bluuebunny/crossref_metadata_2025 huggingface dataset:
646 Is There a Difference in Anastomotic Leak Rates Requiring Re-Operation Following Emergency Right Hemicolectomy Between Colorectal and Non-Colorectal Surgeons?
Authors: Mandal P , Campbell T , Bisheet G , Fernandes R
Published: August 2024

Aim

Right sided colonic cancers can often obstruct and present as an emergency. The decision to perform an anastomosis following the right hemicolectomy resection is often multifactorial. This study explores whether there are differences in leak rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy.

Method

A retrospective study was conducted at a 3-site Trust in South-East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Discharge summaries and clinic letters were then used to ascertain return to theatre for an anastomotic leak.

Results

There were 281 patients who had undergone an emergency right hemicolectomy in this time interval. There was a 152:129 female:male ratio. 17 out of 37 patients had an anastomosis undertaken by an Upper Gastrointestinal Surgeon. 2 out of the 17 (12%) had an anastomotic leak. 129 out of 244 had an anastomosis undertaken by a Colorectal Surgeon. 17 of the 129 (13%) had an anastomotic leak. There was no significant difference between the leak rates between colorectal and non-colorectal surgeons (p=0.888).

Conclusions

The study shows that there is no statistical difference in right hemicolectomy anastomotic leak rates between colorectal and non-colorectal surgeons in the emergency setting.
172 Does Decision Fatigue Impact on Surgical Outcomes? – a Scoping Review
Authors: Ijaz M , Whiteway S
Published: August 2024

Aim

Decision fatigue refers to the concept that the effort required to make repetitive decisions depletes our psychological resources and consequently leads to a fall in the quality and output of further decisions. In carrying out their jobs and often responding to emergency situations, the way surgeons perceive and make decisions plays a crucial role. It is therefore important to consider the effect decision fatigue may have on surgeons and their patients. The aim of this scoping review is to examine evidence from published studies on the impact decision fatigue has on clinical practice and patient outcomes.

Method

A computerised literature search was performed using two online databases: PubMed and Web of Science, Cochrane and Google Scholar. This yielded 9 studies that met the pre-determined criteria.

Results

Analysis of six studies indicate a consistent correlation between decision fatigue and its impact on healthcare professionals, while two studies present contrasting findings, asserting no significant influence. Notably, one study contributes evidence supporting both perspectives, adding complexity to the discourse.

Conclusions

Given the disparity in the evidence, we concluded that decision fatigue is not a generic phenomenon and that it manifests itself in different ways in individuals; with an individualised threshold to the number of high-quality and cognitively demanding decisions one can make before the consequent decisions are impacted. Therefore, more research that takes a qualitative approach is needed to understand the clinical impact of decision fatigue within surgical specialities in more detail.
264 The Impact of COVID-19 on Elective Tonsillectomies in Greater Glasgow and Clyde
Authors: Mathioudaki E , Culley C , Lyuman E , Lim W , Tailor H , Douglas C
Published: August 2024

Aim

Recurrent tonsillitis causes increased morbidity, and negatively impacts a patient’s quality of life. COVID-19 led to a dramatic decline in elective tonsillectomies. Our aim is to quantify the impact of COVID-19 on the number of elective tonsillectomies performed in the adult and paediatric populations; evaluate the impact of the pandemic on healthcare outcomes and utilisation, including indication for surgery, SIGN compliance, waiting times, post-operative complications.

Method

This study employed a multicentre retrospective population analysis within the NHS Greater Glasgow and Clyde (GGC) health board, looking at adult and paediatric populations (n=2,535 and n=4,166 respectively) from 2016 to June 2023. A further retrospective cohort analysis compared the adult cohorts of 2016 (n=359) and 2021 (n=89).

Results

Adult and paediatric tonsillectomies declined from 2016 to 2021 by 81.0% (p<0.0001) and 33.1% (p<0.01) respectively. Detailed analysis revealed an increased proportion of adult tonsillectomies with diagnostic purposes (11% to 31%), as opposed to recurrent tonsillitis which fell (74% to 52%). In 2016, 66.98% of routine adult tonsillectomies complied with the Scottish Government (12 weeks), whereas in 2021 only 4.92% met this target. Conversely, post-operative bleeding decreased from 1 in 4 (24.5%) to 1 in 5 (20.2%) over this timeline.

Conclusions

Considering COVID-19, surgical prioritisation led to a fall in elective tonsillectomies. The numbers have recovered to pre-pandemic levels in children, reflecting the greater urgency to reduce the risk of long-term cardiovascular health problems associated with obstructive sleep apnoea. Furthermore, this study demonstrates the marked changes to routine tonsillectomy practice in the GGC health board because of COVID-19.
526 Clinical Efficacy and Safety of Oral Sirolimus Therapy in Patients with Klippel-Trenaunay Syndrome in a Single Specialist Centre
Authors: Nisbet R , Pang C , Evans N , Papadopoulou A , Khalifa M , Brookes J , Lim C S
Published: August 2024

Aim

The evidence on the efficacy and safety of sirolimus therapy in patients with Klippel-Trenaunay Syndrome (KTS) remained scarce. This study aimed to assess this for patients for whom standard treatment alone was inadequate.

Method

This was a retrospective study of all adult patients with diagnosed KTS who were treated with oral sirolimus where standard therapy was inadequate in a single specialist centre since May 2016. Demographic and clinical data including patient-reported responses, visual analogue scores for pain and adverse effects, and quality-of-life scores (SF-36) were reviewed.

Results

Fourteen KTS patients (6 males: 8 females) with a median age of 44 (range: 27-57) years were included. Six patients stopped sirolimus within two months due to extensive rashes and itching, mouth ulceration, severe chest infection, worsening KTS symptoms, and multiple intolerable side effects. The median duration was 803 (IQR: 1106) days if sirolimus was tolerated. Four patients reported significant reduction in pain, 3 patients had reduced limb swelling, 1 had reduced episodes of cellulitis, 1 had improved coagulopathy and only 2 patients demonstrated limited improvements from sirolimus. The most common adverse effects were headaches (n=5), fatigue (n=5) and abdominal discomfort (n=5). There was an improvement in the mean scores for physical functioning (5.0), role limitations due to emotional problems (11.1), pain (2.5), depression (2.25) and anxiety (0.7).

Conclusions

Oral sirolimus therapy was clinically effective and safe in some complicated patients with KTS when standard therapy alone was inadequate. Longer follow-up would be needed to evaluate oral sirolimus therapy in KTS patients.
529 The Benefit of a University-Supported Foundation Trainee Teaching Buddy Scheme on Medical Student Preparedness for Practical Examinations
Authors: Sokhal B S , Menon S P K , Nanthakumar N , Polymerou E , Carny A , Xiang J , Balbadaoui A , Ashworth C , Rao V
Published: August 2024

Background

A key aspect of Health Education England’s foundation training learning outcomes is to develop the clinical teacher.

Aim

The aim of this initiative was to pair up year 3 medical students (trainee) with foundation trainees (trainer) for bedside teaching ahead of year 3 Objective Structured Clinical Examinations (OSCEs).

Method

Sign-up forms were distributed to year 3 medical students and foundation year trainees of a medical school and affiliated university teaching hospital. Trainees were instructed to deliver their teaching in accordance with the university’s year 3 curriculum and sign-off sheets for work-based assessments. Feedback forms for trainees and trainers were distributed which gathered information on content covered and perceptions of the scheme. Questions were formatted with multiple choice answers and Likert scale of agreement.

Results

27 students provided feedback. 20 (74.0%) students agreed their history taking improved and 24 (88.9%) students agreed their clinical examination skills improved. 24 (88.9%) agreed the scheme enhanced their clinical experiences and 23 (85.2%) agreed the scheme helped prepare them for knowledge examinations and OSCEs. 25 (92.6%) answered they would recommend the scheme to future year 3 students.

Conclusions

For year 3 students, this scheme enhanced clinical experience, confidence in history taking and clinical examination, and preparedness for summative examinations.
553 Early Diagnosis and Clinical Management for Acute Mesenteric Ischemia & Gastrointestinal Complications Following Cardiac Surgery: A Comprehensive Review of the Literature
Authors: Rojanathagoon T , Nainwal T , Lee K B C
Published: August 2024

Aim

Acute mesenteric ischemia (AMI) and gastrointestinal (GI) complications following cardiac surgery are rare but have significant effects on post-operative mortality and morbidity. This review sought to analyse the current diagnosis and management of these conditions.

Method

An updated comprehensive review of the literature to assess the early diagnosis and clinical management to address AMI and GI complications following cardiac surgery in adult patients was performed. A literature search was conducted on PubMed, Ovid Medline, and Embase. Relevant articles were screened by two authors, data extracted, and presented in the relevant sections.

Results

In an analysis of 8 retrospective and case control studies with a total of 264,369 patients who underwent cardiac surgical procedures, 834 had AMI and 7,684 had other GI complications. The average diagnosis time for AMI was 7.5 days and other GI complications was 7.15 days. The overall average mortality in those with AMI and GI complications being 15.2%, with AMI alone indicating significantly higher mortality than other GI complications, in this case 44%. Studies included cited nonspecific symptoms or nonsuggestive characteristics in patients with AMI. Computed Tomography, endoscopy, and colonoscopy were the most common diagnostic tools.

Conclusions

Although the incidence of AMI and GI complications post cardiac surgery is low, the prognosis is poor. In GI complications like AMI where early postoperative symptoms can be unclear, maintaining a high index of suspicion in patients at high risk alongside a low threshold for diagnostic studies can allow for a reduced diagnosis time and earlier intervention, critical in improving morality rates.
1288 The Role of a Student-Led Neuro-Society Organized Neurosurgical Conference
Authors: Al Salloum L
Published: August 2024

Aim

Gain insight into student perceptions of neurosurgery as a surgical specialty. Utilize workshops and a conference to ensure neurosurgery's accessibility. Compare results to previous annual conferences and evaluate the role of these events in bridging the gap between 'competitive' specialties.

Method

Organization of a one-day national neurosurgical conference supported by the local neurosurgical department. Offering neurosurgeon-led workshops and lectures to provide practical skills, portfolio advice and networking opportunities. Hosting eleven, consultant-marked poster presentations throughout the day. Utilizing pre-and post-conference surveys distributed to attendees to establish baseline opinions and post-conference impact through use of a five-point Likert Scale and free-text questions.

Results

Our study involved 47 medical students. After the conference, participants demonstrated a heightened comprehension of the nuances of a neurosurgical career and the strategies for obtaining training. They also expressed an augmented awareness of neurosurgery research, elective options, audits, and project opportunities. The workshops were well-received, and respondents recommended incorporating more female speakers in future sessions.

Conclusions

Student neuro-societies' efforts in hosting neurosurgical conferences effectively bridge the divide between limited exposure to neurosurgery and the challenges of competitive training selection. These conferences provide medical students with an introductory insight into a neurosurgical career through a combination of lectures and hands-on workshops. Attendees not only learn about achieving relevant milestones but also have a platform to present their research. The prospect of adopting student neuro-society-organized conferences on an international scale could serve as a valuable global educational tool, offering significant support to aspiring neurosurgeons among medical students worldwide.
177 Investigating the Secretome of Adipose Derived Stem Cells on Extracellular Matrix Remodelling in Radiation-Induced Fibrosis
Authors: Wai J M Y , Cui X , Frommer M , Langridge B J , Butler P
Published: August 2024

Aim

Radiation-induced fibrosis (RIF) is a debilitating complication following radiotherapy, characterised by fibroblast proliferation and excessive extracellular matrix (ECM) deposition, leading to functional and aesthetic impairments. Although autologous fat grafting (AFG) has shown promise in reversing RIF, the mechanisms, largely attributed to adipose-derived stem cells (ADSCs), remain elusive. This study aimed to investigate ADSCs’ and their secretome on ECM remodelling in RIF management.

Method

The anti-fibrotic potential of the ADSC secretome on human dermal fibroblasts (HDFs) subjected to ionising radiation was assessed via a series of in vitro experiments. Control HDFs were compared with irradiated HDFs to assess any phenotypical changes. Irradiated HDFs were treated with ADSC pre-conditioned media (CM) or ADSC co-culture (CC). Gene expression (COL1A1, TGF-β1, CCN-2, MMP-1, MMP-3, TIMP-1, ACTA2, TNC) was assessed via real-time quantitative PCR (RT-qPCR). ProCollagen1a1 and CCN2 protein concentrations were assessed by ELISA.

Results

Irradiated HDFs demonstrated changes in fibrotic gene expression. ADSC-CM treatment significantly reduced COL1A1 expression, although protein levels remained unchanged. TGF-β1, CCN2, MMP-3, TIMP-1 and ACTA-2 exhibited reduced expression post-ADSC-CM treatment whereas TNC expression was found to be significantly increased. Co-culture with ADSCs led to a general, but not statistically significant, decrease in pro-fibrotic gene expression. Notably, CCN-2 protein expression significantly increased.

Conclusions

This study demonstrates that ionising radiation results in a pathological pro-fibrotic phenotype in HDFs. The ADSC secretome potentially mitigates this, reducing pro-fibrotic gene expression. Unexpectedly, co-culture experiments highlighted a complex interaction with upregulation of fibrosis-associated genes. Further research is needed to clarify these interactions to improve therapeutic interventions for RIF.
251 Patient-Reported Outcome Measures Following Surgical Management of Hidradenitis Suppurativa
Authors: Berjaoui N , Galo A
Published: August 2024

Hidradentitis suppurativa (HS), also known as Acne inversus is a chronic and impairing inflammatory skin disease affecting hair follicle, which has both physical and psychological effects on patients. This study aims to evaluate patient-reported outcomes after Hidradenitis suppurativa (HS) excision and healing using secondary intention versus graft versus flaps, using HS-Quality of Life-24 and POSAS assessment modalities to capture the quality of life related to HS and its impact on the hair follicle. A retrospective analysis of patients with hidradenitis suppurativa to the axilla underwent excision and reconstruction at St. Thomas Hospital's plastic surgery department. Data was collected using GALAXY, HSQoL24, and POSAS, with higher scores indicating greater disease impact. Other factors included wound healing time, dressing changes, information received, and overall satisfaction. A study of 52 patients, 73% female, with an average age of 36, found that wound closure was achieved through secondary intention HS excision. The average total score for HSQoL24 was 62, 54, and 40, respectively. The healing duration ranged from 14 days to 2 months in 40% of cases, and 52% to 12 months in 52% of cases. 60% of cases involved alterations in medical therapy, and 28% experienced weight loss post-surgery. Patients reported overall satisfaction with the surgery, with satisfaction ratings for local flap, SSG, and healing with secondary intention. SSG and local flaps effectively provide coverage for hidradenitis suppurativa, improving quality of life and reducing scar-related complications, however still further research is needed - the optimal surgical approach regarding HS remains uncertain due to paucity of data.
373 The Use of Botulinum Toxin to Improve Cosmesis in Patients with Facial Asymmetry Following Facial palsy/synkinesis
Authors: Makhdoom N , Chaudry A S , Yu Wong Zhen
Published: August 2024

Aim

Facial Palsy (FP) is a common, debilitating condition with a broad range of aetiologies. It causes unilateral paralysis, functional impairments, and asymmetry resulting in overall reduced facial aesthetics. Secondary complications like hyperkinesis or synkinesis can result in a reduced quality of life, including social isolation and deteriorating mental health. Treatments, including botulinum toxin (BTX) injections, aim to correct this asymmetry. This review assesses BTX's efficacy, safety, and cost-effectiveness for enhancing facial symmetry in FP.

Method

PubMed was used to find studies that analysed BTX’s effects and outcomes on patients with FP and its resulting complications. Only studies from 2010 to 2022 in English were included. A total of 16 studies were identified.

Results

Intramuscular injections of BTX are a beneficial long-term treatment for individuals with FP. BTX reduces hyperkinesis, synkinesis and enhances facial symmetry, leading to better cosmesis and improved overall quality of life. The amount of toxin required ranges from 0.5-17 units depending on the muscle targeted with platysma requiring the most amount of toxin. When treating both sides of the face, the normal side requires more toxin compared to the affected side. Limited evidence was found to suggest BTX's potential in acute FP.

Therapeutic effects ranged between 1-21 days, lasting about 4 months, requiring safe, periodic repetition. Adverse effects were found to be mild, transient, and rare with no severe complications or toxin resistance reported.

Conclusions

BTX can be considered a safe and effective treatment to improve facial symmetry and overall cosmesis in the long-term management of patients with facial palsy.
391 Management of Patients Presenting to the Emergency Department with Hand Lacerations
Authors: Bugeja K , Bugeja C , Pace R , Osman Abdelmajid W Abdelmajid , Chircop K L
Published: August 2024

Aim

The audit aimed to assess the adherence to The British Society of Surgery of the Hand (BSSH) guidelines for triaging patients with hand lacerations in the Emergency Department (ED) and to evaluate the impact of adherence on patient outcomes.

Method

A retrospective audit was conducted on 120 consecutive patients who presented to the ED with hand lacerations during the last year. Data was collected from Clinical Patient Administration System (CPAS) and iSoft Clinical Manager (iCM). The BSSH guidelines were used as reference.

Results

The audit included data from 120 consecutive patients who presented with hand lacerations over the past year. With 23 patients being female and 97 being male, various mechanisms of injury, including sharp objects, machinery, animal bites, and others were documented. The triage assessments according to BSSH guidelines were conducted, and adherence to the guidelines was noted in 79%, while in 21% it was not. The average time to assessment was 208 minutes98.3% of patients received adequate wound cleaning. 56.6% received tetanus administration whilst 68.3% received appropriate antibiotic prescription. 30.8% were referred to hand surgery.25.8% experienced complications, with tendon injury being the most common. 97.5% received appropriate wound closure whilst 99.1% received appropriate dressing. 75.8% received appropriate pain management. 92.5% had a follow up scheduled at an appropriate clinic.

Conclusions

The audit highlights both successes and areas for improvement in adherence to BSSH guidelines for hand lacerations in the Emergency Department. While there is commendable adherence, efforts will focus on implementing and refining guidelines to ensure consistent and optimal patient care.
692 A Comparative Analysis of Standard Versus Jelonet/Gamgee Dressings for Lower Limb Free Flap Reconstruction
Authors: Jageer P , Kiely J , Day S , Rollett R , West C , Bhat W
Published: August 2024

Aim

Lower limb free flaps require regular monitoring in the immediate days postoperatively and often mean prolonged outpatient wound care. Post-operative dressings are particularly difficult when a circular external fixator is used. Circumferential post-operative dressings are the standard option, such as Jelonet/gauze/wool/crepe. An alternative option is the use of Jelonet and gauze, with Gamgee (JGG) wrapped loosely over the frame instead. This allows easier monitoring with complete flap visualisation, avoids constriction and much quicker dressing application. This dressing option has been previously described, but no comparative study between standard dressings and JGG dressings has been made.

Method

A retrospective study was completed for consecutive patients treated with a circular frame and free flap for reconstruction of either acute open tibial fractures or fracture related infection between January 2022-October 2023. Demographics, co-morbidities, peri-operative details, flap and wound healing outcomes were recorded and analysed with descriptive statistics and linear regression using Jamovi 2.3.21.

Results

27 patients (average age 40.3 years) were identified, 81% open fracture, 41% gracilis, 37% ALT. 56% had standard dressings, and 44% JGG. No statistically significant difference was found between the dressing groups for flap failure, inpatient stay, or time to completed healing.

Conclusions

This study demonstrates clinical equivalence in outcomes between standard and JGG dressings for this patient group. The JGG dressing also has the advantages of quick and easy application, with improved flap visualisation. We recommend its use in this patient group.
840 Audit Cycle of Surgical Management of Traumatic Open Hand Wounds at BRI – Compliance with BSSH Guidelines
Authors: Bansal R , Teklay S , Shariff Z
Published: August 2024

Aim

To assess whether the Plastic Surgery Department at Bradford Royal Infirmary are compliant with BSSH guidelines regarding timing of surgery for open soft tissue hand traumas (target rate 100%).

Method

Two retrospective data collection sets between 11th October 7th November 2021 and 7th March to 3rd April 2022 using Bradford’s Electronic Patient Records (EPR) and Xero PACS to review Plastic Trauma Clinic (PTC) clerking notes; Operation notes and Clinic letters. Patients included were all adult patients attending PTC with open soft tissue injuries needing definitive surgical treatment in an operating theatre/PTC.

Results

The initial study found a compliance rate of 74%, with a 62.5% compliance when it was the patient’s dominant hand. The number of individual soft tissues for repair was 14 for Flexor Tendon (FT), 17 for Extensor Tendon (ET) and Digital Nerve (DN) with compliance rates of 83.3% for FT and 76.4% for both ET and DN. The repeat cycle found an overall compliance of 72% with 62.5% for FT and DN and 81.5% for ET.

Conclusions

The main reason for non-compliance was due to hospital bed capacity and a lack of list space. Recommendations to improve theatre efficiency was made but despite this the same issues presented in the 2nd cycle. There was a total of 69 days of delay from the initial operation date, resulting in 17 overnight stays. Further recommendations to accurately plan allocated theatre time and not rely on the acute list to reduce cancellations have been made with a view to re-assess.
195 Use of Abdominal Ultrasound Scans in Surgical Assessment Unit
Authors: Okoh M , Ikram S , Abraham-Igwe C
Published: August 2024

Aim

Abdominal ultrasound scan is one of the most common scans performed in general surgery. It is relatively cheaper, faster, and safer than most of the other imaging modalities. However, inappropriate use of abdominal ultrasound scans can lead to delay in diagnosis, unnecessary hospital admission and extended length of stay, which could induce stress in patients. This study aims to evaluate the need and usefulness of abdominal ultrasound scans performed for patients complaining of abdominal pain in SAU.

Method

A 1-month snapshot retrospective case note review of patients that presented to SAU with abdominal pain and underwent subsequent abdominal ultrasound scans. Variables included presenting complaint, working diagnosis, ultrasound findings, and outcome data. Scans were categorised into normal and abnormal. Abnormal was further sub-categorised into positive for diagnostic question, and positive for other diagnosis.

Results

Of the 522 patients that presented to SAU with abdominal pain, 87 had abdominal ultrasound scans. Of these 87 patients, lower (52%) and upper abdominal pain (40%) were the most common presenting complaints. The most common working diagnoses were pathologies of the biliary (41%) and gynaecological (40%) systems. There were 16 abnormal scans, of which the 10 were positive for the diagnostic question. Ten patients required subsequent MR or CT scan and 5 patients required hospital admission.

Conclusions

Most scans were performed to rule out acute surgical pathologies and for reassurance purposes. To reduce the number of abdominal ultrasound scans performed, we created a standard operating procedure flowsheet that will help determine patients to be scanned based on clinical presentations.
349 Improving the Rates of Outpatient Follow-Up for Patients on a New Elective Ward Following Elective Orthopaedic Joint Replacement Surgery
Authors: Vemulapalli K , Gadikoppula S , Sinha S
Published: August 2024

Aim

This study was an audit which aimed to assess and improve the follow-up of orthopaedic patients following elective arthroplasty on a new elective ward at a district general hospital.

Method

Theatre lists were accessed through the electronic patient records. Patients who had an elective joint replacement were identified through this. Patient appointments were then accessed to see if they had any follow up appointments in place. Should the patient have an appointment, the type of appointment was checked using the clinic codes to determine whether the correct appointment type was booked. The standard expected was that 100% of patients undergoing elective surgery should have the correct follow-up appointment in place.

Results

100% of patients had an appointment booked with the orthopaedic team, however only 44% of these were booked in the correct outpatient clinic. The remaining patients were either booked into the fracture clinic or into the wrong subspecialist’s elective clinic. The intervention consisted of a new specific email address which enabled the surgeon to directly request a specific appointment with a dedicated elective orthopaedic secretary following each case. A re-audit yielded that there was an improvement with 76% of patients having the correct clinic booking. This was then planned to be presented to the executive team of the hospital to hire a ward clerk to facilitate further improvements.

Conclusions

Implementation of the change has increased the current follow-up rates; however, the long-term goal should be the hiring of a ward clerk to ensure that appropriate follow-up is in place.
393 Towards Sustainable Care Pathways: A Review of Outpatient Appointments for Elderly Patients Under Fast-Track Discharge from Surgical Specialties
Authors: Yiu J , Ernst T
Published: August 2024

Aim

To conduct a multi-cycle QI project to review outpatient appointments and evaluate the effectiveness of a junior doctor discharge checklist for elderly patients under Fast-Track discharge from surgical wards at a tertiary hospital.

Method

A pilot questionnaire survey was sent to consultants and junior doctors, followed by dissimilation of a peer-reviewed FT discharge checklist to junior doctors. A retrospective review of surgical patients under FT discharge between July 22 to April 23 was carried out. Inclusion criteria were discharged with palliative care injectables and not deceased prior to discharge.

Results

21 responses were received with 95% agreed that OP appointments review was essential and 76% reported that no routine review of OP appointments was carried out. Prior to intervention (checklist), 54% (6/11) of patients from colorectal, orthopaedics and vascular wards have OP appointments including face-to-face (F2F) thrombosis and rheumatology clinics with transport. 3 patients were deceased within 2 months. Post intervention, over two cycles, 3 out of 16 patients had appointments, with fewer F2F follow-up, but increase in telephone-led care.

Conclusions

In light of the Royal College of Surgeons report in Sustainability in Surgery in 2022, this study featuring a short checklist revealed gaps in care pathways for co-morbid FT surgical patients. This could entail unnecessary care burden to patients, inappropriate surgical service distribution and sustainability including carbon emission. Akin to medication rationalisation, there is a need for qualitative studies involving patients and carers and in other centres to raise awareness for more holistic and sustainable post-surgical end of life care.
471 Enhancing Outcomes and Improving Patient Services in Complex Abdominal Wall Reconstruction Through Multidisciplinary Collaboration
Authors: Chong M Y , Baldwin A J , Krzak A M , Murray A
Published: August 2024

Introduction

The management of complex abdominal wall pathologies presents a multifaceted challenge. There remains limited evidence for abdominal wall reconstruction, with variations in surgical technique, prosthetic materials, and patient cohorts. The abdominal wall reconstruction multidisciplinary team (AWRMDT) provides a platform for in-depth discussion of complex abdominal wall problems, drawing on expertise of radiologists, general and plastic surgeons. We aim to outline benefits and challenges in creation of our AWRMDT.

Method

From the creation of the MDT in December 2020, monthly meetings have been conducted to consider patient characteristics, nature of the defect, radiological findings, mesh selection and management. Comprehensive records of discussed cases were maintained, documenting profiles, management, outcomes, and any associated complications.

Results

A total of 105 cases were discussed in the AWRMDT from December 2020 to present. 68 (65%) patients were recommended for surgery, with 20 (19%) undergoing perioperative Botox injections. 26 (25%) patients were not recommended for surgery, while 2 (2%) have opted for treatment in the private sector. 18 (17%) required perioperative optimisation such as reduction in BMI and smoking cessation.

Conclusions

With growing prevalence of abdominal wall surgery, the AWRMDT enhances patient care and optimises the utilisation of limited resources. A collaborative approach to the management of this complex patient group is in line with published recommendations and has allowed our team to provide a more robust and standardised approach to this complex patient cohort. Future plans for our AWRMDT include the routine assessment of functional outcomes and achieving specialist centre status.
533 Use of Clinical Frailty Score in Surgical Patients - a QIP
Authors: Mollier J , Whitehall N , Gray E
Published: August 2024

Aim

Frailty is defined as a state of increased vulnerability to poor recovery after a stressor event. Frailty on admission influences investigations, treatment, appropriate ceilings of care, and helps with anticipating complications, and frailty at discharge determines discharge criteria planning. The clinical frailty score (CFS) is a quick way to assess frailty and has been widely validated as a good indicator of patient outcomes. The aim of this audit is to improve use of CFS on admission and discharge of surgical patients at Southend University Hospital.

Method

59 consecutive general surgery patients admitted between 4th-10th September 2023 were screened for documentation of CFS on their admission clerking and discharge letters. A poster detailing how to determine the CFS was then created and distributed to surgical wards. Admission clerking and discharge letters for 32 patients were screened for documentation of CFS on admission and discharge.

Results

Before intervention, 0% of emergency admissions and 86% of elective admissions had CFS documented on admission. No patients (emergency or elective) had CFS documented on discharge. Post-intervention, 20% of emergency admissions and 100% of elective admissions had clinical frailty score documented on discharge. However, on admission, 100% of elective admissions and 6% of emergency admissions had clinical frailty score documented.

Conclusions

There was some improvement in documentation of CFS on admission and discharge, but further work would include improving awareness of CFS with teaching sessions and providing a space for this to be documented on admission clerking proformas.
665 Timely Gentamicin Sampling and Impacts on Administration in Paediatric Surgical Patients
Authors: Johnson R , Attia A , Wade J , Emordi V , Mernenko R , Hannon E
Published: August 2024

Aim

Gentamicin serum level monitoring is mandatory to ensure safe administration. Optimum guidance in children suggests an 18–23-hour sampling window following the 1st dose. We aim to see if this target is met and to improve timely administration of gentamicin in a paediatric surgery department.

Method

A 6-week retrospective review included paediatric surgical patients receiving once daily gentamicin in our hospital. Data collected included times of blood sampling, receipt by laboratory, result reporting and gentamicin administration. Interventions were then implemented to encourage sampling at 18 hours; including posters, educational sessions, department emails and involvement of nursing, pharmacy, and laboratory teams. Data was then collected prospectively in the same format for comparison.

Results

Our population included 27 patients: 17 pre-interventions, 10 post. Ages ranged between 1-18 years. Primary indications for gentamicin included appendicitis and anorectal surgery. Pre-intervention, 8/17 (47%) patients had samples taken within 18-23 hours. 3/17 (18%) patients received infusions on time; defined as <1hr due (mean administration 3hr 56m late). Post-intervention, 10/10 (100%) patients were sampled before 23 hours (mean sampling 18hr 35m post-dose). 8/10 (80%) patients received infusions on time (mean administration 4m early). In addition, delays in serum level reports dropped from 76% (pre-intervention) to 10% (post).

Conclusions

Junior doctor and nursing education led to significant reduction in sampling and administration delays. Setbacks such as laboratory errors or insufficient samples are often accounted for when sampling at 18 hours post-dose. This mindset can be adopted through simple interventions. Of note, no serum levels met the toxicity threshold.
721 Optimising Acute Pancreatitis Management: A Comprehensive Evaluation of Guideline Adherence and Clinical Outcomes in a District General Hospital
Authors: Mushtaq M , Gurprashad R
Published: August 2024

Aim

This study sought to evaluate compliance with NICE guidelines for assessing and managing acute pancreatitis at a district general hospital, following the implementation of a trust protocol designed to align with these guidelines; with a specific emphasis on initial interventions and Glasgow-Imrie scoring.

Method

A retrospective review of 102 patient admissions from January to October 2023 was conducted. Adherence to initial management protocols, as per NICE guidelines, was scored out of 6; covering fluid resuscitation, analgesia, nutritional support, causal investigations, imaging for suspected complications, and correct antibiotic use. Each patient’s Glasgow-Imrie score on admission was also calculated.

Results

Out of the 102 patient admissions analysed, 9.80% had a Glasgow-Imrie score ≥3, indicative of severe pancreatitis. Among these cases, there was on average a 96.67% adherence rate to NICE-recommended treatments, compared to 88.41% for less severe cases. Suboptimal practices were identified in antimicrobial prescriptions, with 23.54% administered incorrectly as prophylaxis. Additionally, 25.49% of patients were made nil-by-mouth without an alternative nutrition plan. Furthermore, deficiencies were noted in components necessary for Glasgow-Imrie scoring, with only 11.76% and 22.55% of patients having a measured PaO2 and LDH, respectively.

Conclusions

While this study demonstrates a commitment to evidence-based management in severe acute pancreatitis, identified variations in guideline application for more moderate cases emphasise the need for targeted educational interventions, particularly in antimicrobial prescribing and providing nutritional support. Ensuring adherence to often-overlooked parameters (LDH, PaO2) in the Glasgow-Imrie scoring system is crucial for a more accurate assessment of severity, thereby facilitating appropriate and effective management for these patients.
864 Optimizing Prescribing Strategies for Neck of Femur Fracture Patients: The Role of Electronic Order Sets
Authors: Pattnaik S , Sidhu G , Kaur H
Published: August 2024

Aim

Neck of femur fractures impose a substantial burden on the National Health Service (NHS) in the UK, with rising incidence rates and escalating costs. The aim of this study is to investigate the impact of implementing an order set on medication prescribing for patients with neck of femur fractures, with a focus on optimizing pain management and enhancing patient outcomes.

Method

A retrospective analysis was conducted to evaluate medication prescribing practices in patients diagnosed with neck of femur fractures. The study was carried out at Queens Hospital, Burton, a level III trauma unit in the UK, utilizing the Meditech electronic patient records. The prescribing patterns of medications, including paracetamol, opiates, antiemetics, laxatives, intravenous (IV) fluids, oxygen, and preoperative drinks, were assessed before and after the introduction of an order set. The study population consisted of 63 patients, with data collected over a two-month period for each phase of the study.

Results

Prior to implementing the order set, prescribing rates for certain medications were suboptimal. Following the introduction of the order set, there was a significant improvement in medication prescribing for all patients with neck of femur fractures. Prescription rates for paracetamol and opiates remained at 100%, while there were substantial increases in the prescribing of antiemetics (68%), nutritional shakes (81%), and oxygen (87%). IV fluid prescriptions increased by 10%, and laxative prescriptions increased by 32%.

Conclusions

Implementing order sets in the management of patients with neck of femur fractures has shown to be effective in optimizing preoperative prescribing practices and improving patient outcomes.
869 A Comprehensive Evaluation of Patient Satisfaction and Safety in Elective Hip and Knee Replacement Surgeries During the COVID-19 Pandemic
Authors: Sidhu G , Pattnaik S , Kaur H
Published: August 2024

Aim

During the initial phase of the COVID-19 pandemic, elective orthopaedic services were significantly delayed, raising concerns about the delivery of orthopaedic care. This study aims to evaluate patient safety, satisfaction, and service delivery in the context of elective hip and knee joint replacement procedures during the COVID-19 pandemic.

Method

A prospective, single-centre study was conducted at Queen Hospital Burton (QHB) involving 100 patients who underwent elective orthopaedic procedures between mid-June 2020 and August 24, 2020. Patient characteristics, including demographics, COVID-19 risk stratification, procedure types, length of stay, complications, and outcomes, were recorded. Data collection involved standardized assessments and surveys to evaluate patient safety and satisfaction.

Results

The study sample had a mean age of 69.1 years, with females representing 59% of the participants. Most patients received spinal anaesthesia (85%), and the majority of procedures performed were total hip replacement (50%) and total knee replacement (41%). The average blood loss was 350.41 ml, with a low transfusion rate. Postoperative events were observed in 20% of patients, mainly related to acute kidney injury, urine retention, and electrolyte imbalances. There were no cases of COVID-19 contraction during hospitalization or after discharge. Only a small percentage of patients required transfer to the main site, and readmission rates were low.

Conclusions

The implementation of a COVID-free pathway for elective orthopaedic patients at QHB resulted in a safe patient environment, the absence of COVID-19 transmission, efficient transfer to the main site, enhanced patient experience, and a reduction in the waiting list.
942 Improving Communication of Driving Advice to Patients Undergoing Day-Case General Surgery
Authors: Crawford A , Nelson A
Published: August 2024

Aim

Day-case emergency surgery often involves short stays in a hectic environment, with limited patient-professional interaction. However, driving after general anaesthesia, sedation, opioid use, or post-op pain poses risks. Additionally, many insurers don't cover post-surgery driving. This project aimed to improve documentation and appropriateness of driving advice for day-case surgical patients, aligning with DVLA and relevant medical guidelines.

Method

All non-elective general surgical admissions to Bristol Royal Infirmary were identified over 4 weeks. Patients discharged within 48 hours of admission, who underwent a procedure requiring general anaesthesia, local anaesthesia or sedation were included. A search of inpatient notes and discharge documents evaluated whether driving advice was communicated, and the appropriateness of the advice given. Following the initial audit, educational sessions were held for on-call surgical teams and posters erected by surgical workstations to guide appropriate documentation of driving advice. A re-audit took place after two months to identify improvements and barriers.

Results

Initial analysis of 24 patients showed one (4.2%) had advice documented on the discharge summary and one who had advice documented on the operation note. Neither were in line with current guidance. Post-intervention, 4 of 15 (26.6%) had advice documented on discharge summary, all consistent with current guidance. Results were discussed at a surgical governance meeting and barriers identified as rotating staff, busy on-call shifts and difficulty accessing specific guidance.

Conclusions

Although increasing awareness made small improvements, it was agreed to implement a standardised driving advice statement, available as a tick box on a mandatory section of the electronic discharge summary.
638 Abscesses. to Pack or Not to Pack?
Authors: Hussain R , Darling M Finch , Dior A , Singh S , Iqbal N , Singh S , Ramcharan S
Published: August 2024

Aim

Recent studies have suggested packing post incision and drainage (I&D) of abscess results in increased pain with minimal impact on recurrence or fistula formation. The aim of this study is to assess the management of abscesses post I&D and determine short-term outcomes.

Method

Cases undergoing I&D between January 2022 and August 2023 from a single district general hospital in the UK were included. Information regarding patient demographics, type of abscess, wound management and patient outcomes including pain in the acute setting, recurrence, fistula formation, return to daily activities and readmission rate was obtained.

Results

A total of 78 cases were identified (mean age 44 years, s.d 17, males = 38, females = 40). These included perianal (30%), pilonidal (24%), axillary (9%), groin (11.4%), back (11.4%), abdominal (3%), buttock (3.6%), chest (1.3%), chest wall (2.5%), gluteal (2.5%) and infected cyst (1.3%).

83% of patients underwent packing, which was associated with higher rate of readmission overall (3.1% vs. 0%).

For perianal abscesses, packing was associated with a lower recurrence rate (17.6% vs 57.1%) but higher fistula formation (37.5% vs 25%).

Packing did not result in increased post operative pain scores compared to non-packing, however, was associated with more time to return to daily activities within 1 week (25% vs. 38%).

Conclusions

Majority of abscesses were packed (83% vs 17%), leading to a higher rate of readmission and patient morbidity. Emphasising patient experiences of packing and the lack of clinical benefit can ensure that daily practice aligns closer with recent research findings.
66 Escape Room as an Educational Strategy for Foundation Doctors Basic Surgical Skills Induction
Authors: Sohail A , Tay T , Abid Sohail Z , Kaur N
Published: August 2024

Aim

Simulation-based surgical education in the form of an Escape room is a well-published method of teaching surgical content and skills. However, little has been published on the use of Kirkpatrick model in the design of basic surgical skills as part of foundation doctors’ induction. We wanted to evaluate the use of an educational escape room for teaching surgical skills as part of foundation doctors’ induction.

Method

We designed and implemented an escape room for the Induction programme of Foundation Year One doctors in the United Kingdom at our local district general hospital. In groups, the doctors had to work through several tasks including gowning and gloving, knot tying and suturing in order to "escape the room". Pre- and post-session feedback were collected as surveys using Likert scale and semi-structured free-text questions were thematically analysed. Kirkpatrick model was used as a method of designing and evaluating the study.

Results

In total, 11/24 participants completed the feedback forms. On a scale of 1-5 where 1 is strongly agree and 5 is strongly disagree, 9/11 agreed they found escape rooms as a useful method for learning, and 10/11 understood how to scrub in, placing interrupted sutures; all felt confident in putting a hand-tie. Participants highly recommended this for future training. We were unable to evaluate longer term wider impact of this project within the wider surgical team.

Conclusions

Our pilot study indicates that the Kirkpatrick model is useful in the design and evaluation of in the use of Escape room in teaching basic surgical skills induction.