bluuebunny/crossref_metadata_2025 huggingface dataset:
SP3.1.10 Surgical Emergency Assessment Unit and Emergency Surgeon of the Week’ : A Paradigm shift to providing Emergency Surgical Care
Authors: Pangeni Anang , Mohamed Hesham , Imtiaz Mohammad , Shah Ankur , Fernandes Roland , Aravind Biju , Shrestha Ashish Kiran
Published: October 2021

Aims

Ever increasing number of A&E attendance and admissions cause immense strain on hospital beds with drainage of our finite health resources. This prompted the need for implementation and review of alternative schemes: Surgical Emergency Assessment Unit (SEAU) and ‘Emergency Surgeon of the Week’ (ESW) and its impact on our depleted health system.

Patients and Method

Retrospective analysis of a prospectively collected data from SEAU activity logs, patient information center and friends and family questionnaire following implementation of SEAU (November 2014) and ESW (November 2017) in a large DGH.SEAU operates on a five day policy (Monday – Friday, 0800-2000) aided by dedicated imaging pathway and ESW works on a 1:5 (Monday – Thursday, 0800-1800) rota with full complement of the surgical team.

Results

SEAU has attended to 16057 patients (New 9811; Follow Up 6246) from November 2014-October 2019. Emergency general surgical admission pre and post SEAU implementation was 309* and 202*/month respectively, a drop of 35% with a further reduction after introduction of ESW by another 24% to 153*/month. Thus, a total reduction of emergency admission by almost 60%. Stay in SEAU was 4* hours and re-admission rate was 6%. SEAU received 98% friends and family recommendation to others.

Conclusions

A paradigm shift in providing emergency surgical care is required in the face of a strained health care system; the positive outcome achieved after implementation of SEAU and ESW could be the answer to relieving bed capacity and financial pressures, possibly a solution to providing high quality and safe patient care.
SP3.1.13 Does Single-port laparoscopic appendicectomy provide better outcomes compared to conventional (three-ports) laparoscopic appendicectomy?
Authors: Mohamedahmed Ali Yasen Y , Zaman Shafquat , Stonelake Stephen , Hajibandeh Shahin
Published: October 2021

Aims

To evaluate comparative outcomes of single port laparoscopic appendicectomy (SPLA) and conventional three-port laparoscopic appendicectomy (CLA) in the management of acute appendicitis.

Methods

A comprehensive systematic review of randomised controlled trials (RCTs) with subsequent meta-analysis of outcomes were conducted following PRISMA standards. Post-operative pain, cosmesis, need for an additional port(s), operative time, Post-operative complications, length of hospital stay(LOS), readmission, and reoperation were the evaluated outcome parameters.

Results

Sixteen RCTs reporting a total number of 2017 patients who underwent SPLA(n = 1009) or CLA(n = 1008) were included. SPLA showed higher cosmetic score (Mean Difference (MD) 1.11,P= 0.03) but significantly longer operative time (MD 7.08, P = 0.00001) compared to CLA. However, there was no significant difference between SPLA and CLA group in the postoperative pain score at 12 hours (MD -0.13,P=0.69), need for additional port(s) (Risk Ratio (RR)0.03, P = 0.07), postoperative ileus (RR 0.74,P=0.51), SSI ( RR 1.38, P = 0.28), Post-operative intra-abdominal collection (RR 0.00,P=0.62), LOS ( MD -2.41, P = 0.16), readmission to the hospital ( RR 0.45,P=0.22), and return to theatre (RR -0.00, P = 0.49). Subgroup analysis showed that operative time was comparable in adults only subgroup (P = 0.18) while it was significantly loner in paediatrics only subgroup(P = 0.00001). Moreover, LOS was shorter in adults only subgroup (P = 0.003) and no difference observed in paediatrics only subgroup (P = 0.93).

Conclusion

SPLA is associated with a slightly longer operative time; however, its efficacy and safety are comparable to CLA. Subgroup analysis showed that SPLA has better outcome in adults than paediatrics. Additionally, SPLA offers better post-operative cosmesis.
SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital
Authors: Donald Neil , Varatharajan Lavanya , Ratnasingham Kumaran , Irukulla Shashi
Published: October 2021

Aims

Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies.

Methods

Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020).

Results

Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days).

Conclusions

Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.
SP3.2.12 Do the National Emergency Laparotomy Audit (NELA) performance indicators correlate with mortality? A retrospective analysis of years 4-6
Authors: Dick Lachlan , Tucker Stefan , Bairstow Fiona , Green James , Young Jamie
Published: October 2021

Aims

Emergency laparotomy continues to carry significant morbidity and mortality. The National Emergency Laparotomy Audit (NELA) publishes individual hospital reports, detailing key performance indicators. We aimed to determine the impact of performance indicators on mortality.

Methods

NELA aggregate hospital reports from years 4 to 6 were used to extract data relevant to the study aims. Linear regression was used to determine if any of the reported variables could be used as predictors of mortality.

Results

An analysis of 559 hospital aggregates, totalling 73075 laparotomies was carried out. Overall, the average rate of mortality was 9.6%. There was no significant correlation between mortality with any common variable across years 4-6 data, including risk documentation before surgery, arrival in theatre appropriate to urgency, consultant review preoperatively and supervision in theatre, admission to critical care, care of the elderly assessment, unplanned return to theatre or admission to critical care and length of stay.

Conclusion

No single performance indicator alone appears to correlate significantly with mortality. Multivariable analysis may identify some performance indicators, however, given that across all the hospitals there is a high standard of performance for each of the reported variables, the variation in mortality is likely influenced by other factors not evaluated by the hospital aggregate reports.
SP3.2.14 Does the “weekend effect” exist in those patients that require emergency laparotomy?
Authors: Creedon Lee , Boyd-Carson Hannah , Varma Aarti , Tierney Gillian
Published: October 2021

Aims

Multiple studies have concluded that the “Weekend effect” results in worser outcomes for patients admitted during the weekend, when compared to weekday admissions. Patient presenting that require emergency laparotomy are, by default, high risk. It may be assumed that their risk of death is higher should they present during the weekend. The aim of this study was to identify if this cohort of admissions is at an increased risk of death should they present at the weekend.

Methods

All patients entered into the National Emergency Laparotomy Audit database from December 2013 up to and including November 2017 from two independent acute hospitals were included. Adjusted regression analysis (NELA risk score, grade of surgeon and anaesthetist, post-operative admission to critical care and procedure performed) was performed investigating the association between day of admission to hospital and 60-day post-operative mortality. Sunday was used as comparator variable.

Results

Study cohort included 1346 patients, overall 60-day inpatient mortality was 9.63% (134 patients). Following risk adjustment there was no increased risk of mortality when investigating day of admission to hospital; Monday Odds Ratio (OR 1.60, 95% Confidence Intervals (CI) 0.69-3.71), Friday (OR 2.01, 95% CI 0.85-4.7).

Conclusion

Risk of death in those that require emergency laparotomy is not affected by day of presentation to hospital.
SP4.1.8 Patient satisfaction with telephone versus face-to-face consultations during the COVID-19 pandemic
Authors: Psaltis Emmanouil , Tzatzidou Anastasia , Chua Yunli , Abdullmalek Hidayatul , Kanakala Venkatesh
Published: October 2021

Aims

Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. During the COVID-19 pandemic, several face-to-face appointments in the outpatient clinics have been converted to telephone consultations. The aim of this study was to compare patient satisfaction following telephone consultations over face-to-face appointments in General Surgery.

Methods

A retrospective survey on consecutive patients (n = 63) was conducted over the telephone by independent interviewers. Group I (n = 36) consisted of patients who had telephone consultations and Group II (n = 27) of patients who had face-to-face appointments. Patient satisfaction was recorded using the Generic Medical Interview Satisfaction Scale (G-MISS) questionnaire as it has been validated for use in General Surgery. Statistical analysis was performed to assess for any differences between the two groups in the cumulative satisfaction scores and the three dimensions of the G-MISS questionnaire, “relief”, “compliance” and “communication”.

Results

Median, Q1-Q3 of the satisfaction score in Group I (77.3, 62.1-93.3) did not statistically differ compared with Group II (76.5, 62.5-93.3, p = 0.91). “Relief” in Group I (78.1, 57.0-92.9) did not significantly vary compared with Group II (75.0, 53.1-93.7, p = 0.85). “Compliance” in Group I (62.5, 50.0-96.8) was very similar with that in Group II (75.0, 50.0-100.0, p = 0.82). “Communication” in Group I (87.5, 71.8-98.9) was also very similar compared with Group II (87.5, 75.0-100.0, p = 0.74).

Conclusions

We demonstrated high levels of patient satisfaction with telephone consultations. Therefore, during the pandemic the services of the outpatient department remain of high quality. Considering the economic benefits to the NHS, telephone consultations might be “here to stay”.
SP4.1.10 Colorectal Cancer Services During the First Wave of the COVID-19 Pandemic
Authors: Olugbemi Mojolaoluwa , Kitmiridou Despoina , Bavikatte Akshay , Keeling Neil
Published: October 2021

Aims

During the first wave of the COVID-19 pandemic, UK health services ceased National Bowel Cancer Screening programme and non-emergency diagnostic services were halted. This retrospective study evaluated the colorectal cancer (CRC) service at a district general hospital during that period by comparing the CRC services from 31/03/2020 to 28/06/2020 to services offered during the same 3-month period of the previous year.

Methods

65 patients were included in the study (47 from 2019 and 18 from 2020). Demographics, referral modes, treatment aims and Dukes cancer staging at diagnosis were compared. À2 and Fisher’s exact tests were used.

Results

There was a 61.7% decrease in the volume of patients managed and 65.7% reduction in operations relative to the previous year. The mean age(years) of 66.6 (S.D 14.1) during the pandemic was lower than the average during the non-COVID year (75.5(S.D 13)) but gender distribution was similar. COVID-year referrals originated from rapid access pathway (61%), emergency (28%), routine referrals (11%), screening (0%) compared to 56%, 21%, 21%, and 2% respectively during the non-COVID period. Dukes staging varied with Dukes D doubling (39% vs 17%) and no Dukes A (6% in 2019) during the pandemic. The treatment goal during the pandemic was palliative in 44% vs 32% in the other group.

Conclusion

Cessation of non-emergency diagnostic pathways that support identification of early disease contributed to diagnostic delays with increased proportion of palliative/Dukes D disease. Normal CRC services should be sustained during future pandemics to avoid missing curable disease.
SP4.1.12 The impact of COVID-19 on the pattern of presentations with acute lower gastrointestinal bleeding
Authors: Marlow Neale , McNamara John , Ali Roshneen , James Michaela , Bentley Tom , Bond-Smith Giles
Published: October 2021

Aims

Following the initial surge of COVID-19 cases in Spring 2020, data began to emerge on the negative impact of the disease on outcomes for serious medical conditions such as heart disease and stroke. However, the impact of COVID-19 on the pattern of emergency presentations with lower gastrointestinal bleeding (LGIB) has not been published to date.

Methods

We designed a clinical coding search strategy to identify all adult patients with acute LGIB presenting to the Emergency Department (ED) and the Surgical Emergency Unit (SEU) at a UK university hospital from January to July 2020. For context, data on number of overall presentations to ED and SEU were also collated for the same period.

Results

169 patients (median age 63 (16-94) years, 54.4% male) with acute LGIB were identified across the six months. A graphical representation of these data demonstrated notable trends. Overall weekly ED attendances dropped by 52.0% after the national lockdown (from 1500 to 720 patients), before returning to 77.7% of pre-lockdown levels by the end of the study period (1165 patients). Pre-lockdown, there was a fluctuating number of weekly attendances with acute LGIB. After lockdown, consistently fewer patients presented and there was a reduction in the variability of numbers week on week.

Conclusions

These novel data support recently published trends demonstrating a post-lockdown fall in emergency attendances, although the decrease in weekly attendance with acute LGIB was less marked, perhaps reflecting the concerning nature of this symptom for patients.
SP4.1.14 Single centre experience in managing acute appendicitis during COVID-19 pandemic
Authors: Kolaityte Valdone , Mukhopadhyay Ishani , Newport Daniel , Aslam Imran
Published: October 2021

Background

Given the pressure of COVID pandemic, the UK Intercollegiate guidance encouraged a move towards non-operative or open appendicectomy management of acute appendicitis. The aim of the study was to assess the approaches used to manage acute appendicitis and their outcomes during pandemic peak and after it.

Methods

This was a single-centre retrospective study, 2-observer data collection. We collected and analysed data on acute appendicitis management approaches (surgical and non-surgical) and patient outcomes were compared during the peak of the pandemic (04-2020 to 06-2020) and post-peak (07-2020 to 09-2020) periods.

Results

190 patients - (peak – 88, F:M=1.09, median age – 30.5) and post-peak 102 (F:M=1.12, median age -31)). There were no significant differences for APPY risk score, ASA grade, comorbidities between the groups. There was more diagnostic imaging performed during the peak of the pandemic (peak 71.6%, post-peak – 56.9%) (p = 0.035 X2=4.431). Comparison between managing patients during peak and post-peak showed that approaches were the following: conservative (14.8% vs 14.7%, P = 0.998), laparoscopic appendicectomy (65.3% vs 96.6% P = <0.001), open appendicectomy (34.7% vs 3.4% P = <0.001). There was no significant difference in postoperative complications (Clavien-Dindo II-IIIb), readmission to hospital, or total LoS (median=3 days) between the groups (p > 0.05). Median LoS for patients treated conservatively was 1 day. Only 1 patient developed COVID postoperatively, the mortality was 0%.

Conclusions

Treatment strategies adapted and modified in COVID peak were effective and safe in managing acute appendicitis. Laparoscopic surgery remained a safe practice even in the peak of COVID pandemic.
SP4.1.16 V is for vicious: a COVID burnout vector perspective
Authors: James Osian , Bowman Chris , Luton Oliver , Robinson David , Hemington-Gorse Sarah , Lewis Wyn
Published: October 2021

Aims

No employment sector has been more heavily pressed by COVID-19 than healthcare. This study aimed to characterise surgical trainee burnout related to the pandemic, following a previous observational cohort study reporting 59% burnout.

Methods

A 36-point survey, including the 22-point Maslach Burnout Inventory evaluated emotional exhaustion, depersonalisation, and personal accomplishment amongst all surgical trainees within a UK Statutory Education Body, with responses received from 121 (75 Core (CST), 46 Higher Surgical Trainees (HST)).

Results

High burnout levels were evident across one, two, or all three domains in 60.3% (n = 73), 32.2% (n = 39) and 13.2% (n = 16), respectively. Median emotional exhaustion, depersonalisation and personal accomplishment scores were 19 (range 0-48), 7 (0-25) and 36 (6-48), respectively. Median emotional exhaustion score was related to age (25-29yr 25 vs. >40yr 4; p = 0.016), trainee grade (CST 23 vs. HST 13; p = 0.001) and parenthood (parents 13 vs. not parents 21; p = 0.011), as was depersonalisation: 9 (25-29yr) vs. 1 (>40yr; p = 0.001), 8 (CST) vs. 6 (HST; p = 0.006) and 5 (parents) vs. 8 (not parents; p < 0.001), respectively. COVID-19 induced curriculum working pattern disruption was observed in 82.6% (n = 100), with 31.4% (n = 38) redeployed away from surgery. Barriers to training and career development were the commonest stressors (71.9%) and more prevalent among younger trainees (25-29yr. 76.8% vs. >40yr. 28.6%; p = 0.045) and CST (80.0% vs. HST 58.7%; p = 0.011). Clinical workload concerns were associated with emotional exhaustion (OR 3.12; p = 0.008).

Conclusions

Burnout endures, though unique adverse clinical work environments may have boosted resilience. Countermeasures including Enhanced Stress Resilience Training remain a priority.
SP4.2.3 Single centre concept of ‘cold site’ elective surgery during the peak of COVID-19 pandemic: a cohort study
Authors: Iqbal Muhammad Rafaih , Dhahri Adeel Abbas , Darwish Nourelhuda Mohammed Mustafa , Vijay Vardhini
Published: October 2021

Objective

The COVID-19 pandemic caused a major strain on healthcare systems across the globe. As these systems got overwhelmed with the emergency care of the infected patients, widespread cancellations of elective surgery occurred. Our hospital utilised local private hospital as a dedicated cold site (CS) for urgent elective surgery during the peak of the COVID-19 pandemic. We aim to analyse the outcomes at this dedicated cold site.

Method

A retrospective review of a prospectively maintained database of all the cases operated at the CS during a 2-month period (30 March 2020 to 29 May 2020) was carried out. The primary outcome was 30-day COVID-19 related mortality. The secondary outcomes were 30-day non-COVID-19 related mortality, complications, readmission and development of COVID-19 symptoms.

Results

A total of 153 patients were operated on at the CS over the study period with a median age of 57 years (Interquartile range, IQR 47 – 70). 62% were females and 82% had a Body Mass Index (BMI) less than 30. 73% of the operations were performed for cancer. 59% of the surgeries were graded as intermediate and 26% as major or complex. There was no mortality at 30 days from COVID-19 or non COVID-19 causes. There was only 1 (0.65%) readmission. 7 patients (4.57%) developed complications. 1 (0.65%) patient was diagnosed with COVID-19 in the postoperative period while 3 had COVID-19 symptoms but were tested negative.

Conclusion

Urgent elective surgery is safe and feasible during the COVID-19 pandemic if a dedicated cold site is available.
SP4.2.4 Single centre experience of ‘Green Zone’ elective general surgery after the first wave of COVID-19
Authors: Iqbal Muhammad Rafaih , Subramonian Subiksha , Matwala Kabir , Morrison Catherine , Uddin Aaliya , Lovett Bryony
Published: October 2021

Introduction

Elective surgery came to a halt during the first wave of COVID-19. The safe resumption of elective surgery with COVID-19 prevalent in the community, remains a significant challenge. The aim of this study was to look into the outcomes of elective general surgery in a dedicated ‘Green Zone’ following the first wave of COVID-19.

Methods

A ‘Green Zone’ pathway was drafted which was meant to provide a COVID-free environment for patients. Prospective data was collected on consecutive patients who underwent elective general surgical procedure at a single NHS trust over a 10-week period (1st Sept 2020 - 10th Nov 2020). The primary outcome was 30-day COVID-19 mortality. Secondary outcomes included 30-day nonCOVID-19 mortality, readmissions and complications.

Results

The study included 185 patients with a median age 55 years (IQR 41-67); 96 (52%) were females. Majority of the patients were ASA 2 (n = 98, 53%) followed by equal number of ASA 1 and ASA 3 (n = 42, 23%). 33 patients (18%) had been shielding earlier in the year. 96% underwent general anaesthetic. Most of the cases were day cases (n = 131, 71%). There was no 30-day COVID-19 or nonCOVID-19 mortality. One patient developed COVID-19 three weeks after the index operation. 30-day readmission and complication rate were 5% (n = 10) and 10% (n = 18). Most of the complications were Clavien-Dindo grade 1(n = 8, 4%) and 2(n = 8, 4%).

Conclusion

This study has shown that dedicated ‘Green Zone’ elective operating pathway is safe provided a balanced risk assessment approach is adopted.
SP4.2.7 Outcomes following reorganisation of colorectal cancer pathway using FIT testing and a locally developed risk stratification score in a busy District General Hospital in United Kingdom during the COVID-19 pandemic
Authors: Gani Akil , Vijay Vardhini , Allgrove Carol , Vivekanandan Shanmuga
Published: October 2021

Aims/Introduction

Limited availability of endoscopy and CT colonography led to significant pressures on the colorectal cancer pathway during the COVID-19 pandemic. Risk stratification was necessary to determine the order in which patients on the tracking list could access diagnostics. Based on national guidance, patient symptoms and FIT test results, we used a locally developed risk stratification score (RSS). The aim of this study was to evaluate the impact the RSS had on patient diagnoses over a period of 8 months

Methodology

A prospectively maintained database was used to assess the outcomes. Based on their symptoms, patients on the colorectal 2ww pathway were invited to provide FIT samples if eligible. Diagnostics were prioritised using RSS. Results were analysed to assess how the cancer diagnostic yield during the pandemic compared to a similar period the year before.

Results

There were 1133 patients referred on the colorectal 2ww pathway between May - December 2020. 884 of these patients had FIT testing and 249 were not eligible. Of the 69 colorectal cancers diagnosed, 25 were in the FIT group and 44 in those not eligible. The RSS stratified to high or indeterminate risk in the non-FIT group was 31 and 23 in the FIT group. Compared to the previous year’s number of 59 patients diagnosed between May - December 2019, no statistical difference was found.

Conclusion

Our study shows that FIT testing and RSS led to an equivalent pick up rate of colorectal cancer and can be utilised in clinical settings with limited resources.
SP4.2.9 Investigation of patients with qFIT >400µg/g during the initial stages of the COVID-19 pandemic
Authors: Fox Katherine , Bradley Nicholas , Hendry Paul , Crozier Joseph , Rodger Mark
Published: October 2021

Background

During the initial stages of the COVID-19 pandemic non-emergency endoscopy was suspended as per BSG recommendations, resulting in altered pathways for investigation of suspected malignancies. In our unit, patients referred via suspected colorectal cancer (CRC) pathways with a quantitative faecal immunochemical test (qFIT) >400 µg/g were offered CT imaging in the first instance.

Methods

We accessed our electronic records to retrospectively identify patients referred with a qFIT >400 µg/g between March and May 2020. Patient demographics, previous medical history, and referral details were recorded. Primary outcome was incidence of new CRC diagnosis.

Results

21 patients were included. Median follow-up was 218 days, and median time from referral to CT was 17 days. 3 (14.3%) patients had new cancer diagnoses;2 CRC and 1 lung. 42.8% of patients had normal investigations, or benign colorectal pathology. 95.2% patients went on to have an endoscopy; low risk polyps (28.6%), high risk polyps (4.8%) and IBD (9.6%) were identified. 57.1% of patients were discharged following endoscopy, with the remaining 42.9% needing further management which included referral to other specialties and repeat scopes.

Discussion and conclusion

CT scanning did not reduce the need for subsequent endoscopy, but aided in prioritising patients for subsequent investigation. There were no cases of CRC identified endoscopically which were not identified by CT imaging. In conclusion, CT is a viable alternative to endoscopy when restrictions are placed on endoscopy services.
SP4.2.10 COVID-19 and General Surgery in a District General; Safety and Quality data
Authors: Fifer Helen , Hussain Muhammad Ibrar , Grey Tamsyn , Saha Arin , Peter Mark
Published: October 2021

Aim

The Covid-19 pandemic forced departments to change standard modes of delivery of care. Within our unit, reductions in junior workforce and changed operating protocols resulted in greater consultant presence on in-patient wards and the ambulatory unit. This study aimed to determine the effect on patient outcomes by interrogation of data collected from weekly Safety and Quality Clinical Governance meetings.

Methods

Patients admitted between December 2019 and February 2020 were compared to those admitted between April 2020 and June 2020. The weekly meeting mandates consultant discussion of all readmissions, all patients who had a length of stay (LoS) of > 7 days and all admissions to critical care. Outcomes between the two time periods were compared.

Results

There was a marked reduction in admissions during the second study period. However, the proportion of patients discharged from ambulatory care increased as did the proportion of readmissions; in the pre-Covid period, there were 429 readmissions of which 188 (44%) were unplanned but in the post-Covid period, there were 311 readmissions. There were no serious adverse events from discharged patients or readmissions.

There were markedly fewer patients who had a LoS > 7days (179 patients versus 87) and a greater number of unplanned admissions to critical care (44% versus 64%).

Conclusions

Increased consultant presence may explain the reduced LoS and increased readmissions due to the greater ‘risk’ that senior clinicians are prepared to take. Enhanced consultant presence should be a permanent change, even after the pandemic is over.
SP4.2.12 The impact of COVID 19 on colorectal cancer diagnosis and surgical oncological provision; A national perspective
Authors: Donlon Noel , Nugent Tim , Irwin Shane , Ramjit SInead , Davern Maria , Mealy Ken
Published: October 2021

Introduction

The COVID-19 pandemic has interfered with many aspects of cancer management, including delayed diagnoses, stalled screening programmes, limiting treatment and clinical trials. Colorectal cancer is the second commonest cause of cancer death in Ireland. The objective of the current study is to assess the impact of this pandemic on colorectal cancer diagnoses and surgery, at a national level.

Methods

Data on endoscopy, emergency and elective colorectal operations nationally in Ireland over a three year period (2018-2020) were obtained from the National Quality Assurance Improvement System. Data relating to cancer surgery only were included and patient demographics, type of surgery (open/laparoscopic), length of stay (LOS), mortality, admission to critical care and re-admission rates were collected and analysed.

Results

31.33% less cancers have been diagnosed between March and November 2020 inclusive when compared to the same period over the past two years with 22% less rectal cancers identified. There has been a 34% reduction in colorectal cancer surgeries over the same period with a reduction of 42% at the initial wave during the period March-May and of concern, this trend has continued. Laparoscopic right hemicolectomies have reduced by 41%, anterior resections have reduced by 51% with no change in the number of temporary ileostomies over the three year period.

Conclusion

The impact of COVID-19 on colorectal cancer surgery nationally has been profound. The reduction in diagnoses and cancer surgery is concerning and may result in increased late or incurable stage disease as a consequence of late presentation and diagnosis.
SP5.1.5 Bariatric surgery is associated with greater survival and metabolic health benefits than conventional medical management in people with NAFLD
Authors: Muir Duncan , Dempster Niall , Sgromo Bruno , Gillies Richard , Cobbold Jeremy , Tomlinson Jeremy
Published: October 2021

Aims

Non-alcoholic fatty liver disease (NAFLD) represents the hepatic manifestation of the metabolic syndrome.There are no licensed pharmacotherapies for NAFLD, and it is rapidly becoming the leading cause of liver failure worldwide.Bariatric surgery (BS) is an effective and durable intervention for weight loss and type 2 diabetes (T2D) but is not recommended in the UK’s NICE guidelines for NAFLD management.We aimed to determine whether BS was associated with NAFLD regression.

Methods

1067 people with NAFLD were included in this observational cohort study.Liver histology/validated non-invasive biomarkers were used to diagnose NAFLD.Markers of liver and metabolic health were recorded longitudinally for participants undergoing hepatology-led (n = 702) or BS (n = 365) management in a UK tertiary centre. 1-year outcomes were compared using mixed models. 5-year mortality was compared using Cox proportional-hazards regression.

Results

T2D prevalence was similar between cohorts (p = 0.06). Differences in other baseline factors were observed (age, gender, and body mass index (BMI), all p < 0001). BS showed a significantly lower adjusted 5-year mortality (p = 0.02). Both interventions were associated with improved biomarkers of liver health e.g. ALT (p = 0.00). Greater improvements in targets of NAFLD management such as HbA1c (p = 0.00) and BMI (p = 0.00) were observed after BS.

Conclusions

BS showed an improved 5-year survival compared to hepatology-led management. This may be explained by greater improvements in key targets for NAFLD regression in the BS cohort. However, residual confounding despite adjusted survival analysis cannot be excluded. A prospective randomised trial is recommended to ensure fair comparison of these interventions and enhance the clinical management of NAFLD.
SP5.1.8 Long term outcomes of laparoscopic magnetic sphincter augmentation for gastro-oesophageal reflux disease: High patient satisfaction with low dysphagia rates
Authors: Tabbakh Yasmin , Walsh Caoimhe , Tan Tai Joum , Nehra Dhiren
Published: October 2021

Aims

Laparoscopic magnetic sphincter augmentation (MSA) or LINX® procedure is gaining popularity as a treatment for gastro-oesophageal reflux disease. We looked at the long-term outcomes of this procedure with regards to its efficacy, in particular studying the dysphagia rate in relation to the LINX® device size.

Methods

Postal questionnaires were sent to all patients who underwent MSA procedure between 2012-2019 at a single institution. Patients were asked to quantify, as a percentage, their symptom resolution, proton pump inhibitor (PPI) intake and side effects.

Results

124 patients (male:female ratio was 45:55) underwent MSA procedure, with 82 responding to the questionnaire. Patients' age range was 18-71 years (median 49). Over 90% of patients reported improvements in reflux symptoms with 75% reporting complete resolution. 67% of patients no longer required PPI medication, whilst 21% of patients had >50% reduction in their medication. Post-operative dysphagia occurred in 59% of patients at 3 months, which decreased to 16% at 1 year. There was no significant difference in size of LINX® device used between patients with dysphagia at ≥ 1 year versus those without dysphagia at ≥ 1 year (p = 0.554). In total 3 patients (2%) required explantation of the LINX® device. Overall 86% of patients rated their outcomes as satisfactory or very satisfactory.

Conclusions

Our 7 years of experience with laparoscopic MSA has demonstrated that this procedure is safe with high patient satisfaction rates. Dysphagia, although common in the early post-operative period, usually resolves within 3-6 months and is unrelated to LINX® device size.
SP5.1.9 Why are curative treatment rates so low for stage I/II Oesophago-gastric cancer in the West of Scotland?
Authors: Khan Khurram , Gall Lewis , Forshaw Matthew
Published: October 2021

Aims

Over the last decade, quality performance indicators (QPIs) have been used to drive improvements in cancer care in Scotland. QPI-11 targets curative treatment rates for oesophago-gastric (OG) cancer and this target has been consistently missed. This study aimed to investigate why patients with potentially curable Stage I and II OG cancer did not receive curative treatment.

Methods

The West of Scotland MCN database was interrogated for patients with newly diagnosed stage I and II OG cancer between January 2018 and December 2019 to identify those patients who did not have curative treatment. Electronic records were then analysed.

Results

81 patients (mean age of 79.3 ± 8.9 years; 41 (50.6%) female) were identified. Median Scottish Index of Multiple Deprivation was 3 (IQR 1-7). There were 46 (56.8%) oesophageal cancers, 49 (60.5%) adenocarcinomas and 63 (77.8%) were Stage II cancers. Formal CPEX fitness was assessed in only 6 patients (7.4%). Reasons for curative treatment not being received were as follows: not clinically fit (n = 69 (85.2%)); patient declined curative treatment (n = 7 (8.6%)); disease progression (n = 3 (3.7%)) and identification of synchronous cancers (n = 2 (2.5%)). 61 patients (75.3%) are deceased at the time of analysis, with a median time from MDT discussion to death of 6 (IQR 2-11.5) months.

Conclusions

Lack of fitness for radical treatment is the predominant reason for Stage I and II OG cancer patients in the West of Scotland not being treated with curative intent. This may be related to the previously described “West of Scotland” effect on health comorbidities.
SP5.1.11 The immune landscape of the Tumour draining lymph node and the Tumour Microenvironment in oesophageal; A novel therapeutic target
Authors: Donlon Noel , Davern Maria , Sheppard Andrew , Donohoe Claire , Reynolds John , Lysaght Joanne
Published: October 2021

Aim

The tumour microenvironment (TME) and tumour-draining lymph node microenvironment (LNME) remain poorly understood. Our study profiles the immune, angiogenic and inflammatory environment of the LNME and the TME of oesophagogastric patients.

Methods

The prognositc value of nodal status, clinical stage and tumour regression grade (TRG) was evaluated using a cohort of OAC patients (n = 702). Immune checkpoints (ICs) on tumour-draining lymph nodes(TDLNs, n = 6) and tumour tissue(n = 9) at surgical resection was assessed by flow cytometry. We also screened for cytokines, angiogenic mediators and chemokines. Using The Cancer Genome Atlas (TCGA), protein and mRNA levels (n = 72) and mutated versus non-mutated copies(n = 87) of this panel was correlated with survival.

Results

The frequency of CD3+TIM-3 and PD-1+T cells in TDLNs positively correlated with clinical tumour status as did CD8 + PD-1+TIGIT + T cells with nodal burden. Pro-angiogenic factor bFGF was significantly higher within the TME compared with the LNME. PIGF and SAA mediators of tumour growth were significantly higher in the LNME and levels of SAA in LNME positively correlated with adverse features. High levels of pro inflammatory IL-8,IL-6 and Flt1, mutations in pro-inflammatory genes CCL26,IL-31 and IL-17C and anti-tumour IL-1RN and CCL22 correlated with reduced overall survival.

Conclusions

The TME is more immunosuppressive than the TDLN, however, certain pro-angiogenic factors were enriched in TDLNs suggesting the priming of a pre-metastatic niche. Given the association of ICs with clinical features and tumour biology this may help to inform novel therapeutic approaches.
SP6.1.9 Colorectal Cancer and Synchronous Liver-limited Metastatic Disease: The final results of the CoSMIC Inception Cohort Study
Authors: Chan Anthony , Mason James , Siriwardena Ajith
Published: October 2021

Aims

Currently, evidence is inadequate to inform the selection of optimal treatment for patients with colorectal cancer and synchronous liver-limited hepatic metastases. Options include synchronous or staged surgery integrated with systemic chemotherapy. CoSMIC is the first inception cohort study to follow patients from point of presentation in order to identify factors influencing treatment and outcome.

Methods

Patients were identified at presentation to the regional liver metastases MDT at Manchester Royal Infirmary between April 2015-2018. Data were collected on demographics, intervention and outcome. The study was approved by Regional Ethics Committee (REC reference: 14/NW/1397).

Results

Of 125 patients recruited, 109 underwent surgery with 18 (17%) liver-first, 75 (69%) bowel-first and 16 (14%) undergoing synchronous resection. There were no differences in baseline demographics or co-morbidity. Eighty-eight completed the intended surgical pathway, with highest failure in liver-first patients where 39% did not proceed to subsequent bowel resection. Critical care occupancy between staged and synchronous resections (5.6 versus 5.2 days; P = 0.92), and inpatient stay (16.5 versus 16.8 days; P = 0.92) was not significant. There was no 30-day mortality. Cox regression analysis identified surgical sequence as a significant covariate (Х2= 31.3; P < 0.001). Survival was similar between surgical groups (Log-rank test; P = 0.87).

Conclusions

CoSMIC is the first prospective inception cohort study of colorectal cancer and synchronous liver-limited metastasis. The study population is small and from a single centre and thus could be influenced by recruitment and sample bias. However, the important novel finding is that there is no survival difference between treatment pathways.
SP7.1.3 An integrated and upgraded meta-analysis of published randomized, controlled trials exploring the role of oral metronidazole as post-operative proctological analgesic agent
Authors: Rehman Saad , Hamid Moaz , Iqbal Karim , Ray Kausik , Sains Parv , Sajid Muhammad S
Published: October 2021

Aims

Proctological procedures such as haemorrhoidectomy have been reported with significant post-operative pain affecting quality of life as well as capacity to perform daily activities. The objective of this article is to explore the role of conventionally used antibiotic metronidazole as a proctological analgesic.

Methods

A systematic review of the randomized, controlled trials reporting the use of oral metronidazole as post-operative proctological analgesic agent in patients undergoing haemorrhoidectomy published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis.

Results

A total of eight randomized, controlled trials on 447 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of oral metronidazole as a post-operative proctological analgesic agent was significantly associated with the reduced pain score on day 1 (Standardized mean difference (SMD), -0.56; 95% CI, -1.04, -0.07; z = 2.26; P = 0.02), day 3 (SMD, -0.82; 95% CI, -1.33, -0.31; z = 3.15; P = 0.002) and day 7 (SMD, -1.48; 95% CI, -2.51, -0.45; z = 2.82; P = 0.005). There was significant heterogeneity (Tau2 = 0.39, chi2 = 38.38, df = 7, [p = 0.00001]; I2 = 82 %) among included studies.

Conclusion

The use of oral metronidazole as a post-operative proctological analgesic agent following haemorrhoidectomy seems to have proven clinical advantages and may routinely be used.
SP7.1.6 Using Diffuse Reflectance Spectroscopy (DRS) to Identify Tumour and Non-tumour Tissue in Upper Gastrointestinal Specimens
Authors: Nazarian Scarlet , Gkouzionis Ioannis , Anandakumar Arun , Patel Nisha , Elson Daniel , Peters Christopher
Published: October 2021

Aim

Cancers of the upper gastrointestinal (GI) tract remain a major contributor to the global cancer risk. Surgery aims to completely resect tumour with clear margins, whilst preserving as much surrounding tissue. Diffuse reflectance spectroscopy (DRS) is a novel technique that presents a promising advancement in cancer diagnosis. We have developed a novel DRS system with tracking capability. Our aim is to classify tumour and non-tumour GI tissue in real-time using this device to aid intra-operative analysis of resection margins.

Method

An ex-vivo study was undertaken in which data was collected from consecutive patients undergoing upper GI cancer resection surgery between August 2020- January 2021. A hand-held DRS probe and tracking system was used on normal and cancerous tissue to obtain spectral information. After acquisition of all spectra, a classification system using histopathology results was created. A user interface was developed using Python 3.6 and Qt5. A support vector machine was used to classify the results.

Results

The data included 4974 normal spectra and 2108 tumour spectra. The overall accuracy of the DRS probe in differentiating normal versus tumour tissue was 88.08% for the stomach (sensitivity 84.8%, specificity 89.3%), and 91.42% for the oesophagus (sensitivity 76.3%, specificity 98.9%).

Conclusion

We have developed a successful DRS system with tracking capability, able to process thousands of spectra in a small timeframe, which can be used in real-time to distinguish tumour and non-tumour tissue. This can be used for intra-operative decision-making during upper GI cancer surgery to help select the best resection plane.
SP7.1.11 Deprivation has No Effect on Oesophagogastric Cancer Outcomes in North of Scotland
Authors: Hunter Ross , Griffin Fiona , Nanthakumaran Shayanthan , Ramsay George
Published: October 2021

Introduction

Despite advances in medical therapies and surgical techniques, oesophagogastric cancer survival remains low. Poorer survival and outcomes from colorectal cancer have been reported for patients living in areas of higher socioeconomic deprivation1. Our aim was to determine if deprivation affected oesophagogastric cancer survival in North East of Scotland.

Methods

A prospective, single-centre observation study was conducted utilising data from oesophago-gastric cancer MDT referrals and outcomes from January 2013 to December 2019. Patient postcodes were cross-referenced with the Scottish Index of Multiple Deprivation (SIMD) 2020 tool which provided a level of deprivation for each address. Survival outcomes were compared across demographic factors, disease factors and stage at presentation across deprivation quintiles.

Results

1046 patients were included in this study. There were fewer patients in the most deprived (1st) quintile (n = 65) than in the least deprived (5th) quintile (n = 245). There was no significant difference between oesophageal versus gastric cancer presentations nor was there any difference between T, N or M stage at presentation between the most and least deprived groups. No difference was identified between those commenced on a radical therapy with other treatment plans. No difference in survival time was noted between the groups.

Discussion

No difference in survival was demonstrated across areas of deprivation within this catchment area. However, Aberdeenshire is an affluent area with less overall deprivation compared with other areas of Scotland.
SP7.1.13 Facial nerve morbidity after superficial parotidectomy in the absence of nerve conductor: a general surgeon experience from a low resource country
Authors: Dhahri Adeel Abbas , Hashmi Fazila , Akbar Muhammad , Akhtar Riaz , Dhahri Mehvish Adeel
Published: October 2021

Aims

After superficial parotidectomy, the incidence of facial nerve injury, for pleomorphic adenoma of the parotid gland, remains the topic of interest despite different techniques to identify the nerve during surgery. We aim to evaluate the incidence of facial nerve injury in patients undergoing superficial parotidectomy in the absence of nerve conductor.

Methods

After calculating sample size, 101 patients irrespective of age and gender were included in this cross-sectional study at the Department of Surgery, for nine years, from 1st January 2012. The primary outcome was the incidence of temporary or permanent facial nerve injury with a follow-up period of 12 months. The data was calculated using SPSS version 23, where mean and standard deviation were calculated for continuous variables, and frequencies were calculated for categorical data.

Results

Facial nerve injury was evident in 16/101 (15.8%) patients. Among these, the main truck of facial nerve was involved in 6(5.9%); temporary loss of function in 4(4.0%) while permanent injury in 2(2.0%). Most common branch of facial nerve affected was marginal mandibular nerve (6, 5.9%), of which 4(4.0%) had a permanent loss. Additionally, four (4.0%) patients developed salivary fistula whereas (2%) patients developed Frey’s syndrome.

Conclusion

Facial nerve injury should be clearly explained, in the consent, to the patient as a medicolegal purpose. Where the nerve stimulator is not available, identification of the proposed anatomical landmarks allows a safe recognition of the facial nerve.