bluuebunny/crossref_metadata_2025_split huggingface dataset:
567 The Ever-Present Costs of Cosmetic Surgery Tourism; A 5-Year Observational Study
Authors: Abed H , Henry N , Warner R 
Published: May 2021

Abstract

Introduction
Cosmetic surgery tourism is an ever-growing industry. An increasing number of patients are presenting to NHS services with complications from their surgery. This study aims to evaluate the current presentation patterns for complications in cosmetic surgery tourism, as well as the financial burden to a single UK level one trauma centre in Birmingham, UK.

Method
Between 2015 and 2020, all patients presenting to the department of plastic surgery with complications of cosmetic surgery performed outside of the UK were included. A cost analysis was performed for each patient using published ‘National Schedule of NHS Costs.’

Results
A total of 26 patients presented to our hospital within the study period. 32 cosmetic procedures were undertaken, with the majority performed in Turkey (n = 14). Abdominoplasty was the most common procedure, followed by gluteal enhancement surgery. The total financial cost to our hospital from all cosmetic surgery-related complications was £152,946, with an average cost per patient of £5,882.54 (range £362 - £26,585).

Conclusions
Patients seek out medical tourism for multiple reasons. The costs displayed should predominantly be viewed as a reflection of the detrimental effect these complications can have on patients’ lives. Global governing bodies should focus efforts on educating patients and raising awareness on this ever-prevalent issue.
589 Early Results of Single Anaesthetic Bilateral Fixed Bearing Cemented Medial Unicompartmental Knee Replacement
Authors: Roy S , Kiran M , Atwal N , Gosal Ha 
Published: May 2021

Abstract

Introduction
Unicompartmental knee replacement (UKR) results in less morbidity, early mobilisation, and better PROMs in appropriately selected patients. There has been a steady increase in the number of fixed bearing UKRs in the NJR. We present the early results of single anaesthetic bilateral fixed bearing cemented medial UKR.

Method
All patients undergoing bilateral UKR using the ZUK prosthesis (LIMA, UK) under a single anaesthetic between March 2013 and March 2019 were included in this study. Demographic data, surgical data, change in haemoglobin after surgery and occurrence of complications were prospectively recorded in the hospital database. Pre-op and follow-up Oxford knee scores were recorded. Statistical analysis was performed using SPSS 25.0 (IBM, USA) and paired t-test was used to analyse improvement in functional score.

Results
Nine patients were included in this study. The mean age was 53.2years (range 43-71 years). There were 2 females and 7 males. A significant improvement in Oxford knee score from a mean of 37.2 to 53.6(p &lt; 0.01) was seen. The mean drop in Hb was 4.1mg/dl. The mean follow up was 28 months (range 12-76 months).

Conclusions
There was good improvement in functional scores without any significant drop in Hb. Therefore, it is a safe and beneficial procedure.
625 Health Economics and Safety of Frontline Carers in the COVID-19 Era: Time to Abolish Routine Group and Save For Emergency Appendicectomies?
Authors: Baig M , Sarma D , Ng V , Shortland T , Sood S 
Published: May 2021

Abstract

Introduction
Face of healthcare, patient safety and protection of healthcare providers has been completely transformed with global health pandemic. However, emergency surgical procedures must still be performed, with the commonest being appendicectomy.
It is common practice across National Health Service trusts to collect a group and save (G&S) sample pre-operatively which increases healthcare staff exposure to the patient and increased use of personal protective equipment in this pandemic.

Method
Prospective study of adult patients undergoing emergency appendicectomy since the transformation of emergency care with COVID-19 induced restrictions compared with patients undergoing the same operation before the pandemic.

Results
179 adult patients underwent emergency appendicectomy over 6-months in 2019–2020, 60 patients in the 12 weeks period from the start of the transformed emergency services due to the pandemic. Pre-operative G&S samples were taken for 60(33.5%) patients in the pre COVID-19 period, whereas 7(11.6%) were taken for patients undergoing appendicectomy during the pandemic. None of the patients in either group had intra-operative blood loss of more than 500 millilitres and none of them required peri-operative blood transfusion

Conclusions
Our study demonstrates that the routine pre-operative G&S can safely be abandoned as a routine practice for all patients undergoing emergency appendicectomy.
632 Myringoplasty Outcomes from A 5 Year Single Surgeon Experience at A District General Hospital
Authors: Karunaratne D , Violaris N 
Published: May 2021

Abstract

Introduction
Myringoplasty is an operation to repair a perforated tympanic membrane. A UK based myringoplasty national audit showed the overall closure rate for myringoplasty nationally was 89.5% (90.6% for primary surgery and 84.2% for revision surgery).
This study sought to compare the myringoplasty outcomes in terms of achievement of tympanic membrane closure for a single surgeon over the period of 5 years against the national standard.

Method
Data was collected retrospectively. 68 suitable myringoplasty cases were identified as being done under a single surgeon between 2014 and 2019. Operation notes, discharge letters, audiograms and clinic letters were analysed.

Results
The overall closure rate was 97% (66/68) and significantly higher than the national standard (p = 0.0210), the primary closure rate was 98% (53/54) and significantly higher than the national standard (p = 0.0287) and the revision closure rate was 93% (13/14), but not significantly higher than the national standard (p = 0.1872).

Conclusions
This surgeon uses a posterior auricular approach, combined with mastoidectomy with temporalis fascia graft underlay. We suggest that his particular surgical technique contributed to the positive outcomes quoted.
730 An Atypical Presentation of a Hernia: Gastro-Inguinal Hernia
Authors: Patel M , Shabana A , Sud V , Bond-Smith G 
Published: May 2021

Abstract
Acute presentation of an inguinal hernia is a common presentation to general surgery in the United Kingdom (UK). Rarely intra-abdominal organs, outside of small bowel and colon, can present within an inguinal hernia e.g., appendix or bladder. There has been limited publication involving an incarcerated hernia containing the stomach.
We present the case of an 84-year-old male with a background of COPD and hypertension who presented to Accident & Emergency with a three-day history of vomiting and diffuse abdominal pain.
On examination, the patient had a distended abdomen with generalized peritonitis, and an irreducible non-tender inguinoscrotal hernia. A CT scan of the abdomen and pelvis demonstrated small bowel obstruction and gastric outlet obstruction secondary to a large incarcerated right inguinal hernia containing stomach.
The patient rapidly deteriorated clinically, which led to a decision to palliate the patient. The patient died eight days after initial presentation. The cause of death was documented as likely perforated viscus in an inguino-scrotal hernia.
This case illustrates the devastating prognosis of an acute presentation of an inguinal hernia containing the stomach. This should be considered a surgical emergency and immediate operative intervention should take place if the patient is clinically able to have surgery.
1003 A Case of Tunnel-Vision in Upper Renal Tract Imaging: The Invisible Gorilla
Authors: Swamad M , Quraishi M K , Ahmed S 
Published: May 2021

Abstract
We present an interesting case of a 70-year-old female who presented with haematuria on the suspected cancer pathway. Renal ultrasound showed a vascular renal mass on her right kidney measuring 8x7cm with an unremarkable left kidney. She underwent a laparoscopic radical nephrectomy following confirmation of an 8cm renal mass in the right kidney on the contrasted staging CT scan with a repeat review at the multidisciplinary meeting. Post-operatively a subsequent review of the pre-operative CT and ultrasound scan, showed an incidental large left(contralateral) upper quadrant retroperitoneal fatty mass sized 15x10cm, displacing the stomach and spleen. Further investigation in the form of an MRI Abdomen excluded features of a liposarcoma, resulting in the diagnosis of a large retroperitoneal lipoma. This case highlights the significance of selective attention in imaging interpretation. We believe this to be a prime example of the level of meticulousness required as fat-rich tissues have low attenuation on CT-scans, which can be easily missed out. A cautious multi-clinician interpretation of scans should be performed to avoid missing potentially sinister pathology which would impact patient care dramatically. This case has led to more thorough review of future pre-operative imaging by the operating surgical team.
55 Frailty Assessment in Lower Limb Critical Limb Ischaemia Patients
Authors: Malik M I K , Smyth J V 
Published: May 2021

Abstract

Introduction
An increasing number of frail older patients are undergoing surgical procedures. Frailty is an independent risk factor for increased hospital stay and adverse postoperative outcomes. This project aimed to assess frailty and its management in lower limb critical limb ischaemia patients on the vascular ward at Manchester Royal Infirmary.

Method
A prospective review of consecutive admissions admitted with lower limb critical limb ischaemia identified from ward list and vascular activity, and subsequently discharged. Assessment of frailty status using the Edmonton and Rockwood scales within 48 hrs of admission.

Results
A total of 15 patients were identified with an average age of 69.2 years. The average length of hospital stay was 19 days. 69 total days were spent in the hospital once patients were declared ‘medically fit for discharge’ across all patients. Frailty is associated with increased length of hospital stay and discharge to other institutions. Both the Edmonton and Rockwood scales were congruent in assessing frailty.

Conclusions
Frailty needs to be assessed and identified early so it can be flagged to therapy services and discharge arrangements commenced early. Measures need to be put in place to manage frailty and reduce the length of hospital stay.
58 Use of Abdominal Wall or Sucutaneous Drain to Reduce the Risk of Surgical Site Infections
Authors: Mistry H , Woolner B , John A 
Published: May 2021

Abstract

Introduction
Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections.

Method
Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records.

Results
84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures.

Conclusions
Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.
73 An Audit Evaluating the Management of Pre-Operative Anaemia in Elective Bowel Resections at Frimley Park Hospital
Authors: Coyle M , Rangarajan K , Celera S G , Dowson H , Nizar A S 
Published: May 2021

Abstract

Introduction
Pre-operative anaemia is common within the surgical population, particularly those scheduled for elective bowel resections. National and local guidelines recommend the treatment of pre-operative anaemia, as it is an independent risk factor for poor post-operative outcomes, including length of stay in hospital.

Method
A retrospective study of all NHS patients over the age of 18 scheduled for an elective bowel resection at Frimley Park Hospital between 1st May-31st October 2019.

Results
85 patients met the inclusion criteria, with 29 recorded as anaemic. Of these patients, 55% (n = 16) received iron replacement, all of which were intravenous and did not include mildly anaemic patients. The median rise in haemoglobin post-infusion was 14g/L, with only one patient achieving a normal haemoglobin. The median length of stay for patients with a normal haemoglobin was six days, which increased to eight for those with anaemia of any severity. A statistically significant relationship was found between severity of anaemia and increased length of stay, particularly in the female population.

Conclusions
Pre-operative anaemia was linked to increased length of stay in hospital. The findings support the intravenous treatment of all severities of anaemia pre-operatively and therefore suggest treating mild anaemia patients, as normalising their haemoglobin will improve outcomes.
113 Theatre Bleep: Quality Improvement Project
Authors: Weale R , Rivers C 
Published: May 2021

Abstract

Introduction
Efficient use of any theatre is essential for timely operating and maximising the use of resources. There are many reasons for inefficiency, including delays in patient transfer, and issues of communication between the ward and theatre staff. The objectives of this QIP were to establish areas for improvement in communication.

Method
A survey was distributed amongst staff with several questions subjectively rating the communication between theatres and the ward.

Results
Common reasons listed for delays mentioned included staffing (25) and communication (19), with only 18% rating communication when sending for a patient as good, and 58% of theatre staff rating communication when transporting a patient back as poor. A common response was failure of the ward to answer the telephone. A bleep was therefore introduced, which was carried by a nominated nurse on the plastic surgery ward each shift. Following the introduction of this bleep, the survey was repeated, with 71% rating communication when sending for a patient as good, and 86% of staff rating communication when transporting a patient back as either good or excellent.

Conclusions
This simple measure of a new ward bleep significantly improved communication, and we feel this measure should be implemented nationally.
132 Quality Improvement Project (QIP) On Compliance of Vascular Society’s Clinical Care Pathway for Patients with Critical Limb Ischaemia (CLI) Admitted to Vascular Ward At Worcestershire Royal Hospital (WRH)
Authors: Mehta A , Meecham L , Shakarchi J Al , Charlwood N 
Published: May 2021

Abstract

Introduction
Patients often present to the emergency department with critical limb ischaemia (CLI). According to the Vascular Society 2019 guidelines, these patients require.
All metrics should be carried out &gt;80% of the time.

Method
A QIP was conducted of all CLI patients admitted with rapid progression/ deep tissue injury/ rest pain at WRH between 23/01/2020-31/03/2020.
Sources of data - Patient records, ICE and PACS

Results
Compliance target for below were not met.
However, compliance for vascular surgeon face-to-face review within 14 hours stood at 100%.

Conclusions
Failure to fully comply could lead to poor prognostic outcomes such as loss of limb or death. Consequently, the WRH vascular governance board agreed to put the following measures in place.
179 Improving Operative Notes in Upper GI Surgery: An Innovative QI Project Utilising Existing Electronic Hospital Systems
Authors: Sadik H , Butt A , Gowie Z , Carew J , Mehta A , Sheth H 
Published: May 2021

Abstract

Introduction
Operative notes play a valuable role in ensuring that surgical patients receive consistent and adequate care. There are many inherent difficulties affecting their quality. We performed a QI project to improve surgical operative notes at our centre.

Method
A questionnaire assessing subjective quality of operative notes was sent to all foundation doctors delivering post-operative care. Compliance to each inclusion recommendation in the RCS guidelines was analysed. A standardised template for operative notes was incorporated into the hospital’s electronic records system, compliance was then reassessed.

Results
Questionnaire responses (16) were better for typed vs hand-written notes in all domains: ease of accessing notes, following intra-operative steps, following post-operative plans and frequency of asking for additional information regarding plans. After implementation of the template, mean compliance across 19 RCS parameters improved from 69% (55 operations) to 89% (46 operations). Number of parameters with 100% compliance improved from 2/19 to 8/19. Compliance increased in 14/19 parameters, there was no change in 2/19 (already 100%) and a reduction was seen in 3/19.

Conclusions
Results from our analysis and questionnaire showed that typed notes were favourable when compared to hand-written. The introduction of a standardised electronic template, without investment in new software, improved compliance to RCS guidelines.
180 Management of Open Fractures at Oxford University Hospitals NHS Trust Major Trauma Centre
Authors: Ramjeeawon A , Iqbal M , Hawthorne R , Ahmad A , Hasan Y , Abourisha E , Ashraf A , Deakin M 
Published: May 2021

Abstract

Introduction
This audit was developed after noticing patients with open fractures had poor neurovascular assessment documentation (non-specific, none post-manipulation), and to check these patients received appropriate antibiotics. Review of open fracture management guidelines identified areas to be improved.

Method
Pre-operative hospital management of open fractures was audited using the NICE (NG37) and joint BOAST/BAPRAS guidelines on open fracture management. Interventions were awareness and education of junior doctors and editing the Trauma Clerking Form to prompt appropriate management and documentation, followed by re-audit.

Results
30 patients were assessed pre- and post-intervention. Correct antibiotic administration rate (93%vs97%) and speed (50% &lt;2 hours where not given pre-hospital - in both groups) were similar. The initial neurovascular assessment frequency was identical (93%), however documentation of assessment of specific arteries (86%vs30%) and nerves (60%vs23%) and assessing all appropriate arteries (60%vs13%) and nerves (60%vs20%) improved. There were increased frequencies of documenting manipulation in A&E (90%vs47%) and neurovascular assessment post-manipulation (90%vs16%). Tetanus cover (87%vs77%), photo availability (70%vs40%), and appropriate dressing use (47%vs27%) improved.

Conclusions
Antibiotic management was consistent and appropriate. There were improvements in frequency and quality of neurovascular assessment, tetanus cover, availability of photographs of injuries and appropriate dressings used. Overall, pre-operative hospital management of open fractures improved.
244 Does Direct Admission to ICU In Emergency Laparotomy Patients with A NELA Score ≥ 10% Affect Outcome at Fiona Stanley Hospital?
Authors: Shepherd T , Foster A 
Published: May 2021

Abstract

Introduction
The Australian and New Zealand Emergency Laparotomy Audit (ANZELA) is a quality improvement project based on UK NELA. Direct admission to ICU post-operatively for patients with a NELA ≥ 10% is recommended. In the current pandemic, the use of critical care beds must be rationalised. We investigated if patients with NELA ≥ 10% experienced worse outcomes if admitted to the ward post-operatively (instead of ICU).

Method
We performed a retrospective audit of emergency laparotomies at Fiona Stanley Hospital over 6 months December 2019 – May 2020. NELA scores were obtained from the ANZELA database and patient notes reviewed to identify post-operative unplanned ICU admissions and mortalities.

Results
Twenty-four (30%) emergency laparotomy patients had a NELA ≥ 10%. Ten (42%) patients were admitted to the ward post-operatively. There were no unplanned ICU admissions in this group. Two (20%) patients had a documented ‘code blue’ but were managed conservatively on the ward. No patients in this group died within 30 days.

Conclusions
Post-operative ward admission in selected patients with NELA ≥ 10% does not result in unplanned ICU admissions or increased mortality at a tertiary Acute Surgical Unit. This data is reassuring as we expect future ICU bed shortages for non-COVID surgical patients during the pandemic.
274 The Accuracy of Clinical Coding of Developmental Dysplasia of The Hip (DDH) Operations
Authors: Sharrock M , Whelton C , Paton R 
Published: May 2021

Abstract

Aim:
To assess the accuracy of clinical coding of developmental dysplasia of the hip (DDH) operations

Method
106 children underwent surgery for DDH at our turst from 1997 to 2018. Our coding department was sent a list of patients and operation dates and asked to tabulate data on what each operation had been coded as. We compared what each operation was coded as with the procedure actually performed (as per operation notes, clinic letters and intra-operative fluoroscopy images).

Results
Of the 106 patients included in our study, 128 operations were performed. 36 out of 128 (28%) of operations were coded incorrectly. The commonest error was that closed reduction was missed from coding (n = 13). Seven patients did not have their femoral osteotomy coded. Seven patients had a closed reduction incorrectly labelled as an open reduction. Four patients had pelvic osteotomies that were not coded. Two patients had open reductions that were not coded.

Conclusions
We have shown that an unacceptably high number of DDH operations are being coded for incorrectly. This has clear cost implications for the trust. This study questions the use of retrospective coding data in audit and research and suggests inaccuracy when considering the surgical outcomes of developmental dysplasia of the hip.
320 A Closed Loop Audit of Surgical Site Infection Rate in Elective Colorectal Laparotomies, Pre and Post Introduction of Jubilee Dressing Method
Authors: Denton O , Knight K , Steele C 
Published: May 2021

Abstract

Introduction
Surgical site infections (SSI) are responsible for one third of all inpatient infections and are associated with increased morbidity and extended hospital stay. The colorectal department at Glasgow Royal Infirmary introduced the Jubilee dressing method in August 2019 with the aim of reducing SSI incidence.

Method
Closed loop audit of all elective colorectal laparotomies at Glasgow Royal Infirmary pre- and post-introduction of Jubilee dressing method (March – July & August – December 2019). Literature reviews informed selection of baseline characteristics relevant to SSI. Analysis by logistic regression of SSI incidence by characteristic and Jubilee dressing use.

Results
A total of 193 patients were included. There was 52% uptake of Jubilee dressing method in the implementation phase and reduction in total SSI rate from 18.25% to 14.93%. Operation duration and smoking history were the only significant factors at univariate analysis and were put forward to multivariate analysis. Of these, only operation duration made a significant contribution to SSI incidence.

Conclusions
Jubilee dressing use did not make a significant difference to SSI incidence in this sample. This intervention is likely to have small effect size and there were probable confounding factors. Multifactorial influence in SSI incidence suggests larger datasets are required to isolate independent factors.