bluuebunny/crossref_metadata_2025 huggingface dataset:
WE2.12 Prognostic Factors and Predictive Models in Hot Gallbladder Surgery. Results of a High-Volume Tertiary Centre
Authors: Shabana Amanda , Samra Benjamin , Chetwynd Alan , Nixon Michaela , Tebala Giovanni , Bond-Smith Giles ,   Oxford SEU Juniors
Published: November 2022

Introduction

Gallstone disease is a significant worldwide problem constituting almost one third of emergency general surgery admissions. This study aimed identify the prognostic factors and create statistical models to predict the outcomes of having an emergency laparoscopic cholecystectomy (LC) during the acute symptomatic phase.

Methods

A prospective, cohort study was conducted on all patients that underwent a LC for a hot gallbladder between January 2019 to August 2020. Patients were divided on prognostic variables such as: age, comorbidities and time to operation. The primary outcome measured was suboptimal treatment, defined by: abandoned procedure, conversion to open and subtotal cholecystectomy. Secondary outcomes measured were biliary leak, postoperative morbidity, readmission rate, and length of postoperative stay.

Results

A total of 466 patients were included. A multivariate analysis using a backward stepwise linear regression was used to conduct predictive models based on the significant prognostic factors from a univariant analysis. Approximately 10% of patients had suboptimal treatment predicted by age (p<0.0001) and low albumin (p=0.0034). 17.2% of patients had post-operative morbidity predicted by age (p=0.0201), admission day (p=0.0238), and male gender (p=0.0481). 20.8% of patients were re-admitted, predicted by an ASA >3 (p=0.0096), thin-walled gallbladder (p=0.0491) and greater admission to operation time (p=0.0351). Post-operative length of stay was predicted by age (p=0.0048), low albumin (p=0.0048) and greater admission to operation time (p=0.0169).

Conclusion

Several predictive prognostic factors were found to be related to poor emergency LC outcomes which can be used to inform patients of risks pre-operatively and select patients suitable for a delayed cholecystectomy.
WE3.1 Compliance of Prescription of Intravenous Fluid Resuscitation in Surgical Patients According to NICE Guidelines
Authors: Morsy Hesham , Li Michael , Davidson Chris , Patel Dharti , Ali Maryam , Hollingshead James , Gu Kat
Published: November 2022

Aim

Assess compliance of prescription of for intravenous resuscitation fluids in accordance with NICE Guidelines in the acute surgical admissions population.

Method

We collected data prospectively for surgical patients admitted between 25/02/21–18/03/21 (first cycle) & 12/09/2021–4/10/2021 (2nd cycle). Maximum of 5 patients daily randomly selected. Data collected on wards after clerking on Day 1 of admission. Surgical Proforma was used to identify time of admission, presenting history and co-morbidities of patients. NEWS Charts used to identify observations of patients on admission. Drug charts used to assess volume and types of intravenous fluids prescribed. Admissions by audit authors were excluded to prevent selection bias.

Intervention

Posters in Emergency Assessment Unit and Wards, Teaching to junior doctors, Regular reminder messages to on-call teams.

Results

72 patients included in audit. Prescription of Intravenous resuscitation fluids in Acute Surgical Patients in compliance with NICE guidelines rose from 49% to 69% between cycle 1 and 2, respectively. Correct prescriptions in volume and type of fluid rose from 2% (cycle 1) to 44% (cycle 2).

Conclusions

Almost one third of acute admissions met the criteria for resuscitation IV fluids. In indicated patients, nearly one half of patients were correctly prescribed resuscitation fluids in accordance with guidelines.
WE3.5 Audit of Operative Note Standard: A Retrospective Case Series Over Two Cycles
Authors: Qaoud Yazan , Beattie Kate , Dorovenis Andrew , Williams Orla , Aketch Safari , Dhannoon Amenah , Hill Arnold
Published: November 2022

Aims

Clear, legible, and comprehensive operative notes allow for safe transfer of patient information and form important documentation in medical-legal cases. Compliance with criteria identified by the RCSG for the appropriate documentation of operative notes is variable and often poor. We aimed to audit the operative notes within the breast surgical department in a Dublin hospital.

Methods

A retrospective review of randomly selected operative notes, between December 2020 and September 2021, was conducted. Compliance with RCSG criteria was recorded. A poster and an educational program were delivered to surgical registrars.

Results

A total of 49 op notes were analyzed, majority of which were of elective procedures. There was at least 90% compliance in 10/20 of the RCSG criteria. Presence of signature, name of assistant, name of anesthetist, and operative diagnosis were assessed as 82%, 80%, 71% and 61% compliant, respectively. 88% of Op notes contained the start time only, whereas 51% contained both start and finishing times. Among the criteria with poorest compliance were presence of problems/complications (4%), any extra procedures performed (4%), details of any prosthesis used (2%), elective or emergency procedure (0%) and anticipated blood loss (0%). Additional criteria were assessed including legibility (88% compliance) and use of a diagram (65% compliance).

Conclusion

Our results are consistent with previous similar published work, highlighting the potential for variability in appropriate documentation of surgical procedures. Impact of an educational intervention as well as inclusion of more emergency procedures will be further explored in second cycle of this audit.
WE3.8 Surgical Escape Rooms: A Novel Approach for teaching surgical skills
Authors: Thakkar Rudrik , Wharf Olivia , Hanson Mark , Badenoch Tom , Hunter Ian
Published: November 2022

Aim

Escape rooms are a novel form of a practical teaching and simulation demonstrated to be effective in medical education. We compared the effectiveness of the traditional didactic teaching compared to a novel escape room style teaching of basic surgical skills

Method

A crossover study was delivered to two groups of third year medical students. Each group received either the classroom based teaching or the escape room teaching first, were assessed, then received the remaining style. Each student was asked to complete a questionnaire before the session, then after each teaching session. Teaching covered interrupted suturing, simple wound management and administration of local anaesthesia. Assessment was undertaken with confidence scoring with Likert scales, a 10 questions quiz and 5 minute suturing assessment after each teaching session.

Results

24 third year medical students attended. 100% either agreed or strongly agreed the classroom teaching was useful, compared to 75% for the escape room. 79% either agree or strongly agree that escape room style teaching is a useful adjunct to the traditional teaching. 21% either strongly agree or agree they felt confident about suturing before the session compared to 88%. The average number of correctly answered questions were 8 post teaching sessions, compared to 5 post escape rooms. The mean number of correctly applied sutures were 3 post teaching sessions compared to 2 post escape rooms.

Conclusion

Traditional practical teaching is still the preferred method of teaching and effective form of teaching. Although escape room teaching is a useful adjunct to the traditional classroom based surgical teaching.
WE4.5 Meta-analysis of the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) for inguinal hernia
Authors: Anwer Amal Azhar , Hajibandeh Shahab , Hajibandeh Shahin , Evans Louis , Naguib Nader Naeem , Havard Tim , Helmy Ahmed Hazem
Published: November 2022

Aims

To evaluate the outcomes of Trans Rectus Sheath Extra-Peritoneal Procedure (TREPP) in patients undergoing elective inguinal hernia repair

Methods

In compliance with PRISMA statement standards, electronic databases were searched to identify all studies reporting the outcomes of TREPP in patients undergoing elective inguinal hernia repair. The outcomes of interest included recurrence, chronic pain, haematoma, and wound infection. Proportion meta-analysis model was constructed to quantify the risk of postoperative complications and direct comparison meta-analysis model was constructed to compare the outcomes of TREPP and other open techniques. Random-effects modelling was applied to calculate pooled outcome data.

Results

Seven studies enrolling 1891 patients undergoing TREPP were included. Pooled analyses showed that TREPP was associated with 3.00% (95% CI 1.00–6.00%) risk of recurrence, 3.00% (95% CI 2.00–6.00%) risk of chronic pain, 8.00% (95% CI 0.00–20.00%) risk of haematoma, and 3.00% (95% CI 0.00–6.00%) risk of wound infection. The results remained consistent through subgroup analysis of patients with primary hernias and those with recurrent hernias. Analysis of a limited number of comparative studies showed no difference between TREPP and Lichtenstein technique in terms of recurrence (OR: 1.57, P=0.26) and chronic pain (OR: 1.16, P=0.59).

Conclusions

The best available evidence suggests that TREPP may be a promising technique for elective repair of inguinal hernias as indicated by low risks of recurrence, chronic pain, haematoma, and wound infection. Moreover, there is a lack of comparative evidence on outcomes of TREPP versus other techniques highlighting a need for high quality randomised controlled trials for definite conclusions.
WE4.6 Postoperative muscle atrophy: an overlooked cause of morbidity
Authors: Hardy Edward , Hatt Jacob , Doleman Brett , Phillips Beth , Lund Jon
Published: November 2022

Aims

A significant proportion of patients never fully recover baseline activity levels following major abdominal surgery. Postoperative muscle atrophy may be a major contributing factor to this, but is often overlooked. This study aimed to quantify the degree of muscle loss in patients undergoing routine recovery following major abdominal surgery and in patients admitted to critical care.

Methods

Fifteen patients undergoing major open colorectal resection were recruited. Cross surface area (CSA) and muscle thickness (MT) of a quadriceps muscle, Vastus Lateralis (VL) were measured pre-operatively and on post-operative day (POD) 5 using ultrasound. Knee extension strength was also measured pre-operatively and on POD5 using a handheld dynamometer. A systematic literature review was performed to identify studies reporting muscle loss in patients admitted to an intensive treatment unit (ITU), with pooled means of changes in quadriceps muscle CSA calculated.

Results

By POD 5 VL CSA had decreased by 9.16% (± 2.0), and MT had decreased by 8.14% (± 5.93). Associated with this, knee extensor strength decreased by 19.69% (± 12.91). Systematic review identified 4 studies reporting muscle loss in ITU patients, including a total of 126 patients. Pooled mean of quadriceps CSA in patient admitted to ITU decreased by 13.9% (-12.5% -20.75%) by POD7.

Conclusions

Major abdominal surgery is associated with a significant loss of muscle mass and function. Losses are larger in patients requiring ITU admission. This may have a significant impact on patients’ full recovery to baseline function and further work is required to investigate this.
WE5.10 Death in the early post-operative period: recognising the concept of non-beneficiality in emergency laparotomy and modelling its predictors
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Hare Sarah , Lund Jon N , Tierney Gillian M , Moug Susan J
Published: November 2022

Background

The publication of data from the National Emergency Laparotomy Audit (NELA) has resulted in overall improvement in post-operative mortality rates. However, little is known about the characteristics of patients that die in the immediate post-operative period. These patients may represent a missed opportunity for the consideration of palliation. We describe this specific group of patients where death occurred within three days of emergency laparotomy, and investigate predictors of early mortality.

Methods

All patients enrolled in the NELA database from December 2013–2020 were included. Early post-operative death was defined as all-cause mortality within three days of emergency laparotomy. Multi-level logistic regression was carried out with potentially clinically important predictors defined a priori. Frailty was modelled separately due to missing data.

Results

Four per cent of patients (7,442/180,987) died in the early post-operative period and 85% were admitted to critical care post-operatively. Median NELA risk score was 32.4% compared to 3.8% in the rest of the cohort (p<0.001). One in four patients were commenced on an end-of-life pathway following laparotomy. Significant predictors on multivariate analysis included female sex, increasing age, higher ASA, surgery for intestinal ischaemia or perforation, hypotension, reduced GCS, urgency of surgery, cardiac and respiratory signs (n=178,442). The addition of frailty (n=52,766) was also predictive (OR 1.37; 95% CI 1.22–1.55) when added to the model.

Conclusion

Early post-operative mortality is associated with quantifiable predictable factors in addition to the NELA risk score. This finding has significant implications for the multi-disciplinary team having shared decision-making discussions with extremely high-risk patients.
WE5.12 Stress During Laparoscopic Appendicectomy: A Study into the Measurement of Surgeon's Heart Rate During The Critical Steps of A Laparoscopic Appendicectomy
Authors: Kersey James , Clements Caterina , Bezzaa Sabrina , Jamal Karim , Nehra Dhiren , Lewis Trystan
Published: November 2022

Aims

Heart rate variability (HRV) is a validated marker of physiological stress, a lower HRV indicating increased stress. We aim to evaluate the HRV of an on call surgical registrar during a laparoscopic appendicectomy to determine which step of an operation is most stressful and any attributing factors to trainee stress.

Methods

An observational study was performed using a commercially available chest strap to measure HRV. HRV was recorded on different surgical registrars performing laparoscopic appendicectomy at a DGH. HRV was analysed during four critical steps: insertion of ports, dissection of mesoappendix, endoloop placement and ligation of appendix. Impact of registrar grade and consultant presence were also evaluated.

Results

15 recordings from seven different registrar's (ST3 – ST8) were obtained. Average heart rate was 74–130bpm. HRV was observed to be less during port insertion (9.22) and mesoappendix dissection (8.42) compared to the rest of the operation (9.86) indicating a higher level of stress. Ligation of the appendix showed an increased HRV indicating less stress (9.34). A significant difference was observed between ST3/4 and ST5+ grade for mesoappendix dissection (7.39 and 9.46 respectively), the step associated with most stress (p<0.05 using paired T-test)

Conclusions

HRV is highest during mesoappendix dissection compared to that of the whole operation. HRV increases after this step showing that trainees experience increased stress up to and including this step of the operation. The ST3/4 group showed a significantly lower HRV during this step compared to the ST5+ group. Consultant presence did not significantly affect HRV.
WE6.4 Antimicrobial Stewardship in General Surgery
Authors: Leiberman Christopher , Kizis Georgis
Published: November 2022

Aims

National guidance states that prolonged treatment of gentamicin must be discussed with an infection specialist or microbiology if it is to continue beyond 3 to 4 days. This project aimed to audit gentamicin prescribing in a General Surgical ward, against national guidelines and improve prescribing practice.

Methods

Data was collected prospectively over the course of seven days. General surgical admissions were analysed for any gentamicin therapy received, how many days of treatment were received, and if discussion with a specialist occurred if they received prolonged treatment.

A novel sticker was introduced in patient notes to notify clinicians to review gentamicin therapy where appropriate. Data was re-audited 6 weeks later after interventions were introduced.

Results

Initially, 12 patients were identified as receiving gentamicin. Of these, 5 patients received prolonged treatment, 0 of whom had any formal discussion with a specialist documented.

After interventions were introduced, 12 patients were again identified as receiving gentamicin. Of these, 2 received prolonged treatment, 100% of whom were discussed with a specialist and the decision was made for prolonged treatment in the absence of alternatives.

Conclusions

This small audit identified an area of improvement with regards to the prolonged treatment of gentamicin. A simple intervention proved to be effective and managed to improve prescribing practice by 100%.
WE6.7 Abdominal X-rays in Emergency Department: Assessing compliance with RCR iRefer guidelines in a Tertiary Hospital's Emergency Department
Authors: Nolan Oscar , Anderson Robert , Gall Lewis , Khan Khurram
Published: November 2022

Aims

Attendance of adult patients to the Emergency Department (ED) with acute abdominal symptoms is common. Abdominal X-ray (AXR) is commonly the first line of imaging preformed. Our aim was to audit the indication(s) of AXR against Royal College of Radiologists (RCR) iRefer guidelines.

Methods

A retrospective cohort study of consecutive adult patients who had AXR in the ED of a busy tertiary hospital. The study period was from 1st October 2021 to 30th November 2021. Paediatric patients (< 16 years) and AXR performed out with the ED were excluded from the study. Patient's demographics and the indication for AXR were analysed. The indications were audited against the RCR iRefer AXR guidelines (8th edition, 2017).

Results

A total of 295 patients were included in the study. 171 (58.0%) were female and median age was 64 years (16–96). 170 (57.6%) were performed out of hours. Median time delay from request to AXR preformed was 31 minutes.

The indications for AXR were: perforation/obstruction 78.3%; renal colic/foreign body 6.8%; constipation 4.7%; acute exacerbation of IBD 1.6% and palpable mass 1.0%. Overall, 92.9% of AXR requests were compliant with iRefer guidelines.

Conclusions

The compliance with RCR iRefer guideline is high in ED. However, there is room for improvement and ongoing education for junior doctors and dissemination of the latest RCR iRefer guideline will ensure that high standards are achieved and maintained.
WE7.5 Hand trauma Tetanus Immunisation: a tertiary trauma centre experience
Authors: Labib Amir , Nguyen Nga , Banks Jamie , Moledina Jamil
Published: November 2022

Aims

To evaluate adherence of hand trauma service at a tertiary trauma centre to Public Health of England guidance on tetanus immunisation.

Methods

Prospective data collection of all adult hand trauma injuries between March and June 2021. The first cycle was conducted within the first two weeks of March followed by the introduction of a tetanus immunisation booster flowchart based on the Public Health England guidance. The second cycle was conducted within the first two weeks of June.

Results

Of 435 cases reviewed, 380 patients met the inclusion criteria. 69% of cases were male with a mean age of 40 years. Laceration via a sharp object was the most common mechanism of injury followed by machine-related injury representing 44% and 21% respectively. Soft tissue lacerations were by far the most common injury representing 46% of cases. This is the percentage of unnecessary prescription of tetanus booster doses in patients presented with clean wounds falls from 80% in the first cycle to 17% in the second cycle. This reflected in saving the trust £693 within just the period of the first two weeks of June.

Conclusions

The use of an easy-to-follow chart for tetanus immunisation when dealing with hand trauma patients led to a significant reduction of unnecessary prescriptions and costs.
WE7.6 Failure of intensive monitoring in high grade blunt splenic injury: an important consideration beyond NOM failure
Authors: Lee Sheah Lin , Long Joe , Rizkallah George , Modi Sachin , Elberm Hassan
Published: November 2022

Aims

Non-operative management (NOM), including intensive monitoring (IM) and angioembolisation (AE), is the standard of care for haemodynamically stable patients with blunt splenic injury to preserve spleen and it's function. Internal review of local Level 1 Trauma Center revealed a NOM failure rate of 4.4%, but an IM failure rate of 16.2% in high grade blunt splenic injury (HGBSI). Age, Injury Severity Score (ISS) and moderate to severe injuries are predictors for NOM failure. However, predictors of IM failure, which can be successfully treated with AE, is not well understood, motivating the current study.

Methods

Patients with BSI are identified from Trauma Audit and Research Network (TARN) databse from 2015–2020. Clinical, biochemical and radiological data were collated from TARN database and electronic medical records. HGBSI is defined as AAST grade III to V.

Results

Sixty-eight patients with HGBSI were identified. Seventy-eight percent (n=53) were initially managed with IM, with 21% (n=11) requiring subsequent interventions. Majority who failed IM were involved in road traffic accident compared to other causes (p-value=0.035). In addition, a higher proportion had systole blood pressure<90mmHg (p-value=0.033) and pH<7.2 (p-value=0.038) at presentation. AAST grade, ISS or age did not influence requirement for further intervention. Nine of the eleven patients were treated successfully with AE.

Conclusion

Understanding predictors of IM failure will enable better selection of patients for AE at initial presentation, leading to potential reduction in duration of IM, length of stay and blood transfusion. Preliminary work using machine learning algorithm to predict IM failure with larger dataset is on-going.
WE8.8 Analgesia prescribing in a Surgical Assessment Unit
Authors: Stienstra Roxane , Slevin Zack , Cannings Elizabeth
Published: November 2022

Aim

Efficient analgesia administration is paramount to delivering good patient care and is an important factor in the safe assessment of patients. The aim of this audit was to assess analgesia prescribing and administration in the local Surgical Assessment Unit (SAU) and compare it with the standard of care set out by the Royal College of Emergency Medicine guidelines.

Methods

A retrospective audit was performed. Paper and electronic notes, including electronic prescribing data via HEPMA and pain scores were analysed for all patients referred with abdominal pain to SAU by GP's between the 21st of October and the 30th of October 2021. Data was compared with the RCEM best practice guidelines.

Results

A total of 33 patients were included. 39% of patients had a documented first pain score within 15 minutes of arrival, with a median time of 20 minutes. Of all patients presenting with moderate to severe pain, none received analgesia within 20 minutes. Earliest analgesia administration for this group was 1 hour 42 minutes. Overall median time to first analgesia prescription was 2 hours and 4 minutes and median time to administration was 4 hours and 8 minutes.

Conclusion

Since the COVID pandemic, NHS hospital staff- and bed shortages have put increased pressure on the delivery of safe patient care. This audit has found significant delays in both prescribing and administering analgesia for patients presenting to SAU. An electronic prescribing protocol was developed to increase efficiency in prescribing and another audit will be conducted to assess impact.
WE8.10 Management and outcomes of gallstone disease during the SARS-COV-2 Coronavirus pandemic
Authors: Patel Maitreyi , Chaloupkova Dita , Aguayo Xavier , Sivapragasm Princely , Thomas Joel Joy , Sarwary Haschmatullah
Published: November 2022

Aims

The aim of this study was to compare the patient demographics and management of acute manifestations of gallstone disease during the COVID-19 pandemic with an equivalent period in 2019 and assess the differences in recurrence patterns over the period of first and second wave of the pandemic.

Methods

A retrospective cohort study of all adult patients aged >16 years presenting to the emergency department at a large District General Hospital with symptoms related to gallstones was conducted. Data was obtained from electronic patient records. Primary outcome assessed were incidence and management of gallstone disease while secondary outcome studied included length of Stay, re-admission rate and recurrence. Data was tabulated and analyzed using Excel (Microsoft, 2016 version). Chi square, t-test and One way ANOVA tests were used.

Results

51 patients presented during the period of first wave and 105 patients during second wave as compared to 71 patients in the study period during 2019. The median age of patients during the first wave of COVID was significantly higher than pre COVID and that in second wave. During both the waves of the pandemic, there was a no significant difference in patients presenting with cholecystitis compared with 2019 (47 and 94 versus 60; p value 0.39). There was no significant increase in use of cholecystostomy. There was no significant difference in recurrence and readmissions. Majority of the patients still await surgery.

Conclusion

During the pandemic, older patients with higher comorbidity presented with acute gallstone disease. Conservative management was effective in the management of these patients.
TH1.2 Referral of patients with breast pain to breast clinic: a retrospective analysis
Authors: Dyer Marcus , Gate Tim , Ward Thomas
Published: November 2022

Aims

Previous literature provides evidence that in patients with breast pain and a normal breast examination, the incidence of ipsilateral breast cancer is approximately equivalent to the screening incidence. Isolated breast pain is not an indication for a suspected cancer pathway referral as per NICE guidance. We assessed all breast clinic referrals in one month for use of the appropriate referral pathway for patients with isolated breast pain, and correct primary care management of breast pain.

Methods

GP referral letters and breast clinic letters were analysed retrospectively using an electronic clinical data system for all 173 patients referred to breast clinic in September 2021, of which, 47 patients satisfied eligibility criteria. Letters were assessed for urgency of referral and documentation of GP interventions for breast pain (bra fitting advice, simple oral analgesics and topical NSAIDs).

Results

62% of patients presenting with isolated breast pain were referred under a USC or urgent referral pathway to breast clinic. Only one patient with breast pain as a symptom, had documented evidence of GP interventions for breast pain.

Conclusions

The majority of patients presenting with isolated breast pain were inappropriately referred under urgent pathways, potentially impeding capacity in breast clinic for patients that satisfied USC criteria. There was little evidence of GP interventions for breast pain which could negate need for a clinic appointment or alleviate symptoms in the interim. Further GP education could reduce inappropriate urgent referrals of patients with isolated breast pain and improve breast pain management.
TH1.10 Antithyroid peroxidase antibodies and histopathological outcomes in Egyptian patients subjected to total thyroidectomy for nonmalignant nodular goiter. Retrospective study
Authors: Noureldin Khaled , Salman Mohamed , Issa Mohamed , Badawi Marwa , Bisheet Goerge , Maryosh Sally
Published: November 2022

Introduction

Thyroid is an endocrine gland. It produce T3 and T4 hormones through a series of enzymatic actions. These hormones regulate body metabolism and physiology. Immune disorders in this gland can cause hypo/hyperthyroidism.

Objective

The study aimed to assess antithyroid antibodies in patients with benign thyroid masses and the effect of total thyroidectomy on the antibodies titres.

Patients and Methods

This is a retrospective work of 112 cases managed with total thyroidectomy who have positive antithyroid peroxidase antibodies (TPO-Ab), antithyroglobulin antibodies (Tg-Ab), or both. All patients were euthyroid before surgery. Thyroid function tests and thyroid antibodies levels were measured before and 6 and 12 months after surgery.

Results

Histopathological evaluation revealed Hashimoto thyroiditis (47.3%), colloid nodules (22.3%), and lymphocytic thyroiditis (30.4%). All patients were TPO-Ab positive, while 96 patients (85.7%) were Tg-Ab positive before surgery. There was no considerable change in TPO-Ab and Tg-Ab after surgery (p = 0.817, and p=0.560, respectively). Also, there was no significant difference between the three histopathological diagnoses in the levels of TPO-Ab (p = 0.086) or Tg-Ab (p = 0.673).

Conclusions

Antithyroid antibodies are not valuable markers for diagnosis or prognosis of benign thyroid diseases subjected to total thyroidectomy. We do not recommend their use beyond being a supportive evidence of the possibility of autoimmune nature of the disease if other criteria are confirmed.
TH2.4 Systematic Review on Surgical Management of Difficult Common Bile Duct stones
Authors: Sam Zi Hao , Welsh Silje , Kong ChiaYew , Glen Paul
Published: November 2022

Aims

85–95% of common bile duct stones (CBDS) are successfully managed with endoscopic treatment, but a small proportion of CBDS are difficult to remove. These lead to high morbidity secondary to complications of biliary obstruction. This study aims to appraise existing management options for difficult to retrieve CBDS through systematic review of existing published data.

Methods

Systematic literature search was performed on search engines including MEDLINE, EMBASE, Cochrane library and ClinicalTrials.gov using pre-defined search strategy and pre-registered in International Prospective Register of Systematic Review (PROSPERO). All studies regarding management options, efficacies and/or complications of difficult CBDS managements were included. Definition of difficult to clear CBDS were outlined. Results were independently reviewed, assessed for bias, analysed and reported using Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results

59 studies were included through database search. Various difficult stone characteristics, surgical interventions and study designs were reported. Common bile duct exploration was shown to be the preferred management approach with good stone clearance. Stone clearance rate on CBD exploration and biliary enteric anastomoses were found to be overall above 83% among reviewed studies. Adjunctive strategies, particularly laser lithotripsy, were of additional beneficial value in clearing difficult stones. Overall complication rates were found to be low, and majority did not require significant intervention. However, included data were heterogenous and of high risk of biases.

Conclusion

Current evidence suggests good outcomes from surgical management of difficult choledocholithiasis, but evidence is of heterogenous quality. Further randomised controlled trials are warranted to explore preferable management options.
TH2.5 Evaluation of Radiological and Multimodal Prognostic Models in Discriminating Patients by Overall Survival in a Large Single Centre Cohort of Peri-Hilar Cholangiocarcinoma Patients
Authors: Bird Nicholas , Manu Nichola , Shehata Zak , Fenwick Stephen , Jones Robert , Malik Hassan
Published: November 2022

Aims

Several putative prognostic models have been developed to stratify patients with peri-hilar cholangiocarcinoma (PHC) by Overall Survival (OS). The objective of this study was to evaluate the utility of these models in determining prognosis for all patients presenting to a tertiary referral centre with PHC.

Methods

Three hundred and two patients diagnosed with PHC referred to a regional tertiary referral centre between 2008 and 2019 had their demographic and survival data retrospectively analysed from a prospectively held database linked to Hospital Episode Statistics and Somerset Cancer Registry data. Univariate and multivariate modelling was utilised to determine significant prognostic variables. Concordance indices were constructed for the prognostic models to determine internal validity within the cohort.

Results

Multivariate analysis demonstrated that: pre-interventional ECOG status (p 0.02); bilirubin levels (p 0.001); resectional status (p 0.001) and Mayo Clinic (MC) model (p 0.003) were significant predictors of OS. MC staging system demonstrated utility in stratifying patients by OS in pre-interventional patients with peri-hilar cholangiocarcinoma in all comers (p 0.001) and patients who did not progress to resection (p=0.021). There was strongly significant concordance between pre-intervention MC staging and OS in all comers in this cohort (C-index 0.59).

Conclusions

This study has validated the use of the MC model in a pre-interventional clinic setting. Bilirubin, a standardised easily obtainable serological biomarker, should be considered for incorporation into the MC model to refine patient stratification by OS.
TH2.11 The influence of sarcopenia and systemic inflammation on survival in resected pancreatic cancer
Authors: Bryce Adam , Dreyer Stephan , Chang David
Published: November 2022

Aims

Sarcopenia, cachexia and systemic inflammation are early hallmarks of pancreatic cancer. The impact of these processes on survival has been demonstrated in other cancer types using image-based body composition analysis. We sought to determine the impact of sarcopenia and systemic inflammation on survival in pancreatic cancer.

Methods

A database of patients with pancreatic cancer undergoing resection with curative intent was maintained. Single-slice (L3) skeletal muscle index from pre-operative CT was used to define sarcopenia. Pre-operative systemic inflammation measures were curated (modified Glasgow Prognostic Score and neutrophil-lymphocyte ratio).

Results

176 patients underwent resection. Median post-operative survival was 26.3 months and 95 were sarcopenic (54%). Sarcopenia was not associated with worse survival versus non-sarcopenia (median 24.2 months vs 27.4 months, p = 0.558). mGPS was raised in 52 patients (30%) however this was not associated with worse survival versus normal mGPS (median 26.2 months vs 26.6 months, p = 0.193). Raised NLR did not significantly influence survival.

Conclusions

Pancreatic cancer represents a complex biological process with survival likely influenced by tumour biology and the relationship between tumour epithelium and tumour microenvironment. Survival has previously been shown to be influenced by sarcopenia in all patients with pancreatic cancer, suggesting selection of “fitter” patients for resection in our cohort. Further understanding of tumour biology is needed to determine the relationship between tumour epithelium, tumour microenvironment, cachexia and systemic inflammation. Analysis of this relationship is ongoing and we envisage presenting results of this research in conjunction with this abstract if selected for presentation.
TH5.11 Quality Improvement Project-NELA Assessment of factors influencing the mortality of emergency laparotomy patients
Authors: Narayanasamy Sangara , Naing Zwe , Husain Najam , Eccersley James , Thomas Pradeep
Published: November 2022

Aim

NELA aims to enable the improvement of the quality of care for patients undergoing emergency laparotomy, through the provision of high quality comparative data from all providers of emergency laparotomy

Methods

Conclusions

Factors analyzed are

Recommendations
TH5.12 Impact of Nurse Specialist to Clinical Outcomes after Emergency Laparotomy
Authors: Ng Hwei Jene , Clark Maggie , Moug Susan
Published: November 2022

Aims

The role of the Emergency Laparotomy nurse specialist (EmLapNS) is under-researched. In addition to data collection for ELLSA (Emergency Laparoscopic and Laparotomy Scottish Audit), the EmLapNS may provide: education; ERAS principles (daily chest exercises and early mobilisation); advocacy; multidisciplinary meetings; emotional support. We report on clinical outcomes before and after the appointment of an EmLapNS.

Methods

Retrospective analysis was performed on data collected from one site as part of ELLSA. The data were compared between 6 months of 2017 (pre-EmLapNS) and 6 months of 2021 (post-EmLapNS). The role of ELLSA nurse was explored using key ELLSA clinical outcome markers.

Results

95 patients underwent EmLap in 2017 and 68 in 2021. Comparing pre-EmLapNS vs post-EmLapNS, the median age was 66 vs 61 years, 52.6% vs 45.6% were females and 63.2% vs 60.3% were ASA ≥3. Post-operative chest physiotherapy post op day 1–3 was performed in 8.8% pre-EmLapNS versus 48.4% post-EmLapNS (p<0.05); 30-day morbidity was 52.6% vs 33.8% (p<0.05) and length of stay was 11 days vs 8 days. 30-day mortality and rates of readmission were unchanged (11.6% vs 8.8% and 10.5% vs 11.8% respectively).

Conclusions

The introduction of EmLapNS has significantly improved morbidity and perioperative care. These clinical improvements are likely to be complemented by other aspects of this patient-centred role which require further analysis.
TH6.5 Perioperative group and save testing are not routinely indicated for emergency laparoscopic appendicectomy and laparoscopic hernia repairs
Authors: Reece Ieuan , Shakweh Ealaff , Britton Clemency , Chen Jun Yu , Zafar Norman , Al-Musawi Jasim
Published: November 2022

Introduction

Major haemorrhage is a rare complication of laparoscopic hernia repair and laparoscopic appendicectomy. It is common practice for patients undergoing these procedures to have 2 valid group and saves preoperatively, however perioperative blood transfusions for these patients is seldom required. Obtaining valid samples is not only financially burdensome but frequently leads to delays in theatre lists and patient care. Our unit therefore performed a retrospective cohort analysis to investigate blood transfusions performed perioperatively and within 28 days of laparoscopic appendicectomy and laparoscopic hernia repairs.

Method

We used our electronic records system to collect data of all laparoscopic appendectomies and laparoscopic hernia repairs between March 2017-March 2021. Patients of any age undergoing laparoscopic appendicectomy or laparoscopic hernia repair were included. Patients requiring concomitant intra-abdominal surgery or had incomplete medical records were excluded.

Results

1893 patients were included in the study of which 1464(77.3%) had a laparoscopic appendicectomy vs 429(22.7%) laparoscopic hernia repair. In total 3511 group and saves were taken costing £47,398.50. Only 1 patient (0.068%) required an emergency blood transfusion (4 units of red cells) secondary to major haemorrhage and 2 patients (0.11%) required pre-operative transfusions for anaemia.

Conclusion

Our findings demonstrate that the incidence of perioperative blood transfusions for laparoscopic appendicectomy and laparoscopic hernia repairs is low, challenging the indication for routine preoperative group and saves. Considering our findings, the burden of cost, patient discomfort and theatre delays; we advocate a more nuanced approach to preoperative group and saves, reserving these for patients stratified as high risk.
TH6.10 Rare case of concurrent caecal volvulus and internal herniation through the mesenteric defect following a Roux en Y gastric bypass - Case report and review of the literature
Authors: Samarakoon Lasitha Bhagya , Hopkisson Lucy , Pangeni Annang , Fernandes Roland
Published: November 2022

Introduction

Roux En Y gastric bypass [RYGB] remains the most effective bariatric surgical option to date. Unfortunately, the anatomic alterations caused by the surgery can predispose towards the very rare occurrence of internal herniation through the mesocolic defect created if a retro colic approach is used.

Case presentation

We report a patient who underwent laparoscopic roux en y gastric bypass 3 years ago who presented to our surgical unit with acute abdominal pain and obstipation. On exploratory laparotomy, we noted internal herniation of the entire small bowel and caecum through the mesenteric defect with concomitant volvulus of the caecum around its axis. Fortunately, the bowel was viable after detorsion and after reduction, the mesenteric defect was repaired.

Conclusion

Although internal herniation of the small bowel through the trans mesenteric defect following RYGB has been reported, we believe ours is the first report of caecal and ascending colonic herniation. Secondly, we believe our case is unique in that there was concomitant caecal volvulus in addition to herniation through the trans mesenteric defect. A careful search of the literature did not reveal any similar cases with concurrent internal herniation and volvulus of the right colon following RYGB.

Internal herniation and volvulus of the right colon may rarely occur following RYGB. Symptoms may be nonspecific and classic features of small bowel obstruction such as vomiting and abdominal distension may not be seen. Imaging may be nonspecific. A high index of suspicion and early intervention is essential to prevent morbidity and mortality.
TH7.6 Recurrent Gallstone Ileus: A Case Report
Authors: White Annabelle , Shepherd Joanna , Al-Robaie Basim
Published: November 2022

Introduction

Gallstone Ileus (GSI) is a rare cause of mechanical bowel obstruction secondary to impaction of an ectopic gallstone within the bowel lumen. Recurrent GSI is rare, accounting for less than 3% of SBO. The main risk factors for recurrence include a large choleduodenal fistula, an active fistula or faceted gallstones.

There is currently no mainstay approach to managing GSI, with “single-stage” and “two-stage” options advocated.

Case

A 73-year-old lady presented with epigastric pain and vomiting, and was shown to have an obstructing gallstone in the distal ileum. She underwent a laparotomy and enterolithotomy and initially made a good recovery. However, she represented three months later with similar symptoms and was found to have a jejunal gallstone causing proximal small bowel obstruction. She underwent a second enterolithotomy, and is planned for an interval cholecystectomy.

Discussion

The management of recurrent GSI include one of three options: enterolithotomy alone, “single-stage” (enterolithotomy, cholecystectomy and fistula repair) or “two-stage” approach (enterolithotomy and interval cholecystectomy). The optimal approach in management is still debated. The traditionally taught two-stage approach demonstrates a lower mortality and recurrence rate and shorter index procedure in the unstable patient, requiring a skillset common to most general surgeons. However, with increasing reports of recurrent GSI, a single-stage approach during the index procedure has been advocated, citing decreased risk of cholecystitis, cholangitis and repeat laparotomy in the event of recurrence. Our patient underwent emergency enterolithotomy on both presentations, however there may support for a “single-step” approach in certain patient cohorts.
TH7.7 Pre-operative Coagulation Screening in General Surgery
Authors: Yomi-Orungbe Esther , Fazili Noureen
Published: November 2022

Aim

Routine preoperative coagulation screening is considered standard practice to predict peri-operative bleeding. However, according to British Society of Haematology, indiscriminate coagulation screening is not recommended as it may to inappropriate delay of surgery, lead to further unnecessary tests and is also associated with significant costs. Instead, they recommend detailed bleeding history, including family history and use of medications.

Methodology

A retrospective audit of 148 post-operative patients in Northwick Park Hospital admitted under the General Surgical who presented to Surgical Assessment Unit between 01.04.2021 to 14.05.2021 at the initial audit and between 20.09.2021 to 07.10.2021 at the re-audit.

Results

The initial audit was done over a 6 week period with 98 cases selected. 19% of them had appropriate requests with 81% of the tests done being inappropriate. There was significant improvement by the re-audit with appropriate requests increasing to 56% and inappropriate tests dropping at 44%. The criteria for appropriate were: a) Not requested as no significant medical history. b) Requested as clinically indicated. With each coagulation screening costing an average of £29.42, an overall estimate of £2971.42 was expended in inappropriate requests

Conclusion

All patients had relevant blood requests and PMH were documented but many inappropriate requests were made. It was recommended that instead of indiscriminate coagulation testing, a thorough history was advised to determine appropriate testing. There was a marked improvement at the re-audit with more appropriate requests being made.

Recommendations
TH8.4 The potential for day case total parathyroidectomy in patients with secondary hyperparathyroidism
Authors: McDonald Sophie , Al-Saadi Nina , Chang Jessica , Neophytou Christodolous , Houghton Andrew
Published: November 2022

Aims

Hypocalcaemia is a common complication after parathyroidectomy for secondary hyperparathyroidism (SHPT) and is often the cause of a prolonged hospital stay post operatively. Although there is no current guidance on targets for total parathyroidectomy for SHPT, current guidance recommends a day-case rate of 90% for patients undergoing surgery for primary hyperparathyroidism.

Our centre has developed a safe protocol which allows us to perform total parathyroidectomies as a day-case procedure in patients with SHPT. This protocol, developed in conjunction with the renal physicians, involves giving the patients alpha calcidol pre-operatively for 5 days, to minimise the incidence of hypocalcaemia, and close monitoring of the calcium levels post operatively, to permit safe discharge.

Methods

We carried out a single centre retrospective study on all patients who underwent a total parathyroidectomy for SHPT between February 2005 and May 2021. All the patients received the alpha calcidol regimen pre-operatively. Data on patient baseline characteristics, peri-operative calcium, potassium and PTH levels, length of hospital stay, operative procedure details, hospital readmission and 30-day morbidity were collected.

Results

49 patients underwent a total parathyroidectomy during the study period. 67% of patients were discharged on day 0 or on day 1 post-operatively. 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 patients required readmission during the 30-day post-operative period.

Conclusion

Day-case surgery for SHPT can be achieved safely with a pre-operative regimen of alpha calcidol and close monitoring of calcium levels post-operatively.