bluuebunny/crossref_metadata_2025 huggingface dataset:
SP7.2.2 Fascial defect closure in laparoscopic incisional/ventral hernia: a systematic review and meta-analysis of published randomized, controlled trials
Authors: Rehman Saad , Akhtar Muhammad Sajjad , Khan Mansoor , Sains Parv , Sajid Muhammad S
Published: October 2021

Aims

Closure of fascial defect (CFD) during laparoscopic incisional/ventral hernia repair (LIVHR) remains a controversial issue which requires further investigations to reach a solid conclusion. The objective of this study is to present a systematic review comparing the outcomes of randomized controlled trials evaluating the defect closure versus no-defect closure in patients undergoing LIVHR.

Methods

A systematic review of randomized, controlled trials reporting the fascial defect closure in patients undergoing LIVHR until January 2021 published in Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis.

Results

A total of four RCTs involving 443 patients were included. In the random effects model analysis, using the statistical software Review Manager, defect closure during LIVHR showed no difference in hernia recurrence (risk ratio (RR), 0.89; 95% CI, 0.31, 2.57; z = 0.21; P = 0.84). In addition, the post-operative complications (RR, 0.69; 95% CI, 0.41, 1.16; z = 1.41; P = 0.16), duration of operation (Standardized mean difference (SMD), -0.04; 95% CI, -0.52, 0.43; z = 0.18; P = 0.86) and hospital stay (SMD, 0.27; 95% CI, -0.02, 0.56; z = 1.80; P = 0.07) were also statistically similar in both groups. CFD was associated with an increased post-operative pain score (SMD, 1.82; 95% CI, 0.61, 3.03; z = 2.95; P = 0.003).

Conclusion

Fascial defect closure in patients undergoing LIVHR does not demonstrate any superiority over no-defect closure in terms of recurrence, post-operative morbidity, post-operative pain duration of operation and length of hospital stay.
SP7.2.3 Documentation of risk discussions prior to elective inguinal hernia surgery, is it standardised for all?
Authors: McLellan Morag , Stewart Brian
Published: October 2021

Aims

Obtaining consent is fundamental to surgical practice. Rising levels of litigation have led to increased scrutiny of the process. The Royal College of Surgeons (RCS) recommends a structured consent process enabling patients to make better informed decisions, increasing the legal robustness of the process. Our aim is to audit the documentation of risk discussions prior to elective inguinal hernia repair (EIHR).

Methods

Data was collected retrospectively for all patients who had undergone EIHR in a single surgical unit between January 2019 and 2020. Outpatient clinic letters and consent forms were reviewed. The grade of surgeon and documentation of consent discussions were recorded. The results were then analysed using basic statistical analysis.

Results

146 patients (137 male and 9 female) were included in the audit, with an average age of 63 years (range 20-89 years). 77% of clinic letters recorded a consent discussion. Of these, chronic pain was the risk most commonly documented (62%), followed by recurrence (56%). 19.8% of clinic letters included the level of risk quoted. 86% of consent forms were legible. Documentation of risk was significantly more detailed on consent forms compared to clinic letters (p < 0.05). On these, infection was the most commonly documented (97%), followed by bleeding (91%). Overall, there was no significant difference in documentation relative to surgical grade.

Conclusions

This study has demonstrated considerable variability in consent process prior to EIHR. This can have both legal implications and impact upon patient experience. Adopting a strategy to ensure a consistent approach is essential.
SP8.1.3 Primary care practitioners have a high level of satisfaction with the current breast referral pathway but the majority would support a change to patient self-referral
Authors: Russell Thomas , Cooper Jemma , McIntyre Mairead , Ramzi Sa'ed
Published: October 2021

Aims

Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to specialist breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP’s views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates.

Methods

An electronic survey was sent out to PCPs in South West England via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral.

Results

79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs had a high level of satisfaction with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations.

Conclusions

PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.
SP8.1.6 The role of staging imaging prior to neo-adjuvant chemotherapy (NACT) for breast cancer
Authors: Muir Duncan , Gathani Toral , Dodwell David , Remoundos Dennis
Published: October 2021

Aims

The Royal College of Radiologists (RCR) guidelines state that there is no evidence base for routine imaging in patients with early breast cancer (≤T2 and ≤N1 disease) planned for NACT. Standard practice in our unit is to routinely stage all patients scheduled for NACT with CT chest/abdomen/pelvis and MRI marrow. Our aim was to assess the utility of this practice in this group of patients.

Methods

All patients who received NACT for breast cancer from 2017 to 2020 were included. The imaging reports were reviewed to identify whether metastatic disease had been detected, or further investigations were required.

Results

127 patients were identified. 51 patients met the current RCR criteria for imaging and were excluded.

Of the remaining 76 patients with ≤T2 and ≤N1 disease, metastatic disease was found in 13. This was detected by CT in 9 patients, by MRI in 1 patient, and by both modalities in 3 patients. Indeterminate findings requiring further investigation were present in 17 with 6 patients requiring at least one further scan.

Conclusion

Routine staging investigations detected metastatic disease in almost one in five patients with early breast cancer about to start NACT, impacting on their treatment planning. A similar proportion of patients required further investigations due to indeterminate findings. We believe that routine staging using our current criteria for NACT patients should continue. In the absence of evidence from prospective trials, there is a need for ongoing audit of the utility of systemic staging in early breast cancer.
SP8.1.8 Factors influencing the post-operative upgrade of ductal carcinoma in situ (DCIS) to invasive cancer
Authors: Khan Aminah , Tzortzidis Tiffany , Tzortzidis Natasha , Brown Douglas , Macaskill Jane , Pitsinis Vassilis
Published: October 2021

Aims

Ductal carcinoma in situ (DCIS) can be upgraded on pathological histology to invasive cancer and require a subsequent sentinel node biopsy (SNB). This second procedure increases the morbidity and costs of treating DCIS. Our study aims to establish the proportion of preoperatively diagnosed DCIS that is upgraded and identify factors associated with this upgrading.

Method

A retrospective review was conducted of 122 consecutive patients undergoing surgery following diagnosis of DCIS on percutaneous biopsy at our institution, from 1st January 2017 to 30th November 2019. Histological upgrade was evaluated against clinical, radiological and pathological parameters.

Results

Of the 122 patients, 31 (25.4%) were upgraded, with 11 (9.1%) having microinvasive disease (T1mi) only. A third of the upgrade group (n = 11) did not have a SNB during the initial surgery. Upgraded patients were younger (median 54yrs v 62yrs P = 0.005), had a higher BMI (median 28.9 v 26 P = 0.02) and more likely to have a palpable lesion (41.9% v 14.9% P < 0.001). Multivariate logistic regression analysis showed that mass detected on ultrasound (OR 3.6 P = 0.04), a palpable lump (OR 5.2 P = 0.03) and finding high grade DCIS on percutaneous biopsy (OR 11.9 P < 0.001) were independently associated with final tumour upgrade. In contrast, patients undergoing vacuum assisted biopsy were less likely to be upgraded after surgery (OR 0.23 P < 0.001).

Conclusion

Patients that have a higher BMI, palpable lump, mass on ultrasound and percutaneous biopsy showing high grade DCIS are at increased risk of harbouring invasive cancer and should be considered for SNB at initial surgery.
SP9.1.12 Bone protection in neck of femur fracture patients in a DGH without a fracture liaison service
Authors: Brock James , Yoganathan Sanjeevan
Published: October 2021

Introduction

In England and Wales, there are approximately 75,000 proximal femoral fractures per year. Bone protection is vital in these patients and a key recommendation of NICE guidelines (CG124) for multidisciplinary approach in hip fracture management.

Method

Data were collected retrospectively using clinical portal, admission records and medication charts. The data were inputted into the FRAX calculator to calculate a patient’s risk of developing an osteoporotic fracture; depending on their risk they would be appropriate for bone protection or DEXA scanning for further assessment. As certain data criteria were not available for the FRAX calculation, risk calculation was underscored i.e. if parental hip fracture status was not known.

Results

A total of 59 patients were audited between July and October 2019. Of those patients, 25 were calculated as high risk, however, only 6 patients had adequate bone protection. 19 patients were deemed intermediate risk and would benefit from a DEXA scan for further assessment. Of those 19 patients, only 8 had adequate bone protection. DEXA scan was only requested for 2 of the patients who were intermediate or high risk. In the year following, 4 patients have had another fracture, with 3 of those patients not on any bone protection medication and had a high risk FRAX calculation.

Conclusion

Following a local meeting; a proforma was piloted to identify patients at risk and requiring bone protection. With the help of a dedicated orthopaedic pharmacist and nurse practitioners, continuity of care can be achieved to aid patients long-term wellbeing.
SP10.1.2 Increased Access to Computed Tomography Reduces Acute Surgical Admissions: Lessons Learnt During the COVID-19 Pandemic
Authors: Davidson S , Cornett L , McElvanna K
Published: October 2021

Aim

With increased bed pressures due to COVID-19, keeping patients out of hospital became critical. Computed Tomography (CT) utilisation was increased to aid in the assessment of acute surgical patients. The aim of this study was to assess if increased access to CT reduced inpatient admissions.

Methods

A Retrospective audit of patients presenting to the Emergency Department (ED) between 12th July – 23rd August 2020 who required a CT scan. Data collected from Electronic Care Records and NIPACS, including patient destination at time of CT and decision following CT. For comparison, the same time-period in 2019 was assessed.

Results

In 2020, 301 patients required a CT compared to 207 in 2019. 84.7% (255/301) had a CT direct from ED in 2020 vs. 56.5% (117/207) in 2019 (p < 0.001).

Of those who had CT direct from ED in 2020 18.4% (47/255) were discharged, compared to 1.7% (2/117) in 2019 (p < 0.001). 9.8% (25/255) were directed to an alternative specialty in 2020 vs. 2.6% (3/117) in 2019 (p = 0.014).

2.7% (8/301) were discharged for an ambulatory CT in 2020, an increase from 0.5% (1/207) in 2019 (p = 0.07).

Overall, there was a 24% reduction in the number of patients requiring acute surgical admission in 2020 vs. 2019.

Conclusions

There was a significant increase in the number of CT’s carried out directly from ED. This enabled a significant number of patients to be discharged or transferred to a more appropriate specialty. These results demonstrate that increased access to CT can reduce the need for acute surgical admission.
SP10.1.3 The presentation, management and outcomes of acute appendicitis: a comparison of patients presenting during the COVID-19 pandemic and those presenting in a pre-COVID-19 period
Authors: Davenport Matthew , Clarke Alex , Smith Stella , Stathakis Panos , Macutkiewicz Christian , Chan Anthony
Published: October 2021

Aims

This study assesses the impact of COVID-19 on the presentation and management of acute appendicitis (AA). Patients presenting with AA during the first wave of the COVID-19 pandemic are compared to a pre-COVID-19 cohort.

Methods

Patients admitted to a single acute NHS hospital with AA between April and July in 2019 and 2020 were retrospectively identified. Data on presentation, treatment and outcomes was collected.

Results

56 patients were identified in 2019, and 37 in 2020. A greater proportion of patients presented later (>3 days of symptoms) in 2020 (2019=15.6%, 2020=32.4%, p < 0.05). There was no significant difference in the proportion of patients presenting systemically unwell (pyrexial & tachycardic) or with high inflammatory markers (CRP > 50 and white cell count > 15). In 2020, more patients were managed conservatively (2019=7.1%, 2020=35.1%, p < 0.05). Among those who were managed operatively, 75% underwent open appendicectomy in 2020, compared to 7.7% (including cases converted to open from laparoscopic) in 2019. Patients managed operatively during the COVID-19 pandemic had significantly more post-operative complications (2019=17.3%, 2020=50%, p < 0.05). Common post-operative complications in 2020 were abdominal collections (16.7%) and wound infections (12.5%). Median duration of admission was similar (2019=3 days, 2020=2 days) and there was no significant difference in 30-day readmissions (2019=8.9%, 2020=13.5%, p = 0.48).

Conclusions

AA patients in the COVID-19 pandemic were more likely to present later and were more likely to be managed conservatively or with open appendicectomy. There was a higher rate of post-operative complications for patients in 2020. Duration of stay and readmission rates were similar.
SP10.1.6 Benefit of Two week colorectal cancer referrals of patients who had colonic imaging within the last 5 years: do they improve the colorectal cancer outcome?
Authors: Bavikatte prasannakumar A , Nathan C , Kundrapu K , Dennis H , Athisayaraj T.W , Sebastian B
Published: October 2021

Purpose

There has been a significant rise in the number of colorectal rapid access referrals. These referral results in additional demand for hospital services as well as delays assessment and management of other patients. We analyzed the outcome of colorectal fast tract clinic re- referrals on bowel cancer outcome in patients with recent colonic imaging.

Methods

We retrospectively analyzed 1000 consecutive colorectal rapid access pathway referrals in 2019.Patients with complete colonic imaging within the preceding 5 years were included. We assessed their clinical outcome and colonic imaging when performed.

Results

In total, 82 (8.2%) patients out of 1000 met the selection criteria. Among these 12 patients (14%) did not need any further colonic investigations. A further 12 patients (14%) were already on the colorectal surveillance program, including a patient with recently diagnosed rectal cancer. Hence 24 patients (29.2%) referral was not indicated. 58 patients had further colonic imaging in the form of colonoscopy or virtual colonoscopy following clinic consultation. 32 (55.17%) of them had normal colonic imaging. 14 patients (24.1%) were identified with colorectal polyps with only one identified as tubular adenoma. The remaining 12 patients had non neoplastic pathology.

Conclusion

No new significant colorectal pathology was identified in this group of patients. We suggest that symptomatic patients who had complete colonic imaging within 5 years be referred to routine colorectal clinic in order to make the colorectal rapid access referral pathway more effective especially during these unprecedented times.
SP10.1.7 The Important Role of In-Situ Simulation in Preparing Surgeons for the COVID-19 Pandemic
Authors: Montauban Pierre , Balakumar Charannya , Rait Jaideep , Zarsadias Prizzi , Iqbal Sara , Aravind Biju
Published: October 2021

Background

Effective training is vital when facing viral outbreaks such as the SARS Coronavirus 2 (SARS-CoV-2) outbreak of 2019. The objective of this study was to measure the impact of in-situ simulation on the confidence of the surgical teams of two hospitals in assessing and managing acutely unwell surgical patients who are high-risk or confirmed to have COVID-19.

Methods

This was a quasi-experimental study with a pretest-posttest design. The surgical teams at each hospital participated in multi-disciplinary simulation sessions to explore the assessment and management of a patient requiring emergency surgery who is high risk for COVID-19. The participants were surveyed before and after receiving simulation training to determine their level of confidence on a Visual Analog Scale (VAS) for the premise stated in each of the nine questions in the survey, which represented multiple aspects of the care of these patients.

Results

27 participants responded the pre-simulation survey and 24 the one post-simulation. The level of confidence (VAS score) were statistically significantly higher for all nine questions after the simulation. Specific themes were identified for further training and changes in policy.

Conclusion

In-situ simulation is an effective training method. Its versatility allows it to be set up quickly as rapid-response training in the face of an imminent threat. In this study, it improved the preparedness of two surgical teams for the challenges of the COVID-19 pandemic.
SP10.2.5 It SOCS: Surgical On-Call Simulation for final year Medical Students
Authors: Castelhano Rute , Gurung Pratha , Win Khine Myat , Waters Christopher , Coleman Nichola , Scheneiders Hannah
Published: October 2021

Introduction

Simulation is a well-known method of effectively teaching Medical students. Surgical simulation is a gap within the curriculum, especially Surgical on-call simulations. To improve this, we ran simulation sessions designed to replicate a General Surgery themed on-call shift that junior doctors should be able to manage. We aimed to improve confidence in clinical prioritisation and confidence in being an on-call Junior doctor, managing the most common on-call surgical tasks.

Method

Groups of 3-4 final year Medical students participated in a 2 hour-long simulated “on-call” shift, throughout the hospital. There were 8 scenarios, which ranged from prescribing to acute clinical scenarios. Students were given bleeps and were called at set times. They had to receive/give handovers and prioritise tasks according to clinical importance. A debrief following the session focussed on prioritisation and highlighted key learning points. The students completed a pre- and post-session questionnaire as assessment.

Results

The percentage of students who felt confident or very confident in the following domains were compared pre- and post-simulation respectively: confidence in clinical prioritisation (17% vs 86%); confidence in prescribing medication (0% vs 14%); confidence in escalation to seniors (33% vs 71%). 87.5% of the participants felt the session was an effective way to learn how to prioritise clinical tasks, and 100% felt this an effective way to learn about common General Surgical queries whilst on-call.

Conclusion

This project demonstrates how simulation is also effective in improving confidence in prioritisation and knowledge within clinical practice, especially surgery.
SP10.2.6 The Quantitative Impact of COVID-19 on surgical training in the United Kingdom
Authors: Clements Joshua , Burke Joshua , Hope Carly , Nally Deirdre , Griffiths Gareth , Lund Jon
Published: October 2021

Aims

COVID-19 has had a global impact on all aspects of healthcare including surgical teaching and training. This study aimed to quantify the impact of COVID-19 on operative case numbers recorded by surgeons in training, and annual review of competency progression (ARCP) outcomes in the United Kingdom.

Methods

Anonymised operative logbook numbers were collated from e-logbook and ARCP outcome data were collated from the Intercollegiate Surgical Curriculum Programme (ISCP) database for trainees across core and the ten higher surgical specialities. Operative logbook numbers and ARCP outcomes were compared between pre-COVID dates. Effect sizes are reported as incident rate ratios (IRR) with 95% confidence intervals (CI).

Results

5599 surgical trainees in 2019 and 5310 in 2020 in surgical specialty training were included. The IRR was reduced across all subspecialties because of the COVID-19 pandemic (0.55; 95% CI 0.53-0.57). Elective surgery (0.60; 95% CI 0.59-0.61) was affected more than emergency surgery (0.88; 95% CI 0.86-0.89). Regional variance with reduced operative activity was demonstrated across all specialities. 1 in 8 in their final year of training have not been able to achieve curriculum requirements and have had training extended. 1 in 4 trainees entering their final year of training are behind their expected training trajectory.

Conclusion

COVID-19 continues to have a significant impact on surgical training in the UK. Urgent, co-ordinated action is required by key stakeholders to mitigate for these effects and maintain future surgical training.
SP10.2.7 Preparing foundation trainees for surgical on-calls
Authors: Boyle Mark , Thu Khine , Mroczek Thomas , Scicluna Matthew , Byrne Aodhan
Published: October 2021

Foundation trainee feedback has highlighted low levels of confidence with the prospect of surgical oncalls.

Key areas of concern are; assessing the acute surgical patient, identifying which patients need an operation and having the technical skills to competently assist in theatre. This lack of confidence prevents trainees engaging in an educational and rewarding rotation. We have designed and facilitated a day of robust workshops, addressing these key educational needs.

Pre and post course questionnaires assessed the efficacy of teaching. Lectures on the assessment and management of acute surgical patients in general surgery, urology and trauma and orthopaedics were delivered by core surgical trainees. A named consultant oversaw these presentations to ensure quality assurance. Addressing the technical skills development need, an afternoon of surgical skills workshops covered; suturing, knot tying, laparoscopic principles and theatre etiquette. Small groups of trainees rotated through each workshop, delivered by senior specialty trainee registrars, to ensure high fidelity training.

Trainees rated themselves in key areas pre and post course on a scale from 1-5. Pre course, 66% of trainees scored 3+ in “confidence in managing a surgical patient on-call”. This rose to 100% post course. Similarly; “Confidence in decision making regarding whether a patient should proceed to theatre” increased from 37.5% to 93.7%. “Suturing skills” improved from 37.5% to 100%.

All trainees that attended the course displayed marked improvement in their confidence and competence.

We feel this course or similar should be incorporated into the foundation teaching program locally and has scope to be expanded regionally.
SP10.2.9 An audit of consenting practice for elective surgical procedures and patients overall satisfaction
Authors: Noureldin Khaled , Mehmood Afsheen , Ayantunde Abraham
Published: October 2021

Introduction

We evaluated our consenting practice for surgical procedures and patients’ satisfaction.

Patients and Methods

100 patients were evaluated for the timing, details, understanding and satisfaction with the consenting process. Procedures were elective general and colorectal operations. Patients’ overall satisfaction level was rated on visual analogue score.

Results

54 males and 46 females were included, median age was 65 (16-93) years. The mean time between consenting and surgery was 29 (0-358) ± SD 73 days. Legible writings in 88% with completed details in 51%. The names of the responsible surgeon were missing in 49%. All patients fully understood the intended procedure and its possible outcomes. 99% were comfortable with the consenting environment. One patient preferred a different setting and an earlier date. Two patients felt the consenting process was performed in a hurry, but all patients submitted that they had enough time to reflect on the consent and the procedure before surgery. The overall satisfaction levels were excellent in 93% (9&10), good in 5% (7&8) and fair in 2% (5&6). One patient with low satisfaction score was unhappy with the anaesthetist.

Conclusion

Improvement in the legibility and completeness of the consent form are to be encouraged. The overall patients’ satisfaction was good to excellent.
TP1.2.2CT Colonography (CTC) Should be the ‘Gold Standard’ in Suspected Colonic Malignancy: Results of a Retrospective Cohort Study
Authors: Bailey Kimberley , Aldoori Joanna , Avery Ged , Hunter Iain Andrew
Published: October 2021

Aim

Colonoscopy is the ‘gold’ standard with CT Colonography (CTC) being an alternative to investigate symptoms of colorectal cancer (CRC). Colonoscopy is invasive and can be embarrassing and distressing for patients. This retrospective cohort study aimed to investigate the validity of CTC in patients with suspected CRC.

Methods

We retrospectively reviewed 815 electronic patient records for those undergoing CTC in a large teaching hospital, between 2013 and 2015. Demographic data in addition to specific data on indication for CTC, endoscopic evaluation and further radiological imaging was collected until 2018.

Results

Mean age of the cohort was 67 (21 - 93 years). 326 (40%) patients underwent lower GI endoscopy in the three months preceding CTC, whilst 90 (11%) patients underwent endoscopy in the year following CTC. 37 patients had a CT Colonography Reporting Data System score (C-RADS) of C4 suggesting a colonic malignancy. Of these 21 (57%) were confirmed CRC, others demonstrated benign pathology (32%) or were unit or lost to follow up (11%). 56 (7%) had C-RADS of E4 suggesting significant extracolonic findings, 6 (11%) of which were renal cell carcinomas. Only 2 patients went on to develop a colorectal malignancy within our follow up period.

Conclusions

This large retrospective cohort study demonstrates that CTC is a reliable and valid tool. The authors propose that CTC should be the first line investigation with endoscopy reserved for use as an adjunct for diagnosis.Despite the limitations of a retrospective review, we were able to generate large patient numbers in order to establish our outcomes.
TP1.2.4The incidence, implications and risk factors for extracolonic findings at CT colonography in a bowel screening population
Authors: Di Rollo Domenic , McMillan Donald , Horgan Paul , Mansouri David
Published: October 2021

Aim

CT virtual colonoscopy (CTC) is increasingly relied upon in bowel screening programmes. Concern remains regarding the prevalence of incidental extra-colonic findings (ECF). The present study reports on the prevalence and implications of ECF as part of a UK bowel screening programme.

Methods

Reports for 400 consecutive CTCs carried out as part of the Scottish Bowel Screening Programme were examined. Intra and extracolonic findings were recorded using the CT Colonography Reporting and Data System (C-RADS). Medical records pertaining to ECF follow-up were examined. Cost analysis was performed.

Results

394 patients were included. 146 (37%) were males. Median age was 65 years, median follow-up was 72 months (Range 32-110). 92 (23%) patients had CTC as their primary investigation, 302 (77%) patients underwent CTC due to failed colonoscopy. Overall, 244/394 (62%) patients had ECF with only 45/394 (11%) found to have colonic pathology. 65/394 (16%) had moderately or highly significant ECF, (C-RADS E3-4). Of the 244 patients with ECF, 59 (24%) underwent further investigation, estimated cost £17,589. The majority, 37/59 (63%) were found to have benign disease after follow-up.

Conclusion

ECF at CTC are more frequent than colonic findings. The majority of ECF investigated are found to be benign yet a quarter of ECF are further investigated at a cost to the health service and the patient. Clinicians should be judicial when ordering and consenting patients with regards ECF and its implications if CTC is considered. Particularly when the test is part of a public funded and voluntary screening programme.
TP1.2.5Colonoscopic Surveillance Versus Surgical Resection After Polypectomy for Colorectal Polyp Cancers: Are We Overtreating Malignant Colorectal Polyps?
Authors: Jethwa Kishan , Pal Atanu
Published: October 2021

Aims

Colorectal polyp cancers are increasingly detected in the era of screening. This raises the dilemma regarding management by colonoscopic surveillance or surgical segmental resection. The evidence base remains relatively limited and guidelines are still evolving to balance the risk of overtreatment and unnecessary surgical resection or undertreatment and cancer recurrence. In this study we investigate the management of polyp cancers in our centre.

Methods

This single centre retrospective study in a university teaching hospital included all patients with malignant colorectal polyps found endoscopically and over a 15-month period. All patients were discussed at the colorectal MDT. The threshold for incomplete endoscopic excision was 1mm. Data from endoscopy reports, histopathology reports and operation notes was collected to determine rate of surgical resection and of residual disease.

Results

70 patients with colorectal polyps, classified as at least high-grade dysplasia, were included. 22/70 polyp cancers (31%) patients had surgical resection. Residual adenocarcinoma was identified in 1/22 (4%) and one further patient had lymph node metastases. Two individual patients developed post-operative ileus and pancreatitis resulting from surgery.

Conclusions

Of those patients undergoing surgical resection only 8% patients had malignancy in the postoperative specimen, raising the possibility of overtreatment under current guidelines. This highlights a need to update clinical guidelines to avoid overtreatment without compromising oncological outcomes.
TP1.2.6Functional Outcomes of Organ Preservation Strategies - Local Excision Procedures and 'Watchful-Waiting' In Management of Low Rectal Cancers - A Systematic Review
Authors: Ramesh V , Aspari A R , Narayanasamy S N , Kumar G , Gumber A O , Thomas P F
Published: October 2021

Objective

To evaluate functional outcomes and quality of life (QOL) associated with `wait-and-watch’ (WW) strategy and local-excision (LE) of rectal tumours after neo-adjuvant therapy, in comparison to the standard practice of total-mesorectal-excision (TME) for locally-advanced-rectal-cancers.

Data Sources

Medline, EMBASE, PubMed databases, and sources of Grey literature.

Study Selection

Randomised and non-randomised prospective studies, and retrospective studies with propensity-score-matched analyses analysing outcomes of WW and LE procedures for rectal cancer.

Data Extraction and Synthesis

Risk of bias assessments and data extraction were carried out independently by two reviewers. A narrative synthesis of data was presented keeping with the 27-item PRISMA checklist.

Main Outcomes

The outcomes of interest were those of faecal-incontinence (FI), bowel and rectal-evacuatory function, sexual-function, stoma-free-survival, and quality-of-life scores, which were assessed in comparison to those associated with radical surgeries.

Results

7 studies reported functional outcomes. Faecal-incontinence, bowel, and rectal-evacuatory-function assessed by various scoring systems were found to be least affected among patients on WW strategy, followed by those undergoing local excision and most in patients undergoing TME. These reflected on the quality of life assessments (FIQOL and FACT-C questionnaires). Sexual dysfunction was not higher among patients who underwent LE compared to TME. Advantage of stoma-free-survival with organ preservation strategies was realised for up to 2 years after treatment.

Conclusions

Organ-preservation strategies appear to have a favourable functional outcome compared to the gold standard of TME for up to 2 years after the commencement of treatment. Further research is warranted to provide stronger levels of evidence regarding the same.
TP5.2.3 Quality improvement project to reduce turn-around times to improve vascular theatre efficiency
Authors: Gambhir Raghvinder , Carr James , Walter Ben , Little Jessica
Published: October 2021

Aim

One of the factors influencing theatre efficiency is turn-around time (TAT). The aim of this QIP was to reduce turnaround times by 25% thereby reducing financial implications of theatre idle time.

Methods

Baseline data was obtained from electronic theatre record system ‘Galaxy’ for the period October 2019 to February 2020. TAT (Time from the last patient going to recovery and the next one coming into the theatre) was measured and a period average was established. This QIP mapped processes and conducted interviews, to identify issues contributing to longer turnaround times. Interventions were then constructed and implemented over 6 weeks.

Results

One of preventable causes of delay identified from staff interviews and personal observations was inadequate patient preparation by the ward. Preintervention percentage theatre utilisation was 86% and turnaround times was 51.7 minutes. A PDSA cycle was initiated focusing on advanced warning (30 minutes prior to the end of the previous surgery) from theatres to wards and advanced preparation from wards, using a newly designed ward-based checklist. After the first PDSA cycle there has been an improvement in TAT to 42.8 minutes, a decrease of 18.2%. Whilst this did not meet our goal of a 25% reduction, this remains significant. Unfortunately due to COVID -19 the second cycle has been delayed.

Conclusions

Affordable and sustainable improvements will be needed in post COVID-19 recovery phase to tackle the backlog of surgeries. This project has demonstrated that advanced warning system can decrease turnaround times.
TP5.2.6 Use of objective assessment criteria to assess symptom severity and clinical effectiveness following deep venous stenting
Authors: Ghulam Mustafa , Lodhia Krishan , Carter Jemima , Saratzis Athanasios , Saha Prakash
Published: October 2021

Aims

This review aimed to identify measures that assess symptom severity in patients prior to deep venous intervention, and outcomes used to evaluate its clinical effectiveness.

Methods

MEDLINE was searched for studies of stent placement for treatment of iliofemoral venous disease using relevant key words (April 2019). Data were extracted and validated by three authors.

Results

6,356 patients with venous stents were identified from 93 studies. 1,300 patients (20%) were treated for acute thrombosis and 5,056 patients for chronic venous insufficiency (CVI), due to non-thrombotic lesions (2,200 patients, 35%) or post-thrombotic disease (2,856 patients, 45%). The Clinical-Etiological-Anatomical-Physiological classification (CEAP) was reported in 3,233/5,056 CVI patients (64%) pre-intervention (C0:2%; C1:2%; C2:7%; C3:46%; C4:21%; C5:6%; C6:16%). Stent patency was reported in all studies, with variable follow-up (six months – five years). Primary patency was 81% in 3,365 patients and secondary patency 95% in 4,700 patients at one year. 655 patients had active ulceration, of which 397 (61%) healed post-intervention. Venous Clinical Severity Score (VCSS) or revised VCSS was reported in 849 patients (13%). Average VCSS/rVCSS was eight pre-intervention and three post-intervention. Villalta scores were reported in 768 patients (12%) pre-intervention vs. 1,111 patients (17%) post-intervention. Average Villalta scores were 20 pre-intervention vs. five post-intervention.

Conclusions

Few studies use objective measures to quantify the clinical effectiveness of deep venous stenting; consensus is lacking on which is the most appropriate tool to use. More research is needed on ideal assessment measures to identify suitable patients for these interventions and to quantify clinical effectiveness.
TP5.2.7 COVAS: Assessing the impact of Covid-19 On VAscular Surgery: A Single Centre Experience
Authors: Michel Martin , Stocco Fabio , Khaliq Farihah , Sahl Abdullah Bin , Stachan Annabel , Parry Duncan
Published: October 2021

Aims

To quantify the impact Covid-19 has had on vascular surgery during the pandemic at our unit compared to previous operating activity levels at a single vascular centre.

Methods

Retrospective analysis of all vascular operations undertaken in the department dating from 11th March 2020 to 16th November 2020. Historical average data (HD) from the previous five years (2015-2019) over the same timeframe were then collected for comparison.

Results

During the Covid-19 pandemic 237 vascular operations were performed which represented a 48% operative reduction compared to average HD (454). 57 elective day-case procedures (varicose veins/temporal artery biopsies/renal access) were performed compared to a median of 259 from HD. Varicose vein surgery had an 79% reduction (37 vs 180). Renal access surgery was unaffected (15 vs 9). Major limb revascularisation procedures were reduced by 41% (36 vs 61) however this did not equate to any increase in amputation rates (79 vs 84). There was no reduction in carotid procedures performed during the pandemic (26 vs 30). There was a 60% (14 vs 35) reduction in all types of aneurysm procedures.

Conclusion

The Covid-19 pandemic has dramatically affected vascular surgery at our unit. In terms of arterial work the largest disparities compared to previous years was major revascularisation and aneurysm surgery. In respect to elective day case procedures, venous work has unsurprisingly been hardest hit which, once resources allow, will require significant provision to overcome the shortfall. This quantitative study can direct future service delivery and prepare for the post-pandemic recovery.
TP5.2.9 Mortality following major lower extremity amputation in people with and without diabetes in Scotland 2004-2013
Authors: Murgitroyd Ellen , Yao Xuehan , Kerssens Jan , Walker Jeremy , Wild Sarah
Published: October 2021

Aim

To describe short and longer-term mortality following major lower extremity amputation (LEA) by diabetes status over two time periods.

Methods

A retrospective cohort study of patients who underwent major LEA between 2004 and 2013 was conducted based on linkage of national population-based hospital records and a register of people with diagnosed diabetes. Post-operative mortality was estimated at 30 days, one year and where available, five years. Using logistic regression models, we estimated the odds of death associated with diabetes adjusted for age, sex and socio-economic status within these time points compared to the non-diabetic population stratified by type of diabetes and five-year calendar periods.

Results

There were a total of 5436 people who received an amputation during the study period of whom approximately 40% had diabetes. Overall mortality for the 2004-8 and 2009-13 cohorts respectively was not significantly different at 7.9% and 7.3% at 30 days and 31% and 27% at one year. Almost 64% of the 2004-8 cohort were dead within five years. The only statistically significantly associations between diabetes and mortality were observed within five year follow-up of the 2004-8 cohort with odds ratios (95% CI) compared to the non-diabetic population of 1.62 (1.17, 2.26) for type 1 diabetes and 1.38 (1.14, 1.66) for type 2 diabetes.

Conclusions

An adverse association between diabetes and mortality after LEA only became apparent in longer term follow-up.
TP5.2.11 Intervention for mesenteric arterial insufficiency in octogenarians
Authors: Shenoy Sachin , Daly Kevin , Stuart Wesley , Meldrum Alan , Hussey Keith
Published: October 2021

Introduction

Mesenteric ischaemia is associated with significant morbidity and mortality. The poor prognosis associated with mesenteric ischaemia may prejudice decision-making, particularly for an older patient group. We have explored outcomes following intervention for mesenteric ischaemia in patients aged over 80-years old.

Methods

This was a retrospective analysis of a database of intervention for mesenteric ischaemia from 2010 to 2020 from a regional vascular unit covering two Health Boards in Scotland. Patients aged 80-years and over were identified and patterns of intervention and outcome described.

Results

There were 23 procedures performed – there were 17 patients aged 80-years or over. There were 8 patients with acute presentations, 6 had isolated superior mesenteric artery occlusion and thromboembolectomy was the most common procedure (n = 4). Laparotomy was performed in all cases and bowel resection required in 3. At 30-days 4 patients had died, but patients who survived the index admission were still alive at 1-year and symptom free.

Elective was performed on 9 patients. An endovascular approach was favoured (n = 7) with the superior mesenteric artery the preferred target. At 30-days 2 had died, but at 1-year there had only been 1 further death. Three patients experienced recurrent symptoms. The remaining patients were symptom free.

Conclusion

It is appropriate to consider mesenteric intervention for older patients with both acute and chronic mesenteric ischaemia. Meaningful survival can be achieved with good relief of symptoms and return to meaningful quality of life.
TP5.2.16 Organ donation education in schools significantly increases organ donor registration, knowledge, and family discussion
Authors: Byrne Matthew , Mayes Jonathan , Mogg Jasper , Symington Matthew , Hu Lisi , Brathwaite-Shirley Charlotte
Published: October 2021

Aim

Over Six-thousand patients are on the transplant waiting list in the UK and two die each day due to a lack of donors. We aimed to assess the effectiveness of a national organ donation educational intervention in schools at increasing organ donor register (ODR) sign-up, knowledge, and family discussion.

Methods

A fifteen-minute non-biased presentation about organ donation was delivered at secondary schools across the UK by individuals from four centres from July 2018 to July 2019. An optional questionnaire was distributed to students.

Results

1616 students from 25 schools completed the questionnaire. The mean age of students was 14 (SD = 2) years. Following the educational intervention, the number of students who were on or intended to join the ODR significantly increased from 8% to 44% (p < 0.0001), knowledge of organ donation significantly increased from 43% to 79% (p < 0.0002), and planned family discussion significantly increased from 19% to 42% (p < 0.0001). These findings were not influenced by location.

Conclusions

Organ donation educational interventions delivered to school students significantly increases planned ODR sign-up, knowledge, and family discussion.
TP6.1.1 Interventional radiology cholecystostomy in a four year period in our trust
Authors: Ahmed Elmurtada , Al-Robaie Basim
Published: October 2021

Aims

to look in detail at the cases who underwent interventional radiology cholecystostomy in term of male to female ratio, age, was the tube spigoted before removal, did the patient have a tubo-gram prior to removal and when & where was the tube removed, so that we can produce firm guidelines on how to deal with these tubes.

Methods

We looked into the electronic records paper notes in our trust & found that 57 patients have undergone the procedure in the four years between June 2015 & July 2019, at a rate at roughly one patient per month.

Results

Procedure done under local anaesthesia in radiology department either under ultrasound or CT guidance , male to female ratio is 1:1 , two thirds of patients are in the 7th& 8th& 9th decade , the tube was spigeoted in only 10% of patients , the drain was removed in the surgical ward in 65% of patients ,in a few patients it was removed in the clinic , radiology department or other place ,the median time for removal was three weeks (57%) of patients , the drain fell in 23% of patients, a tubo-gram was peformed in 23% of patients at a median time of fourteen days.

Conclusions

There is a degree of inter-unit variation of cholecystostomy drain management so we are trying to produce a practical guide for junior doctors on this issue, we also noticed that the drain fell in 23% (high percentage compared to other centres ) of patients therefore we contacted radiology colleagues & informed them.
TP6.1.2 Laparoscopic subtotal cholecystectomy; change in practice over a 10-year period
Authors: Boyd Kirsten , Bradley Nicholas , Cannings Elizabeth , Wadhawan Himanshu , Wilson Michael , Crumley Andrew
Published: October 2021

Aim

Laparoscopic subtotal cholecystectomy is a safe strategy to avoid bile duct injury when a critical view of safety cannot be obtained. This technique may result in fewer open conversions and was introduced in our DGH in 2013. This study describes the change in practice at our centre following introduction of subtotal cholecystectomy.

Method

Retrospective case series included consecutive cholecystectomies over a ten-year period in a single institution. Cases were divided into subgroups based on operation date; 2009-2012 (Group A) and 2013-2019 (Group B). These groups represent pre- (Group A) and post- (Group B) introduction of laparoscopic subtotal cholecystectomy. Primary outcome was the proportion of patients undergoing laparoscopic total cholecystectomy, laparoscopic sub-total and lap-converted to open cholecystectomy. Secondary outcomes included incidence of bile leak, complication rate, return to theatre, and length of stay.

Results

There were 4248 cases; 1387 in Group A, and 2861 in Group B. The rate of open conversions was higher in Group A than Group B (4.7% vs. 2.8%, p = 0.003). The rate of laparoscopic total cholecystectomy was higher in Group A than Group B (95.3% vs. 92.8%, p = 0.013). In the subtotal group (n = 114, 3.9% of Group B); 14 (12.3%) patients had bile leak requiring ERCP, 6 (5.3%) underwent re-laparoscopy for inadequate biliary drainage, and median LOS was 2 days.

Conclusion

Laparoscopic subtotal cholecystectomy has proven to be a safe technique at our centre, reducing the rate of open conversion and length of stay, with a low rate of reintervention for bile leak.