bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP4.1.4 Stay at home, protect the NHS, Save lives? The impact of the COVID-19 pandemic on acute surgical services
Authors: Brewster Oliver , Thompson Dale , Sewart Emma , Richards Sarah 
Published: October 2021

Abstract

Aims
Several centres described a ‘lockdown effect’: a reduction in emergency surgical admissions during national lockdown (23/03/20-01/06/20). The extent and reproducibility of this is unclear. We evaluated the impact of the COVID-19 pandemic on emergency general surgical activity in a district general hospital.

Methods
We conducted a retrospective analysis of patients admitted under general surgery and urology between 01/01/2017-31/12/2020 using coding data. Unpaired t-tests were used to compare the total monthly admissions, admissions by diagnosis and monthly operations performed between the ‘first wave’ (April-May 2020) and ‘average’ (all months 2017-2019), and between the ‘second wave’ (November-December 2020) and average.

Results
Overall emergency admissions in 2020 were reduced compared to the mean 2017-2019 (4498 vs 5037). Monthly admissions were significantly reduced in the first wave compared to 2017-2019 (mean monthly admissions=284.5 vs 419.8; p &lt; 0.001) with the greatest reduction in patients with non-specific abdominal pain (mean=58 vs 109; p = &lt;0.001). A significant reduction in monthly admissions with pancreatitis (mean=8.0 vs 14.6; p = 0.010) and diverticulitis (mean=10.5 vs 18.8; p = 0.028) were also observed. This effect was less apparent during the second wave (mean total admissions=384.5 vs 419.8; p = 0.249). Monthly emergency operations were reduced in both the first wave compared to average (68 vs 101.9; p = 0.007) and the second wave (74.5 vs 101.9; p = 0.025).

Conclusions
We found strong evidence of a ‘lockdown effect’ in our centre during the first wave. The cause is unclear and likely to be multifactorial. Further research is needed to evaluate whether surgical patients came to harm as a result.
SP4.1.7 Colorectal Cancer: Pathway Disruptions as a Result of COVID-19
Authors: Spyropoulou Liana E , Curley Daniel , Li Mimi , Martin Estelle , Wynn Greg , Doulias Triantafyllos 
Published: October 2021

Abstract

Aims
COVID-19 has impacted diagnosis and treatment of colorectal cancer. Efforts to minimise patient contact have caused delays in cancer pathways, generating a potential risk to patient care. We aim to identify the pandemic effect on colorectal referral pathways.

Methods
All cancer referrals during March-June 2020 were reviewed to obtain information on the timeline and planning of investigation and treatment. The data was compared to evidence from the same referral period in 2019.

Results
681 referrals were received during March-June 2020, compared to 1032 in 2019, indicating a 34% decrease. The majority of patients were reviewed in telephone clinic (76.2%) rather than physical appointments (15.4%). Although the commonest mode of investigation was endoscopy(46.2%), there was increased use of CT scan(35.8%). 114(17.1%) patients were not investigated, of which 40(35.1%) declined investigation, primarily due to COVID-19 apprehension. 6 patients were re-referred and 67(58.8%) were removed from the pathway for unknown reasons. 1 patient was subsequently admitted as an emergency. There were 44 new diagnoses of colorectal cancer based on MDT discussion, of which 14(31.8%) breached the investigation and 20(45.5%) the treatment date. 18 underwent curative surgery compared to 47 in the same period in 2019, indicating 61.7% less operative activity.

Conclusions
COVID-19 has changed surgical practice, forcing alternative clinic, investigation and treatment methods. Disruption of colorectal pathways is causing reduced referrals, investigation delays and less surgical activity. Delayed presentation with advanced disease may deprive the opportunity of treatment with curative intent.
SP4.1.11 Acute general surgical emergency and COVID-19 is a pandemic challenge for surgeons: a UK based practical experience
Authors: Nahid Md Abu Kamal , Rahman Sanjida , Shah Ankur 
Published: October 2021

Abstract

Background
Transmission of COVID-19 is a considerable risk during the perioperative period of emergency surgery. We aimed to provide a practical experienced adaptation to reorganize the emergency surgical pathways during the COVID-19 pandemic.

Methods
A prospective observational study was performed between 30th March 2020 to 30th June 2020 at a large DGH in England. The primary outcome was perioperative COVID-19 related complications and secondary outcome measures included incidence of COVID-19 infections among the surgical doctors and healthcare workers. Data was collected on the number of acute surgical admissions and operations performed. The perioperative COVID-19 status of the patients, doctors and the healthcare workers were recorded.

Results
584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted with COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors, 11 nurses and theatre staff were confirmed for COVID-19 by swab test. Acute cholecystitis and early appendicitis were managed conservatively.

Conclusion
High mortality (20%) observed among the patients who contracted COVID-19 perioperatively. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.
SP4.2.5 Did COVID-19 change the way we treat appendicitis?
Authors: Hurt Libor , Mowbray Nicholas , Powell-Chandler Anna , Reeves Nicola , Chandler Susan , Walters Emyr 
Published: October 2021

Abstract

Intro/aims
In repsonse to the COVID-19 pandemic, the United Kingdom (UK) commenced a national lockdown in March 2020. Initial guidance advocated the avoidance of aerosol generating procedures and hence we hypothesised there would be a decrease in the use of surgery to treat acute appendicitis.

Methods
A prospective audit was undertaken across 4 hospitals in South Wales, UK, during April 2020. Patients over 18 years of age with suspected or confirmed appendicitis were identified and data was collected including their history, radiological findings, management, and re-admission. Comparison was made with theatre and radiological data from April 2018 and 2019.

Results
A total of 254 patients were treated over the 3-year period; 95 patients in 2018, 95 in 2019 and 64 in 2020. During the lockdown, the use of Computed Tomography (CT) increased from 36.3% to 85.9% (p &lt; 0.001). An antibiotic only approach to treat appendicits rose from 6.2% to 40.6% (p &lt; 0.001). Four patients in the lockdown cohort failed the conservative approach and required an appendicectomy. The overall rate of laparoscopic appendicectomy was reduced from 85.3% to 17.2% (p &lt; 0.001). A malignancy was identified in 3% of cases.

Conclusions
Whilst less patients presented with acute appendicitis compared to previous years, there was still a significant reduction in the operation rate. The data aligns with the literature confirming the antibiotic-only approach to be safe with a low failure rate. It is essential however that patients are fully consented for this approach including the risk of a missed malignancy.
SP4.2.8 Does Care quality commission need to change its inspection strategy after COVID-19?
Authors: Bodapati Shruti , Gambhir Raghvinder 
Published: October 2021

Abstract

Aim
To see if the Care quality commission’s (CQC) overall inspection ratings and specific domain ratings had any association with COVID-19 related deaths.

Methods
We looked at CQC ratings of the Shelford group of trusts and 10 trusts with maximum number of deaths in the time period from the first wave till 23rd January 2021. We then looked at each of the 5 domains: safe, effective, caring, responsive, and well led, to see if they were in any way indicative of the number of deaths in that trust.

Results
Among the 19 trusts studied (one trust featured in both groups) only 1 had an overall outstanding rating; 10 were rated good, 8 required improvement. None were rated inadequate in any of the domains, 16 /19 were rated good in effective domain which means “there care, treatment and support achieves good outcomes”. In safe domain 13/ the 19 were rated as requires improvement which means that “a patient may not be protected from avoidable harm”.

Conclusion
COVID-19 is no respecter of the CQC ratings, even if the trust was rated as well led and had good ratings in all other domains it could still have the highest mortality figures from COVID in the UK. CQC probably needs to add a 6th domain to its future inspections to assess the readiness the trusts for future Pandemics.
SP5.1.4 A meta-analysis on the impact of bariatric surgery on lower urinary tract symptoms in men
Authors: Stefanova Irena , Currie Andrew , Newton Richard , Albon Lorraine , Hawkins William , Pring Christopher 
Published: October 2021

Abstract

Background
Obesity is a chronic disease with multisystem morbidity. There are multiple studies reporting the effect of bariatric surgery on cardiovascular and metabolic disease but only few examine its impact on lower urinary tract symptoms. This article aims to perform a systematic review with meta-analysis in order to determine the effects of bariatric surgery on lower urinary tract symptoms in male patients.

Methods
Medline, Embase, conference proceeding and reference lists were searched for studies reporting the quantative measurement of lower urinary tract symptoms score pre- and post-weight loss surgery. The primary outcome was International Prostate Symptom Score (IPSS) before and after bariatric surgery. Secondary outcomes were change in Body Mass Index (BMI) and Total Body Weight (TBW). Weighted mean differences (MD) were calculated for continuous outcomes.

Results
Seven studies were included in the analysis of 334 patients undergoing bariatric surgery. Mean study follow-up was between 3 and 36 months. There was a statistically significant improvement in the IPSS score following bariatric surgery (MD 2.82, 95% CI 0.96 to 4.69, p = 0.003). Bariatric surgery also resulted in statistically significant reduction of BMI and TBW.

Conclusion
Bariatric surgery produces a significant improvement on lower urinary tract symptoms in men with obesity. This may be due to improvement of insulin sensitivity, testosterone levels or lipid profile associated with weight loss. Further studies are necessary to investigate in detail the pathophysiological mechanisms through which lower urinary tract symptoms develop in obese patients, and their improvement following weight loss surgery.
SP5.1.7 What did we miss? A 5 - year retrospective cohort study calculating the endoscopy miss rate for UGI cancers in a Scottish district general hospital
Authors: Rashid M , Clyde D , Driscoll P J , Jafferbhoy H 
Published: October 2021

Abstract

Aims
Despite the widespread use of endoscopy, upper gastrointestinal (UGI) cancers still present at an advanced stage. As survival is closely linked to stage and time of diagnosis, failure to detect subtle precancerous changes at endoscopy may compound poor prognoses. This study calculates the miss rate of UGI cancer over a 5-year period at a district general hospital.

Methods
All patients diagnosed with UGI cancer between January 2015 - December 2019 were identified from a prospectively collected cancer registry. Electronic health records and Unisoft GI reporting tool were used to identify patient demographics and previous UGI endoscopies. ‘Missed cancers’ were defined as patients who had a normal endoscopy within 3 years of their cancer diagnosis.

Results
The median age at diagnosis was 72.2 years (age range 24 - 98, n = 408) with a male predominance of 2:1 (66.6% male vs 33.4% female) in keeping with UK statistics.
Within this 5 year study period, there were 22 missed cancers (5.4%, n = 408).
A year by year break down shows miss rate in 2015 of 3% ( 3,n=100), 2016 of 4.2% (5,n=120), 2017 5.5% (5,n=91), 2018 6.4% (6,n=94) and most recently in 2019 3.2% (3,n=94).

Conclusions
In 2014, a meta-analysis by S.Menon et al recorded a miss rate of 11.3%. More recently published UK studies report miss rates between 6% - 7.3%, more in keeping with our local rate of 5.4%. Further assessment is required to assess whether the 2017 BSG and AUGIS UGI endoscopy quality standard statement will improve this rate.
SP5.1.10 Quality of endoscopy reporting in newly diagnosed oesophageal cancers
Authors: Cunningham Danielle , Khan Khurram , Gall Lewis , Craig Carol 
Published: October 2021

Abstract

Aims
The gold standard for diagnosing oesophageal cancer is gastroscopy (OGD). It is essential that the index OGD report is of a high quality to enable effective communication and facilitate appropriate management decisions by the multidisciplinary team (MDT). This study aimed to analyse the quality of index OGD reports in patients with newly diagnosed oesophageal cancer.

Methods
A retrospective cohort study of all newly diagnosed oesophageal cancers registered in a UK Regional Upper GI MDT between October 2019 and September 2020. The index OGD reports were assessed for documentation of 11 previously published quality indicators (QIs) (including proximal and distal margins, level and involvement of oesophago-gastric junction and presence of Barrett’s) and compared by endoscopist grade and parent speciality.

Results
A total of 243 new oesophageal cancers were diagnosed by 86 individual endoscopists. Mean patient age was 69.9 ± 11.2 years and 168 (69.1%) were male. 60 (24.7%) had impassable cancers. Overall, the median total QIs recorded for passable cancers were 7 (IQR 6-8). No report included all QIs. 30 (17.1%) reports were of “good quality” (≥9 QIs). Non consultant grade were more likely to record perfoming retroflexion (82.7 vs 69.0%, p = 0.039). Non surgeons were more likely to take photos (80.8 vs 64.5%, p = 0.015), document Barrett’s (29.3 vs 11.8%, p = 0.006) and to record an overall greater number of QIs (median 8 vs 7, p = 0.011).

Conclusions
Current endoscopy reporting standards of new oesophageal cancers are suboptimal. Further endoscopist education is required to highlight essential QIs and ensure good quality OGD reporting.
SP6.1.8Fundus-first laparoscopic cholecystectomy for complex gallbladders: A systematic review
Authors: Boghdady Michael El , Arang Hossein 
Published: October 2021

Abstract

Aims
Retrograde ‘fundus-first’ cholecystectomy is when the dissection starts from the fundus of the gallbladder to the infundibulum, in case structures of Calot's triangle cannot be identified. Although feasible in laparoscopic cholecystectomy, it remains an underutilized approach. We aimed to systematically review the fundus-first laparoscopic cholecystectomy and study its safety and feasibility.

Methods
A systematic review was performed in compliance with PRISMA guidelines. A literature search was performed using PubMed/MEDLINE, ScienceDirect and Cochrane-Library for articles published from 2010 to 2020. Search keywords included ‘retrograde cholecystectomy’, ‘fundus-first cholecystectomy’ and ‘fundus-down cholecystectomy’. Quality assessments were applied using the Medical Education Research Quality Instrument (MERSQI) score. The protocol was registered with PROSPERO register.

Results
A total of 3503 studies formed the base for evidence evaluations. 12 studies with 1978 fundus-first cholecystectomies were assessed. Three citations were scored high and 5 moderate quality. Endpoints included blood loss, rate of conversion to open, bile duct injury, gallbladders perforations, postoperative pain and hospital stay. Nine studies provided both strong and moderate scientific evidence for a positive outcome of the fundus-first approach.

Conclusion
The fundus-first cholecystectomy was associated with a reduced need for intraoperative cholangiography, shorter operating time, lower incidence of intra-operative complications, bile duct injury and reduced incidence of conversion to open cholecystectomy.
SP7.2.7 Consenting practice in open inguinal hernia mesh repair and compliance with the British Hernia Society Standards
Authors: Adedeji Janine , Binnie Charlotte , Noureldin Khaled , Shamsiddinova Amira , Praveen Bandipalyam 
Published: October 2021

Abstract

Aims
Inguinal hernia repairs (IHRs) are one of the most frequently performed procedures worldwide with approximately 100,000 taking place in the UK each year. This study analyses open IHR consent practice against British Hernia Society standards, in particular, whether the term ‘mesh’ and significant postoperative complications were stated on consent forms. We also identified whether adequate post operative advice was given upon discharge in order to prevent recurrence.

Methods
This was a retrospective audit of all patients above 18 years old, who underwent open IHR 1 January - 31st December 2019. A total of 94 patients were included.

Results
Although in all cases a prolene mesh was inserted, 8.5% of patients received no mention of mesh in either the clinic letter or consent form.
Postoperative readmission was 5.3% at one week, and 8.5% at one month. Reasons for readmission included pain (1%), haematoma (2%), and wound dehiscence (1%).
In over 90% of consent forms, non-specific complications (bleeding, infection) were documented. However, common IHR postoperative complications, such as chronic pain (not mentioned in 15%), were not mentioned in consent forms.
Only 38% of patients received written postoperative advice.

Conclusion
Adherence to consenting standards benefits both patients and doctors. Our study highlights that further intervention is required to ensure surgeons are consenting patients adequately, as well as providing sufficient postoperative advice. We advise use of pre-filled forms and patient information leaflets, both in line with GMC guidance, to improve the quality of service offered.
SP10.1.4 COVID as a driver of innovation: getting the right patient to the right place at the right time. A novel Registrar-led approach to minimising unnecessary footfall in the Surgical Assessment Unit of a District General Hospital
Authors: Court Emma L. , Lennon Nicola A. , Zarka Anas , Pryor Megan , Lawrence Susan , Alexander Roderick J. 
Published: October 2021

Abstract

Aim
To give shielding Registrars opportunities to innovate and lead service development through telephone triage of Surgical Assessment Unit (SAU) referrals from General Practitioners and Nurse Practitioners.
Prior to the COVID pandemic, referrals were taken by Nurse Coordinators. Increasing call volumes put pressure on the department and disrupted clinical duties. Furthermore, referrers often expressed difficulties in contacting SAU staff.

Methods
During the study, referral calls were diverted for triage by the hospital switchboard. Three outcomes were offered: Clinical advice, ‘Hot Clinic’ (HC) appointment or urgent SAU review.
Prospective referral data (15/6-31/7/2020) and retrospective non-triage data (15/6-1/7/2019) were gathered. Triage effects were measured by outcome comparison with non-triage data and the associated financial implications calculated.
Stakeholder feedback questionnaires were distributed.

Results
Non-triage data showed 56% of patients reviewed in SAU were sent home and 44% admitted, compared to 23.6% and 28.1% of referrals during the 2020 study period. Furthermore, 28.4% of admissions were avoided by triage.
Only 3.1% of triaged patients presented to Emergency Department within 7 days of the triage conversation. Almost half of these had been reviewed in SAU following triage and discharged the same day.
HC availability was limited during the triage study. In view of reduced admissions and overall cost savings of £8330.62/week, expanding these clinics may prove cost neutral.
Triage was universally popular with stakeholders.
Data will inform future development of Urgent and Emergency Care at our hospital.

Conclusions
Traditional ways of working should be challenged. Novel approaches can be cost effective & positively impact patient care.
SP10.1.9 Delay to Elective Colorectal Cancer Surgery and its Potential Implications: A Systematic Review and Meta-analysis
Authors: Whittaker Thomas , Abdelrazek Mohamed , Fitzpatrick Aran , Froud Joseph , Williamson Jeremy , Williams Gethin 
Published: October 2021

Abstract

Aim
The ongoing Covid-19 pandemic has interrupted surgical treatment of colorectal cancer (CRC). This systematic review will assess literature concerning the risk of delay of elective surgery for CRC patients, focusing on overall survival (OS) and disease-free survival (DFS).

Methods
A systematic review was performed as per PRISMA guidelines (PROSPERO ID: CRD42020189158). Medline, EMBASE and Scopus were searched. Patients over 18 with a diagnosis of colon or rectal cancer who received elective surgery as primary treatment were included. Delay was defined as the period between CRC diagnosis and day of surgery. Metanalyses of the outcomes OS and DFS were conducted. Forest plots, funnel plots, tests of heterogeneity, and estimated Number Needed to Harm (NNHs) were produced.

Results
Of 3753 articles identified, seven met the inclusion criteria. Encompassing 314560 patients, three of the seven studies showed a delay to elective resection was associated with poorer OS or DFS. OS was assessed at a one-month delay, the HR for six datasets was 1.13 (95%CI 1.02-1.26, p = 0.020) and at three months the HR for three datasets was 1.57 (95%CI 1.16-2.12, p = 0.004). Estimated NNHs for a delay at one month and three months were 35 and 10 respectively. Delay was non-significantly negatively associated with DFS on metanalysis.

Conclusions
This review recommends elective surgery for CRC patients is not postponed longer than four weeks, as evidence suggests extended delays from diagnosis are associated with poorer outcomes. Focused research is essential so patient groups can be prioritized based on risk-factors for future pandemics.
SP10.2.8 Trainee led Emergency Laparotomy operating; does it impact on outcomes?
Authors: Boyd-Carson Hannah , Doleman Brett , Lockwood Sonia , Tierney Gillian , Lund Jon 
Published: October 2021

Abstract

Introduction
To achieve completion of training in general surgery, trainees are required to demonstrate competency in common procedures performed at Emergency Laparotomy (Em Lap). We describe the patterns of trainee led emergency laparotomy operating and the association between post-operative outcomes.

Methods
All patients who had an Em Lap were extracted from the National Emergency Laparotomy Audit database from December 2013 to November 2017. Patients were grouped by grade of operative surgeon; trainee (speciality registrar) or Consultant (including Post Certificate of Completion (CCT) fellows). Trends in trainee operating by education deanery, hospital size and time of day of surgery were investigated. Adjusted regression analysis for the outcomes of 90-day mortality and return to theatre in operative subgroups of segmental colectomy, Hartmann's procedure, adhesiolysis and repair of perforated peptic ulcer disease were performed.

Results
The study cohort contained 95 520 patients. There were no increased odds of death by 90 days or of return to theatre across any of the operative groups when a trainee was listed as the most senior surgeon present in theatre. Trainees were more likely to operate independently in the Welsh deanery, high volume centres and at night (all P &lt; 0.001).

Conclusion
There is significant variation in trainee led operating in Em Lap cases by deanery, hospital size and by time of day. However, this involvement in cases required for CCT in general surgery does not appear to impact on mortality or return to theatre in patients when adjusting for various pre-operative features.