bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.FRI.948 Outcomes Following Emergency Laparotomy In The Over 70’s
Authors: Gerrard Adam , Haines Emily , Mason Peter , Satchidanand Rajesh 
Published: October 2021

Abstract

Aim
Surgery in the elderly carries greater risk of mortality with those who are frail being most at risk. We aimed to review our outcomes for patients 70 years of age and over, who underwent emergency laparotomy.

Methods
All patients aged 70 and over who had undergone emergency laparotomy within a 12-month period were included for analysis. Patient’s pre-operative risk was assessed by the P-Possum and NELA scoring along with Rockwood Frailty Scale (RFS) and the Geriatric rescue after surgery (GRAS) score.

Results
50/116 patients undergoing emergency laparotomy were aged over 70 years old. Full data was available for 47 of these. Overall 30- and 90-day mortality was 12.8% and 21.3% respectively. 90-day mortality in patients with a RFS of &gt; 4 was 25% compared with 16% with a score of 4 or less. Those with a GRAS score &lt;4 and 4 or greater had a 90-day mortality of 16% and 27% respectively. Where there was a P-Possom mortality risk &gt;10% was no difference in the mortality rates, however when the NELA risk was &gt;10%, 90 day mortality was 26.6% compared with 15.4%.

Conclusion
Emergency laparotomy in the over 70’s carries much higher risk of death. Mortality risk scoring and frailty assessments are useful tools in counselling patients and their families prior to surgery. Future work will assess the predictive value of different and combined scores in this population.
EP.FRI.978 Colonoscopy perforation: A single centre experience
Authors: Gok M A , Habeeb K , Smart C J , Ward S J , Khan U A 
Published: October 2021

Abstract

Aims
Colonic perforation is an adverse event of colonoscopy. This is around 1/1500 in diagnostic colonoscopy, 1/500 in polypectomy procedures & 1/50 in EMR procedure. This study is to evaluate the management of colonic perforation at a single centre.

Methods
Colonoscopy carried out on patients with colorectal cancer symptoms, family history, colorectal cancer & polyp surveillance. Retrospective study carried out since 2012 on all colonoscopies with evaluation of colonoscopy perforation.

Conclusion
7 colonoscopy perforations encountered over 8 years, with incidence of 0.03 - 0.06 % per year. Surgery undertaken in 5 cases with concomitant disease bowel (2 IBD’s & 3 diverticulitis). 2 cases of conservative management. Surgical resection of diseased bowel occurred in 4 cases with 4 cases of diversion stoma. One case of diversion stoma was subsequently reversed, whilst other 2 case were deemed medically unfit. Colonoscopy is carried out by JAG accredited endoscopists. Colonic perforation during colonoscopy is increased in: polypectomy (right colonic), therapeutic EMR, diseased bowel (IBD, diverticular disease), challenging colons. Management of colonoscopy perforation should individualized with early clinical & radiological diagnosis.
EP.FRI.988Life threatening recurrent bleeding gastric fundus Dieulafoy lesion: A case report
Authors: Ayantunde Abraham , Aktar Naeem , Ayantunde Bolu 
Published: October 2021

Abstract

Introduction
Dieulafoy lesion is a rare but significant cause of upper gastrointestinal tract (GIT) bleeding. Over 75% of Dieulafoy lesions are located in the stomach and they tend to be responsible for recurrent upper GIT bleeding. Endoscopic therapy is the first line intervention to achieve haemostasis.

Patient
A 49-year old normally fit man known to have a gastric Dieulafoy lesion since 2008 presented with a history of collapse on the street and significant melaena. He was tachycardic, with a heart rate of 116, and hypotensive, blood pressure 109/68 mmHg on admission. He had significant upper GIT bleeding from the gastric fundus Dieulafoy lesion in April 2008, requiring a massive blood transfusion. At the time, the attempted endoscopic therapy was unsuccessful, resulting in an emergency surgery and under-running of the bleeding vessels.
For the recent admission, he underwent an urgent therapeutic oesophagogastroduodenoscopy, with 3 endoscopic clips applied, but this failed to maintain haemostasis. Four units of packed red cell were transfused and he was transferred immediately to the operating theatre. He underwent an emergency laparotomy, adhesiolysis, gastrostomy and wedge resection of the bleeding gastric fundus Dieulafoy lesion using a linear cutter 75mm stapler. He had an uneventful post-operative recovery and was discharged home on day four after surgery.
The histology of the wedged gastric specimen confirmed an area of gastric mucosa ulceration with a network of mixed dilated, thin and thick-walled tortuous vessels in the adjacent submucosal layer. The histologic features are consistent with a bleeding gastric Dieulafoy lesion.
EP.FRI.992 Milking the COW: A pilot study of seven-day consultant working
Authors: Clements Caterina , Mitchell Robert , Ratnasingham Kumaran 
Published: October 2021

Abstract

Aims
The Five Year Forward View, predicts a funding gap of nearly £30 billion per year by 2020/21, with continued disparity in resources and healthcare demand. Further, the view describes ever widening gaps in three main domains of healthcare; prevention, quality and efficiency.
Those domains raised are echoed in the efficient operative working of a general surgical service with an aged, co-morbid population and inefficient theatre utilisation with increasing case cancellation due to lack of bed space.
In 2012, the Academy of Medical Royal Colleges recommended patients have the same standard of care seven days a week, with consultant review ‘at least once every twenty-four hours’.
In general surgery, will a seven-day consultant led working model with a ‘consultant of the week’ (COW) enable more rapid and appropriate decisions to be made for patients enabling their efficient treatment and reducing length of stay.

Method
A retrospective analysis of hospital length of stay and mortality before and after the implementation of a consultant led weekday and weekend service in general surgery was carried out looking at data in October 2017 and 2018.

Results
The introduction of enhanced seven-day working is associated with reductions of one fifth in length of stay but no difference in mortality.

Conclusions
Whilst statistically significant associations with the COW and reduced length of stay have been made, the clinical significance of one fifth of a day may be negligible. Continued data collection over a longer time period, prospectively will increase the power of the study.
EP.FRI.1012 One plus one equals four: how NELA inspired a quality improvement programme that produced 4 distinct positive outcomes
Authors: Chitre Vivek , Atkari Bence , Sivakkolunthu Ari , Woods Robert , Lal Roshan 
Published: October 2021

Abstract

Aim
To describe how NELA inspired an ‘improving emergency surgery’ quality improvement programme that produced improvements in 4 distinct areas of surgical practice.

Methods
This paper describes how Kotter's improvement methodology was implemented in a district general hospital to achieve NELA targets, reduce the negative appendicectomy rate in children, implement NICE guidance on early laparoscopic cholecystectomy for acute cholecystitis and consistently deliver the 'S' and 'A' of SAFER within the surgery department.

Results
As a result of a systematic quality improvement approach,

Conclusions
Incorporating NELA into a local 'improving emergency surgery' quality improvement programme has delivered important and wide-ranging benefits beyond emergency laparotomy, and protected the service from 'crowding out behaviour' where focus on a single quality improvement can come at the expense of quality in other areas.
SP1.1.8Optimising anaemic patients for colorectal cancer surgery: implementation of day-case iron infusion pathway and closed loop audit of anaemia management
Authors: Malcolm Francesca , Kaji Furqaan , Shelswell Lisa , Speake William , Liptrot Sarah , Coverdale Nicola 
Published: October 2021

Abstract

Aims
Pre-operative anaemia is associated with increased mortality and morbidity in patients undergoing colorectal cancer (CRC) surgery. NICE recommends screening for and treating anaemia in this patient group. Our local guidelines reflect this and advocate the use of pre-operative IV iron provided to patients in the day-case unit. Through 2 audit cycles we assessed whether anaemic CRC patients were prescribed pre-operative iron infusion. Secondary outcome was the requirement of post-operative blood transfusion.

Methods
Data was collected between June-August 2019 (cycle 1) and January-February 2020 (cycle 2) for patients undergoing elective CRC surgery. Data collected included haemoglobin levels pre and post-operatively, pre-operative iron infusion and post-operative blood transfusion rates. Between the cycles education regarding anaemia management and further publicity of the iron infusion pathway took place within the department.

Results
In cycle 1 27.5% (11/40) of patients were anaemic; 18% (2/11) of these patients received appropriate iron infusion pre-operatively. In cycle 2 45.4% (20/44) of patients were anaemic; 60% (12/20) received iron infusion. 45% (5/11) of anaemic patients in cycle 1 had post-operative transfusion; none of these patients had pre-operative IV iron. In cycle 2 20% (4/20) of anaemic patient required post-operative transfusion; 3 out of 4 of these patients had not received pre-operative IV iron.

Conclusions
We have demonstrated how education and improved awareness of local services can increase rate of IV iron prescription and reduce the need for post-operative transfusion in anaemic CRC patients. However these is still room for improvement in management of anaemia within this patient group.
SP1.2.8Are screen detected rectal cancers truely asymptomatic?
Authors: Mcculla Alex , Agarwal Anil , Musbahi Aya 
Published: October 2021

Abstract

Aims
Patients with rectal cancers would be expected to be symptomatic and present to GP and be referred to tertiary care for investigations. Nevertheless nearly 15% of rectal cancers are screen detected. This study compared the presentation, demographics, staging of screen detected rectal cancer (SDRC) and symptomatic rectal cancer (SRC).

Methods
The national bowel cancer-screening database, the Somerset Cancer Register, the Great North Record, hospital electronic patient record and Sunquest ICE system was used to gather clinical information. All rectal cancers diagnosed between 2014 and 2019 were included.

Results
There were 379 SRC and 54 SDRC. The SRC had an average of 1.07 GP visits per patient (range 1-4) and SDRC had an average of 0.27 GP visits per patient (range 0-7) (p &lt; 0.001). Screen detected patients presented to their GP with diarrhoea, change of bowel habit and bleeding whereas symptomatic patients presented with tenesmus, bleeding and change of bowel habit in that order respectively. Screening cancers were more likely to present as T1 or T2 compared to the symptomatic group (p = 0.023).

Conclusion
Screen detected rectal cancer patients presented less frequently to their GP. Those who presented had a different symptom profile to symptomatic cancers. This would explain these patients not seeking advice or the GP not referring them to hospital. Is it the morphological differences of the cancers or is it that the patients in screening group have a different personality trait that prevents them consulting their GP. These questions need investigating in future studies.
SP2.1.1Continuous Monitoring and Assessment of Surgical Technical Skills Using Deep Learning
Authors: Yilmaz Recai , Winkler-Schwartz Alexander , Reich Aiden , Del Maestro Rolando 
Published: October 2021

Abstract

Aims
Excellent surgical technical skills are of paramount importance to perform surgical procedures, safely and efficiently. Virtual reality surgical simulators can both simulate real operations while providing standardized, risk-free surgical hands-on experience. The integration of AI (artificial intelligence) and virtual reality simulators provides opportunities to carry out comprehensive continuous assessments of surgical performance. We developed and tested a deep learning algorithm which can continuously monitor and assess surgical bimanual performance on virtual reality surgical simulators.

Methods
Fifty participants from four expertise levels (14 experts/neurosurgeons, 14 senior residents, 10 junior residents, 12 medical students) performed a simulated subpial tumor resection 5 times and a complex simulated brain tumor operation once on the NeuroVR platform. Participants were asked to remove the tumors completely while minimizing bleeding and damage to surrounding tissues employing a simulated ultrasonic aspirator and bipolar forceps. A deep neural network continually tracked the surgical performance utilizing 16 performance metrics generated every 0.2-seconds.

Results
The deep neural network was successfully trained using neurosurgeons and medical students’ data, learning the composites of expertise comparing high and lower skill levels. The trained algorithm was able to score the technical skills of individuals continuously at 0.2-second intervals. Statistically significant differences in average scores were identified between the 4 groups.

Conclusions
AI-powered surgical simulators provide continuous assessment of bimanual technical skills during surgery which may further define the composites necessary to train surgical expertise. To our knowledge, this is the first attempt in surgery to continuously assess surgical technical skills using deep learning.
SP2.1.3A quick solution for poor knowledge of fasting requirements for surgical patients
Authors: Stahl Rose , Alsheikh Mustafa 
Published: October 2021

Abstract

Aim
To investigate and improve doctors’ knowledge of fasting requirements for surgical patients undergoing imaging.

Introduction
Surgical patients require prompt radiological imaging to confirm diagnoses and rapidly initiate management. Fasting regimes prior to different imaging techniques are confusing and poorly understood but are essential for prime image quality. Poor knowledge of these regimes delays scans and leads to suboptimal patient-care.

Methods
We created a series of MCQs to determine doctors’ knowledge and confidence of these fasting regimes. Our target recipients were surgical junior doctors who frequently requested imaging (n = 27). Modalities included: x-rays, ultrasounds, CTs, MRCPs, and ERCPS. Afterwards, we distributed posters around key clinical area and delivered a 30-minute teaching session. We provided clear guidance of fasting requirements, essential safe-prescribing points and emphasised the importance of communication with the multi-disciplinary team. A questionnaire was then circulated to re-assess doctors’ understanding.

Results
The mean pre-intervention MCQ score was only 49%, and only 8% were confident in ordering fasting regimes. After our intervention, the average MCQ mark improved by 37% (+/-11%, 95%CI) and the proportion of doctors, who felt confident, increased to 92%. Improvement in understanding was seen in all modalities, most significantly in ERCPs and contrast CT-APs. Wilcoxon signed rank test showed a statistically significant improvement in MCQ marks after our intervention (p &lt; 0.001).

Conclusions
Fasting regimes prior to imaging is poorly understood. Teaching sessions and guidance documentation is an effective measure to improve understanding. Key communication with the multi-disciplinary team and awareness of these requirements will improve patient care.
SP2.1.6Virtual Work Experience: A Novel Method for Aspiring Doctors
Authors: Uddin Aaliya , Shakir Taner , Lovett Bryony 
Published: October 2021

Abstract

Aims
Current COVID-19 restrictions have limited face to face exposure of prospective medical students to the hospital environment. We aimed to deliver a virtual work experience event for secondary school pupils to understand the opportunities offered in a medical career.

Methods
We designed an event based upon a chronological progression from medical school to consultancy. Sessions included individual career experiences, the patient journey, a virtual hospital tour, simulated medical school interviews and examination preparation. The event was advertised by direct contact with secondary schools through phone and email, the local hospital trust communications department, and social media. Individuals registered online and were invited to submit targeted questions they would like covered during the session. The free one day event was delivered using online video conferencing software. Pre and post event feedback was obtained.

Results
771 registrations were received from 108 schools in the UK. In addition, the event attracted 26 individuals from India, Dubai, Thailand and the Philippines.
73% of candidates had not attended any prior face to face work experience. Confidence levels of over 4 out of 5 on a visual analogue scale, with respect to the medical school application and interview process, improved from 11% to 81%. 99% of candidates would recommend the course to others and attend future events.

Conclusions
COVID-19 has disrupted the training of potential medical students. We designed and delivered a novel method of work experience at an international level. Encouraging feedback will pave the way for future iterations.
SP2.1.14Remote examination of surgical skills is feasible and desirable during COVID crisis and beyond
Authors: Marsh Stephen , Bruce Caroline , Blackmore Alexander , Ichim Petre , Sharma Ajay , Paraoan Marius 
Published: October 2021

Abstract

Aims
We aimed to investigate the feasibility of employing Zoom technology to undertake structured remote examination of surgical skill during the COVID-19 crisis and beyond as a mean to complement remote training and supervision of basic laparoscopic skills.

Methods
We have adapted a previously reported method of remote training and supervision of laparoscopic skills training successfully used with 7 trainees. Five consultant surgeons with established expertise in surgical education participated in remote mock examination of LapPass skills using Zoom technology. We assessed the feasibility of remote examination by assessing image quality on Maryland visual comfort scale and undertook a trainers’ survey using a 5 point Lembert scale.

Result
The remote examiners recorded excellent quality of views, identical in clarity and detail to the source images.

Conclusions
We demonstrated the feasibility and the benefit of using modern internet technology in delivering a flexible approach to examination of surgical skills met with strong satisfaction by established trainers and trainees alike. All trainers supported the idea of introduction of remote examination as beneficial for all stakeholders and ready to replace face-to-face examination in specific settings. The surgical community should embrace, on a larger scale, the concept of remote supervision and examination whenever possible.
SP2.1.17Prognostic significance of competition ratios in surgical specialty training selection
Authors: Mellor Katie , Robinson David B , James Osian P , Powell Arfon GMT , Egan Richard J , Lewis Wyn G 
Published: October 2021

Abstract

Aims
A Competition Ratio (CR) indicates the ratio of total applications for a training post when compared with numbers of specialty posts available. This study aimed to evaluate CRs’ influence on National Training Number (NTN) selection in a single UK Statutory Education Body.

Methods
Consecutive Core Surgical Trainees numbering 154 (median years since graduation: four, 105 male, 49 female) were studied over a six-year period. Annual specialty specific CRs were obtained from Health Education England’s website, and primary outcome measure was UK National Training Number (NTN) appointment.

Results
Overall NTN appointment was 45.5%. Median CR was 2.36; range OMFS 0.70 (2020) to Neurosurgery 22.0 (2020). Multivariable analysis revealed that NTN success was associated with: CR (OR 0.46, p = 0.003), a single scientific publication (OR 6.25, p = 0.001), cohort year (2019, OR 12.65, p = 0.003), and Universal ARCP Outcome 1 (OR 45.24, p &lt; 0.001). CRs predicted NTN appointment with a Youden index defined critical ratio of 4.42; 28.6% (n = 8) vs. 49.2% (n = 62), p = 0.018.

Conclusions
CRs displayed 30-fold variation, with CRs below 4.42 associated with two-fold better NTN promotion, but strong clinical competence and academic reach again emerged as the principal drivers of career advancement.
SP3.1.12 A Comparison of Polymeric Clips vs Endoloops to Secure Appendicular Stump in Adult Emergency Laparoscopic Appendicectomy
Authors: Ng James Chean Khun , Khanzada Zubair , Lim Ju Lyn , Lee Melody , El-Sharkawy Ahmed M , Bharathan B 
Published: October 2021

Abstract

Aims
To assess the use of polymeric clips (PC) as an alternative to Endoloops (EL) to secure appendicular stump in adult emergency laparoscopic appendicectomy.

Method
A retrospective analysis of all patients who underwent emergency laparoscopic appendicectomy from 1/11/19 to 31/10/20, following introduction of polymeric clips in our institute as a safe alternative to endoloops to secure appendicular stump in October 2019. Patient demographics, operative duration, intraoperative findings, methods to control the appendicular mesentery and stump, post-operative length of stay, complications and grade of operating surgeon were compared in both groups (PCvsEL) and data analysed using SPSS.

Results
A total of 333 patients were included, who underwent laparoscopic appendicectomy and satisfied the inclusion criteria. PC were used in 160 (48%) patients and EL in 173 (52%). Patient demographics, surgeon grade and intra-operative severity of disease were statistically similar between both groups. Mean operative time was 10 minutes shorter in PC group (71 vs 81minutes, p = 0.001). Mesoappendix was ligated by applying laparoscopic titanium clips in EL group 25%, vs 6% PC group (p &lt; 0.001), while 42% of the PC group, used PC on mesoappendix, which was without any additional cost. Post-operative complication rates were similar in both groups, apart from post-operative ileus, which was more in EL group (p = 0.003).

Conclusion
The use of PC in emergency laparoscopic appendicectomy is a safe and effective way to secure the appendicular stump, which results in, not only reduced operating time, but also a significant cost saving (£49/3x Endoloops vs £21/pack of 6x Polymeric clips) to NHS.
SP3.1.15 Prophylactic negative pressure closed wound therapy in patients undergoing laparotomy for any indication is effective in reducing surgical site infection rate: An upgraded meta-analysis of published randomized, controlled trials
Authors: Malik Ahmed , Khan Mansoor , Singh Krish , Sains Parvs , Sajid Muhammad 
Published: October 2021

Abstract

Aims
Surgical site infections (SSIs) are a significant clinical and economic burden on health-care providers. The patients suffering from SSIs have been reporting poor health-related quality of life leading to psychological implications. The objective of this study to explore the role of negative pressure wound therapy (NPWT) in general surgical patients undergoing laparotomy and with closed wounds.

Methods
A systematic review of the randomized, controlled trials reporting the use of NPWT in general surgical patients undergoing laparotomy for any reason published on Embase, Medline, PubMed, PubMed Central and Cochrane databases was performed using the principles of meta-analysis.

Results
A total of nine randomized, controlled trials on 1238 patients were included in this study. In the random effects model analysis using the statistical software Review Manager, the use of NPWT in patients with closed laparotomy wound was associated with significantly reduced risk of SSIs (odds ratio, 0.60; 95% CI, 0.45, 0.81; z = 3.39; P = 0.0007). However, there was significant heterogeneity (Chi2 = 17.06, df = 8, [p = 0.03]; I2 = 82 %) among included studies.

Conclusion
The use of NPWT in general surgical patients undergoing laparotomy seems to have proven clinical advantages of reducing SSIs and may routinely be used as a prophylactic tool.