bluuebunny/crossref_metadata_2025_split huggingface dataset:
713 Use of A Pre-Operative Investigation Checklist in Plastic Surgery Trauma
Authors: Slade R , Combellack E , Kaur A , Eales M , O'Neill T 
Published: May 2021

Abstract

Introduction
In a regional centre for plastic surgery, it had been noted that operations were being delayed due to lack of pre-operative investigations. A pre-operative investigation checklist was developed between anaesthetic and surgical staff for semi-elective plastic trauma surgery patients, based on NICE guidelines. The checklist recommends which blood, radiology and cardiopulmonary tests would be appropriate based upon age, ASA grade and co-morbidity.

Method
A complete cycle audit was used to evaluate the checklist. All patients having GA/block for plastic surgery trauma in a 2-week window were included. Data was collected retrospectively via electronic operative records, anaesthetic assessments, and clinical notes. A minimum of 15 patients was collected per cycle. A single page pre-operative checklist was created for pre-operative investigations were introduced after the first cycle.

Results
The first audit cycle had 16 patients, ASA1 (5), ASA 2(6) ASA 3 (5). 75% had appropriate pre-op investigations. In the second cycle 22 patients, ASA 1 (8), ASA 2 (9), ASA 3 (3), ASA 4 (1). 100% of patients had appropriate pre-operative investigations.

Conclusions
There was increased awareness of pre-operative investigations in medical and nursing staff after the introduction of the checklist. It has helped streamline the delivery of semi-elective trauma surgery in our unit.
717 The Introduction of a Discharge Letter Proforma For Hip Fracture Patients Improves Compliance with VTE Prophylaxis Prescription on Discharge: A Closed Loop Audit
Authors: Williamson C , Brennan C 
Published: May 2021

Abstract

Introduction
Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in inpatients; with those undergoing lower limb surgery at particularly high risk. NICE recommends that Low Molecular Weight Heparin (LMWH) or Fondaparinux should be used for VTE prophylaxis for one month following hip fracture. Our local policy is to prescribe Dalteparin for 30 days following surgery.

Method
A closed loop audit of VTE prophylaxis on discharge for 193 patients with hip fractures was performed. The first audit cycle established whether VTE prophylaxis was being prescribed in line with departmental policy. Following this, a template discharge letter was introduced which included a prompt for appropriate prescription of VTE prophylaxis.

Results
Initially, data for 93 consecutive patients was collected. It was found that 13% had not received VTE prophylaxis in line with guidelines. Of these, six patients had no documented contraindication or alternative prophylaxis prescribed. Results were disseminated locally.
After introduction of the template discharge letter, data for 100 consecutive patients was collected. Re-audit showed a marked improvement in adherence to local policy with 95% of patients now receiving appropriate VTE prophylaxis on discharge.

Conclusions
Introduction of a template discharge letter prompts the documentation of contraindications to prophylaxis and improves compliance with local policy.
725 Monthly Antibiotic Use in The Sheffield Children’s Hospital ED: A Hospital-Based Clinical Audit
Authors: Leong W S , Gray J , Rimmer C 
Published: May 2021

Abstract
Aim: To evaluate guideline compliance of antibiotics prescription in Emergency Department (ED).
To improve documentation of antibiotic prescription.
To highlight the need for good antibiotic stewardship.
To optimise the use of antibiotics.

Method
A cross-sectional, retrospective patient record review was conducted regarding antibiotic prescription over 1 month in Sheffield Children’s Hospital ED. All antibiotic prescriptions over that period were collected. From the total number of prescriptions, a convenience sample of 100 prescriptions was selected to correlate their indications with local guidelines.

Results
A total of 290 prescriptions for 310 antibiotics were collected. The most frequent antibiotic prescribed was Penicillin V (26.7%), followed by Amoxicillin (21.3%), Co-amoxiclav (20.3%), and Flucloxacillin (16.5%). From the convenience sample, 12 antibiotics were prescribed inappropriately, with the most frequent being Co-amoxiclav (41.7%), followed by Penicillin V (25%), Amoxicillin and Flucloxacillin (both 16.7%). Overall, there has been good stewardship of antibiotic use with 88% of antibiotic prescribing conducted appropriately as per ED guidelines.

Conclusions
Antibiotic resistance is a growing concern, with one of the leading causes being inappropriate prescription of antibiotics. Adhering to local guidelines can help to prevent them from developing resistance. Adherence can be improved through induction and training of clinicians.
789 Improving Compliance of The MUST Tool Through Multiple Interventions, Improves Documentation and Assessment of Nutritional Status in Trauma and Orthopaedic Patients Undergoing Surgery
Authors: Hinduja D , Ikram A , Idoye M , Bidwai A 
Published: May 2021

Abstract

Introduction
The Malnutrition Universal Screening Tool (MUST) is a nationally validated risk tool, used to identify adults who are malnourished. 40% of surgical patients are malnourished which significantly impacts the outcomes of elderly patients. The primary aim of this study was to ascertain its utilisation in elderly patients undergoing trauma and orthopaedic surgery in a district general hospital.

Method
We completed a closed-loop audit from October2019-June2020 over two, three-week periods Inclusion criteria was age ≥65 years, and patients undergoing surgery. Data collected included MUST score, nutritional support, pre-operative fasting time, and prescription of fluids. Our intervention included departmental teaching sessions, posters, and the addition of the MUST tool to clerking proformas.

Results
We included analysis of 70 patients. Following our intervention, admission MUST score calculation improved by 8%, and providing nutritional support increased by 21%. However, there was no improvement in reducing pre-operative fasting time and prescription of pre-operative fluids.

Conclusions
Through our intervention’s documentation and assessment of nutritional status in elderly patients has improved. However further work must be completed to reduce time spent ‘nil-by-mouth’ and prescribe fluids for maintenance before surgery. This requires better pre-operative planning and communication between the surgical and ward-based teams.
798 Improving Foundation Doctors’ Confidence and Knowledge of Free Flaps and Their Possible Complications: A Closed-Loop Quality Improvement Study
Authors: Baldwin A , Tanos G 
Published: May 2021

Abstract

Introduction
To assess confidence and knowledge of managing free flaps in foundation doctors’, who, whilst working on a general surgery rota, are expected to intermittently manage plastic surgery patients, and introduce a simple tool to support them.

Method
A single-centre closed-loop quality improvement project, using the ‘Plan, Do, Study, Act’ methodology, was conducted. Initially, a prospective, baseline audit assessing foundation doctors’ confidence and knowledge was carried out. This utilised images and clinical scenarios to assess understanding of complications.
Results were analysed, and a simple poster was designed and distributed for reference. Two months later the questionnaire was repeated to reassess confidence and knowledge.

Results
Pre- and post- intervention surveys were completed by all general surgery foundation doctors (n = 11). Mean confidence was significantly improved following intervention (p = &lt;0.0001). Baseline ability to spot a healthy flap and venous congestion was good. Ability to identify arterial occlusion and a healthy muscle flap, with concurrent split-thickness skin graft, significantly improved (p = &lt;0.0001 and p = 0.0091, respectively)

Conclusions
Foundation doctors lack confidence and knowledge of managing free flaps, despite some being expected to do so whilst on a general surgery rota. This can be improved through a simple, informative resource to refer to when dealing with these patients.
872 Audit - Unexpected Overnight Stay After Day-Case Surgery In ENT
Authors: Darwich H , Dawoud M , Poulios A 
Published: May 2021

Abstract

Introduction
The aim of this audit was to determine the compliance with guidelines regarding patient selection for day-case surgeries in ENT.

Method
Data was collected retrospectively and included all patients who underwent elective ENT surgeries over a one-year period at an NHS hospital. Factors considered included nature of the operation, timing, surgeon’s preference, as well as social circumstances.

Results
Out of 1101 intended day cases, 113 (10%) had an unexpected overnight stay. The major factor contributing to these overnight stays was the timing of the operation, where 85 cases had undergone surgery in the afternoon. Other factors included drain siting, saturation monitoring, post-operative complications, and social circumstances. Tonsillectomy-related and nasal procedures formed the majority of the procedures, with 74 cases in total.

Conclusions
We concluded that most overnight stay cases included in this audit could have been prevented. Careful theatre list planning by prioritizing day cases for morning lists may reduce these numbers significantly. Co-morbidities and social aspects may need to be explored when booking patients for theatres.
925 Is Routine Bloods Group and Save Required for Emergency Appendicectomy?
Authors: Karim S , Shah V , Adegbola S , Tewari S , Gupta V 
Published: May 2021

Abstract

Introduction
Appendicectomy is commonly a safe and low bleeding risk procedure. However, some hospital guidelines stipulate a requirement for routine pre-operative blood group and save (G&S).We aim to determine if pre-operative G&S is required for appendicectomies by looking at the number of tests vs transfusion conducted.The cost of G&S is £4.14 per sample in our trust.

Method
A retrospective review was conducted over a 3-month period. Patient data and demographics were identified using the hospital coding, theatre records and transfusion departments.

Results
118 consecutive appendicectomies were identified. Of which, 99 laparoscopic vs 19 open (13 started open vs 6 converted to open) operations were performed. No patients required a blood transfusion during their admission. There was a total of 219 G&S conducted. Cross matching tests for these procedures cost a total of £906. We estimate a cost projection of £3624 for G&S tests over a year and £18120 over 3 years.

Conclusions
Bleeding complications requiring transfusion following appendicectomies are very uncommon. In our unit, 0% of patients identified required a transfusion during their admission. We suggest stopping routine pre-operative G&S for these patients would be clinically safe and would lead to financial savings and reduce pre-operative waiting time.
980 An Audit of a Surgical Ambulatory Service [SAmS] Performance Pre And Post COVID-19 - The Impact of Senior Decision Making
Authors: Clements J , Olukoga T , Clements B 
Published: May 2021

Abstract

Introduction
Surgical Ambulatory Units have emerged to refine the management of unscheduled care with the aim of reducing admissions and offering timely, accurate treatment strategies. There are 12 principles which underpin an efficient ambulatory Service, one of which is to have a 'Consultant led and delivered Service'. Consequent to the COVID Pandemic we reallocated Consultants to our Ambulatory Service and reviewed the impact of this initiative.

Method
Two periods - Pre COVID 6-17/1/20 and Post COVID 27/4 -10/5/20 were compared with respect to volume, case mix, procedures performed and outcomes in terms of investigations, and completed episodes. Data was retrieved from case notes and electronic databases.

Results
There were no demographic differences across the groups. The case mix and referral patterns were similar as was the volume. There were no differences in procedures or investigations ordered. In the Pre COVID group 20% of sessions were Consultant led compared with 100% in the Post COVID group. In the post COVID group 64% of cases were completed on the index attendance compared with 27% in the pre COVID group.

Conclusions
A Consultant presence in SAmS enhances decision making and risk management and is critical for the efficacy of the Service with respect to patient flow and resource management.
987 MRI As A Guide for Prostatectomy Planning
Authors: Vanalia P 
Published: May 2021

Abstract

Introduction
NICE guidelines suggest that PSA, mp-MRI and targeted biopsies should be used for the diagnosis of prostate cancer. This audit looked at several aspects of prostate cancer assessment and diagnosis at our trust, however we will be focusing on the use of MRI.

Method
A retrospective cohort study was performed at Lancashire Teaching Hospitals and this included 49 patients. We compared the pre-operative MRI tumour location and tumour grading with post-operative histology tumour location and tumour grading of prostate cancer patients. The statistical analysis was performed using Chi-squared testing.

Results
Prostate tumour location mapping based on MRI was accurate in 70% of the cases, these results were statistically significant (p-value &lt;0.01). However, the tumour grading according to the MRI was only accurate in 45% of the cases (p-value &lt;0.05).

Conclusions
Tumour grading based on the MRI result should not be routinely used to stratify risk and plan treatment. However, a prostate planning meeting would be recommended prior to the surgery and this can use the MRI location of the tumour along with the patient’s baseline regarding urinary and erectile function to help plan nerve sparing and surgical margins, this would help improve outcomes for patient's post-operative quality of life.
1025 Readmission & Mortality Rates Following Enhanced Recovery After Surgery (ERAS) For Colorectal Procedures at An Island DGH
Authors: Moore P , Pickering O , Cook E 
Published: May 2021

Abstract

Introduction
Colorectal surgery under ERAS reduces postoperative morbidity by 40-50% and shortens length of hospital stay by 2-3 days. The 2018 National Bowel Cancer Audit reported a 30-day readmission rate of 10.5% for colorectal surgery under ERAS and a 90-day mortality rate of 2% nationally. Evidence shows readmission rates increase with discharge C-reactive protein (CRP); 16.5% when CRP &gt;100 mg/L and 6% when CRP &lt;100 mg/L.

Method
Data was collected prospectively at a small island DGH on 89 patients from September 2018 - March 2020.

Results
The 30-day readmission rate was 7.9% and the 90-day mortality rate was 0% locally. Six (86%) of the readmitted patients had a left-sided colorectal disease (potentially due to increased risk with a colo-colonic anastomosis). Five (71%) patients required return to theatre; four due to anastomotic leaks and one due to a wound collection. 43% of readmitted patients had upward white cell count/c-reactive protein (WCC/CRP) trends on discharge. Readmitted patients had a mean discharge CRP result of 150 (range 15.9 - 311).

Conclusions
Colorectal surgery under ERAS at our institution is at a high standard stemming from effective staff education and post-operative patient counselling. This study provides evidence that WCC/CRP trend is related to postoperative prognosis.
221 UK Medical School Selection Criteria Predicts Success in Part A of The Intercollegiate Membership of The Royal College of Surgeons (MRCS) Examination
Authors: Ellis R , Brennan P , Cleland J , A. Lee  , D. Scrimgeour  
Published: May 2021

Abstract

Background
Selection into UK medical school typically involves a combination of three measures: prior academic attainment, selection tests (e.g., the University Clinical Aptitude Test (UCAT), Biomedical Admissions Test (BMAT), Graduate Medical School Admissions Test (GAMSAT)), and an interview. We investigated whether prior attainment and selection test scores can predict MRCS success.

Method
We used the UKMED database to analyse selection data for all UK graduates who attempted MRCS Part A (n = 9729) and Part B (n = 4644) between 2007-2017. Univariate analysis and Pearson correlation coefficients were used to examine the relationship between selection scores and first attempt MRCS success.

Results
Successful MRCS Part A candidates had better A-Levels and higher scores in UCAT, BMAT and GAMSAT examinations (p &lt; 0.001) than their unsuccessful peers. No statistically significant difference was observed for MRCS Part B. A moderate positive correlation was found between Part A, BMAT (r = 0.315, p &lt; 0.001) and GAMSAT scores (r = 0.346, p &lt; 0.001). A weak positive correlation was found between Part A, A-Level (r = 0.144, p &lt; 0.001) and UCAT scores (r = 0.246, p &lt; 0.001).

Conclusions
A-level results and medical school selection tests predict success in the knowledge-based (Part A) MRCS examination.
229 Uncomplicated Diverticulitis: A Proposed Diagnostic Algorithm
Authors: Kerr B , Ahmed O , Byrnes C 
Published: May 2021

Abstract

Introduction
Covid-19 has changed surgical practice. Infection risk and hospital pressures means appropriate patient ambulation is paramount. Uncomplicated diverticulitis can be managed as an outpatient. Clinical differentiation of uncomplicated and complicated diverticulitis remains challenging. This study aims to develop a diagnostic algorithm to differentiate complicated from uncomplicated disease prior to imaging.

Method
A single-centre retrospective review of 177 patients referred as diverticulitis between Sept-Dec 2018, was performed. Data collected included clinical presentation, biochemistry and imaging. Complicated diverticulitis was defined as occlusion, perforation, abscess formation, fistula and/or bleeding. Inferential parametric analysis was performed to ensure predictive value.

Results
Of 177 patients referred, 71 received a consultant diagnosis of diverticulitis. 60 were confirmed and differentiated on CT scan. LIF/lower abdominal pain (P &lt; 0.01) and bowel habit change (P &lt; 0.05) was significantly higher in patients with diverticulitis compared to other pathology. In complicated diverticulitis, symptoms occurred &lt; 4days (P &lt; 0.05), fever was present (P &lt; 0.001) and CRP was &gt; 75.

Conclusions
Once diverticulitis diagnosis is made based on pain localisation and change in bowel habit, complicated disease can be predicted by symptom duration (&lt; 4 days), presence of fever and a CRP &gt; 75. Plans to assess these findings prospectively in a Surgical Admissions Unit are currently in development.
272 Morbid Obesity in Lower Limb Arthroplasty: Short Length of Stay and Favourable One-Year Outcomes
Authors: Sharrock M , Nugur A , Hossain S 
Published: May 2021

Abstract

Introduction
There are concerns that BMI is associated with a greater length of stay (LOS) and perioperative complications in lower limb arthroplasty.

Method
We analysed data from a six-month period to see if there was a correlation between BMI and LOS. We performed a subgroup analysis for patients with morbid obesity (BMI &gt;40).

Results
285 TKRs and 195 THRs were analysed. For TKRs, the average length of stay was 2.7 days. There was no significant correlation between BMI and LOS (r=-0.0447, p = 0.2267). The morbidly obese category (n = 33) had the shortest LOS (2.5 days) compared to other BMI categories. 30-day readmission rate was 6%. 90-day re-admission rate was 12%. Six patients had minor wound issues requiring no intervention or antibiotics only. The was one prosthetic joint infection, one stitch abscess, one DVT and one patellar tendon injury.
For THRs, the average LOS was 2.9 days. There was no significant correlation between BMI and LOS (r = 0.007, p = 0.4613). The morbid obese category (n = 9) had the shortest LOS (1.9 days) compared to other BMI categories. No patients were readmitted within 90 days or had documented complications.

Conclusions
Increased BMI is not associated with increased LOS. The morbidly obese had the shortest LOS, and commendable complication and re-admission rates.
273 The Consequences of a Failed Screening Programme
Authors: Sharrock M , Whelton C , Paton R 
Published: May 2021

Abstract

Introduction
Controversy exists surrounding the efficacy of the UK screening programme for developmental dysplasia of the hip (DDH).

Method
Clinical records were reviewed in children who were treated surgically for DDH. Demographic data, age and mode of presentation, and surgical treatments were analysed, as well as outcomes, re-operation rate and AVN incidence. Late diagnosis was defined as greater than 4 months.

Results
106 children (16 male, 90 female) underwent surgery from 1997 to 2018. 95 hips were operated for dislocation and 22 were operated for dysplasia. 13 patients had bilateral dislocations. Of the dislocated hips, the median age at diagnosis was 9 months (IQR 2-19). 56% were diagnosed late. In the late diagnosis group the median age for diagnosis was 19 months (IQR 15-21). We have identified an increasing trend in late presentation in recent years. This has been matched with an increasing trend in operation rates for dislocation per 1000 births.

Conclusions
This study demonstrates that DDH is being diagnosed increasingly late, which correlates with an increased need for surgical management. This suggests that the current UK screening programme is failing to identify children with DDH in a timely fashion, which necessitates more aggressive surgical treatment and less favourable outcomes.
368 Perioperative Outcomes in Open versus Laparoscopic Surgery in Elderly Patients Undergoing Right Hemicolectomy
Authors: Lim S Y , Wang R , Tan D J H , Chin Y H , Ng C H , Tham H Y , Buan B J L , Chong C S 
Published: May 2021

Abstract

Introduction
With the global aging population, elderly patients are increasingly undergoing colorectal surgery. This study aims to evaluate postoperative outcomes in open (OS) and laparoscopic surgery (LS) for right hemicolectomy in elderly patients.

Method
We retrospectively reviewed patients aged 70 and above undergoing right hemicolectomy for malignancies at our institution. Additionally, Embase and Medline databases were reviewed, and comparative meta-analysis was conducted.

Results
84 patients were included in our cohort (OS = 34; LS = 50). No significant difference in anastomotic leak (AL) (OS = 4; LS = 2; p = 0.176), surgical site infection (SSI) (OS = 4; LS = 2; p = 0.216), and ileus (OS = 10; LS = 16; p = 0.801) was observed. LS was associated with decreased postoperative stay (p = 0.001). Additionally, LS had faster return of bowel function (ROBF) (p = 0.068) and resumption of diet (p = 0.147), albeit without significance. Overall survival (p = 0.062), and disease-free survival (p = 0.067) did not significantly differ between LS and OS.
Pooled analysis of 463 patients yielded no significant difference in AL (OR:1.15; 95%CI: 0.17-8.01; p = 0.89), SSI (OR:0.88; 95%CI: 0.44-1.76; p = 0.71), and ileus (OR:1.42; 95%CI: 0.69 – 2.92; p = 0.35). Postoperative stay (WMD:1.90 days; 95%CI: -1.81–5.61 days; p = 0.31), and ROBF (WMD:14.49 hours; 95%CI: -4.07–33.05 hours; p = 0.13) were shortened in LS, although without significance.

Conclusions
LS is associated with improved functional outcomes without an increased risk of postoperative morbidity or mortality.