bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP9.1.2We must do better - An audit assessing local compliance with NICE Guidelines (2014) on giving patient discharge advice regarding driving following traumatic brain injury
Authors: Chouari Tarak , Khan Hamza , Wali Umar , Shanmuganandan Arun 
Published: October 2021

Abstract

Introduction
Driving is a complex activity involving the coordination of a number of cognitive and physical skills, which may be impaired after head injury. It is a legal requirement that patients’ inform the licensing authority when they have sustained a head injury. Failure to do so results in possible fines, invalid insurance and prosecution. NICE recommends printed patient advice about driving once discharged following a head injury.

Methods
A retrospective analysis of all traumatic brain injury admissions under the surgical team over a 6 months was performed. The aim was to identify current practice regarding assisting patients to return to safe driving after head injury. Information related to patient demographics, documented driving status and advice (verbal and written) related to driving, was sought. Descriptive statistics were used to portray the results.

Results
56 patients were admitted following a traumatic head injury. The average age was 77 (range of 24 to 94) Patients spent on average 4 days in hospital. Only 2 patients had their driving status documented. These two patients also had a documented occupation dependent on driving. No patients received advice specific to DVLA guidelines.

Conclusion
This study demonstrates that there is poor compliance with NICE guidelines. Indeed, there is a need for change in our practice. We have a duty of care for our patients and in ensuring the safety of the general public. The main limitation of this study relates to the adequacy of documentation. We provide solutions in order to tackle the findings of this audit.
TP9.2.5Routine ultrasound in paediatric appendicitis is highly accurate and substantially reduces negative appendicectomy rate
Authors: Darbyshire Alexander , Towers Ashley , Toh Simon , Mercer Stuart 
Published: October 2021

Abstract

Aims
Our centre routinely uses ultrasound in adults to confirm diagnosis of appendicitis. This study investigated its use in the diagnosis of suspected appendicitis in children and its impact on management.

Methods
Retrospective cohort study of children (5-16 years) managed by general surgeons with suspected appendicitis during 2019. Primary outcomes were ultrasound use. Secondary outcomes were diagnosis, length of stay, complications and negative appendicectomy rate.

Results
A total of 193 children were admitted with suspected appendicitis. The majority underwent an ultrasound scan (169/193 [88%]) which identified an inflammed appendix or secondary-inflammation in nearly all cases of appendicitis (65/71 [91%] and 5/71 [7%] respectively). A normal appendix was identified in more than half of children not diagnosed with appendicitis (53/95 [56%]), with the rest showing an ovarian pathology (3/95 [3%]) or normal scan (39/95 [41%]). Ultrasound had high sensitivity (92% [CI 83-97%]) and specificity (100% [CI 96-100%]) for appendicitis.
The majority of children diagnosed with appendicitis were treated with laparoscopic appendicectomy (75/85 [88%]) and a minority medically-managed (10/75 [12%]). One appendix mass was medically-managed, and two Meckels Diverticulitis underwent a laparoscopic small bowel resection. Negative appendicectomy rate was extremely low (2/77 [2.5%]). Post-operative complication rate was low (6%). Median length of stay was short for appendicitis and all other diagnoses (2days [IQR 2.2] and 1day [IQR 0] respectively).

Discussion
The majority of children with suspected appendicitis underwent pre-operative ultrasound, which was highly sensitive and specific for appendicitis. Negative appendicectomy rate was extremely low, and likely related to routine pre-operative imaging.
TP9.2.6An update of the surgical management of truncal cutaneous abscesses: A systematic scoping review of current practice in 2021
Authors: Bennet Melissa-rose , Hartrick Olivia , Eason Russell , Rajaretnam Niroshini 
Published: October 2021

Abstract

Introduction
NHS England has shown efficiency in patient flow and reduction of length of stay resulting in cost savings. There’s considerable variability in local and national guidelines for Incision and drainage (I&D) of cutaneous truncal abscesses which can financially impact NHS expenditure.
This Systematic Scoping Review (SSR) aims to explore current management recommendations for I&D of cutaneous truncal abscesses in both adult and paediatric populations; and assess the quality of this research.

Method
SSR search strategy employed the PICO framework. Cochrane Library, NICE Evidence, Pubmed, OVID medicine, CINAHL and EBSCO databases were searched using search syntax ((“abscess*”OR“perianal abscess*”) AND (“incision and drainage”OR“I&D”) AND (“Equipment*”OR”instrument*”OR“Kit*”OR“theatre staff*”OR“team*”)). Full texts were systematically assessed. Final review performed in accordance with Joanna-Briggs-Institute protocol.

Results
131 articles were identified. No limit was placed on publication date. After removal of duplicates and abstract screening, 10 full text articles were assessed. Research suggests day-case emergency surgery pathways to manage I&D of abscesses are efficient and sustainable. Antibiotic use after I&D is weakly recommended and there is low quality evidence for using internal packing for healing perianal abscess cavities, and yet, this is established, common practice.

Conclusion
There’s variable quality evidence reviewing the surgical pathways for I&D and the post-operative management of cutaneous truncal abscesses. Overall, the findings are limited and further work is required to establish national guidelines.
TP9.2.7Acute Surgical Admissions at the End of Life: an Analysis of Deaths in Non-operatively Managed Patients
Authors: Clements Hollie , Boghdady Michael El , Alijani Afshin 
Published: October 2021

Abstract

Aims
Patients with advanced illnesses are often admitted with acute surgical emergencies. There is currently no evidence characterising such admissions. We aimed to evaluate emergency patients, managed non-operatively, who died during the same admission.

Methods
This single-centre retrospective, observational study collected data points for a 12 month period including age, prior documented do not resuscitate order (DNAR), existing cancer, Charlson Comorbidity Index, frailty, surgical diagnosis, interval from admission to death and care given. Patients who underwent surgical intervention were excluded. Non-parametric tests were used for statistical analysis.

Results
72 patients were included. 68.1% of patients died within 6 days of admission (median 4.0 days). Patients with visceral perforation, obstruction, bowel ischaemia or known malignancy were more likely to die within 6 days than those with pancreatitis, sepsis or new malignancy (median 2 vs 7 days, p &lt; 0.001). Patients with frailty (2 vs 4 days, p = 0.017) and existing DNAR (3 vs 4 days, p = 0.048) died more rapidly than those without. Age and comorbidity index did not impact time to death.

Conclusion
Frailty, surgical diagnosis and existing DNAR were predictors of shorter admission to death interval, while age and comorbidity index were not. This has implications on inpatient palliative care service planning.
TP9.2.8Conservative versus surgical management of complicated diverticulitis - a retrospective study of long-term outcomes
Authors: Durrity Emily , Elliott Grace , Gana Tabitha 
Published: October 2021

Abstract

Introduction
The management of complicated diverticulitis has evolved over the years, with a shift towards a conservative approach. The aim of this study was to evaluate the feasibility and long-term outcomes of conservative management of an episode of complicated diverticulitis.

Method
We retrospectively evaluated patients presenting with perforated colonic diverticulitis between 2013 and 2017. Demographic, presentation and management data was recorded. CT grading system and Clavien-Dindo classification of complications was used.

Results
Ninety-two patients were included, with a male-to-female ratio of 1:2. Forty patients had a Hartmann’s procedure on the first admission (Group A), the remaining 52 patients were managed conservatively with antibiotics +/- radiological drainage (Group B). Mean follow-up was 64.9 months (range 3-7 years).
CT Grade 3 and 4 disease was observed in 65% of Group A and in 40.4% of Group B patients. 14 (26.9%) patients re-presented with recurrent diverticulitis in Group B, 12 (23.1%) of whom required surgical resection in the course of follow-up.
Group A had significantly increased morbidity and poorer outcomes compared to Group B with a longer median length of stay (23.5 vs 10.2 days). Post-operative complications affected 72.5% (29 patients), with 40% being grade III or higher. Stoma reversal was performed in 10 (25.8%).

Conclusion
In carefully selected cases, complicated diverticulitis including CT grade 3 and 4, can be managed conservatively with acceptable rates of recurrence. Better overall outcomes were observed compared to surgical intervention, which is associated with high rates of post-operative complications (72.5%) and low stoma reversal rates 25.8%.
TP9.2.17Developing Novel Referral Pathways in Emergency Surgery
Authors: Morrison-Jones Victoria , Pearson Katherine , Bailey Ian , Trompetas Vasileios , Berry David 
Published: October 2021

Abstract

Introduction
In line with the principles of GIRFT and recognising the demand on the Emergency Department (ED) the Acute Surgical Unit (ASU) developed a direct admission pathway entitled ‘ASU Direct’ (ASUD). Nurse led ED triage with adherence to a referral proforma allows direct admission of suitable surgical patients eliminating medical ED review or discussion with the on-call Registrar.

Aim
Investigate the usefulness of the ASUD pathway and adherence to admission criteria.

Method
Two retrospective audits of ASUD referrals were completed and compared with concurrent traditional registrar referrals. Inter-departmental discussions occurred between audit cycles.

Results
Audit 1: 13 days, 150 cases (8 excluded). 75 (53%) referred via ASUD, 67 (47%) via surgical registrar. Sixteen ASUD cases (22%) breached pathway protocols including 3 young women referred without pregnancy tests. Seventeen (25%) cases referred via the Registrar fulfilled ASUD criteria. Documentation complete in 56% of ASUD cases.
Audit 2: (3 weeks after feedback) - 10 days, 120 patients (25 excluded). Fifty one ASUD cases (54%) and 44 (46%) registrar referrals. 24% cases breached ASUD criteria, 7 registrar referrals (15%) appropriate for ASUD. ASUD documentation completed in 60% with 100% pregnancy status recorded.

Conclusions
Proportion of ASUD / registrar referrals remained constant but there were fewer missed opportunities for ASUD. Inappropriate ASUD admissions remained similar. While ASUD worked well for visible pathology, less-so for protocol-driven abdominal pain.
Senior ‘front-door’ triage in ED might improve protocol compliance, helping to develop such pathways, observing GIRFT and avoid unnecessary transfer of patients (especially during the COVID pandemic).
TP9.2.20Improving surgical discharge summaries
Authors: Elzaafarany Ahmed , Oyewole Bankole , Ng Vivian , Mangat Shannon , Cheng Amanda , Tawfik Ahmed 
Published: October 2021

Abstract

Introduction
Discharge summaries are a means of communication to the patient, the GP and for medical records. An initial audit showed surgical discharge summaries contained misleading information and sometimes omitted relevant information.
Changes were implemented to improve the accuracy of surgical discharge summaries.

Method
The initial audit assessed the accuracy of discharge summaries over a two-week period and the re-audit was conducted after implementation of change over a similar time period. Data was extracted from electronic patient records (EPR).
Change implementation included educating the surgical team on the need for accurate discharge summaries. The EPR team was notified of the intrinsic error in the PowerChart system which is widely used in various NHS Trust.

Results
Incidence of misdiagnosis or misleading diagnosis in discharge summaries reduced from 42% to zero, lack of relevant investigations decreased from 7% to 1%, No follow up status reduced from 23% to 10% (usually post appendicectomy patients which are not routinely followed up but this needs to be stated in the discharge summary for clarity), at both initial audit and re-audit all patients had relevant surgery or procedures done included in their discharge summaries while the rate at which relevant medications were not stated in the discharge summary decreased from 4% to zero.

Conclusions
Discharge summaries are vital for record keeping and are usually the only written information a patient receives regarding their hospital stay. It is important that errors in EPR systems be flagged up for review.
TP9.2.22A six year retrospective study of appendicular neoplasms and review of literature
Authors: Patel Maitreyi , Mohapatra Shrabani Das , Kirmani Naveed 
Published: October 2021

Abstract

Aims
The aim of this study was to evaluate the incidence of appendiceal neoplasm, identify possible association of pre and intra-operative factors associated with it, and to determine its clinical significance.

Methods
Using pathological reports from surgical specimens of appendix from January 2015 to September 2020, a single centre retrospective analysis was performed. Medical records of patients, pre-operative investigations, intra operative findings, histological reports and post operative management were evaluated.

Results
The incidence of appendiceal neoplasms was 2.33% (65/2791). They consisted of Neuroendocrine tumor (NET) in 35(53.85%), followed by Low grade mucinous neoplasm (LAMN) in 23(35.38%), Goblet cell carcinoid in three (4.62%), mucinous cystadenoma 2(3.08%), one (1.54%) adenocarcinoma and one (1.54%) metastasis. Appendicitis was the most common indication for surgery. 46(70.77%) patients had emergency surgery. 89.13% emergency surgeries was appendicectomy, NET being the most common tumor in 60.87%. 19(29.23%) patients had elective surgery, all had pre operative radiological investigation, LAMN being most common. Only five (7.69%) patients had intra operative suspicion of tumor. Ten patients required second procedure in the form of right hemicolectomy in nine, and cytoreducetive surgery in one. All patients were followed up as per national guidelines.

Conclusions
The incidence of appendiceal neoplasms though low, has been steadily rising. Its diagnosis is rarely evident on pre operative radiological investigations. Surgeons should be aware of these neoplasms and its frequent association with emergency appendicectomies done for suspected acute appendicitis.
TP10.1.5The reorganisation of Emergency General Surgery services during the COVID-19 pandemic in the UK: Outcomes of delayed presentation, mortality and BAME patients
Authors: Chan Anthony , Stathakis Panos , Goldsmith Paul , Smith Stella , Macutkiewicz Christian 
Published: October 2021

Abstract

Background
The COVID-19 pandemic is a global public health emergency. The reconfiguration of local healthcare systems to accommodate the increase in Critical Care capacity has put strain on ‘non-COVID’ specialities. This study characterises the utilisation of Emergency General Surgery (EGS) services at a busy UK university teaching hospital during the COVID-19 lockdown period to evaluate outcomes and to identify patient groups with worse outcomes.

Method
This retrospective study compares EGS admissions during the UK’s lockdown period (23rd March-28th May 2020) to the same period in 2019. Patient demographics were recorded together with details of their hospital stay and treatment outcomes.

Results
A total of 645 patients were included, comprising 223 in the COVID-19 and 422 in the non-COVID-19 periods. There was no difference in age, sex, co-morbidity or socioeconomical status. A lower proportion of Black, Asian and Minority Ethnic (BAME) patients were admitted during the COVID-19 period (20.6% vs 35.4%, p &lt; 0.05). The duration of symptoms prior to presentation were longer, and admission Early Warning Scores and serum inflammatory markers were higher. More patients present with acute kidney injury (9.9% vs 4.7%, p = 0.012). There was no difference in perioperative outcomes or 30-day mortality, but more patients were readmitted following conservative management (10.6% vs 4.7%, p = 0.023).

Conclusion
We show that the UK reorganisation of EGS services has been successful in terms of outcomes and access to services despite a more unwell population. There was a lower proportion of BAME admissions suggesting additional barriers to access to healthcare under pandemic lockdown conditions.
TP10.1.6Short term outcomes of emergency colorectal cancer resections during COVID-19 pandemic;Experience of a district general hospital
Authors: Liyanage Aloka Suwanna Danwaththa , Gokul Krishnan , Babu Bheemanakone Harish 
Published: October 2021

Abstract

Aim
Surgical and oncological outcomes of emergency colorectal cancer (CRC) surgeries are poor compared to those of elective resections. SARS-Cov-2 ambience has added an additional risk on these patients during the course of their perioperative journey. The impact of peri-operative SARS-CoV-2 infection on the outcomes of these unique patients is still under scrutiny. We aimed to analyse a cohort of patients that underwent emergency CRC surgeries during pandemic in our setting.

Methods
We analysed a prospectively maintained database of all patients who underwent emergency CRC surgeries since 11th of March 2020 to 31st of December 2020. Primary outcome measures were Length of stay (LoS) and 90 day mortality. Secondary outcomes were post-operative complications, SARS-CoV-2 infection rates and 30 day readmission rates.

Results
We performed a total of 18 emergency CRC surgeries (Male: Female 1:1). Median age was 76.5 years (Range 39-89 years). Median LoS was 13 days (Range 5-110 days). 90 day mortality was 17% (3/18) and of the two patients who died (2/3), their cause of death was COVID-19 related. 4 (22%) patients had peri-operative SARS-CoV-2 infections. 30 day re-admission rate was 16% (3/18). 78% (14/18) of the patients had their cancer resected. 61% (11/18) of the procedures were palliative.

Conclusions
Peri-operative SARS-CoV-2 infection may have add on effect on the morbidity and mortality on patients undergoing emergency CRC surgeries. Data from large scale multicentre cohort studies would provide more insight in to this.
TP10.2.1Lessons Learnt in the Management of Acute Appendicitis During the Sars Covid-19 [Cv 19] First Wave
Authors: Ngugi Josephine , Patel Nikhita , Al-Whouhayb Maitham , Mathur Pawan 
Published: October 2021

Abstract

Aims
To evaluate the impact of CV19 on surgical technique and patient outcome in management of acute appendicitis during the 1st wave.

Method
Data was collected on patients presenting with appendicitis to ED. Group A: Jan-March 2020, pre COVID and Group B: April-June 2020: peri COVID

Results
There was no difference in sex, age and length of stay between groups. In group A [n = 194], 88% had lap appendicectomy vs Group B [n = 98], 97% had an open operation. Group A had a complication rate of 6% [wound infection] with no readmissions. Group B had 31% complication rate [intra-abdominal collection, bleeding, and ileus] requiring readmission.
685 surgical patients attended ED in the first half of 2020 of which 4 % had an appendicectomy. However the method of surgical access in the 1st wave significantly impacted on patient outcome, resource and re-admission rates.

Conclusion
In our study open appendicectomy undertaken due to concerns around COVID transmission during laparoscopic surgery during the 1st wave, increased rates of complications and readmission thus raising hospital costs and chances of COVID 19 infection in these patients.
As a result of this and due to greater confidence in laparoscopic surgery as a whole we have returned to undertaking laparoscopic appendicectomy in the current wave. Further analysis is underway assessing the impact of COVID on all emergency operations undertaken in the 1st wave.
TP10.2.3Restarting Elective Orthopaedic Surgery during the COVID-19 Pandemic: Experiences and Patient Outcomes
Authors: Vusirikala Anuhya , Saleh Marwan , Laurent Edward , Kuzhupilly Ranjith , Fahmy Amr , Tsekes Dimitrios 
Published: October 2021

Abstract

Aim
The novel coronavirus disease 2019 (COVID-19) resulted in postponing all non- emergency elective surgeries from April 2020. Restarting elective orthopaedic surgery is important to help people with chronic disabilities. Our hospital successfully restarted elective orthopaedic surgery during the pandemic to help improve the quality of life of patients.
This study describes the development of local protocols and pathways to allow for a safe restart of elective orthopaedic surgery in a COVID-19 free ‘green’ site. It also includes the morbidity and mortality outcomes of those patients who underwent non-emergency orthopaedic operations during this time.

Methods
A prospective cohort study evaluating patients undergoing non- emergency orthopaedic procedures through a COVID-19 free surgical pathway in a National Health Service acute general hospital in the United Kingdom from 18th May 2020- 10th July 2020. 104 patients were identified and their outcomes during the 2 week post-operative period was recorded.

Results
No patients developed COVID-19 infection in the two-week post-operative period. There were no intensive care unit admissions or in- hospital deaths during our study time frame. There was no statistical difference found in the development of complications for age (&lt; 70 or &gt;70), gender, body mass index or ASA physical status classification system grades.

Conclusions
This study describes a roadmap to setting up a protocolised elective operating service for orthopaedic surgery. It has shown that standardised protocols in a COVID-19 free ‘green’ site, pre-operative COVID-19 testing and adherence to national guidelines on self-isolation can help prevent developing COVID-19 infection post-operatively.
TP10.2.4Access surgery for dialysis patients during COVID-19
Authors: Liang Kaifeng , Lindsey Ben , Mohammed Ismail , Khurram Mohammed , Sammartino Cinzia , Sivaprakasam Rajesh 
Published: October 2021

Abstract

Aims
To describe the organisation of a triage system and COVID-19-free surgical pathway, and to assess the outcomes after its implementation for planned dialysis access surgery for patients during the first wave of the COVID-19 pandemic in the UK.

Methods
In response to the suspension of elective operations due to SARS-CoV-2 outbreak, we devised a COVID-19 free surgical pathway performed in NHS and an independent hospital. We audited the outcomes of its application in patients requiring access surgery between 17 April and 15 September 2020. The data was collated, analysed, and presented at clinical governess. We are looking to re-audit for the second wave in the coming months.

Results
A total of 235 cases were listed, and 203 procedures were performed. Thirty-two cases were cancelled and the top reason for cancellation was patient refusal. Of the procedures carried out, 47% (n = 96) were arteriovenous fistula formation, 42% (n = 84) were peritoneal catheter procedures, and 11% (n = 23) were arteriovenous grafts. The postoperative complication rate by day 7 was 13.3% (n = 27), by day 30 was 6.9% (n = 14) and they are similar to pre-COVID outcomes.
By performing a definitive dialysis access, we avoided the significant morbidity and mortality associated with tunnel-line based dialysis. No patients acquired COVID-19 or died from its related illnesses in 30 days.

Conclusion
Our results confirmed that our pathway was effective in delivering dialysis access in a timely manner and COVID safe. Our model is safe, easy to replicate COVID-19-free pathway and can be used during similar challenges in the future.