bluuebunny/crossref_metadata_2025 huggingface dataset:
699 Pre-Operative Screening and Investigation of Patients with Suspected Non-Alcoholic Fatty Liver Disease Among Bariatric Surgery Patients
Authors: Antypas A , Austin A , Awad S , Hughes D , Idris I
Published: May 2021

Introduction

Non-alcoholic fatty liver disease (NAFLD) is becoming more prevalent. The investigations used to diagnose NAFLD include FIB-4 score, NAFLD score and AST/ALT ratio (AAR). Gold-standard for diagnosis is liver biopsy. Bariatric surgery reduces steatosis and fibrosis in NAFLD patients. However, in undiagnosed NAFLD, it can lead to worsening fibrosis and decompensation of cirrhosis, causing complications.

The aim is to identify how well bariatric patients are being screened for NAFLD pre-operatively.

Method

Database analysis was conducted in the bariatric clinics at Royal Derby Hospital and analysed using SPSS.

Results

392 patients’ data (Overall group) were analysed and compared with those who had an AAR>1 (Abnormal group). Abnormal group had a higher mean AAR, NAFLD and FIB-4 scores. Surprisingly, ALT and AST levels were higher in Overall group compared to Abnormal. Generally, patients were not pre-operatively checked sufficiently (81.9% LFTs, 62.2% ASTs).

Conclusions

A large number of patients could have undiagnosed NAFLD due to the lack of LFT/AST checks as ALT scores alone would miss fibrosis. Using AAR>1 and FIB-4 would allow clinicians to detect fibrosis earlier to carry out non-invasive diagnostic measures, avoiding unnecessary biopsies. Early diagnosis means patients undergoing bariatric surgery with possible cirrhosis will not experience decompensation and associated complications.
703 The Impact of Introducing A Patient Information Leaflet on Patient Experience of Safety Netting for Cauda Equina Syndrome at Lister Hospital
Authors: Sravanam S , Vella-Baldacchino M , Kitson J
Published: May 2021

Introduction

Cauda Equina Syndrome (CES) is a medical emergency. Patients with symptoms should seek medical attention immediately to prevent long-term neurological consequences. At our hospital, patients with back pain due to prolapsed vertebral discs are discharged with verbal advice about red-flag signs of CES. Studies have shown that patients retain only around half the information discussed in verbal consultations. Practice suggests that verbal advice combined with a patient information leaflet (PIL) allows for better safety-netting.

Method

In this study, we designed a new PIL reflecting latest British Association of Spinal Surgeons guidance. We then examined its impact on patient understanding and safety-netting of CES. Fifty patients who attended the Lister Hospital back pain service between September 2019 and August 2020 were randomly selected. Patients received a copy of the new PIL and were asked to complete a short questionnaire.

Results

Out of 26 respondents, over 86% (vs 59%) agreed/strongly agreed that the PIL helped them understand the red-flag signs of CES better. Furthermore, 81% said they felt better informed about CES than at the point of discharge from hospital.

Conclusions

This shows that the use of an effective way of educating patients about the red-flag signs of a medical emergency like CES.
713 Use of A Pre-Operative Investigation Checklist in Plastic Surgery Trauma
Authors: Slade R , Combellack E , Kaur A , Eales M , O'Neill T
Published: May 2021

Introduction

In a regional centre for plastic surgery, it had been noted that operations were being delayed due to lack of pre-operative investigations. A pre-operative investigation checklist was developed between anaesthetic and surgical staff for semi-elective plastic trauma surgery patients, based on NICE guidelines. The checklist recommends which blood, radiology and cardiopulmonary tests would be appropriate based upon age, ASA grade and co-morbidity.

Method

A complete cycle audit was used to evaluate the checklist. All patients having GA/block for plastic surgery trauma in a 2-week window were included. Data was collected retrospectively via electronic operative records, anaesthetic assessments, and clinical notes. A minimum of 15 patients was collected per cycle. A single page pre-operative checklist was created for pre-operative investigations were introduced after the first cycle.

Results

The first audit cycle had 16 patients, ASA1 (5), ASA 2(6) ASA 3 (5). 75% had appropriate pre-op investigations. In the second cycle 22 patients, ASA 1 (8), ASA 2 (9), ASA 3 (3), ASA 4 (1). 100% of patients had appropriate pre-operative investigations.

Conclusions

There was increased awareness of pre-operative investigations in medical and nursing staff after the introduction of the checklist. It has helped streamline the delivery of semi-elective trauma surgery in our unit.
717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit
Authors: Williamson C , Brennan C
Published: May 2021

Introduction

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery.

Method

A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis.

Results

Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally.

After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge.

Conclusions

Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.
725 Monthly Antibiotic Use in The Sheffield Children’s Hospital ED: A Hospital-Based Clinical Audit
Authors: Leong W S , Gray J , Rimmer C
Published: May 2021

Aim: To evaluate guideline compliance of antibiotics prescription in Emergency Department (ED).

To improve documentation of antibiotic prescription.

To highlight the need for good antibiotic stewardship.

To optimise the use of antibiotics.

Method

A cross-sectional, retrospective patient record review was conducted regarding antibiotic prescription over 1 month in Sheffield Children’s Hospital ED. All antibiotic prescriptions over that period were collected. From the total number of prescriptions, a convenience sample of 100 prescriptions was selected to correlate their indications with local guidelines.

Results

A total of 290 prescriptions for 310 antibiotics were collected. The most frequent antibiotic prescribed was Penicillin V (26.7%), followed by Amoxicillin (21.3%), Co-amoxiclav (20.3%), and Flucloxacillin (16.5%). From the convenience sample, 12 antibiotics were prescribed inappropriately, with the most frequent being Co-amoxiclav (41.7%), followed by Penicillin V (25%), Amoxicillin and Flucloxacillin (both 16.7%). Overall, there has been good stewardship of antibiotic use with 88% of antibiotic prescribing conducted appropriately as per ED guidelines.

Conclusions

Antibiotic resistance is a growing concern, with one of the leading causes being inappropriate prescription of antibiotics. Adhering to local guidelines can help to prevent them from developing resistance. Adherence can be improved through induction and training of clinicians.
789 Improving Compliance of The MUST Tool Through Multiple Interventions, Improves Documentation and Assessment of Nutritional Status in Trauma and Orthopaedic Patients Undergoing Surgery
Authors: Hinduja D , Ikram A , Idoye M , Bidwai A
Published: May 2021

Introduction

The Malnutrition Universal Screening Tool (MUST) is a nationally validated risk tool, used to identify adults who are malnourished. 40% of surgical patients are malnourished which significantly impacts the outcomes of elderly patients. The primary aim of this study was to ascertain its utilisation in elderly patients undergoing trauma and orthopaedic surgery in a district general hospital.

Method

We completed a closed-loop audit from October2019-June2020 over two, three-week periods Inclusion criteria was age ≥65 years, and patients undergoing surgery. Data collected included MUST score, nutritional support, pre-operative fasting time, and prescription of fluids. Our intervention included departmental teaching sessions, posters, and the addition of the MUST tool to clerking proformas.

Results

We included analysis of 70 patients. Following our intervention, admission MUST score calculation improved by 8%, and providing nutritional support increased by 21%. However, there was no improvement in reducing pre-operative fasting time and prescription of pre-operative fluids.

Conclusions

Through our intervention’s documentation and assessment of nutritional status in elderly patients has improved. However further work must be completed to reduce time spent ‘nil-by-mouth’ and prescribe fluids for maintenance before surgery. This requires better pre-operative planning and communication between the surgical and ward-based teams.
798 Improving Foundation Doctors’ Confidence and Knowledge of Free Flaps and Their Possible Complications: A Closed-Loop Quality Improvement Study
Authors: Baldwin A , Tanos G
Published: May 2021

Introduction

To assess confidence and knowledge of managing free flaps in foundation doctors’, who, whilst working on a general surgery rota, are expected to intermittently manage plastic surgery patients, and introduce a simple tool to support them.

Method

A single-centre closed-loop quality improvement project, using the ‘Plan, Do, Study, Act’ methodology, was conducted. Initially, a prospective, baseline audit assessing foundation doctors’ confidence and knowledge was carried out. This utilised images and clinical scenarios to assess understanding of complications.

Results were analysed, and a simple poster was designed and distributed for reference. Two months later the questionnaire was repeated to reassess confidence and knowledge.

Results

Pre- and post- intervention surveys were completed by all general surgery foundation doctors (n = 11). Mean confidence was significantly improved following intervention (p = <0.0001). Baseline ability to spot a healthy flap and venous congestion was good. Ability to identify arterial occlusion and a healthy muscle flap, with concurrent split-thickness skin graft, significantly improved (p = <0.0001 and p = 0.0091, respectively)

Conclusions

Foundation doctors lack confidence and knowledge of managing free flaps, despite some being expected to do so whilst on a general surgery rota. This can be improved through a simple, informative resource to refer to when dealing with these patients.
872 Audit - Unexpected Overnight Stay After Day-Case Surgery In ENT
Authors: Darwich H , Dawoud M , Poulios A
Published: May 2021

Introduction

The aim of this audit was to determine the compliance with guidelines regarding patient selection for day-case surgeries in ENT.

Method

Data was collected retrospectively and included all patients who underwent elective ENT surgeries over a one-year period at an NHS hospital. Factors considered included nature of the operation, timing, surgeon’s preference, as well as social circumstances.

Results

Out of 1101 intended day cases, 113 (10%) had an unexpected overnight stay. The major factor contributing to these overnight stays was the timing of the operation, where 85 cases had undergone surgery in the afternoon. Other factors included drain siting, saturation monitoring, post-operative complications, and social circumstances. Tonsillectomy-related and nasal procedures formed the majority of the procedures, with 74 cases in total.

Conclusions

We concluded that most overnight stay cases included in this audit could have been prevented. Careful theatre list planning by prioritizing day cases for morning lists may reduce these numbers significantly. Co-morbidities and social aspects may need to be explored when booking patients for theatres.
925 Is Routine Bloods Group and Save Required for Emergency Appendicectomy?
Authors: Karim S , Shah V , Adegbola S , Tewari S , Gupta V
Published: May 2021

Introduction

Appendicectomy is commonly a safe and low bleeding risk procedure. However, some hospital guidelines stipulate a requirement for routine pre-operative blood group and save (G&S).We aim to determine if pre-operative G&S is required for appendicectomies by looking at the number of tests vs transfusion conducted.The cost of G&S is £4.14 per sample in our trust.

Method

A retrospective review was conducted over a 3-month period. Patient data and demographics were identified using the hospital coding, theatre records and transfusion departments.

Results

118 consecutive appendicectomies were identified. Of which, 99 laparoscopic vs 19 open (13 started open vs 6 converted to open) operations were performed. No patients required a blood transfusion during their admission. There was a total of 219 G&S conducted. Cross matching tests for these procedures cost a total of £906. We estimate a cost projection of £3624 for G&S tests over a year and £18120 over 3 years.

Conclusions

Bleeding complications requiring transfusion following appendicectomies are very uncommon. In our unit, 0% of patients identified required a transfusion during their admission. We suggest stopping routine pre-operative G&S for these patients would be clinically safe and would lead to financial savings and reduce pre-operative waiting time.
980 An Audit of a Surgical Ambulatory Service [SAmS] Performance Pre And Post COVID-19 - The Impact of Senior Decision Making
Authors: Clements J , Olukoga T , Clements B
Published: May 2021

Introduction

Surgical Ambulatory Units have emerged to refine the management of unscheduled care with the aim of reducing admissions and offering timely, accurate treatment strategies. There are 12 principles which underpin an efficient ambulatory Service, one of which is to have a 'Consultant led and delivered Service'. Consequent to the COVID Pandemic we reallocated Consultants to our Ambulatory Service and reviewed the impact of this initiative.

Method

Two periods - Pre COVID 6-17/1/20 and Post COVID 27/4 -10/5/20 were compared with respect to volume, case mix, procedures performed and outcomes in terms of investigations, and completed episodes. Data was retrieved from case notes and electronic databases.

Results

There were no demographic differences across the groups. The case mix and referral patterns were similar as was the volume. There were no differences in procedures or investigations ordered. In the Pre COVID group 20% of sessions were Consultant led compared with 100% in the Post COVID group. In the post COVID group 64% of cases were completed on the index attendance compared with 27% in the pre COVID group.

Conclusions

A Consultant presence in SAmS enhances decision making and risk management and is critical for the efficacy of the Service with respect to patient flow and resource management.
987 MRI As A Guide for Prostatectomy Planning
Authors: Vanalia P
Published: May 2021

Introduction

NICE guidelines suggest that PSA, mp-MRI and targeted biopsies should be used for the diagnosis of prostate cancer. This audit looked at several aspects of prostate cancer assessment and diagnosis at our trust, however we will be focusing on the use of MRI.

Method

A retrospective cohort study was performed at Lancashire Teaching Hospitals and this included 49 patients. We compared the pre-operative MRI tumour location and tumour grading with post-operative histology tumour location and tumour grading of prostate cancer patients. The statistical analysis was performed using Chi-squared testing.

Results

Prostate tumour location mapping based on MRI was accurate in 70% of the cases, these results were statistically significant (p-value <0.01). However, the tumour grading according to the MRI was only accurate in 45% of the cases (p-value <0.05).

Conclusions

Tumour grading based on the MRI result should not be routinely used to stratify risk and plan treatment. However, a prostate planning meeting would be recommended prior to the surgery and this can use the MRI location of the tumour along with the patient’s baseline regarding urinary and erectile function to help plan nerve sparing and surgical margins, this would help improve outcomes for patient's post-operative quality of life.
1025 Readmission & Mortality Rates Following Enhanced Recovery After Surgery (ERAS) For Colorectal Procedures at An Island DGH
Authors: Moore P , Pickering O , Cook E
Published: May 2021

Introduction

Colorectal surgery under ERAS reduces postoperative morbidity by 40-50% and shortens length of hospital stay by 2-3 days. The 2018 National Bowel Cancer Audit reported a 30-day readmission rate of 10.5% for colorectal surgery under ERAS and a 90-day mortality rate of 2% nationally. Evidence shows readmission rates increase with discharge C-reactive protein (CRP); 16.5% when CRP >100 mg/L and 6% when CRP <100 mg/L.

Method

Data was collected prospectively at a small island DGH on 89 patients from September 2018 - March 2020.

Results

The 30-day readmission rate was 7.9% and the 90-day mortality rate was 0% locally. Six (86%) of the readmitted patients had a left-sided colorectal disease (potentially due to increased risk with a colo-colonic anastomosis). Five (71%) patients required return to theatre; four due to anastomotic leaks and one due to a wound collection. 43% of readmitted patients had upward white cell count/c-reactive protein (WCC/CRP) trends on discharge. Readmitted patients had a mean discharge CRP result of 150 (range 15.9 - 311).

Conclusions

Colorectal surgery under ERAS at our institution is at a high standard stemming from effective staff education and post-operative patient counselling. This study provides evidence that WCC/CRP trend is related to postoperative prognosis.
221 UK Medical School Selection Criteria Predicts Success in Part A of The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination
Authors: Ellis R , Brennan P , Cleland J , A. Lee  , D. Scrimgeour
Published: May 2021

Background

Selection into UK medical school typically involves a combination of three measures: prior academic attainment, selection tests (e.g., the University Clinical Aptitude Test (UCAT), Biomedical Admissions Test (BMAT), Graduate Medical School Admissions Test (GAMSAT)), and an interview. We investigated whether prior attainment and selection test scores can predict MRCS success.

Method

We used the UKMED database to analyse selection data for all UK graduates who attempted MRCS Part A (n = 9729) and Part B (n = 4644) between 2007-2017. Univariate analysis and Pearson correlation coefficients were used to examine the relationship between selection scores and first attempt MRCS success.

Results

Successful MRCS Part A candidates had better A-Levels and higher scores in UCAT, BMAT and GAMSAT examinations (p < 0.001) than their unsuccessful peers. No statistically significant difference was observed for MRCS Part B. A moderate positive correlation was found between Part A, BMAT (r = 0.315, p < 0.001) and GAMSAT scores (r = 0.346, p < 0.001). A weak positive correlation was found between Part A, A-Level (r = 0.144, p < 0.001) and UCAT scores (r = 0.246, p < 0.001).

Conclusions

A-level results and medical school selection tests predict success in the knowledge-based (Part A) MRCS examination.
229 Uncomplicated Diverticulitis: A Proposed Diagnostic Algorithm
Authors: Kerr B , Ahmed O , Byrnes C
Published: May 2021

Introduction

Covid-19 has changed surgical practice. Infection risk and hospital pressures means appropriate patient ambulation is paramount. Uncomplicated diverticulitis can be managed as an outpatient. Clinical differentiation of uncomplicated and complicated diverticulitis remains challenging. This study aims to develop a diagnostic algorithm to differentiate complicated from uncomplicated disease prior to imaging.

Method

A single-centre retrospective review of 177 patients referred as diverticulitis between Sept-Dec 2018, was performed. Data collected included clinical presentation, biochemistry and imaging. Complicated diverticulitis was defined as occlusion, perforation, abscess formation, fistula and/or bleeding. Inferential parametric analysis was performed to ensure predictive value.

Results

Of 177 patients referred, 71 received a consultant diagnosis of diverticulitis. 60 were confirmed and differentiated on CT scan. LIF/lower abdominal pain (P < 0.01) and bowel habit change (P < 0.05) was significantly higher in patients with diverticulitis compared to other pathology. In complicated diverticulitis, symptoms occurred < 4days (P < 0.05), fever was present (P < 0.001) and CRP was > 75.

Conclusions

Once diverticulitis diagnosis is made based on pain localisation and change in bowel habit, complicated disease can be predicted by symptom duration (< 4 days), presence of fever and a CRP > 75. Plans to assess these findings prospectively in a Surgical Admissions Unit are currently in development.
272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes
Authors: Sharrock M , Nugur A , Hossain S
Published: May 2021

Introduction

There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty.

Method

We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI >40).

Results

285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury.

For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications.

Conclusions

Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.
273 The Consequences of a Failed Screening Programme
Authors: Sharrock M , Whelton C , Paton R
Published: May 2021

Introduction

Controversy exists surrounding the efficacy of the UK screening programme for developmental dysplasia of the hip (DDH).

Method

Clinical records were reviewed in children who were treated surgically for DDH. Demographic data, age and mode of presentation, and surgical treatments were analysed, as well as outcomes, re-operation rate and AVN incidence. Late diagnosis was defined as greater than 4 months.

Results

106 children (16 male, 90 female) underwent surgery from 1997 to 2018. 95 hips were operated for dislocation and 22 were operated for dysplasia. 13 patients had bilateral dislocations. Of the dislocated hips, the median age at diagnosis was 9 months (IQR 2-19). 56% were diagnosed late. In the late diagnosis group the median age for diagnosis was 19 months (IQR 15-21). We have identified an increasing trend in late presentation in recent years. This has been matched with an increasing trend in operation rates for dislocation per 1000 births.

Conclusions

This study demonstrates that DDH is being diagnosed increasingly late, which correlates with an increased need for surgical management. This suggests that the current UK screening programme is failing to identify children with DDH in a timely fashion, which necessitates more aggressive surgical treatment and less favourable outcomes.
368 Perioperative Outcomes in Open versus Laparoscopic Surgery in Elderly Patients Undergoing Right Hemicolectomy
Authors: Lim S Y , Wang R , Tan D J H , Chin Y H , Ng C H , Tham H Y , Buan B J L , Chong C S
Published: May 2021

Introduction

With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients.

Method

We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted.

Results

84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS.

Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance.

Conclusions

LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.
384 Use of A Dry Swab During ACL Hamstring Tendon Graft Preparation May Lead to Decreased Graft Diameter at Implantation with Subsequent Rebound in Graft Diameter When Exposed to Haemarthrosis – A Porcine Tendon Study
Authors: Havenhand T , Jain N
Published: May 2021

Introduction

ACL reconstruction surgery commonly utilises a hamstring tendon graft. Grafts are normally covered with a wet swab prior to implantation. The aim of this study was to determine the variance in graft diameter when comparing the traditional wet swab to a dry swab.

Method

Flexor tendons from a selection of fresh pig trotters were isolated and prepared with a standard ACL graft preparation technique. Half of the grafts were covered with a wet swab; the other half were covered with a dry swab. Graft diameters were measured at 10-minute intervals. After 30 minutes the grafts were submerged in Hartmann’s solution to simulate the post-operative haemarthrosis, diameters were checked again after 1 hour in the solution.

Results

Use of a dry swab resulted in a 0.5mm greater reduction in diameter than the wet swab group. The dry swab group also showed an increase in diameter by 0.5mm when soaked in Hartmann’s solution, this was not seen in the wet swab group.

Conclusions

Using a dry swab produces a smaller graft diameter, this would allow smaller bone tunnels, retaining bone stock. The subsequent rebound in diameter when in solution may increase the press fit mechanism and facilitate improved integration into the bone tunnel.
472 Addressing the Quality of Hospital Care of Colorectal Cancer Patients Undergoing Surgery: What Did We Learn from the National Bowel Cancer Audit?
Authors: Li C , Ooi S Z Y , Woo T , Chan P H M
Published: May 2021

Aim

To identify the most relevant clinical factors in the National Bowel Cancer Audit (NBOCA) that contribute to the variation in the quality of care provided in different hospitals for colorectal cancer patients undergoing surgery.

Method

Data from 36,116 patients with colorectal cancer who had undergone surgery were retrospectively collected from the NBOCA and analysed from 145 and 146 hospitals over two years. A validated multiple linear regression was performed to compare the identified clinical factors with various quality outcomes. The quality outcomes defined in this study were the length of hospitalisation, 2-year mortality, readmission rate, 90-day mortality, and 18-month stoma rate.

Results

Four clinical factors (laparoscopy rate, abdominal-perineal-resection-of-rectum (APER), pre-operative radiotherapy and patients with distant metastases) were shown to have a significant (p < 0.05) impact on the length of hospitalisation and 18-month stoma rate. 18-month stoma rate was also significantly associated with 2-year mortality. External validation of the regression model demonstrated the Root-Mean-Square-Error of 0.811 and 4.62 for 18-month stoma rate and 2-year mortality respectively.

Conclusions

Hospitals should monitor the four clinical factors for patients with colorectal cancer during perioperative care. Clinicians should consider these factors along with the individual patients’ history when formulating a management plan for patients with colorectal cancer.
542 The Attune Total Knee Replacement: Early Clinical Performance Versus an Established Implant At 3 Years Post-Surgery
Authors: Gunn F , Walmsley P
Published: May 2021

Introduction

In 2013, the Attune® knee implant system was released as an updated prosthesis design, superseding the PFC Sigma®. Limited data exists regarding the early-to-midterm survival, functional and clinical benefits of the Attune®. The primary aim of this study was to compare functional outcome between the Attune® and PFC Sigma® at 3 years post-op.

Method

A single-centre, prospective cohort study of 110 patients, selected by propensity score matching, was conducted. Patient demographics, peri-operative care, clinical outcomes and functional scores were analysed to determine which prosthesis conferred a superior functional outcome.

Results

Median and mean increases in American Knee Society Score for the Attune® and Sigma® knees were 53 (26.9) and 43.6 (± 15.4) respectively (p = 0.307). Mean increase in Oxford Knee Scores were 21.8 (± 8.8) and 18.7 (± 8.8) for the Attune® and Sigma® respectively (p = 0.27, 95% CI -2.56 to 8.7). Mean and median increased range of movement was 11.8o (± 28) and 1.7o (± 13.5o) for the Attune® and Sigma® respectively (p = 0.05, 95% CI -0.015 to 20.2).

Conclusions

The Attune® knee system displays a significantly improved range of motion and a trend towards higher knee scores over a conventional implant at 3 years post-surgery, which may support use in future clinical practice.
644 Validation of The Prostate Imaging Reporting and Data System (PIRADS) Tool for Prostate Cancer Detection in A Contemporary British Cohort
Authors: Desai C , Ehsanullah S A , Bhojwani A , Dhanasekaran A
Published: May 2021

Introduction

The European Association of Urology (EAU) recommends multiparametric MRI (mpMRI) prior to prostate biopsy for investigation of prostate cancer (CaP). Specifically, the mpMRI should be reported using the Prostate Imaging Reporting and Data System (PIRADS) tool. Our study aims to externally validate the PIRADS tool over a multi-centre district general hospital.

Method

Retrospective review was performed on 104 consecutive patients who underwent mpMRI and subsequent cognitive transrectal ultrasound biopsy of prostate (CTRUSB) over an 18-month period. Collected mpMRI data was correlated with Gleason grading obtained through CTRUSB histology.

Results

On histology findings, a total of 64.4% patients (n = 67) were found to have prostate cancer with a mean PSA density (PSAD) of 0.48. Extremes of the PIRADS scoring tool showed a clear correlation. PIRADS 2 correlated to a 0% prostate cancer detection rate (PSAD 0.16), whereas PIRADS 5 correlated to 93.1% detection rate (PSAD 0.49). However, for PIRADS 3 and 4, prostate cancer detection rates were 49.8% (PSAD 0.25) and 50.9% (PSAD 0.18) respectively.

Conclusions

Our study substantiates the association of lesions scored as PIRADS 5 with prostate cancer detection. CTRUSB in PIRADS 2 lesions can be safely avoided. For PIRADS 3 and 4 lesions, PSAD should be considered before performing a biopsy.
648 External Validation of The European Randomized Study of Screening for Prostate Cancer Risk Calculator 3 (ERSPC-RC3) In the Detection of Prostate Cancer and Avoiding Unnecessary Prostate Biopsies
Authors: Desai C , Ehsanullah S A , Bhojwani A , Dhanasekaran A
Published: May 2021

Introduction

The Prostate Cancer Research Foundation – Stichting Wetenschappelijk Onderzoek Prostaatkanker group has devised the European Randomized Study of Screening for Prostate Cancer (CaP) Risk Calculator 3 (ERSPC-RC3) tool which aims to increase prostate cancer detection rates and avoid unnecessary prostate biopsies. We report the external validation and accuracy of the ERSPC-RC3 in our UK cohort.

Method

Retrospective data was collected for patients who had prostate biopsy at a multi-centre district general hospital over an 18-month period. The ERSPC-RC3 was applied to identify the probability of a positive biopsy for CaP (Gleason score ≥7).

Results

Out of 121 TRUS biopsies, 78 patients met the ERSPC-RC3 inclusion criteria. Patients were stratified as low-risk (detectable CaP risk <12.5%) n = 10, intermediate-risk (detectable CaP risk 12.5-20%) n = 8, and high-risk (detectable CaP risk >20%) n = 60 groups. All low-risk patients had a benign histology. Gleason 7 CaP was found in 37.5% from the intermediate-risk group and 41.7% in the high-risk group respectively.

Conclusions

Our results demonstrate that using ERSPC-RC3 could have prevented 44% (n = 34) of patients from having unnecessary biopsies. We recommend the use of ERSPC-RC3 to risk stratify patients being investigated for suspected CaP.
795 Trends in Cerebrospinal Fluid Leak Rates Following the Extended Endoscopic Endonasal Approach for Anterior Skull Base Meningioma: A Meta-Analysis Over the Last 20 Years
Authors: Zamanipoor Najafabadi A H , Khan D Z , Muskens I S , Broekman M L D , Dorward N L , van Furth W R , Marcus H J
Published: May 2021

Introduction

The extended endoscopic approach (EEA) provides direct access for resection of tuberculum sellae (TSM) and olfactory groove meningiomas (OGM) but is associated with cerebrospinal fluid (CSF) leak in up to 25% of patients. To evaluate the impact of improved skull base reconstructive techniques, we assessed published CSF leak percentages in EEA over the last two decades.

Method

Random-effects meta-analyses were performed for studies published between 2004-2020. Outcomes assessed were CSF leak, gross total resection, visual improvement, intraoperative arterial injury and 30-day mortality. For the main analyses, publications were pragmatically grouped based on publication year in three categories: 2004-2010, 2011-2015, and 2016-2020.

Results

We included 29 studies describing 540 TSM and 115 OGM patients. CSF leak incidence dropped over time from 22% (95% CI: 6-43%) in studies published between 2004 and 2010, to 16% (95% CI: 11-23%) between 2011 and 2015, and 4% (95% CI: 1-9%) between 2016 and 2020. Outcomes of gross total resection, visual improvement, intraoperative arterial injury, and 30-day mortality remained stable over time

Conclusions

We report a noticeable decrease in CSF leak over time, which might be attributed to the development of reconstructive techniques (e.g., hadad bassagasteguy flap, and gasket seal), refined multilayer repair protocols, and selected lumbar drain usage.
836 Presentation, Clinical Outcomes and Prognosis of Primary Appendiceal Adenocarcinoma; Single Centre Experience
Authors: Abounozha S , Waqas A , Kelly S
Published: May 2021

Background

Appendiceal adenocarcinoma is a rare condition. The aim of the study is to determine the pattern of clinical picture, histological diagnosis and prognosis of the disease on patients in our area.

Method

A retrospective data analysis of patients who underwent appendicectomies from January 2011 to December 2019 in Northumbria NHS Trust.

Records of patients with histologically diagnosed appendiceal adenocarcinoma were studied for their demographics, clinical features, laboratory, radiological results, operative notes and histological types.

Results

13 out of 3138 appendicectomies (0.41%: 6 Males, 7 Females with mean age of 69.84 years) were found to have primary appendiceal adenocarcinoma. Almost all the patients presented with clinical picture in keeping of acute appendicitis.

9 patients underwent emergency appendicectomies. 4 patients were treated conservatively.

Appendiceal adenocarcinoma was diagnosed based on colonoscopy in 1 patient, CT scan in 1, post-appendicectomy histology in 9 patients, 2 post RHC histologies.

Survival rate was 71.4% after 1 year, 64.3% after 2 years and 42.9% after 3 years.

Overall median survival time for all TNM stages was 39.0 (95% CI, 15.72 to 62.27) months. Mean survival time was best in stage II 56.33 (95% CI, 48.86 to 63.80) months.

Conclusions

Preoperative diagnosis is very difficult. Overall prognosis is poor.
877 The Transobturator Male Sling: Does It Stand the Test of Time?
Authors: Sohawon R , Rizvi I G , Ravindra P , Pipe M , King T , Belal M
Published: May 2021

Introduction

The commonest cause of stress urinary incontinence in men is radical prostatectomy. We aimed to determine the efficacy, complication rate and need for salvage surgery in the medium-long term for male sling insertion.

Method

Retrospective review of all patients undergoing male sling insertion at one centre between 2009-2018. Data was collected on complications, patient satisfaction and need for further surgery. Preoperative severity was categorized as mild, moderate, or severe. We assessed ICIQ score, 24h-pad usage, patient satisfaction and identified risk factors for treatment success/failure.

Results

91 men had slings inserted (median age- 67.3). Three months success rates in mild, moderate and severe SUI groups were 96%, 86% and 80% respectively which dropped to 65%, 62% and 47% in the medium term. The rate of AUS implantation was 6%, 15% and 33% respectively. Complications included pain, infection, retention and OAB. Patient satisfaction at 5-years was 57%. Only factor predicting success or failure was pre-operative ICIQ-UI(SF) score.

Conclusions

Male sling success rates deteriorate over time. 15% will have an AUS. The risk of complications is low and transient. A pre-operative ICIQ-UI(SF) score of > 18 is a predictor of failure. Sling insertion remains a reasonable treatment option for male patients suffering with SUI.
912 Comparison of Magnetic Resonance Imaging Cognitive Prostate Biopsy Versus Magnetic Resonance Imaging-Ultrasound Fusion Prostate Biopsy in The Detection of Prostate Cancer
Authors: Bhojwani A , Desai C , Ehsanullah S A , Shahzad S A
Published: May 2021

Introduction

Prostate biopsy is performed to obtain tissue specimens to diagnose prostate cancer (CaP). Superimposing magnetic resonance imaging (MRI) on the prostate biopsy machine can improve the targeting of abnormal prostate lesions found on MRI scans. We compare the results of MRI cognitive prostate biopsy to MRI-US fusion biopsy in the detection of prostate cancer.

Method

Data was collected retrospectively for all patient that had an MRI and prostate biopsy from 01/01/2019 to 31/12/2019. Electronic patient records and radiology imaging software were used to collate data.

Results

319 patients with at least PIRADS 3 on MRI prostate were identified. CaP was detected in 70% (26/37) of the cognitive biopsy cohort and 66% (186/282) of the fusion biopsy cohort. None of the patients required additional biopsies. Only the fusion biopsy cohort had complications which were Urosepsis - 7, Haematuria - 3, Urinary retention - 1 and Rectal bleeding- 1.

Conclusions

Our study suggests the CaP detection rates were similar in both cohorts. However, similar patient numbers are required to avoid selection bias. 66.5% of all PIRADS 3 lesions were found to be ≥ Gleason 7. We recommend using magnetic resonance imaging-ultrasound fusion prostate biopsy to enhance prostate cancer detection rates.
945 Re-Audit of Incorrect Tcis; Are We Now Listing the Right Teeth
Authors: Matharu K , Shah A , Shorafa M
Published: May 2021

Introduction

In 2018 in our OMFS out-patients department there were two wrong tooth extraction (WTE) events- at a Clinical Governance meeting we identified that TCI (‘to come in’ forms) were being completed incorrectly; from December 2018 to February 2019 there were 6 separate forms where the teeth listed for extraction was different to the teeth that were planned for extraction. As a result, our first stage audit involved data collection and root cause analysis of the incorrectly completed forms.

As a result of the findings of the first stage audit, we decided to implement a change to TCI forms.

Aim

To assess whether TCI forms were being correctly completed following on change to TCI forms.

Data collection

Retrospective data collection from September 2019- January 2020 analysing any occurrences of incorrect TCI forms

Results

No further incidents of incorrect TCI forms since September 2019 and WTE since the last occurrence in 2018.

Conclusions

Although an incorrect TCI form was not listed as a potential cause for the two WTE events that occurred within the department, incorrect documentation is a known risk factor for WTEs. This completed audit cycle demonstrates successful learning from the WTEs and the implementation of beneficial changes.
518 New In Vitro Model of Traumatic Brain Injury to Assess Biomaterial Based Regenerative Strategies
Authors: Basit R H , Jenkins S I , Chari D M
Published: May 2021

Introduction

Penetrating traumatic brain injury (pTBI) management is largely supportive, with no clinically established regenerative therapies. Neurocompatible biomaterials offer a high potential to promote regenerative mechanisms but facile, high throughput, pathomimetic in vitro pTBI models for the developmental testing of neuro-materials is lacking.

Method

A mouse mixed glial culture system was utilised within which penetrating injuries could be induced. DuraGen PlusTM – an FDA approved neurosurgical grade biomaterial could be implanted into lesions to assess cell-biomaterial responses. Reactive gliosis (astrocytic morphological responses/GFAP expression) and microglial infiltration (Iba1 expression) were assessed/quantified.

Results

Key pathological features of pTBI were observed in the model, with the ability to (i) introduce reproducible lesions (diameter 949 ± 26 μm) and (ii) for DuraGen PlusTM to be implanted into lesions. Peri-lesional astrocytes displayed hypertrophic palisading morphologies and GFAP upregulation, analogous to gliosis in vivo. Significant microglial numbers infiltrated the DuraGen PlusTM implant at 7 days post-lesion (132.41 ± 15.83 cells/mm2) versus lesion only (82.04 ± 5.11 cells/mm2), p < 0.05).

Conclusions

We have developed a novel, neuropathomimetic pTBI model, wherein biomaterial implantation enables investigation of neural cell-biomaterial responses. This model can facilitate early-stage evaluation of novel biomaterials as high throughput, inexpensive and facile screening tool.
11 A Sequential Simulation Experience for Interim Foundation Doctors and Analysis of Preparedness to Practice Early
Authors: Ashcroft J , Havers N , Seebacher-Tomas A , Plesci E , Goh S , Hudson V
Published: May 2021

Introduction

Covid-19 necessitated the early graduation of medical students to join the healthcare workforce as Foundation Interim Year 1 (FiY1) doctors. A sequential simulation session was implemented to improve and assess FiY1 preparedness towards approaching deteriorating patients.

Method

12 FiY1 doctors participated in the session containing three sequential major stations: complex new admission, ward-based management, and acute deterioration. Participants interpreted investigations, performed examinations, created management plans, and escalated using a pager.

Results

There was a significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-simulation 4(4-4.75); p = 0.04) and paperwork (2(2-3.75) vs. 4(3.25-4.75); p = 0.03). Following four weeks of FiY1 participants demonstrated significant improvement in preparedness for giving treatment (median(IQR): pre-simulation 3(3-4) vs. post-FiY1 4.5(4-5); p = 0.01), communication and teamworking (4(3.25-4.75) vs. 5(5-5.75); p = 0.01), and paperwork (2(2-3.75) vs. 5(5-5); p = 0.01). The FiY1 programme improved integration within teams and facilitated training whilst medical school placements left participants feeling apprehensive and unprepared to practice.

Conclusions

This session provided an engaging method of increasing preparedness towards common challenges new physicians face. This study suggests future senior medical student apprenticeships should give the same investment, opportunities, and responsibilities as that of the FiY1 programme.
988 The Prevalence and Incidence of Gender Bias and Sexual Discrimination in Orthopaedics, and Mitigating Strategies: A Systematic Review
Authors: Elbayouk A , Halim U , Ali A , Javed S , Cullen C
Published: May 2021

Background

The aim of this systematic review was to outline the prevalence and impact of Gender bias and sexual discrimination (GBSD) in orthopaedics, and to investigate interventions countering such behaviours.

Method

Original research papers pertaining to the prevalence and impact of gender bias or sexual discrimination, or mitigating strategies in orthopaedics, were suitable for inclusion. PRISMA guidelines were adhered to in this review.

Results

Of 570 papers, 27 were eligible for inclusion. A total of 13 papers discussed the prevalence of GBSD, whilst 13 related to the impact of these behaviours, and 6 discussed mitigating strategies. GBSD were found to be prevalent in the orthopaedic workplace, with all sources showing females to be the victims. The impact of GBSD includes poor workforce representation, lower salaries, barriers to career progression, and reduced academic output for females in orthopaedics. Mitigating strategies in the literature are focussed on encouraging females to apply for orthopaedic training programmes, by providing female role models, mentors, and educational interventions.

Conclusions

GBSD are highly prevalent in orthopaedic surgery, impacting females at all stages of their careers. Mitigating strategies have been tested but are limited in their scope. As such, the orthopaedic community as a whole is obliged to do more to tackle GBSD.