bluuebunny/crossref_metadata_2025 huggingface dataset:
EP.WE.470Emergency General Surgery during the first COVID peak, a single centre experience
Authors: Paramjothy Kiara , Dosis Alexios , Lim Jieqi , Reveendran Dharsshini , Lockwood Sonia
Published: October 2021

Aims

The COVID-19 pandemic brought significant changes on all aspects of health care. We aimed to conduct a retrospective review of the trends in general surgical and vascular procedures during the first peak following the cessation of all elective activity.

Methods

All general and vascular procedures performed during April 2020 were included in the study. Peri-operative data were extracted from electronic patient records. We looked into operation notes, COVID status and post-operative complications. Descriptive analysis was performed using Microsoft Excel software.

Results

Table 1 shows a breakdown of the 54 operations performed. There were 47 patients, with a male to female ratio at 1:1. Mean age was 46.9 years. There were 6 expedited cases but none elective. Mean duration of symptoms prior to presentation was 8.3 days. Laparoscopic work was kept to a minimum. A consultant was present for 63% of the cases. There were only 2 COVID positive patients, but the majority (74%) were not tested. 20% of patients suffered a complication requiring an intervention. 6/54 had an unplanned return to theatre and there were 5 deaths in total.

Conclusion

The number of procedures during the first peak was significantly reduced following the uncertainty around the novel coronavirus. In accordance with the initial intercollegiate guidance, patients were managed conservatively where possible. The high complication rate is indicative of the often-late presentation due to hospital fear following the outbreak of SARS-CoV-2.
EP.WE.499Patient satisfaction with head and neck cancer telephone triage service during the COVID-19 Pandemic in a District General Hospital
Authors: Zhu Yinan , Ding Anni , Walter Hannah , Easto Rachel , Wilde Adam
Published: October 2021

Aims

A head and neck cancer telephone triage pathway was implemented in March 2020 using the Head and Neck Cancer Risk Calculator as part of the 2 week wait cancer referral pathway. This was in response to the COVID-19 pandemic to stream cancer referrals to minimize unnecessary interactions and appointments with health services. The aim of this study is to assess patient satisfaction with the telephone triage system via a customised patient satisfaction questionnaire in the setting of a district general hospital.

Methods

A custom designed patient satisfaction questionnaire covering different facets of the patient experience will be used to measure patient satisfaction. These 16 questions (including open ended questions) are adapted from internally validated questionnaires. All continuous new head and neck cancer referrals to Torbay Hospital over two 6 week periods will be analysed, the first at the inception of the telephone triage service and the second several months later. The focus is on patient satisfaction towards the method of delivery of the telephone triage service rather than the content of delivery.

Results and Conclusions

Data collection is ongoing at the moment and preliminary results suggest that patient satisfaction is mixed, with a proportion of patients being unsatisfied that they did not get an examination, and a larger proportion of patients satisfied with the easier accessibility and safety of the service in the midst of the pandemic.
EP.WE.501The Role of Nerve Sheath Catheters after Major Lower Limb Amputations in Post-operative Pain Control
Authors: Vincenti Cara , Kansal Nisheeth , Bhattacharya Vishwanath
Published: October 2021

Aim

Pain is a common post-operative complication after limb amputation. Though the evidence is mixed, current literature suggests nerve sheath catheters (NSC) have no effect on chronic stump pain, phantom limb pain or post-operative pain score but reduces opioid use. This study aims to compare pain outcomes in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA).

Method

This retrospective study collected information from 32 patients after lower-limb amputation from April 2014 - March 2017. Information regarding indication, anaesthetic and morphine requirement at 72 hours were collected from medical records and standardised questions used to assess phantom limb pain, chronic limb pain and pain intensity (1-10) at 24, 48 and 72 hours.

Results

Of the 11 patients who received a NSC catheter for pain control, 33% experienced no post-operative pain, 18% experienced phantom limb pain, 18% reported chronic limb pain and 62% required higher dosages of morphine at 72 hours. However, two patients used large amounts of morphine potentially giving spurious results.

In comparison, of those patients without NCS, 43% experienced no pain, 9% experienced phantom limb pain, 33% reported chronic limb pain and only 47% required morphine at 72 hours and at lower doses compared to with NSC.

The incidence of phantom limb pain was higher in those who had AKA regardless of the analgesic technique used.

Conclusion

Patients with NSC were less likely to experience chronic limb pain thus proving their role in post-operative pain control despite having higher morphine requirements.
EP.WE.551Killings Fields of the 21st Century- a price of social messaging gone wrong
Authors: Gambhir Raghvinder , Bodapati Shruti
Published: October 2021

Aim

To assess the impact of public health messaging on the COVID-19 deaths

Methods

Review of all government, Public Health England, NHS England messages during the pandemic to see how they influenced public activity and thereby influenced hospital admissions and death.

Results

The one thing that has been consistent in the government messages has been to follow the rules “To save the NHS’. This came in from seeing the Italian health system in Lombardy being overwhelmed in the beginning of the year. Repeatedly public asked on the role of the masks and every time they were told that science did not support its use. It took 6 months for science to catch up with common sense but the message remained “To save the NHS” and not “To save your life”. 76% of the 100,000 deaths occurred in the hospitals making them the killing fields of the 21st Century as primary care shut its door to primary treatment of these patients. The patients got advice form online call centres and waited to get seriously ill before reporting to emergency departments. In the hospitals more deaths occurred on the wards then on ITU as patients were triaged or care rationed.

Conclusion

The government and Public Health England failed to act on the lessons from previous respiratory viruses world over and waited for exact science to be available before changing their social messaging. This in part contributed to lack of public compliance and over 100000 deaths in the UK.
EP.WE.573Outcomes of Emergency Laparotomies during the COVID-19 Pandemic - A retrospective cohort study
Authors: Bedwani Nader Habib , English William , Smith Christopher , Singh Shailendra , Vulliamy Paul , Mukherjee Samrat
Published: October 2021

Aims

A better understanding of patient monitoring and outcomes is required following emergency laparotomy. We aimed to evaluate recovery following emergency laparotomy during the ‘first wave’ of the COVID-19 pandemic and assess for COVID-19-associated coagulopathy in this group.

Methods

We performed a single-centre, retrospective cohort study on adult patients undergoing emergency laparotomy from 23rdMarch – 16thMay 2020 comparing patients with or without suspected or confirmed SARS-CoV-2. Main outcome measures included; 30-day mortality, post-operative respiratory failure, ARDS and other complications, critical care admission and length of stay (CCLOS) and total length of stay (LOS). Laboratory results were collected for three days post-operatively including platelet counts and clotting screen.

Results

33 patients undergoing 36 emergency laparotomies were included, of which 9 had confirmed or suspected COVID-19. Patients with COVID-19 were more likely to have severe complications (Clavien-Dindo grade ≥3) (9/9 vs 5/24; p < 0.001), post-operative respiratory failure (9/9 vs 2/24; p < 0.001), ARDS (3/9 vs 0/24; p = 0.015) and need for critical care stay (9/9 vs 12/24; p = 0.012) with a longer LOS and CCLOS (17 vs 7 days; p = 0.004 and 6 vs 1 day; p < 0.001 respectively). Platelet counts were consistently lower on all peri-operative days and patients had a higher incidence of coagulopathy (7/11 vs 3/17; p = 0.020).

Conclusions

Emergency laparotomy is associated with increased post-operative morbidity in patients with confirmed or suspected COVID-19 with increased respiratory complications and critical care stay. Post-operative patients with COVID-19 show mildly reduced platelet counts and deranged clotting that may be part of a COVID-19-associated coagulopathy.
EP.WE.595Long-term Effects of Psychiatric Medication on Weight Loss after Bariatric Surgery: 5-year Outcomes with 100% Follow Up
Authors: Clements Hollie Alice , Fields Declan , Oglesby Stuart , Alijani Afshin , Patil Pradeep
Published: October 2021

Aims

The long-term effect of psychiatric medication on weight loss after bariatric surgery is unknown. The aim of this study was to compare the 1 year and 5 year percentage excess weight loss (%EWL) and BMI between those prescribed and not prescribed psychiatric medication who underwent laparoscopic bariatric surgery.

Methods

Consecutive patients, who received identical perioperative care were selected from a prospectively maintained database. Patients who had gastric bands and revisional procedures were excluded. Patients were defined as “prescribed psychiatric medication” if prescribed antidepressant, antipsychotic or mood stabilizer at baseline and subdivided into those taking a single agent and those on two or more agents.

Results

Of 119 patients (58 sleeve gastrectomy, 61 gastric bypass), 46 patients were prescribed psychiatric medication (40 one agent, 6 two or more agents). At 1 year, median %EWL did not differ significantly in those taking no agent, 1 agent and 2 or more agents respectively (66.8, 63.3, 57.4, p = 0.433). At 5 years this approached, but did not reach statistical significance (56.6, 54.4, 40.6, p = 0.099). The same pattern was observed for median BMI at 5 years (35.7, 39.2, 40.7, p = 0.086).

Conclusion

There is no significant difference in excess weight loss or BMI at 1 year post surgery between patients prescribed psychiatric medication and those not prescribed psychiatric medication but there is a difference at 5 years, which shows a trend towards statistical significance. Such patients should receive intensive specialist bariatric psychological support for a prolonged period after surgery.
EP.WE.608Hospital within the Hospital – Renaissance of Elective Surgery Amidst the Pandemic
Authors: Ain Quratul , Gala Tanzeela , Rashid Hajr , Ashraf Hajra , Vesamia Shaheen , Vig Stella
Published: October 2021

Aim

COVID had an unprecedented effect on the NHS elective surgical care. To overcome the deficit created due to the pandemic, the concept of a ‘COVID protected zone’ gave birth to the ‘hospital within the hospital’. This included 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen and a separated entrance. Of the fundamentals of the model were enhanced infection control and PPE guidance for staff. The aim of our study was to evaluate the recovery of elective activity brought about by this elective centre.

Methods

Theatre activity data was collected weekly (7/20 to 1/21) through the business informatics system. This was used to compare the activity achieved during the recovery phase from COVID after the first and subsequent wave.

Results

Pre COVID-19, 11 theatres were operating. These managed an average of 263 cases were per week. In the first week of operation of elective centre, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. During the 2nd wave the capacity was reduced to 42% as opposed to 0% during the first wave. This was only possible due to our model elective centre.

Conclusion

This model elective centre has enabled elective care to return to above normal levels, with increased efficiencies. This has not only shortened patient waiting times and cleared the back-log but also delivered training to surgical trainees without compromising safety.
EP.WE.613A multi-centre review of the management of acute appendicitis during the COVID-19 pandemic
Authors: Lockhart Jessica Ruth , O'Brien Scarlett , Armstrong Lara , Armstrong Aidan , McKay Damian
Published: October 2021

Aim

Acute appendicitis is a common surgical presentation and is historically a clinical diagnosis; gold-standard treatment is appendicectomy. Due to anticipated increased demand on in-patient beds during the COVID-19 pandemic there was increased emphasis on conservative management of acute appendicitis. Our aim is to review these changes and determine the representation rate following conservative management.

Methods

Patients with acute appendicitis were identified from daily referral lists across two trusts. Data was collected using electronic care records. A control group (106 patients) was identified from 3 months preceding the pandemic.

Results

In the pandemic group, 213 patients had acute appendicitis; 47% were managed conservatively, compared to 8% of the control group. Overall, during the pandemic 44% of patients had a CT-confirmed diagnosis (compared to 48% of control group); the two trusts’ results varied showing 75% and 30% (compared to 46% and 51% respectively in the control group). Of those treated conservatively only 3% represented to hospital and required admission.

Conclusion

Significantly more patients were treated conservatively during the COVID-19 pandemic. The larger number of patients managed as acute appendicitis in the pandemic group may represent over-diagnosis due to the decision to conservatively manage these patients and account for diagnostic uncertainty. Increased access to early diagnostic CT scans facilitated early decisions regarding definitive management. Variation in access to radiology both during and before the pandemic may account for the difference in use of CT scans. Low rates of readmission to hospital following conservative management of acute appendicitis have been observed to date.
EP.WE.617A clinical audit analysing the completion of junior clerking at the Surgical Admissions Unit at an acute District General Hospital, as impacted by short-staffing due to CoViD-19
Authors: Sawhney Riya , Seite Enora , Fedder Artemis
Published: October 2021

Aims

The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19.

Methods

Admissions to the unit over a 5-day period (n = 92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks.

Results

Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p < 0.05). This was not significantly (p = 0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p < 0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p < 0.05) without. The major theme identified was deferring to the ‘senior review’ section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking.

Conclusions

Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking.
EP.WE.629The effect of different anaesthetic agents in postsurgical inflammatory response in thoracic surgery: a systematic review
Authors: Aquilina Julian , Geropoulos Georgios , Loufopoulos Ioannis , Gupte Anaya , Mitsos Sofoklis , Panagiotopoulos Nikolaos
Published: October 2021

Aims

Post-operative systemic inflammatory reaction is part of the stress response caused by major thoracic surgery. Different anaesthetic agents used affect different immunological phenomena. This systematic review evaluates the impact of anaesthetic agents on the immunological profile and the associated clinical significance.

Methods

A systematic review of MEDLINE, EMBASE and Cohrane databases to explore how different anaesthetic agents affect post-operative inflammatory response.

Results

A total of nine studies were included in our analysis. Peri-operative use of dexmedetomidine, propofol, sevoflurane, isoflurane, ropivacaine, sufentanil, naloxone and clonidine were compared, based on their effect on the systemic release of inflammatory markers. Variance on the levels of the circulating inflammatory molecules such as interleukins, interferon-γ, tumor necrosis factor a and on the cellular response including natural killer, CD4 and CD8 T cells, were observed among different anaesthetic agents.

Conclusions

Inflammation improves immunity and regenerative cell recruitment, however excessive responses can lead to delayed wound healing, organ dysfunction and increased morbidity and mortality. There is still uncertainty regarding the role of immune changes on clinical outcomes of patients undergoing thoracic surgery, and more research is needed to explore other immunological effects related to anaesthetic agents.
EP.WE.718An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital
Authors: O'Brien Stephen , Foley Niamh , Murphy Amy Edwards , McCourt Morgan , Killeen Shane , Andrews Emmet
Published: October 2021

Introduction

A joint statement by the British Society of Gastroenterology and the Association of Upper Gastrointestinal Surgeons in 2017 recommended that photographic documentation of relevant anatomical landmarks should be a Key Performance Indicator of oesophagogastroduodenoscopy (OGD). The aim of this study was to assess this photodocumentation standard among surgeons and gastroenterologists in a tertiary referral centre.

Methods

Cork University Hospital endoscopy unit records were examined for a 2-month period from 01/10/20-27/11/20. OGDs were performed by 3 consultant colorectal surgeons and 4 consultant gastroenterologists over the time period. Demographic data and photodoumentation information were obtained from the Endoraad GI reporting tool. Surgeons and gastroenterologists performances was compared using the chi-squared test.

Results

104 OGDs were analysed. Fifty-three (51%) OGDs were performed in women and 51(49%) OGDs were performed by surgeons. The documentation for each site was; gastro-oesophageal junction- 68% (69/102), fundus on retroflexion- 71% (72/102), gastric body- 32% (33/102), antrum- 61% (62/102), and duodenal bulb- 35% (36/102), without significant differences (p > 0.05) for these sites between surgeons and gastroenterologists. There was more documentation of the upper oesophagus by surgeons (31% vs.12%, p = 0.030) and there was more documentation of the distal duodenum by gastroenterologists (90% vs.47%, p < 0.01). Pictures were unable to be saved in two patients due to technical failure.

Discussion

Photodocumentation is increasingly important from a medico-legal viewpoint. There is room for improvement in our centre, but these rates are comparable to other published series. An educational session is being planned and following this adherence to photodocumentation standards will be re-examined.
EP.WE.727Upper GI Surgery Clinic Referrals; Can We Improve the Patient Experience?
Authors: Abouelazayem Mohamed , Belchita Raluca
Published: October 2021

Aim

To review the new referrals to the Upper GI surgery clinic for appropriateness, investigations requested, and waiting times and to identify potential pathways to reduce waiting times and improve the patient experience.

Method

Patients who attended the UGI clinic over 2 months period were identified. Data were collected from GP referrals and Electronic Patient Records. Follow up, post-discharge appointments, and Did Not Attends were excluded. Data collected included time from referral to first clinic, symptoms, investigations requested, suitability for a pathway, and appropriateness of referral. A first clinic outcome was concluded from reading the GP referral, there were 5 outcomes to choose from; direct to another specialty, discharge back to GP, clinic, surgery, pre-investigate and clinic.

Results

147 referrals were analysed. The average waiting time from referral to the first clinic was 51 days (range 7-119 days). 73% of the referrals were GP referrals and 27% from other specialties. The most common referral was for gallstones and the most common 2 outcomes were Pre-investigate and surgery.

Conclusion

Most of the investigations and outcomes suggested from the project were the same as those from clinic letters. The following pathways can be developed to cut waiting times and costs for the trust:
EP.WE.829Does Covid-19 increase the risk of gastrointestinal perforation? A preliminary UK-based multicentre cohort study
Authors: Thrumurthy Sri , Kaur Vasha , Bello Abdulazeez , Zaidi Ahsan , Vasilikostas Georgios , Wan Andrew
Published: October 2021

Aims

Recent case reports have described occult gastrointestinal perforation secondary to Covid-related microcirculatory thromboembolic phenomena. This study aims to evaluate the effect of Covid-19 on the incidence of gastrointestinal perforations across South West London (SWL).

Methods

A retrospective cohort study included all patients with gastrointestinal perforations presenting to three SWL-based NHS hospitals from 01/04/2020-31/12/2020 (i.e. “pandemic” cohort; from the first national lockdown), versus a representative “pre-pandemic” cohort (01/04/2019-31/12/2019). Data was extracted from the hospital coding records, patient case-notes, and the NELA database, and analysed by two independent clinicians.

Results

A total of 448 patients were included. 9.3% more (214 vs. 234, p = 0.286) gastrointestinal perforations presented during the pandemic period than beforehand. Comparing both periods, there were no significant differences between the numbers of colonic diverticular perforations (183 vs. 185), gastrojejunal ulcer perforations (1 per period), and terminal ileal perforations (1 per period). There were 78% more peptic ulcer perforations (9 vs. 16) and 55% more gallbladder perforations (20 vs. 31) during the pandemic period, although no overall significant difference was derived at the 95% confidence interval (Χ2=3.458, p = 0.484).

Conclusions

While there was no significant overall increase in spontaneous gastrointestinal perforation during Covid-19, this study clearly suggests increased rates of peptic and gallbladder perforations. Larger-scale epidemiological data are warranted to ascertain whether this is secondary to increased consumption of alcohol, non-steroidal anti-inflammatory medication or other pro-ulcerative drug regimes during the pandemic. Further data will also be vital to highlight delays in investigation and/or presentation resulting in these increased perforation rates.
EP.WE.843Acute Appendicitis Management During the COVID-19 Pandemic: A Prospective Cohort Study From A Large UK Centre
Authors: Antakia Ramez , XAnthis Athanasios , Georgiades Fanourios , Hudson Victoria , Davies Justin , Bennett John
Published: October 2021

Aims

The aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of acute appendicitis (AA) during the pandemic.

Methods

We conducted an observational study in a tertiary centre. Data was collected from all patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period).

Results

A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value<0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value<0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value<0.001) during the COVID period compared to pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027).

Conclusions

Radiological diagnosis of AA was more frequent during COVID. More conservative management for AA was employed during COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during COVID without affecting the length of hospital stay.
EP.WE.906Endovascular Repair of Abdominal Aortic Aneurysm – A Retrospective Analysis of Outcomes from a UK Teaching Hospital
Authors: Perin Giordano , Garg Mukesh , Haldipur Nandan
Published: October 2021

Aims

Endovascular Repair of Abdominal Aortic Aneurysm (EVAR) is a minimally invasive technique that has become increasingly popular in the past few years. Recent evidence questioned the long term durability of the technique and highlighted the relevance of long term complications and reinterventions. The aim of this paper is to evaluate long term outcomes of EVAR with a focus on survival and aneurysm related reinterventions.

Methods

We retrospectively analysed all elective EVAR procedures performed for Abdominal Aortic Aneurysm (AAA) between May 2010 and June 2016 in our institution. Data collected included - comorbidities, post operative survival and post operative aneurysm related interventions. Survival analysis was performed using the Kaplan-Meyer method. We build a Cox Proportional-Hazard model to identify factors associated with increased mortality.

Results

182 patients were included in our analysis. Median age was 77 years (50-92). Median follow up was 65 months (31-104). During the follow up period we recorded 41 deaths. 30 day mortality was 0.5% (1), 2 year mortality was 8.7% (16). 17 patients (9.3%) required reintervention during the follow up period (2.4 reinterventions per 100 patient-years).

Conclusions

Our medium and long term outcomes following EVAR are comparable with what has been reported in the literature. A higher ASA grade and advanced age were associated with increased mortality in our cohort.
Ep.We.1001Name That Tune - Acccuracy of Interpreting Hand-Held Doppler Audio Signals in the Assessment of Peripheral Arterial Circulation
Authors: Kamarizan Mohamad , Da Silva Anthony
Published: October 2021

Aims

Interpretation of Doppler audio signals among non-podiatrist has not been thoroughly investigated. This study analyses the accuracy of interpretation of Doppler audio signals among clinicians.

Methods

A single-centre prospective single blind study was used. Clinicians in the vascular department and with prior vascular experience in a district general hospital participated in interpreting 15 12-second Doppler audio signals (5 monophasic, 5 biphasic and 5 triphasic) into either ‘monophasic’, ‘biphasic’ and ‘triphasic’ using a Huntleigh’s Dopplex DMXTM digital hand-held Doppler ultrasound with visual waveform display covered. After all the audio signals were graded, the waveforms of each doppler signals are shown on the hand-held doppler display to reveal the correct responds.

Results

8 clinicians were involved; 5 had less than 6 months of vascular experience. Out of 15 audio signals, the mean number correct grading of signals was 10.1. There is no difference in number of correct grading of the 3 waveforms (monophasic 3.5 out of 5, biphasic 3.25 out of 5, triphasic 3.5 out of 5). There is also no difference in responses between clinicians with less than 6 months and more than 6 months of vascular experience (p = 0.82).

Conclusions

There is a need for further ongoing education among clinicians in the use of hand held Doppler and interpretation of its audio signals. Reliability of Doppler examination in vascular assessment is also in contention, and further studies are required. The use of digital hand-held Doppler with visual wave form display will significantly improve accuracy of interpretation
EP.WE.103223-hour stay following total parathyroidectomy in renal patients
Authors: Neophytou Chris , Chang Jessica , Howard Emma , Houghton Andrew
Published: October 2021

Aim

Total parathyroidectomy in end-stage renal failure (ESRF), is an effective way to improve or stabilise calcium and parathormone levels and thus improve renal osteodystrophy. Previous BAEST guidelines were not in favour of true day-case neck surgery due to the risk of airway compromise from bleeding. Additionally, ESRF patients are at risk of profound hypocalcaemia after total parathyroidectomy.

Patients undergoing total parathyroidectomy are prescribed Alfacalcidol 4mcg daily for 5 days prior to surgery. Following surgery under GA on a morning list, the potassium and calcium levels are checked in the afternoon. Calcium levels are then monitored daily for 3 days and subsequently when required. Oral Alfacalcidol is continued at the same dose until the nephrologists advise otherwise.

Methods

All ESRF patients undergoing total parathyroidectomy for secondary hyperparathyroidism were identified between 01/01/2005 and 31/12/2019 from a prospectively maintained electronic database. Demographics, biochemistry, length of stay (LoS) and outcomes were analysed.

Results

There were 43 (30 male) total parathyroidectomies. The median age was 53 (range 14 – 78), and median LoS 1 day (range 0 -13). 26 patients (60%) were discharged within 23 hours (26% were day-case). Prolonged stay was due to calcium replacement (n = 8) or dialysis (n = 4) requirements. Pre- and post-operative calcium values over 2.49mmol/L were significantly related to 23-hour stay (p = 0.010482 and p = 0.000263 respectively). No 30-day re-admissions were observed

Conclusions

Careful patient selection and adherence to a perioperative management protocol in total parathyroidectomy may enable early discharge within 23 hours. Preoperative calcium levels help predict this outcome.
EP.TH.25Common General Surgical Never Events: An In-depth Analysis of Never Events data held by NHS England
Authors: Omar Islam , Singhal Rishi , Wilson Michael , Parmar Chetan , Khan Omar , Mahawar Kamal
Published: October 2021

Background

There is little available data on common general surgical NE. Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. The purpose of this study was to identify common general surgical NE from the data held by the National Health Service (NHS) England.

Methods

We analyzed NHS England NE data from April 2012 to February 2020 to identify common general surgical NE.

Results

There was a total of 797 general surgical NE identified under three main categories of Wrong-Site Surgery (n = 427;53.58%), Retained Items Post-Procedure (n = 355;44.54%) and Wrong Implant/Prosthesis and (n = 15;1.88%). We identified a total of 56 common general surgical themes - 25 each in Wrong-Site Surgery and Retained Foreign Body category and 6 in wrong implants.

Wrong skin condition surgery was the commonest wrong-site surgery (n = 117;27.4%). There were 18 wrong side chest drains (4.2%) and 18 (4.2%) wrong side angioplasty/angiogram. There were 7 (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and 6 (1.4%) instances of biopsy of cervix rather than colon or rectum.

Retained surgical swabs were the most common retained items (n = 165;46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guidewires, 26 (7.3%) surgical needles; and 9 (2.5%) surgical drains. Wrong stents were the most common (n = 9;60%) wrong implant followed by wrong breast implants (n = 2;13.3%).

Conclusion

This study found 56 common general surgical Never Events. Increased awareness of these common themes of NE may ultimately help reduce their incidence.
EP.TH.26Identification of Common Themes from Never Events Data Published by NHS England
Authors: Omar Islam , Graham Yitka , Singhal Rishi , Wilson Michael , Madhok Brijesh , Mahawar Kamal
Published: October 2021

Background

Never events (NEs) are serious clinical incidents that cause potentially avoidable harm and impose a significant financial burden on healthcare systems. The purpose of this study was to identify common never events.

Methods

We analysed the NHS England NE data from 2012 to 2020 to identify common never events category and themes.

Results

We identified 51 common NE themes in 4 main categories out of a total of 3247 NE reported during this period. Wrong-site surgery was the most common category (n = 1307;40.25%)) followed by retained foreign objects (n = 901;27.75%); wrong implant or prosthesis (n = 425;13.09%); and non-surgical/infrequent ones (n = 614;18.9%).

Wrong-side and wrong tooth removal were the most common wrong-site NE accounting for 300 (22.95%) and 263 (20.12%) incidents, respectively. There were 197 (15%) wrong-site blocks, 125 (9.56%) wrong procedures, and 96 (7.3%) wrong skin lesions excised. Vaginal swabs were the most commonly retained items (276;30.63%) followed by surgical swabs (164;18.20%) and guidewires (152;16.87%). There were 67 (7.44%) incidents of retained parts of instruments and 48 (5.33%) retained instruments. Wrong intraocular lenses (165;38.82%) were the most common wrong implants followed by wrong hip prostheses (n = 94;22.11%) and wrong knees (n = 91;21.41%).

Non-surgical events accounted for 18.9% (n = 614) of the total incidents. Misplaced naso-or oro-gastric tubes (n = 178;29%) and wrong-route administration of medications were the most common events in this category (n = 111;18%), followed by unintentional connection of a patient requiring oxygen to an air flow-meter (n = 93;15%).

Conclusion

This paper identifies common NE categories and themes. Awareness of these might help reduce their incidence.
EP.TH.41Breast Implant-Associated Anaplastic Large Cell Lymphoma
Authors: Moori Parisa , Ibison Fran , Jacob Deepa , Iddon Julie
Published: October 2021

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare, non-Hodgkin lymphoma which arises within the capsules of breast implants. These particular tumours have expression of CD30 and are negative for Anaplastic Lymphoma Kinase (ALK). Here, we report a case of BIA-ALCL in a 48-year-old woman post breast reconstruction. This case report is aimed at raising awareness and education on the significance of considering the development of BIA-ALCL in cases where cytology is negative and helping better understand this disease process.
EP.TH.49The Use of MRCP to Investigate Bile Duct Stones
Authors: Ma Jennifer , Jethwa Paras
Published: October 2021

Aim

Association of Upper Gastrointestinal Surgeons (AUGIS) latest guideline advocates stratification of patients with gallstone disease to determine their risks of common bile duct (CBD) stone and to perform Magnetic resonance cholangiopancreatography (MRCP) for those at intermediate risk. The study assessed the appropriateness of our local hospital's MRCP requests in accordance to the AUGIS standard.

Method

Inpatient MRCP requests for suspected ductal gallstones between June and December 2019 were identified retrospectively. Admission history, ultrasound, MRCP findings and liver function tests were collected from hospital electronic records. Patients with previous cholecystectomy were excluded. Patients were categorized into ‘low risk’, ‘intermediate risk’ and ‘high risk’.

Results

67 patients were included in the study and 24 patients were discovered to have CBD stones on MRCP. The majority of patients (54%) were considered ‘intermediate risk’, whilst the ‘low risk’ group consisted of 13% of the MRCP requests and ‘high risk’ group comprised of 33%. Amongst those in the ‘low risk’ group, only 1 of 9 patients (11%) had cbd stone identified on MRCP. 19% patients in the intermediate group were found to have CBD stone, whilst 73% patients in the high risk group were identified to have CBD stone. On average, patients underwent MRCP within a day of request.

Conclusion

A high proportion of patients at high risk for CBD stone were referred for MRCP, contrary to AUGIS guideline. Inpatient MRCP referrals should be considered carefully in this category as it potentially increases length of stay without change in clinical management.
EP.TH.63Predictive significance of tumour size in patients undergoing curative surgery for colorectal cancers: Retrospective cohort study
Authors: Hajibande Shahab , Barghash Mohammed , Khan Asaf , Ali Baqar
Published: October 2021

Aims

Evaluating predictive significance of tumour size in patients undergoing curative colorectal cancer surgery.

Methods

Patients undergoing curative surgery (77.6% Laparoscopic) for colorectal cancer by a single surgeon between January 2013 and January 2020 inclusive. Linear/binary logistic regression analyses were modelled to assess whether colonic or rectal tumour size could predict R0 resection, specimen length, length >120mm, number of harvested lymph nodes, >12 harvested lymph nodes, number of positive lymph nodes, lymphocytic infiltration, venous invasion, and overall survival.

Results

Total of 192 patients (124 colon and 68 rectal cancers) were eligible. In colon cancer patients, tumour size was independent predictor of the number of harvested lymph nodes (P < 0.001), the number of positive lymph nodes (P = 0.001), and lymphocytic infiltration (P = 0.009). It did not predict R0 resection (P = 0.563), specimen length (P = 0.111), specimen length >120mm (P = 0.186), >12 harvested lymph nodes (P = 0.145), venous invasion (P = 0.103), 5-year overall survival (P = 0.543). Independent predictor in rectal cancers was the number of harvested lymph nodes (P < 0.001), and the number of positive lymph nodes (P < 0.001). It did not predict R0 resection (P = 0.108), specimen length (P = 0.774), specimen length >120mm (P = 0.405), >12 harvested lymph nodes (P = 0.069), lymphocytic infiltration (P = 0.912), venous invasion (P = 0.105), and 5-year overall survival (P = 0.413).

Conclusions

Current study results suggest tumour size alone may not have a significant predictive value in terms of oncological or survival outcomes in patients undergoing curative surgery for cancer of colon or rectum.
EP.TH.81Contribution of Information on GP Referral Letters to Patient Management in a Rapid-diagnosis Breast Clinic
Authors: Gkigkelou Eleonora , Kirkpatrick Katharine , Ravichandran Duraisamy
Published: October 2021

Aims

GP referral letters to rapid-diagnosis breast clinics are often poorly scanned copies of standard 2 week-wait proforma that are difficult to read, lengthy, and contain a large amount of irrelevant information. We studied the contribution of information in referral letters in patient management and compared this with information provided by patients themselves.

Methods

Patients completed a standard questionnaire (one side of A4) on arrival at clinic. This included all information relevant to a breast clinic such as family history and comorbidities. A consultant surgeon then saw the patients with the questionnaire and performed clinical assessment and imaging as necessary, without referring to GP letters. The letters were read before patients left clinic. Any additional useful information was noted.

Results

202 consecutive new patients, median age 44 (16-93) seen in 23 clinics by 2 consultants were studied. The median number of pages in referral letter was 5 (1-14). Patient questionnaire took less than 30 seconds to read. The presenting complaints were real or perceived lump (n = 105), pain (n = 44), both (n = 14) and others (n = 39). 21 patients had cancer. Additional useful information in the referral letter was noted in 20 patients (10%). However, in no case this affected the patient management adversely.

Conclusions

GP letters are lengthy but contribute relatively little to the initial assessment and management of patients in a busy rapid diagnosis breast clinic. A patient-completed targeted questionnaire is quicker and can potentially replace a GP referral letter in most patients.
EP.TH.112The Use Ex-Vivo Renal Autotransplantation to Treat Hypertension Secondary to Renal Artery Disease: Two Case Reports
Authors: Saghir Noman , Saghir Reyan , Machado Bruno , Murilo Rene , Poojary Manoj , Sforza Marcos
Published: October 2021

Renal Auto transplantation (RAT) is the surgical procedure in which the kidney is initially removed and subsequently re-implanted in a different position, allowing for improved outcomes in conditions involving ureteral pathology, renovascular and neoplastic disease primarily.

In this paper, we aim to build upon the understanding of RAT and especially its effectiveness in treating patients with hypertension secondary to renal artery disease, intolerant to previous treatment approaches. In particular, the ex-vivo technique will be focused upon as introduced by Ota et al. in 1967 whereby the use of the workbench is frequently applied for patients requiring in excess of 45 minutes of ischaemic time.

We, therefore, put forth two cases managed in co-operation by the University of Arkansas vascular and urology departments. The first of which was a 52-year-old woman with an aneurysmal Lesion reaching the renal artery at the hilum. The second was an 18-year-old woman with Takayasu arteritis. The use of vasopressin had preserved some renal function however at the time of the diagnosis, they were experiencing difficulty in controlling their hypertension, and thus RAT was performed, and the subsequent patient postoperative outcomes and effectiveness have been recorded and analysed as part of this study.
EP.TH.164Staging CXR preoperatively in invasive breast cancer, is it time it should be abandoned? A single-centre cohort review of its utility
Authors: Fung Claire , Rowland Matthew
Published: October 2021

Aim

The use of preoperative chest x-rays (pCXR) for staging in invasive breast cancer has uncertain benefit. This review aimed to ascertain its utility in this cohort in a single centre.

Methods

Retrospective cohort review of consecutive patients with invasive breast cancer planned for surgery for 2018 was carried out. An 18-month follow-up allowed the identification of any subsequent lung pathology that may have potentially been seen on pCXR. Patients who had staging CT instead were excluded. Formal reports of pCXR and any subsequent imaging were reviewed.

Results

244 patients with invasive breast cancer that was planned for surgery for 2018 were identified, 214 of whom had pCXR. 194 had no abnormalities reported. 16 had lung pathology; eight were indeterminate and were advised to have follow-up imaging. Of the six who had follow-up CTs, three had lung nodules; they were all subsequently discharged from follow-up as they were determined as benign.

At 18 months, nine patients had new thoracic pathology: two had metastatic lung disease; six had lung nodules requiring follow-up. All nine patients’ pCXRs were reported as normal.

Conclusions

pCXR for invasive breast cancer has limited, if any, utility; it does not identify any management-altering pathology. Those that developed malignancy were not predicted by pCXR, but identified by post-operative symptoms, or on staging CT directed by post-operative nodal status. pCXR in this cohort, in the absence of respiratory symptoms, should therefore be discontinued. This would reduce cost, radiation exposure, hospital footfall, radiology reporting time, and likely improve patient satisfaction.
EP.TH.275The role of amino acid transporters SLC1A5 and SLC3A2 in primary breast cancer in older women
Authors: Parks Ruth , Alfarsi Lutfi , Green Andrew , Cheung Kwok-Leung
Published: October 2021

Aims

Breast cancer in older women has more favourable biology, compared to younger women. Increased glutamine metabolism is a hallmark of cancer. The prognostic role of amino acid transporters involved with glutamine flux, SLC1A5 and SLC3A2, has been shown in breast cancer in younger women. This study aimed to investigate the role of SLC1A5 and SLC3A2 in breast cancer in older women as possible prognostic markers.

Methods

Surgical specimens were obtained from an existing series of 1,758 older women (≥70 years) with primary breast cancer, treated in a single institution with long-term (37+ years) follow-up. Of this cohort, 813 had primary surgical treatment. As part of previous work, it was possible to construct good quality tissue microarrays (TMAs) in 575 cases.

Immunohistochemical staining for SLC1A5 and SLC3A2 was performed. H-score was considered as a continuous variable as well as using positivity cut-offs of ≥ 45 for SLC1A5 and ≥15 for SLC3A2, using X-tile software.

Association between H-score and tumour size, grade, ER status, local-recurrence-free-survival (LRFS), overall survival (OS) and breast-cancer-specific-survival (BCSS) was investigated.

Results

No correlation was seen between neither marker and LRFS, OS, or BCSS in older women with breast cancer. Both markers were associated with high tumour grade and negative ER status (both p < 0.001).

Conclusions

These findings are contrary to those found in younger women, where these amino acid transporters are associated with shorter BCSS. This may suggest that breast cancer in older women is less reliant on glutamine metabolism, which is consistent with an overall less aggressive phenotype.
EP.TH.286Optimisation of Secondary Breast Reconstruction
Authors: Lovšin Klemen , Ahčan Uroš , Lapoša Andrej
Published: October 2021

Aims

The purpose of secondary breast reconstruction is to restore patient’s integrity. Autologous breast reconstruction has become the superior method of breast reconstruction, especially in cases with inadequate skin envelope and post-radiotherapy tissue damage. A 3D-template-enhanced secondary autologous breast reconstruction with restoration of innervation was developed at our department.

Methods

Thirty patients are planned to be included in the prospective double-blinded study. The reconstruction is performed with the deep inferior epigastric perforator (DIEP) free flap using 3D template from the contralateral healthy breast. Additionally, coaptation of the anterior branch of the 3rd intercostal nerve with the dominant lateral intercostal nerve innervating the DIEP flap is performed. Breast-Q questionnaires are collected before and after the reconstruction and the breast sensation is assessed on regular intervals.

Results

The preliminary results show an improvement in the sensation of the reconstructed breast and higher patient satisfaction score. Prior to abstract submission, no significant complications have been noted, in one patent abnormal sensation of the breast was reported.

Conclusions

According to previous studies, patients with innervated free flap reconstruction express higher level of satisfaction as the sensation of the reconstructed breast contributes significantly to the level of satisfaction. Furthermore, use of 3D model from the contralateral breast produces results that are superior to traditional methods. Preliminary results showed that the combination of both methods improved patient satisfaction regarding the aesthetic outcome and functional result. With the appropriate patient selection this type of optimised breast reconstruction should be performed.