bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.376 Early Routine CT Scans for All Surgical Admissions for Abdominal Pain May Improve Patient Outcomes
Authors: Quah Samantha , Cheah Hock Ping , Wong Kenneth 
Published: October 2021

Abstract

Aim
Acute abdominal pain remains a diagnostic challenge in the Emergency Department (ED) as pathologies can involve various surgical craft groups. Computed tomography (CT) enables accurate diagnosis of abdominal pathologies. However, with pressures on ED such as the “4 hour rule” established by the Australian NSW Health Emergency Performance Plan, there may be resistance or omission of early CT in ED. We hypothesise that early, routine CT in adult patients presenting with acute abdominal pain requiring hospital admission improves patient outcomes by increasing diagnostic and referral accuracy. This study compares the proportion of correct ED diagnosis of abdominal pain presentations with and without formal imaging reports.

Methods
Data from 118 patients presenting with abdominal pain are collected prospectively in a regional hospital and analysed. Patient demographics, imaging results, initial ED diagnosis and final discharge diagnosis are further examined.

Results
Out of the 118 patients who had abdominal pain, 32 patients obtained complete imaging with a radiology report whilst 86 patients either did not have any imaging performed or was referred to a general surgical unit prior to obtaining a formal report. Among the patients who had imaging reported, 78% (n = 25/32) had the correct diagnosis, whilst those without a radiology report had a 52% (n = 45/86) diagnostic accuracy. This demonstrates an improved accuracy of diagnosis or reduced error rate of 26% when a scan report is available (p = 0.01).

Conclusion
Early, routine CT with formal reporting significantly reduces diagnostic error rates and increases accurate referral. This allows accurate diagnosis and improves patient outcomes.
EP.FRI.390 Improving care for patients with acute bowel obstruction: A closed loop audit
Authors: Clayphan Benjamin , Fairclough Anna , Lim Jeff , Alexander Roderick 
Published: October 2021

Abstract

Aims
Acute Bowel Obstruction (ABO) accounts for 10% of emergency surgical admissions and when surgery is required mortality can exceed 10%. Early diagnosis is associated with improved patient outcomes and timely acquisition of abdominal CT scans can help prevent delays. The NCEPOD 2020 report on ABO identified ‘delays in imaging’ as a key area for improvement in the care of these patients, with these delays being exacerbated if an abdominal X-ray (AXR) was performed as well as an abdominal CT. This study looks at ways to expedite the diagnosis of patients presenting with ABO.

Methods
A retrospective audit of 77 patients admitted from A&E or SAU with ABO from April 2019 to February 2020 was conducted. Imaging modality, time-to-CT scan and time-to-diagnosis was recorded. Results and recommendations were presented locally and an evidence based ABO care pathway was implemented and publicised. 20 patients were audited prospectively, post care pathway implementation.

Results
70.1% of patients from the initial audit received a CT-scan and 42% of these patients received an AXR before their eventual CT-scan. The average wait for a definitive radiological diagnosis was 27.8hr. After implementation of the pathway only 18% of patients audited received both modes of imaging and the average time to diagnosis has been reduced to 10.7hr.

Conclusions
Raising awareness of the appropriate and timely use of CT-scans in the diagnosis of ABO has reduced the number of concomitant AXR for these patients, expediting the making of a definitive diagnosis and improving patient outcomes.
EP.FRI.451 Laparotomy rates and factors influencing treatment modality for diverticulitis during the COVID-19 lockdown
Authors: Yiasemidou Marina , Guadalajara Hector , Lockwood Sonia , Maslekar Sushil , Olmo Damian Garcia , Chetter Ian 
Published: October 2021

Abstract

Background
Infection control measures during the COVID-19 crisis modified diverticulitis treatment. Here we present the treatment applied in three large UK centres compared to the same timeframe in 2019.

Methods
This was a multicentre, comparative study, whereby diverticulitis cases from March 23rdto May 11th2019 acted as historical controls for cases during lockdown. Severity at presentation (SD), comorbidities, treatment modality, Length of Stay (LOS), complications and COVID-19 status (CS) were recorded. Chi-squared, ANOVA, Mann-Whitney test and linear regression were used for analyses.

Results
59 patients presented with diverticulitis in 2020 compared to 130 in 2019 (M:F 27/32, 56/74 and 64vs.62 y.o.). Laparotomy was performed in 6/59 and 12/130 respectively. Comparing 2019 to 2020, there was no statistical difference for severity (p = 0.643), treatment modality (0.946), comorbidities (0.313), LOS (0.602). Linear regression demonstrated statistically significant association between treatment employed (p &lt; 0.001) and SD, while there was no association with age, comorbidities or CS. LOS was associated with severity only (p &lt; 0.001), whilst CS, treatment, age and comorbidities yielded no statistical difference.

Conclusion
Diverticulitis cases during 2020 lockdown reduced noticeably (59vs.130). There was no difference in severity, treatment, comorbidities or LOS between 2019 and 2020. Laparotomy was performed in 6/59 and 12/130 respectively. Decision about treatment and LOS in 2020 was associated with severity of disease only. There was no association with COVID status. These findings should be interpreted with caution due to small COVID positive numbers and not including ambulatory units, however, they are consistent with findings from our sister Spanish group.
EP.FRI.454 National Emergency Laparotomy Audit: are we compliant with pre-operative mortality risk documentation?
Authors: Lam Mark , Ng Sherwin 
Published: October 2021

Abstract
The National Emergency Laparotomy Audit (NELA) set out key performance indicators in patients undergoing emergency laparotomy, one of which is the assessment of individuals pre-operative risk of mortality. This should be made explicit to the patient and recorded clearly on the consent form and in the medical record.1 Pre-operative mortality risk can be calculated through clinical assessment or using the NELA risk scoring tool. Omission of a this can lead to patients missing out on accepted standards of care and belies gaining informed consent. A snapshot audit of patients added to the NELA database was performed between 01/08/2020 and 31/10/2020. Data collected included the pre-operative mortality risk percentage (if calculated) and whether the patient was taken to theatre. This figure was correlated against the patient's physical notes or scanned copies on Medway. A target level of ≥ 85% of patients having their pre-operative mortality risk calculated and the this figure being documented appropriately.
49 patients were uploaded to the NELA database and 80% (n = 39) had a calculated risk. 55% of these patients (n = 27) proceeded to theatre, however correlation with physical notes and scanned documents on Medway revealed none had the correct documentation as per NELA standards. A questionnaire circulated to trainees and consultants exploring their understanding of pre-operative mortality risk documentation. Of the 7 respondents, 4 stated they rarely or never documented the pre-operative mortality risk as per NELA guidance. Ideas for improving the documentation process included a NELA pathway document, visual aids (e.g. poster) and a pre-operative mortality risk sticker.
EP.FRI.466 Indications and Outcome of Abdominal Re-exploration in the Pediatric Population. A Single Centre Experience
Authors: Abdullah Farooq , Gulnaz Nadia 
Published: October 2021

Abstract

Abdominal exploration (ARE) is an important complication of abdominal surgery and has an effect on morbidity and mortality. ARE refers to exploration performed within 60 days following initial surgery.
The purpose of this study is to know the grounds for performing re-exploration and its effects on the outcome.

Methods
This retrospective study was carried out in the pediatric surgery unit of Khyber teaching hospital from May 2017 to May 2019. All patients under the age of 16 years who underwent abdominal re-exploration within 60 days of the initial procedure were included in the study.

Results
A total of 55 re-exploration were done in the study duration of 2 years. The mean age of patients was 41 months (range of 0.06 to 168 months) male patients were 64%. On initial presentation, 56% of cases were emergency cases and 44% were elective. Common indications for re-exploration were, intestinal obstruction 29.1%, peritonitis 16.4%, complications of stoma 16.4%, burst abdomen 10.9%. The mean interval from initial surgery was 12.5±13.7 days. Common operative findings of re-exploration were inter-loop adhesions, anastomotic disruption, burst abdomen, anastomotic leak, intra-abdominal collection, gangrenous stoma, and para-stomal herniation. ARE resulted in 14.5% mortality.

Conclusion
Abdominal re-exploration is mainly indicated for intestinal obstruction and peritonitis. Inter loop adhesions and anastomotic leak are common surgical findings during re-exploration. The mortality rate is high in patients re-explored for peritonitis, fecal fistula, abdominal collection, and wound dehiscence.
EP.FRI.469 A closed-loop audit regarding the practice of sending Pus Swab for culture and sensitivity in Pilonidal abscess drainage
Authors: Sarodaya Varun , Nasser Mohammad Zeeshan , Hussain Mubashar 
Published: October 2021

Abstract

Aim
The purpose of this study was to determine the role of Microbiological swabs taken during an Incision and drainage for Pilonidal abscess in patient management.

Method
We performed a closed-loop audit to determine the role of pus swabs in the management of pilonidal abscess. Parameters like patient demographics, date of surgery, whether or not pus sent for microbiological examination, the subsequent report, the time required for sample processing, antibiotics prescribed were considered. The data was collated, analysed, and presented at clinical governance. We then implemented in our treatment protocol to stop the practice. This data was again, prospectively collected to complete the audit cycle.

Result
A total of 250 patient were included in this study. Prior to the change of practice, swabs were sent in 77% of the cases. The average reporting time of the swabs was 4.3 days and 92% of the patients were discharged on antibiotics. After conducting multiple teaching sessions for the trainees and educating the theatre staff, the percentage of swabs sent was brought down to 58%.

Conclusion
The pilonidal abscess has high infection and recurrence rate. Hence, the management involves incision, drainage and antibiotics cover in most cases. In our study, the swab results did not alter patients management. Most of them were treated with Co-Amoxiclav and some required additional Metronidazole. Hence, we suggested the routine use of swab for culture in pilonidal abscess cases are unwarranted. This change of practice resulted in huge cost savings at our hospital.
EP.FRI.489 Audit of emergency Operation notes (audit cycle)
Authors: Gulnaz Nadia , Oweis Rami , Abdullah Farooq , Crumley Andrew , Tasleem Sadia 
Published: October 2021

Abstract

The Royal College of surgeons has recommended guidelines for documenting operative surgical notes. An operation note must include ample information about the operation.
In our initial audit, we found some areas for improvement. This re-audit of operative notes was aimed to review compliance with the guidelines by the Royal College of Surgeons and to identify areas of further improvement.

Methods
The notes of all patients who underwent emergency surgery from 1st of January to 15th of March 2020 under the General Surgical department were reviewed. Endoscopic procedures were not included in the study. Electronic records were used to review the operation notes.

Results
Notes of a total of 176 patients were included in the study. Significant improvement was seen in most of the domains. Compliance of 100% was seen in documenting operative findings, type of incision, wound closure technique, procedural details, documenting extra procedures, and post operative instructions.
17.6% notes did not clearly document the indication/diagnosis for surgery. 15.3% notes missed information about DVT prophylaxis. 25.57%notes did not include information about peri-operative antibiotics in the context of prophylaxis or post-op need. A significant number (71.6% ) of the notes were missing information about operative blood loss if there was any or none.

Conclusion
Overall operation notes detail most of the information expected by the Royal College of Surgeons. The key areas for improvement are to include specific details about the following:
EP.FRI.511 Optimising Ambulatory Ultrasound in Emergency Surgery
Authors: Handa Ishita , Pearson Katherine , Day Anne Marie , Kirkby-Bott James , Berry David 
Published: October 2021

Abstract

Aims
Service provision and assessing the impact of future innovations can best be assessed by accurate reproducible data collection. The traditional model for our ambulatory surgical clinic with ultrasound allowed booking directly from the Emergency Department (ED) without discussion with the Surgical Team. We questioned whether this was the correct model and changed to a model of discussion with the Surgical team before booking in an effort to better utilise resource and reduce unnecessary footfall in the hospital.

Methods
We reviewed the outcome data of consecutive ambulatory ultrasound clinic referrals before and after implementation of this change in practice (1 month before and after the change)

Results
Ninety four ambulatory Ultrasound referrals were reviewed. In the first cohort 30 of 50 patients came directly from ED without discussion. A positive USS report was recorded in 8 of the 30 (27% USS positivity rate). After the change in practice to discuss with the surgical team, 11 of 43 patients originated primarily from ED with a positive finding in 4 patients (36%).

Conclusions
A key aim of service improvement is to optimise / improve utilisation of resource. This must be achieved without missing pathology. In this study we reduced the number of scans performed by ED whilst increasing the likelihood of a positive scan. This change in practice better utilised resource and reduced unnecessary footfall in the hospital.
EP.FRI.535 A clinical audit of post-operative antibiotics prescription in uncomplicated perianal abscesses
Authors: Zhao Sarah , Najdawi Ahmad , Laliotis Aggelios , Thomas Rhys , Boghdady Michael El 
Published: October 2021

Abstract

Aims
Management of perianal abscesses continues to revolve around prompt surgical drainage. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines state that all patients should have incision and drainage within 24 hours and antibiotics are not indicated in routine uncomplicated perianal abscesses. We aimed to study the antibiotics prescription after surgical drainage in a London university teaching hospital against the national standard.

Methods
A single-centred retrospective analysis of all emergency surgical admissions for incision and drainage of perianal abscess was carried out for a 6 month period. Patients’ demographics, Co-morbidities, local and systemic complications and readmissions were studied.

Results
A total of 36 patients, (mean age 43, 64% males) were included in this study, 21 received incision and drainage without antibiotics prescription, while 15 received empirical post-operative antibiotics. Indications for antibiotic therapy in this group included diabetes, immunocompromise, local complications (necrosis, cellulitis) and recurrence. There was no clear indication for antibiotics in 60% of patients who received them. 86% of patients had surgical drainage within 24 hours of presentation. One patient was readmitted for a second drainage 3 months later. Most common empirical agent used was co-amoxiclav (53%), followed by (33%) combination of co-amoxiclav and metronidazole.

Conclusion
Although surgical drainage was generally carried out in timely manner according to guidance, there was excessive post-operative antibiotic prescriptions. Increase awareness of guidelines is required to improve antibiotic stewardship in these surgical patients in order to avoid unnecessary drugs’ prescription.
EP.FRI.537 Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in Clinical Practice or lack of guidelines
Authors: Zhao Sarah , Najdawi Ahmad , Laliotis Aggelios , Thomas Rhys , Boghdady Michael El 
Published: October 2021

Abstract

Aims
Acute cutaneous abscess is a common surgical condition which mostly require incision and drainage. Despite this, there is no standardised national or international guidance on the post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice of the post-operative antibiotics prescription for cutaneous abscesses in a University teaching hospital in London.

Methods
A retrospective data collection of emergency general surgical admissions for a period of six months from July to December 2020 was carried out. All patients with superficial skin abscess were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients’ demographics, Co-morbidities, local and systemic complications were studied.

Results
A total of 149 patients presented during this period. Mean age was 40 (54% were male). Most common site of abscess was perianal (24%), followed by pilonidal, axilla, back, gluteal, neck, abdominal wall and groin. At total of 108 (72.5%) were managed surgically with incision and drainage, 70 (65%) got antibiotics and only 23 (33%) had indications for it (i.e. diabetic, immunocompromised, sepsis, cellulitis, MRSA carriage) = (χ2[1] =22.03, p&lt;.0001).
Co-amoxiclav was the most common post-operative empirical antibiotic prescribed in 61% of the patients.

Conclusions
This study has identified significant variation in clinical practice regarding post-operative antibiotic usage in superficial abscesses. Further research is required in cooperation with microbiologists to develop standardised evidence-based treatment protocol for management of such common surgical condition.
EP.FRI.543 A rare case of acute jejuno-jenual intussusception in a patient with Roux-en-Y bypass secondary to a benign polyp
Authors: Fardanesh Armin , Powell Jamie , Al-Whouhayb Maitham 
Published: October 2021

Abstract

Introduction
Roux-en-Y Gastric bypass (REYGB) amounts for a third of surgical bariatric interventions. Small bowel obstruction (SBO) is a long-term complication in REYGB and can be caused by intussusception of bowel, in approximately 0.5% of procedures. Intussusception in REYBG is mostly attributed to dysmotility. This report demonstrates a rare case of intussusception in REYGB secondary to a benign polyp.

Case description
A 45 year old female, three years post REYGB, presented to A&E with acute, extreme upper abdominal pain, with three days absolute constipation. She was tender on examination with normal blood tests. CT scan demonstrated small bowel intussusception. Initial concerns were of intussusception of the jejuno-jejunostomy anastomosis causing SBO. She had an exploratory laparotomy, which confirmed intussusception, however this was 20cm distal to the jejuno-jejunostomy. Bowel was gently reduced, and deemed viable. On thorough run-through, a small segment at the transition point, was considered abnormal on palpation. This region was resected and a 1x1cm intraluminal polyp was identified as the causative lead point. The patient did well postoperatively.

Discussion
Small bowel intussusception in adults is typically attributed to pathological lead point, such as benign or malignant lesions. Intussusception in REYBG is a rare but well-documented cause of intestinal obstruction, usually attributed to dysmotility, secondary to ectopic pacemaker cells particularly around anastomoses. In this case, the intussusception was caused by an unusual pathology separate from the jejuno-jejunal anastomosis. We recommend thorough examination of all adjacent bowel to exclude lesions, in this case a polyp, which could result in recurrence.
EP.FRI.650 Are we calculating and documenting the NELA Score pre-operatively?
Authors: Rajain Sakshi , Kotecha Sita , Narula Harjeet Singh 
Published: October 2021

Abstract

Aim
Emergency laparotomy is a common procedure associated with high risk of mortality and morbidity. NELA risk score calculation for patients undergoing emergency laparotomy improves the quality of patient care and compares the organisation of patient care provided to the outcomes following surgery. The aim of this study was to determine if NELA score was calculated and documented pre-laparotomy.

Methods
A retrospective analysis was conducted for patients who had emergency laparotomy at a primary care hospital in England. This study included reviewing the case notes and consent forms to assess if NELA risk score was calculated. Following further education of the surgical team, the audit loop was closed.The primary outcome was to identify not only calculation but also that the score was documented.

Results
Measures taken to enhance NELA risk calculation included theatre co-ordinator asking for NELA risk score while booking for laparotomy and documentation on the booking form and posters on surgical ward. Consequently, 40% notes included Scoring which improved to 70% after making the above changes.

Conclusion
The NELA risk score should be calculated for all patients undergoing emergency laparotomy as it estimates an individual’s risk of death within 30 days of surgery. It also standardises the risk calculation among all laparotomy patients and aids in clinical decision making, therefore is vital to be calculated in pre-operative phase. To ensure it is correctly calculated at all times, regular teaching and updates of NELA score is recommended.
EP.FRI.663 Surgeons’ Views on Documentations on Resuscitation and Escalation Status in Emergency Surgical Admissions
Authors: Chan Deona Mei Lam , Yalamarthi Satheesh 
Published: October 2021

Abstract

Aim
Resuscitation and escalation of care are not always in the best interests of all patients. We surveyed the consultants’ and surgical registrars’ views on the completion of resuscitation and escalation documentations on admission.

Methods
A questionnaire was sent to the clinicians of the surgical department via Google Questionnaire. Data from the responses were collated.

Results
:5 consultants and 5 surgical registrars completed this part of the survey. 80% stated they fill out the section for resuscitation and escalation status; 60% stated they routinely fill this in and 20% would get their trainees to fill in this part of the booklet if they didn’t do it themselves. 40% fills in this section because it enables clear decision-making and 30% felt the lay out of the form is easy to fill in. Overall 50% of the participants feel there are time constraints. Some surgeons indicated sometimes the decision could not be made at presentation and they needed investigations and establish rapport with patients before decisions are made. 40% indicated they would go back and amend the section once a decision is made.

Conclusion
This survey identified surgeons do make efforts to complete documents on resuscitation and escalation status during emergency take. Common factors to stop them doing so are time-constraints and inability to make decision at the time of presentation. We recommend the surgeons to fill in the documentation retrospectively as soon as decisions on resuscitation and escalation are made.