bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP3.2.18 Reducing the negative appendicectomy rate in children as part of the ‘improving emergency surgery’ quality improvement programme: an assessment of outcomes and balancing measures for unintended consequences
Authors: Chitre Vivek , Woods Robert , Lal Roshan 
Published: October 2021

Abstract

Aim
To describe methodology of the quality improvement programme.
To assess outcomes and balancing measures.

Methods
This paper describes how Kotter’s 8-step improvement model was applied in a District General Hospital.
The primary outcome (negative appendicectomy rate) was assessed using GIRFT data over 6 years.
Reducing negative appendicectomies might conceivably result in delayed surgery (with a potentially increased incidence of perforated/gangrenous appendicitis), increased length of stay (LOS) and increased readmissions due to delay-related complications. These were assessed by a retrospective audit of appendicectomies performed over the same 8-week period in 2016 and 2019.

Results
The negative appendicectomy rate in children fell from 16% in 2016-2017 (England average 12%) to 4% in 2017-2018. The improvement was sustained at 6% in 2018-2019 (England average 11%).
The incidence of perforated/gangrenous appendicitis decreased by 6% from 23% in 2016 to 16% in 2019.
Average LOS decreased from 4 days in 2016 to 3 days in 2019.
There was 1 (3%) readmission within 7 days in 2016, and 2 (6%) in 2019. Reasons for readmission were postoperative small bowel obstruction due to omental band adhesion(1) and persistent pain (2). None were caused by delayed operation.

Conclusions
A sustained improvement in negative appendicectomy rate can be achieved by adopting a systematic quality improvement approach.
Against expectations, the reduction in negative appendicectomy rate was associated with a slight decrease in average LOS and reduced frequency of perforated/gangrenous appendicitis.
There was no significant increase in readmissions, and none were due to delayed operations.
SP4.1.1 The impact of the SARS-CoV-2 (COVID-19) crisis on surgical training: a global survey and a proposed framework for recovery
Authors: Yiasemidou Marina , Tomlinson James , Chetter Ian , Biyani Chandra Shekhar , Collaborative REINS 
Published: October 2021

Abstract

Background
The SARS-Cov-2 pandemic had a profound impact on surgical services, potentially causing a detrimental impact on training opportunities. The aim of this global survey was to assess the impact of the COVID-19 crisis on surgical training and develop a framework for recovery.

Methods
A cross-sectional, web-based survey was conducted. This was designed by a steering committee of medical educationalists and validated by a group of trainees prior to dissemination.

Results
608 responses were obtained from 34 countries and 15 specialties. The results demonstrated major disruptions in all aspects of training. The impact was highest for conferences (525/608) and hands-on courses (517/608), but less for in-patient care related training (268/608). European trainees were significantly more likely to experience direct training disruption than trainees in Asia (O.R 0.148, 95% C.I -2.443, -1.378) or Australia (O.R 0.097, -2.981, -1.678) (c2= 87.162 p &lt; 0.001). Alternative training resources (webinars: 359/608, educational videos: 234/608) have emerged, although trainees expressed some dissatisfaction with them.
The collective responses generated a five-pillar framework for training recovery: that involved; prioritisation of trainee and public safety; guidance from training stakeholders with the involvement of trainees; prioritisation of training especially the roles of senior surgeons/trainers; provision of access to alternative/new teaching methods and measures to address trainee anxiety.

Conclusions
Training has been greatly affected. The introduction of new teaching methods and focus on training after the pandemic are imperative.
SP4.1.5The use of Faecal Immunochemical Testing (FIT) and Minimal Preparation Computed Tomography (MPCT) during COVID-19 for Urgent Suspected Cancer (USC) referrals in patients with lower gastro-intestinal symptoms
Authors: Tang A M , Chandler S , Reeves N , Silva L , Harris D A , Dhruva Rao P K 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic necessitated introduction of revised diagnostic pathways for assessing Urgent Suspected Cancer (USC) referrals. Combinations of FIT and MPCT were used to manage referrals and prioritise access to clinical services or invasive tests. The effectiveness of these pathways are evaluated in this study.

Methods
All consecutive patients referred from primary care on the USC pathway between 15th March – 15th June 2020 were included to reflect the effect of full lockdown measures. Data collected included demographics, presenting symptom(s), investigations and timelines and patient outcomes up to 90 days following initial referral.

Results
816 patients across 8 sites in Wales were included in this initial analysis. 52.7% of patients were female with median age 69 (21 – 97) years. Of the 50.7% who had first-line clinical review, 70.5% were virtual consultations. 49.3% had primary investigations, with FIT in 31% of patients and MPCT in 18.3%. This was compliant with locally agreed pathways for 77.3% of referrals. COVID-response pathways achieved a 28.5% reduction in use of colonoscopy as first-line investigation and 84.3% of patients avoided face-to-face consultations altogether during this first wave of the pandemic.
Overall, 5.6% of USC referrals were diagnosed with CRC. Median timescale from diagnosis to treatment for CRC was 82 (4 – 175) days. The NPV for FIT in this cohort was 99.5%. MPCT as the first modality had a NPV of 99%.

Conclusion
A modified investigation pathway maintained cancer diagnosis during the pandemic with improved resource utilisation to that used previously.
SP4.1.6 Introduction of Concentric digital and remote consent into clinical practice during the COVID-19 pandemic
Authors: John Edward St , Loughran Dafydd 
Published: October 2021

Abstract

Introduction
Paper-based consent processes are associated with errors of omission, illegibility and unwarranted variation. During the COVID-19 pandemic the Royal College of Surgeons (England) released guidelines supporting the use of remote consent. The aim was to evaluate the introduction of Concentric, a digital consent application, into clinical practice.

Method
Between April 2020-Jan 2021, Concentric was used optionally for medical consent during registered service evaluations. Data was obtained from Concentric analytics. User and patient feedback was obtained via optional satisfaction surveys.

Results
3417 Concentric consent episodes for 356 unique procedures were performed by 170 clinicians across 16 specialties from 13 healthcare providers. Patients were aged 7-101years, (median 58, IQR 30). Of the completed consent episodes (n = 2799), consent was given; remotely in 23% of episodes, and on the day of surgery in 67%. Consent form information was shared digitally with 82% of patients. Average patient user experience was 8.8 out of 10 (1 very poor - 10 excellent, n = 594). 546/594 (91.9%) patients agreed that Concentric provided all the information they needed to know. Clinicians (n = 23) rated the quality of the consent process with Concentric as 4.8 out of 5 with all supporting the use of Concentric across the Trust.

Conclusion
Concentric has been successfully introduced into clinical practice. Patients and clinicians report high satisfaction scores. Remote consent is feasible and trends in consent practice, such as day of surgery consent can be easily identified and can guide quality improvement work. The introduction of digital consent solutions should be considered for all units.
SP4.2.13 The staging of head and neck cancers at presentation during the COVID-19 pandemic: a regional analysis
Authors: Ding Anni , Smith Lauren , Dickason Aubrey , Easto Rachel , Reece Philip 
Published: October 2021

Abstract

Aim
The impact of COVID-19 on cancer presentations has been debated; this audit aimed to examine the stage at presentation of head and neck (H&N) cancers regionally during the COVID-19 pandemic compared to the identical time period during 2019.

Methods
Retrospective data was collected across 3 hospitals in the South West, identifying all H&N cancer patients discussed at Multi-disciplinary Team Meetings between 1st April-10th October 2019 and the same timeframe in 2020. Patients with lymphomas and thyroid neoplasms were excluded due to separate treatment pathways available.

Results
There were 234 and 272 patients identified in 2020 and 2019 respectively. The median stage at presentation for all cancers was 2 in both years. The commonest cancers in 2020 were oropharyngeal (28%) and oral cavity (22%), similar to that of 2019 (oral cavity-31%, oropharyngeal-22%). The absolute numbers of laryngeal cancers were similar but a greater percentage of those presented late (stages 3&4) in 2020 compared to 2019 (47% vs 35%). There were almost twice as many skin/lip cancers in 2020 proportionately (20% vs 12%) and a greater number of them presented at a later stage.

Conclusion
Overall, COVID-19 has not appeared to affect the stage at presentation of H&N cancers, reflecting an on-going continuity of care for cancer patients. Subgroup analysis revealed skin and laryngeal cancers was most adversely affected by the pandemic, possibly due to delayed presentation and reduced face-to-face consultations, highlighting the need for continued face-to-face appointments as a part of cancer care pathways.
SP5.1.12 Discrete Event Micro Simulation Modeling for the Treatment of Resectable Malignancy of the Oesophagus and Gastrooesophageal Junction
Authors: Bradley Alison , Brown Leo 
Published: October 2021

Abstract

Aims
To assist decision-making by creation of a statistical model that simulates treatment pathways and subsequent outcomes for the management of resectable malignancy of the oesophagus and gastrooesophageal junction.

Methods:
Discrete Event Simulation (DES) modelling is a statistical modelling technique that models the operation of a system as a sequence of events in time to support decision-making. This approach lends itself well to disease modelling by incorporating different treatment strategies targeted at different groups. It offers an advantage over previous decision analysis studies that have relied on Markov modelling which can have reduced accuracy due to lack of memory within the Markov model, the effect of depletion of susceptibles, and the timing of transitioning within the model. This simulation model was populated with data from best available evidence from contemporary randomised controlled trials and ran over 100,000 iterations.

Results
Neoadjuvant chemoradiotherapy was the superior treatment pathway with superior pathway selection frequency of 87.16%. For squamous cell carcinoma neoadjuvant chemoradiotherapy was the superior treatment option with 73.30 months survival time (65.60 QALMs) and had a superior pathway selection frequency of 100%.

Conclusions
DES simulation modeling for decision analysis in treatment of resectable malignancy of the oesophagus and gastrooesophageal junction supports the use of neoadjuvant chemoradiotherapy.
SP5.2.2 A Systematic Review of Living Kidney Donor Enhanced Recovery After Surgery
Authors: Byrne Matthew , Mehmood Ahmed , Summers Dominic , Hosgood Sarah , Nicholson Michael 
Published: October 2021

Abstract

Background
Enhanced recovery after surgery (ERAS) reduces complications and shortens hospital stays without increasing readmission or mortality. However, its role in living donor nephrectomy has not yet been defined. This systematic review aimed to describe the literature on ERAS in live donor nephrectomy.

Methods
Medline, Embase, CINAHL, PsycINFO, and Cochrane Central were searched prior to 1/7/19 for all original randomised control and cohort studies relating to ERAS in living donor nephrectomy. The study was registered on PROSPERO (CRD: CRD42019141706).

Results
1248 patients were identified from 14 studies (630 patients with ERAS and 618 patients without). There were considerable differences in the protocols used and compliance with general ERAS recommendations was poor. Meta-analysis revealed that with ERAS length of stay significantly reduced by 0.83 days (95% CI = 0.30-1.37, p = 0.002), there was a trend towards decreased readmission (OR = 0.45, 95% CI = 0.19=1.10, p = 0.08), and there was no significant difference in complications (OR = 0.73, 95% CI 0.16-3.39, p=0.69). Opiate usage was significantly reduced with ERAS in all studies that measured it and there was no significant difference in creatine clearance.

Conclusions
ERAS in live donor nephrectomy significantly reduces length of stay, and reduces opiate usage, without increasing readmission, complications, or creatinine. There is considerable variation in ERAS protocols used and a guideline for ERAS in live donor nephrectomy should be developed.
SP5.2.4 Stent-graft endobypass for non-infected femoral pseudoaneurysms in high-risk surgical patients: acceptable short-to-mid-term results
Authors: Chaudhuri Arindam , Dey Ramita , Stupalkowska Weronika 
Published: October 2021

Abstract

Aim
Stent-grafts are finding a place in the treatment of femoral pseudoaneurysms (FpsAs), having been described in the treatment of infected pseudoaneurysms. We present the results of endovascular treatment of non-infected FpsAs using stent-grafts.

Methods
Case series of patients who underwent stent-graft coverage of FpsAs from January 2016 to December 2020. Stent-graft fractures, occlusions and reinterventions, length of stay (LOS) and 30-day mortality were assessed.

Results
11 patients (mean age 75±10.3 years, 7 males; all ASA 3 or 4) underwent stent-graft coverage of FpsAs. Original procedures linked to the formation of FpsA were iliofemoral bypass (n = 3), femorofemoral crossover (n = 3), percutaneous coronary interventions (n = 2), aortobifemoral bypass (n = 1), endovascular aneurysm repair (n = 1) and femoral endarterectomy (n = 1). 3 patients had previous open FpsA repair.
Technical success of deployment was 100%. Stent-grafts used included Viabahn Endoprosthesis (WL Gore & Associates, Flagstaff USA; n = 8), Viabahn VBX (WL Gore & Associates; n = 1) and BeGraft (Bentley InnoMed GmbH, Hechingen, Germany; n = 2). All patients were maintained on either antiplatelets or anticoagulant. 10 patients were available for analysis (1 lost to follow-up); radiological follow-up included initial computed tomography angiography and later combined duplex ultrasonography/plain radiography. Median LOS was 4 days (IQR 4). 30-day mortality was 0%. Median survival was 12 months (IQR 17). There was one stent-graft occlusion requiring thrombectomy but no fractures were observed in this series.

Conclusions
This small series suggests that there may be a role for stent-grafts in treatment of FpsAs in carefully selected patients. Given lack of data on long-term outcomes, continued surveillance is recommended.
SP6.1.6 Rule of systematic intraoperative cholangiogram in patients undergoing emergency cholecystectomy
Authors: Hatem Fady , Mostafa Sam , Thomas Jenny , Nassar Ahmad 
Published: October 2021

Abstract

Aims
Incidence of gall stone disease is estimated at 10-15%of population. Intraoperative cholangiography (IOC) diagnose choledocholithiasis, delineates the anatomy of the biliary ducts, facilitate the dissection and reduces injuries. Our aim is to assess the feasibility and role of IOC and the incidence of choledocholithiasis in acute cholecystitis (ACC).

Methods
Retrospective analysis of prospectively collected data for patients admitted with ACC and undergoing same-hospital-stay laparoscopic cholecystectomy (LC). IOC was systematically attempted in all cases.

Results
475cases included. Female to male ratio1.9:1. Conversion to open was done in 3 cases. Preoperative cholelithiasis was confirmed in 439cases versus 34cases with no stones. USS CBD abnormality (dilated or contain stone) found in 53 cases, out of which 8(15%) cases had CBD stones. Jaundice was found in 69cases, where 25(39%) cases had confirmed choledocholithiasis.
IOC was successful in all cases except one. Abnormal IOC was found in 99(21%) cases. Of those; CBD stones were confirmed in 76 (77%) cases regardless the presence of cholelithisasis on USS. Empyema was found in 237 cases and it was associated with higher risk of abnormal IOC in 59(25%) cases where CBD stones were confirmed in 45(76%) cases. Cystic duct (CD) stones found in 80cases, of those 27(34%)cases had choledocholithiasis.

Conclusions
Females have double the risk of ACC. Preoperative jaundice and CD stones are stronger indicators than CBD diameter for presence of choledocholithiasis. The incidence of choledocholithiasis in ACC is (20-25%) regardless the presence of gall stones on USS. IOC is feasible and highly recommended in emergency LC.
SP6.1.10 Can gallbladder polyp surveillance be justified? Experience of a large DGH
Authors: Bradley Nicholas , Wilson Michael , Shearer Christopher , Heron Timothy , Robertson Katie , Crumley Andrew 
Published: October 2021

Abstract

Aims
Gallbladder polyps are typically an incidental finding on sonographic or pathological examination with an estimated prevalence of 0.3 – 9.5%. Their role as a precursor to gallbladder malignancy is disputed. The 2017 European Joint Society Guidelines (ESGAR/EAES/EFISDS/ESGE) aim to standardise management of gallbladder polyps detected prior to cholecystectomy. We aim to describe our experience in the management of gallbladder polyps in a district general hospital.

Methods
This single centre retrospective case series included consecutive cholecystectomies over an 8-year period, identified through pathology records. Medical records were interrogated to identify the presence of gallbladder polyps identified pre-operatively and at subsequent histopathological analysis.

Results
3835 cases were included. Four cases (0.1%) had an adenocarcinoma identified; none of these had pre-operatively identified polyps. Two cases (0.05%) were found to have lesions with high-grade dysplasia, 1 of which had a 17mm polyp preoperatively. One case (0.03%) had cellular atypia, without a pre-operative polyp. Forty six cases (1.2%) were found to have low-grade dysplasia; 1 (2.2%) of these had adenomyomatosis pre-operatively but none had pre-operative polyps. Overall, 53 patients (1.4%) had abnormal pathology with only 1 (1.9%) of these having a pre-operative polyp identified.

Conclusions
Our results suggest that in the real-world setting, intensive surveillance of gallbladder polyps has limited utility in identifying cases of gallbladder malignancy. The burden on services produced by adherence to strict surveillance guidelines is difficult to justify and a less arduous approach is unlikely to significantly influence the management or outcome in patients with gallbladder malignancy.
SP7.1.2 DVT and Abdominoplasty: A Holistic 8-point protocol-based approach to prevent DVT
Authors: Saghir Reyan , Saghir Noman , Okhiria Renee , Sidhu Manu , Okhiria Terrell , Sforza Marcos 
Published: October 2021

Abstract

Aim
Plastic surgery as a speciality is afflicted with one of the highest incidence rates of thromboembolic events, with abdominoplasty procedures known to assimilate the greatest rates of Deep Vein Thrombosis (DVT).

Methods
A total of 1078 abdominoplasty patients were enrolled onto an 8-point prophylaxis protocol with an inclusive holistic approach over a 7- year period. A 4-week smoking, HRT and COC cessation period was imposed on all patients and a maximum BMI score of 40 was required of all preoperative patients. Participants were administered with compression stockings, flowtrons and enoxaparin. Individuals with a DVT history were also required to be 1-year treatment free prior to surgery. Furthermore, the protocol necessitated post-operative deambulation of fit patients within 4 hours.

Results
Between 2008 and 2013, no incidence of DVT was recorded in all 1078 abdominoplasty surgery patients, indicating the potential for this protocol to lead to a significantly lower incidence than any previously published methodology. Due to the zero-incidence rate of DVT, different hypotheses of DVT proportions were tested to find out the rates that could be statistically consistent with our sample, thereby providing conservative incidence rate estimates.

Conclusion
This 8-point DVT prophylaxis protocol is the first non-criteria based inclusive protocol aimed at preventing abdominoplasty-associated DVT. As a result, not a single incident of DVT was recorded over the seven-year period of this study. We therefore believe that a holistic and procedure-specific approach to prophylaxis can drastically reduce the occurrence of DVT in abdominoplasty surgery.
SP7.1.8 Routine use of opioids for post-operative pain in opioid naïve patient can risk long term dependence
Authors: Majeed Talal , Mcgurk Simon , Wilson Jeremy , Magee Conor 
Published: October 2021

Abstract

Aims and Objectives
Aim of our study was to evaluate the current practices of prescribing opioids for post-operative pain in opioid-naive patients in our region and the risk of prolonged opioid use among them.

Methods
A retrospective cohort study was performed where cohort consisted of patients who had surgery in 2018 with at least one year follow up. Endpoints were the proportion of all patients and opioid naïve patients, discharged on opioid prescription and proportion of opioid naïve patients who developed opioid dependence after one year.

Results
During 2018, 17524 patients underwent a total of 20526 surgical procedures by pan surgical specialties in our hospitals. 8772 patients (50%) were discharged with opioid prescription. 673 (7.70%) of those required further opiate prescriptions after discharge, of those requiring opiates, 331 had no opiate exposure before surgery (342 had previous opiate exposure). In opioid naïve patients, at 1 year follow up 151 (45%) had no further opiate prescriptions, but 180 (55%) required ongoing opiate prescriptions after one year follow up. The risk of opioid dependence after surgery is significant in opioid naïve patients.

Conclusion
Results are alarming and evidence-based strategies, national and local guidelines are needed to prevent the opioid crisis in the UK. There is a need for a national campaign to minimize the dependence on opioids and to find, better alternatives to opioids.
SP7.1.14 Our experience of the first 100 cases of prostate biopsy using the Transperineal PrecisionPoint Access system at a hospital in the North West of England
Authors: Anwar Baseerat , Blenkharn Christopher , Rao Praveen , Quddus Bilal , Islam Jawad Ul , Ghiblawi Salaheddin 
Published: October 2021

Abstract

Aims
The diagnosis of prostate cancer has evolved over the past 2 decades with rapid changes occurring in the last 5 years. Traditionally transrectal prostate biopsies were the standard. However due to the risk of sepsis and sub optimal diagnostic accuracy, this method has been superseded by biopsies of the prostate now being performed via the transperineal (TP) route more frequently. Our hospital was the first in our region to use the PrecisionPoint Transperineal Access system to perform TP biopsy under local anaesthetic, and here we present our experience of the first 100 cases. Aims of this study included determining cancer detection rate and MRI correlation, as well as looking at rates of complications post procedure.

Method
This was a retrospective study with 100 patients in our cohort. We assessed MRI and histology correlation and post procedure complication rates.

Results
Histology in 72% of patients was positive for prostate cancer. Correlation between MRI findings and histology were noted to be high. As Likert score decreased, so did percentage of positive biopsies. Rates of significant complications were low, with no hospital admissions required following the procedure.

Conclusion
Our study demonstrates TP biopsy using the PrecisionPoint transperineal access system is a safe and effective method of detecting prostate cancer, which is well tolerated by patients.