bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP10.2.11 Horses for Courses – do surgical courses exist outside of the Royal Colleges?
Authors: Ali Roshneen , Bera Katarzyna , Hassan Maleeha , Lewis Christopher 
Published: October 2021

Abstract

Aims
Educational courses supplement deanery-led teaching, and may be mandatory for training progression. The Royal College websites are the first contact for trainees to search for courses, with other courses identified by word of mouth. This project aimed to collate a first comprehensive database of courses available for core and higher general surgical trainees and to identify areas requiring development.

Methods
A snowballing approach was used to systematically search all online available resources. This includes, but was not limited to, websites of the Royal Colleges, sub-speciality societies, trainee organisations, regional centres, deaneries and surgical technology companies. Course target grade, price, provider and dates were collated into a database. Conferences and symposiums were excluded.

Results
47 sources yielded 173 courses, priced between £50 to £1600 (median £450).
Technical skills (89/173) and clinical courses (45/173) entailed the majority; only 3 courses developed non-technical skills and 4 developed surgical leadership. Other categories include revision (11.6%), teaching (5.2%), and research skills (1.7%). The Royal Colleges provided 27.7% of all available courses, with the majority developed and delivered by other institutions. There was significant variability in available course information.

Conclusions
There are a wide variety of courses available for surgical trainees, however this information is fragmented, duplicated and incomplete. A central database requires maintenance, but would provide a reliable source of information. Leadership, research and non-technical skills are critical skills for surgeons – the lack of courses in these areas was surprising and require development as only 4 courses are endorsed by the Royal Colleges.
SP10.2.13 Theatre-team meeting start times during the COVID-19 pandemic: An audit of elective orthopaedic theatre practices at a high volume elective orthopaedic centre during the COVID-19 pandemic
Authors: Bishi Habeeb , Getachew Fanuelle , Kader Nardeen , Kader Deiary 
Published: October 2021

Abstract

Aims
The estimated cost of running an NHS theatre is 20 pounds per minute therefore it is essential that theatres runs as efficiently as possible to reduce waste.
After elective services were restarted a disproportionate increase in late theatre start times was observed.
An audit was carried out to evaluate whether team meetings were beginning on time (08:00) and if not; the length of and reason for the delay. These findings were presented at Clinical Governance and a re-audit was done to see if there had been any improvement.

Method
Data was recorded on an audit proforma in each theatre before the first case. This was done for 2 weeks over 12 days of theatre sessions and subsequently analysed to evaluate if practice was compliant with local theatre protocols.

Results
First cycle – average team brief start time of 08:05 with 17/18 (94%) of late starts due to surgeon/anaesthetist lateness.
Second cycle - average team brief start time of 08:08 with 10/22 (45%) of late starts due to surgeon/anaesthetist lateness.

Conclusions
Late starts led to further delays to the patient being sent for and arriving in theatre; late starts were usually caused by doctors/surgeons. The proportion of late starts due to the surgeon/anaesthetist (45%) decreased compared to the first cycle (94%) suggesting that theatre team members successfully adapted their practices following changes to local protocols during the COVID-19 pandemic.
A number of extraneous factors were also attributed to the later average start times in the second cycle.
TP1.2.3Oncological Outcomes of Organ Preservation Strategies - Local Excision Procedures and ‘Watchful Waiting’ In Management of Low Rectal Cancers – A Systematic Review And Meta-Analysis
Authors: Aspari A R , Ramesh V , Kumar G , Narayanasamy S N , Gumber A O , Thomas P F 
Published: October 2021

Abstract

Objective
To evaluate local recurrence, metastases, and survival outcomes of `wait and watch’ (WW) strategy and local excision (LE) of tumours, in comparison to the present standard practice of total mesorectal excision (TME) for locally advanced rectal cancers.

Data Sources
MEDLINE, EMBASE, PubMed databases, and sources of Grey literature.

Study Selection
Randomised and non-randomised prospective studies, retrospective studies with propensity-score-matched analyses.

Data Extraction and Synthesis
These were carried out independently by two reviewers. A random-effects methodology was used for meta-analyses. Data was presented keeping with the 27-item PRISMA checklist.

Main Outcomes
The primary outcomes of interest were local recurrence, distant metastases, disease-free-survival and overall-survival, which were assessed in comparison to those associated with radical surgeries (TME).

Results
7 of the 16 studies in the systematic review were included for the quantitative synthesis and meta-analysis. Local recurrence rates were comparable amongst patients in WW group and LE group to those undergoing TME. [Risk ratio (RR) 3.07/1.41; 95% Confidence Interval (CI) 0.86-10.95/0.66-3.01; P = 0.08/P=0.89 respectively]. Rates of distant metastases in the WW group and LE group were comparable to those undergoing TME [RR = 0.71/0.94; 95% CI 0.22-2.30/0.55-1.61; P = 0.56/ P = 0.83 respectively]. The median 3-year disease-free survival among patients undergoing WW, LE procedure, and TME were 88%, 80%, and 78.2% respectively; and the median 3-year overall survival among the three groups were 96%, 93%, and 89.5% respectively.

Conclusions and Relevance
Organ-preservation strategies appear to be a viable treatment option in the management of rectal-cancers. Further research is warranted to provide stronger levels of evidence on organ-preservation strategies.
TP5.2.1 Duplex ultrasound should be interpreted with caution in vascular access
Authors: Wicks Andrew , De Siqueira Jonathan , Bailey Marc , Troxler Max , Scott Julian 
Published: October 2021

Abstract

Aims
Dysfunctional vascular access in haemodialysis has varied clinical presentations, including prolonged bleeding, pain, loss of thrill, difficulties needling and ineffective dialysis. We aimed to establish whether specific presentations correlate with a higher frequency of adverse imaging findings and intervention.

Methods
Duplex ultrasound scans (DUS) of surgical AV fistulae and grafts performed in a teaching hospital trust between 01/07/2019 and 31/01/2020 were analysed. Referral reasons, diagnostic findings, onward imaging and interventions to salvage fistulae and grafts were cross-referenced from electronic patient databases.

Results
359 scans of AV fistulae were performed in the period studied, of which, 220 were performed on men. Median age was 63 years (IQR 49-72). The most common referral reasons were loss of thrill and difficulty needling (n = 46, both). 185/359 (52%) scans lead to subtraction angiography and 46/359 (13%) to open surgical intervention. Median time from DUS to angiography was 21 days and 21% (39/185) of DUS did not match with angiographic results. When assessing outcomes based on presentation, 16/19 (85%, p &lt; 0.01) patients who had high venous pressures on dialysis and 23/31 (74%, p &lt; 0.01) of those with dialysis recirculation required endovascular intervention. Pain on dialysis correlated poorly with future intervention (6/30).

Conclusions
A substantial proportion of DUS of dysfunctional vascular access do not correlate with subtraction angiography. Referral for DUS prior to angiography may delay intervention. Patients with objective signs of dialysis dysfunction (recirculation and high venous pressure) are highly likely to need intervention. Such cases may benefit from proceeding directly to angiography and on-table intervention.
TP5.2.5 The utility of ‘kissing’ common iliac artery stents in the management of occlusive atherosclerotic arterial disease of the aortic bifurcation
Authors: Delaney Jenna , Templeman Joshua , Hussey Keith 
Published: October 2021

Abstract

Introduction
A systematic review published in 2017 concluded that ‘kissing’ iliac stents to treat occlusive disease of the aortic bifurcation was associated with high technical procedural success and good medium-term patency. We have explored this in a regional vascular unit.

Methods
Retrospective review of patients managed with endovascular treatment of aorto-iliac segment (March 2015 to September 2020). The median follow-up was 2-years. Key outcome variables included the patency of the reconstruction and requirement for secondary intervention.

Results
There were 1,348 iliac endovascular procedures performed for occlusive atherosclerotic arterial disease of the aorto-iliac segment of which 56 were ‘kissing’ iliac stents. Intervention was performed for chronic limb threatening ischaemia in 29 cases. In 37 cases patients had unilateral symptoms only and in 41 cases patients had either TASC A or B lesions. Technical success was achieved in 55 cases and the median duration of admission was 1-day. At follow-up there was clinical patency in 54 cases, although there were 3 major extremity amputations performed (all on the index admission).

Conclusion
As with much of the work on ‘kissing’ iliac stents the number of patients is small and the group of patients variable in terms of medical co-morbidity, presenting clinical features and morphology of iliac disease. The procedure appears to have high technical success and can be achieved with little in the way of major morbidity. Medium term durability is good.
TP5.2.12 30-Day mortality in vascular surgery during the COVID pandemic: 1st wave outcomes
Authors: Stocco Fabio , Michel Martin , Khaliq Farihah , Sahl Abdullah Bin , Foster Joseph , Parry Duncan 
Published: October 2021

Abstract

Aims
To assess the 30-day mortality rate in patients undergoing vascular procedures in a single vascular centre during the first wave of the Covid-19 pandemic.

Methods
Retrospective analysis of all vascular operations undertaken at our unit from 11th March 2020 to 16th November 2020. Thirty-day mortality rate, ASA grade, 30-day Covid-19 PCR test positivity and cause of death were assessed. Mortality rate was compared to previous five-year average with a Chi- Square test.

Results
Within the observed period, 237 vascular operations were performed (49% operative reduction). 57 patients (24%) were operated electively through the “Green pathway” (day case) and there were no perioperative positive Covid-19 tests. 180 patients were operated through the “Amber” (elective Inpatient) or “Red” (emergency) pathway. Eight inpatients (4.4%) died within 30 days from surgery, similar to the average 30-day mortality observed in the previous years (5.9% p &gt; 0.05). Three patients (1.42%) tested positive preoperatively but were all asymptomatic from Covid-19. One patient who died tested positive for Covid-19 but was asymptomatic from a respiratory aspect and died of cardiovascular disease.

Conclusion
We found no difference in 30-day post-operative mortality rate during the initial wave of Covid-19. Only 3 patients undergoing emergency operations tested positive. This study does reinforce the “Green pathway” strategy for elective patients to ensure minimising exposure to Covid-19 but we also did not witness any difference in mortality rate in the “Amber” or “Red” pathway. The impact of the second or third “wave” on current numbers will need to be studied further.
TP6.1.8 Meta-analysis and trial sequential analysis of three-port versus four-port laparoscopic cholecystectomy (Level 1 Evidence)
Authors: Hajibandeh Shahab , Finch David A , Hajibandeh Shahin , Satyadas Thomas 
Published: October 2021

Abstract

Aims
to compare the outcomes of three-port and four-port laparoscopic cholecystectomy.

Methods
In compliance with PRISMA statement standards, electronic databases were searched to identify all comparative studies investigating outcomes of three-port versus four-port laparoscopic cholecystectomy. Two techniques were compared using direct comparison meta-analysis model. The risks of type 1 or type 2 error in the meta-analysis model were assessed using trial sequential analysis model. The certainty of the available evidence was assessed using GRADE system. Random effects modelling was applied to calculate pooled outcome data.

Results
Analysis of 2524 patients from 17 studies showed that three-port and four-port laparoscopic cholecystectomy techniques were comparable in terms of operative time (MD:-0.13,P=0.88), conversion to open operation (OR:0.80,P=0.43), gallbladder perforation (OR:1.43,P=0.13), bleeding from gallbladder bed (OR: 0.81, P = 0.34), bile duct injury (RD: 0.00, P = 0.97), iatrogenic visceral injury (RD:-0.00,P=0.81), bile or stone spillage (OR:1.67,P=0.08), port site infection (OR:0.90,P=0.76) and need for reoperation (RD:-0.00,P=0.94). However, the three-port technique was associated with lower VAS pain score at 12 hours (MD:-0.66,P&lt;0.00001) and 24 hours (MD:-0.54,P&lt;0.00001) postoperatively, shorter length of hospital stay (MD: -0.09, P = 0.41), and shorter time to return to normal activities (MD:-0.79,P=0.02).

Conclusions
Robust evidence (Level 1 with high certainty) suggests that in an elective setting with uncomplicated cholelithiasis as indication for cholecystectomy, three-port laparoscopic cholecystectomy is comparable with the four-port technique in terms of procedural and morbidity outcomes and may be associated with less postoperative pain, shorter length of hospital stay and shorter time to return to normal activities.
TP6.2.13 A PEG insertion pathway for Motor Neurone Disease patients improves efficiency and patient outcomes
Authors: Rossi Benjamin , Salem Rola , Andrews Stuart , Bowling Kirk 
Published: October 2021

Abstract

Aims
Patients with Motor Neurone Disease (MND) often require a Percutaneous Endoscopic Gastrostomy (PEG) as a palliative procedure during the later stages of their illness, due to swallowing difficulties. More recently these are being inserted earlier before the inevitable decrease in nutritional intake and subsequent fall in albumin levels. This allows patients to eat food they enjoy rather than concentrating on maintaining intake.
Insertion has traditionally been done with local anaesthetic and OGD, which can be difficult and traumatic. We propose a method of insertion using TIVA (Totally Intravenous Anaesthetic) in theatre with no intubation, performed by the surgical team, with a pathway including pre-operative anaesthetic assessment.

Methods
Data was collected from all PEG insertions performed in theatre from 1/1/2011 to 1/9/2019. MND patients following our pathway were compared to all other indications for PEG insertions. Length of stay (LOS), 30-day re-admission rates, 30-day, 90-day and 1-year mortality were analysed.

Results
98 patients were identified. Median LOS was 3 days (mean 12.2) with a 3% 30-day mortality, 12.2% 90-day mortality and 34.7% 1-year mortality. In the MND group there were 27 patients. Median LOS was 2 days (mean 8.6) with a 7.4% (2 patients) 30-day mortality, which remained 7.4% at 90 days. There were 13 re-admissions (13.3%) overall compared to 0% in the MND group (p = 0.04 (Chi-squaredtest)).

Conclusions
PEG insertion under TIVA for MND patients is safe. A set pathway for admission and pre/post-insertion care increases efficiency with reduced length of stay and improves patient outcomes with no re-admissions.
TP7.2.1 Outcomes of Modified Karydakis flap in the surgical management of sacrococcygeal pilonidal disease: A single surgeon’s experience
Authors: Alam Fahreyar , Farooq Dilawar , Theofilis Aris , Wooler Harry , Payne Richard 
Published: October 2021

Abstract

Aim
To determine the incidence of post-operative complications of patients with sacrococcygeal pilonidal disease who were treated with the Modified Karydakis flap with a specific management bundle. Primary outcomes assessed included the post-operative incidence of seroma, haematoma, SSI, deep SSI, wound dehiscence, re-admissions, return to theatre and flap necrosis. Secondary outcome evaluated was recurrence at 6 month follow up.

Method
It was a retrospective analysis of a single surgeon’s (FA’s) practice results of Modified Karydakis flaps on patients with sacrococcygeal pilonidal disease who were managed according to a specific protocol. Data was collected between June 2017 and June 2020. 96 patients were analysed, of which 9 were excluded as they had excision without closure. Pre, per and post-operative management for the remaining 87 patients was according to a standardised protocol. Data was collected from patient’s notes and from prospectively and retrospectively maintained patient data bases (Theatre System, Medway).

Results
Primary outcomes:
• Seroma: 8/87 (9.2%)
• Haematoma: 1/87 (1.2%)
• SSI: 10/87 (11.5%)
• Deep SSI: 4/87 (4.6%)
• Superficial dehiscence: 7/87 (8.0%)
• Re-admission: 4/87 (4.6%)
• Return to theatre: 0 (0%)
• Flap necrosis: 0 (0%)
Secondary outcome:
• Recurrence at 6 months: 2/87 (2.3%)

Conclusions
Good surgical results can be obtained with Modified Karadakis flap, provided meticulous surgical technique is applied. Placement of a suction drain for a minimum of 72 hours reduces incidence of post-operative haematoma and seroma formation. Three post-operative doses of broad spectrum intravenous antibiotics followed by 5 days of oral antibiotics helps reduce post-operative infections.
TP7.2.6 Frequency of Obstructed Inguinal Hernia in Infants
Authors: Abdullah Farooq , Gulnaz Nadia , Saeed Khawar 
Published: October 2021

Abstract

Inguinal hernia in children is the result of the failure of obliteration of processus vaginalis or weakness of the abdominal wall. The incidence of inguinal hernia ranges from 0.8-5%. It is more common in preterm babies with an incidence of up to 30%.There is disagreement concerning the management of inguinal hernia in infants worldwide with few in favor of early repair of the hernia due to fear of incarceration while some are against it.
This study was conducted to determine the frequency of intestinal obstruction in infants with an inguinal hernia for the development of a proper protocol for the management of inguinal hernias.

Methods
A total of 112 patients were included in the study. The patient’s gender and age were recorded. The presence of hernia was confirmed clinically and by performing an ultrasound. All the relevant data was recorded in a pre-designed printed proforma.

Results
In this study, 112 children were included. 73% of children were in the age between 1-6 months and 27% children were in age between 7-12 months. The mean age was 5 months ±5.87. Male children were 86% and female children were 14%. An obstructed inguinal hernia was observed in 11% of children while 89% of children didn’t have obstructed inguinal hernia.

Conclusion
Our study concludes that the frequency of incarcerated inguinal hernia was 11% in infants mostly occurring at a younger age and in male children.
TP8.1.6 Why do people remain in hospital after mastectomy?
Authors: McLellan Morag , James Karen , Burrah Rajaram , Poonawala Shabbir , Callaghan Callaghan , Vinayagam Raman 
Published: October 2021

Abstract

Aims
Mastectomy is established as a safe day-case procedure. Amidst the ongoing COVID-19 pandemic it is essential to find ways to continue elective surgery with greater efficiency. The aim of this study is to establish factors associated with overnight admission after simple mastectomy, enabling more effective pre-operative planning.

Methods
All patients undergoing simple mastectomy in our unit between January and October 2020 were included. Those undergoing immediate reconstruction were excluded. The electronic case notes were reviewed to include procedure performed and patient characteristics. Basic statistical analysis was performed.

Results
95 patients underwent simple mastectomy (28 with axillary clearance and 58 with sentinel node biopsy). 56% of procedures were day-case. Axillary clearance was more common in the inpatient compared to the day-case surgery group (24% vs 45%). Both average age and ASA were significantly lower in the day-case compared to the inpatient group (p &lt; 0.05). There was no significant difference in BMI or specimen weight between groups. 16 patients underwent simple mastectomy without drain insertion, none required admission. Of the patients admitted overnight following surgery, 50% were pre-planned admissions. 57% of these were for patients identified as high surgical or anaesthetic risk at pre-operative assessment. Overall 5 patients stayed in hospital due to patient preference.

Conclusions
In addition to axillary surgery performed, age, ASA and perceived pre-operative risk are associated with overnight admission following simple mastectomy. Knowledge of these factors can better inform pre-operative planning. Providing enhanced post-operative support at home may enable more patients to be discharged on day of surgery.
TP8.2.1 Quality Improvement Project: Improving the percentage of patients receiving their consent form copy
Authors: Hamid Mohammed , Elserafy Amr , Anis Karim , Dilworth Mark 
Published: October 2021

Abstract

Aim
Good practice set out by the GMC and DoH is to acquire written informed consent for surgery, despite it not being a legal requirement. Baseline data of 50 consecutive surgical cases, undertaken in the UK’s largest trust, found that only 12% of patients were being offered their consent form copy prior to surgery. We constructed a SMART aim to increase this percentage by 20% each month on the general surgical wards of a city hospital.

Method
On analysing the patients’ physical notes, the three primary drivers identified were factors intrinsic to the department, consent form and our patients; signifying there was a lack of standard awareness, education and safety-net to ensure sustainability. To tackle this in-turn, we designed three PDSA cycles: Departmental seminar and poster, legal education session, and theatre checklist adaptation.

Results
Following our first PDSA cycle, the mean percentage increased from 12% to 44%. Using projection analysis, we anticipate this to increase to 76% after the second PDSA cycle, and 100% after PDSA3, with 100% sustainability 1 year later.

Conclusions
Overall, our results to-date show that the proportion of patients receiving their consent form copy has improved following our first PDSA cycle, indicating that awareness plays an important role in the consenting process. We predict that education plays an equal role; and given the research supporting the implications of checklists, we forecast that this later element will be the ultimatum leading to 100% sustainability of patients receiving their consent form copy prior to surgery.