bluuebunny/crossref_metadata_2025 huggingface dataset:
WP6.14 - Automated analysis of operative video in surgical training: Scoping review
Authors: Dick Lachlan , Boyle Connor , Skipworth Richard J E , Smink Douglas S , Tallentire Victoria Ruth , Yule Steven
Published: September 2024

Aims

There is an increasing availability of operative video for use in surgical training. Emerging technologies can now assess video footage and automatically generate metrics that could be harnessed to improve the assessment of operative performance. This scoping review explores the current application of automated video analytics in surgical training.

Methods

PubMed, Scopus, Web of Science and the Cochrane database were searched to identify studies which applied automated video analytics to trainee-performed operations. Search terms included ‘trainee’, ‘video analytics’ and ‘education’. Two reviewers independently screened and extracted data on the methods of analysis, metrics generated and application to training. The Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Review (PRISMA-ScR) guidelines were followed.

Results

Thirteen studies were identified. Computer vision tracking was the most common method of video analysis. Metrics were generated for processes (e.g. movement of instruments) and outcomes (e.g. intraoperative phase duration). Two studies generated metrics to assess critical safety elements (e.g. critical view of safety in laparoscopic cholecystectomy). Automated metrics were able to differentiate between different skill levels (e.g. consultant vs. trainee) and correlated with traditional methods of assessment. There was a lack of longitudinal application to training and only one qualitative study reported the experience of trainees using automated video analytics.

Conclusion

Automated video analytics is an emerging field which provides an objective assessment of operative performance. Gathering evidence to demonstrate the impact of long-term use on training outcomes is a priority for future research.
WP7.1 - MRI for suspected acute appendicitis in pregnant females: What is the best imaging modality?
Authors: Davies Brooke , Day Nicholas , Aiynattu Sony , Guy Richard
Published: September 2024

Introduction/Aims

Acute appendicitis (AA) in pregnancy is the commonest non-obstetric cause of acute abdominal pain, but controversy surrounds the most appropriate imaging modality in this group. Ultrasound (USS) and Magnetic Resonance Imaging (MRI) have no known fetal risks. Hence, The World Society of Emergency Surgeons (WSES) recommends MRI in pregnant patients with suspected appendicitis, if available, but emphasises the preferred initial use of USS. This project explored the use of both imaging modalities in pregnant patients with suspected AA.

Method

Data was collected for all pregnant patients undergoing an MRI for suspected AA between 2015 and 2023.

Results

Of the 29 patients identified, the mean gestation was 23 weeks (range 2-36), and over half (15, 52%) of MRI scans were performed in 2022/3. Intra-abdominal pathology was seen in 17 (59%) patients, with 8 (47%) having MRI features of AA. 63% of those diagnosed with AA had an USS pre-MRI, and 40% identified the appendix as "normal." Other intra-abdominal pathologies picked up on MRI included pyelonephritis(1), small bowel obstruction(1), stercoral perforation(1), and ovarian torsion(2). Of the 8 patients with MRI-proven AA, all underwent appendicectomy: 3 laparoscopic, 2 open, and 3 with simultaneous Caesarean section, of whom 2 required ileocaecal resection.

Conclusions

Diagnosis of abdominal pain in pregnancy is a challenge. USS may be reasonably sensitive and specific in dedicated hands, but pathology may still be missed. In this patient group, for which appendicectomy for AA is associated with better outcomes than non-operative management, MRI should be obtained for accurate diagnosis.
WP7.15 - Surgical dogma… Why change?
Authors: Massie Eleanor , Robb Katie , Moug Susan
Published: September 2024

Aims

Surgical dogma still persists today despite up-to-date evidence. Implementation of evidence into clinical practice takes on average 17 years. Acute appendicitis is typically managed with surgery, despite evidence recommending a non-operative, antibiotic-only strategy as an appropriate first line treatment in uncomplicated cases. This study investigates barriers to, and facilitators of, changing practice with regards to management of acute appendicitis.

Methods

Surgeons involved in emergency general surgery in U.K. hospitals were invited to participate in online/telephone semi-structured interviews. Thematic analysis based on the theoretical domains framework was used to develop belief statements.

Results

16 interviews were conducted to achieve data saturation. 8 consultant surgeons, 8 surgical trainees from secondary and tertiary centres participated. Numerous barriers and facilitators were identified. There is a lack of awareness of current research with variable interpretation of evidence and its practical applications. There were concerns regarding loss of training opportunities in a “benchmark” procedure; failure of treatment and subsequent complications; missed malignancy and cost implications. Surgeons identified a reluctance to change from long standing practice and recognised their communication may skew patients’ decision making. Decision making practice varied from paternalistic to shared/supported. Surgeons believe they undertake a fully informed consent process, despite some not offering non-operative management as an alternative treatment.

Conclusions

Numerous barriers and facilitators exist to implementing change and are often based on surgeons’ personal experiences rather than evidence. The identified factors will be used to develop an implementation strategy to drive evidence-based practice and may be transferable to other surgical conditions.
WP7.17 - Routine Use of Validated Risk Prediction Model in the Management of Acute Appendicitis in a District General Hospital
Authors: Bowry Malika , Muthiah Akash , Francis Louise , Rahman Atiqur , Al-Khusheh Moutaz
Published: September 2024

Aim

Acute appendicitis is the most common general surgery emergency in the UK. Currently, there is no optimal diagnostic pathway for managing the right iliac fossa (RIF) pain. The right iliac fossa pain treatment (RIFT) study group has previously performed an analysis of different risk prediction models to search for the most specific one and made a website (appy-risk.org) to calculate risk scores on presentation. We aimed to look into our practice in a DGH and see how compliant we are in documenting risk scores on presentation with acute RIF pain.

Method

A list of patients presenting with acute RIF pain to the surgical assessment unit in September was prepared. Admission clerking notes were reviewed from the electronic patient record to look for the documentation of the appendicitis risk score. Standard statistical packages were used for data analysis.

Results

A total of 95 patients were presented with RIF pain. Of them, 17 were excluded from the analysis for being over 45 years old. Of the remaining 78 patients' records, only 7 (8.97%) had appendicitis risk scores documented in the clerking notes.

Conclusions

The RIFT study highlighted a high normal appendicectomy rate (NAR) in the UK in comparison to other European countries. In our hospital, NAR was 9.74% in the first six months of 2023. We are in the process of implementing a pathway to manage acute RIF pain using a risk prediction model as advised by the RIFT group to reduce our NAR to less than 5%.
WP8.1 - Perceptions of Higher General Surgical Trainees and Trainers towards Multidisciplinary Team assessment: A deanery’s experience of the new General Surgical curriculum
Authors: Johnston Judith , Quinton Naomi
Published: September 2024

Aims

Explore how multidisciplinary team (MDT) working is assessed as a capability in practice (CiP).

Understand perceptions of problems with assessment of MDT as a CiP.

Methods

Semi-structured interviews were conducted virtually with 8 Higher Surgical Trainees (HST) and 4 Trainers following recruitment within a single deanery. Interviews were transcribed and analysed using reflexive thematic analysis. Ethical approval was granted.

Results

Most participants did not feel that they engaged meaningful with assessment of MDT as a CiP. Despite forming part of the Multi-Consultant Report (MCR), 75% of trainers were unaware of any formal assessment and expressed confusion over the introduction of the new curriculum. All participants reported that they felt MDT as a CiP was most appropriate for senior HST, particularly those peri-FRCS. HST felt excluded from the MDT process while trainers felt trainees did not engage. Trainees placed more value on MDT assessment in their declared subspeciality. All interviewed expressed that other activities were prioritised above MDT, particularly operating. When assessed, participants felt it was based on a balance of knowledge, presentation and preparation. Both HST and trainers felt participation rather than attendance was vital but currently not practiced. When considering grading of assessment, there was confusion from all participants in how to differentiate Level3 (Indirect Supervision) from Level4 (Day1 consultant), particularly in the context of multiple trainers in attendance.

Conclusion

Implementation of MDT as CiP has caused confusion among HST and trainers. It is poorly used and valued. The CiP is perceived as more beneficial to senior HST.
WP8.2 - Human Factors Analysis of CORESS cases using the NOTSS Framework
Authors: McLennan Elizabeth , Wohlgemut Jared , Okocha Michael , Corbett Harriet
Published: September 2024

Aims

Determine human factors implicated in cases submitted to the Confidential Reporting System in Surgery (CORESS), using the non-technical skills for surgeons (NOTSS) framework.

Methods

Consecutive cases submitted to CORESS, between 2005 and 2011 were evaluated as an interim analysis. The type of case, whether patient harm occurred, Clavien-Dindo (CD) classification, and the location of the incident were collected. Demographic data was not collected because they are often changed to protect patient identification. Each case was reviewed according to the non-technical skills for surgeons (NOTSS) taxonomy.

Results

There were 100 cases included in this interim analysis. The most common types of cases were delayed diagnosis (n=19), known complications (n=10), near misses (n=10), poor surgical technique (n=9), misuse of equipment/device (n=8), and wrong site surgery (n=5). Two-thirds of patients were harmed, with complications ranging from minor to life-threatening (9 CD I, 10 CD II, 32 CD III, 12 CD IV), and 4 resulting in death (CD V). Incidents occurred most frequently in the operating theatre (n=54), the ward (n=16), or the emergency department (n=9). There were 71 incidents that endangered patient safety related to deficiencies in situational awareness, 59 to poor communication and teamwork, 48 to poor decision-making, and 48 related to leadership failures.

Conclusions

The main human factors implicated in surgical patient safety incidents related to errors in situational awareness, communication and teamwork, and to a lesser extent, decision-making, and leadership. Efforts to prevent medical errors should be focused on clinician human factors training.
WP8.4 - A closed-loop audit on the use of abbreviations in consent forms in the digestive disease department at a tertiary care centre
Authors: Singh Anurag , Gulab Adil , Bhaskaran Premjithlal , Toh Wei , Elzahed Nada , Sajid Muhammad
Published: September 2024

Background

Consent forms can be misinterpreted due to the use of abbreviations and also in a court of law as a medico-legal document We performed this closed-loop audit to identify and improve the quality of medical consenting in this department.

Method

A prospective collection of data was done from July – Aug 2023 for the first cycle and Oct- November 2023 for the second cycle. 180 (100 surgical and 80 endoscopy) consent forms were analysed in the first cycle and 100 (50 surgical and 50 endoscopy) consent forms in the second cycle. Interventions in the form of posters, teaching sessions and discussions in the clinical governance meeting were used to improve the practice.

Results

In the first cycle, 99% of the surgery and 76 % of the endoscopy had abbreviations. The majority of abbreviations used were in the “risk” subsection (85% in surgical and 86 % in endoscopy) and in the title section (75% in surgical and 86 % in endoscopy).

In the second cycle, 56% of the surgery and 4 % of the endoscopy had abbreviations. The majority of abbreviations used were in the “risk” subsection (42% in surgical and 78 % in endoscopy) and in the title section (38% in surgical and 66 % in endoscopy).

Conclusion

There was a significant drop in the use of abbreviations after the intervention. There were a few biases during the audit including unequal distribution of the consenting doctor. We are planning to improve this figure further by emphasising the importance of consent forms in the induction program of new juniors in the department.
ThP1.14 - A Review of The Implication of Botulinum Toxin Type-A in Breast Surgery
Authors: Lim Jun Sing , Cui Xiangmei , Wai Jasmine , Mosahebi Afshin
Published: September 2024

Background

Breast cancer is a common form of cancer in women, with 28% newly diagnosed in the UK in 2020. Botulinum toxin A (BONT-A), first used for strabismus treatment, could be used in breast surgery to address postoperative complications. This study aims to investigate the efficacy of the implementation of BONT-A on various breast surgeries.

Method

A systematic literature review was conducted with 57 studies identified, including 6 RCTs, 1 retrospective chart review, and 1 case report. Data extraction and analysis were done using PRISMA, ROBVIS, and GRADE, including improvements in post-operative pain and upper limb impairments, capsular contracture, and scar minimization.

Results

The studies involved 347 patients and examined the role of BONT-A in breast reconstruction. Studies reported no clinically significant change in pain intensity up to 6 months from a single administration of BoNT-A (mean 13/100; 95% CI, -4 to 31). Studies showed that after 9 months of 100U intradermal injection, there is improved scar development (15.17±7.6 vs. 13.04±5.44, p=0.034 on the POSAS scale), were smoother (37.46±7.51 vs. 56.77±32.03, p=0.003 at 9 months), with reduced width (p<0.001), reduced early post-operative formation (9 vs. 6 P=0.001 on VSS), and improved capsular contractures. There have been no major adverse events reported across all studies.

Conclusion

BoNT-A may reduce scar formation but lacks evidence for managing postoperative complications, requiring further RCT and observational studies.
ThP2.3 - Fluorescein Sodium - An Alternative to Methylene Blue In Detecting Sentinel Axillary Lymph Node In Carcinoma Breast
Authors: Manjunath Vedanth , Nadipanna Sreeramulu Patarapalli , Sreeramulu Pradhay
Published: September 2024

Aim

To ascertain the validity of fluorescein sodium in the identification of SLN in patients with Breast carcinoma.

Material and Methods

A Prospective Observational study was conducted among 30 patients with carcinoma breast aged >18 years with no clinically identifiable axillary lymph nodes at the Department of General Surgery at a single centre, in rural India over period of 2 year. Institutional Ethical clearance was obtained prior to the start of the study and Informed consent was obtained from all the patients recruited

Results

Mean age was 53.13 ± 14.180 years. The majority of subjects were in the age group 51 to 60 years (26.7%). 20% were in stage T2N0M0, 30% were in T3N0M0 and 50% were in T4BN0M0. on HPE 86.7% had Infiltrating Ductal Ca, 10% had Lobular Ca and 3.3% had Squamous Cell Ca. Fluorescein Dye staining had a sensitivity of 84.21%, specificity was 30.99%, Positive Predictive Value was 39.51%, Negative Predictive Value was 78.57% and Diagnostic Accuracy was 49.54% in comparison with HPE. Methylene Blue staining had a sensitivity of 44.74%, specificity was 35.21%, Positive Predictive Value was 26.98%, Negative Predictive Value was 54.35% and Diagnostic Accuracy was 38.53% in comparison with HPE.

Conclusion

From the study findings it can be concluded that the detection of SLNs using fluorescein was high compared to methylene blue, both methods were feasible and safe in patients with breast carcinoma. Fluorescein dye had better validity in the diagnosis of Sentinel lymph node compared to Methylene blue in the Carcinoma of the breast.
ThP2.4 - Unveiling the Odds: Identifying the Axillary Recurrence rates in Invasive Breast Cancer Surgery in a district general hospital - Seventeen years of Surgical Performance decoded
Authors: Ravindran Sharanya , Kryjak Zigniew , Glassman Daniel
Published: September 2024

Introduction

Axillary recurrence should be minimised by effective staging and treatment where appropriate Minimum standard <5% axillary recurrence at 5 years Target <3% axillary recurrence at 5 years according to UK ABS guidelines.

Methods

All patients with primary cancer diagnosed at our institution between January 2004 and December 2020 were identified from a prospectively maintained database of operations obtained from the medical coding department. Demographics of the patients, pre-operative investigations, MDT discussion outcomes, operative details (and complications), post-operative pathology, neo-adjuvant and adjuvant therapy regimens and follow-up data were recorded. All patients were followed up to the censoring date of December 2021 which gave a median follow-up of 18 months (range, 12- 204).

Axillary recurrence and treatment regimens were recorded. Primary outcome measures were overall axillary recurrence and disease-free. IBM SPSS Statistics (Version 26.0 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis to determine patient and pre-operative pathological characteristics that were predictive of isolated axillary recurrence after completion of the primary treatment course. Significance was defined as P<0.05.

Results

There were 4024 women diagnosed with breast cancer in Midyorks trust between this period who were referred and had surgical intervention.

Of these, 107 patients were identified with recurrences.

12 were found to have an isolated axillary recurrence (8 ANC 4 SLNB)

Conclusion

The 17-year isolated axillary recurrence rate of women treated was 0.3%.

Multimodality management at the time of recurrence, including axillary surgery, radiation, and systemic therapy, significantly improved the morbidity
ThP2.10 - Echocardiographic changes of left ventricular function in coronary artery bypass graft patients - A prospective study with meta-analysis
Authors: Bhaskaran India Premjithlal , Bhaskaran Premjithlal , Aslam Mohammed
Published: September 2024

Coronary artery bypass graft (CABG) improves left ventricular function and reverses adverse remodelling. This has resulted in improved survival rates and decreased the incidence of cardiac events.

Systematic review identified the Echocardiographic (ECHO) indices followed by CABG from the published data. The second part of this study compares the ECHO index of the patients, who had CABG.

Results

Overall, 191 citations were identified from the initial search, of which 43 studies were retrieved. Later, 8 studies included in the review and 6 were subjected to meta-analysis. There was a change in E/A Ratio (MD = -0.33; 95% CI = -0.42 to -0.25), Peak A-Wave (MD = 0.57; 95% C.I = 0.20 to 0.94), and E/E’ Ratio (MD = -3.80; 95% CI = -4.87 to -2.73), Peak E-Wave (MD = 0.26; 95% CI = -0.08 to 0.60), Left ventricular ejection fraction (LVEF) (MD = -0.43; 95% CI = -1.79 to 0.93), diastolic dimension (MD = 0.12; 95% CI = -0.00 to 0.23). However, There was no change in systolic dimension (MD = 0.10; 95% CI = -0.04 to 0.24) among CABG cases. The prospective study includes 30 CABG cases. Of these, 23 (76.7%) males and 7 (23.3%) females with mean age was 62.12 + 8.16. There was a change (p <0.05) LVEF, peak systolic gradient (PSG) from pre operative to six months after CABG.

Conclusion

In spite the changes in E/A Ratio, Peak A-Wave, E/E’ Ratio, LVEF and PSG are the most important echocardiographic indices associated with CABG.
ThP3.13 - Impact of gastrojejunostomy anastomosis diameter on weight loss following laparoscopic gastric bypass: a systematic review
Authors: Al-Fagih Othman , Zuberi Sharukh , Iqbal Fahad , Askari Alan , Munasinghe Aruna , Al-Taan Omer
Published: September 2024

Introduction

Laparoscopic Roux-en-Y Gastric Bypass (RYGB) is a preeminent procedure for achieving significant weight reduction and alleviating obesity-related comorbidities. However, the influence of gastrojejunostomy (GJ) anastomosis diameter on weight loss is not well-elucidated. This review examines the effect of GJ diameter on post-RYGB weight loss outcomes.

Methods

A meticulous systematic search of the literature, limited to English-language publications, was executed with the assistance of an expert librarian. The search encompassed all studies available up to 3 August 2023, the date of the last search. Study quality was evaluated utilizing the Newcastle-Ottawa Scale. Due to the heterogeneity of the outcomes, a narrative synthesis approach was adopted.

Results

From 1,026 records screened, 6 studies met the inclusion criteria, demonstrating a range of GJ diameters and follow-up durations (1-5 years). Generally, smaller GJ diameters were associated with more significant weight loss in the short to medium term. There appears to be a threshold for the reduction in diameter; beyond this, the risk of complications such as stenosis may escalate. The studies indicated a moderate to low risk of bias and underscored the importance of accurate GJ area quantification post-operation.

Conclusion

This review identifies a negative correlation between smaller GJ diameters and weight loss after RYGB. Future investigations should prioritize the standardization of measurement techniques and investigate the potential of intra-operative and artificial intelligence-based methodologies for optimal GJ diameter determination, with the aim of augmenting patient outcomes in bariatric surgery.
ThP4.6 - Diagnostic Implications of Extra-biliary Revelations in Magnetic Resonance Cholangiopancreatography (MRCP) Imaging: Expanding Clinical Insights
Authors: Tan Chin K , Wong Mei K , Ng Shou K , Stevenson Carla , Khan Khurram S
Published: September 2024

Aim

Magnetic Resonance Cholangiopancreatography (MRCP) is increasingly utilised to assess the biliary tree. The primary aim of this study was to assess the prevalence of extra-biliary findings on MRCPs. Secondary aim was to assess the need for subsequent investigations and subsequent outcomes.

Methods

This was a retrospective cohort study of consecutive MRCPs performed on adult patients in a single centre from November 2020 to September 2022. Patient demographics, indication(s) for MRCP, MRCP results including extra-biliary findings and subsequent investigations and outcomes were analysed from electronic case notes.

Results

1,016 MRCPs were included in this study; 616 (60.6%) were for female patients and median age was 64 years (IQR 50-75). 652 (64.2%) were inpatient and 418 (41.1%) were urgent. 592 (58.3%) had at least one extra-biliary finding and 96 (9.5%) required urgent follow-up investigations with 26 (2.6%) new diagnoses of malignancy.

213 (21%) had renal cysts, 18 (11.6%) had hepatic cysts, 69 (6.8%) had pancreatic cysts, 28 (2.8%) had liver cirrhosis, 23 (2.3%) had peripancreatic collection(s), 42 (4.1%) had a hiatus hernia, 79 (7.8%) had pleural effusion(s), 46 (4.5%) had splenomegaly and 2.6% (n=26) had identified diverticular disease.

Conclusions

More than half of the MRCPs conducted revealed at least one extra-biliary finding. Within the findings that required urgent investigations, more than 25% had newly diagnosed malignancy. This emphasises the high sensitivity of MRCPs extends beyond biliary pathologies and can be used in diagnosing extra-biliary pathology. We suggest a structured proforma should be used by clinical radiologists for reporting MRCPs.
ThP5.4 - Which Resection for Distal Cholangiocarcinoma?: Retrospective Study
Authors: Lamara Abdelhak , Nini Badreddine
Published: September 2024

Introduction

The treatment of distal cholangiocarcinoma (DCC) is contingent upon the patient's condition and the local and lymphatic extent of the disease. Surgery remains the sole radical treatment, albeit infrequently feasible and often followed by biliary drainage. The surgical procedure involves resecting the bile duct with healthy distal and proximal margins, accompanied by lymphadenectomy. Cephalic pancreatectomy (DPC) is deemed the optimal oncological treatment for DCC.

Method

This retrospective study encompasses cancers of the main bile duct. Various factors influencing treatment were analyzed, focusing on the type of resection (biliary and pancreatic).

Results

From January 2014 to December 2021, 119 patients were treated for distal cholangiocarcinoma (88 men, 31 women, average age: 61 years). Twenty-one patients underwent endoscopic drainage, 17 transhepatic drainage, and 55 surgical interventions. Among them, 9 underwent preoperative drainage, 28 radical resection, 10 DPC, 18 biliary resections, and one total pancreatectomy. In 27 patients, radical surgery was impossible; 20 underwent drainage, and 7 did not. Three early surgical revisions in the biliary resection group, with incidents of digestive hemorrhage and hemoperitoneum. Two moderate pancreatic fistulas and immediate postoperative hypoglycemia were recorded. Two deaths in the biliary resection group and 7 in-hospital deaths in the biliary drainage group. All patients with external drainage died before 12 months, while 8 patients from the endoscopic drainage group survived after 12 months. Patients with radical surgery and adjuvant treatment exhibited longer survivals (36 months vs. 45 months).

Conclusion

Improving the prognosis of DCC requires early diagnosis and radical surgery combined with adjuvant treatment.
ThP5.10 - Post ERCP Pancreatitis at a Tertiary Center - A Retrospective Incidence and Causal Analysis
Authors: Jain Shubham , Orabi Amira , Davis George Neelankavil , Anderson Sarah , Mekhail Peter
Published: September 2024

Background

Incidence of Post Endoscopic Retrograde Cholangio-Pancreatography (ERCP) Pancreatitis (PEP) varies between 3.5% and 9.7% as per the 2014 meta-analyses. Our aim was to evaluate the incidence, perform a causal analysis and gauge the financial implications of PEP in our hospital for general surgical patients to help optimise the utilisation of resources.

Methods

All General Surgical patients who had ERCP between 01/10/2022 and 31/03/2023 were included in the analysis. A successful ERCP was defined as cannulation of the biliary tree. The digital patient records were analysed and collected onto a master datasheet. They were divided into PEP and non-PEP groups.

Results

A total of 131/155 attempted ERCPs were successful. Of these 131, 13 (9.92%) developed PEP. Females were predominantly affected. Three out of six patients (50%) undergoing ERCP for malignant biliary obstructions developed PEP. Elective ERCPs (15% vs 6.5%) and higher mean bilirubin levels >= 134.92 µmol/L posed a greater risk of developing PEP (p-value=0.021). The mean hospital stay was 3.5 days longer (2-49 days) in the PEP group. The total extra cost to the NHS ranged from £20,475 - £35,763 over 6 months.

Conclusion

Patients with gallstone disease should receive prompt cholecystectomy in adherence to NICE guidelines to reduce the risk of gallstone-related problems and ERCP need. This in turn would lead to a reduction in PEP and positively affect the financial implications on the NHS. We also recommend a randomised control trial for patients with grossly deranged liver function tests to compare ERCP with laparoscopic cholecystectomy and common bile duct explorations combined.
ThP7.1 - The effect of socioeconomic status on outcomes in major trauma: a systematic review and meta-analysis
Authors: Koh Amanda , Adiamah Alfred , Melia Georgia , Blackburn Lauren , Brooks Adam
Published: September 2024

Background

Major trauma poses a significant public health concern, with survivors often suffering long-term disability. There is growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma in recent years. Anecdotal evidence suggests that social deprivation leads to more violent and debilitating injuries. There remains, however, a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation.

Methods

A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed to identify eligible studies from 1947 to March 2024. The primary outcome is to establish the proportion of patients with the highest socioeconomic deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random effects model.

Results

Fourteen studies reporting on 878,872 major trauma patients were included. A substantial proportion of major trauma incidents occurred in the most deprived group at 28%. There were more male patients in the most deprived compared to the least deprived group (OR 1.36, 95% CI 1.14-1.63, I2=99%). There were no differences in surgical intervention (OR 1.74, 95% CI 0.97-3.13, I2=0%) and length of stay (WMD 1.15 days, 95% CI -0.32-2.62, I2=82%) regardless of background. Interestingly, mortality was higher in the most deprived group (OR 2.02, 95% CI 1.14-3.57, I2=80%).

Conclusion

Major trauma is more prevalent in deprived areas. Although rates of surgery and length of stay did not differ, mortality is higher in the most deprived group. The planning of public health interventions should target areas of higher deprivation.
ThP7.8 - What is the gap in operative trauma surgical skills needed for humanitarian and military deployment? A systematic narrative review of surgeons in high-income countries
Authors: Sertedakis Dimitrios Bousoulas , Griffin Damian
Published: September 2024

Aims

The incidence of armed conflict, terrorist attacks and environmental disaster is increasing and death from traumatic injury remains a leading cause of mortality globally, posing complex challenges in surgical care. Despite advancements in trauma systems development, practice in high-income countries (HICs) is characterised by low trauma volumes, evolving non-operative strategies and increasing sub-specialisation, raising concerns about surgical preparedness for managing diverse injuries. This systematic review aims to assess the operative trauma skills of surgeons in HICs mapped against core military and humanitarian procedures. Examination of the breadth of skills acquired and identification of areas where further experience is required will inform the development of more comprehensive and adaptable surgical training programs.

Methods

A systematic literature review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE and EMBASE. Inclusion criteria targeted general and trauma surgery consultants or trainees in HICs, analysing quantitative and qualitative data on operative workload and skills acquisition.

Results

Twelve studies from the USA, UK, Netherlands, Ireland, Australia, and New Zealand were included. Trainees demonstrated experience in general surgical trauma but lack exposure to critical skills in orthopaedic, vascular and obstetric and gynaecological surgery.

Conclusion

This review highlights a gap in the operative trauma surgical skills of surgeons in HICs and the need for re-evaluation of surgical training curricula to address the dynamic challenges posed by contemporary trauma care. Emphasising a versatile skillset and exploring avenues for enhanced exposure through didactic courses and global surgery partnerships might prove crucial for better preparing surgeons for the diverse and demanding scenarios in the field of trauma care
ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital
Authors: Govind Garima , Jayasankar Balaji , Di Franco Filippo
Published: September 2024

Aims

The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail.

Methods

we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA.

Results

A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65.

Conclusions

we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.
ThP8.1 - Long-Term Impact of COVID-19 related disruption of NHS Elective services on Emergency Major Lower Limb Amputations
Authors: Jain Shubham , Choi Jean Yu , Cooper Benjamin , Renwick Bryce , Mohamed Mirghani M , Makris Sotirios
Published: September 2024

Background

The COVID-19 pandemic has affected the healthcare systems worldwide since the dawn of 2020. In March 2020, the United Kingdom government announced the first national lockdown which severely disturbed all NHS healthcare elective services. Our aim is to assess the long-term impact of COVID-19 related disruption of NHS elective services on emergency major lower limb amputations.

Method

Patients' data for emergency major lower limb amputations (MLLA) for critical limbthreatening ischemia and diabetic foot infections performed at Aberdeen Royal Infirmary was collected through Trakcare® and divided into the control pre-pandemic group (April 2018 to March 2020) and the pandemic group (April 2020 to March 2022). The statistical analysis was conducted using the IBM SPSS software [v28.0.1.1 (14)].

Results

A total of 358 patients underwent MLLA and 206 (57.5%) of these had diabetes mellitus. There was a 17% increase in the number of urgent referrals and every one in five of these finally underwent an amputation. There was an increase in the absolute number of Above- and Below-Knee amputations. There was a statistically significant increase by 33% in emergency MLLAs during the pandemic period (p-value <0.05). A total of 165 postoperative deaths up to December 2022 were recorded with 30-day mortality rate of 7.26% (n=26).

Conclusion

NHS vascular management groups should update themselves with evolving technologies to optimise the care provided during future unprecedented times. Furthermore, more effective measures should also be implemented to avoid delayed presentations, which can potentially lead to higher rates of major limb amputations.
ThP8.8 - Role of Lymphoscintigraphy in Lymphoedema
Authors: Sivakanthan Mathumie , Maharjan Surina , Slim Hani , Valenti Domenico , Adrien Peters , Gambhir Raghvinder Pal Singh
Published: September 2024

Aim

Lymphoscinigraphy (LSG) is a gold standard of investigation in patients with Lymphoedema, though not all patients with Lymphoedema are offered LSG and some who are offered decline to have the test. The aim of the present study was to do a clinico-radiological correlation of Lymphoscintigraphic findings.

Methods

All patients who underwent Lymphoscinti scans at a tertiary vascular centre over a 3 year period were included in the study. The technique was standardised and involved injection of a radioactive tracer in the Ist web space of both feet and uptake of the tracer at the groin at 2 hours was determined. Uptake less than 8% at 2 hours was considered abnormal. Clinical findings were compared with scan findings.

Results

207 patients underwent LSG scans for suspected lower limb lymphoedema. 53 (26%) scans were normal. Of those with abnormal scans, 24 had mild lymphatic dysfunction (uptake 5-8%); 57 (28%) had moderate lymphatic dysfunction (uptake 2-5%) and 73 (35%) had severe lymphatic dysfunction with an uptake of <2%.

Male to female ratio was 1:3. Median age at presentation was 60 years (range 3-89). Median BMI was 37Kg/m2 (range 17-71).

Clinical profile based on the worst leg having moderate to severe Lymphatic dysfunction on LSG showed a 78-93% match between the leg affected and the LSG findings. This dropped to 29% in those with mild dysfunction.

Conclusion

Lymphoscintigraphy can objectively confirm and grade lymphoedema. It can be used to guide patients and their carers in following preventative measures to prevent complications.
FP1.3 - SPEC MDT in Aneurin Bevan University Health Board
Authors: Niina Ayako , Elnaghi Mohamed , Khan Usman , Jones Huw G
Published: September 2024

Aims

The SPEC (significant polyp and early cancer) multi-disciplinary team (MDT) meeting was started in ABUHB in 2022 to discuss complex colonic and rectal polyp cases, such as polyps >20mm, likely to be sessile, or difficult to remove endoscopically. The aim was to evaluate the effectiveness and clinical role of the SPEC MDT.

Methods

Data for patients discussed in SPEC MDT since its conception in January 2022 until September 2023 was retrospectively collected from the SPEC MDT database, a prospectively collected database. This included patient demographics, reason for referral, polyp characteristics and MDT outcomes.

Results

In 21 months, there have been 38 SPEC MDTs, with 355 cases discussed (average of 9 cases per MDT). There was at least one laparoscopic colorectal surgeon, gastroenterologist and a histopathologist in every MDT in accordance with BSG guidelines. Main referral reasons included endoscopy findings (72%) and re-discussion post-procedure (22%). Twenty-three patients had adenocarcinomas and three had NETs. MDT outcomes were EMR (23%), endoscopic surveillance (21%), clinic to discuss (no) surgery (19%), TAMIS (16%), urgent endoscopy (13%) or other (8%).

Conclusion

As the busiest Health Board in Wales for Colorectal Cancers, the formation of SPEC MDT has been an important step in improving the detection and treatment of advanced polyps and early cancers. Although too early to measure the impact on early cancer detection rates and improved decision making for these patients, formalising the MDT process in line with BSG guidelines has been an important step in improving the service offered to patients.
FP1.4 - Re-audit of perioperative outcomes after colorectal cancer surgery evaluating the impact of ward based level 1 critical care facility in a DGH
Authors: Udayasankar Sujatha , Obiechina Sylvester , Deans Andrew , Rao Pawan Kumar Dhruva , Mohamed Usama
Published: September 2024

Aim

To evaluate the perioperative outcomes after colorectal cancer surgeries in a ring-fenced pathway and compare the outcomes pre and post implementation of a ward based level 1 critical care facility in a DGH.

Method

Two retrospective audits were conducted, each over 6-month period, between July – December, 2020 (audit 1) and between July – December, 2022 (re-audit after the introduction of fully functional ward based enhanced care unit - ECU). Data collection tool included – patient demographics, tumour staging, ASA, intra-op access, ITU stay, ECU stay, return to theatre, unplanned re-admissions, LOS in hospital, 30-day & 90-day mortality rate.

Results

Audit-1 had 65 cancer surgeries, 66% being recto-sigmoid resections. 66% had laparoscopic and 34% had open procedure. 72% of these patients used ITU bed with a total of 252 bed days. Median length of stay in-hospital was 8 days. The unplanned return to theatre was 2.9%, readmission was 1.5% and 90 day mortality was 1.5%.

Re-audit had 91 cancer surgeries, 65% being recto-sigmoid resections. 79% had laparoscopic and 21% had open procedure. 29% of these patients used ITU bed with a total of 87 bed days. Median length of stay in-hospital was 6 days. The unplanned return to theatre was 1%, readmission was 1% and 90 day mortality was 1.1%.

The ECU was utilised by 55% of patients with a total of 186 ECU bed days and median stay of 4 days.

Conclusion

With the introduction of ECU facility, the perioperative outcomes have improved and there is a significant reduction in the ITU bed days.
FP2.1 - The accuracy of radiological staging in rectal cancer patients post-long course chemoradiotherapy treatment
Authors: Photiou Dana , Lenzi Elisa , Boereboom Catherine , Walter Catherine
Published: September 2024

Aim

Accurate post Long-course chemoradiotherapy treatment (LCCRT) allows safe selection of patients to rectal preservation without delaying resection in those with residual cancer. The aim of this study was to assess the accuracy of radiological staging in these patients.

Methods

Demographic and treatment data from consecutive patients receiving LCCRT for rectal cancer between May 2020 to December 2021 was collected. Local radiological staging post-LCCRT treatment was compared to pathological staging. Where patients had complete radiological response (CRR) and opted for watch and wait (WW) those with demonstrable local recurrence, within 12 months, were assumed to have been under-staged.

Results

Of 61 patients, 37 underwent surgical resection following LCCRT and 24 watch and wait for CRR. Post-LCCRT imaging was taken at a median of 10.86 weeks (IQR, 8.86- 13.00) post completion of treatment and resections 16.57 weeks (IQR 9.71 – 23.00) post-imaging.

Four WW patients were diagnosed with local recurrence at a median of 56.54 weeks of follow-up (IQR, 39.9 – 67.90).

The ratio of patients radiologically staged as T0:T1:T2:T3:T4 was 15%: 0%: 28%: 46%: 10%; whilst the pathology specimens demonstrated 20%: 5%: 12%: 49%: 15% respectively. Nodal staging (N0:N1:N2) was 78%: 20%: 2% with histology showing 71%: 24%: 5% respectively.

Conclusion

In our low-numbered study T-staging of patients with T0 and T1 disease had highest rates of over-staging such that 2 (5%) patients for potential watch and wait were not recognised as CCR by MRI alone. Nodal staging appeared more accurate although a tendency to under-stage N0 disease was seen.
FP2.5 - Predictors for anastomotic leak (AL) in inflammatory bowel disease (IBD) patients and its associated postoperative (PO) complications; A cohort of a single institution experience
Authors: Issa Mohamed , Yeung Antoinette , Singhal Graciaa , Brar Manpreet , Gore Stephen , Sarma Diwakar , Thomas Olivia
Published: September 2024

Introduction

IBD patients are highly susceptible to PO morbidities. This study aimed to look at the predictors of AL and the associated morbidities during hospital stays to increase the awareness of these patients.

Methods

A 5-year retrospective study in DGH. All variables were evaluated:patient-dependent (Age, Gender, BMI, ethnic group, comorbidities),disease-dependent (type of IBD, disease location, disease duration), surgery-dependent (duration, CEPOD type, approach, type of resection),Postoperative(CRP level, VTE, ITU admission, LOS, complications).All data were analysed using SPSS22, and Chi-square test.

Results

131 patients were admitted for IBD resection. Median age 37 years. 76 (58%) were female, Chron’s disease was 98 (74.8%). 101 (77.1%) were done laparoscopically, 87 (66.4%)were elective, and the median LOS was 7days.63 (48.1%) has bowel anastomosis and 15 (23.8%) have AL. The median CRP on PO day3 for AL patients was 118. There was no significant association between PO day3CRP and IBD type with AL (P=0.4, 0.7); however, DVT and PE were associated with AL (P=0.001 and 0.039). Patients with AL had a high tendency for ITU admission with longer LOS (P=0.000).Long stays were seen in patients with leaks post-emergency than elective resections (P=0.047, 0.112). AL was associated with chest infection (P=0.001), collection (P=0.006),wound infection (p=0.000), and a higher rate of re-operation within 30 days (p=0.019).

Conclusion

PO day3CRP is not an independent predictor for AL. Our cohort of IBD patients who had bowel anastomosis showed a significant correlation between VTE and AL.AL was associated with chest and wound infections, high chance of a long ITU stay and subsequently, a long hospital stay. IBD patients with AL are vulnerable to VTE so need high care on these regards.
FP2.6 - Opportunities for Improvement in Venous Thromboprophylaxis (VTE) of High-Risk Patients Hospitalized for Inflammatory Bowel Disease (IBD) Related Bowel Resection
Authors: Issa Mohamed , Yeung Antoinette , Singhal Graciaa , Brar Manpreet , Thomas Olivia , Sarma Diwakar , Gore Stephen
Published: September 2024

Background

IBD had a relative risk of 2.2 for VTE compared to the normal population. In May 2020, an international consensus created a statement on VTE prevention in IBD patients. 28days of extended thromboprophylaxis was recommended after discharge only in high risk patients. We aimed to identify high-risk patients for VTE post-IBD-related bowel resection.

Methods

Retrospective review of 131 patients over 5 years of surgical admissions for IBD-related resection at DGH. Examined factors included patients’ demographics, risk factors for VTE, disease history, and compliance with extended thromboprophylaxis. SPSS22 and Chi-square test were used for analysis.

Results

The median age was37years.76(58%) were female,74(56.5%) were white-British, Chron’s disease (CD) was98(74.8%), median disease duration was65 months, 101(77.1%) were done laparoscopically, 87(66.4%) were elective, and the median LOS was7days. 5 patients (3.7%) had VTE events. No postoperative stroke happened. DVT and PE were associated with failure of extended thromboprophylaxis prescription (P=0.004,0.000). All VTE events were seen in the 1st 10 days post-discharge. Occurrence of DVT was associated with white-British ethnicity(P=0.000), CD> ulcerative colitis (P=0.001), emergency > elective surgery (P=0.026), bowel anastomosis >stoma formation (P=0.029), ITU admission (P=0.000), Post-operative leak (0.0001), postoperative wound complications(P=0.000). Surgical approach, previous VTE event, and site of diseases weren’t associated with VTE occurrence (P=0.8,0.97,0.94).

Conclusion

IBD patients are vulnerable to VTE events more than the normal population. Bowel resection in this group of people needs attention for extended VTE prophylaxis, particularly in patients with CD, ITU admission, postoperative leak, and wound complications. These data outline opportunities for improvement, particularly in regard to the extended VTE prophylaxis for 28 days in the before-mentioned high-risk patients.