bluuebunny/crossref_metadata_2025 huggingface dataset:
521 Optimising Anaemic Patients for Colorectal Cancer Surgery: Implementation of Day-Case Iron Infusion Pathway and Closed Loop Audit of Anaemia Management in Colorectal Cancer Patients
Authors: Malcolm F , Kaji F , Shelswell L , Plummer B , Speake W , Liptrot S , Coverdale N
Published: October 2021

Aim

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

Method

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

Results

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

Conclusions

We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However, these is still room for improvement in management of anaemia within this patient group.
573 What's in A Name? An Audit of Correct Identification of Patients During Ward-Rounds in A Surgical and Urology Receiving Ward
Authors: Sahni D S , McCabe G , Stevenson R P
Published: October 2021

Aim

Clinical governance states that patients should have a named Consultant during their in-patient stay. In our institution, every bed has a whiteboard above it, which mentions the name of the patient and the responsible Consultant. This should correspond with the electronic system, TrakCare. Ouraim was to audit and look into the accuracy of this practice, in order to improve the efficacy of ward-rounds and hence improve patient care and safety.

Method

Data was collected for general surgery and urology receiving wards over 3 consecutive days and was matched to the data available on the electronic system, TrakCare. Intervention was made in the form of verbal and written communication with the nursing staff and junior doctors. Effect of intervention was assessed 2 weeks later.

Results

n = 38 bed-boards were assessed. The first cycle of the audit demonstrated that 7 (18.4%) had either incorrect or no entries. The detailed analysis revealed that of these, 2 had no consultant names whereas 5 were incorrect. The second cycle demonstrated a good improvement with only 1(2.6%) bed-boards having incorrect or no names. The third cycle demonstrated sustainable impact with only 1 (2.6%) missing consultant’s name.

Conclusions

Ward-rounds have been an age-old practice to review patients and are vital to formulate a care plan for patients, particularly in acute settings. It is also important for the patient to know who is providing their care. Wrong or missing entries could compromise patient care and has implications in patient follow up and chasing results. A simple intervention by the nursing and medical staff can improve the quality of care.
576 Audit of Instillation of Intravesical Mitomycin-C Following Transurethral Resection for Bladder Tumour
Authors: McCabe G , Sahni D S
Published: October 2021

Aim

The administration of intravesical chemotherapy (IVCT) following transurethral resection of bladder tumour (TURBT) has been shown to decrease the risk of recurrence and is recommended as standard practice following TURBT for new & recurrent tumours.

Our aim was to evaluate the adherence to this guideline in our trust and if needed, to implement changes in order to improve the patient care.

Method

A retrospective analysis of 25 patients was done and details regarding the time interval between administration, demographic details and disease staging was collected. NICE guidelines were later implemented, and the data was recollected for 24 patients who underwent TURBT

Results

The analysis showed that the mean time between the end point of TURBT and instillation of Intravesicular Mitomycin-C was 7.66 hours. Thereafter, we tried to implement the guidelines by improving communication between the Theatre staff, Nursing staff and the pharmacy. The data was collected for re-audit for 24 patients and it was observed that the interval between surgery and Mitomycin administration had dropped down to 4.67 hours. The 3rd cycle of the audit revealed the interval dropping down further to 4.24hours.The 24hr administration rate was >90%, which was much higher than previous year audits

Conclusions

Engagement with theatre team and pharmacy is required, in order to coordinate the delivery of the IVCT to theatre for administration at the time of surgery. If everyone (hospital pharmacy and theatre staff) is supportive, patients’ quality of care can be improved by following the standardised protocol.
662 Establishing an Acute Extracorporeal Lithotripsy Service in The COVID 19 Pandemic
Authors: Theivendrampillai T , Hart E , Mahesan T
Published: October 2021

Introduction

In England, 40% of patients who present with urinary tract stones as an emergency are actively managed with a procedure, in the majority a stent. This commits them to an inpatient stay, a general anaesthetic and further surgery at a later date. Extracorporeal Shockwave Lithotripsy (ESWL) offers a promising, outpatient alternative especially during the COVID19 pandemic. With COVID19 limiting our ability to provide urgent stone care, we assessed our institutions compliance with Getting It Right First Time (GIRFT) guidelines- which recommends that 10% of patients with acute stones undergo ESWL.

Method

The audit comprised of 2 cycles; collecting data on the number patients that were admitted with renal colic over a 3-month period, and the percentage treated with ESWL. The first cycle collected data from February to April 2020, while the second cycle collected data from May 2020 to July 2020.

Results

The first cycle of the audit revealed that 0 patients were treated with acute ESWL. This required implementation of a referral pathway to Frimley Park Hospital who provided ESWL services. After implementation of a pathway, the 2nd cycle of the audit saw that of 32 patients, 6 patients were referred to Frimley for emergency ESWL (compliance rate: 19%).

Conclusions

With the implantation of a referral pathway, the percentage of patients that we referred for ESWL rose significantly from 0% to 19%, thereby meeting GIRFT guidelines. This audit re-iterates how the pandemic has shifted the way we provide urgent stone care with emergency ESWL in our local trust
696 Are Group and Save Samples Necessary for Common Urological Procedures?
Authors: Mohankumar K , Parish T , Deshpande A
Published: October 2021

Aim

Blood tests are routinely performed as a part of pre-operative assessment (pre-op). We looked at the number of group and save (G+S) samples taken at pre-op and compared that to the number of patients needing blood transfusion having undergone common Urological procedures at our hospital. Our objective was to assess the utility of this invasive procedure in this clinical setting.

Method

Data was retrospectively collected from electronic patient records on 413 patients undergoing elective urological procedures 1st June 2020 to 30th September 2020 at Colchester General Hospital. Major procedures like radical prostatectomies, nephrectomies were excluded. Patients who had G+S samples done prior to surgery were checked. This was compared to the patients who required transfusions.

Results

Amongst 413 patients who underwent an elective urological procedure, 169(41%) were day-case endoscopic, 151(37%) were inpatient, and 93(22%) were penoscrotal procedures. 104(25%) patients had G+S taken, with only 5 patients (1.2%) requiring transfusion. 24(14.2%) patients undergoing day case procedures,79(52.3%) patients undergoing inpatient procedures and 1(1.1%) patient undergoing penoscrotal procedures had G+S tests done. Only 7(1.7%) patients had a baseline haemoglobin of less than 100.

Conclusions

Our data showed that many G+S samples were unnecessary. TURBTs (transurethral resection of bladder tumours) were most likely to need transfusion. Education was fed-back to those running pre-operative assessment clinics that G+S should be considered for TURBTs and those with Hb < 100. We recommend running this audit again to further quantify the G+S tests which could be avoided.
795 Adequacy of Surgical Excision Margins in Lentigo Maligna: An Audit
Authors: Chan K , Maheshwari K , Yousif A
Published: October 2021

Aim

The optimal excision margin for Lentigo Maligna (LM) lesions has been a frequent topic of debate. An audit was carried out to compare the excision margins used for LM excisions with current NICE guidelines, and to assess the adequacy of these excision margins.

Method

A retrospective study was carried out to analyse all excisions of LM lesions in 2018. 33 patients were identified from the plastic surgery departmental database. Patient demographics, the site and distribution of LM lesions, and any history of previous skin cancer were analysed. Patient electronic records, operative notes, and histopathological reports were examined to determine the number of excisions done for each LM lesion along with the peripheral and deep surgical excision margins, and the histological clearance achieved. Complete histological clearance was determined by the Multidisciplinary team for each lesion.

Results

60 cases were identified. 60% of cases were located on the head and neck. The average peripheral surgical excision margin at first excision was 2.3mm. 55% of patients had a 2nd excision. The average peripheral surgical excision margin at 2nd excision was 5.4mm. 70.6% of cases achieved complete histological clearance at 2nd excision. 72.7% of lesions excised at 2nd excision with a 5mm or less surgical excision margin achieved complete histological clearance.

Conclusions

Taking >5mm surgical excision margins did not increase the rate of complete histological clearance for Lentigo Maligna lesions.
825 Hip Fractures in the Emergency Department: Are we keeping to the Big Six Standard?
Authors: Fraser E
Published: October 2021

Introduction

Hip fractures are the most common serious injury in older people (1) with 7364 patients attending the Emergency Department (ED) with a hip fracture in Scotland in 2019 (2). The “Big Six” are key areas in the acute management of hip fractures as outlined in standard 2 of the Scottish Hip Fracture Audit (SHFA): New Early Warning Score; cognition; Water Low Pressure Score; intravenous (IV) access and bloods; nil-by-mouth and IV fluids; and analgesia. In 2019, Ayr ED had a compliance rate of approximately 37.5% with the “Big Six” (2).

Method

One month of hip fracture data (n = 20) relating to the “Big Six” was collected from the Symphony software and audited. Areas where improvements could be made were highlighted to staff, and a further one-month data collection (n = 17) was carried out.

Results

From the first to second round the “Big Six” checklist completion rate increased from 30% to 41% (p = 0.68) and the “Big Six” compliance increased from 60% to 71% (p = 0.5).

Conclusions

In conclusion, compliance increased by 11% with the “Big Six”, however, not to the defined standards identified in the SHFA. Further long-lasting interventions have now been made to ensure that compliance rates continue to improve along with our standard of care.
859 Follow up of distal radius volar plating – No role for post-operative radiographs
Authors: Cheruvu M S , Edakalathur J J , Pickard S J
Published: October 2021

Aim

There is no consensus on the follow up for distal radius fractures after fixation. All patients receive intra-operative image intensifier screening to check the adequacy of reduction and implant position. We propose that if a patient is asymptomatic, you do not require post-operative radiographs.

Method

We conducted a retrospective review of all distal radius fractures operated in our hospital over the last 10 years. Data was collected from electronic records for revision surgery or metalwork removal. Records were assessed for patient symptoms, radiographic findings, and indications for implant removal. Patients had a minimum follow up of 6 months.

Results

900 distal radius fixations were performed over a 10-year period, of which 747 were volar plating. 49 patients had volar plates removed. 14 patients had metal work removal and joint release for stiffness. 6 had the plate removal and carpal tunnel neurolysis with release. 11 implant removals for screw prominence. Other operative indications included reduction failure (n = 2), infection (n = 2) and removal in paediatric patients (n = 3). 47 of the 49 patients for implant removal were symptomatic at follow up. Only two patients had implant removal following isolated radiographic evidence of metalwork mal position.

Conclusions

Intra-operative intensifiers reduce the risk of implant and fixation errors. Routine post-operative radiographs altered the management of only 2 out of 700 (0.3%) patients. We suggest that radiographs have no role in routine post-operative care of distal radius fractures, where patients are asymptomatic with appropriate intra-operative intensifier images.
1064 Extra-Articular Tibial Deformity Management in Total Knee Replacement
Authors: Choi S M , Kumar R , Morgan-Jones R , Agarwal S
Published: October 2021

Aim

In knee replacements, restoration of mechanical alignment is essential. Patients with extra-articular deformities (EAD) pose challenges in planning knee replacements. We present a method, based on our experience and review of literature on planning knee replacement surgery, in the presence of extra-articular coronal plane deformity of the tibia.

Method

Retrospective analysis was made of six patients with EAD of the tibia who underwent knee replacement at our centre. Mechanical axis of the tibia is considered and positioning of the tibia component is planned perpendicular to the mechanical axis of the tibia. The integrity of the collaterals determines the need for correction. Tibial resection >15mm from medial or lateral aspect of the tibia is an indication for corrective osteotomy prior to replacement surgery. The hip knee ankle angle (HKA) was noted. Pre-operative, post-operative clinical score, degree of constraints and post-operative complications were recorded. A post-operative long leg alignment radiograph was obtained.

Result

All patients had total knee replacement without correction of deformity. Adequate alignment of the limb and restoration of mechanical axis was achieved in all six patients without the need for correction of tibial deformity. All patients had improvement in their HKA angle and Oxford knee score. No re-operations were required, and no complications recorded.

Conclusions

Our study will help provide guidance on operative planning and decisions making for patients with extra-articular coronal plane tibial deformities.
829 Perioperative Surgical Patients and The Availability and Utilisation Of ECGs Machines Pre- And Post-Pandemic
Authors: Wareing J , Sandhar H , Howitt A , Yiasemidou M , Craske D
Published: October 2021

Introduction

ECGs are a NICE recommended pre-operative investigation and an integral part of post-operative monitoring. Delay in recognition of cardiac pathology can be catastrophic. Therefore, ECG machines should be readily available. Here, we report the results of an audit assessing the availability of ECG machines in surgical wards.

Method

In 2018 and then 2020, a bespoke, nine-item audit proforma was disseminated to all foundation doctors.

Results

In 2018, 17/32 wards had a ward based, readily available machine, 6/32 shared with another ward and 15/32 did not have a ward-based machine. The same was noted in 2020. In 2018 and 2020, the average time to obtain an ECG machine was 27 and 23 respectively. When no ECG was available, a doctor would obtain the machine 24% in 2018 compare to 52% in 2020. The diagnoses of the patients who had ECGs in 2018 were: normal sinus rhythm, atrial fibrillation, bradycardia, supraventricular tachycardia, sinus tachycardia and STEMI. In 2020 were: normal sinus rhythm, atrial fibrillation, supraventricular tachycardia, sinus tachycardia, atrial flutter, bradycardia, prolonged QTc, hyperkalaemia, STEMI and NSTEMI. The average time for NSTEMI patients to have an ECG was 35mins while for STEMI patients was 11.6mins.

Conclusions

Whilst our audit has highlighted the importance of ECG machine availability, the time to obtain one remained static between the two cycles. A study investigating the impact on patient outcomes may highlight the necessity for available ECG machines further.
1224 Effect of Distal Brachioradialis Release During Open Reduction and Internal Fixation of Distal Radius Fractures
Authors: Hafez A , Shaat A , Zain M , Sajid M A , Butt A
Published: October 2021

Aim

The study aim is to determine the impact of the brachioradialis release during the open reduction and internal fixation of distal radius fractures using a volar approach

Method

Total of 40 patients was treated with Open reduction and internal fixation of intra articular distal radius fractures. Distal release of Brachioradialis was performed to 19 patients, while 21 patients had no release of BR during surgery. Radiological parameters including Radial height, Inclination and volar tilt were measured 1 month post-operatively, while functional outcomes assessed with modified mayo wrist scores and Quick-dash scores

Results

There is no significant difference between age, gender and pre-operative conditions indicating that both the groups (BR release and without BR release) have similar demographic characteristics. Pre-operatively both groups had disturbed values for radial height, inclination, and volar tilt. Postoperatively, the mean of both groups was closer to normal ranges for radial inclination and volar tilt; however, radial height was the least adequately restored radiological parameter for both study group (11.54 ± 1.35 for BR group versus 10.21 ± 2.29 for Non-BR group). Pain, functional status, and grip strength had similar values in both groups whereas BR group showed higher ROM and DASH scores with P values of 0.048 and 0.025 respectively.

Conclusions

Brachioradialis release enhances the reduction and operative fixation, restoring the necessary radiological and subsequent functional parameters in distal radius fractures with reported no complications.
1254 Virtual Fracture Clinic Management of Little (5th) Metacarpal Neck Fractures; a Safe and Feasible Option?
Authors: Townley O , Flatman M , Hoyle A , Eastwood G
Published: October 2021

Aim

To determine the safety and efficacy of a Virtual Fracture Clinic (VFC) in managing little metacarpal neck fractures.

Method

Retrospective review of consecutive little MC neck fractures presenting to the ED June-December 2020 and subsequently referred on to VFC. Patient demographics and clinic outcomes were reviewed using electronic patient records and radiographs.

Results

Fifty patients were identified (Male:Female 37:13; mean age 26 years, range 3-89 years). Of these, 41/50 were discharged directly following VFC advice, with no adverse event. The remaining 9/50 had a face-to-face Fracture Clinic review due to safeguarding concerns (2), concurrent neck of fourth MC fracture (2), concerns regarding fracture pattern (4), and an unclear indication (1). These 9/50 were discharged after single review, with no adverse events to date.

Conclusions

Our data suggest that VFC review of patients with little MC neck fractures is a safe and feasible means of patient care which has the potential to reduce the requirement of face-to-face patient contact during the Covid-19 pandemic and reduce fracture clinic attendance. We suggest the routine incorporation of a Virtual Fracture Clinic for these hand injuries. Further work is needed to formally investigate associated patient satisfaction and the application of this approach to other trauma presentations.
1272 Tension Band Wire vs Apex Intramedullary Fusion Device for Hand Proximal Interphalangeal Joint Arthrodesis
Authors: Kamble R , Mills R , Williams C
Published: October 2021

Aim

Tension band wiring (TBW) is a popular arthrodesis technique for arthritic hand proximal interphalangeal joints (PIPJs), however often patients struggle with prominent metalwork and require further surgery to remove wires. This study compares outcomes of PIPJ fusion using traditional TBW with the newer Apex intramedullary implant and examines its cost-effectiveness.

Method

A retrospective analysis of 50 PIPJ fusions was performed in 37 consecutive patients using either TBW or Apex implant at a single unit between January 2013 and March 2020. Clinical and radiographic pre- and post-operative records were reviewed by two independent surgeons. The primary outcome measure was successful fusion of the joint, and complications or further surgery recorded as secondary outcomes. Cost-benefit analysis was performed to determine overall cost of procedure and any subsequent treatments.

Results

The TBW and Apex groups were comparable as to age, gender, diagnoses, and comorbidities. 27 fusions were performed using TBW compared with 23 fusions using Apex implant. Both cohorts demonstrated 100% union rates. 10 fusions (37%) from TBW group required removal of symptomatic metalwork at a mean 14.7 (± 10.9) months compared to none in the Apex cohort.

Conclusions

PIPJ fusion using the Apex implant demonstrated equivalent fusion rates to TBW and no additional surgery to remove hardware was required. The Apex implant has an additional cost of £655 (plus loan charge) but given that 37% of TBWs required further removal of metalwork, overall, the Apex implant proved to be cost effective. This study supports the use of the Apex implant as a favourable alternative to TBW.
1319 Factors Associated with Mortality in Older Patients Sustaining Pelvic or Acetabular Fractures
Authors: Harrison A , Ordas Bayon A , Chimutengwende-Gordon M , Fortune M , Chou D , Hull P , Carrothers A , Rawal J
Published: October 2021

Introduction

This study aimed to investigate potential factors, including delay to surgical stabilisation, affecting mortality in older patients sustaining pelvic or acetabular (PA) fractures.

Method

A retrospective review of the Trauma Audit and Research Network (TARN) database was performed to identify older patients (aged 65 and over) sustaining PA fractures treated surgically in a UK Major Trauma Centre (MTC) between 2015 and 2019. Chi-squared and Fisher tests were used to compare 1-year mortality rates following operative intervention between patients treated within 72-hours and after 72-hours. Kaplan-Meier curves were used to visualise survival probability; significant predictors of survival were found using Cox proportional hazard models.

Results

Of 564 older patients with PA fractures, 70 met the inclusion criteria. The mean age was 76.1 years. The overall 1-year mortality rate was 20%. When patients were grouped by time to surgery, there was no statistically significant difference in 1-year mortality. Patients whose surgery was delayed more than 72-hours were more likely to have longer hospital stays (p = 0.002) or to have suffered from polytrauma (p = 0.025). Age, Charlson Co-morbidities Index and pre-op mobility status were associated with statistically significant differences in overall mortality. Patient gender, mechanism of injury, polytrauma and head injury were not significant predictors of mortality.

Conclusions

Surgical intervention within 72-hours of injury did not result in decreased mortality in older patients with PA fractures. The 1–year mortality rate between older PA fractures and hip fractures was comparable. Consideration should be given to a combined multidisciplinary approach to managing these patients.
1445 Using BOAST Guidelines to Boost Standards: An Audit of Adherence to BOAST Open Fracture Guidelines
Authors: Wensley K , Rafie A , Orfanos G , MacFayden I
Published: October 2021

Aim

Open fractures require prompt management and appropriate infrastructure is required to deliver optimal care. The BOAST Open Fracture guidelines (2017) set out best practice in their management and advocate a combined Orthoplastics approach.

Method

All patients with open tibial fractures who presented to or were referred to our hospital from January 2018 - March 2020 were included in our audit. The standard used was the BOAST Open Fracture Guidelines. Data was collected retrospectively for cycle one (January – December 2018) then prospectively for cycle two (November 2019 – March 2020). Between cycles, results from cycle one was used to facilitate a business case for the creation of a second scheduled weekly Orthoplastics list in our hospital.

Results

61 injuries met inclusion criteria in cycle one and 23 in cycle two. In cycle one, 28% of cases missed the 72-hour soft tissue coverage target, 11% missed the 7-day target. Only 10% of cases had both Orthopaedics and Plastics consultants involved at initial debridement. Following the invention of an additional weekly Orthoplastics list, the percentage of patients missing the 7-day target for soft tissue coverage halved to 5% and the percentage of cases with both Orthopaedics and Plastics consultants involved at initial debridement more than doubled to 26%.

Conclusions

We advocate multiple weekly Orthoplastics lists to ensure prompt consultant-led management and minimise delays for patients with open fractures. We have demonstrated that audit of current practice is a simple and effective tool to facilitate improvement in guideline compliance.
198 Immediate Post-Operative PDE5i Therapy Improves Early Erectile Function Outcomes after Robot-Assisted Radical Prostatectomy (RARP)
Authors: Nathan A , Rashid A , Shukla S , Sinha A , Sivathasan S , Rassam J , Smart S , Patel K , Shah N , Lamb B
Published: October 2021

Aim

To assess whether the timing of post-operative Phosphodiesterase Inhibitor (PDE5i) therapy after Robot Assisted Radical Prostatectomy (RARP) is associated with a change in early erectile function, continence, or safety outcomes.

Method

Data was prospectively collected from a single surgeon in one tertiary centre and retrospectively evaluated. 158 patients were treated with PDE5i therapy post RARP over a two-year period.

Results

There were no significant differences in pre-operative characteristics between the therapy groups. Patients that had bilateral nerve sparing had a mean drop in Erectile Function (EF) score by 5.4 compared to 8.8 in the unilateral group. Additionally, 34.9% of bilateral nerve sparing patients returned to baseline compared to 12.1% of unilateral. Drop in EF scores and percentage return to baseline for unilateral nerve sparing was respectively 9 and 11.1% of immediate (day 1-2), 7 and 14.8% of early (day 3-14) and 9.7 and 9.5% of late (day >14) therapy (p = 0.9 and p = 0.6). For bilateral nerve sparing this was respectively 3.5 and 42.9% immediate therapy, 5.5 and 35.5% early therapy and 7.3 and 25% late therapy (p = 0.017 and p = 0.045). Pad free and social continence was achieved in 54% and 37% of those receiving immediate therapy, 60% and 33% for early therapy and 26% and 54% for late therapy. There were no differences in compliance, complication, or readmission outcomes.

Conclusions

Immediate PDE5i therapy should be considered in patients following nerve sparing RARP in order to maximise functional outcomes, especially in those undergoing bilateral nerve spare.
384 What Proportion of Pyelonephritis Admissions Under Urology Care Have Surgical Pathology
Authors: Elsllabi M
Published: October 2021

Aim

To identify the proportion of pyelonephritis patients admitted with true urological pathology

Method

Retrospective audit

Results

The majority of adults admitted with diagnosis of pyelonephritis (80%) remain under urology team from 1st day of admission Of the 80% only 9% had an underlying urological pathology confirmed by imaging AND requiring invasive intervention

Conclusions

High rate of inappropriate admission to surgical / urological ward with subsequent pressure on beds and inevitable cancellations on some occasions Acute pyelonephritis should not be routinely admitted under urology unless there is clear evidence of underlying obstructing pathology or no obvious improvement on antibiotics Consider imaging in terms of US/CT KUB in first instance before making any referral to urology
459 Timeline in Management of Muscle Invasive Bladder Cancer (MIBC): Single Centre Outcomes of District General Hospital
Authors: Yee S H , Ljegbai A , Saqib M
Published: October 2021

Aim

According to the European Association of Urology (EUA) guidelines, patients with muscle invasive bladder cancer (MIBC) have better overall survival outcome if they receive definitive treatment within 90 days from point of referral. Our objective was to assess the average timeline of these patients from their 2 week wait (2WW) referral to definitive treatment.

Method

This was a retrospective study in all patients diagnosed with MIBC from 1st January 2018 to 31st December 2019 at Furness General Hospital (UHMBT). Treatment delay was defined as delay in more than 90 days from initial referral to definitive treatment (radical cystectomy /radical radiotherapy with or without adjuvant chemotherapy).

Results

47 patients met the inclusion criteria. Patients had imaging within 27 days, with 32 patients (68%) having a computed tomography (CT) scan and 15 patients (32%) having magnetic resonance imaging (MRI). The duration from referral point to transurethral resection of bladder tumour (TURBT) was 40 days. Multidisciplinary team (MDT) discussion took place within 12 days post-surgery. On average, the journey from date of referral to MDT was 52 days. From MDT discussion to the first tertiary centre appointment took another 27 days making it a total of approximately 79 average days for the patient to have a definitive treatment plan.

Conclusions

12 patients (26%) exceeded the 90-day mark from duration between referral to having treatment. This is mainly due to TURBT being used as the ‘stop the clock’ treatment. The trust has, thus, created a departmental standard operating procedure (SOP) with the aim of minimising this duration.
842 Teleurology; A Prospective Study of Patient’s Perception and Real Time Experience in A Tertiary UK Centre
Authors: Abdalla O , Patel S , Nambi Rajan T , Kumar M
Published: October 2021

Aim

To evaluate the clinical outcome and patient’s satisfaction of our real-time teleurology experience.

Materials

A prospective study, the whole cohort of face-to-face [FTF] clinics was shifted for telephone clinics. The data were collected prospectively for all appointments from 30th March to 3rd April. The primary objectives were clinic outcome and patient’s satisfaction evaluated using a validated questionnaire. The secondary objectives were number of non-attendance, percentage of face-to-face clinics and clinic demographics.

Results

Overall, 95 scheduled appointments for 7 consultants and 2 trainees. Telephone consultations performed for 75 patients, while 6 patients reviewed in FTF Clinics, and 14 patients classified as non-attendant. The non-attendance rate was 14.7%, with estimated 50% reduction in comparison to FTF rate prior to pandemic. The majority of patients (58%) treated conservatively while 14 (17.2%) patients commenced on medications, and 20 patients (24.6%) were listed for surgery. All patients but one (98.1%) agreed that cancelling FTF clinics was reasonable. The majority of the patients 94.2%, 96.2%, 84.6% found the telephone clinic was effective, long enough, and was easy to express their concerns over the phone, respectively. Approximately 90.4% and 100% satisfied with teleurology service and that clinicians were careful, respectively.

Conclusions

Our study elucidated the feasibility of teleurology in a real time setting and showed that it meets the tetrafecta of clinical outcomes, continuity of care, patient’s safety, and patient’s satisfaction. To our knowledge, this is the first study to assess patient’s perception of teleurology using a validated questionnaire.
1398 Active Surveillance Vs. Partial Nephrectomy in Small Renal Masses: Overall and Cancer Specific Survival in A Retrospective Single Centre Study
Authors: Shafi S , Kouli O , Nabi G
Published: October 2021

Introduction

Currently, the gold standard for T1a renal cell carcinoma treatment is partial nephrectomy (PN). However, active surveillance (AS) is increasing in elderly individuals with co-morbidities. Our hypothesis was that individuals choosing active surveillance would have similar cancer specific survival as partial nephrectomy.

Method

This retrospective study used electronic notes to collect patient data presenting with T1a renal cell carcinoma, identified over a 15-year period. Primary outcomes were to compare the survival outcomes of these patients while being related to their comorbidities using the Charlson Comorbidity Index (CCI).

Results

183 patients were identified with 62 (35%) and 121 (65%) undergoing PN and AS respectively. Patients treated with AS were older (mean age of 66 years vs 58 years; P < 0.001) and had a higher CCI (median CCI 3 vs 2; P = 0.001). Overall, a total of 4 (6.5%) and 55 (45.5%) patients died from any cause after PN and AS respectively, with deaths attributed to kidney cancer was 2 (3.2%), and 10 (8.2%) respectively. Multivariate analysis showed only age >70 affected overall survival independently between the two groups (HR 5.85; CI 3.29-10.42; P < 0.001). Tumour size showed to be the only independent variable on cancer specific survival (HR 2.51; CI 1.14 -5.53; P = 0.023). No difference was seen between the treatment options in multivariate analysis in both overall and cancer specific survival.

Conclusions

The study agreed with the hypothesis of similar cancer specific survival. Highlighting for elderly individuals with significant co-morbidities, there is no observed benefit for undergoing partial resection.
894 An Audit of Venous Thromboembolism Prophylaxis in A Busy ENT Department
Authors: Connelly A , Williamson A
Published: October 2021

Aim

Venous thromboembolisms (VTEs) are a common and preventable cause of in-hospital morbidity and mortality. Assessment of risk factors (RFs) on admission and appropriate prescription of mechanical (e.g., TEDS) and/or pharmacological prophylaxis (e.g., low-molecular-weight heparin (LMWH)) is crucial. This is especially true in ENT where the variety of patient cohorts make a one-size-fits-all approach unsatisfactory. Guidelines from ENT UK reflect this.

Method

Electronic medical records were retrospectively reviewed for all emergency and pre-operative admissions (n = 173) to an adult ENT ward over 8 weeks. Adherence to the ENT UK guideline was assessed.

Results

58% of patients had VTE RFs, 27% had bleeding RFs, 2% had mechanical thromboprophylaxis contraindications. VTE risk assessment was clearly carried out for 39% of admissions. 63 patients (36%) met the criteria for LMWH prescription. 22 (35%) received it. 5 received LMWH without meeting the criteria. 96 patients (55%) met the criteria for TEDS prescription. 5 (5%) received it. 1 received TEDS without meeting the criteria. Overall, 45% of admissions had both prescribed according to the guideline. Using a pro-forma (n = 148) significantly improved risk assessment rates (43% vs. 12%), but not correct prescription rates (45% vs 40%) compared to freehand clerking (n = 25). No patients developed a VTE or unexpected bleeding.

Conclusions

Risk assessment and prescription of pharmacological and, especially, mechanical thromboprophylaxis for those who met the relevant criteria has significant room for improvement. However, no apparent harm occurred because of this. Further work will focus on developing a departmental policy and educating staff on its application.
1463 One Urology Unit’s Experience With Holmium Laser Enucleation Of The Prostate(Holep)
Authors: James G , Bryant D
Published: October 2021

Introduction

Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure for the management of Benign Prostatic Hyperplasia and Bladder Outlet Obstruction. The European Associations of Urologists (EAU) recommend HoLEP should be offered to patients with prostates measuring >30cc or who are anticoagulated

Aim

To review the outcomes of one-unit HoLEP procedures. Comparing the first third of patients to the final third of patients in a 183-patient cohort.

Method

We collected data retrospectively over 44-month period from 183 patients using electronic patient records. Outcomes measured; length of stay (los), length of time for catheter. Length of time of procedure. comparing the 1st 61 patient with the last 61 patients and reviewed rates of complications from HoLEP using the Clavien-Dindo classification

Results

The mean size of prostate was 83cc. 149 (81%) of patients had a LOS of £ 1 day. The mean length of catheter time 3.44 days. Mean length of operating time – 71 minutes. Length of time for the 1st 61 patients was 70.2 minutes compared with 73.1 minutes for last 61 patients. With regards to complications, 8 patient had Grade 3 however 0 patients had grade 4 or 5.

Conclusions

Patients undergo HoLEP procedure with Prostate size in keeping with EAU. This unit has a short length of stay post-op with low complication rate. HoLEP has a short post op catheter time.
1604 Infection and Morbidity After Local Anaesthetic Intravesical Botox Treatment Without Prophylactic Antibiotics
Authors: Satherley H , Parkinson R
Published: October 2021

Aim

Intravesical Botulinum Toxin Type A (BoNT-A) is a common treatment for overactive bladder symptoms refractory to anticholinergic and beta-3 agonist medications. Urinary tract infection rates of < 10% are commonly reported for flexible cystoscopy. We aimed to establish whether local anaesthetic flexible cystoscopy BoNT-A treatment could be performed with an acceptable rate of infection and morbidity without prophylactic antibiotics.

Method

Prospective audit of patients treated with local anaesthetic intravesical BoNT-A over 8 weeks. A telephone questionnaire was administered at 10 to 17 days post-procedure assessing symptoms, infection and antibiotic use. Electronic records were used to review pre-procedure urine analysis and post-procedure urine culture. Antibiotic use and positive cultures within 10 days were considered significant.

Results

51 (76%) of the 67 patients treated were contacted by telephone. These consisted of 41 female and 10 male patients with mean (range) age of 58 (25 to 86) years. 35 (69%) reported being asymptomatic or having symptoms as expected and 2 (4%) patients reported symptoms worse than expected following the procedure. 14 (27%) reported having a urinary tract infection with 9 (18%) provided with antibiotics. Positive urine cultures were present in 5 (10%) patients. Pre-procedure urine analysis, patient age, history of recurrent infection and catheter use did not predict post-procedure urinary tract infection.

Conclusions

Patients reported higher levels of infection and antibiotic use than expected. Patients should be well counselled about symptoms and complications to minimise antibiotic use. Further work is planned to establish whether prophylactic antibiotics will reduce symptomatic infections, antibiotic use and healthcare interactions post-procedure.
708 A 360 Degree Exploration of Key Factors in Consent in Aortic Aneurysm Repair
Authors: Rolls A , Guni A , Sharp B , Rajgopal A , Normahani P , Jenkins M , Jaffer U
Published: October 2021

Introduction

Shared decision making is the gold standard for treatment decisions. Although there is an evidence base to recommend either open surgical repair or endovascular repair (EVAR) for patients with abdominal aortic aneurysms (AAA) based on individual outcome factors, there is scope for choice depending on subjective factors. This study aims to identify key factors to be addressed in the consent process using a 360-degree exploration.

Method

A literature search conducted on Medline and Embase databases identified 13 key factors, which were formulated into questions with five-point Likert scales. Seven vascular surgeons, two interventional radiologists, two vascular anaesthetists, two intensivists, one vascular physician, and five patients who underwent either open surgical repair or EVAR were interviewed in a semi-structured manner. Descriptive statistical analysis was performed to identify the importance of each factor.

Results

The most important factors for clinicians and patients were “pre-existing medical conditions” and “risk of post-operative complications”. The least important factors were “need for follow-up appointments” and “post-operative pain”. Patients placed the most importance on “type of anaesthetic used”, and relatively less importance on “length of hospital stay” and “probability of admission to ICU”. Analysis of free-flowing answers yielded another 14 factors. Factors were grouped into “surgical focus”, “medical and perioperative focus” and “patients and communication”.

Conclusions

There is heterogeneity in the importance given to factors between clinicians and patients. The factors identified from this 360-degree assessment should be integrated into formal topics of discussion in the consent process to support patients in making informed decisions regarding AAA treatment.
1705 Mortality Following Major Lower Extremity Amputation in People with And Without Diabetes in Scotland 2004-2013
Authors: Murgitroyd E , Yao X , Kerssens J , Walker J , Wild S
Published: October 2021

Aim

To describe short and longer-term mortality following major lower extremity amputation (LEA) by diabetes status over two time periods

Method

A retrospective cohort study of patients who underwent major LEA between 2004 and 2013 was conducted based on linkage of national population-based hospital records and a register of people with diagnosed diabetes. Post-operative mortality was estimated at 30 days, one year and where available, five years. Using logistic regression models, we estimated the odds of death associated with diabetes adjusted for age, sex and socio-economic status within these time points compared to the non-diabetic population stratified by type of diabetes and five-year calendar periods.

Results

There were a total of 5436 people who received an amputation during the study period of whom approximately 40% had diabetes. Overall mortality for the 2004-8 and 2009-13 cohorts respectively was not significantly different at 7.9% and 7.3% at 30 days and 31% and 27% at one year. Almost 64% of the 2004-8 cohort were dead within five years. The only statistically significantly associations between diabetes and mortality were observed within five-year follow-up of the 2004-8 cohort with odds ratios (95% CI) compared to the non-diabetic population of 1.62 (1.17, 2.26) for type 1 diabetes and 1.38 (1.14, 1.66) for type 2 diabetes.

Conclusions

An adverse association between diabetes and mortality after LEA only became apparent in longer term follow-up.
996 Non ST Elevation Myocardial Infarction (NSTEMI) And Complex Coronary Artery Fistula In A Fit 57 Year Old Man And Its Management
Authors: Malik M I K
Published: October 2021

A fit 57-year-old man presented with exertional chest pain to the emergency department and was found to have anterolateral T wave inversion on ECG and blood troponin of 1290. Coronary angiography showed a severe proximal to mid-course lesion in the mid left anterior descending artery (LAD), severe ostial disease in obtuse marginal 1 (OM1) and large a coronary artery fistula (CAF) between the proximal LAD and main pulmonary artery (PA). Subsequent cardiac computer tomography multiple gated acquisition (CT MUGA) scan showed a coronary artery to main PA fistula, fed by small branches of the LAD and right coronary artery (RCA). Cardiac magnetic resonance (CMR) showed preserved left ventricle systolic function, ejection fraction 62%, and small left to right shunt. Following multidisciplinary discussion, the consensus was to offer coronary artery bypass grafting (CABG) and fistula ligation as the first option, but percutaneous intervention (PCI) to the LAD would also be feasible. After lengthy discussions, the patient declined CABG and opted for PCI and stent insertion.

CAF on angiogram is a rare finding, CAF is an abnormal connection between a coronary artery and either a cardiac chamber or a great vessel including the pulmonary artery. This case highlights a rare finding and its subsequent investigative workup and management considerations.
1566 A Rare Case of Aorto-Duodenal Fistula Associated with Bacterial Meningitis
Authors: Allon O , Williams A , Blaszczynski M
Published: October 2021

Aorto-enteric fistula (AEF) is an extremely rare complication of aortic disease with potentially fatal outcome. AEF is defined as a fistulous connection between aorta and bowel and can be classified into primary (involving native aorta) or secondary (occurring after aortic surgery). Primary AEF is by far the less common of the two and may be associated with malignancy, radiotherapy or infection. We present a case of a 75-year-old male presenting with collapse and haemetemesis. CT imaging revealed a fistula between native aorta and duodenum. Emergency surgery was carried out but ultimately the patient did not survive. The underlying cause remains uncertain. Notably, the patient had a recent history of bacterial meningitis 6 months prior to presentation and, despite negative cultures, infection of the aortic wall was strongly suspected.
299 An Unusual Nasal Lump
Authors: Ainine A
Published: October 2021

A 70-year-old man received a few courses of various antibiotics for left dacrocystitis under the care of ophthalmologists. Despite the treatment, the lump was not improving. The patient, in the meantime, presented to his GP with recurrent left-sided epistaxis and it became apparent that he was also experiencing ipsilateral nasal blockage. He reported a 3-year history of left-sided tinnitus but no other red flag symptoms.

He was subsequently referred as 2-Week-Wait to ENT and nasoendoscopy revealed complete blockage of the left nostril with the postnasal space fully obstructed by enlarged mucosal tissue and no palpable lymph nodes. CT showed an aggressive locally invasive sinonasal tumour and a necrotic posterior mediastinal lesion. MRI further defined the extent of invasion and revealed a significant level 2 lymph node. A gastroscopy and EUA nose were arranged to obtain histology to confirm the differential diagnosis of sinonasal SCC.

This case highlights the importance of lateral thinking when presented with a refractory symptom, as a more sinister diagnosis can be detected earlier. It also reinforces the need for examination of surrounding anatomy that may influence the condition.