bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.TH.756Post-operative sepsis: Is CT reliable in diagnosing the cause of post-operative sepsis?
Authors: Chidambaranath Rajesh , Rajebhosale Ramprasad , Thomas Pradeep 
Published: October 2021

Abstract

Aim
To assess the reliability of computerised tomography in post-operative sepsis in patients who previously underwent laparotomy in the same hospital admission.

Introduction

Method
This study was done on re-operations following an abdominal operation from April 2012 to April 2016 at a district general hospital. Data regarding demography, initial operation, post-operative problems, pre-operative diagnosis, and use of computed tomography, the findings on CT, and operative findings were collected. A comparison was made between the CT findings and findings on re-laparotomy. Also noted was the number of patients who did not have a re-laparotomy following CT.

Result
There were 87 patients, of whom, 10 had no accessible notes and were removed from the list. Of the remaining 77, 53(68.8%) had CT scans, 24 did not (31.2%). Of these that had CT, 29 (54.7%) had findings which matched with intra-operative findings on re-laparotomy, in 12 (22.6%) CT findings did not match 4(7.5%) had minor findings not needing surgery and 8(15.5%) had normal or insignificant findings.

Conclusions
We found in this study that, CT did have a significant contributory role in the arsenal of methods to aid source control in those patients that are septic following an abdominal operation, and this should be used as a pre-operative diagnostic modality.
EP.TH.919Developing A Fast Track Paediatric Herniotomy Service In A District General Hospital
Authors: Chituku Tsitsi , Gupta Pradip , Bartholomew Karen , Moncrieff Michael 
Published: October 2021

Abstract

Introduction
Previously to 2011, babies presented as emergency to our Trust with irreducible inguinal hernia at a rate of 1 baby/year. They were referred to our regional tertiary centre for surgery because there is no out of hours Paediatric Surgeon or Anaesthetist. Usually, patients were either, awaiting an appointment to see surgeon or on an 18-week waiting list. The aims of this SIP were to: expedite elective surgery for paediatric inguinal hernias, and prevent emergency paediatric inguinal hernia referrals to our tertiary centre.

Method
Referrals to paediatric surgical clinics were triaged by the clinic sister. Hernia referrals were expedited to the next available clinic. A provisional date for surgery was arranged ASAP with an identified surgeon and anaesthetist whilst in clinic. Patient demographics and data collected retrospectively.

Results
A 73% reduction in waiting time for surgery, 1 baby (1.4%) presented as emergency and was referred to our tertiary centre for surgery, the post-op complication rate fell from 6.5% to 0%.

Conclusion
The success of the fast-track paediatric herniotomy service at our DGH shows that it is possible to provide timely and safe surgery in a DGH in line with the recommendations of the Paediatric Critical Care and Surgery in Children Review (November 2019).
Moy.02Using aboutmyop.org as an alternative method for post-operative follow-up after elective laparoscopic cholecystectomy – a feasibility study
Authors: Daliya Prita , Carvell Jody , Rozentals Judith , Ubhi Maria , Lobo Dileep , Parsons Simon 
Published: October 2021

Abstract

Introduction
The majority of institutions no longer offer routine post-operative follow-up after elective laparoscopic cholecystectomy. National guidelines however recommend the use of post-operative hotlines or planned telephone follow-up for day-case procedures. At a time when NHS resources are limited, a digital solution may provide a safe alternative to telephone or physical follow-up. Our aim was to identify if digital follow-up with aboutmyop.org; a digital data-sharing platform, was equivalent to telephone follow-up.

Method
Study participants were invited to use aboutmyop.org before and after surgery. Patients were given free choice on whether they opted to use post-operative digital follow-up or routine post-operative care (no follow-up or telephone follow-up). In addition to follow-up compliance, the outcomes measured included 30-day post-operative complications, readmission, and re-operation.

Results
Of 597 laparoscopic cholecystectomy patients who were offered follow-up, 16.4% opted for digital follow-up, and 33.3% phone follow-up. Over 5 times as many patients who opted for telephone follow-up missed their appointment when compared to those who chose digital follow-up (5.6% vs. 30.9%, p &lt; 0.001). Digital follow-up had a high sensitivity (68.2%-100%) and specificity (100%) for identifying complications at 30-days post-operatively and was completed significantly earlier than phone follow-up (median 6 days vs. 13.5 days, p = 0.001) with high patient acceptability.

Conclusion
This feasibility study demonstrates that digital follow-up utilising the aboutmyop.org platform is an acceptable alternative modality to telephone follow-up in elective laparoscopic cholecystectomy patients. Future work should aim to compare matched cohorts of patients undergoing digital follow-up, telephone follow-up, and no follow-up as a randomised controlled trial.
BJS.01Antibiotics as an alternative to appendicectomy in uncomplicated adult appendicitis: analysis of a prospective, multicentre cohort study
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Hollyman Marianne , Lund Jonathan , Moug Susan , Tierney Gillian 
Published: October 2021

Abstract

Aims
Recent randomised controlled trials have shown that non-operative management of acute appendicitis with antibiotics can prevent the need for surgery in 71-84% of patients within 90-days. Changes in the management of appendicitis, brought about by the COVID-19 pandemic, have allowed for this large-scale observational study, which aims to report the outcomes of operative and non-operative management of appendicitis, including non-operative management rates at 90-days.

Methods
This prospective, multicentre cohort study at 97 sites across Great Britain and Ireland included adult patients with a clinical or radiological diagnosis of appendicitis. Propensity-score matching was conducted using age, sex, BMI, frailty, co-morbidity, adult appendicitis score and CRP. Outcomes in the non-operative group were 90-day treatment failure, and in the matched groups 30-day complications and length of hospital stay (LOS).

Results
This analysis included 3420 patients, of whom 1402 (41%) had initial non-operative treatment and 2018 (59%) had operative management. The success rate of non-operative management was 80% (1116) at 90-days, with 18 patients (6%) that failed non-operative management having a histologically normal appendix. Following propensity score matching, 2444 patients were included in the outcomes analysis. In the propensity score matched groups, there was a reduction in complications in the non-operative management group compared to the operative group (OR 0.36; 95% CI 0.26 to 0.50) and a shorter median LOS (2.5 vs 3 days, p &lt; 0.001).

Conclusions
Non-operative management of appendicitis is associated with fewer complications, a shorter LOS, and avoids surgery in the majority of patients.
NELA.01The Impact of Laparoscopy on Emergency Surgery for Adhesional Small Bowel Obstruction: Prospective Single Centre Cohort Study
Authors: Darbyshire Alexander , Kostakis Ina , Pucher Phil , Toh Simon , Mercer Stuart 
Published: October 2021

Abstract

Aims
Laparoscopic adhesiolysis is being increasingly used to treat adhesional small bowel obstruction (ASBO). However, concerns regarding iatrogenic bowel injury and failure to relieve the obstruction have limited its uptake. This study reports our centre’s experience of adopting laparoscopy as the standard operative approach for ASBO.

Methods
A single centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; 01/01/2015-31/12/2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and in-hospital outcome data were compared between different surgical approaches. Linear regression analysis was performed for length of stay.

Results
Of 299 cases, 76.3% were started laparoscopically and 52.2% successfully completed. Rates of attempted laparoscopy increased over the 5 year period. Patients treated laparoscopically had lower P-POSSUM-mortality (2.1 vs 5.7%, p = &lt;0.001), shorter post-operative LOS (4.2 vs 11.3 days, p = 0.000) and lower in-hospital mortality (2 vs 7 deaths, p = &lt;0.001). In regression analysis, laparoscopy had the strongest association with post-operative LOS ( 8.51, p = 0.002).

Conclusion
Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is now the standard approach in our centre, with 83.3% of cases started laparoscopically in 2019. It is associated with reduced post-operative length of stay with no impact on complications or mortality. This challenges the widely held view that laparoscopy should be for selected, straightforward cases.
NELA.02Trends in management and outcomes for patients presenting acutely with inguinal hernia
Authors: Clyde Danielle , Li Lucy , Swan Rebecca , McLean Ross , Brown Leo 
Published: October 2021

Abstract

Aims
Rates of emergency inguinal hernia presentations are increasing as ‘watch and wait’ management approaches become more popular. This study aimed to review current practice regarding clinical management of patients admitted acutely with an inguinal hernia in the North of England.

Methods
Patients ≥18 years admitted acutely with an inguinal hernia between 2002-2016 to North of England NHS trusts were identified. Data on demographics, investigations and operative interventions was collected. Outcomes analysed included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality.

Results
A total of 4698 patients presented acutely with an inguinal hernia, and 2588 patients (55.0%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.1% (2012-2016) (p &lt; 0.001). Patients who had a pre-operative CT were less likely to undergo repair than those who did not (42.2% vs. 56.0%, p &lt; 0.001). Rates of bowel resection were higher in patients who had a CT (9.6% vs. 2.7%, p &lt; 0.001). Of those presenting with obstructive symptoms, only 5.7% required bowel resection, 85.7% of these being small bowel. Bowel resection was associated with increased LoS (p &lt; 0.001) and 30-day postoperative mortality (18.8% vs. 2.0%, p &lt; 0.001). Laparoscopic repair, used in 119 procedures (4.6%), was associated with shorter mean LoS compared with open repair (3.0 vs 4.4 days, p &lt; 0.001) but no difference in 30-day mortality (p = 0.169).

Conclusions
Emergency inguinal hernia repairs, requiring bowel resection, are associated with significantly increased LoS and a 9-fold increase in 30-day mortality. These findings raise important aspects to be discussed with patients during the consent process.
EP.TU.19Are virtual journal clubs a viable alternative in the Covid-19 era?
Authors: Morris James , Jenney Heloise , Park Chang , Scarborough Alexander , Antoniou Vaki , Anakwe Raymond 
Published: October 2021

Abstract

Introduction
During the COVID-19 pandemic, face to face journal clubs have been curtailed due to Governmental guidance for social distancing. We present an example of a virtual journal club set up for Orthopaedic senior house officers (SHOs) & trainees in the North West Thames (NWT) Deanery from April to August 2020.

Methods
Our aims were to establish a regular online journal club for orthopaedic trainees in NWT that successfully met the objectives of the more established face to face meetings. Assessment of each session was evaluated using a post attendance survey created using an established online generator.

Results
64.4% (16/25 participants) had not attended a virtual journal club before, with 100% (33/33) reporting that they would attend another virtual journal club. 39.4% (13/33) of attendees agreed or strongly agreed that they could participate in sessions over more conventional meetings. 24.2% (8/33) of participants reported experiencing technical issues during the sessions. 90.9% (30/33) of respondents reporting the virtual model to be more convenient than standard journal clubs.

Conclusion
The potential benefits of significantly increased accessibility, increased visiting expert contribution whilst still adhering to government guidelines; weighed against marginally less effective teaching nonetheless results in an overall benefit
EP.TU.54Surgical curriculum concordance: requiem for the educational dream
Authors: Luton Oliver , James Osian , Mellor Katie , Eley Catherine , Egan Richard , Lewis Wyn 
Published: October 2021

Abstract

Aim
This study aimed to analyse the degree of relative variation in specialty-specific competencies required for Certification of Completion of Training (CCT) set by the UK Joint Committee for Surgical Training (JCST) 2021 curriculum.

Methods
Regulatory body guidance related to operative and non-operative surgical skill competencies required for CCT were analysed and compared.

Results
Wide inter-speciality variation was demonstrated in the minimum number of logbook cases (median 815; range 54-2100), indexed operations (8; 5-24), Procedure Based Assessments (35; 6-110). Academic competencies related to peer reviewed publications, communications to learned societies, and audits were aligned at zero, zero, and three across specialties respectively. Mandatory courses have been standardised with Advanced Trauma Life Support (ATLS) being the sole pre-requisite CCT for all.

Discussion
JCST certification guidelines have broadly standardised competency domains, yet large discrepancies persist regarding operative indicative numbers, and assessments. This article serves as a definitive CCT guide regarding prevailing changes.
EP.TU.55Increased Communication within hospitals enhances Catheter Care for Colorectal patients
Authors: Bernstein Darryl , Hemaya Maria , Chia Jenny , Subhani Benjamin , Nunn Rebecca , Gupta Vivek 
Published: October 2021

Abstract

Audit Aims
1. To quantify staff compliance in documenting catheter insertion using newest (2019) vs older (2011) Catheter Care Plans (CCPs) in our hospital.
2. To assess completion of CCPs against NICE Quality Guidelines on Infection Prevention and Control1.
3. To action (and measure the impact of) interventions to improve CCP completion.

Methods
CCPs for all emergency and elective colorectal surgery patients with a urinary catheter inserted in our hospital, over a three-week period, were analysed. Interventions (including distributing new CCPs and placing posters) were implemented to raise awareness of desired documentation standards. Post-intervention, the audit loop was closed via a two-week analysis of a similar cohort.

Results
Pre-intervention, 25% of the 20 CCPs were new. The average completion rate of new and old CCPs, respectively, was 63.48% ±9.53% and 49.28% ±7.65%. Post-intervention, 66.6% of the 18 CCPs were new. The average completion rate of new and old CCPs, respectively, was 49.28% ±18.48% and 42.75% ±3.27%. Aside from one uncompleted, new CCP post-intervention, which skewed the results, we were 100% compliant with overall guidance on NICE1.

Conclusions
Increased communication between the wards and theatre teams is pivotal to ensure optimal catheter care for patients. Improvement points include: replacement of residual old forms with new CCPs, and more education to ensure correct completion of new CCPs. Further progress requires both awareness and availability of patient advice leaflets and catheter passports, as well as reminding staff of NICE Quality Guidelines1.
EP.TU.141A 5-year Post Colonoscopy Colorectal Cancer audit with focus on root cause analysis and performance at York Teaching Hospital
Authors: Elsayeh Karim , Brown Alexander , Chintapatla Srinivas , Lim Michael 
Published: October 2021

Abstract

Introduction
Post colonoscopy colorectal cancer (PC-CRC) is an important benchmark of endoscopy performance. Previous publications have reported significant variations between institutions. We chose to perform the root cause analysis (RCA) and the impact of traditional performance indicators on the likelihood of PC-CRC.

Methods
A retrospective analysis was performed on all PCCRC at York Hospital. Electronic endoscopic records and case-note review was performed to identify appropriate cases. Root cause analysis was performed on all identified cases. Performance data and annual procedural volumes of endoscopist were recorded. Adjusted PC-CRC/5-year period allowed endoscopist to be divided into good (&lt;4 PC-CRC) and poor performers (³4 PC-CRC). Mann Whitney U test used to compare groups. P-value of &lt; 0.05 deemed significant

Results
32 (24 male) patients with a PC-CRC were identified . Median age was 72 (IQR 63-79) years. Table provides PCCRC rate for the 5-year period. Root cause analysis identified that most plausible cause was missed lesions despite adequate bowel preparation (76%). The commonest subtype was non interval C (38%). Three out of 18 endoscopist had a higher 5-year adjusted PC-CRC rate and were poor performers. Median withdrawal times, CIR and ADR did not differ between good and poor performers.

Conclusion
The overall PC-CRC rate at our institution is within an acceptable rate. We have noted significant variation of performance between endoscopist, the exact reasons for this observation require further examination.
EP.TU.160Does a foundation interim year one post improve confidence in the care of the dying of general surgical patients in a tertiary centre?
Authors: George Jayan , Mathew Alok , Botsford Edward , Al-Mukhtar Ahmed 
Published: October 2021

Abstract

Aims
1. Understand the confidence levels of current foundation year one (FY1) doctors.
2. Understand whether an interim foundation year one (FiY1) post improves confidence.

Methods
FY1s were surveyed throughout August – December 2020. Six questions used Likert scales (1 to 5: not at all confident to very confident) over some common palliative care themes. Data was initially inputted using Google Docs and analysed in Microsoft Excel.

Results
26.7% (28/105) of FY1s completed the survey. 28.6% (8/28) did not undertake a FiY1 post and 71.4% (20/28) did.
Confidence levels were higher for FY1s who did have a FiY1 post compared to those that did not in managing pain control, psychological distress, spiritual health, speaking to family and the patient in the last days of life.
Confidence levels were similar for all FY1s for dealing with social issues.

Conclusions
FY1s who have had a FiY1 post in a tertiary centre have more confidence in most areas but not all. This data shows the value of the FiY1 post however work needs to be done to improve the experience to the role.
EP.TU.169Gender Representation in the Authorship of Surgical Journals
Authors: Arshad Serish , Gallivan Elisha , Skinner Helen , Burke Joshua , Young Alastair 
Published: October 2021

Abstract

Aims
Despite the increase in female doctors graduating from medical schools internationally, gender disparity in surgery remains. This disparity is also evident in academic surgery. This study aims to quantify the extent of gender disparity in the authorship of articles in major surgical journals.

Methods
The Top 10 Surgical Journals were identified using SCImago Journal Rank indicator. Authorship details for papers published in 2019 were collected. Authors were assigned as female, male or unknown using Gender API software (Gender API, Germany). For each journal, the percentage of first author, last author, corresponding author and all authors split by gender was interrogated. Gender differences by publication type were also identified.

Results
9 of the 10 journals had full names publicly available. Overall, 2414 manuscripts were interrogated which included 16,277 number of authors. Respectively, females and males accounted for 29.8% [22.9-34.9%] (N = 655) and 62.4% [56.3-70.2%] (N = 1419) of first authors, 20.6% [11.8-27.1%] (N = 453) and 74.2% [65.6-84.1%] (N = 1706) of last authors, 23.9% [14.9-29.6%] (N = 510) and 69.9% [60.5-79.3%] (N = 2341) of corresponding authors and in total 27% [19.4-31.6%] (N = 4298) and 65.5% [58.6-73.4%] (N = 9982) of all authors. The wide range in these results could be due to various factors.

Conclusion
This study has identified a gender imbalance in authorship positions, with the greatest difference observed in the most senior author position. Whether this is reflective of the current disparity observed in senior academic surgery positions or due to gender discrimination is unclear.
EP.TU.170Audit to assess the management of patients presenting with lower gastrointestinal (LGI) bleeds in the Trust
Authors: Venkatesh Ashwini , Keeler Barrie , Khanna Achal 
Published: October 2021

Abstract

Aims
To identify presentations of LGI bleeds, assimilate learning and make appropriate recommendations to improve management in hospital.

Methods
336 patients with ‘PR bleed’ on their coding summary in 2019 were identified. Data obtained through eCare and EDM was analysed as outlined:

Results
69% were emergency presentations of LGI bleed and the remaining 31% were elective admissions. 5% of emergency LGI bleed patients were discharged on the same day as compared to 97.4% of elective patients.
The remaining 80% of emergency patients went on to have outpatient investigations. Positive cases included haemorrhoids, inflammatory bowel disease and diverticulitis.

Conclusions
All emergency presentations occurred during inpatient stay creating disparities in manner of presentation and duration of admission between cohorts. However, outcomes between the cohorts were broadly similar, suggesting absence of significant disparities in management.
Colonoscopy is the gold standard diagnostic investigation in LGI bleeds however, flexible-sigmoidoscopy can be considered in under 50’s. 80% of patients had a colonoscopy during admission as per guidelines. No reasoning was documented for patients who underwent other methods of investigation as first-line, thus creating a need for improved documentation when deviating from guidelines.
Recommendation to re-audit in 1 year to assess changes.
EP.TU.193Omental band - A unusual cause of mechanical small bowel obstruction in a virgin abdomen
Authors: Loganathan Santhosh , O'Connor Adam , Singh Amal , Fani Mazyar 
Published: October 2021

Abstract

Introduction
The small bowel obstruction in a non-operated abdomen is rare, and the most common causes are hernia and neoplasm. The complete mechanical small bowel obstruction due to an omental band in a patient with no previous abdominal surgery is rare, and less than five cases have been reported in the literature.

Case presentation
We report a 65 year old male patient presented to the emergency department with complaints of abdominal pain, distension, vomiting and obstipation for four days. On clinical examination, his abdomen was distended, diffusely tender, guarding. The blood investigations showed elevated White blood cells and neutrophils with normal CRP and the Serum lactate. The Abdominal X-ray was suggestive of SBO. The Computed tomography of the abdomen and pelvis showed marked dilatation of the jejunum, the ileum is entirely collapsed, the impression of a double beak sign in the mid-abdomen which would suggest closed-loop obstruction due to a possible internal hernia. We proceeded with emergency diagnostic laparoscopy converted to laparotomy, which showed omental band causing closed-loop proximal small bowel obstruction. The bowel loops appeared congested with the constriction band due to omental band. The omental band was divided, and the obstruction was relieved. Postoperatively patient recovered well and was discharged on day three post-op.

Discussion
The timely diagnosis and intervention could prevent complications like strangulation, ischemia and gangrene. Though the omental band is rare, it should still be suspected as an aetiology in patients without prior abdominal surgery.