bluuebunny/crossref_metadata_2025 huggingface dataset:
20 Post-Operative Biologics and the Rate of Recurrence in Crohn’s Disease
Authors: Ng C H , Jain S R , Ow Z G W , Lim W H , Tham H Y , Wong N W , Chong C S , Foo F J
Published: May 2021

Introduction

Post-operative recurrence after Crohn’s surgery poses a significant challenge to clinicians with an estimated of 70-90% recurrence rate. However, with the advent of biologics, reduction of recurrence after surgery has been observed in various landmark trials. Hence, we aim to quantify the rate of recurrence with post-operative biologics.

Method

Searches were done on Embase and Medline database for articles using biologics for post-operative management. A single arm meta-analysis with generalized linear mixed model and Clopper-Pearson method confidence interval was applied in the synthesis of the data on six months, one year, two year and five year.

Results

A total of 1,864 abstracts were identified, with a final total of 24 articles and 1042 patients were included in the meta-analysis. The one-year rate of recurrence for surgical, endoscopic and clinical was 3.08% (CI: 0.74% - 11.95%), 19.93% (15.81% - 24.81%) and 13.06% (CI: 8.18% - 18.92%) respectively. Correspondingly, the five-year recurrence 16.90% (CI: 9.57% - 28.11%), 84.21% (CI: 72.35% - 91.57%), 5.60% (CI: 9.92% -23.66%) respectively.

Conclusions

An observed reduction in surgical rates was reduced at five years with post-operative Crohn’s disease with biologics. Biologics therapy thus can be considered as a suitable alternative for reducing post-operative recurrence in individuals with higher risk.
373 A Review of Microsatellite Instability (MSI) Testing: Real World Clinical Data
Authors: Harris C , McCallum I , Mills S
Published: May 2021

Introduction

Colorectal cancers (CRC) are the second most common cause of death by cancer, in the UK. Microsatellite instability (MSI) analysis is novel yet important part of managing CRC and used as a tool for predicting prognosis, treatment and identifying lynch syndrome. Where lynch syndrome is identified, preventative screening can be utilised. Previous studies only focused tumour testing on high-risk cases.

Method

A retrospective study at Northumbria Health Care NHS Trust was performed on all new CRC patients between 2017-2020.

Results

A total of 965 patients with CRC were identified. After exclusion criteria was applied to the cohort, a total of 483 patients were identified as having undergone MSI analysis. The mean age was 73.5 years old, with the female to male ratio being 1:1.4. Patients were further grouped into MSI stable, low, and high. MSI High patients accounted for 10% of patients analysed. Further genetic testing was performed on these patients which highlighted 28 patients with BRAF positive genes who went on to screening for Lynch syndrome associated cancers.

Conclusions

MSI testing provides essential diagnostic, prognostic information and also guides treatment options. 2.9% of patients identified as high risk for familial cancers and went on to have genetic screening and surveillance.
428 Hepatic Epithelioid Hemangioendothelioma: A Rare Vascular Malignancy Mimicking as Intrahepatic Cholangiocarcinoma
Authors: Kawka M , Mak S , Qiu S , Gall T M H , Jiao L R
Published: May 2021

Hepatic epithelioid hemangio-endothelioma (EHE) is a rare, often misdiagnosed malignancy of vascular origin. We describe a case of a 36-year-old, who presented with a burning sensation in his chest on exercise and was believed to have bilobar intrahepatic cholangiocarcinoma. After receiving chemotherapy with partial response, the patient underwent staged resection modified ALPPS (associating liver partition with portal vein ligation for staged hepatectomy) procedure – laparoscopic radiofrequency assisted ALPPS (RALPPS). Histological examination of the stage 1 specimen revealed EHE deposits in the left lobe of the liver. The patient proceeded to have stage 2 open right hepatectomy with concurring histology. 90-days follow-up CT scan showed almost complete resolution of EHE lesions.

Low incidence, non-specific clinical and radiological characteristics all contribute to high EHE misdiagnosis rate. Histological analysis can be used for confirmation of the diagnosis; however, specialist staining is required, which is not routinely performed. Multiple treatments are available against EHE, but only liver resection and liver transplantation are potentially curative. ALPPS and its modifications (such as RALPPS) offer an alternative for conventional two-stage hepatectomy for patients with extensive bilobar EHE, who are at risk of developing post-hepatectomy liver failure or patients with anomalous hepatic vasculature anatomy, which makes PVE challenging.
784 Management of Paediatric Epistaxis: An Appraisal of Cautery Versus Topical Antiseptics in The Prevention of Rebleeding Events
Authors: Sagua N , Fishpool S
Published: May 2021

Introduction

Epistaxis is a common acute presentation in childhood that with recurrence often causes great distress for both parent and child alike. For recurrent epistaxis it is common practice in the UK to trial either a topical antiseptic (Naseptin) or silver nitrate cautery. A literature review was conducted to assess which treatment confers greater protection against rebleeding events.

Method

The literature review was performed via a search on Medline via Ovid. As both cautery and topical antiseptics are not new treatments, an age limit was not set to allow older research to be included and provide perspective.

Results

In all but one study included, there was no statistically significant difference between the use of Naseptin versus cautery in the reduction of rebleeding events. A higher incidence of complications such as septal perforation and pain were reported in patients who underwent cautery, whilst no adverse side effects were reported with Naseptin.

Conclusions

The current evidence base relies mostly on short term outcomes, with most patients not being followed up for more than 2 months. If further longitudinal studies provide evidence to support there being a minimal difference in treatment outcomes, using topical antiseptics before considering cautery would be better clinical practice in paediatric patients.
993 Digital Monitoring of Paediatric Patients with Chronic Recurrent Multifocal Osteomyelitis at A National Orthopaedic Centre
Authors: Dave D , Choi J , Karamchandani U , Jacobs B
Published: May 2021

Introduction

Chronic recurrent multifocal osteomyelitis (CRMO) is a paediatric inflammatory bone condition requiring close monitoring by a multi-disciplinary team throughout childhood. Many UK patients are seen at the Royal National Orthopaedic Hospital, Stanmore for more than a decade of specialist management. Prior to the recent COVID crisis, we recognised need for more frequent monitoring without the inconvenience of cross-country travel and so piloted an online system of monitoring CRMO.

Method

An online assessment form was created using the GDPR-compliant Qualtrics system after consultation with CRMO paediatricians and a specialist nurse. 3 medical students telephoned parents of 31 patients to pilot the assessment form. Responses indicating issues were then referred to the CNS for follow-up.

Results

Response data confirmed need for close monitoring with 26% of respondents being seen quarterly, 29% reporting pain greater than 6/10, 29% having side-effects and 30% finding current treatment ineffective. 74% of respondents found online assessment extremely/very useful and 58% preferred it to face-to-face appointments.

Conclusions

A digital CRMO monitoring tool can successfully identify patients with both new and ongoing issues. In the COVID and post-COVID era, digital tools can closely monitor patients with chronic conditions like CRMO whilst improving quality of life by reducing need for face-to-face appointments.
82 A Case of Recurrent Calcifying Aponeurotic Fibroma of the Hand: Managing a Rare Hand Tumour in an Evolving Healthcare Landscape
Authors: Gallagher M , Cooper L , Mata J I
Published: May 2021

Introduction

Calcifying Aponeurotic Fibroma (CAF) is a rare benign tumour originating from the aponeuroses of tendons and their bony insertions. Our case illustrates the technical challenges and considerations of removing a large, recurrent CAF of the hand.

Case Report

A 15-year-old student presented to his GP with a one-year history of a progressively enlarging painless swelling on the dorsum of the middle phalanx of the left middle finger. Plain radiographs identified a calcified soft tissue swelling with no bony involvement. The lesion was excised by the local paediatric orthopaedic service and recurred rapidly. Histology confirmed the diagnosis. He was referred to our specialist hand surgery service and the lesion was excised with the overlying skin (which demonstrated histological but not clinical disease). At six months, there was no clinical evidence of recurrence.

Conclusions

CAF may present atypically, and a high index of suspicion is warranted with calcified soft tissue hand lesions. Excision with conservative margins, and we newly suggest, the overlying skin, is recommended to preserve hand function but minimise recurrence (very common). Hand surgery provision in the UK is changing with adoption of the hub and spoke model and hand tumours may be more appropriately managed at specialist centres.
112 Trans-Scaphoid Perilunate Dislocation. Two Atypical Presentations with Enucleation of The Proximal Pole
Authors: Weale R
Published: May 2021

This article describes two cases of tran-scaphoid perilunate dislocation, both of which have an atypical presentation. In both cases, the proximal pole of the scaphoid was enucleated, one into the carpal tunnel, the other into the distal forearm. In addition, the capitolunate alignment was preserved, with dorsal dislocation of the entire carpus. These cases are presented for educational purposes, as these injuries are highly unstable, and require a different operative approach to a typical perilunate dislocation. In a typical Mayfield II perilunate dislocation, the lunate remains within the lunate fossa, and acts as a 'keystone' for fixation of the dislocated carpus. These cases do not fit the classic Mayfield classification. Given the lunate was also unstable, K-wires were placed through the distal radius into lunate, then from the scaphoid into the lunate.

Another learning point for all training levels is that the referring orthopaedic hospital referred one of these injuries incorrectly as a 'lunate dislocation'. This article provides an opportunity to re-cap the Mayfield classification, and clarify the distinction between lunate and perilunate dislocation. In all cases, stringent monitoring for any carpal tunnel syndrome is required, and urgent decompression should be performed if there is any concern.
124 Post-operative mortality and risk of COVID-19 in patients receiving urgent elective surgical care at a COVID clean facility during the COVID 19 pandemic: a cross-sectional study
Authors: Cheung Lok Ka , Shaikh Shafaque , Rai Shanju , Lawrie David , Qadir Abdul
Published: May 2021

Introduction

The Sars-Cov2 related COVID-19 pandemic has triggered the adoption of unprecedented approaches to contain it across the globe at a very short notice. The aim of this study is to determine post-operative mortality and the risk of developing COVID-19 in a COVID-19 negative population undergoing elective surgical care in a COVID-clean facility. We also explored patient experiences and satisfaction as well patient reported post-operative COVID related symptoms through a patient satisfaction survey.

Method

A patient satisfaction survey was built into the service which was performed by means of a telephone follow-up at 30 days from procedure. One of the aspects of the service review was to capture data on patients developing COVID-19 symptoms post-operatively but not requiring hospital admission or testing.

Results & Conclusion:

Our study has shown promising results with the early outcomes of elective surgical care delivered through a COVID-clean facility with no mortality, low morbidity and high patient satisfaction across all 5 specialties (Plastic surgery, Urology, Gynaecology, General Surgery) in 455 patients operated on over 10 weeks. We have demonstrated safe delivery of elective surgical services by utilising a COVID-clean facility minimising the negative impact of delays experienced due to the COVID-19 pandemic.
130 Boerhaave’s Syndrome: A Rare Complication of Cannabinoid-Induced Hyperemesis Syndrome
Authors: Clarke T
Published: May 2021

A 22-year-old man was referred to our surgical department with severe central chest pain after a three-day history of > 200 episodes of vomiting a day on a known background of cannabinoid hyperemesis syndrome. A computed tomography (CT) scan showed a ruptured oesophagus and pneumomediastinum, in keeping with Boerhaave’s syndrome. Conservative treatment with keeping the patient nil by mouth and administering intravenous fluids, anti-emetics and broad-spectrum antibiotics was initiated. Follow up CT showed significant reduction in pneumomediastinum. The patient was discharged home 7 days after admission. Spontaneous rupture of the oesophagus is a rare but potentially fatal event. It is caused by an abrupt rise in intra-luminal pressure, usually secondary to forceful vomiting. CT scan should be performed in all suspected cases as the findings dictate management, this being conservative, endoscopic, or surgical. We report on the first published case of Boerhaave’s syndrome as a result of cannabinoid hyperemesis syndrome.
149 Emergency Clot Retrieval and Stenting for Posterior Circulation Stroke
Authors: Daga K , Ahmad M T , Taneja M
Published: May 2021

The current literature regarding the morphology and presentations of strokes due to basilar artery stenosis/occlusion is limited. This pathology is a rare cause of stroke and its management is not clearly decided in guidelines or published literature. Moreover, posterior circulation strokes are reported to be more devastating than anterior circulation. We present a case of a 68-year-old male who presented in an acute setting with reduced consciousness, myoclonic jerks, weakness and nausea due to a stroke from an occluded mid-segment basilar artery. MRI showed evidence of left cerebellar and right occipital infarcts. Emergent cerebral angiography was performed, and he was immediately treated by thrombectomy and stenting (Stryker Wingspan stent). The patient made a full recovery within one week and remained well at follow-up 3 months post-procedure. Emergency recanalization of basilar artery strokes, by clot retrieval and stenting, should be considered as a treatment option.
153 Staging Laparoscopy in Bilio-Pancreatic Malignancies Compared To Radiological Staging: A Comparative Study
Authors: Noureldin K , Shalaby A
Published: May 2021

Introduction

The study was to compare the accuracy of laparoscopy in staging and selecting patients diagnosed with malignant obstructive jaundice, to the traditional investigation.

Method

a prospective study conducted in the period between September 2017 and December 2018.30 patients, having malignant jaundice, were divided into two groups for cancer staging to assess their resectability and operability. Staging of 15 patients in group A was limited to conventional diagnostic methods, while 15 patients were in group B,where Laparoscopy was added.

Results

Results showed that the accuracy of routine investigations in staging was 73%, while that of laparoscopy was 93%.The number of cases under staged by imagings were 8 cases(these were 3 in Group A and 5 in group B) thus they were diagnosed as operable. On the other hand, just 1 case was misdiagnosed by the laparoscopy. Regarding the morbidity and mortality, there were variable complications among those who had unrequired laparotomies including one mortality case.on the other side,the incidence of complications were markedly decreased in group B,with no mortality incidence.

Conclusions

Diagnostic laparoscopy has a crucial role in staging people with malignant jaundice and may decrease the rate of unnecessary laparotomy in people found to have resectable disease by conventional imagings.
176 Patient Perception on Fracture Healing
Authors: Sadozai Z , Bokhari S A , Mannan K
Published: May 2021

Introduction

Effective communication skills are an extremely important aspect of good medical practice. Fractures are common with over 1 million fractures occurring each year in the UK; of which 5-10% may have problems with healing. Patient perceptions of factors harmful to the fracture healing process are unknown and our study investigates this.

Method

A total of 418 responses were collected from participants in a single centre in our survey based study to determine patient perception on factors potentially affecting bone-healing.

Results

84% and 73% of patients believed tobacco and alcohol to be harmful to bone-healing. 31% thought that there was a harmful effect to bone-healing with ibuprofen and 25% perceived the same regarding caffeine. Paracetamol, vinegar, and chocolate were considered to be least harmful to bone-healing with 20%,15% and 11% responses respectively.

Conclusions

The majority of patients believed that there was a harmful association with tobacco and alcohol with regards to bone-healing. This harmful relationship is well understood in literature. However, we believe for the benefit of patients, they should all be aware of these detrimental effects. A clear possibility has been identified to improve fracture outcomes by empowering patients to take ownership of their injury by lifestyle modifications which are within their remit.
185 Vascular Hitch Procedure for Accessory Lower Pole Vessels
Authors: Fashina O , Rajimwale A
Published: May 2021

Introduction

The gold standard procedure for pelvi-ureteric junction obstruction has been the Anderson-Hynes dismembered pyeloplasty; involving the repositioning of the ureter and ureteropelvic anastomosis. However, the Hellstroem 'Vascular Hitch Procedure’ dictates the superior translocation of the accessory vessel and its fixation to the anterior pelvic wall. The latter has an estimated success rate >90%.

Method

During 2016-2020, at Leicester Royal Infirmary, 16 operations occurred on paediatric patients with pelvi-ureteric junction obstruction. The dismembered pyeloplasty was performed on 5 patients, 9 patients underwent the vascular hitch procedure, and 2 patients are currently awaiting the latter operation. All patients had a pre-operative functional magnetic resonance urography (fMRU) to identify and localise the accessory lower pole vessel.

Results

The mean hospital stay for the vascular hitch procedure was 1.5 days (range=1-2) in comparison to 4 days (range=3-5) for the dismembered pyeloplasty. The follow-up period ranged from 6 months to 3 years. Overall, it was noted that the patients were asymptomatic, had markedly reduced hydronephrosis on imaging as well as stable renal function noted on the MAG 3 renogram scan.

Conclusions

The laparoscopic vascular hitch procedure appears to be the superior operation for the management of pelvi-uteric junction obstruction as the patients had notably reduced hospital stay lengths.
276 Management of Giant Coronary Artery Aneurysms as a Coronary Sequelae of Kawasaki Disease – Surgical or Conservative Management?
Authors: Quek F F , Tulloh R
Published: May 2021

Introduction

Kawasaki Disease (KD) is the commonest childhood acquired heart disease in developed countries, predominantly affecting children younger than 5 years of age. These patients are at high risks of developing coronary arterial aneurysms (CAA) and CAA with absolute internal luminal diameters measuring ≥8mm or Z-score ≥10 is classified as giant coronary aneurysms (GCA).

Case Report

A 19-year-old girl with previous history of Kawasaki disease was diagnosed with giant coronary aneurysms on echocardiograms. Her subsequent CT coronary angiography showed large aneurysms in the right coronary artery (29mm x 25mm) and left anterior descending artery (10mm x 10mm) with signs of calcification. However, surprisingly, despite the evidence of large coronary aneurysms, she was completely asymptomatic and was physically active. Her cardiac MRI scan showed right coronary perfusion deficit in the distal right coronary territory but with no evidence of myocardial infarction. After having a detailed discussion in the MDT and with colleagues from San Diego, USA, a conservative approach was decided to be in the patient’s best interest. She has been advised to avoid competitive or strenuous exercise due to the associated risks. She is fit-and-well and is currently on Warfarin variable dose and Aspirin 75mg OD, with annual cardiac MRI surveillance.
288 Management of Lateral Third Clavicle Fractures: A Five-Year Review in a Regional Trauma Unit
Authors: Hickland P , Goodland C , Zachariah S , Murphy L , Neil M
Published: May 2021

Introduction

Due to an increased risk of complications, lateral clavicle fractures are usually managed operatively. Unfortunately, there is no consensus on the optimal method of fixation.

Method

We assessed practice in our regional trauma unit by retrospectively identifying patients who underwent fixation of a lateral clavicle fracture between 1st August 2014 and 31st July 2019. Data was extracted from electronic care records and imaging systems.

Results

44 patients were included, with the following demographics: mean age 26 years, 63.6% male, 65.9% high energy injury, and 68.2% Neer II fracture. The following operations were performed; hook plate fixation (HPF) = 10, locking plate fixation (LPF) = 16, coracoclavicular ligament reconstruction (CCLR) = 12, and LPF + CCLR = 6. Patients having LPF had a significantly larger post-operative coracoclavicular distance (7.6mm vs 13.5mm, p < 0.01), and a trend towards incomplete acromioclavicular joint reduction (50.0% vs 89.3%, p = 0.11). There was a significantly higher re-operation rate after HPF (100% vs 23.5%, p < 0.01).

Conclusions

In our unit there is no favoured method of fixation of lateral clavicle fractures. When LPF is used, there should be consideration of concomitant CCLR. The high rate of re-operation after HPF must be considered.
405 Radiological Analysis of Gentamicin Eluting Synthetic Bone Graft Substitute Used in The Management of Gustilo IIIB Open Fractures
Authors: Aljawadi A , Madhi I , Naylor T , Elmajee M , Islam A , Niazi N , Pillai A
Published: May 2021

Background

Management of traumatic bone void associated with Gustilo IIIB open fractures is challenging. Gentamicin eluting synthetic bone graft substitute (Cerament-G) had been recently utilised for the management of patients with these injuries. This study aims to assess radiological signs of Cerament-G remodelling.

Method

Retrospective data analysis of all patients admitted to our unit with IIIB open fractures who had Cerament-G applied as avoid filler. Postoperative radiographic images of the fracture site at 6-weeks, 3-months, 6-months and at the last follow-up were reviewed. The radiological signs of Cerament-G integration, percent of void healing, and bone cortical thickness at the final follow-up were assessed.

Results

34 patients met our inclusion criteria, mean age: 42 years. Mean follow-up time was 20 months. 59% of patients had excellent (>90%) void filling, 26.4% of patients had 50-90% void filling, and 14.6% had < 50% void filling. Normal bone cortical thickness was restored on AP and Lateral views in 55.8% of patients. No residual Cerement-G was seen on X-rays at the final follow-up in any of the patients.

Conclusions

Our results showed successful integration of Cerament-G with excellent void filling and normal cortical thickness achieved in more than half of the patients.
418 The Management of Distal Radius Fractures in Adults with A Removable Soft Cast During the Peak Of The Covid-19 Pandemic: Patient Reported Outcomes And Experiences
Authors: Baawa-Ameyaw J , Kabariti R , Rhee J
Published: May 2021

Introduction

Immobilisation tools for non-operative management of distal radius fractures (DRFs) in adults, include plaster casts, orthotic splints, and recently removable soft cast as per the BOAST COVID-19 guidelines. Limited evidence exists on the effectiveness of removable soft casts in adults with DRFs. We assessed patient reported functional outcomes and experiences of adults with DRFs managed non-operatively in a removable soft cast during the COVID-19 pandemic.

Method

We retrospectively reviewed adults with DRFs, treated with a removable soft cast for 6 weeks between 9th April 2020 and 18th May 2020. Functional scores - Disabilities of the Arms, Shoulders and Hands (DASH) and a 7-question Patient Reported Experience Questionnaire (PREQ) were conducted at 6 weeks, along with a record of complications. A DASH score of < 25 was deemed a satisfactory functional score.

Results

34 patients formed our cohort, with a 65% (22patients) completion rate, mean age of 69years. 82% had a DASH score < 25 and 18% had a DASH score > 25 at 6 weeks. 86% reported satisfactory comfort in the PREQ with 14% reporting discomfort. Two patients re-attended hospital with soft cast related problems.

Conclusions

Most adults with DRFs managed in a removable soft cast reported good early functional outcomes, satisfactory experiences, and no clinic visits at 6weeks.
440 Abdominal Heterotaxia: A More Nuanced Anatomy
Authors: Shaji V , Lander A
Published: May 2021

Introduction

The cardiac anomalies associated with left and right atrial appendage isomerism (LAAI and RAAI) are systematically described. However, for the associated abdominal abnormalities, only the laterality of the organs, cardinality of the spleen (asplenia or polysplenia) and the presence or absence of intestinal malrotation are noted. This study aimed to describe in greater detail the abdominal anatomy in abdominal heterotaxia.

Method

A detailed review of the imaging and clinical records of 23 patients (16 LAAI, 7 RAAI) with abdominal heterotaxia in a cardiac database was performed.

Results

In no patient was a complete description of abdominal anatomy possible, with all patients displaying unique anatomical presentations.

There was a significant association between isomerism and splenic cardinality (12/16 LAAI had polysplenia and 6/7 RAAI had asplenia, p = 0.02). Right-sided stomachs were more commonly associated with gastro-oesophageal reflux (p = 0.048). The stomach and pylorus were ipsilateral in 15/20 patients, with marked variation in gastric orientation; these were novel observations. Ladd’s procedures were performed in 15/23 patients but terminology for intestinal malrotation was inconsistently used.

Conclusions

The heterotaxic anatomy demands better descriptions for scholarly reasons, but these may lead to a better understanding of upper intestinal dysfunction and the subsequent management of these patients.
483 Complete Sciatic Nerve Transection from A Closed Femoral Fracture: A Case Report
Authors: Johnston E , McGarry K , Martin S , Lewis H
Published: May 2021

Introduction

Complete transection of the sciatic nerve following a closed femoral fracture is exceedingly uncommon. Delayed diagnosis may result due to this unrecognised injury pattern.

Case Description:

An 18-year-old male motorcyclist was referred following a significantly displaced closed, femoral fracture. The patient was sedated at the scene and transferred to theatre for definitive fixation, where an open reduction was performed via an anterior approach. Symptoms of paresthesia and weakness were reported immediately postoperatively, and formal neurological examination prompted an emergency MRI. On this basis, the patient was transferred to plastics and underwent surgical exploration, where complete transection of the sciatic nerve was identified just proximal to the bifurcation into the common peroneal and tibial nerve. A nerve gap of five centimetres was identified requiring reconstruction with grouped fascicular sural nerve grafts.

Discussion:

Complete transection of the sciatic nerve is a devastating injury that compromises the function of the posterior compartment of the thigh and all motor function below the knee. To our knowledge, reports of complete sciatic nerve transection secondary to a closed fracture of the femoral shaft are extremely rare in the pertinent literature, with only two other cases reported to date.
567 The Ever-Present Costs of Cosmetic Surgery Tourism; A 5-Year Observational Study
Authors: Abed H , Henry N , Warner R
Published: May 2021

Introduction

Cosmetic surgery tourism is an ever-growing industry. An increasing number of patients are presenting to NHS services with complications from their surgery. This study aims to evaluate the current presentation patterns for complications in cosmetic surgery tourism, as well as the financial burden to a single UK level one trauma centre in Birmingham, UK.

Method

Between 2015 and 2020, all patients presenting to the department of plastic surgery with complications of cosmetic surgery performed outside of the UK were included. A cost analysis was performed for each patient using published ‘National Schedule of NHS Costs.’

Results

A total of 26 patients presented to our hospital within the study period. 32 cosmetic procedures were undertaken, with the majority performed in Turkey (n = 14). Abdominoplasty was the most common procedure, followed by gluteal enhancement surgery. The total financial cost to our hospital from all cosmetic surgery-related complications was £152,946, with an average cost per patient of £5,882.54 (range £362 - £26,585).

Conclusions

Patients seek out medical tourism for multiple reasons. The costs displayed should predominantly be viewed as a reflection of the detrimental effect these complications can have on patients’ lives. Global governing bodies should focus efforts on educating patients and raising awareness on this ever-prevalent issue.
589 Early Results of Single Anaesthetic Bilateral Fixed Bearing Cemented Medial Unicompartmental Knee Replacement
Authors: Roy S , Kiran M , Atwal N , Gosal Ha
Published: May 2021

Introduction

Unicompartmental knee replacement (UKR) results in less morbidity, early mobilisation, and better PROMs in appropriately selected patients. There has been a steady increase in the number of fixed bearing UKRs in the NJR. We present the early results of single anaesthetic bilateral fixed bearing cemented medial UKR.

Method

All patients undergoing bilateral UKR using the ZUK prosthesis (LIMA, UK) under a single anaesthetic between March 2013 and March 2019 were included in this study. Demographic data, surgical data, change in haemoglobin after surgery and occurrence of complications were prospectively recorded in the hospital database. Pre-op and follow-up Oxford knee scores were recorded. Statistical analysis was performed using SPSS 25.0 (IBM, USA) and paired t-test was used to analyse improvement in functional score.

Results

Nine patients were included in this study. The mean age was 53.2years (range 43-71 years). There were 2 females and 7 males. A significant improvement in Oxford knee score from a mean of 37.2 to 53.6(p < 0.01) was seen. The mean drop in Hb was 4.1mg/dl. The mean follow up was 28 months (range 12-76 months).

Conclusions

There was good improvement in functional scores without any significant drop in Hb. Therefore, it is a safe and beneficial procedure.
625 Health Economics and Safety of Frontline Carers in the COVID-19 Era: Time to Abolish Routine Group and Save For Emergency Appendicectomies?
Authors: Baig M , Sarma D , Ng V , Shortland T , Sood S
Published: May 2021

Introduction

Face of healthcare, patient safety and protection of healthcare providers has been completely transformed with global health pandemic. However, emergency surgical procedures must still be performed, with the commonest being appendicectomy.

It is common practice across National Health Service trusts to collect a group and save (G&S) sample pre-operatively which increases healthcare staff exposure to the patient and increased use of personal protective equipment in this pandemic.

Method

Prospective study of adult patients undergoing emergency appendicectomy since the transformation of emergency care with COVID-19 induced restrictions compared with patients undergoing the same operation before the pandemic.

Results

179 adult patients underwent emergency appendicectomy over 6-months in 2019–2020, 60 patients in the 12 weeks period from the start of the transformed emergency services due to the pandemic. Pre-operative G&S samples were taken for 60(33.5%) patients in the pre COVID-19 period, whereas 7(11.6%) were taken for patients undergoing appendicectomy during the pandemic. None of the patients in either group had intra-operative blood loss of more than 500 millilitres and none of them required peri-operative blood transfusion

Conclusions

Our study demonstrates that the routine pre-operative G&S can safely be abandoned as a routine practice for all patients undergoing emergency appendicectomy.
632 Myringoplasty Outcomes from A 5 Year Single Surgeon Experience at A District General Hospital
Authors: Karunaratne D , Violaris N
Published: May 2021

Introduction

Myringoplasty is an operation to repair a perforated tympanic membrane. A UK based myringoplasty national audit showed the overall closure rate for myringoplasty nationally was 89.5% (90.6% for primary surgery and 84.2% for revision surgery).

This study sought to compare the myringoplasty outcomes in terms of achievement of tympanic membrane closure for a single surgeon over the period of 5 years against the national standard.

Method

Data was collected retrospectively. 68 suitable myringoplasty cases were identified as being done under a single surgeon between 2014 and 2019. Operation notes, discharge letters, audiograms and clinic letters were analysed.

Results

The overall closure rate was 97% (66/68) and significantly higher than the national standard (p = 0.0210), the primary closure rate was 98% (53/54) and significantly higher than the national standard (p = 0.0287) and the revision closure rate was 93% (13/14), but not significantly higher than the national standard (p = 0.1872).

Conclusions

This surgeon uses a posterior auricular approach, combined with mastoidectomy with temporalis fascia graft underlay. We suggest that his particular surgical technique contributed to the positive outcomes quoted.
730 An Atypical Presentation of a Hernia: Gastro-Inguinal Hernia
Authors: Patel M , Shabana A , Sud V , Bond-Smith G
Published: May 2021

Acute presentation of an inguinal hernia is a common presentation to general surgery in the United Kingdom (UK). Rarely intra-abdominal organs, outside of small bowel and colon, can present within an inguinal hernia e.g., appendix or bladder. There has been limited publication involving an incarcerated hernia containing the stomach.

We present the case of an 84-year-old male with a background of COPD and hypertension who presented to Accident & Emergency with a three-day history of vomiting and diffuse abdominal pain.

On examination, the patient had a distended abdomen with generalized peritonitis, and an irreducible non-tender inguinoscrotal hernia. A CT scan of the abdomen and pelvis demonstrated small bowel obstruction and gastric outlet obstruction secondary to a large incarcerated right inguinal hernia containing stomach.

The patient rapidly deteriorated clinically, which led to a decision to palliate the patient. The patient died eight days after initial presentation. The cause of death was documented as likely perforated viscus in an inguino-scrotal hernia.

This case illustrates the devastating prognosis of an acute presentation of an inguinal hernia containing the stomach. This should be considered a surgical emergency and immediate operative intervention should take place if the patient is clinically able to have surgery.
1003 A Case of Tunnel-Vision in Upper Renal Tract Imaging: The Invisible Gorilla
Authors: Swamad M , Quraishi M K , Ahmed S
Published: May 2021

We present an interesting case of a 70-year-old female who presented with haematuria on the suspected cancer pathway. Renal ultrasound showed a vascular renal mass on her right kidney measuring 8x7cm with an unremarkable left kidney. She underwent a laparoscopic radical nephrectomy following confirmation of an 8cm renal mass in the right kidney on the contrasted staging CT scan with a repeat review at the multidisciplinary meeting. Post-operatively a subsequent review of the pre-operative CT and ultrasound scan, showed an incidental large left(contralateral) upper quadrant retroperitoneal fatty mass sized 15x10cm, displacing the stomach and spleen. Further investigation in the form of an MRI Abdomen excluded features of a liposarcoma, resulting in the diagnosis of a large retroperitoneal lipoma. This case highlights the significance of selective attention in imaging interpretation. We believe this to be a prime example of the level of meticulousness required as fat-rich tissues have low attenuation on CT-scans, which can be easily missed out. A cautious multi-clinician interpretation of scans should be performed to avoid missing potentially sinister pathology which would impact patient care dramatically. This case has led to more thorough review of future pre-operative imaging by the operating surgical team.
55 Frailty Assessment in Lower Limb Critical Limb Ischaemia Patients
Authors: Malik M I K , Smyth J V
Published: May 2021

Introduction

An increasing number of frail older patients are undergoing surgical procedures. Frailty is an independent risk factor for increased hospital stay and adverse postoperative outcomes. This project aimed to assess frailty and its management in lower limb critical limb ischaemia patients on the vascular ward at Manchester Royal Infirmary.

Method

A prospective review of consecutive admissions admitted with lower limb critical limb ischaemia identified from ward list and vascular activity, and subsequently discharged. Assessment of frailty status using the Edmonton and Rockwood scales within 48 hrs of admission.

Results

A total of 15 patients were identified with an average age of 69.2 years. The average length of hospital stay was 19 days. 69 total days were spent in the hospital once patients were declared ‘medically fit for discharge’ across all patients. Frailty is associated with increased length of hospital stay and discharge to other institutions. Both the Edmonton and Rockwood scales were congruent in assessing frailty.

Conclusions

Frailty needs to be assessed and identified early so it can be flagged to therapy services and discharge arrangements commenced early. Measures need to be put in place to manage frailty and reduce the length of hospital stay.
58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections
Authors: Mistry H , Woolner B , John A
Published: May 2021

Introduction

Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections.

Method

Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records.

Results

84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures.

Conclusions

Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.
73 An Audit Evaluating the Management of Pre-Operative Anaemia in Elective Bowel Resections at Frimley Park Hospital
Authors: Coyle M , Rangarajan K , Celera S G , Dowson H , Nizar A S
Published: May 2021

Introduction

Pre-operative anaemia is common within the surgical population, particularly those scheduled for elective bowel resections. National and local guidelines recommend the treatment of pre-operative anaemia, as it is an independent risk factor for poor post-operative outcomes, including length of stay in hospital.

Method

A retrospective study of all NHS patients over the age of 18 scheduled for an elective bowel resection at Frimley Park Hospital between 1st May-31st October 2019.

Results

85 patients met the inclusion criteria, with 29 recorded as anaemic. Of these patients, 55% (n = 16) received iron replacement, all of which were intravenous and did not include mildly anaemic patients. The median rise in haemoglobin post-infusion was 14g/L, with only one patient achieving a normal haemoglobin. The median length of stay for patients with a normal haemoglobin was six days, which increased to eight for those with anaemia of any severity. A statistically significant relationship was found between severity of anaemia and increased length of stay, particularly in the female population.

Conclusions

Pre-operative anaemia was linked to increased length of stay in hospital. The findings support the intravenous treatment of all severities of anaemia pre-operatively and therefore suggest treating mild anaemia patients, as normalising their haemoglobin will improve outcomes.
113 Theatre Bleep: Quality Improvement Project
Authors: Weale R , Rivers C
Published: May 2021

Introduction

Efficient use of any theatre is essential for timely operating and maximising the use of resources. There are many reasons for inefficiency, including delays in patient transfer, and issues of communication between the ward and theatre staff. The objectives of this QIP were to establish areas for improvement in communication.

Method

A survey was distributed amongst staff with several questions subjectively rating the communication between theatres and the ward.

Results

Common reasons listed for delays mentioned included staffing (25) and communication (19), with only 18% rating communication when sending for a patient as good, and 58% of theatre staff rating communication when transporting a patient back as poor. A common response was failure of the ward to answer the telephone. A bleep was therefore introduced, which was carried by a nominated nurse on the plastic surgery ward each shift. Following the introduction of this bleep, the survey was repeated, with 71% rating communication when sending for a patient as good, and 86% of staff rating communication when transporting a patient back as either good or excellent.

Conclusions

This simple measure of a new ward bleep significantly improved communication, and we feel this measure should be implemented nationally.
132 Quality Improvement Project (QIP) On Compliance of Vascular Society’s Clinical Care Pathway for Patients with Critical Limb Ischaemia (CLI) Admitted to Vascular Ward At Worcestershire Royal Hospital (WRH)
Authors: Mehta A , Meecham L , Shakarchi J Al , Charlwood N
Published: May 2021

Introduction

Patients often present to the emergency department with critical limb ischaemia (CLI). According to the Vascular Society 2019 guidelines, these patients require.

All metrics should be carried out >80% of the time.

Method

A QIP was conducted of all CLI patients admitted with rapid progression/ deep tissue injury/ rest pain at WRH between 23/01/2020-31/03/2020.

Sources of data - Patient records, ICE and PACS

Results

Compliance target for below were not met.

However, compliance for vascular surgeon face-to-face review within 14 hours stood at 100%.

Conclusions

Failure to fully comply could lead to poor prognostic outcomes such as loss of limb or death. Consequently, the WRH vascular governance board agreed to put the following measures in place.
179 Improving Operative Notes in Upper GI Surgery: An Innovative QI Project Utilising Existing Electronic Hospital Systems
Authors: Sadik H , Butt A , Gowie Z , Carew J , Mehta A , Sheth H
Published: May 2021

Introduction

Operative notes play a valuable role in ensuring that surgical patients receive consistent and adequate care. There are many inherent difficulties affecting their quality. We performed a QI project to improve surgical operative notes at our centre.

Method

A questionnaire assessing subjective quality of operative notes was sent to all foundation doctors delivering post-operative care. Compliance to each inclusion recommendation in the RCS guidelines was analysed. A standardised template for operative notes was incorporated into the hospital’s electronic records system, compliance was then reassessed.

Results

Questionnaire responses (16) were better for typed vs hand-written notes in all domains: ease of accessing notes, following intra-operative steps, following post-operative plans and frequency of asking for additional information regarding plans. After implementation of the template, mean compliance across 19 RCS parameters improved from 69% (55 operations) to 89% (46 operations). Number of parameters with 100% compliance improved from 2/19 to 8/19. Compliance increased in 14/19 parameters, there was no change in 2/19 (already 100%) and a reduction was seen in 3/19.

Conclusions

Results from our analysis and questionnaire showed that typed notes were favourable when compared to hand-written. The introduction of a standardised electronic template, without investment in new software, improved compliance to RCS guidelines.
180 Management of Open Fractures at Oxford University Hospitals NHS Trust Major Trauma Centre
Authors: Ramjeeawon A , Iqbal M , Hawthorne R , Ahmad A , Hasan Y , Abourisha E , Ashraf A , Deakin M
Published: May 2021

Introduction

This audit was developed after noticing patients with open fractures had poor neurovascular assessment documentation (non-specific, none post-manipulation), and to check these patients received appropriate antibiotics. Review of open fracture management guidelines identified areas to be improved.

Method

Pre-operative hospital management of open fractures was audited using the NICE (NG37) and joint BOAST/BAPRAS guidelines on open fracture management. Interventions were awareness and education of junior doctors and editing the Trauma Clerking Form to prompt appropriate management and documentation, followed by re-audit.

Results

30 patients were assessed pre- and post-intervention. Correct antibiotic administration rate (93%vs97%) and speed (50% <2 hours where not given pre-hospital - in both groups) were similar. The initial neurovascular assessment frequency was identical (93%), however documentation of assessment of specific arteries (86%vs30%) and nerves (60%vs23%) and assessing all appropriate arteries (60%vs13%) and nerves (60%vs20%) improved. There were increased frequencies of documenting manipulation in A&E (90%vs47%) and neurovascular assessment post-manipulation (90%vs16%). Tetanus cover (87%vs77%), photo availability (70%vs40%), and appropriate dressing use (47%vs27%) improved.

Conclusions

Antibiotic management was consistent and appropriate. There were improvements in frequency and quality of neurovascular assessment, tetanus cover, availability of photographs of injuries and appropriate dressings used. Overall, pre-operative hospital management of open fractures improved.