bluuebunny/crossref_metadata_2025 huggingface dataset:
901 Management, Complications and Neurological Outcomes of Aneurysmal Subarachnoid Haemorrhage in Elderly Patients
Authors: Cheng P H , Simms H N , Abouharb A
Published: October 2021

Aim

To study the management of aneurysmal subarachnoid haemorrhage (aSAH) and compare neurological outcomes in different elderly age groups.

Method

A retrospective cohort study. aSAH patients with age 60 and above admitted to Royal Victoria Hospital Belfast between 2015 to 2019 were enrolled, and divided into 3 sub-groups, age 60 – 69 (Group I), age 70 – 79 (Group II) and age >80 (Group III). Patient characteristics and clinical courses were compared, including co-morbidities, WFNS grades, interventions, complications and neurological outcomes at follow up.

Results

158 patients were included, with 104 in Group I, 49 in Group II and 5 in Group III. Despite Group III patients presented with only WFNS grade 1 & 2, mortality increased exponentially with age from 9.6% to 12.2% to 40% across 3 sub-groups. There was also a linear increase in average length of stay (LOS) from 21 to 24 days. 81 Group I patients (77.9%) developed complications and 38 patients (77.6%) in Group II. In Group III, 3 patients (60%) developed complications when 2 other patients did not survive. Most common complications were hydrocephalus (46.2%) and hospital acquired infections 36.7%).

Conclusions

Our study suggests patients with age >80 had less favourable neurological outcomes despite having low grade aSAH at presentation and received similar intervention. Average LOS in hospital also increased with age. Similar complication rates were noticed in all groups. Comparing our data with other neurosurgical units in UK and Ireland will provide further information in managing elderly aSAH patients and facilitate risk stratification when considering those patients for intervention.
1339 Haemoglobin Threshold for Red Blood Cell Transfusion in Traumatic Brain Injury. A Systematic Review and Meta-Analysis
Authors: Anwar S , Bakhsh A , Manieanan S , khan M
Published: October 2021

Background

Traumatic Brain Injury (TBI) is a significant and growing worldwide healthcare burden. Minimising brain hypoxia is important in preventing secondary brain injury. Anaemia is common in TBI patients but there is little evidence as to which haemoglobin (Hb) threshold transfusion should be considered in TBI patients.

Objective

This present systematic review and meta-analysis of randomised controlled trials aims to assess the effect of high verses low red blood cell transfusion thresholds on functional outcomes and quality of life in TBI patients.

Method

We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science up to June 2020. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. We included randomised studies comparing high verses low Hb threshold for red blood cell transfusion in TBI patients. We assessed the following major outcomes: all-cause mortality, transfusion related adverse events and favourable outcome (Glasgow Outcome Scale, GOS).

Results

We included 3 RCTs involving 311 participants. Our analysis showed no difference in all-cause mortality (3-6 months) (OR 1.17 (95% CI 0.64 to 2.13)) and no difference in GOS (OR 1.10 (95% CI 0.65 to 1.85)) between transfusing red blood cells at 7g/dL or at 9/10g/dL in moderate to severe TBI.

Conclusions

There is no difference between a high and a low Hb threshold transfusion policy. However, considering the limitations in current evidence there is a need for future high quality randomised controlled trials.
1548 Refining the Usability of a Novel Visual Field Assessment App
Authors: Ho J W , Hughes M
Published: October 2021

Introduction

A validated visual field chart designed as a simpler adjunct to formal perimeters is being developed into an app. The app aims to empower patients with pituitary tumours to independently assess their central 25˚ visual field with intra-app instructions and share their results with their clinician. NHSx marked usability as an assessment criterion for validating health apps. This study aims to explore and improve the usability of the beta-version of the app.

Method

Qualitative methods were employed through observation and semi-structured interviews. Recruitment was through convenience sampling. Participants experienced the app solely based on the intra-app information. Meanwhile, a researcher observed the process. Then, qualitative feedback was generated through semi-structured interviews. Observational data was coded and quantified. Thematic analysis was employed to identify common themes and/or categories of the qualitative feedback.

Results

15 participants between 24-58(mean 33.7, SD 10.8) years were recruited. Observational data revealed that 1/15 adhered to all 3 written instructions; 3/15 utilised the hand span distance guidance provided. Participants’ responses on feedback for improvements were coded and categorised. Suggested additional features for improvement – a run-through introduction to the app, a video example of how to conduct the test, a practice run, an option for audio instruction and an option to change font size and type. Suggested additional instructions were to focus on the black dot and remember what you were seeing with the red dots.

Conclusions

Qualitative methods identified aspects of the app requiring improvements. Participants feedback will be utilised to improve the app.
1596 A Retrospective Audit Investigating and Identifying Factors Relating to Delays to Theatre Within Neurosurgery at Leeds - A Tertiary Referral Centre
Authors: Chowdhury M R , Anderson I , Sheikh S , Joumah A , Iqbal H , Goel A
Published: October 2021

Aim

Leeds Neurosurgery receives referrals as a tertiary centre from a cohort covering 3 million people, receiving over 9000 referrals in the last year via its online system, Patientpass. This audit aims to identify factors which leads to delays in surgery, especially in light of the COVID-19 pandemic.

Method

We looked at 760 patients who were included in the study and used the electronic clinical notes system, PPM+ and also the electronic referral system Patientpass and looked at weekday and date of admission, cranial/spinal admission, diagnosis, age, referring hospital, time taken in theatre, theatre used, intraoperative timings, length of stay and date of discharge.

Results

The majority of the cases were either vascular or trauma related. 77.2% of surgeries were either same day or within 24 hours. The average length of stay was 17 days. The average time in theatre, 2h11m. The designated acute theatres were used approximately 75% of the time.

Conclusions

Interestingly, the mean time from admission to theatre was 1.25 days. 225 cases were investigated as a sample randomly selected. It is identified that 30 cases were delayed. 20% were delayed due to imaging requested for surgical management. 6% were due to patients awaiting consultant review. 10% due to awaiting other investigation results (i.e., COVID swab.) There were other identifiable factors such as awaiting ‘hot' theatres, reversing coagulopathies and medically deteriorating patients. We have provisionally identified factors and will re-audit this in the next cycle in order to maximise efficiency.
138 Endovascular Hepatic Artery Stents in The Modern Management of Post-Pancreatectomy Haemorrhage
Authors: Finch L M , Baltatzis M , Byott S , Ganapathy A K , Kakani N , Lake E , Cadwallader R , Hazar C , Seriki D , Butterfield S , Jegatheeswaran S , Jamdar S , de Liguori Carino N , Siriwardena A K
Published: October 2021

Aim

Post-operative haemorrhage is a potentially lethal complication of pancreatoduodenectomy. This study reports on endovascular hepatic artery stents in the management of post-pancreatectomy haemorrhage.

Method

This is a retrospective analysis of a prospectively maintained, consecutive dataset of 440 patients undergoing pancreatoduodenectomy over 68 months. Data are presented on bleeding events and outcome, contextualized by the clinical course of the denominator population. International Study Group for Pancreas Surgery (ISGPS) terminology was used for post-pancreatectomy haemorrhage.

Results

Sixty-seven (15%) had post-operative haemorrhage. Fifty (75%) were male and this gender difference was significant (P = 0.001; two-proportions test). Post-operative pancreatic fistulas were more frequent in the post-operative haemorrhage group (P = 0.029; two-proportions test). The median (IQR) delay between surgery and haemorrhage was 5 (2-14) days. Twenty-six required intervention comprising re-operation alone in 12, embolization alone in 5 and endovascular hepatic artery stent deployment in 5. Four further patients underwent multiple interventions with two having stents. Endovascular stent placement achieved initial haemostasis in 5 (72%). Follow-up was for a median (IQR) of 199 (145-400) days post-stent placement. In two patients the stent remained patent at last follow-up. The remaining 5 stents occluded with a median (IQR) period of proven patency of 10 (8-22) days.

Conclusions

This study shows that in the specific setting of post-pancreatoduodenectomy haemorrhage with either a short remnant GDA bleed or a direct bleed from the hepatic artery, where embolization risks occlusion with compromise of liver arterial inflow, endovascular hepatic artery stent is an important haemostatic option but is associated with a high risk of subsequent graft occlusion.
202 Consenting Practice for Post-Cholecystectomy Diarrhoea After Laparoscopic Cholecystectomy – Are We Missing A Trick?
Authors: Matwala K , Iqbal M R , Shakir T , Karamanakos S
Published: October 2021

Aim

The landmark case of Montgomery v Lanarkshire Health Board led to the defensive Bolam test being discredited and paved the way healthcare professionals (HCP) obtain informed consent. The recent GMC guidance on Decision Making and Consent 2020, states that the HCP should discuss recognised risks that they believe anyone in the patient’s position would want to know. Laparoscopic cholecystectomy is one of the most common general surgical procedures performed in the UK. Chronic diarrhoea is a well-recognised complication with significant impact on patient quality of life (QoL). We aimed to assess quality of consent forms for laparoscopic cholecystectomies with emphasis on documentation of chronic diarrhoea being a consequence of the procedure.

Method

A retrospective review of all elective laparoscopic cholecystectomy consent forms over a 2-month consecutive period from July 1st 2020 to August 31st 2020 was carried out.

Results

43 consent forms were audited. The majority of these consent forms were done by consultants (74.4%: 32/43) while 23.2% (10/43) by registrars. Overall, 39.5% (17/43) of patients were consented for experiencing chronic diarrhoea. Registrars more commonly mentioned diarrhoea (60%: 6/10) compared to consultants (31.2%: 10/32).

Conclusions

The majority of patients undergoing laparoscopic cholecystectomy are not consented for post-cholecystectomy diarrhoea which is a significant QoL-altering complication. Education combined with a standardised consent form and issuing of patient leaflets will improve consenting for chronic diarrhoea.
272 Effectiveness of Intraoperative Botulinum Toxin Injection on Gastric Emptying During Oesophagectomy: A Systematic Review
Authors: Hraishawi I , Khan S Z , MacAulay G
Published: October 2021

Introduction

Oesophagectomy is the standard of care for resectable oesophageal carcinoma and remains pivotal for curative treatment. Pull-up with gastric conduit remains the most common reconstruction. Delayed gastric emptying (DGE) is a recognised complication and may lead to delayed postoperative recovery and prolonged hospital stay. Botulinum Toxin BTA has been used to relax the hypertonic pylorus intraoperatively and improve DGE. The aim of this review was to assess the efficacy of intraoperative BTA on gastric emptying and the need for postoperative endoscopic pyloric intervention (EPI).

Method

Systematic review of literature was conducted using electronic database searched up to October 2020 including Cochrane Library, Medline, Embase and Goggle Scholars to identify relevant studies. Data was extracted and critically appraised by two independent authors.

Results

Eleven studies were included for systematic review with 1800 patients assigned to either BTA, pyloroplasty, pyloromyotomy, or no-intervention. Ten were observational studies and one was a randomised experimental study. Only one study reported a statistically significant benefit of BTA on early DGE (Day 4, 59%, P < 0.001). Three studies reported higher rates of postoperative EPI when chemical pyloroplasty was used. Length of Hospital stay was higher for patients who had BTA compared to other techniques in three studies.

Conclusions

This systematic review did not demonstrate any significant benefit of intraoperative BTA on gastric emptying on the long term. The rate of endoscopic pyloric intervention was higher in these patients as reported by some studies. Further studies are required to investigate the outcome of chemical pyloroplasty during esophagectomy.
346 Meta-Analysis of Simultaneous Versus Staged Colorectal and Hepatic Resections for Colorectal Cancer with Synchronous Hepatic Metastases
Authors: Nawaz G , Qayum M , Hajibandeh S , Hajibandeh S
Published: October 2021

Aim

To evaluate the comparative outcomes of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases

Method

We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models.

Results

We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5,013) or staged (n = 7.068) resections for colorectal cancer with synchronous hepatic metastases. The simultaneous resection was associated with significantly lower rate of bleeding (OR: 0.60, p = 0.03) and shorter length of hospital stay (MD:-5.40, p < 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR:1.04, p = 0.63), mortality (RD:0.00, p = 0.19), anastomotic leak (RD:0.01, p = 0.33), bile leak (OR:0.83, p = 0.50), wound infection (OR:1.17, p = 0.19), intra-abdominal abscess (RD:0.01, p = 0.26), sub-phrenic abscess (OR:1.26, p = 0.48), reoperation (OR:1.32, p = 0.18), recurrence (OR:1.33, p = 0.10), 5-year overall survival (OR:0.88, p = 0.19), or procedure time (MD:-23.64, p = 041) between two groups.

Conclusions

Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.
430 Evaluation of A Prioritisation Policy for HPB Resections in the COVID-19 Era
Authors: El-Koubani O , Schneider C , Srinivasan P
Published: October 2021

Aim

The COVID19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruptions for cancer patients requiring surgery. Hepatopancreatico-biliary cancers are characterised by a low resectability rate and rapid progression. This study aims to assess the effectiveness of a prioritisation policy for this cohort of patients during the initial COVID19 outbreak.

Method

The prioritisation policy and triage system are described in detail. Patients undergoing surgery between April-July 2020 (COVID period) were compared to a control group from the preceding year. Statistical analysis was carried out to evaluate timeliness of treatment, peri-operative characteristics and short-outcomes.

Results

Patient selection was restructured to prioritise patients with performance status of < 2 with presence of cancer complications, borderline resectable- or biologically aggressive disease. Where feasible, neoadjuvant therapy was advocated. An elective safe corridor pathway was established to reduce the risk of COVID19 infection. During the COVID19 and pre-COVID19 period, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID19 post-operatively. There were less patients with ASA≥3 during the COVID19 period vs. pre-COVID19 (12.8% vs. 34.2%; p < 0.001). Median time between referral and surgery was greater during the COVID19 compared to the pre-COVID19 period, at 64 days vs. 49 days, respectively (p = 0.023). Despite this difference no NHS waiting list breaches occurred. Incidence of postoperative complications were comparable between groups.

Conclusions

The outlined prioritisation policy for oncological hepatopancreatico-biliary resections was effective in providing safe surgery during the COVID-19 outbreak. Whether the observed delay in treatment will affect long-term outcomes remains to be seen
435 Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials Comparing Standard Versus Extended Lymphadenectomy Pancreatoduodenectomy For Adenocarcinoma of The Head of Pancreas
Authors: Kotb A , Hajibandeh S , Hajibandeh S , Satyadas T
Published: October 2021

Aim

To compare baseline demographics, operative, and survival outcomes of randomized controlled trials (RCTs) comparing standard versus extended lymphadenectomy in patients undergoing pancreaticoduodenectomy for pancreatic head cancer

Method

we performed a meta-analysis of baseline demographics, operative, and survival outcomes of RCTs comparing standard versus extended lymphadenectomy in patients undergoing pancreaticoduodenectomy for pancreatic head cancer. The uncertainties associated with varying follow-up periods among the included studies were resolved by analysis of time-to-event outcomes. Moreover, we performed trial sequential analysis (TSA) to determine whether the available evidence is conclusive and to assess the risk of type 1 or type 2 errors.

Results

Overall, 724 patients from 5 RCTs were included. There was no difference between standard and extended lymphadenectomy in terms of pancreatic fistula (OR0.64, P = 0.11), delayed gastric emptying (OR 0.68, P = 0.40), bile leak (OR 0.33, P = 0.06), wound infection (OR 0.53, P = 0.06), abscess (OR 0.83, P = 0.63), total complications (OR 0.73, P = 0.27), postoperative mortality (OR 1.01, P = 0.85), and overall survival (HR 1.10, P = 0.46). TSA suggested that meta-analysis was conclusive with low risk of type 2 error.

Conclusions

Robust evidence from randomized controlled trials (Level 1) suggests no difference in postoperative and survival outcomes between standard and extended lymphadenectomy in patients undergoing pancreaticoduodenectomy for pancreatic head cancer. The findings were consistent in patients with positive and negative lymph node status and in studies from the West or East.
473 A Review of The Risk Stratification Models Used in The Management of Oncological Hepato-Pancreato-Biliary Surgical Patients
Authors: Coombs A , Jordan C , Hussain S , Ghandour O
Published: October 2021

Introduction

Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) subspecialty is limited as concerns over precision and applicability prevent widespread clinical implementation. The aim of the review is to discuss clinically useful oncological scoring systems for the surgical management of HPB patients.

Method

Primary articles of validated novel and established scoring systems were searched over a 25-year period using PubMed, Cochrane and Ovid Medline.

Results

This review discusses 9 clinically useful scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong et al.), pancreas (Genc et al., mGPS) and biliary tract (TMHSS, MEGNA). CLIP and BCLC are extensively validated prognostic tools, with BCLC clinically endorsed by guidelines. Conversely, patient and treatment stratification is limited in CLIP and BCLC respectively - ALBI works to improve patient stratification. RETREAT, Fong et al. and Genc et al. scores predict recurrence following surgery, however these scores require further validation in heterogenous patient groups. mGPS and MEGNA are simple prognostic scores, but also require further validation in varied patient cohorts. TMHSS is user-friendly, however is limited at discriminating treatment for the middle patient group.

Conclusion

A diverse range of HPB surgical scoring systems may facilitate evidenced-based treatment decisions and improve management. Future scoring systems need to be developed on heterogenous patient cohorts with improved stratification, with current trends towards implementing machine learning and genetics to improve outcome prediction.
556 A Prospective Review of Risk Factors, Clinical Presentation and Management Outcomes for Chronic Pancreatitis
Authors: Akula B , Sugumar K , Deshpande A
Published: October 2021

Aim

and objectives: To identify the risk factors, symptoms, and severity of Chronic pancreatitis (CP) on admission. To determine the relationship between pancreatic duct diameter and severity of pain and to assess extent of pain relief achieved by medical, endoscopic, and surgical intervention.

Method

75 patients with CP were admitted over 2 years. Data collected included etiology, symptoms, pain scores and CT/MRCP findings. Patients were classified into mild, moderate, and severe category according to Cambridge classification. Type and response to treatment was recorded. Statistical correlation of the pancreatic duct diameter and pain severity as well as the comparison of pain scores after medical, surgical and endoscopy was performed using Chi square test (p value <0.05)

Results

Median age of presentation of CP was 43 years. Male: female ratio was 3:1. Alcohol was the etiology in 66 %, 99% presented with pain, 65 % belonged to severe category. There was no statistical correlation between pain severity and duct diameter. Pain relief following medical management was 66 %, endoscopic - 73% and surgical - 83 %. There was no correlation between Cambridge classification and pain severity. There was no statistical difference between pain relief offered by either of the three modalities. However, there was a statistically significant correlation between duct diameter and type of intervention.

Conclusions

There is no consensus on the best treatment modality for CP as pain relief was equivalent amongst all the modalities. Therefore, the choice of intervention for patients suffering from chronic pancreatitis should be based on imaging characteristics and symptomology.
566 A Study to Investigate CRP and WBC As Early Prognostic Tools in Severe Pancreatitis
Authors: Rajjoub Y , Zourob M , Khan S
Published: October 2021

Aim

To establish the prognostic value of raised inflammatory markers on Day 3 in patients with severe acute pancreatitis

Method

A retrospective study between 01/02/18 till 31/01/19 including all patients with acute pancreatitis. Patient demographics, the aetiology, treatment, severity (as per modified Atlanta's criteria) and inflammatory markers on Day 3 of the hospital admission were included. ROC curves were subsequently generated.

Results

127 patients were included with a median age of 59 years. 113 patients were diagnosed with mild acute pancreatitis while 14 patients had severe acute pancreatitis. The ROC curve illustrates that the value of CRP which maximises discrimination was 176 mg, with a sensitivity of 83% and specificity of 76%. For WBC with a value of 12.11 showed 100% sensitivity and 80% specificity.

Conclusions

This study highlights that elevated CRP and WBC on Day 3 could both be good predictive tools for patients who develop severe pancreatitis.
589 Role of Liver Support Systems in The Management of Post Hepatectomy Liver Failure: A Meta-Analysis and Systematic Review of Literature
Authors: Pufal K , Lawson A , Hodson J , Bangash M , Patel J , Weston C , Gulik T. van , Dasari B V M
Published: October 2021

Aim

Post hepatectomy liver failure (PHLF) is a rare but serious complication following liver resection. PHLF is associated with high mortality of up to 50% in severe cases. With limited treatment options available, there is a need to evaluate the role of systems that support the function of the liver as treatment modalities following PHLF development.

Method

The aim of this study was to review the literature and summarise the role of liver support systems (LSS) in the management of PHLF. Publications of interest were identified using systematically designed searches. Following screening, data from the relevant publications were extracted, pooled where possible, and analysed.

Results

Systematic review identified ten studies, which used either Plasma Exchange (PE) or Molecular Adsorbent Recirculating System (MARS) as LSS after PHLF development. The sample sizes of included studies were small, ranging from N = 2 to N = 13. Across all studies, the pooled 90-day mortality rate was 40% (95% CI: 15% - 68%). However, there was substantial heterogeneity (I2=64%), likely since the studies used a variety of definitions for PHLF and had different selection criteria for patient eligibility for LSS treatment.

Conclusions

Despite potential benefits, the current evidence is insufficient to recommend LSS for the routine management of severe PHLF, with the current literature consisting of only a limited number of studies. There is a definite need for larger, multicentre, prospective studies evaluating the conventional and newer modalities of support systems with a view to improve the outcomes in this group of patients.
788 Variation Between Observed and Perceived Volume of Antireflux Operations Completed by Upper-Gastrointestinal Surgeons at a University Teaching Hospital
Authors: Ashmore C , Hunter D , Boddy A
Published: October 2021

Aim

Increased institutional volume and surgeon experience with antireflux surgery has been shown to improve patient outcomes. We have sought to illustrate the discrepancy between the perceived (self-reported) and observed annual volume of anti-reflux operations completed by each surgeon.

Method

A retrospective questionnaire was delivered to all upper-gastrointestinal (UGI) surgeons performing antireflux surgeries (ARS) at a University Teaching Hospital. Surgeons were asked to estimate the quantity of NHS antireflux cases completed annually. Objective, anonymised data was retrieved from the Surgical Workload Outcomes Audit Database (SWORD) from 2017 to 2020 for comparison.

Results

127 ARS were completed by 6 UGI consultants between January 2018 and December 2020. The average number of ARS completed per surgeon was 5.8 (2-10) in 2018, 8.7 (4-11) in 2019 and 6.7 (1-11) in 2020. Conversely, the average number of self-reported annual procedures per surgeon was 22.4 (12-35). On average, participants overestimated the number of NHS ARS completed by 14.5 (4-27) cases or a factor of 2.08. No surgeon correctly or underestimated the number of ARS performed.

Conclusions

We conclude that self-reported operation volume should not be relied upon for the purposes of assessment or audit. Estimations of annual ARS procedures could be up to triple that suggested by objective data. We recommend that all surgeons maintain a database of ARS for the purpose of self-assessment and audit.
964 Stage Migration in Newly Diagnosed Oesophago-Gastric Cancer During the First Wave Of COVID-19 Pandemic
Authors: Khan K , Chuntamongkol R , McCollum C , Gall L , Forshaw M
Published: October 2021

Aim

Covid-19 has significantly disrupted elective and emergency health care provision including cancer care within the UK. The aim of the study was to investigate the impact of the pandemic on the staging of oesophago-gastric cancers at presentation, determine the time delay in performing gastroscopy and the multidisciplinary team (MDT) treatment outcomes.

Method

A retrospective cohort study of all newly diagnosed oesophago-gastric cancers (adenocarcinoma and squamous cell carcinoma) in a single regional MDT was performed between 1st October 2019 and 30th September 2020. Electronic records were interrogated and patients dichotomised into two groups with those presenting before the introduction of the UK national lockdown of 23rd March 2020 compared to those presenting post-lockdown.

Results

349 new oesophago-gastric cancer patients were discussed in the MDT (192 pre-lockdown versus 157 post-lockdown). Demographics were evenly matched between the two groups. More patients presented as an emergency admission post-lockdown (28.0% vs 12.5%, p < 0.001). Median waiting time for gastroscopy was longer post-lockdown (23 vs 14 days, p = 0.035). Metastatic disease at presentation was more frequent post-lockdown (47.8% vs 33.3%, p = 0.008). Overall, more patients had a palliative rather than curative treatment intent post-lockdown (71.3% vs 57.8%, p = 0.005).

Conclusions

The Covid-19 pandemic has had a significant negative effect on the stage of oesophago-gastric cancers at presentation. This has translated into more patients receiving palliative treatment and ultimately having a poorer prognosis. This study highlights the importance of maintaining cancer services during Covid-19 pandemic.
1040 Evaluation of The Use of Biopatch In Haemodialysis Lines: Are We Reducing the Risk of Infection?
Authors: Win M , Banerjee D , Deng J , Fraser N
Published: October 2021

Aim

Children who had the central venous lines inserted for prolonged vascular access usually experience the catheter-related blood stream infection (CRBSI). CRBSI is known to be associated with high morbidity which increases the cost of the healthcare and the chances of mortality. Clinical evidence suggests that the use of biopatch (chlorhexidine-impregnated dressing) is effective in reducing the rate of infection in central venous lines. The aim of our study was to evaluate whether the use of biopatch actually reduced the CRBSI in children who had had haemodialysis lines at our institution.

Method

Theatre logs and electronic records of 46 patients who had haemodialysis lines inserted between 2015-2019 were retrospectively reviewed. These patients were randomly selected.

Results

The total number of lines inserted in 46 patients were 104. The mean of line per patient was 2.2. Out of 104 lines, 22 lines (21%) had confirmed infection.

Conclusions

Infection of the central line is still a significant problem. Infections were more prevalent in cases which did not use biopatch according to the documentation. We believe the rate of infection can be reduced by encouraging the use of biopatch on regular basis for the haemodialysis lines and the proper documentation of its use in the operation notes.
1124 Is Delayed Presentation A Prognostic Factor for The Survival of Patients with Esophageal Atresia More Than Associated Anomalies? Comparison Between Different Social Realities
Authors: Arora A , Raffaele A , Agarwala S , Parigi G B , Manzoni F , Klersy C , Bhatnagar V
Published: October 2021

Background

The aim is to evaluate if different social reality could represent a prognostic factor as associated anomalies affecting survival of neonates with esophageal atresia (EA).

Method

Retrospective analysis of records of neonates with EA with or without Tracheoesophageal Fistula (TEF) from January 2011 to September 2018 at Policlinico San Matteo Pavia, Italy(SMAT) and the All India Institute of Medical Sciences New Delhi, India (AIIMS).Survival was correlated with the presence of anomalies, different types and the number of organ systems involved.Age at presentation and birth weight were considered to find an association with mortality.

Results

Out of 180 patients,162 were from AIIMS and 18 from SMAT.The overall mortality was 28.85%, which occurred at AIIMS, being 0% at SMAT.83.33% at SMAT and 72.84% at AIIMS had associated anomalies.The mortality was 25% for neonates without an anomaly, being 26.15% for those with one (p > 0.05).No statistically significant correlation between outcome and associated anomalies was found.Instead, survival declines gradually as the age at presentation increases.

Conclusions

The presence of associated anomalies paradoxically does not affect the outcome because incidence of delayed presentation has a stronger effect than the presence of associated anomalies. Sensibilization is necessary to improve survival in EA neonates in developing countries, such as India.
1185 Acute Paediatric Appendicitis(AA)-Decreasing The Negative Rate Of Appendicectomy
Authors: Karagiannidis G , Toma O , Mallidis E , Youssef F
Published: October 2021

Aim

The COVID -19 pandemic has forced changes in the management of Acute Appendicitis (AA), such as prioritising conservative management and avoiding laparoscopic procedures. This observational study aims to monitor and reduce the negative rate of paediatric appendicectomy and optimise the acute paediatric management following the newly introduced workflow.

Method

Retrospective patient data collection via electronic sources for all paediatric patients(0-16 years old) admitted with AA between March 23rd and October 31st 2020.

Results

During this period 74 patients were admitted with suspected AA. Conservative treatment was performed in 16 (22%) patients and operative management in 58 (78%), of which 15 (26%) had an open appendicectomy, while 43 (74%) underwent laparoscopic appendicectomy. The first trimester the negative appendicectomy rate was 25%, which dropped to 11% because of the newly introduced paediatric AA workflow and the more extensive use of US in the context of diagnosis of appendicitis.In the beginning of the study, the percentage of US scanning was 72% and was increased to 90% after the end of the 3rd period.

Conclusions

The introduction of the paediatric AA workflow and the more extensive use of US helped to decrease the percentage of negative rate of paediatric appendicecomy the number of children who underwent unnecessary operation.
1491 Hemi-Nephroureterectomy For Duplex Kidney in Children - The Resulting Effect on Renal Function
Authors: Wadham B , Connolly T , DeSilva A , Alshafei A , Keene D , Hennayake S
Published: October 2021

Introduction

Urinary duplication systems occur in approximately 1% of the population, and may present with recurrent UTIs, incontinence, or be incidentally detected on imaging. DMSA (dimercaptosuccinic acid) imaging is used in these patients to assess split renal function. If found significantly reduced in a single moiety, children may be offered hemi-nephroureterectomy (HNU). We analysed the rate of remnant moiety loss following HNU comparing age and affected moiety.

Method

All HNUs performed at our paediatric tertiary centre 2005-2019 were analysed. Children <16yrs, with pre– and post-operative DMSA imaging were included. Renal loss was categorised as: significant (≥50% of pre-existing function), non-significant (≥25% pre-existing function), no renal loss (<25%), and complete loss (post-operative remnant moiety function ≤5%). Subgroup analysis was performed using χ² statistic.

Results

73 patients were included, mean age 2.1yrs. Median pre-operative function of the affected kidney was 42%. 12 patients (16.4%) had significant renal loss, 13 (17.8%) non-significant loss and 6 (8.2%) had complete renal loss. Children <2yrs had significant and complete renal loss more frequently than those aged ≥2yrs (9/35 and 5/35 vs 3/38 and 1/38 respectively, p = 0.069). Patients with upper moiety HNU (UMHNU) had higher rates of significant and complete renal loss than lower moiety HNU patients (12/53=significant, 6/53=complete vs 0/20 significant/complete, p = <0.05).

Conclusions

HNU for duplex kidney is associated with high rates of remnant moiety damage, with ¼ of patients experiencing significant or complete renal loss. Subgroup analysis suggests this risk is higher in children <2yrs or UMHNU. HNU should therefore only be reserved for symptomatic patients failing conservative management.
18 The Impact of Social Deprivation on TNM Staging of Non-Melanoma Skin Cancers: An Initial Review
Authors: Miles J
Published: October 2021

Aim

Over 150,000 cases of non-melanoma skin cancer (NMSC) are diagnosed per year in the UK [1], with greatest incidence in less deprived socioeconomic groups [2]. The association between social deprivation and melanoma staging has been reported [3], however is not as well considered in Basal or Squamous Cell Carcinomas (BCCs/SCCs).

Method

A pilot review of 200 NMSC excision biopsies completed at a single hospital was undertaken. Specimens were identified via the histopathology database and included all excising specialities and anatomical locations. Registered postcodes were categorised into a decile via the English Indices of Deprivation 2019 database (1= most deprived, 10= least deprived). Tumour staging was identified from the histopathology report.

Results

200 specimens were reviewed including 9 deprivation deciles ranging from Decile 2 to Decile 10. Decile 6 was the most common decile, incorporating 20% of all specimens. pT1 BCCs were the most commonly excised lesion at 68.5%, pT3 BCCs and SCCs were least commonly excised (1.5% of specimens each). Increased proportions of pT2 BCCs and SCCs occurred in less deprived deciles, contrasting with pT3 BCCs which clustered in Deciles 6 and 7. pT3 SCCs comprised 11.1% of excised lesions in Decile 4, the greatest proportion outside of pT1 lesions.

Conclusions

This initial review suggests that the distribution of NMSC staging is not even across social deprivation levels. Increased proportions of pT2 staged lesions occurred in less deprived cohorts. Further expansion of the dataset is justified to assess the degree to which social deprivation may affect NMSC stage at excision.
258 Are Electronic Algorithmic Referral Systems the Future of Triage? Evaluating the Use of The Oxford Acute Referrals System (OARS) For Plastic Surgery
Authors: Prokopenko M , Freethy A , Layton T , Brady M , Abou-Abdallah M , Kent N , Kanabar S , Tucker S
Published: October 2021

Introduction

A traditional referral involves transfer of information over a telephone call and is typically documented in an unstructured format on paper notes, producing poor continuity of referrals between shifts, increasing the risk of error, and compromising patient safety. The Oxford Acute Referrals System (OARS) is an electronic platform that keeps a complete record of referrals, whilst providing the referring clinician with step-by-step specialist advice according to inbuilt BSSH guidelines. This audit demonstrates our experience of its’ use in a tertiary centre Plastics department.

Method

One week of referrals in 2019, prior to the implementation of OARS, were compared with the equivalent week in 2020 once OARS was established. Data was collected retrospectively using electronic patient records.

Results

In one week in 2019, 120 cases were reviewed in the emergency clinic compared with 155 OARS referrals for the equivalent week in 2020. Following OARS implementation, 69% of referred cases did not footfall in the emergency clinic. 46% were managed locally with specialist advice from Plastic Surgery. 10% were brought directly into a theatre list, of which 7% were subsequently treated conservatively. A Plastic surgery consultant reviewing OARS referrals taken by juniors, changed the decision of how or where to manage the patient in 6% of cases.

Conclusions

OARS is an effective triage system that has considerably reduced footfall in the emergency clinic, whilst simultaneously expediting patient care down the correct treatment pathway. Its use led to safe management of patients remotely, which has important implications during a pandemic.
292 Paediatric Dog-Bites: Are ‘Pandemic Puppies’ A Cause for Concern?
Authors: de Berker H , Zhao J , Souéid A
Published: October 2021

Introduction

There has been a substantial increase in dog ownership during the COVID-19 pandemic, in part due to national lockdowns prompting many to seek canine companionship. Published studies from the US have associated this with increased paediatric presentations with dog-bites to the emergency department (ED). However, this has yet to be elucidated in the UK.

Method

All attendances to ED and referrals to our regional paediatric plastic surgery service with paediatric dog-bites between 23/03/2020 and 01/06/2020 (UK national lockdown) were compared with the same period in 2019 (control). The location of bites and total ED attendances were also collected. Chi-squared test was used to determine statistical significance, p ≤ 0.05 taken as significant.

Results

Fewer overall paediatric attendances to ED were noted between the lockdown period compared to control (4429 vs 9620). Similarly, fewer children presented with dog-bites during lockdown compared to control (25 vs 45). Proportionally, this data represents 5.6 bites per 1,000 ED attendances during lockdown vs 4.7 during the control period (p = 0.44). Facial bites were more common during lockdown accounting for 60% vs 47% in the control period (p = 0.28).

Conclusions

Despite reports of increased dog ownership, our findings do not demonstrate significantly more paediatric dog-bite presentations. Although not statistically significant, more facial bites were noted during lockdown. We speculate this may be due to parents presenting with self-perceived more “serious” injuries. Thorough research and careful consideration are essential prior to bringing a new dog into a home with young children.
325 Pretibial Injury and 1 Year Mortality
Authors: Peberdy D
Published: October 2021

Aim

Frailty is increasingly recognised as an important factor for patients under the care of surgical departments. Pre-tibial injury is a common presenting problem to plastic surgery units across the UK. We wanted to assess the 1-year mortality of this patient cohort presenting to our unit.

Method

Retrospective cohort analysis of prospectively maintained clinical database across a calendar year from June 2017 to June 2018. This was perforemd at a UK Regional Plastic Surgery Centre analysinig patients presenting to the Royal Devon and Exeter Hospital. Patients were scored as either frail (Rockwood ≥ 5) or Non-Frail (Rockwood ≤ 4) taken from initial clinical assessment proformas.

Results

A total of 85 patients were included in the study. Mean age was 76.4 (± 18 years), and mean Rockwood Frailty Score of 3.4. Across all patients presenting to the plastic surgery department with pre-tibial injury there was a 20% (17/85) mortality at one year. In frail patients 1 year mortality was 47.6% (10/21). In Non-Frail patients 1 year mortality was 10.9% (7/64). The difference in mortalitly at 1 year was found to be significantly different in Frail vs Non-Frail patients with P = 0.00009 in an unpaired Student's t Test.

Conclusions

Frailty is a common condition in patients presenting with pre-tibial injury. This is a significant predictor of 1 year mortality in patients presenting with pre-tibial injury. Standardised evidence-based pathways of care for these patients could help optimise their management. Opportunities for MDT involvement in their care may improve outcomes.
404 Efficacy and Long-Term Outcomes of Skin Grafts Versus Dorsal Flaps in Syndactyly
Authors: Baltag D
Published: October 2021

Aim

Syndactyly is a congenital condition which is commonly resolved around 18-24 months of age using either a full-thickness skin graft or a flap to address the skin shortage in the web-space. The aim is to review and compare the long-term outcomes of these techniques.

Method

Using medical databases, 673 citations were identified between the years 1966 and 2016 related to simple syndactyly. Of these, 34 were chosen: English-language articles, simple isolated syndactyly, i.e., not syndromic, and procedures using a dorsal-metacarpal advancement flap or skin graft. Outcomes were divided into early post-operative and long-term; earlier outcomes being graft failure and flap necrosis, and long-term outcomes being web creep, scar hypertrophy or contracture, and revision surgery. ORs were calculated to compare rates of complication between the two procedures.

Results

Early post-operative complications showed a statistically significant difference in incidence; both individual and combined incidence (OR, 9.4; 95% CI, 3.6-24.8; P <.05) were more likely to occur in the graft group. Incidence of web creep, (OR, 12.9; 95% CI, 1.7-96.6; P<.05), contracture (OR, 4.5; 95% CI, 1.4-13.6; P < .05) and scar hypertrophy (OR, 49.3; 95% CI, 1.3-215.0; P < .05) were also statistically significant in comparison of the two techniques and more likely to occur in the graft group.

Conclusions

While there is data to suggest a superiority in flap procedures, there is a lack of standardization across studies which undermines the power of systematic reviews and hence a uniform classification would improve the quality of existing research.
424 Improving Interprofessional Teamwork in Plastic Surgery: A Novel Approach to Microsurgical Skills Training for Theatre Nurses
Authors: Gowda S , Mohan A
Published: October 2021

Aim

Shared mental models between surgeons and scrub nurses allow them to effectively communicate with each other and react efficiently to intraoperative complications. Microsurgery poses unique challenges including the use of an operating microscope, fine instruments, and restricted views of the operative field. Our aim was to design and deliver a microsurgical skills session for theatre nurses and evaluate whether attendance influenced perceived understanding of microsurgery and ability in day-to-day role.

Method

A microsurgical training day for theatre nurses was delivered. This consisted of an introduction to and positioning of the operating microscope and three practical stations involving increasingly complex motor tasks, designed to highlight the importance of instrument handling and improve awareness of microsurgical challenges. Consultant plastic surgeons acted as scrub nurses to add an element of role-reversal. Qualitative and quantitative feedback was collected.

Results

Eight theatre nurses participated, all responded ‘strongly agree’ or ‘agree’ that the training was enjoyable, improved their understanding of microsurgery and was relevant and helpful to their day-to-day role. All attendees strongly agreed that they would partake in similar sessions in the future.

Conclusions

Role-reversal and skills-based training is a valuable tool in improving multidisciplinary collaboration in microsurgery. Increasing shared knowledge of complex procedures prospers effective teamwork and communication, which leads to improved efficiency and better patient care. Our study is a first step towards development of a standardized microsurgical skills course for theatre nurses and has broader implications for interprofessional education across all surgical specialties.