bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.608Hospital within the Hospital – Renaissance of Elective Surgery Amidst the Pandemic
Authors: Ain Quratul , Gala Tanzeela , Rashid Hajr , Ashraf Hajra , Vesamia Shaheen , Vig Stella 
Published: October 2021

Abstract

Aim
COVID had an unprecedented effect on the NHS elective surgical care. To overcome the deficit created due to the pandemic, the concept of a ‘COVID protected zone’ gave birth to the ‘hospital within the hospital’. This included 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen and a separated entrance. Of the fundamentals of the model were enhanced infection control and PPE guidance for staff. The aim of our study was to evaluate the recovery of elective activity brought about by this elective centre.

Methods
Theatre activity data was collected weekly (7/20 to 1/21) through the business informatics system. This was used to compare the activity achieved during the recovery phase from COVID after the first and subsequent wave.

Results
Pre COVID-19, 11 theatres were operating. These managed an average of 263 cases were per week. In the first week of operation of elective centre, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. During the 2nd wave the capacity was reduced to 42% as opposed to 0% during the first wave. This was only possible due to our model elective centre.

Conclusion
This model elective centre has enabled elective care to return to above normal levels, with increased efficiencies. This has not only shortened patient waiting times and cleared the back-log but also delivered training to surgical trainees without compromising safety.
EP.WE.613A multi-centre review of the management of acute appendicitis during the COVID-19 pandemic
Authors: Lockhart Jessica Ruth , O'Brien Scarlett , Armstrong Lara , Armstrong Aidan , McKay Damian 
Published: October 2021

Abstract

Aim
Acute appendicitis is a common surgical presentation and is historically a clinical diagnosis; gold-standard treatment is appendicectomy. Due to anticipated increased demand on in-patient beds during the COVID-19 pandemic there was increased emphasis on conservative management of acute appendicitis. Our aim is to review these changes and determine the representation rate following conservative management.

Methods
Patients with acute appendicitis were identified from daily referral lists across two trusts. Data was collected using electronic care records. A control group (106 patients) was identified from 3 months preceding the pandemic.

Results
In the pandemic group, 213 patients had acute appendicitis; 47% were managed conservatively, compared to 8% of the control group. Overall, during the pandemic 44% of patients had a CT-confirmed diagnosis (compared to 48% of control group); the two trusts’ results varied showing 75% and 30% (compared to 46% and 51% respectively in the control group). Of those treated conservatively only 3% represented to hospital and required admission.

Conclusion
Significantly more patients were treated conservatively during the COVID-19 pandemic. The larger number of patients managed as acute appendicitis in the pandemic group may represent over-diagnosis due to the decision to conservatively manage these patients and account for diagnostic uncertainty. Increased access to early diagnostic CT scans facilitated early decisions regarding definitive management. Variation in access to radiology both during and before the pandemic may account for the difference in use of CT scans. Low rates of readmission to hospital following conservative management of acute appendicitis have been observed to date.
EP.WE.617A clinical audit analysing the completion of junior clerking at the Surgical Admissions Unit at an acute District General Hospital, as impacted by short-staffing due to CoViD-19
Authors: Sawhney Riya , Seite Enora , Fedder Artemis 
Published: October 2021

Abstract

Aims
The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19.

Methods
Admissions to the unit over a 5-day period (n = 92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks.

Results
Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p &lt; 0.05). This was not significantly (p = 0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p &lt; 0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p &lt; 0.05) without. The major theme identified was deferring to the ‘senior review’ section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking.

Conclusions
Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking.
EP.WE.629The effect of different anaesthetic agents in postsurgical inflammatory response in thoracic surgery: a systematic review
Authors: Aquilina Julian , Geropoulos Georgios , Loufopoulos Ioannis , Gupte Anaya , Mitsos Sofoklis , Panagiotopoulos Nikolaos 
Published: October 2021

Abstract

Aims
Post-operative systemic inflammatory reaction is part of the stress response caused by major thoracic surgery. Different anaesthetic agents used affect different immunological phenomena. This systematic review evaluates the impact of anaesthetic agents on the immunological profile and the associated clinical significance.

Methods
A systematic review of MEDLINE, EMBASE and Cohrane databases to explore how different anaesthetic agents affect post-operative inflammatory response.

Results
A total of nine studies were included in our analysis. Peri-operative use of dexmedetomidine, propofol, sevoflurane, isoflurane, ropivacaine, sufentanil, naloxone and clonidine were compared, based on their effect on the systemic release of inflammatory markers. Variance on the levels of the circulating inflammatory molecules such as interleukins, interferon-γ, tumor necrosis factor a and on the cellular response including natural killer, CD4 and CD8 T cells, were observed among different anaesthetic agents.

Conclusions
Inflammation improves immunity and regenerative cell recruitment, however excessive responses can lead to delayed wound healing, organ dysfunction and increased morbidity and mortality. There is still uncertainty regarding the role of immune changes on clinical outcomes of patients undergoing thoracic surgery, and more research is needed to explore other immunological effects related to anaesthetic agents.
EP.WE.718An audit of the photographic documentation of upper gastrointestinal endoscopy at Cork University Hospital
Authors: O'Brien Stephen , Foley Niamh , Murphy Amy Edwards , McCourt Morgan , Killeen Shane , Andrews Emmet 
Published: October 2021

Abstract

Introduction
A joint statement by the British Society of Gastroenterology and the Association of Upper Gastrointestinal Surgeons in 2017 recommended that photographic documentation of relevant anatomical landmarks should be a Key Performance Indicator of oesophagogastroduodenoscopy (OGD). The aim of this study was to assess this photodocumentation standard among surgeons and gastroenterologists in a tertiary referral centre.

Methods
Cork University Hospital endoscopy unit records were examined for a 2-month period from 01/10/20-27/11/20. OGDs were performed by 3 consultant colorectal surgeons and 4 consultant gastroenterologists over the time period. Demographic data and photodoumentation information were obtained from the Endoraad GI reporting tool. Surgeons and gastroenterologists performances was compared using the chi-squared test.

Results
104 OGDs were analysed. Fifty-three (51%) OGDs were performed in women and 51(49%) OGDs were performed by surgeons. The documentation for each site was; gastro-oesophageal junction- 68% (69/102), fundus on retroflexion- 71% (72/102), gastric body- 32% (33/102), antrum- 61% (62/102), and duodenal bulb- 35% (36/102), without significant differences (p &gt; 0.05) for these sites between surgeons and gastroenterologists. There was more documentation of the upper oesophagus by surgeons (31% vs.12%, p = 0.030) and there was more documentation of the distal duodenum by gastroenterologists (90% vs.47%, p &lt; 0.01). Pictures were unable to be saved in two patients due to technical failure.

Discussion
Photodocumentation is increasingly important from a medico-legal viewpoint. There is room for improvement in our centre, but these rates are comparable to other published series. An educational session is being planned and following this adherence to photodocumentation standards will be re-examined.
EP.WE.727Upper GI Surgery Clinic Referrals; Can We Improve the Patient Experience?
Authors: Abouelazayem Mohamed , Belchita Raluca 
Published: October 2021

Abstract

Aim
To review the new referrals to the Upper GI surgery clinic for appropriateness, investigations requested, and waiting times and to identify potential pathways to reduce waiting times and improve the patient experience.

Method
Patients who attended the UGI clinic over 2 months period were identified. Data were collected from GP referrals and Electronic Patient Records. Follow up, post-discharge appointments, and Did Not Attends were excluded. Data collected included time from referral to first clinic, symptoms, investigations requested, suitability for a pathway, and appropriateness of referral. A first clinic outcome was concluded from reading the GP referral, there were 5 outcomes to choose from; direct to another specialty, discharge back to GP, clinic, surgery, pre-investigate and clinic.

Results
147 referrals were analysed. The average waiting time from referral to the first clinic was 51 days (range 7-119 days). 73% of the referrals were GP referrals and 27% from other specialties. The most common referral was for gallstones and the most common 2 outcomes were Pre-investigate and surgery.

Conclusion
Most of the investigations and outcomes suggested from the project were the same as those from clinic letters. The following pathways can be developed to cut waiting times and costs for the trust:
EP.WE.829Does Covid-19 increase the risk of gastrointestinal perforation? A preliminary UK-based multicentre cohort study
Authors: Thrumurthy Sri , Kaur Vasha , Bello Abdulazeez , Zaidi Ahsan , Vasilikostas Georgios , Wan Andrew 
Published: October 2021

Abstract

Aims
Recent case reports have described occult gastrointestinal perforation secondary to Covid-related microcirculatory thromboembolic phenomena. This study aims to evaluate the effect of Covid-19 on the incidence of gastrointestinal perforations across South West London (SWL).

Methods
A retrospective cohort study included all patients with gastrointestinal perforations presenting to three SWL-based NHS hospitals from 01/04/2020-31/12/2020 (i.e. “pandemic” cohort; from the first national lockdown), versus a representative “pre-pandemic” cohort (01/04/2019-31/12/2019). Data was extracted from the hospital coding records, patient case-notes, and the NELA database, and analysed by two independent clinicians.

Results
A total of 448 patients were included. 9.3% more (214 vs. 234, p = 0.286) gastrointestinal perforations presented during the pandemic period than beforehand. Comparing both periods, there were no significant differences between the numbers of colonic diverticular perforations (183 vs. 185), gastrojejunal ulcer perforations (1 per period), and terminal ileal perforations (1 per period). There were 78% more peptic ulcer perforations (9 vs. 16) and 55% more gallbladder perforations (20 vs. 31) during the pandemic period, although no overall significant difference was derived at the 95% confidence interval (Χ2=3.458, p = 0.484).

Conclusions
While there was no significant overall increase in spontaneous gastrointestinal perforation during Covid-19, this study clearly suggests increased rates of peptic and gallbladder perforations. Larger-scale epidemiological data are warranted to ascertain whether this is secondary to increased consumption of alcohol, non-steroidal anti-inflammatory medication or other pro-ulcerative drug regimes during the pandemic. Further data will also be vital to highlight delays in investigation and/or presentation resulting in these increased perforation rates.
EP.WE.843Acute Appendicitis Management During the COVID-19 Pandemic: A Prospective Cohort Study From A Large UK Centre
Authors: Antakia Ramez , XAnthis Athanasios , Georgiades Fanourios , Hudson Victoria , Davies Justin , Bennett John 
Published: October 2021

Abstract

Aims
The aim of this study was to determine the efficacy and outcomes of conservative versus surgical management of acute appendicitis (AA) during the pandemic.

Methods
We conducted an observational study in a tertiary centre. Data was collected from all patients (≥16 years) with a diagnosis of AA between 1st November 2019 to 10th March 2020 (pre-COVID period) and 10th March 2020 to 5th July 2020 (COVID period).

Results
A total of 116 patients in the pre-COVID period were included versus 91 in the COVID period. 72.5% (n = 66) of the patients during the COVID period scored as high risk using the Alvarado score compared to 24.1% (n = 28) in the pre-COVID period (p-value&lt;0.001). We observed a significant increase in radiological evaluation, 69.8% versus 87.5% of patients had a CT in the pre-COVID and COVID periods respectively (p-value=0.008). 94.9% of patients were managed operatively in the pre-COVID period compared to 60.4% in the COVID period (p-value&lt;0.001). We observed more open appendicectomies (37.3% versus 0.9%; p-value&lt;0.001) during the COVID period compared to pre-COVID period. More abscess formation and free fluid were found intraoperatively in the COVID period (p-value= 0.021 and 0.023 respectively). Re-attendance rate due to appendicitis-related issues was significantly higher in the COVID period (p = 0.027).

Conclusions
Radiological diagnosis of AA was more frequent during COVID. More conservative management for AA was employed during COVID-19 pandemic, and for those managed operatively an open approach was preferred. Intra-operative findings were suggestive of delayed presentation during COVID without affecting the length of hospital stay.
EP.WE.906Endovascular Repair of Abdominal Aortic Aneurysm – A Retrospective Analysis of Outcomes from a UK Teaching Hospital
Authors: Perin Giordano , Garg Mukesh , Haldipur Nandan 
Published: October 2021

Abstract

Aims
Endovascular Repair of Abdominal Aortic Aneurysm (EVAR) is a minimally invasive technique that has become increasingly popular in the past few years. Recent evidence questioned the long term durability of the technique and highlighted the relevance of long term complications and reinterventions. The aim of this paper is to evaluate long term outcomes of EVAR with a focus on survival and aneurysm related reinterventions.

Methods
We retrospectively analysed all elective EVAR procedures performed for Abdominal Aortic Aneurysm (AAA) between May 2010 and June 2016 in our institution. Data collected included - comorbidities, post operative survival and post operative aneurysm related interventions. Survival analysis was performed using the Kaplan-Meyer method. We build a Cox Proportional-Hazard model to identify factors associated with increased mortality.

Results
182 patients were included in our analysis. Median age was 77 years (50-92). Median follow up was 65 months (31-104). During the follow up period we recorded 41 deaths. 30 day mortality was 0.5% (1), 2 year mortality was 8.7% (16). 17 patients (9.3%) required reintervention during the follow up period (2.4 reinterventions per 100 patient-years).

Conclusions
Our medium and long term outcomes following EVAR are comparable with what has been reported in the literature. A higher ASA grade and advanced age were associated with increased mortality in our cohort.
Ep.We.1001Name That Tune - Acccuracy of Interpreting Hand-Held Doppler Audio Signals in the Assessment of Peripheral Arterial Circulation
Authors: Kamarizan Mohamad , Da Silva Anthony 
Published: October 2021

Abstract

Aims
Interpretation of Doppler audio signals among non-podiatrist has not been thoroughly investigated. This study analyses the accuracy of interpretation of Doppler audio signals among clinicians.

Methods
A single-centre prospective single blind study was used. Clinicians in the vascular department and with prior vascular experience in a district general hospital participated in interpreting 15 12-second Doppler audio signals (5 monophasic, 5 biphasic and 5 triphasic) into either ‘monophasic’, ‘biphasic’ and ‘triphasic’ using a Huntleigh’s Dopplex DMXTM digital hand-held Doppler ultrasound with visual waveform display covered. After all the audio signals were graded, the waveforms of each doppler signals are shown on the hand-held doppler display to reveal the correct responds.

Results
8 clinicians were involved; 5 had less than 6 months of vascular experience. Out of 15 audio signals, the mean number correct grading of signals was 10.1. There is no difference in number of correct grading of the 3 waveforms (monophasic 3.5 out of 5, biphasic 3.25 out of 5, triphasic 3.5 out of 5). There is also no difference in responses between clinicians with less than 6 months and more than 6 months of vascular experience (p = 0.82).

Conclusions
There is a need for further ongoing education among clinicians in the use of hand held Doppler and interpretation of its audio signals. Reliability of Doppler examination in vascular assessment is also in contention, and further studies are required. The use of digital hand-held Doppler with visual wave form display will significantly improve accuracy of interpretation
EP.WE.103223-hour stay following total parathyroidectomy in renal patients
Authors: Neophytou Chris , Chang Jessica , Howard Emma , Houghton Andrew 
Published: October 2021

Abstract

Aim
Total parathyroidectomy in end-stage renal failure (ESRF), is an effective way to improve or stabilise calcium and parathormone levels and thus improve renal osteodystrophy. Previous BAEST guidelines were not in favour of true day-case neck surgery due to the risk of airway compromise from bleeding. Additionally, ESRF patients are at risk of profound hypocalcaemia after total parathyroidectomy.
Patients undergoing total parathyroidectomy are prescribed Alfacalcidol 4mcg daily for 5 days prior to surgery. Following surgery under GA on a morning list, the potassium and calcium levels are checked in the afternoon. Calcium levels are then monitored daily for 3 days and subsequently when required. Oral Alfacalcidol is continued at the same dose until the nephrologists advise otherwise.

Methods
All ESRF patients undergoing total parathyroidectomy for secondary hyperparathyroidism were identified between 01/01/2005 and 31/12/2019 from a prospectively maintained electronic database. Demographics, biochemistry, length of stay (LoS) and outcomes were analysed.

Results
There were 43 (30 male) total parathyroidectomies. The median age was 53 (range 14 – 78), and median LoS 1 day (range 0 -13). 26 patients (60%) were discharged within 23 hours (26% were day-case). Prolonged stay was due to calcium replacement (n = 8) or dialysis (n = 4) requirements. Pre- and post-operative calcium values over 2.49mmol/L were significantly related to 23-hour stay (p = 0.010482 and p = 0.000263 respectively). No 30-day re-admissions were observed

Conclusions
Careful patient selection and adherence to a perioperative management protocol in total parathyroidectomy may enable early discharge within 23 hours. Preoperative calcium levels help predict this outcome.
EP.TH.25Common General Surgical Never Events: An In-depth Analysis of Never Events data held by NHS England
Authors: Omar Islam , Singhal Rishi , Wilson Michael , Parmar Chetan , Khan Omar , Mahawar Kamal 
Published: October 2021

Abstract

Background
There is little available data on common general surgical NE. Lack of this information may have affected our attempts to reduce the incidence of these potentially serious clinical incidents. The purpose of this study was to identify common general surgical NE from the data held by the National Health Service (NHS) England.

Methods
We analyzed NHS England NE data from April 2012 to February 2020 to identify common general surgical NE.

Results
There was a total of 797 general surgical NE identified under three main categories of Wrong-Site Surgery (n = 427;53.58%), Retained Items Post-Procedure (n = 355;44.54%) and Wrong Implant/Prosthesis and (n = 15;1.88%). We identified a total of 56 common general surgical themes - 25 each in Wrong-Site Surgery and Retained Foreign Body category and 6 in wrong implants.
Wrong skin condition surgery was the commonest wrong-site surgery (n = 117;27.4%). There were 18 wrong side chest drains (4.2%) and 18 (4.2%) wrong side angioplasty/angiogram. There were 7 (1.6%) instances of confusion in pilonidal/perianal/perineal surgeries and 6 (1.4%) instances of biopsy of cervix rather than colon or rectum.
Retained surgical swabs were the most common retained items (n = 165;46.5%). There were 28 (7.9%) laparoscopic retrieval bags with or without the specimen, 26 (7.3%) chest drain guidewires, 26 (7.3%) surgical needles; and 9 (2.5%) surgical drains. Wrong stents were the most common (n = 9;60%) wrong implant followed by wrong breast implants (n = 2;13.3%).

Conclusion
This study found 56 common general surgical Never Events. Increased awareness of these common themes of NE may ultimately help reduce their incidence.
EP.TH.26Identification of Common Themes from Never Events Data Published by NHS England
Authors: Omar Islam , Graham Yitka , Singhal Rishi , Wilson Michael , Madhok Brijesh , Mahawar Kamal 
Published: October 2021

Abstract

Background
Never events (NEs) are serious clinical incidents that cause potentially avoidable harm and impose a significant financial burden on healthcare systems. The purpose of this study was to identify common never events.

Methods
We analysed the NHS England NE data from 2012 to 2020 to identify common never events category and themes.

Results
We identified 51 common NE themes in 4 main categories out of a total of 3247 NE reported during this period. Wrong-site surgery was the most common category (n = 1307;40.25%)) followed by retained foreign objects (n = 901;27.75%); wrong implant or prosthesis (n = 425;13.09%); and non-surgical/infrequent ones (n = 614;18.9%).
Wrong-side and wrong tooth removal were the most common wrong-site NE accounting for 300 (22.95%) and 263 (20.12%) incidents, respectively. There were 197 (15%) wrong-site blocks, 125 (9.56%) wrong procedures, and 96 (7.3%) wrong skin lesions excised. Vaginal swabs were the most commonly retained items (276;30.63%) followed by surgical swabs (164;18.20%) and guidewires (152;16.87%). There were 67 (7.44%) incidents of retained parts of instruments and 48 (5.33%) retained instruments. Wrong intraocular lenses (165;38.82%) were the most common wrong implants followed by wrong hip prostheses (n = 94;22.11%) and wrong knees (n = 91;21.41%).
Non-surgical events accounted for 18.9% (n = 614) of the total incidents. Misplaced naso-or oro-gastric tubes (n = 178;29%) and wrong-route administration of medications were the most common events in this category (n = 111;18%), followed by unintentional connection of a patient requiring oxygen to an air flow-meter (n = 93;15%).

Conclusion
This paper identifies common NE categories and themes. Awareness of these might help reduce their incidence.