bluuebunny/crossref_metadata_2025 huggingface dataset:
1303 The Role of Cemiplimab in the Management of Locally Advanced and Metastatic Squamous Cell Skin Cancers: A Case Report
Authors: Kazzazi D , Bhojwani D , Coulson S , Fife K , Khatib M
Published: August 2023

This case report discusses the use of cemiplimab, an immune checkpoint inhibitor, as a single agent for management of locally advanced basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) in a 79-year-old male patient. The patient was initially referred to plastic surgery for facial lacerations closure after a fall and was incidentally found to have suspicious lesions on his central forehead, right lateral canthus, mid-face, & anterior shoulder. He had history of skin lesions treated with photodynamic therapy, and recent palliative radiotherapy and fixation of a right humerus pathological fracture. Biopsy of the lesions confirmed locally advanced BCC and SCC malignancies, and underwent staging imaging, which showed evidence of osseous metastasis and lymphadenopathy. The patient was offered operative treatment with hemi-maxillectomy, orbital exenteration, and neck and axillary dissection but opted for immunotherapy drug with cemiplimab in accordance with National Institute for Health and Care Excellence (NICE) guidelines for treatment. The patient's skin lesions improved significantly after 3 rounds of treatment with shrinkage of the right lateral canthus and right midface lesions, apparent resolution of the forehead lesion, and improvement in the chronic shoulder wound, and no palpable regional lymphadenopathy. This case report adds to the growing body of evidence supporting the use of checkpoint inhibitors for SCCs and BCCs, particularly in cases where surgery and radiotherapy are not suitable. It also discusses current guidelines and socio-economic implications of this treatment. Overall, further research/trials are needed to determine optimal management strategies and improve outcomes for patients with SCC and BCC.
336 Cardiopulmonary Fitness and CR-POSSUM in One-Year Outcomes of Colorectal Patients
Authors: Tay T , Fleet B , Golder U , Legga A , Davies E , Raymond T , Hawkin P , Janta E , Ryska O
Published: August 2023

Aim

Colorectal surgery can be a high-risk surgery. Risk stratification takes the form of calculation tools, like ColoRectal Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM), and measurement of cardiopulmonary fitness using exercise test(CPET). Literature search on Pubmed and Science Direct did not show any studies have reviewed correlation between both tests and postoperative outcomes of patients undergoing colorectal surgery. Hence, we aim to assess correlation of CR-POSSUM and CPET using postoperative morbidity as primary outcome.

Method

All patients with stage I-IV CRC who underwent CPET testing between January 2013-June 2021 were collected and followed-up for 30days. Major postoperative complications were classified using Clavien-Dindo Classification≥Grade 3. Anaerobic threshold (AT) and VO2Max were used as markers of cardiopulmonary fitness on CPET.

Results

In total, 160 individuals with both CR-POSSUM and CPET were included,64% were male,115 underwent surgery. Median age was 77.2(±8.0). Mean CR-POSSUM operative severity, physiology score and predicted mortality were 7.5(7-9), 11.7(6-18) and 7.0(0.7-28.4) respectively. Mean AT was 9.9(±2.27) kg/ml/min and VO2Max was 74.4(±15.2)%. These variables did not show normal distribution(p-<0.05).

AT was correlated with VO2Max(p = 0.03), but not CR-POSSUM. VO2Max was correlated with CR-POSSUM physiology score(p = 0.002) and CR-POSSUM predicted mortality(p = 0.003). Fifteen (13%) patients experienced major post-operative complications. There was no correlation between presence of severe complications and AT, VO2Max or CR-POSSUM(p>0.05).

Conclusions

Some CPET variables correlates with CR-POSSUM physiology score and predicted mortality. Low level of cardiorespiratory fitness did not predict major postoperative complication.
602 Bilateral Warthin's Tumour of the Parotid Gland: A 16-Year Retrospective Analysis and Systematic Review
Authors: Gupta A , Siddiqui Z , Nam R H K , Huynh R C T , Jan M , Dusu K , Dhar V
Published: August 2023

Aim

Warthin’s tumour (WT) is the second most common benign parotid tumour in the United Kingdom. The World Health Organisation (WHO) states that WTs are bilateral in 5-14% of patients. However, current medical literature varies significantly more. We aim to assess the frequency of bilateral WTs over the last 16 years at a large head and neck unit in Kent, England and to perform the first systematic review of literature on bilateral WTs.

Method

A single-centre retrospective analysis of patients who were diagnosed with WT on histology between January 1st, 2005, and December 31st, 2020 was conducted. A systematic review (PROSPERO Registration Number: CRD42022326846) of literature was performed using PubMed and the Cochrane Library. The inclusion criteria were full-text published studies in English describing patients, at any age, who were diagnosed with bilateral WTs.

Results

290 patients (112 females) diagnosed with WTs were included in our retrospective analysis. 24.5% of our patients had bilateral WTs. WTs in female patients were bilateral in 28.6% of cases and 21.9% in male patients. Our systematic review identified 157 papers, of which 14 met our inclusion/exclusion criteria. These studies reported the prevalence of bilateral WTs to range from 0.65% to 40% and the mean was 12.5%.

Conclusions

Our study showed that 1 in 4 of our patients had bilateral WTs and nearly a third of WTs in females were bilateral. This varies significantly from the WHO guidelines (5-14% bilateral WTs). This will be of interest to surgeons who discuss this disease with future patients.
125 Central Lymph Node Dissection Increases the Rate of Postoperative Complications During Thyroidectomy Surgery - a Retrospective Observational Study
Authors: Brzeszczynski F , Pryt M , Kusinski M
Published: August 2023

Introduction

Total thyroidectomy is a commonly performed endocrine surgical procedure. Where thyroid malignancy is suspected, additional central lymph node dissection (CLND) may be performed intraoperatively leading to greater tissue dissection. The aim of this study was to assess the impact of CLND during thyroidectomy surgery on postoperative outcomes.

Method

This single center retrospective observational study was performed with reference to STROBE guidelines. Data from 712 patients undergoing total thyroidectomy and total thyroidectomy with CLND was collected during a 1-year period between September 2021 and September 2022. Patients were assessed by demographic data, surgical characteristics and complication rates including hypocalcemia, dysphonia and length of hospital stay.

Results

567 of the patients underwent total thyroidectomy and 145 patients underwent a total thyroidectomy with central lymphadenectomy. There was no statistically significant difference in age (55 vs. 58, p = 0.768) or sex (88% vs. 86% female, p = 0.914) between the groups. Overall, there was a 14% rate of complications in thyroidectomy with CLND group and 8% rate in thyroidectomy group (p = 0.022). 4% and 7% rates of hypocalcaemia (p = 0.140), 3% and 8% rates of dysphonia (p = 0.016) were recorded in thyroidectomy with CLND and thyroidectomy alone groups, respectively. There was no significant difference in oesophageal damage or post operative bleeding rates between the groups.

Conclusions

Thyroidectomy with CLND compared to thyroidectomy alone is associated with increased rates of post operative complications. These findings are most likely associated with greater tissue dissection and tissue manipulation.
1189 Identifying Opportunities for Global Surgery in Cameroon: An Analysis of Existing Health Policies and Events
Authors: Takoutsing B D
Published: August 2023

Aim

analyze existing national health policies and events in Cameroon to identify opportunities for surgery, obstetrics, trauma, and anesthesia (SOTA) policies.

Method

We searched the Cameroonian Ministry of Health’s health policy database to identify past and current policies. Next, the policies were retrieved and screened for mentions of SOTA-related interventions using relevant keywords in French and English and analyzed using the ‘eight-fold path’ framework for public policy analysis.

Results

We identified 136 policies and events and excluded 16 duplicates. The health policies and events included were implemented between 1967 and 2021. Fifty-nine policies and events (49.2%) mentioned SOTA care: Governance (n = 25), infrastructure (n = 21), service delivery (n = 11), workforce (n = 11), information management (n = 10), and funding (n = 8). Most policies and events focused on maternal and neonatal health, followed by anesthesia, ophthalmologic surgery, and trauma. Nineteen (32.2%) health policies and events focused on Bellwether surgical procedures. National, multinational civil society organizations and private stakeholders supported these policies and events, and the Cameroonian Ministry of Public Health was the largest funder.

Conclusions

Most Cameroonian SOTA-related policies and events focus on maternal and neonatal care, and health financing is the health system component with the least policies and events. Future SOTA policies should build on existing strengths while improving neglected areas, thus attaining shared global and national goals by 2030.
1069 Radiological Diagnosis of Groin Hernia - The New Norm?
Authors: Nishith S , Greene K , Heshaishi M
Published: August 2023

Aim

Ultrasound is an effective means for diagnosis of groin hernia however, RCS England and The British Hernia Society recommend that herniae should be diagnosed clinically and ultrasound should not be arranged at a primary care level. Following an increase in radiologically-diagnosed herniae referred to the general surgery department, we sought to determine whether ultrasound was used as a primary diagnostic tool.

Method

Ultrasound requests received from primary care between January and December 2021 were identified using radiology department records. Exclusion of incomplete, follow up and paediatric scans (<16 years old) was ensured. Electronic records were reviewed for clinical history, examination, radiology request and imaging report.

Results

342 patients were included. 193 patients had the right groin scanned and 149, the left. The predominant symptoms for which scans were requested were “lump/swelling” (46%) and “pain” (36%). 13% were for suspected recurrence. 27% had a hernia on examination and 45% had no documented examination findings. The most common clinical question on imaging requests was “?hernia” (63%). 143 (42%) of ultrasound scans positively identified a hernia. Of these, 52% had a documented hernia on examination.

Conclusions

Ultrasound imaging is commonly used to diagnose or confirm diagnosis of groin hernia in the primary care setting. This study was conducted during the COVID-19 pandemic; reduced access to face-to-face consultations may have resulted in increased use of imaging and absence of clinical examination in the assessment of these patients. Patients with suspected hernia should be reviewed by a secondary care specialist prior to diagnostic imaging.
1199 Impact of COVID-19 on Outcome from One-Stop Hernia Clinics at a District General Hospital – a Single-Centre Retrospective Observational Study
Authors: John J , Trung Le H B , Park E , Couper J , Mousfi S , Raja A , Malik M
Published: August 2023

Aim

The COVID-19 pandemic has created additional pressures on waiting lists for elective surgery due to cancellations and redeployment. There was a concern that clinicians may be reluctant to offer elective operations as a result. This study aims to investigate this by comparing the clinic outcomes of patients referred to our hernia clinic at a district general hospital pre- and post-pandemic.

Method

Data was collected retrospectively for patients reviewed at our department’s outpatient clinics between 01/04 – 01/07 2019 and 01/04 – 01/07 2022 to capture an equivalent pre- and post-pandemic era (n = 1,264). Demographic data (age, BMI, ASA, previous abdominal surgery) was collected based on the GP referral and the outcome was recorded from the clinic letter. A total of 234 (n = 101 in 2019; n = 133 in 2022) were referred to the one-stop hernia clinic and included in this study.

Results

The patients seen in clinic pre-pandemic had the following outcomes: 62.4% (63/101) were offered an operation, 19.8% (20/101) were discharged, 13.9% (14/101) had follow-up, and 4.0% (4/101) had imaging requested. In the post-pandemic era, the patients reviewed had the following outcomes: 68.4% (91/133) were offered an operation, 20.3% (27/133) were discharged, 4.5% (6/133) had follow-up and 6.8% (9/133) had imaging requested. The difference in operations offered between years was not statistically significant (p>0.05). Furthermore. there were no significant differences in the demographics between the two patient groups that could have affected the analysis.

Conclusions

This study demonstrates COVID-19 has not made a significant impact on how frequently we offer our patients elective hernia operations.
894 Attitudes, Barriers and Difficulties to Discharge – a Qualitative Approach
Authors: Lukaszewicz A , Linganathan S
Published: August 2023

Aim

It is well accepted that prompt and effective discharges are crucial in order to sustain patient continuity of care, patient flow and create bed space for patients. Systematic difficulties and the health professional staffing crisis may create further barriers to satisfying the above statement. Thus, the authors have investigated the titled characteristics with a view to instigating beneficial changes.

Method

A curated questionnaire was designed and emailed to all health care professionals who worked within the general surgical department at the authors’ trust who completed discharge summaries. A total of 26 respondents completed the survey.

Results

The main obstacle in completing discharges was lack of patient knowledge (40% of respondents) followed by time pressure (28% of respondents). In addition, each discharge usually took 11 minutes or more. Discharge priority is deemed to be of variable importance, with 52% ranking it as moderate priority and 24% deeming it to be high priority. Multiple symbiotic factors were thought to be important in improving the discharge process. However, the single key factor was dedicated protected time to complete discharge paperwork (17.39% of respondents). 60% of respondents ideally favoured a typed discharge summary with 28% preferring dictation despite a lack of knowledge and understanding of the available resources.

Conclusions

This work has offered a valuable insight into the attitudes, barriers and difficulties surrounding discharges with scope to instigate improvements, such as the use of dictation software, protected time and subsequent possible policy changes.
586 A Systematic Review of Outcomes Following Pyrocarbon Hemiarthroplasty of the Shoulder
Authors: Low W X , Asokan A , Williams D , Aresti N
Published: August 2023

Aim

Pyrocarbon (PyC) is increasingly used in shoulder hemiarthroplasty (HA) due to its favourable tribology in reducing glenoid erosion. This systematic review aims to evaluate the clinical and functional outcomes, along with the survivorship of PyC HA.

Method

PubMed (MEDLINE), Cochrane, Embase, and Google Scholar were systematically searched from inception in accordance with the PRISMA guidelines. Searched terms included ‘Pyrocarbon OR Pyrolytic Carbon’, ‘Hemiarthroplasty’, and ‘Shoulder’. Studies reporting clinical, functional outcomes, or survivorship of stemmed PyC shoulder HA were included. Quality of evidence was assessed using the MINORS criteria.

Results

Six studies met the inclusion criteria. 197 shoulders with PyC HAs were analysed at mean follow-up of 30.1±7.6 months. The Constant Score improved from 35.1±16.5 preoperatively to 74.3±15.6 at final follow-up (p<0.001). Patients with post-traumatic sequelae showed less of an improvement, from 25.4±15.4 to 50.5±20.7 (p<0.005). Subjective Shoulder Value was reported in two studies, showing an improvement from 35.0±21.9 to 81.1±12.9 (p<0.001). Statistically significant improvements in active range of motion were reported across five studies. Radiographic evidence of progressive glenoid erosion was observed in 24.6% of the shoulders, however only 1.7% were revised due to painful glenoid erosion. The overall revision rate was 7.4%.

Conclusions

The current literature suggests PyC HA provides promising clinical outcomes comparable to non-PyC alternatives. The rate of clinically significant glenoid erosion at short-term follow-up remains low. However, the paucity in the literature would benefit from larger and longer-term studies to validate the use of PyC HA over other forms of shoulder arthroplasty.
447 Haptoglobin Treatment to Improve Outcome After Aneurysmal Subarachnoid Haemorrhage: A Consensus Perspective on Clinical Translation
Authors: Galea I , Bandyopadhyay S , Bulters D , Humar R , Hugelshofer M , Schaer D ,   SAH Delphi Group
Published: August 2023

Aim

Aneurysmal subarachnoid haemorrhage (aSAH) is a devastating form of stroke with an unmet need to improve outcome. This study focusses on the development of intrathecal haptoglobin supplementation as a treatment by reviewing current knowledge and progress and arriving at a Delphi-based global consensus regarding the role of extracellular haemoglobin and research priorities for clinical translation of haemoglobin-scavenging strategies.

Method

A narrative review of the topic by searching PubMed with relevant keywords and through discussions with leading expert in the field of aSAH. A modified Delphi processes. Four virtual meetings were held, two prior to starting, and two during the first round. Otherwise, the study was conducted electronically.

Results

Clinicians (n = 72) and scientific experts (n = 28) from five continents participated in the Delphi study. Microvascular spasm, iInflammation, microvascular spasm, and initial intracranial pressure rise were deemed the most important pathophysiological pathways determining outcome. Extracellular haemoglobin was thought to play an important role mostly in iron toxicity, oxidative stress, nitric oxide homeostasis and inflammation. While useful, there was consensus that further preclinical work was not a priority, with most believing the field to be ready for early phase trial. The highest priorities were related to confirming haptoglobin’s anticipated safety, individualized versus standard dosing, timing of treatment, pharmacokinetics, pharmacodynamics and outcome measure selection.

Conclusions

These results highlight the pressing need for early phase trials of intracranial haptoglobin for aSAH, and the immense value of early input from clinical disciplines on a global scale during the early stages of clinical translation.
398 Histological Lymph Node Ratio and Long-Term Survival After Pancreatoduodenectomy for Pancreatic Ductal Adenocarcinoma
Authors: Shaw C , Pericleous S , Patel K , Morare N , Khosh Zaban M , Davidson B ,   RAW Study Collaborators
Published: August 2023

Background

Pancreatoduodenectomy (PD) is recommended in fit patients with a resectable pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head. Early rates of recurrence are high and long-term survival is uncommon. This study aimed to investigate the association between histological lymph node ratio (LNR) and long-term survival.

Method

Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients with histologically confirmed PDAC were identified, and five-year and overall survival rates were compared by LNR (number of positive resected nodes/total number of resected nodes). Analyses were performed using Fisher’s exact test, the Kaplan-Meier method, and the log-rank test.

Results

In total, 885 patients (59.6%) were found to have PDAC. Concerning LNR, 412 patients (48.3%) had a LNR <0.2 and 437 (51.5%) had a LNR ≥0.2 (unknown: 36 cases). Five-year survival was significantly higher in the former (34.0% vs 10.5%, p<0.0001). LNR was 0, >0.0-0.2 and >0.2 in 116 (17.5%), 261 (39.5%) and 284 (43.0%) patients, respectively (patients with missing data were excluded). Median survival was 646 (95% confidence interval: 526-766), 532 (483-581) and 438 (395-481) days, respectively (p<0.00001).

Conclusions

In our multicentre study of PD patients with confirmed PDAC, a histological LNR ≥0.2 was associated with reduced five-year survival. Patients with a LNR of >0.0-0.2 and >0.2 lived a median of 114 and 208 days less than those with a LNR of 0.0.
1111 Should age affect the decision to offer pancreaticoduodenectomy to patients with a suspected malignancy of the pancreatic head? Results from a multicentre study
Authors: Patel K , Shaw C , Morare N , Pericleous S , Khosh Zaban M d , Davidson B ,   RAW Study Collaborators
Published: August 2023

Aim

Prior studies have concluded that advanced age alone should not be an absolute contraindication to pancreaticoduodenectomy (PD). This study aimed to compare PD outcomes by patient age and quantify these risks.

Method

Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for pancreatic head malignancy (29 centres in 8 countries, n = 1484). Patients were grouped by their age and the following were compared: median length of stay (LoS), 30-day readmission rate, 90-day mortality rate, unplanned return to theatre rate, provision of nutritional support, five-year recurrence, and five-year survival. Comparisons were made using the Mann-Whitney U test and Fisher’s exact test.

Results

Concerning patient age, 7.1% were <50 years, 15.7% were 50-59, 36.7% were 60-69, 34.1% were 70-79 and 6.3% were ≥80. 90-day mortality rates were 3.8%, 3.0%, 1.7%, 5.7% and 7.4%, respectively, and five-year survival was 31.1%, 41.2%, 32.5%, 28.5% and 21.9%, respectively. When those aged <70 were compared to those ≥70, median LoS (13 vs 12.5 days, p = 0.8), 30-day readmission (9.6% vs 8.2%, p = 0.4), unplanned return to theatre rate (4.2% vs 6.0%, p = 0.15) and five year recurrence (62.4% vs 58.2%, p = 0.1) were similar but 90-day mortality (2.3% vs 5.8%, p = 0.0006) and five-year survival (34.6% vs 27.5%, p = 0.005) rates were significantly lower in the former.

Conclusions

Older patients should be considered for curative-intent PD if they have an appropriate performance status but one must consider the slightly higher rates of peri-operative mortality and reduced five-year survival.
1248 DELPHI Consensus Study - Splanchnic Venous Thrombosis in Acute Pancreatitis
Authors: Scott M , Bekheit M , Ghazanfar M , Ramsay G
Published: August 2023

Aim

A DELPHI consensus process was conducted to identify new areas for research in the largely understudied territory of Splanchnic Venous Thrombosis (SpVT). The overarching purpose was to help establish at-risk patient subgroups, current expert therapeutic practices and key outcome measures of SpVT in the short-, medium- and long-term care of patients.

Method

Duration: 2021-2022. International pancreatitis experts designed Redcap software surveys following DELPHI consensus methodology. Stakeholder distribution was via international networks, extending outreach to SpVT experts from intensive care, pancreatology, and general/HPB surgical backgrounds, who work in tertiary centres worldwide. Question design targeted at-risk subgroups, optimal diagnostic and management modalities, and order-ranked outcomes. Blinded data analyses were performed using Redcap software.

Results

ROUND 1 n(respondents) = 73/153. ROUND 2 n(respondents) = 53/73.

75% of experts agree that SpVT increases mortality among patients with acute pancreatitis. By Round 2, there was overwhelming consensus that therapeutic anticoagulation was beneficial for Portal Vein SpVT (90.4%) and Superior Mesenteric Vein (92.3%) thromboses (SpVTs), provided there were no significant patient bleeding risk factors. No consensus was reached regarding duration of anticoagulation.

Conclusions

There exists significant heterogeneity for optimal duration of therapeutic anticoagulation to treat SpVT in acute pancreatitis. While consensus clearly suggests a role for therapeutic anticoagulation, this must achieve equipoise against risks. Our DELPHI process identified upper GI bleeding, liver ischaemia and bowel ischaemia as important outcomes of anticoagulation-based SpVT management for the short, mid- and long-terms of patient follow-up. Future DELPHI rounds will involve further enquiry into the optimal duration of anticoagulation for SpVT.
102 An Audit of Phimosis Management at Primary Care Level
Authors: Siah Q Z , Martin J
Published: August 2023

Aim

To audit the appropriateness of phimosis management and adherence to paediatric surgical referral guidelines at the primary care level against the Royal College of Surgeons (RCS) recommendations.

Method

A search of paediatric patients with diagnoses of phimosis, paraphimosis and Balanitis Xerotica Obliterans from January 2016 to October 2021 was performed at one General Practice (GP) surgery with a population size of 14,315 patients. Data on the frequency of urological symptoms reported, the medical treatment initiated, the number of paediatric surgical referrals and waiting times, and outcomes were recorded.

Results

A total of 35 patients with ages ranging from 1-17 years old were included. The most common symptom reported was dysuria (n = 21, 60%). Twenty-five (71.4%) paediatric patients with phimosis were referred. The paediatric surgical referral waiting times ranged from 3–232 days (mean = 111.4). Fourteen of the referred patients (73.7%) who had been reviewed by the surgical team were diagnosed with physiological phimosis and discharged back to the GP. Thirty-two per cent of the referrals (n = 8) were done without trialling on topical steroids. In terms of potency, 53.5% of the steroids (n = 15) prescribed by the GP were weaker than is recommended by the RCS.

Conclusions

Variation in practice was seen in phimosis management, including the types of steroids initiated and decisions on surgical referrals. Only pathological phimosis generally requires a referral. Therefore, a clear management and referral pathway and additional training on phimosis management within primary care providers can help optimise the patient management and appropriateness of secondary care referrals.
321 Transfer of Care to a Clinical Nurse Specialist Pathway for Patients Undergoing Exogen Therapy Improves Outcomes, Compliance, and Refund Rate
Authors: Hadi H , Ibrahim Y , Alligan K , Gheorghe A , Rongavilla W , Malhotra K , Patel S
Published: August 2023

Aim

Exogen (low-intensity pulsed ultrasound) has been shown to improve union rates following delayed/non-union. It is accompanied by a money-back guarantee in unsuccessful cases, dependent on adequate patient compliance. Using a clinician-run pathway, our unit’s results were poor, so our aim was to create a clinical nurse specialist (CNS) pathway with protocols for recording outcomes, collecting data, and claiming refunds for unsuccessful cases.

Method

This was a single-centre, retrospective, multi-cycle audit performed over 60 months on patients undergoing Exogen treatment for delayed/non-union following elective foot and ankle arthrodesis. Data was collected on union rates, Exogen compliance, and refund collections. Results were compared (Chi-squared test) for the original cohort (n = 55) and the CNS-led cohort (n = 18).

Results

In the original cohort, 24 patients (43.6%) united (mean time 225 ±145 days). Only 14 (25.5%) had treatment compliance accurately recorded and compliance rate >95%. Of 31 patients whose Exogen treatment failed, only 7 (22.6%) were eligible for a treatment cost refund due to lack of compliance / record of compliance.

In the CNS-led cohort, 12 (66.7%) patients united (mean time 190 ±77 days, p = 0.089). Sixteen patients (88.9%) had compliance accurately recorded (p<0.001), with increased compliance rates (>99%). Exogen treatment costs were refunded for 5 patients (83.3%) with residual non-union (p = 0.004).

Conclusions

Transferring patient care to a dedicated CNS-run pathway led to a non-statistically significant increase in union rates, and significantly improved compliance and fiscal return rates. Establishing dedicated protocols with paramedical staff can be cost-effective and improve outcomes, whilst reducing out-patient burden in surgical clinics.
767 A 5-Year Retrospective Review of “Code Red” Traumas Requiring Immediate Surgery in a Regional Major Trauma Centre
Authors: Winter J , Canny J , Harbinson D , Yoong S
Published: August 2023

Aim

Trauma is a major cause of mortality leading to over 16,000 deaths annually in England and Wales alone. Code red traumas are the most extreme of these and a proportion will require immediate operative intervention. The aim of this study was to review the outcomes of patients presenting to a regional major trauma centre as code red traumas requiring immediate transfer to theatre and to identify a pathway to facilitate this process.

Method

Data were reviewed for all Code Red Traumas requiring immediate operative intervention between April 2017 and April 2021. Electronic records were searched to identify aetiologies, transfer times and post-operative morbidities and mortalities. Datasets were collected and analysed using Microsoft Excel software.

Results

57 patients were identified and included. The average age was 39 years old. CT was performed in 52/59 patients (88.1%) and median time to CT was 32 minutes. All patients proceeded to theatre with an overall median time to theatre of 144.5 minutes. In hospital mortality was 19.3% (n = 11). Primary operating speciality varied with general surgery making up the majority with 30 cases. A consultant surgeon was present in 72% of cases and a consultant anaesthetist in 81% of cases. 84% (n = 48) of patients were admitted to ICU post-operatively.

Conclusions

Major trauma remains a significant cause of mortality in our cohort. We have developed a pathway for those requiring direct access to theatre. It is envisaged that this will facilitate expediated transfer to theatre and lead to improved patient outcomes.
1038 Introducing a Patient-Initiated Follow Up (PIFU) Pathway to a District General Hospital’s Urology Department: A Two-Cycle Quality Improvement Project Following the First 100 Patients
Authors: Hirniak J , Spurr S , Banerjee S
Published: August 2023

Aim

Outpatient appointments have almost doubled from 54 to 94 million in the last 10-years: 68% follow-up visits, costing £8 billion yearly. Patient-Initiated Follow Up (PIFU) enables patients to initiate follow up ‘as needed’ rather than attend routine follow-up. This project aims to introduce and improve a PIFU-pathway to reduce the 7% yearly increase in local follow-ups and improve patient satisfaction.

Method

Using Plan-Do-Study-Act (PDSA) quality improvement methodology, a PIFU-pathway for new patients under a single consultant was established in a district general hospital’s urology department. Patients in clinic were given a letter with contact number should they request review. Those within 4-to-12 months of PIFU were quantitatively evaluated through retrospective health record analysis. A further PDSA cycle sought to improve the service by acting on patient opinions collected via telephone.

Results

100 patients were evaluated with an average 6-months on PIFU. Mean age 58 years, 41% were female. PIFU indications: lower urinary tract symptoms (57%), stones (12%), UTI (9%), other (22%). Only 2% utilised PIFU, 98% sought no further appointments, 97% reported preference of PIFU over routine follow-up and improved satisfaction. 43% were unaware how to utilise PIFU; 91% either forgot about PIFU or lost PIFU contact information. Subsequent interventions include development of introductory and reminder texts, an email address, and specific webpage.

Conclusions

The project suggests PIFU can reduce the number of unnecessary outpatient appointments in secondary care, whilst improving patient satisfaction and without compromising care across numerous chronic urological conditions. Clinicians can subsequently target active problems or waiting list control.
968 Participant Experience from the Portsmouth Basic Robotic Surgical Skills Course – Addressing an Unmet Need in Robotic Surgical Training
Authors: Yiu A , Stefan S , Mykoniatis I , Niccolò Piozzi G , Naqvi S , Siddiqi N , Khan J
Published: August 2023

Aim

The increasing utilisation of and patient preference for robotic surgery (Aggarwal et al., 2022) has been reflected by surgical trainees desiring greater access to robotic training, as recently demonstrated in a large pan-specialty snapshot study led by ASiT (Fleming et al., 2022). The Portsmouth Basic Robotic Surgical Skills (BRSS) course aims to leverage experience from a leading European robotic centre to address this training gap.

Method

The Portsmouth BRSS course (6 CPD points, ASGBI) has two components. The virtual component introduces the daVinci® (Intuitive Surgical, USA) platform, robotic instruments, and port placement principles. The hands-on component teaches theatre setup, docking, and teamwork, and provides experience of robotic dissection, suturing, and stapling using simulation and synthetic models. 129 participants have successfully completed the course, which ran 14 times in the last 5 years. This study quantitatively analysed course feedback to understand the value and impact of the robotic training provided.

Results

101 feedback forms were analysed (28 pending). 87.1% (n = 88) rated the content as excellent. 84.2% (n = 85) thought they had made quite an or a major improvement in their robotic skills. 97.0% (n = 98) felt more capable using the robot after the course. 54.5% (n = 55) thought it would be >3 months before implementing their skills, due to needing more training (46.5%, n = 47) and/or lacking resources (45.5%, n = 46).

Conclusions

The Portsmouth BRSS course effectively addresses an important unmet need facing current trainees. Future work to address wider barriers in robotic training, such as a lack of higher skill training and accessible robotic resources, is needed.
1155 Role of Robotic Approach in Ileal Pouch-Anal Anastomosis (IPAA): A Systematic Review of the Literature
Authors: Jamal Z , Khawaja Z , Zafar N , Adnan N , Haider I
Published: August 2023

Introduction

Restorative proctocolectomy with ileal pouch–anal anastomosis (IPAA) has become the standard surgical treatment of choice in patients with ulcerative colitis (UC) and familial adenomatous polyposis (FAP) in which the medical management fails. Despite the wide use of the laparoscopic method, the enhanced and innovative features that come with the robotic platform, such as endo-wrist technology, 3D visualization, surgeon-controlled camera, and motion scaling, make it an appealing choice.

Aim

This study aims to investigate the feasibility and safety of robotic approach for proctectomy or proctocolectomy with IPAA as compared to conventional laparoscopic approach.

Method

A systematic review was completed for studies done between 2010 and 2022 comparing the robotic approach with the laparoscopic approach. Nine studies were found to be feasible to be included in this review.

Results

In terms of the outcomes, although the mean operating time was slightly higher than the laparoscopic approach, the other outcomes, such as mean blood loss, return of the bowel movement, mean hospital stay, and conversion to open, were found to be significantly lower in the robotic approach as compared to both laparoscopic and conventional open techniques. Despite the overall increased rate of complications combined from all the studies, the rate of significant complications such as anastomotic leaks requiring readmission and return to the theater was also found to be substantially less.

Conclusions

This study concludes that although the robotic approach is in its initial stages for pelvic surgeries, it can be safely employed due to improved dexterity and visibility.
545 Optimal Surgical Approach for Mid-Transverse Colon Cancer; a Systematic Review and Meta-Analysis
Authors: Elkomos B , Baqar S , Bhatti M , Mazhar M , Hassan M , Nuno A , Ebeidallah G , Elkomos P
Published: August 2023

Background and Aim

The incidence of cancer colon below the age of 50 has increased dramatically. in addition, the database lacks a review to analyze the outcomes of surgeries for mid-transverse colon cancer with several recent controversial studies. Our aim was to compare the outcomes of extended hemicolectomy versus transverse colectomy for mid-transverse colon cancer.

Method

PubMed, Scopes, Web of Science and Cochrane library were searched for eligible studies from inception to 1 May 2022 and a systematic review and meta-analysis were done to detect

Results

according to eligibility criteria 8 studies (2237 patients) were included in our study. The pooled results of the included studies showed no difference in the 5-year OS, 3-year DFS and 5-year DFS between the two types of surgery (5-year OS, RR = 1.15, 95% CI = 0.94-1.39, P = 0.17), (3-year OS, RR = 0.96, 95% CI = 0.88-1.06, P = 0.42) and (5-year DFS, RR = 1.21, 95% CI = 0.91-1.62, P = 0.20). In addition to that, the recurrence rate and the incidence of complications were similar in the two groups (Recurrence rate, RR = 1.08, 95% CI = 0.62-1.89, P = 0.79) and (Complications, RR = 1.07, 95% CI = 0.74-1.54, P = 0.72). however, the number of LN harvest and the time of the operation was more in case of extended hemicolectomy.

Conclusions

Despite harvesting less LN, transverse colectomy has similar oncological outcomes to extended hemicolectomy for mid-transverse colon cancer. Moreover, no significant difference in the incidence of complications.
705 Assessment of a Novel Low-Cost Abdominal Box Simulator for Laparoscopic Skills Training
Authors: Kulkarni Y , Kulkarni S , Bligh C , Redpath N , Sule M
Published: August 2023

Aim

To create a low-cost abdominal box simulator and assess its validity for Hassan’s entry technique and visiport.

Method

A low-cost abdominal box simulator was created using a metal box skeleton. This was covered in a layer of cling-film simulating the peritoneum. Red and blue tubing was placed over this creating the inferior epigastric vessels. A posterior rectus sheath was created on either side using a white cotton sheet whilst thick red woollen socks were used to simulate the rectus abdominus muscles. The entire surface was then wrapped in a thick canvas to simulate the anterior rectus sheath. Finally, a commercial skin with subcutaneous tissue was affixed and the umbilicus demarcated using a pen. This simulator was used by 30 surgical trainees (ST3 to ST7) attending a laparoscopic skills course who were asked to provide feedback on the simulator for both Hassan’s entry technique, visiport entry and the introduction of secondary ports.

Results

The simulator was rated 10/10 for validity as well as ease of use for Hassan’s open entry technique, visiport and secondary port insertion by all 30 of the trainees.

Feedback highlighted that using the simulator trainees were able to see all layers of the abdomen and gain excellent haptic feedback. The model was described as realistic as trainees were able to identify each layer of the abdomen as they performed open or visiport entry.

Conclusions

A low-cost abdominal box simulator can easily be reproduced using our technique and used to train trainees effectively.
13 Surgical Priming Improves Operative Performance in Surgical Trainees: A Crossover Randomised Control Trial
Authors: Feeley A , Feeley I , Merghani K , Sheehan E
Published: August 2023

Aim

The aim of this study was to evaluate the impact of a surgical warm-up using a virtual reality simulator on operative performance.

Method

This was a single-blinded cross-over randomised control trial in a single tertiary Orthopaedic training centre. Orthopaedic trainees were recruited, and each morning participants rostered to theatre were randomised to either undergo a simulated surgical procedure on a virtual reality simulation system prior to their first case as primary operator (priming arm), or to perform their usual preparatory routine for surgery (control arm). Consultant orthopaedic trainers were recruited within the orthopaedic unit to carry out subjective surgical performance assessments using a validated global rating scale tool on the first case the participant performed on 46 the list as primary operator.

Results

Over 3 study periods a total of 151 datapoints were collected, with 49 matched datapoints across priming status and procedural level of difficulty. Subjective assessment tools consistently demonstrated improved operative performance by participants following surgical priming (p = 0.001).

Conclusions

This study highlights that introduction of preoperative priming to improve operative preparation and optimises operative performance. This has not only implications for improved resident training, but also signals towards beneficial downstream effects on patient outcomes, and theatre list planning.
644 Closed Loop Audit: Introducing a Teaching Program and Improving Surgical Teaching in a Major Trauma Centre
Authors: Nour H M , Janakan G
Published: August 2023

Aim

The aim of the project is to introduce a surgical teaching program for surgical registrars/SHO’s/F1’s in a major trauma center and to improve the current teaching practice in Royal Sussex County Hospital (RSCH).

Method

We undertook two cycles over a period of 6 months. These cycles aimed to assess the teaching practice in RSCH using a questionnaire filled by surgical doctors in the department. Multiple teaching session was conducted including journal clubs, case presentation, practical session and high-fidelity simulation course. Hybrid methods including was used to maximize the numbers attending the sessions from home.

Results

A total of 41 doctors were involved in the study (first cycle: 23, second cycle 18). Following the introduction of multiple teaching sessions, 55.5 % of the doctors think they have enough teaching in comparison to 8.7 % in the first cycle. In addition, there was a high level of satisfaction with the teaching sessions. 44.4% of doctors were unable to attend half of the teaching session due clinical commitments such as being scrubbed or doing the ward rounds.

Conclusions

Regular teaching session can be a great challenge in a busy major trauma centre however, introducing a teaching program can improve the practice and the satisfaction between the surgical trainees. Novel methods need to be used to maximize teaching opportunities such as teams and recorded sessions for viewing at later stage. We also recommended that teaching session to be conducted in the morning before handover and this will ensure that most doctors will be able to attend.
756 Improving the Experiences of Surgical Specialties and Career Choices for Trainees. Can We Use a Virtual Platform for Surgical Taster Days?
Authors: Davies B , Gaddah M
Published: August 2023

Aim

Exploring surgical specialities is not something easily achieved as a trainee. With foundation trainees having only five taster days to explore specialities, and COVID-19 causing disruption within surgical training, the opportunities to explore potential career options have further diminished. Inadequate knowledge or experience of the different surgical sub-specialities, alongside increasing competition ratios and portfolio requirements, can make career decisions difficult for trainees.

Method

One-hour insight into surgical specialities (OISS) is a teaching series aimed to bridge the gap and allow future surgeons to experience surgical sub-specialities from behind their computers, i.e., virtually. This voluntary series runs on the platform; Medall, an online organisation that helps to run medical events. Through structured sessions, trainees explore a specialty, gaining insight into the daily job, commitments, potential cases, and portfolio tips.

Results

Over 70 trainees have registered since the series began, with over 40 trainees attending the latest session and over 20 of them being international. The use of a virtual platform, videoconferences, and telemedicine has helped to bridge the gap in hands-on experience, as well as, providing a platform for international trainees and physicians to gain an insight into UK surgical practices.

Conclusions

The series highlights that there is a place for virtual taster days and although, not completely replacing surgical opportunities, the use of technology can be used much more widely in surgical training.
842 Core Surgical Training- Are the Next Generation Prepared?
Authors: Samuels S , Holden P
Published: August 2023

Aim

The application process for core surgical training (CST) is one in which preparation is paramount to success yet knowing where to start can be a major challenge. There is a myriad of papers, books, and online material to read but is this information as good as an interview course. The aim of this project was to assess the demand for courses that support junior doctors applying for core surgical training.

Method

A one-day core surgical training interview course was designed and delivered virtually. Seven faculty members, who were all core surgical trainees, were recruited. The ten candidates recruited were foundation year two or equivalent. The format included lectures and timed practical sessions under the fundamental interview categories: portfolio, clinical and leadership/management. The final station was a mock interview that combined all skills learnt throughout the day. Feedback forms were collected.

Results

Nine out of ten candidates completed the feedback form. 100% rated excellent for the overall course content, the organisation of the course and final mock interview station. 89% rated the portfolio lecture as excellent, the remaining 11% as good. 89% rated the leadership/management lecture as excellent, the remaining 11% as good. 78% rated the clinical lecture as excellent, the remaining 22% as good. Qualitative data collected suggested the course was an excellent example of the interview day. Improvements included having the course earlier to allow for portfolio adjustments.

Conclusions

CST courses are an asset to interview success and better prepares candidates for the CST interview day.
967 Scrubbing Up: A Drain on Sustainability
Authors: Yoganathan S , Zabkiewicz C , Jones T , Shingles L
Published: August 2023

Aim

Surgical scrub is a vital step in infection control prior to operating. Hospitals typically opt for a traditional tap or a sensor-operated tap to control their water source. This project compared the water usage and efficiency per surgical scrub for the two different taps.

Method

Theatre system was reviewed to determine total number of staff members who scrubbed in for each operation, over a one-month period within one health board. Average scrubbing time and quantity of water used per scrub was calculated by observing multiple different staff members.

Results

During September 2022, 6076 staff members scrubbed in for theatres. The average time spent handwashing was 2 minutes and 26 seconds, however only 47 seconds worth of running water was used to wash their hands. Sites using traditional taps used approximately 18.6L of water whilst sensor-operated taps used 13.2L per surgical scrub. This equated to 110,752 litres of water used over the month solely for scrubbing up. Sensor-operated taps would run for 63 seconds when activated with the modal number of times sensors were activated 3. Therefore, traditional taps were more efficient with 32% of running water used for surgical scrub compared to 25% for sensor-operated taps.

Conclusions

Sensor-operated taps used less water per surgical scrub; however, the operating time of the taps reduced its efficiency. Coordinating scrubbing up and ‘sharing’ one tap or adjusting the sensor taps operating time are simple step to minimise water wastage. Furthermore, the use of ‘waterless scrub’ solution is a viable option whilst also minimising infection risk.