bluuebunny/crossref_metadata_2025 huggingface dataset:
TU2.13 Laparoscopic/robotic restorative proctectomy in the District General Hospital setting
Authors: Patel Maitreyi , Aguayo Xavier , Robinson Christine , Banerjee Saswata , Hanson Matthew , Rajendran Nirooshun
Published: November 2022

Aims

Ileal pouch anal anastomosis/restorative proctectomy is a standard surgical treatment for ulcerative colitis performed in a few specialist centres. We report the evolution of the service at our trust which originally carried out open pouch surgery but has moved practice towards laparoscopic and robotic-assisted pouch surgery. The aim of this study was to assess the surgical and functional outcomes of patients undergoing laparoscopic/robotic-assisted IPAA.

Methods

Data were prospectively collected from consecutive laparoscopic/robotic IPAA cases from 2014 to 2021. Patient demographics, operative details, postoperative complications, functional outcomes were collected. Patients were selected by IBD specialized surgeons and reviewed by a pouch nurse. Follow-up consisted of clinical examination and assessment of pouch function.

Results

18 patients underwent laparoscopic or robotic IPAA during the study period, 13 (72.23%) were males. Median age was 28 years. Indication for surgery was ulcerative colitis. Median duration of surgery was 7 hours. Four patients (22.23%) developed postoperative intra-abdominal collection, managed conservatively in all except one, who required laparoscopic washout. The median duration of stay was 8 days. The rate of severe complications, Grade 3 and 4 on Clavien-Dindo classification was 11.12%. During a median follow up of 75 months, there were no pouch failures. The median stool frequency was 6 daily.

Conclusion

Our data suggests that with good patient selection and guidance from an experienced pouch nurse, laparoscopic/robotic IPAA is safe and feasible. Good perioperative outcomes and acceptable pouch function can be achieved in a DGH setting with a team to ensure consistent care of patients.
TU3.1 Effect of COVID-19 on stoma formation rates in elective left sided colorectal cancer resections
Authors: ElZanati Hisham , Zohdy Mohamed , Samuel Sajanee , Marimuthu Kalimuthu
Published: November 2022

Aims

The primary aim of the study was to assess the effect of COVID-19 on rate of stoma formation in elective left sided colorectal cancer resections. Other possible effects of COVID-19 on the management of these patients were explored too.

Methods

Retrospective review of elective left sided colorectal cancer resections over a 2 years period. Patients were divided into 2 groups, Pre-COVID (4/2019–3/2020) and Post-COVID (4/2020–3/2021) There were 43 resections in the Pre-COVID group and 21 resections in the post-COVID group

Results

Patient demographics were comparable in both groups. There was a 30% reduction in total number of colorectal cancer resections and 50% reduction in left sided resections. There was a 3 fold increase in patients not anastomosed primarily post-COVID (from 20.5% to 61%). There was a 2 fold increase in patients ending up with a stoma including patients undergoing primary anastomosis but with defunctioning stomas(from 38.4% to 72.2%). Procedures completed laparoscopically were more or less comparable in both groups. Conversion rate was slightly higher in the post-COVID group (from 14.3% to 21%).

Conclusion

Significant increase in stoma formation in the post COVID group most likely due to guidelines from the royal college early in the pandemic but other possibilities include delay in treatment. More studies are required as the pandemic continues to explore this further and determine whether this was justified and to enable us to adapt to the new normal and assess whether we can return safely to our pre-COVID practice without compromising patient outcomes or adding to their morbidity.
TU3.2 Has Covid-19 Pandemic affected the management of patient's with colorectal cancer?
Authors: Gumaa Duaa , Agrawal Aarushi , Akhtar Mansoor
Published: November 2022

Introduction

Patients on the cancer pathway should be investigated on the 2 weeks wait pathway, but Covid-19 pandemic had universal impact on the Healthcare systems. One of the main worries was the impact on cancer patients due to delayed diagnosis and management. Our study looks at the timeframe of investigations for colorectal cancer during the second wave of the pandemic compared to pre covid time.

Method

Retrospective study looking at the waiting time to investigate patients with +ve qFIT test during the second wave of pandemic (from November 2020 till March 2021).

Results

During this period 150 patients had +ve qFIT test, the main presenting symptom was Change in bowel habits. 90 patients were investigated with colonoscopy, only 16 (17%) patients had the colonoscopy done within 2 weeks from the qFIT result. 23 patients had colonoscopy 2–3 weeks from the result. 30 patients (33%) had the colonoscopy between 3–4 weeks, and 21 patients had to wait between 1–6 months to have the colonoscopy.

Out of the 150 patients, 60 patients were investigated primarily with CT scan or CT colon.

Conclusion

During the covid-19 pandemic, majority of patients in our trust were investigated within one month of +ve qFIT test but yet there was some delay in carrying out the investigations compared to the normal pathway and more patients had CT scans as primary investigations before being referred for colonoscopy.
TU3.4 A relook into the effects of Covid-19 on emergency theatre utilisation
Authors: Rizkalla Nagy , Khalid Ayesha , Merrit Jack , Khaliq Abdual , Khaira Harmeet
Published: November 2022

Background

In 2020 we assessed changes in delivery of emergency surgeries due to the pandemic in a local district general hospital. Significant delays in emergency theatre utilisation were partly abrogated with the early introduction of a second emergency theatre so that Covidpositive, negative and unknown cases could be operated in series (and occasionally in parallel) with minimal disruption.

Aims

We aimed to re-audit emergency theatre utilisation later on during the pandemic to assess the effects of having more established protocols and following recommendations from our first audit.

Methods

Retrospective study of all emergency theatre cases performed during the month of July 2021 compared with previously presented November 2020. Parameters of theatre utilisation included: sending times, anaesthetic times, operating times, recovery time in theatre and total recovery time

Results

The mean time taken to send for patients from wards decreased by 27% in late pandemic versus early (n=110 vs 111, p=1.25*10–7); this was also an improvement on pre-pandemic figures by 17%. Anaesthetic time decreased by 31% (p=0.0001, n=110 vs 111). Recovery time required in theatre decreased by 26% (p = 0.06, n=110 vs 111). Total recovery time however increased by 19% (p=0.097, n=110 vs 111).

Conclusion

Improved Covid testing and testing protocols have most likely had a positive impact on theatre utilisation by reducing sending times, anaesthetic times and recovery times in theatre.

Increases in total recovery time are likely a by-product of increased elective work.
TU3.5 Increasing stoma requirements during the COVID-19 pandemic
Authors: Kumaran Naren , Vijayaregu Vishal , Abdelqader Bushra , Chang Wen Yuan , Sangal Sam , Polson Robin
Published: November 2022

Aims

The COVID-19 pandemic has led to a change in working practices in the diagnosis and management of colorectal cancer. Guidelines emerged which recommended changing anastomotic practice in favour of forming a defunctioning stoma or end stoma in patients who would have previously had an anastomosis. This study aimed to identify whether these changes have resulted in an increase in patients requiring a stoma and its potential impact.

Methods

All patients diagnosed with colorectal cancer in the authors’ tertiary surgical unit in three 4-month intervals were included. These corresponded to before the pandemic (March–June 2019), during the UK's first wave of COVID-19 (March–June 2020), and during the second wave (December 2020–March 2021). The incidence of stomas was compared between groups.

Results

In patients undergoing elective surgery the incidence of stomas was 13% pre-pandemic. However, this tripled to 39% during the first wave and increased to 54% in the second wave. Similar trends were seen in patients undergoing emergency surgery with 36% having stomas before the pandemic which rose to 50% during both the waves.

Conclusion

A change in stoma practice was observed with patients having a stoma when they would usually have had an anastomosis only. As COVID-19 continues to have a severe effect on planned surgery in the UK, patients requiring stoma reversal adds to the backlog. As the huge task of clearing the backlog begins, surgical teams must be provided with appropriate resources, professional and mental health support.
TU3.6 Surgical training salvage during COVID-19: a hospital quality perspective
Authors: Luton Oliver , Mellor Katie , Eley Catherine , Lewis Wyn , Egan Richard
Published: November 2022

Introduction

Vicissitudes including re-deployment, elective cancellations, and remote educational events have restricted training opportunities during the COVID pandemic. This study aimed to analyse COVID's impact on global Higher Surgical Trainee (HST) performance metrics including hospital adaptability and variance.

Materials and Method

Intercollegiate Surgical Curriculum Programme (ISCP) portfolios of 50 HSTs (median age 36 (range 29–46) yr., female 15, male 35), including 191 six-month rotational placements, were analysed over two years (March 2019 to 2021). Primary effect measures were: operative logbook numbers, index procedures validated against curriculum requirements and Work Based Assessments (WBA).

Results

During COVID-19, operative experience per placement declined 26.1% (median 211 vs. 156, p<0.010), with a 32.1% decline in trainee primary surgeon experience (162 vs. 110, p<0.010). Regarding index procedures: cholecystectomy declined 45.5% (11 vs. 6, p=0.027) and inguinal hernia 62.5% (8 vs. 3, p<0.010). WBAs were similar (17 vs. 13, p=0.364). Despite relative equivalence before COVID, median total number of operative procedures performed in District General Hospitals (DGH, n=65) were 40.9% fewer than Tertiary Hospitals (TH, n=110, p<0.010). Radar plots of composite metrics ranged from 11.1 to 75.6% coverage before (p=0.011) vs. 13.3 to 68.9% after COVID (p=0.015).

Discussion

Hospital training metrics varied over five-fold, a difference likely amplified by COVID, with THs more adaptable to existential shared lessons.
TU3.8 Advice and Guidance: an effective communication tool between primary and secondary care in the COVID era?
Authors: Radnaeva Irina , Ward Stephen
Published: November 2022

Introduction

Advice and Guidance is a digital communication tool that allows primary care physicians to seek advice from secondary care clinicians prior or instead of direct referrals.

Aims

Our audit aims to analyse the number of Advice and Guidance e-referrals made to General Surgery consultants at the Queen Elizabeth Hospital Birmingham and measure the outcomes of those conversations in order to determine the usefulness and value of the given platform as well as analyse the timescale of the replies.

Methods

We have retrospectively analysed the outcomes of all the referrals to General Surgery made via Advice and Guidance platform between July 2020 and September 2021. The responses were categorised into 7 different outcomes, main ones being “outpatient clinic referral”, “further investigation required”, “advice from a different specialty is needed” and “advice on management only”. Time taken to reply to the referrals was also analysed.

Results

At total of 2244 referrals were included in this audit. 61% of the referrals were deferred to outpatient clinic for further review, 18% required further investigations, in 10% advice only was given and 8% were referred to a different specialty. Time taken to reply to a referral was 5 days on average.

Conclusions

Advice and Guidance is an appropriate tool that allows direct communication between GPs and General Surgical consultants and is set to reduce the number of unnecessary outpatient clinic referrals made. This in turn reduces pressure on the already stretched secondary care system, especially in the ongoing COVID-19 pandemic.
TU4.2 Robotic surgery for colorectal cancer: a single-center experience
Authors: Butnari Valentin , Mansuri Ahmer , Kaul Sandeep , Huang Joseph , Nirooshun Rajendran
Published: November 2022

Aim

To present our learning-curve data for patients that underwent robotic-assisted colorectal surgery (RCRS) at a large NE London DGH.

Methods

We report our data from 50 initial colorectal cancer resections, performed by two surgeons. We report the gender, age, histopathology, surgery performed, surgical time, conversion, post-operative complications, and hospital stay.

Results

The first 50 patients who underwent RCRS between February 2020 and December 2021 for malignancy were included. Twenty-one were right hemicolectomies, 16 high anterior resection, 6 extended right hemicolectomies, 4 low anterior resections (including a planned robotic boari flap in 1 case by a trained urologist), 3 abdominoperineal excisions of rectum. The male to female ratio was 1:1 and the mean age was 65 (range: 22–85) years. The ASA class distribution was 4% ASA I, 64% ASA II, 32% ASA III.

The median surgical time was 263 minutes (120–620) with median console time 136 minutes (50–540), the median hospital stay 5 days (range: 2–35) and a conversion rate of 6% (3/50 patients). The most common post-operative complications were ileus 4% (4/50), wound infection 6% (3/50), anastomotic leak 6% (3/50), and abscess formation 2% (1/50). 1 mortality occurred in a patient with an operated leak who contracted COVID-19. All patients underwent confirmed R0 resections with a negative CRM.

Conclusion

We report our first 50 robotic cases for colorectal malignancy, showing that robotic-assisted surgery can be performed with low rates of conversion 3 cases (6%) and low rates of post-operative complications despite a challenging patient demographic and a sharp learning curve.
TU4.4 ‘Nurse led Colorectal 2ww clinic’: Impact on early assessment and faster diagnosis of colorectal cancer
Authors: Chowdhury Ashim , Shrestha Anuj , Williams Larissa , Aravind Biju , Basnyat Pradeep , Shrestha Ashish
Published: November 2022

Background

Colorectal cancer (CRC) is the second most common cancer death in the UK with a 5-year relative survival rate is 57%, which has improved over the last 30 years. Early detection of the cancer has a great impact on its prognosis. In our large district general hospital, we receive GP 2 week pathway referrals for suspected CRC with an average monthly referral of 726. Therefore, the aim of this study is to assess if recently introduced nurses led colorectal rapid access clinic has any impact on early assessment that can facilitate faster diagnosis.

Method

A retrospective analysis of a prospectively collected data of the patient referred through a 2-week colorectal clinic pathway from outpatient referral system, was carried out from April, 2021 to November, 2021. Patient feedback and clinician advice and guidance were also evaluated in the same period.

Result

A total of 900 patients were reviewed in our Nurse led clinic with CRC detection rate of 2% approximately. Final diagnosis of cancer been made within the 28th day. Increment of 21% was seen in referrals per month. Optimal slots of 195/week are required but the nurse led clinic capacity is only 40/week. Despite the increased referral, patients are being provided with results within day 13 with positive feedback from the patients.

Conclusion

Despite of overwhelmed referrals, final diagnosis is provided within 28 days. Nurse Led Colo-rectal Clinic could be the answer to relieving the capacity, financial pressures and providing high quality safe patient care for our already strained NHS.
TU4.5 qFIT test: the future of colorectal cancer investigation
Authors: Agrawal Aarushi , Gumaa Duaa , Akhtar Mansoor
Published: November 2022

Introduction

Colorectal cancer is one of the most common cancers. In 2013 in the UK, 41,112 people were diagnosed with colorectal cancer and 15,903 people died from it.

The qFIT(quantitative faecal immunochemical test) is now widely used in the National Bowel Cancer Screening Program (NBSCP). It is also a good test to identify symptomatic people at higher risk of having a diagnosis of colorectal cancer. We present single center experience with Q fit testing.

Methods

Retrospective cohort study performed in a large district general hospital looking at the outcome of patients with +ve qFIT test (≥10 micrograms).

Results

Over the period from July 2020 till November 2021, over 2000 patients had qFIT tests to investigate red flag lower GI symptoms. Out of the 2000 patients, 448 patients had +ve qFIT. Over 70% of the patients Referred by the GP with Change in bowel habits, the test was organized by the hospital not the primary care.

260 patients were investigated with colonoscopy, 17 patients had histology confirming colorectal cancer. 172 patients were not fit enough for colonoscopy and were investigated with CT colon/CT, only 3 patients out of this group had features suggesting colorectal cancer on the CT scan.

Conclusion

20 out of 448 patients were diagnosed with colorectal cancer, the rest of the patients had either benign colorectal polyps or diverticular disease. As the qFIT test is now more widely used, it needs to be organised by the primary care centers to speed up the process of diagnosis and management.
TU4.6 Comparison between the outcome of patient's with qFIT>120 and patients with qFIT<120.Can qFIT<120 be considered a negative test??
Authors: Agrawal Aarushi , Gumaa Duaa , Akhtar Mansoor
Published: November 2022

Introduction

When FIT is used for symptomatic patients presenting to primary care a positive result is considered ≥10 mcgHb/gStool. When qFIT is used for the asymptomatic screening population (i.e NBCSP) a positive result is ≥120mcgHb/gStool.

During covid-19 Pandemic the 120 cut off was used in some of the hospitals to triage patients who require further investigations for either colonoscopy or CT scan.

Methods

Retrospective cohort study done in general district hospital comparing the pathology identified in patients with Qfit results>120 and patients with result <120.

Results

In the period between July 2020 and November 2021, 448 patients had +ve qFIT result (≥10 micrograms).In the first group, 340 patients had qFIT result <120. 191 patients had colonoscopy with 8 confirmed colorectal cancer, and 137 patients had CT/CT colon with only 1 patient was found to have colorectal cancer. Overall 2.6% of the patients had cancer.

While in the second group, 108 patients had qFIT>120. 69 patients had colonoscopy with 9 confirmed cancer. the rest of the patients had CT/CT colon with 2 patients showing features of malignancy. Overall 10.1% of the patients had cancer.

Conclusion

The incidence of colorectal cancer in patients with qFIT result >120 is much higher than the other group, but the incidence of colorectal cancer in patients with qFIT<120 is still significant and the patients shouldn't be discharged without investigations.
TU4.8 An Analysis of Rectal Cancer Patient Treatment and Outcomes in a large NHS Trust
Authors: Hamer Natalie , Hand Rebecca , Kaur Japsimar , Thambi Prem , Wadd Nicholas , Jha Madan
Published: November 2022

Introduction

Rectal cancer (RC) is a common cancer in the UK. Treatment options include surgery, chemotherapy, radiotherapy or a combination of these in the form of neoadjuvant or adjuvant treatment.

Aim

To analyse the treatment type and outcomes of our RC patients.

Methods

We performed an analysis of prospectively collected data on patients diagnosed with RC between Jan-2013 and Dec-2020 in our trust. Details included demographics, histology, staging, treatment and mortality. Twenty patients out of 1202 were excluded due to missing information leaving 1182 for further analysis.

Results

404 patients did not receive resectional surgery due to patient choice (30), inoperability of the tumour (259), or co-morbidity (115).

A total of 778 patients were found to have operable disease with TNM staging as follows; Stage1–291, Stage2–231, Stage3–217, Stage4–39. Among them 302 went on to receive neo-adjuvant treatment of which 67 (22.2%) had a complete response to treatment (ypT0). The remaining 476 patients received primary surgery; 268 did not require any additional treatment and 199 went on to have adjuvant chemo/radiotherapy. Nine patients had further intervention due to incomplete resection or disease recurrence.

The majority of the tumours were adenocarcinomas (97%). Other types included; malignant melanoma, neuroendocrine tumours, and squamous cell carcinomas. The overall 1-year and 5-year mortality for the group receiving primary surgery were 5.0% and 20.4%. In the neoadjuvant group these were 3.6% and 20.9%.

Conclusion

We present data from a large NHS trust demonstrating a multimodal approach which has enabled us to achieve good overall outcomes.
TU4.9 Major elective colorectal surgery at a non-acute site: is it safe or not?
Authors: Hammoudeh Zaid , Williams Gethin , Codd Rhodri
Published: November 2022

Introduction

Recent reorganisation resulted in elective surgical services being separated from emergency facilities due to a new hospital site in our Health Board. Clinicians were initially concerned with regards to postoperative complications and the potential need for transfer to the acute site (6 miles away) for ongoing emergency management. There are no ICU or emergency theatre facilities at the cold site. We audited the first year of the service reconfiguration.

Methods

This study looked at unexpected transfer of major colorectal surgical patients occurring between December 2020 to 2021 from the elective hospital to the acute site. The prospectively maintained departmental database was interrogated.

Results

There were 263 patients undergoing colorectal operations over 12 months. 31 patients (12%) required step-up to the acute hospital for further post-operative care. 10 returned to theatre (4 anastomotic leaks, 1 anastomotic bleed, 1 fluid collection washout, 3 SBO, 1 stoma revision). The remaining 21 patients were managed conservatively by the surgical team (8) or taken over by the medical team (13). The main surgical reason for step-up was due to anastomotic leakage (7). Other step-up reasons included cardiorespiratory compromise (9), infection (6), bowel obstruction (3) and bleeding (2). Median time for transfer was day 4 (range 0–11 days) postoperatively. No transfer delay causing harm was reported. The 30-day mortality rate for all 263 patients was 0%.

Conclusion

Transfer to the acute site seems to have been safe, timely and effective in its first year. Patients have received appropriate and emergency care for these unpredictable complications.
TU4.10 Short term outcomes of patients undergoing transanal total mesorectal excision versus robotic low anterior resection
Authors: Jaskani Sadia , Khan Aftab , Kukreja Neil
Published: November 2022

Introduction

Robotic Low anterior resection has a potential benefit because of its technical difficulty to access the narrow pelvic cavity. The aim of the study was to compare short-term outcomes of patients who underwent TaTME versus Robotic TME for low rectal cancers.

Methods

Retrospective analysis of cases from a single institution was undertaken. Data including demographics, operative details, inpatient complications, and clinical outcomes were collected from patients' notes. Comparative analysis between the two groups was performed using non-parametric statistical tests.

Results

The total sample size was 35 patients who underwent low anterior resection at a single center. Of the 17 patients who had Laparoscopic Transanal Total mesorectal excision (LLAR), (15 LLAR + 2 RLAR converted to LLAR), and Robotic Low anterior resection (RLAR) was performed in 18 patients. Mean age in both groups was comparable (66.5±9.93). There was no significant difference in patient demographics in both groups including Gender (Males 88.2% vs 61.1%), ASA grade, BMI (29.4), and WHO status. There was a statistically significant difference in tumor height from anal verge between both groups, mean LLAR 13.78cm, RLAR 7.5cm (p-value 0.04). There was no difference in circumferential resection margins (p-value 0.366) and number of lymph nodes harvested (mean LLAR 17 vs RLAR 20). Post-operative margins (R0) were positive in 3/17 patients in LLAR group and 1/18 patients in RLAR group (p-value 0.261). There was no difference in post-operative calvin-dindo complication rate and hospital readmission rate.

Conclusion

There was no significant difference identified in clinical and short term oncological outcomes between the two groups
TU4.11 Colonic Polyps Surveillance and outcomes - are we using a magnifying glass?
Authors: Jayasankar Balaji , Balasubramaniam Dinesh , Abdelsaid Kirolos , Frowde Kyle , Galloway Emily , Leeves Laura
Published: November 2022

Introduction

Colonoscopic polypectomy is a well established screening and surveillance modality for malignant colorectal polyps. Following a detection of a malignant polyp patients are either put on endoscopic surveillance or planned for a surgical procedure. We studied the outcome of colonoscopic excision of malignant polyps and their outcomes.

Methods

We performed a retrospective analysis of patients over a period of 5 years who underwent colonoscopy and resection of malignant polyps. Size of polyp, follow up with tumour markers, CT scan and biopsy were considered individually for pedunculate and sessile polyps. The main outcome was to look at the percentage of patients who underwent surgical resection, the percentage of patients who were managed conservatively and the percentage of recurrence post excision. We also identified 5 year outcome of completely removed malignant polyps in accordance with the Maastricht guidelines.

Results

The study was a retrospective analysis of 46 patients from 2015 who underwent colonscopic resection of malignant polyps. The male:female ratio of 1.4:1. 9% (4/44) of the patients went on to have a surgical resection of the malignant part and another 9% (4/44) had a trans-anal procedure for resection; 82% (36/44) were managed successfully by conservative follow up with colonoscopy, radiology and tumour markers.

Conclusions

Colonoscopic polyp resection may prove to be beneficial by avoiding a major resection. A reduction in the frequency and the battery of surveillance may be considered looking at the number of recurrence and surgical intervention.
TU5.2 Lifting the LiDCO on Haemodynamic Monitoring. Which would you PiCCO?
Authors: Afify Sarah Jane , Thida Nge Nge
Published: November 2022

Aims

Surgical patients in the intensive care unit (ICU) are frequently critically unwell with varied abnormal physiology1. The use of haemodynamic monitors in such cases is invaluable in permitting early intervention of complications such as multi-organ failure (MOF), yet is often overlooked1.

A Trust-wide study was performed utilising guidelines outlining criteria for haemodynamic monitor instigation2.

Methods

We retrospectively reviewed the records of 20 surgical patients to determine whether standards were achieved. Concurrently, we conducted a survey of junior doctors in order to establish knowledge and identify areas for improvement.

Results

20% of patients were new admissions with sepsis and MOF. 10% had inotropic requirements in accordance to Trust guidance. 35% required fluid bolus >2l within 12 hours of ICU stay; 40% did not and there was no documentation for 25% of patients. 85% were within the 1st 48 hours post-operatively. Only 4 patients received haemodynamic monitoring, LiDCO and PiCCO monitors being used equally.

12 responses were received from our survey of junior doctors. 66.7% were familiar with different haemodynamic monitor types. 58.3% stated they would be confident knowing when to initiate usage. 83.3% added they would be able to use these monitors independently. Only 2 individuals had read the Trust guidelines on haemodynamic monitoring. All participants stated they would benefit from teaching on this subject.

Conclusions

Our study showed Trust guidance for haemodynamic monitor instigation was not being adhered to optimally. Increased awareness via education programmes would be beneficial, ensuring more favourable outcomes for patients- surgical or otherwise.
TU5.3 Surgical Simulation – Does it improve the undergraduate surgical experience?
Authors: Irvine Laura , Bruce Nikki
Published: November 2022

Aims

Many final year undergraduate students rotating through surgery in our DGH have had their clinical experience adversely affected by COVID due to missed or cancelled patient contact, absence, or cancelled placements earlier in the curriculum. We sought to improve the experience by designing a new simulation programme of acute surgical presentations to become embedded in the teaching schedule and to audit the feedback from this and make improvements.

Methods

We held a small focus group with FYs and medical students to identify surgical presentations that they would benefit from practice on. We wrote a package of simulated cases including “unwell pancreatitis”, “wound dehiscence” and “post op pyrexia”. All scenarios had the aim of encouraging A-E assessment by the student pitched at incoming-FY1 level, and available equipment in the SIM lab includes SIM man, real-time obs, and general ward equipment. Scenarios were written to include multidisciplinary input from nursing, anaesthetic and surgical colleagues and include flexible options depending on student performance. The hospital resus officer helped to run the scenarios.

Results

The scenarios were run with 4 consecutive blocks of students. All feedback was positive with all students grading feedback as “very good” or “excellent”. Other feedback included “more scenarios” and “helps prepare for FY1”. Small improvements were made to the written documentation through PDSA cycles over the 4 blocks and are now embedded in the curriculum.

Conclusions

Availability of surgical simulation helped students to become more confident in A-E assessment of unwell surgical patients despite loss of patient interactions due to COVID.
TU5.6 Teaching to transform surgical culture: An educational programme and thematic analysis in a general surgery department
Authors: Dave Madhav , Mobarak Shahd , Tarazi Munir , Macutkiewicz Christian
Published: November 2022

Introduction

General surgery departments are busy, meaning educational opportunities may be sporadic. Clinical priorities can sometimes supersede teaching and trainees may feel alienated at the periphery of the working community. In this study, we demonstrate how a reflective, multidisciplinary general surgery teaching programme was established and use this to assess the impact of structured teaching on surgical doctors of all grades in the department.

Methods

Twelve semi-structured telephone interviews were conducted with participants of varying grades. Transcripts were analysed using a grounded theory thematic analysis, revealing four themes: the value of teaching; learning as a community; barriers to successful training; and culture of surgery.

Discussion

Teaching helped juniors construct healthy narratives around general surgery and encouraged a process of professional identity formation. Pairing junior and senior colleagues allowed both to develop their skills, and reflective learning revealed new learning opportunities. Transparency across the ‘community of practice’ was achieved and the programme helped juniors overcome negative stereotypes of intimidation embedded in the hidden surgical curriculum.

Conclusion

Reflective, multidisciplinary learning can challenge the hidden curriculum and encourage team cohesion. A commitment to critical reflective teaching will be vital in cultivating surgeons of the future.

NB: submitted to previous ASGBI congress 2020 but later withdrawn due to COVID-19 and congress being cancelled. We wish to re-present our work.
TU5.8 Audit on Adherence to NICE Guidelines for VTE Prophylaxis in Patients Undergoing Surgery for Appendicitis
Authors: Devarakonda Sreekar , Shuttleworth Paul , Clark Edwin
Published: November 2022

Background and Aims

According to the Nice Guidelines (NG89), for any person (over 16 years) undergoing abdominal surgery, pharmacological VTE prophylaxis must be added for a minimum of 7 days (if the risk of VTE outweighs the risk of bleeding). Also, mechanical VTE prophylaxis must commence on admission. We wanted to audit our adherence to these guidelines in the patients undergoing surgery for appendicitis.

Methods

A review of the electronic pharmacy records of the patients (over 16 years) who underwent surgery for appendicitis (proven with a CT scan or diagnosed intra-operatively) was performed from October to December 2021. We used the Department of Health VTE risk assessment form, and only the patients whose risk of VTE outweighed the bleeding risk were included.

Results

Of the 23 patients, 22 (95.6%) underwent laparoscopic appendicectomy and, open appendicectomy was done in 1 (4.4%) patient. 11 (47.8%) patients were females, and 12 (52.2%) were males. The mean age was 38.3 (±16) years, and the mean duration of hospital stay was 2.8 (±1.6) days. VTE risk assessment form was completed only for 12 (52.2%) patients. During the hospital stay, 15 of 23 (65.2%) patients received TEDS, and 18 (78.2%) patients received Enoxaparin. 4 (17.4%) patients did not receive any form of VTE prophylaxis. None of these patients was prescribed seven days of pharmacological prophylaxis.

Conclusions

VTE prophylaxis prescription in patients with short hospital stays is often missed. We must explore the necessary interventions to ensure that patients are given seven days of VTE prophylaxis and regularly audit this practice.
TU5.10 Development of a Novel Near-peer Surgical Simulation-based Teaching Programme for Intern Doctors
Authors: Ferriter Bridgid , Julius Barbara , Burke Sinead , Slattery Natasha , Tormey Shona , Merrigan Anne
Published: November 2022

Background

Trends in healthcare have caused a shift in training towards more competency based programmes. The COVID-19 pandemic has reduced time available for direct exposure and clinical learning, necessitating incorporation of simulation in training. The objectives of this study were to develop, pilot and evaluate a four week simulation based surgical teaching programme.

Methods

Interns pursuing a career in surgery joined a near-peer surgical training programme delivered by NCHDs. A survey established a baseline competency. Four skills workshops were delivered. Outcomes were measured using data from pre and post course surveys as well as a surgical skills competition.

Results

Of the 12 trainees, 71% had scrubbed in theatre before. 50% were already confident to scrub independently, increased to 75% post training. 28% were confident gowning/gloving, increased to 75% post training. 28% were confident to place a simple suture in theatre, this did not increase despite training. 42% were confident performing an instrument tie, increased to 75% post training. 14% were confident hand tying knots, this increased to 62%. 14% of participants were comfortable performing excisional biopsy in theatre, increased to 62% post training. Preparation and administration of local anaestetic could be performed confidently by 14% before training, this increased to 87%.

On completion, a surgical skills competition showed that 100% were able to satisfactorily perform basic skills.

Conclusions

Near-peer delivery of surgical training has enhanced the basic surgical skills of interns. Similar programmes in other sites would ensure that interns have the skills required to safely care for surgical patients.
TU6.1 Tackling the training deficit due to COVID-19 disruptions
Authors: Bodapati Shruti , Gambhir Raghvinder Pal Singh , Kimura Shiori
Published: November 2022

Aim

Surgical training has been severely affected by stop, start and stop of elective surgical activity during the COVID pandemic. The aim of this study was to analyze the effectiveness of strategies put in place to tackle them.

Methodology

We looked at the four UK Statutory Education Bodies (SEBs) published guidance and trainee led resources to see what measures were put in place to mitigate the severe disruptions in surgical training due to COVID-19 pandemic.

Results

Across the world, training programmes have been affected and craft specialities have fared the worst. Lesser operative experience and redeployment to non-surgical critical areas being the top 2 causes.

A Post Graduate Medical Education (PGME) Recovery Programme was established in April 2021 to reset, recover and reform PGME with one to one trainee recovery discussions. Simulations and virtual CME sessions are being put in place to help mitigate the deficiencies in the current training programmes. These measure may be suitable for Medical specialities, but Surgical specialities need hands on training on human cadavers in lieu to catch up and prevent extension of period of training.

Conclusion

The COVID 19 pandemic has not only affected the physical and mental well-being of trainees but has also restricted training opportunities, professional development and severely dented trainee confidence. The plans put in place are not good enough for surgical trainees who need hands on experience. Increased didactic teaching around cadaveric training programs is the quickest way of overcoming this deficit.

References

1. https://www.hee.nhs.uk/covid-19/training-recovery-support; 2. https://www.hee.nhs.uk/covid-19/covid-19-training-recovery-programme
TU6.5 Motivation in the Surgical Workforce
Authors: Marlow Neale
Published: November 2022

Aims

To investigate the motivational spectrum amongst those choosing to work in the theatre environment according to Deci and Ryan's Organismic Integration Theory.

Methods

The Survey of Current Regulation of Behaviour In Theatres (SCRUB-IT) was adapted from the Behavioural Regulation in Exercise Questionnaire (BREQ-3) and administered to theatre staff at a UK university hospital in April 2019.

Results

48 staff members (surgical consultant n=6, surgical trainee n=9, nurse n=24, healthcare assistant n=9, male(%) 15(31.3), mean age 34 (27–59) years) completed the survey. Respondents had been working in theatres for an average of 11 (2–39) years.

The degree of self-motivation to work in the theatre environment was higher in the surgeon group (p=0.037) but there was no significant difference by age (p=0.119) or duration of theatre experience (p=0.227).

Conclusion

Theatre staff demonstrated a high degree of self-motivation and explanations are likely multifactorial (personal fulfilment, sense of duty, team dynamics, technical challenge) although the Hawthorne effect may bias results. These data could inform targeted recruitment and retainment of staff, whilst further work could compare findings with other medical specialties.
TU6.6 The value of immersive endoscopy training for the surgical trainee
Authors: Massie Eleanor , Hughes Rebecca , Vella Mark , Moug Susan , Mackie Helen , Renwick Andrew
Published: November 2022

Aims

Achieving endoscopic targets for CCT is problematic for General Surgery trainees. COVID-19 has negatively impacted all aspects of surgical training. Nationally, only 19% of colorectal trainees report completing 300 colonoscopies by CCT. We report on an immersive endoscopy training programme to achieve CCT targets.

Methods

To confirm reduced access to endoscopy, local General Surgery trainees (n=95) were invited to complete our survey assessing their endoscopic experience during their training to date. We compared the results to outcomes from a new 6-month immersive endoscopy programme. 2 out-of-programme (OOP) trainees; one had no endoscopy experience (completed core training; OOP 1); one had attempted 70 colonoscopies and 130 UGI endoscopies (ST4; OOP2).

Results

42 trainees completed the survey (44% response rate), ranging from ST2-ST8 (74% ST2-ST6, 14% ST7/ST8, 12% OOP). UGI endoscopies attempted by all trainees: mean 119 (range 10–306). 55% had attended or secured a place on the JAG UGI endoscopy course. Colonoscopies attempted by all trainees: mean 67 (range 2–233). 45% having attended or secured a place on the JAG colonoscopy course. 29% of trainees anticipated not reaching target CCT endoscopy numbers. In comparison, in 6 months; OOP1 attempted 49 OGD, 199 colonoscopies with a place secured on colonoscopy course. OOP2 attempted 109 OGD and 216 colonoscopies with both courses completed.

Conclusion

Shortcomings in endoscopic training and courses, particularly for colonoscopy, have been confirmed. Implementation of immersion endoscopy training can achieve CCT target numbers and competency within a short time, irrespective of previous experience.
TU7.2 Preoperative Indications for Coagulation Screening in the Elective Setting- A Single Centre Review
Authors: Ross Amy , Armstrong Lará
Published: November 2022

Aim

NICE Guidelines 2016 state that coagulation screens should be carried out in all patients with chronic liver disease, anticoagulation use or those with an ASA 3 or 4. We aimed to review coagulation screening in elective patients according to current guidelines.

Methods

A single centre, retrospective review was carried out over a 3 month period, of patients undergoing elective procedures in a district general hospital. Data was retrieved from an institutional data base, with follow up information reviewed in an up to date electronic data base.

Results

64 patients were included with a median age 41 years (range 19–85) and 56.3% male. Nineteen patients had an ASA of 3 or 4, however only one of these patients underwent a pre-operative coagulation screen. Four patients were taking anticoagulation medication prior to their procedure, however only one patient underwent pre-operative screening. Neither of these patient groups experienced any intra or post- operative bleeding. 3.1% of patients within the cohort experienced bleeding, all without pre-operative coagulation screening. Overall, screening was indication in 39.1% of patients, but was only performed in 3.1%.

Conclusion

Whilst a small number of patients within this study had bleeding related complications, it is evident that recommendations for patients with ASA 3 and 4 or those on anticoagulation therapy are not being met. Teaching and education on these guidelines will be provided and a further audit cycle completed.
TU7.3 Laparoscopic Cholecystectomy for Ultrasound Proven Gallbladder Polyps – An Unsound Indication?
Authors: Bezzaa Sabrina , Clements Caterina , Patel Puja , Kumapley Leonora , Burney Kashif , Nehra Dhiren
Published: November 2022

Aim

Current European guidelines recommend cholecystectomy for ultrasound proven gallbladder polyps based on size. Over-diagnosis of gallbladder polyps by conventional transabdominal ultrasound may lead to unnecessary surgery. The aim of this study is to correlate the ultrasound findings of gallbladder ‘polyps’ with histology of the removed gallbladder specimens.

Methods

Data from transabdominal ultrasound reports was collected over a 5-year period and cross-referenced with the histology from patients undergoing a laparoscopic cholecystectomy over the same time-period.

Results

60 patients who underwent laparoscopic cholecystectomy with ultrasound proven gallbladder polyps were identified. The age range was 19–79 years. There were 36 females and 24 males.

On imaging 30 patients (50%) had a solitary polyp (size range 2–24mm) and 30 (50%) had multiple polyps (largest polyp size range 4–13mm).

The indication for cholecystectomy was gallbladder polyps with or without gallstone disease in 32 patients (53%) and gallbladder or gallstone disease with incidental polyps in 28 patients (47%).

Only 2/60 (3.3%) patients had adenomatous polyps on histology (9mm and 9.7mm on ultrasound), whilst 18/60 (30%) had pseudopolyps and in the remaining 40 specimens, no lesion of polypoidal type was found. No specimens had evidence of dysplasia or malignancy.

Conclusion

We propose that an ultrasound abdomen is an inadequate imaging modality alone to diagnose gallbladder polyps and that patients require further imaging or MDT discussion as adjuncts to decision making for those referred for consideration of cholecystectomy.
TU7.4 Service Evaluation Audit of Virtual Outpatient Clinics in the Post-COVID-19 era
Authors: Caine Matthew , Wickstone Lydia , Rogers Charlotte , Macutkiewicz Christian , Chan Anthony
Published: November 2022

Introduction

The COVID-19 pandemic has significantly changed outpatient clinic services which now involve virtual (telephone/video) rather than face-to-face consultations. For both new clinic patients or follow-up patients after a recent emergency admission, these changes may impact on their perceptions and confidence in the outpatient service. The aim of this service provision audit is to ascertain both patient satisfaction and confidence in virtual consultations in our unit.

Methods

A retrospective evaluation of all General Surgery virtual clinic appointments between January and March 2021 was undertaken. Patients were contacted for feedback about their surgical consultation based on questions from the National Health Service Outpatient Department Survey (2011).

Results

In total, 151 patients were contacted. Overall satisfaction regarding telephone consultations was significantly higher when compared to survey results of face-to-face appointments in the pre-COVID era. The majority of patients were confident (51%) or confident to some extent (27%) of being listed for surgery without further examination. Only 8% of patients were not confident at the way surgery was explained and 10% were not confident of the risks of surgery. Finally, more than a third were not happy to be discharged from clinic following a telephone consultation.

Conclusion

Follow-up appointments are an integral part of the patient journey following an emergency admission. The COVID-19 recovery phase has necessitated a service reconfiguration towards virtual appointments. We show that patients were satisfied with virtual consultations, although further quality improvement should be undertaken to ensure outpatient discharge is satisfactory for all patients following an emergency admission.
TU7.5 Prostate cancer pick up rate in pure LIKERT 3 lesions on MRI prostate? A retrospective review of 157 cases in a district general hospital
Authors: Chiran Jaginkere , Farooq Abid , Anwar Baseerat , Billington Paul , Abuismaeil Muhammad
Published: November 2022

Introduction

LIKERT 4 and 5 lesions picked up on MRI prostate have a high chance of picking up high grade high volume prostate cancer so they under biopsy. It is quite challenging to decide whether to biopsy pure LIKERT 3 lesions. In our retrospective review of 500 prostate MRI scan we looked for correlation between pure LIKERT 3 lesions and the risk of finding prostate cancer after biopsy.

Materials and Methods

Pre-biopsy Multi parametric MRI prostate was done in 500 cases and reported by two consultant radiologists. 157 mp Prostate MRIs showed one or more pure LIKERT 3 lesions . All 157 cases underwent targeted and saturation biopsies. 91 biopsies (57.96%) out of 157 were benign. 66 biopsies (42%) out of 157 showed prostate cancer. Gleeson score is shown in the table below

Conclusion

157 cases with pure LIKERT 3 lesions on MRI prostate 58% were benign. 42% who had positive biopsies low and intermediate risk i.e. Gleeson 6 or 7 (95.4%) prostate cancer was found. High grade prostate cancer i.e. Gleeson 8 and 9 was seen in 3%. Patients with pure LIKERT 3 lesion on mp MRI prostate should be counselled about the risks of finding prostate cancer, likely grade to help them make an informed decision about PSA monitoring only or undergo prostate biopsies.