bluuebunny/crossref_metadata_2025_split huggingface dataset:
387 Plastics Surgery and the COVID-19 Pandemic: How Our Practice Has Improved as A Consequence
Authors: Yeoh T , Tan A , Ahmed F 
Published: October 2021

Abstract

Aim
Plastic trauma cases were impacted by the COVID-19 pandemic. Multiple plastic trauma theatres were lost due to redeployment and redistribution of staff and resources. Plastic surgery was essentially left with an emergency list to manage trauma cases. This retrospective study aims to highlight the pitfalls and solutions realised during COVID times and how different strategies can be implemented should a third national lock down occur.

Method
Plastic surgery data (trauma, elective) was analysed from the first national lockdown due to COVID-19 in 2020. This data was compared against plastic surgery trauma data from 2019. Theatre time, the number of trauma surgeries, anaesthetic used and delay to theatre were all analysed.

Results
There was a 47% reduction in plastic surgery trauma cases and a 42% reduction in delay to surgery during the national lockdown (2020) when compared with data from 2019. A significant increase in the use of Local Anaesthetic (LA) and Regional Anaesthetic (RA) during COVID times with a decrease in General Anaesthetic when compared with pre-COVID data of 2019 was also identified.

Conclusions
This study identified that the majority of plastic cases could be performed under RA/LA. This would lead to decreased aerosol generating procedures (GA) thus limiting the transmission of COVID, and decreased delay to surgery and theatre time. As a third national lockdown may be on the horizon, it would be prudent to implement these strategies into current practice and by doing so optimising theatre usage and assisting in curtailing the COVID-19 transmission rate.
423 Patient Perspective on the Use of the Independent Sector to Maintain Elective NHS Services During the COVID-19 Pandemic
Authors: Clough O , Lee G , Walker J 
Published: October 2021

Abstract

Introduction
COVID-19 resulted in the suspension of planned treatments for patients worldwide leaving millions suffering the physical and mental effects of delay. Reports indicate that when services have been re-established, patients have been afraid to take up appointments. Hospitals put processes in place to counter this, notably separating emergency and elective patient cohorts. Most notably seen by the co-operation between the NHS and independent private healthcare providers in March 2020 at the height of the pandemic. We undertook a study to ascertain the perceptions of NHS patients who underwent elective treatment at independent ‘cold’ sites during the COVID-19 pandemic.

Method
A cross-sectional study with structured telephone interviews of patients who had planned elective treatments at ‘cold’ independent hospitals between March and September 2020. 1150 patients were identified, and a 20% sample formed a 230 patient study group, with 158 (70%) agreeing to participate.

Results
30% of patients delayed their treatment due to COVID related concerns, with 76% of these only accepting treatment because this was at a ‘cold’ site. 46% of patients perceived treatment at a ‘cold’ site as the most important factor contributing to their safety. 153 patients (97%) supported the paid arrangement between the NHS and the independent sector to provide separate ‘cold’ sites for elective treatments.

Discussion
Safely restarting elective services to allow important planned treatments to take place, as was the pandemic continues, is a priority. Our study indicates that physical separation of patient pathways impacted most on patient confidence, and that the use of ‘cold’ sites is a viable option.
454 Impact Of COVID-19 Pandemic on Elective Theatre Productivity in Otolaryngology
Authors: Lam C M , Owens D 
Published: October 2021

Abstract

Aim
COVID-19 has had a significant impact on otolaryngology surgery. There are new requirements to prepare patients for theatre however the impact on theatre productivity is unknown. This study aims to evaluate the impact of COVID-19 on elective theatre productivity.

Method
We conducted a retrospective evaluation of elective otolaryngology theatre lists. Ten consecutive theatre lists beginning on the final week of November 2019 and November 2020 were analysed. Dedicated emergency operation lists were excluded.

Results
There were fewer operating lists per working day in 2020 (0.9) compared to 2019 (2.0) and a higher percentage of operations cancelled (2020: 15.4%, 2019: 8.6%). Theatre lists finished significantly earlier in 2020 than in 2019 (2020 median: 97.5 minutes, 2019 median: 15.5 minutes; p = 0.00018). The percentage of theatre lists finishing over 60 minutes early was substantially greater than the national average of 23% (2020: 75%, 2019: 30%). The median pre-list delay was higher in 2020 than 2019 (2019: 20.5 minutes, 2020: 31.5 minutes; p = 0.14) whilst the median total delay was higher in 2019 compared to 2020 (2019: 20.5 minutes, 2020: 18 minutes; p = 0.21). Both results were not statistically significant. The commonest reason for delay in 2020 were COVID-19 related reasons such as awaiting test results, in 2019 the commonest reason was patient not being ready for theatre such as consent not completed.

Conclusions
COVID-19 has had a significant impact on theatre productivity and is currently the commonest cause of theatre list delay. The early theatre finishing time suggest that improvements can be made to improve theatre productivity.
460 Remote Orthopaedic Clinics during COVID-19: Lessons for a Sustainable Future
Authors: Curtis A , Parwaiz H , Winkworth C , Sweeting L , Pallant L , Davoudi K , Smith E , Chin K , Kelsey M , Brankin-Frisby T , Stevenson A 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic has led to a focus on non-face to face (NF2F) orthopaedic clinics. Our aim was to establish whether NF2F clinics were sustainable according to the ‘Triple Bottom Line’ framework by taking account of the impact on patients, the planet and financial cost.

Method
This retrospective cohort study was carried out at a large DGH with 261 patients identified as having undergone F2F or NF2F orthopaedic consultations (April 2020). These patients were contacted by telephone to establish their experience, mode of transport and preference for future consultations. Data was also collected relating to environmental and financial costs to the patient and trust.

Results
Final analysis included 180 patients (69%): 42% had a F2F consultation and 58% a NF2F consultation. There was no significant difference between each group in terms of convenience, ease of communication, subjective patient safety, or overall satisfaction rating (p&gt;0.05). 80% of NF2F patients would be happy with virtual consultations in future. Mean journey distance was 18.6 miles leading to a reduction in total carbon emissions of 563.9kg CO2e (66%), equating to 2106 miles in a medium sized car. The hospital visit carbon cost (heating, lighting, and waste generation) was reduced by 3,967kg CO2e (58%). The financial cost (petrol and parking) was also reduced by an average of £8.96 per person.

Conclusions
NF2F consultations are aligned to the NHS ‘Long Term Plan’. They (i) deliver high patient satisfaction with equivalent outcomes to F2F consultations; (ii) have reduced carbon emissions from transportation and hospital running; and (iii) are cheaper.
615 Evening Emergency Theatre Usage Analysis Pre And Post COVID-19: Are We Making the Cut?
Authors: Barzilai L , McArthur G 
Published: October 2021

Abstract

Introduction
Emergency theatre is a 24/7 service. We aim to assess a large UK hospital’s utilisation of theatre time in the evening.

Method
Electronic records of all evening (6pm-9pm) operations between January-February 2020 (pre COVID-19) and July-August 2020 (post COVID-19) assessed for start and finish times, send for times and booking times. Existence of pending cases during downtime noted as well as any delay reasons.

Results
Time between out of room and send for times (when cases pending) average 59 minutes pre COVID-19 vs. 78 minutes post COVID-19 (median 35 minutes vs. 59 minutes, respectively). Time between surgical end and send for times (when cases pending) average 83 minutes pre COVID-19 vs. 96 minutes post COVID-19 (median 64 minutes vs. 81 minutes, respectively). Time between out of room and anaesthetic start average 84 minutes pre COVID-19 vs. 101 minutes post COVID-19 (median 58 minutes vs. 80 minutes, respectively). Send for times post booking for new evening bookings average 80mins pre COVID-19 vs. 57 minutes post COVID-19 (63 minutes vs. 38 minutes, respectively). 20.45% of cases did not have a computer booking for surgery pre COVID-19 vs. 25.92% post COVID-19. Pre COVID-19, theatre overrunning contributed to delays, whereas post COVID-19, delays also due to repeat COVID-19 swabs, repeat group & saves and delays in bed availability.

Conclusions
Lingering effects of COVID-19 have caused further delays to a service already in need of implementation of changes to improve utilisation. Surgical, anaesthetic, nursing and executive teams must work together to improve efficiency.
793 Orthopaedic Surgical Training in The Independent Sector During the COVID 19 Pandemic
Authors: O'Callaghan J , Lochab S , Stanier P , Woods D 
Published: October 2021

Abstract

Introduction
The COVID pandemic had led to the cancellation of elective Orthopaedics in the NHS. The aim of this study was to investigate the effect of the independent sector on orthopaedic training and the effect of the COVID pandemic on training locally.

Method
A retrospective review of trauma and elective operations was made between April and September of 2019 and 2020 to compare the effects of COVID on training opportunities and the additional capacity provided by the private sector.

Results
The impact of COVID on Surgical training at GWH has been no decrease in trauma operating experience, but a 53% decrease in elective operating experience and a 74% decrease in joint replacement operative experience during an equivalent six-month period. Use of the independent hospital has enabled 6% of the total elective surgery experience, and 11% of the joint replacement surgery experience.

Discussion
The private sector has provided additional capacity but a productivity of 66 cases from 48 half day lists is low (1.4 cases per list) has proved disappointing. There has been a low impact on elective training. The challenges have been faced on the elective side as trauma cases have remained consistent during the pandemic.

Conclusions
Use of the alliance between the private sector and NHS as a resource to provide additional training opportunities needs to be developed further in the future with incentivised guidance. Orthopaedic training will inevitably adapt to the challenges presented for the next generations of surgeons.
1222 Improving Consenting for Emergency General Surgery During The COVID-19 Pandemic
Authors: Oyewole B , Sandhya A , Tawfik A , Elzaafarany A , Ma J , Jethwa P 
Published: October 2021

Abstract

Aim
Patients undergoing surgery during the Covid pandemic are exposed to increased risks of pulmonary complications and mortality. These novel risks need to be documented on the consent form. We carried out various interventions to ensure appropriate consenting and documentation following an initial audit that revealed poor compliance with published guidelines.

Method
The initial audit reviewed consent forms of patients undergoing emergency surgery over two-weeks in May 2020 while the re-audit was over a two-week period in June 2020 following implementation of interventions. Inclusion Criteria: Age &gt;18-years, urgent or emergency laparoscopic surgery Exclusion criteria: Age &lt;18-years, Open surgery, ‘Covid-light’ areas, NELA.

Results
57 consent forms were assessed during the audit loop: 22 laparoscopic appendicectomies and diagnostic laparoscopies, 14 incision and drainage, 8 laparoscopic cholecystectomies, 4 hernia repairs, and 9 other procedures. Consenting for covid pneumonia increased from 70% to 89%, potential ITU admission 56% from 25% and the risk of death 63% from 21%

Conclusions
The covid pandemic changed our surgical practice. There are many unknowns regarding the risks to surgical patients, however, evidence shows increased risks of covid pneumonia, ITU admission and death in the perioperative period. Our consenting and the documentation of such conversations with patients must reflect our new reality.
1291 COVID-19 And Skin Cancer Mohs Service: Are We on The Line?
Authors: Cooper K , Kloecker D , Labib A , Odili J 
Published: October 2021

Abstract

Introduction
Mohs surgery is a technique of surgical excision indicated for high-risk basal cell carcinomas involving contemporaneous histopathological assessment to ensure clear margins at the time of excision. Post-Mohs excision, patients should undergo reconstruction by plastic surgeons.

Aim
To explore the impact of the COVID-19 pandemic on a post-Mohs plastic surgery reconstructive service.

Method
A single-centre, retrospective analysis of patient undergoing post-Mohs reconstruction between March and September 2020 – including the first national lockdown period. This was compared with the same period in 2019. Key outcome measures included:

Results
In 2019, between March and September, 12 patients were referred for Mohs surgery and reconstruction versus 23 in 2020. In 2019, patients referred for Mohs waited a mean of 101 days between their clinic appointment and surgery, versus 97 days in 2020. No Mohs surgery was performed during the first lockdown and patients referred during this period waited a mean of 150 days for surgery versus 81 days in this period in 2019. The proportion of patient undergoing direct closure or full thickness skin grafting to post-Mohs defects increased by 20% while the number undergoing local flap reconstruction decreased by 12% in 2020 compared to 2019.

Conclusions
While overall waiting times improved in 2020, those patients referred during the lockdown experienced longer waits for Mohs surgery. The increased proportion of patients undergoing simpler reconstructive techniques in 2020 may reflect pressure on operating time due to the period of inactivity during the lockdown.
1595 Instituting Rapid and Semi-rapid COVID-19 Testing Pathways to Facilitate Emergency Surgery
Authors: Berezowska A , Cross A , Hunt E , Price J , Mirfenderesky M 
Published: October 2021

Abstract

Aim
Defining a patient’s COVID-19 status on admission is essential for optimised patient management, safe bed-placement, and flow across the hospital. Perioperative COVID-19 infection is associated with significantly poorer outcomes and may influence a patient's and/or surgeon's decision to proceed. Rapid PCR tests (1-2 hours) for COVID-19 remain the gold-standard, however most NHS Trust’s either do not have, or have severely limited access to such testing modalities. Our aim was to introduce a surgical triaging algorithm to conserve rapid testing for immediate surgery, whilst developing a semi-rapid pathway with results available in 12-15 hours for surgery within 24-48 hours.

Method
Using quality improvement methodology, based on a ‘PDSA’ model we introduced a surgical triaging algorithm. Testing options were categorised into rapid, semi-rapid or routine (24 hours). Defined outcomes, as well as primary and secondary drivers were identified. Both the pre-analytical and post-analytical testing pathways were characterised, concentrating on electronic requesting, laboratory transportation and reporting. Five ‘PDSA’ cycles were performed with immediate audit and feed-back to surgeons after each round. A vetting procedure was also introduced to improve compliance with requesting.

Results
Turn-around-times for COVID-19 PCR swabs at our institution improved from 23 hrs:13 minutes at baseline, to 9 hrs:38 minutes for semi-rapids, to &lt; 2 hours for rapid swabs.

Conclusions
Adoption of a surgical triaging algorithm ensured prioritisation of rapid and semi-rapid COVID testing based on clinical need. This ensured optimised patient care, safe theatre and anaesthetic Infection Prevention and Control practices, as well as correct post-operative placement.
189 Outcomes in Appendicitis During The COVID-19 Pandemic: A Single Center Report Of 36 Cases
Authors: Angamuthu N , Mirnezami R , Knowles J 
Published: October 2021

Abstract

Introduction
Surgical management of acute appendicitis(AA) during the first peak of COVID-19 was modified somewhat in order to mitigate concurrent infection. Early in the pandemic an open approach was preferable. The management of AA at a single surgical unit over three months during the COVID-19 outbreak is presented.

Method
Data on patients diagnosed with AA (3rd March 2020 to 4th May 2020) were analysed. Management strategies, morbidity, length of stay and readmissions were evaluated.

Results
Median age was 45 years (range 6-75) with a male: female ratio of 2.7:1. The mean white cell count and CRP were 14.7(5.4-25) and 121.6(1- 545), respectively. Appendicectomy (28/36;77.8%) was performed laparoscopically in 23(82.1%) and open in 4(14.3%); 13.9%(5/36) of AA, were managed conservatively. Among the COVID-19 positive patients(5/36), 4 were managed laparoscopically, one needed a laparotomy. Considering COVID-19 positive vs negative/not done status, conversion was seen 50%(2/4) and 5.3%(1/19) respectively. A difference in mean length of stay was noted (positive vs negative/not done = 10.4 days vs 3.43 days). Morbidity was 16.7%(6/36) with a re-admission rate of 11%(4/36).

Conclusions
Surgical units need to be flexible to modify their management plans as the COVID-19 pandemic evolves. Awaiting USS/CECT, wait and watch policy related delays should be avoided when possible. A higher conversion rate, morbidity and readmission rate were noted in this cohort of patients, potentially the result of more complicated inflammation, as patients may present late owing to apprehensions regarding their safety while attending hospital.
896 Can We Count on Serum Hyperbilirubinemia to Predict Acute Complicated Appendicitis?
Authors: Jaskani S , Al-Hamid Z , Chattopadhyay D 
Published: October 2021

Abstract

Aim
Acute appendicitis (AA) is usually a clinical diagnosis and surgical intervention is typically a preferred choice to avoid potentially lethal complications like perforation and purulent peritonitis. Intra-abdominal inflammation can lead to hepatic cholestasis due to cytokine release, which can reflect as rise in bilirubin alone or in combination with other liver enzymes. The aim of this study was to evaluate hyperbilirubinemia as a predictor of complicated acute appendicitis (CA).

Method
A retrospective analysis of all the patients who underwent surgery for AA in a district general hospital in the UK from Jan 2018 to April 2019. All the patients underwent admission blood tests including White cell count (WCC), C- reactive proteins (CRP), and liver function tests (LFTs). For data collection hospital medical record was used. Complicated appendicitis (CA) was defined as Gangrenous, or perforated appendix wall, abscess formation, or generalized peritonitis.

Results
In total 236 patients underwent appendectomy. On histology 25 patients (10.6%) had normal appendix (NA). Furthermore, 161 patients (68.2%) had uncomplicated appendicitis (UA) and 50 patients (21.2%) had complicated appendicitis (CA). Serum Bilirubin (SB) was found to be statistically significantly raised in patients with CA (p value=0.0001) when compared with NA group. Overall sensitivity of SB, CRP and WCC for AA was(15.17%, 79.90%, and 57.82% respectively) and specificity was(100%, 36.36% and 68% respectively).

Conclusions
SB had low sensitivity and high specificity as compared to CRP and WCC for AA. Raised serum bilirubin levels can be considered as one of the supportive markers of complicated appendicitis.
1442 Are Blood Group and Antibody Screening Necessary Before Emergency Laparoscopic Appendicectomy?
Authors: Bhambra T , Pannu A , Jalal Q , Shah N , Rajput I 
Published: October 2021

Abstract

Aim
The incidence of bleeding complications in laparoscopic surgery are low. At present, there are no national guidelines on pre-operative blood group and antibody screening (G&S) in patients undergoing emergency laparoscopic surgery. The aim of this study is to establish the incidence of intraoperative bleeding requiring transfusion during emergency laparoscopic appendicectomy. In turn, this will indicate the necessity of routine preoperative G&S.

Method
Retrospective data collection of all emergency laparoscopic appendicectomy procedures at a large tertiary hospital from January 2015 to January 2020 (5 years). Patients having routine or open procedures were excluded. The transfusion department records were used to identify any patients receiving a transfusion intraoperatively.

Results
1362 emergency laparoscopic appendicectomy procedures were performed during the 5-year period. 4/1362 (0.29%) patients received intraoperative transfusion of blood products. Of these, 3 patients had known haematological disorders. One patient was transfused for bleeding associated with intraoperative miscarriage.

Conclusions
No patients required transfusion for surgical haemorrhage. The small number of patients requiring transfusion were predictable because of pre-existing haematological disorders and clinical status. Our data is one of the largest series available and the results demonstrate that routine preoperative G&S is not justified. Instead, a selective approach would ensure high risk patients are appropriately screened. In event of vessel injury and major haemorrhage, O negative blood can be used. Furthermore, we estimate that elimination of a routine second G&S sample could have saved our institution approximately £2500 per year.
439 Managing Parathyroid Carcinoma in the Age of COVID 19
Authors: Greene K , Truran P , Bliss R , Ramsingh J 
Published: October 2021

Abstract

Aim
Parathyroid carcinoma is a rare malignancy accounting for 1% of cases of primary hyperparathyroidism. Pre-operative diagnosis is difficult because in the absence of metastatic disease, the presentation is similar to benign parathyroid disease. In patients with hyperparathyroidism and severe hypercalcaemia or a significantly raised parathyroid hormone (PTH) level clinicians should consider parathyroid carcinoma and expediting surgical management. During the current pandemic, a high index of suspicion should be maintained to ensure that care is not compromised. A review of the management of patients with suspected parathyroid carcinoma during the COVID-19 pandemic is presented.

Method
In our tertiary referral centre for Endocrine surgery, 4 presentations of parathyroid cancer were reviewed. Their investigations, surgical management and post-operative outcomes are described with a brief literature review of parathyroid cancer.

Results
Of the four cases of parathyroid carcinoma described, all presented with severe hypercalcaemia and significantly raised PTH levels. Pre-operative mean calcium was 3.36mmol/L and mean PTH was 80pmol/L (52-99.8). Patients were imaged with a combination of cross-sectional imaging and ultrasound. Two patients had evidence of distant disease at presentation. 1 patient was transferred as an inpatient to our centre and the other three patients were seen within 2 weeks of referral; the mean time from referral to surgery was 14days (1-23). Post-operatively, all patients achieved normocalcaemia, with PTH levels normal in all but one.

Conclusions
Despite limitations on face-to-face clinic consultations and reduced capacity for elective surgery during the COVID-19 pandemic, all patients were investigated and managed promptly to ensure superior outcomes.