bluuebunny/crossref_metadata_2025_split huggingface dataset:
811 Should We Be Performing Day Case Laparoscopic Cholecystectomy (DCLC) After 3pm? Correlation Between Time of Operation and Post-Operative Hospital Stay
Authors: Alamassi A 
Published: May 2021

Abstract

Introduction
Laparoscopic cholecystectomy (LC) is a common daycase procedure. The British Association of Day Surgery (BADS) Procedure Directory sets out national performance targets for the number of LC’s treated as day cases. This study aimed to assess if operation time predicted unplanned inpatient admission.

Method
An annonymised retrospective review of all patients undergoing LC. The data was undertaken over two cycles. The first cycle was a 6-month period followed by a second cycle that was undertaken over three months. Data was obtained from multiple sources: discharge letters and the theatre data manager.

Results
Total number of cases was 160.
In the first cycle, the zero night stay for DCLC was 56%, which lies within the top 50% of current national performance but is below the BADS target of 75%. In the second cycle, the zero-night stay was 70%, which falls just below the BADS target. While unplanned admissions resembled 30%.
We had 136 cases underwent LC before 3 pm. While 24 cases had their operation after 3 pm. 19 patients out of those 24 stayed at the hospital.

Conclusions
The timing of operation of DCLC predicts inpatient admission; our data suggests that DCLC should not take place after 3pm in the afternoon.
852 Complete Mesocolic Excision (CME) Versus Conventional Surgery for Colon Cancer: A Systematic Review and Metaanalysis
Authors: Crane J , Hamed M , Borucki J , El-Hadi A , Shaikh I , Stearns A 
Published: May 2021

Abstract

Introduction
Complete mesocolic excision (CME) lacks consistent data to advocate operative superiority compared to conventional surgery for colon cancer. We performed a systematic review and meta-analyses, analysing peri-operative, pathological, and oncological outcomes.

Method
A systematic literature review was registered with PROSPERO and carried out using PRISMA guidelines. Outcomes reviewed included lymph node yield, R0, disease free and overall survival at five years.

Results
3039 citations were identified; 148 studies underwent full-text reviews and 34 matched our inclusion criteria. There were no significant differences between the CME and non-CME group in overall complications (13.8% vs.13.8%) or anastomotic leak (1.3% vs. 1.7%). Nodal yield was higher in the CME group, 18.7 compared to 13.6 in the non-CME group. The rate of R0 resection was 96.8% in CME compared to 95.5%. Overall survival at five years was higher in the CME group 77.8% compared to 69.7% in non-CME group.

Conclusions
CME for colon cancer was associated with no significant differences in morbidity and mortality, better lymph node yield and R0 resection compared to the non-CME group. Our meta-analysis further supported this demonstrating an improved overall and disease-free survival at five years in the CME group compared to the non-CME group.
859 Improving Accuracy of Admission Notes Over A Four-Year Period Within an Orthopaedic Trauma Ward: A Four-Cycle Audit
Authors: McCann C , Mackenzie S , White T 
Published: May 2021

Abstract

Background
Accurate medical notes are essential for effective patient care and safety. The Royal College of Surgeons (RCS) set forth guidelines for standards of documentation. Lack of awareness of these standards can result in inaccurate documentation, compromising patient safety.

Method
Four prospective audits of admission documents for orthopaedic inpatients were completed, each 1 year apart. For each cycle, 50 admission documents were assessed to determine compliance with the RCS standards. Interventions were carried out between each audit cycle in the following order: educational posters, change from handwritten to online admission forms and optimisation of the online proforma.

Results
Initially, only two criteria showed above 95% compliance. Implementing educational posters produced significant improvement in one criterion: ‘note signed’ (60% to 96%, p &lt; 0.05). Moving admission documents online improved ‘date stamp’ (66% to 100%, P &lt; 0.05) and ‘contact number’ (0% to 34%, p &lt; 0.05), but decreased documentation of ‘time recorded’ (18% to 0%, p &lt; 0.05) and ‘name and grade’ (74% to 26%, p &lt; 0.05). Further education and modification to the admissions proforma improved documentation of all criteria to over 95%.

Conclusions
Early cycles of this audit highlighted poor standards of documentation in admission records. Changing to online patient records significantly changed documentation standards. These were further improved with educational measures.
892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance
Authors: Hashmi K , Khalid S , Raja K , Zaka A , Easterbrook J 
Published: May 2021

Abstract

Introduction
COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic.

Method
Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined.

Results
Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02).

Conclusions
RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.
896 Improving Intravenous Fluid Therapy to Reduce the Incidence of Acute Kidney Injury in Hip Fracture Patients
Authors: McCann C , Hall A , Leow J M , Harris A , Hafiz N , Myers K , Amin A , MacLullich A 
Published: May 2021

Abstract

Background
Acute kidney injury (AKI) in hip fracture patients is associated with morbidity, mortality, and increased length of stay. To avoid this our unit policy recommends maintenance crystalloid IV fluids of &gt; 62.5mL/Hr for hip fracture patients.

Method
Three prospective audits, each including 100 consecutive acute hip fracture patients, were completed with interventional measures employed between each cycle. Data collection points included details of IV fluid administration and pre/post-operative presence of AKI. Interventions between cycles included implementation of admission/post-take checklist tools and various educational measures for Emergency Department, nursing and admitting team staff with dissemination of infographic posters, respectively.

Results
In cycle one and two, many patients received inadequate fluids (46/100 and 56/100 respectively). There was no significant difference in the incidence of AKI between patients receiving adequate or inadequate fluid in either cycle (p &lt; 0.05).
In cycle three, more patients received adequate fluids (79/100, p &lt; 0.05). Patients prescribed adequate fluids were less likely to develop post-operative AKI (2/79, 2.5% vs 3/21, 14.3%; p &lt; 0.05).

Discussion
This audit demonstrates the importance of administering appropriate IV fluid in hip fracture patients to avoid AKI. Improving coordination with Emergency Department and ward nursing/medical ward staff was a critical step in improving our unit’s adherence to policy.
904 Can Patients with Acute Appendicitis be Ambulated Safely?
Authors: O'Brien S , Armstrong L 
Published: May 2021

Abstract

Introduction
During the COVID-19 pandemic, surgical service and practice has been adjusted in order to reduce acute surgical admissions. Acute appendicitis accounts for a significant proportion surgical admissions in the UK. Intercollegiate general surgery guidance during the COVID-19 pandemic advised appendicitis should be managed conservatively, or with an open appendicectomy if indicated. Our aim was to determine the efficacy and safety of our ambulation service in the conservative management of acute uncomplicated appendicitis.

Method
Data was collected prospectively from 30th March 2020 – 16th August 2020 on all patients presenting with suspected appendicitis. Stable patients with clinically suspected or CT-proven appendicitis were discharged with oral antibiotics as per trust guidance. Readmissions for ambulated patients were recorded.

Results
190 patients presented with suspected appendicitis (range 5-71years). 49.4% patients were deemed suitable for ambulation on initial assessment, 22% of which had a CT confirmed diagnosis on discharge. 65% of the ambulated patients underwent a telephone review within a 72-hour window. 13.8% of patients represented within a 30-day period, 7.4% of which proceeded to appendicectomy.

Conclusions
Patients with uncomplicated appendicitis can be safely managed with antibiotics out of hospital, with low representation rates.
913 An Audit of Colonoscopy Compliance Within A Screening Programme for Patients with A Family History of Colorectal Cancer (CRC)
Authors: Abbakar M , Boxall P , James T , Lim M 
Published: May 2021

Abstract

Introduction
Guidelines on the management of hereditary CRC were updated in 2019 and have led to more stringent use of surveillance colonoscopies. Patients with ‘family history’ (FH) CRC Surveillance programme at York Hospitals Trust were studied to assess compliance with colonoscopy recommendations.

Method
Current BSG/ACPGBI guidelines recommend biennial, quinquennial, one-off or no colonoscopy surveillance for patients with Lynch syndrome, and those deemed to have high, moderate, and average risks of developing hereditary cancer, respectively.
Examination of electronic records and clinical notes were performed to determine if they were Lynch positive and/or if they could be assigned a risk category.

Results
Database of 227 patients, of which 14 were high, 61 moderate and 45 were low risk. 47 had Lynch syndrome. Compliance of colonoscopy was poor for patients with average and moderate FH risk (both 0%). Compliance was higher for patients with high risk of FH (50%) and those with Lynch syndrome (57%)
Risk was indeterminate in 24 patients due to inadequate data therefore compliance could not be assessed.

Conclusions
A large proportion of patients with low to moderate ‘FH’ risk within our current surveillance programme had unnecessary colonoscopies. Stratification of patients into the appropriate risk categories optimizes the benefit from surveillance programmes.
915 Post-Nephrectomy Recurrence Rates in T3 Renal Cell Carcinoma Over A 10-Year Period
Authors: Okwu N , Gooneratne S , Piedad J , Akhtar M 
Published: May 2021

Abstract

Introduction
The objective of the study was to estimate the post-nephrectomy recurrence rate and assess practice around peri-op investigation and treatment.

Method
Imaging, histopathology, and clinical data were gathered using electronic and paper medical records of patients who underwent nephrectomy for T3 RCC. Recurrence defined as local recurrence.

Results
Fifty-one patients with T3 RCC were identified, 74.5% of whom were male with a median age 71 (range 45-91).
One-third had metastatic disease. The majority (96.0%) underwent radical nephrectomy with adrenalectomy (49.0%) and lymph node dissection (19.6%).
Clear cell RCC was the main histopathological type (92.2%) with chromophobe making up 3.9%.
At year one there was recurrence in 20.0% of patients at a median time of 5months (range 1-10, 90.0% grade 3, 10% grade 4).
At year five recurrence was identified in 16.7% in a median time 50months (range 41-56; 50% grade 2 and 3 each).
Ten-year follow-up identified recurrence in 85.7% at a median time 64.5 months (range 62-91; 50% grade 2 and 3 each) with the remaining patient developing jejunal metastatic recurrence in 168 months.
Adjuvant treatment was administered in 57.1%.

Conclusions
Establishing the right time to follow-up patients especially males, 17 months median recurrence time with the most frequently occurring was clear cell RCC.
973 The Effect of Implementing A Proactive Care of Older People Undergoing Surgery (‘POPS’) Team on Length of Stay in Older Surgical Patients
Authors: Bayram J M , Rangar D , Dikiciyan J , Smith I 
Published: May 2021

Abstract

Introduction
POPS is a well-established service which supports care of older surgical patients across multiple UK hospitals. POPS teams have been shown to reduce peri-operative medical complications, reduce length of stay (LOS) and improve multiple other patient outcomes.

Method
A POPS team consisting of two consultants, one foundation doctor and one nurse practitioner was implemented to provide dedicated care to older surgical patients on the general and vascular surgery wards of a large urban teaching hospital. Data were collected over 8 weeks from June 2020 - July 2020 following implementation of the POPS team and compared to pre-POPS data from March 2018 - March 2019. All inpatients were screened by age and Clinical Frailty Score (CFS) for appropriateness and received POPS input based on clinical need. Prior to the POPS team, liaison geriatric input was provided by a sole consultant.

Results
The 36 patients from the POPS group had an average LOS of 15.9 days, which was significantly lower than the LOS of 37.4 days in the 537 patients in the pre-POPS group (p &lt; 0.01). There were no significant differences in demographics between the two groups.

Conclusions
The implementation of a POPS team significantly reduced length of stay in older surgical patients.
992 Short Term Effectiveness of Interventions Aimed at Preventing Post-Operative Acute Kidney Injury (AKI) In Patients Undergoing Elective Lower Limb Arthroplasty
Authors: Jaitley V , Phoenix E 
Published: May 2021

Abstract

Introduction
Acute kidney injury (AKI) is a potentially avoidable complication in patients undergoing elective lower limb arthroplasty. The National Institute for Health and Care Excellence (NICE) offers guidelines to identity and manage AKI. This is a closed loop audit aiming to assess i) adherence to NICE guidelines and ii) whether simple interventions will improve compliance.

Method
We closed the loop on a departmental audit carried out in 2017. NICE guidelines were applied to stratify patients at risk of post-operative AKI. High risk patients included those on nephrotoxic drugs and with pre-existing co-morbidities. We then applied the AKIN criteria to identify post-operative AKI. We presented this data at our departmental trauma meeting. Following this we implemented the following interventions i) poster & ii) aid memoir on patient admission proformas to identity those at risk.

Results
In 2017, post-operative AKI incidence was found to be 11.7%. Following intervention, in 2019 the incidence was 10% at 1 month and 5% at 7 months. Additionally, 80% of AKIs were identified on day 1 post-arthroplasty, compared to only 30% in 2017.

Conclusions
This audit showed that simple interventions reduced the incidence of post-operative AKI. Moving forward, we plan to assess long term effectiveness including the effect of junior doctor rotations.
117 A Systematic Review Comparing Clinical Outcomes Between Hem-O-Lok Clips and Endoloops In Securing the Base of The Appendix During Laparoscopic Appendicectomy
Authors: Khawaja Amir , Conor Magee , Wilson Jeremy 
Published: May 2021

Abstract

Introduction
One of the crucial steps of laparoscopic appendicectomy is to secure the base of appendix. A variety of techniques for stump closure have been described as Endoloops(Vicryl or PDS), Hem-o-lok clips, intracorporeal suturing and endoscopic staplers.

Method
A detailed literature survey using Pubmed, MEDLINE and EMBASE databases was carried out to extract studies conducted between 1990 and 2020. A total of 14 studies- 3 randomized controlled trials & 11 comparative studies enrolling 2098 (1030 in HL & 1068 in EL group) patients were included in the final analysis comparing Hem-o-lok versus endoloops for closure of appendiceal base. Outcome measures were Operative time, Cost benefit, Post-operative complications, and length of hospital stay.

Results
The average time of operation was significantly shorter in the HL group (SMD -0.79; 95% CI -1.03 – 0.56; z = 6.61; p &lt; 0.00001). HL was found to be more cost-effective. (SMD -5.00; 95% CI-7.00 – 3.00; z = 4.90; p &lt; 0.00001). However, no statistical difference was found between both the groups when comparing mean postoperative length of hospital stay & post-operative.

Conclusions
Based on the results of the above study, applying Hem-o-lok clips seems to be a safe, effacious and cost-effective way of securing the base of appendix.
125 The Fate of The Third Molar in The Line of a Mandibular Angle Fracture: A Retrospective Study at A Tertiary Centre
Authors: Dattani A , Aslam A , McMillan K 
Published: May 2021

Abstract
Aim: To evaluate the risk of complications associated with retaining or extracting an asymptomatic third molar in the line of an angle fracture. Aiming to seek a consensus whether third molars should be extracted or retained during surgical repair of mandibular angle fractures.

Method
A retrospective study was undertaken at the Queen Elizabeth Hospital, Birmingham. 150 patients across a span of three years underwent open reduction and internal fixation of mandibular angle fractures with third molar involvement. Patients were classified into two groups, tooth retention during angle fracture and tooth removal during angle fracture repair. Hospital records were evaluated to seek the rate of post-operative complications at follow-up

Results
162 angle fractures were identified with ipsilateral wisdom teeth present. In 37 cases the wisdom tooth was removed during surgery. 6 complications (16.2%) occurred in this group necessitating a return to theatre. In 125 cases the wisdom tooth was left in-situ. Complications necessitating a return to theatre occurred in 14 cases (11.1%).

Conclusions
This study indicates that retention of wisdom tooth overall did not significantly increase the risk of complications associated with angle fractures (p = 0.42). Where wisdom tooth pathology was noted its retention was associated with complications requiring a return to theatre (X2=4.40, p = 0.036).
155 Audit of Functional Outcome of Mason and Molloy Type 2 Posterior Malleolar Ankle Fractures Treated with Open Reduction and Internal Fixation Using A Posterolateral Approach
Authors: Master A , Saad A , George A , Syed A , Laing P , Hickey B 
Published: May 2021

Abstract

Introduction
It has been shown that direct fixation of the posterior malleolus improves functional outcomes. Our aim was to audit the functional outcome of patients with these fractures which were fixed with an isolated posterolateral approach.

Method
A consecutive case series of patients who underwent direct fixation of the posterior malleolus using a posterolateral approach between 20/12/2012 and 23/1/2020 was identified. Fractures were classified according to Mason and Molloy classification based on preoperative CT. Type 2a and 2b fractures were included. Functional outcome was assessed using Olerud-Molander score.

Result
18 patients were included. Mean age at time of surgery was 52 years (range 20 to 75 years). 56% (n = 10) were female. Mean follow up was 18.1 months (range 4.2 months to 7.2 years). OMAS score for type 2a fractures (n = 9) was 71.1 (95% CI 65.3 to 77.0). OMAS score for type 2b fractures (n = 9) was 67.8 (95% CI 54.6 to 81.0). There was no significant difference between groups (p = 0.65).

Conclusions
Fixation of Mason and Molloy Type 2 fractures using an isolated posterolateral approach results in satisfactory functional results for the majority of patients. Further prospective comparative study is needed to identify which patients benefit most from alternative approaches.
657 Comparison of the Intramedullary Nail and Dynamic Hip Screw in the Treatment of Subtrochanteric Femoral Fractures
Authors: Arshad Z , Thahir A , Rawal J , Hull P , Carrothers A , Krkovic M , Chou D 
Published: May 2021

Abstract

Introduction
A subtrochanteric femoral fracture occurs in the 5cm of bone distal to the lesser trochanter. This study aims to compare peri-operative outcomes of patients with such fractures treated with either an IMN or a dynamic hip screw (DHS).

Method
We retrospectively reviewed subtrochanteric fractures presenting to our institution between October 2014 -May 2019, classifying them into two treatment groups: IMN and DHS. These groups
were compared using outcomes including surgical time, blood loss, radiation dose area product (DAP), stay length, re-operation rate and mortality.

Results
During the study period, 86 patients presented with a subtrochanteric fracture, 74 (86%) receiving an IMN and 12 (14%) receiving a DHS. The DHS group showed a significantly lower blood loss (776.19 ml) and DAP (150.30 mGy.cm2) compared to the IMN group (1028.74 ml and 288.86 mGy.cm2 respectively). All other outcome measures failed to reach statistical significance.

Conclusions
Although National Institute for Health and Care Excellence guidelines recommend treating all subtrochanteric fractures with an IMN; the outcomes assessed did not show use of an IMN to be superior. This, along with the reduced financial cost associated with a DHS; may support the use of DHS over IMN for certain subtrochanteric fractures.
740 Transrenal Endovascular Abdominal Aortic Aneurysm Repair in Infrarenal Abdominal Aortic Aneurysms with Anatomically Challenging Neck outside the Indications for Use: A Novel Approach
Authors: Premnath S , Hostalery A , Bungay P , Rowlands T , Quarmby J , Singh S 
Published: May 2021

Abstract

Introduction
Transrenal Endovascular Abdominal Aortic Aneurysm Repair (EVAR) is a novel approach for Infrarenal Abdominal Aortic Aneurysms (AAA) with unfavourable neck anatomy. This study aims to evaluate the long and short-term outcomes of Transrenal EVAR.

Method
Data of patients who underwent Transrenal EVAR in a single centre over 6 years were collected. Follow up on complications and mortality for 3 years post-procedure were analysed.

Results
A total of 36 patients were identified with a mean age of 77 years (61–89 years).

Neck

anatomy

32 (88.9%) cases had a proximal neck &lt; 15mm. 21 (58.3%) had significant neck thrombus and 27(75%) had significant neck calcification. 11 (30.6 %) had an infra-renal neck angulation &gt; 60 0 and 21 cases (58.3%) had an unfavourable shape.

Outcome

Post-procedure 30-day mortality was 5.6%. 4 developed renal dysfunction. The 3-year mortality was 33.3%, only 2 patients (5.6%) died of the aneurysm related complication. 7 (19.4%) patients developed endoleak. 5 patients (13.9 %) underwent reinterventions in 3 years.

Conclusions
In view of the acceptable short term and long-term outcomes, trans renal EVAR can be offered for patients with infrarenal AAA with technically challenging neck anatomy but unfit for open repair in centres with adequate expertise.