bluuebunny/crossref_metadata_2025 huggingface dataset:
1299 MANELS: A Retrospective, Multi-National, Longitudinal Study for Quantitative Analysis of Gender Distribution of Speakers at Paediatrics Surgery Conferences
Authors: Khaliq Raja A K , Abdi Z , Gargan A , Gargan K , Georgi M , Asif A , Thamilmaran A , Burton O , Leung K H C , Tse F , Lee K , Haque S
Published: August 2024

Aim

Academic representation of women at conferences is vital for improving underrepresentation in surgery, despite the rising number of females into the medical profession. This study aimed to quantify the gender distribution of speakers and prevalence of all-male panels (“manels”) at major paediatric surgical conferences.

Method

Retrospective analysis of annual meetings organised across three major paediatrics surgery conferences, between January 2016 and December 2021. Male and female faculty were academically stratified according to mean publications, citations, and H-index. A ‘Manel’ was defined as a session with 2 or more speakers, all of whom identified as male. Sex was defined by gender titles on conference program or Gender Balance Assessment Tool (GBAT).

Results

Of 13 conferences included, there were 896 invited speakers, of which 22.9% (n=205) were female. Across the 146 open panel sessions, 39.0% (n=57) were manels. There was a no correlation in the proportion of manels between 2016 and 2021 (p=0.31). No statistically significant difference in the percentage of manels was observed between online (50.0%, n=8) versus in-person conferences (37.6%, n=57) (p=0.341). There was no significant difference in the mean H-indices of invited speakers (male=26.4, female=21.6; p=0.149) and mean total citations (male=4463.1, female=2323.3;p=0.084). Male invited lecturers had significantly higher publications (male=185.7, female=111.9, p=0.036). Male panellist had a significantly higher H-index (male=19.8, female=15.7, p=0.001), publications (male=110.2, female=70.8, p<0.001) and citations (male=2218.1, female=1310.3, p=0.01).

Conclusions

Despite the increasing representation of women within paediatric surgery, this study shows recurring disproportionate representation of female speakers across major conferences, illustrating the necessity for greater gender distribution and diversity.
174 The Histopathological Assessment of Gastro-Oesophageal Carcinoma Resection Specimens: A Quality Improvement project
Authors: Murphy S , Jeffery H , Vulliamy P , Dawas K
Published: August 2024

Aim

HERO consensus and Royal College of Pathologists provide guidance for the minimum dataset pathological evaluation of gastro-oesophageal cancer resection specimens. The project aimed to assess and improve adherence.

Method

A retrospective study of the pathological evaluation of gastro-oesophageal cancer specimens resected surgically at a tertiary cancer unit (October 2021-March 2022), and re-audit (July-December 2022) following presentation of first cycle results.

Results

26 and 23 specimens in rounds 1 and 2 respectively met inclusion criteria. Adherence was good in both rounds for reporting lymphovascular invasion status (92.3% vs 100%), correct reporting as R1 if tumour cells are found within 1mm of the margin (100% vs 100%), lesser curvature fat-blocking (100% vs 100%), and reporting of lymph node response following neoadjuvant chemotherapy (100% vs 100%). Improvement was seen in testing a minimum of 15 lymph nodes (88.5% vs 91.3%) and recording of resection margins in millimetres (CRM 77.8% vs 100%; LRM 80.8% vs 82.6%). One of the three specimens with <15 node yield was retested in round 1, compared with both specimens in round 2. Reporting of peri-oesophageal fat blocking showed no improvement (88.9% vs 77.8%).

Conclusions

Adherence was good during cycle 1, and there was improvement in most domains following presentation of results. Of note, both specimens in the second cycle with lymph node yield <15 were re-examined. Lymph node yield is determined by both surgical technique and avid pathology node search. The project proved to be an incentive for the MDT group as a whole to seek and adhere to good reporting practice.
51 Can We Predict the Outcome of Traumatic Paediatric Peripheral Nerve Injuries Using Ultrasound and Nerve Conduction Studies? a Case series
Authors: Virdee P K , Abed H , Lawley A , Jester A
Published: August 2024

Management of paediatric peripheral nerve injury varies across clinical practice. Clinical examination is favoured by some, whilst others use a combination of methods such as nerve conduction studies (NCS) and ultrasound studies (US). This case series reviewed outcomes of paediatric peripheral nerve injuries, which underwent both investigations, to establish optimal diagnosis and management of paediatric peripheral nerve injury.

A retrospective case series of eighteen paediatric traumatic peripheral nerve injuries presenting at a tertiary referral centre between January 2019 – August 2023 was completed. Data was collected regarding the type and date of injury, immediate intervention, investigation dates and findings, and management.

Eighteen traumatic upper limb injuries which had both US and NCS were included. The ulnar nerve was most injured, and half of nerve injuries were caused by supracondylar fractures. All cases had NCS completed before US. Fourteen NCS cases showed axonotmesis and four showed neurotmesis. Nerve continuity was visualised on US in eleven cases. Ten patients were managed conservatively. Two cases underwent surgical intervention, where US showed either scarring or non-visualisation.

NCS in paediatric peripheral nerve injury often shows high grade injury; with axonotmesis commonly reported. Most US conducted at similar timepoints to NCS show nerve continuity. Results suggest that US, in addition to NCS, can aid management of peripheral nerve injury and may reduce the need for surgical intervention. Delays in completing US may impact decisions to wait for spontaneous recovery. Future studies should utilise multi-institutional datasets to compare and establish suitable timeframes for injury-specific interventions to aid surgical decision making.
268 Silver Dressings, Metal Clips, VAC’s and Implants - Are Plastic Surgery Patients Safe in the MRI Scanner
Authors: Seddon I , Marar M , Kwasnicki R
Published: August 2024

Aim

Advancements in the devices and dressings used in plastic surgery continue to grow and with complexity comes confusion. This is a response to uncertainty amongst specialists which led to an adverse incident in a specialty where soft tissue imaging is most helpful. Our goal was to create a clear document to be used by the plastics team and radiology department with the aim of dispelling myths surrounding the MRI safety of devices and equipment used in plastic surgery.

Method

Focussing on the orthoplastic theatre environment, a list was collated of all surgical devices/equipment that are left in or on patients and may pose uncertainty with regards to safety when MRI scanning. Devices were divided into internal and external and included further subdivisions such as implants, metalwork, dressings and splints. A literature review was undertaken to identify the safety status (safe = green, unsafe = red, artifact/distortion = amber) of all devices/equipment. Surveys assessing usability were given to members of the plastics team and radiology department.

Results

The majority of devices/equipment were found to be MRI safe. A colour coded aide-memoire was designed and displayed electronically and physically. Positive feedback was received by radiographers and members of the plastics team in response to the memoire.

Conclusions

To clarify uncertainties and promote patient safety, a concise, comprehensive and user-friendly aide-memoire was created which confirmed the safety status of commonly used devices in orthoplastics theatres.
334 Immuno-Modulatory Impact of Adipose-Derived Stem Cells on Radiation-Induced Fibrosis
Authors: Cui X M , Wai J , Frommer M , Langridge B , Butler P
Published: August 2024

Aim

Radiation-induced fibrosis (RIF) is a complication of radiotherapy that occurs 4-12 months post-radiotherapy, which is used to treat head and neck squamous cell carcinoma that has a high morbidity in patients undergoing treatment for malignancy. Autologous fat grafting is a viable method to treat RIF, and adipose-derived stem cells (ADSC) were found to be one of the main components to contribute to that effect. ADSC has demonstrated the immunomodulatory effect by inhibiting inflammation and altering activity of immune cells in previous studies. The aim of this study is to evaluate the potential immunomodulatory effects of human ADSC on irradiated HDF.

Method

Human-derived fibroblasts (HDF) were cultured and irradiated (iHDF) in vitro in the experimental group, with the control group unexposed to radiation. Both experimental group and control group were then inoculated with ADSC-controlled media and co-culture with ADSC, whilst levels of key immunomodulators expressed by iHDF cells were obtained and measured via enzyme-linked immunosorbent assay (ELISA) and real-time reverse transcription-polymerase chain reaction (RT-PCR).

Results

ADSC has significant links with iHDF-secreted CCL3, CCL19, and IL-8, with the other immunomodulators having a subtle effect.

Discussion

The experiment revealed the complex nature of some immunomodulators that could exert both pro- and anti-inflammatory capabilities.

Conclusions

ADSC has some interactions with iHDF, although it is not completely elucidated within this experiment, ADSC was demonstrated to have anti-fibrotic capabilities, by promoting pro-angiogenic factors. Future works required to further investigate in vivo effects of ADSC.
713 Conversational Artificial Intelligence in Plastic Surgery: A Systematic Review
Authors: Zargaran A , Sousi S , Ahmed Z , Zargaran D , Mosahebi A
Published: August 2024

Aim

Rapid advancements in technology have paved the way for the use of artificially intelligent (AI) conversational agents. Conversational AI has the potential to transform patient pathways, with increasing use in triage, virtual consultations and post-operative care. The aim of this systematic review is to evaluate the scale and scope of conversational AI within Plastic Surgery.

Method

Following PRISMA guidelines, a systematic review of PubMed, Embase, PsychInfo, Scopus and Google Scholar using COVIDENCE software, was performed on applications of conversational AI within Plastic Surgery. Assessment of quality and risk of bias was performed for all studies.

Results

Overall, 479 studies were captured by the search and four were included in the final analysis. Three independent reviewers screened s and full texts with a kappa score for interrater reliability of 1.0. Uses of conversational AI included ChatBots (n=2), virtual assistants (n=1) and machine learning models (n=1). Conversational AI was used in various settings including flap monitoring, outpatient management of paediatric burns and general plastics in addition to frequently asked questions (FAQS), and analysis of conversations to promote quality improvement. Only two studies included an evaluation of end-user satisfaction and accuracy. Risk of bias was high, and level of evidence was low.

Conclusions

At present conversational AI has a variety of uses within Plastic Surgery ranging from ChatBots supporting doctors and responding to patient queries, to researching quality improvement strategies. However, conversational AI could be further utilised within Plastic Surgery and further study and innovation are required to fully leverage its potential.
742 Aesthetic Facial Botulinum Toxin Education – a Cross-Sectional Analysis of the United Kingdom (UK) Courses
Authors: Zargaran A , Mansour H Khademi , Smith K , Daneshi K , Sousi S , Zargaran D , Davies J , Woollard A , Mosahebi A
Published: August 2024

Aim

Unregulated proliferation of the aesthetic Botulinum Toxin injection industry represents a potential public health risk to patients. Robust educational standards are key to ensuring practitioner competence. This study assesses the current standard of educational courses in the UK, auditing compliance with Cosmetic Standards Practice Standards Authority (CPSA) and Joint Council for Cosmetic Practitioners (JCCP) guidance.

Method

A systematic online search was performed on search engines including Google, as well as social media platforms. Keywords included “Botulinum Toxin”, “Aesthetics”, “Course”, “Level 7”, “Training” and “certification” using Boolean operators. As a secondary outcome, compliance with national guidance from the CPSA and JCCP was audited.

Results

A total of 297 courses were included from across the UK (83.5% England, 4.7% Wales, 4% Northern Ireland, 7.8% Scotland). Only 25.3% of courses had assessments to pass for certification, whilst 49.9% of courses had no specified entry requirements. Methodologically, 73% had demonstrations on live models, 0.3% on plastic models and 0.3% were purely observational. Mean price for attending the courses was £1,442.14, whilst mean course duration was 1.8 days. Only 14% of courses offered level 7 accreditation. Only 3.4% were fully compliant with CPSA guidance, whilst 3.7% of courses were fully compliant with JCCP guidance.

Conclusions

Educational courses for aesthetic Botulinum Toxin treatments are falling significantly short of national guidance, with heterogeneity in duration, teaching style and accreditation. The majority do not have assessments to pass for certification or specific entry requirements, whilst there is significant variation in cost of courses.
83 Quality Improvement Project on the Adherence to Hot Gallbladder Pathway Clinical Guidelines: An Improvement of the Hot Gallbladder Referral Pathway
Authors: Malkawi H , Bonor E , Khalil A , Lynn W
Published: August 2024

Aim

The quality improvement project’s main aim is to improve utilization of the Hot-Gallbladder(HGB) list. Although the guidelines are clear, a large number of referrals did not meet the criteria and were deemed inappropriate. We designed a self-explanatory proforma and added educational posters/aids that helped increase orientation and clarified the process and criteria.

Method

A set period of referrals was examined and audited and compared to the data collected post introduction of the proforma. The first audit cycle looked at patients referred for emergency laparoscopic cholecystectomy during April-May 2023 which determined the need for interventions to improve utilization of the HGB list and adherence to guidelines. A well designed self-explanatory pro-forma was introduced along with informative posters. A second audit cycle was done during the months of June-July 2023 showing significant improvement.

Results

April-May 2023: 38 referrals, 4/34 accepted (10.5% successful). June-July 2023: 24 referrals, 7/24 accepted (29.2% successful). Average stay in hospital: April-May 2023: 6.45 days, June-July 2023: 3.88 days.

Conclusions

The introduction of the well-designed self-explanatory proforma has improved the quality of referrals and raised the awareness of the presence of the pathway. This has in turn improved utilization of HGB lists, decreased the load on elective lists and improved outcomes.
269 Quality Improvement: Implementing a General Surgery Ward Round Proforma at Stoke Mandeville Hospital
Authors: Khan F , Quek K , Cho S , Puttergill B
Published: August 2024

Aim

In keeping with Good Medical Practice endorsed by the Royal College of Surgeons, a specialised surgical ward round proforma was launched to ensure accurate, clear and comprehensive daily clinical records.1 This is to ensure professional practice and delivery of best medical care.

Method

The specialised surgical ward round proforma was designed and implemented for general surgery inpatients in May 2023. Data was collected at regular intervals to include compliance and aspects of proforma filled. In parallel, feedback forms were collected to improve subsequent versions of the proforma. Two cycles have been completed by October 2023.

Results

Compliance of use of the newly launched surgical proforma over the study period was >85% (n=159). Essential items such as date, patient identity, ward name, NEWS score and presenting issue had high recording rates >95%. Spaces dedicated to details such as analgesia and VTE were removed when transiting from version one to version two having noted reduced rates of completion <30%. Supported by individual feedback, sections with similarly low documentation rates such as antibiotic regime and imaging results were retained due to their value on a patient-by-patient basis.

Conclusions

The introduction of a general surgery ward round proforma has proved useful in ensuring multiple aspects of a patient’s management are considered and documented. Our team looks to implement this proforma at a trust-wide level and aim to analyse improvements in multiple aspects of patient care including informed decision making in patient management, antibiotic stewardship, collaboration amongst the multidisciplinary team and continuity of care.
445 Improving Confidence of General Surgical SHO in Carrying Out Primary Surveys During Trauma Calls, at a Busy District General Hospital
Authors: Fardanesh A , Sharif M , Keshishian K , Jones L , Stavropoulou-Tatla S , Spiteri A , Rohatgi A
Published: August 2024

Aim

General surgery Senior House officers (SHOs) are expected to carry out primary surveys at district general hospitals, although many have not received adequate training to follow the gold-standard Advanced Trauma Life Support guidelines. This project aimed to assess and improve general surgery SHOs ability to undertake primary surveys at trauma calls.

Method

At baseline a questionnaire was distributed to all departmental general surgical SHOs, evaluating how many had attended ATLS, if they were running primary surveys and determining their perceived confidence in doing so (Likert scale out of 10). For the first intervention, we conducted lecture based primary survey teaching sessions. For the second intervention we conducted high fidelity simulation sessions for common scenarios

Results

At baseline we found that just 33% of SHOs carrying out primary surveys had completed ATLS. The perceived confidence average was only 56%. Indeed, roughly a third of SHOs felt they were confident in carrying out primary surveys – all of whom had already completed ATLS. The main limitation of confidence was reported to be being safe and efficient.

After the first intervention, average perceived confidence rose to 70%. After the second interventions simulations sessions, perceived confidence rose to 80%, and all SHOs taking part felt they were more confident in carrying out trauma calls.

Conclusions

This local teaching programme made up of lecture based and high-fidelity simulation teaching was effective at improving confidence of SHOs doing primary surveys. We propose trusts incorporate such programmes in induction especially for more junior SHOs, and those awaiting ATLS accreditation.
493 Because Who Needs Training? A QIP at Kingston Hospital to Deploy PDPs Meetings for Trust-Grade Doctors
Authors: Mithany R
Published: August 2024

Aim

This quality improvement project ( Completed QIP No. #400 at Kingston Hospital NHS Foundation Trust) aims to investigate the critical role of personal development plans (PDPs) for individuals who are not formally engaged in training programs. The focus is on understanding how PDPs contribute to holistic self-improvement, irrespective of formal training, by fostering self-awareness, goal setting, and skill acquisition.

Method

The QIP employs a literature review and real-world examples of trust-grade doctors to explore the practical benefits of PDPs for non-trainees. The method involves analysing the role of PDPs in promoting adaptability and resilience in the face of a rapidly changing world, emphasizing the importance of lifelong learning that should be equally deployed to trainees as well as non-trainees.

Results

The findings reveal that active participation in self-directed development via Personal Development Plans (PDPs) empowers individuals to adeptly navigate uncertainties, seize opportunities, and make meaningful contributions to both personal and professional spheres. The study underscores the transformative impact of cultivating a mindset of continuous improvement on individual well-being, as well as its broader implications for organizational and societal development. Notably, at Kingston Hospital, a significant shift has occurred, with every doctor now engaging in PDP meetings facilitated by AES, marking a substantial integration of these developmental practices into the medical professional landscape.

Conclusions

In conclusion, this QIP advocates for the universal adoption of PDPs as a fundamental tool for individuals seeking success and fulfilment in dynamic environments, regardless of their formal training status positioning it as a key driver for individual growth within the NHS.
573 Improving Access to Surgical Services for Skin Cancer in Buckinghamshire NHS Trust
Authors: Mishra A , Hamod H , Avent Z , Cobb W , Murray A
Published: August 2024

Aim

Skin cancer is an increasingly prevalent condition that requires early diagnosis and prompt surgical management. Our quality improvement project (QIP) aimed to characterise the scale of skin cancer referrals and operating capacity, streamline our referral triage process, and to develop new patient pathways to improve speed of access to surgical services.

Method

The number of new skin cancer referrals was prospectively collected over the course of October 2023. These were analysed to investigate referral quality, extracting data on necessary clinical information for triage. New surgical streams were designed to accommodate additional cases, including a see-and-treat service and an additional junior-led operating list. Skin cancer procedures over April 2023 were retrospectively analysed to assess their suitability for these new patient pathways.

Results

There were 65 new skin cancer referrals in October 2023. Only 1 referral (1.5%) included key information on anticoagulation status, mobility, and mental capacity. From 110 skin cancer procedures in April 2023, 88 (80%) are suitable for management within the new treatment streams.

Conclusions

Our QIP has identified a significant number of new skin cancer referrals per month, often with inadequate clinical information. The development of new surgical pathways has increased operating capacity and is fit for the purpose of managing our current skin cancer surgical outpatients. Future aims will be to improve the quality of incoming referrals, streamlining the patient pathway, and to evaluate the impact of our new surgical streams on the skin cancer waiting list.
739 Pre-operative Holding Bay in Recovery - Preventing Delays and Improving Trauma List Efficacy
Authors: Cyclewala S , Wieczorek Z , Kulkarni A , Smith J
Published: August 2024

Aim

The evidence from national productivity reports and available publications shows that multifactorial delays to operating start times prevail in Trauma and Orthopaedic theatres with a range of clinical and financial consequences.

This Quality Improvement project was carried out to analyse the scale of the problem at our university hospital and to improve patient flow and Trauma Theatre efficacy by introducing a new Standard Operating Procedure to reduce delays in the start times of the morning Trauma Lists.

Method

The data was collected over a 6-month period using electronic records accessed through Bluespier Patient Manager. The agreed start time and arrival time for each first patient on the morning Trauma List were compared and a median delay time was calculated.

Results

The initial results showed a median delay of 30 minutes with the extreme being 140 minutes. The results were discussed with the Theatre, Anaesthetic and Trauma and Orthopaedic teams and a new Standard Operating Procedure was proposed and introduced. The implemented changes were threefold, the re-introduction of Golden Patient, sending for the patient prior to the morning brief and the use of a Recovery Bay as a Holding Bay for the first patient on the morning Trauma List to reduce the delays resulting from patient transfer.

Conclusions

Collected data confirms that delays in the start time of Trauma Lists are prevailing at Bristol Royal Infirmary. Further data will allow us to determine whether the new Standard Operating Procedure reduced them in a statistically significant manner.
741 Introducing a Ward Round Proforma to Improve Surgical Ward Documentation
Authors: Turgutogullari A , Arbis A , Razi K
Published: August 2024

Aim

To improve surgical ward round documentation in a local general surgery department through a standardised ward round proforma. The General Medical Council and Royal College of Surgeons have published guidance on the importance of accurate ward round documentation and this intervention intends to improve adherence to guidelines.

Method

A prospective study was carried out reviewing ward round documentation within the upper gastrointestinal surgery department at St Peter’s Hospital, Chertsey, in accordance with GMC guidance. 100 consecutive wards round entries were reviewed according to 16 parameters. An online proforma was implemented on Oracle Cerner and presented to the team after results of the audit. The proforma will be introduced for one month where a repeat review will be conducted to determine adherence to ward round documentation guidelines.

Results

The first audit cycle found strong adherence to guidelines with entry time (99%), ward round plan (98%), clinical diagnosis (94%), and current issues (94%). Areas for improvement included examination findings (82%), signature (69%), documentation of the patients’ observations (65%), consultant in charge of patients’ care (19%), and contact number (3%). Implementation of a ward round proforma aims to both save clinicians’ time with auto-populated patient details and improve adherence with ward round documentation across the department.

Conclusions

The project has shown areas for improvement within our department’s ward round documentation. A proforma reflecting these areas has been designed and implemented in our trust with follow-up review planned shortly to review whether sustainable improvement has been achieved.
39 Patient Perceptions of and Postoperative Satisfaction with Colorectal Robotic Surgery: A Qualitative Insight
Authors: Anand A , Mahmood Z , Dixon F , Keeler B
Published: August 2024

Aim

This study assesses preoperative perceptions and postoperative satisfaction amongst patients undergoing robotic-assisted colorectal surgery, in order to optimise preoperative information provision and improve patient experience.

Method

A structured quantitative and qualitative questionnaire was designed, to include questions on preoperative perceptions and prior knowledge about robotic surgery, and postoperative experiential feedback. All patients who had robotic colorectal resection at the host institution were included and had previously consented to potential inclusion in future research. Patients were contacted postoperatively. Quantitative outcomes were assessed using descriptive statistics and qualitative analysis was conducted using a thematic approach.

Results

Of 151 eligible participants, 108 provided complete responses. All underwent colorectal resection between November 2019 and August 2022.The mean±SD age of respondents was 63.1±15.2 years and 55% (n=59) were male. Prior knowledge varied; 73% (n=79) knew nothing about robotic surgery and 9% (n=10) reported apprehension, although others were intrigued (16%) or excited (14%). Four percent (n=4) of patients thought the robot was autonomous. After clinic review 81% (n=88) felt well informed about the robotic aspect. Positive feelings towards robotics were based on a perception of new technology as “better” and trust in surgeons’ advice.

Post-surgery feedback was positive; 71% (n=77) were extremely satisfied and only 14% (n=15) had a neutral or negative experience. Ninety-three percent (n=100) would recommend robotic surgery to others.

Conclusions

Improved patient information leaflets may alleviate preoperative concerns about robotic surgery, but generally this innovation is well received by patients and may indicate that patients actively seek out this modality in future.
345 Identifying Unmet Needs Concerning Luminal Device Insertion in Surgery - a Pan-Speciality Cross Sectional Survey and Qualitative Analysis
Authors: Aloul Z , Mills E , Burke J
Published: August 2024

Aim

Surgical drains and luminal devices play a crucial role across the healthcare sector. Drain placement in elective procedures has been questioned following the adoption of Enhanced Recovery After Surgery guidelines. This study aimed to investigate post-operative issues related to drains and luminal devices across surgical specialties.

Method

Clinicians with professional registration in the UK who insert luminal devices were eligible for inclusion. Data were collected through an electronic questionnaire distributed at a national health technology meeting with predefined questions generated through steering group consensus. A thematic qualitative analysis was performed.

Results

40 participants across 13 specialities responded to the survey. 45%(n=18) were General Surgery; 32.5%(n=13) other surgical specialties, and 22.5%(n=9) were in medical specialties. Thematic Analysis elicited 3 central themes: (1) Indication for device, (2) method of securing device and (3) post-operative issues. The most common indications were prophylactic for anticipated blood loss in 55%(n=22) and therapeutic in 24%(n=10) for drainage or source control. 75%(n=30) of respondents utilised non-absorbable sutures for securing the device. Drain positioning issues were reported in 21% of respondents. Complications of poor wound healing, fistula formation, and infection were common in 22% along with complete drain displacement observed by 1/5. Patient discomfort secondary to drain insertion was reported in 38%.

Conclusions

This pilot study provides insight into the attitudes and practices of a common surgical intervention. These findings presented demonstrate a strong signal that further work is required in this area and will be used to inform future national collaborative studies.
626 Obesity Does Not Affect Peritoneal Dialysis Patency but Is Adversely Associated with PD Peritonitis
Authors: Johnson J , Hayes J , Chalklin C , Ilham M A , Stephens M R , Szabo L , Khalid U
Published: August 2024

Aim

Obesity is associated with adverse outcomes following surgery. Peritoneal dialysis (PD), a form of renal replacement therapy for patients with end-stage renal failure, requires the insertion of a PD catheter. The aims of this study were to evaluate the impact of body mass index (BMI) on outcomes following PD catheter insertion.

Method

Data were collected retrospectively from a prospectively maintained database for all patients who underwent PD catheter insertion within a single health board between 01/01/2016 and 10/07/2023. Primary outcomes were PD catheter patency (defined by successful PD commencement), need for PD catheter repositioning, and PD peritonitis. Patients were followed up for a median of 24 months (range 17 – 31 months). The effect of BMI and various patient factors was analysed using univariate and multivariate regression analyses.

Results

365 patients had a PD catheter inserted over the 7-year period. 276 (75.6%) patients successfully initiated PD, 70 (19.2%) required PD catheter repositioning and 143 (39.2%) experienced peritonitis. When controlling for other variables, BMI did not affect patency or repositioning however patients with a BMI of 30 or more experienced increased episodes of peritonitis. Diabetes was also found to increase the risk of repositioning and peritonitis 2.95-fold (p=0.02) and 1.45-fold (p=0.04) respectively.

Conclusions

Increased BMI is associated with increased episodes of peritonitis but does not affect patency or repositioning. Diabetes was found to be an adverse risk factor for repositioning and peritonitis. A targeted approach in diabetic and obese patients may be required to reduce the risk of PD peritonitis.
931 Core Surgical Training; a Postcode Lottery?
Authors: Myatt A , Tomlinson J , Ismail-Koch H , Bamford R
Published: August 2024

Background

Core Surgical Training (CST) is a national training programme. The curriculum provides surgical trainees with the generic professional and specialty-specific capabilities needed to become higher surgical trainees (HST). However, despite it being nationally approved, the provision of the curriculum is decided at a local level, leading to inconsistencies and variability. The aim of this study was to understand the delivery of training in each deanery in the UK

Method

Two custom prospective surveys were electronically distributed to all CST TPDs. The surveys included a combined total of 40 questions, tailored to collect specific data on the local teaching programme and future improvements they would like to see.

Results

There was 91% response rate. There were substantial variations in regional training. The number of trainees in each region is wide-ranging from 10 to 65 (Median 52, IQR 40). 0/11 regions met all 6 of the JCST quality criteria. 4 regions (36%) met 5 of the criteria. 1 region met only 2 of the 6. 100% of deaneries offered extra mandatory teaching sessions locally, over and above the national teaching programme delivered by CST Hub. 66% of these extra sessions are delivered online. 7/11(60%) of TPDs felt greater standardisation of delivery of CST across the country is needed to improve equity of training.

Conclusions

There is considerable unwarranted variation in CST across England & Wales. Our study suggests not all training opportunities are equal and that trainees are subject to a disadvantage from an early stage in training. Further work is needed to address this.
262 Clean and Green: Sustainability in the Operating Theatre
Authors: Ang K S , Teo H X , Ang K L
Published: August 2024

Aim

Surgical scrubbing is an essential part of surgery, yet it still generates substantial waste. Reducing water waste in scrubbing is important for environmental impact. Our study focuses on assessing the amount of water used during a surgical hand scrub and to determine the percentage of water actively used during the procedure.

Method

Surgical scrubbing was observed in one operating theatre and included healthcare practitioners who routinely performed surgical scrubbing. Participants were not informed of the study to avoid altering their behaviour. The mean flow rate of water was determined by measuring the volume of water collected for 1 minute and using a standard density of 997kg/m³. The total time of water flowing, and time of water being used for each surgical scrubbing episode were recorded.

Results

Thirty-five scrubbing episodes were recorded. The average time for which the tap was turned on during surgical scrubbing was 1min 52s (maximum: 3min 7s; minimum: 1min 2s; SD: 29s). The flow rate of the tap was approximately 7.13L/min, resulting in an average of 13.30L of water used per scrub. The mean time of water being actively used during the procedure was 27s (maximum: 1min 2s; minimum: 10s; SD: 3.76s). The mean percentage of water actively used per surgical scrubbing was 23.61% (maximum: 37.69%; minimum: 51.33%; SD: 2.25%).

Conclusions

Only 23.61% of water is being actively used per scrubbing episode. This reveals the potential to decrease water during surgical hand scrubbing without compromising hygiene practices.
597 Thyroid Nodule Size and Risk of Malignancy: A Systematic Review
Authors: Cotter A , Redmond H
Published: August 2024

Aim

The overall aims of this study were to investigate the relationship between thyroid nodule size and malignancy and to examine the association between FNA results and malignancy in small or large thyroid nodules. Systematic review and meta-analysis of observational studies examining the association between malignancy and thyroid nodule size.

Method

A systematic review was completed using search words ‘thyroid, nodule and size’ in pubmed database. Nodules were subdivided into those equal and greater than 4cm and those below 4cm. Two meta-analyses were completed. and The PROBAST tool was utilized to assess risk of bias within each study.

Results

In total 17 studies were deemed eligible for inclusion. The first meta-analysis looked at the association between nodule size and final histology diagnosis. Sixteen studies were included. A Random effects model meta-analysis was undertaken which also indicated a trend towards a lower risk of malignancy in nodules over 4cm with a risk difference of 0.1 (95% CI -0.01,0.21). However, there was significant heterogeneity with an I2 of 99% therefore caution must be exercised when interpreting the results.

The second meta-analysis compared false negative rates in each of the size categories. Eleven studies were included. Results showed that there was no statistically difference between the false negative rates of nodules less than or greater than 4 cm.

Conclusions

While there is a trend towards larger nodule being less likely to indicate malignancy, thyroid nodule size does not appear to have significant influence on the accuracy of FNA in predicting cancer.
661 Is Routine Pre-Operative Group and Save for Laparoscopic Cholecystectomy Worthwhile: A Systematic Review of the Published Literature
Authors: Akharaekpanya T , Nair A , Nevins E J
Published: August 2024

Aim

Routine group and save (G&S) prior to patients undergoing laparoscopic cholecystectomy is a practice employed by many surgical units, however, the need for transfusion is rare. The aim of this review is to assess the rates of transfusion in patients undergoing LC in the published literature to assess if obtaining routine G&S should continue to be routine practice.

Method

Articles published between 01/01/2003-01/01/2023 available on PubMed, Medline and EMBASE were identified. Search terms included “laparoscopic cholecystectomy,” “group and save”, “blood grouping”, “typing and screening”, “transfusion”, “cirrhosis”, “antithrombotic”, and “antiplatelets”. Only full publication in English directly related to the topic were included. Non-cirrhotic and patients not on antithrombotic (ATB) medications were classed as “low risk” patients.

Results

Twenty publications from 8 countries met inclusion criteria with a total of 27,500 patients. Among 23,185 low-risk patients, only 329 (1.42%) received blood transfusion. This rate was even lower in the elective low-risk cohort. In the hight risk cohorts, 3,232 cirrhotic patients were included and blood transfusion rate ranges from 0% for Childs-Pugh class A to 34.74% for Child-Pugh class C. And total of 1,083 patients on ATB were included but only 18 (1.66%) received blood transfusion.

Conclusions

Very few patients undergoing LC required transfusion, even in the high-risk cohorts. Considering that routine G&S for LC carries a high financial, and environmental cost the authors believe that routine pre-operative G&S for LC should not be required unless there are patient specific concerns such as Childs-Pugh class C cirrhosis.
24 Lumbar Spine Fusion Surgery Versus Best Conservative Care for Patients with Severe, Persistent Low Back Pain: A UK Cross-Sectional Survey of Clinicians and Their Views Regarding Equipoise to Randomise Patients in a Future Trial
Authors: Bada E , Gardner A , Beard D , Ahuja S , Window P , Foster N
Published: August 2024

Aim

People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from non-surgical treatments. However, NICE (UK) guidelines recommended not offering surgery for adults with LBP except within a randomised clinical trial (RCT). This survey aims to describe UK clinicians’ views regarding equipoise for randomisation of participants in a future RCT comparing lumbar spine fusion surgery to best conservative care (the FORENSIC-UK trial).

Method

An online cross-sectional survey was shared with clinical professional groups in the UK involved in the management of adults with severe, persistent LBP. The survey had 7 sections covering the respondents' demographics, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future RCTs.

Results

There were 73 respondents (potential response rate of 9.13%) comprising 39 orthopaedic spine surgeons, 17 neurosurgeons, 2 pain specialists and 15 allied health professionals (AHPs). Most (84.7%) chose conservative care as their first-choice management for all five case vignettes. Over 50% reported willingness to randomise three of the five cases to either surgery or best conservative care (BCC), indicating equipoise facilitating the future RCT. Transforaminal interbody fusion was the preferred approach for spinal fusion (36.4%) and for BCC, combined program of physical and psychological therapy (48.5%).

Conclusions

This survey evidence that there is equipoise about the role of lumbar spine fusion surgery and BCC for a range of patients with persistent LBP.
924 Management of Vancouver B2 Periprosthetic Femoral Shaft Fractures
Authors: Shekleton F , Baker W , Dominguez E , Harries L
Published: August 2024

Aim

An increase in hip arthroplasty surgery within our ageing population is leading to a rise in periprosthetic femoral shaft fractures. The Vancouver system is widely used to classify these fractures. Vancouver type B2 fractures are a subject of ongoing management debate, fixation versus revision arthroplasty. The aim of this study was to review the management and outcomes of all patients with a periprosthetic hip fracture over five years in a high-volume single centre with a particular focus on Vancouver B2 fractures.

Method

A retrospective analysis was conducted on patients admitted between September 2016 and September 2021 with periprosthetic femoral shaft fractures. Data on demographics, surgical management, and outcomes were gathered from electronic patient records. Outcomes were radiological union, mortality, and other complications.

Results

168 patients were included in analysis, with an average age of 81. 54% of cases were Vancouver B2. 117 were managed with open reduction and internal fixation (ORIF), 51 with revision. 38% of patients died within the study period. Overall, 80% of revisions demonstrated radiological union, compared to 72% of ORIFs. 74% of Vancouver B2 revisions demonstrated radiological union, compared to 79% of ORIFs. 5.1% of patients died within the study period following revision, compared to 8.5% of those following ORIF. 4.3% of ORIFs went on to require revision surgery.

Conclusions

Periprosthetic fractures are challenging, especially B2 fractures often occurring in frail patients less fit for major surgery. This study has shown similar outcomes in revision and ORIF, suggesting B2 fractures can be effectively treated with ORIF.
1154 Efficacy of Pericapsular Nerve Group Block (PENG) in Day-Case Total Hip Replacement
Authors: White C , Yakubi M , Abdalla W , Manlapaz K , Knight U , Tiwatane S , Subramanian P
Published: August 2024

Aim

Traditional regional anaesthetic blocks in total hip replacement, such as femoral nerve or fascia-iliaca blocks, provide excellent analgesia but at the expense of quadriceps muscle weakness and thus preclude early mobilisation. The pericapsular nerve group block (PENG) targets the articular branches of the femoral, obturator and accessory obturator nerves by injecting local anaesthetic in the plane between the pubic ramus and the iliopsoas tendon. PENG can be combined with a lateral femoral cutaneous nerve block (LFCN) to cover cutaneous innervation at the site of surgery. This study aims to evaluate the effects of PENG with LFCN block in day-case total hip replacement.

Method

A case-series of 14 consecutive day-case total hip replacement patients. Anaesthetic conduct included short acting prilocaine spinal anaesthesia followed by PENG and LFCN under ultrasound performed by a consultant anaesthetist. Multimodal analgesia included paracetamol, NSAID and high dose dexamethasone.

Results

The mean post-operative visual analogue scores (VAS) for pain were 4/10 (immediate post-operative), 5/10 (6 hours post-operative) and 5/10 (24 hours post-operative). The mean time to mobilisation from anaesthesia stop time was 188 minutes (90 – 360 minutes). The mean post-operative opioid consumption was 25mg (0 – 55mg). There were no nerve block related complications. The 30-day readmission rate was 0.

Conclusions

Our experience highlights the feasibility and potential advantages of employing a precise and targeted regional anaesthetic strategy for total hip arthroplasty. This case series demonstrates that this anaesthetic regimen offers excellent pain relief while preserving motor function, thus enabling the provision of total hip arthroplasty as a day-case procedure.
21 Decoding Kidney Tumours: A Comparative Study of Immunohistochemical Markers in Renal Oncocytoma and Chromophobe Renal Cell Carcinoma
Authors: Shaker G
Published: August 2024

Introduction

Renal oncocytoma and Chromophobe Renal Cell Carcinoma (ChRCC) are similar benign kidney tumours, but they have distinct histological and clinical differences. Accurate diagnosis is crucial, yet current methods face challenges. This study aimed to compare the diagnostic accuracy of various immunohistochemistry (IHC) markers.

Method

We analysed 100 cases of renal tumours between 2010 and 2022. IHC was performed using different markers, including cytokeratin 7 (CK7), cytokeratin 20 (CK20), CD117, CD10, Hale's colloidal iron, and parvalbumin. The results of IHC staining were categorised as positive, negative, or equivocal. We calculated the sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), and accuracy of each marker.

Results

Of the 100 cases analysed, 51 were male and 49 were female. Baseline characteristics of the patients were similar between the two groups. CK7 showed the highest sensitivity (86%), followed by CD117 (76%) and CK20 (54%). Hale's colloidal iron had the highest specificity (96%), followed by CD10 (92%) and CK20 (88%). CD117 had the highest PPV (96%), followed by CK7 (91%) and CK20 (79%). Hale's colloidal iron had the highest NPV (91%), followed by CK20 (83%), and CD10 (80%). The combination of CK7 and Hale's colloidal iron showed the highest accuracy (90%).

Conclusions

CK7, CD117, and CK20 are the most accurate IHC markers for distinguishing renal oncocytoma from ChRCC. Hale's colloidal iron and CD10 also show promise. Using CK7 and Hale's colloidal iron together significantly improves diagnostic accuracy. IHC markers can be valuable tools for differentiation, but larger studies in diverse populations are needed for confirmation.