bluuebunny/crossref_metadata_2025 huggingface dataset:
EP-682 Management of Superficial Abscesses: Scope for Day Case Surgery
Authors: Ahmed Ayesha , Olugbemi Jola , Prihartadi Aliya , Ridgway Lucy , Sebastian Boby
Published: November 2022

Background

Superficial abscesses form a large part of surgical emergencies in many units and are considered a low priority emergency often leading to delayed definitive treatment.

Aims and objectives

The aim of this study was to investigate the efficiency of emergency treatment of superficial abscesses and to identify areas for service improvement. A set criterion for ambulatory care was made: Apyrexial on admission, White Cell Count of less than 13.5×10*9/L, CRP less than 100mg/L, no significant co-morbidities and no other medical concerns for admission. Patients who meet this criteria should be sent home to present for planned procedures the next morning.

Methodology

Retrospective audit of care provided to patients who required drainage of superficial abscess under general anaesthesia over a six-month period.

Results

76 patients were included in the study. 39% of the patients had their abscesses drained on the day of presentation with another 50% waited till the next day for procedure while the remaining 11% waited for 2 or more days. The time interval between admission and surgery ranged from 2 hours to 94 hours (mean ± SD 19 ± 16.25. The length of admission ranged from 7 to 167 hours (mean ± 43 hours). Of the 130 overnight beds used by the 76 patients, 53 nights were spent awaiting surgery and 77 following surgery and awaiting discharge.

Conclusion

Out of 76 patients, 40 patients fulfilled the inclusion criteria of ambulatory abscess pathway and could have been discharged the same day for next day surgery.
BJS Prize 1 Postoperative electrical muscle stimulation attenuates loss of muscle mass and function following major abdominal surgery: A split body randomised control trial
Authors: Hardy Edward , Hatt Jacob , Doleman Brett , Phillips Beth , Lund Jon
Published: November 2022

Aims

Significant loss of muscle mass and function occurs after major abdominal surgery. Neuromuscular electrical stimulation (NMES) has been shown to reduce muscle atrophy in some patient groups, but evidence in postoperative patients is limited. This study assesses the efficacy of NMES in attenuating muscle atrophy following major abdominal surgery.

Methods

Fifteen patients undergoing open colorectal resection were recruited to a split body randomised control trial and their lower limbs randomised to control (CON) or NMES (STIM). The STIM limb underwent 15 minutes of quadriceps NMES twice daily on postoperative day (POD) 1 to 4. Ultrasound measurement of Vastus Lateralis (VL) cross sectional area (CSA) and muscle thickness (MT) was made preoperatively and on POD 5, as was dynamometer measurement of knee extensor strength (KES). All outcomes were analysed using linear mixed model techniques. The study was approved by NHS research ethics committee (ref 20/EM/069).

Results

NMES significantly reduced the loss of CSA (-2.52% vs -9.16%, p<0.001), MT (-2.76% vs -8.145, p=0.001) and KES (-10.35% vs -19.69%, p=0.03). No adverse events occurred, and patients reported that NMES caused minimal or no discomfort.

Conclusions

NMES reduces loss of muscle mass and function following major abdominal surgery and may be an important tool in aiding recovery to normal activity levels. This will be especially important in preventing postoperative loss of independence in the increasingly physiologically frail patients undergoing major abdominal surgery. Further studies should establish the efficacy of bilateral whole-leg NMES for improving patient-centred outcomes.
BJS Prize 3 PPE-induced systemic hypercapnic-hypoxaemia: translational implications for impaired cognitive-clinical-functional performance
Authors: Luton Oliver , Stacey Benjamin , Mellor Katie , Egan Richard , Bailey Damian , Lewis Wyn
Published: November 2022

Background

Personal Protective Equipment (PPE) has been reported to adversely influence pulmonary gas exchange, resulting in systemic hypercapnic-hypoxaemia and cerebral hyperperfusion-induced cephalalgia. This study aimed to determine to what extent these changes impact functional cognition and manual dexterity given their relevance to surgical performance.

Method

Thirty-one surgical trainees (20 male, 11 female, aged 29 yr. (29.2 ± 2) participated in a randomised single-blind repeated measures crossover trial, completing one-hour of standardised laparoscopic simulation tasks, on two separate occasions (same day), once in Standard Operating Attire (SOA), and once in full PPE (including FFP3 mask). Global Cerebral Blood Flow (gCBF) was determined using duplex arterial ultrasound. Cognition and manual dexterity were assessed by timed Grooved Pegboard and a novel measure of laparoscopic bead placement.

Results

Following one-hour of simulation, PPE (compared with SOA) increased heart rate (93 ± 13 b/min vs. 79 ± 13 b/min, p=0.001), decreased peripheral O2 saturation (96.9% ±1% vs. 97.9% ±1%, p=0.001), increased gCBF (Δ+7 ± 8 mL/min/100g vs. + 1 ± 11 mL/min/100g, p=0.016; reflecting hypercapnic-hypoxic cerebral vasodilatation) and skin temperature increased by 0.6°C (p=0.001). Cephalalgia was reported by 21 (67.7%) participants wearing PPE vs. 13 (41.9%) wearing SOA (p=0.001). Dominant hand pegboard and laparoscopic bead performance were both impaired by PPE: 71.1s (±12) vs. 61.4s (±12), p=0.001; 270.7s (±135) vs. 192.5s (±67), p=0.001 respectively.

Conclusion

Collectively, these findings are the first to demonstrate that PPE-induced systemic hypercapnic-hypoxaemia is associated with important impaired cognitive-clinical-functional performance that may have a cerebrovascular basis.
Moynihan Prize 1 Antibiotic management of acute appendicitis avoids surgery in over 70% of adults: one-year follow-up from a prospective, multicentre, observational study
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Hollyman Marianne , Lund Jon N , Moug Susan , Tierney Gillian M
Published: November 2022

Background

Surgeons are sometimes reluctant to manage uncomplicated appendicitis non-operatively. Reasons cited are unknown rates of recurrent appendicitis and the risk of missed appendiceal malignancy. The aim of this study was to address these uncertainties and determine the long-term efficacy of antibiotic versus operative management of appendicitis.

Method

One-year follow-up of patients enrolled in the multicentre observational COVID:HAREM cohort study during March-June 2020 was undertaken. Patients were diagnosed with appendicitis either clinically or radiologically; initial operative or non-operative management was determined on a case-by-case basis by the responsible surgeon. Outcomes were the one-year appendicectomy rate, resected appendix histology and predictors of antibiotic failure.

Results

A total of 625 patients who underwent non-operative management were identified from 49 of the original 97 hospital sites. The overall appendicectomy rate at one-year in the initial non-operative group was 29% (180/625), with a median time to appendicectomy of 29 days [IQR 2-124]. Elective appendicectomy accounted for 17% (31/180) of operations with normal histology found in 39% (12/31). The overall normal histology rate was 11% (19/167). There were 7/167 malignancies and 3/167 neuroendocrine tumours identified at delayed operation. The presence of a faecolith (HR 1.72; 95% CI 1.18–2.51) and CRP>300 versus <50 (HR 3.05; 95% CI 1.6–5.81) were independent risk factors for failure of antibiotic-management (n=441).

Conclusion

The success rate of non-operative appendicitis management was 71% at one-year. Appendicitis recurrence was associated with the presence of a faecolith, malignancy and significantly raised CRP. These factors should be considered when counselling patients on non-operative management.
Moynihan Prize 3 Financial implications of gallstone-related complications whilst awaiting elective cholecystectomy: a single institution experience of 900 patients.
Authors: Burford Charlotte , Ainger Ellen , Syed Tayyaba , Tanwar Astha , Efiannayi Antonia , Shah Ankur , Chan Annabel
Published: November 2022

Aims

Over 65,000 cholecystectomies are performed each year in the United Kingdom with increasing waiting-list times due to the COVID-19 pandemic. This study set out to understand the cost to the NHS of complications experienced whilst awaiting cholecystectomy.

Methods

A retrospective cohort study was carried out for all patients who had been awaiting elective cholecystectomy for more than 20 weeks on the 17th September 2021 at a large NHS Foundation Trust. Demographic data was collected at the time of listing. Re-admission data was collected from patient notes. It included clinical history, blood results and imaging investigations. Associated costs were calculated.

Results

900 patients included in the study (median age 56 years, 71.7% female). 138 patients (15.3%) re-presented to hospital whilst on the waiting list with complications of gallstone disease. Of these, 51 had more than one presentation to hospital with 18 patients having more than three presentations. This was equivalent to 625 days in hospital, with only 79 same day discharges, and multiple investigations were performed (ultrasound scan = 79; CT scan = 31, MRCP = 47, ERCP = 21). This was estimated to have cost a minimum of £364,917. Assuming an average time for an elective cholecystectomy of 90 mins at a cost of £1,200 per hour, 202 additional cholecystectomies could have been performed.

Conclusion

This study highlights the enormous potential to reduce patient suffering by increasing the number of elective cholecystectomy lists, and at no overall additional cost to the trust.
SPOD1 Effect of BMI on Safety of Bariatric Surgery during the COVID-19 pandemic, Procedure Choice, and Safety Protocols – an analysis from the GENEVA Study
Authors: Singhal Rishi , Omar Islam , Madhok Brijesh , Ludwig Christian , Tahrani Abd A , Mahawar Kamal
Published: November 2022

Background

It has been suggested that patients with a Body Mass Index (BMI) of >60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach.

Methods

We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI - Group I (BMI<50 kg/m2), Group II (BMI 50–60 kg/m2), and Group III (BMI>60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed.

Results

This study included 7084 patients (5197;73.4% females). The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively. Group I included 6024 (85%) patients, whereas Groups II and III included 905 (13%) and 155 (2%) patients, respectively.

The 30-day mortality rate was higher in Group III (p=0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p=<0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of >70 kg/m2 had a 30-day mortality of 7.7% (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass.

Conclusion

The 30-day mortality rate was significantly higher in patients with BMI >60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection.
SPOD2 Microvesicles as biomarkers for the screening of colorectal neoplasm
Authors: Eddama Mohammad , Gurung Rijan , Fragkos Konstantinos , Cohen Richard , Loizidou Marilena , Clapp Lucie
Published: November 2022

Background

Colorectal cancer (CRC) is the second cause of cancer death worldwide. Screening for CRC by Faecal Immunochemical Test (FIT) aims to detect early cases before symptoms occur. Yet, the FIT has poor predictive value and low compliance rate. To address this, the role of circulating microvesicles as potential screening tool is a novel approach that warrants prioritised research.

Methods

In a two-gate diagnostic accuracy study, 35 patients with benign colorectal polyps (BCRP) (n=16) and colorectal cancer (CRC) (n=19) were compared to 17 age-matched healthy controls. Total annexin-V positive microvesicles and sub-populations positive for selected biomarkers relevant to bowel neoplasm were evaluated in patients’ plasma using flow cytometry.

Results

Total plasma microvesicles, and sub-populations positive for CD31, CD42a, CD31+/CD42a-, EPHB2, ICAM and LGR5 (component factor-1) were able to identify patients with BCRP and CRC with a receiver operator curve (AUC) accuracy of a 100% (95% CI: 100% to 100%) and 95% (95% CI: 88% to 100%) respectively. To identify patients with BCRP, a cut-off point value of component factor-1 ≥761 microvesicles/µL demonstrated a 100% sensitivity, specificity and negative predictive value (NPV) and a 93% positive predictive value (PPV). To identify patients with CRC, a cut-off value of component factor-1 ≥439 microvesicles/µL demonstrated a 100% sensitivity, specificity and NPV and a 65% PPV. CEA+ microvesicles sub-population were significantly (p<0.02) higher in CRC in comparison to BCRP.

Conclusion

Microvesicles as biomarkers for the early detection of CRC is a simple and effective tool that yields a potential breakthrough in clinical management.
SPOD3 F.I.T for Discharge? Role of Faecal Immunochemical Testing (FIT) in ruling out Primary Bowel Cancer: A review of current outcomes.
Authors: Krishna Arun , Ferrara Giovanni , Edwards Joshua , Chaudhary Baber , Lala Anil
Published: November 2022

Aim

NICE recommends that a FIT <10µgHb/g may not warrant an Urgent Suspected Cancer (USC) Referral. Our primary aim was to assess outcomes at a local level for FIT <10µgHb/g. Secondary aims included whether a high FIT(>100µgHb/g) determines increased cancer risk and whether a moderate FIT(10–100µgHb/g) warrants USC inv: estigations.

Methods

A retrospective review of all symptomatic patients who received a FIT in a District General Hospital in North Wales between June-December 2020. These were divided into 3 groups: negative FIT(<10µgHb/g), moderate FIT(10–100µgHb/g) and high FIT(>100µgHb/g). The results of any subsequent investigations such as Endoscopies, CT Colons or CTs were recorded along with the histology results from polyps/biopsies/specimens from Endoscopy/Surgery. Simple sensitivity and negative predictive value(NPV) analyses were performed.

Results

A total of 722 patients returned a FIT result. 544 were negative, 106 moderate and 72 high. 2/544(0.37%) in the negative FIT group had cancer, however histology of both showed Squamous Cell Carcinoma from Anal Cancer. 3/106(2.83%) in the moderate FIT and 15/72(20.83%) in the high FIT group had cancer. Polyp histology demonstrated high-grade dysplasia in 2(2.78%) in the high, 2(1.89%) in the moderate and 0 in the negative group. FIT sensitivity of 90% and NPV of 99.62% was demonstrated.

Conclusions

A negative FIT can adequately exclude primary bowel cancer in symptomatic patients. Patients with high FIT could proceed “straight-to-test”, while moderate FIT may need further outpatient assessment. Inappropriate investigations and delayed diagnosis have drastic clinical and financial implications.
SP1.1.1 Barriers for cadaveric kidney organ utilisation: Results of a National Transplant Access to Theatre (NTACT) pilot study
Authors: Mujeeb Mariyam , Borbas Balint , Tanase Andrei , Aroori Somaiah
Published: November 2022

Aims

There are various barriers to cadaveric organ utilisation across the UK. However, there is a paucity of data on these barriers after the arrival of organ/s at the implanting centre. We set up the national “NTACT” study to identify barriers after arrival of organs at implanting centre.

Methods

Prospective pilot study collecting data on adult kidney/pancreas cadaveric organs across five UK centres in July 2021. Data collected includes time intervals between significant checkpoints prior to transplantation and perceived reasons for delays after arrival at implanting centre. Data was recorded on RedCap and analysed for delays using descriptive statistics.

Results

Between five transplant centres, data was entered on 27 transplants. Five patients were excluded from the study (live transplant-2, incomplete data-3). There were six donation after circulatory death (DCD) and 16 donation after brainstem death (DBD) organs. Fifty percent (n=3/6) of DCD and 12.5% (n=2/16) of DBD allografts surpassed the national recommendations for cold ischaemia time (CIT). Majority of cross-matches were virtual (15-virtual and seven-full). Delays included cross-match results (median=03:37:30), time between arrival of the kidney and patient into theatre (median=03:13:00), time between anaesthetic induction and knife to skin (median=00:52:00). The median warm ischaemia time was 00:41:30 (IQR-00:33:00–00:49:30). Qualitative answers highlight themes including “surgical team occupied in another case”, “emergency theatre occupied”, and “porter availability for transporting patients”.

Conclusion

Our pilot study identified various barriers to implantation, and a significant proportion of kidneys are implanted beyond nationally accepted CIT. Further work is required to get a national picture over an extended period.
SP1.1.3 Feasibility, safety and cost effectiveness of outpatient removal of ureteric stent following kidney transplantation
Authors: Tasleem Sadia , Shetty Kartik , Gulnaz Nadia , Chidambaram Nathan
Published: November 2022

Aims

The aim of this study was to evaluate the feasibility, safety, and costs associated with a dedicated flexible cystoscope for the removal of ureteric stents from transplant recipients in the outpatient setting.

Methods

In our centre, we routinely performed post renal transplant ureteric stent removal in theatres. Recently we have switched this practice to outpatient settings. We performed retrospective analysis of prospectively collected data from two settings between Aug 2018-Dec 2021 to compare the impact on the timing of post renal transplant ureteric stent removal, associated complications, cost effectiveness and patient satisfaction.

Results

In total 99 ureteric stents were removed from 100 transplant recipients in theatre and 100 stents in outpatient department. 2 patients in clinic cohort did not tolerate procedure under LA. 5 patients in theatre cohort and 6 patients in clinic cohort underwent PD catheter removal in theatres along with stent removal.

Earlier stent removal was achieved in clinic compared with theatre with (36 versus 55 days after transplant; p=0.001)

There was no statistically significant difference in infection rates following stent removal in either groups.

Outpatient stent removal proved to be very cost effective to the trust with savings of over £250 per procedure in comparison to the theatre setting.

Patient satisfaction was measured by numerical rating score for pain and discomfort which showed that the patients tolerated the outpatient procedure under local anaesthesia very well,(mean score 4/10).

Conclusions

A dedicated outpatient ureteric stent removal service for kidney transplant recipients seems to be feasible, cost effective, and safe.
SP1.1.4 Caveat Chirurgicus - Opioid use following surgery
Authors: Vijayagopal Kesav Aditya , Majeed Talal , Wilson Jeremy , Magee Conor
Published: November 2022

Introduction

Over the last 20-years there has been increasing opioid related deaths, in the context of a worldwide epidemic of misuse including addiction and overdose. Startlingly, opioid commencement is usually iatrogenic. Most published data is from the USA with little evidence from UK surgical practice.

Methods

Retrospective analysis of surgical unit opioid prescriptions. Data included opioids prescribed on discharge, 1, 3- and 6-months post-discharge usage and milligrams-of-morphine equivalence(mgEq) used to compare regimes.

Results

One hundred cases reviewed. 35% of patients were opioid naïve on admission and of these 20%, 5.71% and 8.57% remained on opioids at 1, 3- and 6-months post discharge respectively.

Females more likely to remain on long-term opioids at 6 months at lower doses (42% v 30%).

Only 6% of discharge summaries recommended GP follow-up and assessment of opioid requirements. Furthermore, none were prescribed a tapering dosage regime on-discharge.

Patients receiving Acute Pain Team reviews, more likely to remain on long-term opioids, at lower doses (30.67mgEq, 29.25mgEq and 32.63mgEq at 1-, 3- and 6-months post-discharge) compared to those without (69.16mgEq, 74.25mgEq and 65.13mgEq).

Only 11% of patients with pre-existing opioid prescriptions were reviewed by the acute pain team.

Worryingly, no documented assessment of opioid misuse risk in patients.

Conclusion

Standardised assessments i.e., opioid Risk Assessment Tools and mgEq need to be documented and monitored in primary and tertiary care. Acute pain team services should be offered to more patients. Our study hopes to raise awareness of the need for effective opioid stewardship in surgical patients.
SP1.2.1 The Theatre Training Checklist (TTC): A toolkit to improve training within the operating theatre
Authors: Aldoori Joanna , Peter Mark , O'Regan David , Robson Andrew
Published: November 2022

Aims

The operating theatre is a crucial learning environment for different trainees (nurses, anaesthetists, surgeons etc.) Equity of access is essential to achieve their individual training requirements. Traditionally, opportunities within a theatre list are informally discussed between trainers and trainees at some point during the list. Furthermore, there is currently limited discussion between different members of the full team. The Theatre Training Checklist (TTC) is a simple framework that aims to facilitate coordination of training for all team members.

Methods

The TTC was devised as an extension of the WHO checklist. It consists of four stages: Trainer/Trainee discussion before theatre brief regarding training goals for the list, formal identification of all trainees within the theatre brief, explanation to the team of what each trainee will undertake, followed by use of theatre debrief to reprise whether training goals were met. The TTC was piloted and outcomes measured using an anonymised structured questionnaire from across the entire team.

Results

27 staff participated, including 7 trainees. Individuals’ understanding of trainees’ objectives improved as a result of the TTC (25/27, 92.6%) along with perceived improved theatre list efficiency (18/27, 66.6%). All trainees agreed that the checklist improved achievement of their training objectives. Qualitative feedback included: “This is a great way to identify what students and trainees want to achieve in theatre and how we can work together to overcome any difficulties”

Conclusion

Initial data suggests the checklist qualitatively improves training. The TTC Toolkit is available for use and consists of the checklist tool and an instructional video.
SP1.2.2 Core Surgical Training Bootcamp- a five year review
Authors: Brewster Oliver , Merker Louise , Bamford Richard
Published: November 2022

Aims

Surgical bootcamps may improve abilities across cognitive, affective and psychomotor domains. This deanery bootcamp is an intensive program involving induction, focussed teaching of core content, technical and non-technical skills. We aim to describe the successes and areas for development for this course through five years of feedback.

Method

A free three-day programme is delivered with lectures, workshops, skills teaching and simulation. Trainees are loaned equipment for self-taught surgical skills practice and laparoscopic simulation. Trainees must meet simulator proficiency targets which may improve early laparoscopic skills. Five years of feedback was analysed and previous attendees were contacted for retrospective focussed feedback.

Results

Across five years, 96–100% of trainees reported that they enjoyed the experience and would recommend attendance to others. 88–100% felt more confident to assess a surgical patient and 100% of responding attendees felt more prepared to begin core training. In the retrospective survey, 75% felt that Bootcamp helped them to get the best out of training and 70% felt that Bootcamp had improved their chances of passing annual progression meetings. There is evidence that attendance at induction core surgical bootcamps correlates with appointment to a national training number. In our study 50% of attendees regarded Bootcamp as helpful towards gaining their specialty training post.

Conclusion

This annual deanery bootcamp has benefited from five years of feedback and improvement. The program has evolved to reflect changes in the surgical curriculum and to tackle new challenges in education. We believe that each deanery should offer this and our format is applicable nationally and internationally.
SP1.2.3 The SIMple Things: Using Simulation Models to Improve Junior and Undergraduate Surgical Teaching in a DGH
Authors: Bruce Nikki
Published: November 2022

Aims

Many clinical activities remain cancelled or uncertain in the COVID world. We established a Surgical Skills Club in our DGH, where students and juniors are rotated far from their home institution. We also aimed to improve our undergraduate teaching by incorporating new surgical Sim sessions.

Methods

We established a weekly Surgical Skills Club by trainees, and promoted this through MedEd to all juniors, students and ANPs. We used a combination of higher-fidelity models owned by the hospital and low fidelity models designed by ourselves such as lap-appendix and hernia. We utilised social media to share ideas. We recorded attendance and sought written feedback. We also set up dedicated simulation sessions as part of ongoing undergraduate teaching.

Results

Anonymous feedback was documented weekly via app/online. For skills club, 100% of attendees documented experience as “great” or “good” (options great, good, average, fair, poor). Attendance varied from 2–15 each week. The best attendance was a formalised session with consultant input. For undergraduate Sim, 100% of attendees rated experience as “great” or “good”. All attendees agreed Sim teaching improved their experience of surgery. 20% stated it made them consider a career in surgery.

Conclusions

Surgical simulation is an excellent tool for improving experience of general surgery especially in a COVID environment, and can widen access to surgical training by allowing juniors to explore their skills in a controlled, informal environment. Lap Skills gave students real-world confidence. A combination of low fidelity models provided the best experience showing that the barrier of cost can be broken.
SP1.2.4 A pilot study: Developing bespoke high volume low complexity (HVLC) theatre lists with a focus on training, in order to address the impact of COVID-19 on training and elective waiting lists
Authors: Moumni Chouari Tarak Agrebi , Zhao Sarah , Rizkallah Georges , Yang Narisu , Vig Stella , Patel Nikheel , Nanda Akriti
Published: November 2022

Introduction

We are faced with long waiting lists coupled with a loss of training opportunities for surgical trainees as a result of COVID-19. It is imperative to ensure training opportunities are optimised and trainees are encouraged to contribute to the service recovery efforts we are faced with.

Methods

A pilot ‘the hernia fest’ was undertaken with the aim of training core trainees, supporting senior trainees as independent practitioners coupled with supporting the delivery of high volume, low complexity (HVLC) care. Parallel bespoke theatre lists with the grouping of specific cases (hernias), have been run with a consultant surgeon overseeing 2–3 lists. Each list includes a selected senior trainee who is suitable to train colleagues. Cases were screened prior to booking. All theatre staff were briefed on the purpose of the lists. All patients, trainees and theatre staff completed a questionnaire.

Results

50 hernia training cases were carried out over 15 sessions. 100% of patients were confident with their treatment and would recommend the service. 100% of trainees felt they had progressed in their operative competence and skill acquisition. 100% of trainees were satisfied. Senior trainees enjoyed the responsibility of running an independent list. 100% of theatre staff felt they would participate in future lists.

Conclusion

This model cultivates a learning environment whilst addressing waiting lists. The grouping of operations together allows for repetitive practice and may encourage rapid skill acquisition. We discuss lessons learnt and a proposed framework & checklist which can be applied to the future planning of such lists.
SP1.2.5 A Prospective Evaluation of Out of Hours Operations: Informing ENT Training Bootcamps
Authors: Dunne Henry , McGilligan Tony
Published: November 2022

Introduction

All trainees are invited to attend national trainee bootcamps upon commencing ENT speciality training. This induction course uses simulations to teach technical and non-technical skills and includes teaching on various emergency procedures. We aimed to prospectively record which procedures are being performed out of hours by ENT trainees to inform training programmes.

Methods

We recorded all operations out of hours performed by ENT speciality trainees in Kent Surrey and Sussex over 6 months. In January - February 2020 and August - November 2021 trainees completed data sheets detailing operations they were involved in that took place between 18:00 and 08:00 on weekdays or on weekends. Responses were analysed using Excel.

Results

Trainee response rate was 92%. In total 89 operations were performed out of hours. The speciality trainee was the most senior surgeon present in 58% of these cases (n=52). 27 different operations were performed. 5 procedures made up 53% of all operations performed: Oesophagoscopy and removal of foreign body (n=23); Tracheostomy (n=10); Removal of foreign body from nose (n=8); Drainage of neck abscess (n=6); and SPA ligation (n=5).

Discussion and Conclusions

To our knowledge, this is the first study to investigate the frequency of ENT procedures performed out of hours by trainees. Our findings can be used to plan and prioritise teaching of procedural skills in national trainee bootcamps. Oesophagoscopy and removal of foreign body was the most commonly performed out of hours procedure and along with other emergency procedures it should be prioritised in training camps.
SP1.2.6 Expanding the General Surgery Extended Surgical Team improves service delivery and provides increased training opportunities for surgical trainees
Authors: Luffman William , Duff Sarah , Capozzi Patrizia , Sharpe Gail , Hine Rachael
Published: November 2022

Aim

The Extended Surgical Team (EST) provides an additional surgical workforce with transferable skills. By expanding our EST and developing our Surgical Ambulatory Care service, we aimed to improve the delivery of acute surgical care to our patients. This also allowed us to improve CST training experience by supporting the CST on-call, providing an admissions base, helping decision making and maximising trainee educational opportunities.

Method

As part of an HEE EST Project, we used funding to expand the ambulatory care unit and employ/train further surgical ACPs. We surveyed the core trainee group regarding their on-call working pattern, training opportunities when on-call and where most time was spent. We implemented a change of working to utilise the new expanded EST, reducing the CST (and patient) time in ED. We re-surveyed the group after intervention.

Results

Results showed a reduction in the amount of time CSTs were spending with patients in the emergency department, easing the pressure on ED. Results showed support for the decision making on-call was greatly improved and the workload eased, allowing for improved educational opportunities for the trainee.

Conclusion

We have shown that the expansion of the EST and ambulatory service, when properly utilised by the surgical team, improves the training opportunities available to junior trainees, whilst also improving the delivery of General Surgery acute services by reducing the surgical patient pressure on our already stretched emergency department. We plan to continue the expansion of our EST and new model of delivery of CST on-call services.
SP1.2.8 Applying Kolb's Experiential Learning Theory Improves Medical Student Confidence in Reviewing Post-Operative Patients
Authors: Marlow Neale J
Published: November 2022

Aims

To see if a structured teaching programme designed according to Kolb's Experiential Learning Theory could be applied to improve medical student confidence in reviewing post-operative general surgery patients.

Methods

Post-final examination medical students at a UK university agreed to participate in the educational pilot in 2019 (n=18). The cohort were interviewed to evaluate any anxieties around undertaking FY1 surgical posts and responses were grouped thematically; reviewing the post-operative patient emerged as a dominant concern. Subsequently, a four-part teaching session was designed to move the learner through ‘Abstract Conceptualisation’ (Before the Bedside), ‘Active Experimentation’ (At the Bedside), ‘Concrete Experience’ (After the Bedside) and ‘Reflective Observation’ (Expert Example). Pre- and post-intervention interviews and Likert scale-based surveys were employed to evaluate impact (Kirkpatrick Level One).

Results

18/18 (100%) participants reported feeling more confident reviewing the post-operative patient after the intervention. Learner feedback included “very little of the subject covered previously so helpful to get a structured approach”, “useful to discuss the history and examination before reviewing the patient” and “observing a consultant post-op review at the end really cemented what we were learning”.

Conclusions

A graded approach to developing confidence in assessing the post-operative patient, as proposed by Kolb's Experiential Learning Theory, seems to offer a useful teaching method and is valued by the learner. Ongoing expansion of this educational pilot will further evaluate its impact.
SP2.1.4 Predictors of Type-2 Diabetes Remission Following Bariatric Surgery After a Two-Year Follow Up
Authors: Noureldin Khaled , Salman Mohamed , Badawi Marwa , Shalaby Ahmed , Tourky Mohamed , Maryosh Sally
Published: November 2022

Purpose

Bariatric surgery is evolving as a successful tool for managing morbid obesity and T2DM. This study aimed to identify predictors of diabetes remission after two types of bariatric procedures.

Methods

This prospective study enrolled 172 patients with morbid obesity associated with T2DM scheduled for bariatric surgery. Two laparoscopic bariatric procedures were done; single anastomosis gastric bypass (SAGB, n=83) and sleeve gastrectomy (LSG, n=68). Lipid accumulation product index (LAP) and quantitative insulin sensitivity check index (QUICKI) were used to evaluate lipid profile and insulin sensitivity. Two years after surgery condition of DM was evaluated as complete remission (CR), partial remission (PR), or improvement. The primary outcome measure was predictors of diabetes remission.

Results

Two years after surgery, 151 patients were available for evaluation, where 75 patients (49.7%) achieved CR, while PR was found in 36 (23.8%). CR was significantly associated with younger age, shorter duration of DM (p < 0.001, for both), higher C-peptide and GLP-1 levels (p < 0.001 and p = 0.002, respectively), and bypass surgery (p = 0.027). On multivariate analysis, shorter duration of DM, lower BMI, and higher C-peptide levels were the independent factors predicting CR.

Conclusion

Complete remission of T2DM can be achieved in nearly half of the patients two years after SG or SAGB. The duration of diabetes and preoperative BMI and C-peptide levels are the independent factors predicting complete remissions.
SP2.1.6 A Systematic Review of the Incidence and Predictors of Incisional Hernias in Robotic Prostatectomy
Authors: Aseem Rabiya , Lau Ashley , Prakash Samip , Ikechi Chijioke , Shrestha Ashish
Published: November 2022

Aims

To conduct a systematic review of the literature to identify the incidence and predictors of incisional hernia (IH) following robotic prostatectomy; and to provide recommendations to reduce the risk factors for IH development post-operatively.

Methods

The review was performed adhering to PRISMA guidelines, using search terms pertaining to robotic prostatectomy and incidence of IH via electronic databases (MEDLINE, EMBASE and Cochrane database). All original peer-reviewed articles in English were assessed for inclusion and quality by two independent reviewers. A quantitative analysis was conducted to evaluate methodologies, patient demographics, and the incidence of IH following robotic prostatectomy.

Results

We included 18 studies with a total of 17,965 patients. Average age of patients was 61.83 years and with an average BMI of 27.35. A transperitoneal, 6 port technique was the commonest robotic approach. Main sites of herniation included supraumbilical and lateral ports. The estimated incidence of IH was 1.49% (95% CI 1.28 to 4.25). Studies examining risk factors found age, high BMI, previous hernia repair and wound infections to be contributory to IH development. Only 6 studies reported surgical repair of IH with 3 patients requiring emergency operations. 5 studies reported reduction in IH following modifications in surgical technique.

Conclusions

Incisional hernias following robotic prostatectomy are a rare complication which can result in high patient morbidity. Our review demonstrated a variable incidence rate with increasing age and high BMI as common potential risk factors. Prevention strategies can result in reduction of IH; however, the studies were heterogenous with inconsistent data quality.
SP2.1.7 The Croydon Elective Centre - Surgical Hub supporting patient care and surgical training
Authors: Rizkallah Georges , Moumni Chouari Tarak Agrebi , Zhao Sarah , Yang Narisu , Vig Stella , Patel Nikheel , Nanda Akriti
Published: November 2022

Aims

NHSE/I and the RCS England have advocated that the separation of elective and surgical care is fundamental in recovering surgical services. It is suggested that the separation is physical and many Trusts are transforming pathways into elective and emergency hospitals. Croydon Hospital (CHS) have created an alternative, with ‘a Hospital within a Hospital’, separating these pathways within one estate, and considers whether this is a successful model for the future.

Methods

The day surgery unit on the ground floor was converted into an emergency centre with an ambulatory surgical hub, a hot clinic, clinical space, 4 emergency theatres and an USS room. The main theatre suite was converted into the Croydon Elective Centre (CEC) with a 12-bedded coronary catheter suite, a lift onto the second floor, 10 theatres, a 12 bedded children's day unit, Moorfields’ eye unit, a new canteen, an admissions unit as well as a 28-bedded elective ward with a new 4-bedded level 1.5 critical care unit.

Results

At the end of wave 1, 3,068 patients awaited treatment, an increase of 30.44% of baseline activity with theatre activity at 28% of normal activity. Activity resumed to 100% within 6 weeks of CEC go live. 2/9,606 patients were Covid-19 positive in the first year. During wave 2, 60% of pre-Covid-19 activity continued. Currently, 2,098 patients await treatment.

Conclusion

The implementation of a surgical hub has supported the treatment of patients as well as provided continuous training opportunities for surgical and anaesthetic trainees as well as the theatre team.
SP2.1.8 Informed consent – Are we appropriately assessing the process?
Authors: Convie Liam , Clements Joshua , McCain Scott , Campbell Jeffrey , Clarke Mike , Kirk Stephen
Published: November 2022

Aims

There is no standardised measure of the validity of consent. Over 300 million invasive procedures take place globally each year. This study aims to define a core outcome set (COS) for informed consent for therapy.

Methods

A prospective mixed method study was undertaken in line with a published protocol and the COS was developed in accordance with Core Outcome Measures in Effectiveness Trials (COMET) methodology. This included a systematic review of outcomes in studies of consent, semi-structured interviews and prioritisation of outcomes using a 2-round modified Delphi technique. Two consensus webinars were used to ratify outcomes for inclusion in the final COS.

Results

36 outcome domains for valid consent were identified and developed by systematic review. 41 semi-structured interviews were conducted with key consent stakeholders (with significant patient involvement) 164 participants from key stakeholder groups across 8 countries completed Delphi Round 1 and 125 completed round 2. 11 of 40 outcomes met the “consensus in” criteria, with 6 meeting “consensus in” in all stakeholder groups. These were included directly in the final COS and the other 5 that met “consensus in” in some but not all stakeholder groups were discussed in consensus webinars. 9 outcomes were defined for the final COS.

Conclusion

This is the first study to define a COS for research into informed consent for therapy. It defines what outcomes are most important to all key stakeholders in the consent process and is a step forward in standardising consent research.
SP2.2.2 Thyroid Ultrasound reporting – an audit of practice
Authors: Oladeji Emmanuel , Dunstan Matthew , Katsos Konstantinos , Tabbakh Yasmin , Burney Kashif , Jamal Karim
Published: November 2022

Aims

Ultrasound (US) is the first line investigation for evaluating thyroid nodules. British Thyroid Association (BTA) guidelines set out a structured characterisation of thyroid nodules to guide further investigation. We conducted a closed loop audit at a District General Hospital to assess compliance of US reporting with BTA guidelines.

Methods

208 examinations were retrospectively analysed in the initial audit cycle. The reports were assessed for U status; number, measurements, characteristics and locations of nodules; comment on lymph nodes; whether FNA was performed or recommended; FNA histology; and the number of examinations performed by each radiologist/radiographer. Departmental teaching was then provided. A re-audit of 100 thyroid ultrasounds was then conducted.

Results

In the initial audit and re-audit, respectively, the number of reporting clinicians decreased from 21 to 15, however the vast majority had reported fewer than 5 scans in each time period. Where nodules were present, the use of U classification in reports increased from 32.5% to 85.3%. Reporting of measurements, characteristics and location of nodules increased from 86.4%, 92.9% and 96.8% to 96.0%, 100.0% and 100.0% of reports, respectively. In both audits, 4.5% of U1/2 nodules were recommended for FNA. For U3–5 nodules, FNA or referral to specialty increased from 71.4% to 75.0%. Comment on lymph nodes increased from 89.4% to 95.9%.

Conclusions

Following education, improvement in compliance was seen in nearly all domains, particularly in the utilisation of U classification. Further work is needed regarding the appropriate use of FNA, and caseload variation between clinicians.
SP2.2.3 Mapping the Landscape of Surgical Registries in the United Kingdom: A Review According to the Synthesis Without Meta-Analysis (SWiM) Methodology
Authors: Moore Connor , Avery Kerry , Young Amber , Hinchliffe Robert , Griffin Xavier , Potter Shelley
Published: November 2022

Aims

Well-designed surgical registries are essential for high-quality patient-centred evaluation of implantable devices and surgical procedures. However, there is currently a lack of information about how existing registries are designed and funded; what data is collected and how this can be used. The aim of this work is to identify existing surgical registries in the UK and describe and summarise their key characteristics to inform recommendations for how surgical registries may be improved.

Methods

Existing surgical registries were identified using multiple different sources, including: society websites; search engine review; a targeted search of Medline and Embase databases and expert knowledge. Details of each registry were extracted using a standardised data extraction proforma developed by the study team. Characteristics of identified registries were summarised into a narrative review.

Results

47 active national surgical registries have been identified, with further identification of registries ongoing. 29 (62%) registries monitor surgical devices and all monitor surgical procedures, with 18 (38%) being mandatory. 40 (87%) registries were accessible online, and 24 (51%) linked with other datasets. 39 (83%) collected clinical outcomes with no core outcome set, and 1 collected clinical outcomes with a core outcome set. 15 (32%) collected patient-reported outcome measures. All registries operated in England with 41 (87%) active in Wales, 28 (60%) in Scotland, and 24 (51%) in Northern Ireland. Length of follow up varied from in hospital to 10 years.

Conclusions

There is considerable heterogeneity in existing surgical registries. Further work is needed to establish a consensus for surgical registry development.
SP2.2.5 Sarcopenia and lymphopenia in patients undergoing chemotherapy and surgery for oesophageal cancer. Can prehabilitive exercise be used to reverse the decline?
Authors: Knight William , Zylstra Janine , Gervais-Andre Louise , Goh Vicky , White Greg , Davies Andrew
Published: November 2022

Introduction

Studies have demonstrated that sarcopenia and lymphopenia are associated with poor oncological and survival outcomes in patients with oesophageal cancer. Neo-adjuvant chemotherapy (NAC) for oesophageal cancer is associated with muscle wasting and sarcopenic obesity. Lymphocytes are essential component of anti-tumour immunity. This study assesses the body composition and peripheral blood markers in patients undergoing a structured exercise program, during neo-adjuvant chemotherapy, as part of a non-randomised trial.

Methods

A prospective non-randomised trial compared a standard care pathway to a structured prehabilitation exercise programme undertaken before and during NAC and surgery for oesophageal cancer. CT determined body composition analysis and peripheral blood markers were collected at multiple timepoints.

Results

Comparison of the Intervention (n=21) and Control (n=19) showed Fat Free Mass increased during NAC in the intervention group (16.1 to 17.3 kg/m2; control 15.4 vs. 14.8 kg/m2, p=0.056) and Fat Mass Index to Fat Free Mass Index ratio (-5.51% Intervention, 10.74% control p=0.043) decreased in the treatment group. Lymphocyte subsets showed a marked increase in the intervention group after chemotherapy (CD3 10.92% vs 84.92% p=0.015, CD4 13.27% vs 107.75% p=0.0147, CD8 12% vs 69% p=0.033).

Conclusion

A structured exercise programme prior to neoadjuvant chemotherapy reverses levels of sarcopenia, reduces visceral adiposity and increases levels of lymphocytes in patients with oesophageal cancer. Further studies will be needed to assess the oncological and clinical implications.