bluuebunny/crossref_metadata_2025 huggingface dataset:
ThTP6.7 Are we getting it right first time: a three hundred patient audit of operation note documentation
Authors: Ibrahim Mohamed , Shirsath Sayali , Tari Paniz , Dogan Mehmet , Shakir Taner , Jose Paul
Published: August 2023

Aims

Collaborative recommendations from the RCS, ASGBI, and GIRFT have been published regarding documentation for inguinal hernia repair, laparoscopic cholecystectomy and appendicectomy. This is built upon foundations which aim to mitigate litigation. A series of recommendations have been made to ensure the most salient points are covered. We retrospectively audited documentation in our local unit.

Methods

Data was retrieved from electronic medical records for operation notes coded to inguinal hernia repair (laparoscopic or open), laparoscopic appendicectomy and laparoscopic cholecystectomy at our District General Hospital. Documentation was evaluated according to the 26 point GIRFT Best Practice recommendations. Data collected was grouped into standard RCS note taking conventions: pre-operative, incision, findings, procedure, closure and post-operative.

Results

300 electronic operation notes were collated from medical records for a period spanning four months. The majority (71%) of notes were written by registrars. Overall compliance with documentation for pre-operative and incision groups were 40% and 65% respectively. Documentation rates for operative findings were 60% and procedural technique was 48%. Adherence to recommendations for closure and post-operative plans were 75% and 59% respectively. Subgroup analysis revealed 96% compliance in sections which were built into the electronic operation note template compared with 44% of free text responses.

Conclusions

Documentation plays a pivotal factor in preventing litigation. We have identified inconsistencies in our local unit with regards to common general surgical procedures. Templated fields improved adherence to recommendations by over two fold. With digital operative notes becoming more commonplace, questions are raised as to whether documentation should adopt a partially templated format.
ThTP7.5 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of treatment with Oral / IV Iron
Authors: Sukumar Aiswarya , Khan Kashuf , Khalid Wardah , Singh-Ranger Deepak
Published: August 2023

Aim

Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay (LOS), recurrence and requirements for blood transfusions.

Method

Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia (IDA) and Non - Iron Deficiency Anaemia(non-IDA). IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, LOS, recurrence, requirement for blood transfusions and treatment for anaemia were collected. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P <0.05.

Results

150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron).

IDA oral and IV treatment versus non-IDA:

Median age 74, 80 and 78 years (P = 0.814),

Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant),

Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596)

Length of Stay (days) 6, 5; 7 (P 0.113),

Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P >0.1), and

Recurrence P >0.1.

Conclusion

In our series, iron treatment does not influence recurrence, LOS, blood transfusion requirements. Tumour location is not significantly different between IDA and non-IDA groups. Patients treated with oral iron are seen to have a larger drop in haemoglobin post operatively than the other groups.
ThTP7.6 COLORECTAL SURGERY VIRTUAL WARD, AN ADJUNCT TO ERAS GUIDELINES
Authors: Ullah Muhammad Fahad , Singh Baljit
Published: August 2023

Enhanced Recovery after Surgery (ERAS) guidelines provide enhanced recovery protocols after Colorectal Surgery, resulting in reduced morbidity and length of stay without readmissions. A digital way of achieving this will be via Virtual Wards, which offer the use of wearable technology for symptoms and signs utilizing scoring systems at the comfort of home resulting in early discharge. Although the technology exists and is being implemented in many places no specific surgical scoring system has been developed or validated to monitor specific postoperative parameters at home. We offer “a colorectal virtual ward model” with a dedicated scoring system to virtually monitor patients at home and reduce 30 days readmissions. Secondary aim of our project is accelerated discharges in line with ERAS.

Method

A novel “Leicester Virtual ward model” was developed after a literature review. Pre tested scoring systems to categorize the common 1st 30 days post complications were merged with modified NEWS score. A software was designed utilizing a warning system to handle red flags or a combination of different green, red and amber scenarios. Patients will be trained and sent home with gadgets and app based questionnaire for daily monitoring.

Results

In the initial phase the virtual ward is being used to reduce readmission rates. In the second phase it will be used for an accelerated discharge of patients allowing remote monitoring with telephone/virtual or face to face advice as needed.

Conclusion

Virtual wards will be a technology-based solution to increase compliance with ERAS by providing support and outpatient surveillance.
ThTP8.8 Ambulatory management of acute pancreatitis
Authors: Wijeyaratne Manuk , Miller Madoc , Claxton Mary , Vaughan-Burleigh Sebastian , Hollyman Marianne
Published: August 2023

Aim

Acute pancreatitis is a common pathology with a spectrum of disease from mild to life-threatening. It is standard practice for all patients to be admitted due the inability to accurately predict severity. However, both considering the wellbeing of patients and pressures on acute hospitals, it may be the time to consider the role of ambulatory care.

We retrospectively reviewed patients with pancreatitis managed ambulatorily, and assessed for trends in their presentation.

Methods

Retrospective review of a prospectively maintained database between 2019-2022 identifying patients with acute pancreatitis with initial ambulatory management.

Results

There were 19 cases of pancreatitis with planned ambulatory management, with only one representing and requiring admission for 36 hours for symptom control.

Of those who had successful ambulatory management, 12 were male (67%). Median age was 55 (range 24-81). Median duration of symptoms at time of review was 5 days (range 1-21). Median number of comorbidities was 1 (0-6), with only a third (6/18) reporting no comorbidities. Median CRP was 11 (<1-153) and WCC 9 (3-25); no patients had acute kidney injury. All patients had a NEWS<2. All but two patients (with a background of pancreatitis) had imaging performed in an ambulatory setting; five had CT scans.

Conclusion

Patients successfully managed ambulatory were a very heterogeneous group. Our data would support that trial of ambulatory management can be considered in the absence of organ failure (renal function, or physiological instability). This should be supported by adequate safety netting, and plans for further review as appropriate.
ThTP8.11 Team-Based Discussions to Improve Preoperative Protocol Adherence in NELA Patients: A Quality Improvement Project
Authors: Aftab Muhammad , Omran Kareem , Wheatstone Sarah
Published: August 2023

Aim

To analyse the success of a quality improvement project (QIP) performed to improve emergency laparotomy outcomes in a tertiary hospital between NELA Year 7 and Year 8 (12/2019-11/2021).

Methods

NELA Year 7 results were presented at local meetings; following multi-disciplinary involvement, a PDSA cycle was initiated. A dedicated NELA team was established and NELA-related discussions at surgical and anaesthetic junior doctor inductions were implemented. Further, Pre-operative Care for Older People undergoing Surgery (POPS) staff were included at monthly morbidity-and-mortality meetings. We retrospectively analysed Year 7 results (156 cases) against Year 8 (162 cases) of NELA Annual Reports.

Results

Risk documentation before surgery significantly increased from 58% to 72%. Arrivals in theatre appropriate to urgency increased from 79% to 82.9%. Post-operatively, rates of unplanned admissions to critical care decreased by 40% in Year 7 relative to Year 8 (2%-1.2%). NELA mean patient length-of-stay (LOS) and risk-adjusted mortality rates were unchanged (26 days,5.5% respectively). Rates of unplanned returns to theatre increased (5%-6%).

Conclusions

This QIP displays the success of low-cost team-based interventions in significantly increasing adherence to preoperative protocol. We propose implementation of NELA-related discussion at GI-surgery trainee inductions nationally. Although successful, further changes must be considered to reduce LOS and mortality rates. NELA scores have since been incorporated into the WHO checklist and we plan to implement special discussions related to long-staying patients during ward round meetings, aiming to analyse the success of this PDSA cycle in Year 9.
ThTP8.12 Introduction of a Physician Associate (PA) led surgical ambulatory emergency clinic (SAEC) in the Highlands of Scotland
Authors: Seehafer Frances , El-Hakim Hesham , Grant Alan
Published: August 2023

Aim

The delivery of surgical care in the Highlands has changed. SAEC was developed to alleviate bed pressures, improve patient satisfaction and avoid unnecessary workload. We aim to identify whether SAEC is alleviating pressures in the surgical inpatient department - is it used appropriately and cost effectively.

Methods

Attendance was collected prospectively (1/9/22 to 31/10/22) using a dedicated data audit book and booking diary. Patient’s individual review outcomes were gathered.

Results

Of the 165 patients referred to SAEC, 90% were reviewed by the PA, 10% only by the consultant. On average, 3.7 patients were seen per day. The referral reasons were wide ranging: 64 referrals for abdominal pain in addition to abscesses, constipation, weight loss, vomiting, stoma reviews and more. The age of patients ranged from 20-91. 61% were female. 46% had a scan. 85% received a diagnosis. 93% received definitive management. No patients made an unplanned re-presentation within the week following their review. The average time spent in SAEC per patient was 2 hours 48 minutes. 17% of patients were admitted, preventing 116 admissions. This saved approximately £45,820 through admission prevention. In addition, approximately a further £47492 was saved as this was PA led rather than consultant.

Conclusion

Prior to the employment of a PA, SAEC did not provide a consistent service, brought all patients to its surgical ward and required employment of a second consultant. SAEC has improved patient flow and increased bed capacity whilst providing safe and high-quality care that is cost-effective.
ThTP8.13 The international PIACO study: pattern of surgical approaches for acute surgical pathologies in Spain versus UK. Was conservative treatment and open surgery during COVID-19 the way to go?
Authors: Lathan Ross , Gualajara Hector , Yiasemidou Marina , Lockwood Sonia , Chetter Ian , Garcia-Olm Damian
Published: August 2023

A multicentre, comparative, international study was conducted in 16 centres in Spain and four in the UK, aiming to assess the impact of the COVID-19 pandemic and associated public health measures, on presentation and management of acute surgical pathologies.

Overall, 2181 cases were analysed (Table 1). A significantly lower percentage of mild cases of appendicitis presented during the pandemic in Spain and the UK, compared with the same time interval a year before (2020, 466 (57.7 per cent); 2019, 882 (65.2 per cent), P < 0.001. Surgery was less frequently employed during the pandemic (509 (62.3 per cent) versus 921 (68 per cent), P = 0.007). When it was employed, it was significantly less frequently laparoscopic (251 (70.1 per cent) versus 622 (90.8 per cent), P < 0.001).

The independent predictors of non-surgical treatment of appendicitis and cholecystitis were presenting in the UK (appendicitis OR0.026, P < 0.001; cholecystitis, OR0.148, P=0.031), non-severe condition at diagnosis (appendicitis OR 11.433, P = 0.036; cholecystitis OR7.944, P=0.022) and a COVID-19-positive diagnosis (OR 0.142, P < 0.001). Predictors for open surgery were presenting in the UK (OR 0.152, P < 0.001) and COVID-19-positive status (OR 0.112, P = 0.002). There were no differences in mortality between the two years. Severity at diagnosis was the only independent predicting factor for major complications (OR 3.148, P = 0.003).

This study demonstrates a shift towards conservative treatment and open surgery during the first wave of the COVID-19 pandemic. Surgical treatment did not correlate with higher complication rates; indicating that surgical treatment may have been as safe as conservative treatment during COVID-19.
ThTP8.14 Microbiology pus swab sampling in incision and drainage of abscesses
Authors: Paul Melanie , Redfern Victoria , Sellicks Jemima , Lund Jon , Tierney Gillian
Published: August 2023

Background

Obtaining microbiology swabs during emergency incision and drainage (I&D) is commonplace for general surgeons. Its necessity is controversial but despite this, abscess swabbing is still routine despite little evidence of follow up of results.

Methods

All abscess I&D procedures admitted to Surgical Assessment Unit (SAU) at RDH over the period of 3 months from May 2022 to June 2022 were reviewed. Data collection included demographics, admission white cell count (WCC), C-reactive protein (CRP) levels, temperature and co-morbid status as well as any perioperative antibiotic regime.

Results

97 patients underwent I&D either under local or general anaesthesia. The most commonly encountered abscess site was perianal (20%) followed by pilonidal (13%). 22% were admitted on antibiotics started elsewhere. 71% had a recorded microbiology swab taken. 59% of microbiology swabs demonstrated no significant growth. 2 swabs (3%) grew MRSA. There was no documented evidence of GP or patient information of this result. 11 patients who were admitted with a temperature of ⩾ 37.5°C (11%); 7 (64%) grew a named organism on pus sampling. 12 patients had a WCC ⩾13 x109/L, and samples were sent in 9. 6 patients grew the following; mixed anaerobes, E.coli, Citrobacter, and Gram positive cocci.

Conclusions

Microbiology pus sampling for I&D cases is performed ad hoc and results are not routinely chased. For well ambulatory patients I&D can be performed without the need for pus swab sampling at surgeon discretion. If it is performed there should be named clear instruction on follow up of the outstanding results.
FTP1.10 Analgesic Management of Traumatic Rib Fractures on the General Surgery Take in a Non-Trauma Unit
Authors: Ling Quake Ms Sharmaine Yen , Nasser Dr Ibrahim , Hewitt Dr Peter , Walls Mr Martin , Subramonia Mr Sriram
Published: August 2023

Aims

To evaluate the analgesic prescription for inpatients with rib fractures

Methods

Patients (18 years or over) who were admitted with rib fractures and underwent imaging between August 2021 and September 2022 were identified from a prospectively maintained radiology database. Those discharged or transferred to a tertiary centre were excluded. Analgesic prescription, pain scores and referral to specialist services were retrieved from a prospectively maintained electronic patient record system (Meditech, Version 6, USA).

Results

Type of analgesia Percentage of patients receiving prescription (%) Paracetamol 100% NSAIDS 29% Weak opioid (codeine/ tramadol) 54% Strong opioid 100% Patient controlled analgesia 17% Thoracic epidural 4% Regional anaesthesia blocks 0%

Conclusions

The current practice of multimodal analgesic prescription for inpatients with rib fractures needs improvement.
FTP1.13 Improving the use of chest drains in trauma - Small but perfectly formed
Authors: Awadalla Marina , Marsden Max , Mohammed Mohammed , Bernard Fiona , Sasikumar Sivanantham , Nikolopoulos Ioannis
Published: August 2023

Aims

The Western Trauma Association (WTA) advocates using small-bore chest drains (e.g. 14Fr) in haemodynamically normal trauma patients for management of small Haemothoraxes (HTX) or Pneumothoraxes (PTX). This quality improvement project aimed to assess implementation of this guidance.

Method

We compared the use and outcomes of small-bore chest drains for management of HTX or PTX before (Cohort 1) and after (Cohort 2) adoption of WTA recommendations in a District General Hospital in London. We included all patients admitted under the General Surgeons with rib fractures.

Results

All patients were admitted with blunt chest injuries. Cohort 1: 60 patients [36 males, mean age 72 years (range 31-96)] admitted from May–December 2021. Cohort 2: 77 patients [42 males, mean age 73 years (range 23-102)] admitted from May–December 2022.

In cohort 1, 10 patients (16%) required chest drains, all were surgically inserted large-bore drains (median size 28 Fr) there were no peri-procedural complications.

In cohort 2, 11 patients (14%) required chest drains; 5 were surgically placed large bore drains (median size 28 Fr) and 6 were small-bore drains inserted by Seldinger technique (median size 18Fr). Two large-bore drains had periprocedural complications and both required re-insertion. The mean age was 60 years. In the small-bore group there were no peri-procedural complications, no drains occluded and the mean age was 75 years.

Conclusion

After the implementation of this policy, small-bore drain use increased and appeared safe. This audit supports recent literature suggesting small-bore drains are as effective as larger bore and better tolerated.
FTP2.7 Omental-derived Stromal-vascular Cell Fraction / Alginate Gel Composite Vs Control to Improve Murine Colonic Anastomotic Leak Rate – M-OMENTUM Randomised Controlled Study
Authors: Burke Joshua , Maisey Thomas , Wong Jason , Quyn Aaron , Herrick Sarah , Jayne David
Published: August 2023

Aim

Colorectal anastomotic leak (AL) remains a significant challenge. The M-OMENTUM study compared omental-derived stromal-vascular cell-fraction (OSVCF) / alginate gel composite vs control subgroups to prevent murine AL.

Methods

C57BL-6 mice were subjected to an AL model with a leak rate (LR) of 40% and randomised (1:1) to OSVCF / alginate gel or control subgroups (gel alone and no treatment) powered to detect a 20% minimum difference (50% absolute reduction in LR); HO Licence PP9886008. Mice underwent laparotomy and colo-colonic anastomoses. In the intervention group, OSVCF was harvested and applied to the anastomosis in an alginate gel. Mice underwent schedule 1 killing at day 7 or earlier if they failed to meet wellness thresholds. The primary outcome was LR. Secondary outcomes included leak severity, weight, and adhesion score. An intention-to-treat analysis was performed.

Results

128 mice (M:64/F:64), mean age 13.1 weeks (SD,1.2), mean weight, 24.1g (SD,4.3) were randomised. OSVCF/Gel containing mean 3.3x103cells/mg (SD,0.3x103) was applied in the intervention group. Overall LR was 49.2%. There was a numerical difference in LRs between the intervention group (30/64, 46.9%) and control groups (33/64, 51.5%) with a LR reduction of 9.1% (RR 0.91 [95%CI:0.64-1.69]; P=0.72). 12/33(36.4%) that received gel alone and 5/33(15.2%) that received no treatment developed an abscess rather than feculent peritonitis (RR 2.26 [95%CI:1.11-5.20]; P=0.04).

Conclusions

OSVCF/gel produced a 9.1% reduction in LR, but this did not reach statistical significance. The application of gel to an anastomosis alters the severity of anastomotic leak, favouring abscess formation rather than faecal peritonitis.
FTP2.8 The impact of implementation of a colon capsule endoscopy (CCE) service on demand for lower GI endoscopy: A retrospective analysis in a large district general hospital
Authors: Callan Rory , Leong Wei Sheng , Freed Ebru , Malik Kamran
Published: August 2023

Aims

Demand on endoscopy services have increased due to higher numbers of 2WW referrals and the COVID-19 backlog. Alternatives to endoscopy including CT colonography and colon capsule endoscopy (CCE) have been seen as a way to reduce pressure on endoscopy services. Our centre implemented a CCE service, for patients referred via 2WW colorectal pathway with FIT of 10-100μg Hb/g, or undergoing surveillance. We analysed the impact of this service.

Methods

We retrospectively analysed patients referred for CCE, from initiation of the service in July 2021 to October 2022. We analysed presenting symptoms, findings at CCE, completion of CCE, and further investigations/treatment required. A total of 198 patients were included.

Results

68% (134/198) of CCE were complete, defined as full visualisation of the large bowel through to the anus. 66% (89/134) of these required no further investigations. Of those patients requiring further investigations, 21 underwent flexible sigmoidoscopy, 15 underwent colonoscopy and 6 underwent CT-AP. Only 1 required an operation for malignancy. Of the 64 patients with incomplete CCEs, 63 underwent further investigations, mostly endoscopic (17 colonoscopies, 31 flexible sigmoidoscopies).

Conclusions

The implementation of a CCE service resulted in 94/198 patients not requiring endoscopic investigations over a 14 month period, highlighting the role for CCE in reducing endoscopy demand. However, there was a high rate of incomplete procedures (32%). With a higher rate of completion, a greater number of endoscopies could be avoided, further reducing the pressure on endoscopy departments.
FTP2.11 Delay to elective colorectal cancer surgery
Authors: Ekong Tolu , Zadeh Delaram Mostowfi , Shirsath Sayali , Reay-Jones Nicholas
Published: August 2023

Aim

To determine whether a delay to elective surgery of 12 weeks or more results in upstaging of colorectal cancer

Method

We looked retrospectively at all patients who had undergone elective colorectal cancer surgery over a 3-year period, from January 2020 - December 2022. We identified those patients who had delayed surgery. We defined delayed elective colorectal surgery as 12 weeks or more from the date of diagnosis. Patients who underwent endoscopic excision or those delayed due to neoadjuvant chemoradiotherapy were excluded from our study. TNM stage recorded by CT or MRI scan at the time of diagnosis and just before the delayed surgery were compared to determine if upstaging of the cancer had occurred.

Result

406 patients underwent elective colon or rectal cancer resections from January 2020 to December 2022. After excluding those who had neoadjuvant chemoradiotherapy, the number of patients who had their surgery delayed by 12 weeks or more was 13. The median time delay was 16 weeks (12-30). All 13 patients had a staging scan at time of diagnosis, however only 7 out of the 13 had a re-staging scan prior to their delayed surgery. The pre-operative stages ranged from T0-T3, N0-N2, one patient had a single liver metastasis that resulted in a combined hemicolectomy and hepatectomy. None of the patients who were re-staged had a worse TNM stage.

Conclusion

In our cohort of patients, although a small total number, delaying elective cancer surgery by 12 weeks or more did not cause upstaging of their cancer.
FTP2.13 Outcomes of emergency and elective colorectal resections in a busy DGH
Authors: Enver Muqeet , Nijran Kirandip , Shams Marvi , Goh Yan Li , Akingboye Akinfemi , Waterland Peter
Published: August 2023

Aims

Evaluate outcomes of emergency and elective colorectal resections in a busy DGH.

Methods

Single-centre retrospective study of emergency and elective colorectal resections between December 2021-November 2022.Each patient’s hospital records were reviewed, and data were collected on patient demographics, type of operation performed in the emergency or elective setting, ASA, post-operative complications encountered based on Clavien-Dindo classification, mortality rates, and length of hospital stay.

Results

A total of 201 cases were performed (132 elective,69 emergency), 57 cases were open,136 laparoscopically and 8 were converted. Median age was 70(range 20 – 92) years old, 114males:87females. The median length of hospital stay was 8(range 3–105) days. ASA grade of most (57.2%) patients were ASA 3. Missing data were unavailable in 20.4% of cases. Pre-operative VTE compliance rates were prophylactic clexane (92.5%) and TEDS (91.5%) respectively.

The elective operations performed include right hemicolectomy (46.2%), extended right hemicolectomy (4.5%), anterior resection (23.5%), ultra-low anterior resection (6.1%), left hemicolectomy (2.3%), APER (7.6%), Subtotal colectomy (2.3%), Total colectomy (2.3%), Panproctocolectomy (2.3%), Proctocolectomy (1.5%) and Hartmanns (1.5%). Four patients returned to theatre for pouch resection (1 case), laparotomy + stoma formation (2 cases) and closure of burst abdomen (1 case). Our elective mortality rate was 1.5%.

The emergency operations performed include right hemicolectomy (43.5%), extended right hemicolectomy (2.9%), anterior resection (5.8%), subtotal colectomy (8.7%) and total colectomy (2.9%). Four patients returned to theatre for relook laparotomy and refashioning of stoma with a 5.8% mortality rate.

Conclusions

This snapshot audit demonstrates low morbidity and mortality rates in our centre, despite our patient cohort having co-morbidities of ASA III.
FTP3.1 Impact of Covid-19 on Emergency Laparotomies due to Cancer
Authors: Ehsan Aisha , Javed Anum , Anderson Helen , Trivedi Prateesh
Published: August 2023

Aim

To study the effect of the COVID-19 pandemic on the number of emergency laparotomies for bowel cancer.

Methods

Emergency laparotomies undertaken at St Peter’s Hospital (SPH) from August 2018 to August 2021 were identified. Pre-Covid era (PCE) was defined as August 2018 to January 2020; Covid-19 era (CE) was defined as February 2020 to August 2021. Electronic records were examined to identify the indication for surgery (cancer vs non cancer), length of stay and mortality. Patients undergoing multiple laparotomies in a single admission were only counted once.

Results

The total number of emergency laparotomies was 473 (PCE= 233, CE = 240). Emergency cancer laparotomy numbers in CE were significantly increased compared to PCE (68 vs. 44, p-value <0.05). CE emergency cancer laparotomy patients had a longer median length of stay. There was no significant difference in 30-day mortality (PCE 9 vs. CE 8 days).

Conclusion

There were an increased number of emergency laparotomies for cancer during CE. Possible causes include not presenting due to national lockdown and concerns regarding COVID-19.

Further regional and nationwide data needs to be studied to establish whether this finding has been replicated on a wider scale or whether it is a local issue. Further analysis of data to determine the TNM staging will be useful to see the level of disease pathology.
FTP3.5 Patients undergoing elective colorectal surgery are at increased risk of surgical site infections: a single centre experience
Authors: Koh Amanda , Ng Oliver , Calderbank Tom , Das Kieran , Smith Katherine , Tierney Gillian
Published: August 2023

Introduction

Surgical site infections (SSIs) account for 16% of all healthcare-associated infections and pose a considerable burden on the NHS due to prolonged hospital stay, comorbidities, and increased costs. Due to the nature of colorectal surgery, SSI rates in this patient cohort are even higher. The aim of this audit is to establish our colorectal SSI rates and identify associated risk factors with a view to create and implement an SSI bundle.

Methods

A retrospective audit, from a large institution, of all patients who underwent elective colorectal surgery were collected between April 2019 to March 2022. Data from the operation were extracted, including the operation date, procedure performed, surgical approach, and stoma formation. SSI was recorded if any of the following were present at 30 days: purulent discharge, clinical or imaging diagnoses, microbiology, wound dehiscence with pain, swelling, redness or pyrexia.

Results

Five hundred and fifty-seven patients were included in the preliminary analysis; 62.3% of which were open, 20.8% laparoscopic and 7.9% robotic. A total of 116/557 (20.8%) had an SSI. This increased the length of stay by 4.3 days. Open approach was associated with higher SSI rates (21.2% in open, 18.9% laparoscopic, and 10.4% robotic). The formation of stoma also increases SSI rates (17.4% in patients without stoma, 25.4% colostomy and 28.1% ileostomy).

Conclusions

Further data analysis will be conducted to identify patients at a higher risk of developing an SSI. An SSI bundle has been created within the department, and a re-audit will be performed following its implementation.
FTP3.7 Influence of neoadjuvant treatment strategy on operability in locally advanced rectal cancer
Authors: McFeetors Carson , O'Connell Lauren , Regan Mark , Joyce Myles , Hogan Aisling , Nugent Emmeline
Published: August 2023

Background

Neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). Neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) further improves pCR rates. While some patients forgo surgery, total mesorectal excision (TME) remains the standard of care. While TNT appears to be non-inferior to nCRT with respect to short-term oncological outcomes, little data exists on perioperative outcomes. Factors such as conversion, sphincter preservation and anastomosis rates do not impact oncological outcomes but affect quality of life (QOL).

Methods

An institutional colorectal oncology database was interrogated from inception (2009) to November 2022. Inclusion criteria comprised patients with histologically confirmed rectal cancer who had undergone neoadjuvant therapy and TME. Exclusion criteria comprised patients with a non-colorectal primary, those operated on emergently or who had local excision only. Primary outcomes were rates of conversion to open, sphincter preserving surgery and anastomosis formation.

Results

In total 156 patients were eligible for inclusion (standard nCRT, n= 111, TNT, n=45). Sphincter preservation and anastomosis formation were more frequent in the nCRT cohort, while conversion rates were higher in the TNT cohort. Although these differences were not statistically different, the conversion value approached significance (sphincter preservation, 70% vs 62%, p=0.3484; anastomosis, 72% vs 64%, p=0.4632, conversion, 34% vs 17%, p=0.0501).

Conclusions

In this series TNT appears to be associated with higher conversion rates and lower rates of anastomosis formation. While larger studies will be required to confirm these findings, QOL factors should be considered alongside oncological benefits when selecting treatment strategies.
FTP3.14 Comparing thoracic epidural anaesthesia to rectus sheath catheter induced analgesia in reducing postoperative pain following major abdominal surgery. A systematic review
Authors: Nour Hussameldin M , Abogabel Sameh , Peristeri Dimitra V , Bhaskaran Premjithilal , Singh Krishna , Sajid Muhammed S
Published: August 2023

Aims

Effective analgesia is mandatory for achieving optimum post operative recovery. The aim of this study is to compare between thoracic epidural analgesia and rectus sheath catheter analgesia in reducing pain score after open major abdominal surgery.

Methods

Standard medical electronic databases were searched with the support of a local librarian. Relevant published randomised controlled trials (RCT) comparing thoracic epidural analgesia and rectus sheath catheter analgesia after open major abdominal surgery, were shortlisted according to the inclusion criteria.

Result

Four RCTs on 351 patients undergoing major abdominal surgery were included in this meta-analysis. There were 176 patients in the thoracic epidural group (TEA) and 175 patients in the rectus sheath catheter group (RSC). In the random effect model analysis, there was no significant difference in VAS pain score in 24 hours at rest [SMD -0.46; 95% confidence interval (95% CI) -1.21 to 0.29; z =1.20 P=0.23] and movement [SMD -0.64; 95% confidence interval (95% CI) -1.69 to -0.14; z = 1.19 P= 0.23] between TEA and RSC. Similarly, there was no significant difference in pain score in 48 hours at rest [SMD -0.14; 95% confidence interval (95% CI) -0.36 to 0.08; z = 1.29 P= 0.20] and movement [SMD -0.69; 95% confidence interval (95% CI) -2.03 to 0.64; z = 1.02 P= 0.31].

Conclusion

There was no significant difference in pain score between TEA and RSC following major abdominal surgery and both approaches can be used safely according to the choice and expertise available.

Acknowledgement

This work was previously presented.
FTP4.7 A stitch in time; Surgeon learning curve in Robotic Assisted Colorectal Cancer Resection Operating Times
Authors: McGuire Carina , Khopekar Faid , Saldanha James , Komolafe Segun , Maxwell Fraser
Published: August 2023

Aims

We began performing Robotic Assisted (RAS) colorectal cancer (CRC) resections in our hospital in 2022. In order to understand whether we could demonstrate a surgeon learning curve, we assessed for any difference in median length of operating time (OT) in RAS CRC resections from their implementation to present time.

Method

We performed a retrospective review of theatre logs for RAS CRC resections from 2nd May 2022 until 17th January 2023. We recorded ‘knife to skin’ and ‘close’ time for each case alongside resection type. We included the 4 highest volume resection types and identified the median OT for the first half of cases, from which we subtracted the median OT from the second half of cases performed. We then calculated median time difference between the sets.

Results

As table 1 demonstrates, the median OT decreased for all included RAS CRC resections (n=51) from the first data set to the second. The median time saved over all resection types was 26.5 minutes.

Discussion

In surgery, demonstrating a learning curve involves looking at a marker of progress (such as operating time) and assessing it against exposure to, for example, a new technique or instrument. RAS represents a unique opportunity for this. We were able to demonstrate an early surgeon learning curve with a decrease in median OT across our highest volume RAS CRC resections within 8 months of their implementation at our centre.
FTP4.9 An audit to measure if >5% reduction in weight occurred, as recommended by the National Institute of Health and Clinical Excellence (NICE), for patients suffering from osteoarthritis before their scheduled total joint replacement surgery, at Darwen Health Link Surgery
Authors: Sarma Akanksha , Mustafa Syed
Published: August 2023

Aim

Osteoarthritis causes damage to synovial joints, manifesting as pain, loss of function, and disability. A high BMI is correlated with an increased incidence of osteoarthritis, for which NICE recommends a >5% (ideally >10%) decrease in baseline weight to improve pain and functionality. This audit aims to measure Darwen Health Link’s adherence to NICE guidelines 226 “Osteoarthritis in over 16s: diagnosis and management” for the management of osteoarthritis patients regarding weight-loss.

Method

This audit analysed 15 osteoarthritis patients with a BMI>30 who underwent total joint replacements from November 2021 to November 2022. Patient records were analysed for their weight management from 3-12 months prior to surgery, up till their surgery period to assess: if weight-loss advice was provided and if >5% weight-loss took place. Standards were designated per clinician recommendations and NICE guidelines.

Results

All osteoarthritic patients (n=15) were given weight-loss advice at presentations before surgery. However, only 20% (n=3) of patients lost >5% of their baseline weight before their joint replacements, against the 50% standard. Therefore, interventions to improve weight-loss in patients and clinician guidance were implemented. These include a targeted poster, detailed weight-loss advice packs for patients, and clinician education about weight-loss programmes available locally.

Conclusion

The first part of the audit indicates suboptimal performance by Darwen Health Link. Their performance will be re-audited in 3 months post-interventional implementation. Reducing osteoarthritis’s burden on patients in primary care can significantly reduce pain and the need for surgery.
FTP5.1 Incidence of hyponatremia in general surgical patients at a district hospital in NHS
Authors: Arifuzaman Mohammed , Shah Jigar , Dalmia Sanjay
Published: August 2023

Aims

To understand the perioperative Na values in general surgical patients. To understand factors and predictors for Na imbalance.

Methods

Retrospective analysis of all patients admitted under general surgery, elective and emergency, from 15-4-2022 to 15-10-2022 were included. Daycase patients who were discharged on POD0 were excluded. A total of 462 patients studied. Collected data included hospital number, age, sex, ASA grade, co-morbidities, IVF and NBM status, Na values over the admission period. Statistical analysis performed in StatsDirect3.

Results

Median day 1 Na value was 131 (SD 2.50). On day 1, patients with severe hyponatremia (Na<125) were 0, moderate hyponatremia (125-129) 28, mild hyponatremia (130-135) 395, reference range of Na were 59 and 0 hypernatremia patients. The day 2 Na value was a median of 129.5 (SD 2.84).

On day 2, patients with severe hyponatremia (Na<125) were 1, moderate hyponatremia (125-129) 32, mild hyponatremia (130-135) 398, reference range of Na were 31 and 0 hypernatremia patients.

Multivariate regression analysis comparing day 2 of Na with day 1 Na, sex, type of IVF (Hartmanns vs NS) and age resulted in a P < 0.0001 for day 1 Na, P < 0.0001 for type of IVF. Patients on Hartmann's have a predicted day 2 Na of 137 and those on NS 130 (243 patients received NS and 217 Hartmann's on admission day 1).

Conclusion

Majority of surgical patients present with hyponatremia (91.3 %). Hyponatremia more common on day 2 of admission. First day Na value is statistically significant in predicting the 2nd day Na values.
FTP5.2 Functional deficits in older patients undergoing major gastrointestinal surgery
Authors: Daniels Sarah , Lee Matthew , Moug Susan , Wilson Tim , Brown Steve , Wyld Lynda
Published: August 2023

Aim

Gastrointestinal surgeons face an increasingly complex patient population. Patients are older, often with co-morbidities, frailty, nutritional, functional, and cognitive impairments. The aim of this study was to compare functional outcomes of a cohort of older patients following emergency and elective major gastrointestinal surgery.

Methods

A prospective cohort study in 3 NHS trusts was performed (NCT04545125). Baseline comprehensive assessment including quality of life, physical activity levels, functional, nutritional, and cognitive status was performed. Functional status (WHODAS v2, & Activities of Daily living questionnaire) and quality of life (EQ-5D-5L) were assessed at baseline, 6 weeks, 3 months, and 6 months following surgery.

Results

Ninety-eight patients were recruited; median age 74 years, 56% male. Eighty-two patients underwent elective surgery and 16 underwent emergency surgery. At baseline, 13.9% elective vs 68.8% emergency patients were considered vulnerable or frail on frailty testing; 35.9% elective vs 62.5% emergency were identified as malnourished or at risk of malnutrition. Emergency patients had lower Independent Activities of Daily Living score median 6 versus 8 (p=0.007). Baseline activity was lower in emergency patients compared to elective; 1,386 vs 3,882 MET minutes per week (p=0.06). Functional status and quality of life appeared to recover in elective patients by three months, however this was lower at baseline in emergency patients and this persisted over follow-up.

Conclusion

High levels of baseline functional, cognitive and nutritional deficits were found in this study. Whilst elective patients appear to recover within 3 months, emergency patients have persistent deficits in functional capacity and quality of life.
FTP5.4 Ethical Considerations Within Paediatric Bariatric Surgery: A Systematic Review
Authors: Shah Aishwarya , Kumar Niraj
Published: August 2023

Aims

With childhood obesity prevalence increasing rapidly, bariatric surgery is being given greater consideration in the paediatric population. Paucity of long-term evidence, physical and emotional risks, and reliance on parental decision-making are factors constituting this moral complexity, forming debate around eligibility and timing of offering the procedure. To evaluate these ethical considerations, a systematic review was conducted.

Methods

All relevant synonyms of “Ethics”, “Bariatric Surgery” and “Paediatric” were used to identify papers for inclusion in the systematic review and reference lists were also scanned. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results

10 papers were included. A key ethical dilemma frequently explored was the issue of consent, and ensuring the child is at the forefront of the decision. Paediatric bariatric surgery causes controversy as children are exposed to surgical risk early in life, and thus prolonged preventative measures are encouraged with the aim to mitigate obesity by adulthood causing unnecessary harm. Children without a strong support network have additional obesity risk, whereby withholding surgery may be viewed as inequitable and non-beneficent. There is also conflict between delaying surgery until the child is Fraser-competent versus increased complication risk.

Conclusions

Further evidence to guide assessment criteria are needed to facilitate informed consent. Post-operative support should be audited, with sustained health outcomes and inclusive care monitored. Although preventative methods are important in the paediatric population, clinicians must not discriminate against those for whom it proves ineffective, with bariatric surgery being a last resort for high-risk obese patients.
FTP5.7 Championing Benign Biliary Patients in a UGI Tertiary Referral Cancer Centre. Results from a 3 year Quality Improvement Project
Authors: Forsyth Katrina , Johnson Roison , Boghdady Michael El , Wheatstone Sarah , Tomasi Ivan , Knight William , Atkinson Simon , Ebied Husam
Published: August 2023

Background

A biliary quality improvement project (QuIP) was established in 2019 following 3 audit cycles highlighting delays to laparoscopic cholecystectomy (Lap-C) in patients with gallstone pancreatitis. Limited theatre space and prioritisation of high volume cancer work hindered previous efforts to improve the service between 2015 and 2019. The latest phase of the QuIP has introduced a dedicated consultant lead biliary service, a live biliary admission tracking system, increased in-patient Lap-C, implementation of ambulatory pathways and a patient centred integrated care approach.

Methods

Prospectively collected data from a live biliary tracking system was compared with retrospective audit data from 2015-2019. Key performance indicators were; average time to Lap-C, rate of Lap-C with-in 2 weeks following pancreatitis, inpatient Lap-C rate and out-patient appointments saved.

Results

343 patients were managed through inpatient and ambulatory biliary pathways from November 2021-2022. 2 week Lap-C post pancreatitis improved from 27% to 69% (41% as inpatients) with average time to Lap-C improving from 68 days to 13 days. 103 outpatient appointments were save by counselling and pre-assessing patients for Lap-C as inpatients, saving £12360 in outpatient costs. In-patient Lap-C rate improved from 2% to 19% for fit and consenting patients.

Conclusion

Patients with biliary pathology may be at risk of lower standards of care when treated in centres with a high tertiary UGI cancer burden. A higher quality of care can be achieved for biliary patients through effective patient prioritisation, increasing inpatient Lap-C, the establishment of ambulatory pathways and a robust outpatient tracking system.
FTP5.8 Gall bladder service developments to improve outcomes based on national guidelines
Authors: Bajomo Oreoluwa , Dickson-Lowe Richard
Published: August 2023

Introduction

Nationally, acute gallstone disease accounts for over 1/3rd of emergency general surgery admissions and referrals. Guidelines recommend laparoscopic cholecystectomy within 1 week for acute cholecystitis, on index admission for acute gallstone pancreatitis and within 18 weeks for uncomplicated gallstone disease. Presently, NHS Trusts struggle to meet these targets due to unrelenting demand for limited resources.

We present interventions to improve a laparoscopic cholecystectomy service which nearly halved the elective surgery waiting time.

Method

Retrospective data was collected on patients who underwent elective laparoscopic cholecystectomy at a DGH pre- and post-intervention (March-July 2021 & January-April 2022). Data collected from electronic medical records included patient demographics, waiting list times, operation details and post-operative outcomes.

Interventions included introduction of a boarding card which included Cholecystectomy As A Day-case (CAAD) scoring and laparoscopic cholecystectomy standard operating procedure (SOP). The SOP specified criteria for preoperative investigations, theatre list organisation, post-operative admission and high-risk patients requiring specialist surgeon input.

Results

Pre-intervention cycle included 82 patients, with 78 patients booked as day-case operations and 40.2% unplanned postoperative admissions rate. The post-intervention period assessed 72 patients, with 46 patients booked as day-cases and 30.6% unplanned postoperative admissions. The median day-case LOS remained at 0 days pre- and post-intervention.

Median elective laparoscopic cholecystectomy waiting time significantly decreased from 140 to 75 days (p< 0.0001).

Conclusion

Our study demonstrates interventions to restructure a laparoscopic cholecystectomy service significantly shortened waiting times, with national targets of 18-week wait for uncomplicated gallstone disease surgery met. Additionally, fewer unplanned postoperative admissions allows better bed management therefore reducing disruption to elective and emergency service delivery.