bluuebunny/crossref_metadata_2025_split huggingface dataset:
TP9.1.3The Effect of Hip Fracture Anatomy and Surgical Modality on the Rate of Red Blood Cell Transfusion and Mortality: A Retrospective Analysis
Authors: Greenhalgh Michael , Gowers Benjamin , Iyengar Karthikeyan , Adam Riad 
Published: October 2021

Abstract

Aims
This study assesses the effect of hip fracture anatomy and operation performed on transfusion rates within our centre. We aim to identify patients most likely to require transfusion early, to improve outcomes.

Methods
A retrospective cohort study of 324 consecutive hip fracture patients presenting to a district general hospital over one year. Data was collected from patient records, local transfusion laboratory and the national hip fracture database.

Results
324 hip fractures were categorised as 188 (58%) intracapsular, 121 (37%) intertrochanteric and 15 (5%) subtrochanteric fractures. The most common operation performed was hemiarthroplasty (128), followed by dynamic hip screw fixation (75).
75 (23%) patients received a blood transfusion. 15% of intracapsular, 35% of intertrochanteric and 33% of subtrochanteric fractures received transfusions.
47% of long intramedullary nails, 45% of short intramedullary nails, 29% of dynamic hip screws, 18% of hemiarthroplasties and 9% of total hip arthroplasties resulted in blood transfusions.
One-year mortality was higher in the transfused cohort at 52% compared to 30.5% in non-transfused, with an odds ratio of 2.466 (95% CI 1.4555 to 4.178, p = 0.0008).

Conclusions
Almost a quarter of hip fracture patients received a blood transfusion, which was associated with an almost two and a half times increased risk of one-year mortality. Extracapsular (intertrochanteric and subtrochanteric) fractures most commonly led to transfusions. Long intramedullary nailings were most associated with transfusions and total hip arthroplasties the least. Patients more likely to require transfusion and subsequently have a higher one-year mortality risk can therefore be identified at presentation.
TP9.2.9Luminal Investigation Following CT Diagnosed Acute Diverticulitis
Authors: Gerrard Adam , Artioukh Dmitri 
Published: October 2021

Abstract
The commissioning guide for colonic diverticular disease by the Royal Collage of Surgeons (2014) states that all patients should undergo luminal investigations once an acute attack of diverticulitis has passed. The rational behind this is to ensure a malignant polyp is not missed, however there is mounting evidence and opinion that this may not be necessary.
We aim to evaluate how our unit follows the commissioning guide and investigate the number of subsequent polyps and cases of malignancy found.
Surgical inpatients with a CT proven diagnosis of acute diverticulitis within a one year period (2018) were included. Their CT scans were reviewed to confirm the diagnosis and electronic records examined to see if luminal investigations were requested, occurred and what the findings were.
There were 78 cases of CT confirmed diverticulitis. Of these 11 patients underwent emergency Hartmanns procedure. This left 67 patients in whom investigations were requested in 47. Within the 20 cases were follow up was not requested, 50% had a mitigating factor. 40/47 patients who had investigations booked underwent the requested test. In 6 cases a polyp was found and there were no cases of colorectal cancer.
Based on current guidance there is scope to improve the follow up investigations in this population of patients with CT proven diverticulitis. As no colorectal cancers were found this is in keeping with the growing notion that colonoscopy may be reserved for those with complicated diverticulitis on CT or with CT findings on a background of ‘red flag’ symptoms.
TP9.2.10The risk and predictors of mortality in octogenarians undergoing emergency laparotomy: A multicentre cohort study
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Shah Jigar , Maw Andrew , Mansour Moustafa , Satyadas Thomas 
Published: October 2021

Abstract

Aims
To evaluate the risk and predictors of postoperative mortality in octogenarians undergoing emergency laparotomy.

Methods
In compliance with STROCSS guideline for observational studies, we conducted a multicentre retrospective cohort study. All consecutive patients aged over 80 with acute abdominal pathology requiring emergency laparotomy between April 2014 and August 2019 were considered eligible for inclusion. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measures were in-hospital mortality and 1-year mortality. Statistical analyses included simple descriptive statistics, binary logistic regression analyses, and Kaplan–Meier survival statistics.

Results
A total of 523 octogenarians were eligible for inclusion. Emergency laparotomy in octogenarians was associated with 21.8% (95% CI 18.3-25.6%) 30-day postoperative mortality, 22.6% (95% CI 19.0-26.4%) in-hospital mortality, and 40.2% (95% CI 35.9-44.5%) 1-year mortality. Binary logistic regression analysis identified ASA status (OR: 2.49,95% CI 1.82-3.38,P&lt;0.0001) and peritoneal contamination (OR: 2.00, 95% CI 1.30-3.08, P = 0.002) as predictors of 30-day postoperative mortality. The ASA status (OR: 1.92,95% CI 1.50-2.46,P&lt;0.0001), peritoneal contamination (OR: 1.57,95% CI 1.07-2.48,P=0.020) and presence of malignancy (OR: 2.06,95% CI 1.36-3.10,P=0.001) were predictors of 1-year mortality. Log-rank test showed significant difference in postoperative survival rates among patients with different ASA status (P &lt; 0.0001) and between patients with and without peritoneal contamination (P = 0.0011).

Conclusions
Emergency laparotomies in patients older than 80 years with ASA status more than 3 in the presence of peritoneal contamination carries a high risk of immediate postoperative and 1-year mortality. There is a need to incorporate modern prognosticators into the available preoperative mortality risk assessment tools.
TP9.2.11Venous Thromboembolism Assessment and Thromboprophylaxis in Pregnant Women admitted to Hospital under Non-Obstetric Specialties
Authors: Hosny Shady Gaafar , Ghosh Trisha , Saksena Rhea , Suliman Ibnauf 
Published: October 2021

Abstract

Aims
During a non-obstetric admission, there is minimal awareness amongst other specialties regarding the need to reassess venous thromboembolism (VTE) prophylaxis requirements. The primary aim of this study was to review whether perinatal patients are accurately assessed for VTE risk factors during non-obstetric admissions and being prescribed appropriate thromboprophylaxis upon discharge.

Methods
Data collection was carried out by retrospectively identifying all admissions of pregnant women in hospital under a non-obstetric team over a period of six months.
Patients were scored according to their individual risk factors related to pregnancy and the admission. Comparison was made between the recommended and actual prophylaxis given.

Results
152 patients were included in the study. Only 13 women received appropriate VTE management whilst 35 patients were deemed high-risk and did not receive prophylaxis. VTE assessment was not documented in nearly 60% of patients. 68% of patients were found to be at intermediate risk.

Conclusion
Reassessment for risk of VTE in antenatal and postnatal patients is poorly documented when managed by non-obstetric led teams. Women with both established and transient risk factors for VTE are not receiving appropriate thromboprophylaxis. Raised awareness of this specific problem is required amongst non-obstetric teams.

Key Statement
Appropriate thromboprophylaxis is vital at the point of admission of a pregnant patient to hospital as this is associated with an 18-fold increased risk of VTE.
Further improvements need to be made in order to educate non-obstetric teams caring for obstetric patients regarding the importance of VTE risk assessment.
TP9.2.13Outcomes of Emergency Groin hernia repair: 30-months experience of a tertiary care hospital
Authors: Kumar Dileep , Tan Brandon , Guilbert Michael , Elsllabi Mohamed , Muthukumarasamy Girivasan 
Published: October 2021

Abstract

Aims
Repair of Emergency groin hernia is variable across different regions and even within same units. Mesh is increasingly used these days. We aim to evaluate peri-operative and long-term outcomes over last 30-months.

Methods
Retrospective analysis of all emergency groin hernia repairs from January 2018- July 2020 in a tertiary Centre. Case notes and electronic patient records (clinical portal, PACS system etc.) used for data collection.

Results
Of 89 emergency groin hernia repairs 62(69.7%) males, 32/89 (35.9%) indirect inguinal hernia and 29 (32.5%) femoral hernia. Median age 72 years (range 20-95), 74(83.1%) primary hernia and 15(16.9%) recurrent hernias. Femoral hernia was most common in females 25/27 (92.5%) in contrast 58/62 males (93.5%) had inguinal hernia. All patients, except 1(1.1%) laparoscopic, had open repair, 11/89 cases (12.3%) required bowel resection, of those 10 (90.9%) had suture repair. Additionally, 6/89 cases (6.7%) needed laparotomy. Of 68/89 (76.4%) cases who had mesh repair, 52(76.4%) were inguinal and 23.5% (16/68) femoral hernia. Only 55% femoral hernias repaired with mesh. Median LOS was 3 days (range 0-54), 6/89 cases (6.74%) had wound complications (3 wound infections, 2 haematoma and 1 fluid collection). With median 19 months (range 6-36 months) follow-up, 1(1.1%) recurrence each in both mesh and suture repair groups, no mesh infection and 2/89 (2.2%) 30-day mortality recorded.

Conclusion
Mesh repair is increasingly used in emergency groin hernia repair without increased risk of mesh infection, although suture repair is still preferred in groin hernias requiring bowel resection.
TP9.2.14A novel 'one stop' service for Gallstone (GS) disease utilizing Emergency General Surgery (EGS) ambulatory clinic (AC) and dedicated expedited theater lists for early Cholecystectomy
Authors: Majeed Talal , Baig Mirza Saboor , Buckley Katherine Alice 
Published: October 2021

Abstract

Introduction
GS related disease account for almost 1/3rd admissions and referrals in EGS 1. Rate of early cholecystectomy, as mandated by NICE guidelines, in a recent RCS annual report was only 0-30% of eligible patients.2

Aims
The aim was to determine if an improved rate of acute cholecystectomy (AC) had been achieved by; increasing elective capacity for emergency general surgeons (EGS), ring fencing hot lists for AC, increased use of NCEPOD list and campaign of awareness among theatre and anaesthetic staff.

Material and Methods
A retrospective study of rates of AC before and after implementation of changes in working practice was conducted using hospital episode data. All patients eligible for early cholecystectomy were included. AC rate, Intra and post -operative complications, length of stay and number of referrals to the elective upper gastrointestinal (UGI) service were determined.

Results

Conclusion
Acute cholecystectomy during acute admission by emergency surgical had been significantly improved. It is safe and does not increase post-operative LOS.
TP9.2.21Laparoscopy in Emergency General Surgery (The LEGS Study): NELA Database Analysis -Comparison of Outcomes in Laparoscopic versus Open Surgery
Authors: Parmar Kat , Badrick Ellena , Malcomson Lee , Renehan Andrew , Sharma Abhi , Heywood Nick 
Published: October 2021

Abstract

Introduction
Guidelines suggest the laparoscopic approach may be safe and feasible in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) rate of laparoscopic surgery remains low. Our earlier analysis of the NELA database identified factors associated with use of laparoscopy, then recommended further analysis to compare outcomes between laparoscopic and open surgery.

Methods
We obtained information from the NELA database (2013 - 2017) and performed logistic regression on all first operations during the hospital admission. Outcomes were compared between open and laparoscopic approach (fully laparoscopic, laparoscopic assisted and laparoscopic converted). The primary outcome was death during hospital admission; secondary outcomes were admission to intensive care unit (ICU), length of ICU stay and return to theatre.

Results
The cohort comprised 68,928 open (52% men, mean age 65) and 12,144 laparoscopic (51% men, mean age 58). In a model adjusted for all factors influencing primary or secondary outcomes (age, gender, p-possum, weekday versus weekend, operative time of day, malignancy, peritoneal soiling, CEPOD urgency, surgical grade and anaesthetist grade), death rates were significantly lower in the laparoscopic group (OR 0.65, 95% CI 0.59 – 0.71). Post-operative admission to ICU and ICU stay &gt; 3 days were both significantly lower in the laparoscopic group (OR 0.59, 95% CI 0.56 – 0.62; OR 0.82, CI 0.75 – 0.89). There was no difference in return to theatre.

Conclusions
Outcomes for laparoscopy in emergency general surgery appear superior to open surgery, although there may be residual unmeasured confounding factors. Further analysis will compare outcomes between pathologies.
TP9.2.24Is preoperative ABO blood typing required in emergency appendicectomies?
Authors: Rodrigues Ricardo , Reece Ieuan , El-Masry Nabil 
Published: October 2021

Abstract

Aims
Intra-operative bleeding is very rarely a complication of laparoscopic appendicectomy. Despite this, it is often mandatory for any patient undergoing an emergency appendicectomy to have pre-operative ABO blood type sampling. This could be an unnecessary expense and may lead to patients being delayed for theatre. The aim of this study was to see how many patients who underwent an appendicectomy required a blood transfusion intra-operatively or within 30 days of their operation.

Methods
Data were collected retrospectively for patients of all ages who underwent an appendicectomy for suspected appendicitis at a single centre from March 2018 to May 2020. The primary outcome measure was intra-operative and post-operative blood transfusion up until 30 days after the operation.

Results
Over 26 months, 698 appendicectomies were performed. Preoperative ABO blood typing was performed in 95% (n = 663) of patients. Collectively, 1,305 blood samples were obtained at a combined total cost of £13,703 to the hospital. None of the patients required blood transfusion intra- or post-operatively. Pre-operative blood transfusion was performed in only three patients, all due to chronic anaemia. 21 (3%) patients were delayed in going to theatre whilst awaiting two valid ABO blood typing results.

Conclusions
Emergency appendicectomies very rarely experience complications associated with bleeding or requiring blood transfusion. Clinical guidelines should reflect this by avoiding recommendation of such tests in emergency appendicectomies, reducing delays to surgery and resulting in a more efficient allocation of financial and staff resources.
TP10.1.11Into the Pandemic and Out of the Fire?
Authors: Green Sophie , Ronan Dominic , Ralston David 
Published: October 2021

Abstract

Aim
The Covid-19 pandemic has seen various government restrictions on all aspects of daily life. We assessed whether these lifestyle alterations have affected the number, severity and presentation of burns seen at a Paediatric Burns Unit.

Methods
We looked at Paediatric Burns admissions to Plastic Surgery during the Covid-19 pandemic of March 2020 to Jan 2021 (DC), as well as comparison data prior to Covid-19 from April 2019 to February 2020 (PC). We also looked at specific periods of national lockdown. Using data from our electronic records we looked at varying aspects of a patient’s journey.

Results
In total 788 cases were admitted to the Burn’s team from April19 -January21. The mean age of patients both DC and PC were 4.7 years with the mean during the first lockdown of 5. The time to presentation PC was 2.6 days, DC was 1.79 days and 2.4 days during the first lockdown. This was not significant (p = 0.2). The median total body surface area (TBSA) was &lt;1% in both PC and DC patients. Scalds made up 53% of the first lockdown injuries, this had no statistically significant difference as compared to PC and DC injuries (48% and 46% respectively).

Conclusions
Overall burns admissions during the Covid-19 pandemic did not significantly change as compared to the previous year. This contrasts published adult results, which demonstrates reduced burns admissions during Covid-19. We suggest this may be due to unchanged causative factors in paediatric burns which are predominantly found in domestic lockdown environments.
TP10.1.12Personal Protective Equipment impairs pulmonary gas exchange causing systemic hypercapnia-hypoxaemia and cerebral hyperperfusion-induced cephalalgia
Authors: James Osian , Stacey Benjamin , Hopkins Luke , Robinson David , Bailey Damian , Lewis Wyn 
Published: October 2021

Abstract

Aims
To what extent Personal Protective Equipment (PPE) impacts integrated cardiopulmonary-cerebrovascular function has not been examined. The hypothesis tested was that PPE adversely influences pulmonary gas exchange, resulting in systemic hypercapnic-hypoxaemia and cerebral hyperperfusion-induced cephalalgia.

Methods
Eight male Higher Surgical Trainees (aged 33 ± 2y) participated in a repeated measures crossover study, completing two-hour laparoscopic simulation tasks, on two separate occasions (separate days), once in standard operating attire, and once in full PPE (including FFP3 mask).

Results
Following two hours of simulation, full PPE (compared with standard operating attire) was associated with increased FICO2 (7.9% (±0.8%) vs. 7.1% (±1.2%); p = 0.025), decreased FIO2 (16.0% (±0.4%) vs. 16.6% (±0.5%); p = 0.011), and decreased peripheral O2 saturation (95% (± 1%) vs. 98% (±1%); p = 0.001). Headaches were reported by three participants in PPE (Chi2 3.692, p = 0.055), and was associated with increased Middle Cerebral Artery flow velocity; 82 (±4) cm/s, compared with 63 (±9) cm/s in the remaining five participants (p = 0.008). Skin temperature increased by 1.3 °C during simulation in PPE (p = 0.001), with an equal mean insensible fluid loss of 300ml under both conditions (p = 0.049).

Conclusions
Collectively, these findings highlight the integrated cardiopulmonary-cerebrovascular complications associated with PPE-induced impairment in pulmonary gas exchange. Protective countermeasures should be designed to prevent risk to healthcare staff and patients alike.
TP10.2.8Adaptation in providing renal access surgery service in response to covid-19 pandemic- a single centre experience
Authors: Mir S A , Kumar Avneesh , Chidambaram Nathan , Pararajasingham Ravi 
Published: October 2021

Abstract

Aim
Evaluate impact of Covid-19 pandemic on renal access surgery and changes in practice towards counteracting limitations to provide safe and effective peritoneal and haemodialysis.

Methods
Retrospective review of procedures for dialysis in ESRD patients from institutional databases in a single centre was carried out. Patients undergoing peritoneal catheter insertions (PD) or AV fistula formation (HD) between March 2020 and October 2020 were compared with similar period in 2019. Demographic, procedure and postoperative outcome data was collected.

Results
Between March and October 2019, 143 combined PD and HD procedures were performed compared to 98 in the same time period in 2020. The mean age of patients was 65 ± 15 years and 62 ± 12 years, respectively. In 2020, 26 patients had PD catheter insertion and 22 patients in 2019. 18% of these were performed laparoscopically in 2019 compared to 33% in 2020. The same day discharge rate increased to 34% from 22%.
Patients having complex fistula procedures including basilic vein transpositions and grafts requiring overnight stay dropped from 83% patients (n = 23) to 71% (n = 7) in 2020.
In 2019, 80% (n = 49) patients had radio-cephalic fistula performed as same day procedure increasing to 98% (n = 22) in 2020.
Day-surgery unit utilisation increased from 55% to 71%. Same day discharge rate increased from 53% to 66%. There were no readmissions.

Conclusions
Adaptations in terms of increased support for same day surgery even for complex renal access procedures has improved service. A greater proportion of renal access service can be same day procedures avoiding inpatient stay.
TP10.2.13Outcome of Acute appendicitis management during COVID-19 pandemic in a tertiary hospital
Authors: Lim Su Kwan 
Published: October 2021

Abstract

Aim
Coronavirus (COVID) has influenced the management of acute appendicitis. The Royal Colleges of Surgeons recommend best practice depending on local circumstances. The aim of this project is to assess the 30-day outcome of patients managed operatively and conservatively for acute appendicitis during the first wave of the pandemic in the UK.

Method
Patient data were collected prospectively at the end of March 2020, when Covid-19 became prevalent in the UK and lockdown started. Data was collected for patients admitted to the acute surgical unit for the admission dates of 20/03/2020 to 15/05/2020. At 30 days after admission, a search was done on the electronic clinical portal to check if the patient was readmitted for operation. The inclusion criteria are any patients above 16-year-old admitted through acute surgical unit with a clinical diagnosis of acute appendicitis or computed tomography scan findings of proven acute appendicitis.

Result
A total of 34 patients (median age, 33; range, 17-74) were identified from March 2020 to May 2020. All patients have covid-19 status as negative and were given intravenous antibiotics at point of admission. All patients received a course of seven-day of antibiotic. 17 patients underwent operation and 17 patients were managed conservatively. Only one patient who was treated conservatively for acute appendicitis, was re-admitted within 30 days of admission date.

Discussion
The readmission rate of patients treated conservatively for acute appendicitis after 30 days were low during the first wave of the pandemic.
The Miocene wetland of western Amazonia and its role in Neotropical biogeography
Authors: Hoorn Carina , Boschman Lydian M , Kukla Tyler , Sciumbata Matteo , Val Pedro 
Published: October 2021

AbstractIn the Miocene (23–5 Ma), a large wetland known as the Pebas System characterized western Amazonia. During the Middle Miocene Climatic Optimum (c. 17–15 Ma), this system reached its maximum extent and was episodically connected to the Caribbean Sea, while receiving sediment input from the Andes in the west, and the craton (continental core) in the east. Towards the late Miocene (c. 10 Ma) the wetland transitioned into a fluvial-dominated system. In biogeographic models, the Pebas System is often considered in two contexts: one describing the system as a cradle of speciation for aquatic or semi-aquatic taxa such as reptiles, molluscs and ostracods, and the other describing the system as a barrier for dispersal and gene flow for amphibians and terrestrial taxa such as plants, insects and mammals. Here we highlight a third scenario in which the Pebas System is a permeable biogeographical system. This model is inspired by the geological record of the mid-Miocene wetland, which indicates that sediment deposition was cyclic and controlled by orbital forcing and sea-level change, with environmental conditions repeatedly altered. This dynamic landscape favoured biotic exchange at the interface of (1) aquatic and terrestrial, (2) brackish and freshwater and (3) eutrophic to oligotrophic conditions. In addition, the intermittent connections between western Amazonia and the Caribbean Sea, the Andes and eastern Amazonia favoured two-way migrations. Therefore, biotic exchange and adaptation was probably the norm, not the exception, in the Pebas System. The myriad of environmental conditions contributed to the Miocene Amazonian wetland system being one of the most species-rich systems in geological history.