bluuebunny/crossref_metadata_2025 huggingface dataset:
SP11.16 Development and Validation of a Novel Simulation-Based Assessment of Operative Skill for Higher Specialist Trainees in General Surgery
Authors: Toale Conor , Morris Marie , Roche Adam , Voborsky Miroslav , Traynor Oscar J , Kavanagh Dara O
Published: August 2023

Introduction

Simulation is an established training modality, though its use in high-stakes assessment is under-explored. This study sought to develop and validate a novel assessment of operative competence for higher specialist trainees in general surgery.

Methods

Content validity was derived from a previously conducted Delphi consensus study of trainers. Eight stations were created using a combination of virtual reality and bio-hybrid models. The assessment was designed to assess performance at the end of ‘phase 2’ of training. Performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure Based Assessment (PBA) tool. Validity evidence was analysed in accordance with Messick's validity framework. Both ‘junior’ (ST2 - ST4) and ‘senior’ trainees (ST 5 - ST8) were included to allow for comparative analysis.

Results

Thirteen trainees (six ‘junior’ trainees and seven ‘senior’ trainees) were observed and scored by a total of ten assessors across eight stations. Inter-station reliability was high (Cronbach's alpha 0.81). Inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004). Mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall’s tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all ‘senior’ trainees passing and 4/6 (66.66%) of junior trainees failing the assessment.

Conclusion

This study demonstrates the validity, reliability and feasibility of a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.
SP11.17 The predictive paradigm: examining the validity of a national selection process in surgical training
Authors: Toale Conor , Morris Marie , O'Keeffe Dara , Doherty Eva M , Traynor Oscar J , Kavanagh Dara O
Published: August 2023

Introduction

Selection processes should conform to a ‘predictive paradigm’, identifying candidates who will become competent professionals. This study investigates the ability of a centralised, multi-modal national selection process to predict the future performance of surgical trainees.

Methods

A retrospective analysis of prospectively collected data from successful applicants to the Royal College of Surgeons in Ireland (RCSI) Core Surgical Training (CST) programme from 2016-2020 was conducted. Performance in subsequent assessments, attrition rates, and rates of progression to Higher Specialist Training (HST) were recorded. Selection decisions were based on a total score, composed of technical aptitude assessments, undergraduate academic performance, and a four-station multi-interview. CST performance was assessed using workplace-based and simulation-based assessments. Associations between selection and assessment measures were explored using Pearson correlation, binary logistic regression, and multiple linear regression analyses.

Results

Data was available for 303 trainees. Composite scores were positively associated with likelihood of progressing to HST (Exp(B) 1.09, 95% CI 1.05 – 1.13, p<0.001), and were significantly associated with performance across all CST assessments (r .23 - .34, P<0.001). On multivariate analysis, technical aptitude scores were the strongest predictor of future operative performance, both in the workplace (B 0.31, 95% CI .14 - .48, p<0.001) and simulated environments (B .57, 95% CI .33 - .81, p<0.001). The ‘interpersonal skills’ interview station was the strongest predictor of performance in simulated non-technical skill assessments (B .55, 95% CI .22 - .87, p<0.001).

Conclusion

Performance at the time of national selection, measured across technical and non-technical domains in a multi-modal fashion, is associated with future performance in the workplace and in simulation-based assessments.
WTP1.2 Quality of Life concerns in patients undergoing operations for diabetic foot disease during the COVID-19 pandemic
Authors: Ali Lara , Restrepo Laura Lopez , Bates Kersten Morgan , Metcalfe Matthew
Published: August 2023

Aim

To evaluate QOL of diabetic patients following diabetic foot surgeries during the Covid-19 pandemic.

Method

Single Centre retrospective data collected from hospital systems between 01/01/2021- 31/12/2021.

30 patients requiring surgery for diabetic foot disease identified and were called for QOL questionnaire, 23 participated.

Results

56% (13/23) patients were <70 years. 52% (12/23) underwent major limb amputations.

Pre-operatively, 54% (7/13) of the <70 years and 40% (4/10) >70 years had mainly physical concerns and 46% (6/13) <70 years and 60% (6/10) of >70 years emotional concerns.

Post-operative concerns were divided into 7 groups. The commonest were the “ability to mobilise and loss of independence” 65% (15/23), “wound healing duration & worries about tissue healing” 48% (11/23) and “further hospitalisation or re-intervention” 43% (10/23). These were similar when divided by age groups. Additionally, feeling abandoned post discharge was frequently described.

Conclusion

QOL concerns in our diabetic population following foot operations highlighted important issues that need to be addressed. The majority voiced concerns regarding their loss of independence/mobility, fear of the wound site not healing and worry regarding the need for further re-intervention. This further highlights the need of patient education and support and enhancing service provision pre- and post –op.
WTP1.6 Unmask Latent Lymphoedema through bipedal Lymphoscintigraphy
Authors: Sivakanthan Mathumie , Odiase Ruth , Gambhir Raghvinder Pal Singh
Published: August 2023

Aim

Lymphoscintigraphy (LSG) is the gold standard investigation in Lymphoedema. The study aimed to determine the presence of Latent Lymphoedema (LL) in the unaffected limb when a patient presents with unilateral lymphoedema.

Methods

All new and follow up patients seen in the Lymphoedema clinic between the January and May 2023 by either a vascular consultant or a lymphoedema nurse were included in the study. Their electronic patient records were retrospectively reviewed. Clinical presentation and findings were compiled from clinic letters and if the signs and symptoms were suggestive of lymphoedema they were then offered an LSG scan. Protocol involved determining the uptake of nano colloid tracer at the ilio-inguinal lymph nodes 2 hours post subcutaneous injection in the 1st web space of each foot. Quantitative uptake of < 8% at 2 hours was considered abnormal.

Results

114 patients with a median age of 63.2 (Range 24-83) were seen in the Lymphoedema clinic. Of those, 62 patients had LSG scans. About 37% (n = 23) patients presented with unilateral swelling of lower limb. On LSG scan they had average uptake of 1.6 1.6% in the clinically affected limb. However 57% (n = 13) of these patients had an average of 2.7 2 % uptake in the unaffected Ilio-inguinal lymph nodes, unmasking latent Lymphoedema on that side.

Conclusion

Presence of lymphatic dysfunction on the unaffected limb should be considered as unmasking of LL. This will allow initiation of preventative measures to prevent development of gross disease in future.
WTP1.7 Long-term Outcomes After Repair of Paediatric Traumatic Lower Limb Arterial Injury: Systematic Review
Authors: Giorga Andrea , Hughes Michael , Cai Paris , Stansfield Tim
Published: August 2023

Aims

Paediatric vascular injuries account for 1% of paediatric major trauma cases with 30% of arterial injuries located in the lower limb. Current management of paediatric lower limb arterial injuries have been extrapolated from adult injuries. The aim was to review studies specific to paediatric population due to the anatomical and physiological differences, particularly limb length discrepancy (LLD) following injury.

Methods

A literature review was conducted. Study PICOS - Population: Patients <18 years old with traumatic lower limb arterial injury. Intervention: Surgical, endovascular or no intervention. Comparison: Primary repair or Conduit repair using autologous vein or synthetic material or endovascular repair. Outcomes: Rate of success of revascularisation, amputation, graft infection, long term limb function, LLD, mortality.

Results

7 studies were included for data extraction, resulting in 15 male patients, aged 4-14. The popliteal artery was most commonly injured (60%), followed by the femoral (40%). The most common repair was with reversed Great Saphenous Vein graft (GSV)(13/15) for which good long-term outcomes were reported (85% success rate). One endovascular repair was identified which was successful and one with synthetic material which resulted in a minor complication.

Conclusions

There is a preference for the use of autologous vein grafts in paediatric lower limb arterial repair with good outcomes. Endovascular procedures are becoming more common whereas synthetic grafts are not favoured due to their inability to lengthen as vessels grow. Further research is required to evaluate the long-term outcomes as the current reported cases are scarce.
WTP1.8 The diagnostic test accuracy of remote or virtual follow up for detecting wound infection in surgical wounds
Authors: Lathan Ross , Sidapra Misha , Yiasemidou Marina , Totty Joshua , Smith George , Chetter Ian
Published: August 2023

Background

The Sars-CoV-2 pandemic catalysed integration of digital health models worldwide. This review appraises literature investigating digital methods of identifying SSI post discharge, and summarises effectiveness using diagnostic test accuracy measures.

Methods

Databases were searched for telemedicine and wound infection studies. Titles and abstracts, followed by full texts, were screened by two independent authors and mediated by a third. QUADAS-2 was used to assess methodological quality. The primary outcome was summary sensitivity and specificity. 

Results

Of 1400 studies identified by searching, 17 studies were included in meta-analysis. There were 11,437 observations available with a weighted mean age of participants of 47.1 years. Risk of bias was present in all included studies, and there were high applicability concerns in nine studies. The mean sensitivity of all methods of telemedical follow up for detecting SSI was 88% (95% CI 68%-96%) and the mean specificity 97% (95% CI 94%-98%). The overall rate of SSI was 5.6% across studies. 

Conclusion

Telemedicine is highly specific for SSI diagnosis, with potential as a screening tool post discharge. However, participants were young, and may under-represent the surgical population. Work is required to maximise engagement with telemedicine in the elderly and digitally naive before widespread adoption can occur.
WTP1.10 Infra-malleolar bypass in patients with chronic limb threatening ischaemia
Authors: Moody Nick , Chong Rosemund , Potdar Tejal , Hussey Keith
Published: August 2023

Introduction

There is clinical equipoise surrounding the optimal strategy for revascularisation of infra-popliteal arterial disease. The BASIL-2 trial is attempting to address this. The trial has been designed to try and define whether a ‘vein bypass first’ or ‘best endovascular first’ strategy is superior. We have sought to explore the outcomes associated with ultra-distal bypass in a single Scottish Health Board.

Methods

This was a retrospective review of a single surgeon’s ultra-distal bypass practice over a 7 year period. Index cases were identified from a prospectively maintained logbook. Outcomes included were primary graft patency and amputation free survival.

Results

There were 22 procedures performed over the 7-year period of interest. Mean age of 66 years. 15/22 (68%) were diabetic. The dorsalis pedis was the most common arterial target (n=14). The primary graft patency at 3-years was 54%. During the follow-up period 50% of the patients had a major limb amputation. There was 1 death in the post-operative period prior to discharge.

Discussion

Primary patency and limb salvage at 3-years are acceptable, although they are less than that described in the contemporary literature. It is likely that this may a consequence of selection bias given the local prejudice for an endovascular ‘first strategy’.
WTP1.13 The A-HeAD Study: Effects of socio-economic deprivation on modifiable preoperative health behaviours and outcomes after aortic aneurysms repair. A retrospective review
Authors: McCone Emma , Prentis James , Sandip Nandhra , Sillito Sarah , Nesbitt Craig
Published: August 2023

Aims

Social Deprivation is associated with health inequalities and poor clinical outcomes. As yet outcomes for aneurysm surgery are not well understood. This study aims to explore the association of Abdominal Aortic Aneurysm (AAA) surgery and socio-economic status on postoperative complications and outcome.

Methods

All elective AAA repair (open and endovascular) performed between January 2015 and January 2020 at a tertiary vascular centre were analysed. Deprivation (index of multiple deprivation (IMD)) data was sourced from the English indices of deprivation 2019, by postcode. Primary outcome was overall survival by Kaplan-Meier. Secondary outcomes included comparison of pre-operative fitness assessments, and comorbidity. Clinical outcomes included length of hospital stay (LOS) and complications. Cox-proportional hazard analyses were conducted.

Results

Patients (n=472) were divided into two groups (IMD 1-3 (n=171) and IMD 4-10 (n=301)). Gender ratios were comparable, with similar AAA size, other co-morbidities and CPET assessment results. IMD 1-3 participants were younger (72.4(8.1) vs 74.6 (7.8), p=0.011), had higher smoking rates (61.4% vs 19.6%, P=0.03) and more frequent history of stroke (18.1% vs 11.3%, P=0.036).

There was no difference in survival based upon IMD but patients from IMD 1-3 spent longer in level 2/3 care (2(2-3) vs 1(1-2), P=0.022) and experienced more re-admissions (14% vs. 6%. P=0.003). In addition, cox-regression indicated that patients without COPD were twice as likely to survive (HR 0.54 (0.31-0.94 P=0.03).

Conclusion

IMD was not associated with poor outcome. Smoking was more prevalent in lower IMD groups. As COPD was associated with increased likelihood of death, pre-operative optimisation can be targeted towards higher risk groups.
WTP1.14 A Regional Audit of Carotid Endarterectomy Symptom to Surgery Target Times within the North-East of England
Authors: Sillito Sarah , Stansby Gerry , Dunlop Paul , Wong Peng
Published: August 2023

Aim

The National Institute of Health and Care Excellence (NICE) recommend a target time for symptomatic carotid stenosis symptom onset to surgery of 14-days so to minimise the chance of high-risk patients developing a major stroke. A regional audit of Vascular Units within the North-East of England to meet this target was undertaken to review performance and identify causes for delays.

Methods

The performance of three North-East based Vascular Units for the period of October 2021-March 2022 has been assessed retrospectively using Carotid Endarterectomy data from the National Vascular Registry (NVR). Data was collated and reviewed as per the distinct time phases in the CEA treatment pathway outlined in the NVR Annual Reports.

Results

66 CEAs were performed, with the region achieving 45.45% within the 14-day target (median time from symptom onset to surgery 16 days; IQR 4-102). Patients referred to Vascular Surgery in <7 days of symptom onset was achieved in 69.70% of patients (median 4 days; IQR 0-56); patients receiving surgery within <7 days of the referral to Vascular Surgery was achieved in 25.76% of patients (median 11.5 days; IQR 0-82).

Conclusion

The North-East region is struggling to meet the 14-day symptom to CEA target. Understandably, there is variation in CEA pathway workings across the Units but improvements can be made regionally. A delay between patients being referred to Vascular Surgery and then receiving surgery accounts for the biggest delay. A questionnaire identifying possible barriers to meeting the 14-day target has been distributed amongst the region’s Vascular Consultants and Registrars with a view to improvements being made.
WTP2.5 Improving the Recording of Thoracic Surgeries on Dendrite Database – Departmental Quality Improvement Project
Authors: Lakshmipathy Gokul R , Hall Sheila , Shatila Mohamed , Fallouh Hazem , Kalkat Maninder
Published: August 2023

Objectives

Well-maintained database of thoracic operations is critical for quality improvement, service provision and driving research forwards. We examined adequacy of operative recording on clinical database.

Methods

Thoracic operations were uploaded onto Dendrite database. Operative entries on Dendrite were compared with surgeries performed from October 2021 to June 2022. Missing operative records were identified. Incomplete entries were categorised into missing procedure names, procedure dates and operation notes. Personal reminders, published league table of best performers in weekly departmental meetings were introduced in February 2022 to encourage surgeons to record data accurately.

Results

599 thoracic surgeries were performed in the nine-month period. 20% of operations were not recorded on Dendrite. 5% of records lacked, procedure names, 2% lacked operation notes and 0.2% lacked procedure date. Table below demonstrates monthly data before and after improvement measures. Missed and incomplete entries were significantly lower in the post-intervention period (42) compared to pre-intervention (104) (p=0.002).

Conclusion

Maintaining complete and accurate database is paramount in most services. However, the level of compliance can be variable. This study demonstrates that motivational approach to completing database can increase engagement and compliance. Furthermore, we plan to introduce virtual dendrite training programme and re-evaluate effect on data recording.
WTP2.6 Early experience and short-term outcomes of Robotic Assisted adrenalectomy in a high volume tertiary referral centre
Authors: Maharajh Sandeep , Ashoush Fouad , Ramsingh Jason
Published: August 2023

Aim

Robotic assisted surgery has become the standard of care in most surgical specialties, however, in the UK, endocrine surgery has not fully adopted robotics. This paper presents the experience in seventeen (17) patients who had robotic assisted adrenalectomies performed at a tertiary referral endocrine surgery department in the northeast of England. Outcomes were compared to national and international performance standards.

Methods

Seventeen elective cases were performed at tertiary hospital over a 5-month period. Patient demographics including age, comorbidities, operative indications and technical details such as docking time, time on operative console, rates of conversion to open procedure, complications, length of stay and tumour size were analysed.

Results

Over a 5-month period, 17 robotic assisted adrenalectomies were performed. Seventy-one percent (71%) (n=12) of the patients were female with median age of 60 years. Median BMI was 28. Functional tumours accounted for 82%(n=14) of patients with the most common being pheochromocytomas and cortisol producing adenomas (n=6 respectively). Median docking time was 7 minutes with a median intra-operative time on the console of 48 minutes. Resected tumour size ranged between 1cm to 14cm. There were no conversions, complications or mortalities. Median length of stay postoperatively was 1 day.

Conclusion

This cases series demonstrates robotic assisted adrenalectomies to be a safe and feasible approach with similar outcomes to laparoscopic surgery. Adoption of robotic assisted surgery will improve outcomes for patients, however large clinical trials and longer follow up are needed.
WTP2.7 Short and Long term Kidney Transplantation outcomes in Severely Obese Recipients. A UK NHSBT Transplant Registry Big Data Analysis over the last 20 years. An Epidemiology in Transplant Study Group (ETrSG) Initiative
Authors: Ng Oon-Hui , Devkaran Bhavesh , Kapoor Kunal , Sharma Abhishek , Mehra Sanjay , Sharma Hemant
Published: August 2023

Purpose

Outcomes of renal-transplant-recipients with Class 3 obesity (severely obese) is extremely limited. An outcome-analysis of severely- obese transplant recipients reported to UK-NHSBT-Transplant-Registry was performed.

Methods

We harmonized the NHSBT-UK-Data to shortlist the renal-transplants performed on Class 3-obese recipients in the UK from 2000-2019. The demographics-report and survival-analysis at 1,3 and 5 years post-transplant were data-mined. Cox-Regression was done to identify predictors of survival.

Results

N=163 recipients with Class-3 obesity underwent renal-transplant since year 2000 (N=60 DBD, N= 48 DCD & N=55 Living Donor Kidney). The median-recipient-age was 47 years - DBD, 51 years DCD, and 43 years LRD transplants. The odds of females getting renal-transplants were OR 2.44(1.14- 5.19) p=0.01. Median-eGFR at 3 months was 40, 38, and 46.5 mL/min/1.73m2 for DBD, DCD, and LRD recipients, Median-eGFR at 12 months was 42, 46.5, and 51.5 mL/min/1.73m2 for DBD, DCD, and LRD recipients, respectively. The median-KDRI of transplanted kidneys was 1-07 and 1,08 for DBD & DCD kidneys, respectively. The commonest cause of graft-failure was acute-rejection within the first 12-months of transplant. The technical failure-rate was 1.8%. DCD-Grafts were more likely to suffer rejection (OR 2.25(1.13-3.89) p=0.002. The Graft-survival for DBD-kidneys was 97%, 92% and 89% at 1,3 & 5 years, The Graft-survival for DCD-kidneys was 89%, 86%, and 76% at 1,3 & 5 years, Graft-survival for LRD-kidneys was 98%, 95% and 86% at 1,3 & 5 years. (Log-Rank- 0.48).

Conclusions

Renal-Transplantation for severely-obese patients can be safely done with acceptable survival outcomes. Living donor kidneys have better results, but there is no statistical difference in graft-outcomes from DCD versus DBD-Kidneys.
WTP2.10 A retrospective study of effect of donor obesity on fibrosis and kidney outcome in live donor kidney transplantation
Authors: Aswad Mayar Ghazal , Ismail Wisam , Hosgood Sarah , Brunskill Nigel , Nicholson Michael
Published: August 2023

Aims

Donor obesity has increased over the last decade. The aim of this study was to assess the effect of donor obesity on fibrosis in pre-implantation biopsy and kidney outcomes in live kidney transplants.

Methods

A series of 288 live kidney donors between 1998 and 2010 were studied. The series was divided into three groups according to the donor Body Mass Index (BMI); Normal BMI 17-24.9 (n=119), overweight BMI 25–29.9 (n=118) and obese BMI ≥30 (n=51). Donor and recipient demographics were gathered and recipient post-transplant renal function up to five years was retrieved. Fibrosis level in pre-implantation biopsies was analysed and graft and recipient survival were assessed.

Results

Hypertension and live kidney donor profile index LKDPI were statistically significantly higher in obese donors compared with non-obese donors (p=0.004 and p<0.001 respectively). Donor creatinine levels for obese group were comparable to the other two groups over three post-operative years (p=0.933). Fibrosis analysis showed no statistically significant difference among the three BMI groups (p=0.063). Donor obese group had statistically significant higher 5 year graft and patient loss rate compared with non-obese BMI groups (p=0.018 and p=0.015 respectively). Recipient post-operative creatinine levels showed no statistically significant differences among the three BMI groups (p=0.393). Similarly, fibrosis in pre-implantation biopsies had no statistically significant impact on recipient post-operative creatinine levels (p=0.243).

Conclusions

Donor obesity has no significant impact on fibrosis in the pre-implantation biopsy and on recipient post-operative kidney function. However, Donor obesity results in lower five-year graft and patient survival rate.
WTP3.2 Audit of percutaneous cholecystostomy practice against Tokyo Guidelines, 2012 – 2020
Authors: Baggus Elisabeth , Henry-Blake Connor , Chrisp Benjamin , Coope Ashley , Gregory Andrew , Lunevicius Raimundas
Published: August 2023

Aims

Percutaneous cholecystostomy (PC) is employed to improve prognosis when cholecystectomy is deemed inappropriate in high-surgical-risk patients with severe acute cholecystitis (AC). Tokyo guidelines (TG) 2013 and 2018 provide specific guidance on indications for PC. We aimed to audit the percutaneous cholecystostomy service at an adult tertiary centre to assess compliance with Tokyo Guidelines.

Methods

This was a single-centre, retrospective cohort audit. Patients with PC performed for AC during index admission between 2012 and 2020 constituted the study cohort, identified using the ICD-10 and OPCS-4 code the Trust business intelligence unit provided. Data was collected by inspection of electronic records. Patients were stratified into sub-groups by TG severity of AC, Charlson comorbidity index (CCI), ASA class, and NELA score. Management features of each subgroup were analysed to assess adherence to TG.

Results

Seventy-six patients (52.6% male) with a median age of 76 (IQR 67.5-83.3) were included. The median duration of acute biliary symptoms was 6.7 days (IQR 3.0-12.4). Seventy-three (96.1%) patients had at least one comorbidity. Fifty-three (69.7%) had a CCI of ≥4, and 56 (73.7%) had an ASA grade of ≥3. All 76 patients had appropriate pre-procedural imaging, and all had blood/bile cultures taken. Sixty-three (82.9%) patients received antibiotics immediately. When assessing for indications for PC, 29 patients (38.2%) met the severity grading (severe AC, grade 3). Twenty-eight patients (36.8%) met all Tokyo criteria for emergency PC.

Conclusions

PC is overperformed compared to the TG gold standard. Further evaluation of clinical outcomes in this cohort of patients is needed.
WTP3.4 Improvement of biliary service in hospital by altering the management of suspected or confirmed bile duct stones. Confirmed bile duct stones can be managed by single-stage procedure of laparoscopic cholecystectomy (LC) plus common bile duct exploration (CBDE). Intra-operative cholangiogram (IOC) can be used to avoid delays waiting for MRCP
Authors: El-Hakim Hesham , Seehafer Frances , Penman Gemma , Thomas Ian
Published: August 2023

Background

Significant delays can follow the process of emergency admissions with biliary problems in hospitals. Routine pathway for gallstones and abnormal liver functions tests (LFTs) is ultrasound (US) followed by MRCP. Pathway for confirmed common bile duct (CBD) stones has been routinely an ERCP followed by LC either as inpatient or outpatient. Significant delays take place awaiting MRCP considering that there is no out-of-hours or weekend service, while ERCP lists only occur twice weekly for both emergency and elective which can lead to unnecessary delays.

Methods

An audit was performed for 2 months period from 1st October 2022 to 30th November 2022 to assess how patients were managed in the department.

Results

A total of 16 emergency LCs were done in this period. 3 of them had ERCP prior to operation while 5 had MRCP prior to exclude CBD stones. Average length of stay (LOS) for these 8 patients was 7 days. It was estimated that LOS for these patient would have been reduced to 4 days if IOC +/- CBDE were done. A total of 37 ERCPs were done in the same period. 22 of them were done as emergency of which 12 were for CBD stones, 7 for cancers and 3 for bile leak. 7 of the 12 emergency ERCPs for CBD stones would have benefited from one stage procedure of LC + CBDE reducing their LOS and leaving space for other cases in ERCP lists.

Conclusion

A dedicated weekly IOC/CBDE list was proposed to overcome this problem.
WTP3.7 Are we using antibiotics appropriately in acute pancreatitis?
Authors: Akhtar Amina , Asarbakhsh Mariam , Schuijtvlot Nicolaas
Published: August 2023

Aim

To re-evaluate antibiotic use in the management of acute pancreatitis at our hospital.

Method

This retrospective closed loop audit incorporated patients with acute pancreatitis admitted to our hospital between 01/04/22 and 30/06/22. The initial audit was conducted in 2020. The gold standard was guidelines published by the World Society of Emergency Surgery (2019). Data sources included patient paper notes, and clinical results and prescribing software.

Results

44 patients presented with acute pancreatitis during the re-audit period; 80 patients were included in the initial audit. 22 of the re-audit patients (50%) received antibiotics, compared with 47 patients (59.1%) in the initial audit. Co-amoxiclav was the most used antibiotic (10 re-audit patients, 46.2%). 19 of the re-audit patients (86.3%) receiving antibiotics had mild or moderate acute pancreatitis (on Modified Glasgow Score); whereas most patients (29, 61%) in the initial audit had severe pancreatitis. Procalcitonin was not measured prior to commencing antibiotics in either audit. Also, no re-audit patient had CT-confirmed evidence of infected pancreatic necrosis. 5 re-audit patients (21.4%) were treated appropriately with antibiotics for extra-pancreatic infection, including acute cholecystitis and hospital-acquired pneumonia.

Conclusion

Decisions to commence antibiotics in acute pancreatitis have generally been inattentive to guideline recommendations, with greater focus on clinical impression of patient condition and inflammatory markers, such as C reactive protein. However, inappropriate antibiotic use may not bring patient benefit and negatively affect clinical care, for example yielding Clostridium Difficile infection and antimicrobial resistance. Hence, we will now change practice and measure procalcitonin to inform decision-making about antibiotics in acute pancreatitis.
WTP4.8 Management of Acute appendicitis during the COVID-19 pandemic A single centre retrospective cohort study
Authors: Bukhari Ishtiyaq , Afzal Zeeshan , Mitrasinovic Stefan , Chan Onton , Francis Francesca , Satheesan Stephen
Published: August 2023

Background

Management of Acute appendicitis changed significantly in the UK during COVID-19. The aim of study was to compare management of Acute appendicitis before and during COVID-19 pandemic.

Materials and Methods

We performed a single centre retrospective cohort study in UK comparing the management of acute appendicitis before the pandemic from March - August 2019 and during the Pandemic from March- August 2020.

Results

Over period of 6 months, a total of 179 patients were diagnosed with Acute appendicitis in 2019 versus 152 in 2020. In 2019, median age was 33 and 52% (n=93) patients were female. In 2020, median age was 37 and 48% (n=73) of the patients were female. At first presentation, in 2019, 97% of the patients (174/179) received surgical treatment compared to 70% (107/152) in 2020. 3% of the patients (n=5) were managed conservatively in 2019 as compared to 30% (n=45) in 202. Pre-Pandemic only 32% of the patients received imaging to confirm the diagnosis as compared to 53% during pandemic. During 2019, 92% (n=161) of the patients who received surgical treatment underwent laparoscopic surgery as compared to only 74% (n=95) in 2020. Post op complications occurred in 5% (n=9/176) of the surgical patients in 2019 as compared to 13% (n=16/128) in 2020. Mean length of hospital stay in 2019 was 3 (1-11) days versus 5 (1-35) in 2020. 30-day readmission rate was 5% (8/179) versus 19% (29/152).

Conclusion

Our study shows that the change in management of acute appendicitis during Pandemic was associated with longer length of hospital stay, more readmissions and increase in post-operative complications.
WTP4.9 Use of the American Association for Surgery and Trauma (AAST) Scale as a Predictive Tool in the Laparoscopic Approach to Adhesive Small Bowel Obstruction in a Tertiary Hospital
Authors: Aguilera Beatriz Carrasco , Cueto Emilio López-Negrete , Garcia Miguel Martinez-Cachero , Rodicio Miravalles Jose Luis , Vico Tamara Diaz , Alvarez Lourdes Sanz
Published: August 2023

Aims

The laparoscopic approach (LA) in treating adhesive small bowel obstruction (ASBO) has been shown to be a beneficial technique. Despite being a minimally invasive procedure, it is still not a widespread technique.

Tools to identify which patients with ASBO may benefit from LA are needed. The AAST scale classifies ASBO into five grades of obstruction, differentiated by radiological, intraoperative, and pathological findings.

The correlation between AAST-radiological and AAST-intraoperative is evaluated, as well as the association between the AAST scale and the rate of conversion to open surgery.

Methods

Observational, descriptive, retrospective, single-center, retrospective study from January 2011 to April 2022 of patients undergoing emergency laparoscopic surgery for suspected ASBO.

Results

43 patients were analyzed. By CT scan 13.5% of patients had AAST-I, 43.2% AAST-II, and 43.2% AAST-III. Intraoperatively 11.6% of patients had AAST-I, 46.5% AAST-II, 25.5% AAST-III, 13.9% AAST-IV, and 2.3% AAST-V. The overall conversion rate was 27.9%. Using the univariate logistic regression model, an association was found between conversion rate and intraoperative AAST, as patients with an AAST≤II were less likely to convert to open surgery (OR 0.03, 95%, CI 0.00-0.26, p=0.03). This association was not observed between conversion rate and AAST-radiological. The degree of agreement between radiological-AAST vs intraoperative-AAST was moderate (Kappa coefficient 0.532).

Conclusions

Although radiological AAST is a guiding tool in selecting patients in whom the entire LA can be performed, it is the intraoperative findings that increase conversion, which encourages a laparoscopic approach in these cases.
WTP4.10 Utility of CT Imaging in a Successful Ambulatory Emergency Surgical Unit
Authors: Claxton Mary , Quinn Marcus , Williams Lian , Barton Jessica , Trent Neil , Hollyman Marianne
Published: August 2023

Aim

Drives towards ambulatory management in emergency surgery have resulted in increased availability of urgent imaging to expedite decision making. This review of CT usage aimed to assess frequency of surgical pathology identified, and subsequent management.

Methods

All acute general surgery referrals to an established ambulatory clinic between 01/01/2021 and 22/07/2022 were included. Information regarding presentation, imaging, and diagnosis were collected in prospectively maintained databases, and subsequently analysed.

Results

3154 patients were seen over an 18-month period with a 91.7% successful ambulation rate (n=2938). CT was performed in 577 patients (18.2%); the majority were contrast CT abdomen/pelvis (CTAP, 58.3%, n=331), or CT Kidney/Ureter/Bladder (CTKUB, 40.1%, n=228).

The majority of CTAPs were diagnostic (77.0%, 242/331), with 16.0% (n=53) resulting in admission; admission rate for non-diagnostic CTAPs was 4.5% (n=4/89). Subsequent operations occurred in 9.6% (32/331) who underwent CTAP; 5.1% (17/331) underwent emergency operation, urgent ambulatory operations in 3.0% (10/331), and 1.5% (5/331) were listed electively.

CTKUBs identified urological pathology in 40.4% (n=92), whilst 7.4% (n=17) identified other pathology. Diagnostic CTKUB led to a 17.5% admission rate (n=17, including 5 non-urological).

Conclusion

Selective ambulatory CT scanning is a useful adjunct to diagnosis, and admission avoidance. CTKUBs identify lower, but acceptable levels of pathology including non-urological conditions.

Judicious use of CT is important to balance resource utilisation, whilst limiting admissions.
WTP4.12 Treating the cause of Acute Pancreatitis: lessons from NCEPOD guidelines
Authors: Seth Shatadru , Boghdady Michael El , Boven Carine
Published: August 2023

Aim

The objective of this study was to facilitate in identifying remediable factors in the quality of care provided to patients being treated for acute pancreatitis and assess compliance to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) guidelines.

Method

All emergency surgical admissions for patients aged 16 or older, diagnosed with acute pancreatitis at the period between August and October 2021 were included. A retrospective analysis in juxtaposition with 8 cardinal NCEPOD recommendations: management of co-morbidity & involvement of relevant specialists, adherence to antibiotic policies, assessment of risk of malnutrition, exclusion of gallstones in all index presentations, early surgical intervention, alcohol liaison support, further investigation - MRCP / ERCP and retrospective morbidity & mortality discussions. Each of the domains were scored based on adherence to the above standards, and subsequently coded as Red–Needing Urgent Attention, Amber–Scope for Improvement and Green–Satisfactory Compliance.

Results

A total of 79 patients were included in this study. Compliance towards the recommendation of routine nutritional assessment of patients was found to be in the RED category, scoring 23.7%. Management of medical co-morbidity & inclusion of specialists, early surgical intervention and alcohol liaison support were all found to be in the AMBER category, scoring 44.8%, 28.0% and 57.1% respectively. The rest of the recommendations showed satisfactory levels of compliance.

Conclusion

Many patients did not receive adequate nutritional assessment. The RED and AMBER areas will need urgent attention. To minimise the risks of severe morbidity and mortality from acute pancreatitis, we envisage a better compliance to NCEPOD recommendations.
WTP5.2 Length of stay and it’s predictors after elective general surgical procedures at a district hospital in NHS
Authors: Arifuzaman Mohammed , Bhattacharya Sayan , Jalal Sadic
Published: August 2023

Aims

To study the length of stay of patients following elective general surgical procedures at a district hospital in NHS and the predictors for long stay. To be able to better predict the pattern of hospital stay and discharge. To understand the patients which stay longer in the hospital.

Methods

Retrospective analysis of elective general surgeries conducted at a busy district hospital in NHS from December 2021 to May 2022. Emergency cases were excluded. Data was collected form the theatreman app, which was hospital number, age, sex, ASA category, surgical time, anaesthesia time, list number of the patient in the theatre list. Statistical calculations were done on the StatsDirect 3 software.

Results

A total of 181 patients were studied of which 90 male and 91 female patients. Total admission days utilised were 318 and a median of 1 day per elective surgical patient. 94 patients (52 %) got discharged on the 0 post operative day (POD), 67 (37 %) were discharged on POD 1, 12 (6.6 %) on POD 2, 1 (0.55 %) on POD 3, 2 (1.1 %) on POD 4, 1 (0.55 %) on POD 5, 3 (1.65 %) on POD 6, 1 (0.55 %) on POD 12. Multiple linear regression analysis resulted in a p <0.0001 for surgical time and ASA grade and 0.0231 for age.

Conclusion

Surgical time, ASA grade and age have a statistically significant correlation on the length of stay after elective surgeries. Patients aged > 60 years, ASA >2 and Surgical time > 100 minutes will stay for 2 days or more in the hospital and such patients must be booked as inpatient.
WTP5.4 The Sheen Paajanen groin Recommended Treatment ‘SPoRT’ score for groin pain
Authors: Biswas Sayan , Pilkington James , Stathakis Panos , Harwood Rachel , Paajanen Hannu , Sheen Aali
Published: August 2023

Aim

Evaluating groin pain still evades many clinicians with at times difficulty in determining the cause of pain when no true hernia exists. This study’s aim was to evaluate a simple and novel scoring system which is reproducible, to help determine whether conservative measures or surgery is recommended for the management of groin pain attributable to inguinal disruption.

Methods

A retrospective analysis of all patients from 2018 - 2020 that underwent surgery or conservative management for inguinal disruption with at least a 1 year follow up were evaluated. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from -2 to +2 based on the defined findings listed. Sensitivity and specificity analysis was conducted for each potential score cut off point.

Results

A total of 172 patients were evaluated with 33 patients (19%) undergoing conservative management and 139 patients (81%) undergoing surgery. The mean SPoRT score of the physiotherapy group was statistically significantly lower than that of the surgery group (-1.33 vs 1.84, p = 3.55 x 10-25). An optimal cut off of ≤ 0 for physio and ≥ 1 for surgery was established, yielding a sensitivity of 90.9% (95% CI: 75.7% - 0.981%), a specificity of 89.2% (95% CI: 82.8% - 93.8%) and an area under the curve (AUC) of 0.9356 (95% CI: 0.874 – 0.997).

Conclusion

SPoRT score of ≤ 0 can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment with a score of ≥ 1 recommending surgery.
WTP5.6 Enhanced Monitoring for Better Recovery and Cancer Experience in Greater Manchester (EMBRaCE-GM): A Qualitative Study of Clinician Experiences on Deploying and Supporting Consumer Wearable Devices
Authors: Chan Anthony , Balata Haval , Tholouli Eleni , Merchant Zoe , Kitchen Gareth , Wilson Anthony
Published: August 2023

Introduction

Consumer wearables such as smart watches and rings have the potential to provide continuous monitoring of patients receiving cancer treatment in their prehabilitation and rehabilitation phases of care. Enhanced Monitoring for Better Recovery and Cancer Experience in Greater Manchester (EMBRaCE-GM) is a multi-centre prospective trial evaluating feasibility and acceptability of wearable technologies for patients undergoing treatment for colorectal cancer, lung cancer or lymphoma within Greater Manchester (ClinicalTrials.gov NCT05099237). We report the initial findings of the clinician’s perspective on deploying and supporting the use of wearable devices.

Methods

A qualitative study was conducted to ascertain the experiences of researchers who recruited participants to EMBRaCE-GM. Three interviewers conducted structured interviews and a thematic analysis was performed.

Results

Thirteen researchers were interviewed, and 3 major themes identified. The first identifies the importance of the device set-up phase, such as integration into the patient’s existing technological ecosystem, and the training provided to clinical teams. The second theme was patient engagement with the technology, such as the burden of interacting with the device (‘digital load’), and comfort and aesthetics. The final theme involved the support infrastructure for technical issues and device maintenance as well as safe protocols and governance for responding to device alerts, particularly if patients were unwell.

Discussion

Wearable technologies have the potential to provide ongoing benefit through continuous monitoring outside the hospital setting for patients receiving cancer treatment. This study, as part of the EMBRaCE-GM project, identifies important themes critical for future patient and clinician adoption of wearable devices.
WTP5.9 Does anti-reflux surgery offer durable symptom remission in a tertiary centre?
Authors: Fairbrass Dominic , Hammett Felix , Wilkins Alexander , Dexter Eloise , Pellen Michael , Patel Fatema
Published: August 2023

Aims

Anti-reflux surgery success can be affected by multiple factors. We sought to evaluate pre-operative and technical factors influencing medium-term outcomes.

Methods

A retrospective analysis of laparoscopic anti-reflux surgery in a tertiary centre between 2016 and 2019. Patients were identified through clinical coding. Electronic patient records were reviewed with minimum follow up of 3 years. Outcomes analysed included pre-operative work-up, type of fundoplication, remission and relapse of symptoms at follow up and revision surgery.

Results

104 patients underwent fundoplication. The majority were Nissen 68 (65%) and the remaining were partial wrap configuration.18 (19%) of these patients were revisional anti-reflux procedures.

Pre-operative investigations noted most underwent endoscopy 85 (81.7%) and oesophageal physiology in 74 (71.2%) with barium swallow in 34 (32.7%). 15/104 (14%) underwent all three studies.

50 (48.1%) patients were symptomatic at initial follow up with dysphagia (21.3%) and dyspepsia (13.5%) most prevalent.

Of these 104 patients, 15 (14.4%) required revisional surgery. 6/36 (17%) partial and 9/68 Nissen (13.2%) fundoplications underwent re-operation. Timing of revision varied: 8 (53.3%) within one year including early 30-day re-operation for complications. 3 (20%) at 1-3years and 4 (26.7%) after 3 years.

Subsequent revision rate was higher for revisional patients: 4/18 (22.2%) compared to primary 11/86 (12.7%).

Conclusion

Almost half of the patients had at least one symptom at initial follow up, however only 14.4% patients required revisional surgery by 3 years follow up. Partial fundoplication and previous fundoplication surgery had higher revision surgery rates.
WTP5.10 Developing Walking Routes to Encourage Post-Surgical Mobilisation in Hospital, and Assessment of Patient Satisfaction
Authors: Hall Susanne , Burke Dermot
Published: August 2023

Aims

Physical activity soon after surgery contributes to earlier discharge and better outcomes. However, patients often feel anxious to leave their ward and walk around. This project aimed to develop walking routes for patients in order to reduce this anxiety and encourage people to walk post-surgery. Once developed, we evaluated patients' views.

Methods

In a large hospital with five separate wings, we created a multi-professional team to advise on development. Safe walking routes were measured, timed, photographed and assessed for interest. We then produced a walking routes website, informed by multi-professional opinion, for use by patients from 21 surgical wards. This website was accessible to patients at the bedside, via a QR code scanned on their mobile phone. An electronic questionnaire on the website was used to assess patient satisfaction with the new resource.

Results

The majority of respondents (69.2%) felt that the walking routes website lead to them being more active during their admission (n=13). Respondents also felt that the website provided them with enjoyment, benefitted their mental health and made them feel more informed and involved in their recovery. Respondents felt their experience of the walking routes website would be improved by access to the website earlier in their hospital stay.

Conclusion

Despite the small sample size, this evaluation suggests the walking routes website has the potential to be a useful tool for surgical patients to increase early postoperative mobilisation, and improve patient hospital experiences.