bluuebunny/crossref_metadata_2025_split huggingface dataset:
1346 Hardware Complications in Cephalomedullary Nailing for Intertrochanteric Hip Fractures: A Retrospective Cohort Study
Authors: Legg P , To C , Selmon G 
Published: October 2021

Abstract

Introduction
Intertrochanteric hip fractures are common injuries in elderly patients and can result in significant morbidity. The use of cephalomedullary femoral nailing (CMN) has gained popularity, particularly for unstable fracture patterns. We investigated hardware complications and mortality of patients undergoing long and short CMN for intertrochanteric hip fractures.

Method
We conducted a retrospective cohort study of consecutive cases in a single UK-based trauma unit between 01 July 2016 – 31 Dec 2019. Primary outcome measures were implant failure and revision surgery. The secondary outcome measure was mortality.

Results
335 patients were included, mean age 82.9 years. 176 long (LN) and 167 short (SN) CMNs were performed. 25/335 (7.5%) hardware complications occurred resulting in 19 (5.7%) revision surgeries. Overall implant survivorship was 94.3%. There was no statistically significant difference in implant survivorship between LN and SN (p = 0.93), or between proximal screw configuration (p = 0.20). Cox regression analysis did not identify any independent predisposing factors leading to hardware complications. 30-day, 90-day and 1-year mortality rates were 7.9%, 15.2% and 26.5% respectively. There was no significant difference in mortality between LN and SN (p = 0.53). Regression analysis identified age and male gender as statistically significant independent factors of increased mortality.

Conclusions
For intertrochanteric fractures, there is no difference in hardware complications or mortality between long and short cephalomedullary nails. We highlight the risk of implant fracture at the lag screw-nail interface; accounting for one-quarter of failures. The revision rate of 5.7% due to hardware failure should be a consideration for surgeons undertaking CMN for intertrochanteric fractures.
1436 A Stab in The Back: Assessment of Suspected Cauda Equina Syndrome by The Emergency Department Prior To Referral to Orthopaedics in A District General Hospital
Authors: Hyett V , Campbell N , Olukoya O 
Published: October 2021

Abstract

Introduction
Within the UK, Cauda Equina Syndrome (CES) is a rare surgical emergency which has the potential to cause significant morbidity. Within hospitals that do not have an on-site neurosurgical service, assessment of potential CES patients is performed in the Emergency Department (ED) prior to referral to either local orthopaedic or regional neurosurgical services. Delay or inefficiency in this assessment can result in delayed treatment and worsens patient outcomes.

Method
A retrospective study with patients identified from the orthopaedic trauma meeting lists over a 6-month period. Only patients assessed by the emergency department were included (25 total). Direct referrals and those with infective symptoms were excluded. ED clinical notes were assessed, and the documentation was compared against a standard from the American Spinal Cord Injury Association. Documentation of pre- and post-void bladder scan was also assessed.

Results
Of the 25 total patients, 60% had a full lower limb neurological examination documented. 20% had no documented neurological examination and 20% had an incomplete neurological examination. Only 68% of patients had a Per Rectal exam performed, of those 94% had perianal sensation assessed. 56% of patients did not have a post-void bladder scan documented.

Conclusions
Limitations to initial ED assessment of likely CES patients can delay diagnosis and treatment which can have devastating consequences for the patient. The data is limited by reliance on an accurate trauma list and exclusion of patients who were referred directly to neurosurgery from ED. Our recommendations include introduction of a CES assessment proforma within ED and a re-audit cycle.
1453 Assessing Procedure-Specific Risk Discussion in Elective Arthroplasty
Authors: Heylen J , Antoniou V , Kemp O , Roberts J , Vats A 
Published: October 2021

Abstract

Introduction
Improper consent is a failure of clinical care and also a major cause of litigation within health care authorities. 4% of surgical negligence claims are attributed to improper consenting in the NHS, with an average settlement fee of approximately £40,000 per claim. Improving quality of consenting therefore not only improves patient care but could also reduce healthcare cost.

Method
A retrospective analysis of 100 elective hip and knee arthroplasties at a district general hospital in the South of England. Clinic letters and consent forms were reviewed, using the British Orthopaedic Association (BOA) consent proforma as a comparison standard. Quality of consent was reviewed based upon inclusion of BOA associated risks.

Results
40% of hip arthroplasty clinic letters and 20% of knee arthroplasty clinic letters did not include a risk discussion. Common risks on consent forms when compared to BOA standards were 84.8% compliant in knees and 88.8% in hips. Less common risks on consent forms were 100% compliant in knees and 96% in hips. Rare risks on consent forms were 74.8% compliant in knees and 57.7% in hips. Notably blood clots and infection were consented for in almost all patients. Risk of death meanwhile, was only consented for 62% of the time, across both procedures.

Conclusions
Standard of consenting in this audit falls short of BOA standards. Improvement is needed to improve patient care and avoid medical litigation. An integrated electronic form linking consent process of both outpatient and pre-operative review could be a beneficial intervention.
862 A Retrospective Audit on Management of Ankle fracture In a District General Hospital in South east England
Authors: Thanuja Jayadhar A , Kesharwani D , Freire de Almeida P H S , Sobti A , Menon K , Unnitan A 
Published: October 2021

Abstract

Aim
Ankle fractures are common injuries encountered by orthopaedic surgeons on a daily basis. Primary aim of the audit is to compare management of ankle fracture in Ashford and St Peter’s Hospital under NHS trust with the BOAST guidelines. As a secondary objective, quality of life of patients less than 60 years of age is assessed in order to review the specificity of timing of surgery as mentioned in the guidelines.

Method
An audit was conducted among patients who have undergone open reduction and internal fixation for ankle fracture during a period of one year in Ashford and St. Peter’s hospital. BOAST guidelines was kept as a standard to compare the management practice in the trust. Quality of life is assessed with the help of COST (Chertsey Outcome Scoring for Trauma) scoring method.

Results
Trust showed good compliance with the guidelines regarding documentation and reviewing patients within 6 weeks’ time. Only 45% of the patients, less than 60 years old had surgery within 24 hours. The average COST score does not show any significant difference between those who had surgery within 24 hours and after that.

Conclusions
To conclude, trust showed good compliance in certain aspects like documentation and reviewing patients, but the surgery was delayed up to 19 days for patients less than 60 years of age. The average COST score showed that there are no functional benefits for patients who had surgery on an early date. So, the specificity of timing in the BOAST guideline is questionable.
1574 Does Use of Intra-Operative PPE Affect Post-Operative Infection Rates in Hip Fracture Patients?
Authors: Mercer A 
Published: October 2021

Abstract

Aim
COVID-19 has required significant change to theatre protocol. Regional guidelines dictate full PPE must be donned for all procedures where aerosol generating procedures (AGP) occur. Additionally, no one may enter or leave theatre whilst an operation is in progress, or until 20 minutes after an AGP. We hypothesized that adopting these protocols may lead to a reduction in post-operative infection in hip fracture patients.

Method
Multicentre retrospective cohort study comparing post-operative infection and return to theatre rates (&lt;30-days post-op) from 18/03/20 to 27/04/20 with respective period in 2019. COVID-19 was considered endemic in Northern Ireland from 18/03/20. Patients were identified from the Fracture Outcomes Research Department database and relevant inpatient episode reviewed via Electronic Care Record.

Results
464 patients were included– 261(2020) and 203(2019). In 2019, 4 patients (1.5%) returned to theatre within 30-days, however only one was due to wound dehiscence. In 2020, 1 patient (0.5%) returned to theatre for traumatic wound dehiscence, however they had no documented infection.

Conclusions
There was no difference in post-operative complication rate requiring return to theatre within 30 days between cohorts. Whilst PPE can be considered important for protection of patients and staff against COVID-19, it may not have significant effect on post-operative infection rates.
1665 Characterising the Escalation in Hospital Trauma Admission During the Easing of the COVID-19 Level 4 Lockdown Restrictions
Authors: Holt L , Sud A , Dixon G , Rutka O , Taylor J 
Published: October 2021

Abstract

Introduction
Major trauma reduced by over a third during the institution of UK level-4 national lockdown (Rajput K. et al; 2020). Easing of lockdown on a societal level posed unprecedented uncertainties. With the easing of restrictions, it is expected that the quantity of trauma would increase. In the absence of ‘normality’ it remains uncertain about the extent of the quantity, severity and aetiology of the trauma. The effect of lockdown easing on patterns of traumatic admissions has not been studied and it has important implications upon service provision.

Method
A retrospective cohort study using the data from 2017-2019 were used as a 3-year control to compare each month of 2020. Regional trauma data (TARN data) from Aintree level-1 Major Trauma Centre, the regional tertiary Specialist Units. Easing of restrictions to the regional tier system began in May-July. This index 3months was compared to the control data.

Results
Following easing of restrictions there was a significant increase in the Incident Severity Scores from trauma admissions. The %mortality during the level-4 lockdown decreases but as restrictions are eased there is an increase in the % mortality. The number of stabbings and road traffic collisions are also seen to increase following the ease of restrictions.

Conclusions
There is a decrease in the number of trauma calls seen following the easing of restrictions, yet the severity of the incident and the mortality rate has increased. Therefore, is the trauma more severe of does COVID-19 influence this?
84 Optimising The Assessment and Management of Acute Renal Colic in Secondary Care
Authors: Fonseka T , Ellis R , Gowda A , Tuckwood L , Careless A , Satherly H , Stanford R , Caddeo G 
Published: October 2021

Abstract

Aim
The latest guidance in acute renal colic states that patients should have serum calcium and urate (stone bloods) measured during inpatient admission. The guidance also states that follow-up imaging should be in the form of computed tomography (CT)-, ultrasound (USS)-, or X-ray- kidney, ureters and bladder (KUB). X-ray intravenous urogram (IVU) is now considered obsolete as it can result in over-exposing patients to radiation. Aims of this 2-cycle QIP were twofold;

Method
Data was extracted from electronic patient records on whether or not they had stone bloods measured during admission and also what follow-up imaging was requested. In the first cycle baseline data was extracted. A stone proforma was then created, incorporating the latest guidelines. In the second cycle the impact of the stone proforma was assessed.

Results
The study included 119 patients. After introducing the stone proforma we were successful in improving the rate of stone bloods being measured, increasing from 13% to 53%. We were also successful in reducing the rate of performing X-ray IVU, decreasing from 25% to 14% of patients.

Conclusions
This QIP demonstrates that management of acute renal colic can be optimised using a stone proforma and move current practice towards best practice. This is supported by the ‘Getting it Right First Time’ (GIRFT) Urology report 2018. The third cycle is currently underway, and we hope to see further improved outcomes.
324 Outcomes of Prostate Artery Embolisation In Catheterised Patients: A Case Series
Authors: Johnston M , Majkowska A , Ahmad M , Kamaledeen S , New F , Beckett D , Bent C , Turner K , Hanna L 
Published: October 2021

Abstract

Aim
Prostate artery embolisation (PAE) is an approved treatment for men with lower urinary tract symptoms secondary to benign prostatic hyperplasia (BPH-LUTS). Evidence of efficacy for PAE in patients who are unable to void urine spontaneously is scant, however. Traditional treatments for BPH-LUTS have evidence in retention patients and this series aims to report outcomes for PAE in catheterised patients.

Method
The records of consecutive men with BPH-LUTS which required either an indwelling bladder catheter or clean intermittent self-catheterisation (CISC) who subsequently underwent PAE were retrospectively reviewed. Basic demographics were collected along with information on the prostate volume and PAE procedure specifics. The primary outcome was whether patients were catheter/CISC free at 3 months. Other outcomes include complications, use of medications and the need for other surgical treatments post-PAE.

Results
63 men underwent PAE for urinary retention and BPH-LUTS between 2013 and 2020. Of these, 7 underwent a unilateral embolisation for aberrant anatomy. The mean prostate volume was 128ml. 61% of men were free from a catheter/CISC post-treatment. 4 patients suffered post-PAE UTI, whilst 3 patients subsequently underwent Transurethral Resection of the Prostate following PAE for failure to become catheter free. 13 men were entirely free from BPH-LUTS medications.

Conclusions
PAE for catheterised men results in a similar catheter-free rate post procedure to several more invasive BPH treatments. It has a low side-effect profile and gives men with poor health an option to try to become catheter free. PAE should be discussed with men with catheters as a treatment option.
327 Relative Benefits of Extracorporeal Shockwave Lithotripsy (ESWL) Compared to Observation in Acute Renal Colic
Authors: Lovegrove C , Spencer M , Turney B , Neal N 
Published: October 2021

Abstract

Aim
NICE guidance recommends patients with renal colic be offered surgical treatment, including extracorporeal shockwave lithotripsy (ESWL), within 48 hours if pain is uncontrolled or stones unlikely to pass. We compared outcomes for ureteric stone passage after ESWL with those of observation to ascertain the relative benefits of ESWL.

Method
We collected data on stone location, size, and number of ESWL treatments required prospectively over 18 months. Stone passage was confirmed radiologically. Data were compared with MIMIC, a multi-centre collaborative study examining spontaneous stone passage after observation alone.

Results
166 patients had ESWL for ureteric stones. Median size was 6.5mm (IQR 5.0-8.0mm). 57.2% (N = 95) were proximal stones. Smaller stones required fewer treatments (P = 0.003). Patients with a ureteric stone &lt;5mm required median 1.0 ESWL treatments (IQR 1.0-2.0). Ureteric stones 5-7mm had median 1.0 treatments (IQR 1.0-2.0) and stones &gt;7mm median 2.0 treatments (IQR 1.0-2.0). Compared to MIMIC, patients with ESWL for stones &lt;5mm were 11% more likely to achieve stone clearance (100.0% vs 89.0%, P = 0.001). ESWL for 5-7mm stones had 28.1% greater clearance compared to observation (77.1% vs. 49.0%, P &lt; 0.001) and ESWL for stones &gt;7mm 21% greater likelihood of clearance (50.0% vs. 29.0%, P &lt; 0.001). Proximal ureteric stones were 16.4% more likely to pass with ESWL than observation (68.4% vs 52%, P = 0.02). Distal stones showed similar passage with ESWL (77.5%) and observation (83.0%), P = 0.43.

Conclusions
Proximal ureteric stones and those &gt;5mm stones benefit most from ESWL. Results aid identification of patients whose stones are less likely to pass and warrant urgent review to consider ESWL.
494 Is it Time to Reassess Thromboprophylaxis in Endourology?
Authors: Simpkins S , Nalagatla S , Nalagatla S 
Published: October 2021

Abstract

Introduction
Evidence regarding risk of post-operative venous thromboembolism (VTE) versus bleeding in Endourology is acknowledged as weak. Sequela of both post-operative VTE and bleeding, whilst low in Endourology procedures, can represent significant morbidity and mortality for patients. European Association of Urology (EAU) guidelines advise against pharmacological VTE prophylaxis in Endourology procedures. A retrospective audit of the rate of VTE and bleeding, as well as adherence to EAU guidelines was performed.

Method
Patient data was gathered on those undergoing Endourology procedures at our institution, over a 6-week period. Medical records were reviewed for pre-operative VTE risk factors, VTE prescribing and adherence to EAU procedure-specific guidelines. The incidence of VTE and post-operative bleeding was also studied.

Results
A total of 21 patients underwent Endourology procedures, with 15 undergoing an Ureteroscopy, 5 Percutaneous Nephrolithotomies (PCNLs) and 1 Cystoscopy. One patient was identified as high-risk for VTE in accordance with the EAU guidelines. A further 7 and 13 patients were deemed as medium and low risk respectively. Pharmacological prophylaxis was prescribed in 66.6% of patients. No post-operative VTE or bleeding was reported. However, only 33.3% of patients had VTE prophylaxis prescribed in accordance with EAU guidelines.

Conclusions
The audit highlighted sub-optimal VTE prophylaxis prescribing in accordance with the EAU guidelines, with patients being over prescribed VTE prophylaxis. However, the criteria may underestimate potential morbidity and mortality in high-risk patient groups. It is therefore prudent to take into account patient and procedure risk, to more accurately estimate both VTE and post-operative bleeding.
757 An Audit of Post-Vasectomy Semen Analysis Adherence
Authors: Michael K , Walbaum C , Gonzalez V , Bourdoumis A , Surange R 
Published: October 2021

Abstract

Aim
Following vasectomy, patients undergo post-vasectomy semen analysis (PVSA) to determine whether they can be “cleared” to safely discontinue contraception. The adherence rates to PVSA are notoriously poor in the literature. The aim of this project is to assess our patient’s adherence to PVSA and identify areas for improvement.

Method
All vasectomies undertaken at a large urology centre between 01/01/2019 and 31/12/2019 were included. PVSAs were scrutinised one year later to determine clearance or special clearance according to the 2016 Laboratory Guidelines for Post-vasectomy Semen Analysis endorsed by the British Andrology Society.

Results
256 patients underwent bilateral vasectomy, with 132 (51.6%) undergoing PVSA, at a median of 16.4 weeks (range 7.3 – 71.6). At time of review, 71 (54.5%) of these have been cleared; 45 (63.4%) after a single PVSA and 19 (26.8%) after the second. Seven patients (9.9%) received special clearance, two patients (1.5%) were not cleared despite meeting the special clearance criteria and one patient suffered early failure (0.8%). Clearance letters were issued at a median of 2.7 weeks (range 0.1 – 28.8) following satisfactory PVSA results. Moreover, 33 patients (25%) had at least one PVSA sample rejected by the lab, mainly due to timing issues or incomplete information on the request form.

Conclusions
The adherence rate to PVSA in our cohort is in keeping with the literature, and the majority of patients who are cleared achieve this with just one PVSA. Interventions aimed at counselling patients about the importance of PVSA, reducing unnecessary repeats and reducing rejected samples are necessary.
853 Post-BCG Surveillance – General Anesthetic Rigid Cystoscopy in Intermediate/High-Risk Bladder Cancer. A Quality Improvement Project Done at A District General Hospital in South-East England
Authors: Kesharwani D , Raja Thinagaran J K , Tadtayev S , Arumainayagam N 
Published: October 2021

Abstract

Aim
High/ intermediate risk bladder cancer is treated with BCG immunotherapy and cystoscopy surveillance is the standard of care. Performing a General Anesthetic Rigid Cystoscopy (GARC) enables resection or sampling of suspicious lesions. We aim to evaluate its benefits while the alternative is Local Anesthetic Flexible Cystoscopy (LAFC).

Method
A retrospective analysis of patients that underwent rigid cystoscopy under GA over 2 years from January 2018-December 2019, post induction & maintenance cycles of BCG following primary TURBT. Overall inference (cystoscopy outcomes) was based on intra-operative findings, BCG cycle, suspicious lesions, recurrence/disease progression based on histology.

Results
A total of 53 patients had 114 procedures. Mean age of 72.29±8.98. 14 inpatient admissions due to GA/procedural complications or social reasons. 58.2% of patients primarily had G3T1 disease, 22.6% G2, 14.3% G1 & 4.9% had primary CIS. T1 & Ta disease were 42% & 43% respectively. GA cystoscopy showed normal findings in 57.1%, 33.33% suspicious lesions & 9.6% visible recurrence. 88% suspicious lesions upon biopsy showed benign findings on histology and only 12% malignant. 24% of lesions thought to be recurrence showed benign findings on histology, 56% as G3T1 disease and 20% as G3Ta disease. No one had stage progression and 3 patients had grade progression. Sub-analysis of various stages and grades showed an average of about 10% malignant findings only.

Conclusions
LAFC as first line for post-BCG surveillance can be recommended which aim to prevent GA complications, extra admissions, overall cost reduction in management of bladder cancers and GARC can be reserved for second line
1014 Assessment of Prostate Gland Volume Estimations Using MRI And TRUS Compared to Radical Prostatectomy Specimens
Authors: Yallappa S , Aneke I A , Amjad M , Clark A , Gommersall L 
Published: October 2021

Abstract

Introduction
The prostate volume is an essential criterion to calculate prostate specific antigen density (PSAD). When selecting patients for active surveillance (AS), in newly diagnosed low risk prostate cancer group or continuing AS in previously diagnosed cancer prostate, PSAD plays a major role. Estimation of the volume using digital rectal exam or PSA are inaccurate. This study aims to conduct a retrospective review to evaluate the accuracy of prostatic volume estimates in patients who had TRUS and MRI scans, comparing the obtained volumes to the reference standard which is the actual volume of radical prostatectomy specimen.

Method
Data was collected retrospectively for all patients who had robotic assisted radical prostatectomy (RRP) at the Royal Stoke Hospital between October 2015 and October 2018. Clinical information of TRUS and MRI prostate volumes were extracted from PACS and prostate specimen volume was collected from the histopathology report of RRP specimen.

Results
Pathological specimen prostate volume showed a positive relationship between MRI and TRUS prostate volume with a correlation efficient of 0.71 for MRI vs RRP specimen volume and 0.81 for TRUS vs RRP specimen volume. Mean TRUS volume underestimated prostate volume by 7.33cc and mean MRI volume underestimated prostate volume by 0.02cc

Conclusions
Although the study showed positive correlation between measuring prostate volume using MRI and TRUS as compared to RRP specimens, MRI showed a greater accuracy as compared to TRUS. We conclude that using MRI prostate volume gives more precise prostate volume estimate aiding appropriate therapeutic planning of patients with prostate cancer.