bluuebunny/crossref_metadata_2025 huggingface dataset:
eP71 Audit of Emergency Laparotomy Workload in a District General Hospital: Are We Compliant with NELA Data Entry?
Authors: Itaman Usifoh , Shahrokhi Nazanin , Anam Fatima , Barghash Mohammed , Dalmia Sanjay
Published: January 2025

Aim

The National Emergency Laparotomy Audit (NELA) requires all emergency laparotomies to be registered on its database after completion of care. This audit aimed to evaluate our compliance with NELA data entry by comparing the hospital's workload with national NELA data.

Method

This retrospective audit was conducted over two cycles, covering a total of 30 months. The first cycle focused on NELA Year 8, a 12-month period, which included 61 patients. The second cycle assessed NELA Years 9 and 10, covering an 18-month period, with 75 and 38 patients, respectively. All emergency laparotomies were included, while elective surgeries and procedures not captured by NELA were excluded. Data were extracted from patient records and compared with the NELA database. Analysis was performed using Microsoft Excel.

Results

In the first cycle (Year 8), 61 procedures were eligible for NELA registration, but only 31 (50%) were entered, with just 4 (13%) meeting the submission deadline. Additionally, 18 (67%) cases were registered more than 6 months after discharge, with an average delay of 206 days. Following the intervention, the second cycle showed marked improvement. In Year 9, 84% of cases were registered, and in Year 10, 95%. The average time to data entry decreased to 100 days, and all cases were submitted before the deadline.

Conclusion

Timely NELA data entry is essential for accurate representation of departmental activity. Significant improvements in compliance were achieved through targeted interventions, demonstrating the effectiveness of focused efforts in meeting national audit requirements.
eP79 Fast Pain Relief Matters: Evaluating Adherence to Chest Trauma Guidelines
Authors: Cujic Oliver , Wall Joshua , Herrod Phillip , Tierney Gillian
Published: January 2025

Aims

Patients with rib fractures represent an increasing proportion of the emergency general surgery take. All blunt chest wall trauma guidelines emphasise the importance of establishing early, adequate analgesia - defined as the ability to deep breathe and cough effectively - to reduce the risk of complications. This audit aims to assess adherence to local guidelines for analgesia in blunt chest wall trauma.

Methods

A retrospective clinical audit was conducted, reviewing patient records on the electronic medical records software (Lorenzo) in a single NHS trust. Data were collected on the time from general surgery admission to the first analgesia prescription, compared against the trust guidelines. The study sample included 18 patients admitted to general surgery with rib fractures over a two-week period (08/07/24 - 21/07/24).

Results

22% (4 out of 18) of patients were prescribed analgesia within 30 minutes of admission to general surgery. 50% (9 out of 18) of patients were prescribed analgesia within 60 minutes. 83% (15 out of 18) of patients were prescribed analgesia within 90 minutes. 94% (17 out of 18) of patients were prescribed analgesia within 150 minutes. 100% of patients were prescribed analgesia within 300 minutes.

Conclusion

This audit demonstrates a 50% lack of adherence to trust guidelines, potentially resulting in significant clinical complications. Delays in analgesia prescription may be multifactorial, including patient comorbidities and resource limitations. Further audits are planned to assess the appropriateness and adequacy of prescribed analgesia and the incidence of analgesia-related complications.
eP80 Transitioning from trauma: Audit on discharge quality for major trauma patients
Authors: Hughes Declan , Hancorn Kate
Published: January 2025

Introduction

Major trauma patients require complex multidisciplinary management with significant physical, medical, psychological, and social community rehabilitation needs. Clear effective communication on discharge is vital to ensure safe transition of care from hospital to community services. This audit aims to assess discharge quality, identify issues, and improve transition of care for major trauma patients.

Methods

Data was collected on major trauma patient discharge summaries before and after the implementation of a standardised discharge proforma, local training and education. Results were audited against the RCP discharge summary toolkit. The standard was that records would be 100% complete.

Results

The initial audit (n=20) revealed that discharges were often incomplete, unclear, and of insufficient quality with an average completion rate of 44.1%. Following proforma introduction, staff education and training this improved to 66.57%. Root cause analysis of issues comparing discharge between patients admitted on specialist major trauma ward (n=20,73.14%) vs outlier wards (n=20,60.00%) revealed significant disparity (t(50)=5.42, p=0.000). Following further reinforcement, a third cycle revealed improvement at 78.92% (trauma ward 81.08% vs outliers 76.76%; t(50)=2.12, p=0.037).

Conclusion

Major trauma patients are a unique cohort requiring comprehensive yet clear discharge to facilitate transition of care into the community. This can involve a multitude of different surgical specialties. Long-term quality improvement and education of rotational trainees on induction is essential for sustained quality. Patients on outlier wards are at higher risk of discharge issues. We present our proforma for multiply injured patients to improve discharge communication and patient care.
eP81 SIGMOID VOLVULUS – Are we Managing it Right?
Authors: Taggarsi Meghana , Chatterjee Sunetra , Senthilkumar Karishmah , Rao Milind
Published: January 2025

Aims

Endoscopic decompression for sigmoid volvulus (SV) has success rate of >80%, recurrences range between 45-71%. There is no consensus for management of SV. This study was performed to outline guidelines for management of SV in our trust.

Methods

This was a retrospective study performed over 3 years. Comorbidities were analysed using Charlson Comorbidity Index (CCI). Outcome measures included successful endoscopic decompression, length of stay, surgical management, mortality and recurrence.

Results

42 patients were included. 73.8% were male. The median age was 77 years and 85.7% were >60 years. Median CCI was 4. 76.2% had moderate and severe CCI. 69.04% were over-investigated with both AXR and CTAP.Data Parameters (N=42)Chronic constipation52.4% (22)Care home inmates9.5% (4)Bed bound19% (8)DiagnosisAXR - 73.8% (31)CTAP - 95.2% (40)Both – 69.04% (29)Deranged Electrolytes64.3% (27)Raised lactate9.5% (4)Recurrent SV33.3% (14)Management of SVSelf resolved4Rigid sigmoidoscopy (RS)18Flexible sigmoidoscopy (FS)12Both RS and FS7Sigmoid colectomy1

1 patient suffered perforation after decompression and was palliated. 4 patients had definitive elective surgery. 1 patient underwent Hartmann’s procedure following failed decompression during the 11th recurrence. Recurrences after endoscopic decompression was 53%, which corroborates with literature.

Conclusion

Endoscopic decompression remains the first line of management. However, early definitive treatment plan is necessary to reduce recurrences. This in turn would reduce readmissions and cost burden. Management of SV requires a holistic approach. This study supports early decision to elective surgery if feasible.
eP82 NELA - has it lost its way?
Authors: Wong Chloe , Hassan Kiran , Mohammed Musab , Saha Arin
Published: January 2025

Aims

NELA reports describe hospital-level mortality, process and outcome measures after emergency laparotomy. However, reports have not described which process measures influence mortality. This study analysed NELA data to determine which factors are common to low-mortality hospitals.

Methods

The Year 8 Annual RAG table was interrogated. Hospitals were grouped into ‘low mortality’ (lower than national average) and ‘high mortality’. Process measures were grouped into Red (<55%) or Amber/Green (>55%). Chi-squared tests assessed which process measures were associated with low mortality hospitals.

Results

There were 21710 cases. National adjusted mortality was 9.03% (range, 2.5%-18.4%). There was wide variability in achieving process measures; for example, the proportion of patients who went to ICU ranged from 36% to 100%.

There were no associations between any process measure and low-mortality hospitals apart from lower rates of unplanned return to theatre (P=0.009). This analysis was repeated for all NELA reports; no process measure had any association with low mortality hospitals. Hospitals with low mortality were associated with lower case ascertainment.

Conclusions

NELA reports do not describe which process measures reduce mortality. The only variable associated with lower mortality is unplanned return to theatre, suggesting that high-quality primary surgery is the only factor which hospitals should focus on. Low mortality hospitals were associated with low case ascertainment which may suggest that some (higher mortality) cases have not been submitted. The NELA data offer an unparalleled opportunity to produce meaningful findings to help improve outcomes and future reports should offer specific management recommendations and algorithms.
eP83 Enhanced Abscess Pathway. Emergency surgical flow through an Ambulatory Care Unit. A Pilot Study
Authors: Hamady Ali , Alsibai Mohamed , Nayak Peramapally , Pandey Vikas
Published: January 2025

Aims

The Enhanced Abscess Pathway (EAP) was introduced to improve patient experience and flow, utilising an outpatient setting -our Ambulatory Care Unit (ACU)- to facilitate throughput of patients. This study analysed the safety and efficacy of the EAP.

Methods

Patients >16 years with a cutaneous abscess drainage by the general surgery team were identified. Eligibility criteria included: a) general surgery abscess location, b) no spreading or extensive cellulitis, c) no IV Drug abuse, d) tachycardia resolving with analgesia, e) NEWS <2.

Abscess management was compared with a period 6-months prior to implementation of the EAP.

Results

EAP eligibility in both cycles of the audit was 76.3% (55/72) vs 80.6% (75/93). The EAP increased the rate of same-day discharges pre- (27.5%, p=0.0012) and post-operatively (25.7%, p=0.0031). The median bed day in the 1st Cycle was 1-day (IQR: 2), decreasing to 0-days (IQR:1) after the EAP. In the re-analysis, 49.3% (37/75) of eligible patients went through the pathway. 94.6% (35/37) were discharged the same day post-operatively vs 44.7% of non-EAP (17/38). There were no acute events in the discharge period during either cycle. No significant difference in prolonged admission >2 days – 5.5% (3/55) vs 6.7% (5/75) after EAP. Low risk of re-admission within 1-month in both cycles: 0% vs 4% after EAP. Readmission after the EAP was 2.7% (1/37) in the EAP group vs 5.3% (4/38) in the non-EAP group.

Conclusions

This study demonstrates that the EAP utilising the ACU environment is safe and improves patient flow for minor surgical emergencies.
eP86 Improving NELA Risk Documentation with EPIC Electronic Medical Records
Authors: Choo Li Ling , Brar Jasdeep , Wilson Iain
Published: January 2025

Aims

Identifying and extracting data from medical records can be difficult and time consuming. This can serve as a barrier to clinicians calculating a risk assessment score for patients undergoing emergency laparotomy.

The EPIC electronic patient records system enables clinicians to develop ‘Smartphrases’ to identify and extract specific data from a patient’s medical record. We developed a Smartphrase to identify the data required to calculate a NELA Parsimonious Risk Score in order to make risk calculation easier and more efficient.

Methods

A closed loop audit was conducted. Documentation of risk scores in patient notes or consent forms was observed between November 2022 to February 2023. The NELA Smartphrase was developed and publicised. Documentation of risk scoring was subsequently observed between September 2023 to September 2024. Data was analysed using a one-tailed test.

Results

42 NELA cases were retrospectively identified in the first cycle. 18/42 (42.9%) patients had a documented NELA score. 175 NELA cases were prospectively identified in the second cycle. Following introduction of the Smartphrase, 148/175 (84.6%) patients had a documented score. Introduction of the NELA Smartphrase significantly increased risk score documentation (p<0.0001).

Conclusions

This closed-loop audit demonstrates that EPIC electronic patient records can aid clinicians in calculating and documenting risk assessments for NELA patients. This tool improves efficiency and can help trusts achieve best practice tariff. This tool can be shared beyond our trust.
eP87 To pack or not to pack (abscesses) - that is the question. An audit evaluating local practice and its estimated environmental impact
Authors: Bramer Solange , Atkins William , Ingleton Rose , Sengupta Neel
Published: January 2025

Introduction

Consensus guidelines in general surgery recommend intra-operative packing for haemostasis following incision and drainage (I&D) of perianal abscesses, but suggest there is insufficient evidence for regular post-operative packing. This audit evaluated current practice in a general surgery department regarding packing of perianal and cutaneous abscesses after I&D, and estimated associated carbon emissions.

Methods

Operation notes of I&D of abscesses were reviewed in two cycles over a 6 month period. After the first cycle, results were disseminated and discussed with the department, with a recommendation for regular packing after discharge only when considered necessary. Estimated carbon savings were calculated using published emissions factors.

Results

In cycle one, 100% of the 56 patients had intra-operative packing, and 89% were recommended regular packing changes after discharge. In the second cycle of 50 patients, there was a 10% reduction in intra-operative packing and 43% decrease in post-operative packing. Carbon emissions were estimated to be 16% lower for patients without regular post-operative packing (57 kgCO2e vs 68 kgCO2e), when calculating emissions for the entire patient pathway (including travel to healthcare facility, A&E attendance, surgery, and wound care consumables).

Conclusion

This ongoing QI project has demonstrated that there is a carbon saving associated with reducing regular post-operative packing after abscess I&D. There are likely to be other benefits, such as financial savings and improved patient experience, which could be assessed through future study. We continue to work on optimising the abscess pathway and disseminating best practice guidelines locally.
eP88 The Cost Burden of Diverticular Disease in the UK: A Retrospective Analysis at a Tertiary Referral Centre
Authors: Mehmi Krisha , Williams Sophie , Haji Amyn
Published: January 2025

Aims

Diverticular disease (DD) is highly prevalent. Management largely targets complications with surgical intervention frequently used in recurrent, complicated disease. DD poses a significant burden on healthcare systems, warranting thorough cost-analysis for informed resource allocation and policy decisions. Current UK data on the cost of DD is lacking. We aim to establish the cost burden of DD at a UK tertiary referral centre.

Methods

Data were collected retrospectively from our centre between 2012 and 2021. Parameters collected included demographics, comorbidities, clinic attendances, clinical interventions and emergency and elective surgical procedures. Cost burden was quantified using Healthcare Resource Groups cost codes for each intervention, adjusted for variables including comorbidities and length of stay (LoS).

Results

470 patients were analysed. There was a mean of 8 clinic appointments per patient, with 523 total hospital admissions. Hospital bed stays totalled £600,000. Emergency surgical procedures cost approximately £225,000 (8% of total DD cost). The most frequent elective surgical procedure was sigmoid colectomy or Hartmann's procedure, costing approximately £932,000 (32% of total DD cost). The total cost burden of DD in this period exceeded £2.9 million.

Conclusions

This study revealed the substantial financial burden associated with DD. Emergency and elective surgical procedures, though utilised in only a quarter of patients, represented much of the cost. Areas for potential cost savings include reducing the repeat utilisation of CT imaging and a focus on preventative measures. Future research should be aimed at ascertaining the nationwide cost of DD and establishing cost-effective measuresfor more sustainable DD management.
eP92 Impact of a ‘Peri-operative Care of Older People undergoing Surgery (POPS)’ service on length of hospital stay in older patients undergoing emergency laparotomy
Authors: Beach Timothy , Tennant Anna , Hollyman Marianne
Published: January 2025

Aims

Older and frailer patients undergoing emergency laparotomy face increased morbidity, mortality, and length of hospital stay (LOS). Multidisciplinary teams, such as POPS (Peri-operative Care of Older People undergoing Surgery), aim to address these issues. We assessed the impact of our POPS team on LOS in older patients undergoing emergency laparotomy.

Methods

We conducted a retrospective analysis comparing LOS in patients aged 65 and above from the NELA database who met NELA criteria for geriatric review before (2014–2017) and after (2019–2020) the introduction of the POPS service at our hospital.

Results

In patients aged 65 and over undergoing emergency laparotomy between 2019 and 2022 (n=396), clinical frailty score significantly increased with age (P < 0.001), and higher frailty scores were associated with increased LOS (P = 0.047). NELA criteria mandate perioperative geriatric review for all patients aged 80 and above, regardless of frailty. Given the lack of frailty data before 2019, we compared LOS in patients aged 80 and over before (n=137) and after (n=111) the introduction of the POPS service. Eighty-eight percent of patients aged 80 and over were reviewed by the POPS team between 2019 and 2022, and LOS decreased from 19 to 16 days (P = 0.17), equating to over 300 ‘bed days’ saved.

Conclusion

The introduction of the POPS team has reduced LOS for older emergency laparotomy patients. Future assessment of additional measures, including discharge destination or time to mobilisation, may further demonstrate the team's positive impact on patient care.
eP96 Negative Pressure Wound Therapy and Surgical Site Infection in Emergency Laparotomies - A Single Centre Experience
Authors: Pringle Heather , Whitcroft Alex , Sinha Surajit
Published: January 2025

Introduction and Aims

The impact of surgical site infection (SSI) can include increased length of stay, quality of life, cost and pain for the patient. Some patients have a greater risk of wound breakdown including those who are elderly. The aim of this study was to observe the use of negative pressure wound therapy (NPWT) in our hospital in relation to SSI and to determine whether there is a group of high risk patients who may benefit more from NPWT.

Methods

Retrospective data collection using the NELA database followed by interrogation of medical records to establish incidence of SSI and choice of dressing following emergency laparotomy for the year 1st June 2022-31st May 2023.

Results

141 patients were included in this study. The mean age was 66.7 years with a mean frailty score of 3. There were 66 males and 75 females. The mean NELA score was 7.5%. The mean length of stay was 16.3 days (ranging from 3 to 65 days). NPWT was only used on 4 occasions during the data collection period and there were 4 recorded SSIs (2.8%) none of which used NPWT.

Conclusions

The finding of 2.8% SSI is higher than the literature which states 1.9% although the numbers are small. The use of NPWT is surgeon dependent rather than related to intraoperative findings and no significant difference in SSI. Huge numbers would be required to demonstrate a difference in SSI between NPWT and standard dressing and could be performed in a large multicentre trial.
eP97 Management of acute diverticulitis in the modern EGS setting
Authors: Singh Urvashi , Peckham-Cooper Adam , Ng Oliver
Published: January 2025

Introduction

This retrospective audit assesses diverticulitis management in a modern tertiary EGS unit against 2023 GIRFT guidelines. Differences in the management of patients presenting with diverticulitis in a surgical assessment unit (SAU) and an ambulatory/hot surgical clinic (ASC) environment were assessed.

Method

All patients with CT proven diverticulitis presenting on SAU between February-April 2024 were included. Data from ASC was prospectively collected as a direct comparison over June 2024 only and was included based either on CT confirmation or a clinical diagnosis of diverticulitis.

Results

58 patients presented to SAU with CT-proven diverticulitis. 62% had uncomplicated diverticulitis, 31% had complicated diverticulitis with abscess or contained collection <3cm, 7% had complicated diverticulitis with collection >3cm or free perforation. 70% uncomplicated diverticulitis patients received intravenous antibiotics, 50% had outpatient endoscopy follow-up and 25% were prescribed further antibiotics on discharge. High CRP, longer hospital stays, and surgical management was correlated with complicated diverticulitis – with 100% receiving IV antibiotics on admission but only 18% having follow-up endoscopy arranged.

6 patients presented to ASC with acute uncomplicated diverticulitis. 50% had a CT proven diagnosis, and 50% patients were diagnosed clinically. 85% of patients were conservatively managed without antibiotics, with only 1 of 6 patients receiving home antibiotics and OP colonoscopy.

Conclusion

In SAU, uncomplicated diverticulitis was overtreated with antibiotics and OP colonoscopy contrary to GIRFT guidance. Ambulatory management adhered to guidelines better with majority being managed conservatively. Complicated diverticulitis was treated with IV antibiotics and IR drainage/surgery in line with GIRFT guidance.
eP99 Abdominal Wall Abscess: An Exceedingly Rare Case of Cholecysto-cutaneous Fistula
Authors: Maharajh Sandeep , Jacob Roshan , Iqbal Affan , Lambert Joel , Jegatheeswaran Santhalingam
Published: January 2025

Aims

Cholocysto-cutaneous fistulae are exceedingly rare in modern surgical practice. Their aetiologies range from cholecystitis to carcinoma. Such patients require emergent resuscitation, sepsis management and diagnosis of underlying cause. We present a case of a cholecysto-cutaneous fistula in a patient with known gallstones, emergency management, radiological investigations and further definitive care.

Methods

A 70-year-old male presented to the emergency department with a 3-week history of an enlarging mass of the abdominal wall in the right hypochondrium. This was associated with 6 weeks of intermittent abdominal pain and fever. Serology showed an elevated C-reactive protein of 275 mg/L and white-cell count of 16 X 10*9/L. Emergency CT revealed a 20 cm subcutaneous collection and pneumobilia with poorly visualized gallbladder.

Results

Clinical photographs and radiological investigations are presented. The patient was resuscitated. Initial percutaneous drainage was unsuccessful due to high viscosity. For source control of infection, incision and drainage under local anaesthetic followed, with drainage of 2.2 litres of pus and bile. Interim MRCP confirmed tethering of contracted gallbladder to anterior abdominal wall. Antibiotics were continued for 10 days and patient was discharged well with definitive plan for open cholecystectomy and fistulectomy.

Conclusion

This unique case presents a rare cause of a relatively common presentation to the emergency department; cutaneous abscess. Surgical trainees commonly manage abscesses but can utilize this case as a learning point for differentials and management of an anterior abdominal wall mass. Such patients require comprehensive investigation, differentiation between benign and malignant aetiology and definitive treatment once well.
eP102 Review of delays during emergency operating (CEPOD) theatre
Authors: Moore Alexander
Published: January 2025

Introduction

The running of an emergency operating theatre can lead to unnecessary delays and a source of misused resources. We observe there are multiple negative outcomes from this, which affect patients, healthcare workers and society. We try to quantify this via time lost between operating.

Methods

We observed the functioning of the emergency theatre and followed patients from ward to post-op recovery during a 10-day period during the hours 08:00-20:00, finishing at this time or whenever all patients were operated on. The process was divided into steps, noting the time elapsed between these. Events affecting this time were observed. Finally, this data was compared to useful theatre time (spent in theatre/anaesthetic room).

Results

In 10 days, 1802 minutes passed between cases, corresponding to £36,040, compared to 4449 minutes of useful theatre time. Of the time between cases, 30% was spent waiting for the patient to leave the ward. This corresponds to an average of 14.08 minutes per case, although this varies from 23.75 to 7.5 minutes per case.

Conclusion

Factors such as good communication, individual motivation and having a dedicated waiting area for patients to stay prior to surgery gave better results. When patients were taken to recovery before theatre, absolute numbers of time lost per case was lower. However, when this happened, multiple cases were briefed together, having a knock-on effect on time lost elsewhere – this did not greatly change the proportion of time lost in each step of the theatre process, but did reduce the absolute numbers.
eP116 The Carbon Footprint of Energy Use in Emergency Operating Theatres: A Prospective Observational Study
Authors: Richardson Philippa , Bashaireh Leila , Eng Abigail , Khan Umar , Spence Cathy , Chan Anthony
Published: January 2025

Introduction

The NHS is responsible for 4% of the UK’s total carbon footprint. Typically, surgical operating theatres consume 3-6 times the energy when compared to a hospital ward. Considerations for emergency theatres include a rapid response time for critically unwell patients who require surgery. The aim of this study is to quantify areas of energy consumption within an emergency operating theatre over a 24-hour period to develop a framework to measure environmental impact.

Methods

A prospective observation study using a bottom-up approach was designed to quantify the energy usage in an emergency theatre complex in a tertiary hospital in September 2024. An inventory of all electrical devices dependent on mains electricity, their power rating and times of operation (including standby, active, or charging modes) were recorded. Daily energy consumption from heating, ventilation and air conditioning (HVAC) was estimated using previous published data (Chien et al 2022).

Results

The estimated average energy consumption of an emergency theatre over a 24-hour period was 891 kWh. Energy consumption was stratified into 4 domains: the theatre complex (795 kWh; 89.3%), anaesthetic devices (9.2%), surgical equipment (1.4%), and patient devices (1.2%). HVAC systems attributed to 87% of total usage, translating to a carbon footprint of 245 kgCO₂, equivalent to the daily energy use of 33 homes.

Conclusion

The carbon footprint of an emergency theatre exceeds elective theatres due to the ‘always available’ requirements. We identify the theatre complex (mainly the HVAC system) and anaesthetic devices as areas for sustainability quality improvement.
eP117 The Accuracy of Clinical Coding in Electronic Patient Records Systems in Emergency General Surgery
Authors: Yasmin Amina , Yau Christopher , Chan Anthony
Published: January 2025

Introduction

Clinical coding is a process that converts healthcare information into a machine-readable format. Accurate coding is clinically essential as an integral part of the electronic patient record (EPR) as well as underpinning the data used for healthcare research, service planning and revenue. The nature of emergency general surgery (EGS), however, introduces coding challenges due to significant individual variation in clinical presentation and management. This audit evaluates the accuracy of clinical coding in EGS at a large UK acute tertiary centre.

Methods

A retrospective audit was designed to evaluate the accuracy of clinical coding of unselected EGS patients. A ‘gold standard’ coding for past medical (PMH) and surgical history (PSH) was defined for each patient by an experienced surgeon from any information available within the EPR. This standard was compared to the EPR coding, and clerking entries from both Emergency Department (ED) doctors and the admitting surgeon.

Results

Fifty patients admitted in January 2024 were included. On average, EPR coding contained 48% of PMH and PSH elements when compared to the gold standard. Clerking documents from ED doctors and admitting surgeons averaged 49% and 58% respectively. Drug history recorded in the EPR was concordant in 71% of patients compared to ED (47%) and surgical (53%) clerkings.

Conclusion

This audit highlights the need for quality improvement in clinical coding accuracy. The data transformation benefits of EPRs are well established but are dependent on good quality data input. Inaccurate coding can have wide ranging implications inside and outside the direct care setting.
eP122 A Tertiary Center Audit on SDEC Acute Appendicitis Pathway
Authors: Oo Zon Poe , Oladeji Ibrahim , Gull Sadaf
Published: January 2025

Aims

To improve the management of surgical SDEC pathway in patients presenting with clinical suspicion of appendicitis to Surgical Triage Unit STU in Nottingham University Hospital by following SDEC acute appendicitis pathway recommended by GIRFT.

Methods

This retrospective study enrolled 50 patients aged 16 years or older presenting with RIF to STU in June 2024. Data about patient demographics, clinical presentation and findings, investigation results, operative details, and post-operative/ post-discharge management plans were obtained from Electronic medical records of NUH. Acute appendicitis score AAS was calculated. Second cycle was carried out by collecting data from 26 patients in September 2024 after implementing interventions and developing local guidelines.

Results

On the first cycle, 85% of patients presenting with low AAS had imaging scans (CT/US) among which 2 presented with complicated appendicitis. 17 out of 50 (34%) underwent laparoscopic appendicectomy (12 within 24 hours) among which 14 had uncomplicated appendicitis. Antibiotics were only stopped in 53% of uncomplicated appendicitis patients after surgery. Only 34 out of 50 (68%) had recommended open access and safety netting instructions. Second cycle showed 93% of low AAS patients had imaging scans, 8 out of 9 patients underwent urgent surgery within 24 hours, antibiotics were stopped in 42% of uncomplicated appendicitis patients after surgery, and 92% of patients gained open access to STU.

Conclusion

This audit cycle improved post-discharge plans of SDEC pathway and highlighted the importance of imaging in clinically suspected cases in low AAS patients, and the continued need of improvement for antibiotic prescribing.
eP124 Perianal Abscess Rupture and Incidence of Fistula Formation After Surgery - PARIS Study
Authors: Shaikh Amarah Ghani , Saunders Jada , Shah Isran Ali
Published: January 2025

Aim

Perianal abscesses are common anorectal conditions that can lead to significant complications, including perianal fistula formation. This study aims to assess the impact of abscess rupture status on the incidence of fistula formation following incision and drainage (I&D) procedures.

Method

This retrospective cohort study analysed data from 1,835 patients treated for perianal abscesses at a District General Hospital between June 2019 and June 2023. Patients were categorized into two groups: those presenting with spontaneously ruptured abscesses and those with intact abscesses requiring I&D. The primary outcome was the incidence of fistula formation within one-year post-procedure. Chi-square tests and multivariate logistic regression were used to identify predictors of fistula formation.

Results

The incidence of fistula formation was significantly higher in patients with spontaneously ruptured abscesses (54%) compared to those with intact abscesses (28.9%). Younger patients, particularly those under 50 years of age, were more likely to develop fistulas. Additionally, 67% of patients who developed fistulas had the external opening at the site of the original incision, indicating that the location of the incision may influence the type and complexity of the fistula.

Conclusions

Spontaneous rupture of perianal abscesses is associated with a higher risk of fistula formation. Early surgical intervention, careful incision placement, and consistent follow-up are recommended to reduce this risk and improve patient outcomes. The findings of the PARIS study highlight the importance of proactive management strategies in preventing long-term complications in patients with perianal abscesses.
eP125 Who does the Laparoscopic Appendicectomy: Struggles of the Modern-Day Core Surgical Trainees and Junior Clinical Fellows
Authors: Tjhin Yovita , Swe Thin Thin , Smith Jason , Pawa Nikhil
Published: January 2025

Background

In the early 2000s, the shift to laparoscopic surgery led to a significant decrease in appendicectomies performed by Core Surgical Trainees/Junior Clinical Fellows (CST/JCFs). Previously, CST/JCFs conducted 33% of open appendicectomies; however, this dropped to 8.7% by 2002. Alarmingly, by 2006, a district hospital reported that no CST/JCFs had conducted laparoscopic appendicectomies. This trend raises serious concerns regarding the diminishing opportunities for CST/JCFs to acquire essential experience in this critical surgical procedure. The current study assesses the training opportunities for CST/JCFs in minimally invasive surgery.

Methods

Emergency laparoscopic appendicectomy (ELA) in one University Hospital from September 2022 to August 2024 were identified retrospectively. Grade of the operating surgeon was categorized into Consultant, Registrar, or CST/JCF.

Results

Out of 574 identified ELAs, 572 were included after excluding two given missing digital notes. Documentation of the surgeon's level was ambiguous in 41 cases. The analysis revealed Consultants performed 52% (n=298) while CST/JCFs conducted only 11% (n=65). Among 126 paediatric cases, Consultants performed 64% (n=85), while CST/JCFs accounted for 10% (n=13).

Conclusion

The opportunity for CST/JCF to perform appendicectomy has significantly declined, affecting recruitment into higher surgical training programs that now mandate documented appendicectomy experience. Studies have shown no significant morbidity or mortality rates differences between appendicectomy performed by consultant/registrars and CST/JCF. CST/JCF involvement is crucial in fostering their competency in essential surgical skills and further national evaluation is required to assess quality of CST/JCF training.
eP126 Outcomes after emergency surgery in the elderly – implications for the organisation of an acute service
Authors: Hassan Kiran , Wong Chloe , Saha Arin
Published: January 2025

Aims

Few studies have assessed ‘whole service’ requirements for a safe model of care for emergency operations in elderly patients. This study aimed to describe outcomes after emergency surgery in elderly patients.

Methods

All patients who had emergency abdominal surgery from January-March 2024 were identified. Outcomes in patients aged 80 or above were compared with those in younger patients. Minimum follow-up was 6 months.

Results

There were 529 operations; 51 (10%) were in patients aged 80 or above. There were 12 urology and 39 general surgery procedures. 14 cases were eligible for entry onto NELA database.

Time between admission and decision to operate was longer in older patients (median 2.5 days vs. 1 day, P<0.005) with a greater proportion of patients having an initial non-operative treatment plan. Older patients had a greater burden of co-morbidities (Charlson score 9 vs. 4, P<0.005) and required more time in the anaesthetic room (median 16 minutes vs. 7 minutes, P<0.005) and the recovery room (median 68 minutes vs. 36 minutes).

There were three returns to theatre (bladder washout-2, planned relook-1) and no post-operative deaths. Eight patients had died (16%) within 6 months as compared with 2% in younger patients.

Conclusions

Emergency surgery in elderly patients comprised almost 10% of all acute operations, and were associated with greater co-morbidity, longer pre-operative preparation, and longer recovery. There was a greater likelihood of death within six months. Surgical and anaesthetic teams should provide extra capacity for elderly patients and ensure full understanding of longer term risks.
eP128 New Doctors Cross-Specialty Induction Programme: A Closed Loop Quality Improvement Project at a Tertiary Acute Hospital in UK
Authors: Maharajh Sandeep , Allen Christopher , Tohfa Mohamed , Morton Rosemary , Mcintyre Iain , Chan Anthony
Published: January 2025

Introduction

Doctors in acute specialities are required to provide effective, timely and safe patient care. Human factors can make cross-speciality working challenging. Siloed departmental junior doctor inductions often do not promote effective multidisciplinary working across the on-call and emergency service provision. This quality improvement project (QIP) trials a joint specialty induction programme to promote collaboration, understanding and teamwork at one of the largest hospitals in the UK.

Methods

A pre-QIP structured survey was carried out to ascertain the induction experiences of the previous junior doctor rotation. A collaborative approach between surgical, medical and emergency (ED) departments were used to create a joint induction programme which was audited following its pilot.

Results

The joint induction programme shared the responsibilities for each speciality as well as the clinical, organisational and educational pressures that individuals may face, such as ED patient flow targets, or surgical logbook number targets. New components also detailed holistic support of residents, wellbeing and academic opportunities. The programme was piloted in August 2024. Most respondents (85%) agreed that the joint induction promoted a better understanding and greater teamwork within the hospital. More attendees rated the new induction as more effective than a departmental one.

Conclusion

This QIP demonstrates a joint induction programme to be an effective and collaborative approach for inducting new doctors in complex tertiary care centres. Together with increasing demands on NHS services and educational pressures on trainees, initiatives promoting better teamwork and hospital cohesion are particularly important within acute specialities.
eP133 What is the role of ICG in bowel surgery in the emergency setting with regards to predicting the requirement for stoma formation – A Systematic Review
Authors: Swe Thin Thin , Tjhin Yovita , Sheth Camy , Kulkarni Ankita , Pawa Nikhil
Published: January 2025

Background

Emergency bowel surgery presents an elevated risk of anastomotic leaks, attributed to factors such as comorbidities, sepsis, and inadequate pre-operative optimization. This heightened risk often results in a greater likelihood of stoma formation, which can lead to significant patient distress. This study aimed to assess the efficacy of Indocyanine Green (ICG) as a predictor for bowel resection and stoma requirement in emergency general surgery.

Methods

A systematic search was conducted on Embase and PubMed using the keywords: ICG, emergency, surgery, bowel, ischemia, and perfusion. Out of 266 articles identified, 32 original studies were included for analysis.

Results

A total of 308 individual cases were evaluated. Intra-operative visual findings were consistent with ICG perfusion results in 61% of cases (n=188). Two cases did not report ICG-intra-operative finding compatibility. In instances of discrepancy, ICG assessment led to altered surgical decisions in 47% (n=89) cases. Seven patients required further resection due to ongoing ischemia; notably, bowel resection was avoided in three patients despite ICG indicating poor perfusion. ICG predicted the bowel perfusion/viability in 302 cases, contributing to avoiding unnecessary resections in 21.7% (n=67) cases.

Conclusion

Our study showed that ICG can reliably indicate adequate bowel perfusion and therefore viability in 98% of emergency general surgery cases. ICG is a valuable predictor for the need for stoma formation in emergency surgical contexts. To explain the discrepancy between this result and reality, human decision-making bias is worth exploring.
Circular RNAs in the management of human osteoporosis
Authors: Gargano Giuseppe , Pagano Simona M , Maffulli Nicola
Published: January 2025

Background

Osteoporosis (OP) is a metabolic bone disease producing reduction in bone mass with consequent bone fragility. Circular ribonucleic acid (CircRNA) is a form of RNA that forms a loop structure rather than a linear one. CircRNA can be used for therapeutic purposes, including molecular targets or to test new therapies.

Sources of data

A systematic search of different databases to July 2024 was performed to define the role of circRNA in OP therapy. Seventeen suitable studies were identified.

Areas of agreement

CircRNAs may be useful in studying metabolic processes in OP and identify possible therapeutic targets and new drug therapies.

Areas of controversy

The metabolic processes involved in OP are regulated by many genes and cytokines that can be targeted by CircRNAs. However, it is not easy to predict whether the in vitro responses of the studied CircRNAs and their interaction with drugs are also applicable in vivo.

Growing points

Metabolic processes can be affected by gene dysregulation of CircRNAs on various growth factors. Areas timely for developing research: Despite the predictability of CircRNA pharmacological response in vitro, such pharmacological response cannot be expected to be replicated in vivo.

Data availability

The data that support the findings of this study are available from the corresponding author.
Significant oligodendrocyte progenitor and microglial cell death is a feature of remyelination following toxin-induced experimental demyelination
Authors: Gaitsch Hallie , Assinck Peggy , Dimas Penelope , Zhao Chao , Morcom Laura , Rowitch David H , Reich Daniel S , Franklin Robin J M
Published: January 2025

The extent to which glial cell turnover features in successful remyelination is unclear. In this study, the rat caudal cerebellar peduncle-ethidium bromide lesion model was used to profile oligodendroglial and microglial/macrophage cell death and proliferation dynamics over the course of repair. Lesioned and control tissue was co-labelled with antibody markers for cell identity, proliferation, and apoptosis (TUNEL assay), then imaged at full thickness using confocal microscopy and quantified using custom CellProfiler pipelines. Early remyelination time points were marked by an increased density of total proliferating cells, including oligodendrocyte progenitor cells. Late remyelination time points featured increased TUNEL+ oligodendrocyte progenitor cells: however, most TUNEL+ cells within remyelinating lesions were Iba1+ microglia/macrophages. These results indicate that repairing lesions are characterized by a high degree of glial cell death and suggest that monitoring cell death-related by-products might have clinical value in the setting of remyelination.
My battle with psoriasis: from struggle to advocacy – a life transformed by new treatments
Authors: Irwin Caroline , Yong Ji Fung , Dolan Michelle , Greenwood Michelle , McMahon David , Tobin Anne-Marie
Published: January 2025

Caroline’s experience of living with psoriasis highlighted the significant impact this chronic inflammatory skin condition has on both her physical and mental well-being. This led to the establishment of the Psoriasis Association of Ireland and, eventually, to her becoming a founding member of the Irish Skin Foundation, with the goal of reaching out and supporting others in similar circumstances. The emergence of biologic treatments has revolutionized the quality of life for people living with psoriasis. With the new concept of proactive early intervention, it aims to reduce the cumulative disease burden and prevent comorbidities, further improving patient outcomes.
B cells recruitment promotes M2 macrophage polarization to inhibit inflammation during wound healing
Authors: Yin Yuye , Wu Shusheng
Published: January 2025

Introduction

Wound healing causes heavy economic burdens for families and society, becoming a critical issue in the global healthcare system. While the role of immune cells in the wound healing process is well-established, the involvement of B cells remains poorly understood. This study aims to elucidate the essentiality of B cells in wound repair. Our findings demonstrate a rise in B cell population during the early stage of wound healing, which further intensifies during the later stage.

Methods

We employed anti-CD20 antibodies to deplete B cells in mice and created a whole skin excisional wound mice model, analyzing wound closure over 12 days. B cells were isolated from the animals’ spleen and co-cultured with macrophages from bone marrow. The polarization of M1 and M2 macrophages was analyzed by real-time qPCR and flow cytometry.

Results

The wound healing process in mice was observed to be considerably delayed following the elimination of B cells. The wounds exhibited a state of inflammation primarily characterized by the presence of pro-inflammatory M1 macrophages. The decrease in M2 macrophages within the local wound area resulted in impairment of the wound repair mechanism. B cell-macrophage co-culture system revealed that B cells effectively induce the polarization of macrophages towards M2-like phenotype. Furthermore, we found that follicular B cells play predominant role in modulating the polarization of M2 macrophages.

Conclusion

Consequently, our findings indicate that B cells can be recruited to the wound site and facilitate the polarization of M2-like macrophages, thereby accelerating the healing process during wound healing.
A ticking time bomb? The impact of objective class and stratification beliefs on societal conflict perceptions in South Africa
Authors: Kirsten Frederich , Biyase Mduduzi
Published: January 2025

In South Africa, inequality has worsened over the past two decades, leading to the country being recognised as the most unequal society globally. The escalating inequality has sparked social conflicts, threatening the already fragile social cohesion. However, there is a limited understanding of public perceptions regarding these conflicts; it is crucial to comprehend their dynamics. To shed light on this issue, we used the International Social Survey Programme dataset for 2009 and 2019 to investigate the changing factors influencing perceived social conflict (PSC) in South Africa, specifically testing the role of objective class positions and stratification beliefs. Our findings reveal that objective class plays a significant and reinforced role in shaping perceptions of social conflict, aligning with the Marxist notion of a strong link between class position and conflict perceptions through class consciousness. Middle-class imagery does not affect PSC and tolerance for inequality and also exerts diminished influence on PSC. Overall, these results offer valuable insights for policymakers in their efforts to address the pressing issues of class, conflict and inequality. This is particularly true in the aftermath of the July 2021 unrest while South Africa continues to grapple with social instability caused by deep class divisions.