bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.385A retrospective audit reviewing current practice on managing the incidence of anaemia and iron deficiency in pre-operative oesophagogastric resection patients
Authors: Bhatti Sumbal , Evans Laith 
Published: October 2021

Abstract

Aims
NICE guidelines state patients with anaemia should be offered iron therapy before and after surgery. An audit was undertaken at a tertiary care centre to assess compliance in patients undergoing oesophagogastric resection.

Methods
Retrospective audit looking at oesophagogastric resections over a period 12 months at a tertiary care centre. Data is being gathered from ORSOS and ICE to record pre, peri and post-operative haemoglobin and MCV, amongst other metrics, including whether iron therapy was prescribed. Data is also being gathered on post-operative outcomes. An intervention aiming to increase pre-operative haemoglobin levels will be implemented and then a repeat audit cycle will be carried out.

Results
Preliminary results from cycle 1 suggest that despite 71% of patients undergoing oesophagogastric resection having a haemoglobin&lt;130g/l in men and &lt;120g/l in women, only 6.7% are receiving preoperative iron therapy of any kind (i.e. oral or intravenous). 42.8% of all patients included suffered a post-operative complication. We predict implementation of changes in pre-operatively will reduce the post-operative complication rate.

Conclusions
The majority of patients undergoing oesophagogastric resection are not receiving adequate iron therapy prior to surgery and are being put at an increased risk of post-operative complications. Ongoing auditing will highlight the scope of the problem and reduce the risk of post-operative complications. Data is preliminary at this stage but due to the novelty of the audit (only one relevant paper was returned upon completing a structured literature search) we are submitting this abstract now as we believe it to be of clinical significance.
EP.WE.406Adherence to operative standards for ulnar polydactyly excision in times of COVID-19 pandemic
Authors: Eiben Inez , Bahadori Darab Payam , Eiben Paola , Filson Simon 
Published: October 2021

Abstract

Aims
Simple ulnar polydactyly excision is a very common surgical procedure ideally performed within the first 6 months of infants life and under local anaesthetic. In conditions preceding COVID-19 pandemic this procedure was performed in controlled environment of operating theatres on a weekly basis. Increase in pressure on the NHS and operating theatre reorganisation meant elective procedures had to be cancelled with no alternatives in sight. We have suggested therefore, it be performed in a clinic environment instead under strict supervision and guidelines. No recommendations however, have been implemented when considering completion of WHO checklist and standard operation documentation. We investigated therefore adherence to typical Evelina Hospital theatre guidelines when considering documentation.

Methods
Completed documentation for each patient undergoing ulnar polydactyly excision in clinic room was reviewed between May 2020 and December 2020. Categories of WHO checklist completion, operation note present and legible, appropriate local anaesthetic information and instrument count correct were reviewed.

Results
92% of procedures did not have WHO checklist completed. Furthermore, as many as two thirds of the documents were completed illegibly and did not contain required information.

Conclusions
Following the transfer of ulnar polydactyly excision procedure to clinic rooms we found the quality of documentation to be substandard. This provides opportunity for error and cause for concern. We introduced therefore standardised operative documentation pack to be completed at each polydactyly excision procedure in clinic room. Re-audited results showed improved compliance with standard operative rules and regulations and therefore improved quality of care.
EP.WE.409Stoma forming surgery – has lockdown changed our operative practice during COVID 19
Authors: Manson Ross , Tallo Tracy , Robertson Isabell , Anderson John , Sharma Praveen , MacDonald Angus 
Published: October 2021

Abstract

Aims
This study aimed to establish whether the initial lockdown resulted in a shift towards emergency surgery, changes in stoma formation and in rate of surgery with curative intent.

Methods
A retrospective data collection was performed. Patients were identified using a local database of all patients with stomas. Data was collected from 16/03/20 to 16/09/20. A comparison data set was taken (16/03/19 to 16/09/19). Data was collected on whether the case was performed as an emergency; the type of stoma formed and whether the operation was performed with curative intent.

Results
Seventeen patients were identified in the 2020 cohort (age: 51-84, mean age: 67.6, M:F 10:7). Fourteen cases (82.4%) were performed as emergencies, three electively (17.6%). Six (35.3%) had end colostomies, three (17.6%) had loop colostomies, one (5.9%) had a caecostomy, four (23.5%) had an end ileostomy and three (17.6%) had a loop ileostomy. Ten operations were for patients with cancer, three (30%) were performed with curative intent.
38 patients were identified in the 2019 cohort (age: 28-85, mean age: 63.0, M:F 17:21). 23 (60.5%) were emergencies, fifteen (39.5%) were performed electively. Nine (23.7%) had end colostomies, eight (21.1%) had loop colostomies, three (7.9%) had caecostomies, ten (26.3%) had end ileostomies and nine (23.7%) had loop ileostomies. There were nineteen operations for cancer, eight (42.1%) were with curative intent.

Conclusions
Cessation of elective activity caused a shift towards emergency operating, with an associated shift towards surgery with non-curative intent. The distribution of stomas formed has not changed.
EP.WE.412An unusual case of a 13.8cm Gastric Schwannoma invading into Transverse Mesocolon: A case report and literature review
Authors: Sharma Sameera , Milani Marika , Oglesby Stuart , Walsh Shaun 
Published: October 2021

Abstract
Gastric Schwannomas (GS) are benign, slow-growing, Sub-mucosal tumours (SMT’s) that constitute 0.2% of all gastric tumours. They usually have a homogenous appearance on contrast enhanced computed tomography of the abdomen (CECT Abdomen) and rarely show malignant features such as irregular borders, calcification, local invasion and mucosal ulceration. Due to lack of mucosal changes and poor yield during Oesophago-Gastro-Duodenoscopy (OGD) and biopsy, they are often misdiagnosed as Gastro-Intestinal Stromal tumours (GISTs), a malignant SMT.
Treatment options range from conservative management to major open resections and are dependent on the size and clinical presentation. Histologically, GS are spindle cells tumours with lymphoid cuffing. On Immunohistochemistry, they test positive for S100 but negative for DOG1, Smooth muscle actin and Desmin which are markers of GISTs.
Here we present the case of a 61-year-old female with a 15-year history of epigastric fullness that turned out to be a 13.8cm GS originating from the greater curvature of the stomach. On CECT Abdomen, the tumour appeared heterogeneous, with multiple calcium deposits and local invasion into the transverse mesocolon. The patient underwent a Sub-total gastrectomy with en-bloc transverse colectomy.
Symptoms from GS can be vague and can pose a significant diagnostic and investigative dilemma. Physicians and Surgeons should have a low threshold to investigate prolonged symptoms with CECT Abdomen. Despite their benign nature, if left undiagnosed, GS can grow to significant sizes and mimic malignant gastric tumours on conventional imaging resulting in unconventionally major resections.
EP.WE.429Surgery during the COVID-19 pandemic: Are we obtaining informed consent?
Authors: Robinson Emily , Ayathamattam Joseph , Harris Holly , McFall Malcolm 
Published: October 2021

Abstract

Background
It was estimated that 1 in 4 inpatients with COVID-19 acquired the virus whilst admitted in December 2020. Surgical patients that contract COVID-19 have poor outcomes, with mortality rates as high as 24% and risk of pulmonary complications as high as 50%. The Royal College of Surgeons of England published COVID-19 consenting guidelines in June 2020.

Aims
To identify the proportion of surgical patients who were informed of the risk of acquiring COVID-19 during the consenting process at two District General Hospitals.

Methods
The consent forms of 220 surgical patients who had either elective or emergency surgery during the second COVID-19 lockdown were reviewed retrospectively (1/11/2020-20/11/2020). This included General Surgery, Trauma and Orthopaedics and Urology. Patients with incomplete notes or who lacked capacity were excluded.

Results
In total, 193 patients were included. We found that 41.5% of patients were consented for the risk of acquiring COVID-19 peri-operatively. This did not vary significantly between elective and non-elective patients.

Conclusions
Our study shows that current practice does not meet national recommendations. In order to provide informed consent, surgeons must engage in emerging research regarding the local prevalence of COVID-19 and the implications of infection during the peri-operative period. Only with this knowledge, will surgeons be able to balance the risks and benefits on a case by case basis, to provide the patient with necessary information for consent. We recommend that trusts adopt a COVID-19 consenting policy, as part of the pre-operative assessment.
EP.WE.434Impact Of COVID-19 Pandemic On Approach To Patients With Suspected Appendicitis Pre-Covid V/S Early Covid V/S Late Covid
Authors: Alhabsha Osama , Kudchadkar Shantata J , Sinclair Elizabeth , Sagar Jayesh 
Published: October 2021

Abstract

Introduction
COVID-19 brought concerns of increased perioperative mortality and spread of infection during aerosol generating procedures. As a consequence, intercollegiate guidelines recommended Computed Tomography to confirm the diagnosis of acute appendicitis and open surgical approach to minimize aerosol generation.

Aims
To identify the impact of COVID-19 on the diagnostic and management approach for patients with acute appendicitis.

Method
A single-centre, retrospective study. Data of patients suspected/confirmed, clinically/radiologically with acute appendicitis was collected over 3 periods of 6.4 weeks. Pre-COVID (11/02/2020 – 22/03/2020), Early COVID (25/03/2020 – 10/05/2020) and Late COVID (23/10/2020 – 06/12/2020), number of patients is 44,22 and 30, respectively. Outcomes included patient demographics, COVID status, management plan, surgical approach (open v/s laparoscopic), imaging modality, admission to critical care, 30-day complication, mortality and length of stay.

Results
During late COVID, number of patients with acute appendicitis slightly increased as compared to initial phase. Interestingly, number of males were consistent throughout all 3 phases. Only 10% presented with perforation during late versus 50% in Early COVID phase. Imaging decreased significantly during late (33.3%), as compared to early phase (72.7%). Open approach was performed in only 1/30 in late, versus 20/21 in early group. There was no 30-day mortality in all 3 groups.

Conclusion
COVID-19 disrupted the usual surgical management plan of acute appendicitis in UK, during initial phase of lockdown. With the use of appropriate strategies and adherence to latest national guidelines, we were better prepared during the second lockdown. Construction of pathways for such pandemic events is helpful.
EP.WE.467A Snapshot Audit on the Compliance of Postoperative ERAS Protocol Following the Resumption of Elective Colorectal Surgical Operations in the COVID-19 era
Authors: Roslan Farah , Balsom Stephanie , Rajangam Akshaya , Evans John , Ihedioha Ugo 
Published: October 2021

Abstract

Aim
The COVID-19 pandemic has put a pause on most elective surgical procedures nationally. Although the efficacy of ERAS protocol has been well established, its compliance following the resumption of elective services is unknown. Our study aims to assess the level of adherence in the postoperative arm of ERAS in a large district general hospital (DGH).

Methods
Patients who underwent elective colorectal surgery were audited prospectively between 1st September 2020 and 15th October 2020.

Results
The mean age (SD) of the 23 patients audited [11(48%) male] was 65 (16) years. Of the cases audited, 17 (74%) had malignant pathology and 6 (26%) were benign. The overall mean compliance score was 4.91 out of 7 (70%). Nasogastric tube was not used in most patients [22(96%)]. However, compliance was poor with regards to opioid avoidance [2(8%)]. Majority of cases complied with early discontinuation of intravenous fluids administration and catheter removal, 14 (61%) and 13 (57%) respectively. 18 patients (78%) resumed oral intake by the first day after surgery and 21 patients (91%) mobilised by the third postoperative day. Higher compliance was significantly associated with decreased length of stay (p = 0.01) but did not reveal significant association with 30-day morbidity.

Conclusion
Although the compliance to postoperative ERAS protocol is generally good, our study highlighted a strong need to improve the postoperative practice of opioid avoidance. Stricter adherence should be aimed for as it is associated with shorter hospital stay which is particularly important in the COVID-19 pandemic era.
EP.WE.470Emergency General Surgery during the first COVID peak, a single centre experience
Authors: Paramjothy Kiara , Dosis Alexios , Lim Jieqi , Reveendran Dharsshini , Lockwood Sonia 
Published: October 2021

Abstract

Aims
The COVID-19 pandemic brought significant changes on all aspects of health care. We aimed to conduct a retrospective review of the trends in general surgical and vascular procedures during the first peak following the cessation of all elective activity.

Methods
All general and vascular procedures performed during April 2020 were included in the study. Peri-operative data were extracted from electronic patient records. We looked into operation notes, COVID status and post-operative complications. Descriptive analysis was performed using Microsoft Excel software.

Results
Table 1 shows a breakdown of the 54 operations performed. There were 47 patients, with a male to female ratio at 1:1. Mean age was 46.9 years. There were 6 expedited cases but none elective. Mean duration of symptoms prior to presentation was 8.3 days. Laparoscopic work was kept to a minimum. A consultant was present for 63% of the cases. There were only 2 COVID positive patients, but the majority (74%) were not tested. 20% of patients suffered a complication requiring an intervention. 6/54 had an unplanned return to theatre and there were 5 deaths in total.

Conclusion
The number of procedures during the first peak was significantly reduced following the uncertainty around the novel coronavirus. In accordance with the initial intercollegiate guidance, patients were managed conservatively where possible. The high complication rate is indicative of the often-late presentation due to hospital fear following the outbreak of SARS-CoV-2.
EP.WE.499Patient satisfaction with head and neck cancer telephone triage service during the COVID-19 Pandemic in a District General Hospital
Authors: Zhu Yinan , Ding Anni , Walter Hannah , Easto Rachel , Wilde Adam 
Published: October 2021

Abstract

Aims
A head and neck cancer telephone triage pathway was implemented in March 2020 using the Head and Neck Cancer Risk Calculator as part of the 2 week wait cancer referral pathway. This was in response to the COVID-19 pandemic to stream cancer referrals to minimize unnecessary interactions and appointments with health services. The aim of this study is to assess patient satisfaction with the telephone triage system via a customised patient satisfaction questionnaire in the setting of a district general hospital.

Methods
A custom designed patient satisfaction questionnaire covering different facets of the patient experience will be used to measure patient satisfaction. These 16 questions (including open ended questions) are adapted from internally validated questionnaires. All continuous new head and neck cancer referrals to Torbay Hospital over two 6 week periods will be analysed, the first at the inception of the telephone triage service and the second several months later. The focus is on patient satisfaction towards the method of delivery of the telephone triage service rather than the content of delivery.

Results and Conclusions
Data collection is ongoing at the moment and preliminary results suggest that patient satisfaction is mixed, with a proportion of patients being unsatisfied that they did not get an examination, and a larger proportion of patients satisfied with the easier accessibility and safety of the service in the midst of the pandemic.
EP.WE.501The Role of Nerve Sheath Catheters after Major Lower Limb Amputations in Post-operative Pain Control
Authors: Vincenti Cara , Kansal Nisheeth , Bhattacharya Vishwanath 
Published: October 2021

Abstract

Aim
Pain is a common post-operative complication after limb amputation. Though the evidence is mixed, current literature suggests nerve sheath catheters (NSC) have no effect on chronic stump pain, phantom limb pain or post-operative pain score but reduces opioid use. This study aims to compare pain outcomes in those with and without NSC after above knee amputations (AKA) and below knee amputations (BKA).

Method
This retrospective study collected information from 32 patients after lower-limb amputation from April 2014 - March 2017. Information regarding indication, anaesthetic and morphine requirement at 72 hours were collected from medical records and standardised questions used to assess phantom limb pain, chronic limb pain and pain intensity (1-10) at 24, 48 and 72 hours.

Results
Of the 11 patients who received a NSC catheter for pain control, 33% experienced no post-operative pain, 18% experienced phantom limb pain, 18% reported chronic limb pain and 62% required higher dosages of morphine at 72 hours. However, two patients used large amounts of morphine potentially giving spurious results.
In comparison, of those patients without NCS, 43% experienced no pain, 9% experienced phantom limb pain, 33% reported chronic limb pain and only 47% required morphine at 72 hours and at lower doses compared to with NSC.
The incidence of phantom limb pain was higher in those who had AKA regardless of the analgesic technique used.

Conclusion
Patients with NSC were less likely to experience chronic limb pain thus proving their role in post-operative pain control despite having higher morphine requirements.
EP.WE.551Killings Fields of the 21st Century- a price of social messaging gone wrong
Authors: Gambhir Raghvinder , Bodapati Shruti 
Published: October 2021

Abstract

Aim
To assess the impact of public health messaging on the COVID-19 deaths

Methods
Review of all government, Public Health England, NHS England messages during the pandemic to see how they influenced public activity and thereby influenced hospital admissions and death.

Results
The one thing that has been consistent in the government messages has been to follow the rules “To save the NHS’. This came in from seeing the Italian health system in Lombardy being overwhelmed in the beginning of the year. Repeatedly public asked on the role of the masks and every time they were told that science did not support its use. It took 6 months for science to catch up with common sense but the message remained “To save the NHS” and not “To save your life”. 76% of the 100,000 deaths occurred in the hospitals making them the killing fields of the 21st Century as primary care shut its door to primary treatment of these patients. The patients got advice form online call centres and waited to get seriously ill before reporting to emergency departments. In the hospitals more deaths occurred on the wards then on ITU as patients were triaged or care rationed.

Conclusion
The government and Public Health England failed to act on the lessons from previous respiratory viruses world over and waited for exact science to be available before changing their social messaging. This in part contributed to lack of public compliance and over 100000 deaths in the UK.
EP.WE.573Outcomes of Emergency Laparotomies during the COVID-19 Pandemic - A retrospective cohort study
Authors: Bedwani Nader Habib , English William , Smith Christopher , Singh Shailendra , Vulliamy Paul , Mukherjee Samrat 
Published: October 2021

Abstract

Aims
A better understanding of patient monitoring and outcomes is required following emergency laparotomy. We aimed to evaluate recovery following emergency laparotomy during the ‘first wave’ of the COVID-19 pandemic and assess for COVID-19-associated coagulopathy in this group.

Methods
We performed a single-centre, retrospective cohort study on adult patients undergoing emergency laparotomy from 23rdMarch – 16thMay 2020 comparing patients with or without suspected or confirmed SARS-CoV-2. Main outcome measures included; 30-day mortality, post-operative respiratory failure, ARDS and other complications, critical care admission and length of stay (CCLOS) and total length of stay (LOS). Laboratory results were collected for three days post-operatively including platelet counts and clotting screen.

Results
33 patients undergoing 36 emergency laparotomies were included, of which 9 had confirmed or suspected COVID-19. Patients with COVID-19 were more likely to have severe complications (Clavien-Dindo grade ≥3) (9/9 vs 5/24; p &lt; 0.001), post-operative respiratory failure (9/9 vs 2/24; p &lt; 0.001), ARDS (3/9 vs 0/24; p = 0.015) and need for critical care stay (9/9 vs 12/24; p = 0.012) with a longer LOS and CCLOS (17 vs 7 days; p = 0.004 and 6 vs 1 day; p &lt; 0.001 respectively). Platelet counts were consistently lower on all peri-operative days and patients had a higher incidence of coagulopathy (7/11 vs 3/17; p = 0.020).

Conclusions
Emergency laparotomy is associated with increased post-operative morbidity in patients with confirmed or suspected COVID-19 with increased respiratory complications and critical care stay. Post-operative patients with COVID-19 show mildly reduced platelet counts and deranged clotting that may be part of a COVID-19-associated coagulopathy.
EP.WE.595Long-term Effects of Psychiatric Medication on Weight Loss after Bariatric Surgery: 5-year Outcomes with 100% Follow Up
Authors: Clements Hollie Alice , Fields Declan , Oglesby Stuart , Alijani Afshin , Patil Pradeep 
Published: October 2021

Abstract

Aims
The long-term effect of psychiatric medication on weight loss after bariatric surgery is unknown. The aim of this study was to compare the 1 year and 5 year percentage excess weight loss (%EWL) and BMI between those prescribed and not prescribed psychiatric medication who underwent laparoscopic bariatric surgery.

Methods
Consecutive patients, who received identical perioperative care were selected from a prospectively maintained database. Patients who had gastric bands and revisional procedures were excluded. Patients were defined as “prescribed psychiatric medication” if prescribed antidepressant, antipsychotic or mood stabilizer at baseline and subdivided into those taking a single agent and those on two or more agents.

Results
Of 119 patients (58 sleeve gastrectomy, 61 gastric bypass), 46 patients were prescribed psychiatric medication (40 one agent, 6 two or more agents). At 1 year, median %EWL did not differ significantly in those taking no agent, 1 agent and 2 or more agents respectively (66.8, 63.3, 57.4, p = 0.433). At 5 years this approached, but did not reach statistical significance (56.6, 54.4, 40.6, p = 0.099). The same pattern was observed for median BMI at 5 years (35.7, 39.2, 40.7, p = 0.086).

Conclusion
There is no significant difference in excess weight loss or BMI at 1 year post surgery between patients prescribed psychiatric medication and those not prescribed psychiatric medication but there is a difference at 5 years, which shows a trend towards statistical significance. Such patients should receive intensive specialist bariatric psychological support for a prolonged period after surgery.