bluuebunny/crossref_metadata_2025_split huggingface dataset:
678 Can patients have their old life back? Using PM:L3 ratio to predict discharge destination of emergency laparotomy survivors
Authors: Ming J Y , Holmes M , Gani J , Pockney P 
Published: October 2021

Abstract

Aim
Psoas muscle:L3 vertebra (PM:L3) ratio is a relatively new risk assessment tool for emergency laparotomy(1,2) based upon the proven concept that sarcopenia – as diagnosed by low skeletal muscle index(3–6), psoas muscle density(7–9) or total psoas area(10–13) in a single axial slice CT image – correlates with increasing risks of bad outcomes in surgery. This study looks into the association between PM:L3 ratio of emergency laparotomy patients from home and their discharge destination.

Method
We performed an analysis on patients in the Hunter Emergency Laparotomy Audit (HELA) database, from January 2016 to December 2017. HELA is a retrospective review of all emergency laparotomy undertaken in a discrete area in NSW, Australia. All patients admitted from home, survived to be discharged from hospital and had an available CT abdomen were included (N = 433/562). A single slice axial CT image at the L3 endplate level was analysed using ImageJ® software to measure the area of L3 and bilateral psoas muscles.

Results
PM:L3 ratio is significantly lower in the group of patient discharged to a care facility than the group discharging back to their previous home residence (mean 0.951 vs. mean 1.128, p &lt; 0.001). Upon further analysis, the PM:L3s are divided into quartiles and stratified by sex. There is an association between lower PM:L3 and risk of discharging into a care facility (Q1 22.45%, Q2 19.59%, Q3 19.10%, Q4 5.71%).

Conclusions
PM:L3 ratio can predict the discharge destination of patients undergoing emergency laparotomy.
812 Mortality Risk prediction in Emergency Laparotomy (ORIEL) Study Outcomes at Wythenshawe Hospital
Authors: Carey C , Pittam B , Mobarak S , Varley R , Kingston J , Agwunobi A 
Published: October 2021

Abstract

Aim
Emergency laparotomy is a high-risk procedure with significant morbidity and mortality. ORIEL is a multi-centre national study aiming to compare the 30-day mortality predictions generated by NELA, P-POSSUM, ACS-NSQIP and SORT risk calculators with observed 30-day mortality rates in patients undergoing emergency laparotomies. We present the data collected from Wythenshawe hospital.

Method
Data were collected retrospectively on adult patients undergoing an emergency laparotomy between 01/12/2017 to 30/11/2019 at Wythenshawe hospital from the online NELA database. The median pre-operative mortality risks were calculated using the four risk calculators for all patients. Mortality and morbidity were compared with data reported in the Sixth NELA report.

Results
The median predicted pre-operative mortality (IQR) for all patients studied using NELA, P-POSSUM, ACS-NSQIP and SORT were: 4.3 (13.0), 5.2 (14.2), 3.4 (8.2) and 2.9 (9.3) respectively. Among patients who were alive 30 days post-operatively, the median predicted mortalities (IQR) were: 3.8 (8.5), 4.8 (11.0), 2.6 (6.9) and 2.8 (7.1) respectively, and among those who died were: 30.8 (18.9), 30.3 (63.4), 16.9 (13.9) and 20.3 (16.2). Compared to the national average, mortality rates at Wythenshawe were lower (9% v 9.3%), the median length of stay in hospital was lower (12 days v 15.4 days) and the percentage of high-risk patients admitted to critical care was higher (93% v 85%).

Conclusions
Similar values were generated with all the scoring systems among all patients. Wythenshawe hospital reports lower mortality rates and shorter stays in hospital despite operating on higher risk patients (ASA grades 3-5).
837 High Prevalence of Anaemia and Mortality in Older Patients Undergoing Emergency Laparotomy
Authors: Bakewell Z , Wilkinson A , Todd F , Okocha M , Baker K , McCarthy K 
Published: October 2021

Abstract

Aim
Anaemia affects 1in10 elderly (&gt;65) patients with a myriad of causes. Elderly patients undergoing emergency laparotomy often present with anaemia. Little is known however about the prevalence of anaemia in older people who require emergency laparotomy and the influence it may have on their outcomes.

Method
Elderly patients (&gt;65-years old) undergoing an emergency laparotomy between May2016-November2018 in a tertiary trauma centre were prospectively identified. Data included patient demographics, haemoglobin, MCV and ferritin, blood transfusions and iron products administered, readmissions and mortality.

Results
231 patients underwent emergency laparotomy. Prevalence of pre-operative anaemia in this group was 43%. 5% were very-anaemic and 38% mildly-anaemic. Ferritin was checked within 89 patients; insufficient levels were present in 20%. 31% of all patients were given blood in the peri-operative period. 100% of patients discharged, were anaemic. For pre-operative anaemic vs non-anaemic patients, ASA grade was higher (4 vs 3), readmission rate was 19% vs 18%, 30-day mortality was 18% vs 14% and 1-year mortality rate high(34% vs 22%, p &lt; 0.05). Very-anaemic patients (92%) received peri-operative blood compared to (41%) of mildly-anaemic patients. 30-day mortality was 0 vs 21% in very-anaemic vs mildly-anaemic patients. Mortality was 45.8% in patients who received transfusions compared to those who did not 19.9% (P &lt; 0.0001).

Conclusions
The prevalence of anaemia in older patients undergoing emergency laparotomy is high and related to significantly increased mortality(12 months after surgery). We have identified a high-risk group of older patients with mild anaemia on presentation who may be at increased risk of mortality 3months after surgery.
889 Management of Paediatric Appendicitis During the First Wave of COVID-19: Comparison of Our Centre to National Practice
Authors: Darbyshire A , Miles J , Towers A , Tan C , Toh S 
Published: October 2021

Abstract

Aim
Our hospital took part in a multi-centre prospective cohort study “the CASCADE study” investigating the management and early outcomes of children with appendicitis in the UK and Ireland during the first wave of the COVID-19 pandemic (1). The aim of this study was to compare our local outcomes to those at a national level.

Method
This was a prospective cohort study with data collected from 01/04/2020 to 31/05/2020. Primary outcome was treatment strategy for appendicitis. Secondary outcomes were duration of symptoms, ultrasound findings, rate of simple vs perforated appendicitis and complications.

Results
Overall, only a minority (2/24 [8%]) were initially treated non-operatively, with both proceeding to appendicectomy due to pain. Remaining children (24/26 [92%]) were primarily treated with appendicectomy. All were performed laparoscopically with no conversions to open. Ultrasound was performed for most children (23/26 [88%]) which accurately identified appendicitis (22/23 [95%]) and negative appendicectomy rate of zero. Rates of complex appendicitis were not higher than expected (10/26 [38%]) but had a longer duration of symptoms (median 66.0h [IQR21.5] vs 30.0h [27.2], p = 0.008) and more complications (4 vs 1). Post-operative length of stay was significantly shorter for simple appendicitis than complicated (median 1.0d [IQR0.0] vs 4.0 [IQR2.8], p = 0.001).

Conclusions
Practice in our centre contrasts with the CASCADE study's National findings where 39% were treated non-operatively, only 48% of appendicectomies were performed laparoscopically, only 53% of children had diagnostic imaging and negative appendicectomy rate was 4.5%. Rates of complications for simple and complex appendicitis were similar, but post-operative length of stay shorter in our centre.
975 On Call on Friday 13th: Unlucky for Some?
Authors: Gowda A , Caddeo G , Ellis R 
Published: October 2021

Abstract

Introduction
Despite the practice of evidence-based medicine, superstitions remain common amongst healthcare workers around the world. Friday 13th is a day that can cause anxiety amongst many surgeons on-call. Our aim was to determine whether there is a significant difference between working an on-call as a surgeon on Friday 13th compared to the preceding Friday at a large teaching hospital.

Method
We conducted a retrospective, longitudinal cohort study that analysed admissions and operative data for all emergency general surgical and urology patients at a large teaching hospital over a five-year period. The main outcome measures assessed included the number of emergency surgical admissions, emergency general surgical operations and emergency urological operations.

Results
There was no statistically significant difference between the number of admissions (412 vs 405, p=0.835), number of general surgical operations (63 vs 49, p=0.069), and number of urological operations (2 vs 4, p=0.449) on Friday 13th compared to Friday 6th.

Conclusions
Friday 13th will inevitably be unlucky for some, but this study shows that being on-call on Friday 13th is just as unlucky as being on-call any other Friday.
1030 Paediatric Appendicectomy - Appropriateness of Operative Intervention
Authors: Lu Q , Elakkad M , Daak A , Choh C , Durrani A , Brent A 
Published: October 2021

Abstract

Aim
Acute appendicitis is one of the most common paediatric surgical emergencies. Prompt diagnosis and interventions reduce the risk of perforation and prevents complications. The aim of the audit was to determine the appropriateness of operative intervention and to improve patient care by implementing changes. We assessed several performance indicators including the percentage of appendicectomy performed within 12 hours of decision to operate, the percentage of negative appendicectomy and the 30 days re-admission rate.

Method
All consecutive paediatric patients who had appendicectomy in our district general hospital from Jan 2017 to 2019 were included in the initial audit. For re-audit, we collected data from July 2019 to March 2020. Patients were identified from the theatre system and ward notes, theatre charts and biochemistry and histology results were collected from the electronic patient records.

Results
A total of 193 patients were included in the initial audit. Results showed that 52.8% of patients were reviewed by a consultant prior to surgery, 92% of patients had surgery within 12 hours of the decision to operate. The rate of negative appendicectomy rate was 25%.

Conclusions
Following this audit, several changes have been implemented including improving consultant review of paediatric patients, increasing imaging done by radiologists for paediatric patient. Re-audit showed that 86.7% of patients were reviewed by a consultant preoperatively. Negative appendicectomy rate remained the same at 24.4%. Admissions within 30 days of discharge improved from 13.8% in the initial audit to 11.5% in re-audit.
1156 NELA – Time to Antibiotics
Authors: Waterman J , Abdel-Dayem M 
Published: October 2021

Abstract

Introduction
Early administration of antibiotics is vital in patients that have intra-abdominal sepsis. The National Emergency Laparotomy Audit (NELA) 2019 found only 19% of patients with suspected sepsis received antibiotics in the first hour. The aim of this project was to audit the current time to antibiotics in patients who underwent an emergency laparotomy in our District General Hospital (DGH) in Wales.

Method
This was a retrospective audit of all patients that underwent an emergency laparotomy between January to July 2019. Data was collected from the NELA database and Clinical Notes.

Results
33 patients underwent an emergency laparotomy, 2 patients were excluded leaving a total of 31 patients. 55% of patients received antibiotics prior to theatre. 61% of patients triggered the systemic inflammatory response syndrome (SIRS) criteria on admission but only 47% of these patients received antibiotics. Of those that received antibiotics only 16% had them prescribed within 1 hour of arriving to the hospital. 41% of patients waited over an hour from the antibiotics being prescribed to receiving them and 1 patient did not receive the antibiotics at all.

Conclusions
This project shows there are many areas for improvement. Although antibiotics maybe prescribed, clear communication with nursing staff is important, so that they can be given in a timely manner. It is also important simple measures, like working cannulas, do not prevent administration of antibiotics. Re-audit of these results is vital after education. Some patients may not require antibiotics – but missing those that do could cost lives!
1308 Investigating the Use of a Novel Pre-Hospital Triage Tool for Acute Abdominal Surgical Emergencies – A Two-Phase Single Centre Cohort Study
Authors: Misbert E , Hughes M , Burke J , Schofield C , Young A 
Published: October 2021

Abstract

Background
Despite the recent improvements in mortality in patients undergoing emergency laparotomy(EL) within the UK, delay to theatre continues to be associated with increased mortality. This study aimed to assess if patients requiring urgent surgical intervention for acute abdominal surgical pathology could be identified in the pre-hospital setting.

Method
A two-phase, single-centre, cohort study was performed. Phase 1 retrospectively investigated patients who underwent emergency laparotomy between 01/01/2019-31/12/2019 at Leeds Teaching Hospital Trust (LTHT) through the NELA database. Phase 2 prospectively assessed NEWS2 for all patients presenting to LTHT Surgical Admissions Unit with abdominal pain between 01/01/2020-31/01/2020.

Results
Phase 1: 45 patients were coded through NELA and confirmed through operation note review as undergoing EL for gastrointestinal perforation. 66%(n = 30) were assessed by the ambulance service and 80% (n = 24) had a NEWS2 of 3 or greater. Phase 2: 319 patients were assessed in SAU/ED, of which 69 initially treated by the ambulance service. 30% (n = 21) of these patients had an initial NEWS2 of 3 or above. Sensitivity of a NEWS2 score of &gt;/3 in predicting the need for immediate surgical intervention including EL was 95%(95%CI, 74-99) and specificity was 95% (95%CI, 83-99) with a PPV of 86%(95%CI 67-95) and NPV of 98% (95%CI, 87-99).

Conclusions
A NEWS2 score of &gt;/3 predicts the need for emergency surgical intervention including laparotomy for gastrointestinal perforation with reasonable sensitivity in this cohort. A pre-hospital triage tool for patients presenting with abdominal pain could utilise NEWS2 as an adjunct to decision-making in an acute abdominal pathway.
1416 Trauma Laparotomy: Experience of a Newly Established Major Trauma Centre in Northern Ireland
Authors: Lee F , Bashabayev B , Yoong S 
Published: October 2021

Abstract

Aim
The aim of this study was to assess the perioperative pathway and outcomes of trauma laparotomy during a one-year period in a newly established Major Trauma Centre in Northern Ireland.

Method
Retrospective review of a trauma registry undertaken at the Belfast Royal Victoria Hospital between August 2019 and August 2020.

Results
During this one-year period, there were a total of 17 trauma laparotomies, with a female-to-male ratio of 6:11, and a mean age of 38.9 years. 15 of 17 cases were due to blunt trauma, with only 2 cases of penetrating trauma. Of trauma laparotomies, 8 were performed during day-time hours (0801-1800), 4 during evening-hours (1801-0000), and 5 during night-time hours (0001-0800). One perioperative death was recorded. The mean time to CT from arrival to ED was 34 minutes (national target of 30 minutes). The mean time until final report was 477 minutes (national target of &lt; 24 hours). The decision to proceed to trauma laparotomy was made prior to the final report in 9 cases. The mean length of inpatient stay for trauma laparotomy patients was 23.3 days, with a mean of 8.9 days spent in critical care.

Conclusions
This review provides an overview of provision of care for patients who underwent trauma laparotomies in Royal Victoria Hospital MTC and identifies areas for improvement. We plan to prospectively review outcomes following the opening of the Major Trauma Ward on 7th September 2020 and the implementation of the Northern Ireland Major Trauma Network Bypass protocol on 26th October 2020.
288 Impact of Trainee Surgeons Performing Thyroid Procedure on Patient Safety
Authors: Nessa A , Aspinall S 
Published: October 2021

Abstract

Introduction
Impact of trainee surgeons performing thyroid procedure on patient safety

Aim
The primary aim was to evaluate the impact of trainee as the principal operator on patient safety in thyroid surgery.

Method
The data was extracted from a single consultant’s data from 2009 to 2020 in the British Association of Endocrine and Thyroid Surgeons (BAETS) National audit. Multivariable analysis of predictive factors (including trainee primary operator) for temporary and permanent hypocalcaemia was performed.

Results
There were 507 thyroid cases. After excluding cases with missing data in variables analysed 378 (74.5%) cases were analysed. Vocal cord palsy occurred in 5/378 (1.3%), postoperative bleeding 3/378 (0.8%), temporary hypocalcaemia 68/378 (18.0%) and permanent hypocalcaemia 20/378 (5.3%). Predictive factors analysed included hyperthyroidism 117/378 (31%), retrosternal goitre 33/378 (8%), reoperation, 43/378 (11%), total thyroidectomy 184/378 (49%), nodal dissection 21/378 (6%) and trainee principal operator 15/378 (4%). Multivariable analyses of temporary and permanent hypocalcaemia found only two variables significantly affected incidence of temporary hypocalcaemia were total thyroidectomy (OR 7.82, 95% CI 3.41-17.92, p &lt; 0.001) and nodal dissection (OR 3.53, 95% CI 1.20-10.38, p = 0.02), and for permanent hypocalcaemia these were reoperation (OR 5.05, 95% CI 1.09-23.25, p = 0.04) and total thyroidectomy (OR 5.76, 95% CI 1.35-24.54, p = 0.018).

Conclusions
There was no evidence that trainee principal operator adversely affected the outcome of thyroidectomy; it is worth noting that only 4% of operations were done by trainees and so this study would support trainees undertaking more thyroidectomies as principal surgeon.
637 Patients' Perceptions of Complications Following Thyroidectomy
Authors: Marchitelli G , Tingle S , Bliss R , Truran P , Ramsingh J 
Published: October 2021

Abstract

Aim
The aim of this study was to assess patients' understanding of the risks of thyroid surgery and to assess whether their understanding of risks improved following the implementation of a pre-operative risk-tool.

Method
Single centre prospective cohort study between June 2019-August 2019. All patients that underwent thyroid surgery were recruited. Patients had either the standard process of consent or were provided with a pre-operative risk-tool and information leaflet. Post-operatively all patients were provided with a questionnaire to determine their understanding of the risks involved in having thyroid surgery. Data was analysed using GraphPad Prism v6.

Results
51 thyroidectomy patients were recruited; 28 patients had a standard process of consent and 23 patients were provided with the risk-tool. Patients undergoing standard consent processes had a poor understanding of the magnitude of post-operative risk; their median score for risk magnitude was 4.5/10 (2-7) versus 8/10 (4-10) in the cohort receiving the risk-tool. The proportion of intervention to non-intervention participants giving the correct answer reached a statistically significant difference in 50% of questions asked (P &lt; 0.001).

Conclusions
It is imperative thyroidectomy patients are made aware of both rare events but also the frequency of which events occur so that they are properly informed prior to consenting. We have demonstrated that standard processes of consent in thyroidectomy patients leads to poor perception of risks; providing a surgical risk-tool can counteract this. These results warrant development of clear guidelines on the use of pre-operative surgical risk-tools in thyroidectomy patients.
71 The Use of Sternocleidomastoid Rotational and Cervicofacial Advancement Flap for Closure of a Persistent Mastoid Cutaneous Fistula
Authors: Mantelakis A , Tsitsiou Y , Joshi A 
Published: October 2021

Abstract

Introduction
Postauricular mastoid fistula is a rare occurrence, typically following repeated soft tissue injury, commonly caused by chronic suppurative otitis media and repeated surgical treatments. Management is challenging with a limited number of reported, successful surgical techniques, which often have limited applicability.

Case report
We present a case of a 55-year-old male patient with a persistent right post-auricular cutaneous mastoid fistula as a result of two previous mastoidectomies. Although the patient underwent two simple primary closures, the fistula recurred. This was successfully treated with a new technique utilising a Sternocleidomastoid Rotational and Cervicofascial Advancement Flap which was completely healed at the 1-year follow-up without a recurrence of the fistula.

Conclusions
This novel technique provided a definitive obliteration of a persistent cutaneous mastoid fistula. By utilising a double layered flap, via a facelift incision, the flap results in an excellent functional and cosmetic result.
247 Single-Photon Emission Computed Tomography (SPECT) In Predicting Localisation of Parathyroid Adenomas: A Closed-Loop Prospective Study
Authors: Ahmed O , Gao C , Buchanan M , Pfleiderer A , Al-lami A 
Published: October 2021

Abstract

Aim
to measure the sensitivity of SPECT in localising parathyroid adenomas particularly whilst attempting minimally invasive parathyroidectomy.

Method
2-cycles prospective study correlating SPECT and operative findings was conducted. All patients underwent ultrasound and SPECT, those with concordant findings on both modalities underwent minimally invasive parathyroidectomy, whilst patients with discordant findings on both modalities had central neck exploration. Following operative findings, recommendations of changing the SPECT reporting method such as surgically relevant structures adjacent to the lesion, such as the thyroid, were implemented. Following which, a second prospective study assessed the outcome of change.

Results
In the first cycle, 20 patients underwent partial parathyroidectomy, either by open (n = 13), or minimally invasive (n = 7) approach. SPECT sensitivity was 85% (n = 17) in identifying the adenoma. Out of all histologically confirmed adenomas, SPECT identified all adenomas (n = 17) on the correct side and 41% (n = 7) on the correct level (superior vs. inferior parathyroid). In the second cycle following recommendation, 14 patients had surgery, 9 as minimally invasive and 5 as open approach. SPECT sensitivity was 79% (n = 11) for adenoma identification. Of all confirmed adenomas, SPECT identifying adenomas at the correct side increased to 91% (n = 10) and correct level to 91% (n = 10).

Conclusions
SPECT alone is not yet regarded as gold standard in parathyroid adenoma localisation. The study has demonstrated that feedback to the radiologist of the operative findings may enhance its usefulness, particularly in attempting to proceed with a minimally invasive parathyroidectomy.