bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.FRI.835 5 Years, 4 F1s, 3 Registrars, 2 Pandemic Waves, 1 VTE audit: Half a decade of VTE prophylaxis on a surgical ward
Authors: Sylvester Helena Colling , Slim Naim , Okocha Michael
Published: October 2021

Aim

Venous thromboembolism(VTE) is a preventable complication of hospital admission. This audit aims to compare VTE prophylaxis over 5 years in one surgical assessment unit and identify areas for improvement.

Methods

This was a snapshot, 5-cycle audit of the analysis of VTE risk, prescribing practice and prophylactic therapies offered at admission.

We prospectively reviewed notes of patients admitted under general surgery over a snapshot period annually. Data was compared to figures collected over four previous years. Induction VTE prophylaxis teaching was introduced after the first cycle, HCA VTE champions were introduced after the second, digital reminders were introduced after the third, and monthly email reminders sent after the fourth cycle.

Results

VTE risk was documented for 92% of patients in 2017, 65% in 2018, 57% in 2019, 76% in 2020 and 53% in 2021.  In the years 2017, 2018, 2019, 2020, 2021, Enoxaparin was prescribed for 96%, 68%, 75%, 55% and 73% of patients respectively. In 2017, 2018, 2019, 2020 and 2021, TED stockings were prescribed for 96%, 68%, 62%, 50% and 73% of patients respectively.

Conclusions

We utilised a multidisciplinary and digital approach against the issue of VTE prophylaxis on surgical wards. Despite best efforts, compliance was highly fluctuant with a drop during the first wave of the pandemic. This has demonstrated that with redistribution of regular nursing and medical staff, new patient filtering systems and increased healthcare pressures, previous mechanisms cannot be relied upon. We have began the process of electronic prescriptions with mandatory VTE prophylaxis checklists.
EP.FRI.840 Lymphopaenia and laparotomy – a predictor of mortality
Authors: Pollock Alasdair , Galbraith Norman , Bleakley Anna , Setford Isobel , Halcrow Elaine , Moug Susan
Published: October 2021

Aims

Immune dysfunction is often seen in patients undergoing emergency laparotomy. Efforts to correct T-cell dysfunction & apoptosis by use of immune checkpoint inhibitors in prospective trials are underway, where lymphopaenia is an indication for therapy. We investigated the association of lymphopaenia in patients undergoing emergency laparotomy as a measure of immune dysfunction and predictor of 30-day mortality. 

Methods

Retrospective analysis was performed on emergency laparotomies at the Royal Alexandra Hospital using the prospectively maintained Emergency Laparotomy and Laparoscopic Scotland Audit (ELLSA) database. White cell count (WCC), Neutrophil count, Lymphocyte count and C-reactive protein (CRP) were compared between those who died within 30 days and those who survived using Mann-Whitney-U test (p < 0.05).

Results

Between 2017-2018, 196 cases were analysed for assessed, after 4 patients excluded due to insufficient data. Mean age was 63 years, 86 were male and 108 were female. Eighteen (9.2%) deaths were recorded within 30 days of emergency laparotomy. Non-survivors demonstrated a decreased lymphocyte count on day 3 and 7 following emergency laparotomy when compared to the survivor group (p < 0.05). No significance was found when comparing the WCC, Neutrophil count or CRP of both groups.

Conclusions

Patients who did not survive emergency laparotomy were found to have decreased lymphocyte counts when compared with survivors.  This may be a surrogate measure of sepsis or trauma-associated immune dysfunction. Further study into immune related mechanisms may lay the foundation for prospective studies using immune checkpoint inhibitors in the emergency laparotomy population.
EP.FRI.886 Clinicians’ compliance and diagnostic utility of digital rectal examination in acute abdominal emergencies: a prospective, blinded study
Authors: Mifsud Martina , Camilleri Ruth , Abela Andrè , Camilleri-Brennan John
Published: October 2021

Aims

One hundred years ago, Sir Zachary Cope described digital rectal examination (DRE) as ‘extremely important and informative’ in the assessment of the acute abdomen. Medical students have always been taught of the importance of including a DRE as part of the abdominal examination. It has however been observed that DRE is often omitted in clinical practice. The aims of the study are to determine how frequently DRE is carried out in acute abdominal emergencies and also to determine the diagnostic utility of DRE in this setting.

Methods

Patients over the age of 18 presenting to the on-call general surgeons in a teaching general hospital with any acute abdominal symptoms over a 15 day period were assessed prospectively. The performance of a DRE by any clinician at any point up to 24 hours post-admission was recorded, and the findings of DRE were analysed with respect to the final diagnosis. 

Results

Out of the 168 patients presenting with an abdominal emergency, 41 (24.4%) had a rectal examination. 70.7% of DRE were done by surgical trainees and foundation doctors. Most DREs were performed when the presenting complaints were constipation, rectal bleeding, and suprapubic pain. The findings on DRE directly contributed to the final diagnosis in 11 patients. 

Conclusions

DRE is only preformed selectively during the initial evaluation of surgical patients presenting with acute abdominal symptoms. However DRE remains a key part of clinical examination. The theoretical and practical skills in the performance of DRE should be safeguarded via continuing education and training.
EP.FRI.948 Outcomes Following Emergency Laparotomy In The Over 70’s
Authors: Gerrard Adam , Haines Emily , Mason Peter , Satchidanand Rajesh
Published: October 2021

Aim

Surgery in the elderly carries greater risk of mortality with those who are frail being most at risk. We aimed to review our outcomes for patients 70 years of age and over, who underwent emergency laparotomy.

Methods

All patients aged 70 and over who had undergone emergency laparotomy within a 12-month period were included for analysis. Patient’s pre-operative risk was assessed by the P-Possum and NELA scoring along with Rockwood Frailty Scale (RFS) and the Geriatric rescue after surgery (GRAS) score. 

Results

50/116 patients undergoing emergency laparotomy were aged over 70 years old. Full data was available for 47 of these. Overall 30- and 90-day mortality was 12.8% and 21.3% respectively. 90-day mortality in patients with a RFS of > 4 was 25% compared with 16% with a score of 4 or less. Those with a GRAS score <4 and 4 or greater had a 90-day mortality of 16% and 27% respectively. Where there was a P-Possom mortality risk >10% was no difference in the mortality rates, however when the NELA risk was >10%, 90 day mortality was 26.6% compared with 15.4%. 

Conclusion

Emergency laparotomy in the over 70’s carries much higher risk of death. Mortality risk scoring and frailty assessments are useful tools in counselling patients and their families prior to surgery. Future work will assess the predictive value of different and combined scores in this population.
EP.FRI.978 Colonoscopy perforation: A single centre experience
Authors: Gok M A , Habeeb K , Smart C J , Ward S J , Khan U A
Published: October 2021

Aims

Colonic perforation is an adverse event of colonoscopy. This is around 1/1500 in diagnostic colonoscopy, 1/500 in polypectomy procedures & 1/50 in EMR procedure. This study is to evaluate the management of colonic perforation at a single centre.

Methods

Colonoscopy carried out on patients with colorectal cancer symptoms, family history, colorectal cancer & polyp surveillance. Retrospective study carried out since 2012 on all colonoscopies with evaluation of colonoscopy perforation. 

Conclusion

7 colonoscopy perforations encountered over 8 years, with incidence of 0.03 - 0.06 % per year. Surgery undertaken in 5 cases  with concomitant disease bowel (2 IBD’s & 3 diverticulitis). 2 cases of conservative management. Surgical resection of diseased bowel occurred in 4 cases with 4 cases of diversion stoma. One case of diversion stoma was subsequently reversed, whilst other 2 case were deemed medically unfit. Colonoscopy is carried out by JAG accredited endoscopists. Colonic perforation during colonoscopy is increased in: polypectomy (right colonic), therapeutic EMR, diseased bowel (IBD, diverticular disease), challenging colons. Management of colonoscopy perforation should individualized with early clinical & radiological diagnosis.
EP.FRI.988Life threatening recurrent bleeding gastric fundus Dieulafoy lesion: A case report
Authors: Ayantunde Abraham , Aktar Naeem , Ayantunde Bolu
Published: October 2021

Introduction

Dieulafoy lesion is a rare but significant cause of upper gastrointestinal tract (GIT) bleeding. Over 75% of Dieulafoy lesions are located in the stomach and they tend to be responsible for recurrent upper GIT bleeding. Endoscopic therapy is the first line intervention to achieve haemostasis.

Patient

A 49-year old normally fit man known to have a gastric Dieulafoy lesion since 2008 presented with a history of collapse on the street and significant melaena. He was tachycardic, with a heart rate of 116, and hypotensive, blood pressure 109/68 mmHg on admission. He had significant upper GIT bleeding from the gastric fundus Dieulafoy lesion in April 2008, requiring a massive blood transfusion. At the time, the attempted endoscopic therapy was unsuccessful, resulting in an emergency surgery and under-running of the bleeding vessels.

For the recent admission, he underwent an urgent therapeutic oesophagogastroduodenoscopy, with 3 endoscopic clips applied, but this failed to maintain haemostasis. Four units of packed red cell were transfused and he was transferred immediately to the operating theatre. He underwent an emergency laparotomy, adhesiolysis, gastrostomy and wedge resection of the bleeding gastric fundus Dieulafoy lesion using a linear cutter 75mm stapler. He had an uneventful post-operative recovery and was discharged home on day four after surgery.

The histology of the wedged gastric specimen confirmed an area of gastric mucosa ulceration with a network of mixed dilated, thin and thick-walled tortuous vessels in the adjacent submucosal layer. The histologic features are consistent with a bleeding gastric Dieulafoy lesion.
EP.FRI.992 Milking the COW: A pilot study of seven-day consultant working
Authors: Clements Caterina , Mitchell Robert , Ratnasingham Kumaran
Published: October 2021

Aims

The Five Year Forward View, predicts a funding gap of nearly £30 billion per year by 2020/21, with continued disparity in resources and healthcare demand. Further, the view describes ever widening gaps in three main domains of healthcare; prevention, quality and efficiency.

Those domains raised are echoed in the efficient operative working of a general surgical service with an aged, co-morbid population and inefficient theatre utilisation with increasing case cancellation due to lack of bed space. 

In 2012, the Academy of Medical Royal Colleges recommended patients have the same standard of care seven days a week, with consultant review ‘at least once every twenty-four hours’.

In general surgery, will a seven-day consultant led working model with a ‘consultant of the week’ (COW) enable more rapid and appropriate decisions to be made for patients enabling their efficient treatment and reducing length of stay.

Method

A retrospective analysis of hospital length of stay and mortality before and after the implementation of a consultant led weekday and weekend service in general surgery was carried out looking at data in October 2017 and 2018.

Results

The introduction of enhanced seven-day working is associated with reductions of one fifth in length of stay but no difference in mortality.

Conclusions

Whilst statistically significant associations with the COW and reduced length of stay have been made, the clinical significance of one fifth of a day may be negligible. Continued data collection over a longer time period, prospectively will increase the power of the study.
EP.FRI.1012 One plus one equals four: how NELA inspired a quality improvement programme that produced 4 distinct positive outcomes
Authors: Chitre Vivek , Atkari Bence , Sivakkolunthu Ari , Woods Robert , Lal Roshan
Published: October 2021

Aim

To describe how NELA inspired an ‘improving emergency surgery’ quality improvement programme that produced improvements in 4 distinct areas of surgical practice.

Methods

This paper describes how Kotter's improvement methodology was implemented in a district general hospital to achieve NELA targets, reduce the negative appendicectomy rate in children, implement NICE guidance on early laparoscopic cholecystectomy for acute cholecystitis and consistently deliver the 'S' and 'A' of SAFER within the surgery department.

Results

As a result of a systematic quality improvement approach,

Conclusions

Incorporating NELA into a local 'improving emergency surgery' quality improvement programme has delivered important and wide-ranging benefits beyond emergency laparotomy, and protected the service from 'crowding out behaviour' where focus on a single quality improvement can come at the expense of quality in other areas.
SP1.1.8Optimising anaemic patients for colorectal cancer surgery: implementation of day-case iron infusion pathway and closed loop audit of anaemia management
Authors: Malcolm Francesca , Kaji Furqaan , Shelswell Lisa , Speake William , Liptrot Sarah , Coverdale Nicola
Published: October 2021

Aims

Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion.

Methods

Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycles education regarding anaemia management and further publicity of the iron infusion pathway took place within the department.

Results

In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron.

Conclusions

We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However these is still room for improvement in management of anaemia within this patient group.
SP1.2.8Are screen detected rectal cancers truely asymptomatic?
Authors: Mcculla Alex , Agarwal Anil , Musbahi Aya
Published: October 2021

Aims

Patients with rectal cancers would be expected to be symptomatic and present to GP and be referred to tertiary care for investigations. Nevertheless nearly 15% of rectal cancers are screen detected. This study compared the presentation, demographics, staging of screen detected rectal cancer (SDRC) and symptomatic rectal cancer (SRC).

Methods

The national bowel cancer-screening database, the Somerset Cancer Register, the Great North Record, hospital electronic patient record and Sunquest ICE system was used to gather clinical information. All rectal cancers diagnosed between 2014 and 2019 were included.

Results

There were 379 SRC and 54 SDRC. The SRC had an average of 1.07 GP visits per patient (range 1-4) and SDRC had an average of 0.27 GP visits per patient (range 0-7) (p < 0.001). Screen detected patients presented to their GP with diarrhoea, change of bowel habit and bleeding whereas symptomatic patients presented with tenesmus, bleeding and change of bowel habit in that order respectively. Screening cancers were more likely to present as T1 or T2 compared to the symptomatic group (p = 0.023).

Conclusion

Screen detected rectal cancer patients presented less frequently to their GP. Those who presented had a different symptom profile to symptomatic cancers. This would explain these patients not seeking advice or the GP not referring them to hospital. Is it the morphological differences of the cancers or is it that the patients in screening group have a different personality trait that prevents them consulting their GP. These questions need investigating in future studies.
SP2.1.1Continuous Monitoring and Assessment of Surgical Technical Skills Using Deep Learning
Authors: Yilmaz Recai , Winkler-Schwartz Alexander , Reich Aiden , Del Maestro Rolando
Published: October 2021

Aims

Excellent surgical technical skills are of paramount importance to perform surgical procedures, safely and efficiently. Virtual reality surgical simulators can both simulate real operations while providing standardized, risk-free surgical hands-on experience. The integration of AI (artificial intelligence) and virtual reality simulators provides opportunities to carry out comprehensive continuous assessments of surgical performance. We developed and tested a deep learning algorithm which can continuously monitor and assess surgical bimanual performance on virtual reality surgical simulators.

Methods

Fifty participants from four expertise levels (14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 medical students) performed a simulated subpial tumor resection 5 times and a complex simulated brain tumor operation once on the NeuroVR platform. Participants were asked to remove the tumors completely while minimizing bleeding and damage to surrounding tissues employing a simulated ultrasonic aspirator and bipolar forceps. A deep neural network continually tracked the surgical performance utilizing 16 performance metrics generated every 0.2-seconds.

Results

The deep neural network was successfully trained using neurosurgeons and medical students’ data, learning the composites of expertise comparing high and lower skill levels. The trained algorithm was able to score the technical skills of individuals continuously at 0.2-second intervals. Statistically significant differences in average scores were identified between the 4 groups.

Conclusions

AI-powered surgical simulators provide continuous assessment of bimanual technical skills during surgery which may further define the composites necessary to train surgical expertise. To our knowledge, this is the first attempt in surgery to continuously assess surgical technical skills using deep learning.
SP2.1.3A quick solution for poor knowledge of fasting requirements for surgical patients
Authors: Stahl Rose , Alsheikh Mustafa
Published: October 2021

Aim

To investigate and improve doctors’ knowledge of fasting requirements for surgical patients undergoing imaging.

Introduction

Surgical patients require prompt radiological imaging to confirm diagnoses and rapidly initiate management. Fasting regimes prior to different imaging techniques are confusing and poorly understood but are essential for prime image quality. Poor knowledge of these regimes delays scans and leads to suboptimal patient-care.

Methods

We created a series of MCQs to determine doctors’ knowledge and confidence of these fasting regimes. Our target recipients were surgical junior doctors who frequently requested imaging (n = 27). Modalities included: x-rays, ultrasounds, CTs, MRCPs, and ERCPS. Afterwards, we distributed posters around key clinical area and delivered a 30-minute teaching session. We provided clear guidance of fasting requirements, essential safe-prescribing points and emphasised the importance of communication with the multi-disciplinary team. A questionnaire was then circulated to re-assess doctors’ understanding.

Results

The mean pre-intervention MCQ score was only 49%, and only 8% were confident in ordering fasting regimes. After our intervention, the average MCQ mark improved by 37% (+/-11%, 95%CI) and the proportion of doctors, who felt confident, increased to 92%. Improvement in understanding was seen in all modalities, most significantly in ERCPs and contrast CT-APs. Wilcoxon signed rank test showed a statistically significant improvement in MCQ marks after our intervention (p < 0.001).

Conclusions

Fasting regimes prior to imaging is poorly understood. Teaching sessions and guidance documentation is an effective measure to improve understanding. Key communication with the multi-disciplinary team and awareness of these requirements will improve patient care.
SP2.1.6Virtual Work Experience: A Novel Method for Aspiring Doctors
Authors: Uddin Aaliya , Shakir Taner , Lovett Bryony
Published: October 2021

Aims

Current COVID-19 restrictions have limited face to face exposure of prospective medical students to the hospital environment. We aimed to deliver a virtual work experience event for secondary school pupils to understand the opportunities offered in a medical career.

Methods

We designed an event based upon a chronological progression from medical school to consultancy. Sessions included individual career experiences, the patient journey, a virtual hospital tour, simulated medical school interviews and examination preparation. The event was advertised by direct contact with secondary schools through phone and email, the local hospital trust communications department, and social media. Individuals registered online and were invited to submit targeted questions they would like covered during the session. The free one day event was delivered using online video conferencing software. Pre and post event feedback was obtained.

Results

771 registrations were received from 108 schools in the UK. In addition, the event attracted 26 individuals from India, Dubai, Thailand and the Philippines.

73% of candidates had not attended any prior face to face work experience. Confidence levels of over 4 out of 5 on a visual analogue scale, with respect to the medical school application and interview process, improved from 11% to 81%. 99% of candidates would recommend the course to others and attend future events.

Conclusions

COVID-19 has disrupted the training of potential medical students. We designed and delivered a novel method of work experience at an international level. Encouraging feedback will pave the way for future iterations.
SP2.1.14Remote examination of surgical skills is feasible and desirable during COVID crisis and beyond
Authors: Marsh Stephen , Bruce Caroline , Blackmore Alexander , Ichim Petre , Sharma Ajay , Paraoan Marius
Published: October 2021

Aims

We aimed to investigate the feasibility of employing Zoom technology to undertake structured remote examination of surgical skill during the COVID-19 crisis and beyond as a mean to complement remote training and supervision of basic laparoscopic skills.

Methods

We have adapted a previously reported method of remote training and supervision of laparoscopic skills training successfully used with 7 trainees. Five consultant surgeons with established expertise in surgical education participated in remote mock examination of LapPass skills using Zoom technology. We assessed the feasibility of remote examination by assessing image quality on Maryland visual comfort scale and undertook a trainers’ survey using a 5 point Lembert scale.

Result

The remote examiners recorded excellent quality of views, identical in clarity and detail to the source images.

Conclusions

We demonstrated the feasibility and the benefit of using modern internet technology in delivering a flexible approach to examination of surgical skills met with strong satisfaction by established trainers and trainees alike. All trainers supported the idea of introduction of remote examination as beneficial for all stakeholders and ready to replace face-to-face examination in specific settings. The surgical community should embrace, on a larger scale, the concept of remote supervision and examination whenever possible.
SP2.1.17Prognostic significance of competition ratios in surgical specialty training selection
Authors: Mellor Katie , Robinson David B , James Osian P , Powell Arfon GMT , Egan Richard J , Lewis Wyn G
Published: October 2021

Aims

A Competition Ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body.

Methods

Consecutive Core Surgical Trainees numbering 154 (median years since graduation: four, 105 male, 49 female) were studied over a six-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK National Training Number (NTN) appointment.

Results

Overall NTN appointment was 45.5%. Median CR was 2.36; range OMFS 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p = 0.003), a single scientific publication (OR 6.25, p = 0.001), cohort year (2019, OR 12.65, p = 0.003), and Universal ARCP Outcome 1 (OR 45.24, p < 0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n = 8) vs. 49.2% (n = 62), p = 0.018.

Conclusions

CRs displayed 30-fold variation, with CRs below 4.42 associated with two-fold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.
SP3.1.12 A Comparison of Polymeric Clips vs Endoloops to Secure Appendicular Stump in Adult Emergency Laparoscopic Appendicectomy
Authors: Ng James Chean Khun , Khanzada Zubair , Lim Ju Lyn , Lee Melody , El-Sharkawy Ahmed M , Bharathan B
Published: October 2021

Aims

To assess the use of polymeric clips (PC) as an alternative to Endoloops (EL) to secure appendicular stump in adult emergency laparoscopic appendicectomy.

Method

A retrospective analysis of all patients who underwent emergency laparoscopic appendicectomy from 1/11/19 to 31/10/20, following introduction of polymeric clips in our institute as a safe alternative to endoloops to secure appendicular stump in October 2019. Patient demographics, operative duration, intraoperative findings, methods to control the appendicular mesentery and stump, post-operative length of stay, complications and grade of operating surgeon were compared in both groups (PCvsEL) and data analysed using SPSS.

Results

A total of 333 patients were included, who underwent laparoscopic appendicectomy and satisfied the inclusion criteria. PC were used in 160 (48%) patients and EL in 173 (52%). Patient demographics, surgeon grade and intra-operative severity of disease were statistically similar between both groups. Mean operative time was 10 minutes shorter in PC group (71 vs 81minutes, p = 0.001). Mesoappendix was ligated by applying laparoscopic titanium clips in EL group 25%, vs 6% PC group (p < 0.001), while 42% of the PC group, used PC on mesoappendix, which was without any additional cost. Post-operative complication rates were similar in both groups, apart from post-operative ileus, which was more in EL group (p = 0.003).

Conclusion

The use of PC in emergency laparoscopic appendicectomy is a safe and effective way to secure the appendicular stump, which results in, not only reduced operating time, but also a significant cost saving (£49/3x Endoloops vs £21/pack of 6x Polymeric clips) to NHS.
SP3.1.15 Prophylactic negative pressure closed wound therapy in patients undergoing laparotomy for any indication is effective in reducing surgical site infection rate: An upgraded meta-analysis of published randomized, controlled trials
Authors: Malik Ahmed , Khan Mansoor , Singh Krish , Sains Parvs , Sajid Muhammad
Published: October 2021

Aims

Surgical site infections (SSIs) are a significant clinical and economic burden on health-care providers. The patients suffering from SSIs have been reporting poor health-related quality of life leading to psychological implications. The objective of this study to explore the role of negative pressure wound therapy (NPWT) in general surgical patients undergoing laparotomy and with closed wounds.

Methods

A systematic review of the randomized, controlled trials reporting the use of NPWT in general surgical patients undergoing laparotomy for any reason published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis.

Results

A total of nine randomized, controlled trials on 1238 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of NPWT in patients with closed laparotomy wound was associated with significantly reduced risk of SSIs (odds ratio, 0.60; 95% CI, 0.45, 0.81; z = 3.39; P = 0.0007). However, there was significant heterogeneity (Chi2 = 17.06, df = 8, [p = 0.03]; I2 = 82 %) among included studies.

Conclusion

The use of NPWT in general surgical patients undergoing laparotomy seems to have proven clinical advantages of reducing SSIs and may routinely be used as a prophylactic tool.
SP3.2.3 The open abdomen is associated with increased morbidity and mortality after emergency laparotomy: a retrospective cohort study
Authors: Harrison Charlotte , Beresford Charles , Magro Tania , Marinos Spyros , Sunthareswaran Rame , Ceresa Carlo
Published: October 2021

Aims

The open abdomen following emergency laparotomy for peritoneal contamination is becoming an increasingly popular method of managing severe intra-abdominal sepsis. However, this approach has been associated with increased morbidity and mortality. The aim of this study is to compare patient populations and post-operative outcomes from patients undergoing primary closure or those managed with an open abdomen after emergency laparotomy.

Methods

A retrospective case note review was undertaken of all patients recorded on the NELA database over a five-year period at a district general hospital. Patients with no intra-abdominal contamination or who were palliated peri-operatively were excluded. Data collected included P-possum morbidity and mortality, post-operative complications (Clavien-Dindo), length of stay and in-hospital mortality.

Results

811 NELA entries were reviewed; 313 were included with 79% (n = 248) undergoing primary closure. Cohorts were similar in age and sex. P-possum morbidity and mortality scores were significantly higher in the open abdomen group (89% vs 79%, p = 0.0003; 38% vs 24%, p = 0.0003, respectively). Of the outcome variables, significant complications (34% vs 11%, p = 0.001), length of stay (31 vs 18 days, p = 0.0001) and mortality (11% vs 4%, p = 0.001) were significantly higher in the open compared to closed abdomen group. Only 10% of patients undergoing primary closure required further surgery.

Conclusions

This study highlights that the open abdomen is used in higher risk patients, with significantly poorer outcomes. This approach, which confers a significant physiological burden requiring further intervention should be used with caution in selected cases.
SP3.2.6 Success of Ultrasound-Guided Reduction of Intussusception Using Normal/Saline And Factors Resulting In Failure of the Procedure
Authors: Abdullah Farooq , Gulnaz Nadia
Published: October 2021

Intussusception is one of the common pediatric surgical emergencies in age less than one year. The initial radiological study for detection of intussusception is ultrasound.

Treatment of choice of intussusceptions has remained controversial and varies from center to center. Surgical exploration was the main treatment in the past and still practiced as first-line treatment in some centers. However, in the past few decades, there is a trend to reduce intussusception under radiological guidance.

This study aims to determine the success rate of ultrasound-guided hydrostatic reduction of intussusception using normal saline and determination of possible factors that result in failure of the procedure.

Methods

This prospective study was conducted in the Pediatric Surgery department of Khyber Teaching Hospital, Peshawar from Jan 2018 to Sept 2018. All patients aged between 3 months to 24 months with clinical signs and symptoms and confirmatory sonographic evidence of intussusception were included in this study. The procedure was then carried out under ultrasound guidance using normal saline as a medium for reduction.

Findings

A total of 80 patients were included in this study. Successful reduction was achieved in 66 (82.5%) patients while in 14(17.5%) patients the procedure failed to reduce the intussusceptions. No mortality is reported in our study There were 6 recurrences 4 of which were managed by ultrasound guidance reduction while 2 underwent laparotomy.

Conclusion

Ultrasound-guided hydrostatic reduction of intussusception is an effective way to reduce the intussusception. It must be adopted as the primary procedure for the reduction of intussusception.
SP4.1.3 The effect of the Covid-19 pandemic on case selection and perioperative outcomes of emergency laparotomies: a UK-based multicentre cohort study
Authors: Thrumurthy Sri , Tsang Derrick , Bello Abdulazeez , Zaidi Ahsan , Vasilikostas Georgios , Wan Andrew
Published: October 2021

Aims

Evaluating the effect of Covid-19 on case selection and perioperative outcomes of emergency laparotomies across South West London (SWL).

Methods

A retrospective cohort study including all emergency laparotomies performed at three SWL-based NHS hospitals from 01/04/2020-31/12/2020 (i.e., “pandemic” cohort; from the first national lockdown), versus a “pre-pandemic” cohort (01/04/2019-31/12/2019). Data was extracted from the NELA database and hospital records, and analysed by two independent clinicians.

Results

414 patients met the inclusion criteria. 17.6% fewer (227 vs. 187) laparotomies were performed during the pandemic period. There were no significant sociodemographic differences between cohorts (mean age 64.5 vs. 62.7 years, p = 0.284; M:F ratio 1:1.154 vs. 1:0.928, p = 0.221). Pre-operative NELA risk scores were higher before the pandemic (mean 13.05% vs. 9.55%, p = 0.020). The commonest indication for laparotomy in both cohorts was small bowel obstruction (32.6% vs. 37.4%), treated most commonly with adhesiolysis. Postoperatively, fewer patients received HDU/ITU care during the pandemic than before (ward-based recovery 4.7% vs. 13.8%, HDU/ITU recovery 93.4% vs. 79.4%, χ2=15.4, p < 0.005). Mean duration of ITU stay was significantly shorter during the pandemic (4.5 vs. 2.7 days, p < 0.005), as was total length of inpatient stay (20.2 vs. 14.3 days, p = 0.0156).

Conclusions

The overall reduction in emergency laparotomies observed during the pandemic period was potentially secondary to tighter case selection guided by objective risk stratification. Fewer patients were recovered postoperatively on HDU/ITU, and patients were generally discharged from hospital earlier. Such trends in perioperative care served to support organizational prioritization in response to Covid-19 service provision.
SP4.1.13 Management of appendicitis during COVID-19 pandemic; short-term outcomes
Authors: Lucocq James , Radhakishnan Ganesh
Published: October 2021

Aims

COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19.

Methods

Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups.

Results

One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups.

Conclusion

CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.
SP4.1.17 Surgical Hot Clinic support during Covid 19 pandemic
Authors: Jalali Uzma , Bennett Jayne
Published: October 2021

Aims

To determine the role of Surgical Hot clinic during covid 19.

Methods

All patients attending Hot clinic from September 2020 to December 2020 were included in retrospective study.

Results

Total number of 373 patients have attended Hot clinic, sixty percent were females. Emergency department referred 43.3% of patients who were reviewed and referred by emergency and /or surgical doctors. Ward discharged patients were second highest in numbers, comprising 21.7% and were mostly post-surgical patients. GP referrals were 19.3% also 6% were referred by consultants and similar percentage was re booked in Hot clinic.

Forty one percent of the patients presented with abdominal pain, the most common being right upper quadrant followed by iliac fossae pain. Post produre review accounted for 24.6% of patients. Abscess were 16.3% whereas uncomplicated hernia, bleeding per rectum presented less.

Majority of patients was discharged on their first visit. The percentage of patients rebooked into Hot clinic was 9.6% with 6.7% referred to consultant’s outpatient clinic after requesting investigations. Only 3.4% were admitted for surgical care and 1.6% was brought back next day for day case procedure.

Conclusion

In light of the increased demand on ECC services, Hot clinic has emerged as a strong support during Covid 19 Pandemic. It has been utilized not only for urgent surgical referrals but also to facilitate early discharge to avoid Covid exposure. During the reduction of face to face appointments, both outpatients and GP, Hot clinic has provided services for pre-op and/ or investigation review.
SP4.2.14 The benefits and risks of provision of a hospital-wide high-definition video conferencing virtual visiting service
Authors: Dhahri Adeel Abbas , Dethabrew Agampodi-Umanda , Ladva Nirali , Pardoe Helen
Published: October 2021

Aims

Since the start of pandemic, Virtual visiting (VV) has become especially important due to visiting restrictions in hospital and telemedicine has become more evident. This project aimed to determine VV’s impact on staff and family members affected by COVID-19 and its applicability in the future.

Methods

This quality improvement pilot study was conducted 16/04/2020 till 30/11/2020, using Attend Anywhere (AA) as VV tool on iPads. In five dedicated COVID-19 wards, family members could request a 10-minutes VV through email run by a dedicated administrative staff. A Standard Operating Procedure (SOP) was described, and dedicated volunteers were recruited from a pool of existing hospital staff and physician associate students. An open-ended survey was emailed to staff and relatives following visits. The transcripts were coded into five themes and sub-themes and reviewed by two analysers independently. Thematic analysis was generated manually to form the conclusions.

Results

There were 138 feedback responses, including 108 (78.3%) from relatives and 30 (21.7%) from staff). Twenty-seven codes assigned to the data were amalgamated into the five stated themes: appreciative factors (129, 93.5%), organisational skills (44, 31.9%), palliative care (38, 27.5%), communication from staff (14, 10.1%), and VV issues (11, 7.9%). Overall, 131 (94.9%) of total responses had generally positive comments (111 from relatives while 20 from staff).

Conclusion

Virtual Visiting delivered to the front line has worked effectively with excellent reliability in a secure cyber environment. Despite these barriers or weaknesses, VV can be potentially implemented in the hospital wards even beyond post-pandemic era.
SP5.1.3 Analysis of National Bariatric Surgery Related Clinical Incidents: Lessons Learned and a Proposed Safety Checklist for Bariatric Surgery
Authors: Omar Islam , Madhok Brijesh , Parmar Chetan , Khan Omar , Wilson Michael , Mahawar Kamal
Published: October 2021

Background

Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the UK every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents.

Methods

We analyzed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. The authors used their experience to identify learning themes and design a safety checklist.

Results

We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.3% (N = 164), intraoperative 38.1% (N = 206), and postoperative accounted for 31.6% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively.

The most commonly reported high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most commonly reported high severity theme was improper management of diabetes mellitus (35;6.5%).

Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively.

Conclusion

We identified 58 specific themes of bariatric surgery-related clinical incidents. We proposed specific recommendations for each incidents theme in addition to a bariatric safety checklist to help improve the safety of bariatric surgery worldwide.
SP5.2.1 Renal Transplant Outcomes Through the COVID-19 Pandemic at a London Transplant Centre
Authors: Mahdibeiraghdar Sara , Ghazanfar Abbas , Heap Sarah , Siddiky Abul , Taylor Claire Fraser , Wadoodi Ashar
Published: October 2021

Aims

The aim of this audit was to establish the impact of COVID-19 on the outcomes of renal transplant recipients in the post-transplant period at our centre, through the 2020 calendar year.

Methods

Living donor and deceased donor renal transplant recipients in the period of interest were identified and any complications or adverse outcomes were reviewed and compared to outcome data from the previous year.

Results

A total of 88 renal transplants were performed in 2020. Fifty-five cases were performed after reopening the Unit. Five patients tested positive for COVID-19 in the post-transplant period. One patient was admitted to the Intensive Care Unit and subsequently died from related complications. Another patient suffered from internal jugular vein thrombosis shortly after testing positive and could be attributed to the hypercoagulable state post-infection.

A total of 4 deaths and 1 graft loss were recorded within 2020. This compares to 1 death, 2 graft losses and 1 primary non-function in 172 transplants in 2019. Of the 4 deaths, one was directly linked to COVID-19. The other 3 deaths could be indirectly linked to the disruptions that were made in the healthcare system during this period in adapting to the pandemic.

Conclusions

It was anticipated that COVID-19 will directly and indirectly affect patient outcomes from surgery during this period. This was clearly seen at this Unit, with mortality rates having increased almost eight-fold in the post-transplant period compared to the same period in the previous year. However, no significant difference was seen with graft losses.
SP5.2.5 A 4-year single-centre cohort study assessing outcomes in vascular surgery patients undergoing calf fasciotomies
Authors: Laloo Ryan , Bailey Marc , Troxler Max , Russell David , Scott David Julian Ashbridge
Published: October 2021

Aims

Acute compartment syndrome (ACS) is a surgical emergency. Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation. This study compared patient outcomes following calf fasciotomies to prevent ACS (prophylactic) versus treat ACS (therapeutic) and early (within 6 hours of ACS diagnosis) versus delayed fasciotomies (beyond 6 hours) at a single vascular centre.

Methods

All patients undergoing calf fasciotomies between 1st January 2017 and 31st December 2020 were identified from a prospectively collected departmental database. Caldecott-approved data collection was conducted. The primary outcomes were wound infection, foot drop, muscle debridement, split-skin graft (SSG) requirement, vacuum dressing, 30-day amputation and death rates. Statistical analysis was performed using Fisher’s exact test.

Results

73 patients (51 men, 22 women; median age 67, IQR 56-75 years) underwent calf fasciotomies (44 therapeutic and 29 prophylactic) mainly following acute thromboembolic ischaemia. Higher complication rates occurred among delayed (15) versus early (29) fasciotomy patients: wound infection (13.3% vs 3.4%), foot drop (20.0% vs 3.4%), muscle debridement (40.0% vs 24.1%), loss of anterior compartment (13.3%, 3.4%) need for SSG (29.5% vs 17.2%), vacuum dressing (46.7% vs 20.7%) and 30-day amputation rate (20.0% vs 13.8%) but lower 30-day death rate 13.3% vs 17.2%). None of these results were statistically significant. 34.1% of delayed fasciotomies were due to awaiting emergency theatre availability.

Conclusion

ACS patients undergoing calf fasciotomies are at high risk of complications including amputation and death. Ongoing education on mortality risk and early communication with emergency theatres are critical in their management.