bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP3.2.3 The open abdomen is associated with increased morbidity and mortality after emergency laparotomy: a retrospective cohort study
Authors: Harrison Charlotte , Beresford Charles , Magro Tania , Marinos Spyros , Sunthareswaran Rame , Ceresa Carlo 
Published: October 2021

Abstract

Aims
The open abdomen following emergency laparotomy for peritoneal contamination is becoming an increasingly popular method of managing severe intra-abdominal sepsis. However, this approach has been associated with increased morbidity and mortality. The aim of this study is to compare patient populations and post-operative outcomes from patients undergoing primary closure or those managed with an open abdomen after emergency laparotomy.

Methods
A retrospective case note review was undertaken of all patients recorded on the NELA database over a five-year period at a district general hospital. Patients with no intra-abdominal contamination or who were palliated peri-operatively were excluded. Data collected included P-possum morbidity and mortality, post-operative complications (Clavien-Dindo), length of stay and in-hospital mortality.

Results
811 NELA entries were reviewed; 313 were included with 79% (n = 248) undergoing primary closure. Cohorts were similar in age and sex. P-possum morbidity and mortality scores were significantly higher in the open abdomen group (89% vs 79%, p = 0.0003; 38% vs 24%, p = 0.0003, respectively). Of the outcome variables, significant complications (34% vs 11%, p = 0.001), length of stay (31 vs 18 days, p = 0.0001) and mortality (11% vs 4%, p = 0.001) were significantly higher in the open compared to closed abdomen group. Only 10% of patients undergoing primary closure required further surgery.

Conclusions
This study highlights that the open abdomen is used in higher risk patients, with significantly poorer outcomes. This approach, which confers a significant physiological burden requiring further intervention should be used with caution in selected cases.
SP3.2.6 Success of Ultrasound-Guided Reduction of Intussusception Using Normal/Saline And Factors Resulting In Failure of the Procedure
Authors: Abdullah Farooq , Gulnaz Nadia 
Published: October 2021

Abstract

Intussusception is one of the common pediatric surgical emergencies in age less than one year. The initial radiological study for detection of intussusception is ultrasound.
Treatment of choice of intussusceptions has remained controversial and varies from center to center. Surgical exploration was the main treatment in the past and still practiced as first-line treatment in some centers. However, in the past few decades, there is a trend to reduce intussusception under radiological guidance.
This study aims to determine the success rate of ultrasound-guided hydrostatic reduction of intussusception using normal saline and determination of possible factors that result in failure of the procedure.

Methods
This prospective study was conducted in the Pediatric Surgery department of Khyber Teaching Hospital, Peshawar from Jan 2018 to Sept 2018. All patients aged between 3 months to 24 months with clinical signs and symptoms and confirmatory sonographic evidence of intussusception were included in this study. The procedure was then carried out under ultrasound guidance using normal saline as a medium for reduction.

Findings
A total of 80 patients were included in this study. Successful reduction was achieved in 66 (82.5%) patients while in 14(17.5%) patients the procedure failed to reduce the intussusceptions. No mortality is reported in our study There were 6 recurrences 4 of which were managed by ultrasound guidance reduction while 2 underwent laparotomy.

Conclusion
Ultrasound-guided hydrostatic reduction of intussusception is an effective way to reduce the intussusception. It must be adopted as the primary procedure for the reduction of intussusception.
SP4.1.3 The effect of the Covid-19 pandemic on case selection and perioperative outcomes of emergency laparotomies: a UK-based multicentre cohort study
Authors: Thrumurthy Sri , Tsang Derrick , Bello Abdulazeez , Zaidi Ahsan , Vasilikostas Georgios , Wan Andrew 
Published: October 2021

Abstract

Aims
Evaluating the effect of Covid-19 on case selection and perioperative outcomes of emergency laparotomies across South West London (SWL).

Methods
A retrospective cohort study including all emergency laparotomies performed at three SWL-based NHS hospitals from 01/04/2020-31/12/2020 (i.e., “pandemic” cohort; from the first national lockdown), versus a “pre-pandemic” cohort (01/04/2019-31/12/2019). Data was extracted from the NELA database and hospital records, and analysed by two independent clinicians.

Results
414 patients met the inclusion criteria. 17.6% fewer (227 vs. 187) laparotomies were performed during the pandemic period. There were no significant sociodemographic differences between cohorts (mean age 64.5 vs. 62.7 years, p = 0.284; M:F ratio 1:1.154 vs. 1:0.928, p = 0.221). Pre-operative NELA risk scores were higher before the pandemic (mean 13.05% vs. 9.55%, p = 0.020). The commonest indication for laparotomy in both cohorts was small bowel obstruction (32.6% vs. 37.4%), treated most commonly with adhesiolysis. Postoperatively, fewer patients received HDU/ITU care during the pandemic than before (ward-based recovery 4.7% vs. 13.8%, HDU/ITU recovery 93.4% vs. 79.4%, χ2=15.4, p &lt; 0.005). Mean duration of ITU stay was significantly shorter during the pandemic (4.5 vs. 2.7 days, p &lt; 0.005), as was total length of inpatient stay (20.2 vs. 14.3 days, p = 0.0156).

Conclusions
The overall reduction in emergency laparotomies observed during the pandemic period was potentially secondary to tighter case selection guided by objective risk stratification. Fewer patients were recovered postoperatively on HDU/ITU, and patients were generally discharged from hospital earlier. Such trends in perioperative care served to support organizational prioritization in response to Covid-19 service provision.
SP4.1.13 Management of appendicitis during COVID-19 pandemic; short-term outcomes
Authors: Lucocq James , Radhakishnan Ganesh 
Published: October 2021

Abstract

Aims
COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19.

Methods
Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups.

Results
One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p &lt; 0.00001). There was no significant difference in the outcomes between the two groups.

Conclusion
CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.
SP4.1.17 Surgical Hot Clinic support during Covid 19 pandemic
Authors: Jalali Uzma , Bennett Jayne 
Published: October 2021

Abstract

Aims
To determine the role of Surgical Hot clinic during covid 19.

Methods
All patients attending Hot clinic from September 2020 to December 2020 were included in retrospective study.

Results
Total number of 373 patients have attended Hot clinic, sixty percent were females. Emergency department referred 43.3% of patients who were reviewed and referred by emergency and /or surgical doctors. Ward discharged patients were second highest in numbers, comprising 21.7% and were mostly post-surgical patients. GP referrals were 19.3% also 6% were referred by consultants and similar percentage was re booked in Hot clinic.
Forty one percent of the patients presented with abdominal pain, the most common being right upper quadrant followed by iliac fossae pain. Post produre review accounted for 24.6% of patients. Abscess were 16.3% whereas uncomplicated hernia, bleeding per rectum presented less.
Majority of patients was discharged on their first visit. The percentage of patients rebooked into Hot clinic was 9.6% with 6.7% referred to consultant’s outpatient clinic after requesting investigations. Only 3.4% were admitted for surgical care and 1.6% was brought back next day for day case procedure.

Conclusion
In light of the increased demand on ECC services, Hot clinic has emerged as a strong support during Covid 19 Pandemic. It has been utilized not only for urgent surgical referrals but also to facilitate early discharge to avoid Covid exposure. During the reduction of face to face appointments, both outpatients and GP, Hot clinic has provided services for pre-op and/ or investigation review.
SP4.2.14 The benefits and risks of provision of a hospital-wide high-definition video conferencing virtual visiting service
Authors: Dhahri Adeel Abbas , Dethabrew Agampodi-Umanda , Ladva Nirali , Pardoe Helen 
Published: October 2021

Abstract

Aims
Since the start of pandemic, Virtual visiting (VV) has become especially important due to visiting restrictions in hospital and telemedicine has become more evident. This project aimed to determine VV’s impact on staff and family members affected by COVID-19 and its applicability in the future.

Methods
This quality improvement pilot study was conducted 16/04/2020 till 30/11/2020, using Attend Anywhere (AA) as VV tool on iPads. In five dedicated COVID-19 wards, family members could request a 10-minutes VV through email run by a dedicated administrative staff. A Standard Operating Procedure (SOP) was described, and dedicated volunteers were recruited from a pool of existing hospital staff and physician associate students. An open-ended survey was emailed to staff and relatives following visits. The transcripts were coded into five themes and sub-themes and reviewed by two analysers independently. Thematic analysis was generated manually to form the conclusions.

Results
There were 138 feedback responses, including 108 (78.3%) from relatives and 30 (21.7%) from staff). Twenty-seven codes assigned to the data were amalgamated into the five stated themes: appreciative factors (129, 93.5%), organisational skills (44, 31.9%), palliative care (38, 27.5%), communication from staff (14, 10.1%), and VV issues (11, 7.9%). Overall, 131 (94.9%) of total responses had generally positive comments (111 from relatives while 20 from staff).

Conclusion
Virtual Visiting delivered to the front line has worked effectively with excellent reliability in a secure cyber environment. Despite these barriers or weaknesses, VV can be potentially implemented in the hospital wards even beyond post-pandemic era.
SP5.1.3 Analysis of National Bariatric Surgery Related Clinical Incidents: Lessons Learned and a Proposed Safety Checklist for Bariatric Surgery
Authors: Omar Islam , Madhok Brijesh , Parmar Chetan , Khan Omar , Wilson Michael , Mahawar Kamal 
Published: October 2021

Abstract

Background
Hundreds of thousands of patient-safety clinical incidents are reported to the National Reporting and Learning System (NRLS) database in the UK every year. The purpose of this study was to identify bariatric surgery-related learning points from these incidents.

Methods
We analyzed bariatric surgery-related clinical incidents reported to the UK NRLS database between 01 April 2005 and 31st October 2020. The authors used their experience to identify learning themes and design a safety checklist.

Results
We identified 541 bariatric surgery-related clinical incidents in 58 different themes. Preoperative incidents represented 30.3% (N = 164), intraoperative 38.1% (N = 206), and postoperative accounted for 31.6% (N = 171). In terms of severity of incidents, (150;27.7%) were of high severity, whereas medium and low severity incidents were (244;45.1%) and (147;27.2%) respectively.
The most commonly reported high severity theme was failure of thromboprophylaxis (50;9.2%). Intraoperative high severity incidents included 17 incidents of stapling of orogastric/nasogastric tubes or temperature probes, 8 missed needles, 8 broken graspers, and 6 incidents of band parts left behind. Postoperatively, the most commonly reported high severity theme was improper management of diabetes mellitus (35;6.5%).
Medications errors represented a significant proportion of the medium severity incidents and included (26;4.8%) incidents of improper or missed prescription of routine medications and anticoagulants preoperatively and (45;8.3%) wrong prescriptions, dosage or prescribing of contraindicated medications postoperatively.

Conclusion
We identified 58 specific themes of bariatric surgery-related clinical incidents. We proposed specific recommendations for each incidents theme in addition to a bariatric safety checklist to help improve the safety of bariatric surgery worldwide.
SP5.2.1 Renal Transplant Outcomes Through the COVID-19 Pandemic at a London Transplant Centre
Authors: Mahdibeiraghdar Sara , Ghazanfar Abbas , Heap Sarah , Siddiky Abul , Taylor Claire Fraser , Wadoodi Ashar 
Published: October 2021

Abstract

Aims
The aim of this audit was to establish the impact of COVID-19 on the outcomes of renal transplant recipients in the post-transplant period at our centre, through the 2020 calendar year.

Methods
Living donor and deceased donor renal transplant recipients in the period of interest were identified and any complications or adverse outcomes were reviewed and compared to outcome data from the previous year.

Results
A total of 88 renal transplants were performed in 2020. Fifty-five cases were performed after reopening the Unit. Five patients tested positive for COVID-19 in the post-transplant period. One patient was admitted to the Intensive Care Unit and subsequently died from related complications. Another patient suffered from internal jugular vein thrombosis shortly after testing positive and could be attributed to the hypercoagulable state post-infection.
A total of 4 deaths and 1 graft loss were recorded within 2020. This compares to 1 death, 2 graft losses and 1 primary non-function in 172 transplants in 2019. Of the 4 deaths, one was directly linked to COVID-19. The other 3 deaths could be indirectly linked to the disruptions that were made in the healthcare system during this period in adapting to the pandemic.

Conclusions
It was anticipated that COVID-19 will directly and indirectly affect patient outcomes from surgery during this period. This was clearly seen at this Unit, with mortality rates having increased almost eight-fold in the post-transplant period compared to the same period in the previous year. However, no significant difference was seen with graft losses.
SP5.2.5 A 4-year single-centre cohort study assessing outcomes in vascular surgery patients undergoing calf fasciotomies
Authors: Laloo Ryan , Bailey Marc , Troxler Max , Russell David , Scott David Julian Ashbridge 
Published: October 2021

Abstract

Aims
Acute compartment syndrome (ACS) is a surgical emergency. Delayed diagnosis and fasciotomy can result in irreversible muscle necrosis causing permanent disability and major amputation. This study compared patient outcomes following calf fasciotomies to prevent ACS (prophylactic) versus treat ACS (therapeutic) and early (within 6 hours of ACS diagnosis) versus delayed fasciotomies (beyond 6 hours) at a single vascular centre.

Methods
All patients undergoing calf fasciotomies between 1st January 2017 and 31st December 2020 were identified from a prospectively collected departmental database. Caldecott-approved data collection was conducted. The primary outcomes were wound infection, foot drop, muscle debridement, split-skin graft (SSG) requirement, vacuum dressing, 30-day amputation and death rates. Statistical analysis was performed using Fisher’s exact test.

Results
73 patients (51 men, 22 women; median age 67, IQR 56-75 years) underwent calf fasciotomies (44 therapeutic and 29 prophylactic) mainly following acute thromboembolic ischaemia. Higher complication rates occurred among delayed (15) versus early (29) fasciotomy patients: wound infection (13.3% vs 3.4%), foot drop (20.0% vs 3.4%), muscle debridement (40.0% vs 24.1%), loss of anterior compartment (13.3%, 3.4%) need for SSG (29.5% vs 17.2%), vacuum dressing (46.7% vs 20.7%) and 30-day amputation rate (20.0% vs 13.8%) but lower 30-day death rate 13.3% vs 17.2%). None of these results were statistically significant. 34.1% of delayed fasciotomies were due to awaiting emergency theatre availability.

Conclusion
ACS patients undergoing calf fasciotomies are at high risk of complications including amputation and death. Ongoing education on mortality risk and early communication with emergency theatres are critical in their management.
SP6.1.1 Cholecystectomy or expectant management after endoscopic sphincterotomy and bile duct stone removal?
Authors: Toogood Kate , Pike Thomas , Coe Peter , Everett Simon , Toogood Giles , Smith Andrew 
Published: October 2021

Abstract

Aims
Following ERCP, NICE guidance suggests that surgically fit patients undergo cholecystectomy to prevent recurrence of choledocholithiasis and its complications. However, for many patients who are deemed unfit or who choose not to have surgery, ERCP is their definitive management. This study examines the clinical outcomes and costs of expectant management (EM) or cholecystectomy following ERCP.

Methods
All patients that underwent ERCP, sphincterotomy and common bile duct (CBD) clearance at St James’s University Hospital between January 2015 and December 2018 were identified from a prospectively maintained ERCP database. The clinical outcomes for patients that had undergone an ERCP, sphincterotomy and CBD clearance for gallstones were identified from their electronic patient record. A cost analysis for the complete patient pathway was performed.

Results
820 patients underwent ERCP and CBD clearance for gallstones with a median 3.9 year follow up. 222 patients had undergone a cholecystectomy prior to ERCP and were excluded from analysis. 203 patients underwent planned cholecystectomy with 15% (31 patients) requiring complex surgery and 12% (24 patients) needing readmission. 395 patients received expectant management (EM). 9 (2.3%) patients returned with CBD stone symptoms, 6 (1.5%) went on to laparoscopic cholecystectomy (LC). The readmission rate in the EM group was 9%. The average cost per patient in the expectant management group was £7,487 and in the cholecystectomy group was £10,584.

Conclusion
The results from this study suggest that the need for cholecystectomy following ERCP is uncertain, with similar rates of biliary re-admissions in both groups.
SP6.1.3 Readmissions After Cholecystectomy in a Tertiary UK Center: Incidence, Causes and Burden
Authors: Omar Islam , Hafez Ahmed 
Published: October 2021

Abstract

Context
Although cholecystectomy is a widely performed procedure, postoperative readmissions place a heavy burden on healthcare facilities.

Aims
This study assesses the incidence, causes and burden of 30-day readmissions after cholecystectomy in a tertiary UK center.

Settings and Design
University Hospital, Retrospective Cohort Study.

Methods and Material
Information was obtained from our prospectively maintained database and hospital’s computerised records.

Statistical analysis
The encounters are expressed in numbers and percentages. The hospital stay, BMI and age are expressed in mean, standard deviation (SD), min-max and median. Microsoft Excel® was used to calculate the means, SD, min-max and median.

Results
Out of the 1,140 cholecystectomies performed over this time, there were 75 true readmissions and 29 revisits; thus, the actual readmission rate is 6.58%. Non-specific abdominal pain ± deranged liver function tests (LFT) is the most common cause of readmission at (38;36.54%) cases, followed by (18;17.31%) wound infections and (12;11.54%) collections/bile leaks/abscess. This costed the center 93 scans; 30 procedures and 295 days of hospital stay.

Conclusions
Non-specific abdominal pain ± deranged LFT is the most common cause of readmissions/revisits in the center. Readmissions after a cholecystectomy are a significant encumbrance.
SP7.1.7 The impact of surgical subspecialisation on patient outcomes in those admitted with gallstone disease in the North of England: a retrospective cohort study
Authors: McGovern Julia , Young John , Brown Leo , McLean Ross 
Published: October 2021

Abstract
The management of gallstone disease has evolved over time and includes laparoscopic and open cholecystectomy, interventional radiology, endoscopic intervention and conservative management. Subspecialisation within general surgery is commonplace, allowing development of specialist skillsets. The aim of this study is to assess the impact of consultant subspecialisation on patient outcomes in those admitted with gallstone disease.
A retrospective cohort study - data was collected on patients admitted with gallstone disease in the North of England between 2002 and 2016. Subspecialisation was categorised as Upper GI or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach and length of stay.
A total of 62,286 patients were admitted with gallstone disease. Overall 30-day mortality was 2.1%. The UGI specialists had a higher operative rate - 21.5% vs 10.7% (&lt;0.001) than their colleagues including performing more laparoscopic cholecystectomies– 15.6% vs 6.4% (&lt;0.001), and on-table cholangiogram (OTC) – 3.5% vs 1.5% (p &lt; 0.001).
22,071 patients were diagnosed with acute cholecystitis. Non-UGI Consultants preferred conservative management (76.5% vs 59.0% - p &lt; 0.001) which did not significantly affect 30-day mortality. Data was analysed using IBM SPSS Statistics. Categorical data were compared with chi-square test, and continuous data with t-test or ANOVA. Statistical significance was defined as a p value of ≤ 0.05.
UGI consultants performed significantly more “hot gallbladders” than their non-UGI counterparts. UGI consultants choose to operate laparoscopically and perform significantly more OTCs, likely reducing need for pre-operative MRCP but not significantly reducing overall 30-day mortality or length of stay.