bluuebunny/crossref_metadata_2025 huggingface dataset:
491 Comparison of Pandemic and Pre-pandemic Practices of Managing Acute Appendicitis
Authors: Salih L , Sabaratnam R , Kim H K , Bevan K
Published: October 2021

Aim

Acute appendicitis (AA) is a common indication for abdominal surgery, with more than 30,000 appendicectomies performed in England per year. However, SARS-CoV-2 (COVID-19) changed usual surgical practices following advice to minimise laparoscopic surgery, and instead favouring conservative management, or open surgery for AA.

Method

In this study, we compared the management of 50 patients with suspected/confirmed AA during the first wave of the COVID-19 pandemic at a district general hospital (DGH) with our usual practices, against 50 patients admitted with suspected/confirmed AA during a similar time period, one year prior to the pandemic.

Results

Demographics of patients in both groups were comparable with median age of 34 in the pandemic vs 32.5 in the pre-pandemic group. 74% of patients in the pandemic group (PG) underwent imaging to confirm appendicitis, compared to 58% of patients in the pre-pandemic group (PPG). 64% of PG patients were treated conservatively, compared to 8% in PPG patients. Outcomes demonstrated re-attendance events of 12% in the PG, as compared to 10% in the PPG, although the follow up period was longer in the PPG. Despite a significantly smaller number of patients managed surgically during the pandemic, 27% of patients undergoing appendicectomies had post-operative complications in the PG, as compared to 7% in the PPG.

Conclusions

During the pandemic, more patients at our DGH with AA were treated conservatively, more patients had re-attendance events and post-operative complications when compared to patients in the pre-pandemic group.
520 Can Low Lymphocyte Count Be Used to Predict the Presence Of COVID-19 In Emergency Surgical Patients?
Authors: Munro C , Strong C , Mount A
Published: October 2021

Introduction

With regards to COVID-19, low lymphocyte count (LC) [1] [2] [3] is a recognised feature and can be linked to disease severity [1][4]. This project aims to establish if lymphopenia is predictive of COVID-19 in the acute surgical patient.

Method

All emergency general surgical admissions to the Northumbria NHS Trust 15/4/20 -31/5/20 (n = 152) and 15/4/19 - 31/5/19 (n = 92) were reviewed. Exclusions included ‘Elective’ admissions and non-abdominal complaints.

Statistical analysis was performed using the STATA package. Low LC was compared with COVID-19 status; established through imaging, swab results, or clinical suspicion.

Results

Within the 2020 cohort 76.3% of patients (n = 116) had swabs within a week of admission. 8 patients within that cohort were deemed to have COVID-19, only one had a positive swab. Low LC as a predictor for COVID-19 had a sensitivity of 75%, specificity of 36.2%, PPV of 6.38% and NPV of 96.2%. Mann Whitney statistical analysis was used to identify a relationship between low LC and COVID-19 status, showing no significance (p = 0.91).

Conclusions

Low LC is not a predictor of whether surgical patients have COVID-19, and therefore should not be used for screening. There was no increase the number of patients presenting with lymphopenia in the acute surgical take in the ‘COVID Era’ compared with 2019.
539 Post-Covid-19 Smell Clinic - Management of Patients With ‘Long Covid’
Authors: Gopikrishna D , Rocke J , Chu M , Kumar N
Published: October 2021

Introduction

Olfactory dysfunction following COVID-19 infection is a prevalent issue in the post-viral phase of illness. Around 50% of patient’s self-report loss of sense of smell with COVID-19. Approximately 10% of these patients report no recovery in sense of smell at 4-6 weeks after onset. Patients with olfactory dysfunction often describe life as living in 2D, with lasting effects on eating habits and relationships. The aim of this project was to establish a novel ‘Post-Covid-19 smell clinic’ for patients, which monitored any changes relating to olfactory dysfunction and to provide advice on management of the condition for these patients with “Long-Covid”.

Method

The ‘smell clinic’ was set up based on BRS guidelines. Patients were asked to carry out the ‘UPSIT’ smell test and eODQ questionnaire. Patients were then advised to carry out ‘smell retraining’ for 4 months and pointed to appropriate resources. We analysed patients’ presentations to identify patterns that may identify patients who are likely to suffer long term olfactory dysfunction following Covid-19 infection. Parameters including prevalence of parosmia, cacosmia, dysgeusia, demographics were collected.

Results

Initial data, from 20 patients, showed 40% experienced parosmia and 40% had associated rhinological symptoms such as rhinorrhoea. The range UPSIT score: 22-34, eODQ score: 42-151.

Conclusions

Our initial analysis of the clinic identified symptoms range from anosmia, parosmia and loss of flavour. Parosmia patients experienced this in relation to smells such as excrement and coffee. Future implications involve analysing the possible benefits of ‘smell retraining’ after repeating UPSIT and the eODQ score
545 Assessing the Impact Of COVID-19 On the Diagnosis and Management of Bladder Cancer in The United Kingdom – The West Midlands Experience
Authors: Desai C , Ehsanullah S A , Khashaba S
Published: October 2021

Introduction

The British Association of Urological Surgeons (BAUS) issued an interim strategy for the management of bladder cancer as a contingency measure during the COVID-19 pandemic. We aim to assess the actual implementation of these recommendations and deviation from the standard of care in the West Midlands.

Method

A questionnaire was devised and sent to bladder cancer leads of 12 NHS Trusts in the region in June 2020. Responses were analysed and compared with the BAUS COVID-19 strategy.

Results

11 centres were aware of the BAUS COVID-19 strategy. 2 centres were offering teleconsultations only for 2-week-wait referrals, and 6 centres had changed their practice for non-visible haematuria referrals. All centres were offering TURBTs for new and high-risk tumours. 8 centres had clear MDT documentation of NICE risk-stratifications of all bladder tumours and 10 centres were also documenting any changes in treatment. Only 7 centres continued to give BCG to newly diagnosed NMIBC. All centres continued with staging CT for newly diagnosed MIBC. Patients were still being referred for cystectomies, however few were performed. Radiation as curative and palliative intent continued. Of the 5 regional cancer centres, only 1 continued with cystectomies as normal, whereas 2 performed the procedure on a case-by-case basis, and the procedure was delayed/deferred in the other 2 centres.

Conclusions

Diagnostics, and definitive management of bladder cancer has been severely affected by COVID-19. In particular, deferred intravesical BCG and delayed radical treatment can have a dire impact on the long-term outcomes of the patients presenting during the pandemic.
579 Emergency Surgical Admissions During The COVID-19 Pandemic; Comparative Study of Emergency Surgery Outcome Before and During The COVID-19
Authors: Soliman H , Hussain A , Manejwala O , Ghosh A , Shauib S , Hafeez R , El-Hasani S
Published: October 2021

Introduction

There are relatively few studies on emergency surgical practice in the COVID-19 pandemic. Our aim is to analyse the outcomes of emergency surgery before against those during COVID-19.

Method

Retrospectively we collected the emergency admissions to the general surgery department at a district general hospital during November 2019, which is a representative of our regular activity, and April 2020, the height of the COVID-19. The primary endpoint was the number and nature of surgical admissions and procedures. The secondary endpoints were morbidities and mortalities, laparoscopic and procedure approach (laparoscopic vs open), inflammatory markers (white cell count and C-reactive protein), hospital stay, gender and age.

Results

During the two months a total of 332 patients were admitted; 177 during November 2019 and 146 patients during April 2020. The mean age was 51 years in the November group and 49 years in the April group. 146 operations were conducted in November, while 117 procedures were performed in April. Hospital stay average was 5.87 days and 5.43 days for November and April groups, respectively. In the April group, seven patients tested positive for COVID-19. Mortality was slightly higher during April (2.05%) than November (1.6%). Postoperative complications, C-reactive protein level and prevalence of acute cholecystitis were much higher during April, while abscess and diverticulitis prevalence were significantly lower.

Conclusions

Morbidity, mortality and acute cholecystitis were significantly higher during the COVID-19 pandemic, while abscess and diverticulitis were significantly less prevalent likely due to and tendency by patients to avoid hospitals and hence late clinical presentation.
598 Burns Management at A UK Major Trauma Centre During The COVID-19 Lockdown
Authors: Payne A , Campbell E , Welman T , Pahal G , Myers S
Published: October 2021

Aim

The COVID-19 pandemic forced huge changes in healthcare delivery in the UK within a matter of weeks. We report our experience of managing burns presenting to a UK Major Trauma Centre during the COVID-19 lockdown period.

Method

Retrospective patient data was collected on aetiology, severity and management of burns during the first six weeks of the government-enforced lockdown. Data was compared with patients presenting with burns during the same period in 2019 (control) and statistical analysis was performed.

Results

Fifteen patients were treated during the COVID-19 lockdown and fourteen in the control group. Adults treated during the COVID-19 lockdown had a greater total body surface area (TBSA) (9% vs. 2.9%, p 0.035) and were more likely to suffer full thickness burns (40% vs. 0%). In the COVID-19 group all patients that did not require resuscitation, seven of whom met criteria for referral to burns services, were managed locally by the plastic surgery department with good outcomes.

Conclusions

Despite the increase in severity of adult burns seen during the COVID-19 lockdown period, local plastic surgery units have been able to adapt their practice and successfully manage more complex burns. This adaptability will be key as we move through the pandemic.
658 Managing the Acute Surgical Patient – How has COVID-19 Changed Our Approach?
Authors: Wall J , Maguire R , Plotkin T , Kowal M , Peckham-Cooper A
Published: October 2021

Aim

COVID-19 has changed how surgical admissions are triaged and treated. This retrospective cohort study aims to detail the effects of a national lockdown on emergency general surgical referrals at a tertiary centre.

Method

A retrospective search identified all emergency general surgery referrals prior to and during the UK national lockdown. Pre (10-23 Feb 2020;PLG) and intra-lockdown (30 Mar-12 Apr 2020;ILG) groups were compared using descriptive statistics and significance was quantified with Chi-squared.

Results

600 patients were included of which 426 (71%) presented in the PLG. The PLG had proportionally fewer ED referrals (40.8%vs.51.1%, p = 0.02) and less cross-sectional imaging performed (31.5%vs.40.8%, p = 0.03). There was a significant reduction in non-specific abdominal pain (NSAP) during lockdown (25.12%vs.14.94%, p = 0.007). GP referrals (48.8%vs.46.6%, p = 0.61), admission (46.2%vs.44.8%, p = 0.09) and operative intervention (21.4% vs.17.24%, p = 0.25) showed no disparity.

Conclusions

Predictably, the advent of lockdown resulted in a reduction in hospital attendance and surgical referrals. Our data showed a similar proportion of referred patients admitted pre- and intra-lockdown despite a reduction in absolute terms. This may be due to a trend towards later presentation coupled with a focus on conservative management and prevention of admission. The decrease in NSAP raises questions that require further exploration. Cross-sectional imaging was used more freely as an adjunct in the ILG suggesting increasing acuity and delayed presentation or may result from a tendency towards image-guided discharge. Admissions have since trended towards pre-lockdown levels, but it is yet to be seen if a reduction in elective operating will lead to an increase in emergency admissions.
726 Consenting for Surgery During the Pandemic: A Closed-Loop Audit on Discussing and Documenting the Risks of Hospital-Acquired COVID-19
Authors: Kim W A , Wu F , Al-Afifi S , Sebastian J
Published: October 2021

Introduction

There is limited data on the nosocomial transmission of COVID-19. The Royal College of Surgeons (RCS) have published guidance on consenting for surgery, which includes discussing the risks of hospital-acquired COVID-19 with patients as part of the consenting process1. We performed a closed-loop audit on our unit’s consenting practice to assess compliance using the RCS guidelines as the audit standard.

Method

A retrospective case review, including elective and emergency procedures, were identified from June to November 2020. Consent forms were reviewed for evidence of patient counselling for the risks of hospital-acquired COVID-19 using the RCS guidance for comparison. Positive SARS-CoV-2 RT-PCR swabs and radiological imaging suggestive of COVID-19 within 30-days were also assessed.

We undertook the 1st cycle of data collection in September. Following this, we used a local meeting to educate the surgical team. The 2nd cycle (re-audit) was performed in December.

Results

In cycle 1, from June to August 17/29 (59%) case notes documented the discussion of the COVID-19 risk. None of these patients contracted the virus. In cycle 2, from September to November, compliance improved to 28/33 (80%). One (3%) patient had contracted COVID-19. They had a positive SARS-CoV-2 RT-PCR swab and signs suggestive of COVID-19 on their CT chest.

Conclusions

The re-audit demonstrated an improvement in our consenting practice from 59% to 80%. One patient had hospital-acquired COVID-19 during our period of data collection, which reflects current data that suggests nosocomial COVID-19 is rare2. With new advisory guidelines, it is important to discuss these risks.
816 Managing Acute Appendicitis During the First Wave of the COVID-19 Pandemic: A Single-Centre Retrospective Study
Authors: Lotfallah A , Aamery A , Moussa G
Published: October 2021

Introduction

The COVID-19 pandemic provoked a change to normal surgical practice and led to a higher proportion of acute appendicitis (AA) patients being treated conservatively with antibiotics. We aim to analyse patients presenting with AA during the first wave of the pandemic, comparing surgically and conservatively managed patients.

Method

All patients presenting to our centre with AA between March and July 2020 were included. Six-month follow-up data was collected retrospectively using electronic records. Patients were categorised into surgically and conservatively managed groups. The primary outcome was the complication rate (post-operative complications vs failure of antibiotic treatment) and the secondary outcome was length of hospital stay.

Results

Fifty-seven patients (n = 57) were admitted with AA, 45.6% (n = 26) managed conservatively compared to 54.4% (n = 31) treated surgically. Higher complication rates were observed amongst the conservatively managed group, although not statistically significant (16% vs 35%; p = 0.131). There was no significant difference in length of hospital stay observed between the two groups (surgical: median, 2; interquartile range, 2-3 vs conservative: median, 3; interquartile range, 2-4). White cell count (WCC) and Alvarado score were higher on admission in the surgical group with statistical significance (p = 0.012 and p = 0.028 respectively).

Conclusions

Stratification criteria, such as Alvarado score and WCC may identify patients more suitable for conservative management. Longer term follow-up will be carried out, which may alter complication rates in either group. We suggest all patients treated conservatively should undergo computerised tomography (CT) to exclude complicated appendicitis. Further UK-based studies will add to the evidence-base surrounding management of AA during the COVID-19 pandemic.
824 UK CoPACK Study: Health Care Workers Knowledge and Confidence in Using Personal Protective Equipment (PPE) And Related Anxiety Levels During The COVID-19 Pandemic
Authors: Ismael S , Manoharan G , Al-Kaisi K , George A , Abas S , Al Musabi M , Rao P , Singh R
Published: October 2021

Aim

The COVID-19 pandemic has resulted in significant pressures on the NHS. Healthcare workers (HCWs) are at increased risk of infection. Personal protective equipment (PPE) lowers the risk of infection transmission. However, during the early phases of the pandemic, the information available regarding COVD-19 and the use of PPE has been unclear, with constantly changing guidelines. The aim of this study was to determine the knowledge and confidence about PPE usage among HCWs, in addition to measuring their anxiety levels during the COVID pandemic.

Method

A validated questionnaire was distributed among HCWs in as many UK hospitals as possible, during April 2020. The questionnaire consisted of 13 questions regarding demographics, knowledge on PPE guidance, HCW training and confidence levels in PPE usage and finally anxiety levels measured using the GAD-7 psychometric tool.

Results

1055 responses were received. Nurses (49%), Healthcare Assistants (HCA - 20%), Doctors (17%), Physios (8%) and other (6%). 99% of respondents indicated they were familiar with PPE guidance, but only 1.6% answered all 3 questions on PPE guidance accurately. 86.4% of respondents received mask-fitting checks. 79.7% received donning-doffing training. Despite this, only 46.8% were confident on their familiarity with PPE. 32.5% felt that their hospital communication regarding PPE policy during COVID-19 pandemic was poor or very poor. 30% HCWs experienced severe anxiety.

Conclusions

National guidance and local training on PPE usage during the COVID-19 pandemic has been unsatisfactory, leading to higher anxiety among HCWs. Improved information delivery and training are essential in preparation for the second wave and future pandemics.
902 Safe Elective & Emergency Surgery During the COVID-19 Crisis: Experience of a Large Tertiary Centre During the First Wave of the Pandemic
Authors: Giorga A , Thompson J , Lo T , Baker R
Published: October 2021

Aim

In addition to a reduction in elective surgery, the COVID-19 pandemic has been associated with concerning rates of post-operative mortality in COVID-19 patients highlighting the threat of nosocomial transmission. Relocation of elective patients into a protected cold wing of a tertiary centre, vigilant testing and staff test, and trace were implemented to address these issues.

Method

Retrospective analysis of 5069 consecutive patients who underwent procedures in theatre from 11/03/20 – 08/09/20 was performed. Comparison of numbers of procedures was compared with the same study dates in 2019. Detailed analysis of nosocomial transmission of COVID-19 and mortality was performed using patient notes and death certificates.

Results

5854 procedures were performed in 2020 compared with 13219 in 2019, representing a reduction of 55.7%. The overall mortality in 2020 was 2.7% (135/5069). COVID-19 negative mortality was 2.36% (119/5033). 74 patients tested positive for COVID-19 at any time (1.3%); mortality amongst patients who tested positive seven days pre- to 30 days post-procedure was 5.4% (4/74). Nosocomial transmission rate was 0.27% in elective admissions (10/3773) and 0.97% in acute admissions (20/2052).

Conclusions

The first wave of the pandemic has predictably caused a significant reduction in elective activity. Our hospital infection prevention measures have kept nosocomial transmission rates low, particularly for elective admissions. We have observed lower rates of post-operative mortality in COVID-19 patients than published in other centres. Continuation of surgical services is important for patient outcomes, and essential for training the surgeons of tomorrow.
977 The Role of Telephone Triage in Head and Neck Cancer Care in a Teaching Hospital
Authors: Turner T , Daniels J , Belloso A
Published: October 2021

Introduction

NHS England sets standards to ensure prompt specialist review, diagnosis, and treatment of cancer. Patients with suspected cancer should receive specialist review within 14 days of referral, diagnosis by day 28 and first treatment by day 62. To reduce transmission during the SARS-CoV-2 pandemic, the NHS recommended telephone triage as the first specialist appointment. The effect of telephone triage on head and neck cancer timeframes in an NHS teaching hospital was assessed.

Method

Four head and neck cancer telephone triage clinics during July 2020 were selected at random. Clinical correspondence and the electronic patient records were reviewed for each patient and cancer pathway timeframes were analysed.

Results

31 patients were referred for telephone triage and 100% received specialist review within 14 days. Subsequently 17 (55%) patients were investigated, 12 (71%) of which received a diagnosis within 28 days. 4 patients received a cancer diagnosis, but none received first treatment within 62 days. 24 (77%) patients were seen in a face-to-face clinic after telephone triage on average 7 days after telephone triage.

Conclusions

In this sample, telephone triage allowed safe initial specialist review by meeting the 14-day standard. However, the 28-day diagnosis and 62-day treatment standards were not adhered to. Telephone triage does not largely reduce overall patient contact, with 77% of patients subsequently reviewed in a patient-facing setting. The addition of telephone triage delayed first clinical examination by a specialist by an average of 7 days, which may be a contributing factor to the delays seen in diagnosis and treatment.
1016 The Impact Of COVID-19 On Prostate Cancer: Is This the Calm Before the Storm?
Authors: McCauley N , Rashid M , Wilson J , Carter A , Cox A
Published: October 2021

Aim

Cancer treatment targets were halted in the COVID-era due to a major re-organisation of services and coincided with a drop in prostate cancer (PCa) referrals, investigations, and diagnoses. This study measures the impact of the pandemic on a PCa diagnostic pathway in a major cancer centre.

Method

Data was collected during the onset of COVID-19 (March to June 2020) and the same months in 2019 for urgent suspected prostate cancer (USPC) referrals. All referrals, PSA tests, multiparametric MRI's of prostate (mpMRI-P), and TRUS-guided biopsy of the prostate (TBP) were recorded.

Results

USPC referrals reduced by 65% from a mean 315 referrals per month to 110 during the pandemic. During March-June 2019 a total of 10,404 PSA tests were conducted in the healthcare trust, which reduced by 39% during COVID-19. Multiparametric MRI of prostate was reduced by 45%. TRUS biopsies were down by 65%, from a mean of 31 to 11 biopsies per month, with only 3 biopsies being conducted in April 2020.

Conclusions

The reduction in PCa referrals and workload in our centre in the COVID-era has been significant. The uncertainty associated with such a drop in demand poses concerns for meeting future cancer targets when prostate cancer referrals return to baseline.
1063 Incidence, Risk Factors, and Outcomes of ARDS in Patients with SARS-CoV-2 Infection
Authors: Devarakonda S , Narayanan S , Lingamdenne P E , Kandasamy S , Korula P J
Published: October 2021

Introduction

Many asymptomatic patients are diagnosed with SARS-CoV-2 infection on screening, which might alter their expected course of illness. We wanted to study the incidence, risk factors, and ARDS outcomes in these patients admitted to our ITU.

Method

A review of all admissions (medical, surgical, and obstetric) to our ITU from May to October 2020 was done after institutional ethics approval. Age, gender, comorbidities, admission diagnosis, APACHE II score, and in-hospital course were studied. ARDS was defined as PaO2/FiO2 ≤ 300 mmHg (with PEEP or CPAP ≥ 5 cmH2O) in the absence of cardiac failure or fluid overload. Data were analyzed using Statistical Package for Social Services (SPSS) software Version 21.0 (Armonk, NY: IBM Corp).

Results

Of the 832 cases, 119 (14.3%) had SARS-CoV-2 infection. 41 of 119 (34.4%) cases developed ARDS. Among the comorbidities studied, only hypertension (OR 2.6, 95% CI 1.0-6.2) seemed to increase ARDS odds. Patients with Severe Acute Respiratory Illness (SARI) had a higher incidence of ARDS when compared to the asymptomatic ones (P < .05). Patients with sepsis (OR 5.8, 95% CI 2.4-13.7) and APACHE II score ≥10 (OR 5, 95% CI 2.0-12.3) had higher odds of developing ARDS. Age, gender, trauma, and recent surgery did not seem to increase the risk of ARDS.

Conclusions

Even though COVID-19 patients admitted with SARI and sepsis are at a higher risk of developing ARDS, further research will be needed to predict the extent to which SARS-CoV-2 infection will influence the course of their illness.
1075 Paediatric Injuries Pre And During COVID-19 Requiring an Operative Intervention: The District General Hospital Experience
Authors: Howard E , Arshad S , Kabariti R , Roach R
Published: October 2021

Aim

To assess the effect of lockdown and the following summer period on paediatric trauma patients who required an operative intervention in a district general hospital.

Method

A single centre retrospective audit was performed on all paediatric patients <16 years requiring an operative intervention. Two study periods were assessed – pre-COVID (22/03/2019- 30/09/2019) and during the COVID-19 pandemic and subsequent summer period (26/03/2020 – 26/09/2020). Data were collected on patient demographics, type of injury sustained, and intervention performed.

Results

During the COVID-19 pandemic 119 operations were performed, compared to 238 operations performed before the pandemic. Distal radius fractures were the most common injury both during and before the pandemic. However, during the pandemic there was a higher incidence of both hand injuries and lower limb lacerations. The most common type of operation both before and during the pandemic was manipulation under anaesthetic, but there was an increased incidence of washouts performed during the pandemic.

Conclusions

Despite extensive restructuring of services due to COVID-19, 119 operations were performed during the pandemic. However, this is 119 fewer operations than the same period of the previous year. The reduced rate of operations could be a consequence of increased parental supervision, and less outdoor activity during the pandemic period, but further research is necessary.
1154 The Effect Of COVID-19 Pandemic on Mortality Rates in General Surgery in A District General Hospital
Authors: Bhattacharya P , Mobarak D
Published: October 2021

Introduction

WHO declared COVID-19 to be a global pandemic on March 11th 2020. It has has a profound on health care delivery and allocation of resources.

Aim

To find out the effect of the COVID-19 pandemic on mortality rates of patients admitted under general surgery in our hospital.

Method

Retrospective data collection of deaths in all inpatients from March to November 2020 (group A)and comparing it with data collected on inpatients from March to November 2019( Group B).

Results

There were 46 deaths out of 3534 admissions in group A compared to 55 deaths out of 6576 admissions in group B. This meant a rise of mortality from 0.84% in 2019 to 0.94 % in 2020, this is a statistically significant result (p = 0.02). The median age of mortalities in 2020 is 81.5 vs 79 years in 2019 and median documented interval between onset of symptoms to presentation in hospital was 2 days in 2020 as it was during 2019. Perforations accounted for more than half of 2020 deaths ( 29 out of 46) and 6 patients out of 46 were COVID-19 on swab testing.

Conclusions

1. COVID-19 has had a significant impact on mortality rates in general surgery in 2020. 2. Perforations account for a majority of deaths, as evidenced by mean time to presentation at hospital; this may be attributed to delayed seeking of healthcare facilities as a result of lockdown. 3. Public education is required to seek medical attention early to improve outcomes of serious surgical conditions.
1256 Orthopaedics and The COVID19 Pandemic: Was Achilles Just A “Weekend Warrior”?
Authors: Murphy B , Hurson C
Published: October 2021

Background

The COVID19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions pertaining to sports saw a sudden return to play for many people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. In our institution, we appeared to have a large number of these injuries within a short space of time. We hypothesised that Phase 3 of “Lockdown”, where all sports were allowed to return, led to increased Achilles tendon rupture rates vs. the same period in 2019 due to a prolonged period of inactivity.

Method

Data from electronic theatre logbooks of all operations performed in the trauma theatre from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected.

Results

772 cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 of these occurred after Phase 3. 555 cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2%). 11 of these occurred after Phase 3.

Conclusions

Overall, there was a greater number and greater rate of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. 8 of the 11 occurring after Phase 3 in 2020 occurred in the month of July. This led the authors to believe they were occurring more frequently. In conclusion, the COVID19 pandemic restrictions and subsequent return to play after inactivity does not increase the rate of Achilles tendon rupture.
1274 Impact of Covid 19 on Urgent Suspicion of GI Cancer Referral in a District General Hospital
Authors: Barman S , Ng H J , Teo S , Blaney E M , Mansfield O
Published: October 2021

Aim

Endoscopy services across United Kingdom were affected significantly since March 2020 due to Covid-19 pandemic. Services were reduced and were more selective. We aim to compare the impact on duration between referral to colonoscopy and the detection rate of pathology between February (pre- Covid) and August (Covid impacted) 2020.

Method

Data was analysed from a prospectively maintained database of patients referred for colonoscopy to Royal Alexandra Hospital, Scotland. Patients underwent colonoscopy in month of February and August 2020 were included. Bowel screening patients were excluded. Positive findings included diverticulosis, colitis, polyp and adenocarcinoma. P value of < 0.05 was considered significant.

Results

Total number of patients included was 97 (55 in February, 42 in August). Median age was 61 and 69 years, respectively. Mean duration from referral to colonoscopy were 4 weeks in February and 7 weeks in August. qFIT test were found raised in 50.9% in February and 57.1% in August with positive findings of 47.3% in February and 66.7% in August. 46.4% in February and 16.7% in August had raised qFIT but normal findings (p < 0.05). Two high grade dysplasia polyps and two adenocarcinomas were identified in February, none found in August.

Conclusions

Covid-19 pandemic has disrupted the endoscopic services prolonging the duration from referral to colonoscopy. qFIT test is more heavily relied to prioritise urgent colonoscopies resulting in more positive findings on colonoscopy. Cancer detection rate has reduced which is a consistent finding as the UK national endoscopy study. Massive efforts are needed to restore endoscopy services.
1294 Online Education for Patients Undergoing Elective Orthopaedic Surgery During A Global Pandemic
Authors: Siddiqui M , Bokhari A
Published: October 2021

Introduction

lective hip and knee joint replacement patients at the East Lancashire Hospitals NHS Trust (ELHT) are required to attend the ‘Hip and Knee Joint School’. This is an award-winning patient education programme. Pre-pandemic, it was a day at the hospital dedicated to introducing patients to the specifics of a hip and knee joint replacement surgery. This takes the patient from the process of anaesthesia to post-operative ward care.

Method

Due to the virulent transmission of COVID-19, strict social distancing rules have been implemented. Therefore, it was decided that converting the joint school into online videos would be the best medium for patient education. Various healthcare professionals contributed to the videos included orthopaedic surgeons, anaesthetists, specialist nurses, healthcare assistants, occupational therapists, and physiotherapists.

Results

Eleven videos were filmed, edited, and approved by the trust’s communications team. These included, ‘Introduction to the Joint School’, ‘You and your surgery’, ‘Leading up to your operation’, ‘Your Operation Journey’, ‘Introducing the Anaesthetist’ ‘Total Hip Replacement Surgery’, ‘Total Knee Replacement Surgery’, ‘Post-op Wound Care’, ‘Your Safe Discharge Home’, ‘FAQ’s’ and ‘COVID-19 Green Pathway’.

Conclusions

The global pandemic has driven innovation and novel ideas in medicine. We have seen similar changes in our trust with the online patient education videos being a prime example. This joint school was originally started in our trust, but now as it had been converted to videos, we believe that it can be modified and used across all trusts in the NHS.
1358 Does A COVID Protected Hospital Within A COVID Hospital Enable Elective Care and Training Opportunities?
Authors: Rashid H , Gala T , Ain Q , Ashraf H , Vesamia S , Vig S
Published: October 2021

Introduction

Elective care in the UK came to a standstill with the advent of the COVID-19 pandemic. A restart could only be enabled with ‘green site’ separation and a ‘covid protected’ zone. A ‘hospital within the hospital’ concept was developed including 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen, and a separated entrance. This model was underpinned with PPE, enhanced infection control and guidance for staff. The study documented the ability to recover elective activity and therefore provide a training environment for surgical trainees.

Method

Data was collected weekly (7/20 to 1/21) through the business informatics system with regard to theatres cases completed compared to the activity achieved in the 11-theatre elective estate pre COVID-19.

Results

Pre COVID-19, an average of 263 cases were completed per week. In the first week of operation, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. This was maintained until the impact of the second wave where activity has reduced to 50% but is not anticipated to reduce further as local anaesthetic and blocks maybe utilised.

Conclusions

This ‘hospital within the hospital’ has enabled elective care to return to above normal levels, with increased efficiencies. This has enabled a rapid return to a training environment for trainees disheartened with deployment to critical care in the first wave.
1408 Virtual Phone Call or Video Consultations: Patient and Clinician Preference During Covid-19
Authors: Kinsella A , Hassan I , Malone C
Published: October 2021

Aim

In response to COVID-19 and social distancing guidelines, healthcare services have evolved. Telehealth is part of this change and many services introduced virtual telephone clinics. The HSE recently approved a video conferencing tool, ‘Attend Anywhere’, however this is not widely used at present. We have received positive feedback from patients, but only a few studies provide information on overall satisfaction of virtual consultations. We aim to validate this by assessing preferences towards virtual telephone and video consultations.

Method

50 patients from the breast care clinic were included. Patients excluded were any new symptomatic patients or those with any incapacity. Questionnaires with Likert scales were used to assess patient and clinician attitudes towards ‘phone’ (PC) or ‘video’ consultations (VC).

Results

The majority of patients (64%) requested a PC rather than a VC (36%). More patients used technology regularly in the VC group (88%) than the PC group (69%), and 94% of VC patients had experience with video calls (47% PC). VC patients felt safe using ‘Attend Anywhere’(94%), said it was ‘more personal’ than a phone call (72%) but preferred face-to-face for future consultations as they ‘liked the reassurance of a physical exam’(78% VC; 59% PC). All clinicians felt the lack of examination in virtual clinics impacts the doctor-patient relationship and would prefer face-to-face consultations where possible.

Conclusions

Our findings demonstrate a positive patient and clinician attitude to virtual clinics, however face-to-face appointments are preferred by both groups. We will repeat this survey following COVID-19 restrictions to determine if attitudes have changed.
1424 Enhanced Consent in Endocrine Surgery in The Era Of COVID-19
Authors: Greene K , Truran P , Bliss R , Ramsingh J
Published: October 2021

Aim

Informed consent is the process by which surgeon and patient agree to undergo a procedure after the risk, benefits and alternative treatments have been discussed. The current COVID-19 pandemic provides unique challenges to the consent process such as the uncertain risk of acquiring the virus and the impact of a second peak on the health services. The aim of this audit was to use an enhanced consent tool to inform patients of specific risks associated with surgery during the pandemic.

Method

At the beginning of the pandemic, elective operating was postponed - these patients were added to a COVID-19 database. With the resumption of services, all patients had a telephone clinic appointment with a 2-fold aim: 1) to ensure they wanted to remain on the waiting list and 2) to discuss consent specifically with regard to COVID-19 using an enhanced consent tool.

Results

Over a 6-week period, 79 patients were contacted. All patients were awaiting thyroid, parathyroid and adrenal operations. Of the 79 patients contacted, 77 (97%) agreed to remain on the waiting list after discussing the risks using the enhanced consent tool. The remaining 2 patients asked for their operations to be delayed. To date, none of our patients have acquired COVID-19 upon the resumption of services.

Conclusions

Despite the uncertain risks of COVID-19, the majority of patients requiring endocrine surgery were happy to proceed. Ongoing review of available literature concerning preoperative risk and COVID-19 is essential for clinicians involved in the consent process. The use of an enhanced consent tool standardised the consent process and enabled patients to make an informed decision concerning their care.
1465 Anaesthetic Preferences in a Tertiary Hand Surgery Unit & Aetiology of Hand Trauma Presentations During the First UK lockdown: Lessons for the Future
Authors: Khoury A , Thomson D , Jones M
Published: October 2021

Introduction

Our tertiary plastics unit serves a 4.3 million population in the South East, providing a seven-day hand trauma service. Our aim was to assess differences in quantity and aetiology of hand trauma during the April 2020 lockdown compared with the equivalent period in 2019, and our ability to reduce risk by carrying out more procedures under local anaesthetic.

Method

Retrospective notes review for hand trauma surgery patients in April 2020 (3 weeks in first UK lockdown), with a comparative period in April 2019. Fisher’s Exact Test was applied to assess for difference in method of anaesthetia, injury location (workplace vs home) and DIY versus non-DIY aetiology.

Results

2020 group: n = 165. 2019: n = 239. (31% reduction). Mean age 45 during lockdown vs 49 in 2019. There was significant reduction in the proportion of workplace injuries in 2020 (22% vs 29%), but the proportion of power tool injuries was similar (31.6% 2020 vs 26.6%). DIY injuries increased significantly (33.5% versus 9.2%). Use of local anaeshesia including increased significantly in our unit (84.2% vs 66.1% 2019) with reduction in use of regional and general anaesthesia.

Conclusions

Caseload somewhat reduced during lockdown. Fewer injuries occurred in the workplace. Our unit made good use of local anaesthetic techniques to avoid regional anaesthesia (and risk of need for GA conversion) wherever possible. Public safety warnings existed (BAPRAS and BSSH), but perhaps were less publicly available than desirable. Improving awareness further could reduce trauma surgery burden as we enter a third wave of the pandemic.
1475 Management of Appendicitis During COVID19 - A Shift to Conservative Management
Authors: Bhattacharya P , Stonelake S , Peterknecht E , Zaman S , Budhoo M
Published: October 2021

Introduction

The COVID19 pandemic posed challenges in dealing with common surgical conditions, by causing a redirect of manpower and resources as well as having correlation of added morbidity if present in patients undergoing surgery

Aim

To find out the proportion of patients undergoing conservative management and their outcomes compared to operative management

Method

Retrospective data collection of patients admitted with appendicitis from 25/03/2020 to 15/07/2020.

Results

A total of 72 encounters had a discharge diagnosis of appendicitis.35 (48.6%) patients were treated with conservative management. while 37 (51.4%) patients had operative management. In the conservative group CT scan was done in 64%, which showed simple appendicitis in 78% and complicated in 17 %, whereas in the operative group CT scan was done in 59.4% , 86 % had simple appendicitis and 9% and complicated appendicitis. Median length of stay in both groups were 2 days. There were no readmissions in the operative group and 84.3% patients had no readmissions in the conservative group in the study in a follow up period up to 6 months. 2 patients initially treated conservative were eventually offered surgery on readmission.

Conclusions

1. Conservative management of appendicitis has proved to be a valuable alternative to surgical management during this pandemic 2. Patients should be offered a choice of conservative management for simple appendicitis with prior discussion of benefits of avoiding surgery versus risk to recurrence (up to 39% reported in literature for uncomplicated appendicitis)
1524 Design and Implementation Of ICE-COVID, A Double-Blind Randomised Placebo-Controlled Trial on The Efficacy of Iota-Carrageenan Nasal and Throat Spray for Covid-19 Prophylaxis
Authors: Lim J Y , Jessop Z M , Gibson J A G , Jovic T H , Combellack E , Dobbs T D , Healy B , Humphreys Ian R , Eccles Ronald , Hutchings Hayley A , Whitaker Iain S
Published: October 2021

Introduction

The severity of Covid-19 infection is associated with viral load. For infection to occur, viruses including SARS-CoV-2 must first penetrate the respiratory mucus to attach to the host cell surface receptors. Iota-carrageenan (I-C), a sulphated polysaccharide extracted from red edible seaweed, has shown efficacy against a range of viruses in clinical trials, through prevention of viral entry into respiratory host cells and in-vitro activity against SARS-CoV-2. Our aim, as an academic surgical department, was to design and implement a clinical trial to investigate whether I-C nasal and throat sprays are effective in reducing the rate and severity of Covid-19 infection.

Method

The study is a single centre, double-blinded randomised controlled trial. Recruitment of 480 participants aged ≥18 years without previous Covid-19 infection and who have not yet been vaccinated, commenced in December 2020. Participants are randomised to either the treatment (0.12% I-C in 0.5% saline spray) or placebo (0.5% saline spray) arm and will prophylactically apply the spray to their nose and throat while completing a daily symptom tracker for a total of 10 weeks. The primary outcome is the acquisition of Covid-19 infection. Secondary outcomes include symptom type, severity and duration, subsequent familial/household Covid-19 infection and infection with non-Covid-19 upper respiratory tract infections.

Discussion

Our hypothesis is that I-C sprays will reduce SARS-CoV-2 attachment to the naso- and oropharyngeal mucosal epithelial cells thus reducing the effective viral infective dose. If proven effective, the self-administered prophylactic spray would have wider utility for key workers and the general population.

Trial registration number

NCT04590365
397 Seasonal Variation in Acute Cholecystitis; An Analysis to Predict Resources Allocation
Authors: Gala T , Venkatesan G , Mohsin M , Abdelkarim M , Murali S , Shahzad N , Morgan R
Published: October 2021

Background

Acute cholecystitis accounts for 20% of Emergency General Surgical admissions. The concept of seasonal variation is still a developing concept in surgical literature. Whether acute cholecystitis also follows a seasonal trend remains to be established.

Aim

Given the struggle healthcare system has been facing towards resource and staff allocation to deliver best possible patient care, we thought this may be a step forward to predict North Wales demand of resources seasonally and make appropriate arrangements ahead of time.

Method

We performed a retrospective analysis of patients across North Wales who had a discharging diagnosis of acute cholecystitis from January 2010 to December 2019. Chi-square goodness-of-fit test was used to analyse seasonality of acute cholecystitis adjusting for variation in number of days between seasons. The number of days for seasons were taken as 92, 92, 91, and 90.25 for spring, summer, fall, and winter, respectively.

Results

Overall, 4100 patients presented to the three hospitals across North Wales with acute cholecystitis during the study period. The frequency of hospital admissions varied between months (minimum February n = 302, maximum July n = 373) and seasons (minimum winter n = 971, maximum spring n = 1067). After applying chi-square goodness-of-fit test to check significant seasonality, we did not find any significant seasonal variation in acute cholecystitis (p-value = 0.262).

Conclusions

Our data failed to show any significant seasonal variation in patients presenting with acute cholecystitis in North Wales. We recommend prospective collection of data at national level to validate our results.
409 The impact of inadequate pain control following chest trauma on hospital acquired pneumonia rate and hospital admission length
Authors: Ong C T , Budha Magar O , Butterworth W
Published: October 2021

Introduction

Patients with blunt chest wall injuries often have severe associated injuries and even isolated chest injuries may have a high mortality and morbidity. The National Audit Office (2010) report estimated that there are 20,000 cases of major trauma per year in England; 5,400 people die of their injuries with many others sustaining permanent disability.

Aim

To assess compliance with trust guidelines for chest trauma pathway and the impact of poorly controlled pain on hospital acquired pneumonia (HAP) rate and hospital admission length

Method

A retrospective audit of all chest trauma between October 2019 to February 2020. Data obtained from electronic patient records and admission notes. Patients notes and imaging records are used to analyse adequate pain control based on local chest trauma pathways.

Results

28 patients identified (M:F 15:13) aged 47-94 yrs old (average age 73) who suffered from chest trauma in a district general hospital in England. Chest trauma was associated with high levels of morbidity (32%) and mortality (7%). 39% of patients were found to have inadequate pain control based on the local chest trauma pathway. 33% of chest trauma patients developed a HAP and 44% of pts with inadequate pain control developed a HAP. The admission length of patients with HAP secondary to chest trauma was on average three times longer relative to uncomplicated patients (15 days vs 5 days).

Conclusions

Chest trauma patients often receive inadequate pain control and delayed specialist team input. This results in an increase in the frequency of HAPs and admission length.