bluuebunny/crossref_metadata_2025 huggingface dataset:
WP8.13 - Validating Remote Basic Surgical Skills Certification: A Randomised Controlled Trial
Authors: Khalil Miriam , Pazvakavambwa Hannah , Kader Nayaab Abdul , Komperla Siddharth , Aloul Zaina , Rawaf David
Published: September 2024

Aims

Simulation based training comprises a fundamental component of modern surgical education, necessitating the development and advancement of affordable, functional, and validated simulators. This study explored the effectiveness of using the Inovus Basic Surgical Skills (BSS) simulator in improving core surgical skills amongst junior trainees.

Methods

This was a multicentre, RCT between August 2022 – November 2022 involving junior trainees yet to complete a validated basic surgical skills course. All participants completed an initial series of basic surgical tasks, including a range of suturing and knot-tying techniques. Three parameters (objective scoring tool, time taken for task completion, self-assessment questionnaire) were used to evaluate each surgical skill. Subsequently, participants were randomly allocated to the intervention group (BSS simulator) for at home training, or the control group receiving no further training.

Results

5 domains were assessed for suturing tasks through respect for tissue, motion and efficiency, visuo-spatial, suture quality and time taken. Knot-tying was assessed by quality and time taken. Independent samples t-test revealed no significant difference between control and intervention groups (p>0.05) despite improvement in task quality and reduced completion time. Self-assessment questionnaires revealed a significant (p<0.05) improvement in confidence performing more complex tasks in intervention groups.

Conclusions

Study results demonstrate an improvement in both the quality of basic surgical skills and reduced completion time with use of the BSS simulator. Participants report increased confidence post-intervention following use of the BSS simulator. Despite the limitation of a small sample size, these findings underpin the potential benefits of BSS simulator use for surgical education amongst trainees, increasing accessibility to surgical training through an exceptionally realistic remote training environment.
ThP1.2 - Management of breast cancer sentinel lymph node macrometastasis in the axilla; audit of current unit practice and evaluation of factors that influence patient management
Authors: Farthing Charlotte , Hussain Zahra , Jones Sian , Tahir Wasif , MacInnes Emma , Kim Baek
Published: September 2024

Aims

Detection of sentinel lymph node (SLN) macrometastasis for breast cancer no longer mandates further axillary surgery. Association of Breast Surgery (ABS) guideline provides recommendation to optimise patient management. It also acknowledges management uncertainties in specific patient groups. We aimed to examine our unit practice against national guideline and evaluate potential factors that influence axillary management.

Methods

Retrospective analysis of prospectively maintained electronic database determined clinico-pathological characteristics on patients diagnosed with SLN macrometastasis (n=127) at the Leeds Breast Unit (2020-2022). Axillary management was compared against ABS guideline.

Results

56 (44.1%) received completion axillary node clearance (cANC), 37 (29.1%) axillary radiotherapy (aRT), and 34 (26.8%) no further axillary treatment. 80.3% had one macrometastasis. As per guideline, all patients who had >3 macrometastasis (n=10) underwent cANC. Type of breast surgery (mastectomy vs. breast conserving surgery; BCS) did not affect further axillary treatment rate (76.7% vs. 70.1%). Type of further axillary treatment varied with cANC commonest for mastectomy patients (78.3%) and aRT commonest for BCS patients (57.4%). In contrast to the guideline, 58% of post-menopausal BCS patients with ER+HER2- T1 tumours (n=12) received further axillary treatment. Where guideline stated management uncertainty, further axillary treatment was frequent; pre-menopausal patients (82%), T2 tumours (73%), lymphovascular invasion (74%), and extranodal spread (77%).

Conclusion

Our unit’s SLN macrometastasis management is mostly in line with national guideline but further work is required to avoid overtreatment. Where management uncertainty exists, patients commonly received further axillary treatment. Further research is required in these patient groups to optimise axillary management.
ThP2.5 - Number of lymph nodes removed in SLNB: comparison between standard technique versus Magtrace from a single-centre study
Authors: Castelhano Rute , Gavisiddappa Chandana , McManus Penny
Published: September 2024

Introduction

Sentinel lymph node biopsy (SLNB) is a precise method for axillary staging in early breast cancer. Historically, the standard approach used radioisotope, often combined with blue dye, for localising the sentinel lymph node (SLN). Recently, the introduction of the superparamagnetic iron oxide mapping agent, Magtrace, offers an alternative. Following the adoption of Magtrace, there was a perception that more nodes were being removed during SLNB. This study aims to compare the number of lymph nodes removed, during SLNB, between both techniques.

Methods

A retrospective single-centre study (2022-2023) included 316 patients undergoing SLNB at Royal Lancaster Infirmary. Before the late 2022 adoption of Magtrace, the standard technique involved radioisotope+/-blue dye. Subsequently, based on consultant preference, patients received Magtrace alone or with blue dye. The comparison focused on the number of identified SLN between the magnetic and standard techniques.

Results

Data from 316 patients was analysed across two periods: March to October 2022 (standard technique n=160), and March to October 2023 (Magtrace n=120; Magtrace+blue dye n=30; blue dye only n=5). Comparative analysis of the number of nodes removed produced the following results: standard technique 2.425, magnetic technique alone 2.403, magnetic technique with blue dye 2.133, and blue dye only 1.6.

Conclusion

Despite initial concerns regarding the perceived increase in the number of nodes removed during SLNB with the implementation of the Magtrace technique, our study reveals that the use of this technique results in a reduction in the number SLNs removed in comparison to the standard dual technique.
ThP3.1 - Dysphagia: Should we be going straight to scope? A retrospective analysis within a single Scottish District General Hospital
Authors: McDowall Neil , Agiotakis Stefanos , Khan Khurram S
Published: September 2024

Aim

Dysphagia is the main symptom in patients with oesophageal cancer. British Society of Gastroenterology guidelines state that all patients with an Edinburgh Dysphagia score (EDS) of >3.5 should be investigated with an urgent oesophagogastroduodenoscopy (OGD) for suspicion of cancer. We aim to investigate the outpatient clinic outcome for patients referred with dysphagia.

Methods

A retrospective cohort study of all urgent suspicion of cancer (USOC) referrals with dysphagia between April to September 2022. Patients demographics, clinic outcome and waiting time for OGD were analysed. This study was registered with Clinical Quality Project (LanQIP 14747).

Results

138 (37.5%) of 361 USOC referrals had dysphagia. Median age was 63 years (IQR 51-72) and 78 (56.5%) were female. Median Scottish Index of Multiple Deprivation was 4 (IQR 2-6). 3 (2.2%) patients were referred straight to scope. 125 (90.6%) patients attended clinic, of these 106 (84.8%) patients had an OGD requested. 84 (67.2%) were requested urgently, 16 (12.8%) routinely and 25 (20%) did not receive a scope.

The median waiting time to clinic was 42 days (IQR 62-31) and median time from clinic to OGD was 36 days (IQR 24-59). Total waiting time from the referral to OGD was 81 days (IQR 62-111).

Conclusions

The majority of patients presenting with dysphagia will necessitate urgent OGD following clinic consultations. Therefore, to expedite the diagnostic process, implementing a direct referral pathway to endoscopy, bypassing clinic wait times, is recommended.
ThP3.4 - Suture Endoclips coding, a novel technique to improve efficiency and reduce errors In laparoscopic repair of peptic ulcer perforation
Authors: Zino Samer , Alaeq Ali , Djoudi Assia , Hanna Michael , Costello Amy
Published: September 2024

The presentation describes our a novel technique of using Endo clips to tag the sutures during laparoscopic repair of perforated peptic ulcer utilizing Graham omental patch,

Methods

Four patients presented with perforated peptic ulcer. All treated with Laparoscopically. Supine position with split leg was standard. 5 and10mm thirty-degree scopes were used to facilitate efficient and comprehensive washing, through 11 mm umbilical port and two 5 mm ports. An extra 5mm port was needed on the lateral right Upper Quadrant for drain or liver retractor. We used 5mm endoclips to tag the end of sutures and create a tunnel to pass the patch through it. Each suture end was tagged with either one, two or three clips, in order. The suture ends were held together to create a tunnel, where the omental patch was passed through that tunnel.

Corresponding sutures end where identified easily by holding endoclips in order, then removed to allow the two ends to be tied without mixing the sutures. Furthermore, the endoclip tagging prevents suture looping around each other, minimizing wasted time, error and dislodging the stitches during identifying, correcting the looping and picking the corresponding ends.

All patients had uneventful recovery, with assuring follow up.

Conclusions

Our novel technique of suture Coding with endolcips eliminated the confusion between the different suture threads and prevents looping and consequently improved the technique efficiency and prevent mistakes and loose ties
ThP3.6 - Long Term Surgical Outcome of Complete Intrathoracic Stomach (CIS)
Authors: Pal Shreya , Divekar Omkaar , Fernandes Roland , Basu Sanjoy
Published: September 2024

Background & Aims

Surgery is required for medically fit symptomatic CIS patients to avoid complications (volvulus, obstruction & strangulation) that have high morbidity & mortality. To assess the long term outcome including QOL (quality of life) for patients who underwent laparoscopic biological hiatal mesh reconstruction for CIS (100%).

Methods

Retrospective analysis of a prospectively collected of 34 CIS of 154 consecutive GPEH(Giant Para-Esophageal Hernia) patients intervened between March 2008- December 2023 in a large DGH.

Data collected included demographics, BMI, ASA, Preoperative investigations (OGD & Computerised Tomography), operative details including complications, & standardised GERD-Health Related Quality of Life Questionnaire(GERD-QOL) scores of 0-5, 6-10, 11-15 & more than 15 as excellent, good, fair & poor respectively (pre-operatively, 6-month post-operative & long-term), postoperative diet, SOB (shortness of breath) & patient satisfaction.

Results

34 included M:F 11: 23, age 72*(45-83) years, BMI 29 *(20-43), ASA III *(II-III). 20(59%), 20(59%), 18(53%), 14(41%), 14(41%) & 12(35%) had heartburn, dysphagia, retrosternal discomfort, vomiting, weight loss and SOB respectively. 6 (18%) emergencies, 22 (65%) incomplete OGDs, operative time 210* (150-510) mins, 1(3%) conversion, 3*(9%) surgical mortality & PO stay 3*(2-27) days. Pre and 6-month post surgery GERD-QOL poor (≥15) & excellent (<5) in 21(62%) & 32(94%) respectively with 32(94%) excellent satisfaction.

Follow up at 102*(16-190) months had 2 more unrelated deaths, 21(72%) contacted with GERD-QOL excellent (<5) in 14(67%), poor 1(5%), 19(90%) solid diet, 2(10%) SOB with 19(90%) excellent satisfaction.

Conclusion

Favourable long term outcome achieved here supports complex surgery for this debilitating condition in the medically fit symptomatic elderly patients.

* Median
ThP4.3 - How accurate is the clinical diagnosis of acute cholecystitis? A plea for specialisation in biliary emergencies!
Authors: Omran Asmaa , Al Shaye Ahmad A , Hayyawi Israa , Nassar Ahmad H M
Published: September 2024

Aim

To evaluate the accuracy of preoperative diagnosis of acute cholecystitis (AC).

Methods

A prospective database of cholecystectomies and bile duct explorations spanning 30 years was analysed.

Results

593/6140 patients (9.6%) had a preoperative diagnosis of AC (Group 1) 12.3% had no AC at surgery. 300/5547 patients (5.4%) had AC without preoperative criteria (Group 2).Group 1Group 2Emergency admission588 (99.1)203 (67.6)Presentation with Jaundice96 (16.2)110 (36.6)Previous acute cholecystitis76 (12.8)3 (1)USS:GB Thick wall or contraction389 (65.6)112 (37.3))Bile duct dilatation66 (11.1)179 (36.6)Preoperative imaging:MRCP23 (3.8)21 (7)CT76 (12.8)15 (5)ERCP8 (1.35)11 (3.6)Operative GB findingsAcute193 (32.5)140 (46.7)Empyema313 (52.8)160 (53.3)Difficulty Grading I&II20 (3.4)--III177 (29.8)117 (39.1)IV344 (58)168 (56.2)V52 (8.8)15 (4.7)Adhesions GB to:Duodenum503 (84.8)241 (80.3))Hepatic flexure410 (69.1)169 (56.3)Difficult cystic pedicle524 (88.3)273 (91)Fundus first dissection39 (6.6)19 (6.3)Bile Duct Exploration:106 (17.8)98 (32.6)Transcystic93 (15.6)72 (24)Choledochotomy13 (2.2)26 (8.7)Operative time (median, range)80 min (32-280)85 (35-350)Open conversion3 (0.5)3 (1)Morbidity40 (6.7)30 (10)Hospital stay (median, range)9.9 (1-62)13 (1-100)Mortality4 (0.67)1 (0.3)Resolved in one episode427 (72)189 (63)

Conclusions

300/806 (37.2%) of AC or empyema encountered at operation do not have preoperative criteria. 25% of all AC require bile duct exploration. Emergency biliary admissions should be dealt with by specialist surgeons.
ThP4.10 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter
Authors: Winter Jonny , Gudyma Jaroslaw , Eltayeb Omer
Published: September 2024

Aim

Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach in a district general hospital over a two-year period.

Methods

Prospectively collected data regarding all patients who underwent LC+LCBDE over a period from January 2022 to December 2023 was retrospectively reviewed. Data concerning indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel.

Results

50 patients were identified. CBD diameter (as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.25mm). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-8 days) and readmission rate was 6%. One patient experienced a complication beyond Clavien-Dindo Grade 2, this caused by a superficial wound infection requiring washout under general anaesthetic. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for management of retained CBD stones.

Conclusions

LC+LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small common bile duct diameter. Small CBD should not necessarily be a deterrent to consideration of LCBDE as a therapeutic option in appropriately selected patients.
ThP4.11 - Preoperative respiratory disease and outcomes of pancreatoduodenectomy performed for malignancy
Authors: Jordan Caitlin , Rees Jonathan , Russell Tom , Aroori Somaiah ,   RAW Study Collaborators, Mavroeidis Vasileios K
Published: September 2024

Background

Despite improvements to morbidity and mortality rates in recent decades, pancreatoduodenectomy for malignancy (PD) remains a high-risk operation. Patients with pre-existing respiratory disease are likely to be at increased risk of developing postoperative complications but few prior studies have investigated this. This may be as few patients with significant respiratory pathology are considered appropriate surgical candidates. This study aimed to compare PD outcomes in patients with a prior respiratory condition to those without. The outcomes of interest were median length of stay (LoS), 30-day readmission, 90-day mortality, unplanned return to theatre rate and five-year survival.

Methods

Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n=1484). Pre-existing respiratory disease included a prior diagnosis of: asthma, chronic obstructive pulmonary disease (COPD), pulmonary fibrosis, pulmonary embolism, asbestosis, obstructive sleep apnoea, pleural effusion, tuberculosis, pulmonary sarcoidosis, pneumoconiosis or hypersensitivity pneumonitis. The Mann-Whitney U test and Fisher exact test were used to compare the two groups.

Results

Out of a total of 1484 cases, 142 patients (9.6%) had a pre existing respiratory comorbidity. Asthma and COPD both affected 4.2% of patients. All other included pathologies affected less than one percent of patients. 30-day readmission (8.5% vs 9.1%, p=0.1), 90-day mortality (1.4% vs 3.7%, p=0.2), and unplanned return to theatre rate (3.5% vs 5.1%, p=0.5) were similar between the two groups, however, median LoS was significantly longer in those with a prior respiratory disease (14 vs 13 days, p<0.0001). Five-year survival was also higher in those without respiratory disease but this was not statistically significant (24.6% vs 32.5%, p=0.06).

Conclusion

In our multicentre study of patients with confirmed malignancy, PD patients with a preoperative respiratory disease had significantly longer length of stay. There was a trend towards lower 5-year survival.
ThP5.2 - Comparison of perioperative outcomes of open (CUSA) versus laparoscopic (LOTUS) major hepatectomy – revisited. First evaluation of efficacy and safety of AEON stapler
Authors: Iqbal Affan , Baltatzis Minas , Stathakis Panos , Siriwardena Ajith , Jamdar Saurabh , Sheen Aali Jan
Published: September 2024

Introduction

In 2019, preliminary data matching 40 cases demonstrated improved outcomes of laparoscopic major liver resections using the BOWA-LOTUS liver blade (Devon, UK). An updated and expanded comparison between open and laparoscopic major hepatectomies is presented as well as evaluating of an endovascular stapler AEON™ (Lexington Medical, Massachusetts, USA).

Methods

January 2020 to June 2023 patients were identified from a prospectively maintained database. Propensity score matching analysis used R statistical tool in SPSS (IBM, New York, USA) to isolate matched open and laparoscopic cases. LOTUS ultrasonic energy device was used for parenchymal transection in laparoscopic cases and CUSA (Valleylab, Colorado, USA) in open procedures. AEON endovascular stapler was used from early 2021.

Results

86 patients constitute the study population after applying propensity score matching analysis in a 1:1 ratio. The median (range) age in the matched sample was 63 (27-83) yrs. Hospital stay (mean 7.8 v 14.7 days; p=0.025) and blood transfusion requirement (0 v 4 units; p=0.035) were all significantly improved when comparing laparoscopic to open. Comparison of the AEON stapler with Endo-GIA (Medtronic, MN, USA) showed no significant difference in any outcome measure, although AEON demonstrated (non-significantly) a reduced trend in operating time comparing all cases (56 v 69 mins; p=0.300) and laparoscopic (56 v 71 min; p=0.295).

Conclusion

The LOTUS liver blade continues to be associated with acceptable outcomes in laparoscopic liver resections. The AEON endovascular stapler was equivalent to other staplers with a trend towards a shorter operating time in liver transectional surgery.
ThP5.9 - Evaluation of cholecystectomy service in a general NHS hospital
Authors: Albendary Mohamed , Abbasova Aisel , Jacob Preethi , Sakr Mohamed , Elarian Mohamed , Ihedioha Ugo
Published: September 2024

Background

Cholecystectomy is commonly performed for biliary pathologies, as elective, emergency, or at prioritised basis (Hot Gall bladder service).

Aim

Evaluating local performance of cholecystectomy, outcomes and areas for improvement.

Results

Over a 4-week period, 38 cholecystectomies were performed, all laparoscopically. Almost half had cholecystitis or cholangitis requiring at least 1 admission with 5 patients required more than 1 admission in 12 months prior to surgery. 50% of cholecystectomies were done in 6 months, while the longest waiting time was 13 months. 50% of procedures were done electively, whereas the rest in emergency and hot gall bladder lists. Indications included acute cholecystitis (13), biliary colic (11), chronic cholecystitis (6), biliary pancreatitis (4), GB polyps (3) and CBD stones (1).

Only 2 had subtotal cholecystectomy, and Nassar operative difficulty was graded as one in 18, two in 15, three in 4 and four in 1 of the cases. Critical view of safety was obtained in 85% and biliary anatomy was unusual in 12 cases. Operative cholangiogram and CBD exploration were performed in 5 and 8 cases respectively. Complications included bile spillage (12/38), and bleeding (7/38).

30-day follow up showed 16 patients were discharged in 24 hours and only 3 readmitted. The incidence of complications was 37%, 11 cases had SSI and 3 had pulmonary complications). No bile leak or CBD injury. All specimens were sent for examination showing benign histology.

Recommendation

Emergency and hot cholecystectomy services not only cut down waiting lists but also reduce costs of reoccurring admissions, with no significant added complications. Selective gall bladder histological examination may reduce costs with no recognised risks.
ThP6.12 - Pain relief prescribing in Surgical Emergency Unit triage: are prescribers helping to provide patients with humane care via prompt analgesia prescriptions, and can simple educational interventions improve timeliness?
Authors: Sadler Emma , Pearce Phill , Bond-Smith Giles
Published: September 2024

Aims

The RCEM target for receipt of analgesia for moderate-severe pain is within 15 minutes of arrival in ED. This study aimed to establish if a surgical emergency triage unit was achieving a more generous target of analgesia prescription within 60 minutes of clerking, and whether this could be improved with educational interventions.

Methods

Records of patients presenting to triage were reviewed. Patients were excluded if they did not report pain of any cause, were under 18 years old, or were prescribed adequate analgesia by the referring department. The integrated EPR system enabled straightforward comparison of timestamps for arrival in the department, clerking by a registered prescriber, and first prescription. Data were considered for a full continuous week each time, in late August, and in mid-December 2023. Educational interventions were made between collection periods: a teaching session about analgesia in emergency surgery; a presentation of first round results at a departmental meeting; and ‘postcards’ attached to all workstations highlighting the EPR pathway.

Results

Of encounters in which analgesia was prescribed, there was an increase in the proportion of prescriptions made within 60 minutes of clerking, from 67% to 86%. This increase was observed across all prescriber grades, both rotational and non-rotational.

Conclusions

The precise quantifiable impact of the educational interventions is unclear as the study period spans a changeover for FY1s, but the increase in timely prescription at all grades indicates some effect. This is reassuring from a perspective of considering human patient care.
ThP7.12 - Penetrating Neck Injuries as a form of deliberate self-harm: A Pre and Post COVID-19 Comparison
Authors: McGrath Chloe , Taylor John
Published: September 2024

Introduction

In March 2020, the UK government implemented the first national lockdown to contain the spread of COVID-19. Despite success at curbing infection rates, early studies suggested a rise mental health issues, including an increased incidence of violent self-harm. This included penetrating neck injuries. Limited research is available on the pandemic’s effect on self-harm in the UK.

Methods

Data was collected from self-harm major trauma activations to a regional trauma centre, between 01/01/17 to 31/12/22. All patients identified with neck-related self-harm injuries were included. Demographic information and injury data was grouped for analysis into pre-COVID-19 (2017-19), and post-COVID-19 outbreak (2020-22) groups.

Results

Penetrating neck injuries due to self-harm, post-2019, increased fourfold (12 vs 47). Men were the majority in both periods, but women had a larger proportional increase (men 10 vs 34, women 2 vs 13). Mean ages of Men presenting increased (Men 44 vs 53, Women 36 vs 35)

Conclusions

The frequency of self-harm related neck injuries increased following lock down. Older men were most likely to present, however there was an associated rise in the number of women. We must further investigate the impact the pandemic had on the population’s mental health and tendency towards violent self-harm, particularly in older men.
ThP8.5 - The Incidence and Characteristics of Complications Associated with Peripherally Inserted Central Venous Catheter and Midline Utilisation in Surgical Patients: A Retrospective Cohort Study
Authors: Lu Yanqiang , Tzatzidou Anastasia , Islam Mariam , Strachan Danielle , Smith Tanisha , Cheruvu Chandra , Karategos Athanasios
Published: September 2024

Background

Peripherally inserted Central venous catheters (PICC lines) and midlines are pervasive clinical interventions. However, they are not devoid of adverse events such as catheter-associated thrombosis, mechanical anomalies, catheter-related bloodstream infections, and cellulitis. This study aims to investigate the nature and prevalence of these complications within a high-volume tertiary care centre.

Methods

A retrospective cohort study was conducted, including 473 patients subjected to PICC line and midline insertion within the Department of General Surgery during the period from June 2022 to June 2023.

Results

Over 5949 catheter days, a total of 73 complications were identified, reflecting an incidence rate of 15.43% (12.27 per 1000 catheter days). Notably, catheter-associated infections were predominant, manifesting at a rate of 4.20 per 1000 catheter days (n=25, 5.20%). Accidental withdrawal occurred at a rate of 3.87 per 1000 catheter days (n=23, 4.86%), incorrect positioning at 2.02 per 1000 catheter days (n=12, 2.54%), occlusion at 1.51 per 1000 catheter days (n=9, 1.90%), and rupture at 0.67 per 1000 catheter days (n=4, 0.84%).

Conclusion

The insertion of PICC and midline is associated with a substantial burden of morbidity, primarily characterised by catheter-associated infections. Emphasis on early identification of catheter-associated bloodstream infections is imperative. Mitigating these complications warrants the institution of a multidisciplinary educational initiative to augment nursing proficiency, coupled with the implementation of a local guideline governing PICC line and midline insertion and care.
ThP8.10 - Diagnostic accuracy of aortic dissection detection risk score and D-dimer to rule out aortic emergencies in the emergency department – outcomes from a multicentre study
Authors: Khan Anas , Masoura Constantine , Mitra Anu , Smith Thomas
Published: September 2024

Background

Acute aortic syndromes (AAS) are rare but potentially fatal vascular emergencies affecting the aorta, including aortic dissection, penetrating aortic ulcers, intramural haematoma and occasionally aortic aneurysm rupture. The variety of presentations can make it difficult to decide which patients should have definitive computerised tomography aortogram (CTA) imaging. This study aims to evaluate the diagnostic accuracy of the aortic dissection detection risk score (ADD-RS) combined with D-dimer to rule out AAS in the emergency department.

Methods

This retrospective cohort study involved two centres. Results of patients who had CTAs between 1st March 2020 – 31st March 2022 were reviewed. Patient data including demographics and laboratory results were logged from day of presentation.

Results

A total of 435 CTAs were requested. Patients with diagnosis of AAS had higher mean total ADD-RS (1.6 vs 1.0, P<0.05) and higher mean D-dimer (8,836 vs 1,462ng/mL, P<0.05). The use of ADD-RS≤1/normal D-dimer had sensitivity of 100.0% and specificity of 27.9%. Negative predictive value (NPV) was 100%. In this cohort, there were no false negatives.

Conclusion

This study appears to support the implementation of a new guideline in these departments that incorporates ADD-RS and D-dimer to aid deciding next steps for suspected AAS. In this cohort ADD-RS ≤1 and negative D-dimer (<500ng/mL) had high sensitivity, and low failure rate and could have prevented at least 70 and up to 229 patients from receiving unnecessary radiation. The results suggest that in low-risk patients, with ADD-RS≤1/negative D-dimer, AAS can be safely ruled out. New guidelines could prevent patients receiving unnecessary radiation, contrast induced nephropathy and reduce burden of stretched emergency departments.
ThP8.11 - Causes of delay to surgical interventions in patients with transient ischaemic attack and stroke
Authors: Lee Yeon Joo , Williams Debbie , Slim Hani , Valenti Domenico , Gambhir Raghvinder Pal Singh
Published: September 2024

Aims

The UK National Institute for Health and Care Excellence (NICE) guidelines and vascular society of surgery Great Britain and Ireland (VSGBI) emphasize the importance of scheduling carotid endarterectomy (CEA) within 2 weeks of symptom onset to reduce the risk of recurrent stroke. However the National vascular Surgery report for 2023 showed that this target was met in only 52% of patients. This study aimed to examine the possible causes of these delays.

Methods

This study analysed patient or hospital-derived factors impacting the timing of surgical intervention for patients with symptomatic carotid disease. A retrospective database was established to gather data on CEAs performed during an 8-month interval (January to August 2023) at a major teaching hospital.

Results

36 patients underwent CEA; 13 (36.1%) received the procedure within 2 weeks of symptom onset, while 23 (63.9%) experienced delays. The main reasons for not meeting the two-week timeframe were associated with surgical scheduling, patient presentation, and referral processes. Specifically, among the 23 patients facing delays, 10 (43.5%) were due to surgical scheduling, 6 (26.1%) encountered delays in presenting to medical services, 5 (21.7%) were affected by delayed patient referral or review, and 2 (8.7%) were from lack of patient fitness. None however ended up with recurrent stroke while awaiting surgery on best medical management.

Conclusions

Prompt surgical intervention can reduce the risk of recurrent strokes. 63.9% of CEAs encountered delays, primarily associated with surgical scheduling. Prioritised pooled lists may be the answer.
FP1.5 - Safety and efficacy of Ambulatory treatment of uncomplicated acute diverticulitis: A two-centre cohort study and a proposal of an Ambulatory pathway
Authors: Mohamedahmed Ali Yasen , Issa Mohamed Talaat , Gamage Pulasthi , Patel Nikhil Kieren , Sarma Diwaker , Thomas Pradeep , Husain Najam
Published: September 2024

Aim

This study aimed to assess the safety and efficacy of ambulatory treatment in patients with uncomplicated acute diverticulitis (AD) compared with inpatient treatment.

Methods

This is a retrospective comparative study conducted in two hospitals. All patients presented to the emergency department with CT-confirmed Hichney 1a AD during the period from 01/01/2022 to 31/12/2022 were included in this study. Patients with complicated diverticulitis or CT was not performed were excluded. All patients were followed for 12 months for re-admission and AD recurrence. Data analysis was performed with SPSS 27.

Results

A total of 137 patients were presented during the study period with CT-confirmed Hinchey 1a AD. The median age was 62 (24-94) years old, with a female-to-male ratio of 1.7:1. In the majority of patients (75.9%), WBCS was < 15 and CRP < 100. Moreover, 37.2% had previous AD, and it was complicated in 5.8%. For 12 months of follow-up, 19% of the cases developed diverticulitis recurrence. However, only 1 patient required surgery, and no patient required radiology intervention. No mortality was reported. A luminal investigation (CT colonoscopy or endoscopy) was organized in 61.3%, and colon cancer was detected in one patient. A comparison of patients who were treated as ambulatory (n=35) versus inpatient (n= 102) showed no significant difference regarding re-admission and recurrence of AD (P= 0.22) and surgical intervention (P=0.5) during 1-year follow-up.

Conclusion

With comparable results to inpatient treatment, the Ambulatory treatment of Hinchey 1a AD is safe and feasible and provides a reduction of treatment expenses.
FP3.4 - Identifying missed opportunities in emergency presentations of colorectal cancer to improve patient outcomes
Authors: Charavanamuttu Vidhya , Sargsyan Narek , Vijay Vardhini
Published: September 2024

Introduction and Aim

A significant proportion of patients diagnosed with colorectal cancer are diagnosed during emergency admissions with presentations such as bowel obstruction, perforation and bleeding. Despite increasing numbers of suspected colorectal cancers referrals from the community being sent straight to test, the proportion of patients presenting as emergencies in the United Kingdom remains at20%.

Emergency presentations of colorectal cancer are associated with significantly worse outcomes – both short- and long-term, with research suggestive that emergency presentations remain an independent poor prognostic factor following curative colorectal resection.

This study aims to assess if patients diagnosed with colorectal cancer following emergency presentation had missed opportunities of diagnosis on previous presentations in secondary care.

Methods

A database of patients who have been diagnosed with colorectal cancer following emergency presentation from January2020-October2023 was analysed. Previous attendances to the emergency department and outpatient department were identified and assessed for symptoms of colorectal cancer – including abdominal pain, change in bowel habits, rectal bleeding and iron deficiency anaemia – and if these prompted investigation.

Results

Of 100 patients – 6were identified that had previous presentations with symptoms suggestive of colorectal malignancy. 2 had been reviewed in colorectal clinic prior to their diagnosis, with appropriate planned investigations but were lost to follow up. A further 4 had been seen in ED with symptoms of colorectal cancer but further investigations were not performed.

Conclusion

The majority of patients diagnosed with colorectal malignancy following emergency presentation had no earlier opportunities of diagnosis in secondary care. Further work needs to be done ensuring the continuity of care of patients following discharge from both the emergency department and clinic.
FP3.11 - Postoperative ileus (POI) in colorectal cancer resections: A cohort study
Authors: Gok M A , Bughio M , Mathieson N O M , Yim S , Sadat M M , Khan U A
Published: September 2024

Aims

Postoperative ileus (POI) has reported incidence of < 30 % in malignant colorectal surgery. POI leads to delayed recovery, increase morbidity, prolonged hepatization & increased healthcare costs. Aim of study is to assess management of POI at single centre.

Methods

Cohort study was carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative outcomes were evaluated for POI patients, with non-ileus used as controls.

Results

Ileus (n = 275) Non ileus (n = 1436) Mann Whitney U (p value) Age(yrs) 71.8 70.1 NS Sex(M:F) 191 : 84 766 : 670 < 0.0001 ASA(median) 2 2 NS BMI(kg/m2) 26.9 26.4 NS Elective () 209 1139 Emergency(n) 66 297 Laparoscopic(n) 140 819 Open(n) 135 617 LN harvest(n) 12 12 NS Complications (n) (%) Leaks 14 52 HAP 64 125 Anaemia (transfusions) 10 43 Wound infections 41 115 Collection 27 69 Sepsis 37 49 Operation time(mins) 186.0 172.8 < 0.05 LOS(days) 14 ± 6 7 ± 3.5 < 0.0001 POI onset(days) 5 ± 2 NG tube(days) 3 ± 1 POI diagnosis (n) Clinical 62 AXR 70 Gastrograffin 64 CT scan 113 Mortality (n) 30 day 10 48 60 day 16 68 90 day 18 80 Survival rates (%) 1st year 89.0 87.6 Logrank 5th year 73.5 70.5 P = NS 10th year 64.3 62.4 (uncensored) 15th year 62.1 59.2

Conclusion

POI occurred in 15.6 % of all CRC resections. Prolonged operative time, resulted in ileus, but did not adversely affect survival. POI can be diagnosed clinically or radiologically. POI resulted in prolonged hospitalization. Early diagnosis & intervention (NG tube decompression, fasting, IV fluids, gastrograffin & prokinetics) is key to reducing the adversity of POI
FP4.3 - Right sided colonic cancers – to tattoo or not to tattoo?
Authors: Reid Rebecca , Magee Conor , Wilson Jeremy
Published: September 2024

Aim

Current evidence suggests that endoscopic tattooing for colonic cancer is associated with higher lymph node yield. However, the ACPGBI and BSG guidelines do not recommend tattooing for caecal tumours. Our aim was to identify whether tattooing in right sided colon cancers was associated with higher lymph node yield and if tattooing should be standardised for all colonic cancers.

Methods

Retrospective review of all patients endoscopically diagnosed with colonic cancer who underwent surgery between April 2018 to March 2021 at a single DGH. Patients with synchronous or rectal cancers, neoadjuvant therapy and emergency resections were excluded. All data were collected from Somerset database and electronic patient records.

Results

224 patients with colonic cancers were identified; 110 with tattoo and 114 without. Overall, there was no statistical difference in lymph node yield with tattoo vs no tattoo (mean 21 v 20, p=0.141). There were 92 patients with right sided cancer; 30 with tattoo and 62 without. There was significant difference in lymph node yield (mean 24 v 20, p=0.018). 10 out of 42 patients with caecal cancer were tattooed with statistically greater lymph node yield (26 v 20, p=0.016).

Conclusion

Whilst small sample sizes make interpretation challenging, our nodal yield results for right sided and caecal cancers with tattoo suggests significant difference in lymph node yield which could promote standardised use of tattooing throughout the colon. We recommend further analysis with a larger sample size to assess whether there is true difference.
FP4.6 - A Re-audit on the completion of pathology request forms following Colorectal Cancer Resection
Authors: Umenze Franklin , Saraee Danial , Khadka Subodh , Coup Andrew , Kaur Geetinder
Published: September 2024

Aim

Good Histopathology is key to accurate staging for Colorectal cancer. The Royal College of Pathologists have outlined a number of important parameters to detail on the pathology request form following colorectal cancer resection surgery including confirmation of specimen, diagram, approach, dissection plane, part of BCSP, biopsy details, pre-operative chemoradiotherapy, history of IBD/familial cancer and pre-op staging. The aim of this re-audit was to detect any improvement in our adherence to these guidelines in comparison with our 2019 audit.

Method

The forms for all colorectal cancer resections performed from 2019-2023 were interrogated for the various parameters using pathology software DART.

Result

Of 1615 cases, 320 were included. 30% mentioned the approach versus 78% in the previous audit. Diagrams were completed in 36% compared to 44% previously. Conversely, only 4.5% in the previous audit had information on preoperative therapy, as compared to the current 20%. There were marginal improvements in information on screening, familial cancer and IBD. In addition, the degree of completion showed significant difference in some parameters in the case of consultants who emphasized on correct completion of forms (e.g. 97% included type of surgery, 91% had diagrams).

Conclusion

It is important to complete the Colorectal cancer resection pathology forms according to recommended standards to enable the pathologist to provide accurate tumour staging and thus guide appropriate management. Disappointingly, we did not find significant improvement in our adherence to the recommended standards as compared to our previous audit. We therefore need to focus on wider scale education and ensure implementation of newly designed forms with active consultant involvement and a re-audit.
FP4.10 - Oncosurgical Outcome Differences of Left and Right Colonic Cancer Resections Still a Colorectal Enigma
Authors: Tan Chin Kiat , Shen Elliot Quay Fu , Mukherjee Arijit
Published: September 2024

Aims

The study aimed to compare surgical outcomes between right (RCC) and left colonic cancer (LCC) resections at a single centre (DGH) with special reference to 3 and 5-year survival rates.

Methods

100 colonic resections (2017-2021) were included. Length of stay (LOS), pathology results and 3 and 5-year survival rates were analysed. The Kaplan-Meier estimate was used for patients within 5 years post-operative.

Results

68 RCC and 32 LCC noted.

RCC:

37 female, 31 male, median age of 73. 66 R0 resections, 2 R1, none R2.

TNM: 52 (86.1%) had T3/4, 26 (38.2%) had N1/2.

20 had extramural venous invasion (EMVI), 26 intramural venous invasion (IMVI), 8 mucinous, 11 perineural invasion. Estimated 3-year survival rate 0.8530, 5-year 0.7766. No local recurrences, 4 subsequent distant metastases within 5 years.

LCC:

11 female, 21 male, median age of 67. 23 R0, 2 R1, 2 R2 resections.

TNM: 28 (87.5%) had T3/4, 15 (46.9%) had N1/2.

18 EMVI, 11 IMVI, 1 mucinous, 9 perineural invasion. Estimated 3-year survival rate 0.7498, 5-year 0.5965. No local recurrences, 9 subsequent distant metastases within 5 years.

Both cohorts’ median LOS similar (6 days).

Discussion

This study shows higher survival rates in RCC, contradicting acclaimed superiority of LCC survival in literature(1-5). The limited LCCs in this study (during Covid pandemic) being pathologically more advanced, possibly accounts for the statistically significant mortality. A prospective audit of tumour biology and oncological outcome is ongoing with intentions to validate our early observation.
FP7.7 - Evaluation of small bowel obstruction management: A local audit in comparison to NASBO guidelines
Authors: Holt Tristan , Rana Sarina , Wu Fiona
Published: September 2024

Aims

The National Audit of Small Bowel Obstruction (NASBO) report provides recommendations for optimising the management of small bowel obstruction (SBO). We aimed to audit our management and compare our outcomes with the NASBO report.

Methods

Retrospective case reviews were conducted for 115 patients admitted with SBO from July-December 2022, evaluating adherence to NASBO guidelines and assessing outcomes.

Results

The average age was 76 (21-94) years old; 53% male and 47% female. Adhesions (41.7%), hernias (30.4%), malignancy (13%) and inflammatory bowel disease (6.1%) were predominant causes. Treatment included conservative management in 67% of cases, surgery in 27% (of which, 6.1% had a trial of conservative management initially) and palliative care in 6.1%. A summary of the management and outcomes below.Table 1:Summary of managementCT scan on admissionAverage time to CTSurgery performedAverage time to surgeryNutritional screening assessmentLocal audit98.3%9 hours27%2.4 days100%NASBO80%2.2 days48%1 day90%Table 2:Summary of outcomesUnable to eat normally for ≥5 daysAverage length of stay30-day mortality30-day readmissionLocal audit12%7 days14%18%NASBO49%10.7 days8%13%

Conclusion

We are performing CT scans in a timely manner and screening for malnutrition. Despite a shorter length of stay compared to NASBO, our audit has identified opportunities to improve hospital readmission, suggesting that we may be discharging patients prematurely. We have introduced a SBO checklist to ensure NASBO recommendations are adhered to and to improve our 30-day outcomes.
FP7.8 - Perioperative risk prediction for Emergency Laparotomy in Adults, using the National Emergency Laparotomy Audit (NELA) and the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk prediction tools – an Eastern European perspective
Authors: Moscalu Andrei , Iordache Andi , Sinclair Martin , Timofeiov Sergiu
Published: September 2024

Background

Worldwide, emergency laparotomy (EL) is one of the most common procedures. Having an actual 30-day mortality (30-dm) of 10 to 15%, EL has a high mortality rate, particularly in patients >70 years old. Preoperative risk assessment and stratification can improve outcomes. The American-College-of-Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) and the National Emergency Laparotomy Audit (NELA) risk prediction tools are the most used risk calculators, but both can under or overpredict.

Methods

This is a single-center, retrospective, cohort study that looked at the correlation between actual and predicted 30-dm using NELA and ACS-NSQIP in adults ≥18, following EL, over 2 years, in a single-tertiary-center from Romania. The primary outcome was defined as the correlation between actual 30-dm and NELA or ACS-NSQIP predicted 30-dm. Statistical analysis was performed using GraphPad-Prism 10.1.1. and Stata18.

Results

207 cases were analyzed. Male/female ratio was 1.49; age 65 years (50;77); BMI 26.25kg/m² (23.01;28.35); preoperative lactate 1.8 mmol/L (1.5;3.4); ASA grade 3 (2;4) clinical frailty score 4 (3;4); and Charlson Comorbidity Index 5 (3;8). Actual 30-dm was 31.4% with NELA and ACS-NSQIP predicted 30-dm of 5.78% (1.84;21.48) and 5.5% (1.2;24.2) respectively. NELA and ACS-NSQIP predicted 30-dm expressed a strong positive correlation, R²=0.88; p<0.0001. Both NELA and ACS-NSQIP predicted 30-dm showed a significant positive correlation with actual 30-dm: R²=0.33, p<0.0001; and R²=0.41, p<0.0001 respectively. All data is presented as Median + IQR.

Conclusion

In a Romanian setting both ACS-NSQIP and NELA risk calculators underpredicted 30-dm, despite expressing a strong positive correlation with actual 30-dm.
FP7.10 - An audit assessing the documentation of antibiotic indication and course length on an acute surgical unit
Authors: Carey Charles , Harshen Raj
Published: September 2024

Aims

Documenting antibiotic indications and course lengths on drug charts at the time of prescription is recommended in numerous publications. A closed loop audit was therefore performed to assess the documentation of this information for acute general surgery patients in a district general hospital.

Methods

During the first cycle, drug charts from acute general surgery patients were reviewed and the rates of documentation for antibiotic indication and course length were assessed. To improve these measures, the results from this cycle were presented to junior doctors and cards reminding doctors to complete antibiotic documentation were made and attached to drug charts when necessary. The impact of these measures was examined during a re-audit.

Results

50 patients were assessed during cycle one and antibiotic indication and course length were documented in 54.0% and 42.0% of cases respectively. Data from a further 50 patients were collected following the presentation to junior doctors working in general surgery and the introduction of the reminder cards. Following these interventions, antibiotic indication and course length were documented in 74.0% and 68.0% of cases respectively. Co-amoxiclav and Tazocin were the most common agents prescribed across cycle 1 (64.0% and 14.0% respectively) and cycle 2 (60.0% and 16.0% respectively).

Conclusions

The documentation of antibiotic indication and course length on drug charts needed improving in this cohort. Although the presentation of the data from cycle 1 and reminder cards achieved this outcome, further improvements are required and should be assessed during future re-audits.