bluuebunny/crossref_metadata_2025 huggingface dataset:
585 Surgical Excision of Isolated Gastrointestinal Metastasis from Malignant Melanoma – a 10-Year Survey
Authors: Edah E , Kuan J Y , Pursnani K , Turner P , Ball C , Parkin E , Shetty V D
Published: August 2023

Aim

Patients with malignant melanoma (MM) can develop isolated metastasis years after treatment of the primary. The spleen and small bowel are the recognised intra-abdominal sites of isolated metastasis. Excision of these metastases is recommended as several international case series have shown good prognoses after excision.

Method

This is a 10-year retrospective study of patients with MM diagnoses who underwent excision of isolated metastasis at our Trust. Splenectomy and small bowel resection unrelated to MM and patients with disseminated metastasis were excluded. The surgical management, postoperative outcome and overall survival of the patients were assessed.

Results

In these 10 years, 2160 patients diagnosed with MM were treated in our Trust. Of these, 4 patients developed isolated splenic metastasis, and one had an additional small bowel metastasis. The primary MM location was the trunk in 2 patients, the posterior auricular region, and the left forearm in the other 2 patients. The patients developed metastasis an average of 47 months after treatment of their primary MM (range 11 - 96 months). The first patient underwent laparoscopic excision; the subsequent 2 patients underwent robotic-assisted excision. The patient with 2 isolated metastases underwent an open procedure. All four patients had no postoperative complications. The mean length of stay was 6 days with a zero-readmission rate. The mean survival time was 28 months (range: 3-60 months).

Conclusions

Isolated metastasis from MM is very uncommon. Surgical excision should be offered to all suitable patients. The feasibility of minimally invasive surgical excision should be considered in each patient.
1231 Radical Vulvectomy and Reconstruction for Severe, Refractory Crohn's Disease of the Vulva: A Case Report
Authors: Polluk D , Chappatte O , Attard-Montalto S , Mackey S
Published: August 2023

Vulval Crohn’s disease (VCD) is rare and can arise from direct infiltration, through fistulae or as non-contiguous lesions, so called metastatic disease. We present a case of a 32-year-old female with severe, refractory vulval Crohn’s disease (VCD), requiring radical vulvectomy and reconstruction.

She had a subtotal colectomy for Crohn’s disease 8 years previously, and for one year had experienced vulval swelling and pain associated with perianal fistulae for which she underwent an abdomino-perineal resection. Though she achieved long term remission of her gastrointestinal disease, she continued to experience severe vulval symptoms with recurrent infections and abscesses despite treatment with immunomodulators and biologics over a period of 10 years.

She then underwent a radical vulvectomy with bilateral gluteal fold flap reconstruction and skin grafting. She made an uncomplicated post-operative recovery. Histopathology showed active non-caseating granulomatous vulvitis. At 1 year follow up, there were no further disease flares, with significant improvement of her pain. Further plastic surgery is being considered.

Our case demonstrates the value of surgical management in refractory VCD to improve symptoms, function and quality of life. Though medical therapy with immunosuppressive agents is recommended as first-line treatment, the course of VCD is unpredictable and often relapses on treatment cessation. VCD may persist for long after remission of gastrointestinal disease and may require more aggressive surgery using a multispecialty approach even in the context of active infective disease.
1269 A Rare Case of Bilateral Phyllodes Tumour of the Breast
Authors: Ikram H , Wyld L
Published: August 2023

Introduction

Phyllodes tumours are rare breast fibroepithelial neoplasms. More rare presentations of these tumours include bilateral disease. Surgical excision with clear margins is the treatment of choice.

Case Summary

We report a case of a 60-year-old female with bilateral asynchronous breast Phyllodes. She initially underwent an excision of a left breast lump that revealed a borderline malignant Phyllodes. Six years later she presented with a lump in her right breast for three months and underwent a lumpectomy that revealed a malignant Phyllodes. Subsequently she had an excision of the inferior margin, and a staging computed tomography scan showed no evidence of metastasis. She was referred for genetic testing and adjuvant radiotherapy.

Discussion

In conclusion, bilateral representation of Phyllodes is rare and this is one of few cases reported in literature. In view of limited evidence available, the management of these patients is quite challenging. The indication of radiotherapy and chemotherapy in managing these tumours remains controversial and highlights the need for clear guidelines.
957 Otitis Externa (Oe) Management Review in Tayside
Authors: Sunthara Moorthy M , Onwordi L , Green R
Published: August 2023

Introduction

Although otitis externa (OE) can usually be managed in the community, a large number are referred from GPs to ENT Emergency Clinics.

Aim

To assess primary care referrals of OE to NHS Tayside, with adherence to local guideline recommendations of investigations and management.

Method

The digital notes of patients with OE referred to NHS Tayside via Emergency Clinic between August 2021- February 2022 were examined, focusing on their swab sampling status, microbiology lab results and antibiotic treatment modalities. The resultant data was analysed and compared to data from the initial (Jan 2016 - Jul 2016) OE Audit.

Results

53 of the 518-patient seen in ENT Emergency clinics were referred with OE. 96.2% of these patients had swabs performed for culture and sensitivity (C&S) analysis. 18.9% had been treated with oral antibiotics despite no recorded signs of external infection. Pseudomonas (17.6%) and Candida (19.6%) were the most common organisms.

Conclusions

Comparisons to the initial audit shows that there has been a marked improvement in patients being swabbed prior to referral (96.2% compared to < 65%). The percentage of patients with candidal growth were higher this time. However, it is possible that the previous insufficient swabbing may have led to incorrect treatment. Fewer patients were needlessly prescribed oral antibiotics when compared to the initial audit results. Oral antibiotics should only be prescribed if facial involvement is present. Swabbing and C&S aids effective treatment with an appropriate antibiotic choice.
696 “The Doctor Will See You… Soon”: The Impact of the COVID-19 Pandemic on Acute Biliary Surgery and Patient Experience
Authors: Carter A , Sabah Y , Weaver S
Published: August 2023

Aim

Managing biliary disease acutely is cost effective and has high patient satisfaction. Our unit has established a successful “hot” gallbladder pathway, but COVID-19 and reduced operating capacity has potentially impacted this. This study compares rates of “hot” cholecystectomy, patient satisfaction and quality of life (QoL) impact pre and during COVID-19 pandemic, to determine whether performance has been affected.

Method

Quantitative data on time from diagnosis to surgery was collected from September to March in 2016-17 and 2021-22. A QoL questionnaire was piloted and distributed to eligible patients in March-April 2017 and 2022, enquiring about symptoms, mental health, anxiety, and patient experience.

Results

Mean wait for non-elective cholecystectomy was 2.4 days (range 0-8) in 2016-17, versus 6 days (range 0-86) in 2021-22. 100% (n = 57) of patients in 2016-17 had surgery within 8 days, compared with 83% (n = 53) in 2021-22. Median number of “hot” cholecystectomies weekly was unchanged. Patient satisfaction was sustained; 92% of patients in 2022 would “definitely” recommend the service, compared to 100% in 2017. 33% of patients in 2022 reported that mental health was impacted “extremely” or “quite a lot”, compared with 27% in 2017. 38% of patients in 2022 were “extremely” anxious about recurrent symptoms before surgery, compared to 27% in 2017. 33% of patients felt that COVID-19 impacted access to services for gallbladder disease.

Conclusions

The “hot” cholecystectomy service has been impacted by COVID-19, but performance remains high. It is still possible to deliver a successful service despite COVID constraints. Despite increased delays, patients remain very satisfied with their care.
715 The Acute Abdomen: Have You Ruled Out Splenic Torsion?
Authors: Nebo V , Adeshina O , Cooke J
Published: August 2023

Background

Splenic torsion is very rare, with approximately 500 cases reported worldwide and an incidence of 0.2% (1). The aetiology is thought to be hypermobility of the spleen’s supporting ligaments enabling migration to the pelvic or iliac region of the abdomen. The presentation can range from asymptomatic to a surgical emergency.

It is thought that the under-diagnosis of this condition leads to the higher prevalence of surgical emergency type presentations.

Aim

We present a rare case of an acute abdomen, secondary to torsion, due to a massive splenic cyst. A literature review detailing the most common symptoms, signs and investigations in adult patients is reported, to aid the reader rule out this rare but life-threatening condition in clinical practice.

Method

We performed a PubMed search using the terms ““splenic torsion” or “twisted spleen” or “wandering spleen””. Only acute (<3months) (3) symptomatic presentations in adult human patients (>18years), who had confirmed splenic torsion were included. Of the 220 case reports/series found, 100 did not meet the inclusion criteria, were not accessible in English, or did not describe the patient symptoms.

Results

Of the 120 acute splenic torsion adult cases between 1974-2022 evaluated, the most common symptom was abdominal pain (95%) then vomiting (34.2%). The most frequent sign was abdominal mass (61.7%). Diagnosis was most commonly confirmed by CTAP (76.7%).

Conclusions

Splenic torsion is an important differential in the acute abdomen patient presenting with abdominal pain, vomiting and a palpable mass. This life-threatening condition can usually be excluded by CTAP.
819 ELLIPSE: Electrical Impedance Analysis in Patients Undergoing Emergency Abdominal Surgery
Authors: Aftab R , Matthews L , Wooton S , Edwards M
Published: August 2023

Introduction

An ageing population represents greater operative risk; therefore, preoperative risk stratification is required to allow patients to make an informed decision. One method of risk stratification is bioelectrical impedance analysis (BIA) which can provide information such as muscle and fat mass, providing a proxy for patient metabolic health.

Aim

Metabolic health is intrinsically linked to outcomes following surgery. We hypothesised that BIA is a feasible method of assessing patients undergoing emergency abdominal surgery and predicting postoperative outcomes.

Method

A BIA analyser was used to measure patients body composition. All adult patients who met the National Emergency Laparotomy Audit (NELA) inclusion criteria were prospectively recruited and followed up until 30 days postoperatively. These patients had serial BIA measurements and compared with a healthy population. The phase angle (PA) is a raw variable which can be standardised to a healthy reference population and matched for age and gender. In summary, a higher phase angle is associated with improved outcomes.

Results

31 patients were recruited and BIA analysis in patients undergoing emergency abdominal surgery was feasible. Patients with a phase angle lower than the reference population had a greater incidence of complications (p = 0.03) and had more severe complications (p = 0.023). Furthermore, the same patients also had a significantly higher NELA morbidity percentage (p = 0.022).

Conclusions

Our study shows that conducting BIA analysis in patients undergoing emergency abdominal surgery is feasible. The presence and severity of complications correlates with the phase angle. This represents a successful proof of concept study of BIA to predict postoperative outcomes.
1225 Retrospective Study of Emergency Right Hemicolectomies at a Tertiary UK Centre
Authors: Subramanian A , Singh A , Siby J , Swaminathan C
Published: August 2023

Aim

To assess the efficacy and complication rates of emergency right hemicolectomies conducted at a tertiary UK Hospital.

Method

Study type: Retrospective data analysis. Study period: 2016-2021.

Inclusion criteria

All cases requiring an emergency right hemicolectomy performed by an individual surgeon (To eliminate surgeon bias).

Exclusion criteria

Elective resections and cases involving open conversion.

Parameters checked included demographics, duration from admission to theatre, duration of hospital stay and complications. These results were compared to known standards available in indexed journals.

Results

A total of 48 patients were studied, of which 29 were male and 19 were female. The mean age was 63.41 years. Mean duration of stay was 15.14 days. 26(54.2%) patients were discharged in under 10 days.

The most common diagnosis was adenocarcinoma of the colon (23- 47.9%)- mostly presentling as large bowel obstruction. The second most common diagnosis was ileo-caecal Crohns(8-16.6%) presenting either as stricturing disease or as an abscess. 20 patients were taken to theatre within 48 hours of admission(41.66%) of which 2 were taken back to theatre ( for anastamotic leak and post-operative adhesions ).7 had major complications(35%) commonest being pneumonia(20%). 4 developed post op ileus (20%).No deaths. 28 patients were taken to theatre after 48 hours of admission. One returned to theatres (anastamotic leak). 3 deaths (10.7%,6.2% overall) were noted. Pneumonia was noted in 7 patients (25%).

Conclusions

Mortality and morbidity results were comparable to acceptable levels in the literature. Early mobilisation especially in diagnostic dilemmas leads to lower mortality and morbidity.
1264 The Impact of ‘Rib Block’ Administration on Patients with Multiple Rib Fractures at a Major Trauma Centre: A Retrospective Observational Study
Authors: Bethel J , Christodoulou A , Smart Y W , Fernando K , Emer N , Vasireddy A
Published: August 2023

Aim

Rib fractures carry a mortality rate of 10% which is doubled in the elderly population. They are common following blunt thoracic trauma and are a marker of injury severity. The timely delivery of regional analgesia is crucial to prevent pain induced hypoxia, atelectasis, pneumonia and respiratory failure.

We compare the trauma-related injuries and outcomes between patients with >2 rib fractures who received regional analgesic blocks with those who didn’t receive blocks.

Method

Retrospective data was collected from 187 patients presenting as a trauma call with >2 rib fractures over a period of 18 months. Patient demographics, ISS, length of stay and respiratory complications were collected from electronic patient records (EPR).

Results

69 patients received a regional rib block compared with 118 who did not. Patients who had a rib block were older compared to those who did not have a block (62.1±17.6 vs 55.4±18.2, p = 0.007). There was no significant difference in number of rib fractures (6.8±3.2, p<0.2), post-admission chest infection rate (23.1±42.5 vs 20.8±40.8, p<0.4), or length of hospital stay (18.7±13.3 vs 21.7±19.1, p<0.2). ISS score was significantly higher in non-blocked patients compared to blocked patients (27.4±14.3 vs 19.5±9.5, p<0.05).

Conclusions

Patients with significantly higher ISS scores did not receive a regional rib block, however this did not appear to impact on post-admission chest infection rate or length of stay. Further work is needed to identify the reasons behind this trend.
355 Surgical Images and Social Media- Patient Centred or Just a Desperate Need for "Likes"?
Authors: Digne-Malcolm H , Butler R , Reid R , Mohamed R , Ahmed M , Htet W , Peters P , Khan J S , Wilson Jeremy , Magee Conor
Published: August 2023

Aim

Social media platforms, such as Twitter, are an expanding space for education/interprofessional discussion. Guidance regarding doctors’ use of social media is available but much is left open to interpretation, unlike the stringent guidelines used for traditional media. Public social media postings are unpoliced and can go viral - with sometimes devastating fallout.

We aimed to ascertain whether professional standards are adhered to when patient images are shared through Twitter.

Method

Prospective review of Twitter posts with patient images. Outcomes: is there a statement of patient consent? Has confidentiality been maintained? Does the Tweet purpose justify the images included? Are professional standards maintained?

Results

54 images were identified for review from 18/12/20 to 26/09/22. Most tweets were by consultant surgeons (74%). Only one image had a statement of patient consent despite 48% being deemed identifiable or potentially identifiable. Location was shared for 27% of cases and the external patient was visible in 48% of Tweets. 17% were potentially identifiable through rarity of the case. 52% images had educational value; 31% promoted the owner of the Tweet or their colleagues; 18% were identified as posted for general interest. Only half of the Tweets were felt to justify the use of patient images.

Conclusions

Patient images are being shared through Twitter without being kept to the same rigorous standards as through traditional media. These risks breaching patient confidentiality and undermining professional standards on which patient trust depends. There is a pressing need for robust guidelines to protect both patients and healthcare professionals.
1211 Review of the Factors Leading to an Unplanned Inpatient Stay Following a Day Case Laparoscopic Cholecystectomy in a Tertiary Centre
Authors: Rao A , Rao M , Doyle C , Karki B
Published: August 2023

Aim

To review the factors responsible for an unplanned Inpatient Stay (IPS) following a day case Laparoscopic Cholecystectomy (LC).

To develop strategies preventing unnecessary hospital stays after Day Case LC.

Method

We retrospectively collected data on all the LC performed in a Tertiary Centre over 3 months (January – March 2022).

Results

162 patients underwent LC during this period; 135 (83.3%) patients were planned day cases out of which 68/135 (50.37%) had an IPS and 67/135 (49.62%) were same-day discharges (SDD). 27/162 (16.66%) patients had emergency LC. 54% n = 37 LC performed in the afternoon had IPS compared to 14% n = 10 among the SDD [p<0.0001]. 47% n = 32 In-patient LC performed by non-consultant grade compared to 32% n = 22 among the SDD.

7% n = 5 IP due to social issues, 10% n = 7 no documented IP causes identified and 4% n = 3 had booking error, booked as Inpatient despite the patient having SDD. Other identified causes were drain Insertion (9% n = 6), longer operations (n = 1; mean operation time 92 min IP vs 82 min SDD) and late recovery (9% n = 6).

Conclusions

The rate of an unplanned overnight stay was found to be significantly high (50.37%, n = 135). Several human factors such as errors in the booking proforma, late-afternoon lists, and no clear discharge planning in the post-op notes were among the few factors which could easily be improved. A review of these factors is deemed necessary not only for improving patient outcomes & quality of care but equally for reducing healthcare costs.
694 An Undergraduate Virtual Neurosurgery Lecture Series: Knowledge Acquisition, Career Insights and Perspectives Upon Neurosurgical Teaching in the Current Medical Curriculum
Authors: Dhaliwal J , Mihaela-Vasilica A
Published: August 2023

Aim

The undergraduate medical curriculum succeeds in providing students with a generalised approach to medicine yet limits in delivering adequate exposure to explore subspecialties. Conferences are integral to students’ career decisions. Our deliverance of the ‘Encephalon Lecture Series’ encompassed nine neurosurgery talks from world-renowned clinicians to allow students to further their interests. This study aims to analyse the impact of the lecture series on attendee knowledge improvement and elucidate opinions towards the amount of neurosurgical teaching within the medical curriculum.

Method

Attendee feedback was collated from questionnaires after each webinar session. Self-improvement of knowledge and neurosurgical career interest was extracted from all responses using a 10-point interval scale to determine the significance of the conference and to evaluate the differing views concerning the lack of neurosurgical teaching in the medical curriculum.

Results

A total of 199 attendees were recorded over the lecture series. The post-webinar feedback questionnaire was completed by 83 attendees (41.71%). Attendance resulted in a 62% average increase in self-reported improvement in knowledge among participants. Of the sessions, the greatest areas of knowledge improvement were indicated after the Brain Mapping webinar (110.71%), followed by the Skull Base Neurosurgery webinar (93.55%) and the Functional Neurosurgery webinar (66.15%). A mean of 8.39 ± 1.47 reflected webinars’ relevance to attendees’ future professional development.

Conclusions

Conferences are prominent resources for students to propel their knowledge, network with clinicians and discuss career options. Neurosurgery is an ever-evolving profession, and greater undergraduate exposure to the speciality will demystify the field and clarify the training pathway for students.
651 The Impact of Methylation Array Analysis on the Diagnosis of Central Nervous System Tumours: DNA Quality, Concordance and Cost Efficiency
Authors: Evans D , Walker L , Schlecht H , Burghel G , Roncaroli F
Published: August 2023

Aim

Genome-wide DNA methylation arrays are commonly used in diagnostic practice to classify central nervous system tumours; they are still regarded as a research tool and are not clinically validated. Epigenetic profiles may not match the pathology or return identities with low calibration scores (low confidence). We conducted a multi-centre audit on the impact of methylation arrays on brain tumour diagnosis, including DNA quality and cost efficiency.

Method

Seventy-six tumours were analysed between January 2020 and June 2022 using the v11b.4 Heidelberg classifier. Tumour pathology, methylome and calibration scores (high = ≥0.84, low = 0.30-0.83) were extracted and concordance assessed (histological versus epigenetic classification). Microscopic features of all cases were reviewed. Each methylation analysis cost £470.

Results

DNA quality of 22.37% of samples was inadequate for testing due to damage or low DNA concentration. Inadequate DNA depended on diathermic artefacts or size of viable tissue. There was no concordance between pathology and arrays in 30.51% of cases; 66.67% of these had low calibration scores. High calibration scores, low calibration scores and “unidentified tumours” occurred in 47.46%, 32.20% and 20.34% of samples, respectively. Of the total cost of methylation arrays (£35,72), £9,400 was spent on non-contributory tests.

Conclusions

Methylation arrays are helpful but are not free from limitations. Specimen size, extent of necrosis and coagulation artefacts affect DNA concentration. Interpretation of profiles with low calibration is challenging when methylation profiles and pathology are discordant. The 20% of unidentified tumours required further analysis including whole genome sequencing and gene fusion analysis.
1175 Management and Outcome of Intracranial Fungal Infections in Africa: A Scoping Review
Authors: Takoutsing B D , Ooi S Z Y , Egu C , Gillespie C S , Bandyopadhyay S , Dalle D U , Erhabor J , Ciuculete A C , Kesici Ö , Awad A K , Dokponou Y C H , Khan M , Ikwuegbuenyi C A , Dada O E , Bankole N D A
Published: August 2023

Aim

To detail the management, and outcome of intracranial fungal infections (IcFIs) across Africa.

Method

This scoping review was conducted using the Arksey and O'Malley framework. MEDLINE, EMBASE, Cochrane Library, African Index Medicus, and African Journals Online were searched for relevant articles from database inception to August 10th, 2021. The Preferred Reporting Items for Systematic Review and Meta-Analysis extension for Scoping Reviews guidelines were used to report the findings of the review.

Results

Of the 5,779 records identified, 133 articles were included. The mean age of 35.7 years and the majority (52.3%) were males. The majority (n = 4,732/8,330, 84.4%) of IcFIs presented as meningitis, and the most common predisposing factor of IcFIs was HIV/AIDS (n = 8,176/9,054, 90.3%). Cryptococcus species was the most common (n = 8,789/9,054, 97.1%) causative organism. The most commonly used diagnostic modality was cerebrospinal (CSF) cultures (n = 5,793/9,054, 64.0%). The most common treatment modality was medical management with antifungals only (n = 4,242/9,054, 46.9%). The mortality rate was (n = 3,810/9,054, 42.1%).

Conclusions

Most IcFIs occurred in immunosuppressed individuals, and despite the new diagnostic techniques, CSF culture was mostly used in Africa. The outcome of IcFIs in Africa was poor.
407 Robotic Assisted Cholecystectomy and Common Bile Duct Exploration for Single Stage Management of Complex Gallstone Disease
Authors: Lewis H , Latif J , Bandlamudi N , Bhatti I , Awan A
Published: August 2023

Aim

Laparoscopic cholecystectomy and common bile duct exploration (LC-CBDE) is an alternative to endoscopic retrograde cholangiopancreatography (ERCP) for treatment of choledocholithiasis. The ‘Achilles heel’ of LC-CBDE is the choledochotomy incision and closure following duct clearance. Robotic assisted surgery (RAS) aspires to overcome these technical challenges by providing improved views (3D enhancement) and articulated instruments potentially improving surgical precision. We aim to scrutinise the outcomes of an early series of robotic assisted cholecystectomy and common bile duct exploration (RC-CBDE) cases performed at our institution.

Method

Retrospective analysis from a specialist benign pancreatico-biliary unit in the United Kingdom was undertaken from April 2022 – December 2022 inclusive. All patients who underwent RC-CBDE for complicated gallstone disease were included. Collated data included patient demographics, perioperative investigations, intraoperative approach, and postoperative outcomes.

Results

10 patients were identified. Median (IQR) age was 51 (33 – 66) years. Median (IQR) BMI was 26 (21 – 32) kg/m2. Median (IQR) Charlson Co-morbidity Index (CCI) was 1 (0 – 4). 4 patients were operated on during the acute presentation, with median (IQR) bilirubin 51 (34 – 252.5). Median (IQR) operative time was 176 (124 – 222) minutes. Median (IQR) post-operative length of stay was 4 (1 – 5) days. One patient required reintervention for port site hernia repair from drain site.

Conclusions

RC-CBDE is a safe and effective treatment for choledocholithiasis with equivocal outcomes to LC-CBDE. Benefits of RAS include enhanced views and ergonomics aiding precise closure of choledochotomy, which may both reduce complications and promote wider uptake of common bile duct exploration – a previously underutilised, technically-challenging operative procedure.
530 False Positive Rate from Pet-Ct in Cutaneous Malignant Melanoma – a Systematic Review and Meta-Analysis
Authors: Martin J , Smith B , Abed H , Hardwicke J
Published: August 2023

Aim

Cutaneous Malignant Melanoma (CMM) is increasing in incidence and is the leading cause of skin cancer mortality. Diagnosis involves primary excision followed by appropriate staging tests. Positron Emission Tomography combined with Computed Tomography (PET-CT) use has increased in recent years for clinical staging and detection of recurrence. False positive (FP) results are not uncommon and can have deleterious psychological, physical, and economic consequences. Few studies have quantified this. Thus, we present the first systematic review and meta-analysis of the pooled proportion of FP results in prospective studies of CMM and distribution of these by system.

Method

A systematic review and meta-analysis of FP results in prospective CMM PET-CT studies with distribution of FP results by body system.

Results

14 studies were included with 851 patients. Primary reasons for exclusion were lack of FP reporting or studies being retrospective. Patient-based reporting had the lowest pooled proportion of 5.8% (95% CI = 3.5% to 8.6%), lesion-based was highest with 9.6% (95% CI = 3.1% to 19.1%) and combined was 6.9% (95% CI = 4.4% to 10.2%). Bias was low to unclear other than for FP reporting. Heterogeneity (I2) was considerable for all analyses. FP findings were mainly lymphatic, dermatological, respiratory, or skeletal.

Conclusions

Our data suggest that between 5.8% and 9.6% of PET-CT results are FPs; far higher than reported FP rates in current CMM literature. FP reporting was often inconsistent between studies and lacking in detail. Future work should include retrospective studies also and PET-CT research should consistently report FP results in more detail.
1288 Animated Patient Information Videos to Enhance Understanding of Free Functional Muscle Transfer Surgery for Dynamic Treatment of Facial Palsy
Authors: Brown S , Zubler C , Ressis Di , Grobbelaar A
Published: August 2023

Aim

Facial palsy affects approximately 25-30 per 100,000 people a year causing physical and psychological symptoms including facial asymmetry, a lack of facial expression, oral incompetence, difficulties in articulation and reduced quality of life. The treatment of choice for many patients is free functional muscle transfer (FFMT), a highly complex surgery. Due to the complexity, patients’ ability to understand and retain information during traditional consultations poses a barrier to truly informed consent. Our study aims to utilise animated patient videos and integrated messaging platform to improve patients’ understanding of FFMT surgery, its potential complications, and recovery period.

Method

We developed a new electronic adjunct for patients undergoing FFMT surgery to complement the traditional consent process. The platform employs narrated animations and secure integrated messaging service for patients to directly communicate with their surgeon. A multilingual narrative script, suitable for all ages, complements the animations outlining the details of FFMT surgery in multiple subcategories including scar placement, wound care and signs to identify complications.

Results

We will present a series of patient information videos from 7 subcategories covering all portions of FFMT surgery, demonstrate the ease of use of the messaging platform and summarise the feedback collected.

Conclusions

We have successfully developed an electronic patient information platform to support the traditional informed consent process for FFMT as a treatment of facial palsy which increases patients’ understanding and engagement. Patients can review every step of their journey, from first entering the hospital until the end of rehabilitation, at their own pace, and as frequently as required.
253 Virtual Acute Shoulder (VAS) Clinic in University Hospital Crosshouse (UHC): Developing a New Pathway and Delivering Cost-Effective Patient Care in Compliance with British Orthopaedics Association (BOA)
Authors: Al-Abbasi G , Taylor G , Tanagho A
Published: August 2023

Aim

Setting up this model reduces the waiting time for specialty review of shoulder fractures, provides a timely management plan which would eventually lead to a better patient journey and outcome.

Method

A retrospective 3-cycles QIP of the shoulder fracture clinic in UHC from Jan 2020 - May 2022. We analysed the outcomes of these patients; number of telephone reviews, hospital review appointments, number added to the trauma list for intervention and/or discharged and the cost-benefit analysis.

Results

In 2020 VAS was introduced, out of 383 scheduled patients 14.36% (55) of them were virtual appointments. This percentage increased to 40.17% (188) in 2021 and 42.06% (53) so far in 2022. All of the VAS attendances met the 4-hour A&E target and did not require admission. All patients were contacted by an advanced physiotherapy practitioner following virtual review of clinical notes and radiographs by the senior author within 7 days. The VAS model saved at least £5500 (2020), £18,800 (2021) and £5300 (2022) by avoiding physical appointments and admissions. In addition, we avoided unnecessary preoperative admission and repetition of outdated COVID-19 PCR tests which saved additionally up to £1660 since 2020, this is because all operations (56) were allocated to designated sub-specialty trauma lists.

Conclusions

UHC pioneered a new VAS model in times of rising pressures and financial constraints to manage all shoulder fractures attending A&E; including injuries that potentially require surgery. It reduced unnecessary outpatient appointments, admissions and provided specialist input in a timely manner (right person, right time).
444 Post Colonoscopy Colorectal Cancer, Are We Compliant? A Year in Review
Authors: Basamh M , Manoharan M , Mohamed E , Kulkarni N
Published: August 2023

Post Colonoscopy Colorectal Cancer (PCCRC) is defined as a Colorectal Cancer (CRC) that is diagnosed after a colonoscopy in which no cancer was found.

Aim

To identify the incidence of PCCRC at a district hospital trust and to check our compliance with national guidance (audit against Joint Advisory Group on GI Endoscopy standards). We review the performance in our second cycle and take lessons forward.

Method

Phase 1 collected data from January 2016 to June 2019 following approval. Patients with colorectal cancer were identified from the MDT pathway. Those newly diagnosed with CRC who had colonoscopy within 6-36 months prior to their diagnosis were included. Patients with appendiceal tumours, anal SCC, small bowel GIST, carcinoid tumours or those who had surveillance endoscopies were excluded. Hospital records were used to collect data retrospectively on patient demographics and comorbid diseases. Phase 2 collected data from 01/09/2021 to 01/09/2022 with similar criteria.

Results

The first phase of the study identified 1334 patients. Those not meeting the inclusion criteria as set out from the World Endoscopy Organisation (WEO), or those with non-primary CRC were excluded. Histologically confirmed CRC from phase one yielded 1323 cases. The rate of PCCRC according to the WEO classification was 3%. Phase 2 identified 330 patients with histologically proven CRC, the rate of PCCRC in phase 2 was a marginal decrease to 2%.

Conclusions

Our rate of PCCRC is compliant with national guidance, however key learning points and recommendations are drawn to help NHS services to reach national targets and improve care.
868 Development & Implementation of a Patient Information Leaflet for Elective Daycase Laparoscopic Cholecystectomy – a Quality Improvement Project
Authors: Hamid O , Dorudi Y , Walker T
Published: August 2023

Aim

Daycase surgery reduces post-operative complications. Facilitating safe discharge is of paramount importance. One way of ensuring this is to enable patient access to reliable information.

In this quality improvement project, we aimed to create and implement an information leaflet that would give succinct information to patients on what to expect on discharge, and signposting to further resources if required. It was felt that this would ultimately result in a better and safer patient experience.

Method

A leaflet was designed in conjunction with surgical, nursing, and anaesthetic colleagues, using information available from the Royal College of Surgeons and British Association of Day Surgery. This was then given to all relevant patients post-operatively. Subsequently, a cohort of patients were called and asked for feedback on the usefulness of this leaflet, using a questionnaire approach based on the psychometric Likert scale.

Results

A total of 15 patients were contactable, of which 14 (n = 15, 93%) reported having received the leaflet. A further 12 (n = 14, 86%) described the leaflet as useful, with comments such as ‘it was a comfort blanket’ and that ‘it allayed some anxieties I had about my recovery’. 2 people (n = 14, 14%) mentioned that some information was difficult to understand.

Conclusions

Information leaflets make a positive contribution to the post-operative patient experience. In future, we will look to conduct further study into whether the introduction of this leaflet has improved our day case rate, reduced re-admissions and whether patients have had an overall better experience of care.
1263 Venous Thromboembolism (VTE) Risk Assessment and Thromboprophylaxis Among Hospitalised Patients: A Single-Centre Closed Loop Audit
Authors: Quek F F , Cyclewala S , Smith J
Published: August 2023

Aim

With an estimated incidence rate of 1 to 2 cases per 1,000 population, venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in the United Kingdom. It is reported that VTE is responsible for approximately 60,000 deaths per annum. Furthermore, VTE has a huge financial impact on the NHS. It is reported that VTE treatment costs the NHS approximately £640 million every year.

Notably, at least two-thirds of hospital-acquired VTE are preventable. NICE guideline recommends that all patients should be risk-assessed on admission and re-assessed at the point of consultant review [NG89]. The purpose of this closed-loop audit was to evaluate the effectiveness of simple interventions in improving the efficiency of VTE risk assessments at a large teaching hospital.

Method

Results from the first cycle were analysed and interventions were implemented with the aim to improve the standard of practice. These include the utilisation of technology in VTE risk assessments, mandatory teaching sessions and the development of prompts within clerking proformas. A repeat audit was subsequently performed to re-assess the new standard of practice and the effectiveness of these interventions.

Results

Our VTE risk assessment completion rates increased substantially from 16.67% to 100% and the median time taken to complete VTE risk re-assessments also improved notably from 97 to 21 hours. Positive feedbacks have been received on the effectiveness of these interventions.

Conclusions

By implementing these simple interventions, we can see a substantial improvement in the standards of VTE risk assessments, in compliance with the NHS Standard Contract and NICE guidelines.
1309 A Quality Improvement Project on Small Bowel Obstruction Operative Mortality Rate
Authors: Azri Yahaya A M , Hollingshead J
Published: August 2023

Aim

Higher than average emergency laparotomy mortality rates had been identified via the National Emergency Laparotomy Audit (NELA), at a particular hospital. Small bowel obstruction (SBO) is the commonest cause for emergency laparotomy. The aim of this project was to evaluate the management of SBO, and to implement changes to reduce the operative SBO mortality rate.

Method

NELA was used to assess emergency laparotomy cases between 1st Dec 2018 - 30th Nov 2019; (n = 198), of which there were 24 mortalities. The dataset was filtered for SBO (n = 87), of which there were 12 mortalities. The clinical management of these 12 SBO mortality cases were analysed and compared to the latest ASGBI and NCEPOD recommendations on SBO management.

Following this review, a systematic change in the management of SBO was introduced with the aim of reducing time to operation, appropriate candidate selection and avoiding drifting in management. This consisted of producing a SBO management flowchart as well as ensuring allocation of theatre slot within 72 hours for patients suitable for operation.

Results

Following the intervention, we assessed cases between 1st April 2021 - 31st March 2022 (n = 152), of which there were 13 mortalities. The dataset was filtered for SBO cases (n = 57), of which there were 3 mortalities. Emergency laparotomy mortality rate reduced from 12% to 9%. SBO operative mortality rate reduced from 14% to 5%. Emergency laparotomy deaths relating to SBO reduced from 50% to 23%.

Conclusions

The intervention resulted in improvement in SBO operative mortality rates as well as overall emergency laparotomy mortality rates.
844 Surgical Outcomes and Mortality for Patients Undergoing Total Pelvic Exenteration for Colorectal Cancer at One Year
Authors: Ralston C , Schizas A , Hainsworth A , Ferrari L , George M
Published: August 2023

Total pelvic exenteration (TPE) is undertaken at specialist centres for locally advanced rectal cancer. It carries significant morbidity and mortality. Research is often performed on small sample sizes resulting in limited data on surgical outcomes and mortality.

A retrospective study conducted in St Thomas’ Hospital analysed colorectal cancer patients who underwent TPE’s from 2017-2021. Demographics and perioperative data including Clavien-Dindo (CD) score, 90 day and 1 year mortality was collected. Significant post-operative complications were considered for patients scoring >2 on CD scale.

124 patients were included in the study, mean age 63 (SD 10), (87% male; 13% female). TPE was undertaken for a primary rectal cancer in 77% and for recurrent disease in 23% of patients. Mean blood loss was 1688mls and median length of hospital stay was 18 days. Significant complications seen in 34% of patients. 69% patients had R0 resection, 25% R1 resection. Disease recurrence was significantly more prevalent in patients with R1 resections (p<0.0001). In total 42 patients experienced disease recurrence (60% metastatic, 40% local), mean disease free period was 405 days. 71% of relapsed patients had adjuvant therapy advised, with only 27% of advised patients going on to receive treatment. 1 year mortality shown to be 12% with 3 patients within 90 days of surgery.

Patients experience a considerable risk of post-operative complications following TPE with over a third experiencing significant complications in the immediate post-operative period. Patients with R0 resections go on to have significantly less disease recurrence. Further research required into long term survival.
193 The Effect of a Targeted Teaching Program on Patient Care in SMART Vascular Unit
Authors: Elkawafi M , Al-kassar A , Barclay A , Elgzairi M , Ghatwary T
Published: August 2023

Introduction and Aim

The usual outcome for any QIP is education focused around the topic in order to raise awareness. At South Mersey arterial (SMART) unit, we developed a targeted teaching program to address key topics. We aim to identify the effect of the program targeted at Foundation and core training level doctors on our patients ward based care measures using regularly audited data points.

Method

The program at SMART started in 2020 and is a repeated selection of talks which address specific recommendations per national guidelines. We have correlated the timing of the teaching programs with the start of each rotational change (4 to 6 monthly). We have repeated multiple audits to assess specific outcomes including antiplatelet, DVT prophylaxis, diabetic control, amputation pathway, lipid modulation. We reviewed the results of the multiple audits in conjunction with the repeated teaching program.

Results

The results of the Multiple Audits show an overall improvement on the adherence to Best medical therapy, DVT prophylaxis, Amputation pain-control pathway (25% to 92%), lipid modification therapy (74.3% to 99%) and diabetic screening and control (32% to 100%). Overall, the feedback on the teaching program was encouraging from all grades.

Conclusions

We recommend based on our multiple Audit outcomes, A regular repeated teaching program targeting specific topics especially at the transition periods for Foundation and Core training level doctors is a useful method to improve patient care and target specific defect areas as well as provide educational benefit to the attendees.
271 Surgical Trainees’ Burnout During Covid-19 Pandemic
Authors: Egbe A , Abuelgasim M , El Boghdady M
Published: August 2023

Introduction

The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. We aimed to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialities, and to identify factors that may modify the risk of burnout.

Method

A systematic review was performed in compliance with the PRISMA guidelines to identify articles related to the keywords “surgeons’ burnout and Covid-19’’ and “surgical trainees burnout and Covid-19”. A search was performed on PubMed/Medline and ScienceDirect for articles published from January 2020 to August 2022.

Results

A total of 19 articles met the inclusion criteria, 3866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees during the pandemic was between 9.0%-95.2% across the globe. Burnout rates were higher in general surgery (33.1%-95.2%) than in urology (17.6%-55%), neurosurgery (16.2 %-44.1%), and orthopaedic surgery(9% - 44.1%). Otorhinolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included female gender, being a more junior trainee, and increased working hours.

Conclusions

There has been a high level of burnout amongst surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training, and the serious consequences of surgeons’ burnout both for the individual, and for patients, targeted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed and must be prioritised by healthcare institutions and training programmes.
852 The Impact of Surgical Training on Clinical Outcomes After Oesophagectomy: A Systematic Review and Meta Analysis
Authors: Gysling S , Peck D , Elso A , Codreanu S , Rushton F , Caruana E
Published: August 2023

Aim

Surgical training, including in technical skills through theatre exposure, is integral to healthcare delivery and sustainability. We sought to investigate the impact of intraoperative trainee involvement during oesophageal resection on perioperative outcomes.

Method

A protocol was registered at PROSPERO (CRD42022330705). Seven databases were searched up to May 2022. Studies providing direct comparison between consultant- and trainee-performed oesophagectomies in adult patients were included.

The co-primary outcomes were length of hospital stay and 30-day survival.

Data was analysed in Stata SE v17. Log odds ratios (log OR) were calculated for dichotomous outcomes, whilst continuous variables were summarised as mean differences (MD). A random-effects model was employed. Heterogeneity was assessed using I2. Bias was assessed using ROBINS-I.

Results

804 studies were screened, with 9 papers considered in the final quantitative synthesis. 3183 (72% male) patients, including 762 (24%) trainee-led cases, were included. There was a high risk of bias across included papers.

Hospital stay was significantly shorter in the trainee group (MD -1.83 days: 95% CI [-2.88, -0.78], p<0.01). There was no difference in 30-day survival (p = 0.23), in-hospital survival (p = 0.92), anastomotic leak (p = 0.80), operative time (p = 0.63) or completeness of resection (p = 0.76) between groups.

Conclusions

Trainee involvement in oesophageal resections does not appear to have a detrimental impact on patient safety and outcomes. High-quality studies, with consistent outcome reporting and larger populations are needed to further inform this area of interest.