bluuebunny/crossref_metadata_2025 huggingface dataset:
SP8.1 - Emergency Robotic General Surgery in the UK: Operations, Staff, and Missed Opportunities
Authors: Smith Emily ,   Moynihan Academy Collaborative, Wohlgemut Jared , Okocha Michael
Published: September 2024

Aims

The primary aim was to determine the volume of emergency robotic general surgery performed in the UK. Secondary aims were to determine compatible operations with opportunities for training and the availability of robotic-trained staff.

Methods

Freedom of Information (FOI) requests were sent to 122 UK Acute Trusts, asking for data on general surgery procedures (open, laparoscopic, robotic) from January 2019 to January 2023. Data on common emergency procedures, in-patient length of stay, robotic complications, and availability of robotically trained staff was requested.

Results

Of the 122 Acute Trusts, 22 did not respond (82% response rate), 32 had no general surgery robotic access, 16 could not comply due to cost (under section 12 of FOI Act), and 52 provided data. Fifteen Trusts performed emergency robotic surgeries: cholecystectomy (262 cases), hernia repair (140), and appendectomy (3). 86% of these Trusts utilized the DaVinci system, while the CMR Versius system was employed by the remaining 14%. There was a median of 12.5 (range 2-40) robotic-trained staff in-hours, versus a median of 0 (range 0-4) out-of-hours.

Conclusions

Emergency robotic general surgery in the UK is limited by financial constraints, staff availability, and selective procedural use. Compatible emergency operations that have been performed were cholecystectomies, hernias, and appendectomies. To expand its role, there's a need for training, infrastructure investment, and further research into the cost-effectiveness and outcomes of robotic surgery in emergency cases.
SP8.2 - Single centre experience in establishing a robotic colorectal surgery programme in a UK district hospital
Authors: Moolamannil Mathew , Rajaratnam Kanapathi , Bevan Katharine , Georgiades Fanos
Published: September 2024

Aim

To describe our centre’s experience in establishing a robotic programme for colorectal surgery procedures.

Method

Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre.

Results

38 colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform between April-December 2023. These were compared to a laparoscopic cohort of 57 consecutive colorectal resections. 37% (n=14) of the robotic cases were proctored and all were resections for malignancy. There were 57.9% (n=22) males in the robotic cohort and 50.9% (n=28) in the laparoscopic cohort. There was no statistical difference between the demographics of the two cohorts in terms of age, body mass index and ASA grade. 21/38 (55.3%) robotic resections were left sided compared to 35/57 (61.4%) laparoscopic resections. No robotic cases were converted to open or laparoscopy, but 8.8% (n=5) of laparoscopic cases were converted to open. Laparoscopic procedures were shorter (median operative time 277 min compared to 412 min, p<0.001). A stoma was formed in 13/38 (34.2%) robotic cases and 16/57 (28.1%) laparoscopic cases. All bowel anastomoses performed in the robotic cohort were stapled with 16/32 (50.0%) being intra-corporeal. The median length of stay was 5 days for both cohorts. 5.3% (n=2/38) Vs 12.3% (n=7/57) had a significant post-operative complication (Clavien-Dindo ³3). No mortalities were recorded within 90 days of the procedures.

Conclusions

Other than longer operative times, robotic colorectal resections in a district hospital setting is comparable to laparoscopic resections.
SP8.5 - Enhancing the confidence of FY1 Doctors in managing General Surgical Patients through the introduction of an online handbook– A quality improvement project
Authors: Sims Oliver , Abishek Joshua , Manji Ali , McCarthy Deirdre , Mallappa Sreelakshmi
Published: September 2024

Background

Emerging as a Foundation Year 1 (FY1) doctor from undergraduate training can be daunting. Furthermore, working in Colorectal Surgery can pose challenges: managing both elective and acute surgical patients with complex needs. We designed a General Surgery and Colorectal Surgery handbook to help FY1 doctors navigate training. This Quality Improvement Project aimed to assess the impact of and alleviate some of the uncertainty experienced by FY1 doctors during this transitional phase.

Methods

An electronic handbook was compiled with contributions from across the Multidisciplinary Team which was reviewed and approved for distribution within our Trust. An online questionnaire was distributed to assess pre-placement confidence in key domains on a 10-point Likert scale. This was sent to FY1 doctors who had previously completed a rotation within colorectal surgery without the handbook. The handbook was distributed to new cohort of FY1 doctors a week prior to the start of their rotation in Colorectal Surgery. An identical questionnaire was sent to the new cohort of FY1s within a month of their rotation and results were compared with previous cohort.

Results

In all surveyed areas, there was an improvement in confidence in the post-intervention group compared to that shown in the pre-intervention group. The average improvement in median score across all areas was 3.8 points.

Conclusion

This project demonstrated an overwhelmingly positive response to a formalised handbook by FY1 doctors in training. This intervention has helped FY1 doctors manage colorectal and general surgery patients with enhanced confidence thus paving way for safer patient care.
SP8.10 - Systematic Review and Meta-Analysis of Interactive multimedia Interventions used in the Informed Consent Process
Authors: Clements Joshua Michael , Clements Jake Simon , Clarke Mike , Kirk Stephen
Published: September 2024

Aim

The use of digital technology to improve the informed consent process has increased over the past decade. A wide range of multimedia modalities are now available. This review aimed to assess the impact of interactive multimedia interventions on the informed consent process.

Methods

This was a subgroup analysis of a larger systematic review and meta-analysis conducted in accordance with a predefined protocol registered on PROSPERO (CRD42023380406). Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of interactive multimedia interventions designed to improve the informed consent process. Adults >18 years undergoing invasive interventions with the capacity to consent were included. The Cochrane Risk of Bias (RoB) tool was used to assess study quality. Standardised mean difference for continuous variables and risk ratios for dichotomous variables were used to assess effect. Meta-analyses were performed in RevMan5.

Results

21 studies (22 interventions arms) with 2090 participants were included. All studies involved patients undergoing informed consent in an elective hospital setting for various surgical, cardiological and radiological procedures. Statistically significant improvement in immediate (SMD 0.40, 95% CI 0.18 to 0.62, I2=55%) and short-term knowledge (SMD 0.47, 95% CI 0.16 to 0.79, I2=45%) were demonstrated. No statistically significant differences were found for long term knowledge, generalised anxiety, satisfaction with the consent process or length of consultation.

Conclusions

Interactive multimedia interventions improve immediate and short-term knowledge in patients undergoing invasive interventions and could be considered as an adjunct to enhance patient knowledge during the informed consent process.
SP9.2 - Changes in frailty and discharge destination post emergency laparotomy
Authors: Ng Hwei Jene , Quasim Tara , Moug Susan
Published: September 2024

Aims

Frailty affects morbidity and mortality post emergency laparotomy (EmLap). Studies have shown that some frail patients do not return to baseline post EmLap. We aim to explore the change in frailty status at 90-day post EmLap and the association between pre-EmLap frailty and changes in home environment on discharge.

Methods

EmLap patients age ≥65years from a district hospital were recruited from May 2022 to April 2023. Discharge data were collected prospectively, and frailty was assessed using Rockwood Clinical Frailty Scale at pre-EmLap and day-90 post-EmLap with score >4 as frail. EmLap patients with no complete 90-day follow-up were excluded. P-value of <0.05 was considered significant.

Results

63 EmLap patients were included, 57.1% were female and median age was 75years. 17.5% were frail pre-EmLap and on day-90 post-EmLap, 33.3% were found frail (15.9% developed frailty). Pre-EmLap, all patients came from home with 13.6% had package of care service (POC) already in place. On discharge post-EmLap, 27% had change of home environment; 1 to care home, 1 still an inpatient at 90-day post EmLap, 2 had new POC and 13 had increased POC. Of this cohort, 52.9% were frail pre-EmLap. There was a significant association between pre-EmLap frailty and change in home circumstances on discharge (p<0.00001).

Conclusion

About 16% developed frailty post-EmLap with almost a third had a change in home environment on discharge. Frailty should be assessed in all EmLap patients to improve shared decision making and development of post-EmLap discharge strategies.
SP9.6 - Introduction of a Dedicated Motivational Movement Rehabilitation Service to Reduce Length of Stay in Emergency Laparotomy Patients
Authors: Watson Hannah , Payne Christopher , Gray Carol
Published: September 2024

Aim

Emergency laparotomy patients represent a high-risk group with the need for both physical and emotional recovery post operatively. National audit data demonstrated our institution has a longer length of stay than other health boards. The need to proactively support postoperative mobilisation within this patient group was identified and funding achieved for a period of one year to employ two heath care support workers to provide a dedicated motivational movement service with the aim to reduce overall length of stay (LOS).

Method

Feedback was sought from staff and patients to inform the roles. The team provide daily individual patient centred movement goals with 1:1 movement support, gain an understanding of 'what matters to you' for every patient and bring positivity, encouragement and enthusiasm to recovery by providing daily motivation and wellbeing support.

Results

First quarter data since implementation, from March to May 2023, demonstrated a reduction in average and median LOS by 9.5 days and 5.8 days respectively compared to same quarter data from 2022. This was reproduced for the second quarter with average LOS reducing by 9.0 days and median LOS by 6.2 days compared to previous year. 95% of patients were asked ‘What matters to you?’. Feedback from patients and staff about this service has been overwhelmingly positive.

Conclusion

The introduction of a dedicated 7-day motivational movement service has reliably reduced LOS in this patient group for the first two quarters since implementation. The service has received universally positive feedback indicating the increased quality of recovery felt by patients.
SP9.13 - Influence of Gastrojejunostomy Diameter on Weight Reduction Following Roux-En-Y Gastric Bypass Surgery
Authors: Al-Fagih Othman , Niaz Osamah , Razzaq Ahsen , Askari Alan , Munasinghe Aruna , Al-Taan Omer
Published: September 2024

Introduction

The debate on whether the diameter of the gastrojejunostomy in Roux-En-Y Gastric Bypass (RYGB) affects long-term weight loss was addressed in this study by comparing outcomes between two different anastomosis diameters.

Methods

This retrospective study analysed primary RYGB performed from January 2017 to July 2021, comparing 30mm and 45mm gastrojejunostomy diameters. Weight loss was assessed at 12, 24, and 60 months post-operatively.

Results

Of the 1,081 patients who had RYGB, 79.6% were female, with a median age of 48 (IQR 40-55). The median starting BMI was 44.6 Kg/m2 (IQR: 40.4-50.1). The 30mm group comprised 36.6% (396/1,081) of the participants. There were no notable differences in baseline demographics such as gender, age, ASA classification, and medical history between the groups. At the 12-month follow-up, the average BMI reduction was 12.8 Kg/m2 (IQR: 9.3-17.9), with no significant differences between the 30mm (median: 13.0 Kg/, IQR: 9.4-23.5) and 45mm groups (median: 12.6 Kg/m2, IQR: 9.1-16.9, p=0.053). At 24 months, the BMI reduction was more substantial in the 30mm group (median: -16.2 Kg/m2, IQR: 11.6-40.5) than in the 45mm group (median: -15.3 Kg/m2, IQR: 10.0-35.6, p=0.006). A greater divergence was observed at 60 months, with the 30mm group showing more weight loss (median: -17.2, IQR: 11.3-31.1) compared to the 45mm group (median: -15.8, IQR: 11.9-28.3, p=0.003).

Conclusion

A smaller gastrojejunostomy diameter of 30mm is linked with greater BMI reduction up to five years post-RYGB. Further study is necessary to evaluate the anastomosis size's impact on long-term weight maintenance and regain.
WP1.1 - Examining the effectiveness of prescribing Tamsulosin before elective surgery for inguino-scrotal hernias - a case series
Authors: Carey Charles , James Stuart , Jaunoo Shameen
Published: September 2024

Aims

Urinary retention following surgery is a common issue that can result in significant morbidity and prolonged hospital admissions. Tamsulosin is commonly used to manage patients at risk of urinary retention in the community but its usefulness at preventing retention following surgery is currently unclear. This case series describes the effectiveness of using short courses of tamsulosin to prevent post-operative urinary retention at a single centre.

Methods

Males aged over 70 who underwent elective surgery for an inguino-scrotal hernia between January 2022 and January 2024 were included in this series. Inclusion also required the patients to be planned as day case procedures under general anaesthetic. Patients with a known history of prostatic disease and/or who were already taking Tamsulosin or another alpha-1 adrenoceptor inhibitor were excluded.

Results

67 patients who took 400 micrograms of Tamsulosin once daily for 2 days before and on the day of surgery were included in this series. The patients were aged between 70 - 89 years and all underwent elective open mesh hernia repairs under the same surgeon with the same materials. None of the patients suffered post-operative urinary retention and so were able to be discharged as day cases.

Conclusions

The absence of any instances of post-operative urinary retention in this series suggests that a course of Tamsulosin before elective inguino-scrotal hernia repair can effective as prophylaxis against the condition. This data alongside additional randomised control trials demonstrating the benefits of pre-operative Tamsulosin may result in it being used more widely.
WP1.2 - Does intraoperative urinary catheterisation decrease postoperative urinary retention after laparoscopic inguinal hernia repair? A systematic review and meta-analysis
Authors: Romman Saleh , Fagbemi Ona , Ghassemi Nader , Hajibandeh Shahin , Athwal Tejinderjit , Cheruvu Chandra , Hajibandeh Shahab
Published: September 2024

Aims

To evaluate comparative outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation.

Methods

A systematic search of MEDLINE, CENTRAL and Web of Science and bibliographic reference lists were conducted. All comparative studies evaluating outcomes of laparoscopic inguinal hernia repair with and without use of intraoperative urinary catheterisation were included and their risk of bias were assessed using their risk of bias were assessed using ROBINS-I tool. Postoperative urinary retention was analysed as the primary outcome parameter and an odds ratio (OR) was determined using Random-effects modelling.

Results

We included 6 comparative studies reporting a total of 8,675 patients who underwent laparoscopic inguinal hernia repair with (n=3,318) and without (n=5,357) use of intraoperative urinary catheterisation. There was no significant difference in postoperative urinary retention between the two groups (4.3% versus 3.7%, OR 0.93; 95% CI 0.55-1.58, p=0.80). There was significant heterogeneity among the included studies (I2: 75%, p=0.001). Results of sensitivity analyses were consistent with the results of the main analysis.

Conclusions

Meta-analysis of best available evidence (level 2a) demonstrated that use of intraoperative urinary catheter has no advantage in prevention of postoperative urinary retention following laparoscopic inguinal hernia repair. Future randomised controlled trials are required to control for confounding factors that increases the risk of urinary retention.
WP1.11 - Total Extra Peritoneal (TEP) Inguinal hernia repair is safe and feasible for recurrent inguinal hernia post Total Extra Peritoneal repair "TEP on TEP is possible”
Authors: Zino Samer , Alaeq Ali , Costello Amy , Djoudi Assia
Published: September 2024

This abstract share our experience in surgical management of recurrent inguinal hernia post total extra peritoneal (TEP) repair by utilizing the same approach TEP.

Methods

Two patients with recurrent inguinal hernia post TEP were consulted for laparoscopic VS open approach, and both opted for the laparoscopic approach, understanding the higher risk of conversion.

Result

The first case of 62y male with recurrent left inguinal hernia after bilateral TEP. The second case of 69y male with recurrent left inguinal hernia post lap TEP repair.

Standard three lower midline ports technique, no balloon spacer was used. The first and most important step was developing the plane above the previous mesh. 20 ml of 1 % xylocaine and 1/200000 was instilled in the extra peritoneal space to minimize oozing. Separating the previous mesh from the inferior epigastric artery and posterior wall of rectus muscle, down into bony lard marks and cord structures was performed using suction and sharp dissection with minimal diathermy. All landmarks were exposed in the three zones, before utilizing anatomical mesh. Both patients stayed overnight and operation time was 84 and 90 minute respectively. Three months follow up showed no recurrence or significant pain.

Conclusion

To our knowledge, this is first study describe the use of TEP on TEP. It suggests that TEP should not be excluded in patients with previous posterior mesh repair, emphasizing the importance of proper consultation. The abstract calls for further cases and studies to assess the efficacy and safety of this approach.
WP2.5 - Impact of repeated phlebotomy in long-stay patients and patients requiring total parenteral nutrition
Authors: Noureldin Khaled , Ramesh Kirtika , Aghwa Hisham , Aslam Jabeen , Mohamed Mustafa
Published: September 2024

Introduction

Blood tests are an essential for patient management. Repeated tests can be associated with harm. The study aimed to assess the consequences of repeated phlebotomy in patients with a long hospital stay or requiring total parenteral nutrition (TPN).

Methods

Retrospective data was collected from general surgical patients with a length of stay (LOS) of at least 14 days, over a period of 6 months. Biochemical parameters including haemoglobin were recorded on day of admission, day 14 and day 21. Complications following phlebotomy were also noted.

Results

133 patients were identified. 84 patients had a LOS >21 days. The longest inpatient stay was 92 days. The most common pathologies were related to lower gastrointestinal disease at 45 cases. TPN was required in 35 cases.

Average blood loss as a result of blood sampling was 325 ml/admission (105ml-850 ml), with associated average drop in haemoglobin of 20%. In 6 cases, haemoglobin dropped >40%. Rate of testing per admission length was 1every two days. (45 times as a peak)

The most common complications noted were technical ( lab errors/ inadequate sampling). Other physical and psychological factors. A Full set of blood tests costs 150£.

In our intervention, 4ml paediatric blood vacutainers (to 13 ml adult’s) were trialled in 10 cases. The results were very comparable. Potential 60% reduction in blood loss was noted.

Conclusion

careful clinical judgment and controlled approach with restricted practice towards phlebotomy is mandatory .It can be harmful, if not clinically required. Plus it’s expensive costs. Paediatric blood vacutainers can be a beneficial alternative in those requiring regular blood sampling.
WP2.6 - Improving theatre utilisation and reducing waiting list times – could ‘standby’ patients be the answer?
Authors: Conroy Soraya , Kirkley Kirstie , Case Valerie , Butcher Katrina
Published: September 2024

Aims

With the NHS waiting list at a record high of over 7.3 million patients, it has never been more important to maximise theatre productivity. We piloted a ‘standby patient’ initiative for patients awaiting elective day-case procedures, with the aim of optimising theatre utilisation, reducing waiting lists, improving hospital revenue and ultimately patient care.

Methods

The principle of a ‘standby’ patient is to reduce the rate of ‘on the day’ cancellation and utilise theatre time. Suitable patients were offered the opportunity to be on ‘standby’ for selected day case lists. If list capacity allowed, the patient was called in. If postponed, they were offered a dedicated date. A patient questionnaire was also conducted to gain an understanding of the ‘standby’ patient experience.

Results

Between May and November 2023, 12 ‘standby' patients were identified, average waiting list time of 44 weeks. Cases included hernia repairs and laparoscopic cholecystectomies. 6/12 were operated on their standby slot, 1 patient cancelled, and 5/12 were postponed but had surgery within an average of 6 weeks. This earnt the trust approximately £15240 in additional tariff. 10/12 patients responded to the patient questionnaire with all reporting either good or excellent experience of the initiative. Positive comments included ‘good communication’ and ‘excellent standard of care’.

Conclusion

The standby patient initiative is well received by patients, and provides a cost-effective solution to optimise theatre utilisation, reduce waiting list times, and improve patient care. Following this successful pilot, we plan to introduce the standby patient across further surgical lists within the trust.
WP2.16 - Hartman’s Reversal; A comparison of conventional vs minimally invasive surgical approach
Authors: Salam Ammara , Osunlunsi Oluwafemi , Isknadar Amir , Waraich Naseem
Published: September 2024

Background

Hartman’s procedure is a safe operation for emergency colonic resections. Hartman’s reversal, however, is a technically challenging operation with high morbidity. Hence, almost half of the patients choose to live with lifelong stoma. Hartman’s reversal can be done open or laparoscopic, with single incision laparoscopic surgery (SILS) as an emerging minimally invasive technique. We will discuss the different surgical techniques along with their results and challenges.

Methods

This is a single centre retrospective study done at District General Hospital. All the Hartman’s reversals done between July 2021 to July 2023 were included in the study. Demographics, primary disease, interval between primary operation and reversal, post-operative complications and hospital stay was calculated.

Results

A total number of 19 Hartman’s reversal operations were done between July 2021 to July 2023. Average age of the patients was 61.8 years. The pathology was cancer in 7 patients and 12 cases were benign. The average interval between Hartman’s procedure and reversal was 23.2 months. Only 3 (15.7%) patients had a co-morbid. Out of 19 Hartman’s reversals done, 11 (57.89%) were done open, 5 (26.3%) SILS, 1 (5.2%) laparoscopic, and 2 (10.5%) laparoscopic converted to open. The complication rate in open cases was 61.5% vs 33.33% in laparoscopic/SILS. Average length of stay (LOS) was 10.38 days in open vs 9.19 days in laparoscopic group.

Conclusion

The limitations of this study are single centre and low sample size. The length of stay is slightly better in minimally invasive group, and much better post-operative outcomes. We suggest a multicentre study can help establish more reliable results.
WP3.15 - National Emergency Laparotomy (NELA) deaths within 90 days: A cohort study
Authors: Gok M A , Bughio M , Zaidi M , Mathieson N O M , Sadat M M , Khan U A , Riaz Komal
Published: September 2024

Aims

NELA is committed to enhancing quality of care of patients undergoing emergency laparotomy. NELA care pathways include: initial clinical assessment, resuscitation, prompt diagnosis, early surgery, peri-operative care. NELA emphasizes the importance of identifying high risk patients, who are associated with significant morbidity & mortality. Aim of study is to review the NELA 90-day deaths.

Methods

Cohort study of NELA deaths within 90 days, from Jan'2014 to Jan'2024 at single centre. Descriptive demography, outcomes were evaluated. NELA survivors beyond 90 days were controls.

Results

90 Day (n = 113) Others (n = 751) Mann Whitney U (p value) Age(yrs) 74.3 66.6 < 0.0001 Sex(M:F) 58 : 55 334 : 417 NS ASA 3 2 < 0.0001 BMI(kg/m2) 25.1 25.7 NS Lap(n) 16 218 Ns Open(n) 97 533 < 0.01 Op time(mins) 120.2 119.1 NS LOS(days) 17 12 NS ITU/HDU 70 318 < 0.001 ITU stay(day) 3 2 < 0.05 Lactate(mmol/L) 3.0 1.9 0.0002 WCC(x109/L) 13.2 12.3 NS CRP(mg/L) 93.6 68.8 < 0.0001 Physiological score 28.2 21.6 < 0.0001 Operative severity score 20.0 16.4 < 0.0001 Pre possum score 29.4 11.9 < 0.0001 PP mortality score 23.4 6.1 < 0.0001 PP morbidity score 82.9 63.5 < 0.0001 Survival Rate (%) 1styear 81.4 5thyear 63.0 10thyear 50.7

Conclusion

90-day NELA mortality rate is 13.1 %. NELA deaths occurred in older, frail, multi-comorbid & higher ASA status Patient survival appears to plateau out beyond 90-days (natural deaths). NELA risk scores were greater amongst the 90-day deaths. NELA risk scores can identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetist and intensivists may identify and allocate appropriate surgical & critical care intervention.
WP3.17 - Rationalising the use of Abdominal X Ray to ensure the best utilisation of clinical radiology services
Authors: Jatania Jignesh , Barber Margaret , Locurcio Lino , Hewitt Peter
Published: September 2024

Aim

To rationalise indications for Abdominal Xray (ABXR).

Method

All patients undergoing ABXR from 1st September 2022 to 31st December 2022 were included timing the Xray, requesting department and grade of doctor noted

We compared the indications of the request and whether patients proceeded to CT scan.

Based on the iRefer recommendations Grade C as well as need of CT, inappropriate requests were identified and ones that could be avoided.

Results

279 patients underwent ABXR

184 Xrays were done during in hours(IH) (0800-2000hrs)

175 requests originated from A&E, 103 from Wards and 1 from GP.

137/279 ABXR were requested for obstruction. 37/279 for Foreign Body.

Other common IH requests included identifying retained capsule, post enteral tube placements as well as diagnostic/therapeutic gastrograffin result. IH request also included identification of renal stones following CT KUB.

134/279 concurred with Recommendation A/B and 145/279 Recommendation C of iRefer guidelines.

62/279 patients underwent post ABXR CT scan.

70% (43/62) were to rule out obstruction for which in the majority ABXR would not be indicated. Of these 49% (21/43) were normal and 51% (22/43) showed obstruction.

45/62 of the patients who underwent CT had an avoidable ABXR.

In total 144 ABXRs could have been avoided. 1 request was from GP and hence could not be commented on.

Conclusions

Avoiding abdominal Xray will improve patient care, bypassing inadequate tests and moving straight to CT where clinically appropriate. Rationalising the use of ABXR will minimise overburdening clinical radiology services and decrease unnecessary exposure of radiation to patients.
WP5.15 - A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital in United Kingdom
Authors: Pal Shreya , Yi Zoe Ng Zhen , Sunwar Semosh , Pangeni Anang , Nahid Md Abu Kamal , Shrestha Ashish
Published: September 2024

Aims

Emergency surgical presentations require urgent attention by surgeons to ensure appropriate treatment, However, increased waiting time in A&E often leads to delayed diagnosis and subsequently delayed management.

A direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays and subsequently improve patient outcome.

Methods

A retrospective observational study of Emergency General Surgery (EGS) admissions from May 2023 to December 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome.

Results

A total of 265 patients were channeled through DAP referrals during the study period, of which 96.6% were appropriate referrals. The main source of the referral the A&E (52.4%), while the UTC-GP and GP constituted the remaining (47.6%). The most common clinical presentations were abdominal pain (32.4%), followed by subcutaneous abscess (17.3%). The median watiting time for initial assessment by the surgical team was 60 minutes. In terms of outcomes - 15 % patients were admitted, 14.7% were discharged after intervention, 35.8 % were discharged without intervention and 28.6% were planned to return for investigations or interventions.

Conclusion

The DAP for EGS admissions has enabled surgical emergencies to be addressed more promptly, and thus seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&E pathway.
WP5.18 - Quality Improvement Project – Assessing current practice of percutaneous cholecystostomy tube (PCT) management in a DGH and proposal of local guidelines
Authors: Sharmin Afroza , Hammett Claire , Hamdan Mohammed
Published: September 2024

Rationale

The absence of evidence-based guidelines for Percutaneous Cholecystostomy Tube (PCT) management has led to a lack of standardization in its care across NHS Trusts. Existing literature provides varied recommendations. Davis et al.(1999) suggested allowing 7-10 days for tract maturation, although they did not describe how this was evaluated. Other authors recommended proposals based on their local practice.

Aim

To establish standardized care following PCT insertion at our DGH, focusing on improving efficiency and ensuring uniformity in performance.

Methods

A retrospective cohort study was conducted, reviewing the period between January 2021 to December 2022. 68 patients were identified to have PCT insertions.

Results

Findings revealed 24% (16/68) had no documented discharge plan. 57% (39/68) of patients had a planned Surgical Assessment Unit review within a wide timeframe (4-49 days). A tubogram was arranged for 47 of 68 patients (69%) meaning the rest had no fluoroscopic examination before PCT removal. This was performed on average at 4.8 weeks and (range 1-10 weeks). 31% (21/68) had no UGI clinic review. The mean PCT removal time was 9.4 weeks with some outliers ranging between 0.5 to upto 40.5 weeks.

Conclusion

While some patients had PCT in-situ for longer than necessary, in two cases PCTs were removed prematurely, though no complications were recorded. The observed practice variability prompted the introduction of a local pathway, with recommendations from UGI consultants. This initiative should help prevent delays in patient care, particularly considering that the rotating junior doctors usually will lack familiarity with the management of such cases.
WP6.11 - Systematic Review and Meta-Analysis of Written Interventions Used In the Informed Consent Process
Authors: Clements Joshua Michael , Clements Jake Simon , Clarke Mike , Kirk Stephen
Published: September 2024

Aim

Written interventions are the earliest and most prevalent mode of information provided to patients in clinical practice. They are used as an adjunct to the verbal discussions between clinician and patients during the informed consent process. This review aimed to assess the effects of these interventions.

Method

This was a subgroup analysis from a larger systematic review and meta-analysis conducted according to the predefined protocol developed and registered on PROSPERO (CRD42023380406). . Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of written interventions designed to improve the informed consent process. Adults > 18 years with the capacity to consent were included. The Cochrane risk of Bias (RoB) tool was used to assess study quality. Effect measurements were assessed using standardised mean differences and risk ratios for continuous variables and dichotomous variables respectively.

Results

35 studies (37 intervention arms) contributing 3600 patients met the inclusion criteria. All but one study were conducted in an elective setting across a variety of surgical, radiological, endoscopic, oncological, and medical disciplines. Statistically significant improvement was demonstrated, in short (SMD 0.88, 95% CI 0.29 to 1.47, I2 = 81%) and long-term knowledge (SMD 0.38, 95% CI 0.14 to 0.62, I2 = 66%). There was no difference in immediate knowledge, satisfaction, or anxiety with the informed consent process.

Conclusions

This review provides a global overview of the impact of written interventions which has demonstrated improvement in short and long-term knowledge. These readily accessible intervention types should be considered as an adjunct during informed consent consultations to better inform decision making.
WP6.17 - Assessing the value of a general surgical handbook to improve confidence levels in foundation year one doctors
Authors: Brown Denise , George Jayan , Savage Daniella , Yeluri Sashidhar
Published: September 2024

Aims

Evaluate the surgical handbook with former foundation year one (FY1) doctors in general surgery. Identify areas where further support could be given to improve confidence levels.

Methods

FY1 doctors from August 2022 – July 2023 who rotated through general surgery were invited to evaluate the guide in January 2024. Twenty questions used Likert scales (1 to 5: not at all confident to very confident; not useful to very useful) to assess the management of the general surgical patient having read the guide. Four questions assessed the overall value of the guide and a further four questions focused on how to improve the guide; including, individual sections needing further development. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results

32% (10/31) completed the survey.

100% (10/10) found the guide helpful and felt it would enhance their general surgical experience.

90% (9/10) felt the guide would have a positive effect on their morale through their rotation.

Modal scores ranged from four to five for how confident FY1 doctors are in managing different aspects of general surgery having read the guide.

Overall, the guide was seen as very useful.

Areas where the guide could be improved include; post bariatric surgery, post-surgery nutrition and pancreatitis.

Conclusions

Evaluation of the surgical guide was very positive. This guide could be used to help enhance the general surgical rotation of FY1 doctors.
WP7.3 - FAMiSH: FAsting prior to eMergency general Surgery in Hospital – Quality improvement project protocol
Authors: Khirfan Hamzeh , Shams Ola , Alexiadis Aris , Ragatha Ram
Published: September 2024

This study was conducted to evaluate adherence to preoperative fasting guidelines at the RD&E hospital, focusing on safety and reducing prolonged fasting complications particularly in patients with extremes of age, diabetic or co-morbid.

Data were gathered anonymously over 2 cycles for 4 weeks through patient records and questionnaire to access patient given instructions for fasting. All patients with planned procedures were included, excluding emergency operations (NCEPOD) 1 or 2a/2b classification. Issues such as inadequate communication, excessive fasting, insufficient monitoring, and medication mismanagement were addressed.

Cycle one revealed 25% of patients fasted for more than 6 hours, 56.25% did not consume liquids for more than 12 hours, and 25% abstained from drinking for more than 8 hours preoperatively. It was noted that guidelines were not thoroughly adhered to. Some patients have missed their medications, as well as diabetic patients with prolonged hours of fasting. We have provided a session for junior doctors and nurses aiming education on ASA guidelines and encouraging individualised fasting plans for patients. Information leaflets were created to be distributed to patients planned for surgery. In the second cycle only 20% and 24% of patients didn’t follow fasting guidelines for solids and liquids respectively as compared to 68.75% of the patients receiving inappropriate instructions in 1st cycle, showing significant improvement in patient care.

In our study at the RD&E we have noted an improvement in departmental focus on adherence to fasting guidelines, which focus on abstaining from solid foods up to 6 hours and drinks up to 2 hours prior to surgery, aiding patient safety and improvement of quality of care.
WP7.13 - Recognising Clinical frailty in the Periooperative setting in the Acute Surgical Unit
Authors: Small Sarah , McGucken Sara , Yoong Susan
Published: September 2024

Aim

Due to an ageing population the number of elderly patients undergoing surgery is increasing. The literature and NELA guidance has highlighted frailty can lead to increased risks related to surgery, quantified by Clinical frailty scoring. With the introduction of the regions first Perioperative care for Older People undergoing Surgery (POPS) service, we aim to determine if formal documentation of clinical frailty score improved awareness of these patients and impacted on clinical outcomes.

Methods

A 3 week note review was completed of all patients over 65 admitted to the acute surgical emergency unit. Frailty was scored using the Rockall Score. The first cycle was a review of current documentation practice, with a subsequent cycle of documentation of frailty score following interventions included; clinical posters in clinical areas, teaching and medical and nursing staff handover.

Results

At baseline zero patient had a Rockall Clinical frailty score CFS documented. There has been an increase in the number of patients >65 years old who have a frailty score documented within 24 hours of admission. 15/40 patients over 65 had a CFS documented improved by 37.8%.

Conclusion

Overall improvement of documentation and awareness has been demonstrated highlighting higher frailty patients and those for POPS review to improve perioperative outcomes.
ThP1.7 - Moving to a specialist nurse-led service for genetic testing in breast cancer
Authors: Jones Stacey , Booker Susan , Frame Richard , Hamilton-Burke Werbena , Waterworth Alison
Published: September 2024

Aims

To assess the impact of a genetics nurse led clinic in breast cancer patients treatment.

Methods

A specialist, nurse-led breast cancer genetics service was set up in September 2022 for patients meeting the R208 and R444 criteria. A prospective data collection was performed from September 2022 to October 2023 and included patient demographics, test result and if the result led to any alteration in management of patient.

Results

78 eligible patients, with a mean age of 52.8 (31-90) years. 4 (5.1%) were male. 1 (1.3%) patient declined testing, a further 1 (1.3%) patient was undecided and 1 (1.3%) wished for storage only. Patients waited 1-2 weeks following a breast cancer diagnosis to see the nurse specialist and 4-6 weeks for urgent results. The pathogenic variants identified were BRCA1 (5.3%), BRCA2 (6.7%), CHEK2 (2.7%) and PALB2 (1.3%). Of the remainder 84% of patients tested negative. Altered management occurred in 8 (10.7%) patients, 4 (50%) received risk reducing surgery, 2 (25%) received Olaparib and 2 (25%) received Olaparib and underwent risk reducing surgery.

Conclusion

The move to a nurse-led service has proved to be successful in terms of reduced waiting times for genetic testing appointments and results. It also ensured that all appropriate patients with breast cancer were offered genetic testing, leading to more effective and efficient treatment decisions, such as risk reducing surgery and tailored chemotherapy which could improve long-term health outcomes.
ThP1.11 - Harnessing digital consent analytics to highlight multicentre operative and consent trends in breast surgery
Authors: John Edward St , Moore Connor
Published: September 2024

Introduction

Paper-based consent is difficult to audit at scale, therefore hospital episode statistics data is used to provide insights into national breast surgical practice. However, as digital consent is becoming routine, analysis of amalgamated data is possible to provide a better understanding of consent practice.

Methods

Between 22/04/2020-29/11/23, patient anonymised digital consent data was analysed retrospectively using Concentric Health analytics (Audit ID:1123ABS). Inclusion criteria required the responsible clinician to be a breast surgeon, with non-breast surgical procedures excluded.

Results

n=6860 digital consent episodes were performed across 10 NHS Trusts and 4 private institutions (n=890 unique operations. n=82 unique responsible clinicians, n=191 consenting clinicians). 45.6% (n=3125/6860) of the cases were consented by consultants. 18.7% (n=1286/6860) underwent a mastectomy; 78.5% simple & 21.5% reconstruction (of which 82.6% implant and 17.4% autologous reconstruction). 40.1% (n=2750/6860) underwent breast conserving surgery (79.2% WLE, 18.9% therapeutic mammoplasty, 1.9% Intercostal perforator). Re-excision of margins accounted for 16% of BCS cases (n=441/2750). SLNB was performed in 40.6% and ANC in 11.5% of all breast surgery cases. Regarding localisation; 44.5% Seed, 30.6% Wire, 21.7% palpable/other, 3.2% USS skin mark.

Conclusion

As well as providing benefits in terms of information sharing and improved patient satisfaction, digital consent also provides an opportunity to provide high-level data, regarding which operations are being consented to, when and by whom.
ThP1.13 - Short term safety outcomes of immediate pre-pectoral implant based reconstruction
Authors: Jones Stacey , Frame Richard , Hamilton-Burke Werbena , Waterworth Alison
Published: September 2024

Aims

In the UK up to 43% of women undergo immediate breast reconstruction (IBR) following mastectomy for breast cancer. Implant reconstruction is the commonest form of breast reconstruction and pre-pectoral techniques have been introduced with the aim of improving cosmetic outcome and avoiding animation.

To assess the safety of pre-pectoral implant based breast reconstruction (PPBR), including infection rates, 30 day re-admission to hospital, need for unplanned surgery and implant loss at 3 months.

Methods

A retrospective study of 80 consecutive women who underwent PPBR for breast cancer or risk reduction between October 2020 and October 2023. Demographic, operative and complication data were collected.

Results

Eighty women (70 cancer, 8 risk reducing and 2 cancer/risk reducing) underwent 94 PPBR procedures (80 Skin sparing mastectomies and 14 Nipple and skin sparing mastectomies) with a mean age of 51.5 (range 28 to 79) years and a BMI of 25.2 kg/m2. 7 (8.8%) of women were smokers. The mean implant size used was 385cc (range 160cc to 650cc) with a mean breast weight of 448.6g (range 45g to 1700g). 10 (12.5%) women required oral antibiotics for wound infection with a further 2 (2.5%) women requiring re-admission within 30 days for IV antibiotics. 17 (21.3%) developed a seroma with 8 (47.1%) requiring drainage. No implant losses were recorded within 3 months of reconstruction.

Conclusion

We have demonstrated that PPBR is a good option for patients of a wide age range with a large variation in breast size with minimal complications and no implant losses.
ThP2.15 - Investigating the use of autologous stem cell therapy in the treatment of Androgenetic Alopecia
Authors: Lim Jun Sing , Cui Xiangmei
Published: September 2024

Background and Introduction

Androgenetic alopecia (AGA) is the commonest form of alopecia and is characterised by progressive degeneration of hair follicles and programmed cell death, impacting individuals of both genders. This affects 80% of individuals in the Caucasian population and causes impairment of quality of life. The cause of AGA is complex and involves androgens, genetics, and hormonal miniaturisation. Dihydrotestosterone (DHT) is the primary androgen responsible for activating pathogenic pathways, resulting in the shortening of terminal follicles. Existing treatment methods are currently limited, and the development of a therapeutic approach that overcomes these limits might be of importance in plastic surgery.

Method

A comprehensive search is conducted on databases including Pubmed, Medline, Ovid, and Embase. Research studies are extracted and analysed using the PRISMA table.

Results

The bulge region serves as a vital reservoir of epidermal and melanocytic stem cells. The use of Rigenera® and autologous stem cell therapy has the capability to collect and separate these stem cells (SCs), leading to a 29% ± 5% augmentation in hair density over a span of 6 months. Additional types of multipotent stem cells, such as those found in adipose tissue, bone marrow, and human umbilical cord blood, might potentially be suitable for the purpose of hair regeneration. Possible advantages include a reduced number of biopsies, a shorter treatment duration, and not being limited by the number of donor follicles compared to surgical intervention.

Conclusion

Autologous stem cell therapy demonstrates potential effectiveness and warrants additional investigation to enhance the therapeutic efficacy of AGA.
ThP3.5 - A systematic review of comparing the outcomes of per-oral endoscopic myotomy vs pneumatic dilation in patients diagnosed with achalasia
Authors: Singh Anurag , Khan Nida , Kanagasundaram Sivanthi , Swaminathan Christie , Singh Krishna , Sajid Muhammad
Published: September 2024

Objective

The objective of this meta-analysis is to compare the success rate of per-oral endoscopic myotomy (POEM) versus pneumatic dilation (PD) for patients with achalasia.

Methods

Studies reporting success rates and symptoms in patients undergoing POEM versus PD were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results

Four studies on 319 patients reporting success rates and Eckardt scores were included. In the random effect model analysis, the success rate [odds ratio (OR) 6.22, 95%, CI (3.23, 11.97), Z = 5.47, p = 0.00001] favoured the PD and there was no heterogeneity (Tau2 = 0; Chi2 = 1.29, df = 2 (P = 0.53; I2 = 0 %) among included studies. Eckardt scores [mean difference -0.36, 95%, CI (-0.76, 0.03), Z = 1.79, p = 0.07] suggesting the achalasia symptoms severity was also similar in both interventions. There was moderate heterogeneity (Tau2 = 0.10; Chi2 = 7.47, df = 3 (P = 0.06; I2 = 60 %) among the included studies.

Conclusion

The POEM seems to be more successful when compared to the PD for patients with achalasia. On comparison of Eckardt score, there was no statistical difference seen between the two groups.