bluuebunny/crossref_metadata_2025 huggingface dataset:
244 Does Direct Admission to ICU In Emergency Laparotomy Patients with A NELA Score ≥ 10% Affect Outcome at Fiona Stanley Hospital?
Authors: Shepherd T , Foster A
Published: May 2021

Introduction

The Australian and New Zealand Emergency Laparotomy Audit (ANZELA) is a quality improvement project based on UK NELA. Direct admission to ICU post-operatively for patients with a NELA ≥ 10% is recommended. In the current pandemic, the use of critical care beds must be rationalised. We investigated if patients with NELA ≥ 10% experienced worse outcomes if admitted to the ward post-operatively (instead of ICU).

Method

We performed a retrospective audit of emergency laparotomies at Fiona Stanley Hospital over 6 months December 2019 – May 2020. NELA scores were obtained from the ANZELA database and patient notes reviewed to identify post-operative unplanned ICU admissions and mortalities.

Results

Twenty-four (30%) emergency laparotomy patients had a NELA ≥ 10%. Ten (42%) patients were admitted to the ward post-operatively. There were no unplanned ICU admissions in this group. Two (20%) patients had a documented ‘code blue’ but were managed conservatively on the ward. No patients in this group died within 30 days.

Conclusions

Post-operative ward admission in selected patients with NELA ≥ 10% does not result in unplanned ICU admissions or increased mortality at a tertiary Acute Surgical Unit. This data is reassuring as we expect future ICU bed shortages for non-COVID surgical patients during the pandemic.
274 The Accuracy of Clinical Coding of Developmental Dysplasia of The Hip (DDH) Operations
Authors: Sharrock M , Whelton C , Paton R
Published: May 2021

Aim:

To assess the accuracy of clinical coding of developmental dysplasia of the hip (DDH) operations

Method

106 children underwent surgery for DDH at our turst from 1997 to 2018. Our coding department was sent a list of patients and operation dates and asked to tabulate data on what each operation had been coded as. We compared what each operation was coded as with the procedure actually performed (as per operation notes, clinic letters and intra-operative fluoroscopy images).

Results

Of the 106 patients included in our study, 128 operations were performed. 36 out of 128 (28%) of operations were coded incorrectly. The commonest error was that closed reduction was missed from coding (n = 13). Seven patients did not have their femoral osteotomy coded. Seven patients had a closed reduction incorrectly labelled as an open reduction. Four patients had pelvic osteotomies that were not coded. Two patients had open reductions that were not coded.

Conclusions

We have shown that an unacceptably high number of DDH operations are being coded for incorrectly. This has clear cost implications for the trust. This study questions the use of retrospective coding data in audit and research and suggests inaccuracy when considering the surgical outcomes of developmental dysplasia of the hip.
320 A Closed Loop Audit of Surgical Site Infection Rate in Elective Colorectal Laparotomies, Pre and Post Introduction of Jubilee Dressing Method
Authors: Denton O , Knight K , Steele C
Published: May 2021

Introduction

Surgical site infections (SSI) are responsible for one third of all inpatient infections and are associated with increased morbidity and extended hospital stay. The colorectal department at Glasgow Royal Infirmary introduced the Jubilee dressing method in August 2019 with the aim of reducing SSI incidence.

Method

Closed loop audit of all elective colorectal laparotomies at Glasgow Royal Infirmary pre- and post-introduction of Jubilee dressing method (March – July & August – December 2019). Literature reviews informed selection of baseline characteristics relevant to SSI. Analysis by logistic regression of SSI incidence by characteristic and Jubilee dressing use.

Results

A total of 193 patients were included. There was 52% uptake of Jubilee dressing method in the implementation phase and reduction in total SSI rate from 18.25% to 14.93%. Operation duration and smoking history were the only significant factors at univariate analysis and were put forward to multivariate analysis. Of these, only operation duration made a significant contribution to SSI incidence.

Conclusions

Jubilee dressing use did not make a significant difference to SSI incidence in this sample. This intervention is likely to have small effect size and there were probable confounding factors. Multifactorial influence in SSI incidence suggests larger datasets are required to isolate independent factors.
325 The Appropriate Use of Plain Film Abdomen in The Acute Surgical Assessment Unit: The Experience of a Model Three Irish Hospital
Authors: Hefferon T , Khullar N , AL-Zubaidy R , Pretorius F
Published: May 2021

Introduction

A plain film abdomen (PFA) is a useful modality of imaging if used correctly. However, when used inappropriately, it leads to unnecessary cost and increases patients’ exposure to radiation. The aim of this study is to assess the adherence to the Royal College of Radiologists (RCR) guidelines for PFA use in acute surgical patients.

Method

A retrospective study was conducted in the Acute Surgical Assessment Unit (ASAU) of a Model 3 Irish Hospital over a 12-day period in October 2019. Data was obtained using a Patient Census Book and the National Integrated Medical Imaging System (NIMIS). Recorded indications for the PFAs were compared against RCR guidelines.

Results

A total of 207 patients were reviewed, 113 males and 94 females, with a median age of 45. In 67 out of 207 patients (31.4%) a PFA was performed. A total of 31 (46.3%) were valid indications. A significant finding was present in 6 of the PFAs none related to the presenting complaint.

Discussion

Based on RCR guidelines regarding the indications for PFA, >50% of the patients had a PFA for reasons not indicated by their presenting complaint. If implemented properly, adherence to guidelines could save cost and more importantly, safeguard our patients.
340 Pre-operative Screening and Treatment of Iron Deficiency Anaemia in Upper GI Cancer Surgery
Authors: Tan J R , Bird N , Rao R
Published: May 2021

Introduction

NICE guidelines recommend intravenous iron for patients with iron deficiency anaemia (IDA) before major elective surgery to reduce blood transfusion rate. The aim of this audit was to assess pre-operative screening for anaemia and treatment of IDA in patients undergoing Upper GI (UGI) cancer surgery.

Method

A retrospective audit of all patients who underwent UGI cancer surgery in year 2019 at a tertiary centre. Data were collected from electronic records.

Results

Pre-operative haemoglobin level was performed in 110/111 (99.1%) patients. 43 (39.1%) patients were found to be anaemic using the WHO definition and 9/43 (20.9%) were severely anaemic (Hb < 100g/L). All anaemic patients had iron status checked and 26/43 (60.5%) patients were diagnosed with IDA. 17/43 (39.5%) anaemic patients received treatment, including IV iron (n = 8), blood transfusion (n = 3), oral iron (n = 3), and both IV iron and blood transfusion (n = 3). Anaemic patients (n = 17) who received treatment had a significant improvement in anaemia (P = 0.005).

Conclusions

This audit has demonstrated good pre-operative anaemia and IDA screening; however anaemic patients are not adequately treated, and IV iron is not routinely offered. Pre-operative anaemia treatment is effective in improving haemoglobin level. We have implemented a new anaemia treatment pathway and MDT proforma to improve the quality of care.
348 Virtual Patient Assessment for Hand Fracture Management: A Departmental Analysis of Financial and Clinical Implications
Authors: Roberts N , Totty J , Pinder R
Published: May 2021

Introduction

The COVID-19 pandemic demanded reduced face-to-face (FTF) contact. Our department integrated virtual assessment into the incoming referral pathway to enable continuation of high-quality care. This study aimed to assess any potential efficiency benefit of this change in service whilst ensuring no compromise to clinical outcomes.

Method

A prospective analysis was undertaken of all hand fractures referred virtually during a seven-week period starting at the initiation of national lockdown. Cost analysis using NHS reference costs, inflated to 2019/20 prices, was performed. Clinical performance was assessed using the British Society for Surgery for the Hand (BSSH) Standards for Open and Closed Hand Fractures.

Results

Seventy-six hand fractures were referred; FTF attendance was avoided in 35 cases, with an estimated per-patient cost saving of £179.16. Of the 33 patients who attended FTF, 13 achieved same day non-operative treatment; 20 underwent operative intervention with 95% compliance to BSSH standards. No complications occurred.

Conclusions

Our pilot model demonstrates potentially significant cost savings of £6270 over a relatively short period, as well as clinical non-inferiority. This supports sustained integration of virtual patient assessment in the ‘new normal’. Further work across all disciplines is needed to define acceptable limits of telemedicine and new avenues for potential benefit.
349 Improving Assessment of Patients with Suspected Cauda Equina Syndrome Using A Standardised Proforma
Authors: Ramasubbu R , Ahlo R , Liao Q , Periasamy K
Published: May 2021

Introduction

Cauda Equina Syndrome (CES) has a devastating impact on the life of affected individuals. Most patients are reviewed by doctors who do not have specialist spinal expertise. NHS Lanarkshire guidelines for CES are based on ‘Standards of Care in Cauda Equina Syndrome’ (Todd and Dickson) 2016.

Method

Documented assessment of a sample of patients with suspected CES in our hospital was audited against standards set in regional guidelines. A tick-box proforma was introduced to standardise assessment, with re-audit thereafter. Chi-squared was used for statistical analysis.

Results

Cycle 1 (2018): Documented assessment of findings in 30 patients - bilateral radiculopathy (80%), urinary incontinence (93%), faecal incontinence (73%), anal tone (93%), saddle anaesthesia (83%), bladder volumes (90%) and ASIA chart (20%).

Cycle 2 (2019): Documented assessment of above findings was 100% in patients where a proforma was used. Proforma was used in 81% of patients.

Conclusions

Use of a standardised proforma improved assessment of CES. There was a statistically significant improvement in use of an ASIA chart (P < 0.01) and assessment of faecal incontinence (P = 0.039). Compliance with use of this proforma could be improved further, to enhance patient care. Following the success of the proforma, it is being reviewed for implementation on a regional level.
357 Improving Surgical Consent – A Quality Improvement Project to Enhance the Consenting Process
Authors: Shrivastava M , Brown J , Sun L , Rajagopal R
Published: May 2021

Introduction

RCS guidelines on consent, recently updated, encourage a dialogue where all risks material to that patient are discussed and are clear. An audit was performed to assess whether practice at Oxford Hospitals is compliant with these guidelines – that all patients for elective surgery are consented prior to admission.

Method

Thirty-two undergoing elective Functional Endoscopic Sinus Surgery (FESS), Tonsillectomy and Septoplasty were interviewed in May-June 2019. Baseline data were presented at a local educational meeting, along with education on the recent changes to the RCS guidelines. Repeat audit took place in August-September 2020.

Results

All 32 patients were consented as per RCS guidelines and understood the reason for their surgery, but only 31% could explain the risks, and 56% could explain alternative options. Twenty (63%) consent forms were easily legible on randomised heuristic assessment. After education and change in department practice, understanding of the operation was much improved (80-100%). One outcome was to create pre-filled consent forms for common ENT operations.

Conclusions

Whilst RCS policy on completing consent prior to admission is being achieved, patient interviews suggest a lack of understanding of the operation. Standardised consent forms have the potential to enhance this understanding, as well as saving time.
408 Hand Trauma Consent
Authors: Masterton G , Aly R , Siddiqui A , Talwar C , Talwar C
Published: May 2021

Background

Consenting patients for procedures is a regular process for a trainee surgeon. The process of consent has come under scrutiny in recent years due to inadequacies highlighted by legal cases. With over 1.36 million patients attending A&E per year with hand trauma, this is the most common acute referral to Plastic surgeons.

Aim

To review current local practice by auditing risks and complications from hand trauma consent forms.

To develop and implement a standardised pre-printed label including relevant risks and complications for hand trauma.

Method

Sample of hand trauma related consent forms audited assessing and comparing the risks and complications sections to a standardised set agreed locally by Consultant Plastic surgeons, cross referenced with literature.

Standardised label including relevant risks and complications put into practice then re-audit their use.

Results

Use of the new standardised label demonstrated an elimination of omissions and increased adherence to 100% for all the relevant risks and complications.

Conclusions

Significant improvements in the process of consent were achieved through the development and implementation of a standardised risk and complications label. This ensures standards from the GMC and RCS guidelines are satisfied; positively impacting on service provision by improving the quality of the consent process.
461 Surgical Telemedicine Clinic - Patient reported Outcome
Authors: Ekowo O , Khan A , Elgabry A , Gouveia N
Published: May 2021

Introduction

To evaluate the patient reported effectiveness (PROM) of surgical telemedicine clinic (STMC) introduced during the Covid-19 pandemic.

Method

The study was registered as a quality improvement project and approved by the information governance team. This study was conducted at Darent Valley Hospital during the period between March – August 2020. Patients who were called as part of the STMC during covid-19 pandemic were contacted to provide a feedback about their experience. The study is ongoing. Herein we present our initial results.

Results

The target sample of 300 patients has been set. A total of 102 patients completed the questionnaire. Overall, 50% of the respondents felt the clinic performance was excellent, 28% rated this performance very good or good whilst 20% rated the clinic poor or very poor. About 80% felt reassured about their condition during the STMC. Despite the satisfactory report about the STMC, 75% reported to prefer face-to-face consultation in future.

Conclusions

Patients rating of the STMC was generally well received, a great majority would prefer face-to-face consultation if given an option to choose.
487 Reducing Intraoperative Fluoroscopic Radiation Exposure in Orthopaedic Theatres at A Trauma Centre
Authors: Hayter E , Rashid M , Johnson F , Erotocritou M , Thomas P
Published: May 2021

Introduction

Intraoperative fluoroscopic imaging in orthopaedic trauma surgery subject’s theatre staff and patients to increasing radiation exposure and its detrimental health effects. This audit cycle uses a target maximum for total number of intraoperative fluoroscopic images taken, as defined by recently published reference values, to reduce intraoperative radiation exposure.

Method

This is a two-phase audit cycle retrospectively reviewing all trauma operations over a 12-month period (456 cases) and a 10-month period (256 cases) after disseminating the target standards through posters and focused training. Audit standards describe target maximum total intraoperative images taken for 5 commonly performed procedures, applicable to 33% of total cases. Operative notes, total intraoperative image count and radiation dose report were reviewed through ORMIS and PACS.

Results

Audit standard compliance improved/remained at 100% in 4/5 of the investigated ‘common procedures’: from 2/5 procedures <80% compliance and 1/5 procedures =100% compliance initially, to 0/5 procedures <80% compliance and 2/5 procedures =100% compliance target upon re-audit. This translated to an improvement in mean radiation risk (DAP Gy.cm^2) in 3/4 common procedures (one exclusion due to dissimilar cohort characteristics).

Conclusions

This study demonstrates employing a target maximum total image count limit reduced radiation exposure in trauma theatres.
514 Audit to Assess Negative Appendicectomy Rate (NAR) in Adult Patients in The Leicester Royal Infirmary (LRI)
Authors: Baguley M , Palser T
Published: May 2021

Aim:

Determine the NAR rate in Leicester Royal Infirmary (LRI) and compare to the national average (20%)

Additional objectives:

Method

This was a retrospective audit which considered all patients admitted over a three-month period to the LRI with suspected appendicitis. Data was collected on patients proceeding to surgery, and then whether their histology was pathological.

Results

318 patients were included, of which 80 proceeded to surgery.

Objective 1

- NAR of 5% (4/80)

Secondary objective 1

Secondary objective 2

- Appendix visualised in 29.3% (48/164) of Ultrasounds

Conclusions

This audit has demonstrated that both USS and CT have a very low false-positive rate in assessment of appendicitis; however, USS visualises the appendix in less than 30% of cases.

I believe the pathway should be altered to remove USS scanning for obese patients where the appendix is difficult to visualise; or in older patients, where there is less concern in using the CT modality.
569 Improving the Urology Post Take Ward Round with Best Clinical Practice and A Governance Checklist. Quality Improvement Project Within Belfast Health and Social Care Trust 2020
Authors: McLoughlin P , McAdam A
Published: May 2021

Introduction

The post take ward round (PTWR) is a vital element to ensure patient safety. Although well established as a necessity, often documentation is poor and does not accurately reflect a clinical assessment or generated management plan. This quality improvement project aimed to assess the pitfalls of the PTWR and improve these were possible in-line with best clinical practice.

Method

Audit standards were established using national guidelines, including those by the Royal College of Physicians, Royal College of Surgeons, GAIN guidelines and NICE. An initial audit was carried out against these guidelines. Following this, three distinct interventions were implemented namely, Junior Doctor Education Sessions, a Urology Consultant Email Circular, and the development of a Urology PTWR Checklist. After each intervention, a re-audit was carried out.

Results

Compliance with guidelines improved across all standards set. Overall compliance improved from 19.0% to 70.4% after our three interventions were implemented.

Conclusions

The results of the initial audit outlined that PTWR documentation is often very poor or severely lacking. Fortunately, this QIP demonstrates how the urology PTWR can be significantly improved with relatively simple measures.
658 An Audit of Frequency of Cancer Genetics Referral in Patients with a Family History of Colorectal Cancer
Authors: Abbakar M , James T , Boxall P , Lim M
Published: May 2021

Introduction

Guidelines on the management of hereditary colorectal cancers were updated in 2019. In this study, data from patients within the colonoscopy surveillance programme for hereditary cancer at York Teaching Hospitals Trust were analysed to assess category of risk and appropriateness of referrals to regional geneticists.

Method

After examination of electronic records and clinical notes, patients were assigned a risk category of average, moderate or high according to the Amsterdam criteria and latest BSG/ACPGBI/UKCGG guidelines. Patients were then assessed to see if a concurrent referral had been made to the regional cancer genetic services.

Results

There were 228 patients. 72(31.6%) patients were in the average, 81(35.5%) in the moderate and 41(18%) were in the high-risk category. 34 (14.9%) patients with insufficient data and/or assessments were in the indeterminate category.

18 of 72 (25%) patients with average risk were unnecessarily referred to the regional genetics team, while 5/41(12%) of high-risk patients were not. A large proportion of patients with insufficient data (19/34, 55.8%) were rightly or wrongly, referred to the regional genetics team.

Conclusions

Assessment of hereditary cancer risk is difficult in the absence of good quality information. Risk assessment may be improved with use of a dedicated family history questionnaire/template - this facilitates identification of high-risk patients that benefit most from referral to geneticists.
670 Assessing Patient Satisfaction of the Fast-track Pathway to Pancreatic Resection
Authors: Lambe T , Roberts K , Powell-Brett S , Pustula M
Published: May 2021

Introduction

The ‘fast-track’ pathway to pancreatic resection is a straight to surgery approach that avoids potentially harmful preoperative biliary drainage. A possible criticism is that the shortened time span from diagnosis to surgery makes it more difficult for patients to adjust to their new diagnosis and mentally prepare for surgery. The emotional impact that ‘fast-track’ surgery has on patients has never been assessed. This study evaluated patient satisfaction of the ‘fast-track’ pathway compared to standard care.

Method

23 consecutive patients undergoing pancreatic resection between December 2019 and March 2020 at the QEHB were included. Patient were assigned to ‘fast-track’ (N = 12) or standard care (N = 11) pathways and satisfaction was assessed via a standardised, clinician supervised questionnaire using Likert scales to grade satisfaction.

Results

There was no significant difference in patient satisfaction between patients on the ‘fast-track’ pathway and patients undergoing standard care (p > 0.05). Satisfaction levels were high for both cohorts, with 91.97% of responses rated as ‘Good’ or ‘Outstanding’.

Conclusions

The ‘fast-track’ pathway does not have a negative effect on patient satisfaction and therefore, emotional impact should not be a barrier to implementing this pathway nationally.
715 A Re-Audit of Compliance with Documentation Standards in General Surgery Operation Notes at A District General Hospital
Authors: Ogundeji O , Hornby S , Dwerryhouse S
Published: May 2021

Introduction

The operation note is an important document in patient care. It is an essential part of a patient’s medical record. Apart from helping to ease the continuity of care, it is also a crucial medico-legal document.

The aim of this audit was to re-assess the compliance of current operation note documentation in the department with the guidelines set out by the Royal College of Surgeons (RCS) of England.

Method

We carried out the re-audit 4 months after presenting the initial findings. 40 operation notes, randomly selected, were used for this audit over 6 weeks. Only operations conducted by General Surgery consultants (24) or registrars (16) were audited. Both Emergency and Elective procedures were audited (13 Emergency; 27 Elective).

Results

Time was still inconsistently documented in operation notes although there was a slight improvement (37%; 47.5%). Operative diagnosis was present in 82.5% of notes, compared with 78% in the first audit. 100% of notes had the signature of operating or assisting surgeon. Detailed post-operative plans were present in 95%, an improvement of 17% from the previous audit.

Conclusions

The quality and compliance with standards of the operation notes improved generally but there is still room for further improvement.
765 Reducing ‘At Risk’ Skin in Neck of Femur Fracture (NOF) Patients – A Quality Improvement Project Standardising Catheterisation and Peri-Operative Care
Authors: Sambhwani S , Kandiah A , Rayan F , Wazir A , Sheikh N
Published: May 2021

Introduction

A service evaluation audit highlighted significant variation in our practice as regards catheterisation in NOF patients. A pilot protocol was developed with real time data monitoring to see if we could improve our patients’ pathway.

Method

The protocol focussed on early catheterisation, monitoring the condition of patients’ skin, documentation around catheter care and removal instructions and surveillance for urinary tract infection rates (UTI)

Results

150 patients were included in the pilot. There was a reduction by more than 50% of patients assessed as having at risk or broken skin. 94.5% of patients were catheterised out of theatres (previously only 4%) saving an average of 14 minutes of theatre time per case. Delays in catheter removal after documented request reduced by 2 days and our UTI rates were relatively unchanged (3.3% compared to 2.7%). Documentation significantly improved. We also noted that overall length of stay was reduced by 2 days.

Conclusions

Standardising our care pathway has improved our patient care and documentation. It has benefitted theatre efficiency and also nursing of fragile skin in 'at risk' patients. Prompting early removal and compliance may have also had a positive impact on overall length of stay. This has been a successful quality improvement project in our department.
774 Primary vs Deferred Ureteroscopies In Stone Management-Quality and Cost Evaluation
Authors: Wani M , Hassan W
Published: May 2021

Introduction

To investigate quality and cost benefits of primary ureteroscopies (URS) compared to deferred URS after initial ureteric stenting in patients presenting with urolithiasis.

Method

This was one-year, retrospective study, carried out to evaluate quality and cost benefits of primary URS in comparison to deferred URS after initial stenting. 85 patients underwent emergency stenting while as 148 patients underwent elective URS (Including both primary as well as deferred URS). The quality assessment was based on patient factors -including number of procedures, days spent at hospital, days off work and expertise of person operating. Cost analysis included hospital stay expenses and income loss due to off work.

Results

Study revealed the average stay of patients who had a stent inserted on index admission was 2.54 days compared to 1.35 in patients who underwent primary URS during index admission. Overall, additional expenditure in patients who did not undergo primary URS was in the range of £ 1800 for hospital alone, excluding loss of work for patients, who needed to return for multiple procedures.

Conclusions

We conclude approach of primary URS and management of stone in index admission in stone management is very effective in both improving quality of patients as well as bringing down cost.
785 Ankle Fractures Management in Stoke Mandeville Hospital
Authors: Gkorila A , Wehbe J , Neal-Smith G , Augustine R , Duncan J , Aktselis I
Published: May 2021

Introduction

Ankle fractures treatment aims to restore joint stability and alignment to achieve full functional recovery. Current quality of care in Stoke Mandeville Hospital was compared to the gold-standard management approach as described in BOAST-12 guidelines.

Method

This closed loop audit looked at closed malleolar and syndesmotic ankle injuries in skeletally mature patients under Trauma and Orthopaedics. In the first audit cycle, 16 patients were included over a one-month period and 53 cases, with similar management, were identified over a three-month period for the second audit cycle.

Results

The initial audit cycle revealed that the main aspects of management that required improvement were the timing of reduction and splinting, as well as the documentation of neurovascular status post-reduction.

We discussed our findings at the clinical governance meeting and interventional posters were distributed around the hospital.

Documentation of the timing of reduction and splinting significantly increased from 6% to 85% post-interventions, and neurovascular examination post-reduction improved from 17% to 43%. All other quality assessment criteria recorded more than 90% documentation rates after implementation of changes.

Conclusions

Quality of care significantly improved post-interventions, which indicates that BOAST-12 gold-standard is achievable. The introduction of a proforma was suggested to further facilitate appropriate documentation.
811 Should We Be Performing Day Case Laparoscopic Cholecystectomy (DCLC) After 3pm? Correlation Between Time of Operation and Post-Operative Hospital Stay
Authors: Alamassi A
Published: May 2021

Introduction

Laparoscopic cholecystectomy (LC) is a common daycase procedure. The British Association of Day Surgery (BADS) Procedure Directory sets out national performance targets for the number of LC’s treated as day cases. This study aimed to assess if operation time predicted unplanned inpatient admission.

Method

An annonymised retrospective review of all patients undergoing LC. The data was undertaken over two cycles. The first cycle was a 6-month period followed by a second cycle that was undertaken over three months. Data was obtained from multiple sources: discharge letters and the theatre data manager.

Results

Total number of cases was 160.

In the first cycle, the zero night stay for DCLC was 56%, which lies within the top 50% of current national performance but is below the BADS target of 75%. In the second cycle, the zero-night stay was 70%, which falls just below the BADS target. While unplanned admissions resembled 30%.

We had 136 cases underwent LC before 3 pm. While 24 cases had their operation after 3 pm. 19 patients out of those 24 stayed at the hospital.

Conclusions

The timing of operation of DCLC predicts inpatient admission; our data suggests that DCLC should not take place after 3pm in the afternoon.
852 Complete Mesocolic Excision (CME) Versus Conventional Surgery for Colon Cancer: A Systematic Review and Metaanalysis
Authors: Crane J , Hamed M , Borucki J , El-Hadi A , Shaikh I , Stearns A
Published: May 2021

Introduction

Complete mesocolic excision (CME) lacks consistent data to advocate operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analyses, analysing peri-operative, pathological, and oncological outcomes.

Method

A systematic literature review was registered with PROSPERO and carried out using PRISMA guidelines. Outcomes reviewed included lymph node yield, R0, disease free and overall survival at five years.

Results

3039 citations were identified; 148 studies underwent full-text reviews and 34 matched our inclusion criteria. There were no significant differences between the CME and non-CME group in overall complications (13.8% vs.13.8%) or anastomotic leak (1.3% vs. 1.7%). Nodal yield was higher in the CME group, 18.7 compared to 13.6 in the non-CME group. The rate of R0 resection was 96.8% in CME compared to 95.5%. Overall survival at five years was higher in the CME group 77.8% compared to 69.7% in non-CME group.

Conclusions

CME for colon cancer was associated with no significant differences in morbidity and mortality, better lymph node yield and R0 resection compared to the non-CME group. Our meta-analysis further supported this demonstrating an improved overall and disease-free survival at five years in the CME group compared to the non-CME group.
859 Improving Accuracy of Admission Notes Over A Four-Year Period Within an Orthopaedic Trauma Ward: A Four-Cycle Audit
Authors: McCann C , Mackenzie S , White T
Published: May 2021

Background

Accurate medical notes are essential for effective patient care and safety. The Royal College of Surgeons (RCS) set forth guidelines for standards of documentation. Lack of awareness of these standards can result in inaccurate documentation, compromising patient safety.

Method

Four prospective audits of admission documents for orthopaedic inpatients were completed, each 1 year apart. For each cycle, 50 admission documents were assessed to determine compliance with the RCS standards. Interventions were carried out between each audit cycle in the following order: educational posters, change from handwritten to online admission forms and optimisation of the online proforma.

Results

Initially, only two criteria showed above 95% compliance. Implementing educational posters produced significant improvement in one criterion: ‘note signed’ (60% to 96%, p < 0.05). Moving admission documents online improved ‘date stamp’ (66% to 100%, P < 0.05) and ‘contact number’ (0% to 34%, p < 0.05), but decreased documentation of ‘time recorded’ (18% to 0%, p < 0.05) and ‘name and grade’ (74% to 26%, p < 0.05). Further education and modification to the admissions proforma improved documentation of all criteria to over 95%.

Conclusions

Early cycles of this audit highlighted poor standards of documentation in admission records. Changing to online patient records significantly changed documentation standards. These were further improved with educational measures.
892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance
Authors: Hashmi K , Khalid S , Raja K , Zaka A , Easterbrook J
Published: May 2021

Introduction

COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic.

Method

Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined.

Results

Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02).

Conclusions

RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.
896 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Hip Fracture Patients
Authors: McCann C , Hall A , Leow J M , Harris A , Hafiz N , Myers K , Amin A , MacLullich A
Published: May 2021

Background

Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of > 62.5mL/Hr for hip fracture patients.

Method

Three prospective audits, each including 100 consecutive acute hip fracture patients, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included implementation of admission/post-take checklist tools and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively.

Results

In cycle one and two, many patients received inadequate fluids (46/100 and 56/100 respectively). There was no significant difference in the incidence of AKI between patients receiving adequate or inadequate fluid in either cycle (p < 0.05).

In cycle three, more patients received adequate fluids (79/100, p < 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI (2/79, 2.5% vs 3/21, 14.3%; p < 0.05).

Discussion

This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.
904 Can Patients with Acute Appendicitis be Ambulated Safely?
Authors: O'Brien S , Armstrong L
Published: May 2021

Introduction

During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis.

Method

Data was collected prospectively from 30th March 2020 – 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded.

Results

190 patients presented with suspected appendicitis (range 5-71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy.

Conclusions

Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.
913 An Audit of Colonoscopy Compliance Within A Screening Programme for Patients with A Family History of Colorectal Cancer (CRC)
Authors: Abbakar M , Boxall P , James T , Lim M
Published: May 2021

Introduction

Guidelines on the management of hereditary CRC were updated in 2019 and have led to more stringent use of surveillance colonoscopies. Patients with ‘family history’ (FH) CRC Surveillance programme at York Hospitals Trust were studied to assess compliance with colonoscopy recommendations.

Method

Current BSG/ACPGBI guidelines recommend biennial, quinquennial, one-off or no colonoscopy surveillance for patients with Lynch syndrome, and those deemed to have high, moderate, and average risks of developing hereditary cancer, respectively.

Examination of electronic records and clinical notes were performed to determine if they were Lynch positive and/or if they could be assigned a risk category.

Results

Database of 227 patients, of which 14 were high, 61 moderate and 45 were low risk. 47 had Lynch syndrome. Compliance of colonoscopy was poor for patients with average and moderate FH risk (both 0%). Compliance was higher for patients with high risk of FH (50%) and those with Lynch syndrome (57%)

Risk was indeterminate in 24 patients due to inadequate data therefore compliance could not be assessed.

Conclusions

A large proportion of patients with low to moderate ‘FH’ risk within our current surveillance programme had unnecessary colonoscopies. Stratification of patients into the appropriate risk categories optimizes the benefit from surveillance programmes.
915 Post-Nephrectomy Recurrence Rates in T3 Renal Cell Carcinoma Over A 10-Year Period
Authors: Okwu N , Gooneratne S , Piedad J , Akhtar M
Published: May 2021

Introduction

The objective of the study was to estimate the post-nephrectomy recurrence rate and assess practice around peri-op investigation and treatment.

Method

Imaging, histopathology, and clinical data were gathered using electronic and paper medical records of patients who underwent nephrectomy for T3 RCC. Recurrence defined as local recurrence.

Results

Fifty-one patients with T3 RCC were identified, 74.5% of whom were male with a median age 71 (range 45-91).

One-third had metastatic disease. The majority (96.0%) underwent radical nephrectomy with adrenalectomy (49.0%) and lymph node dissection (19.6%).

Clear cell RCC was the main histopathological type (92.2%) with chromophobe making up 3.9%.

At year one there was recurrence in 20.0% of patients at a median time of 5months (range 1-10, 90.0% grade 3, 10% grade 4).

At year five recurrence was identified in 16.7% in a median time 50months (range 41-56; 50% grade 2 and 3 each).

Ten-year follow-up identified recurrence in 85.7% at a median time 64.5 months (range 62-91; 50% grade 2 and 3 each) with the remaining patient developing jejunal metastatic recurrence in 168 months.

Adjuvant treatment was administered in 57.1%.

Conclusions

Establishing the right time to follow-up patients especially males, 17 months median recurrence time with the most frequently occurring was clear cell RCC.
973 The Effect of Implementing A Proactive Care of Older People Undergoing Surgery (‘POPS’) Team on Length of Stay in Older Surgical Patients
Authors: Bayram J M , Rangar D , Dikiciyan J , Smith I
Published: May 2021

Introduction

POPS is a well-established service which supports care of older surgical patients across multiple UK hospitals. POPS teams have been shown to reduce peri-operative medical complications, reduce length of stay (LOS) and improve multiple other patient outcomes.

Method

A POPS team consisting of two consultants, one foundation doctor and one nurse practitioner was implemented to provide dedicated care to older surgical patients on the general and vascular surgery wards of a large urban teaching hospital. Data were collected over 8 weeks from June 2020 - July 2020 following implementation of the POPS team and compared to pre-POPS data from March 2018 - March 2019. All inpatients were screened by age and Clinical Frailty Score (CFS) for appropriateness and received POPS input based on clinical need. Prior to the POPS team, liaison geriatric input was provided by a sole consultant.

Results

The 36 patients from the POPS group had an average LOS of 15.9 days, which was significantly lower than the LOS of 37.4 days in the 537 patients in the pre-POPS group (p < 0.01). There were no significant differences in demographics between the two groups.

Conclusions

The implementation of a POPS team significantly reduced length of stay in older surgical patients.
992 Short Term Effectiveness of Interventions Aimed at Preventing Post-Operative Acute Kidney Injury (AKI) In Patients Undergoing Elective Lower Limb Arthroplasty
Authors: Jaitley V , Phoenix E
Published: May 2021

Introduction

Acute kidney injury (AKI) is a potentially avoidable complication in patients undergoing elective lower limb arthroplasty. The National Institute for Health and Care Excellence (NICE) offers guidelines to identity and manage AKI. This is a closed loop audit aiming to assess i) adherence to NICE guidelines and ii) whether simple interventions will improve compliance.

Method

We closed the loop on a departmental audit carried out in 2017. NICE guidelines were applied to stratify patients at risk of post-operative AKI. High risk patients included those on nephrotoxic drugs and with pre-existing co-morbidities. We then applied the AKIN criteria to identify post-operative AKI. We presented this data at our departmental trauma meeting. Following this we implemented the following interventions i) poster & ii) aid memoir on patient admission proformas to identity those at risk.

Results

In 2017, post-operative AKI incidence was found to be 11.7%. Following intervention, in 2019 the incidence was 10% at 1 month and 5% at 7 months. Additionally, 80% of AKIs were identified on day 1 post-arthroplasty, compared to only 30% in 2017.

Conclusions

This audit showed that simple interventions reduced the incidence of post-operative AKI. Moving forward, we plan to assess long term effectiveness including the effect of junior doctor rotations.
117 A Systematic Review Comparing Clinical Outcomes Between Hem-O-Lok Clips and Endoloops In Securing the Base of The Appendix During Laparoscopic Appendicectomy
Authors: Khawaja Amir , Conor Magee , Wilson Jeremy
Published: May 2021

Introduction

One of the crucial steps of laparoscopic appendicectomy is to secure the base of appendix. A variety of techniques for stump closure have been described as Endoloops(Vicryl or PDS), Hem-o-lok clips, intracorporeal suturing and endoscopic staplers.

Method

A detailed literature survey using Pubmed, MEDLINE and EMBASE databases was carried out to extract studies conducted between 1990 and 2020. A total of 14 studies- 3 randomized controlled trials & 11 comparative studies enrolling 2098 (1030 in HL & 1068 in EL group) patients were included in the final analysis comparing Hem-o-lok versus endoloops for closure of appendiceal base. Outcome measures were Operative time, Cost benefit, Post-operative complications, and length of hospital stay.

Results

The average time of operation was significantly shorter in the HL group (SMD -0.79; 95% CI -1.03 – 0.56; z = 6.61; p < 0.00001). HL was found to be more cost-effective. (SMD -5.00; 95% CI-7.00 – 3.00; z = 4.90; p < 0.00001). However, no statistical difference was found between both the groups when comparing mean postoperative length of hospital stay & post-operative.

Conclusions

Based on the results of the above study, applying Hem-o-lok clips seems to be a safe, effacious and cost-effective way of securing the base of appendix.
125 The Fate of The Third Molar in The Line of a Mandibular Angle Fracture: A Retrospective Study at A Tertiary Centre
Authors: Dattani A , Aslam A , McMillan K
Published: May 2021

Aim: To evaluate the risk of complications associated with retaining or extracting an asymptomatic third molar in the line of an angle fracture. Aiming to seek a consensus whether third molars should be extracted or retained during surgical repair of mandibular angle fractures.

Method

A retrospective study was undertaken at the Queen Elizabeth Hospital, Birmingham. 150 patients across a span of three years underwent open reduction and internal fixation of mandibular angle fractures with third molar involvement. Patients were classified into two groups, tooth retention during angle fracture and tooth removal during angle fracture repair. Hospital records were evaluated to seek the rate of post-operative complications at follow-up

Results

162 angle fractures were identified with ipsilateral wisdom teeth present. In 37 cases the wisdom tooth was removed during surgery. 6 complications (16.2%) occurred in this group necessitating a return to theatre. In 125 cases the wisdom tooth was left in-situ. Complications necessitating a return to theatre occurred in 14 cases (11.1%).

Conclusions

This study indicates that retention of wisdom tooth overall did not significantly increase the risk of complications associated with angle fractures (p = 0.42). Where wisdom tooth pathology was noted its retention was associated with complications requiring a return to theatre (X2=4.40, p = 0.036).