bluuebunny/crossref_metadata_2025 huggingface dataset:
THTP3.4 Performances measures in Robotic-Assisted Surgery- A Systematic Review
Authors: El-sayed Charlotte , Yiu Andrew , Burke Josh , Todd James , Munsch Chris , Bach Simon P
Published: August 2023

Background

Robotic-Assisted Surgery (RAS) has seen a global rise in the past 30 years. Despite the increased adoption, there is no current standardised training curricula or measure of performance. The aim of this systematic review was to define the RAS metrics used to assess technical performance across the surgical specialities.

Methods

Using the PRISMA 2020 guidelines, Pubmed, Embase and the Cochrane Library were searched systematically for full texts published 31st January 2020 – 31st January 2022. All randomised controlled trials (RCTs) and observational studies were considered. Review articles and systematic reviews were excluded. The papers’ quality and bias score were assessed using the Newcastle Ottawa Score for the observational studies and Cochrane Risk Tool for the RCTs.

Results

The initial search yielded 1189 papers of which 74 were eligible. The majority were published in urology (45% n=33). 27 unique metrics were identified and categorised as “task based”, “procedural based”, “cognitive assessments” and “global assessments”. Global assessments were the most common category of assessment (n=12); the most frequently used was GEARs (Global Evaluative Assessment of Robotic Skills). Only 4 metrics (automated, Proficiency Based Progression (PBP), pupillary measures and time to completion) used quantitative measures to assess performance whilst the remaining relied upon Likert scales thereby creating variability amongst users.

Conclusion

There is wide variation in tools used to assess performance in RAS. The majority of tools are subjective which increases the risk of bias amongst users and therefore accuracy in the measure of performance. A validated, objective global assessment tool that utilises quantitative measures is required.
ThTP3.7 Video-Based Coaching for Surgeons in the UK: Consensus on Essential Elements
Authors: Gunn Eilidh G M , Johnson Adam P , Pius Riinu , Smink Douglas S , Tambyraja Andrew L , Yule Steven
Published: August 2023

Aims

To determine consensus on essential elements of a video-based surgical coaching program for general surgeons in the United Kingdom.

Methods

A modified e-Delphi study was designed with three sequential rounds utilising cross-sectional survey design, distributed using REDCAP software. A purposeful sample of international experts from affiliated disciplines were invited to participate. Survey statements were rated on level of importance for inclusion in a coaching program using a 7-point Likert scale (1=extremely unimportant, 7=extremely important). Consensus criteria was defined as 70% of participants rating a given statement at 6 or 7.

Results

Fifty-nine experts participated. Round 1 consisted of 8 open questions developed from a systematic review of audiovisual coaching. Analysis of responses generated 92 novel statements regarding surgical coaching, categorised within 8 domains: infrastructure (9), coaching session components (9), audio-visual technology (22), program (20), formation of coaching pairs (11), coaches (8), coaches (4), and outcome criteria (9). In round 2, participants rated each statement, with a total of 22 statements reaching consensus criteria, 32 statements for reconsideration, and 38 statements rejected. Currently in round 3, a further 4 statements have met consensus criteria. Overall, the highest rated statements were: Clear and formal training for coaches prior to participation (90.6%) and Coaches should be good communicators (90.6%).

Conclusions

Prior surgical coaching work has predominantly been implemented in North America. This consensus study has established 26 essential elements for a video-based surgical coaching program in the UK. These results will inform a user-centered design of a video-based coaching pilot.
ThTP3.11 Abscess Incision and Drainage Under Local Anaesthetic: Greener, Faster, Cheaper
Authors: Innes Ailsa , Kammath Vipin , Arora Ankita , Ali Oroog , Dent Barry
Published: August 2023

Introduction

It is standard practise for incision and drainage (I+D) of abscesses in our general surgery department to be performed under general anaesthetic (GA), despite evidence that local anaesthetic (LA) drainage is safe and effective.

Aims

To evaluate the acceptability and environmental benefits of LA abscess I+D.

Methods

Data were collected for abscesses assessed from January-July 2022. Abscesses that were >5cm, perianal/perineal, on multiple sites, or drained during another procedure were deemed unsuitable for LA. Questionnaires to evaluate patient opinions on sustainability were distributed to 26 patients requiring I+D from November-December 22. Carbon footprints were calculated using published carbon footprint estimates for patient travel and healthcare activity.

Results

130 of the 162 patients seen with abscesses underwent I+D, with 119 done under GA. Of those who had GA I+D, 71 were possibly suitable for LA. Of these 71 patients, 66 were done the following day, requiring admission or the patient to go home and return. The estimated additional carbon footprint of performing these procedures under GA was 1,806kgCO2e. 84% of patients surveyed thought it was ‘important’ or ‘very important’ that their procedure was cost effective, and 57% thought it was ‘important’ or ‘very important’ that their procedure was good for the environment.

Conclusion

Performing suitable abscesses under LA could save 3,096kgCO2e per year: equivalent to driving 19,000km. It would also save money, emergency list space and be more convenient for patients. It is important to many of our patients that their treatments are sustainable.
ThTP4.7 Laparoscopic Appendicectomy Consent Form Audit
Authors: Manson David , Jones Tabitha , McKnight Gerard , Morris Christopher , Poh Jian Zi
Published: August 2023

Aims

Surgical consent forms are difficult for patients to interpret. Surveys show that patients struggle to grasp surgical concepts. Procedure specific consent forms (PSCFs) improve surgical consent because they provide a standardised list of complications. However, PSCFs are nationally underutilised. Laparoscopic appendicectomies are one of the most common operations. Our aim was to assess the variability of appendicectomy consent forms in preparation for the inception of a PSCF.

Methods

A prospective audit on patients requiring laparoscopic appendicectomy. Their consent forms were assessed for legibility, abbreviations and complications included. Lastly, all were checked to see if the patient had been offered alternative treatment option in the form of antibiotics. Subsequently, each patient was contacted and asked a series of standardised questions.

Results

17 consent forms were assessed. 100% included infection and bleeding; 88% conversion to open; 82% bowel resection and damage to local structures; and 76% blood clots. 18 separate complications were used in total, with highly variable inclusion. Of the 17 forms 76% were legible, with 65% of them containing acronyms. 82% indicated that alternative therapies had been discussed. In the post-op questionnaire, approximately 80% of patients gave details surrounding their operation and what it entailed, however only 64% were able to successfully recall some of the basic potential complications. Interestingly, only 43% remember being given options on alternative treatments.

Conclusion

The use of PSCFs would be beneficial in standardising complication lists and also in ensuring patients are fully aware of alternative therapies.
ThTP4.9 Adherence to extended venous thrombo-embolism prophylaxis for post operative resection of colorectal malignancies
Authors: Yeung Thomas , Ng Sherwin , Sidhu Resham , Ali Muhammad
Published: August 2023

Aim

Patients undergoing cancer resection abdominal surgery are at high risk of developing venous thrombo-embolism (VTE) in the post-operative period. To reduce this risk, these patients should be considered for extended pharmacological VTE prophylaxis for 28 days post-surgery as per NICE guidelines (NICE NG89). In our surgical department, we give all colorectal cancer resection patients 5000 units of Deltaparin for 28 days post resection unless it is contraindicated. We aimed to evaluate adherence to this guideline.

Method

This is a single-centre retrospective audit study. We included 100 colorectal cancer resection cases between 1st October 2021 and 28th February 2022 (n=100). Retrospective data was collected including the type of procedure, histology and whether post-operative Deltaparin was prescribed for 28 days. All consecutive colorectal cancer resections were included in the study. The data was collected from the patient electronic records, electronic prescribing system and the electronic discharge summaries.

Results

The most common operation was anterior resection of the rectum (42%) followed by right hemicolectomy (40%). The Adherence to the NICE guidelines for extended VTE prophylaxis was 87%.

Conclusion

The adherence to the NICE guidelines in our department falls below the national target of 90% adherence. To improve the compliance, we will carry out staff education on appropriate anticoagulation prescribing and also display informative posters in the surgical wards to increase the awareness. We will aim to re-audit the adherence to the guidelines after implementing these measures.
ThTP6.1 Unplanned Admissions following Elective Laparoscopic Cholecystectomy Day Cases
Authors: Haidar Omar , Tabassum Tanzin , Kim Hyun-Kyung , Gupta Sanjay
Published: August 2023

Background

Laparoscopic Cholecystectomy (LC) represents a significant proportion of surgical caseload in the United Kingdom with over 50,000 operations per year (1). LC is recommended for patients with symptomatic gallstone disease (2). For appropriately selected patients, day case LC is recommended. British Association of Day Surgery (BADS) suggests a benchmark rate of 75% LC to be performed as day cases (3).

Aim

Retrospective audit of patient outcomes following elective day case LC, compared with national standards, to identify areas of improvements.

Method

Retrospective analysis of 100 elective planned day case LC at a District General Hospital between May 2021 - May 2022.

Results

29 out of 100 patients had unplanned admissions. The most common reason for unplanned admission was intraoperative drain insertion (20/29, 69%), with 85% of these drains removed day 1 or 2 post op. Higher ASA grade patients were more likely to have unplanned admissions; 12.5% of ASA 1 patients vs 32.2% of ASA 2 patients vs 41.2% of ASA 3 patients. Patients with unplanned admissions had higher rates of subsequent re-admission (4/29; 13.8%), compared with day cases (3/71; 4.2%).

Conclusion

Our audit found the majority of ‘failed day cases’ were a result of intraoperative drain insertion. Drain insertion did not instigate further interventions, but did lengthen patients' stay. BADS recommend avoiding routine use of drains in LC and state that they can also be removed on the day of surgery (3). Our audit also highlights that high ASA cases should be performed earlier in the operative list, allowing for more time for observation to aid same-day discharge.
ThTP6.2 Comparison of length of post-operative hospital stay following robot-assisted laparoscopic nephrectomies with traditional laparoscopic nephrectomies: a single-centre retrospective study
Authors: Trung Le Ha Bao , Park Eunsoo , Cheah Michael , Richards Colin , Wilson Ian
Published: August 2023

Aim

The study aims to compare the length of post-operative hospital stay following robot-assisted laparoscopic (RAL) nephrectomies with stays following traditional laparoscopic (LAP) nephrectomies at a district general hospital.

Method

This study retrospectively compares the post-operative length of hospital stay using information documented on patient’s paper notes scanned onto an online system. Between January 2021 and December 2021, 25 patients underwent LAP nephrectomies in this unit. Following the introduction of RAL at our unit, all patients requiring a nephrectomy had this procedure done using RAL. Between January 2022 to November 2022, 33 patients underwent a RAL, 3 of which required conversion to open and excluded from this study. Additionally, data on age, BMI, tumour size and ASA score was collected to identify any evidence of systemic bias.

Results

Mean post LAP hospital stay was 3.60 (±3.24) nights, while post RAL was shorter at 2.07 (±1.44) nights to a statistically significant degree (p-value=0.0357). There was no significant difference in any of the demographic factors between the two groups (LAP and RAL). When including data for partial nephrectomies (n=20; LAP=11, RAL=9) and pyeloplasties (n=9; LAP=5, RAL=4), length of post-operation hospital stay was still significantly shorter for patients who had undergone robot-assisted laparoscopy. Mean post-LAP hospital stay was 3.56 (±2.62) nights, while post-RAL was shorter at 2.21 (±1.68) nights to a statistically significant degree (p-value=0.00666).

Conclusions

The use of robot-assistance during laparoscopic nephrectomies was associated with significantly shorter post-operative hospital stays over traditional laparoscopic procedures in this cohort of patients.
ThTP7.8 Laparoscopic to Open Conversion in Malignant Colorectal Cancer Resections (CRC): A 15-year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A
Published: August 2023

Aims

Colorectal cancer is 3rd most common & 2nd leading cause of cancer deaths. Laparoscopic resection has evolved as main surgical technique in management of colorectal malignancies (66 % NBOCA 2022). Laparoscopic to open conversion is reported in < 21 %. Aim of study is to assess implications of laparoscopic to open conversions.

Methods

Single-centre cohort study was carried out from January 2008 to February 2023; with evaluations postoperative outcomes in laparoscopic to open conversions. Laparoscopic and open colorectal CRC resections were recruited as controls.

Results

Conclusion

Over 15 years, lap-open conversion rate was 12.1 %. Lap-open conversions had higher BMI’s, prolonged operations & hospital stay (p < 0.05.), but this did not adversely affect survival. Lap-open conversion should not be deemed as failure of laparoscopic surgery but as implementation of safe surgery in presence of intra-operative challenges.
ThTP7.10 Does robotic anterior resection improve the outcomes for patients with rectal cancer over standard laparoscopic surgery?
Authors: Nwabueze Maureen , McPherson Symon
Published: August 2023

Background

Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS).

Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS.

Aims

To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness.

Methods

A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database.

141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review.

Results

Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p=0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p=0.03, 0.0001<, 0.001<, 0.001). Overall, R-AR had lower rates of intraoperative complications.

Conclusions

Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.
ThTP7.11 Comparison of oncological outcomes of patients having colorectal surgeries: During lockdown vs post lockdown
Authors: Gowda Manoj Srinivas , Mesut Erel , Peter Bennett , Venkatesan Gowtham , Thulasiraman Sri , Jha Madan
Published: August 2023

Aims

When the UK entered the lockdown, the cancer pathways changed to deal with the pandemic and protect cancer patients from infection. The objective of our study is to compare the oncological outcomes of patients having surgery for colorectal cancer (CRC) during and after lockdown.

Methods

Patients who underwent surgery for CRC between March-2020 to February-2022 were included in the study. All patient related and disease specific details were collected from the prospectively maintained database. Patients were divided in to two groups: Surgeries before (group-A: during lockdown) and after 22/2/21 (group-B: after lockdown). Patient demographics such as age, tumour and nodal staging, and survival outcome was calculated. Log-rank test and Kaplan-meir survival curve was used to analyse the survival outcome.

Results

A total of 450 patients underwent surgeries during this period, of which 358 had cancer resections. During lockdown 171 patients had cancer resections (Group-A) and 187 patients had surgery for cancer after lockdown (Group-B). The median age of patients is 72 and 73 years in group-A and B respectively(p-value:0.29). There is no difference between the two groups with respect to tumour and nodal staging. In group-A, 13 patients had recurrence and 26 died due to disease with a median follow up of 23 months. In group-B, 22 patients had recurrence and 18 died due to disease with a median follow up of 13 months (p-value:0.42 log rank test).

Conclusions

The patients undergoing treatment of CRC during lockdown had similar oncological outcomes compared with patients having treatment after the lockdown.
ThTP8.4 What is the longer-term impact of emergency laparotomy for older people living with frailty? A mixed-methods study protocol
Authors: Price Angeline , Smith Johnathan , Pearce Lyndsay , Martin Peter , Griffiths Jane
Published: August 2023

Introduction

A third of emergency laparotomies performed in the United Kingdom (UK) are in older people living with frailty (OPLWF). Despite high risk of adverse clinical outcomes for this group, there is a lack of research into patient experience. Longer-term outcomes have also not been fully explored. This data is essential in enabling informed shared decision making and robust post-operative care tailored to the holistic needs of this group.

Study aim

This study aims to understand the impact of emergency laparotomy for OPLWF in two ways. Qualitative interviews will explore patient experience following surgery. A retrospective analysis of the National Emergency Laparotomy Audit (NELA) database will examine longer-term outcomes including death and hospital readmission.

Methods

Phase One: 30 participants (≥ 65yrs, CFS ≥ 5) are being recruited from hospital sites across the UK to undertake interviews within one month of surgery. Data is being analysed using thematic analysis. The results will enable targeted data collection in phase two.

Phase Two: 12 participants (≥ 65yrs, CFS 5/6) will be recruited to undertake interviews at 3-, 6- and 12-months. Longitudinal Interpretative Phenomenological Analysis will facilitate in-depth understanding of lived experience following surgery.

In the NELA analysis, the primary outcome measure will be time to all-cause mortality, secondary outcome measure will be time to hospital readmission.

The results from phase one are expected by April 2023.

Discussion

This study will provide much needed knowledge of longer-term impacts of emergency laparotomy for OPLWF, informing future service delivery and providing context to shared decision-making
ThTP8.5 Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Pakistan
Authors: Sabir Alifa , Rauf Fatima , Javed Muhammad Umar , Malik Naveed Akhtar , Hanif Muhammad
Published: August 2023

Objective

The study aimed at assessing the bacterial profile and antimicrobial susceptibility patterns of the pathogens isolated from patients diagnosed with surgical site infection.

This study will help identify the organisms and will guide in formation of protocols to prevent and treat surgical site infections.

Methods

This descriptive cross-sectional study was conducted in the Department of Surgery from May 2021 to May 2022, using convenient sampling technique. Wound samples were taken from patients diagnosed with surgical site infection and cultured on Blood and MacConkey agar. Antimicrobial susceptibility was performed on Muller Hinton agar. Data was entered and analyzed using SPSS v.23.

Results

A total of 101 samples from 78 patients were analyzed. Out of the bacteria from positive growth cultures, Escherichia coli (19,18.8%) was the most common isolate followed by Pseudomonas aeruginosa (17,16.8%) and Klebsiella pneumoniae (15,14.9%). Acenitobacter baumanni was isolated from 11 (10.9 %) patients, methicillin-resistant Staphylococcus aureus from 4 (4 %) patients and Proteus mirabilis from 2 (2 %) patients. However, 9.9% samples showed no growth on cultures. Escherichia coli was the most sensitive to amikacin (89.5%) and meropenem (78.9%). While Pseudomonas aeruginosa showed maximum susceptibility towards meropenem (82.4%).

Conclusion

Escherichia coli was the most commonly isolated pathogen from surgical site infection sites, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Acenitobacter baumanni as causative agents for SSI’s. This study demonstrates the increasing incidence of infections from once uncommon organisms like Klebsiella pneumoniae and Acenitobacter baumanni. This calls for action and formation of protocols to fight the menace of SSI’s.
ThTP8.7 Streamlining ambulatory management of emergency general surgery
Authors: Waggett Helena , Claxton Mary , Wijeyaratne Mnuk , Hollyman Marianne
Published: August 2023

Aims

There is a trend to increase ambulatory management of general surgical patients, both improve the experience and outcomes for patients, as well as reduce need for inpatient beds.

Prior to 2019, our trust had no ambulatory service; during 2019 a clinic was opened, which was located remotely from the admissions ward, and as a result we were unable to direct the majority of patients to the clinic to support ambulatory management. We sought to assess the benefit of the clinic, and to co-locate the ward and ambulatory triage clinic to increase access of ambulatory management.

Methods

Admission rates were assessed before and after the ability to run virtually all patients through the ambulatory ‘triage’ clinic before making a decision to discharge or admit. Data have been used from electronical hospital systems.

Results

In 2019 the average number of patients reviewed was 18, with a 81% admission rate.

Practice was variable during the COVID pandemic, once things stabilised in 2022, 25 patients were reviewed between clinic and the ward daily, with 16.2(65%) admission rate.

The move of the ward and the clinic in 2022 did not change the total number of clinical contacts a day (25), however there is a reduction in the average percentage of patients staying overnight to 13.5(54%).

Conclusions

We have demonstrated that we can reduce the number of inpatient stays and reduce the length of stay of patients. The same day discharge rate was improved by allowing the majority of patients to be reviewed in the clinic, before a decision regarding admission was made.
ThTP8.10 Creating a Team Culture of Building a reliable NELA Database in a District General Hospital
Authors: Tsiourva Evangelia Ioanna , Dunstan Matthew , West Nicholas
Published: August 2023

Introduction

In St Helier Hospital, Surrey, we run a busy Emergency General Surgery Service, performing almost 200 laparotomies annually. It is remarkable that in our Department every laparotomy case is consultant-led and that the percentage of HDU admission of high perioperative risk cases reaches 100%, leading to survival rates that are above the UK average. However, the NELA database has not been updated consistently with cases missing and others entered erroneously. As a result, the NELA database does not reliably reflect the quality of care we provide to our patients and undermines the Department’s CQC metrics.

Methods

We established a multidisciplinary QI Project involving the Departments of General Surgery, Anaesthetics and Intensive Care to create a team culture of commitment to NELA collection data.

Interventions

Results

Conclusion

Simple measures as well as raising awareness among the implicated professionals has led to great improvement in adherence to updating NELA database.
FTP1.5 The forgotten tribe in healthcare? Mechanism of injury and outcome of injured adolescents in a UK Major Trauma Centre
Authors: Miller Eleanor , Morris Louise , Wood Damian , Kurien Thomas , Brooks Adam
Published: August 2023

Aim

Trauma is the leading cause of mortality in the adolescent and young adult population. Adolescents, particularly those aged 16-17 years often fall between provisions of traditional adult and paediatric services. This study examines the outcomes for injured adolescents treated at one combined adult/paediatric UK major trauma centre.

Methods

An observational study included patients aged 10-24.99 years treated at a single MTC between April 2020 and April 2022. Demographic and injury mechanism and severity (ISS) data were recorded for three subgroups: paediatric (10-15 years), transitional (16-17) and young adult (18-24). Outcomes were compared including length of stay, surgical procedures and mortality.

Results

343 patients were included (78.4% male). 16-17 year olds were significantly more likely to be victims of violence and require a longer stay in hospital. Mortality was 4.1% overall.

Conclusions

It is vital that the specific needs of young people aged 16-17 are recognised in terms of violence reduction and injury prevention strategies, and in planning and delivery of hospital services.
FTP2.2 Retrospective analysis of potentially missed right-sided colon cancer
Authors: Albendary Mohamed , Ojha Soumya , Badh Manpreet , Foley Jordan , Shinwari Husna , George Anil
Published: August 2023

Background

Right colon cancer can be missed due to either inadequate assessment or suboptimal investigations. This audit evaluated a present clinical practice and highlighted points to improve the diagnostic ability of clinicians.

Methods

Records of patients diagnosed with right colon malignancy between 2015 till 2020 were screened for missed diagnostic opportunities in the 3 years preceding their cancer diagnosis. Reasons were categorised as: a critical miss (includes inadequate investigations of a significant encounter with suggestive symptoms or lost follow up) and a potential miss (encounters with less suggestive symptoms or insufficient investigations).

Results

While 116 patients (49%), out of the included 235 patients, had at least 1 previous encounter with suggestive symptoms, only 83 (71.5%) of them were investigated. 56 patients had a previous colorectal investigation, with CT imaging being the most frequent test requested, and performed for approximately half of the patients.

30 (13%) incidents of critical diagnostic miss, and 28 (12%) incidents of potential diagnostic miss were identified. (Table 1)

Conclusions

Clinicians should adequately investigate suggestive symptoms of right colon cancer, including patients older than 40 with appendicitis.

Our results conform with the reported less than optimal sensitivity (75-100%) of non-targeted CT to pick up early colonic cancer, and with the probable false sense of reassurance after unremarkable flexible sigmoidoscopy for potential symptoms of right colon cancer.
FTP2.12 The National Consultant Information Programme (NCIP) and its effect on current Colorectal surgical practice, specifically looking at Exenteration of Pelvis for Lower Gastrointestinal Cancer
Authors: Galla Aashlesha , Maxwell-Armstrong Charles , Booth Matthew , Young Lucy , Bogovac Marina , Williams Norman
Published: August 2023

Aim

Extract and contextualise relevant data from NCIP tool, focusing on exenteration of pelvis for lower gastrointestinal (GI) cancer. Understand Covid's impact on surgical practice, and any variations seen at trust and national level, to gain insight into current colorectal surgical practice in England.

Method

Pseudonymised data extracted from NCIP dashboard by NHS England Improvement data analysts. NCIP data is primarily from Hospital Episode Statistics, and other relevant databases and registries. Various metrics were analysed including pre-Covid-19 or during Covid-19, frequency of cases, procedure sub-group, length of stay (LOS), readmission and mortality. Data contextualised by comparing observed data with previous literature, if possible.

Results

687 cases from April 2018-March 2022. All elective, all 17+ years. 340 cases between April 2018-March 2020 and 347 cases between April 2020-March 2022.

4 procedures: 11 Lateral Lymphadenectomies, 20 Other Exenterations, 161 Posterior Exenterations, 495 Total Exenterations. Decrease in frequency of cases post-covid for all procedure sub-groups except total exenteration (5% increase).

40 centers across England, 99.27% of cases performed at NHS trusts. Center variation observed with numerous providers doing less than 10 cases in the 4-year period.

Average length of stay (LOS): 23.65 days ± 0.75 with 95% CI [22.18, 25.12], however maximum LOS of 154 days.

30-day readmission was 21.83%. 90-day mortality was 2.47%.

Conclusion

Impact of Covid-19 pandemic not observed in the data. Significant variation observed at provider level for each procedure sub-group, possibly contributing to variation seen in metrics such as LOS. Data suggests the need for further exploration into observed variation.
FTP3.12 Can pre-operative MRI predict the extent of surgery in Deep Infiltrating Endometriosis – An Observational Study
Authors: Sarodaya Varun , Blake-James Benedict , Birkett Victoria , Petty Daniel , Sanaullah Fawzia , Bandyopadhyay Dibyendu
Published: August 2023

Aims

Deep Infiltrating Endometriosis (DIE) surgery is complex & the interventions involving multi-specialties can be unpredictable. Frequently it depends on the extent of the bowel/bladder involvement. We aim to study the role of MRI in predicting such involvement & in pre-operative multidisciplinary planning of DIE surgery.

Methods

All consecutive patients between Jan 2021 & Dec 2022 who underwent MRI scan & subsequent DIE surgery in an accredited endometriosis center were included. Correlation was studied especially with reference to the bowel/bladder involvement between MRI findings & operative interventions.

Results

A total of 19 patients were included. Mean age of the patients was 41.83 years (range 27-55 years). Five out of 19 (26%) & 2 of 19 (10%) patients showed measurable (length & depth) endometrial deposits rather than adhesions/endometrial scarring on MRI in bowel (rectum &/or sigmoid) & bladder wall respectively. Two patients had anterior resection and primary anastomosis and 6 had either shaving or disc excision of the bowel wall. Both patients with bladder wall involvement required full thickness resection of bladder wall. The sensitivity, specificity and positive & negative predictive values of MRI depicting the extent of bowel and bladder intervention were 71%, 90%, 90% & 69% respectively.

Conclusion

MRI helps predict the extent of DIE surgery & facilitates pre-operative planning of multi-specialty approach. Specific volume categorization of the measurable deposits may influence the nature of bowel/bladder surgery (resection vs shaving). A large scale multicenter prospective study would be useful for further evaluation.
FTP4.8 A survey on enhanced recovery after surgery (ERAS) in Pakistan
Authors: Rauf Fatima , Rauf Sidra , Sannan Abdul , Hanif Muhammad
Published: August 2023

Introduction

ERAS protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the stress response following surgery. Despite a significant body of evidence indicating that ERAS protocols lead to improved outcomes, implementation has been slow, and is not yet universal.

The aim of this study was to evaluate current implementation of enhanced recovery protocols among Pakistani surgeons.

Methods

A survey questionnaire consisting of 23 items was created to assess current trends in perioperative management of patients undergoing major surgery, and to ascertain the extent to which ERAS is understood and implemented.

Results

The survey was answered by 100 individuals. 32 % of participants were familiar with ERAS protocols. All participants gave pre-operative counselling. 26% performed preoperative nutritional assessment with provision of pre-operative nutritional support in 24 % cases. Anaemia was managed in 84 % cases and smoking cessation done in 70 %. Patients were kept nil per oral for > 6 hrs in about 80 % cases. Antibiotic prophylaxis given in 94 % cases. Preoperative loading with carbohydrate drinks is carried out in only 2% of cases with 90 % being unfamiliar with the term; nasogastric tube done (58 %), transurethral drainage (42%). opioid analgesia use 54 % and multi modal analgesia used in only 32 %. Prophylaxis for postoperative nausea and vomiting (34%), VTE prophylaxis 26 %. Early mobilization (84%) and early feeding in only 32 % was performed.

Conclusion

An ERAS program requires a dedicated multidisciplinary team willing to abandon out-dated paradigms and embrace new ideas.
FTP5.12 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan
Authors: Hassan Rawan , Osman Sarah , Mohamed Walid , Hassan Razan , Mohamed Sagad
Published: August 2023

Aim

Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries.

Methods

Hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p < .05.

Results

80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p > .001), malignant nature of the disease (p > .001), intra-operative blood loss (p > .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).

Conclusions

The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.
FTP5.13 Laparoscopic cholecystectomy is more cost effective than robotic cholecystectomy: a systematic review of published studies
Authors: Singh Anurag , Kaur Mandeep , Swaminathan Christi , Sains Parv , Singh Krishna , Sajid Muhammad
Published: August 2023

Objective

Robotic cholecystectomy (RC) has been proven safe and postoperative outcomes have also been quoted to be equivalent to conventional laparoscopic cholecystectomy (LC). The objective of this review to evaluate the cost effectiveness of RC compared to LC.

Materials and methods

All types of comparative studies reporting the cost of RC versus LC were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4.

Results

Four comparative studies (one randomised trial and 3 retrospective studies) on 817 patients undergoing RC versus LC were found and deemed suitable for analysis. There were 559 patients in the LC group and 258 patients in the RC group. In the random effects model analysis, LC was associated with the reduced cost [standardised mean difference -5.39, 95%, CI (-8.97, -1.81), Z = 2.95, P=0.003] compared to RC. However, there was significant heterogeneity (Tau2 = 13.06; Chi2 = 583.52, df = 3; (p < 0.00001; I2 = 99%) among included studies.

Conclusion

The LC seems to be more cost effective compared to RC in terms of procedural cost. However, due to statistically significant heterogeneity among included studies and paucity of the randomised, controlled trials, these findings should be taken cautiously. A Major multicentre randomised, controlled trial is needed to validate these findings.
FTP5.14 A comparison of robotic and laparoscopic surgery in the management of benign and malignant general surgical conditions
Authors: Grewal Callum Singh , Karri Rama , Yassin Nuha
Published: August 2023

Background

Robotic surgery is a relatively novel approach to minimally invasive surgery. The ability for greater precision, control and visualisation offers an advanced treatment option. This study compared the clinical outcomes for general surgical patients undergoing robotic and laparoscopic surgery.

Methods

A retrospective analysis of 172 surgical patients undergoing surgery for malignant and benign conditions was conducted. Analysis of demographics, pre-, intra-, and post-operative care and complication rate was studied. Patients were divided into three groups: Colorectal cancer (CRC), inflammatory bowel disease (IBD), and general (diverticular disease, rectal prolapse and hernia repairs).

Results

This study compared 114 robotic surgeries to 58 laparoscopic procedures for general surgery patients. Among the robotic patients, 83 were treated for CRC, 20 for IBD and 11 in the general group; sigmoid cancer (42.2%) and Crohn's disease (75%) were the most common pathologies respectively. In the laparoscopic group, 69% were treated for CRC and 31% for IBD. Robotic surgery had a longer median operation time of 255 minutes compared to 250 minutes for laparoscopic surgery, but shorter average hospital stays (6.2 days vs 11 days) and lower 30-day readmission rates (7.9% vs 17.2%). Fewer robotic patients required blood transfusions (1.8%) than laparoscopic patients (8.6%). One laparoscopic patient required conversion to open surgery, and the mortality rate was 0% across all groups.

Conclusion

Robotic surgery has been found to have shorter hospital stays, fewer complications, and fewer readmissions compared to laparoscopic surgery for a variety of pathologies. These findings suggest that it may be a superior approach to minimally invasive surgery.
FTP6.13 Do prophylactic antibiotics on general anaesthetic induction improve surgical site and intra-abdominal infection post emergency laparoscopic cholecystectomy?
Authors: Yang Peiming
Published: August 2023

Background

The role of prophylactic antibiotics in reducing surgical site infection (SSI) and intra-abdominal infection rates in emergency laparoscopic cholecystectomy remains controversial. New antimicrobial Trust guidelines at our unit introduced in May 2022 stated that all emergency “hot” laparoscopic cholecystectomies should receive single dose of IV antibiotics on general anaesthetic induction. We aim to assess whether SSI and intra-abdominal infection rates have improved since introducing these new guidelines.

Methods

Retrospective study comparing SSI and intra-abdominal infection rates within 30 days of all emergency laparoscopic cholecystectomy cases between February and April 2022 (before new guidelines), to those between August to October 2022 (post new guidelines).

Results

Total of 56 emergency “hot” laparoscopic cholecystectomy cases prior to, and 44 cases after introduction of new guidelines. 91% cases received IV antibiotics on induction post new guidelines, compared to 35% prior to new guidelines (P=0.038). Proportion of patients who continued with antibiotics post-surgery between 2 cohorts was not statistically significant (P=0.69). There was no statistically significant improvement in overall SSI rates post introduction of new guidelines (P=0.61). Skin closure method (P=0.044) and operating time (P=0.031) were statistically significant in contributing to SSI. There was further no statistically significant difference in rate of intra-abdominal infection post introduction of new guidelines (P=0.83).

Conclusion

Prophylactic antibiotics at induction do not appear to improve either SSI or intra-abdominal infection rates post emergency lap cholecystectomy cases. Further evaluation is needed over a longer study period, however, in order to ascertain whether these guidelines should be altered for future practise.
FTP7.2 Case report: Percutaneous Transgastric Endoscopic Retrograde Cholangiopancreatography for common bile duct stones
Authors: Duncan Tobias , Campbell Stewart , Sutherland Diarmid , Mahmud Sajid , Khan Khurram
Published: August 2023

Introduction

Post-operative patients with head and neck cancers do not have easy endoscopic access to the gastrointestinal tract to preform endoscopic retrograde cholangiopancreatography (ERCP) for stone disease. However, by gaining percutaneous access to the stomach via Radiologically Inserted Gastrostomy (RIG), ERCP can be safely performed.

Case presentation

This was a 68 years old man with symptomatic common bile duct (CBD) stones with multiple episodes of self-limiting cholangitis. Previous history of oral cancer requiring tongue resection complicated by oesophageal/pharyngeal stricture, radiation necrosis of mandible with subsequent resection and reconstruction. Patient had RIG inserted for feeding three years ago. Conventional endoscopy failed due to previous operations.

Transgastric ERCP via existing RIG tract was undertaken under general anaesthesia as combined procedure. RIG tract was gradually dilated with progressively larger laparoscopic ports (5mm, 11mm and 15mm). Once sufficiently dilated, gastroscope was passed via the tract into stomach to ensure intra-luminal position. This was replaced by the side viewing scope and ERCP carried out as standard. Patient underwent successful sphincterotomy and stone extraction. Skin over the RIG tract was then partially closed to narrow the tract and 18Fr gastrostomy tube placed. The procedure was completed in 35 minutes and RIG feeding recommenced 3 days later. There was no post-operative complications. He remained well with no further episodes of cholangitis two years post procedure.

Conclusion

ERCP via RIG tract is feasible and should be considered in patients where upper gastrointestinal tract is not amenable to endoscopy. This requires multidisciplinary approach between Upper GI surgeons and gastroenterologists.
FTP8.5 Patients Named Consultant: Who is the patient under?
Authors: Shah Saumil , Richardson Tom , Ahmad Adil , Kamal Mona , Datta Uttaran , Waraich Naseem
Published: August 2023

Aims

As per the Francis report patients must have a named clinician assigned to them. Knowledge of named consultant prevents confusion for medical staff and patient’s alike.

This study assessed named consultant discrepancies between in patient lists (nursing/medical), electronic patient record (EPR) and patient knowledge.

Methods

Data was collected from doctors/nursing list, EPR and patients themselves on general surgical wards. Patients lacking capacity were excluded and reasonable adjustments made for those with difficulty communicating.

The following interventions were implemented: results emailed to relevant staff, findings presented at doctor's teaching, posters in the ward office and marker pens made available. Interventions were re-audited at 12 days.

Results

Round 1: 52 patients. 63% had the correct consultant name on EPR, nursing and medical lists. 19% had named consultant over their bed space. 44% could name and a further 10% could describe their named consultant.

Round 2: 38 patients. 68% had the correct consultant name on EPR, nursing and medical lists. 37% had named consultant over their bed space. 50% could name and a further 8% could describe their named consultant.

Conclusions

Despite improvement; only 1:2 patients could name their consultant, 1:3 have consultant name over their bed and 1:3 have some discrepancy in named consultant on EPR or medical/nursing list.

Elective patients were most likely to know their consultant so future interventions should focus on emergency admissions. Other interventions should involve clerical staff, formal introduction of consultant to patients and ensuring on call consultant is known to the nursing team on ward.
FTP8.6 Informed Written Consent for General Surgery in Tertiary Care Center: A Closed Loop Audit
Authors: Oh Ke En , O'Leary Stephen , Anwar Afiq , Meshkat Babak
Published: August 2023

Aim

The aim of the study was to perform an audit of standard consent form in which patients sign prior surgical intervention in our institute. This audit is compared to ‘Code of Practice for Surgeons’ standard developed by Royal College of Surgeons in Ireland.

Methods

A pre-interventional cycle was conducted to evaluate the standard of consent of patients underwent surgery obtained using electronic records in the Department of General Surgery. This was performed over a period of one week. Following the analysis of collected data, teaching sessions was given to non-consultant hospital doctors (NCHDs) obtaining consent for patients underwent surgical procedure which include colorectal surgery, upper gastrointestinal surgery, breast and endocrine surgery. A post-intervention cycle was conducted to assess for any improvement in the standard of consent.

Results

A total of 50 consents forms were obtained in the pre-intervention cycle. Patient’s name, date of birth (DOB), patient’s identifier (PID) was correctly labelled in all the consent forms (100%). However, only 38 (76%) consents forms were correctly documented without using abbreviations or acronyms. In the post-interventional cycle, 75 consents forms were obtained. All (100%) consent forms were correctly labelled included patient’s name, DOB and PID. A total of 65 (87%) consents forms were correctly labelled without using abbreviations or acronyms.

Conclusion

This audit demonstrated that standard of consent can be significantly improved by general surgery NCHDs with virtual education sessions. Intervention like education sessions can be informative and improve the documentation of consent forms to optimise patient safety.