bluuebunny/crossref_metadata_2025_split huggingface dataset:
197 Acute Management of Traumatic Anterior Shoulder Dislocations During COVID-19: Are We Meeting Published National Standards for Treatment During the Pandemic?
Authors: Donovan R , Abdelmalek A , Crowther M , Packham I 
Published: May 2021

Abstract

Background
BESS/BOA Patient Care Pathways provide national guidelines for acute management of traumatic anterior shoulder dislocations with respect to emergency reduction and clinic follow-up. COVID-19 posed challenges in terms of analgesia choice for reductions and altered follow-up arrangements. This study aimed to assess variance from the care pathway.

Method
We performed a retrospective case note analysis of all emergency presentations with acute traumatic anterior shoulder dislocations at the MTC in Bristol from 01/04/2019-31/05/2019 to the same period in 2020 to analyse the effects of COVID-19 on management of these injuries.

Results
We identified 32 patients in 2019, and 24 in 2020. Entonox usage fell, in favour of Penthrox. Use of conscious sedation (requiring full PPE) remained around 20%. Pre- and post-reduction imaging was near 100% throughout. Referral to follow-up was 88% in 2019 but 38% in 2020. Those assessed in clinic during COVID-19, fewer were mobilised early or referred to outpatient physiotherapy compared to 2019.

Conclusions
Acute management of anterior shoulder dislocations during COVID-19 was challenged by choice of suitable analgesia that limits AGPs, and limiting access to ’face-to-face’ follow-up. A key concern was a significant decrease in patient follow-up, thus limiting the access to optimal aftercare such as physiotherapy and further imaging.
258 Increase in Cycling Injuries During COVID-19: Unintended Consequences of Lockdown Restrictions in The United Kingdom
Authors: Ansari S A , Al-Jader B , Khan N , Younis F 
Published: May 2021

Abstract

Introduction
Higher number of cycling injuries were observed during the COVID-19 period in the United Kingdom at our institution. Many were serious injuries requiring hospitalisation and some requiring surgery. We investigated whether the lockdown led to a legitimate increase in incidence of cycling related injuries, resulting in a higher number of aerosol generating procedures (AGPs). This would assess whether the guidance on exercise during lockdown was appropriate, shaping future regulation in the case of cyclical lockdowns.

Method
Records were screened retrospectively for cycling related injuries between April 1st and May 12th (lockdown) 2020 and for same period in 2019 as a control group. Injury severity, distribution and number of surgical procedures resulting from these were assessed.

Results
The proportion of injuries due to cycling rose threefold (n = 55) during the COVID-19 lockdown. Injuries included fractures, soft tissue injuries and mixed injuries. An increase in the number of operative procedures (n = 13) and AGPs was also noted.

Conclusions
Vague guidance and allowance of one form of outdoor exercise per day may have unintentionally contributed to rise in cycling injuries as many took to cycling for recreation. To make the guidance appropriate, usual forms of exercise should be encouraged, risk taking behaviours discouraged and safe cycling practices endorsed.
283 Laparoscopic Surgery During Covid-19 Pandemic: A Systematic Review of Recommendations
Authors: Boghdady M El , Ewalds-Kvist B 
Published: May 2021

Abstract

Introduction
Aerosol generating procedures such as laparoscopic surgery are known to be associated with increased risks of viral transmission to the healthcare workers. The safety of laparoscopy during the COVID-19 pandemic was therefore debated. We aimed to systematically review the literature regarding the safe use of laparoscopy during COVID-19.

Method
We performed a systematic search using PubMed and ScienceDirect databases from inception to 1st May 2020. The following search terms were used: ‘’laparoscopic surgery and COVID-19’’; ‘’minimally invasive surgery and COVID-19’’. The study protocol was registered with PROSPERO register.

Results
Altogether, 174 relevant citations were identiﬁed and reviewed for this study, of which 22 articles were included. The analysis of the findings was presented in tabular form. We scrutinized the common recommendations for performing laparoscopy during the COVID-19 pandemic in forms of pre-, intra- and postoperative phases.

Conclusions
There is no scientific evidence to date for the transmission of COVID-19 by means of laparoscopic surgery. If safe, conservative management is the primary alternative during the pandemic. If indicated, laparoscopic surgery can be used with precautions because of supplementary benefits compared to open surgery. We concluded that recommended precautions should be respected while performing laparoscopy during the pandemic.
287 COVID-19 and Surgical Specialties – Lessons Learnt: A Rural DGH Perspective
Authors: Zahari F , Shahrokhi N , Byrne H C , Gurung G , Hughes G , Navaratnam D M , Rambani R , Rao M 
Published: May 2021

Abstract

Introduction
The COVID-19 pandemic has seen the restructuring of surgical services worldwide. We aimed to evaluate pre-operative planning and post-operative outcomes in expedited colorectal surgery (ECRS), emergency general surgery (EGS), and emergency orthopaedic surgery (EOS) during the COVID-19 era at our rural hospital.

Method
This was a prospective observational cohort study. Electronic hospital systems identified adult patients who underwent ECRS, major EGS or EOS at our site, from the start of the UK lockdown.

Results
Following exclusion criteria, 98 patients were included in data analysis. Post-operative respiratory complications were seen in 27.8% of ECRS patients, 13.3% of EGS patients and 4% of EOS patients. 2 patients were diagnosed with COVID-19, with 1 COVID-19 associated mortality. Length of hospital stay was reduced for EOS in the COVID-19 setting and this was found to be statistically significant (p value &lt;0.001).

Conclusions
When compared to the literature, COVID-19 related complications in surgical patients were found to be lower at our rural hospital. This could be due to regional variation in the prevalence of COVID-19. If there were to be a second surge, we suggest NHS Trusts should be given the autonomy to make local decisions on modifying their elective caseload, rather than following a national ‘one-size-fits-all’ guideline.
333 Management of Distal Radius Fractures During The COVID-19 Crisis
Authors: East J , Tahir M , Bose D , Quraishi H 
Published: May 2021

Abstract

Introduction
Distal radius fractures are common. Treatment depends on a multitude of factors including the pattern / displacement of the fracture, patient age, pre-morbid function, and surgeon preference. We aim to investigate the effect of the pandemic on the management and short-term outcomes of patients with DRF’s.

Method
Retrospective review of all adult DRF’s two months before and after BOA released emergency standards on trauma management. The primary outcome measure was the proportion of patients managed non-operatively before and during COVID-19. Data extracted: demographics, comorbidities, cognitive baseline, treatment, and follow-up. Radiographs were reviewed for displacement [dorsal tilt (&gt;10o), ulnar variance (&gt;3mm), intra-articular step (&gt;2mm)].

Results
Pre-COVID (n = 29), COVID (n = 35). Characteristics were comparable in terms of median age (66 and 72 years, p = 0.41), %aged ≤65 (48% and 37%, p = 0.37), dominant side fracture (36% and 40%, p = 0.52), presence ≥ 2 co-morbidities (41% and 43%, p = 0.91). More patients were managed non-operatively during COVID (86% vs. 69%, p = 0.11), 2 of whom had unstable fracture pattern and developed malunion, compared to none in pre-COVID period.

Conclusions
Management of DRF’s remains a controversial topic, particularly in age &lt;65 years. Long term follow up of patients with significant fracture displacement managed conservatively during COVID pandemic could help guide future practice.
387 Plastic Surgery Workload During The COVID-19 Pandemic
Authors: Gohil K , Al-Himdani S , Walkden A , Price G 
Published: May 2021

Abstract

Introduction
COVID-19 has been a formidable opponent to every aspect of the NHS. A comparative study examined referral workload at a regional Plastic Surgery Unit, Major Trauma Centre & Burns Facility during the initial stages of the lockdown period. Lessons learnt can then help prepare for the future.

Method
From initial lockdown (24/03/2020), all Plastic Surgery referrals were documented for 28 days. This data was compared to the same period in 2019. Demographics, diagnosis, mechanism of injury and time to presentation and surgery were noted.

Results
A total of 525 patients were managed, with a 48% reduction in referrals during lockdown. Hand trauma referrals reduced by 16% but increases in deliberate self-harm (100%), DIY injury (75%), lower limb trauma (250%) and burns (64%) were seen. Fewer work and school related injuries were managed in keeping with lockdown rules. Notably, access to surgical management did not alter.

Conclusions
The COVID-19 pandemic significantly affected the workload of our service. Social behaviours and psychological impact were common contributing factors. As Plastic Surgeons this should be acknowledged and consideration of optimising mental health services and health education should be prioritised for the future.
416 Prospective Multicentre Study of Impact of COVID-19 on Colorectal Cancer Resections
Authors: Kumar L , Mahfooz Buksh M , Merali N , Hammer C , Nagendram S , Kenny R , Chakravartty S , Madan R 
Published: May 2021

Abstract

Introduction
COVID-19 pandemic has posed a major challenge to healthcare systems globally. In NHS, around 36,000 cancer operations have been estimated to be cancelled during the peak time alone. This regional study evaluated the risk of COVID-19 in patients undergoing surgery for colorectal cancer during the peak time.

Method
This prospective multicentre observational study conducted in four busy district hospitals included 52 patients with colorectal cancer who underwent surgery during the COVID lockdown period (23rd March to 5th May). PCR swab testing was used to detect COVID. Data was collected from patient notes, MDT files and pathology results.

Results
73% (38/52) underwent elective procedures, 90% with curative intent. Overall, mean (SD) age was 70 (12.2) years, 50% were female. 60% (32/52) had left sided cancers and a total of 48% (25/52) patients had stage 3 or above. 27% (14/52) had post-operative complications, with 4% (2/52) being Grade 3 Clavien-Dindo. Total mortality was 6% (3/52) of which 1 was elective patient. Only one patient developed COVID infection during the inpatient stay.

Conclusions
Data suggests, local policies to prevent COVID spread have been effective. Local lockdown in case of second peak may be a reasonable option. Improvement in COVID testing could have major impact on outcomes.
484 Early Orthopaedic Input in Trauma Patients During COVID Times And Its Importance in The Post-COVID Era
Authors: Saleem S , Parikh S , Loeffler M 
Published: May 2021

Abstract
The Pandemic made way for interdepartmental collaborative efforts to action an early orthopaedic review of all trauma patients bypassing AnE, during the COVID pandemic.
Retrospective, single centre collection of data including 55 wrist and 40 ankle injuries that presented to the hospital in the month of January and April, marking pre-COVID and COVID times respectively. Data was gathered under following parameters: 1-Number of hospital visits, 2-Number of fracture clinic appointments, 3-Number of admissions and 4- Time to definite management. Simple data analysis was done to calculate means of all the parameters.
The average time to definite Management for distal radius fractures dropped from 2.78 to 0.86 days. For the same cases a dip in number of hospital visits was noted, from 2.72 to 2.09. Mean admissions for these patients dropped from 0.12 to 0.09.
The results quiet evidently show that early orthopaedic input reduced hospital visits, hospital admissions and time to definite management for distal radius fracture cases. A decrease in patient exposure to the hospital translates to reduced chance of contracting the COVID-19 virus. These results can prove very useful in setting guidelines, as we navigate patient care in uncertain COVID times.
491 Clinical Characteristics and Outcomes of Patients Undergoing Emergency Appendicectomy During the Pandemic Of COVID-19 Infection – A Single Centre Experience
Authors: Aladeojebi A , Salgaonkar H , Murcott D , Cheruvu C 
Published: May 2021

Abstract

Introduction
In March 2020, the World Health Organisation declared a global pandemic with the outbreak of a novel coronavirus. As the morbidity and mortality rates increased, the healthcare system was burdened with grave challenges including decisions on how to manage patients who needed emergency surgery during the pandemic. In the absence of clear guidelines and undetermined effects of peri-operative COVID-19 infection on surgical patient outcomes; our aim was to publish our surgical outcomes for emergency appendicentomies done during the pandemic.

Method
Prospective data was collated from 1st of March to 5th of June 2020 (n = 132) had appendicectomies over the period stated. Patient demographics, presenting symptoms, peri-operative events, investigations, and post-operative results and complications were documented and analysed. The results were then compared with outcomes of retrospective analysis at the same centre (n = 206) carried out from 1st March to 30th June 2019.

Results
The incidence of complications of appendicitis were similar without any significant differences. The negative appendix rate was significantly lesser in 2020 group, which may correlate to strict patient selection criteria for surgery.

Conclusions
Under strict selection protocols to reduce transmission of COVID- 19 and best surgical practice emergency appendicectomy is safe and feasible. However these observations warrant further well-designed future studies.
505 A Single Center Cohort Observational Study to Assess The Surgical Admissions During COVID-19 And Recommendations For Redeployment Of The Surgical Workforce
Authors: Abdalla M l , Connolly T , Bujoreanu I , Stylianides N A 
Published: May 2021

Abstract

Introduction
The redeployment of the surgical workforce to support other frontline specialties was an integral part of the nationwide response to the COVID-19 pandemic. The R number is gradually increasing in different parts of the UK suggesting a second wave is imminent. Aimed to analyze the surgical emergency workload and provide recommendations for future redeployments.

Method
Three separate cohorts of adult emergency admissions; emergency admissions prior to lockdown (23rd of February to 22nd of March), 1 month after (23rd of March to 22nd of April) and 2 months after (23rd of April to 22nd of May). Data was collected regarding patient characteristics, duration of symptoms prior to presentation, clinical outcomes and compared between these groups.

Results
Notable initial decrease in admission per day (4.3 to 2.5) and interventional management (30%) during the 1st month of lockdown. A marked increase in 24-hour discharge rate (50%). These parameters begun to normalize by the 2nd month. The rate of overall conservative management gradually increased from 36.7% pre-lockdown to 60.9% at the 2nd month.

Conclusions
Providing elective work is cancelled, surgical teams could safely tolerate working with 30%-40% of original staffing level, which will need to be gradually increased to 50%-70% after 1 month.
531 COVID-19 and Patients with Congenital Heart Disease: Are the Risk Higher? A Systematic Review
Authors: Haiduc A , Ogunjimi M , Shammus R , Mahmood S , Harky A 
Published: May 2021

Abstract

Introduction
We aimed to determine if patients with CHD are at a higher risk of poor outcomes if they have COVID-19, compared to those without CHD.

Method
A systematic review was executed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. To identify articles related to COVID-19 and CHD, an extensive literature search was performed on EMBASE, Medline, Scopus and Global Health databases using keywords and MeSH terms.

Results
12 articles met the inclusion criteria and were included for analysis in this systematic review. Two themes were identified for data extraction: [1] evidence supporting higher risks in CHD patients and [2] evidence against higher risks in CHD patients. After combining the data, there were 99 patients with CHDs out of which 12 required admission to ICU.

Conclusions
This systematic review suggests that CHD may increase the risk of poor outcomes for those with COVID-19, but also highlights the necessity for more research with larger sample sizes in order to make a more justified conclusion, as the majority of papers that were analysed were case series and case reports. Future research should aim to quantify the risks if possible while accounting for various confounding factors such as age and treatment history.
537 Implications of Covid-19 on Vitreoretinal and Cataract Surgery
Authors: Kabbani J , Kabbani J 
Published: May 2021

Abstract

Introduction
The coronavirus pandemic (COVID-19) has greatly impacted ophthalmic surgery, including changes to surgical protocols and training. We explored the effects on vitreoretinal and cataract surgeries, which constitute the commonest areas of ophthalmic surgery.

Method
Literature searches were performed for the terms “vitreoretinal”, and “cataract”, each in combination with “surgery” and “Covid-19”. Relevant results were assessed to determine perceived impact on ophthalmic theatres.

Results
36 search results were analysed; 25 and 11 for cataract and vitreoretinal surgery respectively. Efforts to reduce infection rates have significantly reduced non-urgent operations, with reports of just 5.7% of ophthalmologists in certain areas performing cataract surgeries. Furthermore, surgeons have been advised to perform bilateral cataract surgery, and to combine phacoemulsification with vitreoretinal surgery, thereby avoiding deferred operations and further exposure. Other recommended changes in surgical strategies to enhance safety include three-dimensional heads-up displays for vitreoretinal surgeries, novel microscope drapes, and virtual consultations for surgery follow-up. Various reports indicate a negative impact on junior surgeon training and mental well-being; indeed, The Royal College of Ophthalmology has recommended assigning operations to experienced surgeons.

Conclusions
Ophthalmic surgery rates and protocols have been impacted in the effort to reduce Covid-19 spread. Trainee surgeon education and well-being warrant further attention.
561 Outcome of Patients Undergoing Neck of Femur Fracture Surgery During COVID Period
Authors: Saha A , Demoulin E , Newman J 
Published: May 2021

Abstract

Introduction
The aim of the study is to determine the 7- and 30-day mortality rate, hospital stay period and pre- and post-operative symptoms in NOF fracture patients undergoing surgery and compare between COVID-19 positive and negative cohorts.

Method
This was a retrospective, descriptive study involving 188 NOF fracture patients who underwent operation from 21/03/20 to 21/07/20 in Mid Yorkshire Hospitals Trust. Only people who tested positive for COVID-19 within 30 days of operation were counted in the positive cohort.

Result:
Total 21 patient tested positive for COVID-19, 16 within 30 days of operation and 5 tested beyond 30-day period. 24 were not tested. 143 tested negative. The average age of patients was 79.02±11.163 years. Average hospital stay was 14.688±10.657 days (average stay for positive patients 22±13.789 days). 12 patients had pre-operative symptoms (respiratory symptoms, fever) out of which 2(16.67%) tested positive. 7-day post-op mortality was 2.128% (6.25% for COVID-19 positive patients). 30-day mortality was 6.383% (5.814% for untested/negative patients and 12.5% for positive patients). 41 patients (21 .81%) developed post-operative respiratory symptoms (56.25% for positive patients). 8.51% developed post-operative sepsis (25% of positive patients).

Conclusions
Mortality and morbidity rate was higher for NOF fracture patients with positive COVID-19 test.
575 Management of Acute Appendicitis During the COVID-19 Pandemic. Our Experience at The General Surgery Department in Queen Elizabeth Hospital, London
Authors: Chatzikonstantinou M , Pouncey A , David M l , Aljarad F , Sorelli P 
Published: May 2021

Abstract

Introduction
The pandemic of CoViD-19 had a major impact on provision of emergency services. National (CoViD-19) Guidelines (NG) were issued by the Colleges of Surgeons for the management of surgical patients.

Aim
To assess the impact of CoViD-19 in the management of patients with acute appendicitis (AA) and review patients’ characteristics and compliance with NG.

Method
A single-centre retrospective analysis of prospectively collected data on surgical admissions with suspected AA between March and May 2020. Main outcomes of interest were the pre-operative investigation, the type of operation and the negative appendicectomy rate (NAR) comparing to 2019.

Results
A total of 109 patients were referred for suspected AA. Out of 39 patients who had surgery 21 (53.8%) were investigated with a CT and 13 (33%) with an ultrasound. There was a 31.6% reduction in appendicectomies compared to 2019. 30 patients (76.9%) had an open procedure vs 9 laparoscopic (23.1%) in alignment with the NG2. Histology showed AA in 37 out of 39 of the cases. The NAR was 5.12 vs 12.2 for 2019.

Conclusions
There was a 31.6% reduction in appendicectomies during CoViD-19. Most patients were investigated with a CT and underwent an open procedure. Pre-operative investigation with a CT led in reduction of NAR.
594 Optimising Hand Trauma Care at a Major Trauma Centre (MTC) During the COVID-19 Pandemic
Authors: Khajuria A 
Published: May 2021

Abstract

Introduction
This study evaluates the management of hand injuries during COVID-19 following the prompt implementation of the BOA guidelines; reconfiguration of hand services and implementation of the ‘one-stop’ model.

Method
285 cases OVER A 1-MONTH PERIOD were RETROSPECTIVELY reviewed to evaluate the effectiveness of managing patients using the ‘one-stop’ model and the new Urgent Treatment Centre (UTC).

Results
277 patients were included in the study. During Covid-19, operative cases fell by 62%. 86.3% (239/277) of cases were managed in the UTC; 54.4% (130/239) required conservative management and 45.6% (109/239) required minor procedures (in UTC). REMOVABLE SPLINT USE was optimized through design of ‘softcasts’ for non-operative management of distal radius fractures. A patient education video: ‘softcast removal at home’ was created and in cases requiring sutures, 95.1% (39/41) were absorbable, thereby avoiding COVID-19 exposure for follow-up. Only 50.5% (140/277) of patients had formal follow-up arranged and patient information follow-up cards were developed.

Conclusions
The one-stop model prevents delay in definitive treatment, allows effective initial treatment, and minimizes the need for face-to-face follow up. In light of a possible second wave of COVID-19 cases, this new model should be considered for implementation by all hand’s units for the foreseeable future.