bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.194 Patellar height after Anterior Cruciate Ligament rupture reconstruction using the autologous bone-patellar tendon-bone graft technique in the Maltese population
Authors: Psaila Rachel , Bugeja Kristian , Attard Lucienne , Esposito Ivan 
Published: October 2021

Abstract

Aim
The primary aim of this study is to determine whether there is a change in patellar height after closure of the patellar tendon defect after a bone-patellar tendon-bone graft harvesting. The secondary aim is to evaluate clinical and functional outcomes.

Method
A retrospective observational study was conducted. Patients who were diagnosed with ACL injury and underwent reconstruction of ACL using the bone- patellar tendon- bone graft technique from 2015 to 2020 were included (56 patients). All patients underwent the same procedural steps. All patients had pre- and post-operative knee radiographs (antero-posterior and lateral views). The Caton- Deschamps Index was used to measure patellar height pre- and post-operatively. The International Knee Documentation Committee-Subjective Knee Evaluation Form was used to assess functional outcome. Clinical outcome was assessed by reviewing patient records.

Results
There was a change from the pre-op index 0.995 +/− 0.144 (mean +/- SD) to the post-op index 0.948 +/− 0.150. With a statistically significant decrease in index of 0.048 +/− 0.131 (p value 0.009) was found. The null hypothesis (that there is no change) is rejected and therefore the alternative hypothesis (a decrease in patellar height) is accepted. The mean IKDC-SKF score was 76.851 +/− 15.015 (SD) ranging from 40.2 to 100.

Conclusion
Performing ACL reconstruction using the B-pT-B technique, although predisposing to a decreased patellar height, it does not increase the incidence of patella baja. An overall good functional outcome was achieved, mean IKDC-SKF 76.85. However, no clear association between change in patellar height and PF symptoms could be demonstrated.
EP.FRI.204 Does Sarcopenia Increase the Risk of Needing a Stoma During Emergency Laparotomy?
Authors: Campbell Ross , Bradley Nicholas , Wilson Michael 
Published: October 2021

Abstract

Aims
Sarcopenia is a multisystem disorder which can be diagnosed clinically and radiologically. It is associated with impaired functional status and inferior perioperative outcomes, in particular increased mortality following emergency laparotomy. This study aimed to show whether sarcopenia, as defined by low psoas muscle area (PMA) on pre-operative CT, was associated with increased need for stoma formation.

Methods
A retrospective analysis of consecutive emergency general surgical laparotomies over a 3-year period. PMA was measured on a single pre-operative CT image at L3 and normalized to vertebral body area to create a psoas muscle index (PMI). New stoma formation and perioperative outcomes were recorded from patient records. Cases were split by the median value into high “non-sarcopenic” and low “sarcopenic” PMI groups.

Results
299 patients underwent emergency laparotomy between 01/01/2016 and 31/12/2018. 46 patients (30.67%) in the low psoas index group required a stoma compared with 37 (24.83%) in the higher group (p = 0.159). Survival was inferior in the sarcopenic group with a mean survival of 42 months compared to 48 months in the non-sarcopenic group (p = 0.032). Median follow-up was 43 months. Patients in the sarcopenic group were significantly older (Mean age 68 compared to 54 in the non-sarcopenic group, p = &lt;0.001) but there was no difference in other baseline variables.

Conclusions
Sarcopenia does not significantly increase the risk of requiring a stoma during emergency laparotomy but does reduce survival.
EP.FRI.221Safe delivery of emergency laparotomy using Personal Protective Equipment (PPE) during the first peak of the COVID-19 pandemic
Authors: O'Connor Adam , Bennett Jayne , Alam Imran 
Published: October 2021

Abstract

Aims
To evaluate emergency laparotomies and examine operating surgeon use of PPE as per guidelines in the first COVID-19 peak.

Methods
The NELA database for our hospital was interrogated to examine for emergency laparotomy cases between March to September 2020. Data was recorded on age, pathology, NELA mortality score, post-operative destination, mortality COVID-19 swab status as an inpatient and use of PPE.

Results
55 laparotomies were undertaken. The median age was 67 years. 48% had a Clinical Frailty Score &gt;4. 53% of patients were 'high-risk' in their NELA mortality score (&gt;5%). 56% were ASA &gt;3. 44% went to intensive care post-operatively. 18% and 36% had significant cardiac and respiratory co-morbidities. The mean NELA mortality score was 10% pre-operatively. Mean post-operative risk of mortality score was 67%. Only 1 patient contracted COVID-19 whilst an inpatient and subsequently died of acute cerebrovascular accident unrelated to her COVID-19. PPE was available and used as per guidelines in all cases.

Conclusions
Our department remained busy throughout the first peak however there was a reduction in cases compared with 2019. Our population is generally heavily co-morbid based on ASA scores and cardiorespiratory co-morbidity. Nevertheless only 1 patient contracted COVID whilst an inpatient in this cohort. Access to adequate amounts of personal protective equipment is paramount to ensure safe and timely access to emergency laparotomy for patients and surgeons alike.
EP.FRI.229 The Role of Ultrasound in the Diagnosis of Paediatric Appendicitis
Authors: Armstrong Lará , McGuigan Conor , Yousaf Muhammad 
Published: October 2021

Abstract

Background
Acute appendicitis remains the most common acute surgical presentation among children and adults. Ultrasonography is a commonly used investigation for patients with right iliac fossa pain were the diagnosis is unclear, however in a district general hospital (DGH), appropriate radiologists are not often readily available. The aim of this study was to determine the value of ultrasonography in the diagnosis of appendicitis in children.

Methods
A retrospective review was carried out of all paediatric patients (aged 5-16), who underwent an appendicectomy in a single acute surgical unit, over a 6 month period. An institutional database and up to date electronic care records were used to record preoperative ultrasound results, intraoperative findings and histopathology results.

Results
A total of 59 patients were admitted with possible appendicitis within the audit window, 31 of which underwent an appendicectomy, 58% performed laparoscopically. 38.7% underwent pre- operative ultrasound, 33.3% of which identified an acutely inflamed appendix. The remaining patients who did not proceed to theatre were successfully discharged with no re-attendance following a period of observation. Following histopathological confirmation, ultrasonography was found to have a sensitivity and specificity of 100%. Negative appendicectomy rate returned at 6.7%.

Conclusion
Ultrasonography is a low cost, highly sensitive diagnostic tool in appendicitis, where provisions are in place to do so. Visualising the appendix on ultrasound can reduce negative pathology rates. This is a small study within a DGH and access to ultrasound is limited. Better utilisation or the development of a protected ultrasound slot should be sought.
EP.FRI.247 Incidence and diversity of the primary appendiceal tumours in patients presenting with acute appendicitis: Our Experience
Authors: Aspari Ajay , Ayantunde Bolu , Ayantunde Abraham 
Published: October 2021

Abstract

Background
Primary appendiceal tumours are rare. Our experience with the incidental primary appendiceal tumours and their histological diversity.

Patients and Method
Operative and pathological databases of appendicectomies for presumed diagnosis of acute appendicitis between January 2015 and December 2020 were interrogated. Clinicopathological data were collected and analysed to present the incidence of primary appendiceal tumours, histopathological diversity and outcomes.

Results
1908 appendicectomies were performed over the study period. 22 patients with primary appendiceal tumours (incidence rate 1.2%) had a mean age of 45.6(15-97) years and M:F ratio of 1:1.2. Only six patients (27.3%) had appendiceal tumour suspected either before or during surgery. 91% of the patients underwent laparoscopic appendicectomy. Right hemicolectomy was performed as the first intervention and further surgical procedure in 1 and 5 patients respectively.
Histological tumour types included carcinoid(10), adenocarcinoma(4), low grade appendiceal mucinous neoplasm(4) mucinous adenocarcinoma & carcinoid(1), goblet cell carcinoid(2) and dysplastic serrated polyp(1). Tumours were located at the tip(10), body(10) and base(2). Median tumour size was 13(2.0-55.0) mm. Median hospital stay was 1.5(0-25) days.
The mean survival was 30.9(2.80-73.70) months. Disease related death was a 97-year-old lady with a T4 adenocarcinoma and peritoneal disease who stayed for 25 days and offered palliative supports post appendicectomy.

Conclusion
Primary appendiceal tumours are diverse in histological types and are of varying prognosis. Appendicectomy alone seemed to be adequate in most cases with early-stage disease. Further surgery such as right hemicolectomy was required for adenocarcinoma and other high-grade tumours.
EP.FRI.248 The bezoar, the bowel, and the blockage: A rare case of a spontaneously passed phytobezoar
Authors: McGuigan Conor , Davidson Sophie , Mark David 
Published: October 2021

Abstract

Background
Bezoar, from the Persian meaning antidote, denotes a trapped mass in the gastrointestinal system. There are several types, but here we present a case of phytobezoar.
A phytobezoar is one which is composed of undigestible plant material. While all bezoars account for less than 4% of intestinal obstruction, most occur within the stomach or small intestine. Phytobezoars causing large bowel obstruction appear to be extremely rare.

Case report
We present a case of a phytobezoar causing large bowel obstruction in a 29-year-old man. He presented with a four-day history of abdominal pain and distension with associated vomiting and no bowel opening.
An abdominal X-ray demonstrated significant dilatation of transverse colon. Subsequent CT revealed large bowel obstruction with transition point in the distal sigmoid. An intraluminal lesion, with mottled appearance, containing locules of gas – a phytobezoar – was noted as the cause.
The Patient was clinically well with no peritonism and planned for a flexible sigmoidoscopy in the first instance. However, the patient went on to pass two large, hard bowel motions leading to significant resolution of symptoms. A flexible sigmoidoscopy was carried out to exclude other pathology and demonstrated that the obstruction had been relieved.

Conclusion
While it seems phytobezoar is an incredibly rare cause for large bowel obstruction, most of the literature suggests operative management of the problem by means of laparotomy and enterotomy. This case demonstrates the potential for conservative management and possibility for spontaneous resolution, despite emergency presentation.
EP.FRI.257 ELF 2: Defining the Denominator
Authors: McLennan Elizabeth , Price Angeline , Boyle Jemma 
Published: October 2021

Abstract

Introduction
The collaborative UK Emergency Laparotomy and Frailty (ELF) study was one of the first to investigate the older adult population undergoing emergency surgery. Despite accounting for almost half of emergency laparotomies and many considered high-risk, there remains a paucity of research in this population. One undefined area is the older patient who presents with acute abdominal pathology treatable by laparotomy but who do not undergo surgery.

Aims
The primary aim is to estimate the 90-day mortality in older patients presenting with acute abdominal pathology potentially treatable by emergency laparotomy who do not undergo surgery (NoLap). The secondary aims are the characterisation of this group, including frailty and sarcopenia with comparison to those older adults that have undergone emergency laparotomy (NELA and ELLSA). In addition, the decision-making process will be explored.

Method
Multicentre prospective cohort study via established research collaboratives (WelshBarbers, SSRG, OPSOC). ELF 2 requires at least 47 centres, recruiting 700 patients for 3months prospective data collection via REDCap of NoLap patients with the same NELA inclusion/exclusion criteria. This data will be compared with a matched cohort from NELA and ELLSA. ELF2 data collection includes demographics, co-morbidities, frailty and sarcopenia. Each patient will be followed up for 90-day and 1-year mortality. Heuristics behind the decision will be analysed.

Discussion
This trainee led collaborative project aims to improve understanding of the older adult population being considered for emergency laparotomy. With the ageing population being the dominant health users of the future, defining the denominator is essential for shared decision-making
EP.FRI.258 A closed loop audit of deep vein thrombosis prophylaxis in the acute surgical receiving unit of a large teaching hospital; reducing morbidity and mortality, and improving cost-effectiveness
Authors: Chen Jun Yu , Norman Fraser , Paterson-Byrne Paul , Nicholson Gary 
Published: October 2021

Abstract

Aims
Acute surgical patients have a significant risk of venous thromboembolism (VTE) due to factors such as surgery, immobility, dehydration, and existing comorbidities. All patients admitted to an acute surgical unit should have their VTE risk assessed. Our aim was to assess VTE prophylaxis practices.

Methods
We performed a closed loop audit on DVT prophylaxis using the Scottish Intercollegiate Guidelines Network proforma. Data on anti-embolic stockings (AES) and low molecular weight heparin (LMWH) were collected and presented at a local audit meeting. The intervention included reinforcing the importance of VTE prophylaxis compliance amongst junior doctors and nursing staff, and provision of posters within the department and on patient trolleys. Data was collected to complete the audit cycle.

Results
A total of 171 patients were included. Prior to the intervention, 13.9% did not receive LMWH when indicated and 37.4% were non-compliant with AES. Overall, 40% had insufficient DVT thromboprophylaxis. Post implementation, 8.9% did not receive LMWH when indicated and 46.4% were noncompliant with AES. Overall, 50% had insufficient DVT thromboprophylaxis. LMWH compliance was 5.0% higher on re-auditing however AES compliance was 9.0% lower.

Conclusions
Adherence to thromboprophylaxis regulations was below expected standards. Thromboprophylaxis is cost-effective and prevents considerable morbidity and mortality, so ongoing audits alongside analyses of potential causes should be encouraged. We acknowledge the data’s limitations in that the reasons for low compliance cannot be ascertained here, but results suggest that there exists room for more interventions aiming to encourage a marked improvement both in LMWH and AES compliance.
EP.FRI.306 The Mule who took us for a ride
Authors: El-Abbassy Islam , Perakath Benjamin 
Published: October 2021

Abstract

Introduction
Foreign body ingestion is not uncommon in patients with mental disorders, alcohol intoxication and for purposes of drug trafficking. Small objects pass spontaneously; however, larger ones may get stuck in the oesophagus, stomach or at narrow areas of the bowel. "Body packers" is a term used to describe persons who swallow or insert drug-filled packets into a body cavity. They are also called “swallowers”, “internal carriers” “couriers” or “mules”.

Case report
We report a 37 year old previous drug abuser who presented with dysphagia. Upper GI endoscopy showed an oblong foreign body covered in plastic in the lower oesophagus. This could not be extracted and hence was pushed into the stomach. Three weeks later, he presented with bowel obstruction that was shown on abdominal radiograph and confirmed by CT indicating multiple dilated small bowel loops with a transition point in the terminal ileum where the ingested package was identified. The package was then removed through a longitudinal enterotomy.

Conclusion
Ingested foreign bodies causing dysphagia should ideally be extracted endoscopically. If not possible, then a watch and wait policy may be justified. While most ingested objects pass spontaneously, unusual and larger ones may require surgical extraction.
The contents, nature and reason for ingesting this strange object remain a mystery. With history of drug abuse and the consistent denial of knowingly swallowing that object, we can only conclude that the patient was trying to transport an illicit drug in the packet.

Keywords
Foreign body ingestion, bowel obstruction, body packers.
EP.FRI.309 Rib fractures – an overlooked part of general surgical take? An audit and creation of a local pathway
Authors: Mai Dinh Van Chi , Singh Anjana 
Published: October 2021

Abstract

Introduction
Battle et al devised a validated scoring system to stratify patients with rib fractures (RF) at risk of complications based on age; number of fractures; oxygenation; respiratory illness and anticoagulation use. Risk of complications increases with score e.g. ≤10 and ≥31 give estimated complications risk of 13% and 88% respectively (2).

Method
We conducted a local retrospective audit of 45 patients admitted with RF over 26 months. Initial and subsequent analgesia was recorded. Four subgroups were created based on Batlle score: ≤10, 11-20, 21-30, ≥31. Outcomes included complications, length of stay (LOS) and mortality.

Results
Whilst overall median score was 18, we observed 20% (n = 9) scored ≥31. Initially, oral analgesia alone was given to 64% of patients; 66% went on to require lidocaine patch and 15% required patient controlled analgesia. Only 2.2% (n = 1) received regional analgesia. Despite 35.6% (n = 16) scoring ≥21, only four proactive critical care referrals were made.
Overall pneumonia rate was 20% (n = 9); 44% (n = 4) in the ≥31 group. There were two deaths overall, both in the ≥31 group. Median LOS was 3 days; however 44% (n = 4) of the ≥31 group required ≥7 days.

Conclusion
One in five RF cases scored ≥31 and consequently had the worst outcomes. There was initial suboptimal analgesia, inadequate early escalation of higher risk patients to critical care and low rates of regional blocks. Consequently, we have created a local pathway based on Battle score (2) to standardise risk stratification and management of these patients in order to improve outcomes.
EP.FRI.332 Impact of Nutritional Deficit in Emergency Surgery (INDIcatES): A cohort study
Authors: O'Connor Tim , Mackenzie Laura , Clarke Rory , Wilson Timothy , Lee Matthew 
Published: October 2021

Abstract

Background
Emergency laparotomy is associated with significant morbidity. Nutritional status is an important factor that can influence outcomes, particularly in this setting where temporary gastrointestinal failure can occur. This study aims to compare the performance of three nutrition risk tools in predicting time without enteral nutrition.

Methods
A prospective cohort study was conducted across two sites (NCT04696367). Patients undergoing NELA eligible procedures were invited to participate. Data collected included demographics, surgical diagnosis, surgical procedure, and surgical outcomes. Nutrition risk was assessed using three tools: MUST score, the Nutritional Risk Index (NRI), and Nutritional Risk Score 2002 (NRS).

Results
In total, 56 patients were recruited of whom 21 had small bowel obstruction. Median age was 69 years and 23 participants were female. Overall, 23 participants (41.8%) were identified as high risk using the MUST score, compared to 11 (20.0%) using NRS and 4 (8.9%) using NRI. Median time to return to normal enteral intake was 10 days (IQR 7-14). 91%, 90%, and 95% of those identified as low risk according to MUST, NRS, and NRI respectively were without enteral intake for 5 days or more. The median complication index score was 15 (IQR 0-34). There was no significant difference in duration of time without intake or complications seen in any of the nutritional risk groups.

Discussion
This study shows that patients undergoing emergency laparotomy spend a prolonged time without enteral intake. Current tools do not adequately stratify the likelihood of prolonged starvation at baseline, or in light of surgical findings.
EP.FRI.374 Characteristics of Emergency General Surgery Operations at Night. An Avoidable Issue?
Authors: Quah Samantha , Cheah Hock Ping , Wong Kenneth 
Published: October 2021

Abstract

Aim
Most hospitals mandate afterhours operations to permit only cases that are life or limb-threatening. This is in the interests of promoting patient safety and reducing surgical errors. The incidence and caseload of night-time operations has not been well defined in Australia. This study aims to investigate the characteristics emergency operations involving consultant general surgeons between 10pm to 7am in regional and rural hospitals.

Methods
A multicentre, prospectively collected health service database of all emergency general surgery operations performed over a 12-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon and time of operation were analysed.

Results
There were a total of 2059 emergency operations performed with 1344 cases performed in the regional hospital and 715 performed in the rural hospital within the area health network. Consultant surgeons were involved in 62 cases at night beyond 10.00pm, of which majority were laparotomies (n = 26/62, 42%), appendicectomies (n = 21/62, 34%), and hernia repair ((n = 4/62, 6.5%). In comparison, surgeons in the rural hospital performed seven emergency cases at night comprising of 6 laparotomies and one abscess drainage.

Conclusion
Larger hospitals have higher volumes of emergency cases, which increases the likelihood of afterhours operating. The rural hospital does not have other subspecialty cover competing for emergency operating time. This allows most emergency cases to be performed in the evening. In order to promote safe working hours and improved patient safety, theatre availability and staffing could be increased in the evening to diminish necessity for midnight to morning consultant operations.