bluuebunny/crossref_metadata_2025 huggingface dataset:
SP5.13 - Assessing the use of electronic QLIK app in Mortality and Morbidity meetings compared with traditional manual hand collected data in colorectal surgery
Authors: Soon Justin , Moriaty Karmena , Jones James , Grimble Sarah , Allen Ultan , Humes David
Published: September 2024

Aims

To validate and compare the effectiveness of the QLIK app as an electronic method of data collection compared to traditional manual methods for mortality and morbidity meetings (M&Ms).

Methods

All data from the theatre operating management system was linked in the Trust Data Warehouse to clinical test and vital statistics data and displayed using a QLIK App. A retrospective study was conducted comparing the manual collection of data of elective colorectal M&M with the QLIK app data for the years 2021 and 2022. Data collected included: total operations, number of deaths, readmissions, reoperations and post-operative complications. The combined data was then analysed in three different rounds of validation.

Results

There was a high level of concordance between the manual data and the QLIK app, with both correctly identifying the same number of deaths. In 2021 the app recorded 569 total operations compared to 584 in the manual data, and 127 post operative complications to 126 respectively. In 2022, the app recorded 607 operations to 489 in the manual data, and 120 complications compared to 149. Of the complications recorded in the manual data but not the app, 96.8% of these were Clavien-Dindo Grade 1 and 2 complications. Manual data collection of the M&M data was estimated to take approximately 250 hours per year from collection to analysis, whilst the app displayed the data in near real time.

Conclusions

Use of data visualization tools and coded electronic hospital data for M&Ms can minimise errors and allow for greater efficiency. This approach gives real time surgical performance data.
SP6.4 - Were QR codes to distribute information to patients following a consultation beneficial in a clinical setting?
Authors: Murthy Neel , Murthy Krishnamurthy S
Published: September 2024

Aims

To investigate whether the use of QR codes to distribute information from brochures online would be accepted and preferred by patients compared to physical paper brochures; If paper waste can be reduced - fewer brochures being printed and discarded and hence eco-friendly and cost effective

Methods

Benign breast conditions were chosen for this project and QR codes generated with specific URLs for each booklet linked to a scannable QR code. At the end of clinical consultation, the Consultant invited and guided patients to scan the QR code brochure specific for their symptoms. 60 patients, from October 2022 to March 2023 were invited to take part in this original study, as a part of their consultation, with their responses gathered and analysed.

Results

60 patients completed the feedback form with a 100% response rate. The age range was 20 to 70 (mean age = 45 years), of which 76.7% were aged under 50 years, and 96.7% were female. The majority (78.3%) preferred accessing an electronic leaflet via a QR code instead of a paper leaflet, and 88.3% found it easier to access information online via the QR code over other methods to access websites.

Conclusions

The majority of the patients were satisfied/very satisfied with the use of QR codes to access the online brochures. Although this was a simple study, it provides the basis to design a larger trial with a standardised methodology procedure, so that we can draw meaningful results from appropriate statistical analyses.
SP6.7 - Exploring the Mechanistic Basis of the Adipose Derived Stem Cell Secretome on Extracellular Matrix Remodelling in Radiation Induced Fibrosis
Authors: Wai Jasmine May Yen , Cui Xiangmei , Frommer Marvin , Langridge Benjamin , Butler Peter
Published: September 2024

Background

Radiation-induced fibrosis (RIF) is a debilitating complication following radiotherapy, characterised by fibroblast proliferation and excessive extracellular matrix (ECM) deposition, leading to functional and aesthetic impairments. Although autologous fat grafting (AFG) has shown promise in reversing RIF, the mechanisms, largely attributed to adipose-derived stem cells (ADSCs), remain elusive. This study aimed to investigate ADSCs’ and their secretome on ECM remodelling in RIF management.

Methods

The anti-fibrotic potential of the ADSC secretome on HDFs subjected to ionising radiation was assessed via a series of in vitro experiments. Control HDFs were compared with irradiated HDFs to assess any phenotypical changes. Irradiated HDFs were treated with ADSC pre-conditioned media (CM) or ADSC co-culture (CC). Gene expression (COL1A1, TGF-β1, CCN-2, MMP-1, MMP-3, TIMP-1, ACTA2, TNC) was assessed via real-time quantitative PCR (RT-qPCR). ProCollagen1a1 and CCN2 protein concentrations were assessed by ELISA.

Results

Irradiated HDFs demonstrated changes in fibrotic gene expression. ADSC-CM treatment significantly reduced COL1A1 expression, although protein levels remained unchanged. TGF-β1, CCN2, MMP-3, TIMP-1 and ACTA-2 exhibited reduced expression post-ADSC-CM treatment whereas TNC expression was found to be significantly increased. Co-culture with ADSCs led to a general, but not statistically significant, decrease in pro-fibrotic gene expression. Notably, CCN-2 protein expression significantly increased.

Conclusion

This study demonstrates that ionising radiation results in a pathological pro-fibrotic phenotype in HDFs. The ADSC secretome potentially mitigates this, reducing pro-fibrotic gene expression. Unexpectedly, co-culture experiments highlighted a complex interaction with upregulation of fibrosis-associated genes. Further research is needed to clarify these interactions to improve therapeutic interventions for RIF.
SP7.5 - Time to CT for Acute General Surgery and Trauma in patients undergoing emergency laparotomy. A major trauma centre experience
Authors: Green James , Yung Diana , Frith Daniel
Published: September 2024

Introduction

In our institution separate care pathways exist for patients presenting with major trauma and acute abdomen (AA). Trauma patients activate a Consultant led trauma team attendance on arrival and CT imaging within 30 minutes where indicated. Our acute abdomen pathway attracts ST3+ general surgical review within 2 hours of emergency department referral and CT within a further 1 hour. We aimed to compare the two laparotomy cohorts with respect to clinical outcomes.

Methods

A retrospective analysis was performed on patients that underwent an emergency laparotomy following CT at our institution between December 2020 and February 2022. Patients were identified from the NELA and TARN databases.

Results

66 trauma and 64 AA patients were identified. The mean time to CT in trauma was 56.1 minutes ± 24.8 and in AA 390.7 minutes ± 306.1 (p<0.001). There was no difference in length of ITU stay (mean days 3.1 ± 8.1 vs 4.2 ±9.8 p=0.260) or hospital stay (mean days 13.7 ± 19.2 vs 13.8 ±11.7 p=0.494). no correlation between time to CT and length of hospital stay (r=0.233 p=0.97) or ITU stay (r=0.224 p=0.964) in trauma patients or AA (r=0.217 p=0.58 and -0.001 p=0.562 respectively for hospital and ITU stays) was detected. However, there was a trend towards lower mortality in the trauma cohort (3% vs 7.8% p=0.227).

Conclusion

Trauma patients were scanned quicker than acute abdomen presentations likely due to greater personnel resource and better care pathways. This was associated with a trend towards lower mortality because of earlier pathology detection and Consultant directed care from hospital arrival.
SP7.7 - A 6-month retrospective re-audit of “Code Red” trauma requiring surgical intervention in a regional major trauma centre
Authors: Winter Jonny , Yoong Susan
Published: September 2024

Aim

Major trauma (MT) is a significant cause of morbidity and mortality in the United Kingdom, with an estimated incidence of 20,000 cases annually in England. A certain proportion of patients presenting following MT require immediate operative intervention. This study is a re-audit of the process for managing these patients in order to assess the impact of introduction of a Damage Control Surgery (DCS) pathway.

Methods

Data were reviewed for all patients presenting as Code Red MT and requiring immediate operative intervention from May to November 2023. This accounts for all patients since the implementation of the DCS pathway. Patient details were taken from a MT database, Electronic Care Records were used to determine aetiologies of trauma and outcomes, and Theatre Management System software was used to determine timings.

Results

9 patients were identified, with a median age of 30.33. 89% of patients underwent preoperative CT imaging, with an average time to CT of 15 minutes (range 5 to 57 minutes). Median time to theatre was 88 minutes (range 39 to 325 minutes). Specialties involved included General Surgery, Vascular, Cardiothoracics and Trauma and Orthopaedics, with multispecialty involvement in some cases. Overall mortality was 22%. Seven cases were the result of road traffic collisions.

Conclusions

MT remains a significant cause of mortality in our cohort, but implementation of a DCS pathway has led to significant improvements in both time to CT and time to theatre compared with our initial audit cycle (32 minutes/144.5 minutes).
SP7.11 - Long term mortality risk factors for patients that underwent a Carotid surgery
Authors: Olivier Axel , Thawabeh Abdullah , Slim Hani , Odiase Ruth , Valenti Domenico , Pal Singh Gambhir Raghvinder
Published: September 2024

Aims

Carotid endarterectomy is the gold standard intervention to reduce carotid stenosis induced embolic cerebrovascular events. Current literature lacks long-term large sample analysis for post-carotid surgery mortality risks. The aim of this study was to determine long term all-cause mortality after carotid surgery.

Method

Single centre 10-year retrospective observational study of CEA mortality evaluating pre, intra and post-operative factors between 2010 and 2020. The data was manually extracted from the hospital’s database. Odds ratios and mortality rates were calculated and adjusted for age by adapting linear regression.

Results

970 patients’ data were identified with an average follow up of 6.65 ±3.37 years for an average mortality rate of 31.9%. There was a non-significant (p>0.05) age adjusted odd of survival between gender (aOR 1.81 ±0.298) elective admission (aOR 0.932 ±0.321) and symptomatic patients (aOR 1.274 ±0.47). There was a significantly (p>0.05) decreased chance of survival for current smokers (aOR 0.433 ±0.54) and patients on ACE/ARB (aOR 0.516 ±0.091). On the other hand, single (aOR 2.934 ±0.531) and dual anti-platelet (aOR 4.964 ±0.286) showed a significant (p>0.05) protective effect. The 5-year age-adjusted death rate was elevated for all patients at 1.42.

Conclusion

The results highlight the smoking cessation, DAPT and appropriate prophylaxis remain important factors in increasing survival odds post carotid surgery. 30% mortality at 5 years is similar to those after Aortic interventions in these arteriopathic patients with extensive co morbidities.
SP8.6 - Exploring Barriers of Entry for Women Pursuing Surgery: Impact of a Conference on the Confidence, Understanding, and Preparedness of Attendees
Authors: Tagalpallewar Samruddhi , Melloul Lara
Published: September 2024

In the UK, women are underrepresented in surgery. Women make up only 16% of consultant surgeons and 34% of surgical registrars in the UK, whilst 59% of medical students are female. This project aims to explore the impact of conferences on perceived barriers and attitudes of female medical students aspiring to become surgeons.

A survey was administered to 130 attendees, yielding 95 eligible responses, at a national student-led conference held at UCL encompassing speaker events, workshops, and speed mentoring. Pre- and post- questionnaires were provided. This included an open ended question on personal barriers, and a 5-Point Likert Scale to assess opinions on barriers of entry, confidence in surgical skills, preparedness for a surgical career, and understanding of challenges faced by women in surgery. Wilcoxon Signed-Ranks Test was used to assess statistical significance.

The study included participants aged 18-30 from 23 universities and NHS trusts, representing 7 ethnic groups and 12 medical professions, with medical students comprising 87% of the cohort. Following the conference, 14 barriers of entry were analysed and there was a notable average increase in measured outcomes: confidence in surgical skills by 175%; preparedness by 192%; and understanding of the challenges faced by 177%. Overall, an average increase of 181% across reported metrics.

Overall, the study data has demonstrated the effectiveness of the UCL Women in Surgery conference in empowering students pursuing surgical careers. Specialised conferences offer safe spaces for networking, mentorship, and field insights, while also mitigating financial barriers through low registration costs. Representation matters, and supporting aspiring surgeons by addressing barriers of entry for women is crucial.
SP8.7 - The Impact of Covid-19 on ARCP Outcomes issued to Higher Specialty Trainees in General Surgery
Authors: Barter Charlotte , Humes David , Lund Jon
Published: September 2024

Aims

To quantify the impact of the Covid-19 pandemic on the Annual Review of Competency Progression (ARCP) outcomes of higher specialty trainees in General Surgery in the UK.

Methods

All ARCP outcomes awarded to higher specialty trainees in General Surgery between 2017 and 2022 were collated from Intercollegiate Surgical Curriculum Programme (ISCP). Associations between year, trainee sex, age, stage of training, and outcome were explored using multivariate logistic regression models.

Results

A total of 7,414 outcomes issued to 1,874 trainees were analysed. The Adjusted Odds Ratio (AOR) of receiving a non-standard outcome in 2020 (compared to 2017) was 3.07 (95% CI:2.47–3.81, P<0.001) and this remained elevated through 2022 (2.11, 95% CI:1.69–2.64, P<0.001). Female (AOR 1.27 (95% CI: 1.13–1.43, P<0.001) and older trainees (1.51 (95% CI:1.34–1.70, P<0.001) were more likely to receive non-standard outcomes. Being at a later stage of training during the pandemic did not increase the chances of receiving non-standard outcomes (AOR 1.09, 95% CI:0.97-1.22, P=0.134), but more outcomes advising extra training time were issued to this group (15.5% versus 4.3% in 2021). There was significant regional difference in the use of Covid-19 outcomes. The awarding of non-standard outcomes rose most years, even outside of the pandemic.

Conclusions

The Covid-19 pandemic had significant impact on the training trajectory of UK General Surgical trainees. Female and older trainees were more likely to receive non-standard ARCP outcomes before and during Covid-19. Urgent efforts are required to restore surgical training, and addressing differential attainment is essential for success.
SP8.11 - Conflict Resolution in Surgery
Authors: Castelhano Rute , Riding David
Published: September 2024

Aim

In our study, we dive into perspectives gathered from academic and public investigations, shedding light on how patient safety is at risk when communication and professional behaviours crumble within surgical teams. Despite clear evidence, current educational paths for both undergraduates and postgraduates prioritise surgical knowledge and skills, sidelining the crucial aspects of effective teamwork and conflict resolution. The increasing diversity in the surgical workforce, paired with a spectrum of personalities, emphasises the urgency of evaluating the evidence base on how interpersonal conflict impacts and exploring effective interventions. This evaluation is pivotal for shaping the direction of future curricula.

Methods

We took a systematic approach, exploring databases using keywords like "conflict resolution," "surgery," and "healthcare professionals," and related terms. Following PRISMA guidelines, we analysed identified studies, resolving any discrepancies through collaborative discussions among reviewers.

Results

Sixty-three studies reveal the adverse effects of interpersonal conflict on healthcare professionals (HCPs), leading to stress, burnout, job dissatisfaction, and compromising team effectiveness and patient safety. Conflict causes were categorised into systemic and interpersonal factors, with resolution interventions focusing on improving communication skills, organising team-building workshops, and facilitating debriefing sessions. Despite recognising the value of conflict resolution, variations in strategies were noted across different surgical specialties.

Conclusion

This systematic review underlines interpersonal conflict within surgical teams as a significant threat to patient safety and the well-being of healthcare professionals. The literature exposes strategic diversity in reported educational interventions, advocating for the integration of formalised training in teamworking and conflict resolution—an often overlooked yet vital component in surgical curricula.
SP9.4 - Post-operative outcomes after emergency stoma surgery in frail older adults in the West of Scotland
Authors: Venkata Sujashree Yadala , Bayne Fraser , Kulasekaran Ajitha , MacDonald Scott , Moug Susan , Creamer Felicity
Published: September 2024

Aim

An emergency laparotomy (EmLap) is a common surgical procedure in the United Kingdom for older adults aged 65 and above. A significant proportion of the EmLap population is frail (20%), which is associated with increased post-operative mortality and care requirements. Stoma formation is often preferred over a bowel anastomosis in this frail population, as an anastomosis is often considered too high risk. However, there is a lack of research describing post-operative outcomes after emergency stoma surgery for this frail older adult population.

Methods

A retrospective review of a prospectively maintained EmLap database (ELLSA) across 3 hospitals was performed between December 2019 to 2022. Older adults undergoing emergency stoma formation per NELA criteria were included. All patients had 1-year minimum follow-up. A Rockwood frailty score of more than 4 was considered ‘frail’.

Results

234 older adults were identified (Median age: 74 years (Range: 65 to 91 years); 23% frail; Median follow-up: 27 months). 30% of frail patients died within 30-days, compared with 19% of non-frail patients (p=0.04). Of the frail survivors, only 47% were managing their stoma independently (compared with 76% of those without frailty, p<0.001) and 20% were in new long-term care (compared with 6% of those without frailty, p=0.002).

Conclusion

Frail older adults experience unfavourable outcomes after emergency stoma surgery, indicated by higher mortality rates and a limited ability to manage their stomas independently. Therefore, in selected cases, these patients may benefit from discussion around a higher risk anastomosis rather than a stoma. This study underscores the importance of further research to identify such patients and enhance pre-operative supported decision-making processes.
WP1.8 - No, we can’t repair your hernia: An audit to assess pre-operative optimisation for umbilical hernia repair
Authors: Kabir Tahmid , Lingam Gita , Sivarajah Vernon
Published: September 2024

Aims

The European Hernia Association recently published guidelines which clearly outline the importance of pre-operative optimisation for those undergoing elective umbilical/epigastric hernias. The main factors of importance are: smoking cessation and BMI <35. This audit aimed to identify if we are adequately optimising our patients.

Methods

We retrospectively evaluated all elective umbilical hernia repairs from 1st January 2022- 31st December 2022 within a district general hospital setting. Clinic letters and pre-operative records were used to ascertain smoking status, BMI and diabetic control (HbA1c).

Results

60 umbilical hernias were performed in our district general hospital setting from 1st January 2022- 31st December 2022. Of these patients, 12% (N=7) were known smokers and 13% (N=8) had a BMI of over 35 documented. Additionally, only in 15 cases, was there clear documentation of the patient smoking status. Out of these patients, 9 were subsequently found to be non-smokers and 6 remained smokers despite being given smoking cessation advice. Furthermore, in 10% (N=6) of these cases, there was poor diabetic control (HbA1c > 48), which was not addressed in clinic pre-operatively.

Conclusion

Patient factors such as smoking, obesity and diabetic control have been shown to significantly increase the rate of post-operative wound infections and complications. Patients are not being adequately optimised for elective procedures which puts them at increased risk of complications and increases the burden on limited NHS resources.
WP1.9 - An audit of prophylactic antibiotic use in elective inguinal hernia repair
Authors: Hume Claire Johnston , Dunlop Hannah
Published: September 2024

Aims

National guidance states that antibiotic prophylaxis is not indicated in low-risk patients undergoing inguinal hernia repairs and that high-risk patients require a single dose. This audit aimed to compare the use of prophylactic antibiotics by general surgeons in a district general hospital performing elective inguinal hernia repair, to the current national guidance. The rate of post-operative wound infection was also recorded.

Method

All patients who underwent an elective inguinal hernia repair in the six months between January and June 2023, were identified retrospectively via the hospital database. Data was collected via the electronic patient record system on whether patients were prescribed antibiotics prophylactically at the time of surgery. Data was also collected on patient demographics including sex, age, BMI and rate of post-operative wound infection.

Results

The patient cohort was 94% male with an average age of 64. 94.79% of repairs were open. 53.33% of patients received antibiotics in line with national guidelines. Overall, 50.00% of patients in this audit had prophylactic antibiotics.

The rate of post-operative wound infection was 1.04%, with 0% in patients who received prophylactic antibiotics and 2.08% in those who did not, which is not a statistically significant difference (P = 0.175).

Conclusions

Current evidence for antibiotic use is weak and therefore auditing local practice is essential in antibiotic stewardship. This audit is limited by the reliance on accurate record keeping, with regards to antibiotic prescribing and documentation of post-operative wound infections. Furthermore, patients may have had post-operative wound infections managed in the community setting.
WP1.10 - Are we Appropriately Consenting Patients for the Risks of Post Operative Urinary Retention following Groin Hernia Surgery?
Authors: Spellar Kayleigh , Laurie Alex , Bunting David
Published: September 2024

Aims

Consent is a fundamental process within surgery. General Medical Council (GMC) guidance advises that any recognised risks of harm resulting from a procedure should be discussed. Post-operative urinary retention (POUR) is a frequently encountered risk following groin hernia surgery, yet it can be missed when consenting. We aimed to review how frequently POUR occurs following groin hernia surgery in our hospital, along with how frequently it was consented for.

Methods

Retrospective data was collected on all patients undergoing planned groin hernia surgery in a single centre over a 6-month period between March and August 2023 . Data was collected on demographics, post-operative complications including POUR, and any other complications requiring hospital re-admission within 30 days. Consent forms were reviewed to identify whether POUR was documented as a risk.

Results

128 groin hernia surgeries were carried out over the 6-month period. 13 patients (10.2%) experienced POUR, which was the most common complication in this group of patients. 7 of these patients did not have POUR documented as a risk factor on their consent. With only 46% overall having POUR documented as a risk factor on their consent.

Conclusion

Despite POUR being a common complication following groin hernia surgery, patients are often not being informed of this as part of the consent process. As over half of those patients who did experience POUR were not warned about this potential complication. Considering its frequency and potential impact on patients, improvements in consenting for POUR should be made.
WP1.17 - Double Trouble - A Case of Duplex Appendix
Authors: Ramadan Widad Abdelrahman , Mooney James , Jones Claire
Published: September 2024

Introduction

Duplex appendix, a rare anatomical anomaly is often encountered incidentally during appendicectomy procedures. It is characterised by the presence of two appendiceal lumens and can be classified using the Cave-Wallbridge classification system.

Case

An 18-year-old male presents to the Emergency Department with a two-day history of migratory right iliac fossa pain. He was consented and booked for a laparoscopic appendicectomy based on clinical suspicion of acute appendicitis. Intra-operatively, an unexpected finding surfaces—a second pendunculated mass adjacent to the inflamed appendix. Employing laparoscopic linear staples, both the appendix and the adjacent mass were divided.

One day post-discharge, the patient presents with severe abdominal pain and computed tomography imaging suggests an intra-abdominal leak. The patient underwent an emergency laparotomy and ileo-caecal resection overnight. Histology revealed the second pedunculated mass was indeed a second appendix, a phenomenon with a reported incidence of 0.004 to 0.009%.

Discussion

Addressing the nuances of using imaging modalities in the diagnosis and operative planning of acute appendicitis, our discussion raises pertinent questions regarding the necessity of definitive pre-operative imaging in suspected cases. Considering potential pitfalls of incorrect clinical diagnoses; the presence of anatomical anomalies; and other factors influencing surgical decision-making; we scrutinise the proposition of pre-operative imaging protocols in suspected acute appendicitis.

Conclusively

our case encapsulates the diagnostic and therapeutic conundrums posed by duplex appendix instances, prompting a deeper exploration into the use of imaging techniques in a traditionally clinically diagnosed presentation and the implications thereof in surgical management.
WP2.11 - Improving prescription of discharge medications for day case surgery patients using electronic patient records system (EPIC); a closed loop audit
Authors: Ahmed Haythem , Kahka Ehab , Mossaad Mafdi , Joyce Amy , Wilson Iain
Published: September 2024

Aim

It is important to provide patients who have undergone day surgery with appropriate analgesia, antiemetics, and laxatives. Failure to do this can result in a poor patient experience, patient requests for advice, readmission and morbidity. This study audited our adherence to the GIRFT guidelines for day case discharge prescribing.

Methods

Data was collected retrospectively on the discharge medications for all patients undergoing elective, day case laparoscopic cholecystectomy and inguinal hernia repair at two district general hospitals in our trust over a five-week period. A pre-populated discharge medication order set was then created on the Trust's electronic health records system (EPIC) to improve adherence to the GIRFT guidelines. Discharge medications were observed over a subsequent four-week period.

Results

Prior to our intervention, adherence to GIRFT guidelines was poor with 25% of patients only received the correct discharge medications. Following introduction of the pre-populated order set, 83% of patients received the correct discharge medications.

Conclusions

This audit demonstrates that utilizing electronic systems effectively can improve efficiency, ensure patient safety and enhance patient care.
WP2.13 - Local Audit based on MAGIC study to improve abscess management at Royal Devon University Healthcare Trust
Authors: Khirfan Hamzeh , Alexiadis Aris , Shams Ola , Ragatha Ram
Published: September 2024

Aim

To assess efficacy of current management approaches of subcutaneous abscess at the Royal Devon University Healthcare Trust (RD&E).

Methods

Our audit is based on the MAGIC (Management of Acute surGIcal absCesses) national audit which involved anonymous retrospective analysis of patient records at the RD&E during September – December 2022. We collected data on patient demographics, clinical characteristics and their management. Furthermore, we conducted a literature review to compare our results to the recommended practice.

Results

31 patients records were analysed whereby 22 underwent surgical intervention (general anesthetic 17, local anesthetic 5) whereby the most common incision type was transverse (n=7). Nine patients were diabetic, two were immunosuppressed, 29 had hidradenitis suppurativa, while 19 had a past medical history of abscesses (n=31). The most common abscess type was pilonidal sinus (n=10). Eighteen patients received antibiotics prior to hospital admission, 12 of whom underwent surgery. Furthermore, 19 patients received antibiotics upon admission to hospital (n=31). Of the surgically treated cohort, 19 underwent packing and six were discharged with antibiotics.

Conclusion

Most subcutaneous abscess are approached surgically. However, postoperative care varies widely, with prolonged packing and frequent use of antibiotic postoperatively. Literature reviews have suggested no benefit of postoperative packing and specified certain circumstances of antibiotic use. Furthermore, clear communication with primary care providers detailing clear postoperative instructions is vital for patient safety and cost effectiveness.
WP3.11 - Emergency laparotomies in the elderly: long term outcomes
Authors: Hale Emily , Davis Heather , Sert Sena , Bowling Kirk
Published: September 2024

Aims

Emergency laparotomy is understood to be high risk in the elderly, but there is limited long term outcome data. This study assesses long term outcomes in the elderly including: survival and functional outcomes.

Methods

Patients, aged 80 and above, were identified from the prospective National Emergency Laparotomy Audit (NELA) database, who underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Surviving patients were followed up.

Results

132 cases were undertaken (22% of total emergency laparotomies performed). Mean age was 85 years. Most common ASA was 3. Preoperatively, the most common clinical frailty score was 6, i.e., moderately frail and 89% were living at home without care. The most common procedure was adhesiolysis.

50% of patients were admitted to intensive care. 5 patients returned to theatre. 17% were readmitted within 30 days of discharge. The most common reason for was fall.

20% of patients did not survive to discharge. 38% did not survive to August 2023.

After the procedure 46% of patients were able to return home independently; 5% had care at home; 26% were discharged to community hospital and 2% to care home.

By January 2024 61% of survivors were living independently at home with no functional decline. Most commonly, patients needed support with bathing/stairs/dressing (37%). 11% of respondents were completely dependent.

Conclusion

Emergency laparotomy confers a significant mortality, morbidity and risk to an elderly patient’s long term functional status. We believe this information is essential for surgical decision making and the consent process.
WP3.14 - A Single Unit Service Review in Northern Ireland: The Ever-increasing Acute Surgical Take and the Need for Service Adaptation
Authors: Lockhart Jessica , Bardon Aimee , Spence Rob
Published: September 2024

Aims

Referrals to the on-call general surgeons in the unit has increased significantly over the past year. Staff levels and hospital resources have not changed to reflect this increasing demand on the service. Our aim is to evaluate the increase in numbers and develop a strategic plan for resolution.

Methods

A database of referrals to the on-call surgical team was developed using the daily handover records. Two periods of data collection were undertaken, each lasting a duration of 30 days, taking place approximately one year apart. Patient demographics and clinical information was gathered using our electronic care record and electronic notes record. Data gathered included diagnosis, treatment, investigations, interventions, length of stay, suitability for ambulation and follow up.

Results

The total number of patients referred to the on-call team during cycle one was 233, compared with 405 in cycle two; this is a 74% increase in referrals. During the windows of data collection, 75% of patients with an unscheduled admission did not undergo any intervention and 80% were deemed suitable for ambulation.

Conclusion

Increasing demands on the NHS require a forward-thinking approach to how we provide an acute surgical service. This study demonstrates that a large proportion of patients are suitable for an ambulatory model of care and development of this service would be a valuable adjunct to the unit. To propose an ambulatory service providing urgent surgical assessment would be an asset to the Trust; potential outcomes would include improving the patient experience, reducing inpatient admissions and bed days, with the associated cost-saving.
WP4.5 - Changes in Social Care Post Major Emergency General Surgery Procedures
Authors: Niaz Osamah , Khalil Abdullah , Batt Mohammed , Al-Fagih Othman , Askari Alan , Al-Taan Omer
Published: September 2024

Introduction

Emergency General Surgery (EGS) is a major part of the provision of healthcare and patients undergoing EGS are at elevated risk of morbidity and mortality. The aim of this study is to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences.

Methods

Data from patients in the NELA database (2014-2022) was analysed, considering demographics, ASA score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on post-discharge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement post-discharge. Significance was set at p<0.05.

Results

Data from all patients in the NELA database (n=1,611) was analysed. Nearly one in ten patients over the age of 70 never returned home. Patients requiring additional support were on average 8.6 years older (p=0.008). Over the age of 80 years, the need for extra social support increased substantially with each increasing year in age and those over the age of 85 years old were more than twice as likely to require extra support than 80-year-olds (p<0.001). Patients who died were 11.4 years older compared to those discharged without additional support (p<0.001).

Conclusion

A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care post-emergency surgery. These important social factors need to be considered before operating as they may have significant quality of life and economic implications.
WP5.4 - Uncomplicated acute diverticulitis can be managed in an ambulatory setting
Authors: James Nicole , Abbad Mutaz , Fung James , Bignell Mark , Bond-Smith Giles
Published: September 2024

Aims

We aimed to evaluate a treatment pathway for acute diverticulitis at our Surgical Emergency Unit (SEU) and analyse the outcomes. We hypothesised that a significant number of patients can be managed in an ambulatory setting.

Methods

We reviewed clinical records of all adult patients (aged ≥18 years) admitted with acute diverticulitis between April 2022 to March 2023. Those presenting with clinical suspicion of acute diverticulitis were assessed clinically, biochemically and radiologically with cross-sectional imaging. This allowed early detection and treatment for those with complications of diverticulitis, and early ambulation within 24 hours for those without. We evaluated their length of stay, modified Hinchey classification of disease severity, antibiotic prescription, and readmission for diverticulitis within 3 months after discharge.

Results

We included 370 patients (160 males, 210 females). The mean age was 63.2 (range 23-96) years. Fifty-five (14.9%) presented with acute complicated diverticulitis (Hinchey classification 1b or above). In total, 218 patients (58.9%) were ambulated within 24 hours of presentation. The proportion of patients ambulated early with and without complications of diverticulitis were 21.8% (12/55) and 65.4% (206/315) respectively (p<0.001). The average length of stay in hospital was 54 (range 0.3-711) hours. Among those ambulated early, 196 were prescribed with oral antibiotics. Only 10 patients (4.6%) had persistent symptoms after 2 weeks from ambulation. Twenty-six patients (11.9%) were subsequently readmitted within 3 months.

Conclusions

In our experience, over half of patients diagnosed with acute diverticulitis were successfully managed on an ambulatory pathway. There was a low percentage with persistent symptoms or readmission. The development of appropriate patient pathways is crucial to improve efficient use of hospital resources.
WP5.7 - Do we follow-up our patients after emergency laparotomy?
Authors: Watson Hannah , Aljarad Feras , Payne Christopher , Gray Carol
Published: September 2024

Aim

Emergency Laparotomy (EL) carries a high risk of major morbidity and mortality and patients can require an extended period of recovery after surgery. Within our organisation, all patients who undergo EL are supported by a dedicated 7-day service to support their mobility, motivation and goal settings as well as wellbeing needs. However, this support does not extend beyond discharge and we do not have standardised follow-up protocol. This audit aimed to review the outpatient follow-up that EL patients received.

Methods

EL data is recorded prospectively and submitted to the Emergency Laparotomy and Laparoscopic Audit (ELLSA). All ELLSA patients admitted between June 2021 and July 2022 were included. Electronic records were reviewed to see what follow-up they received.

Results

258 patients underwent EL during this time period. Only 136 patients received follow-up (53%). Of the appointments carried out, 76% were review by Surgical Team and 45% were review by Colorectal Specialist Nurses. 70% of patients follow-up was face-to-face, with the remainder by telephone. The average time to surgical clinic follow-up was 111days (range 12-371 days).

Conclusions

Only half of the patients received any follow-up after EL, and even fewer received a face-to-face clinic with their consultant. There was also considerable delay for some patients. We feel this is evidence that a dedicated follow-up service for ELLSA patients is required to reduce this variation. We intend to implement a protocolised follow-up as a result of this audit.
WP5.19 - The undifferentiated general surgical take over 10 years: admissions
Authors: Hale Emily , Bowling Kirk
Published: September 2024

Aims

The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital in order to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands.

Methods

Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis.

Results

Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023.

Conclusions

Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.
WP6.1 - A survey of the estimated cost of surgical consumable items within Ear, Nose, Throat departments
Authors: Divekar Omkaar , Stephen Sarah , Tikka Theofana , Haymes Adam , Kanegaonkar Rahul
Published: September 2024

Aims

Studies suggest that practitioners lack knowledge on cost of consumables and fail to appreciate the financial consequences of waste. We aimed to investigate this claim amongst ENT practitioners.

Methods

An online questionnaire, requiring cost estimations for 20 consumable items, was distributed to London ENT departments. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price.

Results

10.65% of all estimations were ‘correct’. There was no correlation between job role and cost-estimation accuracy. The most accurately estimated item was ‘fenestrated sterile drape’ (24.4%), the least was ‘1L bag of IV normal saline’ and ‘package of sterile sponges’ (0%).

Conclusions

We found poor cost appreciation of consumables amongst ENT surgeons. This could serve as a catalyst for the inclusion of health economics in specialty training curricula, improving cost-awareness.
WP6.3 - Neurodivergence Toolkit for Trainers, Supervisors and Educators
Authors: Badenoch Thomas , Ong Eng
Published: September 2024

Aim

To create a simple and easy to use reference toolkit for trainers, supervisors and educators to support neurodivergent trainees.

Methods

Around 15% of the UK population is neurodivergent, increasing annually. Between 2014-2020 the number of autistic medical students doubled. Neurodivergent doctors have little support, as few as 32% of neurodivergent doctors disclose to a supervisor and only 15% to Occupational Health. Only half of those who had asked for reasonable adjustments had them implemented.

Neurodivergence impacts training, delaying graduation for up to 25% of individuals, increasing acts of self-harm by 50% and 24% increase of attempted suicide.

We set out to create a simple reference toolkit of adjustments beneficial to neurodivergent doctors without negatively impacting neurotypical doctors, so it can be implemented without need for disclosure of neurodivergence.

A literature review was completed using the terms “neurodivergent”, “neurodiversity”, “autism” and “education”, “training”. Adjustments in different clinical settings were developed with experts in higher education, neurodivergence and supervising trainers.

Results

A reference toolkit divided by training setting and by level of adjustments has been completed and will be published by in full for use by trainers and trainees in early 2024.

Conclusions

Effective adjustments can be made in a number of domains with varying levels of required trainer effort:

Planning: Educational brief, Checklisting, Flexibility

Environment Modification: Ambient noise reduction, Task completion, Reduced distractions

Metacognition: Refocus on aims, Breaks from engagement, Two way communication

Feedback: Specific behavioural feedback, achieved competency frameworks, reframing of difficulties, written descriptive feedback
WP6.6 - Sentiment Analysis of Social Media Posts by Medical Professional in the UK
Authors: Aditya Kesav
Published: September 2024

Aims

Notoriously described as being controversial in nature, we aim to objectively assess the language used amongst medical professionals in social media (SM).

Methods

Data was extracted from the Reddit SM website under the sub-page "r/DoctorsUK" forum, through a data-extraction code written in the python language. This was then analysed through a Natural Language Toolkit algorithm to classify language used into positive, negative and neutral sentiments with an overall polarity score ranging from -1 noting most negative to 1 being most positive.

Results

A total of 992 articles were examined over a 24-day period, as limited by Reddit data application programme interface (API) protocols. A total of 210 positive, 218 negative and 564 neutral articles were noted with an average of 43 articles posted per day. Headlines sentiment on average was overall marginally positive at 0.0154. Comment tree within each headline was also examined, noting a more positive 0.173. Through regression analysis, it was noted that headline and comment sentiments was directly correlated, and this was statistically significant(P=1.24*10-10). It was also noted that more negative headlines had higher “likes” and were therefore featured more prominently within the forum.

Conclusions

Although SM posts are overall positive in sentiment, it is noted that more negative sentiments are often up-voted and therefore featured more prominently due to their more provocative nature and emotions incited amongst readers. As SM posts elicits strong psychological and psychosocial reactions from a community, there is an urgency to more accurate data driven models in developing future policies to maintain an effective professional morale within the NHS.
WP6.12 - What the bleep? Have we finally found a solution to the bleep system?: Exploring the efficacy of a WhatsApp-style messaging system as an alternative to traditional bleeps in the healthcare setting
Authors: Betts Daniel , Lingam Gita , Sivarajah Vernon
Published: September 2024

Aims

Traditionally, bleeps have been integral to the role of a doctor. A pre-pandemic study estimated that more than 10% of the world’s bleeps are currently being used by the NHS. However, in response to the 2021 directive by the health secretary to phase out bleeps within NHS England, new approaches to communication in healthcare are being implemented. One of these is Alertive, a WhatsApp-style messaging system. This study utilises a quality improvement approach to determine the efficacy of Alertive in conveying messages as a replacement for bleeps, and to investigate the reasons behind its perceived poor uptake.

Methods

A ten-day evaluation of the uptake of 15 distinct Alertive roles within the surgical department, accompanied by a satisfaction survey circulated among departmental juniors.

Results

The survey findings revealed a prevailing consensus among users endorsing the efficacy and superiority of Alertive as a concept over the previous bleep system. However, user-reported constraints related to functionality and application logistics. These have been identified as sources of frustration and thereby impeding the broader utilisation and efficacy of Alertive.

Conclusion

Effective multi-disciplinary communication is imperative in a hospital setting. While Alertive presents a potential alternative to traditional bleeps, challenges such as poor role uptake and communication appropriateness persist and represent significant barriers to full integration and staff satisfaction. Role uptake is variable with some surgical teams having better compliance than others. While users report that the concept of Alertive is beneficial, no single communication system has been identified as being superior, emphasising the ongoing need for solutions in healthcare communication.