bluuebunny/crossref_metadata_2025_split huggingface dataset:
1188 Management of Prosthetic Joint Infections and Fracture Related Infections at A District General Hospital
Authors: Rajgor H , Ponniah G , Li M , Osman K , Moores T 
Published: October 2021

Abstract

Aim
The aim of our study was to determine if there was cohesion in management of orthopaedic infections between the surgical and microbiology team to ensure optimal patient outcome in accordance with BOA standards for management of Orthopaedic infections. Surgical sampling intraoperatively of orthopaedic infections was evaluated.

Method
We retrospectively reviewed 19 patients that had suspected PJI or fracture related infections between July 2019 to December 2019 at a District General Hospital. Patient information was collated from patient notes, fusion, bone infection database and MDT notes. Analyses were performed using R (R Foundation for Statistical computing, Vienna, Austria).

Results
19/19 patients had a preoperative antibiotic plan prior to index surgery. 0% of discharge summaries contained information for patients or primary care staff regarding management of a suspected orthopaedic infection. 100% of patients who were septic were reviewed by a consultant within 24hours of admission. 72% of patients that had operative intervention had 5 microbiology + 2 histology samples. 0% of patients had surgical recording of process of sampling. All patients were discussed at the newly formed Bone infection MDT with a microbiology consultant, radiologist, and allied health professionals.

Conclusions
For optimal management of orthopaedic infections an MDT approach is vital. Early microbiological input and appropriate surgical sampling and debridement are key to providing a diagnosis of deep infection. The newly created PJI pathway will aid future management of orthopaedic infections and standardise care.
1260 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Management of Subtrochanteric Femoral Fractures
Authors: Arshad Z , Thahir A , Rawal J , Hull P , Carrothers A , Krkovic M , Chou D T S 
Published: October 2021

Abstract

Aim
Subtrochanteric femoral fractures are said to occur in the 5cm of bone immediately distal to the lesser trochanter. This study aims to compare peri-operative outcome measures in patients with subtrochanteric fractures treated with either an IMN, or an alternative construct, the dynamic hip screw (DHS).

Method
A retrospective review of all subtrochanteric fractures presenting to our institution between October 2014 and May 2019 was performed. All patients were classified into two treatment groups, IMN or DHS. These groups were compared on outcome measures including radiation dose area product (DAP), length of hospital stay, estimated blood loss, mortality, and re-operation/complication rate.

Results
A total of 86 patients presented to our institution with a subtrochanteric femoral fracture during the study time period. Of these, 74 (86%) received an IMN and the remaining 12 (14%) received a DHS. The only comparative outcome measures showing a statistically significant difference between the two groups were radiation DAP and blood loss., both of which were significantly lower in the DHS group. All other comparative outcome measures failed to reach statistical significance.

Conclusions
Although current United Kingdom national guidelines advise all subtrochanteric femoral fractures should be treated with an IMN, the outcome measures used in this study suggest that the DHS, which also has a reduced implant cost compared to an IMN, may be the better option in some cases. There may not be one optimal implant for all subtrochanteric fractures. Recent biomechanical research suggests that the DHS is able to provide adequate fixation in more stable fracture subtypes, whereas an IMN may be required for unstable subtrochanteric fractures.
861 Bone Protection in Neck of Femur Patients in A DGH Without A Fracture Liaison Service
Authors: Yoganathan S , Ibrahim I , Sharma A 
Published: October 2021

Abstract

Introduction
In England and Wales, there are approximately 75,000 proximal femoral fractures per year. Bone protection is vital in these patients and is a key recommendation of NICE guidelines (CG124) for multidisciplinary approach in hip fracture management.

Method
Data were collected retrospectively using clinical portal, admission records and medication charts. The data were inputted into the FRAX calculator to calculate a patient’s risk of developing an osteoporotic fracture; depending on their risk they would be appropriate for bone protection or require a DEXA scan for further assessment. As certain data criteria were not available for the FRAX calculation, risk calculation was underscored i.e., if parental hip fracture status was not known.

Results
A total of 59 patients were audited between July and October 2019. Of those patients, 25 were calculated as high risk, however, only 6 patients had adequate bone protection. 19 patients were deemed intermediate risk and would benefit from a DEXA scan for further assessment. Of those 19 patients, only 8 had adequate bone protection. DEXA scan was only requested for 2 of the patients who were intermediate/high risk. In the year following, 4 patients have had another fracture, with 3 of those patients not on any bone protection medication and had a high risk FRAX calculation.

Conclusions
Following a local meeting; a proforma has been piloted to identify patients at risk and requiring bone protection. With the help of a dedicated orthopaedic pharmacist and nurse practitioners, continuity of care can be achieved to aid a patient’s long-term wellbeing.
1439 A Change in The Use of Post-Operative Drains in Total Knee Arthroplasty (TKA)
Authors: Erdman P , Ali R , Bhattacharya R 
Published: October 2021

Abstract

Aim
Closed suction drains (CSD) are routinely used to reduce the risk of haematoma formation and wound infections in TKA. Our study aims to determine if the use of drains has any impact on estimated blood loss, transfusion rates and length of stay in hospital.

Method
Elective TKA cases performed under a single consultant between February 2018-March 2020 were identified. Electronic medical records were reviewed, and data collected on relevant variables. Estimated blood loss was calculated using Ward’s formula. Mann-Whitney U test was applied to assess for statistical significance.

Results
A total of 86 elective TKA cases were included in the study. In 41 cases patients had a CSD insitu post-operatively (group 1), in the other 45 cases a drain was not used (group 2). Both groups had similar distributions of age, BMI, and sex. We found no statistically significant differences in mean change (+/-SD) in haemoglobin post-operatively between group 1 (21.3 (+/- 9.4)) and group 2 (19 (+/- 10)), (p = 0.34). Mean estimated blood loss was 915mls (+/-365) for group 1 and 871mls (+/-455) for group 2, (p = 0.45). Group 1 had a higher rate of transfusion (4.8% vs 2.2%); however, this was not statistically significant (p = 0.51). After accounting for unrelated medical complications or social barriers to discharge, the length of hospital stay was 4.7 (+/- 2.27) and 4.9 (+/- 3.14) for group 1 and 2 respectively, (p = 0.84). There were no reported cases of wound infection in both groups.

Conclusions
We found the use of drains in TKA confers no benefits in the outcomes evaluated.
218 The Impact on Minimally Invasive Urological Cancer Surgery During the Covid-19 Pandemic
Authors: Boyle C , Gallagher K , Leung S , Good D , McNeill S A , Laird A 
Published: October 2021

Abstract

Aim
Learned bodies recommended restricted use of, or extensive precautions when using, laparoscopic/robotic surgery during the Covid-19 pandemic. We aimed to determine whether minimally invasive surgery (MIS) in uro-oncology patients was safe for patients and staff.

Method
From 16 March to 16 June 2020, patients having MIS in a tertiary referral urology centre were identified from a prospectively collected database. Patient characteristics, operative details and 30-day follow-up for adverse events were recorded including Covid-19 tests and results. Any theatre staff Covid-19 event was traced back 14 days to determine any involvement in these cases.

Results
87 patients were eligible for inclusion (33 robotic prostatectomies, 38 laparoscopic prostatectomies, 11 laparoscopic nephrectomies, 5 robotic nephrectomies). All patients were assessed for symptoms of Covid-19 on the day of theatre. 18(21%) patients had pre-operative screening (all swabs, no CT chest). 46(53%) underwent 14 days pre-operative self-isolation. 38(44%) cases were performed with FFP3 protection. No modification to operating procedure was made for any cases. No patients tested positive for Covid-19 in the 30-day postoperative period. No staff member involved tested positive in the postoperative period. 1 patient tested positive pre-operatively, delaying the operation by 7 weeks. No patients tested positive after the introduction of mandatory screening.

Conclusions
Based on our case-series MIS urological surgery appears to be safe for patients and staff, with no increased risk of Covid-19 complications in patients who are asymptomatic pre-operatively. The introduction of mandatory pre-operative swabs for elective patients, and the use of FFP3 protection, did not significantly alter results.
255 Relationship Between Acute Urinary Retention Episode and Risk of Death in Men
Authors: Ejikeme C 
Published: October 2021

Abstract

Introduction
Acute urinary retention (AUR) is a urological emergency, with incidence increasing with age, being highest amongst men over 70 years. Such adverse events need to be managed properly to avoid complications. Studies have highlighted the association between urinary retention and death. Advancing age and co-morbidities are the two significant factors determining the outcomes of these patients.

Aim
The main outcome measure will be the death rate within 12 months of retention episode, irrespective of if first or subsequent episodes of retention.

Method
A total of 231 patients attended emergency department from January to June in the years of 2016 to 2018 with AUR. A total of 42 patients died following episode of urinary retention. Hospital records of these patients were examined with regards to their age at retention, date of retention and date of death. Co-Morbidities, details of any resulting admission and outcome of trial without catheter were also recorded.

Results
A total of 42 (17.9%) had died. 24 out of 42 (10.2%) died within twelve months of their episode of urinary retention; this represents 57% of all total death relating to this cohort. 16 (66.7%) cases of the 24 that died within 12 months were noted to have ASA of 3 and Charlson co-morbidity index of &gt; 1. 15 (62.5%) cases of that died within 12 months also had long term catheter.

Conclusions
The management of AUR whilst aimed at immediate relief of retention and preventing possible complications, holistic patient approach should be adopted. Multi-disciplinary team involvement should be instituted as appropriate.
883 A Closed-Loop Audit to Improve Admissions Documentation in A Busy ENT Department
Authors: Connelly A , Law K , Williamson A 
Published: October 2021

Abstract

Aim
Accurate and thorough admissions documentation is crucial for patient safety and effective care. We amended the admissions pro-forma used on a busy adult ENT ward to improve adherence to a modified version of Royal College of Surgeons of England guidelines.

Method
Baseline documentation of the 25 parameters of interest was assessed using electronic medical records for all emergency and pre-operative admissions over a 4-week period (n = 75). A new pro-forma was introduced, and the documentation over the following 4 weeks (n = 75) was assessed in the same way. Statistical analysis was done using Excel and RStudio (z-test for two proportions, p-value ≤ 0.05).

Results
The two groups were similar in age, gender, length of stay, and presenting complaint. The new pro-forma was completed for more admissions than the prior version (91% vs 77%) and resulted in documentation improvements in 19 out of 25 parameters. 9 of these were statistically significant, including initial vital signs and differential diagnosis. Parameters that improved, but not significantly, include admission source, medication history, and cognitive assessment. Across the 8 weeks, using a pro-forma (n = 126) significantly improved documentation of 11 parameters compared to freehand clerking (n = 24).

Conclusions
Adequate documentation at admission can help with immediate patient care, and act as a point of reference during extended stays. We were able to increase use of a pro-forma and produce meaningful documentation improvements quickly. Further work is required to assess why certain parameters are infrequently completed, and how future pro-forma iterations can become more user-friendly.
562 Biopsy of Localised Renal Masses Offers High Diagnostic Yield and Low Complication Rate in Patients with Suspicious Renal Masses
Authors: Ng Cheong Chung J , Isgro G , Page T , Thomas D , Haslam P , McNeil A , Soomro N , Rix D , Rai B , Veeratterapillay R 
Published: October 2021

Abstract

Aim
Biopsy of localised renal masses is generally accurate at detecting benign or malignant histology but can cause complications. The aim of this study was to determine the detection rate and complication rate of renal mass biopsies.

Method
Patients undergoing a renal mass biopsy at a single tertiary centre between January 2015 and December 2019 were identified electronically using a prospective database. Details about their biopsies were recorded including tumour size, radiological guidance, number of cores, longest margin of biopsy, accuracy of biopsy, histology type, and complications.

Results
This study included 334 biopsies (Median age 68 years (IQR 60-72); 61.4% (n = 204) male). Median size of tumour was 30mm (IQR 25-50) and 79.9% (n = 267) were solid masses. The biopsies were done under ultrasound (78.4%) or computed tomography (21.6%) guidance. 91.9% had core biopsies (n = 307) with median biopsy margin of 14mm (IQR 9-21). Benign histology was observed in 18.9% (n = 63), malignant in 72.1% (n = 241) while biopsy was non-diagnostic in 9.0% (n = 30). 62.6% (n = 209) of the cases were renal cell carcinoma with clear cell subtype more commonly seen (72.2%, n = 151). Complications following biopsy included haematoma (n = 7, 2.1%), haemorrhage (n = 3, 0.9%), pneumothorax (n = 1, 0.3%) and vasovagal episode (n = 1, 0.3%), resulting in an overall complication rate of 3.6%.

Conclusions
Biopsy of localised renal masses in this study showed a detection rate of 91% and complication rate of 3.6%. This study suggests renal mass biopsies have high diagnostic yield and low complication rate.
621 Robot-Assisted Radical Cystectomy: A Complete Audit Cycle of Our First 118 Cases
Authors: Eli N , Dowdeswell M , Elsayed W , Mak D , Cooke P 
Published: October 2021

Abstract

Aim
There are 10,200 cases of bladder cancer diagnosed every year in the UK, accounting for 3% of all new cancer diagnoses. Robot-assisted radical cystectomy (RARC) is a minimally invasive treatment option for muscle invasive and high-risk bladder cancer with a rising uptake. Between 2017 and 2019, RARC accounted for 40.6% of all cystectomies performed in the UK, increasing to 52% in 2018 to 2019. We compared our outcomes with the best practice of RARC set by the Pasadena consensus panel in 2015.

Method
A review of the prospective database of all RARC performed by two surgeons at Royal Wolverhampton Hospital between May 2013 and October 2020 was conducted. Operative and oncological outcome data were collected from Clinical Web Portal and Somerset Cancer Register and analysed using Microsoft Excel.

Results
A total of 118 RARC were performed in the study period, 50 cases were analysed in the first audit loop and 68 cases in the second. The mean age was 69 years (44 – 82), 84% were men and 70% were ASA grade II or less. Median operating time was 376 minutes (210 – 555) and the median blood loss was 250mls. 79% of urinary diversion was intra-corporeal and 84% was ileal conduit diversion. Median length of stay was 8 days; complication rate with Clavien Dindo score of III or higher was 12.7%. 86% of our patients are still alive.

Conclusions
RARC is a safe option for the radical management of bladder cancer. Our outcomes are consistent with the Pasadena consensus recommendations.
688 Cancellation Rate of Prostate Template Biopsy: Are There Any Merits to Implementing Pre-Operative Bowel Preparations?
Authors: Lim P , Damola A , Apakama I 
Published: October 2021

Abstract

Introduction
The aim of this quality improvement project was to analyse the cancellation rates of the template biopsy done at the George Eliot Hospital. The focus was mainly on those due to poor bowel prep whereby manual evacuations have failed. Locally we have sometimes noted the failure rate of transperineal prostate biopsy as a result of the poor quality of the ultrasound due to inadequately evacuated rectum. Unfortunately, there are very limited studies which have looked into this issue hence the significance of this problem is not universally acknowledged.

Method
Retrospective review of all the template biopsies that were planned from April 2019 to April 2020 using the operation notes and local theatre management software.

Results
There was a total of 105 planned template biopsies from April 2019 to April 2020. 72 cases were attempted and within this, 7 of these cases required manual evacuations in which 3 resulted in abandonment of procedure. There were 33 cases which were cancelled due various other reasons.

Conclusions
The results showed that the failure rates due to poor bowel prep were not significant (4%). Based on these findings we have decided not to proceed with the implementation of pre-operative bowel prep with phosphate enema as we felt that the potential benefits were not enough for it be initiated as a routine practice. We aim to address the other reasons identified for cancellations.
966 Comparison of Lord and Jaboulay Procedure for Hydrocele Repair
Authors: Henderson L , Simpkins S , Nalagatla S 
Published: October 2021

Abstract

Aim
Hydrocele is a common surgical pathology with a variety of operative techniques described, including Lord plication and Jaboulay procedure. Whilst current evidence suggests no difference in the recurrence rate between different techniques, the Lord’s procedure is described as having the lowest complication rate. NICE guidelines state all men aged 20 - 40 should receive a pre-operative ultrasound scan. We aimed to audit the complication rate between the two procedures as well as the rate of pre-operative ultrasound assessment.

Method
A retrospective review of all elective hydrocele repairs was performed within one health board over a 17-month period. All elective patients over the age of twelve and three-quarters were included, with emergency repairs excluded. Patient records were accessed, and data collected including hydrocele side and size, procedure performed, co-morbidities, medication, pre-operative ultrasound, and incidence of immediate and late complications.

Results
83 cases were identified. All men aged 20 - 40 received pre-operative ultrasound assessment. 27 (33%) repairs utilised Lord’s technique, whilst 56 (67%) used Jaboulay’s technique. There was no statistical difference in complication rate for all complications (10% vs. 16% p = 0.48), haematoma (3.4% vs. 12% p = 0.16), infection (1.7% vs. 12% p = 0.08) or reoccurrence (1.7% vs 0% p = 1.0) between Jaboulay’s and Lord’s respectfully.

Conclusions
Analysis in this series showed the complication rate is higher for Lord’s procedure versus Jaboulay’s, however this was not found to be statistically significant. All patients aged 20-40 within our analysis received pre-operative ultrasound assessment.
893 Consenting for Appendicectomy
Authors: Mohamed N , Sinclair K 
Published: October 2021

Abstract
Appendicitis denotes to the inflammation of the appendix with over 50,000 cases in the UK per year. The treatment of choice is appendicectomy and this is one of the most common operations in the UK.
There are nil NICE or King’s College Hospital (KCH) guidance available on consenting for appendicectomy. Thus, guidance from Guy’s and St Thomas’ and Whittingham Health was used as reference and the consent forms at KCH were analysed for all appendicectomies over 2 months. A retrospective observational audit (Cycle 1) was conducted between Dec 2018 – Jan 2019 consisting of 34 patients. It assessed whether common complications were documented clearly and any possible complications.
This audit identified that consenting for diagnostic laparoscopy/appendicectomy did not cover many serious complications and was overall inadequate. One of the most common and serious complications was ileus/SBO (occurred in 9%) and was not consented for in 88% of patients. 12% of patients had a normal appendix and this was not consented in 100% of these patients.
Later, posters and teaching sessions were created to optimise the consent process for appendicectomy.
This was re-audited (Cycle 2) again between June 2019 – July 2019 with 49 patients to identify whether a positive change was identified. It identified that an 12% increase in consenting for ileus/SBO, 10% increase in conversion to open and 47% of individuals started consenting for hernia repair.
This work is vital as inadequate consenting can destroy doctor-patient relationship and result in litigation and we encourage clear consenting guideline for appendicectomies across trusts.
1328 A Risk Stratified Post-Nephrectomy Surveillance Protocol – 5-Year Assessment of Performance
Authors: James J , Drummond L , Clancy N , Leung S 
Published: October 2021

Abstract

Introduction
Recurrence rate of surgically treated localised renal cell carcinoma (RCC) is reported to be approximately 20%. There is lack of consensus on the optimal surveillance regimen. We assess the performance of our surveillance protocol based upon prognostic histological factors. We report the outcome of our first cohort to reach 5 years follow up.

Method
A retrospective analysis was performed of patients who underwent a radical or partial nephrectomy between March 2014 and October 2015. Patients were classified as high, intermediate, or low risk based on pathology; with each group undergoing individualised radiological follow up.

Results
80 patients with pathologically confirmed RCC who underwent partial or radical nephrectomy were identified. Recurrence was noted in 24% (n = 19), and a third of those patients (n = 7) died within the 5-year follow-up period. 79% (n = 15) of patients with recurrence were of intermediate or high-risk group. 90% of recurrences were picked up on surveillance scans, 5% due to symptoms related to the recurrence and 5% incidentally. 70% occurred within the first 2 years post-surgery. 92% (n = 6) of those who died had an ASA of 2 or higher. In the whole cohort, total number of deaths was 13. 38% (n = 5) died of RCC, 54% (n = 7) died of other causes and in 8% (n = 1) cause of death of was unclear.

Conclusions
Our risk stratified surveillance protocol identified 90% of recurrences within the 5-year follow-up. Future refinement of our protocol could include an assessment of performance status which may influence the schedule of radiological surveillance.