bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP3.1.13 Does Single-port laparoscopic appendicectomy provide better outcomes compared to conventional (three-ports) laparoscopic appendicectomy?
Authors: Mohamedahmed Ali Yasen Y , Zaman Shafquat , Stonelake Stephen , Hajibandeh Shahin 
Published: October 2021

Abstract

Aims
To evaluate comparative outcomes of single port laparoscopic appendicectomy (SPLA) and conventional three-port laparoscopic appendicectomy (CLA) in the management of acute appendicitis.

Methods
A comprehensive systematic review of randomised controlled trials (RCTs) with subsequent meta-analysis of outcomes were conducted following PRISMA standards. Post-operative pain, cosmesis, need for an additional port(s), operative time, Post-operative complications, length of hospital stay(LOS), readmission, and reoperation were the evaluated outcome parameters.

Results
Sixteen RCTs reporting a total number of 2017 patients who underwent SPLA(n = 1009) or CLA(n = 1008) were included. SPLA showed higher cosmetic score (Mean Difference (MD) 1.11,P= 0.03) but significantly longer operative time (MD 7.08, P = 0.00001) compared to CLA. However, there was no significant difference between SPLA and CLA group in the postoperative pain score at 12 hours (MD -0.13,P=0.69), need for additional port(s) (Risk Ratio (RR)0.03, P = 0.07), postoperative ileus (RR 0.74,P=0.51), SSI ( RR 1.38, P = 0.28), Post-operative intra-abdominal collection (RR 0.00,P=0.62), LOS ( MD -2.41, P = 0.16), readmission to the hospital ( RR 0.45,P=0.22), and return to theatre (RR -0.00, P = 0.49). Subgroup analysis showed that operative time was comparable in adults only subgroup (P = 0.18) while it was significantly loner in paediatrics only subgroup(P = 0.00001). Moreover, LOS was shorter in adults only subgroup (P = 0.003) and no difference observed in paediatrics only subgroup (P = 0.93).

Conclusion
SPLA is associated with a slightly longer operative time; however, its efficacy and safety are comparable to CLA. Subgroup analysis showed that SPLA has better outcome in adults than paediatrics. Additionally, SPLA offers better post-operative cosmesis.
SP3.2.10 Establishing an Emergency Surgical Ambulatory Care (ESAC) pathway for acute laparoscopic cholecystectomies: a single centre experience from a District General Hospital
Authors: Donald Neil , Varatharajan Lavanya , Ratnasingham Kumaran , Irukulla Shashi 
Published: October 2021

Abstract

Aims
Early laparoscopic cholecystectomy is the gold standard for acute cholecystitis and gallstone pancreatitis. In order to deliver this service, a local Emergency Surgical Ambulatory Care (ESAC) pathway with a dedicated ESAC theatre list was established. The aim of this audit was to determine whether ESAC was associated with (1) improved length of stay and (2) cost efficiencies.

Methods
Consecutive patients who underwent an emergency laparoscopic cholecystectomy between October 2018 to October 2019 were identified. Data related to patient demographics, operating time, complications length of stay (LOS), reason for inpatient stay and re-admissions were collected. A dedicated ESAC service was introduced in July 2020. Outcomes were re-audited (July – December 2020).

Results
Prior to the introduction of ESAC, 142 patients (42% male, mean age 51 years (range 14 -82 years)) underwent an acute cholecystectomy, of which 13% were discharged on the same day. Median pre-operative LOS was 2 days (range 0-12 days) and median post-operative LOS was 1 day (range 1-16 days). Following the introduction of ESAC, 78 patients (32% male, mean age 49 years (range 22 – 89 years)) underwent an acute cholecystectomy, of which 76% were discharged on the same day and 90% within 1 day. Median pre-operative LOS was 0 days (range 0 to 7 days) and median post-operative LOS was 0 days (range 0-16 days).

Conclusions
Our results show that the introduction of a dedicated ESAC pathway improved both pre- and post-operative LOS. This subsequently saves approximately £80,000 per annum in hospital bed days.
SP3.2.12 Do the National Emergency Laparotomy Audit (NELA) performance indicators correlate with mortality? A retrospective analysis of years 4-6
Authors: Dick Lachlan , Tucker Stefan , Bairstow Fiona , Green James , Young Jamie 
Published: October 2021

Abstract

Aims
Emergency laparotomy continues to carry significant morbidity and mortality. The National Emergency Laparotomy Audit (NELA) publishes individual hospital reports, detailing key performance indicators. We aimed to determine the impact of performance indicators on mortality.

Methods
NELA aggregate hospital reports from years 4 to 6 were used to extract data relevant to the study aims. Linear regression was used to determine if any of the reported variables could be used as predictors of mortality.

Results
An analysis of 559 hospital aggregates, totalling 73075 laparotomies was carried out. Overall, the average rate of mortality was 9.6%. There was no significant correlation between mortality with any common variable across years 4-6 data, including risk documentation before surgery, arrival in theatre appropriate to urgency, consultant review preoperatively and supervision in theatre, admission to critical care, care of the elderly assessment, unplanned return to theatre or admission to critical care and length of stay.

Conclusion
No single performance indicator alone appears to correlate significantly with mortality. Multivariable analysis may identify some performance indicators, however, given that across all the hospitals there is a high standard of performance for each of the reported variables, the variation in mortality is likely influenced by other factors not evaluated by the hospital aggregate reports.
SP3.2.14 Does the “weekend effect” exist in those patients that require emergency laparotomy?
Authors: Creedon Lee , Boyd-Carson Hannah , Varma Aarti , Tierney Gillian 
Published: October 2021

Abstract

Aims
Multiple studies have concluded that the “Weekend effect” results in worser outcomes for patients admitted during the weekend, when compared to weekday admissions. Patient presenting that require emergency laparotomy are, by default, high risk. It may be assumed that their risk of death is higher should they present during the weekend. The aim of this study was to identify if this cohort of admissions is at an increased risk of death should they present at the weekend.

Methods
All patients entered into the National Emergency Laparotomy Audit database from December 2013 up to and including November 2017 from two independent acute hospitals were included. Adjusted regression analysis (NELA risk score, grade of surgeon and anaesthetist, post-operative admission to critical care and procedure performed) was performed investigating the association between day of admission to hospital and 60-day post-operative mortality. Sunday was used as comparator variable.

Results
Study cohort included 1346 patients, overall 60-day inpatient mortality was 9.63% (134 patients). Following risk adjustment there was no increased risk of mortality when investigating day of admission to hospital; Monday Odds Ratio (OR 1.60, 95% Confidence Intervals (CI) 0.69-3.71), Friday (OR 2.01, 95% CI 0.85-4.7).

Conclusion
Risk of death in those that require emergency laparotomy is not affected by day of presentation to hospital.
SP4.1.8 Patient satisfaction with telephone versus face-to-face consultations during the COVID-19 pandemic
Authors: Psaltis Emmanouil , Tzatzidou Anastasia , Chua Yunli , Abdullmalek Hidayatul , Kanakala Venkatesh 
Published: October 2021

Abstract

Aims
Patient satisfaction is an important and commonly used indicator for measuring the quality in health care. During the COVID-19 pandemic, several face-to-face appointments in the outpatient clinics have been converted to telephone consultations. The aim of this study was to compare patient satisfaction following telephone consultations over face-to-face appointments in General Surgery.

Methods
A retrospective survey on consecutive patients (n = 63) was conducted over the telephone by independent interviewers. Group I (n = 36) consisted of patients who had telephone consultations and Group II (n = 27) of patients who had face-to-face appointments. Patient satisfaction was recorded using the Generic Medical Interview Satisfaction Scale (G-MISS) questionnaire as it has been validated for use in General Surgery. Statistical analysis was performed to assess for any differences between the two groups in the cumulative satisfaction scores and the three dimensions of the G-MISS questionnaire, “relief”, “compliance” and “communication”.

Results
Median, Q1-Q3 of the satisfaction score in Group I (77.3, 62.1-93.3) did not statistically differ compared with Group II (76.5, 62.5-93.3, p = 0.91). “Relief” in Group I (78.1, 57.0-92.9) did not significantly vary compared with Group II (75.0, 53.1-93.7, p = 0.85). “Compliance” in Group I (62.5, 50.0-96.8) was very similar with that in Group II (75.0, 50.0-100.0, p = 0.82). “Communication” in Group I (87.5, 71.8-98.9) was also very similar compared with Group II (87.5, 75.0-100.0, p = 0.74).

Conclusions
We demonstrated high levels of patient satisfaction with telephone consultations. Therefore, during the pandemic the services of the outpatient department remain of high quality. Considering the economic benefits to the NHS, telephone consultations might be “here to stay”.
SP4.1.10 Colorectal Cancer Services During the First Wave of the COVID-19 Pandemic
Authors: Olugbemi Mojolaoluwa , Kitmiridou Despoina , Bavikatte Akshay , Keeling Neil 
Published: October 2021

Abstract

Aims
During the first wave of the COVID-19 pandemic, UK health services ceased National Bowel Cancer Screening programme and non-emergency diagnostic services were halted. This retrospective study evaluated the colorectal cancer (CRC) service at a district general hospital during that period by comparing the CRC services from 31/03/2020 to 28/06/2020 to services offered during the same 3-month period of the previous year.

Methods
65 patients were included in the study (47 from 2019 and 18 from 2020). Demographics, referral modes, treatment aims and Dukes cancer staging at diagnosis were compared. À2 and Fisher’s exact tests were used.

Results
There was a 61.7% decrease in the volume of patients managed and 65.7% reduction in operations relative to the previous year. The mean age(years) of 66.6 (S.D 14.1) during the pandemic was lower than the average during the non-COVID year (75.5(S.D 13)) but gender distribution was similar. COVID-year referrals originated from rapid access pathway (61%), emergency (28%), routine referrals (11%), screening (0%) compared to 56%, 21%, 21%, and 2% respectively during the non-COVID period. Dukes staging varied with Dukes D doubling (39% vs 17%) and no Dukes A (6% in 2019) during the pandemic. The treatment goal during the pandemic was palliative in 44% vs 32% in the other group.

Conclusion
Cessation of non-emergency diagnostic pathways that support identification of early disease contributed to diagnostic delays with increased proportion of palliative/Dukes D disease. Normal CRC services should be sustained during future pandemics to avoid missing curable disease.
SP4.1.12 The impact of COVID-19 on the pattern of presentations with acute lower gastrointestinal bleeding
Authors: Marlow Neale , McNamara John , Ali Roshneen , James Michaela , Bentley Tom , Bond-Smith Giles 
Published: October 2021

Abstract

Aims
Following the initial surge of COVID-19 cases in Spring 2020, data began to emerge on the negative impact of the disease on outcomes for serious medical conditions such as heart disease and stroke. However, the impact of COVID-19 on the pattern of emergency presentations with lower gastrointestinal bleeding (LGIB) has not been published to date.

Methods
We designed a clinical coding search strategy to identify all adult patients with acute LGIB presenting to the Emergency Department (ED) and the Surgical Emergency Unit (SEU) at a UK university hospital from January to July 2020. For context, data on number of overall presentations to ED and SEU were also collated for the same period.

Results
169 patients (median age 63 (16-94) years, 54.4% male) with acute LGIB were identified across the six months. A graphical representation of these data demonstrated notable trends. Overall weekly ED attendances dropped by 52.0% after the national lockdown (from 1500 to 720 patients), before returning to 77.7% of pre-lockdown levels by the end of the study period (1165 patients). Pre-lockdown, there was a fluctuating number of weekly attendances with acute LGIB. After lockdown, consistently fewer patients presented and there was a reduction in the variability of numbers week on week.

Conclusions
These novel data support recently published trends demonstrating a post-lockdown fall in emergency attendances, although the decrease in weekly attendance with acute LGIB was less marked, perhaps reflecting the concerning nature of this symptom for patients.
SP4.1.14 Single centre experience in managing acute appendicitis during COVID-19 pandemic
Authors: Kolaityte Valdone , Mukhopadhyay Ishani , Newport Daniel , Aslam Imran 
Published: October 2021

Abstract

Background
Given the pressure of COVID pandemic, the UK Intercollegiate guidance encouraged a move towards non-operative or open appendicectomy management of acute appendicitis. The aim of the study was to assess the approaches used to manage acute appendicitis and their outcomes during pandemic peak and after it.

Methods
This was a single-centre retrospective study, 2-observer data collection. We collected and analysed data on acute appendicitis management approaches (surgical and non-surgical) and patient outcomes were compared during the peak of the pandemic (04-2020 to 06-2020) and post-peak (07-2020 to 09-2020) periods.

Results
190 patients - (peak – 88, F:M=1.09, median age – 30.5) and post-peak 102 (F:M=1.12, median age -31)). There were no significant differences for APPY risk score, ASA grade, comorbidities between the groups. There was more diagnostic imaging performed during the peak of the pandemic (peak 71.6%, post-peak – 56.9%) (p = 0.035 X2=4.431). Comparison between managing patients during peak and post-peak showed that approaches were the following: conservative (14.8% vs 14.7%, P = 0.998), laparoscopic appendicectomy (65.3% vs 96.6% P = &lt;0.001), open appendicectomy (34.7% vs 3.4% P = &lt;0.001). There was no significant difference in postoperative complications (Clavien-Dindo II-IIIb), readmission to hospital, or total LoS (median=3 days) between the groups (p &gt; 0.05). Median LoS for patients treated conservatively was 1 day. Only 1 patient developed COVID postoperatively, the mortality was 0%.

Conclusions
Treatment strategies adapted and modified in COVID peak were effective and safe in managing acute appendicitis. Laparoscopic surgery remained a safe practice even in the peak of COVID pandemic.
SP4.1.16 V is for vicious: a COVID burnout vector perspective
Authors: James Osian , Bowman Chris , Luton Oliver , Robinson David , Hemington-Gorse Sarah , Lewis Wyn 
Published: October 2021

Abstract

Aims
No employment sector has been more heavily pressed by COVID-19 than healthcare. This study aimed to characterise surgical trainee burnout related to the pandemic, following a previous observational cohort study reporting 59% burnout.

Methods
A 36-point survey, including the 22-point Maslach Burnout Inventory evaluated emotional exhaustion, depersonalisation, and personal accomplishment amongst all surgical trainees within a UK Statutory Education Body, with responses received from 121 (75 Core (CST), 46 Higher Surgical Trainees (HST)).

Results
High burnout levels were evident across one, two, or all three domains in 60.3% (n = 73), 32.2% (n = 39) and 13.2% (n = 16), respectively. Median emotional exhaustion, depersonalisation and personal accomplishment scores were 19 (range 0-48), 7 (0-25) and 36 (6-48), respectively. Median emotional exhaustion score was related to age (25-29yr 25 vs. &gt;40yr 4; p = 0.016), trainee grade (CST 23 vs. HST 13; p = 0.001) and parenthood (parents 13 vs. not parents 21; p = 0.011), as was depersonalisation: 9 (25-29yr) vs. 1 (&gt;40yr; p = 0.001), 8 (CST) vs. 6 (HST; p = 0.006) and 5 (parents) vs. 8 (not parents; p &lt; 0.001), respectively. COVID-19 induced curriculum working pattern disruption was observed in 82.6% (n = 100), with 31.4% (n = 38) redeployed away from surgery. Barriers to training and career development were the commonest stressors (71.9%) and more prevalent among younger trainees (25-29yr. 76.8% vs. &gt;40yr. 28.6%; p = 0.045) and CST (80.0% vs. HST 58.7%; p = 0.011). Clinical workload concerns were associated with emotional exhaustion (OR 3.12; p = 0.008).

Conclusions
Burnout endures, though unique adverse clinical work environments may have boosted resilience. Countermeasures including Enhanced Stress Resilience Training remain a priority.
SP4.2.3 Single centre concept of ‘cold site’ elective surgery during the peak of COVID-19 pandemic: a cohort study
Authors: Iqbal Muhammad Rafaih , Dhahri Adeel Abbas , Darwish Nourelhuda Mohammed Mustafa , Vijay Vardhini 
Published: October 2021

Abstract

Objective
The COVID-19 pandemic caused a major strain on healthcare systems across the globe. As these systems got overwhelmed with the emergency care of the infected patients, widespread cancellations of elective surgery occurred. Our hospital utilised local private hospital as a dedicated cold site (CS) for urgent elective surgery during the peak of the COVID-19 pandemic. We aim to analyse the outcomes at this dedicated cold site.

Method
A retrospective review of a prospectively maintained database of all the cases operated at the CS during a 2-month period (30 March 2020 to 29 May 2020) was carried out. The primary outcome was 30-day COVID-19 related mortality. The secondary outcomes were 30-day non-COVID-19 related mortality, complications, readmission and development of COVID-19 symptoms.

Results
A total of 153 patients were operated on at the CS over the study period with a median age of 57 years (Interquartile range, IQR 47 – 70). 62% were females and 82% had a Body Mass Index (BMI) less than 30. 73% of the operations were performed for cancer. 59% of the surgeries were graded as intermediate and 26% as major or complex. There was no mortality at 30 days from COVID-19 or non COVID-19 causes. There was only 1 (0.65%) readmission. 7 patients (4.57%) developed complications. 1 (0.65%) patient was diagnosed with COVID-19 in the postoperative period while 3 had COVID-19 symptoms but were tested negative.

Conclusion
Urgent elective surgery is safe and feasible during the COVID-19 pandemic if a dedicated cold site is available.
SP4.2.4 Single centre experience of ‘Green Zone’ elective general surgery after the first wave of COVID-19
Authors: Iqbal Muhammad Rafaih , Subramonian Subiksha , Matwala Kabir , Morrison Catherine , Uddin Aaliya , Lovett Bryony 
Published: October 2021

Abstract

Introduction
Elective surgery came to a halt during the first wave of COVID-19. The safe resumption of elective surgery with COVID-19 prevalent in the community, remains a significant challenge. The aim of this study was to look into the outcomes of elective general surgery in a dedicated ‘Green Zone’ following the first wave of COVID-19.

Methods
A ‘Green Zone’ pathway was drafted which was meant to provide a COVID-free environment for patients. Prospective data was collected on consecutive patients who underwent elective general surgical procedure at a single NHS trust over a 10-week period (1st Sept 2020 - 10th Nov 2020). The primary outcome was 30-day COVID-19 mortality. Secondary outcomes included 30-day nonCOVID-19 mortality, readmissions and complications.

Results
The study included 185 patients with a median age 55 years (IQR 41-67); 96 (52%) were females. Majority of the patients were ASA 2 (n = 98, 53%) followed by equal number of ASA 1 and ASA 3 (n = 42, 23%). 33 patients (18%) had been shielding earlier in the year. 96% underwent general anaesthetic. Most of the cases were day cases (n = 131, 71%). There was no 30-day COVID-19 or nonCOVID-19 mortality. One patient developed COVID-19 three weeks after the index operation. 30-day readmission and complication rate were 5% (n = 10) and 10% (n = 18). Most of the complications were Clavien-Dindo grade 1(n = 8, 4%) and 2(n = 8, 4%).

Conclusion
This study has shown that dedicated ‘Green Zone’ elective operating pathway is safe provided a balanced risk assessment approach is adopted.
SP4.2.7 Outcomes following reorganisation of colorectal cancer pathway using FIT testing and a locally developed risk stratification score in a busy District General Hospital in United Kingdom during the COVID-19 pandemic
Authors: Gani Akil , Vijay Vardhini , Allgrove Carol , Vivekanandan Shanmuga 
Published: October 2021

Abstract

Aims/Introduction
Limited availability of endoscopy and CT colonography led to significant pressures on the colorectal cancer pathway during the COVID-19 pandemic. Risk stratification was necessary to determine the order in which patients on the tracking list could access diagnostics. Based on national guidance, patient symptoms and FIT test results, we used a locally developed risk stratification score (RSS). The aim of this study was to evaluate the impact the RSS had on patient diagnoses over a period of 8 months

Methodology
A prospectively maintained database was used to assess the outcomes. Based on their symptoms, patients on the colorectal 2ww pathway were invited to provide FIT samples if eligible. Diagnostics were prioritised using RSS. Results were analysed to assess how the cancer diagnostic yield during the pandemic compared to a similar period the year before.

Results
There were 1133 patients referred on the colorectal 2ww pathway between May - December 2020. 884 of these patients had FIT testing and 249 were not eligible. Of the 69 colorectal cancers diagnosed, 25 were in the FIT group and 44 in those not eligible. The RSS stratified to high or indeterminate risk in the non-FIT group was 31 and 23 in the FIT group. Compared to the previous year’s number of 59 patients diagnosed between May - December 2019, no statistical difference was found.

Conclusion
Our study shows that FIT testing and RSS led to an equivalent pick up rate of colorectal cancer and can be utilised in clinical settings with limited resources.
SP4.2.9 Investigation of patients with qFIT &gt;400µg/g during the initial stages of the COVID-19 pandemic
Authors: Fox Katherine , Bradley Nicholas , Hendry Paul , Crozier Joseph , Rodger Mark 
Published: October 2021

Abstract

Background
During the initial stages of the COVID-19 pandemic non-emergency endoscopy was suspended as per BSG recommendations, resulting in altered pathways for investigation of suspected malignancies. In our unit, patients referred via suspected colorectal cancer (CRC) pathways with a quantitative faecal immunochemical test (qFIT) &gt;400 µg/g were offered CT imaging in the first instance.

Methods
We accessed our electronic records to retrospectively identify patients referred with a qFIT &gt;400 µg/g between March and May 2020. Patient demographics, previous medical history, and referral details were recorded. Primary outcome was incidence of new CRC diagnosis.

Results
21 patients were included. Median follow-up was 218 days, and median time from referral to CT was 17 days. 3 (14.3%) patients had new cancer diagnoses;2 CRC and 1 lung. 42.8% of patients had normal investigations, or benign colorectal pathology. 95.2% patients went on to have an endoscopy; low risk polyps (28.6%), high risk polyps (4.8%) and IBD (9.6%) were identified. 57.1% of patients were discharged following endoscopy, with the remaining 42.9% needing further management which included referral to other specialties and repeat scopes.

Discussion and conclusion
CT scanning did not reduce the need for subsequent endoscopy, but aided in prioritising patients for subsequent investigation. There were no cases of CRC identified endoscopically which were not identified by CT imaging. In conclusion, CT is a viable alternative to endoscopy when restrictions are placed on endoscopy services.