bluuebunny/crossref_metadata_2025 huggingface dataset:
413 The Clinical Efficacy of Intra-Operative Peritoneal Fluid Sampling in Abdominal infections
Authors: Mostowfi Zadeh D , Praveen B
Published: October 2021

Aim

To uncover the practical efficacy of intra-operative peritoneal fluid sampling and the impact on antibiotic prescription and clinical outcomes in patients undergoing emergency surgery due to intra-abdominal infections.

Method

Our retrospective study included all patients undergoing emergency surgery for intra-abdominal infections at Southend University Hospital over 6 months (January – July 2019). Data was collected from electronic patient records, case notes and microbiology reports and included the following information: patient age demographics; type of infection; peritoneal fluid sampling indication; samples taken; details of swab culture report including organisms grown and antibiotic sensitivity; clinical course and incidence of subsequent intra-abdominal infection to include readmission and/or further procedures; the type, duration and route of antibiotic prescribed and duration of hospital stay. This audit was approved by the Departmental Audit Lead.

Results

441 patients undergoing emergency surgery for intra-abdominal infection were identified. After exclusions, intra-operative peritoneal fluid samples were indicated in 77 patients (mean age 39.4 years). Of these only 3 had samples taken (3.9%). The most common organisms isolated were mixed anaerobes followed by Streptococcus angiosus. The most common antibiotic sensitivity was Metronidazole and Penicillin. One readmission occurred due to an intra-abdominal tubo-ovarian abscess.

Conclusions

The study shows that the current practice in our hospital regarding intra-operative peritoneal fluid sampling in intra-abdominal infections reflects the present widely held attitudes regarding its reduced practical utility. Abandoning routine sampling had no significant impact on the clinical course and may be more cost-effective. The study may help surgeons reflect on changing perspectives on this traditional practice.
620 Daycase Appendicectomy and Same Day Discharge After Laparoscopic Appendicectomy
Authors: Gumaa D , Shrestha S , Jenner D
Published: October 2021

Introduction

Laparoscopic appendicectomy (LA) is the most common emergency surgical operation. Recently Same day discharge after uncomplicated LA has been more popular. Our study has sought to assess the safety of same day discharge and creating a pathway for day case appendicectomy.

Inclusion Criteria

Pre-operative: No signs of sepsis. CT proven or clinically suspected mild appendicitis (WCC<15, CRP<150) Intra-operative: Mild appendicitis, No perforation, No Gangrene, No free pus. Post-operative: Pain is controlled with oral analgesia. Patient is tolerating oral intake. No need for post-operative antibiotics according to WSES Jerusalem Guideline for diagnosis and treatment of acute appendicitis 2016. Social circumstances do allow safe discharge.

Method

A prospective case series study was undertaken at a large district general hospital over a 9-month period. 27 patients were included in the study, age range (10-78) years. 74% had ASA 1. 8 patients underwent day case LA & were sent home on oral antibiotics the day before the operation and asked to come back the following morning. 22 patients did not require any post op antibiotics. 5 patients received 1 dose of IV antibiotics post-operative. The 30-day morbidity/ mortality were zero. There were no readmissions during this time and patient satisfaction was high.

Conclusions

Same day discharge after laparoscopic appendectomy is safe and valid. Day case appendectomy should be considered for appropriate patients. Both approaches will decrease patients’ risk of hospital acquired infection and also decrease the burden on the NHS.
678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors
Authors: Ming J Y , Holmes M , Gani J , Pockney P
Published: October 2021

Aim

Psoas muscle:L3 vertebra (PM:L3) ratio is a relatively new risk assessment tool for emergency laparotomy(1,2) based upon the proven concept that sarcopenia – as diagnosed by low skeletal muscle index(3–6), psoas muscle density(7–9) or total psoas area(10–13) in a single axial slice CT image – correlates with increasing risks of bad outcomes in surgery. This study looks into the association between PM:L3 ratio of emergency laparotomy patients from home and their discharge destination.

Method

We performed an analysis on patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. All patients admitted from home, survived to be discharged from hospital and had an available CT abdomen were included (N = 433/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles.

Results

PM:L3 ratio is significantly lower in the group of patient discharged to a care facility than the group discharging back to their previous home residence (mean 0.951 vs. mean 1.128, p < 0.001). Upon further analysis, the PM:L3s are divided into quartiles and stratified by sex. There is an association between lower PM:L3 and risk of discharging into a care facility (Q1 22.45%, Q2 19.59%, Q3 19.10%, Q4 5.71%).

Conclusions

PM:L3 ratio can predict the discharge destination of patients undergoing emergency laparotomy.
812 Mortality Risk prediction in Emergency Laparotomy (ORIEL) Study Outcomes at Wythenshawe Hospital
Authors: Carey C , Pittam B , Mobarak S , Varley R , Kingston J , Agwunobi A
Published: October 2021

Aim

Emergency laparotomy is a high-risk procedure with significant morbidity and mortality. ORIEL is a multi-centre national study aiming to compare the 30-day mortality predictions generated by NELA, P-POSSUM, ACS-NSQIP and SORT risk calculators with observed 30-day mortality rates in patients undergoing emergency laparotomies. We present the data collected from Wythenshawe hospital.

Method

Data were collected retrospectively on adult patients undergoing an emergency laparotomy between 01/12/2017 to 30/11/2019 at Wythenshawe hospital from the online NELA database. The median pre-operative mortality risks were calculated using the four risk calculators for all patients. Mortality and morbidity were compared with data reported in the Sixth NELA report.

Results

The median predicted pre-operative mortality (IQR) for all patients studied using NELA, P-POSSUM, ACS-NSQIP and SORT were: 4.3 (13.0), 5.2 (14.2), 3.4 (8.2) and 2.9 (9.3) respectively. Among patients who were alive 30 days post-operatively, the median predicted mortalities (IQR) were: 3.8 (8.5), 4.8 (11.0), 2.6 (6.9) and 2.8 (7.1) respectively, and among those who died were: 30.8 (18.9), 30.3 (63.4), 16.9 (13.9) and 20.3 (16.2). Compared to the national average, mortality rates at Wythenshawe were lower (9% v 9.3%), the median length of stay in hospital was lower (12 days v 15.4 days) and the percentage of high-risk patients admitted to critical care was higher (93% v 85%).

Conclusions

Similar values were generated with all the scoring systems among all patients. Wythenshawe hospital reports lower mortality rates and shorter stays in hospital despite operating on higher risk patients (ASA grades 3-5).
837 High Prevalence of Anaemia and Mortality in Older Patients Undergoing Emergency Laparotomy
Authors: Bakewell Z , Wilkinson A , Todd F , Okocha M , Baker K , McCarthy K
Published: October 2021

Aim

Anaemia affects 1in10 elderly (>65) patients with a myriad of causes. Elderly patients undergoing emergency laparotomy often present with anaemia. Little is known however about the prevalence of anaemia in older people who require emergency laparotomy and the influence it may have on their outcomes.

Method

Elderly patients (>65-years old) undergoing an emergency laparotomy between May2016-November2018 in a tertiary trauma centre were prospectively identified. Data included patient demographics, haemoglobin, MCV and ferritin, blood transfusions and iron products administered, readmissions and mortality.

Results

231 patients underwent emergency laparotomy. Prevalence of pre-operative anaemia in this group was 43%. 5% were very-anaemic and 38% mildly-anaemic. Ferritin was checked within 89 patients; insufficient levels were present in 20%. 31% of all patients were given blood in the peri-operative period. 100% of patients discharged, were anaemic. For pre-operative anaemic vs non-anaemic patients, ASA grade was higher (4 vs 3), readmission rate was 19% vs 18%, 30-day mortality was 18% vs 14% and 1-year mortality rate high(34% vs 22%, p < 0.05). Very-anaemic patients (92%) received peri-operative blood compared to (41%) of mildly-anaemic patients. 30-day mortality was 0 vs 21% in very-anaemic vs mildly-anaemic patients. Mortality was 45.8% in patients who received transfusions compared to those who did not 19.9% (P < 0.0001).

Conclusions

The prevalence of anaemia in older patients undergoing emergency laparotomy is high and related to significantly increased mortality(12 months after surgery). We have identified a high-risk group of older patients with mild anaemia on presentation who may be at increased risk of mortality 3months after surgery.
889 Management of Paediatric Appendicitis During the First Wave of COVID-19: Comparison of Our Centre to National Practice
Authors: Darbyshire A , Miles J , Towers A , Tan C , Toh S
Published: October 2021

Aim

Our hospital took part in a multi-centre prospective cohort study “the CASCADE study” investigating the management and early outcomes of children with appendicitis in the UK and Ireland during the first wave of the COVID-19 pandemic (1). The aim of this study was to compare our local outcomes to those at a national level.

Method

This was a prospective cohort study with data collected from 01/04/2020 to 31/05/2020. Primary outcome was treatment strategy for appendicitis. Secondary outcomes were duration of symptoms, ultrasound findings, rate of simple vs perforated appendicitis and complications.

Results

Overall, only a minority (2/24 [8%]) were initially treated non-operatively, with both proceeding to appendicectomy due to pain. Remaining children (24/26 [92%]) were primarily treated with appendicectomy. All were performed laparoscopically with no conversions to open. Ultrasound was performed for most children (23/26 [88%]) which accurately identified appendicitis (22/23 [95%]) and negative appendicectomy rate of zero. Rates of complex appendicitis were not higher than expected (10/26 [38%]) but had a longer duration of symptoms (median 66.0h [IQR21.5] vs 30.0h [27.2], p = 0.008) and more complications (4 vs 1). Post-operative length of stay was significantly shorter for simple appendicitis than complicated (median 1.0d [IQR0.0] vs 4.0 [IQR2.8], p = 0.001).

Conclusions

Practice in our centre contrasts with the CASCADE study's National findings where 39% were treated non-operatively, only 48% of appendicectomies were performed laparoscopically, only 53% of children had diagnostic imaging and negative appendicectomy rate was 4.5%. Rates of complications for simple and complex appendicitis were similar, but post-operative length of stay shorter in our centre.
975 On Call on Friday 13th: Unlucky for Some?
Authors: Gowda A , Caddeo G , Ellis R
Published: October 2021

Introduction

Despite the practice of evidence-based medicine, superstitions remain common amongst healthcare workers around the world. Friday 13th is a day that can cause anxiety amongst many surgeons on-call. Our aim was to determine whether there is a significant difference between working an on-call as a surgeon on Friday 13th compared to the preceding Friday at a large teaching hospital.

Method

We conducted a retrospective, longitudinal cohort study that analysed admissions and operative data for all emergency general surgical and urology patients at a large teaching hospital over a five-year period. The main outcome measures assessed included the number of emergency surgical admissions, emergency general surgical operations and emergency urological operations.

Results

There was no statistically significant difference between the number of admissions (412 vs 405, p=0.835), number of general surgical operations (63 vs 49, p=0.069), and number of urological operations (2 vs 4, p=0.449) on Friday 13th compared to Friday 6th.

Conclusions

Friday 13th will inevitably be unlucky for some, but this study shows that being on-call on Friday 13th is just as unlucky as being on-call any other Friday.
1030 Paediatric Appendicectomy - Appropriateness of Operative Intervention
Authors: Lu Q , Elakkad M , Daak A , Choh C , Durrani A , Brent A
Published: October 2021

Aim

Acute appendicitis is one of the most common paediatric surgical emergencies. Prompt diagnosis and interventions reduce the risk of perforation and prevents complications. The aim of the audit was to determine the appropriateness of operative intervention and to improve patient care by implementing changes. We assessed several performance indicators including the percentage of appendicectomy performed within 12 hours of decision to operate, the percentage of negative appendicectomy and the 30 days re-admission rate.

Method

All consecutive paediatric patients who had appendicectomy in our district general hospital from Jan 2017 to 2019 were included in the initial audit. For re-audit, we collected data from July 2019 to March 2020. Patients were identified from the theatre system and ward notes, theatre charts and biochemistry and histology results were collected from the electronic patient records.

Results

A total of 193 patients were included in the initial audit. Results showed that 52.8% of patients were reviewed by a consultant prior to surgery, 92% of patients had surgery within 12 hours of the decision to operate. The rate of negative appendicectomy rate was 25%.

Conclusions

Following this audit, several changes have been implemented including improving consultant review of paediatric patients, increasing imaging done by radiologists for paediatric patient. Re-audit showed that 86.7% of patients were reviewed by a consultant preoperatively. Negative appendicectomy rate remained the same at 24.4%. Admissions within 30 days of discharge improved from 13.8% in the initial audit to 11.5% in re-audit.
1156 NELA – Time to Antibiotics
Authors: Waterman J , Abdel-Dayem M
Published: October 2021

Introduction

Early administration of antibiotics is vital in patients that have intra-abdominal sepsis. The National Emergency Laparotomy Audit (NELA) 2019 found only 19% of patients with suspected sepsis received antibiotics in the first hour. The aim of this project was to audit the current time to antibiotics in patients who underwent an emergency laparotomy in our District General Hospital (DGH) in Wales.

Method

This was a retrospective audit of all patients that underwent an emergency laparotomy between January to July 2019. Data was collected from the NELA database and Clinical Notes.

Results

33 patients underwent an emergency laparotomy, 2 patients were excluded leaving a total of 31 patients. 55% of patients received antibiotics prior to theatre. 61% of patients triggered the systemic inflammatory response syndrome (SIRS) criteria on admission but only 47% of these patients received antibiotics. Of those that received antibiotics only 16% had them prescribed within 1 hour of arriving to the hospital. 41% of patients waited over an hour from the antibiotics being prescribed to receiving them and 1 patient did not receive the antibiotics at all.

Conclusions

This project shows there are many areas for improvement. Although antibiotics maybe prescribed, clear communication with nursing staff is important, so that they can be given in a timely manner. It is also important simple measures, like working cannulas, do not prevent administration of antibiotics. Re-audit of these results is vital after education. Some patients may not require antibiotics – but missing those that do could cost lives!
1308 Investigating the Use of a Novel Pre-Hospital Triage Tool for Acute Abdominal Surgical Emergencies – A Two-Phase Single Centre Cohort Study
Authors: Misbert E , Hughes M , Burke J , Schofield C , Young A
Published: October 2021

Background

Despite the recent improvements in mortality in patients undergoing emergency laparotomy(EL) within the UK, delay to theatre continues to be associated with increased mortality. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting.

Method

A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020.

Results

Phase 1: 45 patients were coded through NELA and confirmed through operation note review as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80% (n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED, of which 69 initially treated by the ambulance service. 30% (n = 21) of these patients had an initial NEWS2 of 3 or above. Sensitivity of a NEWS2 score of >/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95% (95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98% (95%CI, 87-99).

Conclusions

A NEWS2 score of >/3 predicts the need for emergency surgical intervention including laparotomy for gastrointestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.
1416 Trauma Laparotomy: Experience of a Newly Established Major Trauma Centre in Northern Ireland
Authors: Lee F , Bashabayev B , Yoong S
Published: October 2021

Aim

The aim of this study was to assess the perioperative pathway and outcomes of trauma laparotomy during a one-year period in a newly established Major Trauma Centre in Northern Ireland.

Method

Retrospective review of a trauma registry undertaken at the Belfast Royal Victoria Hospital between August 2019 and August 2020.

Results

During this one-year period, there were a total of 17 trauma laparotomies, with a female-to-male ratio of 6:11, and a mean age of 38.9 years. 15 of 17 cases were due to blunt trauma, with only 2 cases of penetrating trauma. Of trauma laparotomies, 8 were performed during day-time hours (0801-1800), 4 during evening-hours (1801-0000), and 5 during night-time hours (0001-0800). One perioperative death was recorded. The mean time to CT from arrival to ED was 34 minutes (national target of 30 minutes). The mean time until final report was 477 minutes (national target of < 24 hours). The decision to proceed to trauma laparotomy was made prior to the final report in 9 cases. The mean length of inpatient stay for trauma laparotomy patients was 23.3 days, with a mean of 8.9 days spent in critical care.

Conclusions

This review provides an overview of provision of care for patients who underwent trauma laparotomies in Royal Victoria Hospital MTC and identifies areas for improvement. We plan to prospectively review outcomes following the opening of the Major Trauma Ward on 7th September 2020 and the implementation of the Northern Ireland Major Trauma Network Bypass protocol on 26th October 2020.
288 Impact of Trainee Surgeons Performing Thyroid Procedure on Patient Safety
Authors: Nessa A , Aspinall S
Published: October 2021

Introduction

Impact of trainee surgeons performing thyroid procedure on patient safety

Aim

The primary aim was to evaluate the impact of trainee as the principal operator on patient safety in thyroid surgery.

Method

The data was extracted from a single consultant’s data from 2009 to 2020 in the British Association of Endocrine and Thyroid Surgeons (BAETS) National audit. Multivariable analysis of predictive factors (including trainee primary operator) for temporary and permanent hypocalcaemia was performed.

Results

There were 507 thyroid cases. After excluding cases with missing data in variables analysed 378 (74.5%) cases were analysed. Vocal cord palsy occurred in 5/378 (1.3%), postoperative bleeding 3/378 (0.8%), temporary hypocalcaemia 68/378 (18.0%) and permanent hypocalcaemia 20/378 (5.3%). Predictive factors analysed included hyperthyroidism 117/378 (31%), retrosternal goitre 33/378 (8%), reoperation, 43/378 (11%), total thyroidectomy 184/378 (49%), nodal dissection 21/378 (6%) and trainee principal operator 15/378 (4%). Multivariable analyses of temporary and permanent hypocalcaemia found only two variables significantly affected incidence of temporary hypocalcaemia were total thyroidectomy (OR 7.82, 95% CI 3.41-17.92, p < 0.001) and nodal dissection (OR 3.53, 95% CI 1.20-10.38, p = 0.02), and for permanent hypocalcaemia these were reoperation (OR 5.05, 95% CI 1.09-23.25, p = 0.04) and total thyroidectomy (OR 5.76, 95% CI 1.35-24.54, p = 0.018).

Conclusions

There was no evidence that trainee principal operator adversely affected the outcome of thyroidectomy; it is worth noting that only 4% of operations were done by trainees and so this study would support trainees undertaking more thyroidectomies as principal surgeon.
637 Patients' Perceptions of Complications Following Thyroidectomy
Authors: Marchitelli G , Tingle S , Bliss R , Truran P , Ramsingh J
Published: October 2021

Aim

The aim of this study was to assess patients' understanding of the risks of thyroid surgery and to assess whether their understanding of risks improved following the implementation of a pre-operative risk-tool.

Method

Single centre prospective cohort study between June 2019-August 2019. All patients that underwent thyroid surgery were recruited. Patients had either the standard process of consent or were provided with a pre-operative risk-tool and information leaflet. Post-operatively all patients were provided with a questionnaire to determine their understanding of the risks involved in having thyroid surgery. Data was analysed using GraphPad Prism v6.

Results

51 thyroidectomy patients were recruited; 28 patients had a standard process of consent and 23 patients were provided with the risk-tool. Patients undergoing standard consent processes had a poor understanding of the magnitude of post-operative risk; their median score for risk magnitude was 4.5/10 (2-7) versus 8/10 (4-10) in the cohort receiving the risk-tool. The proportion of intervention to non-intervention participants giving the correct answer reached a statistically significant difference in 50% of questions asked (P < 0.001).

Conclusions

It is imperative thyroidectomy patients are made aware of both rare events but also the frequency of which events occur so that they are properly informed prior to consenting. We have demonstrated that standard processes of consent in thyroidectomy patients leads to poor perception of risks; providing a surgical risk-tool can counteract this. These results warrant development of clear guidelines on the use of pre-operative surgical risk-tools in thyroidectomy patients.
71 The Use of Sternocleidomastoid Rotational and Cervicofacial Advancement Flap for Closure of a Persistent Mastoid Cutaneous Fistula
Authors: Mantelakis A , Tsitsiou Y , Joshi A
Published: October 2021

Introduction

Postauricular mastoid fistula is a rare occurrence, typically following repeated soft tissue injury, commonly caused by chronic suppurative otitis media and repeated surgical treatments. Management is challenging with a limited number of reported, successful surgical techniques, which often have limited applicability.

Case report

We present a case of a 55-year-old male patient with a persistent right post-auricular cutaneous mastoid fistula as a result of two previous mastoidectomies. Although the patient underwent two simple primary closures, the fistula recurred. This was successfully treated with a new technique utilising a Sternocleidomastoid Rotational and Cervicofascial Advancement Flap which was completely healed at the 1-year follow-up without a recurrence of the fistula.

Conclusions

This novel technique provided a definitive obliteration of a persistent cutaneous mastoid fistula. By utilising a double layered flap, via a facelift incision, the flap results in an excellent functional and cosmetic result.
247 Single-Photon Emission Computed Tomography (SPECT) In Predicting Localisation of Parathyroid Adenomas: A Closed-Loop Prospective Study
Authors: Ahmed O , Gao C , Buchanan M , Pfleiderer A , Al-lami A
Published: October 2021

Aim

to measure the sensitivity of SPECT in localising parathyroid adenomas particularly whilst attempting minimally invasive parathyroidectomy.

Method

2-cycles prospective study correlating SPECT and operative findings was conducted. All patients underwent ultrasound and SPECT, those with concordant findings on both modalities underwent minimally invasive parathyroidectomy, whilst patients with discordant findings on both modalities had central neck exploration. Following operative findings, recommendations of changing the SPECT reporting method such as surgically relevant structures adjacent to the lesion, such as the thyroid, were implemented. Following which, a second prospective study assessed the outcome of change.

Results

In the first cycle, 20 patients underwent partial parathyroidectomy, either by open (n = 13), or minimally invasive (n = 7) approach. SPECT sensitivity was 85% (n = 17) in identifying the adenoma. Out of all histologically confirmed adenomas, SPECT identified all adenomas (n = 17) on the correct side and 41% (n = 7) on the correct level (superior vs. inferior parathyroid). In the second cycle following recommendation, 14 patients had surgery, 9 as minimally invasive and 5 as open approach. SPECT sensitivity was 79% (n = 11) for adenoma identification. Of all confirmed adenomas, SPECT identifying adenomas at the correct side increased to 91% (n = 10) and correct level to 91% (n = 10).

Conclusions

SPECT alone is not yet regarded as gold standard in parathyroid adenoma localisation. The study has demonstrated that feedback to the radiologist of the operative findings may enhance its usefulness, particularly in attempting to proceed with a minimally invasive parathyroidectomy.
350 Cross Over Septal Flap Technique for Choanal Atresia Surgery: Two Centre Series with Outcomes
Authors: Adegboyega G , Elhassan H A , Karligkiotis A , Searyoh K , Zocchi J , Bozkurt G , Bandi F , Turri-Zanoni M , Battaglia P , Bignami M , Castelnuovo P
Published: October 2021

Introduction

Choanal atresia (CA) is a congenital obstruction of the posterior nasal aperture due to nasal cavity canalisation failure. Endoscopic endonasal surgery has led to successful CA repair and fewer complications compared to open surgery. We describe our surgical technique that uses septal mucosal flaps without need for stenting or subsequent intubation.

Method

A multicentre retrospective review of patients who underwent surgery using the cross over septal technique. Patient demographics and outcomes were recorded. Flap design: bilateral vertical septal mucosa incisions are performed on either side of the posterior third of the septum to form two mucoperiosteal flaps. The posterior vomer and atretic plates are removed. One flap is pedicled superiorly and rotated over the bare sphenoid rostral bone. The contralateral flap is pedicled inferiorly and rotated to cover exposed bone of nasal cavity floor. Lateral nasal wall mucosal integrity is maintained. This technique is used both for unilateral and bilateral atresia.

Results

Twelve patients from 2013 to 2020 were included. Age range was 0.07-50 years, male to female ratio of 1:5. Ten patients had unilateral CA, two had bilateral. Nine had bony CA, the remainder mixed. 5 patients (mean age 2.8 years) underwent second-look endoscopy under sedation an average 36 days following primary surgery.

Conclusions

The cross over technique for CA has low morbidity and 100% success in our multicentre series. Use of mucoperiosteal flaps to cover the exposed bone, removal of vomer and minimal instrumentation to the lateral nasal wall are the best ways to avoid postoperative stenosis.
400 A Comparative Study of Intracapsular & Extracapsular Coblation Paediatric Tonsillectomy in A Tertiary Centre
Authors: Wilson B , Li L , Gomati A , Sharma A
Published: October 2021

Background

Intracapsular tonsillectomy has emerged as a novel alternative to traditional tonsillectomy where the tonsillar capsule is left intact with a small amount of overlying tonsillar tissue. There is growing evidence to suggest that intracapsular tonsillectomy is associated with reduced post-operative pain, haemorrhage and readmission rates. The aim of this study was to assess the reported benefits of intracapsular tonsillectomy within the ENT department at a tertiary paediatric hospital.

Method

Retrospective analysis comparing two cohorts of 72 consecutive paediatric patients undergoing coblation intracapsular and extracapsular tonsillectomy between March-2019 and November-2020. Patient age at procedure, removal of adenoids, indication, surgeon grade, and discharge time were recorded. Post-tonsillectomy bleeding and 30-day readmission rates were used as the main outcome measures.

Results

The median age in both groups was 5 years. The intracapsular cohort demonstrated a lower 30-day readmission rate (8.3% vs. 15.3%), lower primary (<24 hours) post-op bleed rate (0% vs. 2.78%) and lower secondary (>24hours) post-op bleed rate (4.2% vs. 12.5%) when compared to the extracapsular cohort. Eight cases were conducted as day cases in total, all Intracapsular, with none of these patients requiring readmission within 30 days.

Discussion

Coblation Intracapsular tonsillectomy is an effective and low-risk alternative to extracapsular techniques. It is hoped with the reduced associated risks and morbidity associated with the procedure, the department can move towards day case tonsillectomy procedures resulting in a reduction in overall healthcare costs and improved patient experience.
450 Low Dose CT Protocols - The Future for Paediatric Foreign Body Aspiration?
Authors: Ash J , Daya H
Published: October 2021

Aim

Suspected foreign body aspiration is a common attendance at the paediatric emergency department. Low dose Computer tomography (CT) protocols (0.06-2mSv) have been developed to be able to diagnose these patients more effectively.

Method

All paediatric low dose CT protocols for foreign body aspiration from a large tertiary level hospital were identified retrospectively over a year. Data was collected on prior imaging, result, further intervention and subsequent follow up of patients.

Results

Eight patients were identified. Three (37.5%) identified a foreign body on CT. All three had subsequent microlaryngoscopy and all found a foreign body present. Of the five negative scans, none re-presented or had any associated symptoms of a foreign body at follow up. Five had previous Chest X-ray, all of which were inconclusive.

Conclusions

Although need for ongoing research into the area, low dose CT thorax protocols for suspected foreign body aspiration is a promising and effective tool. Its use across the country will likely lead to reduced negative microlaryngoscopy rates with huge associated benefits for both the patient and the ENT department.
512 The Management of Aural Foreign Bodies During the COVID-19 Pandemic - MKUH ENT Department Experience
Authors: Ho G C , Thind R , Yap D , Hunt A
Published: October 2021

Aim

During the initial wave of the COVID-19 pandemic, ENT UK published a clinical guide on surgical prioritisation which suggested that aural foreign bodies can be removed between one and three months from initial presentation. This case series aims to investigate the impact of leaving aural foreign bodies in situ for a prolonged period of time, including the risk of complications, success rates of subsequent removal attempts and whether foreign bodies can clear themselves without intervention.

Method

Retrospective study of all aural foreign body referrals to the ENT emergency clinic over a 6-month period.

Results

Thirty-four patients were identified. The duration of foreign bodies left in-situ ranged from 1 to 78 days. Four patients suffered from traumatic removal upon initial attempts, however there were no other significant complications. First attempts made by non-ENT specialists (68.8%) all failed and were associated with a high risk of trauma (36.4%). The chances of successful removal on second attempt (28.6%) reduced dramatically when compared to the first attempt (52.9%). Two patients had no foreign body visualised upon second attempt, suggesting it has cleared itself. A total of 7 patients (20.6%) required removal under general anaesthesia.

Conclusions

Due to the unique circumstances of the COVID-19 pandemic, this is the first case series to look specifically at the relationship between duration of aural foreign bodies left in situ for over 30 days from presentation and the risk of complications. Our data suggests that prolonged duration did not increase the incidence of complications.
665 Management of Epistaxis Patients After Nasal Pack Removal - Quality Improvement Project
Authors: Priskorn F , Wong P , Daultrey C
Published: October 2021

Introduction

Epistaxis is a common emergency and treatments include cautery and nasal packing. NICE guidelines recommend Naseptin® (chlorhexidine and neomycin) and routine practice is to perform cautery if bleeding point identified following pack removal.

Method

Retrospective analysis of electronic records over a 9-month period identified 114 patients admitted with epistaxis.

Results

Demographics: 65 male, 49 females (roughly 13:10 ratio), an average age of 72.5 and median age: 76. 8 patients had 2 presentations with epistaxis (3 had SPA ligation on repeat admission). 97 patients were packed, 17 no packing performed. Reasons for admission without packing was observation after cautery (7), observation without cautery (5) and admission under medics for non-epistaxis issue (5). Of patients with discharge summaries, 90% had naseptin prescribed. Of patient admitted under medics, only 60% discharged with naseptin. 70 patients (61.4%) were cauterized, 16 patients (14%) examined, but no cautery required, and 28 patients (24.5%) had no documentation of examination or cautery attempt.

Conclusions

The majority of patients are receiving naseptin on discharge but room for improvement. Although small sample size of 5, greater portion medical patients discharged without naseptin, better handover required. Almost a quarter of patients (24.5%) did not have any documentation of cautery attempts.
686 Evaluating and Modernising the Management of Nasal Trauma in Emergency ENT Clinic
Authors: Rassam J , Blackabey V , Srouji I
Published: October 2021

Aim

1. Optimise and compare management of nasal fractures at a single UK based centre with nationally excepted standards from ENT UK and published literature. 2. To measure the non-attendance (DNA) rate in the emergency ENT clinic for patients with nasal trauma. 3. To assess the ratio of face to face (F2F) appointments to patients listed for a manipulation under anaesthesia MUA. 4. To provide additional insight into the aetiology of nasal trauma

Method

Retrospective analysis of clinical notes for all nasal traumas reviewed in the ENT emergency clinic at a single centre from 1st July 2019 – 1st March 2020. Parameters investigated included – demographics, days from injury, F2F:MUA, DNA rate and aetiology of injury. Implementation of a video-based clinic and local anaesthetic MUA clinic.

Results

At total of 255 patients and 311 appointments notes were reviewed in this period. DNA rate was found to be 28%. F2F:MUA was found to be 4:1. Patients were reviewed on average 9 days post-injury. Most common causes of trauma were assault (39%), fall (31%), sport (13%), accidental hit (10%).

Conclusions

The DNA rate was found to be 20% higher than the national average for outpatient clinics and a F2F:MUA of 4:1 displays a high burden of unnecessary F2F contact. A video-based and local anaesthetic nasal fractures clinic has been implemented to combat these issues which will be re-audited.
918 Nasal Packing Duration in The Management of Epistaxis: A Cohort Study
Authors: Collins R , Addison A , Paul C , Clark A , Philpott C
Published: October 2021

Aim

Nasal packing is one of the mainstays of inpatient treatment for epistaxis. However, no current guidelines exist on optimal duration of nasal packing. This paper seeks to determine the optimal duration of nasal packing in terms of re-bleeding.

Method

A retrospective cohort study was conducted on patients admitted over a two-year period. Data collected included re-bleeding events following pack removal, age, gender, site of epistaxis, hypertension, trauma and anticoagulation medication.

Results

The rate of re-bleeding increased with length of pack duration; over 12 hours was associated with greater re-bleeding rates (p = <0.001) and continued to be statistically significant when controlling for co-founders (p = 0.01). Those packed over 24 hours were over five times more likely to re-bleed than those packed less than 12 hours (p = 0.01. OR 5.34).

Conclusions

A packing duration of less than 12 hours is associated with lower rates of re-bleeding. Admitting teams should therefore aim to ensure that patient pathways involve early pack removal.
974 Improving Safety for Tracheostomy and Laryngectomy Patients Within A Regional Head and Neck Unit
Authors: Simpson L , Watson G
Published: October 2021

Aim

To improve the safety of tracheostomy and laryngectomy patients within a UK-based regional head and neck unit.

Method

This audit was conducted against standards taken from the National Tracheostomy Safety Project (NTSP). Inclusion criteria were all patients with a tracheostomy or laryngectomy on the ward, there were no exclusion criteria. Data was collected per inpatient episode for a one month period pre- and post- implementation of each intervention (1st March to 31st May 2020).

Results

Pre-intervention results showed that none of the 19 neck-breathing inpatients during March 2020 had a bedhead sign or emergency algorithm displayed, however all patients had required bedside equipment and the only unavailable ward equipment was capnography. Laminated bedhead signs and algorithms were implemented and 33% neck-breathing patients had signs displayed during April 2020. Further intervention in May 2020 to educate ward staff led to 90% of patients having a bedhead sign displayed and 80% having an algorithm displayed.

Conclusions

Overall, our unit has very high standards of care for neck-breathing patients. The use of bedhead signs and emergency airway algorithms is an integral part of providing safe care for neck-breathing patients and all members of staff are responsible for their use. The COVID-19 crisis has impacted on the number of elective procedures being performed which has impacted upon the numbers for the post-intervention arms of our audit. Reduced staffing due to sickness during the pandemic may have contributed to the substandard results.
1168 Radiotherapy Dose for HPV Driven Oropharyngeal Cancer: What Is Enough?
Authors: Penny F , Shanmugasundaram R , Patel N
Published: October 2021

Aim

Squamous cell carcinoma of the oropharynx is associated with high-risk Human Papilloma Virus (HPV) infection. HPV positive oropharyngeal cancer is often more radiosensitive and first line treatment includes either radiotherapy or surgical resection. Trials are ongoing to establish situations in which radiation doses can be reduced with the aim of reducing late tissue toxicity (“de-escalation trials”) . We report a case in which a patient failed to complete his prescribed radiotherapy treatment, describe his clinical outcomes and the potential questions this situation raises.

Method

In 2009 a male patient presented with a right T2N0MO P16 positive tonsillar squamous cell carcinoma. He was scheduled to complete a course of chemoradiotherapy. However, he was only able to complete a third of the radiotherapy course. Due to unresolved symptoms, he underwent a right transoral laser extended tonsillectomy, however this showed only fibrous tissue.

Results

Despite not completing the radiotherapy course he has not experienced local recurrence of the tonsillar OPSCC 11 years post initial treatment.

Conclusions

This case illustrates that some patients with HPV driven oropharyngeal cancer can have a clinically significant tumour response to markedly lower doses of radiotherapy than is currently recommended. Further randomized controlled trials are required to establish the optimum dose in the management of HPV driven oropharyngeal squamous cell cancer.
1189 ENT Emergency Clinic: The Introduction of The Online Booking System
Authors: Motter D , Downes S
Published: October 2021

Introduction

The ENT department at the Royal Glamorgan Hospital introduced the use of an online booking system for the emergency clinic. The aim of it was to provide a more organised clinic that can be run efficiently and reduce the waiting time for patients. We aimed to assess the efficiency of the transition between paper-based and online booking system.

Method

We initially carried out a 3-week retrospective data collection on patients booked using the paper-based system, and then collected data during the 3-week transition period, and finally 3 weeks after the use of the online booking system only. We compared the findings for each and analysed the results

Results

Over the 9-week period, 370 appointments were booked into the emergency clinic. We analysed that since the introduction of the online booking system, there has been a reduction in booking errors, number of overlapping and overbooked sessions. Initially, 11 slots were overbooked with the paper-based system, but after the use of the online booking system, only 2 sessions were overbooked.

Conclusions

The transition to the online system has significantly improved the quality of the ENT emergency clinic. Patients were less likely to be waiting in an overfilled waiting room and each patient will have enough time allocated to address their needs. The online booking system allows an MDT approach as it can be accessed by the entire ENT team, this can be an important tool to aid in audits and quality improvement projects.
1199 Attend Anywhere: The Virtual Clinic for Routine ENT Consultations
Authors: Motter D
Published: October 2021

Introduction

During the COVID-19 pandemic, the ENT department at the Royal Glamorgan Hospital introduced the use of “Attend anywhere” which is a virtual platform that is used by medical professionals to carry out clinics remotely. It ensures confidentiality between the physician and the patient, as well as practicing social distancing. We assessed the number of patients seen in the virtual clinic, the conversion rate of virtual to face-to-face appointments and technical issues with Attend Anywhere.

Method

We carried out a 3-month retrospective data collection on patients seen in the Attend Anywhere clinic. We accessed their clinical records using the Welsh Clinical Portal system. The outcome for each patient was documented. We also assessed any technical issues with the platform.

Results

305 patients were scheduled to be seen on the platform. Of the 305, 264 attended their appointment. 4 of the patients required urgent medical attention and were subsequently scheduled for urgent face-to-face appointment within the 24 hours.

19 patients had technical issues with the Attend Anywhere platform, and 14 of them were subsequently converted to telephone consultations. The issues were not specifically documented, but connectivity to webcam was a common recurrence. 70 patients were safely discharged from the ENT department

Conclusions

The introduction of the Attend Anywhere virtual clinic has greatly helped prevent a backlog of patients waiting to be seen by the ENT team. 26% of patients were safely discharged back to the GP. The results with the virtual clinic platform are promising and could be a new practice for the NHS.
1251 Risk Stratification in the Management of Post-Tonsillectomy Haemorrhage
Authors: Holden P , Wilson G , Daniel M , Srivastava R
Published: October 2021

Aim

Tonsillectomy represents 17% of the elective workload in ENT and post-tonsillectomy haemorrhage is the most significant complication of this procedure. Accordingly, the GIRFT (Getting It Right First Time) report for ENT surgery focusses on the prevention of post-tonsillectomy bleeding. However, there is little guidance on the management of post-tonsillectomy haemorrhage. A local guideline for the management of post-tonsillectomy haemorrhage was introduced in 2020 based on expert consensus. This audit examines the management of patients readmitted with post-tonsillectomy haemorrhage in 2019 and compares this to the management suggested in the new guideline.

Method

Patients readmitted with post-tonsillectomy haemorrhage within 30 days of a tonsillectomy performed in 2019 were identified. These were retrospectively stratified into risk categories according to both patient and clinical factors. Management was audited against the new guideline including both the initial patient assessment and the treatment suggested for their respective risk category.

Results

Fifteen patients were identified and stratified into low, medium and high-risk categories. All patients in the “low risk” category were successfully treated conservatively. One patient from the “medium risk” category had a further bleed as an inpatient during the proposed period of observation in the new guideline and was thereafter treated as “high risk”. Within the “high risk” category two patients required return to theatre for arrest of post-tonsillectomy haemorrhage.

Conclusions

These results show that the risk stratification proposed in these guidelines may be useful in the management of post-tonsillectomy haemorrhage. Amendments to the guideline and a re-audit are in progress.
1261 Incidence and Risk of Post Tonsillectomy Bleeds for Tonsillitis And/Or Peritonsillar Abscess (Quinsy) In Adult Patients
Authors: Majhail G , Wise K
Published: October 2021

Aim

Determine the incidence of post tonsillectomy bleeds (PTB) in patients 16 years and over with a background of tonsillitis and/or quinsy. Explore factors that can increase the risk of a haemorrhage. Assess the operation notes for completeness.

Method

A retrospective review was conducted of 30 tonsillectomies for quinsy and recurrent or chronic tonsillitis from the 01/08/20 to 10/12/20. They were followed up for 28 days. Patient notes including operation notes were reviewed.

Results

Following surgery 8 out of the 30 patients (26.7%) had a secondary PTB. There were no primary PTB. 4 out of the 8 patients (50%) had to return to theatre to arrest the haemorrhage. The median time was 6 days post-op. Only 1 PTB (12.5%) occurred following a cold dissection and the other 7 (87.5%) following electro dissection. This equated to 39% of the electro dissections resulting in PTB compared to 8.3% of the cold techniques. There were 6 robot-assisted surgeries with 3 (50%) resulting in a haemorrhage. Just over a third (35%) of patients 25 years of age and over had a PTB vs. 10% of those under 25. Only 1 out of the 30 operation notes was completed fully. Examples of details omitted are estimated bloods loss, power settings, findings, and indications.

Conclusions

A 3.5 times greater rate of PTB is seen in those aged 25 years and over. Hot techniques, in particular those that were robot-assisted, showed a higher incidence of haemorrhages. A pro forma should be utilised to improve the completeness of operation notes.