to improve the cultural competency.
EP.TU.317Assessing the competency of foundation doctors in urethral catheterisation
Authors: Walker Emily , Rao Praveen , Khan Zia
Published: October 2021

Aim

Our aim was to assess FY1/FY2 doctors’ experiences and confidence in performing urethral catheterisation in a teaching hospital.

Methods

This was a single centre, survey based study. An anonymous online questionnaire was circulated to all foundation doctors at the trust. The survey contained 18 questions. The domains included the number of catheterisations performed, confidence levels and whether they had been signed off as competent. This was followed by a series of knowledge questions.

Results

The survey was sent to 71 email addresses and the response rate was 53%. The results showed that respondents’ lacked experience and confidence in urethral catheterisation. We also found that 32% trainees had not inserted a female catheter during foundation training, and 55% had failed to insert a catheter in the last year. The vast majority (71%) of respondents did not feel confident in female catheterisation.

Conclusions

This study shows that knowledge and competency in urethral catheterisation (which is an essential GMC requirement) amongst junior doctors is still inadequate.
EP.TU.369Straight to Test (STT) vs. Traditional Colorectal Target Investigations Pathway - A Local Audit
Authors: Fong Michelle , Shepherd Sophie , Dixon Luluwa , Meleagros Loukis , Dvorkin Lee , Navaratnam Romesh
Published: October 2021

Aims

The STT pathway was borne out of the National Cancer Strategy 2015 and faster diagnosis standard to rule in, or out, cancer within 28 days of referral. We aimed to review local target standard of practice, including comparison of STT vs Traditional pathways towards reaching the national standards.

Methods

The Somerset Database for all target referrals to the department was accessed. We chose October 2019 as a period unaffected by COVID-19. Time to investigation, results and treatment were reviewed. SPSS v.16 was used to perform an unpaired T-test of Traditional vs. STT time to diagnosis.

Results

212 patients were referred for target investigations. 53 declined, DNA-ed or were unfit. 159 proceeded to investigations of which 7 cancers were diagnosed: 4 colorectal, 1 gastric and 2 lung. Time to diagnosis averaged 45.8 days and only 47/159 (29.6%) had their definitive diagnosis in 28 days. 52 patients were streamed to STT and 107 traditional pathways. STT patients were diagnosed at 36.3 days (95% CI 28.1-44.6) and traditional patients 50.5 days (95% CI 45.4-55.7) (P = 0.005). Cancer treatment was received median day 59 (range 27-189) and 4/7 received this within 62 days.

Conclusion

Target investigations have low pick up rates of cancers with ever increasing referrals. Our centre did not meet aspirational national targets of time to treatment or diagnosis, although STT patients were diagnosed significantly faster. With COVID-19, rationalisation of patient contact with maintained diagnosis rates must be strategised. Stricter FIT testing with risk stratification and STT expansion is one strategy.
EP.TU.380Compliance with delirium guidelines in older surgical patients and susceptibility to improvement
Authors: Toe Ko Ko Zayar , Pressler Marc , Lees Nick , Vardy Emma , Price Angeline
Published: October 2021

Aim

Delirium in older hospitalised adults is both common and serious, particularly following surgery. It is associated with increased mortality, prolonged admission and greater care needs. All patients ≥ 65 years should have a delirium assessment within 24 hours of admission, and again post-operatively. Where delirium is identified, a thorough assessment of reversible causes should be undertaken using validated tools. Despite clear guidelines, delirium remains under-recognised and inconsistently managed. A study was undertaken to determine compliance with delirium assessment and management guidelines for older surgical patients in one acute hospital, and their susceptibility to improvement.

Methods

A QI project was undertaken using the PDSA cycle. 50 patient records were reviewed retrospectively. Multidisciplinary educational sessions were delivered. A further 50 patient records were audited after 1 month. Primary outcome: delirium assessment (4AT) within 24 hours of admission. Secondary outcome: TIME bundle completed where delirium identified.

Results

Conclusion

Delirium assessment and identification is improved through the use of a standard tool (4AT) and targeted educational sessions. As a common post-operative complication, delirium assessment is an important aspect of routine post-operative care. Further work is needed to improve compliance with use of the TIME bundle when delirium is present.
EP.TU.411Thinking Ahead: Improving Documentation of Treatment Escalation Plans for Surgical Patients
Authors: Tregidgo Laura , Sutton Grace , Mukhtar Hasan , Cave Charlie
Published: October 2021

Aims

The GMC recommends early decision making on CPR status for all acutely unwell patients admitted to hospital. An audit was undertaken of documentation of treatment escalation plans (TEPs) for general surgical patients at a District General Hospital.

Method

A retrospective study looking at documentation of TEPs in patients (n = 55) admitted under the care of the general surgical team over a one month period. Documentation from the surgical admission clerking and the first consultant ward round were reviewed for evidence of a TEP.

Results

Of 55 patients admitted only 24% had a TEP documented within 48 hours of admission under the general surgeons. Of those that had a TEP recorded (n = 13), twelve were in the admission surgical clerking and one was completed on the post-take consultant ward round.

Conclusions

This project highlighted the lack of TEP documentation for surgical patients within 48 hours of admission to hospital. Our recommendation is to develop a specific ‘post-take ward round’ proforma with mandatory TEP, to be filled out within 24 hours of patient admission. This updated process will then be reassessed for improved compliance with TEP documentation. We anticipate this will improve early decision making regarding escalation status and facilitate TEP discussions with patients. Overall this process should help ensure a more patient-centered approach to care planning.
EP.TU.426Evaluating the Efficacy of Online Teaching for Neuroscience, Neurology & Neurosurgery
Authors: Ali Yousif , Sheppard Jack , Parvez Ameerah , Vasilica Anca Mihaela , Kurpyte Gabriele
Published: October 2021

Aims

The current climate brought forth by the COVID-19 pandemic has caused considerable changes in academic teaching at the undergraduate and postgraduate level. Online teaching and webinars over video conferencing platforms have become the new standard for delivery of material. Here we evaluate the efficacy of online webinars in the area of Neuroscience, Neurology and Neurosurgery.

Methods

We delivered 10 online webinars across 10 weeks, with one or two speakers, covering a range of topics across the fields of Neuroscience, Neurology and Neurosurgery. Feedback was gathered anonymously using an online feedback form following the event. Results were statistically analysed and significance reported using the Wilcoxon signed-rank test.

Results

Our results show a statistically significant increase in the attendees’ self-reported knowledge on the subject, before and after the webinar (P < 0.0001, n = 117); this represents a 57.3% increase in self-reported knowledge. Our feedback indicated that of all attendees across the 10 webinars, 82.9% rated the event overall “Very Good”, 79.5% were “Very Satisfied” with the organisation of the event, 84.6% with the speaker(s), 76.9% with the content of the event and 82.9% with the format of the webinar.

Conclusions

In summary, our analysis shows that delivering Neurological and Neurosurgical teaching via an online platform is a viable and effective method of delivering knowledge. This finding has significant implications not only in the current response to the COVID-19 pandemic, but also in the future provision of medical education at the undergraduate and postgraduate level.
EP.TU.465Role of CT scan as initial investigation in colorectal rapid access patients
Authors: Athisayaraj T , Bavikatte A , Olugbemi J , Sebastian B , Mishra A
Published: October 2021

Background

We looked into CT colonoscopies and CT abdomen and pelvis which were booked as initial investigation in patients referred via the colorectal rapid access pathway. These tests were directly booked following the referral after a nurse led triage.

As per our colorectal straight to test protocol (STT) any patients over the age of 75 or unfit individuals will have a CT colonoscopy (virtual colonoscopy) instead of colonoscopy. CT trunk was used during COVID pandemic as the initial investigation when the aerosol generating procedures were stopped. CT trunks are also the initial investigation as per the STT protocol when patients are referred with suspected abdominal mass, weight loss or abdominal pain.

Methods

Retrospective analysis of prospective electronic data base of colorectal STT referrals from Feb 2020 to end of October 2020.

Results

Conclusion

CT colonoscopies and CT trunks form part of initial diagnostic tool in the colorectal rapid access patients. They are particularly useful in high risk patients who cannot tolerate colonoscopy. These investigations complement the lower GI endoscopy. These scans also identify non-colorectal malignancies and retroperitoneal pathology such as AAA.CT trunks were useful tools during COVID 19 Pandemic.