bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.FRI.530 ‘Emergency’ Laparoscopic Common Bile Duct (CBD) Exploration: Is this the right time to change?
Authors: Patil Sangram , Daniel Sudin , Hussain Abdulzahra , Vasas Peter
Published: October 2021

Aims

Common Bile Duct (CBD) stones are becoming more common on surgical emergency take and accounts for up to 20 % of patients presenting with acute biliary pathologies. The hospital stay is prolonged whilst waiting for Endoscopic Retrograde Cholangio Pancreatography (ERCP). We aim to evaluate the feasibility, safety and cost-effectiveness of emergency laparoscopic CBD exploration (LCBDE) in these patients. 

Methods

A cohort of patients with CBD stones underwent emergency LCBDE between January 2016 and December 2020 at a regional hospital in the United Kingdom was retrospectively reviewed.

Results

In total, 11 LCBDE were performed on emergency list. All patients were admitted with acute symptoms of either obstructive jaundice cholangitis or pancreatitis. All procedures were performed with choledochotomy. The mean patient age was 58 years and male-to-female ratio was 2:9. 3 patients (27%) had T- tube otherwise all ducts were primarily closed. Average hospital stay was 8.5 days. 1 patient returned to theatre for retained stone of 11mm. There was no 30 days mortality. There were no readmissions. Initial analysis with small number of patients showed, performing these procedures on emergency basis not only improved patient’s overall experience but also benefitted NHS Trust by approximately £18,500 as per the National Tariff System 2020/21.

Conclusions

Emergency LCBDE is safe, feasible and cost effective. We can safely aim to increase the proportion of LCBDE performed as an emergency case, where clinically appropriate, to reduce the financial burden and improve patient’s outcome with overwhelming NHS Trust funds.
EP.FRI.552 Evaluating short term and long term outcome for patients undergoing emergency laparotomy in comparison to NELA mortality risk calculator
Authors: Darwish Nourelhuda , Mohammed Elsammoual , Warrag Ibrahim , Dhahri AdeelAbbas , Ivanov Bogdan
Published: October 2021

Aim

NELA is a project that was introduced in the UK since 2013, aiming to improve quality of care for patients undergoing emergency laparotomy.  NELA mortality risk calculator”was launched in 2017, which estimates the risk of death within 30 days of emergency laparotomy.  Our aim is to determine the short-term (30-day) and long-term (12 months) outcome in patients undergoing emergency laparotomy surgery and compare this with the estimated scores that were documented in the NELA website.

Methods

This is retrospective study involving patients who underwent emergency laparotomy surgery in the year of 2019. The primary outcome is to determine short-term (30-day) mortality.

Results

A total of 135 patients were included. The overall 30-day mortality was 8.8% (12/135). 55.77% (78/135) had NELA mortality score of < 5%. Only 1 out of these (1.28%) died within 30 days. (4/78,5.12%) died in 6 to 12 months period of this group. 9 patients (11.53%) had NELA score > 30%, of which 6 (66.66%) died within 30 days and 1 died within 6 months. 26.96% (48/135) had NELA scores 55 to 30%, 5 of them (10.41%) died within 30 days while 7 (14.58%) died within 6-12 months. 

Patients with NELA scores more than 5% who survived the operation had higher chance of 30-day complications (25.58%, 11/43), when compared to those with scores less than 5% (11.68%, 9/77).

Conclusion

NELA mortality score has high accuracy especially if it was >30%. In addition, high NELA scores are associated with increased risk of post operative complications.
EP.FRI.554 How long do patients wait for emergency laparoscopy? A local audit of service
Authors: Fraser T , Emslie K , Wheatley T
Published: October 2021

Aim

Anecdotal experience suggested patients undergoing diagnostic laparoscopy for appendicitis faced long pre-operative waiting periods. This project was undertaken to quantify the situation and determine how long patients were waiting for surgery. National guidelines recommend patients can reasonably wait 6-18 hours for surgery, as per NCEPOD classification of intervention (appendicitis considered to fall under urgent 2b category).

Method

A retrospective audit of 39 patients listed for diagnostic laparoscopy or appendicectomy during November 2019 was performed. Clinical notes and electronic records were reviewed to determine the timeline of clinical decision making and patient’s arrival in theatre. Operative and histopathology findings were also noted.

Results

The majority of patients (61%) underwent surgery within 18 hours of a documented decision to operate. Average wait was 17.5 hrs (mean). Longest wait was 41 hours (excluding isolated outlier). Documentation of decision to operate was noted to be poor (undocumented in 5 cases) and in some cases the patient was booked before a documented decision to operate. Variation between the operative and histopathological diagnosis of appendicitis was apparent.

Conclusions

The findings are re-assuring that once the decision was made to operate most patients had surgery within 18 hours. However, there is still room for improvement with regards to timeliness and documentation. The discrepancy between operative and histological findings highlight the challenge of diagnosing appendicitis accurately.
EP.FRI.557 A systematic review on the use of prophylactic Proton Pump Inhibitors in patients with a hip fracture and their effect on developing acute gastrointestinal haemorrhage and mortality
Authors: Doyle Finian
Published: October 2021

Hip fractures represent a significant burden to every Orthopaedic department. Acute gastrointestinal haemorrhage (AGIH) /stress ulceration is a postoperative complication associated with increased mortality. Stress ulcer prophylaxis such as the use of proton pump inhibitors (PPI) is an important measure to decrease this perioperative complication.  

Aims

This systematic review will aim to determine whether there is any benefit for patients with hip fractures being treated with prophylactic PPI medication to prevent AGIH and whether they reduce mortality.  

Methods

A systematic review of the literature was conducted according to PRISMA guidelines. Studies were identified according to the selection criteria and analysed using statistical software.

Results

A total of 3 observational studies with 3413 participants met the criteria for inclusion. Patients taking PPIs had a reduced risk of an AGIH hip fracture than those without PPI therapy (RR 0.15 (95% CI 0.04–0.57, p < 0.0001).The use of PPIs in hip fracture patients shows a reduced mortality risk (RR 0.12 (95% CI 0.01–1.06, p < 0.0001).

Conclusion

These results suggest that prophylactic PPI use in hip fracture patients is associated with a reduced risk of AGIH and also a reduced rate of mortality in this patient group. Orthopaedic surgeons should be aware of the risk of AGIH as a complication in hip fracture patients, knowledgeable to the factors which increase risk in their patient population and be cognisant that the prophylactic use of PPI medication is of benefit in reducing the complication of AGIH and correlates with a decreased mortality rate.
EP.FRI.574 Screening tool to improve patient referral to acute surgical care from Emergency Department
Authors: Razzaq Humayun , Rao Ahsan , Sathananthan Sharlini , Dworkin Michael , Panamarenko Ben
Published: October 2021

Introduction

The study aimed to audit the appropriateness of surgical referrals to general surgery; and, secondly, to devise a screening tool for use in the emergency department  to screen patients that are safe to be discharged and to be seen in surgical ambulatory clinics.

Methods

The first phase of the study was an audit to check appropriateness of the surgical referrals (1st-18th February 2020). In the second part, a screening tool questionnaire was prospectively tested (1st February-24th March 2020) on the surgical referrals. The accuracy of the screening tool outcome was compared to actual patient consultation outcomes. The sensitivity and specificity of the questionnaire was assessed using an ROC curve.

Results

In the first audit, 68.9% patients were discharged on the same day with or without follow up in the ambulatory surgical clinic.  In the prospective questionnaire phase of the study, there were 98 patients and the most common presentation was abdominal pain (n = 60) followed by urological symptoms (n = 11), symptoms of hernia complication (n = 10), abscess (n = 7) and testicular pain (n = 2). The sensitivity and specificity of the screening tool was 60.7% and 100%, respectively with overall accuracy being 88.82%. The area under the ROC curve was 0.80.

Conclusion

A large proportion of the patients referred to the acute surgical unit can be deferred and seen in the ambulatory clinic. The screening tool has the potential to screen patients who can be seen in the ambulatory clinic and safe to identify patients who require urgent surgical admission.
EP.FRI.752 Delay to Surgery in Acute Perforated and Ischaemic Gastrointestinal Pathology – A Systematic Review
Authors: Murray Victoria , Burke Joshua , Hughes Michael , Schofield Claire , Young Alistair
Published: October 2021

Aims

Patients with acute abdominal pathology requiring emergency laparotomy who experience a delay to theatre have an increased risk of morbidity, mortality and complications. The timeline between symptom onset and operation is ill-defined with international variance in assessment and management.  This systematic review aims to define where delays to surgery occur and assess the evidence for previous interventions.

Methods

A systematic review was performed searching MEDLINE and EMBASE databases (January 1st 2005 to May 6th 2020). All studies assessing the impact of time to theatre in patients with acute abdominal pathology requiring emergency laparotomy were considered.

Results

17 studies were included in the final analysis.  15 unique timepoints were identified in the patient pathway between symptom onset and operation which could be classified into four distinct phases.  

Time from admission to theatre (1 to 72 hours), and mortality rate (10.6-74.5%) varied greatly between studies.  Mean time to surgery was significantly higher in deceased patients compared to survivors.  Delays were related to imaging, diagnosis, decision-making, theatre availability and staffing.  Four of five interventional studies showed a reduced mortality following introduction of an acute laparotomy pathway. 

Conclusions

There is wide variation in the definition and measurement of time delays prior to emergency surgery with few studies exploring interventions.  Given the heterogenous nature of the patient population and pathologies, an assessment and management framework from onset of symptoms to operation is proposed.   This could be incorporated into national mortality prediction and audit tools and assist in the assessment of interventions.
EP.FRI.849 Quality Improvement Project for Management of Unstable Ankle Fracture in Scunthorpe General Hospital
Authors: Poh Jian Zi
Published: October 2021

Introduction

In SGH, little emphasis is placed on ankle fracture as compared to hip fracture. Hence, an audit was done to compare management of unstable ankle fracture in adherence to BOAST guidelines. It was found out that few aspects of management in A&E were inadequate. Analyzing the root cause of non-adherence to guideline can lead to better care for these patients.

Aim

Primary aim is to ensure that ankle fractures are treated effectively in line with BOAST guidelines. Secondary aim is to ensure that ankle fractures are treated in a timely manner.

Change in practice

Discussion was held between Orthopaedic consultant and A&E consultant. Firstly, poster displaying algorithm for ankle fracture management displayed in A&E. Secondly, Orthopaedics doctor would come to A&E to reduce fracture after first failed attempt.

Methods

Prospective data is collected. Patients with unstable ankle fracture who are admitted in SGH are assessed in regards to BOAST guidelines via WebV, PACS and clinical notes.

Results

Major improvement is seen in different aspects. The documentation of neurovascular assessment and skin integrity in A&E department is improved by 57%. Additional radiographs of the whole leg when clinical examination suggests a more proximal fracture of the fibula (Maisonneuve injury) was performed in 60% more patients as compared to previously. Adequacy of reduction done in A&E is improved by 25%.

Conclusion

Small changes can make a big difference. Good communication and teamwork between different departments is the best way to provide better care for patients.
EP.FRI.945 Common Factors in Patients needing Emergency Colorectal Cancer Resections
Authors: Khan Sharib Ziya , Lim Jieqi , Sasapu Kishore
Published: October 2021

Aim

Colorectal cancer resection is a major part of general surgical emergency workload. We aimed to identify common characteristics amongst cohort of patients needing emergency resection for colorectal malignancies.

Materials & Methods

This is a single centre study focusing on patients operated urgently for colorectal cancer between 2017 and 2018. Patients’ information was obtained from a prospectively maintained local trust database. The variables were subjected to Mann-Whitney, Chi-Square analysis and cumulative survival function plots. 

Results

79 patients had emergency colorectal cancer resections. A mean age of 79 years and equal gender distribution were observed. 

The male cohort was associated with older age at surgery, younger age at death, longer length of stay (LoS) and higher proportion of open versus laparoscopic surgery (all p< 0.05)

We also observed longer LoS in patients who had open surgery, presence of stoma post-surgery and patients whose carcinoma was first identified and referred by a secondary care team. These latter patients were more likely to present with obstructive and pain symptoms. Histologically, they were found to have more advanced tumour and nodal staging (all p < 0.05). Interestingly also, patients with T3 tumours are more likely to present with bleeding and those with T4 more likely with pain (p < 0.05).

Within the 18 deceased, we found longer post-surgery LoS, higher grade of tumour and nodal involvement (p < 0.05). 

Conclusion

A sub-cohort of patients at higher risk of significant morbidity and mortality can be identified from patient characteristics and targeted for improving their outcomes as well as further research.
EP.FRI.971 Is routine endoscopic evaluation of the colon necessary after an episode of acute diverticulitis?
Authors: Hussain Adiba , Dhanri Akash , Sayed Rehma , Saleh Ahmed , Saha Arin , Peter Mark
Published: October 2021

Aim

Currently standard practice is for patients diagnosed with diverticulitis to undergo endoscopic evaluation of the colon following the acute episode. The primary aim of endoscopy is to exclude underlying malignancy which may have been undetectable on initial CT scanning. We aim to determine if endoscopic evaluation of the colon is necessary for all patients.

Methods

All patients with CT proven diverticulitis were included between May 2017 and July 2018. Medical records, CT and endoscopy reports of 154 consecutive patients were retrospectively reviewed. Based on the CT reports, diverticulitis was classified as either uncomplicated (colonic wall thickening, pericolic fat stranding) or complicated (perforation, abscess, generalised free air and/or fluid).

Results

There were 154 patients included in the study. 59% percent were male. Median age at the time of diagnosis was 56 years old.  There were 114 patients with uncomplicated and 40 patients with complicated diverticulitis. 79 patients (50 flexible sigmoidoscopy, 29 colonoscopy) with uncomplicated diverticulitis and 21 patients (15 flexible sigmoidoscopy, 6 colonoscopy) with complicated diverticulitis underwent endoscopy. Of the patients that underwent endoscopy, one patient (1.3%) with uncomplicated disease and one patient (4.8%) with complicated disease were found to have colorectal cancer (both rectal). Neither of these were associated with the diverticular segment.

Conclusions

Our data shows that routine endoscopic evaluation of the colon after an episode of acute diverticulitis may not be necessary in all cases. Patient numbers in this study are small therefore further work is required to draw conclusions which could influence future clinical practice.
EP.FRI.974 NELA 30 day mortality: A single centre experience
Authors: Gok M A , Shams O , Ftaieh F , Khan U A
Published: October 2021

Aims

National emergency laparotomy audit (NELA) developed in 2014 in the UK, aims to improve of quality of care of patients undergoing emergency laparotomy. NELA highlights the importance of identifying high risk patients for potential significant morbidity and mortality. The aim of this study is to review the NELA 30 day mortality at a single centre.

Methods

This is a retrospective review of all 30 day NELA mortality patients since 2014 carried out at East Cheshire NHS Trust until January 2020. The NELA survivors beyond 30 days were used as controls.

Results

Conclusion

The overall NELA 30 day mortality rate was 9.8 %. NELA deaths occurred in the older, frail, multi-comorbid & high ASA status patients. Most NELA deaths occur within 90 days, whereas patient survival curve appears to plateau out beyond 90 days. P possum can be used to identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetists and intensivists may identify and allocate appropriate surgical intervention.
SP1.1.11Is polyp detection rate a suitable surrogate measure for adenoma detection rate in colonoscopy?
Authors: Javanmard-Emamghissi Hannah , Perry Isabel , Deb Rahul , Tierney Gillian
Published: October 2021

Aims

The Joint Advisory Group on GI Endoscopy (JAG) has set key quality indicators for colonoscopy, which includes an adenoma detection rate of a minimum of 15%. Given the difficulty in reporting adenoma detection rate, JAG have stated that polyp detection rate is accepted as a surrogate measure. Our aim was to assess whether polyp detection rate can be used as a substitute marker for adenoma detection, by examining the histology of samples taken as polyps to determine what proportion are truly adenomas.

Methods

The pathology department provided a registry of all histological samples taken from the colon or rectum during a one-year period April 2017 to April 2018. These samples were cross-referenced with the endoscopy report to assess which were identified as “polyps” by the performing endoscopist. The pathology report was then reviewed to determine what the histological conclusion was for each “polyp”.

Results

A total of 1601 colorectal histology samples were reviewed, taken by 32 different endoscopists. 451 of these were identified as polyps by the performing endoscopist. On histological review 153 (33.9%) were not adenomas of the colon or rectum. Common alternative histological diagnoses were hyperplastic polyp, inflammatory polyp and normal tissue. Rarer alternative histological diagnoses were melanosis coli, submucosal leiomyoma and endometriosis of the rectum.

Conclusions

Polyp detection rate which is used as a surrogate marker for adenoma detection rate is an inaccurate measure of colonoscopy quality.
SP1.1.13Assessing quantitative FIT within the colorectal two-week wait pathway as a triage tool to focus endoscopy services
Authors: Gendia A , Rottenburg H , Tam A , Faux W
Published: October 2021

Aims

Quantitative Faecal Immunochemical test (qFIT) is highly specific for luminal colonic pathology. This study models the potential impact on health care services of its introduction as a tool of triage for the 2-week wait referrals pathway. The Model utilises the recently published NICEFIT tudy.

Methods

All symptoms and results for patients within the colorectal two-week wait pathway are prospectively collated into a relational database. We modelled the impact of introducing targeted FIT testing to those patients without anaemia, rectal mass or overt rectal bleeding. Based on the recent NICEFIT Study, we set a population positivity value of 37% at 2µg/g with sensitivity of identifying colorectal cancer of 97%.

Results

4240 patients were referred in 12 months up to till July 2019. 1333 referrals met the modelled criteria. These 1333 patient events generated 1619 investigations in 1227 patients. Malignancy was found in 4.3% of the investigated referrals (2.8% colorectal, 1.5% extracolonic). By applying FIT to the selected demographics with a positive value of 37%, the number of colonoscopies would fall by 63% (from 815 to 303) with estimated cost saving of £192,000. The FIT negative group would be investigated by selective cross-sectional imaging, with selected use of endoscopy as needed.

Conclusion

The high sensitivity of FIT permits its application as a screening tool in selected symptomatic patients. This can reduce the number of colonoscopies performed by almost 63% within a defined patient group. This would reduce the waiting time for positive high-risk patients as well as cutting overall costs.
SP1.2.1The use of first-line CT scan in the Suspected Colorectal Cancer Pathway at a District General Hospital during the COVID-19 Pandemic
Authors: Connolly Thomas , Nicoll Jennifer , Hall Claire
Published: October 2021

Aim

During the initial phase of the COVID-19 pandemic the British Society of Gastroenterology and Joint Advisory Group on GI Endoscopy published guidance to halt all non-emergency endoscopy. CT was used as the first-line investigation with delayed completion endoscopy. We reviewed the efficacy of this change to determine its influence on future practice.

Methods

All patients referred via the suspected colorectal cancer pathway (SCCP) to our district general hospital from 15/04/20-15/05/20 (initial COVID-19 lockdown) were included. Retrospective analysis of patient records was performed. Results were analysed using χ² statistic. Significant incidental pathology (SIP) was defined as non-colorectal pathology requiring referral to different speciality or further imaging.

Results

There were 115 patients for analysis, mean age 68 years. 2/115 (1.7%) demonstrated a colorectal malignancy on CT, with no further diagnoses at completion colonoscopy. CT imaging detected SIP in 31/115 (27%). This included 8/42 (19%) who would have otherwise been referred direct to endoscopy alone based on symptoms and fitness.

Subgroup analysis by presenting complaint showed SIP was most likely to be detected in those presenting with weight loss (13/36, 36.1%, p = 0.049) or anaemia (12/31, 38.7% p = 0.084).

Conclusions

CT is a valuable first-line investigation in SCCP patients. In this cohort, no colorectal malignancies were missed on CT that were later detected at endoscopy and 27% detected SIP. Weight loss demonstrated a statistically significant correlation with incidental pathology. These findings suggest CT as a possible first-line investigation in patients presenting with weight loss, anaemia or where there is delayed access to endoscopy.
SP1.2.4A Single Centre experience in Robot-assisted Colorectal Surgery: First 70 cases
Authors: Rea William , Singh Sandeep , Nai Shaun , Kukreja Neil , Wegstapel Hendrik
Published: October 2021

Aim

To analyse the short-term outcome of robot-assisted colorectal surgery (RACS) in a single centre.

Methods

All the patients who underwent RACS using the DaVinci Xi platform between June 2018 and December 2020 were included in our study. RACS was performed by two consultant team. Data was collected from a prospectively maintained database.

Results

Over the 31-month study period, 70 RACS were performed with no 30-day mortality. Male to female ratio was 4:3, with mean age was 66 years (SD 12). The mean body mass index was 28.7 (SD 5.1). Pre-operative American society of anaethesiology (ASA) score was reported as 1-2 in 65% of patients and 35% as 3.

Indication for surgery was malignancy in 89% (62/70) of patients and the remainder benign pathology. Type of surgery performed was high anterior resection (AR) in 39% (27/70) patients, low AR 33% (23/70), right hemicolectomies 21% (15/70), Hartmann’s procedure 3% (2/70), abdominoperineal resections 3% (2/70), and left hemicolectomy 1% (1/70).

The mean operating time was 295 minutes (SD 92), with only 1 reported case of conversion to open. Complete resection (R0) was achieved in 95% (59/62) of malignant resections. The mean lymph nodes harvested were 19 (range 7-36).

Post-operative complications occurred in 23% (16/70) of patients, including 6% (4/66) anastomotic leaks. The mean length of stay was 8 days (range 1-53), with readmission rate of 14% (10/70).

Conclusion

The robotic minimally invasive technique can be safely introduced for major colorectal resections without excessive morbidity.
SP1.2.5Robot-assisted Colorectal Surgery: Short-term Outcome of First 70 cases at Different Time-intervals along the Learning Curve
Authors: Singh Sandeep , Rea William , Nai Shaun , Sollei Tamas , Kukreja Neil , Wegstapel Hendrik
Published: October 2021

Aim

To analyse the evolution of robot-assisted colorectal surgery (RACS).

Methods

All the patients who underwent RACS between June 2018 and December 2020 were selected. Study period was divided into 3 intervals along the learning curve; group A represents the 1st 10 months, group B 2nd 10 and group C last 11.

Results

Over the 31-month study period, 70 RACS were performed. Male to female ratio was 4:3, with mean age of 66 years and BMI 28.7. ASA score was reported as 1-2 in 65% patients and 35% as 3.

Indication was malignancy for 89% patients and the remainder benign pathology. High or low anterior resection performed were 72%, right hemicolectomies 21%, Hartmann’s 3%, abdominoperineal resections 3%, and left hemicolectomy 1%.

RACS performed in group A was 20 compared to 19 in B and 31 C. Type of RACS performed, BMI, ASA, complications, anastomotic leaks, R0 resections and harvested lymph nodes were unrelated to selected time-intervals along learning curve. Mean total duration of procedure dropped down to 247 minutes in group C from 375 in group A (p = <0.001). No significant difference in mean length of stay and readmission rate was observed in 3 groups (p = 0.7, p = 0.59).

Conclusion

The study demonstrates that introduction of this new surgical technique is safe even in the early phase of adoption with no significant difference in pre-and post-operative morbidities. Significant difference in time taken for surgery was observed with reduction of 88 minutes in average operating time between the start and end of the study.
SP2.1.9Augmented terminal feedback influences cognitive ability of surgical trainees: a randomised controlled trial
Authors: Riaz Mohammad , HO Rachel Phing , Tang Benjie , Alijani Afshin
Published: October 2021

Introduction

Formative assessments in the form of Global assessment (GAS) and procedural based assessment (PBA) are the current methods used for feedback in British laparoscopic surgical training. Video error signature feedback (VESF) has been proposed as an alternative approach to enhance motor skills in laparoscopic training through influencing cognitive approach.

Methods

Twenty laparoscopic novice students were randomised into Current standard feedback (CSF) and VESF groups. Both groups tied laparoscopic double square knots in four sequential stages. Standard human reliability assessment method (HRA) was utilised to assess unedited video recordings for errors. A validated scoring system by expert trainers assessed proficiency gain. Similar assessment was performed for both groups. Unedited video recordings of the VESF group were annotated for errors at each stage and provided as feedback through video hosting website. CSF group received assessment sheet as their feedback, comparable to current practice. Error numbers, time execution and proficiency gain were the outcomes. Inter-rater reliability among trainers for error detection was established.

Results

A total of 6490 movements were studied with 1613 errors detected. VESF group committed significantly less errors as compared to the CSF group [1011/1613 (63%) vs 602/1613 (37%), p < 0.01]. VESF group gained proficiency earlier. Time execution was similar. Inter-rater reliability for error detection was high (p = 0.96).

Discussion

VESF effects cognitive framework of a laparoscopic task in trainee’s mind, ultimately reducing errors. This work demonstrated the practical application of video error signature feedback by demonstrating a simple laparoscopic task and analysing its learning process through novice brains.
SP2.2.4National multi centre cohort study of transferable skills acquired among redeployed core surgical trainees to intensive care units during the COVID-19 pandemic
Authors: Vyrides Yiannis , Golpe Antonio Leyte , Shirazi Shahram , Bogdanova Anna , Daum Peter , Wan Andrew
Published: October 2021

Aim

Due to the COVID-19 pandemic a large number of core surgical trainees have been redeployed to intensive care units across the country. This study analyses the procurement of transferable skills by trainees mapped to the ISCP curriculum among a large national cohort.

Methods

An anonymous questionnaire mapped to common areas in the ISCP syllabus, including basic sciences, post-operative care, critical care and management of the dying patient, was administered to a nationwide group of core surgical trainees redeployed to ITU. The results were compared with responses from a cohort of trainees that were not redeployed. Subgroup analysis was also performed on the redeployed cohort to compare skills before and after redeployment.

Result

A total of 72 complete responses from among 3 deaneries nationwide were received, 39 who were redeployed, and 33 who were not. Mean age (24.5 vs 24.9 years) and time post-graduation (37.5 vs 38.2 months) were similar in each group. The average length of redeployment was 12 ±0.157 weeks. The mean score in those not redeployed was 1.85 ±0.167, compared to 4.02±0.175 in the redeployed cohort (p < 0.05). Among those redeployed, scores prior to redeployment were significantly lower 1.89 ±0.122 (p < 0.05).

Conclusion

This study demonstrates that even a brief period of intensive care experience significantly increases knowledge of key aspects of the ISCP curriculum. It is the authors’ opinion that a module of intensive care experience during core surgical training should be considered. Our cohort will be followed to assess performance in postgraduate examinations.
SP2.2.9Using high fidelity simulation to improve hospital-based medical student education
Authors: Huttman Marc , Koo Hui Fen , Boardman Charlotte , Saunders Michael
Published: October 2021

Introduction

The evidence shows that experiential learning has multiple benefits in preparing medical students for foundation training. An immersive ‘on call simulation’ session was designed for final-year medical students at a district general hospital. The aim of this project was to assess how beneficial the sessions were and how they can be improved.

Methods

Pairs of students received 12 bleeps over 2 hours directing them to wards where mock patient folders were placed. Students prioritised bleeps involving deteriorating patients, chasing results and dealing with nursing queries. Simulated senior input was available from the session facilitator. A structured debrief session allowed discussion of each case. Quantitative feedback was gathered using a sliding scale (measured in percentage) for confidence before and after the session. Qualitative feedback was gathered using a free-text box.

Results

Four sessions were held between October 2020 and January 2021 for a total of 28 students, of which 26 provided feedback. Average confidence increased from 38% to 66%. 96% of students were ‘extremely satisfied’ with the session. Feedback included: “Incredibly immersive and fun” and “I was made to think through my priorities and decisions”. Improvements could be made by using actors/mannequins to simulate unwell patients and by use of skills models.

Conclusion

High fidelity simulation training is valuable and should be considered a standard part of the student curriculum. It is particularly suited to final year students who have the required clinical knowledge for foundation training but are still developing confidence in clinical decision making and prioritisation.
SP2.2.14Evaluating the benefits of increasing exposure to the operating theatre for Foundation Year One Trainees in General Surgery
Authors: Fardanesh Armin , Boardman Charlotte , Al-Whouhayb Maitham , Mathur Pawan , Klein Martin
Published: October 2021

Aims

Many foundation year one (FY1) doctors report little exposure to the operating theatre. Surgical departments welcome FY1s in theatres, but ward duties often prevent them from achieving direct exposure to operations. Following the implementation of specific days on the timetable dedicated to attending the operating theatre, this project aimed to reflect on the impact on FY1 training in General Surgery.

Methods

Structured interviews were held with the 9 FY1 doctors who were 2 months into their rotation in General Surgical block.

Results

All FY1s believed that assisting in operations added to their experience of the specialty. They reported increased understanding of the procedures and recovery pathways for their patients, which improved their ability to manage these patients peri-operatively.

As expected, seven FY1s confirmed that they did not have the opportunity on non-allocated days to attend theatre due to “being busy on the ward” and not wanting to “give the others more work”. Two FY1s who intend on pursuing a career in surgery described additional benefits including the opportunity to gain practical skills and build a surgical logbook.

Conclusion

One of the main barriers for FY1s wanting to attend theatre sessions is an excessive ward workload. By allocating theatre days on the rota this challenge was overcome and the benefits of attending theatre are evident. Regular exposure to the operating theatre improves foundation training in General Surgery by increasing understanding and confidence in managing surgical patients and assisting prospective surgical applicants with early, supervised surgical skills practice.
SP2.2.18UK Surgical Training in the Independent Sector During COVID-19 – A Snapshot Survey
Authors: Kolaityte Valdone , El-Sayed Charlotte , Burke Josh
Published: October 2021

Aims

In response to the COVID-19 pandemic and the cancellation of elective surgery, the Independent sector (IS) has been utilised to provide COVID-light sites. On average operative log book numbers have been reduced by 50% due to a reduction in operative exposure. The Four Educational Bodies continue to support training within the independent sector. This study aimed to qualitatively assess access and barriers to UK surgical training in the Independent Sector.

Methods

A snap-shot online survey was distributed to ASIT members of all training specialities and grades between 21/10/2020-11/11/2020 . Data measures included participant demographics, frequency of access, participation in training opportunities including outpatient clinic, theatre lists and endoscopy and any barriers encountered. A mixture of Likert scale and short answer questions were utilised.

Results

249 complete responses representing all grades and specialities were included in the final analysis (34.29% CST and 56.3% HST). 35.7% of trainees reported access to the IS. 22.9% had access to at least one operating list whilst 70.3% had none. Access to outpatient clinics and endoscopy was negligible. 75% of trainees ‘strongly agreed’ that when access was achievable, it was beneficial to their training. Multiple barriers were identified including Human Resource requirements and local service provision.

Conclusions

Within the sample, access to the IS has been poor. There is wide variation in barriers to access across the 4 nations and IS providers. Trainees and Trainers should maximise training opportunities in the IS. Where barriers exist, they should be reported to local Training Programme Directors.
SP3.1.14 NELA; what happens after discharge?
Authors: Mohamed Sarah A , Silva L , Strong P , Dietrich A , Cornish J
Published: October 2021

Aims

NELA has been instrumental at improving perioperative care and 30–day mortality following emergency laparotomy (EmLap); long-term outcomes and follow-up are less well reported. This study aims to establish the unscheduled and scheduled service use of EmLap patients after discharge.

Methods

This is a single-centre service evaluation. Patients were included if they had an EmLap recorded from 2016-2019 at our local institute and were alive on discharge. Outcomes were 30-day readmission rate and outpatient follow-up.

Results

944 patients were included. 11.9% re-presented to the surgical department within 30-days; 58.0% of these needed readmissions. The most common causes for re-presentation (n = 112) were management of a wound issue (15.2%), ongoing pain without evidence of complication (10.7%) and ongoing intra-abdominal sepsis (9.8%).

1-year survival was 81.4%. Of these (n = 856); 74.3% were invited to outpatients; DNA rate was 8.8%, with only 67.8% of patients having a follow-up review. Median time to follow up was 9 weeks. Patients were more likely to be invited for outpatient review if they had a new stoma (OR 2.56, 95% CI 1.81 – 3.56), and less likely if adhesiolysis was the primary procedure (OR 0.55, 95% 0.39-0.76).

Patients who failed to attend an appointment were significantly younger (median age 53 vs. 60 years, p = 0.0033) and from more deprived areas (average WIMD 673.6 vs 977.3, p = 0.002).

Conclusion

This study demonstrates higher levels of unscheduled care and lower levels of scheduled care than expected. Care standards should be extended beyond the 30-day milestone to fully appreciate the morbidity associated from EmLap.
SP3.2.2 Closed Incision Negative Pressure Wound Therapy reduces Surgical Site Infection following Emergency Laparotomy: A Propensity Matched, NELA Registry Study
Authors: Hawthornthwaite Emma , Cheong-Chung Jordan Ng- , Watkinson Tom , Blyth Ursula , Harji Deena , Griffiths Ben
Published: October 2021

Aims

Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in people undergoing emergency surgery. Prophylactic closed incision negative pressure therapy (CINPT) has been shown to reduce SSI rates in patients undergoing elective laparotomy however there is limited evidence for their use in the emergency setting. This study aimed to determine whether prophylactic CINPT provides comparable SSI rate to SSD for midline incision following emergency laparotomy.

Methods

A registry-based, prospective cohort study was undertaken using data from National Emergency Laparotomy Audit (NELA) database at our centre. The primary outcome measure was SSI as defined by the Centers for Disease Control (CDC) criteria. Secondary outcomes included 30 day post-operative morbidity and grade using Clavien-Dindo (CD) classification and the Comprehensive Complication Index, length of stay, 30 day mortality and readmission rates. CINPT and standard surgical dressing group were compared with respect to peri-operative characteristics and post-operative outcomes. A propensity- score matching (PSM) was performed to mitigate for selection bias.

Results

A total of 1484 patients were identified. Following PSM, a matched cohort of 474 patients were identified with 237 patients in each arm. SSI rate in CINPT cohort was found to be significantly lower compared to the SSD cohort (16.9% vs. 33.8%, p < 0.001). The rate of superficial and deep infections were higher in the standard dressing arm compared to the CINPWT, p < 0.001. There were no overall differences in 30-day morbidity and grade of post-operative complications.

Conclusion

Prophylactic CINPT in the emergency laparotomy is associated with reduced SSI rates.
SP4.1.2 Appendicitis during the COVID pandemic – Are we seeing more complicated presentations?
Authors: Wadham Bianca , Connolly Tom , Beer Phoebe , Ainsworth Paul
Published: October 2021

Aims

Studies have suggested a decrease in emergency presentations of appendicitis during the COVID-pandemic along with a nationwide fall in non-COVID related presentations to A&E. We therefore hypothesised that those treated for appendicitis had later presentations resulting in increasing incidence of ‘complicated appendicitis’ and post-operative complications.

Methods

We retrospectively analysed all patients ≥16years, undergoing emergency appendicectomy during 3-month period of UK national lockdown (pandemic cohort). Data was compared to the same period one year previously (pre-pandemic cohort). Primary endpoint was nature of appendicitis (uncomplicated or complicated). Secondary endpoints were operative approach, LOS and post-operative complications. Statistical analysis was performed using Fisher’s Exact Test.

Results

A total of 31 patients (median age 35years) underwent emergency appendicectomy in the pre-pandemic cohort and 30 patients in the pandemic group (median age 37). 9/31 (29%) and 18/30 (60%) were found to have complicated appendicitis in each group respectively (p = 0.021). Open procedures took place in 2/31 pre-pandemic, and 12/29 (4 of which were converted from laparoscopic procedures) in the pandemic cohort (p = 0.002). Median LOS was 2 in each group, though the pandemic cohort had a much wider range (0-7 vs 0-25 days). Post-operative complications occurred in 1/31 and 5/30 patients respectively (p = 0.104) with 1 mortality within 30 days.

Conclusions

Despite overall volume and demographics of patients remaining the same, the COVID-19 pandemic has resulted in a statistically significant increase in complicated presentations of appendicitis to our hospital. Subsequently this has resulted in increasing incidence of open operations and post-operative complications.
SP4.1.4 Stay at home, protect the NHS, Save lives? The impact of the COVID-19 pandemic on acute surgical services
Authors: Brewster Oliver , Thompson Dale , Sewart Emma , Richards Sarah
Published: October 2021

Aims

Several centres described a ‘lockdown effect’: a reduction in emergency surgical admissions during national lockdown (23/03/20-01/06/20). The extent and reproducibility of this is unclear. We evaluated the impact of the COVID-19 pandemic on emergency general surgical activity in a district general hospital.

Methods

We conducted a retrospective analysis of patients admitted under general surgery and urology between 01/01/2017-31/12/2020 using coding data. Unpaired t-tests were used to compare the total monthly admissions, admissions by diagnosis and monthly operations performed between the ‘first wave’ (April-May 2020) and ‘average’ (all months 2017-2019), and between the ‘second wave’ (November-December 2020) and average.

Results

Overall emergency admissions in 2020 were reduced compared to the mean 2017-2019 (4498 vs 5037). Monthly admissions were significantly reduced in the first wave compared to 2017-2019 (mean monthly admissions=284.5 vs 419.8; p < 0.001) with the greatest reduction in patients with non-specific abdominal pain (mean=58 vs 109; p = <0.001). A significant reduction in monthly admissions with pancreatitis (mean=8.0 vs 14.6; p = 0.010) and diverticulitis (mean=10.5 vs 18.8; p = 0.028) were also observed. This effect was less apparent during the second wave (mean total admissions=384.5 vs 419.8; p = 0.249). Monthly emergency operations were reduced in both the first wave compared to average (68 vs 101.9; p = 0.007) and the second wave (74.5 vs 101.9; p = 0.025).

Conclusions

We found strong evidence of a ‘lockdown effect’ in our centre during the first wave. The cause is unclear and likely to be multifactorial. Further research is needed to evaluate whether surgical patients came to harm as a result.
SP4.1.7 Colorectal Cancer: Pathway Disruptions as a Result of COVID-19
Authors: Spyropoulou Liana E , Curley Daniel , Li Mimi , Martin Estelle , Wynn Greg , Doulias Triantafyllos
Published: October 2021

Aims

COVID-19 has impacted diagnosis and treatment of colorectal cancer. Efforts to minimise patient contact have caused delays in cancer pathways, generating a potential risk to patient care. We aim to identify the pandemic effect on colorectal referral pathways.

Methods

All cancer referrals during March-June 2020 were reviewed to obtain information on the timeline and planning of investigation and treatment. The data was compared to evidence from the same referral period in 2019.

Results

681 referrals were received during March-June 2020, compared to 1032 in 2019, indicating a 34% decrease. The majority of patients were reviewed in telephone clinic (76.2%) rather than physical appointments (15.4%). Although the commonest mode of investigation was endoscopy(46.2%), there was increased use of CT scan(35.8%). 114(17.1%) patients were not investigated, of which 40(35.1%) declined investigation, primarily due to COVID-19 apprehension. 6 patients were re-referred and 67(58.8%) were removed from the pathway for unknown reasons. 1 patient was subsequently admitted as an emergency. There were 44 new diagnoses of colorectal cancer based on MDT discussion, of which 14(31.8%) breached the investigation and 20(45.5%) the treatment date. 18 underwent curative surgery compared to 47 in the same period in 2019, indicating 61.7% less operative activity.

Conclusions

COVID-19 has changed surgical practice, forcing alternative clinic, investigation and treatment methods. Disruption of colorectal pathways is causing reduced referrals, investigation delays and less surgical activity. Delayed presentation with advanced disease may deprive the opportunity of treatment with curative intent.
SP4.1.11 Acute general surgical emergency and COVID-19 is a pandemic challenge for surgeons: a UK based practical experience
Authors: Nahid Md Abu Kamal , Rahman Sanjida , Shah Ankur
Published: October 2021

Background

Transmission of COVID-19 is a considerable risk during the perioperative period of emergency surgery. We aimed to provide a practical experienced adaptation to reorganize the emergency surgical pathways during the COVID-19 pandemic.

Methods

A prospective observational study was performed between 30th March 2020 to 30th June 2020 at a large DGH in England. The primary outcome was perioperative COVID-19 related complications and secondary outcome measures included incidence of COVID-19 infections among the surgical doctors and healthcare workers. Data was collected on the number of acute surgical admissions and operations performed. The perioperative COVID-19 status of the patients, doctors and the healthcare workers were recorded.

Results

584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted with COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors, 11 nurses and theatre staff were confirmed for COVID-19 by swab test. Acute cholecystitis and early appendicitis were managed conservatively.

Conclusion

High mortality (20%) observed among the patients who contracted COVID-19 perioperatively. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.