bluuebunny/crossref_metadata_2025 huggingface dataset:
SP4.2.13 The staging of head and neck cancers at presentation during the COVID-19 pandemic: a regional analysis
Authors: Ding Anni , Smith Lauren , Dickason Aubrey , Easto Rachel , Reece Philip
Published: October 2021

Aim

The impact of COVID-19 on cancer presentations has been debated; this audit aimed to examine the stage at presentation of head and neck (H&N) cancers regionally during the COVID-19 pandemic compared to the identical time period during 2019.

Methods

Retrospective data was collected across 3 hospitals in the South West, identifying all H&N cancer patients discussed at Multi-disciplinary Team Meetings between 1st April-10th October 2019 and the same timeframe in 2020. Patients with lymphomas and thyroid neoplasms were excluded due to separate treatment pathways available.

Results

There were 234 and 272 patients identified in 2020 and 2019 respectively. The median stage at presentation for all cancers was 2 in both years. The commonest cancers in 2020 were oropharyngeal (28%) and oral cavity (22%), similar to that of 2019 (oral cavity-31%, oropharyngeal-22%). The absolute numbers of laryngeal cancers were similar but a greater percentage of those presented late (stages 3&4) in 2020 compared to 2019 (47% vs 35%). There were almost twice as many skin/lip cancers in 2020 proportionately (20% vs 12%) and a greater number of them presented at a later stage.

Conclusion

Overall, COVID-19 has not appeared to affect the stage at presentation of H&N cancers, reflecting an on-going continuity of care for cancer patients. Subgroup analysis revealed skin and laryngeal cancers was most adversely affected by the pandemic, possibly due to delayed presentation and reduced face-to-face consultations, highlighting the need for continued face-to-face appointments as a part of cancer care pathways.
SP5.1.12 Discrete Event Micro Simulation Modeling for the Treatment of Resectable Malignancy of the Oesophagus and Gastrooesophageal Junction
Authors: Bradley Alison , Brown Leo
Published: October 2021

Aims

To assist decision-making by creation of a statistical model that simulates treatment pathways and subsequent outcomes for the management of resectable malignancy of the oesophagus and gastrooesophageal junction.

Methods:

Discrete Event Simulation (DES) modelling is a statistical modelling technique that models the operation of a system as a sequence of events in time to support decision-making. This approach lends itself well to disease modelling by incorporating different treatment strategies targeted at different groups. It offers an advantage over previous decision analysis studies that have relied on Markov modelling which can have reduced accuracy due to lack of memory within the Markov model, the effect of depletion of susceptibles, and the timing of transitioning within the model. This simulation model was populated with data from best available evidence from contemporary randomised controlled trials and ran over 100,000 iterations.

Results

Neoadjuvant chemoradiotherapy was the superior treatment pathway with superior pathway selection frequency of 87.16%. For squamous cell carcinoma neoadjuvant chemoradiotherapy was the superior treatment option with 73.30 months survival time (65.60 QALMs) and had a superior pathway selection frequency of 100%.

Conclusions

DES simulation modeling for decision analysis in treatment of resectable malignancy of the oesophagus and gastrooesophageal junction supports the use of neoadjuvant chemoradiotherapy.
SP5.2.2 A Systematic Review of Living Kidney Donor Enhanced Recovery After Surgery
Authors: Byrne Matthew , Mehmood Ahmed , Summers Dominic , Hosgood Sarah , Nicholson Michael
Published: October 2021

Background

Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stays without increasing readmission or mortality. However, its role in living donor nephrectomy has not yet been defined. This systematic review aimed to describe the literature on ERAS in live donor nephrectomy.

Methods

Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 1/7/19 for all original randomised control and cohort studies relating to ERAS in living donor nephrectomy. The study was registered on PROSPERO (CRD: CRD42019141706).

Results

1248 patients were identified from 14 studies (630 patients with ERAS and 618 patients without). There were considerable differences in the protocols used and compliance with general ERAS recommendations was poor. Meta-analysis revealed that with ERAS length of stay significantly reduced by 0.83 days (95% CI = 0.30-1.37, p = 0.002), there was a trend towards decreased readmission (OR = 0.45, 95% CI = 0.19=1.10, p = 0.08), and there was no significant difference in complications (OR = 0.73, 95% CI 0.16-3.39, p=0.69). Opiate usage was significantly reduced with ERAS in all studies that measured it and there was no significant difference in creatine clearance.

Conclusions

ERAS in live donor nephrectomy significantly reduces length of stay, and reduces opiate usage, without increasing readmission, complications, or creatinine. There is considerable variation in ERAS protocols used and a guideline for ERAS in live donor nephrectomy should be developed.
SP5.2.4 Stent-graft endobypass for non-infected femoral pseudoaneurysms in high-risk surgical patients: acceptable short-to-mid-term results
Authors: Chaudhuri Arindam , Dey Ramita , Stupalkowska Weronika
Published: October 2021

Aim

Stent-grafts are finding a place in the treatment of femoral pseudoaneurysms (FpsAs), having been described in the treatment of infected pseudoaneurysms. We present the results of endovascular treatment of non-infected FpsAs using stent-grafts.

Methods

Case series of patients who underwent stent-graft coverage of FpsAs from January 2016 to December 2020. Stent-graft fractures, occlusions and reinterventions, length of stay (LOS) and 30-day mortality were assessed.

Results

11 patients (mean age 75±10.3 years, 7 males; all ASA 3 or 4) underwent stent-graft coverage of FpsAs. Original procedures linked to the formation of FpsA were iliofemoral bypass (n = 3), femorofemoral crossover (n = 3), percutaneous coronary interventions (n = 2), aortobifemoral bypass (n = 1), endovascular aneurysm repair (n = 1) and femoral endarterectomy (n = 1). 3 patients had previous open FpsA repair.

Technical success of deployment was 100%. Stent-grafts used included Viabahn Endoprosthesis (WL Gore & Associates, Flagstaff USA; n = 8), Viabahn VBX (WL Gore & Associates; n = 1) and BeGraft (Bentley InnoMed GmbH, Hechingen, Germany; n = 2). All patients were maintained on either antiplatelets or anticoagulant. 10 patients were available for analysis (1 lost to follow-up); radiological follow-up included initial computed tomography angiography and later combined duplex ultrasonography/plain radiography. Median LOS was 4 days (IQR 4). 30-day mortality was 0%. Median survival was 12 months (IQR 17). There was one stent-graft occlusion requiring thrombectomy but no fractures were observed in this series.

Conclusions

This small series suggests that there may be a role for stent-grafts in treatment of FpsAs in carefully selected patients. Given lack of data on long-term outcomes, continued surveillance is recommended.
SP6.1.6 Rule of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy
Authors: Hatem Fady , Mostafa Sam , Thomas Jenny , Nassar Ahmad
Published: October 2021

Aims

Incidence of gall stone disease is estimated at 10-15%of population. Intraoperative cholangiography (IOC) diagnose choledocholithiasis, delineates the anatomy of the biliary ducts, facilitate the dissection and reduces injuries. Our aim is to assess the feasibility and role of IOC and the incidence of choledocholithiasis in acute cholecystitis (ACC).

Methods

Retrospective analysis of prospectively collected data for patients admitted with ACC and undergoing same-hospital-stay laparoscopic cholecystectomy (LC). IOC was systematically attempted in all cases.

Results

475cases included. Female to male ratio1.9:1. Conversion to open was done in 3 cases. Preoperative cholelithiasis was confirmed in 439cases versus 34cases with no stones. USS CBD abnormality (dilated or contain stone) found in 53 cases, out of which 8(15%) cases had CBD stones. Jaundice was found in 69cases, where 25(39%) cases had confirmed choledocholithiasis.

IOC was successful in all cases except one. Abnormal IOC was found in 99(21%) cases. Of those; CBD stones were confirmed in 76 (77%) cases regardless the presence of cholelithisasis on USS. Empyema was found in 237 cases and it was associated with higher risk of abnormal IOC in 59(25%) cases where CBD stones were confirmed in 45(76%) cases. Cystic duct (CD) stones found in 80cases, of those 27(34%)cases had choledocholithiasis.

Conclusions

Females have double the risk of ACC. Preoperative jaundice and CD stones are stronger indicators than CBD diameter for presence of choledocholithiasis. The incidence of choledocholithiasis in ACC is (20-25%) regardless the presence of gall stones on USS. IOC is feasible and highly recommended in emergency LC.
SP6.1.10 Can gallbladder polyp surveillance be justified? Experience of a large DGH
Authors: Bradley Nicholas , Wilson Michael , Shearer Christopher , Heron Timothy , Robertson Katie , Crumley Andrew
Published: October 2021

Aims

Gallbladder polyps are typically an incidental finding on sonographic or pathological examination with an estimated prevalence of 0.3 – 9.5%. Their role as a precursor to gallbladder malignancy is disputed. The 2017 European Joint Society Guidelines (ESGAR/EAES/EFISDS/ESGE) aim to standardise management of gallbladder polyps detected prior to cholecystectomy. We aim to describe our experience in the management of gallbladder polyps in a district general hospital.

Methods

This single centre retrospective case series included consecutive cholecystectomies over an 8-year period, identified through pathology records. Medical records were interrogated to identify the presence of gallbladder polyps identified pre-operatively and at subsequent histopathological analysis.

Results

3835 cases were included. Four cases (0.1%) had an adenocarcinoma identified; none of these had pre-operatively identified polyps. Two cases (0.05%) were found to have lesions with high-grade dysplasia, 1 of which had a 17mm polyp preoperatively. One case (0.03%) had cellular atypia, without a pre-operative polyp. Forty six cases (1.2%) were found to have low-grade dysplasia; 1 (2.2%) of these had adenomyomatosis pre-operatively but none had pre-operative polyps. Overall, 53 patients (1.4%) had abnormal pathology with only 1 (1.9%) of these having a pre-operative polyp identified.

Conclusions

Our results suggest that in the real-world setting, intensive surveillance of gallbladder polyps has limited utility in identifying cases of gallbladder malignancy. The burden on services produced by adherence to strict surveillance guidelines is difficult to justify and a less arduous approach is unlikely to significantly influence the management or outcome in patients with gallbladder malignancy.
SP7.1.2 DVT and Abdominoplasty: A Holistic 8-point protocol-based approach to prevent DVT
Authors: Saghir Reyan , Saghir Noman , Okhiria Renee , Sidhu Manu , Okhiria Terrell , Sforza Marcos
Published: October 2021

Aim

Plastic surgery as a speciality is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT).

Methods

A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7- year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours.

Results

Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Due to the zero-incidence rate of DVT, different hypotheses of DVT proportions were tested to find out the rates that could be statistically consistent with our sample, thereby providing conservative incidence rate estimates.

Conclusion

This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We therefore believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery.
SP7.1.8 Routine use of opioids for post-operative pain in opioid naïve patient can risk long term dependence
Authors: Majeed Talal , Mcgurk Simon , Wilson Jeremy , Magee Conor
Published: October 2021

Aims and Objectives

Aim of our study was to evaluate the current practices of prescribing opioids for post-operative pain in opioid-naive patients in our region and the risk of prolonged opioid use among them.

Methods

A retrospective cohort study was performed where cohort consisted of patients who had surgery in 2018 with at least one year follow up. Endpoints were the proportion of all patients and opioid naïve patients, discharged on opioid prescription and proportion of opioid naïve patients who developed opioid dependence after one year.

Results

During 2018, 17524 patients underwent a total of 20526 surgical procedures by pan surgical specialties in our hospitals. 8772 patients (50%) were discharged with opioid prescription. 673 (7.70%) of those required further opiate prescriptions after discharge, of those requiring opiates, 331 had no opiate exposure before surgery (342 had previous opiate exposure). In opioid naïve patients, at 1 year follow up 151 (45%) had no further opiate prescriptions, but 180 (55%) required ongoing opiate prescriptions after one year follow up. The risk of opioid dependence after surgery is significant in opioid naïve patients.

Conclusion

Results are alarming and evidence-based strategies, national and local guidelines are needed to prevent the opioid crisis in the UK. There is a need for a national campaign to minimize the dependence on opioids and to find, better alternatives to opioids.
SP7.1.14 Our experience of the first 100 cases of prostate biopsy using the Transperineal PrecisionPoint Access system at a hospital in the North West of England
Authors: Anwar Baseerat , Blenkharn Christopher , Rao Praveen , Quddus Bilal , Islam Jawad Ul , Ghiblawi Salaheddin
Published: October 2021

Aims

The diagnosis of prostate cancer has evolved over the past 2 decades with rapid changes occurring in the last 5 years. Traditionally transrectal prostate biopsies were the standard. However due to the risk of sepsis and sub optimal diagnostic accuracy, this method has been superseded by biopsies of the prostate now being performed via the transperineal (TP) route more frequently. Our hospital was the first in our region to use the PrecisionPoint Transperineal Access system to perform TP biopsy under local anaesthetic, and here we present our experience of the first 100 cases. Aims of this study included determining cancer detection rate and MRI correlation, as well as looking at rates of complications post procedure.

Method

This was a retrospective study with 100 patients in our cohort. We assessed MRI and histology correlation and post procedure complication rates.

Results

Histology in 72% of patients was positive for prostate cancer. Correlation between MRI findings and histology were noted to be high. As Likert score decreased, so did percentage of positive biopsies. Rates of significant complications were low, with no hospital admissions required following the procedure.

Conclusion

Our study demonstrates TP biopsy using the PrecisionPoint transperineal access system is a safe and effective method of detecting prostate cancer, which is well tolerated by patients.
SP7.2.4 Evaluation of Non-crosslinked Acellular Porcine Dermal Mesh – A Single Centre Experience
Authors: Karri Rama , Aamery Amaar , Singh-Ranger Deepak
Published: October 2021

Aims

We report our experience with a cellular porcine dermal non-crosslinked biological mesh (EGIS®). We conducted a review of indications and outcomes of patients requiring the mesh for incisional hernia/complex abdominal wall reconstruction with component separation, parastomal hernia repairs and ELAPE. Patients were followed for a minimum of 6 and assessed for recurrence, seroma formation and chronic pain. Secondary outcome was the assessment of ease of use by the Surgeon – suturing and pliability.

Method

A retrospective case notes review of patients requiring biological mesh (EGIS®) from 2016 to present. A qualitative survey about ease of use of EGIS® for operations studied was sent to all Consultant Surgeons.

Results

EGIS® mesh was used in 38 patients: 23 Hernia repairs – 13 Incisional, 8 Parastomal, 2 Paraumbilical; 12 Pelvic floor repairs after ELAPE; and 3 abdominal wall reconstructions. Hernia recurrence occurred in 12 (32%), seroma 7 (18%) and chronic pain 7 (18%). The highest complications occurred in the incisional and parastomal hernia groups. Incisional hernia: recurrence in 5 (38%), seroma in 5 (38%) and chronic pain in 3 (23%). Parastomal hernia: recurrence in 3 (38%), chronic pain 2 (25%), seroma 1 (13%). Consultants scored the mesh 4.3 to 4.5 out of 10 for pliability, ease of use and suturing.

Conclusion

Biological mesh is used to reinforce hernia repairs in contaminated or potentially contaminated fields. Non-crosslinked meshes are preferred for their greater cellular infiltration from host tissue with improved integration. Our experience with this mesh shows a high complication rate and requires re-evaluation.
SP8.1.2 The Effect of Ginger Oil on Postoperative Nausea and Vomiting (PONV) After Breast Augmentation Surgery
Authors: Saghir Reyan , Saghir Noman , Sidhu Manu , Okhiria Renee , Okhiria Terrell , Sforza Marcos
Published: October 2021

Aim

Postoperative nausea and vomiting (PONV) is one of the commonest complaints following general anaesthetic. Poorly controlled due to its multifactorial nature most current antiemetics are not effective and have an undesirable side effect profile. As such we have studied the effect of Ginger (Zingiber Officinale), a relatively inert yet powerful antiemetic and its properties in managing PONV.

Methods

A double-blind (surgeon/anaesthetist), randomised, placebo-controlled, single-centre study was carried out in a homogenous 30 female patient cohort undergoing breast augmentation surgery. Participants were randomly allocated to have 3 drops of either Ginger oil (110mg Zingiber officinale) or a simple control oil on the laryngeal mask before insertion. PONV and visual analogue scales (VAS) were used as outcome measures and were plotted against the dose of morphine used in the patient.

Results

Multivariate analysis of variance (MANOVA) was conducted on the data. Using Pillai’s trace, there was a significant effect of ginger on PONV/VAS, V = 0.87, F(3,16)=34.78, P < 0.001. Separate univariate ANOVAs showed: PONV Mean=1.70, PONVSD=0.48 compared with no ginger treatment plan group; PONV Mean=4.20, PONVSD=0.79. VAS Mean= 5.0, VASSD=1.63 for the ginger treatment plan group; and VAS Mean=5.9, VASSD=2.33 for the no ginger treatment plan group.

Conclusion

This study has found that ginger has an important role in preventing postoperative vomiting, reducing postoperative nausea, and is useful in breast augmentation. We have demonstrated a novel application of ginger oil during induction of anaesthesia and have provided evidence of its use in opioid-induced PONV.
SP9.1.4 Management of Small Bowel Obstruction: A Comparison to NASBO
Authors: Ahmed Babur , Thompson Anna , Colgan Aoife , Brindle Rachel
Published: October 2021

Aim

Prompt diagnosis and proactive decisions in management of small bowel obstruction (SBO) can reduce the associated morbidity, in-hospital stay and mortality. Following recommendations of National Audit of Small Bowel Obstruction (NASBO) and Bologna (2017), the “agreed pathway” of The Association of Surgeons of Great Britain and Ireland (ASGBI, 2018) sets clear guidelines to aid timely management of SBO. We aimed to audit our practice to these guidelines and compared outcomes to NASBO.

Methods

Data was collected retrospectively on patients admitted with SBO from July 2019 - December 2019 and presented as percentage, median or interquartile range (IQR).

Results

Median age of 76 included patients was 62.0 years, 53.9% were female. Aetiologies were; adhesions (59.2%), hernia (27.6%), malignancy (10.5%) and others (2.6%). Admission CTs were performed in 92.1% vs. 80.0% (NASBO), with a median time of 3.3 hours vs. 2.2 days (NASBO). Median time to surgery in those managed operatively (n = 35) was 10 hours vs. 1 day (NASBO), while in 72.0% vs. 21.0% (NASBO) of non-settling SBO, water soluble contrast study (WSCS) was performed in a median (IQR) time of 39.0 (20.0-45.4) hours. Adhesional SBO resolved in 85.7% of cases suitable for non-operative approach. Objective nutritional assessment was performed in 94.7% vs. 90.0% (NASBO). In-hospital stay, 30-day morbidity and mortality compared to NASBO were 5.0 vs. 10.7 days, 31.6% vs. 23.0% and 5.3% vs. 8.0% respectively.

Conclusion

ASGBI guidelines provide multi-faceted proactive approach in managing SBO; including early cross-sectional imaging, prompt WSCS use and timely nutritional interventions, promoting improved outcomes.
SP10.1.8 Thrombotic syndrome in COVID-19
Authors: Aggarwal Aditi , Bala Ashok , Slim Hani , Rashid Hisham , Ammar Thoraya , Gambhir Raghvinder
Published: October 2021

Aim

To discuss the varied manifestations of COVID-19 thrombotic syndrome.

Methods

We reviewed all patients referred to vascular surgery with evidence of thrombosis in at least one vascular bed. Electronic patient records were reviewed, patient laboratory and radiological investigations analysed, and COVID-19 status confirmed.

Results

72 patients presented over 8 weeks with systemic thrombosis involving all sized vessels from aorta to visceral to crural arteries. Of these, 15 patients had RT-PCR or radiological evidence of COVID-19 infection. We investigated these 15 patients further. 27% presented with symptoms of thrombosis as the initial presentation of COVID-19 infection. 93% were COVID RT-PCR positive. 7% had evidence of COVID pneumonitis on CT chest but were COVID RT-PCR negative. 47% presented to the Emergency Department, whilst 53% were hospital admitted patients. All patients presented with ischaemic effects and D-dimers were raised in all patients in whom it was performed. 33% were lymphopenic. Fibrinogen levels and hypercoagulability profile was not routinely done for all and where available was negative. Echocardiogram demonstrated normal left ventricular systolic function and no evidence of thrombus in all patients in whom it was performed. 13% were managed with surgery and 6% with thrombolysis or other endovascular intervention. 73% were managed with anti-coagulation alone. 33% died during hospitalisation of COVID-19.

Conclusion

There is evidence that COVID-19 initiates an immuno-thrombotic state. Anti-coagulation alone was the preferred management strategy, as governed by patient co-morbidities. There is high mortality associated with patients with thrombosis and COVID-19 infection.
SP10.2.10Efficacy of Outpatient Appointment Reminders in Colorectal Surgery: A Prospective Analysis
Authors: Abdulhussein Dalia , Luo Rong , Aseem Rabiya , Smith Jason , Pawa Nikhil
Published: October 2021

Introduction

There is increasing mandate to improve attendance in outpatient clinics to support delivery of High-Quality Care. Non-attendance in Colorectal Cancer (CRC) has clinical and financial implications. Patient appointment reminders (letters, text-messages and telephone) have been implemented to reduce non-attendance. We examine the efficacy of patient appointment reminders in CRC patients.

Methods

A prospective study was conducted for 3-months in our CRC department surveying patients on their appointment reminders. Non-attending patients were surveyed via telephone to ascertain cause of non-attendance and preference of patient reminders. Data collected was analysed on SPSS.

Results

547 patients were prospectively surveyed. 19% did not receive appointments letters, from which 73% were made aware via Text message and 25% via Phone calls. 50% received letters > 2 weeks’ notice. 183 patients did not attend (DNA) their appointment from which 100 were successfully surveyed through telephone. 60% of patients did not received an appointment reminder (letter), or received it following the date of their appointment. 79% patients preferred to be contacted via text messaging or an appointment app vs 13% via letters. Cost analysis releveled significant losses due to missed appointments.

Conclusion

Patient appointment reminders are fundamental in reducing non-attendance in clinics. Our study demonstrates that appointment letters are an unreliable method of patient communication. In an ever-increasing digital age, methods such as timely text-messages or an appointment app for CRC patients’ needs urgent implementation as per patient preferences. Further research is required to assess non-attendance and causality in other specialities for comparison.
SP10.2.12 Information Sustainability: The revitalisation and upcycling of 373,342 historic surgical pathology records into the contemporary electronic patient record in one UK NHS Hospital Trust
Authors: Rahman Fatima , Hales Alan , Cable David , Burrill Keith , Bateman Adrian , Rew David
Published: October 2021

Aims

Surgical and Cellular pathology (‘e-pathology’) record sets are a valuable data resource with which to populate the Electronic Patient Record (EPR). Accessible reports, even decades old, can be of great value in contemporary clinical decision making and as a resource for longitudinal clinical research. They commonly identify the operation, the location and the pathology, even if not to modern reporting standards.

Methods

Since 2010, we have built and implemented a timeline structured EPR for the ‘whole-of-life’ visualisation of the electronic documents (e-Docs) of 2.5M+ patients on our Master Index. Prior to this project, our earliest e-Docs dated to 1995. We tracked down 373,342 inert e-pathology reports from our legacy Ferranti (1990-1997) and Masterlab (1997-2004) systems. These were uploaded into our active file servers, following appropriate data quality and patient identity reconciliation checks.

Results

We have progressively restored 373,342 previously inaccessible e-pathology records to clinical use and to immediacy of access, and in the process extending our “addressable EPR” back to 1990 for living and deceased patients. This process has also allowed us to populate and validate an EPR-integral breast cancer data system of 20,000 cases with e-pathology records dating back to 1990.

Conclusions

The sustainable revitalisation of old e-pathology reports into a timeline structured EPR creates preserves and upcycles the investment in pathology reporting which is otherwise progressively lost to clinical use. E-pathology records provide reliable, life-long evidence of critical transition points in individual lives and disease progression for clinical and research use, when they can be instantly accessed.
TP1.2.1SeHCAT scan as an investigation for chronic diarrhoea; a single trust experience
Authors: Al-Azzawi Marwa , Darnborough Sally , Devlin Lynsey , Han Sai , Bolster Alison , Nicholson Gary
Published: October 2021

Introduction: 

Recent published (British Society of Gastroenterology) guidelines strongly recommended investigating unexplained chronic loose stools with  SeHCAT  scans when available rather than empirical treatment.  SeHCAT  scan was  introduced  at our trust in 2015. We aimed to audit this locally.  

Methods

 All  SeHCAT  scans that were done at our trust trust from Jan 2015 to March 2020  were included. Patient demographics along with risk factors and duration of symptoms were documented as well as the referred speciality.  

Results

  55 patients were identified. Average age at time of diagnosis was 50y (18-70y).  M:F  was 1:3.2 . Most scans were requested by the oncology team as part of the “pelvic radiotherapy late effects service” (n = 25), followed by the gastroenterology team (n = 22) and general surgery team (n = 8). The mean duration of symptoms was 4 years. 73% of the scans showed evidence of bile acid malabsorption (BAM)  (n = 40) with bile retention <15%, with the majority of them (n = 30) having severe BAM (retention <5%).  60% of the patients had at least one lower GI endoscopy as part of their workup. The majority of patients were found to have type 3 BAM (n = 37).   60% of patients had symptom improvement on either diet alone or with bile-acid sequestrants (n = 23) and were discharged.

Conclusion: 

SeHCAT scan is a useful test to investigate unexplained chronic diarrhoea. It is important to identify patients at risk of developing bile acid malabsorption. It is currently underutilized by our trust, which might be because of funding issues and awareness among clinicians.
TP5.2.13 Perceived risk of pre-operative abdominal aortic aneurysm rupture due to pulmonary function testing: all blown out of proportion?
Authors: Badawy Ayman , Stupalkowska Weronika , Chaudhuri Arindam
Published: October 2021

Aim

Though contraindicated in some respiratory laboratories due to a perceived increased risk of aneurysm rupture, pulmonary function tests (PFT) and cardiopulmonary exercise tests (CPET) are used commonly in preoperative assessment of patients with abdominal aortic aneurysm (AAA) considered for elective repair. We examine whether preoperative PFT/CPET are associated with increased AAA rupture risk.

Methods

A retrospective analysis of a prospective database of patients with AAA ≥50mm who had PFT/CPET/both as part of their preoperative assessment from November 2012 to December 2020 in a single vascular hub before elective AAA repair (open/endovascular). Patients with AAA <50mm, or those who did not have PFT/CPET preoperatively were excluded from analysis. Baseline demographics, AAA size, type of repair, time from PFT/CPET to repair, rupture rate and 30-day post-operative mortality are presented.

Results

A total of 410 patients (mean age 74 ± 8 years, 361 (88%) male) were included in the analysis. The mean AAA size was 63 ±11mm. 350 (85%) patients underwent endovascular repair. 220 (53%) patients had PFT, 69 (17%) had CPET and the remaining 121 (30%) had both PFT/CPET preoperatively. The median time from PFT/CPET to repair was 36 days (IQR 48 days), with no preoperative AAA rupture in this cohort. 30-day post-operative mortality was 3%.

Conclusions

This study strongly suggests that PFT and CPET are not associated with increased risk of AAA rupture and are therefore safe for assessing respiratory function in patients considered for AAA repair without adding to pre-operative rupture risk.
TP5.2.14 A quality improvement project: Engaging and educating our thyroidectomy patients
Authors: Aderombi Adetayo , Mahfouz Yasmin , Wu Fiona , Beatson Kevin , Ahmed Ibrahim
Published: October 2021

Aims

Hypocalcaemia can occur in up to 30% of patients post-total thyroidectomy. Severe hypocalcaemia can lead to life-threatening tetany and seizures. As part of the consent process, risks are discussed typically face-to-face, often with the aid of anatomy illustrations. As tele-consultations become increasingly commonplace, patient-information leaflets (PILs) can be invaluable in enhancing informed consent, and empowering patients regarding their own care. We performed a quality improvement project to assess the feasibility and effects of distributing PILs following consultations to improve patients’ understanding of post-operative complications (specifically hypocalcaemia).

Methods

A retrospective review of post-total thyroidectomy patients was performed from January 2019 to January 2020. A telephone survey was conducted to assess each patient’s understanding of post-operative complications. As tele-consultations began to be utilised during the COVID-19 pandemic, we designed a simple PIL to distribute to patients awaiting elective total thyroidectomy aiming to improve health literacy. Following distribution of PILs, the survey was repeated to evaluate feasibility and effectiveness.

Results

Conclusions

A simple and inexpensive intervention, PILs can be distributed to patients awaiting elective surgery to improve health literacy, and reduce potential patient harm.
TP6.2.12Prognostic significance of symptomatic presentation in patients with Gastro-Intestinal Stromal Tumours
Authors: Nageswaran Hari , Hall Hannah , Kruber Samuel , Satherley Lucy , Powell Arfon , Lewis Wyn
Published: October 2021

Background

Gastro-Intestinal Stromal tumours (GISTs) are rare neoplasms of mesenchymal origin that arise in the GI tract and account for approximately 0.1-3% of all GI tumours. The aim of this study was to determine whether the mode of clinical presentation of GISTs has an effect on outcome.

Methods

Consecutive 143 patients diagnosed with GISTs were identified from the regional network database (median age 67 (21-88) years, 85 male). Data were collected on presenting symptoms, tumour, treatment undertaken, and the primary outcome measure was survival.

Results

The commonest GIST anatomical sites were stomach (69.9%), small bowel (13.3%), and colon (4.9%). Commonest symptoms were abdominal pain (30.0%), dyspepsia (11.8%), and anaemia (11.1%). Symptomatic presentations were associated with older age (p = 0.056) and higher mitotic index (>5 per 50HPF, p = 0.045). On univariable analysis the factors associated with cumulative 10-year survival were age (p = 0.076), the presence of symptoms (78.1% vs. 96.4%, p = 0.028), mitotic index (p = 0.011), and modified National Institutes of Health (NIH) prognostic index (p = 0.010), but not deprivation index, anatomical site or GIST diameter. Symptomatic patients aged over 60 years with mitotic index >5 per 50 HPF had the poorest 10-year survival at 63.6% (HR 2.577, 95%CI 1.132-5.867). On multivariable analysis, NIH index (HR 4.283, 95%CI 1.395-13.149, p = 0.011) and age (HR1.061, 95%CI 1.006-1.118, p = 0.029) were independently associated with 10-year survival.

Conclusions

Age, symptoms, and NIH criteria represent the most important prognostic biomarkers in patients diagnosed with GISTs.
TP6.2.16General practitioner compliance with Scottish cancer referral guideline for Oesophago-gastric cancer
Authors: Chuntamongkol Rongkagorn , Khan Khurram , McCollum Catherine , Forshaw Matthew
Published: October 2021

Aims

The outcome of oesophago-gastric cancer is often poor. Timely referral of suspected cancer is essential for early diagnosis and optimal outcome. This study aims to audit the General Practitioners (GPs) compliance with the Scottish referral guidelines for suspected oesophago-gastric cancer.

Methods

A retrospective cohort study of all newly diagnosed oesophago-gastric cancers who were referred from the primary care and discussed in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and symptomatology audited against the Scottish cancer referral guidelines.

Results

Of the 349 patients, 227 (65.0%) were referred from the primary care. 150 (66.1%) were male and the mean age was 69.5 ± 10.9 years. Mean Scottish Index of Multiple Deprivation was 5 ± 3. 149 (65.6%) had dysphagia and/or odynophagia and 181 (79.7%) were oesophageal cancers. 67 (29.5%) were T4 disease and 87 (38.3%) were metastatic at presentation. Urgency of referral was: 25 (11.0%) routine, 54 (23.7%) urgent and 148 (65.2%) Urgent Suspicion of Cancer (USOC). 192 (84.6%) patients qualified to be referred as USOC, of these 138 (71.9%) were actually referred as USOC. Of the 35 (15.4%) patients who did not qualify for the USOC referral, 10 (28.6%) patients were referred as USOC. The sensitivity was 71.9% and specificity 71.4%.

Conclusions

GP compliance with the adherence with the National guidelines remains a barrier in the USOC in oesophago-gastric cancer. Further GP education and awareness is required to improve their compliance.
TP6.2.17 How good is Edinburgh Dysphagia Score in identifying patients with oesophageal cancer?
Authors: Khan Khurram , Chuntamongkol Rongkagorn , McCollum Catherine , Forshaw Matthew
Published: October 2021

Aims

Due to limited resources and increase in the referral for endoscopy, various scoring systems have been developed in an attempt to identify high risk patients of having oesophageal cancer. The aim of this study was to analyze the utility of Edinburgh Dysphagia Score (EDS) in patients who have presented with oesophageal cancer.

Methods

A retrospective cohort study of all newly diagnosed oesophageal cancers with dysphagia in a single regional MDT was performed between October 2019 and September 2020. Electronic records were interrogated and EDS calculated. EDS contained six parameters: age, sex, weight loss, duration of symptoms, localization of dysphagia and acid reflux. Patients divided into lower-risk group (EDS <3.5) and higher-risk group (EDS ≥ 3.5).

Results

Of the 349 patients, 182 (52.1%) had dysphagia at presentation. 149 (81.9%) were referred from the primary care. There were 127 (69.8%) male and the mean age was 69.1 ± 11.0 years. 135 (74.2%) patients had adenocarcinoma, 51 (28.0%) were T4 disease and 58 (31.9%) were metastatic. The median EDS was 7 (IQR 6-8). 178 (97.8%) patients had higher-risk EDS and 4 (2.2%) patients lower-risk EDS.

Conclusions

This study suggests that EDS can positively identify patients who are high risk of having oesophageal cancer in majority of patients. This simple scoring system can be used to vet the referrals in order to reduce the pressure in the secondary care setting to effectively use the available resources.
TP7.2.11 Hypochromia is an early marker of iron deficiency anaemia
Authors: Hwang Inae , Cheong Jeremy , Subramonia Sriram
Published: October 2021

Aim

Microcytosis in iron deficiency anaemia triggers an urgent referral for investigation of suspected gastrointestinal cancers. This study evaluated whether the inclusion of hypochromia as a marker for iron deficiency would lead to earlier referrals.

Method

Consecutive patients referred from primary care under the 2-week wait suspected gastrointestinal cancer pathway with unexplained iron deficiency anaemia between October 2019 and October 2020 were included. Results of red cell indices were obtained from an electronic platform for accessing laboratory test results(Sunquest ICE™, Version 5.4, Sunquest Information Systems). Mean corpuscular haemoglobin (MCH) of 27-32pg and mean corpuscular volume (MCV) of 80-102fL were considered normal.

Results

Seventy nine patients (32 men, 47 women) were included. Median (IQR) age was 73 (62-80) years. 67% (53/79) had a low MCH and 43% (34/79) had a low MCV at the time of referral.

In the preceding months of referral (median [IQR] 4.3 [1.8-7.9] months) 64 patients had a full blood count performed of which 55% (35/64) had a low MCH and 20% (13/64) had a low MCV.

The earliest available full blood count prior to referral (43 patients, median (IQR) of 16.5 (12-37) months) showed that 86% (37/43) had a low MCH compared to 33% (14/43) with a low MCV. A fall in MCH always preceded a fall in MCV at all the three time points analysed.

Conclusion

The inclusion of hypochromia as a marker of iron deficiency in the referral criteria for suspected gastrointestinal cancers would trigger significantly earlier referrals.
TP8.1.7 The utility of a timeline and episode structured breast cancer data system to study outcomes following neoadjuvant chemotherapy for cases stratified by HER2 status
Authors: Rahman Fatima , Copson Ellen , Hales Alan , Rew David
Published: October 2021

Background

Breast neoplasia displays complex patterns of whole-of-life disease progression, which are difficult to study using legacy data systems. Our timeline- and episode-structured breast cancer data set of 20,000 records allows direct visualisation of the entire documentary record of every patient. The embedded data mining module permits research into a wide range of patient cohorts by pathology, treatment and outcome.

Methods

We selected the cohort of patients aged between 15 and 75 with HER-2 –ve and HER-2 +ve breast cancer who were treated with neoadjuvant chemotherapy (NAC), with or without anti-HER2 therapy between 2002 and 2019. We also studied the patterns and time intervals (in months) of disease progression and response to treatment from primary diagnosis, through loco-regional recurrence and distant metastasis to final outcome.

Results

Of 301 women with confirmed early stage breast cancer were treated with NAC over that time, 186 had HER2- and 115 had HER2+ tumours. The patterns and intervals of disease progression, as displayed on the Master Lifetrack, were mapped and measured for every patient. The proportions of patients with Her2+ve tumours receiving trastuzumab and analogues, and the tumour responses to treatment, were audited. The underlying data set was validated by review of the original records.

Conclusions

The whole-of-life timeline structured cancer data system introduces a new direction for clinical data visualisation, record management and user utility in surgical practice. This study validates the model as a tool for the better understanding of treatment effects and longitudinal behaviours in any selected range of cancer phenotypes.
TP8.1.8 Blue flag clinics. A way to achieve a 2 week wait service in the age of plentiful referrals, radiological pressures and pension threat
Authors: Rybinski Blazej , Thomas Peighton , Sulieman Mona , King Polly
Published: October 2021

Introduction

In early 2019 increased referrals to the Breast 2WW Service, limited radiologist capacity and the pension crisis combined to cause the 2 week wait target to fail. A multidisciplinary solution was sought. Using the Nottingham Breast Institute triage criteria and decoupling clinical and radiological assessments, patients were referred along 2 pathways; red and blue flag.

Methods

Patients were clinically assessed by a trained breast surgeon within 2 weeks. Red flag patients underwent standard triple assessment. The aim for blue flag patients was to undergo any necessary imaging within 10 days. In both cohorts selected patients were given a patient satisfaction questionnaire. Data from red flag clinics were obtained from cancer services. Notes were reviewed for blue flag patients.

Results

Data on 858 blue flag patients seen were analysed.

There was no difference between satisfaction scores.

Conclusions

The 2WW target was regained within a month of implementing change. As long as the standard operating procedure is maintained, the triage criteria adopted were successful and reduced pressure on radiology services. Patient safety and satisfaction were maintained.
TP8.1.12 Diagnostic Utility of MRI in the Evaluation of Potential Malignancy in Patients Presented with Nipple Discharge
Authors: Yang Nixon Phua Cher , Butt Muhammad Adeel Javed , Nijjar Parmvir Singh , Phyu Saung , Barkeji Musa
Published: October 2021

Aims

Nipple discharge is a presentation commonly seen at breast clinics. It is conventionally evaluated with physical examination and sonography( or mammography). The aim of this study is to investigate the diagnostic value of magnetic resonance imaging (MRI) as an additional imaging tool in the evaluation of potential malignancy in patients presented with nipple discharge.

Methods

A retrospective evaluation of 85 patients with nipple discharge who underwent breast ultrasound (USS) and MRI between 04/06/2008 and 25/10/2019 was conducted. Clinical notes, radiographic reports and biopsy results were reviewed. Sensitivity, specificity, positive predictive value and negative predictive value of USS and MRI were calculated.

Results

Out of the 85 patients (all female; mean age 45.33 +/- 12.93 years old) with nipple discharge, 11 were found to have biopsy-proven malignancy (invasive ductal carcinoma/ ductal carcinoma in situ; 12.94% risk). USS failed to identify seven malignancies (27.27% sensitivity) while MRI missed three malignancies (72.72% sensitivity). USS falsely identified four malignancies from 74 patients with no malignancy (94.59% specificity) while MRI only falsely identified one case (98.65% specificity). For patients with negative USS results (U1/U2/U3) or negative MRI results (BI-RADS category 1,2 or 3), the negative predictive values of USS is 89.74% while that of MRI is 96.05%. The positive predictive values of USS and MRI are 42.86% and 88.88% respectively.

Conclusion

Compared to USS, MRI has a higher sensitivity, specificity, positive predictive value and predictive value. It will be a valuable addition to the standard nipple discharge evaluation workup to help rule out malignancy.
TP8.2.21 Two Teams, One Patient: Identifying Barriers to Patients’ Flow from Emergency Departments to Surgical Wards
Authors: Morris Lucy , Tarazi Munir , Waugh Christopher , Foster Karl , Shah Jigar , Mansour Moustafa
Published: October 2021

Aims

The transfer of responsibility for patient care across the Emergency Department (ED)/ inpatient interface has always been recognised as a challenging process. Current research focuses on qualitative data and is based occasionally on anecdotal information. The aim of this study was to identify barriers to efficient patient flow with a specific focus on type and quality of referrals and logistics involved.

Methods

Quantitative retrospective data was collected on referrals received by the surgical team from ED (n = 83). The outcome of the referral was recorded. Quality of referrals was assessed on clinical information, examination and investigations performed as well as working diagnoses. Further data was collected on location and time to review referred patients.

Results

Outcome of referral: 14.5% were discharged directly from ED, 16.9% were admitted for <24 hours, 4.8% were referred to another speciality within 24 hours and 63.9% were admitted for > 24 hours. Quality of referral: 18.1% patients were referred without working diagnosis. 31% of patients presenting with upper abdominal pain did not have amylase checked prior to referral and 20% of patients with suspected PR bleeding lacked a PR examination. Logistics: 57% of patients were seen in ED. 15.7% were reviewed within 1 hour (median: 133mins).

Conclusions

Referrals often failed to meet the needs/criteria of the speciality team. Combining the above with high volume of referrals and logistical challenges of working across multiple areas leads to potential delays in timely patients’ review. Intense workloads create stressful environments which eventually breed interpersonal discord.