bluuebunny/crossref_metadata_2025_split huggingface dataset:
339 The Glasgow Lumbar Spinal Stenosis Scale: An Individualised Measurement Formula for the Radiological Assessment of Lumbar Spinal Stenosis
Authors: Bradley R , Kumar A , Barrett C 
Published: October 2021

Abstract

Background
Lumbar spinal stenosis (LSS) is a common spinal problem. Currently there is no universally accepted quantitative approach to the radiological measurement of LSS. Quantitative descriptions do exist, but these are unidimensional and do not consider normal variation in anatomy. We propose a universal and individualised measurement system for the quantitative radiological assessment of lumbar spinal stenosis.

Method
A retrospective case series of patients who had undergone surgery for symptomatic lumbar spinal stenosis over a 3-year period. Pre-operative T2 weighted lumbar spine MRI were analysed. Each patient had the degree of lumbar canal stenosis quantified using our approach.

Results
Our novel formula for the quantitative radiological assessment of LSS is two dimensional, repeatable, and presented as a percentage, to correct for the individual patient. The surface area of the canal at the level of stenosis is measured (mm2). The adjacent 2 levels are then measured and averaged. The calculation becomes (A-S/A) x 100 = R, where S is the canal surface area at the stenosed level, A is the average canal surface area of the two levels adjacent to the level of interest and R is the relative degree of lumbar spinal canal stenosis expressed as a percentage.

Conclusions
This novel quantitative measurement formula for the radiological assessment of lumbar canal spinal stenosis is quick and simple to calculate and most importantly adjusts for the individual patient’s normal or degenerative anatomy. This new measurement tool will need validation against specific clinical and operative criteria in the future.
901 Management, Complications and Neurological Outcomes of Aneurysmal Subarachnoid Haemorrhage in Elderly Patients
Authors: Cheng P H , Simms H N , Abouharb A 
Published: October 2021

Abstract

Aim
To study the management of aneurysmal subarachnoid haemorrhage (aSAH) and compare neurological outcomes in different elderly age groups.

Method
A retrospective cohort study. aSAH patients with age 60 and above admitted to Royal Victoria Hospital Belfast between 2015 to 2019 were enrolled, and divided into 3 sub-groups, age 60 – 69 (Group I), age 70 – 79 (Group II) and age &gt;80 (Group III). Patient characteristics and clinical courses were compared, including co-morbidities, WFNS grades, interventions, complications and neurological outcomes at follow up.

Results
158 patients were included, with 104 in Group I, 49 in Group II and 5 in Group III. Despite Group III patients presented with only WFNS grade 1 & 2, mortality increased exponentially with age from 9.6% to 12.2% to 40% across 3 sub-groups. There was also a linear increase in average length of stay (LOS) from 21 to 24 days. 81 Group I patients (77.9%) developed complications and 38 patients (77.6%) in Group II. In Group III, 3 patients (60%) developed complications when 2 other patients did not survive. Most common complications were hydrocephalus (46.2%) and hospital acquired infections 36.7%).

Conclusions
Our study suggests patients with age &gt;80 had less favourable neurological outcomes despite having low grade aSAH at presentation and received similar intervention. Average LOS in hospital also increased with age. Similar complication rates were noticed in all groups. Comparing our data with other neurosurgical units in UK and Ireland will provide further information in managing elderly aSAH patients and facilitate risk stratification when considering those patients for intervention.
1339 Haemoglobin Threshold for Red Blood Cell Transfusion in Traumatic Brain Injury. A Systematic Review and Meta-Analysis
Authors: Anwar S , Bakhsh A , Manieanan S , khan M 
Published: October 2021

Abstract

Background
Traumatic Brain Injury (TBI) is a significant and growing worldwide healthcare burden. Minimising brain hypoxia is important in preventing secondary brain injury. Anaemia is common in TBI patients but there is little evidence as to which haemoglobin (Hb) threshold transfusion should be considered in TBI patients.

Objective
This present systematic review and meta-analysis of randomised controlled trials aims to assess the effect of high verses low red blood cell transfusion thresholds on functional outcomes and quality of life in TBI patients.

Method
We searched Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and Web of Science up to June 2020. We also searched clinical trial registers, conference proceedings, and reference lists from previous systematic reviews and included studies. We included randomised studies comparing high verses low Hb threshold for red blood cell transfusion in TBI patients. We assessed the following major outcomes: all-cause mortality, transfusion related adverse events and favourable outcome (Glasgow Outcome Scale, GOS).

Results
We included 3 RCTs involving 311 participants. Our analysis showed no difference in all-cause mortality (3-6 months) (OR 1.17 (95% CI 0.64 to 2.13)) and no difference in GOS (OR 1.10 (95% CI 0.65 to 1.85)) between transfusing red blood cells at 7g/dL or at 9/10g/dL in moderate to severe TBI.

Conclusions
There is no difference between a high and a low Hb threshold transfusion policy. However, considering the limitations in current evidence there is a need for future high quality randomised controlled trials.
1548 Refining the Usability of a Novel Visual Field Assessment App
Authors: Ho J W , Hughes M 
Published: October 2021

Abstract

Introduction
A validated visual field chart designed as a simpler adjunct to formal perimeters is being developed into an app. The app aims to empower patients with pituitary tumours to independently assess their central 25˚ visual field with intra-app instructions and share their results with their clinician. NHSx marked usability as an assessment criterion for validating health apps. This study aims to explore and improve the usability of the beta-version of the app.

Method
Qualitative methods were employed through observation and semi-structured interviews. Recruitment was through convenience sampling. Participants experienced the app solely based on the intra-app information. Meanwhile, a researcher observed the process. Then, qualitative feedback was generated through semi-structured interviews. Observational data was coded and quantified. Thematic analysis was employed to identify common themes and/or categories of the qualitative feedback.

Results
15 participants between 24-58(mean 33.7, SD 10.8) years were recruited. Observational data revealed that 1/15 adhered to all 3 written instructions; 3/15 utilised the hand span distance guidance provided. Participants’ responses on feedback for improvements were coded and categorised. Suggested additional features for improvement – a run-through introduction to the app, a video example of how to conduct the test, a practice run, an option for audio instruction and an option to change font size and type. Suggested additional instructions were to focus on the black dot and remember what you were seeing with the red dots.

Conclusions
Qualitative methods identified aspects of the app requiring improvements. Participants feedback will be utilised to improve the app.
1596 A Retrospective Audit Investigating and Identifying Factors Relating to Delays to Theatre Within Neurosurgery at Leeds - A Tertiary Referral Centre
Authors: Chowdhury M R , Anderson I , Sheikh S , Joumah A , Iqbal H , Goel A 
Published: October 2021

Abstract

Aim
Leeds Neurosurgery receives referrals as a tertiary centre from a cohort covering 3 million people, receiving over 9000 referrals in the last year via its online system, Patientpass. This audit aims to identify factors which leads to delays in surgery, especially in light of the COVID-19 pandemic.

Method
We looked at 760 patients who were included in the study and used the electronic clinical notes system, PPM+ and also the electronic referral system Patientpass and looked at weekday and date of admission, cranial/spinal admission, diagnosis, age, referring hospital, time taken in theatre, theatre used, intraoperative timings, length of stay and date of discharge.

Results
The majority of the cases were either vascular or trauma related. 77.2% of surgeries were either same day or within 24 hours. The average length of stay was 17 days. The average time in theatre, 2h11m. The designated acute theatres were used approximately 75% of the time.

Conclusions
Interestingly, the mean time from admission to theatre was 1.25 days. 225 cases were investigated as a sample randomly selected. It is identified that 30 cases were delayed. 20% were delayed due to imaging requested for surgical management. 6% were due to patients awaiting consultant review. 10% due to awaiting other investigation results (i.e., COVID swab.) There were other identifiable factors such as awaiting ‘hot' theatres, reversing coagulopathies and medically deteriorating patients. We have provisionally identified factors and will re-audit this in the next cycle in order to maximise efficiency.
138 Endovascular Hepatic Artery Stents in The Modern Management of Post-Pancreatectomy Haemorrhage
Authors: Finch L M , Baltatzis M , Byott S , Ganapathy A K , Kakani N , Lake E , Cadwallader R , Hazar C , Seriki D , Butterfield S , Jegatheeswaran S , Jamdar S , de Liguori Carino N , Siriwardena A K 
Published: October 2021

Abstract

Aim
Post-operative haemorrhage is a potentially lethal complication of pancreatoduodenectomy. This study reports on endovascular hepatic artery stents in the management of post-pancreatectomy haemorrhage.

Method
This is a retrospective analysis of a prospectively maintained, consecutive dataset of 440 patients undergoing pancreatoduodenectomy over 68 months. Data are presented on bleeding events and outcome, contextualized by the clinical course of the denominator population. International Study Group for Pancreas Surgery (ISGPS) terminology was used for post-pancreatectomy haemorrhage.

Results
Sixty-seven (15%) had post-operative haemorrhage. Fifty (75%) were male and this gender difference was significant (P = 0.001; two-proportions test). Post-operative pancreatic fistulas were more frequent in the post-operative haemorrhage group (P = 0.029; two-proportions test). The median (IQR) delay between surgery and haemorrhage was 5 (2-14) days. Twenty-six required intervention comprising re-operation alone in 12, embolization alone in 5 and endovascular hepatic artery stent deployment in 5. Four further patients underwent multiple interventions with two having stents. Endovascular stent placement achieved initial haemostasis in 5 (72%). Follow-up was for a median (IQR) of 199 (145-400) days post-stent placement. In two patients the stent remained patent at last follow-up. The remaining 5 stents occluded with a median (IQR) period of proven patency of 10 (8-22) days.

Conclusions
This study shows that in the specific setting of post-pancreatoduodenectomy haemorrhage with either a short remnant GDA bleed or a direct bleed from the hepatic artery, where embolization risks occlusion with compromise of liver arterial inflow, endovascular hepatic artery stent is an important haemostatic option but is associated with a high risk of subsequent graft occlusion.
202 Consenting Practice for Post-Cholecystectomy Diarrhoea After Laparoscopic Cholecystectomy – Are We Missing A Trick?
Authors: Matwala K , Iqbal M R , Shakir T , Karamanakos S 
Published: October 2021

Abstract

Aim
The landmark case of Montgomery v Lanarkshire Health Board led to the defensive Bolam test being discredited and paved the way healthcare professionals (HCP) obtain informed consent. The recent GMC guidance on Decision Making and Consent 2020, states that the HCP should discuss recognised risks that they believe anyone in the patient’s position would want to know. Laparoscopic cholecystectomy is one of the most common general surgical procedures performed in the UK. Chronic diarrhoea is a well-recognised complication with significant impact on patient quality of life (QoL). We aimed to assess quality of consent forms for laparoscopic cholecystectomies with emphasis on documentation of chronic diarrhoea being a consequence of the procedure.

Method
A retrospective review of all elective laparoscopic cholecystectomy consent forms over a 2-month consecutive period from July 1st 2020 to August 31st 2020 was carried out.

Results
43 consent forms were audited. The majority of these consent forms were done by consultants (74.4%: 32/43) while 23.2% (10/43) by registrars. Overall, 39.5% (17/43) of patients were consented for experiencing chronic diarrhoea. Registrars more commonly mentioned diarrhoea (60%: 6/10) compared to consultants (31.2%: 10/32).

Conclusions
The majority of patients undergoing laparoscopic cholecystectomy are not consented for post-cholecystectomy diarrhoea which is a significant QoL-altering complication. Education combined with a standardised consent form and issuing of patient leaflets will improve consenting for chronic diarrhoea.
272 Effectiveness of Intraoperative Botulinum Toxin Injection on Gastric Emptying During Oesophagectomy: A Systematic Review
Authors: Hraishawi I , Khan S Z , MacAulay G 
Published: October 2021

Abstract

Introduction
Oesophagectomy is the standard of care for resectable oesophageal carcinoma and remains pivotal for curative treatment. Pull-up with gastric conduit remains the most common reconstruction. Delayed gastric emptying (DGE) is a recognised complication and may lead to delayed postoperative recovery and prolonged hospital stay. Botulinum Toxin BTA has been used to relax the hypertonic pylorus intraoperatively and improve DGE. The aim of this review was to assess the efficacy of intraoperative BTA on gastric emptying and the need for postoperative endoscopic pyloric intervention (EPI).

Method
Systematic review of literature was conducted using electronic database searched up to October 2020 including Cochrane Library, Medline, Embase and Goggle Scholars to identify relevant studies. Data was extracted and critically appraised by two independent authors.

Results
Eleven studies were included for systematic review with 1800 patients assigned to either BTA, pyloroplasty, pyloromyotomy, or no-intervention. Ten were observational studies and one was a randomised experimental study. Only one study reported a statistically significant benefit of BTA on early DGE (Day 4, 59%, P &lt; 0.001). Three studies reported higher rates of postoperative EPI when chemical pyloroplasty was used. Length of Hospital stay was higher for patients who had BTA compared to other techniques in three studies.

Conclusions
This systematic review did not demonstrate any significant benefit of intraoperative BTA on gastric emptying on the long term. The rate of endoscopic pyloric intervention was higher in these patients as reported by some studies. Further studies are required to investigate the outcome of chemical pyloroplasty during esophagectomy.
346 Meta-Analysis of Simultaneous Versus Staged Colorectal and Hepatic Resections for Colorectal Cancer with Synchronous Hepatic Metastases
Authors: Nawaz G , Qayum M , Hajibandeh S , Hajibandeh S 
Published: October 2021

Abstract

Aim
To evaluate the comparative outcomes of simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases

Method
We conducted a systematic search of electronic information sources, and bibliographic reference lists. Perioperative morbidity and mortality, anastomotic leak, wound infection, bile leak, bleeding, intra-abdominal abscess, sub-phrenic abscess, reoperation, recurrence, 5-year overall survival, procedure time, and length of hospital stay were the evaluated outcome parameters. Combined overall effect sizes were calculated using random-effects models.

Results
We identified 41 comparative studies reporting a total of 12,081 patients who underwent simultaneous (n = 5,013) or staged (n = 7.068) resections for colorectal cancer with synchronous hepatic metastases. The simultaneous resection was associated with significantly lower rate of bleeding (OR: 0.60, p = 0.03) and shorter length of hospital stay (MD:-5.40, p &lt; 0.00001) compared to the staged resection. However, no significant difference was found in perioperative morbidity (OR:1.04, p = 0.63), mortality (RD:0.00, p = 0.19), anastomotic leak (RD:0.01, p = 0.33), bile leak (OR:0.83, p = 0.50), wound infection (OR:1.17, p = 0.19), intra-abdominal abscess (RD:0.01, p = 0.26), sub-phrenic abscess (OR:1.26, p = 0.48), reoperation (OR:1.32, p = 0.18), recurrence (OR:1.33, p = 0.10), 5-year overall survival (OR:0.88, p = 0.19), or procedure time (MD:-23.64, p = 041) between two groups.

Conclusions
Despite demonstrating nearly comparable outcomes, the best available evidence (level 2) regarding simultaneous and staged colorectal and hepatic resections for colorectal cancer with synchronous hepatic metastases is associated with major selection bias. It is time to conduct high quality randomised studies with respect to burden and laterality of disease. We recommend the staged approach for complex cases.
430 Evaluation of A Prioritisation Policy for HPB Resections in the COVID-19 Era
Authors: El-Koubani O , Schneider C , Srinivasan P 
Published: October 2021

Abstract

Aim
The COVID19 pandemic has caused oncological services worldwide to face unprecedented challenges resulting in treatment disruptions for cancer patients requiring surgery. Hepatopancreatico-biliary cancers are characterised by a low resectability rate and rapid progression. This study aims to assess the effectiveness of a prioritisation policy for this cohort of patients during the initial COVID19 outbreak.

Method
The prioritisation policy and triage system are described in detail. Patients undergoing surgery between April-July 2020 (COVID period) were compared to a control group from the preceding year. Statistical analysis was carried out to evaluate timeliness of treatment, peri-operative characteristics and short-outcomes.

Results
Patient selection was restructured to prioritise patients with performance status of &lt; 2 with presence of cancer complications, borderline resectable- or biologically aggressive disease. Where feasible, neoadjuvant therapy was advocated. An elective safe corridor pathway was established to reduce the risk of COVID19 infection. During the COVID19 and pre-COVID19 period, 94 and 115 patients underwent surgery, respectively. No patients contracted COVID19 post-operatively. There were less patients with ASA≥3 during the COVID19 period vs. pre-COVID19 (12.8% vs. 34.2%; p &lt; 0.001). Median time between referral and surgery was greater during the COVID19 compared to the pre-COVID19 period, at 64 days vs. 49 days, respectively (p = 0.023). Despite this difference no NHS waiting list breaches occurred. Incidence of postoperative complications were comparable between groups.

Conclusions
The outlined prioritisation policy for oncological hepatopancreatico-biliary resections was effective in providing safe surgery during the COVID-19 outbreak. Whether the observed delay in treatment will affect long-term outcomes remains to be seen
435 Meta-Analysis and Trial Sequential Analysis of Randomized Controlled Trials Comparing Standard Versus Extended Lymphadenectomy Pancreatoduodenectomy For Adenocarcinoma of The Head of Pancreas
Authors: Kotb A , Hajibandeh S , Hajibandeh S , Satyadas T 
Published: October 2021

Abstract

Aim
To compare baseline demographics, operative, and survival outcomes of randomized controlled trials (RCTs) comparing standard versus extended lymphadenectomy in patients undergoing pancreaticoduodenectomy for pancreatic head cancer

Method
we performed a meta-analysis of baseline demographics, operative, and survival outcomes of RCTs comparing standard versus extended lymphadenectomy in patients undergoing pancreaticoduodenectomy for pancreatic head cancer. The uncertainties associated with varying follow-up periods among the included studies were resolved by analysis of time-to-event outcomes. Moreover, we performed trial sequential analysis (TSA) to determine whether the available evidence is conclusive and to assess the risk of type 1 or type 2 errors.

Results
Overall, 724 patients from 5 RCTs were included. There was no difference between standard and extended lymphadenectomy in terms of pancreatic fistula (OR0.64, P = 0.11), delayed gastric emptying (OR 0.68, P = 0.40), bile leak (OR 0.33, P = 0.06), wound infection (OR 0.53, P = 0.06), abscess (OR 0.83, P = 0.63), total complications (OR 0.73, P = 0.27), postoperative mortality (OR 1.01, P = 0.85), and overall survival (HR 1.10, P = 0.46). TSA suggested that meta-analysis was conclusive with low risk of type 2 error.

Conclusions
Robust evidence from randomized controlled trials (Level 1) suggests no difference in postoperative and survival outcomes between standard and extended lymphadenectomy in patients undergoing pancreaticoduodenectomy for pancreatic head cancer. The findings were consistent in patients with positive and negative lymph node status and in studies from the West or East.
473 A Review of The Risk Stratification Models Used in The Management of Oncological Hepato-Pancreato-Biliary Surgical Patients
Authors: Coombs A , Jordan C , Hussain S , Ghandour O 
Published: October 2021

Abstract

Introduction
Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) subspecialty is limited as concerns over precision and applicability prevent widespread clinical implementation. The aim of the review is to discuss clinically useful oncological scoring systems for the surgical management of HPB patients.

Method
Primary articles of validated novel and established scoring systems were searched over a 25-year period using PubMed, Cochrane and Ovid Medline.

Results
This review discusses 9 clinically useful scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong et al.), pancreas (Genc et al., mGPS) and biliary tract (TMHSS, MEGNA). CLIP and BCLC are extensively validated prognostic tools, with BCLC clinically endorsed by guidelines. Conversely, patient and treatment stratification is limited in CLIP and BCLC respectively - ALBI works to improve patient stratification. RETREAT, Fong et al. and Genc et al. scores predict recurrence following surgery, however these scores require further validation in heterogenous patient groups. mGPS and MEGNA are simple prognostic scores, but also require further validation in varied patient cohorts. TMHSS is user-friendly, however is limited at discriminating treatment for the middle patient group.

Conclusion
A diverse range of HPB surgical scoring systems may facilitate evidenced-based treatment decisions and improve management. Future scoring systems need to be developed on heterogenous patient cohorts with improved stratification, with current trends towards implementing machine learning and genetics to improve outcome prediction.