bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels
Authors: Hardy Edward , Smart Thomas , Hatt Jacob , Lund Jon 
Published: October 2021

Abstract

Aims
General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS).

Methods
Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change.

Results
89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care.
There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, &gt;4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, &gt; 4D 35%).

Conclusions
A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.
SP3.2.5 Meta-analysis of the incidence of right-sided colon cancer in patients aged over 40 with acute appendicitis: Implications for routine preoperative CT scan and follow up colonoscopy
Authors: Hajibandeh Shahab , Hajibandeh Shahin 
Published: October 2021

Abstract

Aims
To determine the incidence of right-sided colon cancer in patients aged over 40 with acute appendicitis.

Methods
We performed a systematic review in accordance with PRISMA statement standards. A search of electronic information sources was conducted to identify all studies reporting the incidence of right-sided colon cancer in patients aged over 40 years with acute appendicitis. The ROBINS-I tool was used to assess the risk of bias of the included studies. Fixed-effect and random-effects models were applied to calculate pooled outcome data.

Results
Eight studies, enrolling 4328 patients, were included. The mean age of patients was 59 (95% CI 53-65); 54% were male (2330 out of 4328). The diagnosis of appendicitis and colon cancer were based on histological assessment only. In patients aged over 40 years the pooled incidence of right-sided colon cancer was 1.043% (95% CI 0.762-1.367); the level of between-study heterogeneity was low (I2=0%, P = 0.45). The risk of right-sided colon cancer in patients aged over 40 with acute appendicitis was significantly higher than the risk in general population (standardised risk ratio: 10.65 95% CI 3.83 - 29.66, P &lt; 0.0001). The number needed to treat was calculated as 112 patients (95% CI 83 - 171).

Conclusions
The risk of right-sided colon cancer in patients aged over 40 years with acute appendicitis is 10 times higher than the risk in general population. This suggests a need for routine preoperative CT scans and follow up colonic assessment in all patients aged over 40 with acute appendicitis.
SP3.2.7 Surgical techniques in emergency hernia repair - what are we doing? Findings from the MASH study
Authors: Green Susanna ,   MASH Steering Group,   MASH Collaborators
Published: October 2021

Abstract

Aims
There is limited evidence to guide the emergency management of acutely symptomatic abdominal wall and groin hernias (ASH) and there is a lack of consensus on optimal surgical technique. This study aimed to explore surgical techniques used to repair ASH.

Methods
A prospective 12-week cohort study (NCT04197271) recruited adult patients with ASH across 23 UK sites. Baseline characteristics, quality of life, management strategy and 30/90-day outcomes were collected. For those undergoing surgery, detailed information was recorded on: time to surgery, anaesthetic technique, grade of surgeon, intraoperative findings, antibiotic use, operative approach, repair technique (mesh vs suture), mesh/suture type and position and whether bowel resection/stoma formation was required.

Results
Of the 264 patients recruited, 214 (82%) underwent acute repair within 48 hours of admission. 95% underwent open repair, with 93% under general anaesthetic. 5% of inguinal and femoral hernias had laparoscopic repair. Mesh was used in 89% of inguinal hernias vs 29% of umbilical hernias. The majority (86%) used a synthetic non-absorbable mesh (94% inguinal, 84% umbilical). Mesh placement varied widely for epigastric and umbilical hernia, with onlay used most commonly (24%). Similar variation was seen in suture choice. 8% developed an SSI by 30 days, the majority of which were in umbilical repairs. One patient developed early hernia recurrence (umbilical) requiring surgery.

Conclusions
This data demonstrates variation in the surgical management of ASH, especially with the use of mesh. Laparoscopic surgery was uncommon. Further studies are required to clarify optimal technique strategies in the emergency setting.
SP3.2.9 The concordance between emergency CT reporting in non-traumatic abdominal pain with surgical findings at laparotomy
Authors: Edwin Claire , Bradley Alice , Liccardo Filomena , Bowman Georgina , Crisford Sophie , Pawa Nikhil 
Published: October 2021

Abstract

Aims
Abdominal CT imaging is commonly used to assess the acute abdomen, and is relied upon by clinicians in decision making, often influencing the timeliness of intervention. Increased demand for CT imaging has led to departments out-sourcing reporting out of hours. The aim of this audit was to evaluate the concordance between emergency laparotomy findings and pre-operative CT reports.

Methods
115 patients underwent emergency laparotomy with a pre-operative CT scan pertinent to the clinical episode (May 2019-October 2020). 2 surgical assessors independently assessed the CT reports and laparotomy findings to determine discrepancies. Using published audit standards, discrepancies were defined as major-felt to affect patient treatment- and further classified as false positive, false negative, misdiagnosis, indeterminate; or minor and unlikely to change course of patient care.

Results
32/115 had discrepancies, 28/32 major (16/28 misdiagnosis, 4/28 false negative, 3/28 false positive, and 5/28 indeterminate). 71/115 reported by in house radiology. 19/71 discrepancies reported in house (16 major, 3 minor), 13/32 discrepancies reported by out of hours service (12 major, 1 minor). Relative risk of major discrepancies between in house radiology and out of hours service was 1.2 (p = 0.5).

Conclusions
Published audit standards are that CT reports should have &gt;90% concordance with laparotomy findings; this audit found concordance in 76%. Further analysis comparing gastrointestinal vs. non-gastrointestinal specialist radiologist to assess the impact on concordance will be performed. We aim to explore the discrepancies, and seek to identify if our imaging and operating practices can be improved.
SP4.1.15 Maintaining elective surgery in a district general hospital during a global pandemic. Lessons in surgical leadership and collaborative working from the first wave of COVID-19
Authors: Jones Dylan , Owen Amy , Swarnkar Keshav , Gomez Kelvin , Somasekar Krishnamurthy , Delicata Raymond 
Published: October 2021

Abstract

Aims
To share our experience of maintaining elective surgery, during the 1st wave of COVID-19. Paucity of evidence regarding COVID-19 pathogenicity provided an opportunity for surgical leadership to collaborate with infection control in establishing local guidelines for mitigating Nosocomial transmission. We aim to demonstrate that early engagement with management facilitating an interdepartmental collaborative approach can provide lessons for maintaining clean elective surgical pathways.

Methods
Retrospective audit April – June 2020 using a digital electronic patient record system (CWS) linked to an operating theatre system (Ormis). Review of published guidelines.

Results
Mean Age 61 (24-89). Mean ASA 2, Performance Status &lt;1. 86% swabbed &lt;5 days pre admission, 25% &lt;3. 3 -ve postoperative COVID-19 swabs. No deaths. Peak Community case rate 110\100,000 population.

Conclusions
Elective Colorectal/Breast Cancer and urgent Biliary/General surgery was successfully maintained at the peak of the 1st wave in a region with high community transmission. No perioperative COVID-19 infections\mortalities. Our experience of leading collaboration with management\key departments can provide lessons in maintaining elective surgery in the face of repeated waves of COVID-19 or indeed future viral pandemics.
SP4.2.1 The Global impact of COVID-19 on Surgeons and Team members (GlobalCOST) Study
Authors: Jaffry Zahra , Sobti Anshul , Negida Ahmed , Singh Bijayendra , Brennan Peter , Imam Mohamed 
Published: October 2021

Abstract

Aims
To describe the impact of the COVID-19 pandemic on the well-being of surgeons and allied health professionals across the world and assess the support provided by their institutions.

Methods
An online survey was distributed through medical organisations, social media platforms and collaborators from the 15th of July to the 15th of December 2020.

Results
1590 responses were received. 80.0% were surgeons, 6.4% nurses, 5.3% assistants, 3.1% anaesthetists, 1.4% operating department practitioners and 3.8% classed as other. Of participants, 64.0% had found difficulty gaining access to personal protective equipment (PPE), 29.8% had not received training on its use and 32.0% had become physically ill since the start of the pandemic (59.9% of which were due to COVID-19 symptoms). 29.0% saw a decrease in salary and 35.2% a decrease in time spent with family. Between a time two weeks before the start of the pandemic and after, there was a significant increase in mean scores for depression (4.22 (CI = 3.98-4.46)) and anxiety (2.24 (CI = 2.01-2.46)), based on the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) respectively (p &lt; 0.0001). In terms of support, only 36.0% had easy access to occupational health, 58.5% were able to take regular breaks, 16.5% had access to 24 hour rest facilities and 14.2% to 24 hour food and drink facilities.

Conclusions
This work has highlighted a need and ways in which to improve conditions for the health workforce. This will inevitably have a positive effect on the care received by patients.
SP4.2.2 The hidden harm of conservative management in emergency general surgery during the COVID-19 pandemic
Authors: Jackson Andrew , Ng Oliver , Bharathan Balamurali , Simpson Alastair , Humes David , Parsons Simon 
Published: October 2021

Abstract

Aims
Appendicitis, biliary disease and abscesses make up almost half of the emergency general surgery (EGS) workload. Our aim was to establish whether the shift towards non-operative management during the COVID-19 pandemic for these conditions has led to adverse patient outcomes.

Methods
Patient data were analysed from a prospective EGS database at a large UK tertiary centre. Patients were grouped by admission date into quarters (January-March, April-June, July-September, October-December) and compared with the corresponding time period from the preceding year.

Results
EGS saw 8226 and 7589 patients in 2019 and 2020 respectively. Following the first lockdown EGS admissions fell by 31%. Operative management of appendicitis fell from nearly 100% in 2019 to 32.9% and 54.7% in two of the four study periods. Complicated appendicitis was more common in 2020 leading to a 50% rise in length of stay (LOS), 4.5 days average. 30 day readmissions increased by 228% (n = 7, 2019 v n = 16, 2020). Biliary disease was managed conservatively with 11 patients undergoing percutaneous drainage from Apr-Dec 2020.Very few patients received emergency cholecystectomy in 2019 or 2020 due to institution preference. Readmission rates and LOS remained similar between years. Fewer abscesses were seen and operated on in 2020 with similar readmission rates and LOS between years.

Conclusions
Non-operative management and delays in presentation of appendicitis during the pandemic has had an adverse effect on patient outcomes. The rise in more complex cases has led to higher readmission rates and longer lengths of stay. The outcomes for biliary disease and abscesses remained unchanged.
SP4.2.6 Colorectal cancer services during COVID-19; an experience of a tertiary centre
Authors: Shang E , Hamer N , Jha T , Abu Talib M , Garg D , Jha M 
Published: October 2021

Abstract

Aims
COVID19 has placed unprecedented constraints on healthcare services. Colorectal cancer (CRC) care was one of the many areas predicted to suffer due to these additional pressures. We believe that despite the challenges posed by COVID19, we have continued to deliver a standard of care for elective and emergency CRC resection that compares favorably with the national average.

Method
We conducted an analysis of the elective and emergency CRC resections carried out at a tertiary center over a 10-month period (Feb-Dec 2020). Data was collated from patient, operative, and theatre records and compared to the national average as defined by the 2020 National Bowel Cancer Audit (NBOCA).

Results
A total of 227 patients underwent surgery (189 elective and 38 emergencies), with a median age of 69. Of these, 153 were laparoscopic (67%), 57 open (27%), and 17 robotic (7%). The median length of stay was less than the national average; 5 days for elective surgery (NBOCA: 6) and 8 days for emergencies (NBOCA: 10). Within 30 days, overall unplanned readmissions rate was 6.5% (NBOCA: 11.6%) and return to theatre was 3.2% (NBOCA: 8.4%). Elective surgery had a 90-day mortality of 1% (NBOCA: 3%) compared to 7.8% for emergencies (NBOCA: 10.5%).

Conclusion
Despite the added constraints of the COVID19 pandemic, CRC resection in our unit remains safe with better outcomes than the national standard. We have demonstrated that with adequate precaution and a concerted team effort, delivery of safe care with reasonable outcome is achievable.
SP4.2.11 Access to emergency theatre during the COVID -19 pandemic
Authors: Dosis Alexios , Lim Jie Qi , Reveendran Dharsshini , Paramjothy Kiara , Lockwood Sonia 
Published: October 2021

Abstract

Aims
To investigate the impact of the COVID-19 pandemic on general surgical emergencies and access to theatre during the pandemic.

Methods
We retrospectively reviewed emergency theatre lists in three distinct time periods: October 2019 (pre-COVID-19 era), April 2020 (first peak) and October 2020 (regional second peak). We extracted and compared data from a prospectively maintained database to calculate patient waiting times. Statistical analysis was performed with SPSS software v21.0 to compare median waiting times between groups and significance was set to a p value of &lt; 0.05.

Results

Conclusions
Despite the initial major drop in general surgical procedures and waiting times, the decreased availability of theatre lists due to staff redeployment and sickness, the introduction of routine pre-operative COVID-19 testing have all resulted in a significant increase in waiting time for urgent (CEPOD 2A) cases during the second peak.
SP4.2.15 An international multi-centre appraisal of the management and outcomes of acute CHOLEcystitis during the COVID-19 pandemic: The CHOLECOVID Study
Authors: Spiers Harry VM ,   CHOLECOVID Collaborative
Published: October 2021

Abstract

Introduction
National guidance issued in response to COVID-19 resulted in adoption of non-surgical modes of treatment in emergency surgery, including acute cholecystitis (AC). The CHOLECOVID Study is the definitive global audit of the management and outcomes of AC during COVID19.

Methods
Patients &gt;18 years admitted to hospital with radiologically confirmed AC, during two predefined 8-week time periods: P1 (pre-pandemic) 12/09/19- 12/11/19; P2 (during the pandemic) 12/03/20-12/05/20, were included. The primary outcome was 30-day all-cause mortality. Secondary outcomes included severity of AC, radiological diagnostic modalities implemented, definitive management and pulmonary complications.

Results
9,615 patients were included from 39 countries (P1:5,381; P2:4,234). 30-day mortality was higher in P2 (1.7%vs2.4%; p &lt; 0.015). Higher rates of moderate and severe AC were seen in P2 (30.1%vs35.1%;3.7%vs4.1%). First-line CT imaging was more common in P2 (36.3%vs46.3%; p &lt; 0.001). There were higher failure rates of conservative management in P2 (37.4% vs 44.4%; P &lt; 0.001). Cholecystostomy rates were higher in P2 (5.8%vs8.8%; P &lt; 0.001). Overall 4.6% (n = 193) of P2 patients were COVID-19 positive, with overall mortality of 0.7% (n = 30). There was no significant difference in pulmonary complications between COVID-19 positive or negative patients.

Conclusion
During the COVID-19 pandemic, a small increase in mortality among AC patients was noted, when compared to the pre-pandemic cohort. Patients during the COVID-19 pandemic presented with more severe AC, resulting in altered trends in diagnosis and management. New guidance and clear pathways are required to safely manage AC moving forward, in the face of further waves of COVID-19.
SP5.1.1 The harsh reality of a long waiting list for bariatric surgery, a prospective study regarding health-related quality of life (HRQoL) among morbid obese patients following bariatric surgery versus those on a waiting list, a two-year follow-up study
Authors: Rodicio Jose , Moreno María , Vico Tamara , Negrete Emilio , Valdés Covadonga , Sanz Lourdes 
Published: October 2021

Abstract

Aims
The aims of this study were to assess the changes in HRQoL during the 2 years follow-up between patients who underwent surgery and those on a long waiting list .

Methods
Between January to December 2017, 70 surgical patients and 69 patients on the waiting list were interviewed at baseline, 12-month and 24-month follow-up. Quality of life was measured by the SF-12v2 and the Impact of Weight on Quality of Life-Lite (IWQoL) questionnaires. Socio-demographics, clinical, and surgical-related variables were collected.

Results
139 patients were analyzed, with similar baseline characteristics. Analyzing the entire sample: the higher the BMI, the worse the scores in the IWQoL. Performing more qualified work improves several aspects of the SF-12v2. In contrast, patients with depression tended to score worse on all dimensions of both questionnaires, women scored worse on the Self-Esteem domain and men improved on the Mental Health one. At 12 and 24-month follow-up, statistically significant differences were found among all aspects of the questionnaires between both groups (P&lt;.001). Furthermore, scores were lower in all domains in the evolution of wait-listed patients, with statistically differences among Bodily Pain, Emotional Role, Mental Health, and Mental Component Summary domains (P&lt;.05) at 12 months, but differences were not found at 24 months.

Conclusions
The quality of life of patients undergoing bariatric surgery is normalized one year after surgery, while patients on the waiting list get worse. Knowing the benefits of bariatric surgery, working on programs with long waiting lists should move us to fight against an unfair and unacceptable situation.
SP5.1.13 Upper gastrointestinal (UGI) mural thickening on Computed Tomography (CT) and its significance in the multi-disciplinary team (MDT) pathway
Authors: Ashmore Christopher , Hunter David , Kenningham Richard , Bowrey David 
Published: October 2021

Abstract

Aims
Patients are frequently referred to the UGI MDT based on CT reported thickening of either the oesophagus, stomach or duodenum. We have sought to illustrate the efficacy of CT within the UGI cancer referral pathway.

Method
A retrospective analysis was carried out on patients referred to the UGI MDT at a University Teaching Hospital over a 22-month period. Patients referred with CT evidence of UGI tract thickening prior to endoscopy were included. CT findings were correlated with symptomatology, subsequent endoscopy and histology findings.

Results
442 patients were referred to the UGI MDT between April 2014 and February 2016. 125 were referred for CT thickening alone (67 (53.2%) oesophageal, 49 (39.2%) gastric, 9 (7.2%) duodenal). 49 (39.2%) patients were subsequently diagnosed with UGI cancer, 57 (45.6%) had evidence of benign disease and 18 (14.4%) patients had no abnormality evident on endoscopy. CT thickening of 15mm and above was significantly more likely be malignant versus thickening less than 15mm [42/87 (48.3%) vs 7/38 (18.4%); p &lt; 0.05]. Patients with thickening in the presence of a hiatus hernia were significantly less likely to have an associated cancer vs those without [3/26 (13%) vs 20/42 (51.1%); p &lt; 0.05].

Conclusion
We conclude that patients should not be referred for MDT opinion on CT evidence of UGI thickening alone. All patients should have an endoscopy prior to referral, particularly those with a hiatal hernia on CT. A high index of suspicion for malignancy should be adopted in patients with thickening greater than 15mm on imaging.
SP5.2.3 Comparison of Open Abdomen Management Techniques in a cohort of patients with Encapsulating Peritoneal Sclerosis – A large single centre retrospective review
Authors: Bannon Aidan , Leatherby Robert , Birtles Linda , Augustine Titus , Moinuddin Zia , Dellen David van 
Published: October 2021

Abstract

Aims
Encapsulating peritoneal sclerosis (EPS) is a rare phenomenon characterised by encasement and obstruction of the bowel by thickened peritoneum. In our centre, EPS laparotomies are typically managed with open abdomen (OA) and planned relook at 24-48 hours. The aim of the study was to compare ABTHERATM open abdomen negative pressure wound therapy (NPWT) with packing (betadine-soaked gauze) as temporary abdominal closure (TAC) techniques in OA management.

Methods
We performed retrospective analysis of a contemporaneously maintained database of all patients who underwent surgery for EPS between 2010-2020. A variety of variables were included with the primary endpoint being time to definitive fascial closure. Patient demographics, surgical complications, subsequent method of closure (including mesh usage) and outcomes were recorded.

Results
99/122 patients underwent open abdomen management. 43/99 were managed with NPWT and 56/99 were managed with packing. The NPWT group had significantly higher fascial closure rates without need for subsequent bridged (mesh) closure when compared to the packed abdomen [62.8% vs 12.5%, (p &lt; 0.001, c2 test)]. In the NPWT group, there were also fewer failed closures [4.7% vs 19.6%, (p = 0.03, c2 test)] along with shorter time to definitive closure and reduced theatre episodes. No incidence of intestinal fistulation was associated with NPWT.

Conclusion
This study provides definitive guidance as to the benefit of ABTHERATM open abdomen NPWT for fascial closure following open abdominal management. ABTHERATM open abdomen NPWT provides significant advantages over traditional methods of TAC and may provide benefit in OA management in other patient groups (sepsis and trauma) as well.