bluuebunny/crossref_metadata_2025 huggingface dataset:
TP5.2.2 Office based endovascular radiofrequency ablation (OBEVRFA) as a standalone procedure for varicose veins
Authors: Balasubramanian Ashok , Gambhir Raghvinder , Rashid Hisham
Published: October 2021

Aims

The aim of this study was to identify the number of patients that required a secondary procedure for persistence/ recurrence of symptoms within 3 years of the index (OBEVRFA) procedure.

Method

Retrospective analysis of data collected prospectively for patients booked to have OBEVRFA in the period January 2017- January 2018 was accessed from electronic patient records. Their clinic follow letters, scans and any secondary procedures done were documented on an excel sheet.

Results

A total of 303 patients, were booked for an OBEVRFA of which 17 (5.6%) patients did not attend the procedure. 39 (12.8%) patients were cancelled on the day of the procedure.

247 patients (M:F 1:1.5), underwent OBEVRFA. 53 patients (21.8%), had residual veins or were symptomatic & were followed up beyond their 3 month period. 24 patients had a duplex scan which showed complete recanalization in 4, a reflux in non-treated secondary vein (Like Anterior thigh vein or duplicated Long saphenous vein) and a new perforator incompetence in others.

40 (16.1%) patients eventually underwent secondary procedures, 8 underwent classical High flush ligation and stripping with multiple stab avulsions (MSA) , 7 had a redo OBEVRFA, 3 had a redo RFA with MSA under GA, others had MSA alone and 1 had successful sclerotherapy. 3 patients were not keen for a secondary procedure.

Conclusion

OBEVRFA alone provides complete symptomatic relief in over 80% of patients with only 16% needing a secondary procedure. For symptomatic varicose veins from truncal reflux OBEVRFA should be the first line treatment on NHS.
TP5.2.4 Patency of radiocephalic versus brachiocephalic arteriovenous fistula in a major tertiary hospital
Authors: Wong Fui Lin , MacAulay Ewan , Hussey Keith
Published: October 2021

Introduction

The patency of brachiocephalic fistulae is generally considered to be superior to radiocephalic fistulae. We have explored this in a major tertiary hospital.

Method

This was a retrospective review of fistulae created between 1st January 2015 and 31st July 2020. Index cases were identified from a prospectively maintained vascular access database. Patient demographics, procedure details and subsequent interventions are described.

Results

There were 915 fistulae created on 813 patients (528 males and 285 females). There were 388 radiocephalic fistulae created on 374 patients and 363 brachiocephalic fistulae were formed on 301 patients. Both groups had 315 fistulae with patency data available. Age and a diagnosis of diabetes were comparable. There were significantly fewer female patients in the radiocephalic cohort (p = 0.004). Primary patency at 3 months, 1 year and 3 years were 84.6%, 58.1% and 37.9% for radiocephalic and 87.9%, 63.1% and 37.0% for brachiocephalic fistula (p = 0.273). Primary assisted patency at 3 months, 1 year and 3 years were 92.3%, 87.0%, 77.4% for radiocephalic and 96.1%, 88.6%, 79.9% for brachiocephalic fistulas (p = 0.295). Secondary patency at 3 months, 1 year and 3 years were 93.3%, 88.3% and 81.5% for radiocephalic fistulas and 97.4%, 90.6% and 85.7% for brachiocephalic fistulas (p = 0.134).

Conclusion

We have demonstrated similar primary, primary-assisted and secondary patency for radiocephalic and brachiocephalic fistulae. Pre-operative ultrasound vein mapping, selective ultrasound surveillance, surgical expertise and careful patient selection may contribute to the high secondary patency and absence of difference between the groups.
TP5.2.18 Should follow up to bariatric surgery be extended beyond 2 years for patients with concurrent renal disease?
Authors: Stephenson Josh , Yokum Dawn , Durman Katie
Published: October 2021

Aims

Following bariatric surgery, all patients must be offered a minimum follow up period of 2 years to support patients with potential early and long-term post-operative complications. Patients with end-stage renal disease may need extra support for extended period as micronutrient homeostasis may be impaired long term due to reduced kidney function.

This study aims to analyse micronutrient homeostasis of patients with concurrent renal disease and post-op bariatric surgery, to determine need for an extended minimum follow up period.

Methods

The study was performed in a single referral centre between 2009-2021 and the data was collated from a prospectively collected database. All patients included must have concurrent renal disease and bariatric surgery and followed up for at least 3 years. In addition to clinical variables, micronutrient and metabolic data were collected and analysed.

Results

A total of 35 patients were included in this study. Micronutrient homeostasis difficulties were recorded in 32 of the 35 patients. Specific micronutrients that were affected includes: vitamin A, B12, folate, ferritin, copper, zinc, selenium, calcium and magnesium. All micronutrient instabilities lasted a period of at least 3 years without a renal transplant.

Conclusion

Data from this study suggests that patients post bariatric surgery with concurrent renal disease have difficulties maintaining micronutrient homeostasis. This suggests that extending the minimum follow up period and may be necessary to avoid pathological sequalae from micronutrient excess and or deficiency.
TP6.1.3 Bayesian Network Meta-Analysis of Upfront Surgery versus Neoadjuvant Therapy for Potentially Resectable Pancreatic Ductal Adenocarcinoma
Authors: Bradley Alison , Van Der Meer Robert , McKay Colin
Published: October 2021

Aims

To compare upfront surgery and neoadjuvant treatment strategies for potentially resectable PDAC.

Methods

PubMed, MEDLINE, Embase, Cochrane Database and Cochrane Databases were searched for studies comparing neoadjuvant and upfront surgery. A Bayesian network meta-analysis was conducted using the Markov chain Monte Carlo method to better handle the heterogeneity of existing studies. Convergence was assessed using the Brooks-Gelman-Rubin method. In accordance with NICE guidelines inconsistency was measured by comparing deviance residuals and DIC statistic in fitted consistency and inconsistency models. Cochrane Collaboration’s risk-of-bias, ROBINS-I and GRADE tools were used to assess the quality of included trials.

Results

25 studies were included (n = 32,921). Aggregate rate (AR) of R0 was marginally higher with neoadjuvant therapy (0.7389 versus 0.7306, O.R 1.12, 95% CI 0.60-2.08). AR of 1,2,3,4 and 5-year survival were higher with neoadjuvant therapy (1-year survival: 0.8109 versus 0.6403, O.R: 2.12, 95% CI: 1.59-2.93; 2-year survival: 0.5135 versus 0.3002, O.R: 1.65 95%, CI: 1.16-2.34; 3-year survival: NAT 0.3151 versus 0.2147, O.R: 1.50, 95% CI: 1.10-2.04; 4-year survival: 0.2114 versus 0.1647 O.R: 1.57, 95% CI: 0.80-2.99; 5-year survival: 0.2118 versus 0.1736, O.R: 1.65, 95% CI: 0.68-3.73). Multimodal treatment was the key determinant of optimal outcome.

Conclusion

Considering the flaws in the existing evidence neither treatment pathway is conclusively superior at population level analysis. Receipt of multimodal treatment at individual level within either pathway optimises outcomes. This study demonstrates the importance of developing statistical methods that better engage with system complexity and uncertainty to move towards more personalised predictive medicine to support decision-making.
TP6.2.2 Multi-disciplinary interventions to increase utilisation of NELA scores and critical care involvement following emergency colorectal surgery
Authors: Smith Scott , Hodge Katherine , Ying Andrew , Swan Rebecca , Von Maydell Alexander , Ventham Nicholas
Published: October 2021

Aims

This audit aimed to assess pre-operative NELA risk score documentation and subsequent specialist peri-operative critical care involvement.

Methods

This complete audit cycle retrospectively reviewed notes (electronic patient records, anaesthetic charts and CEPOD booking forms) of all patients undergoing emergency laparotomy between March and May 2019. The NELA score was calculated retrospectively if not documented. Following the initial audit, the following multi-disciplinary interventions were instituted: alteration of the physical CEPOD booking form to include NELA score (Surgical); a sticker added to anaesthetic charts to prompt NELA calculation (Anaesthetic), formal recording of NELA score during theatre brief (Theatre staff); and by increasing awareness of NELA via departmental education (All). The audit cycle was completed by reassessment between October and November 2020.

Results

The initial cycle included 34 patients, with only 2 (6%) having a NELA documented. The repeat cycle included 35 patients, with 29 (83%) having a NELA documented. Regarding post-operative critical care admissions, both cycles found that 100% of patients with a NELA of ≥ 5%, were admitted to either surgical HDU or ICU (n = 17 in first cycle, n = 17 in second cycle). For those with a high-risk NELA of ≥ 10% (n = 11 in first cycle, n = 7 in second cycle), only 2 (18%) were admitted to ICU in the first cycle vs 7 (100%) in the second cycle.

Conclusions

This complete audit cycle demonstrates improved NELA score calculation following institution of several multidisciplinary interventions. The improved NELA score uptake was associated with increased critical care review and admission to ITU in high-risk cases.
TP6.2.6 A meta-analysis and systematic review of Laparoscopic versus open hepatectomy for malignant liver tumours in the elderly patients
Authors: Mohamedahmed Ali Yasen Y , Zaman Shafquat , Albendary Mohamed , Wright Jenny , Mankotia Rajnish , Sillah Abdul Karim
Published: October 2021

Aims

To evaluate comparative outcomes of laparoscopic versus open hepatectomy for malignant liver tumours in elderly patients.

Methods

A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing laparoscopic (LH) versus open hepatectomy (OH) for both primary and metastatic malignant liver tumours in the elderly were included. Total operative time (minutes), need to perform Pringle’s manoeuvre, blood loss (ml), requirement for blood transfusion intra-operatively/post-operatively, post-operative complications, R0 resection rate, specimen resection margin (mm), re-operation rate, length of hospital stay (LOS), and 90-day mortality were the evaluated outcome parameters.

Results

Twelve studies reporting a total number of 1762 patients who underwent laparoscopic (n = 831) or open (n = 931) hepatectomy were included. OH group was associated with a significantly higher number of post-operative complications compared to LH (P = 0.00001). Complications such as post-operative liver failure (P = 0.02), ascites formation (P = 0.002), surgical site infection (P = 0.02), blood loss (P = 0.03), blood transfusion rate (P = 0.05) and LOS (P = 0.00001) were significantly higher in the OH group when compared to LH. There was no significant difference between the two groups in terms of total operative time (P = 0.53), bile leak (P = 0.12), R0 resection rate (P = 0.36), re-operation (P = 0.70) and 90-day mortality (P = 0.11).

Conclusion

Laparoscopic liver resections are safe with at least equal or superior peri-operative outcomes in the elderly population. Importantly, oncological outcomes are also comparable with open surgery. This approach needs to be utilised wherever possible to provide optimal healthcare in an aging population.
TP6.2.14 Outcome of POEM (Per-oral endoscopic myotomy) for achalasia
Authors: White Annabelle , Hwang Woochan , Kotta Alekhaya , Beasley Daniel , Chow Katarina , Botha Abraham
Published: October 2021

Aims

Laparoscopic Heller’s myotomy (LHM) has been the surgical gold standard for treatment of oesophageal achalasia. Peroral endoscopic myotomy (POEM) has been proposed as an alternative technique. The aim of this study was to assess the safety and efficacy of POEM for achalasia in our unit.

Methods

We have operated on 202 patients for oesophageal achalasia since 2005: 107 had LHM, 86 had POEM, and 9 had an oesophagectomy. We assessed the clinical outcome of POEM comparing pre- and postoperative endoscopic, radiologic and manometric findings, as well as Eckardt-, GERD- and DsQoL score for achalasia. All follow-up patients were offered endoscopy.

Results

Data were completed for the first 45 POEM patients. The average age was 45 years. 18 patients (40%) had prior achalasia treatment. The median hospital stay was 2 days (2-5). There was no mortality, but 4 patients (9%) had post-operative complications. The median follow-up was 24 months (12-49). Clinical success (Eckardt score ≤ 3) was achieved in 39 patients (87%). Thirteen patients (29%) were taking PPIs for chest symptoms. Eleven of these underwent pH studies of whom only 1 had a DeMeester score > 14.5. Of the 24 patients who had post-operative endoscopy, 40% was diagnosed with oesophagitis grade A, yet only 5 of them were symptomatic.

Conclusions

POEM appears to be safe and effective and warrants consideration as first-line therapy in expert achalasia centres. Longer term randomized studies comparing the outcomes of POEM with LHM and pneumatic dilatation will determine its place in the treatment of achalasia.
TP6.2.15 Staging Laparoscopy and Peritoneal Cytology for Gastric and Gastro-oesophageal Junction Malignancy: an Audit from a Single Oesophagogastric Resection Centre
Authors: Clements Hollie Alice , Rupasinghe Sukitha Namal , Alam Mushfique , Murphy Kieran , Rao Rohith
Published: October 2021

Aims

AUGIS recommends staging laparoscopy in all gastric cancers and selected gastro-oesophageal junction (GOJ) cancers. We previously audited our practice of staging laparoscopy and peritoneal cytology and found that in a cohort of 158 consecutive patients, no tumours less than T3 with negative nodes had positive cytology, resulting in change in practice to selectively use peritoneal cytology in patients with a T-stage of 3 and above or N+ disease. Our aim was to assess the impact of this audit on current practice.

Methods

We retrospectively reviewed the notes of patients undergoing staging laparoscopy and oesophagogastroduodenoscopy (OGD) identified by MDT from January 2019 to December 2019. Patients who underwent resection on the same day were excluded.

Results

63 patients underwent staging laparoscopy and OGD, 54 for GOJ and 9 for gastric disease. The majority were staged as T3 or T4a (81%). As a result of staging laparoscopy and OGD, 4 (6%) patients were changed from curative to palliative pathway, 2 (3%) of whom had positive cytology. No patients had positive peritoneal cytology for a T stage of 2 and below with no positive nodes, further demonstrating the safety of the recommendation.

Conclusions

Peritoneal cytology has a low yield in changing the clinical course of patients but can upstage up to 6% of patients. The re-audit backs up the previous guidance in the safety of using our current threshold for recommending peritoneal cytology and potentially prevents delaying treatment while waiting for cytology results.
TP6.2.20 UK- single centre experience with the ElipseTM intragastric balloon; Early safety and effectiveness
Authors: Oyewole Bankole , Stefanova Irena , Sandhya Anu , Mangat Shannon , Monkhouse Simon
Published: October 2021

Introduction

The ElipseTM gastric balloon (EIGB) is an established outpatient, non-invasive, non-surgical device for weight-loss not requiring endoscopy nor sedation. This study reports the early safety and effectiveness from the largest and only reported UK cohort treated with the EIGB.

Methods

A retrospective study of 224 consecutive patients undergoing EIGB insertion between May 2018 and December 2020 was performed. EIGB placement involved swallowing of the ElipseTM capsule followed by a pre-inflation abdominal radiograph to confirm position. Inflation was performed with 550mls of sterile water followed by a post-inflation radiograph.

Patients had weekly follow-up to assess symptoms, weight-loss, time and route of balloon expulsion.

Results

224 patients underwent EIGB insertion during the study period; 39 patients were lost to follow-up. 185 patients (28 male and 157 female) were included in the final analysis with a mean age of 38.1 years. Mean study follow-up was 10 weeks, mean weight at insertion was 97.7 kg. Mean %Total Body Weight (TBW) loss was 6.5% at 4 weeks and 9% at last follow-up. 32 patients had 15.3 %TBW loss at 16 weeks follow-up. Frequently experienced symptoms during the first week were acid reflux, abdominal pain and bloating, nausea and vomiting. One patient had early expulsion at 8 weeks. Seven patients required early deflation due to severe symptoms (5), pancreatitis (1) and hyperinflation (1).

Conclusion

EIGB is a safe and effective method of weight loss. Longer follow-up studies in the UK population are required to assess overall patient outcomes and associated factors for weight loss.
TP7.2.4 Skin-to-gel is a safe and effective method to prevent patients sliding during minimally invasive colorectal surgery
Authors: Florance Charlotte , El-Dhuwaib Yesar , Miller Matthew
Published: October 2021

Aims

Minimally invasive colorectal surgery often requires manipulating the patient position to facilitate exposure of the surgical field, such as a steep Trendelenburg position. However, this exposes patients to risks of sliding on the operating table. Preventive interventions are available, such as bean bags; we explore our experiences of gel pads within a district general hospital.

Methods

A retrospective analysis was performed of all colorectal patients undergoing laparoscopic resections over the last ten years, identifying complications associated with the use of intra-operative gel pads (skin-to-gel) with no shoulder support.

Results

Over 500 patients have undergone laparoscopic colorectal resections during this time, all utilising pressure-relieving gel pads. Patients are placed skin-to-gel, lying on a single torso-length gel pad laid directly on the operating table mattress. Dependent upon the operative approach, the legs can be placed in stirrups or maintained supine on table extensions. There have been no DATIX recorded skin-tears, pressure or position-related injuries. The pads have also proven to prevent patient movement on the operating table, negating the use of shoulder supports when adopting the Trendelenburg position. On discussions with theatre staff, the Consultant body and interrogation of the DATIX database, there has only been one reported incidence of slipping when a patient was left on the slide sheet on top of the gel pad. They are relatively inexpensive, durable and easily maintained, proving a highly cost-effective piece of equipment.

Conclusion

Gel pads have proven to be highly effective in preventing both pressure-related injuries and patient movement during laparoscopic surgery.
TP7.2.10 The Un-abating Debate of using Drains following Colorectal Anastomosis: a systematic review
Authors: Hussain Mubashar
Published: October 2021

Aims

To study whether routine use of drains in colorectal surgery/anastomosis help reduce postoperative complications and whether has a selective role in high risk patients.

Methods

A systematic search of electronic database performed using PubMed, Embase, and Cochrane Central database. Clinical literature from 1988 to 2018 was reviewed including randomized, non-randomized controlled studies, meta-analysis and systematic reviews for routine use of drain versus no usage of drain at index surgery & compared for clinical benefits. Terms used for search were ‘colorectal’, ‘rectal’, ‘colonic’ surgery/anastomosis’ and drain. Main outcome: anastomotic leak whilst secondary outcome were to study collections, re-surgical intervention, wound infection, DVT/PE, chest complications & mortality. Case reports and small cohort studies (<25 patients) were excluded.

Results

2243 patients were included from 14 RCTs, 2 meta-analysis and 3 systematic reviews. 1178 patients in the drain group and 1065 patients in the no drain group. Using Chi square test, data analysis demonstrated no statistically significant differences between the two groups (drains Versus no drains) for anastomotic leakage, P >0.35; re-operation, P >0.41, wound infection, P >0.41; DVT/PE, P > 1.1; chest complications, P > 0.51 and mortality, P >0.48.

Conclusions

Routine use of drains in colorectal surgery/anastomosis does not confer significant benefit in reducing postoperative complications.

However, selective use of drains in the high risk patients for anastomotic leak may have a role but warrants more studies.
TP7.2.12 Robotic versus laparoscopic inguinal hernia repair: a systematic review
Authors: Imsirovic Anja , Bagga Rahul , Khan Mansoor , Singh Krishna , Sains Parv , Sajid Muhammad S
Published: October 2021

Aims

Robotic inguinal hernia repair (RIHR) is considered to improve surgical outcomes in patients undergoing inguinal hernia surgery. The objective is to present a systematic review of RIHR compared to laparoscopic repair (LIHR).

Methods

A systematic review of comparative studies until January 2021 published on Embase, Medline, PubMed, PubMed Central and Cochrane databases reporting the surgical outcomes in patients undergoing RIHR versus LIHR was performed.

Results

A total of 12565 patients in 10 comparative studies were included. In the random effects model analysis using the statistical software Review Manager, statistically the RIHR prolonged the duration of operation (Standardized mean difference (SMD), 3.33; z = 5.84; P = 0.00001) but the length of stay (SMD, -0.8; z = 0.66; P = 0.51) and post-operative pain score (SMD, -0.47; z = 1.19; P = 0.24) were similar in both groups. In addition, the recurrence rate was similar in both groups (p = 0.92). The incidence of post-operative complications (OR 1.67; 95% CI, 1.14, 2.45; z = 2.64; P = 0.008) and chronic groin pain (OR 2.14; 95% CI, 0.97, 4.72; z = 1.88; P = 0.06) was higher in RIHR group.

Conclusion

RIHR is feasible and safe, but the duration of operation is significantly longer with equivocal other variables such as stay and pain score. There was higher incidence of post-operative morbidity and chronic groin pain as well. Major multi-center randomized controlled trial is mandatory to assess the long terms outcomes and cost effectiveness before the routine use of RIHR.
TP7.2.17 Are there any predictable trends in the pattern of two week referrals for suspected gastrointestinal cancers?
Authors: Hussain Adiba , Dharni Akash , Sayed Rehma , Saleh Ahmed , Eltilib Ibrahim , Saha Arin
Published: October 2021

Aims

Patients with suspected cancer are referred to secondary care on the “two week wait” pathway. Investigation and management of these patients is resource intensive and puts a significant strain on services. We aim to determine if there are predictable trends in quantity of referrals or cancer detection rates (conversion rates) for suspected upper and lower gastrointestinal cancers. Identifying such trends could guide future resource allocation and provision of services.

Methods

Two week wait referrals to upper and lower gastrointestinal clinics between 2015 and 2019 were included. The number of referrals and conversion rates were analysed on monthly, quarterly and annual basis.

Results

Upper GI total referrals: 1094 in 2015 vs 1357 in 2019. Lower GI total referrals: 1827 in 2015 vs. 3278 in 2019. Upper GI conversion rates: 8.8% in 2015 vs. 8.36% in 2019. Lower GI conversion rates: 6.47% in 2015 vs. 4.07% in 2019. There were no identifiable significant trends in referral numbers or conversion rates when analysed on a monthly and quarterly basis.

Conclusions

The number of two week wait referrals for suspected cancers has shown a sustained year on year increase. Conversion rates for the time period have remained somewhat static and in some cases decreased. Our data shows no evidence of any spikes or troughs in demand related to the time of year. Should demand continue to rise at the current rate then alternate modes of assessment such as telephone assessment clinic or a straight to test approach may become more widespread.
TP8.1.10 Factors predicting residual disease on re-excision after breast conserving surgery
Authors: Simpson Duncan , Allan Jennifer , McFall Brendan
Published: October 2021

Introduction

Breast conserving surgery is the standard of care for early breast cancer, however in a quarter of patients, satisfactory margins are not achieved, usually leading to re-excision. Residual disease is found in less than half of these re-excisions, leading to increased morbidity,poorer cosmesis and increased cost with no oncological benefit. Our study aimed to identify a group of patients with unsatisfactory margins but a low risk of residual disease, who may be able to avoid re-excision.

Methods

All patients from our unit undergoing re-excision for unsatisfactory margins after breast conserving surgery between January 2013 and October 2019 were identified. Pathological factors predicting residual disease were investigated using univariable and multivariable analysis.

Results

220 patients were included. 90 (41%) had residual disease in the re-excision specimen. Residual disease was more likely in those having mastectomy than cavity shaves (61% vs 32%, p < 0.0001). Residual disease increased in a linear fashion with number of involved margins and with increasing tumour size. Tumour size <20mm (p = 0.045), a pathological to radiological tumour size ratio less than 1.5 (p < 0.0001) and disease-free cavity shaves taken at initial surgery (p = 0.041) were all significant predictors of a low chance of residual disease on multivariable analysis. Patients with all three factors had a 14% chance of residual disease.

Conclusions

More than half of patients undergo unnecessary re-excision, and patients with small, radiologically obvious tumours are less likely to have residual disease. The decision on re-excision should include these factors in addition to the margin status.
TP8.2.2 Surgical Escape Rooms: A Novel Approach to identifying and addressing Resilience and Academic Buoyancy
Authors: Ahmad Manal , Law Sarah , Hester Ben , Hunter Ian , Bamford Richard
Published: October 2021

Introduction

Traditional Simulation is useful practice for real life scenarios whilst Surgical Escape Rooms (ER) assess other elements. Resilience contributes to physical and emotional wellbeing as well as the development of coping strategies. Consistent short-term Academic Buoyancy levels can have an impact on long-term levels of Resilience.

Method

Two groups of 4th year medical students were given the validated Brief Resilience Scale (BRS) and the Academic Buoyancy Scale (ABS) before and after. The first group completed the Surgical ER whilst the second group completed a Surgical Simulation. During the ER session, participants were assessed by multiple, independent assessors on 4 parameters - participation, objective display of frustration/stress, interaction with the team and definitive decisions taken. These were then correlated with their initial self-assessments scores.

Result

The ER group ABS Scores improved (3.45 to 3.8; Range 0-4) whilst BRS scores decreased (4.5 to 3.9; Range 0-5). The Simulation group ABS scores decreased (3.4 to 2.9) whilst BRS scores improved (2.9 to 3.2). Scores became more polarised across all groups. Participants who scored low on the BRS/ABS displayed lower levels of participation, team interaction and fewer definitive actions taken but also displayed fewer indicators of overt stress in comparison to their higher scoring counterparts.

Conclusion

Escape Rooms are useful in challenging individuals to improve problem solving skills and encourage lateral thinking. It would be useful to incorporate ER’s in the early stages of training to build confidence and reduce the immediate negative impact of Simulation at later stages.
TP8.2.11 Impact of surgical training on long-term patient outcomes in sleeve gastrectomy
Authors: Ghosh Aishwarya , Lo Christina , Reddy Marcus , Khan Omar
Published: October 2021

Aims

Although few studies have examined the impact of surgical training on early postoperative outcomes in bariatric surgery, there is limited data on longer-term outcomes in trainee-performed cases. Our aim was to evaluate the effect of surgical training on weight loss outcomes following laparoscopic sleeve gastrectomy (LSG).

Methods

Data was prospectively collated on patients undergoing primary LSG at a Quaternary Bariatric London teaching Hospital between 2016-2017. Inclusion criteria was BMI≥35. Exclusion criteria were BMI<35 or > 60, planned HDU admission and LSG with concomitant hiatus hernia repair. Operative time, length of stay, complications and longer-term excess weight loss was recorded with outcomes of consultant and trainee cases compared.

Results

76 LSG patients were included; 44 performed by consultants, 32 by trainees. There was no difference in age, gender, pre-operative weight, BMI and number of obesity-related comorbidities between groups.

Operative time (trainee105±10.0 vs consultant91±18.1 mins) and length of stay (trainee2.6±0.4 vs consultant2.8±0.9 days) were similar between groups. There were 3 complications in the trainee group (intra-abdominal collection requiring drainage, wound infection, hypokalaemia); and 2 with consultants (wound infection, intra-operative bleeding with ICU admission).

Excess Weight Loss (%) at 2years was 55.9%±7.5% for trainee cases and 52.4%±6.7% for consultants(p = 0.49).

Excess Weight Loss (%) at 3.5years was 54.9%±9.9% for trainee cases and 50.7%±9.9% for consultants(p = 0.54).

Conclusion

Outcomes in trainee-performed LSG are comparable to those performed by consultants. Surgical training in a high-volume teaching hospital does not appear to have detrimental effect on patient outcomes following LSG.
TP8.2.13 Impact of peer-delivered tuition/feedback on appointment to UK Higher Surgical Training
Authors: Joy Melvin , Choong Wen Ling , Madurska Marta , Tang Benjie , Ip Brian
Published: October 2021

Aims

In the UK, Core Surgical Trainees (or equivalent) undergo a rigorous National Selection (NS) process to secure a ST3 Training Post in General/Vascular Surgery. Despite decrease in competition ratio from 3:1 in 2012 to 1.48:1 in 2017, many applicants were unable to secure ST3 Training Posts. We hypothesise this is due to applicant performance anxiety rather than lack of clinical experience. We designed a 2-day structured course to address the applicant’s confidence levels in preparing for NS.

Methods

This is a prospective observational study following 27 delegates who completed a 2-day course delivered by surgical consultants and trainees; consisting of didactic lectures and interactive practice with a 1:1 faculty:delegate ratio. A specific mentor was nominated to oversee the delegate’s progress throughout and post course. Personalised feedback was given by the entire faculty throughout the course. Delegates were asked to complete evaluation forms to track their perceived confidence levels of success at NS at different timeframes, measured by a visual analogue scale. Paired t -test was performed to compare the mean confidence level pre- and post- course.

Results

Evaluation forms were received from all (n = 27) delegates. Self-reported confidence increased significantly for all domains except Professional Communication. 23 (85%) participants were successful at interviews post course. There was no statistically significant difference between UK and non-UK graduates, first time and not-first-time applicants.

Conclusions

Peer-delivered teaching, practice and feedback as a structured interview practice course significantly improves applicants’ confidence levels which translates to higher success rate at National Selection.
TP9.1.4Use of a modified Delphi process to develop research priorities in Major Trauma
Authors: McElroy Luke , McGillivray J , Wilson Michael
Published: October 2021

Aims

Delphi methodology can be used to develop consensus opinion amongst a group of stakeholders. This can be used to prioritise clinically relevant, patient centred research questions to guide future funding allocations. The aim of our study was to identify key future research priorities pertaining to the management of major trauma in the UK.

Methods

A three-phased modified Delphi process was undertaken. Phase 1 involved the submission of research questions by members of the trauma community using an online survey (Phase 1). Phases 2 and 3 involved two consecutive rounds of prioritisation after questions were subdivided into 6 subcategories: Brain Injury, Rehabilitation, Trauma in Older People, Prehospital, Interventional, and Miscellaneous (Phases 2 and 3). Cut-off points were agreed by consensus among the steering subcommittees. This established a final prioritised list of research questions.

Results

201 questions across all were submitted by 65 stakeholders in phase 1. After analysis and with consensus achieved, 186 questions were taken forward for prioritisation in phase 2 with 114 included in phase 3. 56 prioritised major trauma research questions across the 6 categories were identified with a clear focus on long-term patient outcomes.

Conclusions

Consensus from within the major trauma community has identified 56 key research questions across 6 categories. Dissemination of these questions to funding bodies to allow for the development of high-quality research is now required. There is a clear indication for targeted multi-centric multi-disciplinary research in major trauma.
TP9.1.5Optimizing Patient Outcomes and Improving Organization Efficiency through Enhanced Management of Low Back Ache and Sciatica
Authors: Peri Harish , Harvitkar Rafique Umer , Ansari Khursheed
Published: October 2021

Aim

This study was undertaken to tackle the rising incidence of Low Back Ache and Sciatica in a primary care government setup, which had contributed to a disabled and diminished workforce. The aim being improving patient outcomes by implementing changes in the current management protocol (measured against the standard NICE guidelines by an initial clinical audit)

Method

Two Plan-Do-Study-Act (PDSA) cycles were implemented post an initial clinical audit among 59 patients of the institution. Data was collected using self-made questionnaires and then analyzed. Re-audits were done to measure the outcome against a set standard.

Results

20-30% (n = 12-18) of patients were aware of their risk category, understood various treatment modalities and use of orthotics in the initial clinical audit. 56% (n = 33), 73% (n = 43), 88% (n = 51) of the patients were absent from work or had diminished work output, were offered imaging and were put on medication respectively. 10% of the patients were offered psychological counselling. Post implementation of changes from the first PDSA cycle, the set target of 90% was achieved in most of the categories. Further, 24% (n = 14) of patients reported that they were still apprehensive about their condition. A second PDSA cycle was undertaken and post implementation of changes, the set standard of 10% or less patients being apprehensive was noted.

Conclusions

Increased awareness among patients through means of regular educational sessions, psychological counselling, updated management protocols have led to healthier patients, less absence from duty and improved work output thereby increasing the organizational efficiency as a whole.
TP9.2.18Are delays to diagnosis and treatment associated with reduced survival in oesophageal cancer?
Authors: Magnoli Matteo , Murgitroyd Ellen , Lamb Peter J , Skipworth Richard JE
Published: October 2021

Aims

Oesophageal cancer has low survival rates due to diagnosis commonly occurring in advanced stages. We performed a systematic review of delays to diagnosis and treatment in oesophageal cancer, and the impact of delay on clinical outcome.

Methods

A systematic review of Pubmed, Embase and Cochrane Library was carried out using the following search terms: (esophageal cancer) AND ((time) OR (diagnosis)) AND ((delay) OR (wait)). 821 results in English were retrieved and independently reviewed by two researchers. Studies were included if they were randomised controlled trials (RCT), meta-analyses or observational studies, and assessed delay in relation to at least one clinical outcome or TNM stage at diagnosis.

Results

15277 patients across 12 studies were included. 10/12 studies were retrospective, and there were no RCT. Heterogeneity existed amongst the studies in defining delay and outcomes (morbidity = 1/12, mortality = 2/12, disease-free = 2/12 or overall survival = 5/12, TNM stage = 6/12).

No studies demonstrated that reduced delay improved clinical outcome. Longer patient delay correlated with presence of malnutrition in one study but did not result in reduced survival.

Conclusions

Systematic review of published literature did not demonstrate a relationship between diagnosis/treatment delay and patient outcome in oesophageal cancer. Multi-centre prospective studies/RCTs are required to identify the impact of delay and the optimal timing of treatment.
TP9.2.19Factors Associated with Multiple Presentations Prior to Appendicectomy in Children Presenting with Suspected Appendicitis
Authors: Ng James Chean Khun , Tay Vi June , Malcolm Francesca Ligori , Chia Zoe , El-Sharkawy Ahmed M , Quarmby John
Published: October 2021

Aims

Appendicectomy is amongst the most common emergency operations in children. We aim to audit the rate of re-presentation within 30-days prior to appendicectomy in children presenting to the emergency department (ED) with suspected appendicitis and identify the factors associated with re-presentations.

Methods

Retrospective review of the medical notes of all children that had an emergency appendicectomies between June 2016 and June 2019.

Results

A total of 231 appendicectomies were performed, all presented through ED, with 8.2%(n = 19) re-presenting within 30-days prior to appendicectomy. Negative appendicectomy rates were similar in those that had appendectomy at initial presentation or when they re-presented (13.2(n = 28)%vs.15.8%(n = 3), p = 0.752), respectively. Of those that re-presented, 84.2%(n = 16) were not reviewed by the surgical team at the index presentation. Female patients accounted for 62.5%(n = 10) of those that re-presented, compared with 31%(n = 57) of those that presented once(p = 0.010). Pyrexia(p = 0.029), Rovsing's sign(p = 0.032), nausea or vomiting(p = 0.012) was associated with histological appendicitis. Absence of migratory pain(p = 0.005), anorexia(p = 0.004), right iliac fossa tenderness(p < 0.001) or guarding(p < 0.001) was associated with higher successful discharge rate. Among those re-presented, there was significant CRP rise between first and second presentation (median(Q1,Q3): 6(1.25,28.5)vs.95.5(27,176.5), p = 0.016) however, white cell count was comparable (median(Q1,Q3): 14.6(11.98,16.05)vs.14.0(11.02,18.58), p = 0.815).

Conclusion

Clinical symptoms and signs correlated with histological appendicitis. A significant proportion of those that re-presented were not assessed by the surgical team at initial presentation. Early surgical consultation at initial presentation may reduce rates of re-presentation.
TP9.2.26Patients admitted onto an Emergency General Surgery unit with rib fractures are mostly elderly and frail and outcomes may be poor: results of a 12-month audit
Authors: Lewis Elaine , Shamim Sarah , Guy Richard
Published: October 2021

Aim

An audit of rib fracture (RF) patients admitted to an EGS unit to determine demographics, injury mechanisms & outcomes.

Methods

Retrospective analysis was undertaken of all RF patients admitted between 1st Jan & 31st Dec 2019. Patient demographics, injury mechanism, comorbidities, length of stay (LOS) & outcomes were recorded. Analysis of age-related differences was undertaken using Mann Whitney U & Chi Squared tests.

Results

There were 115 patients (67 males) with median age 74 (38 patients <65 yrs; 77 patients >65 yrs). Seventy-three patients (63.5%) sustained injury after a fall. Eighty (69%) patients had cardiorespiratory, cerebrovascular or metabolic conditions, of whom 62 (54%) were >65 yrs, & 31 (27%) were on antiplatelets or anticoagulants. Thirty-eight (33%) had a pneumothorax or haemothorax, 19 (5.4%) flail chest & 39 (34%) additional bony injuries. Some 107 (93%) were managed on a rib fracture pathway. Thirty-seven (32%) patients developed pulmonary complications (infection 27, effusion 5, contusion 5) & 8 (7%) died. Subgroup analysis revealed a significant difference in LOS (median 3 vs 6.5 days, p = 0.00144) for age <65 vs >65 years & gender (females 9.5 vs males 3.5 days, p = 0.00114), as well as for age <65 vs >65 & injury mechanism (no fall vs fall, p = 0.042).

Conclusion

RFs are commonly sustained in frail elderly patients following a fall & are associated with significant pulmonary consequences in around a third, with potentially long hospital stay. Close collaboration with Pain Teams and specialists in Medicine for the Elderly is essential.
TP10.1.1Unveiled by Covid-19: The True Rate of Emergency General Surgery
Authors: Ali Roshneen , Bignell Mark , Tebala Giovanni
Published: October 2021

Aims

The Covid-19 pandemic has impacted every NHS service, including the provision of elective and emergency surgery. National lockdown, travel restrictions and intercollegiate guidance on conservative management of acute surgical conditions were introduced in an effort to reduce the burden on emergency services. This service evaluation aimed to evaluate the impact of the Covid-19 pandemic on emergency general surgical presentations and operations, and to determine whether the rate of surgical intervention changed.

Methods

Patients presenting to the surgical emergency unit in a large tertiary centre were identified through electronic admission records between March to April 2019 and the same period in 2020. Data on presentation, admission and operations were collected and compared between the two periods.

Results

Presentations in 2020 reduced by 38% from 1324 to 823. Operations performed decreased by 44% from 334 to 188. The proportion of presentations requiring emergency operations was 23% in 2020 compared to 25% in 2019. Emergency laparotomies increased from 30 to 40, constituting a greater proportion of operations (9% vs. 21%). Rates of appendicectomies remained the same at 26% vs. 27%. Urgent procedures including cholecystectomies, hernia repairs and abscess drainage decreased from 55% to 42% of all cases.

Conclusions

There was an absolute reduction in emergency presentations and operations between the two periods. This reduction could be accounted for by decreased presentations of patients with non-surgical abdominal pain due to lockdown. However, more critically unwell patients presented indicated by the increased number of laparotomies demonstrating the ongoing need for emergency surgery.
TP10.1.13A model for safe elective liver resection during the SARS-CoV-2 (COVID-19) pandemic – lessons for enhanced recovery
Authors: Jitsumura Maki , Sethi Pulkit , Welsh Fenella KS , Chandrakumaran Kandiah , Rees Myrddin
Published: October 2021

Background

The COVID-19 outbreak in January 2020 rapidly became a pandemic, adversely impacting elective cancer services in the UK. This study describes the pandemic-driven changes to existing admission and enhanced recovery protocols, which allowed the Unit to maintain a liver resection service, and evaluates their impact on patient safety.

Methods

During the pandemic, all patients undergoing liver resection in this Unit isolated for 14 days prior to their admission, with COVID-19 testing 48 hours pre-admission. Patients were admitted on the day of surgery to the day surgery unit, a designated COVID-free environment. They underwent liver surgery, recovery and post-operative care, all within the day surgery unit. Using a prospectively collected database, short-term outcomes of consecutive patients undergoing elective hepatectomy during the COVID-19 pandemic (April - June 2020) were retrospectively compared to patients during the same period in 2019.

Results

During the pandemic, 24 patients underwent hepatectomy compared to 34 patients in 2019. There was no statistical difference in demographics, indications for surgery, intra-operative parameters or complications between these periods. The median post-operative length of stay (LOS) was significantly shorter during the pandemic [3 (IQR: 3-4) days vs. 4 (IQR; 4-7) days, p = 0.015], as was the overall LOS [4 (IQR: 4-6) days vs. 6 (IQR; 5-9) days, p = 0.006]. No patient contracted COVID-19 per-operatively.

Conclusions

Patient pathway changes during a pandemic enabled safe liver surgery to be undertaken with improved outcomes – a model that is transferrable to other Units.
TP10.2.2Adherence to the new Royal College of Surgeons (RCS) guidance pertaining to acute appendicitis management during COVID-19
Authors: Khan Rajab , Shamsad Sabina , Rahimi Umaimah , Salih Hamisha , Razzaq Humayun , Adedeji Janine
Published: October 2021

Aims

The mainstay of acute appendicitis treatment is a surgical approach. However, in the tumultuous COVID-19 era, the approach to acute appendicitis management has altered.

We sought to assess the applicability of the new RCS COVID-19 guidance after resolution of the global pandemic.

Methods

A retrospective study was conducted on 244 patients presenting between 01/03/2020 and 17/07/2020. Three sources of data were sought: patients presenting to A&E with signs of appendicitis, operative logs for patients who underwent removal of their appendix and all CT/US scans where the clinician had queried appendicitis in the request.

Results

139 patients were treated conservatively with antibiotics (57.0%). 35 (25.2%) represented within 6 months. Conservative treatment was successful in 92.1% of cases.

65 appendectomies were completed during that time. 45 cases presented acutely whereby the surgical management of acute appendicitis was the primary choice. The decision to operate was due to: 13 (20%) because the patient was 16 or younger. 4 cases presenting with signs of severe sepsis. 4 cases had a complicated appendicitis on their imaging results. 22 (33.8%) cases were completed without initial conservative management. 9 (3.7%) cases failed conservative treatment thus requiring surgical management.

11 (4.5%) cases represented within 6 months due to recurrent appendicitis despite successful antibiotic treatment. Therefore, the recurrence rate following conservative treatment was 7.9%.

Conclusions

There was mixed adherence to the new guidance. Surgical management remains the best approach towards acute appendicitis. However, excellent results can still be achieved with appropriately targeted antibiotic therapy.