bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.721The effects of COVID-19 on emergency theatre utilisation
Authors: Rizkalla Nagy , Cubas Vanessa , Digne-Malcolm Holly , Sallam Ali , Fishwick Anna , Khaira Harmeet 
Published: October 2021

Abstract

Aims
The ongoing COVID-19 pandemic and subsequent lockdown have adversely affected elective care services within the NHS. Emergency Services are also affected to varying extents nationally. Due to deferred elective services our hospital was able to implement two emergency theatres running in parallel as an attempt to minimise these effects.
We aimed to assess the change in delivery of essential and emergency surgeries due to the pandemic in a local district general hospital.

Methods
Retrospective study of emergency theatre cases performed during the month of November 2019 and November 2020. Parameters of theatre efficiency included: sending times, anaesthetic times, operating times and length of recovery, with specific attention to recovery in theatre time

Results
The time taken to send for patients from the wards increased by 24% (n = 124 vs 49) during the pandemic compared with before. Anaesthetic time also increased by 15% (p = 0.0072, n = 124 vs 49). Recovery time required in theatre increased by 150% (p = 0.0321, n = 124 vs 49). Total recovery time however reduced by 9%.

Conclusion
Our audit quantifies the effects of COVID 19 pandemic on surgical care delivery and documents delays at nearly all stages of the patient journey through emergency theatres.
Alternating procedures in a second emergency theatre has mitigated the delay of theatre-based recovery.
EP.WE.741Management of a giant extraocular sebaceous carcinoma during the COVID-19 Pandemic: a case report
Authors: Mantelakis Angelos , Nicholas Rebecca , Geh Jenny 
Published: October 2021

Abstract

Introduction
Sebaceous carcinoma is a rare malignant skin tumour of the sebaceous glands which is most frequently located in the ocular region (75% of cases). Prompt recognition and treatment is vital, as it bears a high mortality rate ranging from 9 – 50%. We present a rare case of a giant sebaceous carcinoma of the upper back, managed as a day-surgery case because of resource and safety restrictions due to the COVID-19 pandemic.

Case report
We present a case of a 58-year-old male patient with a giant lesion on his upper back measuring 13 x 13cm in size. Due to the COVID-19 pandemic, this was resected under local anaesthetic. The histology and immunohistochemistry confirmed the diagnosis of a giant sebaceous carcinoma. Resection margins were clear and subsequent investigations confirmed there were no metastases. The defect was reconstructed with Matriderm © and a split-thickness skin graft, achieving a satisfactory cosmetic outcome at 3 months follow-up.

Conclusion
This is the first report which demonstrates the wide local excision under local anaesthetic for a rare presentation of a giant sebaceous carcinoma. This approach may be more widely utilised in the extraocular manifestation of this tumour, reducing the morbidity and length of hospital stay for such patients.
EP.WE.791Assessing the use and effectiveness of catheter-directed thrombolysis in a single vascular centre
Authors: Ashmore Daniel , Pillay Woolagasen 
Published: October 2021

Abstract

Aims
In the UK, venous thromboembolism remains a leading cause of mortality and morbidity. This audit aimed to assess the use, success and cost of the average patient journey undergoing catheter-directed thrombolysis (CDT) following a diagnosis of a deep vein thrombosis (DVT) within a single vascular centre.

Methods
A retrospective audit of all procedures (n = 249) between 2010 and 2019 coded as 'angioplasty' were identified; only adults that had CDT for a confirmed iliofemoral DVT were included. Patient anthropological, biochemical and radiological data were collected. Cost of items were confirmed with appropriate hospital departments.

Results
In ten years, a total of 36 patients (21 female, 15 male, mean age 47 years) started CDT for iliofemoral DVT; one procedure was abandoned due to safety reasons. Almost half of DVTs were provoked. Ultrasound confirmed diagnosis in 92% of patients. CDT was successful in approximately 70% of patients. A quarter of patients developed another DVT following discharge. Average length of stay was 8 days at a cost of £11,235 per patient journey. All patients commenced an anticoagulant regime on discharge.

Conclusions
This audit supports the use and effectiveness of CDT to treat patients with iliofemoral DVT, however there is a room for improvement regarding long term success given the significant patient and financial costs involved.
EP.WE.1026Pathways to the Upper GI MDT; an evaluation of the factors influencing patient routes to diagnosis of oesphago-gastric cancer
Authors: Bullingham Roberta , McKane Thomas , Hughes Frances 
Published: October 2021

Abstract

Aims
To review the characteristics of the patient group referred to Barts Health with Oesphago-gastric (OG) Cancer in one year (2018-19). To evaluate demographic trends in patients presenting as emergency referrals and the effect of language on patients’ pathway to diagnosis.

Methods
We collated a list of patients referred to the Upper GI MDT with OG cancer in one year (2018-2019). We collected relevant pre-determined data points from the trust electronic record system. Patients with missing or insufficient data were excluded.

Results
Our population of 125 patients (median age 69) included 51% White British, 11% Bangladeshi, 10% Afro-Caribbean and 4% Pakistani; proportions which are significantly different to that of the UK average (p &lt; 0.002). 46% of patients presented by GP 2WW referrals and 32% emergency referrals. The 29% of the population that did not have English as a first language were not shown to be more likely to present acutely (p = 0.49). 18.7% of patients had more than 62 days between referral and MDT discussion; themes of delay were inappropriate referral type, histology delay and atypical presentation.

Conclusions
Our OG cancer population has a significantly different ethnic makeup compared to UK average. Our data shows higher acute presentations and lower GP 2WW referrals. We did not demonstrate that language as a single parameter was linked to acute presentation. A number of modifiable delays to diagnosis were identified particularly the need for repeat biopsies. Further analysis is required using more sophisticated socio-economic parameters to assess how ethnicity can influence presentation of OG cancer.
EP.TH.5Online application for self-referral of the patients with breast symptoms
Authors: Rao Ahsan , Razzaq Humayun , Panamarenko Ben , Gray Emma , Bottle Alex , Majeed Azeem 
Published: October 2021

Abstract

Introduction
The study aimed to devise a self-referral mobile/web application for patients with new breast symptoms, giving them an outcome, thus bypassing the need for primary care consultation.

Methods
The online application was designed on the automated algorithm based on evidence-based guidelines for referral to breast onco-plastic units. A retrospective questionnaire-based anonymous survey was carried out at the breast unit in Southend University Hospital (January 2019 to March 2020). The outcome of the patients was recorded, the same data was entered in the software and its outcome was compared with their clinic outcome to assess and validate the software. Chi-square and t test were used in formulating results.

Results
Data was collected for 366 patients who were referred urgently to the clinic. Only 50.5% (n = 186) were appropriately referred, with the main complaint being breast lump (94.1%). 39.6% of referred patients did not require a secondary care referral. Sensitivity and specificity for identifying patients requiring urgent referral was 100% and 98%, respectively.

Conclusion
A significant number of urgent referrals to breast units do not require urgent specialist referral, and this results in a big strain on the hospital service. The discussed self-referral pathway is a promising alternative with the potential to reduce workload in primary and secondary care and improve patient satisfaction.
EP.TH.15Review of cholecystectomies laparoscopic & open plus conversion rate in a five year period
Authors: Ahmed Elmurtada , Jenner Deborah , Al-Robaie Basim 
Published: October 2021

Abstract

Aim
Look & audit our practice of cholecystectomy & try to identify areas that require improvement

Method
Look at all cholecystectomies, laparoscopic & open in 5 years from January 2014 till December 2018, we looked at demographics, number of operations per year, conversion & re-admission rate, information collected from electronic note record

Results
male to female ratio similar to national figures, number of laparoscopic operations (2422 in that period, 61 cases converted, conversion rate 2.5%) going up steadily over the 5 years while open & conversion rate are dropping significantly, early re-admission rate higher than national figure, reasons for conversion determined & analysed Reasons for doing it open from the start also determined, commonest cause for conversion in our trust is: previous surgery/adhesions, obscure anatomy & severe inflammation of gall bladder . Commonest cause of re-admission is pain followed by wound complications collections retained stone & bile leak. Number of open cholecystectomies was 22 in 2104 dropping to only 2 in 2018. 3 deaths occurred in the group giving rise to a mortality of 0.12%

Conclusion
Majority of cases attempted laparoscopically & most patients discharged home within 48 hours, our conversion rate is low = 2.5% with consultants with higher number of operation having less conversions, ours re-admission rate is high mainly for pain, our mortality is low. We recommend looking closer at re-admissions to see how that number could be reduced.
EP.TH.30Effect of One Anastomosis Gastric Bypass on Haematinics, Vitamin D, and Parathyroid Hormone Levels: A comparison between 150 cm and 200 cm Bilio-Pancreatic Limb
Authors: Omar Islam , Sam Miraheal , Pegler Maya , Pearson Emma , Boyle Maureen , Mahawar Kamal 
Published: October 2021

Abstract

Introduction
There is little data on the effect of One Anastomosis Gastric Bypass (OAGB) on Haematinics, Vitamins D, and Parathyroid Hormone levels. It is further unclear if an OAGB with a Bilio-Pancreatic Limb (BPL) of 150 cm (OAGB-150) would deliver better outcomes than that with a BPL of 200 cm (OAGB-200).

Methods
We investigated our records to obtain information on patients who underwent an OAGB-200 or OAGB-150 until 31st July 2018 in our unit.

Results
A total of 405 patients underwent either an OAGB-200 (n = 234) or OAGB-150 (n = 171). The mean age was 46±10.98 years and 276 (67.3%) were females. The mean preoperative weight and the Body Mass Index (BMI) were 139±29.96 kg and 49±8.14 kg/m2 respectively. With OAGB-200 there was a significant increase in anaemia rates at 1 and 2-years compared to preoperative levels with a significant fall in haemoglobin levels. After OAGB-150 there was a significant fall in haemoglobin levels at 1 and 2-years but the increase in anaemia rate was only significant at 2-years. There was a significant increase in PTH levels and the number of abnormal values at 1 and 2-years with OAGB-200. With OAGB-150, PTH changes were significant at 2 years only.

Conclusion
Both OAGB-200 and OAGB-150 are associated with a significant increase in anaemia and secondary hyperparathyroidism. Our findings should prompt the evaluation of supplementation protocols with higher dosages than we recommend for iron, folate, and calcium. Consideration should also be given to evaluating shorter BPL lengths than 150 cm with OAGB.
EP.TH.37Radioembolization with yttrium-90 microspheres for management of breast liver metastases: a systematic review and pooled analysis
Authors: Feretis Michael , Fedotovs Arturs , Solodkyy Andriy 
Published: October 2021

Abstract

Aims
Radioembolization with yttrium-90 microspheres is an emerging option for management of liver metastases of breast cancer when other systemic therapies have failed. The aims of this systematic review were to assess the effect of radioembolization on i) tumour response and ii) patient survival post -radioembolization.

Methods
The review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A systematic literature search was performed using the PubMed and EMBASE databases from January 2007 to December 2019. The initial search yielded 265 reports which were potentially suitable for inclusion in this review. Studies published in English reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts; case reports, animal studies and reports not published in English were excluded from this review.

Results
The final number of studies which met the inclusion criteria was 12 (n = 452 patients). There were no randomized controlled trials identified. The age of the patients included in this review ranged from 52 to 61 years. The duration of follow-up ranged from 6 to 15.7 months. The total number of patients with breast metastases not confined to the liver was 236 (52.2%). Cumulative analysis revealed that radioembolization conferred tumour control rate in 81% of patients. Overall survival post-radioembolization ranged from 3.6 to 20.9 months with an estimated mean survival of 11.3 months.

Conclusion
Radioembolization with ytrrium-90 appears to confer control of tumour growth rate in most patients, however its effect on patient survival need to be elucidated further.
EP.TH.43Biliary cooling during radiofrequency ablation of liver tumours close to central biliary tree: A systematic review and pooled analysis
Authors: Feretis Michael , Zhang Bridget , Wang Yishen , Liau Siong-Seng 
Published: October 2021

Abstract

Aims
Biliary cooling during radiofrequency ablation (RFA) of liver tumours has been proposed as a protective measure for RFA-related biliary complications in cases whereby the RFA-site is close to central biliary tree. This systematic review aims to assess the effect of biliary cooling on i) the development of biliary complications and ii) tumour recurrence rates at ablation site.

Methods
A systematic literature search was performed using the PubMed/EMBASE databases using PRISMA methodology (2000-2019). The initial search yielded 75 reports which were potentially suitable for inclusion. Studies reporting at least one outcome of interest were considered to be suitable for inclusion. Conference abstracts, case reports and animal studies were excluded. Data was retrieved on patient demographics, tumour characteristics, method of cooling, biliary complications, local tumour recurrence and duration of follow-up.

Results
The final number of studies which met the inclusion criteria was 7, involving 100 patients. There were no randomized controlled trials identified after the literature search. The mean age of the patients included was 65 years. Biliary cooling was performed with the use of a nasobiliary tube in 4 out of 7 studies, via a choledochal incision in 2 out of 7 studies and through the cystic duct in a single study. The overall biliary stricture rate was 2% and the overall tumour recurrence rate at RFA treated site was 14.5%.

Conclusion
Biliary complications appear to be low after biliary cooling during RFA close to central biliary tree. More evidence is required to assess the tumour recurrence rates.
EP.TH.136Does laparoscopic transversus abdominis plane (TAP) block reduce postoperative opioid usage in bariatric patients?
Authors: Lin Yi-Tzu Linda , Goh Ian , Cheng Anthony 
Published: October 2021

Abstract

Introduction
Laparoscopic TAP block has been used in various surgical subspecialties to reduce postoperative opioid requirement and hence its side effects. The aim of our study was to evaluate the effect of laparoscopic TAP block in bariatric surgery.

Methods
We performed a retrospective analysis in patients who underwent bariatric surgery by two surgeons at a metropolitan public hospital from January 2019 to March 2020. One surgeon routinely performed laparoscopic TAP block (TAP group) with 80ml of 0.2% ropivacaine and the other surgeon performed port-site infiltration (non-TAP group) with either 0.2% or 0.75% bupivacaine. Patients with chronic pain were excluded. Baseline characteristics (age, gender, pre-op BMI, types of bariatric surgery), postoperative usage of opioids (in recovery, in the first 24 hours and opioid dosage) and length of stay (LOS) were collected and analysed.

Results
Seventy-nine patients were included in this study, of which 46 (58.2%) received laparoscopic TAP block and 33 (41.8%) received port site infiltration. Opioid requirement rates were lower in the TAP group: 54.3% (n = 25/46) received no opioids in recovery and 21.7% (n = 21/46) in the first 24 hours, compared to 48.5% (n = 16/33) in recovery and 9.1% (n = 3/33) in the first 24hours in the non-TAP group. However, there was no statistically significant difference (p = 0.61 and p = 0.13 respectively) between the two groups. Mean LOS was comparable in both groups.

Conclusion
Our study showed a non-statistically significant trend in reducing postoperative opioid usage with laparoscopic TAP block. Further evaluation with a prospective randomised controlled trial is warranted.
EP.TH.140Enhanced Recovery in Liver Surgery: Effect on Survival in Patients with Colorectal Liver Metastases
Authors: Stefanova Irena , Martinou Eirini , Kumar Rajesh , Riga Angela , Worthington Tim , Karanjia Nariman 
Published: October 2021

Abstract

Aims
Enhanced recovery after surgery (ERAS) has shown to reduce perioperative stress and improve short-term postoperative outcomes. However, little is known regarding the effect of ERAS on long-term oncological outcomes. This study aimed to investigate the impact of ERAS on overall survival in patients undergoing liver resection for colorectal liver metastases (CRLM).

Methods
Between 2006 and 2014, 387 patients underwent liver resection for CRLM at Royal Surrey County Hospital. The ERAS protocol after liver surgery was implemented in 2011. Data regarding patients’ demographics, oncological characteristics, long and short-term postoperative outcomes were obtained from a prospectively maintained institutional database. Comparative analysis was performed between the ERAS and non-ERAS patients. The primary objective was overall survival (OS) and secondary objective included identification of factors affecting OS.

Results
The groups were similar in terms of demographics, primary and secondary disease oncological characteristics. Intrahepatic recurrence rates were comparable between ERAS and non-ERAS group (30.3% vs 27% p = 0.496). Patients in the ERAS group demonstrated better 3-year survival rates in comparison with the non-ERAS ones (78.2% vs 68%, p = 0.027). Although survival was better at 5-years as well, this did not reach statistical significance (54.2% vs 50%, p = 0.470). The Cox proportional hazards analysis showed that increased length of hospital stay (HR 1.338, 95% CI 1.039-1.723, p = 0.024) and operative time (HR 1.580, 95% CI 1.173-2.128, p = 0.003) were the only parameters associated with increased risk for worse OS.

Conclusions
ERAS protocol may be associated with improved 3-year survival in patients undergoing liver surgery for CRLM.
EP.TH.155Assessment of the appropriate use of imaging and reporting in acute pancreatitis in a secondary care setting
Authors: Kirchhoff Chris , Omokehinde Tope Johnson , Achunine Portia , Marshall Caitlin , Ikechi Chijoke , Shah Ankur 
Published: October 2021

Abstract

Background
Acute pancreatitis is the world's most common gastrointestinal disease requiring hospital admission. Our audit aim was to assess the timeframe within which Abdominal Ultrasound Scans (USS) and Computerised Tomography (CT) were performed, reported indications for CT and the prognostic factors noted in imaging reports.

Methodology
A retrospective search included admissions with acute pancreatitis between 01/09/19 to 30/11/19, collecting demographics, admission time & date, time and date of both radiological investigations and imaging reports. Patients under the age of 18 were excluded.

Results
This search identified 75 patients (M:F, 40:35) with a median age of 53 (18-95) years. USS were performed within 24 hours of admission in 40.0% (n = 30) of cases. Out of the patients (n = 44) who received a CT scan, 15.9% (n = 7) were scanned after more than 72 hours of onset of symptoms and 84.1% (n = 37) were scanned within less than 72 hours. Furthermore, 88.6%(n = 39) of CT request indications were in keeping with our standards. The average length of hospital stay was 6.1 days when scanned within 72 hours and 11.8 days when scanned after more than 72 hours.

Conclusion
Only 17.3% (n = 13) of the patients audited met all our standards and were managed according to the guidelines. The average length of hospital stay was half in those who had a CT scan after more than 72 hours of admission and this was also used to monitor disease progression/regression.
EP.TH.166Evaluation of the impact of the COVID-19 pandemic on the practice of axillary node dissection
Authors: Harris Grant , Townend Alice , Youssef Madgi 
Published: October 2021

Abstract

Aims
The Association of Breast Surgery's "COVID-altered" guidance for management of breast cancer during the COVID-19 pandemic, includes that neoadjuvant chemotherapy was only to be used only in inoperable disease and not to downstage the axilla. Delayed presentation with increased nodal involvement was also a concern.
We aim to establish if axillary node dissection (AND) increased in the context of pandemic.

Methods
Patients undergoing surgery for breast cancer were identified from theatre coding in a UK breast unit. Pre-COVID (March 2018 - February 2020) and COVID pandemic (March - September 2020) cohorts were compared. Indication, tumour receptor status, neoadjuvant chemotherapy (NAC) and deviation from routine practice were ascertained for those undergoing AND. Trust Caldicott and audit department approval was obtained for this retrospective review of practice.

Results
AND was performed in 20.2% (23/114) of breast cancer operations during the pandemic compared with 18.97% (78/411) pre-COVID. Indication for AND during the pandemic and pre-COVID respectively - clinically node positive 82.6%/79.4%; positive sentinel node biopsy 4.3%/17.9%; recurrence or metastases from contralateral cancer 13%/2.5%. NAC preceded AND in 30% of cases in both cohorts. NAC for one node positive HER2+ cancer was omitted due to the pandemic and another patient had adjuvant chemotherapy omitted for a HER2+ cancer with a single positive sentinel node mandating an AND which yielded no further positive nodes.

Conclusions
The COVID-19 pandemic has not significantly impacted rates of AND in our practice. However, we identified 2 patients who may have avoided AND with normal chemotherapy protocols.