bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-EGS18 The outcomes of upper gastrointestinal bleeds with unsuccessful endoscopy in a district hospital with no interventional radiology
Authors: Wintrip Dorothy 
Published: December 2021

Abstract

Background
Acute upper gastrointestinal bleeding (UGIB) is a common emergency estimated to occur in 80 to 150 out of 100,000 people each year. First line management is endoscopy and pharmacological but those who fail this can pose a challenge. Current NICE guidelines recommend repeat endoscopy to patients who re-bleed, those unstable consider interventional radiology (IR) or emergency surgery. The estimated mortality rate is approximately 10%. This study was conducted to review our current surgical outcomes and whether referral for IR is appropriate and could reduce mortality.

Methods
Retrospective study of 11 patients who underwent surgery for refractory non- variceal UGIB between November 2015 and March 2021 with a mean age of 61. Data was collected from the electronic records.

Results
All patients underwent an emergency laparotomy, 82% had an ASA of 4 the remainder ASA 3, a mean NELA mortality of 31.1% and a mean Blatchford 11.1. The initial OGD was performed on the day of admission in 54% of patients. 45% during initial OGD became hemodynamically unstable and transferred to theatre, one patient re-bleed 3 days after and taken to theatre the remainder (45%) re-bleed and had a 2nd OGD. 2 patients unstable during OGD went to theatre, 3 re-bleed within 24hrs 1 within 48hrs and taken to theatre. Mortality rate was 27%, complication rate 45%, mean LOS 24.6.

Conclusions
These findings highlight the high rate of morbidity and mortality associated with surgical treatment for UBIB. A small number of cases occurred over 7 years requiring surgical intervention,45% had two OGD’s and 9% went on to have a 3rd. Was there a window of opportunity to use IR if it were available. Recent studies have shown that transcatheter arterial embolization is safer than surgical intervention in the high risk patient population and has a lower 30-d mortality rate.
P-EGS26 Outcomes of Surgical Treatment for Perforated Peptic Ulcer in a non-Upper Gastrointestinal Surgery Centre
Authors: Firdaus Azhar , Han Lai Jun , Xuan Sam Chi , Yunus Alif , Ahmad Khairol Ashraf , Ming Yap Lee 
Published: December 2021

Abstract

Background
Perforated peptic ulcer (PPU) remains a common surgical emergency worldwide requiring surgical intervention. Although commonly performed, morbidity and mortality rate remained high. This study aimed to analyze the factors that contribute to the outcome of PPU surgery in a non-upper gastrointestinal surgery center in Malaysia.

Methods
Data were collected by retrospective review of all PPU surgeries done throughout the year 2020, looking into various preoperative, intraoperative, and postoperative details.

Results
In this study, we have a total of 24 PPU patients underwent surgery resulted in 7 (29.2%) deaths. Majority of our subjects were elderly (median age 65 years, IQR 48.5 – 73.0) with 4 (16%) being of ASA (American Society of Anesthesiologist) category 3 - 4. The most common cause of death was uncontrolled systemic infection in 4 patients (57.1%), followed by 2 (28.6%) fatal arrhythmia and 1 (14.3%) massive upper gastrointestinal bleed. Our analysis found that size of perforation ≥ 30mm (OR = 0.18, 95%CI 0.08 - 0.44), and postoperative complications (OR = 12.5, 95%CI 1.6 – 97.6) were significantly associated with a higher postoperative death. Low serum albumin level (mean 34.3 ± 9.1g/L), negative base excess level (mean -3.28 ± 4.89), and prolonged interval between admission and commencement of surgery (median 750 mins, IQR 258 – 2218) were all significantly associated with increased mortality post PPU surgeries.

Conclusions
This study highlighted to us various perioperative factors which could potentially be modifiable thus necessary measures can be taken in the future to ensure a better operative outcome of PPU surgery.
P-EGS28 Management of obstructive jaundice secondary to gall stones in an ambulatory setting
Authors: Boag Katie , Amtul Nasira , Roy Pratik , Singh Rahulpreet , Kandiah Shivanthi , Toogood Giles , Ahmad Aman 
Published: December 2021

Abstract

Background
Our data from Leeds shows a 30% increase in patient attendance to the Surgical Assesment Unit (SAU) across a 5 year period, putting unprecedented demands on the acute surgical service. A new Ambulatory Surgical Centre (ASC) was established for the advancement of ambulatory care pathways that would ensure that acute patients are seen promptly and kept safe with monitoring in an appropriate setting without needing admission to the hospital bed base. Gallstone related disease accounts for a third of patient attendance to the emergency surgical services. We present our experience with an ambulatory pathway to manage patients with obstructive jaundice caused by gall stones, and propose a protocol driven pathway.

Methods
The ASC operates an acute, consultant led clinic, with access to urgent blood tests and dedicated USS, CT and MRI imaging capacity, and offers a direct referral service from Primary Care Networks (PCNs) through the Primary Care Access Line (PCAL). Patients referred with clinical jaundice or RUQ/Epigastric pain are investigated for derangement in their liver function, and assessed for the presence and severity of Acute Cholangitis (AC), according to the 2018 Tokyo Guidelines. Patients without evidence of cholangitis, or with AC Grade I are planned for management in the ambulatory setting, including investigations, monitoring and endoscopic/surgical intervention. Outcome data was collected retrospectively from PCAL data source, spanning from Oct 2020 till July 2021.

Results
A total of 98 patients were referred to the acute surgical service during this period. Out of these, 47% had Grade II (n = 35) or Grade III (n = 17) AC. 48% were suitable for ambulatory management, with no evidence of AC(n = 5) or Grade I AC(n = 43). 20% patients were found to have a cause other than gall stone disease. 55% have undergone intervention (33 Laparoscopic cholecystectomies, 22 ERCP) while 12 are on the waiting list for surgery.

Conclusions
Our protocol offers a safe, comprehensive and timely pathway for the management of patients with gall stone related obstructed jaundice in an ambulatory setting. This has helped reduce the demand on hospital beds for surgical patients.
P-L09 Pyogenic Liver Abscess: a Retrospective Study of Patients Presenting to a UK Tertiary Liver Centre
Authors: Sams Emily , Duncan Patricia , O'Reilly David , Alessandri Giorgio , Parry Craig , Kumar Nagappan 
Published: December 2021

Abstract

Background
Pyogenic liver abscess (PLA) carries a significant mortality of between 2-12%. The incidence is higher in East Asia than in Western countries, and recent data looking at PLA in western populations is limited. Increasingly, we find that PLA is primary in the liver rather than from a secondary source, even in the western world. The aim of this retrospective study is to analyse data on presentation and outcomes of PLA at a UK tertiary liver centre.

Methods
Data was collected on patients diagnosed with a PLA and treated at the University Hospital of Wales, Cardiff between December 2010 and December 2020. Patients were identified by searching the Cardiff Liver Unit surgical database and Radiology database using the search term “liver abscess”. Patients with an abscess secondary to gallbladder perforation into the liver were excluded. Data was gathered using the available electronic health records, including comorbidities, mode of presentation, cause of PLA, microbiology, treatment received (surgical, radiological drainage, or antibiotic therapy), and outcomes.

Results
There were 86 patients with a median age of 69 (16-91), Male:Female ratio was 2:1. Main symptoms were abdominal pain and fever; 61.6% (n = 53). Treatment was surgical in 49% (n = 42), US guided drainage in 21% (n = 18) and antibiotics only in 30% (n = 26). Mortality was 9.3% (n = 8), with a median age of 76, significantly higher than survivors (p = 0.012). In this group, Male:Female ratio was 7:1; proportion with &gt;2 co-morbidities was 62%, compared with 39% of survivors; and there was a greater delay in diagnosis (average 4 days versus 2 days in survivors), although these factors were not statistically significant.

Conclusions
PLA is a serious infection that can lead to mortality. Forty percent of patients can present with non-specific symptoms and early imaging in this group is essential for diagnosis. In our cohort, significant number of patients were treated with surgery compared to the literature, with good outcomes. Although the numbers are small to be statistically significant, delayed diagnosis, multiple comorbidities, and male gender confer an increased risk of mortality, as does advanced age. We conclude that early diagnosis and referral to a Liver centre for opinion or management is essential for optimal outcomes.
P-O06 A scoring system to support surgical decision-making for cardial submucosal tumors
Authors: Geng Zi-Han , Zhu Yan , Chen Wei-Feng , Li Quan-Lin , Zhou Ping-Hong 
Published: December 2021

Abstract

Background
Submucosal tunneling endoscopic resection (STER) and non-tunneling techniques are two alternative options for the treatment of cardial submucosal tumors (SMTs). We aimed to establish a regression model and develop a simple scoring system to help clinicians make surgical decisions for cardial submucosal tumors.

Methods
A total of 246 patients who suffered cardial SMTs and received endoscopic resection were included in this study. All of them were randomized into the training cohort (n = 147) or internal validation cohort (n = 99). Then, the scoring system was proposed based on multivariate logistic regression analysis in the training cohort and assessed in the validation cohort.

Results
Of 246 patients, 97 were treated with STER, and the others with non-tunneling endoscopic resection. In the training stage, four factors were weighted with points based on the β coefficient from the regression model, including irregular morphology (-2 points), ulcer (2 points), the direction of the gastroscope (-2 points for reversing direction and 1 point for entering direction), and originating from the muscularis propria (-2 points). The patients were categorized into low-score (&lt; -4), medium-score (-4 - -3) and high-score (&gt; -3) groups, and those with low scores were more likely to be treated with STER. Our score model performed satisfying discriminatory power in internal validation (Areas under the receiver-operator characteristic curve (AUC), 0.829; 95% confidence interval (CI), 0.694-0.964) and goodness-of-fit in the Hosmer-Lemeshow test (P = .4721).

Conclusions
This scoring system could provide clinicians the references for making decisions about the treatment of cardial submucosal tumors.
P-O08 Effect of socioeconomic deprivation on clinical characteristics and outcomes of patients undergoing an emergency appendectomy
Authors: Miller Gillian , Khan Khurram , Gall Lewis , AlAzzawi Y , Macdonald Andrew 
Published: December 2021

Abstract

Background
Appendicectomy is one of the commonest emergency general surgical operations performed. Previous studies have shown that socioeconomic status (SES) impact outcomes in a number of diseases. Currently, there is no study analysing the impact of SES on the outcome of appendectomy. Our aim was to compare the clinical characteristics and outcomes of adults having an emergency appendectomy between deprived and less deprived SES groups.

Methods
A multicentre retrospective observational study of all adult patients who had an emergency appendectomy across four hospitals (two district general and two tertiary care hospitals) between August 2018 and November 2020 was performed. Patients were identified through pathology records. Data was extracted from electronic records for demographics, pre-operative (peak) blood results, pre and post-operative imaging, operative details and the clinical outcomes. Patient’s residential address was used to calculate Scottish Index of Multiple Deprivation (SIMD). The patients were grouped by SIMD into a more deprived SES group (SIMD 1-5) and a less deprived SES group (SIMD 6-10) and results compared.

Results
A total of 1,105 patients (57.5% male) were included. Median age was lower in the more deprived group (35 vs 40 years, p &lt; 0.001). The less deprived group were more likely to be fitter: ASA-1 grade 51.6% vs 43.5%, p = 0.008. There were fewer appendectomies in most deprived decile compared to the least deprived decile (5.2 vs 11.3 per 10,000 population per year, p &lt; 0.001). There was no difference in inflammatory markers, pre-operative imaging, surgical approach, severity of appendicitis and the median length of stay (3 days). However, there were more surgical site infection in the more deprived group (3.4% vs 0.9%, p = 0.006).

Conclusions
This study demonstrates that SES does impact on the age of presentation and incidence of appendectomy. Surgical site infection were seen more frequently in the more deprived patients undergoing emergency appendectomy. This may be a reflection of the underlying comorbidities.
P-O15 “Knife to Skin” time: The invariable variable
Authors: Michel Martin , Fifer Helen , Moran Emily , Bonner Clare , Hammett Felix , Khawgali Mohamed , Kronberga Madara , Saab Ala , Balbola Mohamed , Saha Arin 
Published: December 2021

Abstract

Background
The Covid-19 pandemic has affected all aspects of healthcare globally. Theatre utilisation assumes a substantial proportion of hospital resources, creating a streamlined pathway increases efficiency and productivity. With concerns regarding aerosol generating procedures, viral transmission to health care workers in theatre and patient pathways through the hospitals the covid-19 pandemic has added another dimension to the theatre pathway. The aim of this study was to quantify the impact of Covid-19 on the “knife to skin” (KTS) time and compare it to previous historical data (HD).

Methods
Retrospective analysis of real time theatre data was analysed for the first 12 months of the pandemic from 11th March 2020 to 11th March 2021. To try and minimise variability between different specialities and operations we picked one operation to study: Laparoscopic cholecystectomy (LC). Historical data was also gathered from the same time frame over the last 5 years (2015-2020) for comparison. Data collected included emergency or elective, time sent for patient, anaesthetic start time, knife to skin time and duration of operation. Comparison of means were analysed by One-way ANOVA tests and Student’s T-Test.

Results
399 laparoscopic cholecystectomies were performed during the first year of the pandemic. KTS time was calculated as operation start time minus time sent for patient. Average time during the pandemic for emergency LC KTS was 56 minutes and 35 minutes for elective LC. Comparison of these times to HD revealed no statistical difference (Emergency LC 56 mins vs 58 mins p &gt; 0.05, Elective LC 35 mins vs 35 mins p &gt; 0.05). The anaesthetic time for emergency LC during the pandemic vs HD was 10 mins vs 14 mins (p &lt; 0.05), no statistical difference was found in the elective group, 16mins vs 14mins (p &gt; 0.05)

Conclusions
The Covid-19 pandemic has had no detectable effect on Knife to skin time as compared to our previous historical data. It seems the extra Covid 19 precautions involving PPE, pathways etc. have not affected theatre efficiency or utilisation. In fact, there was very little variance in KTS time over the six years studied (2015-2021) with very consistent levels for both elective and emergency procedures. The shorter anaesthetic time for emergency LC during the pandemic needs to be further investigated but one hypothesis is the unconscious or conscious decision to decrease the amount of preoxygenation to minimise aerosolisation.
P-OGC01 Prevalence and treatment of nutritional deficiencies following Upper Gastrointestinal Surgery for Oesophageal or Gastric Cancer
Authors: Dossou Vida , Murphy Amy 
Published: December 2021

Abstract

Background
Patients undergoing Upper Gastrointestinal (UGI) surgery for cancer are left nutritionally vulnerable due to alterations in digestion and absorption this is becoming increasingly evident as more patients are achieving five year survival.
Patients are more likely to endure nutritional deficiencies in particular B12, Iron, Vitamin D, Calcium, Zinc and folic acid.
Reduced absorption and inadequate dietary intake of calories, protein and micronutrients are the main contributing factors post operatively and longer term.
At 2 years post UGI resection the following nutritional deficiencies have been observed: 48% Iron, 42% B12, 40% Folic Acid, 34% Calcium, 33% Zinc, 24% Vitamin D.

Methods
Data was collected retrospectively from various systems on our Trusts Network.
The trusts reporting system was utilised for blood results.
Digital systems were used to confirm if any action had been taken and if this was appropriate. Additional digital systems were used to obtain clinic lists for the last 6 months.
The Data was collected and entered into an Excel spread sheet for comparison.
Chi squared testing was utilised to compare deficiency rate between different Upper GI surgeries.

Results
Chi squared statistical analysis of the nutritional deficiencies in the three main Cancer surgery types (Ivor Lewis / Total OG / Sub-total OG) found there was no statistical difference in prevalence of nutritional deficiency.
Comparison of deficiencies indicated that the main prevalence was or Zinc and Vitamin D pre and post operatively.

Conclusions
Nutritional deficiencies should be corrected pre operatively. Monitoring thereafter of nutritional vitamin and mineral status should be individually tailored to suit the patient.
All UGI patients should be commenced on a nutritionally complete vitamin and mineral supplement at the point of initial assessment in the UGI surgical clinic pre operatively.
The recommendation would be to commence Forceval vitamin and mineral supplement as this offers optimal trace element coverage.
Vitamin D deficiency pre operatively should have supplementation to maintain 25(OH)D levels greater than 50nmol/L and rechecked after 3 months. Zinc replacement should be monitored routinely.
P-OGC12 Nasogastric tube drainage and pyloric intervention after oesophageal resection: UK practice variation and effect on outcomes
Authors: Bull Alexander , Pucher Philip , Maynard Nick , Underwood Tim , Lagergren Jesper , Gossage James 
Published: December 2021

Abstract

Background
Over 1,500 patients with oesophageal cancer undergo a resection in the UK each year. At surgery, patients commonly have a nasogastric tube (NGT) placed and may undergo a pyloric intervention. There is conflicting evidence on the use of both NGTs and pyloric interventions during oesophageal resections. We performed a national survey of oesophageal centres and assessed practice variation.

Methods
An electronic survey was distributed to all resection centres in England, Wales and Scotland. Variations in practice regarding NGTs and pyloric intervention were assessed, and compared to nationally reported centre volumes and length-of-stay data

Results
Most centres (31/39, 79%) responded to the survey. All centres reported routine NGT use. The majority of centres (19/31, 61%) did not perform pyloric interventions. When used, surgical pyloroplasty was the most frequent strategy (8/31, 26%). Routine post-operative radiological assessment was utilised in 9/31 (29%) of centres. Criteria for NGT removal and dietary progression was highly variable, with every centre reporting different protocols. There were no significant differences in practice between high and low volume centres. There were also no trends seen when comparing centres above vs at-or-below the median length-of-stay. The majority (68%) of centres were willing to take part in a trial assessing NGT use and pyloric interventions.

Conclusions
Pyloric intervention use varies widely, with no clear link to outcomes. NGT use remains standard practice despite evidence for safe omission. Surgeons require and recognise the need for a trial to assess requirement for NGTs and pyloric intervention after oesophageal resection.
P-OGC13 Chest drainage after oesophageal resection: A systematic review
Authors: Bull Alexander , Pucher Philip , Lagergren Jesper , Gossage James 
Published: December 2021

Abstract

Background
Modern enhanced recovery protocols discourage drain use due to negative impacts on patient comfort, mobility, and recovery, and lack of proven clinical benefit. After oesophagectomy, however, drains are still routinely placed. This review aimed to assess the evidence for, and how best to use chest drains after oesophageal surgery.

Methods
A systematic literature search was performed in Medline, Embase and Cochrane collaboration databases. Studies reporting outcomes for different types or uses of thoracic drainage, or outcomes related to drains after trans-thoracic oesophagectomy were included. Studies were collated into domains based on variations in number, position, type, removal criteria, diagnostic use and complications of drains. Methodological quality was assessed with Newcastle-Ottawa and Jadad scores.

Results
Among 434 potentially relevant studies, 27 studies met the inclusion criteria and these included 2564 patients. Studies that examined the number of drains showed pain reduction with a single drain compared to multiple drains (3 studies, n = 103), and transhiatal placement compared to intercostal (6 studies, n = 425). Amylase levels may aid diagnosis of anastomotic leak (9 studies, n = 888). Narrow calibre Blake drains may effectively drain both air and fluid (2 studies, n = 163). Drain removal criteria by daily drainage volumes of up to 300ml did not impact subsequent effusion rates (2 studies, n = 130). Complications related directly to drains were reported by 3 studies (n = 59).

Conclusions
Available evidence on the impact of thoracic drainage after oesophagectomy is limited, but has the potential to negatively affect outcomes. Further research is required to determine optimum drainage strategies.