bluuebunny/crossref_metadata_2025 huggingface dataset:
WP3.10 - Variability of frailty scoring during unplanned surgical admissions in older persons - why accuracy matters
Authors: Rothnie Alex , Hamza Mohamed , Williams Sophie , Cross Jason , Thin Katie , Mamidanna Ravi , Ramdin Ashling
Published: September 2024

Introduction

The Clinical Frailty Score (CFS) is a reliable predictor of outcomes for older patients in the acute hospital setting and is used to guide management decisions. Our hospital routinely calculates the CFS for older adults on admission to the Emergency Department (ED). Patients admitted under general surgery will then be referred for a Comprehensive Geriatric Assessment (CGA) by our Perioperative Medicine for the Older Patients undergoing Surgery (POPS) team who also calculate CFS. This study aimed to compare the CFS calculated in ED and CGA for these patients.

Methods

We performed a single centre prospective study of emergency general surgical admissions who were reviewed as an inpatient by our POPS team between August 2022 and September 2023. CFS from ED documentation was compared to that after CGA. A two tailed, paired t test was performed to compare the CFS on admission and after CGA using GraphPad Prism version 10.0.

Results

A total of 293 patients were identified with a mean age of 79 years(65-102). There was a difference between the admission CFS [4.2 (3.9-4.4 95%CI)] and the CFS following POPS review [4.5 (4.3-4.7 95%CI)] which was statistically significant (p<0.0001). Univariate analysis showed that CFS was predictive of length of hospital stay.

Conclusion

CFS calculated in the ED can both over and underestimate the degree of frailty when compared to the CFS calculated during the CGA. As evidence suggests that CFS is predictive of outcomes in this cohort, we suggest staff are adequately trained in undertaking an accurate assessment of this score.
WP4.7 - Use of cholecystostomy to manage acute cholecystitis in high risk patients in a rural hospital
Authors: Krishna Oochit , Luke Thompson , Fultang Joshua , Maruthachalam Karthik
Published: September 2024

Aim

To evaluate outcomes after percutaneous cholecystostomy (PC) in patients with acute cholecystitis in a rural DGH.

Methods

Retrospective data collection on patients who underwent PC between October 2019 and January 2024. Variables collected included; Demographics, ASA grade, Charlson Comorbidity Index (CCI), inflammatory markers, length of hospital stay (LOS), complications, duration of PC, mortality and subsequent management.

Results

Complete data was available on 58 patients. 53.5% were male and mean age was 74±10.5years. 42(73%) patients were ASA III or above, 17(29%) had moderate CCI (3-4) and 35(60%) had severe CCI score of 5 or above. No difference noted in inflammatory markers from Day 1 to day of cholecystostomy (p=0.43) reflecting failure to antibiotic treatment. 15.5% of patients needed critical care. Average duration of PC in situ was 48 days; 11(19%) had PC in for >80 days. 27(46.5%) patients underwent cholecystograms prior to removal and 19% were abnormal. Median LOS was 12(2-159) days. 4(6.9%) patients had complications from PC insertion. 30-day and 1-year mortality was 3.5% and 5% respectively. Care episodes needed following discharge with PC in situ was 2(Mean). 17(29.3%) patients had cholecystectomy following PC removal with 12% having open conversion.

Conclusions

Percutaneous cholecystostomy offers a safe alternative to laparoscopic cholecystectomy in managing acute cholecystitis in high risk patients. Subsequent cholecystectomy has a higher rate of conversion to open.
WP4.8 - Separating the sheep from the goat - Outcomes Based on Low, High and Extreme Risk NELA scoring
Authors: Jayasankar Balaji , Govind Garima , DiFranco Filippo
Published: September 2024

Background

According to the UK National Emergency Laparotomy Audit (NELA), high-risk emergency laparotomy is defined as any patient with a NELA risk score of ≥ 5%, indicating a predicted mortality rate of 5% or higher within 30 days after the procedure. However, scores ranging between 5%-100% fall within the similar ambit of requiring intensive care support. There is a lack of distinction among the patients in the high-risk group with measurable outcomes.

Given the broad margin, we stratified NELA mortality into low risk (<5%), high risk (5-50%) and extreme risk (>50%). The study was retrospective, involving 150 laparotomies, and looked at the outcome amongst various stratifications.

Methods

A retrospective analysis of 150 patients who underwent emergency laparotomy was evaluated against the documented NELA scoring and stratified into categories.

Baseline characteristics, encompassing age, usual place of residence, ASA physical status, and NELA score, were analyzed to compare the three groups (low, high and extreme risk). The outcomes under consideration included 30- and 90-day mortality, hospital length of stay, re-operation rates and the length of stay in critical care.

Results

There existed clear outcomes with the 30-day mortality and re-operation rates between the three groups.

Our study highlighted the gap that exists in the clinical prognosis and shared decision-making in patients with high (5-50%) and extreme risk (>50%) NELA scores. Further, we worked out a risk stratification model that could guide consenting these patients.

Conclusions

Outcomes based on NELA score stratification will only strengthen the shared decision-making process for a patient with an objective understanding of the risks involved.
WP5.3 - Rejuvenating the golden patient protocol in a tertiary centre general surgical emergency theatre
Authors: Ahmed Sheheryaar , Johnston Annabelle , Mann Kulbir
Published: September 2024

Aims

Poor patient flow and complex sub-specialty decision making discussions lengthened time to operation of lower priority operations e.g. appendicectomy/abscesses. By prioritising start times and registrar patient selection for low complexity cases/day case discharge, we rejuvenated the golden patient protocol (GPP) and assessed the implementation and impact of a novel GPP in a tertiary centre emergency list on surgical wait times and overall theatre flow.

Methods

The GPP was agreed between surgical/anaesthetic night registrars and theatre staff which took into consideration the urgency of the surgery, fitness of patient and anaesthetic/technical difficulties. Eligible patients were identified prior to 08:00 and scheduled as the first case of the day to be huddled and sent for by 08:30. Two cycles were conducted, one month before and after GPP introduction, using the trust theatre management system (TMIS).

Results

Time series analysis was conducted for patient sent-for, anaesthetic room entry, and procedure start times during both cycles. Results indicated a median decrease of 11-minutes in patient sent-for time (Cycle 1: 08:56, Cycle 2: 08:45) and a 12-minute reduction in median procedure start time (Cycle 1: 09:42, Cycle 2: 09:30). The proportion of low complexity cases performed first-on-list also increased by 22.5% (Cycle 1: 35.5%, Cycle 2: 58.0%).

Conclusions

This analysis demonstrates a positive change by starting theatre faster with lower complexity cases, developing surgical registrar independence, improving time to treatment without complex discussions delaying first send.
WP5.6 - Beyond the Left Side: Emergency Colonic Stenting for Acute Malignant Large Bowel Obstruction
Authors: Gardner Shona , Farrow Emily , Pullyblank Anne
Published: September 2024

Introduction

Acute malignant large bowel obstruction (LBO) is traditionally treated by surgical diversion or resection in patients who are fit enough. European guidelines suggest colonic stenting as a bridge to surgery in curative disease.

The aim was to examine the safety and efficacy of a change in practice from emergency laparotomy towards colonic stenting for acute malignant LBO.

Methods

Patients with LBO from 01/01/2019 to 31/12/2022 were included and data was obtained from the NELA database and electronic patient records.

Results

42 patients underwent emergency laparotomy (EL) for LBO. 33% (14/42) patients had right-sided tumours (n=14) and/or perforated disease (n=6) where stenting was contraindicated. 28/42 patients (22% of total) went straight to EL for clinical/ organisation factors.

73 patients were stented; 44% (32/73) were at/ proximal to splenic flexure. Perforation rate was 10% (7/73) with 4/7 requiring EL. Failure rate was 14% (10/73) with 6/10 patients requiring EL. 41% (30/73) were stented with curative intent; 70% (21/30) then underwent elective resection.

The rate of stoma formation and minimally invasive surgery in patients stented with curative intent was 40% (12/30) and 60% (18/30) respectively (including 9 EL following stent complications). Compared with 88% (37/42) and 19% (8/42) in patients undergoing primary EL.

Conclusion

Almost 2/3 of patients presenting with acute malignant LBO were suitable for stenting. Stenting reduced the need for a stoma and enabled elective minimally invasive surgery with low complication rates. This rate of colonic stenting was achievable without a 24/7 colonic stenting rota or sub-specialty cover.
WP5.8 - Robotic versus laparoscopic general surgery in the emergency setting: a systematic review
Authors: Anyomih Theophilus T K , Mehta Alok , Sackey Dorcas , Woo Caroline A , Gyabaah Emmanuel Y , Askari Alan
Published: September 2024

Introduction

Robot-assisted general surgery, a cutting-edge technology in minimally-invasive procedures, is increasingly utilised in elective general surgery, demonstrating advantages over laparoscopy in select cases. While laparoscopy remains a standard approach for common acute abdominal conditions, the role of robotic surgery in emergency general surgery is unclear. This systematic review aims to compare outcomes in acute general surgery settings for robotic versus laparoscopic surgeries.

Method

A PRISMA compliant systematic search across MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane library was performed. The literature review focused on articles comparing perioperative outcomes of emergency general surgery managed laparoscopically versus robot-assisted. A descriptive analysis was performed and outcome measures recorded.

Results

Six articles, reporting on 1063 patients, compared outcomes of robotic and laparoscopic procedures. Two covered cholecystectomies, while the others addressed ileocaecal resection, subtotal colectomy, hiatal hernia and perforated gastrojejunal ulcer repair. The level of evidence was low. Laparoscopic bowel resection in inflammatory bowel disease (IBD) patients had higher complications; no significant differences were found in complications for other operations. Operative time showed no differences for cholecystectomies, but robotic approaches were longer for other procedures. Robotic cases had shorter hospital length of stay, though the associated costs were significantly higher.

Conclusion

Perioperative outcomes for emergency robotic surgery in selected general surgery conditions are comparable to laparoscopic surgery. However, recommending robotic surgery in the acute setting requires a well-powered large population study for stronger evidence.
WP5.16 - Profile of Colorectal cancers presenting as emergencies at GEH during last 3 years - (Jan 2019 -Jan 2022) Incidence, presentations ,treatment options Biology, and prognosis -Single institutional experience
Authors: Haji Altaf , Vijayaraghavalu Shashikanth , Elhassan Ali Ali , Ahmad Aftab , Narayanan Aravindan , Piramanayagam Bala , Marimuthu Kalimuthu , Aslam Imran
Published: September 2024

Aim

This retrospective, single-institutional study aimed to comprehensively investigate the demographic features, clinical presentations, and outcomes of emergency procedures in individuals with colorectal cancers presenting as acute emergencies at GEH over the last three years.

Methods

In this study at GEH, we analysed colorectal cancer cases presenting as emergencies from January 2019 to January 2022 were examined. Out of 310 total colorectal malignancy surgeries during this period ,57 cases (18.38%) were identified as acute emergencies. Demographic details, clinical history, outcomes of emergency procedures, adjuvant therapies, and prognostic variables were retrieved from hospital records and electronic medical records. Cases operated on elective basis & cases without confirmed colorectal cancers were excluded.

Results

The study revealed demographic insights, with an average age of 72 years and a balanced gender distribution. The majority presented with obstructive symptoms (87.7%), emphasizing the acute nature of cases. Emergency procedures exhibited diversity, with right hemicolectomy and Hartman's procedure being predominant. Gender-specific patterns in emergency procedures, along with details on tumor location, morphology, and complications, were analysed. Right-sided tumours, particularly caecal tumours, were prevalent. Adenocarcinoma was the predominant tumor morphology. Treatment approaches included curative intent in 56.14% and palliative intent in 35.09%. Adjuvant chemotherapy was administered in 50.88%, and adjuvant radiotherapy in 7.02%. Recurrence was noted in 12.28%, while mortality rates varied among different emergency procedures.

Conclusion

This study provides a comprehensive understanding of colorectal cancers presenting as emergencies, offering valuable insights into demographic characteristics, emergency procedures, tumor characteristics, treatment approaches, and outcomes. Prospective studies are recommended to further validate and extend these findings, contributing to a nuanced comprehension of emergency colorectal cancer scenarios.
WP6.13 - REINVENT- Robotic SurgEry: INnoVation for EfficieNt Training- A qualitative study assessing training in RAS (Robotic Assisted Surgery) and future implementation
Authors: El-Sayed Charlotte , Munsch Chris , Campbell Marion , Bach Simon P , Rooshenas Leila
Published: September 2024

Introduction

Despite the rise in use of RAS in UK surgical practice, concerns have been reported regarding the lack of standardisation in training.

Little is known on the current exposure to RAS training in the UK and thoughts on how training should be delivered in the future.

Methods

Semi-structured interviews were completed in person/online with four stakeholder groups:(1) pan speciality surgical trainees; (2) robotic trainers; (3) leads in curriculum development; (4) RAS industry leads. Respondents were pan-speciality and from across the UK. Topic guides focussed on personal perspectives on RAS training, current barriers to accessing training and views on how RAS training can be optimally delivered in the future. Data collection ceased upon saturation in themes and were analysed thematically.

Results

Twenty-seven informants were interviewed, including 8 trainees, 7 curriculum developers, 6 robotic surgeons and 6 industry leads. Respondents reported multiple challenges in training including barriers to accessing the robot such as the geographical location of the systems; the consultant RAS learning needs; equality and diversity issues and challenges with delivering platform agnostic training. However, respondents reported an anticipated growth in RAS and a need for the surgical training bodies to invest in structured RAS training which should be implemented earlier in surgical training.

Discussion

RAS training in the UK requires overcoming several barriers to deliver equitable, standardised training. A further study is required to reach a consensus amongst stakeholders on how RAS should be delivered within the current infrastructure of both the UK health care system and surgical training climate.
WP7.4 - A closed loop audit assessing adherence to NELA frailty guidelines in over 75’s undergoing Emergency Laparotomy
Authors: Harper Alexander , Banks Philippa , Edginton Oscar , Yiasemidou Marina , Clarke Rory , Lockwood Sonia
Published: September 2024

Background and Aims

The National Emergency Laparotomy Audit (NELA) 2023 recommend patients over 65 should have clinical frailty score (CFS) recorded, and, if frail or aged 80 or over, should have Care of the Elderly (COE) input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk. This audit reviewed use of these recommendations at a large District General Hospital (DGH).

Methods

We performed a closed loop audit on all patients aged 75 and older who had an emergency laparotomy between September 2020 to December 2023. We collected data from their admissions, including CFS and if COE reviews had occurred. The data was analysed. Interventions included presentation at clinical governance, discussion with the COE consultant and a poster was developed for the surgical assessment unit. The data was again retrospectively collected to complete the audit cycle.

Results

A total of 94 patients were included. The initial audit found 0 patients had CFS recorded and 16% had COE review. The reaudit found significant improvement, with 92% of patients having CFS recorded and 46% having had COE review.

Conclusion

The second cycle audit has shown significant improvement at the DGH in recording CFS and organising COE reviews for patients over 75 having an emergency laparotomy. However, there remains scope for improvement. Suggested improvements include: a referral pathway to prompt COE reviews and the creation of the “general surgery geriatrician” similar to the ortho-geriatrician role. Organising COE reviews could improve patient outcomes and provide more holistic care.
WP8.3 - "Effectiveness of Malnutrition Screen and Interventions for Surgical Inpatients - A MUST Score Based Audit"
Authors: Ylli Kristali , Sheehan Ciaran , Nugent Tim
Published: September 2024

Malnutrition significantly impacts surgical inpatients, affecting outcomes like infection rates, hospital stays, and wound healing. This audit evaluates the effectiveness of the Malnutrition Universal Screening Tool (MUST) in identifying at-risk surgical inpatients and examines the subsequent interventions and nutrition assessments.

Our prospective audit encompassed surgical inpatients admitted for elective procedures or via the emergency department. Data were collected through patient records and medical charts, focusing on MUST score completion, accuracy, and updates. The audit assessed staff training, consistency in scoring, and the quality of nutrition interventions documented by dietitians.

Key findings revealed a high completion rate (83.3%) of MUST scores but identified significant inaccuracies due to insufficient consideration of BMI, weight loss, and acute disease effect. Only a minor percentage (15.6%) of patients had their MUST scores updated. Staff training inadequacies and inconsistent scoring practices were noted. Despite these limitations, clinical teams effectively identified at-risk patients using their judgment and promptly initiated interventions.

A malnutrition awareness week was organised with the dieticians, and teaching sessions were conducted for the healthcare staff to enhance understanding and application of the MUST tool. This initiative aimed to raise awareness and improve the quality of malnutrition screening and management.

The audit highlights the need for improved accuracy in MUST scoring, enhanced staff training, and ongoing professional development. Recommendations include comprehensive staff training, standardized documentation processes, interdisciplinary collaboration, and patient and family education.

This audit underscores the importance of accurate malnutrition screening and effective interventions to improve patient care quality for surgical inpatients. It calls for action plans to address the identified gaps, thereby enhancing malnutrition management within healthcare settings.
ThP1.1 - Unilateral Nipple Discharge: Contemporary Approaches to Investigation and Management across a Multi-site Trust
Authors: Calcuttawala Mr Murtaza , Lawrence Miss Eloise , Ali Amina , Dobrogowska Rozalia , James Shiney , Wahab Tajudeen
Published: September 2024

Nipple discharge, in the absence of a palpable breast lump, constitutes 3-9% of referrals to breast services[i],[ii]. While the ABS released updated guidelines on nipple discharge in 2019, a standardised management protocol is yet to be established. This study aims to scrutinize the efficacy of imaging (mammogram, USS, MRI) and nipple discharge cytology in predicting malignancy outcomes in patients with unilateral nipple discharge.

Aims

Determine the incidence of malignancy in women presenting with unilateral nipple discharge.

Assess sensitivity, specificity, and positive predictive value of imaging modalities (mammogram, USS, MRI) and cytology.

Methodology

110 patients presenting with unilateral nipple discharge between 11/2022-12/2023 were retrospectively analysed. Data encompassing patient demographics, diagnostic procedures, and outcomes were systematically collected.

Results

31.6% underwent surgical intervention, revealing a malignancy rate of 5.6%. Positive predictive values for detecting malignancy were 75% for mammogram, 50% for ultrasound, and 66% for nipple discharge cytology. No patients underwent MRI or ductoscopy as part of investigations.

Conclusion

This study highlights variable diagnostic accuracy of imaging and cytology and the necessity for large-scale collaborative data to draw substantive conclusions. The National Unilateral Discharge Study is anticipated to provide comprehensive insights and contribute to the establishment of a national investigative framework for patients presenting with unilateral nipple discharge.

[i] Vargas HI, Romero L, Chlebowski RT. Management of bloody nipple discharge. Curr Treat Options Oncol 2002; 3: 157–161.

[ii] Seltzer MH. Breast complaints, biopsies, and cancer correlated with age in 10,000 consecutive new surgical referrals. Breast J 2004; 10: 111–117.
ThP1.6 - Chaperone in Breast Examination: A Comprehensive Systematic Review of Patient and Clinician Perspectives, and Documentation
Authors: Ou Kai Qi , Wong Zhen Ning , Wong Zhen Yu
Published: September 2024

Aims

The use of chaperones during breast examination is a logical step, particularly in an increasingly litigious society. This review aims to summarise the current information regarding patients’ and clinicians’ perspective in chaperone use in both specialities.

Methods

A PRISMA compliant search was conducted in electronic databases from inception until April 2023 for qualitative literature regarding patients and clinician perspective in chaperone use in breast and plastic surgery. An inductive thematic analysis in three domains (physician-associated, patient-associated factors and chaperone documentation) was done.

Results

10 studies were included after screening 939 articles. Regarding breast surgery, the presence of male and older surgeons, nurse availability, rural setting, and patients’ psychiatric comorbidities were found to increase the propensity of having a chaperone present during consultations. With medico-legal concerns being a prominent factor for male breast surgeons, female breast surgeons highlighted the need for technical support as their main motivation for having a chaperone while logistical issue was a common hindrance. Gender of physicians remained to be an important factor for patients, but conflicting evidence was found regarding patient preferences for chaperone and purpose for having a chaperone present during consultations. Poor documentation was generally observed despite implementing quality improvement projects.

Conclusion

This study emphasizes the vital role of chaperones in clinical practice, urging a precise definition and targeted resolution for implementation challenges. Patient preferences highlight the need for a personalized approach, and increased awareness among healthcare professionals is essential.
ThP2.2 - Breast cancer in the very young
Authors: Sonola Omobolade , Goh Steven
Published: September 2024

Aims

A small proportion of breast cancer (BC) affects women under 35 years old: very young breast cancer (VYBC). We conducted a retrospective cohort study of VYBC treated by our breast unit with the aim of adding to the existing, limited literature.

Methods

All patients treated between January 2012 and July 2023 were included. Case notes, MDT outcomes, operative findings and histology reports were cross-referenced. The primary outcome assessed was overall survival. Other factors investigated were parity, genetics, treatment plans and some, specific, psychosocial concerns.

Results

There were 95 women with VYBC in this 11-year study period. The median age at diagnosis was 32 years, and median length of follow-up was 5 years. 81% of the cohort had early BC, and 28% of carcinomas were triple negative. Overall survival was 87%. 16% of women either presented with or developed distant metastases, with a survival rate of less than 27% in this group. BC recurrence affected 21% of women. Surgery was performed in 94% of patients, with 64% having at least a unilateral mastectomy. Ahead of treatment, fertility concerns were expressed by at least 45% of women. 85% of the cohort were genetically tested, revealing a genetic mutation in 20% of these patients.

Conclusions

This study demonstrates the outcomes of VYBC within our breast unit, which are comparable to published reports. It also highlights unique, psychosocial challenges faced by these women. Long term follow-up of this group is recommended.
ThP2.16 - A prospective study with meta-analysis of echocardiographic changes of left ventricular function in aortic valve replacement patients
Authors: Bhaskaran India Premjithlal , Bhaskaran Premjithlal , Aslam Mohammed
Published: September 2024

Aortic valve replacement (AVR) improves cardiac function and it reverses adverse remodeling. Measurements of left ventricular ejection fraction (LVEF) are used to identify the patients for pharmacological therapy or AVR.

Systematic review identified the Echocardiographic indices followed by AVR. Second part of this study compares the Echocardiographic indices of the patients, who had followed AVR.

Results

Overall, 145 citations were identified from the initial search, of which 43 studies were retrieved. Later, 8 studies included in the review and 5 were subjected to meta-analysis. There was a change in peak A-wave (MD = 7.30; 95% CI = 5.51 to 9.09), peak E-wave (MD = 3.70; 95% CI = 1.86 to 5.54) before and after AVR. There was no change in LVEF (MD = 0.74; 95% CI = -0.76 to 2.25), E/A ratio (MD = -0.26; 95% CI = -0.75 to 0.23), diastolic dimension (MD = 1.10; 95% CI = -2.08 to 4.28) and systolic dimension (MD = 0.20; 95% CI = -3.41 to 3.81) among AVR cases. Prospective study includes 30 AVR cases. Of these, 23 (76.7%) males and 7 (23.3%) females with mean age was 63.36 + 8.34. There was a change (p >0.05) in peak E-wave, peak gradient and peak diastolic gradient from preoperative to six months after AVR.

According to literature, peak E-wave, peak gradient, and peak diastolic gradient changed after AVR. E/A ratio, peak A-wave, E/E ratio, LVEF, diastolic dimension, and systolic dimension were stable (p >0.05) from preoperative to six months after AVR.
ThP3.3 - Prophylactic Endoluminal Vacuum Therapy – towards an era of reducing leak related morbidity after elective oesophago-gastric resection
Authors: Saqib Imad-ud-din , Al-Ani Zena , Ribbits Alexander , Gourgiotis Stavros , Bennett John , Hardwick Richard , Safranek Peter , Sujendran Vijay , Hindmarsh Andrew , Noorani Ayesha
Published: September 2024

Aims

Uncontrolled sepsis following leak from oesophago-gastric surgery is a devastating condition with increased morbidity & mortality affecting longer-term cancer-free survival in patients with cancer resections. We hypothesised that endoluminal vacuum therapy (EVT), previously used to treat leaks, could be used in prophylactic settings to provide source-control, prevent mediastinitis and minimise sepsis related morbidity from leaks.

Methods

An ad-hocEVT device was created using VACgranufoam (KCI)and a nasogastric-tube(16/18Fr), and placed intraluminally across the repair/anastomosis in select high-risk cases. Continuous negative pressure(75–125mmHg) was applied. Assessment of the repair-site/anastomosis was performed by radiology, endoscopy, clinical assessment or a combination following cessation of EVT.

Results

27 patients had prophylactic EVT; M:F ratio was 3:1 and the median age was 68 years (range: 41-82years). 26surgeries were for cancer, while 1 was benign. The rationale for prophylactic EVT included patient related (10), technical factors (16) or both (1). The median duration of prophylactic EVT was 7 days (range: 4-14days). The median length-of-stay was 19.7 days (range: 6-96 days), the two longest admissions were unrelated to the anastomosis(prolonged chyle-leak, and long-term-sequelae of life-threatening bleed). One-patient developed a full-thickness microleak at endoscopic-evaluation, yet remained well with no systemic signs of sepsis, successfully managed with luminalEVT for a further 6days in a ward-based environment. Though prophylacticEVT did not prevent the leak, it significantly minimised the systemic hit that traditionally results from leak and associated mediastinal sepsis.

Conclusions

ProphylacticEVT is a useful adjunct for management of patients with a high risk for leak, though not a substitute for good surgical technique. There are no short-term complications, yet the additional morbidity, mortality and length-of-stay associated with a fully-fledged leak is avoided. Randomised-controlled-trials are required to further standardise selection criteria, assess potential patient benefit and longer-term impact on survivorship.
ThP3.14 - Four-Year Experience of Laparoscopic Transcystic common bile duct exploration at a District Hospital
Authors: Vrachni Vasiliki , Kontaxi Ourania , Andreou Alexandros
Published: September 2024

Aim

This study aims to assess the outcomes of Laparoscopic Common Bile Duct Exploration (LCBDE) as a single-stage procedure for symptomatic choledocholithiasis.

Methods

In this retrospective analysis we included 87 patients with high suspicion of common bile duct (CBD) stones, imaging proven choledocholithiasis or failed Endoscopic Retrograde cholangiopancreatography (ERCP). These patients underwent either LCBDE or CBD exploration under fluoroscopy between 2019 and 2023.

Results

Among the 87 patients selected for a single stage procedure, 59 underwent Laparoscopic transcystic CBDE. Successful CBDE was achieved in 40 cases (68%), with four patients after failed ERCP. In one case on table ERCP with rendez-vous technique was used to complete CBD clearance. Two of them needed complementary post operative ERCP to remove impacted stones. Most cases with unsuccessful CBDE, 19 in total (32%), was due to difficult cannulation of a narrow cystic duct. Three were managed with on table ERCP and five had post-operative ERCP. Six patients (7%) experienced unplanned readmissions, three with retained stones post-successful stone clearance and two after clear on table cholangiogram, who were managed with ERCP. Bile leak occurred in two cases and it was self-limited within 14 days. The mean hospital length of stay (LOS) was 5,3 days with a median LOS of 4 days.

Conclusion

Transcystic LCBDE, when surgical expertise and experience are available, is an effective and safe procedure for treating choledocholithiasis, providing comprehensive CBD clearance while avoiding the risks associated with ERCP.
ThP5.6 - Intraoperative blood transfusion and postoperative infective complications in patients who undergo pancreatoduodenectomy for malignancy
Authors: Jordan Caitlin , Rees Jonathan , Russell Tom , Aroori Somaiah ,   RAW Study Collaborators, Mavroeidis Vasileios K
Published: September 2024

Background

Prior authors have suggested that patients who receive an intraoperative blood transfusion (IOBT) are at increased risk of postoperative infective complications (transfusion-related immunomodulation). This study aimed to investigate whether pancreatoduodenectomy (PD) patients who received IOBT were more likely to develop an infective complication than those who did not.

Methods

Data was 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 from 8 countries, n=1484). Patients who received IOBT were identified and compared to those who did not. The primary outcome measure was the development of at least one postoperative infective complication, including: hospital acquired pneumonia, cholangitis, Clostridium difficile, intra-abdominal collection, liver abscess, sepsis of unknown origin, surgical site infection and urinary tract infection. The Mann-Whitney U test and Fisher exact test were used for statistical analysis.

Results

Blood transfusion data was available from 907 patients (61.1%). In total, 165 patients (18.1%) received IOBT. The median number of units given was two (range: 1-36, interquartile range (IQR): 1). Patients who received IOBT were similar to those who did not in terms of median age (68 vs 67 years, p=0.5), median BMI (23.8 vs 25.3 kg/m2, p=0.0001) and ASA grade (33.3% vs 34.5% grade >II, p=0.8). These patients also had similar rates of preoperative diabetes (24.8% vs 20.9%, p=0.3), cardiac (41.2% vs 45.9%, p=0.3) and respiratory disease (7.9% vs 12.1%, p=0.01) compared to patients without IOBT. Transfused patients experienced more infective complications but this was not statistically significant (24.2% vs 17.6%, p=0.06).

Conclusion

In our multicentre study, there was a trend amongst patients undergoing PD who received IOBT to develop more infective complications. Blood transfusions should only be given when strictly indicated.
ThP6.2 - Benign and malignant biliary strictures encountered during single session laparoscopic cholecystectomy and bile duct exploration. Rationalising preoperative imaging and relying on routine cholangiography can optimise outcomes
Authors: Omran Asmaa , Al-Shaye Ahmad R A , Hayyawi Israa , Nassar Ahmad H M
Published: September 2024

Aim

To review causes, diagnostic features and operative strategies of biliary strictures discovered on routine cholangiography (IOC) during single session treatment of bile duct stones.

Methods

A prospective database of cholecystectomies and bile duct explorations spanning 30 years was analysed. Cross sectional imaging and ERCP play a limited role in patients with confirmed gall stones except in suspected malignancies.

Results

53/6140 patients (0.86%) had strictures on IOC.Malignant Strictures 27 (%)Benign strictures 26 (%)Females18 (66.6)12 (46)Age Median7262Emergency admission24 (88.8)15 (57.7)Presentation: Jaundice22 (81.5)15 (57.7)USS: GB Thick or contracted6 (22.2)4 (15.4)Bile duct dilatation16 (59.2)14 (53.8)Suspected CBD stones23 (85.2)24 (92.3)Preoperative imaging: MRCP1 (3.7)6 (23)CT6 (22.2)4 (15.4)ERCP1 (3.7)5 (19.2)Gall bladder conditionMucocele10 (37)3 (11.5)Acute/Empyema6 (22.2)4 (15.4)Contracted5 (18.5)9 (34.6)Cholangiography abnormality:Strictures + dilated ducts12 (44.4)22 (84.6)Dilated ducts/stones/no flow15 (55.5)4 (15.4)Bile Duct Exploration:Choledochotomy17 (63)10 (38.4)Transcystic5 (18.5)11 (42.3)NONE5 (18.5)5 (19.2)Choledochoscopy21 (77.7)20 (76.9)Biliary drains13 (48)18 (69)Stents9 (33.3)3 (11.5)Operative time (median)135 min135Open conversion1 Bilioenteric anastomosis0Morbidity4 (14.8)7 (26.9)Hospital stay median1413Postoperative ERCP11 (40.7)11 (42.3)Postoperative surgery322 year survival122

Conclusions

Careful clinical assessment and exclusion of risk of malignancy optimises preoperative imaging and maximise benefits of single session management of suspected CBD stones.
ThP6.10 - Overview of Necrotising Soft Tissue Infections' Risks and Outcomes
Authors: Pha Sai Yan , Asfour Aref , Christie Hannah , Burke Joshua , Peckham-Cooper Adam
Published: September 2024

Introduction

Necrotising Soft Tissue Infections (NSTI) are severe life-threatening conditions, which are increasing in incidence. Associated with high mortality and morbidity, NSTI’s are a significant burden to health care services globally. Identifying themes, risk factors and underlying causation is therefore of interest.

Methods

A retrospective data cohort study examining clinical data for all histologically confirmed NSTI cases in a single centre between 2012 to 2022 was conducted.

Results

73 confirmed NSTI cases were identified. Patient co-morbidities included the following:CasesDiabetic34Smoker16Post-op12IVDU8Trauma7Immunosuppressed6Bowel Perf5Cancer5

68 patients underwent urgent surgical debridement, with an average of 3.59 (Range 1-11) further surgical interventions required. Patients spent an average of 8.24 days (Range 1-42 days) in ICU, with a hospital stay of 44.02 days. (Range 7-180 days)

6(8%) patients died (5 within first week of presentation). Defunctioning stomas were performed in 24 patients during the admission and 32 patients underwent reconstructive surgery after recovery from the acute phase.

An array of causative organisms were identified with no clear delineating trends.NumberAnaerobes36Streptococcus35Staphylococcus20E Coli + Coliforms20Enterococcus15

Conclusion

NSTIs continue to increase in incidence and prevalence. The old surgical adage ‘You will see one NSTI in your lifetime is no longer true. Associated morbidity and mortality is significant and a focus on early recognition and prevention is vital. Further larger data sets are required to delineate clear trends and associated risk factors that can effect meaningful health care policy change.
ThP6.17 - ‘If it’s not documented, it didn’t happen’: an audit into surgical ward documentation and clinicians expectations in a district general hospital
Authors: Sadczuk Dominika , O’Neill Aoife , Fox Katherine
Published: September 2024

Introduction & Aims

There are guidelines published by the Royal College of Surgeons (RCS) on adult surgical ward round documentation. Locally, documentation is done on pre populated sheets containing blood results, antibiotics and VTE prophylaxis. We aimed to assess documentation in our unit against the RCS guidelines.

Methodology

We audited documentation for surgical inpatients over 1 week, looking at daily ward rounds (DWR), and initial consultant post take ward round (PTWR). Through an online survey, we established the minimum standards of documentation expected by doctors of varying seniority on a ward round within our unit.

Results

21 DWR and 21 PTWR entries were reviewed; 90% (n=19) contained the date and 95% (n=20) the name of the reviewing consultant. Time of review was documented in 29% (n=6) and 35% (n=7) respectively. 33% (n=4) DWR entries documented examination findings, compared to 8 40% (n=8) PTWR entries. 45% (n=10) PTWR contained the presenting complaint. 26 doctors completed the online survey; 100% thought date, time and examination findings were important. More senior doctors highlighted that drain status was a key part of ward round documentation.

Conclusions

Within our unit, there is poor adherence with the RCS ward round documentation guidelines. Juniors suggested this is because ward rounds are too fast paced, often on complex and comorbid patients. We plan to address our findings with an improved surgical admission proforma and an electronic handover to ensure all team members are up to date with patients’ admission details.
ThP8.6 - A real-world diagnostic algorithm for identifying carotid artery stenosis
Authors: Elkorety Mohamed , Khosravi Annie , Rosenfeld Kevin , Naseer Afifa , Sarin Sanjeev
Published: September 2024

Aim

Eighty-five percent of ischaemic strokes are caused by extracranial atheromatous lesions involving a narrowing of the Internal Carotid Artery so accurate and timely diagnosis is vital for management. The aim of this study was to correlate CT angiogram (CTA) and ultrasound doppler (US) derived measurements of carotid artery stenosis (CAS), with a view to identify those cases where second modality is required to reduce potential errors.

Methods

All consecutive carotid US and CTA examinations performed in 2021 and 2022 were included for comparison in this retrospective cohort study. Collected data was then reviewed and evaluated by a multidisciplinary team. North American Symptomatic Carotid Endarterectomy Trial (NASCET) and St Mary’s criteria were used to narrow down the percentage stenosis.

Result

There were fifty-one patients (102 carotid arteries) over this period who had both studies performed. Twenty-nine males and twenty-three females with a median age of seventy-three. Initial data analysis showed no discrepancy in ninety-one (90%) carotid arteries between both modalities. After MDT review, there were eight (7.1%) false positive results and three (2.9%) true positive (2 symptomatic & 1 asymptomatic). In three (2.9%) cases quantification was significantly inaccurate in the initial imaging modality because of heavily calcified vessels.

Conclusion

This study supports the use of US or CTA as a single modality in grading CAS. Heavily calcified vessels on the first test should be a ‘red flag’ for triggering further alternative imaging to reduce the risk of error. Persistent discrepancies even after the second modality will require a further modality e.g. enhanced magnetic resonance angiography.
ThP8.7 - Giant Cell Arteries: Diagnostics
Authors: Elkorety Mohamed , Naseer Afifa , Anton Jeny , Sarin Sanjeev
Published: September 2024

Aim

Giant cell arteritis (GCA) poses a risk of severe ischaemic complications such as irreversible blindness which mandates early recognition of condition. We aimed to evaluate effectiveness of ultrasound doppler (USD) in diagnosing GCA compared to temporal artery biopsy (TAB) and American College of Rheumatology (ACR) score.

Method

This retrospective study included patients with suspected GCA who had consecutive TAB and USD examinations performed over a course of three years (2017-2022) which was correlated with ACR score. The data was also analysed to assess further management.

Results

There were 64 patients over this period who had both studies performed (22 were excluded as they did not have TAB) with 64% having an ACR score ≥3. Twenty males and forty-four females with a median age of 77 years (IQR 84-67). Overall, 81% patients had a negative USD result. Comparing USD results with TAB gold standard, there was sensitivity of 63% and specificity of 84%. Comparing USD results with ACR as gold standard, there was sensitivity of 20% and specificity of 83%. Forty percent patients with negative doppler result were continued on treatment mainly due to improvement of symptoms in response to steroids.

Conclusion

US Doppler has high diagnostic specificity and low sensitivity which makes it time-efficient, cost-effective and allows for the implementation of fast-track management pathway for majority patients. In certain circumstances, as cases of low clinical suspicion and positive doppler result, an additional test (TAB) would be required to confirm the diagnosis and cases where clinical suspicion is high with negative doppler, TAB should be considered.
FP1.10 - Functional Outcomes of a Standard vs Modified Brooke Ileostomy – A Quality of Life Study
Authors: Bruce Nikki , Tallo Tracy , Duffy Norma , Robertson Isabel , Macdonald Scott , Thornton Michelle , Macdonald Angus
Published: September 2024

Aim

Previous studies have shown that IBD patients with a modified Brooke ileostomy, where there is retention of the ileocolic sphincter, may have improved stoma function by preserving a functional high pressure zone. This study aims to review functional outcomes through a patient-reported quality of life survey.

Methods

This cohort study was conducted across two sites, one performing Standard Brooke Ileostomy (SBI), and the other Modified Brooke Ileostomy (MBI), as standard practice. Patients with diagnosis of colitis were identified from a prospectively collected database. A stoma activity log and a validated stoma Quality of Life survey (PRATO) was sent, with 23 responses obtained (14 MBI, 9 SBI). Activity log included bag emptying, hours of interrupted sleep, and number of visits to stoma nurse.

Results

For QoL survey (minimum score 20, max 80), patients with MBI scored higher (mean 55.36), compared to SBI (mean 48.22), (p=0.037).

Bag emptying over 24 hours was similar (MBI mean 5.71, SBI mean 5.86), as was bag emptying overnight (MBI mean 1 (range 0-3), SBO mean 1 (range 1-2).

MBI patients reported longer mean uninterrupted sleep (7.07 hours vs 5.43 hours (p=0.005)).

MBI patients required fewer stoma nurse visits in the first year (mean 5.3, median 5, range 0-13). SBI (mean 10.7, median 10, range 2-33).

Conclusion

A practice of Modified Brooke Ileostomy has comparable patient reported quality of life outcomes to a standard Brooke Ileostomy and performs better overall in terms of less interruption to sleep and lower disruption of daily life through hospital visits.
FP2.2 - Does preoperative nutritional assessment correlate with postoperative outcomes of patients undergoing surgery due to colorectal cancer? A bicenter prospective observational study
Authors: Frountzas Maximos , Kozadinos Alexandros , Lidoriki Irene , Theodoropoulos George , Toutouzas Konstantinos , Schizas Dimitrios
Published: September 2024

Aims

Preoperative nutritional status has been investigated as a risk factor for postoperative complications in patients undergoing surgery due to colorectal surgery. The aim of the present study was to investigate the predictive role of preoperative nutritional assessment in terms of morbidity and mortality in such patients.

Methods

Patients undergoing surgery due to colorectal cancer from March 2022 until March 2023 at two university surgical departments were included in the present study. Patients’ demographics and postoperative parameters, such as complications’ severity according to Clavien-Dindo classification and mortality, along with malignancy stage were reported. Preoperative nutritional assessment was conducted according to the Patient-Generated Subjective Global Assessment (PG-SGA) tool and the Geriatric Nutritional Risk Index (GNRI) tool. The present study was registered in ClinicalTrials.gov (NCT05795374).

Results

The present study included 159 patients with a mean age of 69 ± 12 years old. Severe malnutrition according to the PG-SGA tool was associated with advanced disease stage (66% vs 59%, p=0.006). In addition, the high risk of malnutrition according to the GNRI tool was correlated to major (Clavien-Dindo≥3) postoperative complications (19% vs 15%, p=0.026) and increased 30-day mortality (34% vs 9%, p=0.026).

Conclusions

Postoperative morbidity and mortality of patients undergoing surgery due to colorectal cancer seem to be associated with preoperative nutritional stratification, especially with the high malnutrition risk.