bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.943 Time to surgical review in NELA patients
Authors: Kenny Laura , Waqas Ahmed , Hall Elizabeth 
Published: October 2021

Abstract

Introduction
The Royal College of Surgeons standards on unscheduled surgical care state that an ST3 or above should review emergency cases within 60 minutes of referral from the Emergency Department (ED).

Method
Data was gathered from all admissions (n = 50), from 01/9/19 to 31/10/19, registered on the National Emergency Laparotomy Audit (NELA). After exclusions, there were 20 patients who were admitted to surgery from ED. 14 of these had both time of referral and time of review documented.

Results
On average, patients were reviewed 2 hours and 23 minutes after referral. 9 of these patients (64%) were referred overnight (20:00-08:00) and their average time to review was longer; 2 hours and 49 minutes. 7 of all 50 NELA patients (14%) were never referred to surgery from ED.

Conclusion
Limitations include that ED doctors did not document what time patients were referred to surgery, and a small sample size; partially due to poor documentation.
The recommended 60 minutes time to registrar review is not being achieved but data is limited. To improve this, surgical registrars will be asked to document time of referral. Data on time to review will continue to be gathered. An abdominal pain pathway will be introduced to improve ED’s recognition of surgical patients. A re-audit which will encompass patients admitted via ED and ambulatory care, as well as including data on time to decision to operate is currently underway.
EP.FRI.1030 Splenic rupture in an obstructed colorectal cancer
Authors: Gok M A , Shams O , Ftaieh F , Sadat M M 
Published: October 2021

Abstract

Aims
A case report of a splenic rupture resulting from an obstructed sigmoid cancer in a 62 year old patient. Patient presented with colorectal cancer symptoms, suddenly developed severe abdominal pain and hypotensive shock, a diagnosis of splenic rupture resulted in early surgical intervention (splenectomy, Hartman’s resection).

Conclusion
Atypical presentations could have adversely delayed the diagnosis of splenic rupture. Serial clinical assessments and observations, supported by serological and radiological tests is crucial in the management and can lead to early surgical intervention in an unstable patient. Prompt resuscitation and imaging facilitated an early diagnoses and surgical management.
CT scan showed large volume of haemo-peritoneum with evidence of splenic rupture. Spleen histopathology was generally normal, with a potential of angiomatosis, but no metastatic disease.
Emergency colorectal cancers still accounts for 20% of all colorectal cancers. Splenic rupture is a rare complication in an obstructed colorectal cancer, but under-reported. Traumatic splenic rupture accounts for approximately 75 % whilst atraumatic represents less than 12 %. Splenic rupture can occur in the presence of splenic neoplasms as either primary or secondary disease.
This is caused by excessive traction on the spleno-colic ligament causing avulsion and tear of splenic capsule, heamatoma and subsequent spleen rupture. This can be considered as internal trauma to a viscus organ. Awareness of such a mechanism of splenic rupture in an obstructed sigmoid cancer can lead to an earlier diagnosis and get better outcomes, in the absence of trauma.
SP1.1.2Perineal reconstruction following extralevator abdominoperineal excision of rectum - Is IGAP flap a feasible option
Authors: Thambi Prem , Dzihni Wafa Abdul Muiz , Jha Trisha , Siddiqui Haroon , Jha Madan 
Published: October 2021

Abstract

Aim
Extra-levator abdomino-perineal excision for low rectal cancer has been shown to reduce tumor perfoation rates and incidence of local recurrence when compared to a conventional abdominoperineal excision. This is however associated with increased wound complications. This study was done to evaluate the feasibility of an inferior gluteal artery flap in patients undergoing ELAPE.

Methods
This was retrospective analysis was done at tertiary centre for all patients who underwent an ELAPE over a period of 7 years (December 2013 to July 2020). Patient demographic, relevant co morbidities and the data regarding chemotherapy and radiotherapy were analysed.

Results
A Total of 33 patients underwent ELAPE with an IGAP flap wound reconstruction. The mean age was 68 (44-86) with a mean BMI of 27 (25-45). 26 patients out of 33 (82%) received neoadjuvant treatment for cancer. The mean LoS was 11 days (6-31). The perineal wound complications were graded as per Clavein Dindo classification and 56 % had no wound complications recorded. 07/33 had Grade I and 06/33 had Grade II complications.

Conclusion
IGAP flap closure for perineal defects, does offer the advantage of compatibility with both minimally invasive and open procedures and the avoidance of using irradiated tissue. This case series does demonstrate the feasibility of IGAP flaps as viable option to cover perineal defects following radical low rectal cancer surgery with low morbidity.
SP1.1.6Incidence of post colonoscopy colorectal cancer, are we compliant with national guidelines?
Authors: Mohamed Eyas , Srikumar Bhairavi , Shishkin Bronwyn , Kulkarni Nikhil 
Published: October 2021

Abstract

Aims
To investigate the incidence of post colonoscopy colorectal cancer (PCCRC) at a district NHS trust and assess compliance with UK key performance indicators and quality assurance standards for colonoscopy guidelines endorsed by JAG and the ACPGBI

Methods
We conducted a retrospective review of our trust colorectal MDT database to identify patients diagnosed with colorectal cancer in the period between January 2016 till June 2019 who underwent a colonoscopy within 6-36 month prior to their diagnosis with colorectal cancer.
Patient demographics, indication of colonoscopy, date of cancer diagnosis, procedure related factors such as quality of bowel preparation, presence of diverticular disease, prior history of inflammatory bowel disease, previously diagnosed polyps and also grade of endoscopist were extrapolated.

Results
1323 patients were diagnosed with colorectal cancer during the study period, out of these there were 111 patients who underwent a colonoscopy within 6-36 month prior to their diagnostic colonoscopy. After exclusion of cases with anastomotic recurrence (n = 2) and cases with no PCCRC (n = 82), there were 27 patients with confirmed PCCRC in accordance with WEO classification (PCCRC 2.8%, acceptable target 5%)
Upon review of the 27 cases with PCCRC, there was equal gender distribution while the majority were 71-80 years old. There was evidence of diverticular disease in 44% and previous colonic polyps in 48%. The quality of bowel preparation was recorded as good in 25 cases while grade of endoscopist was consultant (n = 24), associate specialist (n = 1), nurse endoscopist (n = 2)

Conclusions
The incidence of PCCRC in our trust falls within national guidelines.
SP1.1.7PBX4 functions as a novel oncogene and promotes angiogenesis in colorectal cancer: A comprehensive analysis of the PBX gene family
Authors: Martinou Eirini , Moller-Levet Carla , Bagwan Izhar , Simpson Guy , Meira Lisiane , Karanjia Nariman 
Published: October 2021

Abstract

Aims
Pre-B-cell Leukaemia (PBX) genes are important in organ development during embryogenesis. To date, four members of the PBX family (PBX1, PBX2, PBX3, PBX4) have been identified to be involved in human cancers, but little is known about their role in colorectal cancer (CRC). The aim of this study was to determine their differential expression, prognostic role and function in CRC.

Methods
Molecular and overall survival (OS) data from 614 patients with CRC were obtained from the National Cancer Institute, Tissue Cancer Genome Atlas (TCGA) database. To investigate the differential PBX gene mRNA expression, we performed a comparative cancer to normal computational analysis in edgeR. To determine PBXs prognostic value, we conducted Kaplan-Meier survival analysis and COX regression, selecting 10-year OS as primary outcome. Lastly, to explore the effect of PBX4 in CRC cell growth and angiogenesis, we performed gene expression modulation experiments using a PBX4-overexpressing plasmid-vector. Cell proliferation and VEGFA angiogenic factor expression were defined as primary and secondary in vitro outcomes respectively.

Results
Among PBXs only PBX4 was significantly upregulated showing a 4-fold increase in CRC vs normal colon (p &lt; 0.0001). Survival analysis showed that only high PBX4 mRNA expression was associated with increased risk for worse OS in patients with CRC (HR:1.3 95%CI:1-1.6, p = 0.02). Functionally, overexpression of PBX4 significantly increased CRC cell proliferation in vitro (p &lt; 0.001) and markedly upregulated the expression of VEGFA (p &lt; 0.0001).

Conclusions
Comprehensive analysis of the PBX gene family identifies that PBX4 may function as a novel oncogene and may promote angiogenesis through VEGFA in CRC.
SP1.2.12A meta-analysis of the impact of rectal washout on local recurrence following anterior resection for rectal cancers
Authors: Hidayat Hena , Connelly Tara , Agarwal Anil , Gill Talvinder , Shanmugam Venkatesh , Etherson Kevin 
Published: October 2021

Abstract

Background
Standardisation of surgical technique in form of total mesorectal excision (TME) and the use of preoperative radiotherapy have led to improved oncological outcomes in rectal cancer. However, the effectiveness of rectal washout in reducing local recurrence (LR) following anterior resection remains debatable. The aim of this meta-analysis was to evaluate the effectiveness of rectal washout in reducing incidence of LR after anterior resection for rectal cancer.

Methods
A literature search of electronic databases including PubMed, Embase, Scopus and Cochrane was performed for studies that compared rectal washout to no washout after anterior resection using TME for rectal cancers. The review included all articles reporting oncological outcome of local recurrence. Meta-analysis was carried out using random effect model.

Results
A total of 5 studies involving 5315 patients were included in meta-analysis. Median follow-up was 60 (range 33–60) months. Overall local recurrence rate was 6.6 % with no significant difference in LR rate between the rectal washout and no washout groups (5.23% vs. 9 %)(P = 0.93; RR 0.97; 95% CI 0.52- 1.83).Similarly in subgroup analysis including prospective studies only no significant difference in LR was seen after washout (P = 0.06) or in group of patients treated with a curative intent(P = 0.50). LR was significantly lower in patients who had a rectal washout with normal saline (P &lt; 0.00001; RR 0.59; 95% CI 0.47-0.74).

Conclusion
This meta-analysis shows that there is no benefit of rectal washout in reducing incidence of local recurrence after anterior resection for rectal cancers.
SP2.1.12Use of the eLogbook in surgical training in the United Kingdom: A nationwide survey and consensus recommendations from the Association of Surgeons in Training
Authors: Beamish Andrew J , Rabie Mohamed , Johnston Maximilian j , Harries Rhiannon L , Mohan Helen , Gokani Vimal J 
Published: October 2021

Abstract

Introduction
Operative cases recording is essential to demonstrate experience. However, indicative numbers may incentivise overstatement or misrepresentation of experience. This study aimed to determine the perceptions of eLogbook use by UK trainees.

Methods
An anonymous online questionnaire was disseminated electronically using a yield-maximization strategy. Mixed methods evaluation of quantitative and qualitative data was used. Based on the results of this survey, a modified Delphi process was conducted within the Council of the Association of Surgeons in Training to develop recommendations for eLogbook improvement.

Results
Analysis included 906 complete responses (34.8% female) from all UK specialities and all training grades. More than two-thirds (68.5%) believed that overstatement of case involvement occurs and almost a third (32.7%) had witnessed overstatement. A fifth (20.8%) witnessed trainees logging cases not participated in, yet few (15.1%) had raised such an issue with a supervisor.
Feeling pressured to overstate involvement and number recorded was reported by more than a quarter (28.6% and 28.1%) of respondents. Almost a third (31.5%) felt that indicative case numbers were not achievable. Female trainees were less likely to feel well supervised (p = 0.022) and to perceive targets for training completion were achievable (p = 0.005).
Thematic analysis identified four key themes to explain logbook misuse: Pressure to achieve training milestones; eLogbook functionality issues; training deficiencies and probity.

Conclusions
Inaccurate operative recording was widely reported, largely in response to perceived pressure to achieve career progression targets. Operative logbooks may not be as accurate as intended. Consensus recommendations are made for improvement in the eLogbook and its use.
SP2.2.3How to make the perfect tweet: exploring factors which affect retweetability of surgical research
Authors: Mahendran Ashuvini , Perin Giordano , Baker Megan , Hanton Alice , Lumley Emma , Saha Arin 
Published: October 2021

Abstract

Aims
Twitter is a powerful platform for sharing information. Retweets allow users to reach a wider audience quickly. Our aim was to determine what tweet and twitter-account related factors affect the “retweetability” of surgical publications.

Methods
All papers published (in print) in Annals of Surgery, BJS and JAMASurgery in 2019 were selected. We identified each paper’s first appearance on Twitter and analysed characteristics of the posting twitter account and the tweet itself. The association between such characteristics and the number of retweets was investigated.

Results
413 papers were selected. Median number of retweets was 3 (range, 0-121). The first tweet created about a paper was usually from a reader (42%) with only a minority created by the journal (17%) or the authors (20%).
Use of visual abstracts (22/413, p&lt;0.001), pictures (145/413, p&lt;0.001), hashtags (149/413, p&lt;0.001), mentions (183/413, p&lt;0.001), number of followers (p &lt; 0.001), age of twitter account (p = 0.003) and authors as creators of the first tweet (p &lt; 0.001) were associated with higher retweets. When the journal created the first tweet, retweets were also increased (P &lt; 0.001). Posting the title of the paper alone attracted fewer retweets (p &lt; 0.001).
Multivariate analysis confirmed visual abstracts (p &lt; 0.001), hashtags (p=p.008), pictures (p &lt; 0.001) and authors as creators of the first tweet (p &lt; 0.001) were predictive of increased retweetability.

Conclusions
Authors and journals should create the first presence on social media to improve engagement with their papers. Such tweets should use visual abstracts or pictures, relevant hashtags and avoid solely posting the paper title to make their research more widely shared.
SP2.2.12Safety and Quality using GIRFT parameters; the use of hospital coded data as a quality measure
Authors: Fifer Helen , Hussain Muhammad Ibrar , Grey Tamsyn , Saha Arin , Peter Mark 
Published: October 2021

Abstract

Aim
Several indicators measure performance of hospital departments. Despite keeping accurate personal logbooks, surgeons rarely interrogate hospital-level data though these are used nationally (such as on HES databases) to assess performance. This study assessed the accuracy of hospital-level data.

Methods
Patients who were recorded as having had a length of stay (LoS) of &gt; 7 days, readmissions and patients who had a return to theatre were identified. A weekly ‘Safety and Quality (SnQ)’ governance meeting was established where consultant general surgeons assessed and analysed these data. Differences between hospital level data and outcomes after consultant review were compared.

Results
Over a six month study period, there were 306 patients (32 elective, 274 acute) who had a LoS of &gt; 7 days. After review, just 33 patients (13%) had a prolonged LoS due to a complication whereas the majority were due to non-surgical reasons.
There were 789 coded readmissions. Most coded readmissions were actually planned with 318 patients (43%) having an unplanned readmission. There were 47 recorded cases of a ‘return to theatre’ but after review, one-third (15 cases) were for planned central venous access and 22 cases were planned returns.

Conclusions
This responsive and accurate clinical governance system can assess performance beyond standard morbidity and mortality review. Hospital-level data often miss nuance; in this study, most coded readmissions were planned rather than unplanned and these discrepancies may reflect poorly on the department if entered onto national databases. Engagement with these data can help units improve outcomes and accuracy of their performance metrics.
SP3.1.9 Building the ‘LIEGS’ way – The development and delivery of ambulatory surgical services in the busiest acute surgical unit in the UK
Authors: Peckham-Cooper Adam , Giorga Andrea , Amtul Nasira , Ahmad Aman , Toogood Giles , Smith Andrew 
Published: October 2021

Abstract

Background
Managing unplanned surgical care presents enormous challenges to trusts and continues to be resource intensive. Significant patient numbers can be managed in novel ways preventing admission with effective triage to alternative flow streams using outpatient/ambulatory models. Leeds Institute of Emergency General Surgery (LIEGS) reports its early experience.

Methods
Patients requiring assessment or admission from primary care are triaged directly by a consultant. GP’s are offered advice or patients are directed to appropriate assessment/triage pathways. A number of alternative pathways exist depending on pathology and patient demographics. Prospective data for all patients referred are captured and retrospective analysis of outcomes collected. We report our experience from October-November 2020.

Results
Consultant triage and early senior decision-making has streamlined patient pathways and flow. 51%(237) of all GP referrals(465) were assessed primarily in ASC, 8%(36) required advice only and 10%(44) were directed to other specialities. 30%(139) were seen on the Surgical Assessment Unit ward representing a reduction of 70% compared to the previous year. Outcomes from those patients seen in ASC were discharge after imaging (87,18.7%), discharge without imaging (74,15.9%), hospital admission (65,14%), acute operation (63,13.5%), referral to other specialty (64,13.8%) and Rapid Access Theatre for day case operation (32,6.9%).

Conclusion
71.7% of all acute surgery primary care referrals were managed on in an ambulatory fashion providing an invaluable resource. Early senior decision making, a one-stop clinic for investigations and day case Rapid Access Theatre (RAT) lists can significantly improve the patient pathways and experience.
SP3.2.1 Consultant-led Urgent Ambulatory Management of Righted-sided Lower Abdominal Pain: Prospective data collection
Authors: Hussain Mubashar 
Published: October 2021

Abstract

Aims
To study if right lower abdominal pain could be managed safely on ambulatory basis when referred from emergency department or primary healthcare as suspected acute appendicitis to surgical ambulatory unit (SAU).

Methods
Data collated prospectively involving 586 patients, who presented with right iliac fossa/right-sided pelvic pain from january 2019 to January 2021.

Results
0ut of 586 patients, 234 (40%) were admitted and 352 (60%) managed in ambulatory settings after being reviewed by Consulant-lead surgical oncall team. Age ranged from 3 to 92 years. Male to female ratio was 3:2. Their management included clinical history/and examination, urinalysis and blood tests. 157 (44%) patients had scans, 43 (12%) had CT scans and 114 (32%) had pelvic USS the same day or the following morning/day and were reviewed by oncall-surgeons and 107 (30%) patients had repeat blood tests. 39 (11%) out of 352 paitents were admitted the following day review, of which 18 (5%) patients underwent laproscopic appendicectomy (LA) and 8 (2.2%) patients treated conservatively. 9 (1.98%) patients represented with persistent/or worsening symptoms and 5 (1.4%) patients of these had LA and 2 (0.56%) patients had pelvic collection, drained radiologically and 2 (0.56%) had wound infections treated with antibiotics. Complications rate in ambulatory patients compared to in-patients was insignificant, P-value set at 0.05% using Mann-Whitney U test.

Conclusions
SP3.2.15 Patient demographics and outcomes following emergency presentation with a groin hernia; a 15-year retrospective cohort study from the North of England
Authors: Clyde Danielle , Li Lucy , Swan Rebecca , McLean Ross , Brown Leo 
Published: October 2021

Abstract

Aims
Over 70,000 groin hernia repairs are performed in the UK annually. While most are performed in day-case settings, emergency presentation remains common and has a high associated morbidity and mortality. This study aims to report on patient demographics and outcomes following emergency presentation with a groin hernia.

Methods
Data was collected for all patients &gt;18 years admitted acutely with an inguinal or femoral hernia to NHS trusts between 2002-2016 in the North of England. This included patient demographics and operative interventions. Outcomes of interest were thirty-day inpatient mortality and length of stay (LoS).

Results
Overall, 6165 patients presented as an emergency with a groin hernia (76.2% inguinal) over the 15-year study period. There was a male preponderance (n = 4469, 72.5%) with a median age of 73 years (IQR: 58,82). No changes in the distribution of age or gender were noted over the study period. Comorbidity, as measured by Charlson score, increased over time (p &lt; 0.001). Median LoS was 2 days (IQR: 1,5), increasing with age and comorbidity (both p &lt; 0.001). Emergency surgery was performed for 3904 patients (63.3%). The thirty-day mortality rate of 3.1% rose to 3.7% in the subgroup of patients undergoing operative repair and 5.6% in those with associated bowel obstruction. Greater comorbidity and advanced age were again associated with increased mortality (both p &lt; 0.001).

Conclusions
This study highlights changing patient demographics more comorbid patients presenting acutely with groin hernias. These patients must be counselled regarding their increased mortality risk as part of the shared decision-making process.