bluuebunny/crossref_metadata_2025 huggingface dataset:
O029 Adverse renal outcomes following endovascular or open repair of infra-renal and supra-renal abdominal aortic aneurysms: a systematic review and meta-analysis
Authors: Tsai J , Brown T , Pouncey A , Powell J , Bicknell C
Published: May 2023

Introduction

This study aims to quantify the risk of permanent renal dialysis for AAA repair, with comparison between endovascular (EVAR) and open repair (OAR) techniques for suprarenal (SR) and infrarenal (IR) AAA.

Methods

Systematic review, meta-analysis and meta-regression of post-operative, permanent dialysis outcomes were performed, following PRISMA guidance (Prospero registration: CRD42021272422). Database searches were conducted on MEDLINE, Embase, CENTRAL using ProQuest Dialog. We included data published after 2011, reporting primary elective AAA repair, for a minimum of 100 patients with >75% of operations undertaken after January 1, 2000.

Results

Seventy-nine studies (IR AAAs: 54877 EVAR & 7145; SR AAAs: 4241 EVAR & 1723 OAR) were included (n=67986). Overall, low rates of permanent dialysis were reported: 0.35% of IR-EVAR, 0.68% IR-OAR, 0.82% SR-EVAR, and 0.59% SR-OAR. No significant difference in the risk of permanent dialysis for endovascular and open repair was observed (EVAR vs. OAR: odds ratio (OR) 0.52 95% CI[.06, 4.78], for IR, 2.14 [.46, 10.05], for SR). A lower risk of permanent dialysis was observed for IR vs. SR EVAR (OR .05 [0, .46]). Meta-regression indicated that post-operative permanent dialysis decreased over time as determined by study midpoint for IR-EVAR and IR-OAR. For IR-OAR, increased dialysis rates were significantly associated with study participants’ ages.

Conclusion

The rate of permanent dialysis <1% for all modalities of SR and IR AAA repair. For EVAR, the risk of dialysis was higher for SR compared to IR AAA. The likelihood of permanent dialysis has decreased with modern practice yet increases among older patients.
O032 Gastrointestinal and satiety responses to oral feeding in participants with obesity compared with those of healthy weight: an MRI study
Authors: Althubeati S , Simpson E J , Bush D , Hoad C , Elgdeghaidy S , Gowland P , Macdonald I A , Lobo D N
Published: May 2023

Introduction

Satiety is regulated by behavioural and physiological mechanisms. This study aimed to investigate the effects of food ingestion on subjective satiety, gastric emptying, mesenteric blood flow, and blood glucose concentration.

Methods

Twenty healthy males (10 Lean:10 Obese) were recruited to the study. Gastric content volume (GCV) and superior mesenteric blood flow (SMABF) were measured by magnetic resonance imaging (MRI) (Philips 3T Ingenia and dStream Anterior Coil at baseline) during fasting and immediately after a standard meal (2.5MJ, 78g Carbohydrate, 24g Protein, 21g Fat) and then every 30-minutes for four hours. Gastric emptying rate (GER) was derived from GCV. Blood glucose (BG) and combined satiety scores (CSS; 0–100 mm visual analogue scale) were measured. Data were presented as mean (SD).

Results

Participants in the lean (age: 38(14) y, BMI: 24(2) kg/m2) and obese (age: 38(13) y, BMI: 34(3) kg/m2) groups showed no statistically significant differences in fasting CSS [39.1(22.6) vs. 30.9(13.5) mm], GCV [59(32.6) vs. 58(29.6) ml], SMABF [7.7(2.5) vs. 6.5(2.6) ml/s], and BG [4.5(0.8) vs. 4.2(0.5) mmol/l]. In response to eating, no differences were seen in CSS, GCV, BF, and BG between the groups. Postprandial CSS correlated positively with GCV (R2=0.42, P<0.001 vs. R2=0.30, P<0.001). GER did not differ between the groups (1.7 vs. 1.8 ml/min). Participants with obesity reported lower satiety scores immediately after eating [85(22.6) vs. 67(22.7) mm] and across the 4 hours (P<0.05).

Conclusion

Participants with obesity reported lower postprandial subjective satiety. However, this did not appear to be related to gastrointestinal function.
O033 Intraoperative margin assessment in breast conserving surgery using immunoguided labelling with Tenascin-C antibody
Authors: Kanth S , Sunggoro D , Ngai V , Tai J , El Sheikh S , Ahmed M
Published: May 2023

Introduction

Extracellular matrix protein tenascin-C (TNC) is a new potential target for visualising tumours and their response to neoadjuvant chemotherapy (NACT). The application of chemotherapy and radiotherapy to cancers, results in an elevation of tenascin-C. This retrospective cohort analysis investigates whether Tenascin-C can be used as a predictor of responsiveness to chemotherapy and in intraoperative margin assessment in breast conserving surgery post chemotherapy.

Method

A feasibility study with Twenty-four breast cancer patients who had received NACT recruited from a single centre. The distribution and intensity of TNC expression in paraffin embedded breast specimens were analysed using a pre-determined scoring system. These scores were then correlated with the patients’ clinicopathological characteristics and ‘PREDICT’ scores.

Results

TNC was strongly expressed in the cancer tissue post NACT and was greater in the tumour-associated stroma than in the tumour cells. PR-positive cancers and patients with better post-surgical ‘PREDICT 10’ tended to have greater TNC expression. More invasive cancers eg triple negative breast cancer had TNC expression that was more pronounced at the tumour invasive border. Increased TNC expression in the center of tumour was corelated with a better pathologic response to NACT.

Conclusion

This study shows that TNC is strongly expressed in the stroma of post-NACT breast cancer tissue, and may be linked to pathologic response to NACT, tumour phenotype, and prognosis. There are many potential clinical applications. TNC can be used a s (1) predictor of responsiveness to NACT and/or adjuvant therapies, (2) therapeutic target and (3) prognostic marker.
O034 Exploring neutrophil-lymphocyte ratio as a predictor of postoperative breast cancer overall survival
Authors: Jaffer A , Cullinane C , Feeney G , Jalali A , Merrigan B , Baban C , Buckley J , Tormey S
Published: May 2023

Introduction

Neutrophil-lymphocyte ratio (NLR) is an established strong predictor of mortality in colorectal, hepatocellular, gastric, pancreatic and lung cancers, however there is limited evidence regarding breast cancer. The relationship of the host immune system and tumour biology plays a known integral role in oncological outcomes. The NLR provides an approximate quantification of host inflammatory response in advancing or more aggressive tumours. Routine inclusion of the full blood count in preoperative workup thereby offers a possible cost-effective prognostic biomarker. This project explores the association between preoperative NLR and breast cancer overall survival.

Methods

This retrospective cohort study reviewed an institutional database of breast cancer patients undergoing primary curative surgery at University Hospital Limerick from January 1, 2010 to June 1, 2017. The primary endpoint studied was overall survival. Log-rank testing examined overall survival between groups of patients with NLR <2.5 and NLR ≥2.5.

Results

In the included cohort of 579 cases, the mortality rate was 18% (n=105). The cohort had a median preoperative NLR of 2.63 (SD 1.42). Patients with NLR ≥ 2.5 were significantly associated with poorer overall survival (HR 1.71, 95% CI 1.12 to 2.60, p=0.011). Median survival time is not available for this dataset at this time and will be reported upon longer follow up.

Conclusion

Preoperative NLR ≥2.5 was found to be an independent predictor of breast cancer overall survival. Analysis of this data is ongoing to adjust for confounders, as well as evaluate recurrence free survival.
O044 The PI-RADS 3 lesion. Can we use a higher PSA density to reassure patients with MRI PI-RADS 3 score?
Authors: Natarajan M , Yousaf A , Abou Chedid W , Moschonas D , Patil K , Kusuma M , Langley S , Perry M
Published: May 2023

Introduction

Prostate cancer has the second highest cancer incidence worldwide. Diagnosis of clinically significant prostate cancer (CSPC), defined as Gleason ≥3+4 or ≥ISUP 2, is underpinned by Prostate Imaging-Report and Data System (PI-RADS) scoring on MRI and serum PSA, with confirmation with prostate biopsy. Positive predictive value of PI-RADS 3 for CSPC is 13%. A PSA-density threshold of 0.15-0.18 ng/mL/cc is commonly utilised to justify biopsy vs PSA monitoring for PI-RADS 3.

Methods

Retrospective analysis of MRI, PSA and pathology results for consecutive patients undergoing diagnostic investigations for prostate cancer between November 2021 and March 2022.

Results

Average age of 200 males was 66.4 (SEM 0.62). MRIs reported 6% ≤PI-RADS 2, 61.5% PI-RADS 3 and 32.5% ≥PI-RADS 4. Among the PI-RADS 3 (n=123), average prostate volume was 70.0cc (SEM 3.21) and PSA density was 0.12 (SEM 0.01). 17.9% PI-RADS 3 patients underwent prostate biopsy although just 8.9% had PSA-density >0.18 ng/mL/cc. 40.9% biopsies identified CSPC with average PSA-density 0.23 (SEM 0.06). Conversely, for the 59.1% biopsies with no cancer or non-CSPC, average PSA-density was 0.14 (SEM 0.03) (p 0.078).

Conclusion

Almost 3/5 prostate biopsies carried out in patients with PI-RADS 3 lesions revealed non-CSPC or no cancer. There was a notable difference in PSA-density among PI-RADS 3 patients with biopsy-proven CSPC vs. non-CSPC or benign histology. Based on our institutions experience, we would propose a 0.2 ng/mL/cc PSA-density threshold when recommending biopsy over PSA monitoring for MRI reported PI-RADS 3 to improve patient selection for biopsy to identify CSPC.
O049 Interleukin-16 in flush effluent fluid as a biomarker for kidney viability prior to transplantation
Authors: Dobbins J , Cheemungtoo G , Tingle S , Mahendran B , Bates L , Amer A , Sen G , Hammond J , Figueiredo R , Talbot D , Manas D , White S , Sheerin N , Ali S , Wilson C
Published: May 2023

Background

Kidney transplantation is limited by the number of transplantable organs. Biomarkers that can predict organ viability will reduce the number of organs currently discarded (13% UK, 2021-22, NHSBT). The kidney microcirculation can be flushed, prior to transplantation, with preservation solution as part of the back-table preparation. The effluent fluid is usually discarded, but we propose this as a source of potential biomarkers. Interleukin-16 (IL-16) is a pro-inflammatory cytokine previously shown to predict viability in liver grafts. Here we examine IL-16 in the context of kidney viability.

Methods

IL-16 concentration was measured, in the flush effluent, using an electrochemiluminescent multiplex assay. The total protein content of each sample was concurrently measured to normalise the concentration. IL-16 concentrations were then compared to donor characteristics and early transplant outcomes.

Results

Samples were collected from 30 transplanted kidneys (10 DCD, 10 DBD, 10 live donor) and 5 declined kidneys (4 DCD, 1 DBD). IL-16 concentration was significantly higher in DCD kidneys (mean 81.8+/-38 (SD)) compared to live donor kidneys (17.7+/-18 pg/ml) (p=0.0001). CIT did not affect IL-16 concentration (β=-0.014, p=0.4), nor was IL-16 able to predict delayed graft function. However, IL-16 was significantly higher in kidneys declined for transplantation (transplanted: 54.7+/-30 vs non-transplanted: 98+/-43, p=0.03).

Conclusion

Flush effluent is a rich source of potential biomarkers. IL-16 concentration in flush effluent fluid correlates with organ quality. With real-time assessment, it will be possible to identify kidneys currently discarded; that are either transplantable directly or would benefit from advanced therapy prior to transplantation.
O055 Robotic appendicectomy: a systematic review of feasibility
Authors: Arang H , El Boghdady M
Published: May 2023

Introduction

Acute appendicitis is known to be one of the most common abdominal surgical emergencies. Laparoscopic appendicectomy is considered the gold-standard management. There has been an increasing trend in the routine use of robotic surgery in abdominal surgery. However, it remains underutilised in emergency surgeries. We aimed to systematically review robotic appendicectomy (RA) procedures in elective and emergency settings and study its indications and feasibility.

Methods

A 20-year systematic review was performed in compliance with the PRISMA guidelines. The search was performed on PubMed, ScienceDirect and the Cochrane-Library databases. For quality assessment, Amstar 2 and MERSQI score were applied. The research protocol was registered with PROSPERO register for systematic reviews (CRD42022324582).

Results

A total of 1346 resulted from the systematic search, of which a final 9 articles were included in this study. A total of 174 procedures were included, 161 elective, 12 emergency and one interval RA. MERSQI mean score was 10.72 (SD= 2.56), with 4 high quality, 2 moderate and 3 low quality studies. The endpoints across the studies were: rate of conversion to open surgery, length of hospital stay, intra-operative blood loss and operative time.

Conclusions

Robotic appendicectomy is considered a safe and feasible technique with minimal blood loss and without conversion. The operating time and the hospital stay were within acceptable limits. Future studies are recommended to further evaluate RA with a focus on its application during emergency settings and on its cost-effectiveness.
O056 The impact of surgical risk factors on the development of stump appendicitis
Authors: Lodhia M , Ahmed H , Hargest R
Published: May 2023

Introduction

Stump appendicitis (SA) is a post-operative complication where inflammation occurs in the residual appendix following incomplete excision. Diagnosis is delayed due to the history of appendectomy, leading to a higher risk of complications such as perforation and peritonitis. This study aimed to investigate the incidence of SA and the surgical risk factors contributing to its development.

Methods

A literature review was conducted using Ovid Medline and Embase to evaluate the literature surrounding SA. A retrospective study was conducted at our centre to investigate the incidence of SA between June 2012 and June 2022.

Results

Literature review revealed 43/12,989 (0.33%) patients with SA. In the local cohort of 5401 patients who underwent appendectomy or right hemicolectomy for appendicitis, 15 developed SA (0.28%). Laparoscopic appendectomy was identified as a risk factor, with 66.67% of SA patients in Cardiff undergoing laparoscopic surgery for their primary appendicitis. Complicated primary appendicitis was reported in 53.33% of SA patients compared to 19.33% of the wider cohort. An appendicolith was present in 33.33% of SA patients compared to 12.11% of the total cohort. Residual stump length above 1.5cm was also acknowledged as a risk factor with a stump length ≥1.5cm reported in all local SA patients.

Conclusion

SA is associated with modifiable and non-modifiable risk factors. Care should be taken to identify the appendiceal base clearly at primary operation. Complicated appendicitis and the limitations of laparoscopic appendectomy present challenges in identifying the appendiceal base, thus contributing to the development of SA.
O057 The impact of urgency of umbilical hernia repair on adverse outcomes in patients with cirrhosis: a population-based cohort study from England
Authors: Adiamah A , Rashid A , Crooks C , Hammond J , Jepsen P , West J , Humes D J
Published: May 2023

Introduction

Umbilical hernia is common in patients with cirrhosis, however, there is a paucity of dedicated studies on postoperative outcomes in this group of patients. This population-based cohort study aimed to determine the outcomes after emergency and elective umbilical hernia repair in patients with cirrhosis.

Methods

Two linked electronic healthcare databases from England were used to identify all patients undergoing umbilical hernia repair between January 2000 and December 2017. Patients were grouped into those with and without cirrhosis and stratified by severity into compensated and decompensated cirrhosis. Length of stay, readmission, 90-day case fatality rate and the odds ratio of 90-day postoperative mortality were defined using logistic regression.

Results

In total, 22163 patients were included who underwent an umbilical hernia repair and 297 (1.34%) had cirrhosis. More patients without cirrhosis had an elective procedure 86% compared with 51% of those with cirrhosis (P<0.001). In both the elective and emergency settings patients with cirrhosis, had longer hospital length of stay (elective: 0 vs 1 day, emergency: 2 vs 4 days, p<0.0001) and higher readmission rates (elective: 4.87% vs 11.33%, emergency:11.39% vs 29.25%, p<0.0001) than those without cirrhosis. The 90-day case fatality rates were 0.16% and 2% in the elective setting and 2.96% and 19% in the emergency setting in patients with and without cirrhosis respectively.

Conclusion

Emergency umbilical hernia repair in patients with cirrhosis is associated with poorer outcomes in terms of length of stay, re-admissions, and mortality at 90-days.
O059 Introduction of the SHOUT protocol in the early post-operative period following carotid surgery
Authors: Faisal M , Morshed A , Baker D , Agu O , Benaragama K
Published: May 2023

Introduction

The SHOUT protocol acts as a tool for assessing risk to the airway following anterior neck surgery. While this tool is commonly used in other specialities, we have introduced the protocol for regular use in the post-operative period in carotid surgery.

Methods

The SHOUT protocol was included in the operative notes of all patients undergoing carotid intervention, allowing all members of the post-operative team to be aware of major warning signs. A Retrospective review of all patients undergoing carotid artery intervention between November 2018 and June 2022 was completed.

Results

A total of 216 patients underwent carotid artery intervention, 100 had intervention before the application of the SHOUT protocol (Group A), all having endarterectomies. 116 patients were treated after the introduction of the protocol (Group B), consisting of 112 endarterectomies and 4 stents. In Group A, 9 patients (9%) required reimaging for urgent neurological symptoms, and 2 (22%) of them had new stroke findings and were managed medically. 3 patients underwent urgent surgical re-intervention; 2 returned to theatre without imaging due to significant hematoma. In Group B, 11 patients (9.4%) required reimaging, 3 (27.2%) had new stroke findings and were managed medically, while only one patient (0.8%) needed surgical re-intervention for haematoma evacuation.

Conclusion

The SHOUT protocol is a simple tool that aids all members of the post-operative team in the early recognition of potential time-sensitive complications. Early recognition allows for more time to formulate and execute the appropriate management plan.
O064 Management of acute aortic syndrome with evolving individualized precision medicine solutions: lesson learned over two decades and literature review
Authors: Sultan S , Acharya Y , Long K , Hatem M , Hezima M , Veerasingham D , Soliman O , Hynes N
Published: May 2023

Introduction

Thoracoabdominal acute aortic syndrome is associated with high morbidity and mortality. We aim to scrutinize our evolving strategies for acute aortic syndromes (AAS) management using minimally invasive and adaptive surgical techniques.

Methods

This is a longitudinal observational study at our tertiary vascular centre from 2002 to 2021. Amongst 96 with symptomatic aortic thoracic pathologies, 71 had AAS. Our primary endpoint was combined aneurysm and cardiovascular-related mortality.

Results

There were 43 males and 28 females (5 Traumatic Aortic Transection (TAT), 8 Intramural Hematoma (IMH), 27 Symptomatic Aortic Dissection (SAD) and 31 Thoracic Aortic Aneurysm (TAA)) with a mean age of 69. All AAH received optimal medical therapy (OMT) and TAT underwent emergency thoracic endovascular aortic repair (TEVAR). Fifty-eight patients had aortic dissection, of which 31 developed TAA. These 58 received OMT initially and interval surgical intervention with TEVAR or sTaged hybrId sinGle lumEn Reconstruction (TIGER). To increase our landing area, we performed left subclavian chimney graft with TEVAR in 12 patients. Average follow-up was 78.2 months, and 11 patients (15.5%) had combined aneurysm and cardiovascular-related mortality. None had stroke or bowel ischaemia. 26% developed endoleaks, and 15% required re-intervention (type II & III). Four patients had paraplegia (5.7%) and succumbed to death from renal failure. Eight IMH patients on OMT died within 30 days.

Conclusion

Acute aortic hematoma necessitates close monitoring and early intervention. TIGER technique with interval TEVAR has salvaged complex situations in young patients. Our experience shows that minimally invasive techniques could be a viable option for AAS.
O076 Single-centre experience with administration of neoadjuvant chemotherapy for breast cancer patients – a retrospective analysis over a 11- year period
Authors: Reveendran D , Hogan B
Published: May 2023

Introduction

Neoadjuvant chemotherapy (NACT) has been established in down-staging tumours, allowing breast conserving surgery. Additionally, NACT informs treatment decisions guided by tumour response. Pathological complete response (pCR) correlates with disease-free survival. It is known that response rates vary according to biological subtype. This retrospective analysis aimed to analyse the rate of pCR post NACT according to breast cancer subtypes.

Methods

A retrospective analysis of NACT usage was conducted from January 2011 to December 2021. Clinical data of patients who received NACT were collected using the local Breast Unit database. Clinical data included patient demographics, menopausal status, size of tumour, type of surgical procedure, axillary procedure, histopathology details of breast tumour, pathological response to NACT and time to local and/or systemic recurrence.

Results

531 patients received NACT for breast cancer between January 2011 to December 2021. 288/531 (54.2%) of the patients were pre-menopausal. There was an increase in patients with subtypes (Triple Negative, triple positive & Her 2 positive) receiving NACT over the years. 202/538 (37.5%) breast cancers achieved pCR post NACT. pCR rate was higher for grade 3 tumours (41.9%) compared to grade 1 (28.8%) or grade 2 (28.8%). Triple negative and HER2 +ve subtypes had the highest pCR rate (45.5% and 60.3% respectively).

Conclusion

Patients with human epidermal growth factor receptor (HER)2-positive and triple-negative tumours are good candidates for neoadjuvant chemotherapy as they have higher probability of achieving pCR. Future studies are being conducted to determine how to anticipate which triple-negative and her2+ tumours will achieve pCR.
O083 The impact of prehabilitation on outcomes in frail, older adult patients undergoing major abdominal surgery: a systematic review and meta-analysis
Authors: Skořepa P , Ford K L , Prado C M , Gomez D , Lobo D N
Published: May 2023

Introduction

Prehabilitation comprises multidisciplinary preoperative interventions including exercise, nutritional optimisation and psychological preparation aimed at improving surgical outcomes. The aim of this study was to determine the impact of prehabilitation on postoperative outcomes in frail, older adult patients undergoing abdominal surgery.

Methods

Embase, Medline, CINAHAL and Cochrane databases were searched from 2010 to 2022 for prospective randomised clinical trials (RCT) and observational studies evaluating unimodal (exercise) or multimodal prehabilitation programmes. The primary endpoint was the development of severe postoperative complications. Secondary endpoints, among others, included length of hospital stay. The analysis was performed using RevMan v5.4 software.

Results

Sixteen studies (6 RCT, 10 observational) reporting on 3339 patients (1406 prehabilitation group, 1933 control group) were included. The median (interquartile range) age was 74.0 (71.0–78.4) years. Ten studies reported on patients undergoing colorectal surgery. Of the remaining studies, two investigated prehabilitation in patients undergoing mixed gastrointestinal surgeries, two in gastric and oesophageal surgery, and two in hepatobiliary surgery. Prehabilitation was multimodal in the majority of studies and was unimodal in one study. Ten studies addressed severe complications and a meta-analysis revealed a decline in their occurrence by up to 44% (OR 0.56, 95% CI 0.37 to 0.82). Meta-analysis of nine studies showed a reduction in hospital stay (WMD -1.07, -1.60 to -0.53).

Conclusion

Given the significant impact on severe complications and tendency to shorten length of stay, prehabilitation should be encouraged in routine practice in frail, older adult patients undergoing major abdominal surgery.
O086 Prehabilitation: what is the best approach for patients with cancer undergoing surgery?
Authors: Jandu A , Wilson V , Nitayamekin A , Lobo D N , Stevenson J , Vohra R
Published: May 2023

Introduction

Evidence suggests that physical fitness interventions, mental health support and nutritional advice before surgery (prehabilitation) could reduce hospital stay and improve quality of life of patients with cancer. In this study we captured the opinions of a group of cancer patients undergoing these interventions after surgery to discover what a prehabilitation programme should encompass.

Methods

Patients from the Cancer and Rehabilitation Exercise (CARE) programme based in Nottingham took part in a 26-point online questionnaire about the design of prehabilitation programmes.

Results

The questionnaire was completed over a 2-week period by 54 patients from the CARE programme. Their responses were as follows: 44 patients (81%) would have participated in prehabilitation had it been available to them and 28 patients (52%) ranked physical exercise as the most important component. Forty patients (74%) believed the counselling aspect of prehabilitation would have contributed to a successful outcome and 35 (65%) thought dietary advice would have benefitted them before surgery. Thirty-one patients (57%) preferred the programme to take place in a fitness centre, rather than at home or hospital and 43 (80%) would have liked to have known about prehabilitation from their doctor at the time of diagnosis.

Conclusion

Patients are interested in prehabilitation to become more physically fit and mentally prepared for surgery. They express the need for a focus on physical exercise, counselling to improve mental health and personalised nutritional advice. Tailoring a prehabilitation programme, with input from patients, could contribute to improving patient outcomes following cancer treatments.
O089 Efficacy and safety of extended pharmacological venous thromboembolism (VTE) prophylaxis after major abdominal and pelvic surgery: an international, prospective cohort study
Authors: Sgrò A
Published: May 2023

Introduction

The optimal duration of postoperative pharmacological prophylaxis after major abdominal and pelvic surgery is debated, with limited evidence on the impact of extended prophylaxis on VTE-associated morbidity and mortality. This study aimed to determine international variation in VTE prophylaxis practice, and the efficacy and safety of extended prophylaxis.

Methods

An international, prospective cohort study enrolled consecutive adults undergoing major abdominal and pelvic surgery (January-July 2022). Extended prophylaxis was considered at least 28 days of anticoagulant prescription post-surgery. The primary efficacy outcome was radiologically diagnosed VTE, the primary safety outcome was clinically relevant bleeding within 30 postoperative days (European Medicines Agency definition). The independent association of these outcomes with extended prophylaxis was explored using multivariable logistic regression.

Results

Overall, 24,218 patients from 29 countries were included (12,705 women, 52.5%; median age 61.0 years). The postoperative VTE rate was 0.8% (n=185), with 18.9% (n=35) diagnosed after discharge. The median prophylaxis duration was 11.0 days (range 3.0-28.0) with 27.3% patients (n=4,662) receiving extended prophylaxis. Following multivariable adjustment, there was no evidence extended prophylaxis was associated with significant change to VTE incidence (OR: 2.45, 95%CI: 0.74-8.11, p=0.141) or bleeding risk (OR: 0.83, 95%CI: 0.49-1.39, p=0.473).

Conclusion

In modern practice, the incidence of postoperative VTE is low. Extended prophylaxis appears safe, yet the clinical efficacy remains uncertain. Further work is required to define patients who stand to benefit.
O091 Predict factors of hepatocyte growth factor family and bone morphogenetic proteins for breast cancer nodal metastasis
Authors: Cong B B , Cao X S , Jiang W G , Ye L
Published: May 2023

Introduction

Lymph node metastasis is essential for the outcome of patients with breast cancer. Bone morphogenetic proteins (BMP) and hepatocyte growth factor (HGF), key to angiogenesis and metastasis of cancers, were investigated for their roles in the predication of nodal metastasis from breast cancer.

Methods

Expression of BMP family ligands, BMP receptors, HGF, its receptor MET and regulatory factors of HGF activation including HGF activator (HGFA), HGFA inhibitor 1 (HAI1), HAI2, Matriptase-1 and Matriptase-2 were determined in breast cancers (n=127) using real time quantitative PCR. Transcript levels of these genes were analysed in the breast cancers for their implication in lymphatic involvement using Mann-Whitney test. Predictive potential of those genes for nodal metastasis of these molecules was evaluated using both binary logistic regression and receiver operating characteristic (ROC) with SPSS (Version 27).

Results

With median as a cut-off value, logistic regression analyses showed that MET, Matriptase-1 and BMP15 were positively associated with nodal metastasis whereas Matriptase-2, BMP3 and HAI1 were inversely correlated with nodal involvement. After integrating these six prospective factors, ROC model returned with a significant value against nodal status (RUC=0.657, p=0.001). With the optimal ROC cut-off value to dichotomise patients, the integrated expression produced a significant prediction of nodal metastasis (p=0.006, HR=2.929). MET and HAI1 was correlated with the lymphangiogenesis marks of LYVE1, podo, prox1. Matriptase-1 was inversely correlated with podo, whilst Matriptase-2 and BMP15 showed a positive correlation with prox1.

Conclusion

The MET/Matriptase-1/BMP15 and the inversed Matriptase-2/BMP3/HAI1 are connected significantly with lymph node metastasis in breast cancer.
O098 Diclofenac alters expression of genes regulating muscle lipid metabolism during resistance exercise training in humans, but does not change IMCL content
Authors: Chivaka P , Mallinson J , Taylor T , Constantin D , Constantin-Teodosiu D , Simpson E J , Greenhaff P L
Published: May 2023

Introduction

Diclofenac is an NSAID commonly used off-label to reputedly enhance athletic training adaptation. Diclofenac activates PPAR-γ and upregulates the expression of lipid metabolism genes in vitro. This study investigated the impact of diclofenac administration on IMCL content and muscle genes regulating lipid metabolism during resistance exercise training in healthy volunteers.

Methods

Following informed consent and screening, 17 healthy, young, exercise-trained males matched for leg strength were allocated to Diclofenac (75mg diclofenac sodium daily, n=9) or Placebo (n=8) groups. Participants performed 5×30 sets of maximal isokinetic (90°/s) knee extensions with the non-dominant leg 3× weekly over 12 weeks. Vastus lateralis biopsies were obtained in the fasted state at baseline and 1, 7, 28, and 84 days of training for histochemical determination of IMCL content and muscle mRNA expression using microfluidic gene cards. IPA identified gene networks altered from baseline.

Results

There were significant changes in muscle mRNA expression levels associated with the upregulation of muscle lipid metabolism at all time points compared to baseline in Diclofenac. This was not evident in Placebo, where the inhibition of lipid metabolism was predicted by day 84. Mean (±SEM) IMCL content was no different between groups at baseline (7.4±3.8% Placebo vs. 6.9±2.6% Diclofenac), and no time/treatment interactions with resistance exercise training were observed (ηp2=0.07).

Conclusion

Diclofenac administration had a rapid, robust impact on genes regulating muscle lipid metabolism during 12 weeks of exercise training in humans. However, these responses were not associated with changes in IMCL content and further investigation is warranted.
O106 Trends in the mortality, incidence and disability-adjusted life-years relating to appendicitis in EU15+ countries: an observational study of the Global Burden of Disease database, 1990-2019
Authors: Proctor D W , Goodall R , Borsky K , Salciccioli J D , Marshall D C , Shanmugarajah K , Mohamed A , Shalhoub J
Published: May 2023

Introduction

Acute appendicitis (AA) is the most common abdominal surgical emergency in the world and places a substantial burden on global healthcare systems. Further characterisation of the disease burden in European Union (EU) 15+ countries may help optimise the distribution of healthcare resources. This observational study assessed the trends in incidence and mortality of appendicitis across EU15+ countries between the years 1990 and 2019.

Methods

Age standardised mortality rates (ASMRs), age standardised incidence rates (ASIRs) and disability adjusted life years (DALYs) data for appendicitis in males and females were extracted from the 2019 Global Burden of Disease (GBD) study. Time trends within the study period were analysed using Joinpoint regression analysis.

Results

The median ASMRs across EU15+ countries in 2019 were 0.08/100,000 and 0.13/100,000 for females and males, respectively. Between 1990 and 2019 the median percentage change in ASMR was -52.12% for females and -53.18% in males. The median ASIRs in 2019 for females and males were 251/100,000 and 278/100,000, respectively, with a median percentage change of +7.22% for females and +3.78% for males during the observation period. Decreasing trends in DALYs were observed over the 30-year study period, with median percentage changes of -23.57% and -33.81% for females and males, respectively.

Conclusion

Overall, a general trend of decreasing appendicitis ASMRs was observed across EU15+ countries, despite small overall increases in appendicitis ASIRs. Variations in both diagnostic and management strategies for appendicitis over the study period are likely contributory to the changing trends.
O107 Surgical workforce in conflict: qualitative perspectives from the Middle East and North Africa
Authors: Marks I H , Kanya L , Singh D , Saleh R , Friebel R , Hargest R
Published: May 2023

Introduction

There is a paucity of data regarding the experiences of the local surgical workforce present during conflicts. Whilst we know that surgical trauma burden increases during conflict, little is known about workforce adaptation to new injury modalities, higher caseloads, and additional system pressures. Qualitative research is an effective methodology for elucidating surgical systems in such settings.

Methods

Medically qualified personnel performing surgery during a conflict, who had worked in this setting before the onset or escalation of conflict, were identified through a pre-interview questionnaire distributed through the Royal College of Surgeons of England and other targeted networks. A structured guide was used to conduct in-depth interviews and a thematic analysis was undertaken.

Results

Surgical practitioners (male:female 19:2), of different seniority and representing 9 subspecialties, from 9 Middle Eastern and North African countries were interviewed. There were notable differences in the experiences of practitioners within new conflict settings (Libya, Syria, Egypt and Sudan) compared to those with previous conflict experience, where medical education and training were more likely to be uninterrupted. This necessitated training during active situations, which many practitioners regarded as very fruitful. Junior trainees in new conflict areas often had to ‘act up’ under intense pressure, often without adequate supervision whilst practitioners in previous conflict settings have normalized conflicts and developed cultural coping mechanisms.

Conclusion

This study contributes to the evidence gap on the surgical workforce in conflict settings and highlights the need for innovative and swift support for entire surgical ecosystems to maximize impact.
O110 Prophylactic appendicectomy and cholecystectomy prior to prolonged expedition in extreme environments
Authors: Johnson P , Johnson J
Published: May 2023

Introduction

Over the past century, there has been a reasonable amount of evidence to support the concept of prophylactic appendicectomy and cholecystectomy prior to commencing prolonged expeditions to extreme environments such as the Antarctic and space. However, the risks and ethics of removing perfectly healthy organs to prevent a possible future complication must be accounted for. We aimed to perform a qualitative review of existing literature on the risks and ethics of prophylactic surgical procedures prior to prolonged expeditions.

Methods

We conducted a review of PubMed/Medline and Google Scholar databases on the use of prophylactic surgical procedures following ENTREQ guidelines.

Results

We utilized 23 studies returned in our search to synthesize a body of literature concerning the risks, benefits, and ethics of prophylactic surgical removal of non-essential organs prior to prolonged expeditions. In Antarctic expeditions, the risk of developing acute appendicitis has been projected as high as 43 per 1 million person days. Perioperative complications and risk of death are also high in these prolonged ∼30-year expedition settings. With lack of access to such minimally invasive laparoscopic technologies in extreme environments and unknown exposures, it is anticipated that management would be increasingly challenging with a high risk of complication and death. The risks of surgery must also be considered in individuals with co-morbidities, personal circumstances, and in the context of medical fitness for certification.

Conclusion

The benefit versus risk analysis is variable. Most literature suggest screening and performance enhancement for explorers undertaking prolonged missions.
O112 The COVID-19 pandemic-induced waiting list delays for shoulder and elbow surgery- analysis of the impact on patient reported EQ5D-5L data and their intention to proceed with the planned procedures
Authors: Anazor F , Sibanda V , Bhadresha A , Altaf K , De C , Relwani J
Published: May 2023

Introduction

The aim of this comparative study was to evaluate patient reported outcome measures (PROMS) using the EQ5D-5L and EQ5D-5L visual analogue scale (VAS) following elective shoulder and elbow orthopaedic list delays arising from the COVID-19 pandemic.

Methods

Patients on the elective waiting list for more than 26 weeks were included in the study. Telephone interviews were conducted utilizing EQ5D-5L and the EQ5D-5L VAS data at the time of addition to the waiting list and current status.

Results

75 out of 324 screened patients were eligible for inclusion. 62 (82.7%) patients still wanted to proceed with their planned procedure (group A) while 13 (17.3%) patients no longer wanted to proceed with surgery (group B). There was no statistically significant difference in the mean age, gender, initial trial of conservative treatment and limb laterality between these groups (P<0.05). There was a statistically significant difference in the mean duration of being on the waiting list between groups A and B (40.4 +/-19 weeks versus 62.9 +/-17.5 weeks respectively). Furthermore, statistically significant differences (P<0.05) in the current EQ5D-5L VAS scores were observed between these groups (52.4 versus 65.8 respectively).

Conclusion

This study has shown that majority of patients on elective shoulder and elbow orthopaedic lists with prolonged waiting list delays and improved EQ5D-5L scores are likely to decline the planned procedure and vice versa. Nevertheless, the unplanned “watchful waiting” caused by the COVID-19 pandemic and leading to patients deciding to decline surgery, is not a substitute for timely planned surgery to alleviate patients’ suffering.
O113 ELEVATED METAL ION LEVELS CAN BE TOLERATED BY SOME PATIENTS
Authors: Menakaya C , Durand-Hill M , Hadjikyriacou C , Ahmed I , Wahidun N , Sabah S , Mccoulloch R , Hart A , Donaldson J , Briggs T , Skinner J
Published: May 2023

Introduction

Ten years following withdrawal and revision of large diameter metal on metal hips (MOM), there remains an uncertainty in how best to manage asymptomatic patients with abnormal imaging and/or raised blood metal ion levels. This study investigates the trajectories of symptoms, serological metal ion tests and cross-sectional imaging in these patients.

Methods

523 patients with 707 acceptable functioning MOM hips (defined as Oxford Hip Score (OHS) >30) on active monitoring were identified. Surveillance at two time intervals included: patient-reported pain and function (OHS), blood metal ion (Cobalt (Col) and Chromium (Chr)) and/or cross-sectional imaging with MRI.

Results

Mean serum metal ion levels in parts per billion (ppb) were Co1 4.5 (S.D. 11.5), Co2 4.7 (S.D. 11.6) and Ch1 3.0 (S.D. 4.8) and Ch2 3.2 (S.D. 4.9). Median OHS was 42 (IQR 28–27). OHS was not significantly correlated to serum metal ion levels (Col Pearson correlation = -0.105 P = 0.106, Chr Pearson correlation = -.125 P = 0.054). There was no significant change in Col (-0.48, P = 0.414) and Chr levels (-0.25, P = 0.325) between the two time intervals. 45 patients had metal ion levels >7 ppb, 64.4% had OHS >30. 6 patients had metal ions level greater than 50 ppb, with no significant deterioration of OHS.

Conclusion

Our results indicate that there are a subset of patients with high metal ion levels, stable imaging and acceptable function who can safely be actively monitored thereby assisting in joint decision making with this challenging patient group.
O115 Is humeral head resurfacing still a valid treatment for younger patients? 10-15-year patient follow up data for the global conservative anatomic prosthesis
Authors: Khokhar O , Khan S , Cash T , Khokhar H , Waseem M
Published: May 2023

Introduction

Humeral head resurfacing has fallen out of favour owing to high reported revision rates. We present 10-15 year follow up data for the Global Conservative Anatomical Prosthesis (CAP).

Methods

Patients who underwent humeral head resurfacing using the Global CAP between March 2005 and May 2010 were contacted via telephone. All operations were performed by a single surgeon. Patients rated pain and satisfaction on a 11-point numerical scale (0-10). Oxford shoulder scores (OSS) and Quick-DASH scores were also completed.

Results

Some 46 patients (49 resurfacings) were identified. 20 patients were deceased, 3 had been revised, 3 were uncontactable and 1 developed dementia. Complete data was obtained for 19 patients (73% response rate). The mean respondent age at time of surgery was 68.8 years. 68% were female. The principal indication was osteoarthritis (74%). The mean pain score was 2.2 with a mean satisfaction score of 6.9. The mean OSS was 43.1 and mean Quick-DASH 14.1 indicating good shoulder function. When stratified according to age at time of surgery, younger patients (<65) were found to have higher OSS (p=0.036) and lower Quick-DASH scores (p=0.029) at follow up (Mann-Whitney U Test).

Conclusion

At 10 year follow up, patients who underwent humeral head resurfacing had low pain scores, high satisfaction scores and good patient reported outcome measures. We propose that humeral head resurfacing retains value, particularly for painful osteoarthritis in younger patients who do not wish to undergo total shoulder replacement. The operation is simple and preserves humeral bone stock for future surgery.
O116 Clinical innovation network analysis (CINA) and readiness for implementation of novel digital health interventions for postoperative monitoring: a systematic review
Authors: McLean K , Knight S , Diehl T , Varghese C , Ng N , Potter M , Zafar S , Bouamrane M , Harrison E
Published: May 2023

Introduction

Increasing numbers of digital health interventions (DHIs) for remote postoperative monitoring have recently been developed and evaluated. We aimed to review DHIs for postoperative monitoring and evaluate their readiness for implementation into routine care.

Methods

This systematic review identified studies on implementation and evaluation of DHIs for postoperative monitoring published before 31st December 2021 (PROSPERO ID: CRD42021264289). Studies which included postoperative monitoring use-cases for general postoperative recovery or specific complications were defined according to their IDEAL (Idea, Development, Exploration, Assessment and Long-term follow-up) stages of innovation. A novel clinical innovation network analysis (CINA) using co-authorship and citations of previous work was used to examine collaboration and progression. The WHO framework for monitoring and evaluating DHIs was used for narrative synthesis.

Results

Seventy-five novel DHIs were identified from 7,605 records. Of these, 76.0% (n= 57/75) were classed as early-stage innovations (IDEAL stage 1 & 2a), and none had achieved routine implementation. There is limited evidence of collaboration based on co-authorship or citations, with 91.3% (n=63/69) of studies beyond IDEAL stage 1 without prior publications. There were notable differences in evaluation, with clear omissions in evaluation across all use-cases: more than 4/5 studies did not consider the feasibility, accessibility, or impact of these interventions on the cost, efficiency or quality of care.

Conclusion

Use of DHIs for postoperative monitoring remains at an early stage of innovation, with promising but generally low-quality evidence. Comprehensive evaluation within high-quality, large-scale trials and real-world data are required to definitively establish readiness for routine implementation.
O120 A functional assessment of hepatic ischaemic injury on hepatocellular carcinoma behaviour
Authors: Cheemungtoo G , Dobbins J , Tingle S , Mahendran B , Bates L , Zatorska M , Clark J , Figueiredo R , Govaere O , Wilson C
Published: May 2023

Introduction

Hypothermic oxygenated perfusion (HOPE) preservation improves outcomes after donation after cardiac death (DCD) liver transplantation. Database analysis has also suggested significantly lower hepatocellular carcinoma (HCC) recurrence rates in recipients with HOPE-DCD livers compared to non-perfused livers. Whilst HOPE may protect against severe hepatic ischaemia-reperfusion injury, the exact mechanisms for lower recurrence rates are not fully understood. As HOPE preservation fluid, or perfusate, dynamically flushes out many inflammatory and ischaemic markers from the donor liver, the effect of these contents on in-vitro HCC cell behaviour was investigated.

Methods

An HCC cell line, HepG2, was functionally assessed following treatment with HOPE perfusate samples from 3 human livers declined for transplant. In-vitro HepG2 proliferation, stemness and initiation were assessed by an MTS assay, cytokeratin-19 (K-19) immunocytochemistry, and a colony-forming assay respectively. All experiments were conducted with approval by an ethical committee.

Results

All 3 HOPE perfusate samples resulted in significant HepG2 proliferation and increased aggressive behaviour potential. At 24 hours, HepG2 proliferation was significantly greater after treatment with 1:2 perfusate dilution compared to blank perfusate (p<0.05). Membrane invadopodia development, signifying an increased invasive potential, was also noted at 24 hours with treatments of 1:2 and 1:20, without observed differences in K-19 expression compared to untreated controls.

Conclusion

End-timepoint HOPE perfusate from declined livers facilitate increased HepG2 proliferation and aggression. HOPE may reduce early tumour recurrence in HCC patients by dynamically flushing out these liver-secreted trophic factors.