bluuebunny/crossref_metadata_2025_split huggingface dataset:
1118 The Role of Emergency Surgery in Diverticular Strictures of Those Who Were Initially Managed Conservatively
Authors: Jayawardena P , Jayawardena O , Peris R , Rafie A 
Published: October 2021

Abstract

Aim
The presence of diverticulosis can lead to several different complications including formation of strictures. However, the literature concerning management of diverticular strictures is poor. The purpose of this study is to evaluate the patients who were initially treated non surgically and had to undergo emergency surgery.

Method
A retrospective study was performed using a cohort of patients between 2016 and 2020 where 84 patients with diverticular strictures were identified and followed up. Data on the management of diverticular stricture was captured using the hospital’s electronic medical records.

Results
Out of 84 patients with diverticular strictures, 9 had elective surgery without any medical treatment while 75 had medical treatment first. Out of the 75 patients who were medically treated, 12 underwent emergency surgery while 2/75 underwent elective surgery after receiving medical treatment due to ongoing symptoms. Out of the 12 patients that underwent emergency surgery, 9 patients presented with obstruction while 3 had a bowel perforation. 6 patients had Hartmann’s procedure, 5 had defunctioning colostomy and 1 patient had adhesiolysis. No patient deaths were recorded at 12 months.

Conclusions
Although medical management remains the preferred method of managing diverticular strictures in the UK, it is not without its complications. 1 in 5 patients had an acute surgical admission requiring emergency surgery. This raises the importance of a good ‘safety net’ in those managed non-surgically, to reduce delays associated with seeking medical advice. We also appreciate the importance of carrying out more extensive studies to establish the best way to manage diverticular strictures.
1146 Use of Prophylactic Oral Antibiotics in Preventing Postoperative Surgical Site Infections in Elective Colorectal Surgery – A Review
Authors: Arumuga Jothi A 
Published: October 2021

Abstract

Aim
To prevent postoperative surgical site infections (SSIs), prophylactic oral antibiotics (OA) administration in combination with mechanical bowel preparation (MBP) and prophylactic parenteral (IV) antibiotics have been a preoperative procedure in elective colorectal surgery. Hence, the aim of this article is to review the effectiveness of prophylactic OA in preventing SSIs in elective colorectal surgery.

Method
PubMed and Scopus databases were searched. Search criteria included keywords such as antibiotic prophylaxis, oral antibiotic prophylaxis, parenteral antibiotic prophylaxis, postoperative surgical site infection and colorectal surgery. Selection criteria included any randomised controlled trials (RCTs) which investigated the effectiveness of prophylactic OA, with or without prophylactic IV antibiotics in preventing SSIs in elective colorectal surgery in adult population, published from the years 2010 onwards. Only full text studies and papers published in English language were chosen.

Results
Ten RCTs were included in this study. Studies indicated that OA alone could significantly reduce the risk of postoperative SSIs (p &lt; 0.05). Further analysis of these studies showed that in the presence of IV antibiotic prophylaxis, there is an even greater reduction in the risk of SSIs (P &lt; 0.05). However, an article by Hjalmarsson et al. showed that there was a significantly greater rate of incisional SSIs in prophylactic OA group in comparison to prophylactic IV antibiotics group (P &lt; 0.022).

Conclusions
These studies indicate that OA in combination with IV antibiotic prophylaxis is superior to either IV antibiotic prophylaxis or OA prophylaxis respectively. Hence, it is advisable to administer a combined OA and IV antibiotic prophylaxis in elective colorectal surgery.
1266 Digital Rectal Examination: Do You Still Put Your Foot in It If You Don’t Put Your Finger in It?
Authors: Marlow N , McNamara J , Ali R , Bentley T , James M , Bond-Smith G 
Published: October 2021

Abstract

Introduction
Most surgical trainees are familiar with the aphorism ‘if you don’t put your finger in it, you put your foot in it’, with regards to digital rectal examination (DRE). This commonly taught maxim, attributed to Bailey and Love in their Short Practice of Surgery, was coined to highlight the folly of neglecting DRE in patients with histories suggestive of malignant anorectal pathology. However, data are lacking on the diagnostic yield of DRE for detecting anorectal cancer in patients with lower gastrointestinal bleeding (LGIB), whilst advances in biomarker and imaging technology beg the question: is there still a role for DRE in the assessment of patients with LGIB?

Method
We designed a clinical coding search strategy to identify all adult patients with acute LGIB referred to general surgery at a UK university hospital from January to July 2020. Electronic patient records were interrogated to identify history and examination findings, diagnoses and clinical outcomes.

Results
169 patients (median age 63 (16-94) years, 54.4% male) were identified, 74.6% (126/169) with bright red bleeding, 23.7% (40/169) with altered blood and 1.8% (3/169) with melaena. DRE was performed in 91.1% (154/169) of patients, identifying blood in 42.9% (66/154) of cases and suspicious lesions, which were subsequently confirmed as anorectal malignancy, in 1.3% (2/154).

Conclusions
DRE represents a possibly stigmatising and uncomfortable examination for patients and clinicians alike. These data support the utility of DRE in patients with LGIB and may inform the discussion at the bedside to facilitate the timely diagnosis of anorectal malignancy.
445 Review of Restarting Elective Surgical Service in District General Hospital Post COVID 19
Authors: Singh N , Chin Y F , Hajiesmaeili H , Rahman E , Vidya R 
Published: October 2021

Abstract

Aim
National Health Service (NHS) has massively reduced non-urgent elective surgical service as COVID-19 hit the UK.This study aims to evaluate the measures taken by our trust to restart elective surgical work which was suspended due to the COVID-19 pandemic.

Method
This is a single centre, retrospective, observational study. We analysed records of the first 100 patients who underwent any type of elective General Surgical operative procedure since June 2020.

Results
Our cohort included 51 female, and 49 male patients. Youngest patient was 19 years old and the eldest was of 86 years with mean age of 55.5. In our group, 16 patients were ASA grade 1, 57 were ASA 2, 26 ASA 3 and 1 patient was ASA grade 4. The median ASA grade among our patient group was 2. In this study shortest hospital stay was of 1 day and longest of 53 days with average stay of 5.2 days and SD of 7.6. In our cohort, 18 patients developed Grade 2 Clavein-Dindo(CD) Complications,6 patients developed Grade 3 and none developed complications of CD Grade 4 or beyond. Repeat COVID-19 tests for all patients staying over 7 days were negative.

Conclusions
In conclusion, through appropriate isolation and with adhering to trust guidelines, restarting of elective surgery in non-covid free hospital compound via separate pathways are feasible and should be reflected upon before stopping all elective surgical services in the future considering the threat of further waves of covid-19 or the new variant of the virus looks very real.
489 Assessing the Impact Of COVID-19 On Head and Neck Cancer Treatment and Preparing for The Next Wave
Authors: Daga K , Argus L , Goswami J 
Published: October 2021

Abstract

Introduction
As of 11th of March 2020, the World Health Organization (WHO) declared the novel coronavirus 2019 (COVID-19) a pandemic. It is estimated that urgent cancer referrals have reduced 70-89% across hospitals in England during the COVID-19 pandemic, in addition to reductions in attendance for the different treatment arms. The aim of our investigation is to assess the impact of COVID-19 on MDT outcomes and patients attending/receiving treatment as compared to before for head and neck cancer.

Method
Data was collected retrospectively over a period of 203 days (7th January to 28th July 2020), including 66 patients prior to COVID-19 being declared a pandemic and 116 patients since, at a regional cancer centre. A total of 182 patients undergoing treatment were identified. These patients were assessed by TNM staging, MDT outcomes and final initial treatment intents, which were compared to pre-COVID outcomes.

Results
With respect to MDT outcomes, there was an increase in the number of patients decided for surgery from 10.61% to 23.28% (p = 0.78) during the first wave of the pandemic. Patients decided for radiotherapy and chemotherapy increased by 12.49% and 4.31% respectively. Notably, there was a decrease in further investigations and referrals from 37.88% to 18.10%. Moreover, an increase in palliative treatment intent by 10.55% was noted during the pandemic.

Conclusions
As the UK enters into the next peak of the pandemic, with reduced capacity for elective surgery and outpatient clinics, it is essential to consider its impact on the standard of care delivered to current cancer patients.
638 The Implication of Telephone Consultations During COVID-19 Pandemic on Informed Consent
Authors: Ayoub N , Gareb F , Akhtar M 
Published: October 2021

Abstract

Aim
Is to find whether telephone consultations have affected patient’s comprehension of the proposed surgical management and possible risks until the day of surgery and accordingly ability for informed consent.

Method
This study included a sample of patients admitted to QEQM hospital for elective day case surgery during November 2020 and had only telephone consultation when referred for surgery. A feedback survey assessing quality of information given to patients before and on day of surgery was filled by the patients after the procedure.

Results
The sample included 40 patients undergoing different procedures [cholecystectomy (25), inguinal hernia repair (25), rectal examination under anaesthesia (5), ventral hernia repair (2), incisional hernia (2), inguinal lymph node biopsy (1)]. It was found that 27.5% of patients didn’t have thorough explanation of possible risks and no explanation about postoperative care in 35%.20% were not provided a leaflet about procedure, 57.5% had concerns before surgery and 75% of patients wished for a leaflet with illustrative diagrams, explanation of risks with their management to be able to take the right decision and majority of these patients were from cholecystectomy subgroup.

Conclusions
The lack of face-face appointment affected greatly the informed consent process resulting in patient dissatisfaction which raised the need for new leaflets containing diagrammatic explanation of procedures and possible risks with their management to ensure fulfilment of autonomy principle.
743 Establishing COVID-Secure Surgery: Maintaining Urgent Elective Surgery During The COVID-19 Pandemic
Authors: Phelan L , Digne-Malcolm H , Hassett D , Naumann D N , Dilworth M P , Bowley D M 
Published: October 2021

Abstract

Introduction
The COVID-19 pandemic continues to impose significant direct burdens on secondary healthcare services in the UK and around the world. Maintaining timely and safe delivery of major urgent elective surgery throughout the pandemic is essential if we are to continue to treat cancer and other time-critical surgical conditions. Our Trust established a COVID-secure hospital within the Trust to deliver urgent elective surgical care.

Method
Basic demographics, operative interventions and 30-day outcomes of consecutive patients undergoing major surgery at our COVID-secure site were collected between June-November 2020. Major surgery was defined as patients requiring admission to the Post Anaesthetic care unit (PACU). PACU provides Level 2 care for 23 hours before discharging patients to the ward.

Results
279 consecutive patients were included. PACU admission &gt;23 hours were associated with increased total length of stay (LOS) (p = 0.004), 30-day complications (p &lt; 0.0001), higher rate of transfer to a ‘COVID-hot’ hospital (p = 0.01) and nosocomial COVID-19 infection (p = 0.051). Compared to spinal anaesthesia, epidural anaesthesia was associated with PACU admission breach (p = 0.02), increased total LOS (p = 0.01), increased transfer to the ‘hot’ sites (p = 0.03) and 30-day complications (p = 0.06).

Conclusions
Establishing a COVID-secure site enabled continuation of major urgent elective surgery within a viral pandemic. Level 2 support is essential to ensure safe delivery of complex surgery at ‘cold’ sites. This study has identified clinically relevant advantage with the use of adjuvant spinal anaesthesia in preference to epidural. Enhancing critical care services is essential to minimise patient transfer to ‘hot sites’ and limit nosocomial COVID infection.
839 Patterns of Management of Acute Cholecystitis during the COVID 19 Pandemic
Authors: Brown B , Varley R , Reynolds E , Galloway S 
Published: October 2021

Abstract

Aim
The poor outcomes described by CovidSurg in patients with Covid-19 undergoing surgical intervention and the unknown safety of laparoscopic surgery initially led to increased conservative management in acute cholecystitis (AC). As the number of cases continues to rise, we aim to assess how the coronavirus pandemic has affected our service and adherence to AUGIS guidelines.

Method
We retrospectively analysed all adult admissions with radiologically confirmed AC from defined 2-month periods (pre-pandemic (PP), wave-1 (W1) and wave-2 (W2)) at an acute general surgical service without dedicated hot gallbladder lists where the prevalence of coronavirus has remained high throughout. Primary outcome was rate of index admission (acute) cholecystectomy.

Results
93 patients were included in total (PP 35, W1 33, W2 24). Demographic details were similar across all groups. Tokyo grade I (mild) cholecystitis was more commonly admitted PP (63.9% versus 48.5% and 50.0%). Conservative management was trialed in 91.7%, 100.0% and 62.5% and failed in 18.2%, 21.2% and 21.1%. Cholecystectomy rates were 13.9%, 12.1% and 29.2%. Increased use of CT in W1 has returned to PP imaging pattern in W2. 30-day readmission rates were 5.6%, 18.2% and 4.2%. Two patients in W1 tested positive for Covid-19 and were managed conservatively. No post-operative pulmonary complications were recorded and no difference in biliary complications was observed.

Conclusions
Operative management of AC as per AUGIS guidelines during the pandemic in Covid-19 negative patients is safe and improves outcomes compared to conservative management with no appreciable increase in biliary complications.
845 Diabetic Foot Care Services in COVID-19 Era – A University Hospital Multi specialty Team Experience
Authors: Ain Q , Solanki P , Georgi T , Gala T , Ashraf H , Kelleher D , Vig S 
Published: October 2021

Abstract

Introduction
Multidisciplinary foot care services contribute to the reduction in amputations from foot ulceration secondary to diabetes. The COVID-19 pandemic pressurised services and required a pause of elective care. This study reports the patient’s experience of foot care provision during the first wave where self-care, virtual appointments and patient directed appointments were utilised.

Method
Diabetic foot patients were retrospectively identified over a one-month period booked for MDT care (in hospital, OPD, diabetic foot clinic, community podiatry clinic or at home). All patients&gt;16 years of age diagnosed with a new or previous diabetic foot ulcer or post-operative foot wound were included. Data was collated via a patient survey form and descriptive statistics were used to characterize the study population and responses.

Results
63 patients were identified (1/10 – 30/10) with data collated from 51 respondents (81%). 78% (40/51) were male. Median age was 69 years (IQR 59–76). 86% were comfortable attending a hospital appointment. 92% reported continuing to receive an appropriate level of care. All of the patients felt well supported and knew how to access the foot care service. 29% utilised virtual care. 82% (42/51) considered face to face appointments were more suitable for follow up rather than virtual/phone appointments.

Conclusions
It was possible to continue to provide safe diabetic foot care despite the COVID-19 pandemic but careful patient selection and communication is the key.
888 The Impact Of COVID-19 Pandemic on Orthopaedic Trauma Workload In QEH-Gateshead
Authors: Mousa A , Zhang M , Hinsche A 
Published: October 2021

Abstract

Aim
To assess the impact of COVID-19 pandemic on Trauma workload after the social distancing and lockdown measures from mid-March 2020.
To review the evidence of local experience to support our trauma management during this pandemic to learn for the next time.

Method
Retrospective
Acute referrals and Trauma theatre cases between:

Results
Total acute referrals for T&O dropped significantly from 302 to 168 cases over the course of the same 6 weeks period in 2019 (Pre-COVID) and 2020 (Post-COVID). A significant drop in performing ORIF as definitive management of fractures from 33% to only 15% with more reliance on conservative management. During the pandemic, 26% of the fractures were NOF cases in the elderly population which was nearly half this size (15%) last year. This reflects the effect of the national lockdown on reducing the trauma workload of other injuries such as RTC, sports, and leisure activities. Mortality rates doubled postoperatively; 6 cases (2019) and 12 (2020) with 7 cases were COVID negative and 5 cases were positive. With 67 years old median age, the postoperative complications were COVID-19 respiratory infection or cohort-age-related.

Conclusions
COVID-19 virus pandemic has hit the world in March 2019. This has dropped Trauma workload significantly due to the lockdown measures which reduced accidents rates and fractures requiring fixation. Unavoidable NOF injuries remain static, regardless of the pandemic measures. Few learning points were absorbed from the first pandemic wave made us prepared for the second and third waves.
925 Maintenance of Elective Surgical Care During Covid-19 Pandemic
Authors: Digne-Malcolm H , Kanwal A , Puventhiranathan P , Phelan L , Hamid M , Hendrickse C , Dilworth M P 
Published: October 2021

Abstract

Introduction
Recent publications demonstrate significant morbidity in surgical patients with concurrent COVID-19 infection. This, combined with the redistribution of resources to support the pandemic, led to abrupt cessation in planned operating. COVID-19-free ‘cold’ sites were established to enable elective surgery to resume with reduced risk. We evaluate the outcomes and limitations of a newly established cold site.

Method
Data were collected retrospectively for all patients operated between June and September 2020 by either General Surgery or Urology. Primary outcomes were 30-day COVID-19 infection and 30-day mortality. Secondary outcomes included length of stay, 30-day complications, and need for transfer to ‘hot’ hospital sites.

Results
881 patients were included. No patients had a positive COVID-19 test within 30 days of their operation. 30-day mortality was 0.01% (n = 1). The mean (+/-SD) length of stay was 1.69+/-3.42 days. 12.15% (n = 107) of patients experienced a complication within 30 days and 11.7% (n = 103) were readmitted within 30 day of discharge. 3.3% (n = 29) of patients required transfer to a ‘hot’ hospital site. 44.8% of these were admitted to level 2 or level 3 care, 17.2% required total parenteral nutrition, and 20.7% returned to theatre.

Conclusions
‘Cold’ surgical sites are effective in preventing peri-operative COVID-19 infection. Elective surgery can therefore continue safely through the pandemic with such precautions. Further development of on-site resources, including provision for total parenteral nutrition and access to higher level care, will help to minimise the need for patient transfers to COVID-19 exposed sites.
927 Epistaxis Management in COVID-19
Authors: Chandrasekar B , Oremule B , de Carpentier J 
Published: October 2021

Abstract

Aim
Traditional management of epistaxis include endoscopic examination of the nasal cavity and/or cautery requiring close contact between doctor and patient. We aimed to reduce the length of in-patient stay for patients with epistaxis whilst maintaining patient safety during the COVID-19 pandemic.

Method
A retrospective and prospective audit was performed to assess the management of patients and their outcomes prior to and after new COVID-19 epistaxis guidelines were introduced in our unit. A PDSA cycle was undertaken.

Results
27 patients presented to our ENT department in each 3-month audit cycle. 20 patients in each group were packed. More patients were packed bilaterally in group 2. The admission rate reduced from 100% to 25%. Packing duration increased from 1.8 (in group 1) to 3 days in group 2. 1 patient in each group required surgical management. The 30-day re-bleed rate increased from 11% to 30% All re-bleeds in group 1 were admitted. Only 1 patient (3.7%) with a re-bleed in group 2 required admission. The mortality rate was unchanged. The length of time during the initial visit decreased. Hospital visits per patient (for removal of pack, pain, and re-bleeding) increased from 1.1 in group 1 to 2.7 in group 2.

Conclusions
Our COVID-19 epistaxis guidelines reduced close contact, in-patient admissions, and length of stay. However, there is an increase number of visits per patient and increase re-bleed rate (suggesting that cautery plays an important role). The next cycle plans to introduce a patient leaflet and a virtual clinic.
955 Management of A Progressed SCC Case in the COVID-19 Era
Authors: Gkorila A , Mastronikoli S 
Published: October 2021

Abstract
We herein report the case of an elderly patient who underwent amputation of their hand for a squamous cell carcinoma (SCC) due to lack of timely treatment during the COVID-19 pandemic.
The patient had a biopsy-proven SCC of the dorsum of their left hand, first diagnosed in March 2020, before the first lockdown. The lesion was 3cm, mobile, easily excisable, and the defect routinely reconstructable. Unfortunately, a number of appointments were missed and when the patient was eventually seen back in the clinic, the lesion was bigger and firmly fixed to the deeper structures. An urgent wide excision of the lesion with split skin graft reconstruction was planned. Intraoperatively, axillary lymph nodes were identified and a FNAB reported metastatic disease. After a failed attempt to fully resect the hand lesion and salvage the surrounding structures, a joint consultant decision was made that an amputation would give the patient the best chance of survival. Since the patient was lacking capacity, and following a discussion with the family, an above wrist amputation was performed in the patient’s best interests.
This case sheds light on the unseen and unrecorded victims of COVID-19. Due to the pandemic, most outpatient follow-up appointments were cancelled, and operating waiting times were significantly increased. National research studies showed that all skin cancer treatments were negatively affected by the COVID-19 pandemic. During this lockdown, there is an urgent need to continue the provision of these services as the risk of untreated skin cancer is even greater.