bluuebunny/crossref_metadata_2025_split huggingface dataset:
EP.WE.205Impact of the Covid-19 Pandemic on Loop Ileostomy Formation
Authors: Farrow E Z , Cook T A 
Published: October 2021

Abstract

Aim
Uncertainty during the early phases of the Covid-19 pandemic regarding availability of critical care beds and peri-operative impact of SARS-CoV-2 led to changing intercollegiate guidance in favour of increased stoma formation. This study assessed the impact the Covid-19 pandemic had on loop ileostomy formation.

Methods
Data were reviewed from a prospectively collected database on the number of loop ileostomies formed over a 10-month period from 1st March to 31st December 2020. Comparison was made with the same period in 2019. Details were confirmed using clinical letters.

Results
114 loop ileostomies were formed in the 20-month period. There was a 10.0% reduction in loop ileostomy formation in 2020 compared with 2019. The median number of loop ileostomies formed per month over the two 10-month periods was 6. This peaked at 11 in April 2020 coinciding with the first wave of Covid-19, falling in subsequent months. All 11 of these loop ileostomies were formed in colorectal cancer patients undergoing anterior resection, after appropriate counselling.

Conclusions
There was a reduction in the number of ileostomies formed in 2020 compared with 2019 reflecting the impact of the Covid-19 pandemic on both elective and emergency case load and presentations. These results show reactive change in surgical practice corresponding to guidance at a time of maximum uncertainty. Primary anastomosis still occurred but with an increased likelihood of a defunctioning stoma to minimise the consequences of an anastomotic leak. A subsequent reduction in stoma formation in the following months indicates that practice rapidly returned to normal.
EP.WE.308COVID-19 and the impact on oncological surgery at a district general hospital
Authors: Brown Jasmine , Dick Lachlan , Berlansky Martin 
Published: October 2021

Abstract

Introduction
Covid-19 has had a significant impact on all aspects of healthcare. Efforts to maintain oncological surgery have continued throughout the pandemic despite facing significant challenges. We aimed to characterise our experience of oncological surgery during the first 2-months of the pandemic in Scotland and compare that with the same period in 2019.

Methods
A prospective cohort study was performed from 23/03/20 to 07/05/20. All elective oncological operations at a single district general hospital, predominantly managing breast and colorectal malignancies, were included. Data on patient demographics, waiting time to surgery, inpatient characteristics and oncological outcomes were recorded. Statistical analysis was used to compare these with retrospective data from 2019.

Results
A total of 37 patients were included, 18 in 2019 and 19 in 2020. There were no differences in patient age (63 vs 66.2 years, p = 0.486), length of stay (5.3 vs 4.3 days, p = 0.697) time spent on waiting list (25.4 vs 20.9 days, p = 0.303) or surgical approach (p = 0.300). Oncological outcomes were comparable with no statistical difference in clear resection margin status (88.9 vs 84.2%, p = 0.189) or positive nodal status (5.6 vs 26.3%, p = 0.086). No patient in either cohort had a post-operative complication.

Conclusion
Oncological surgery during Covid-19 can be performed safely and with favourable oncological outcomes. The longer-term effects from delayed diagnoses remain to be evaluated.
EP.WE.339The Role of a “Clean Ward” Model in Minimizing COVID-19 Exposure for Elective General Surgical Patients
Authors: Deeny Dearbhla , Kerr Rebecca , Davidson Sophie , McKay Damian 
Published: October 2021

Abstract

Aims
To assess if a “clean ward” model is effective in preventing peri-operative COVID-19 infection in elective general surgical patients.

Methods
Elective general surgical cases were audited prospectively in three thirty-day cycles - May–July 2020, September–October 2020 and December 2020–January 2021. Patients isolated for 10 days and required a negative COVID swab prior to admission. Nursing and surgical staff underwent weekly swabbing, operations were carried out in a dedicated “clean theatre” and a no-visiting policy was enforced. Inpatient COVID cases and COVID-19 status at 14 days post discharge were recorded and compared to the community COVID-19 Reproduction (R) number.

Results
Cycle 1, (May-Jul 20, R number=0.3-1.5) 44 elective patients. One patient was diagnosed with clinical COVID post-operatively and recovered well.
Cycle 2, (Sept-Oct 20, R number=0.8-1.8) 57 patients identified. No positive COVID-19 cases during inpatient admission or at 14 days post discharge.
Cycle 3, (Dec 20-Jan 21, R number=1.0-1.9) 38 elective patients. One patient tested positive for COVID-19 following transfer to the emergency surgical ward due to COVID-19 related bed pressures. No other positive cases were identified during follow up.

Conclusions
Despite an ongoing rise in community COVID-19 cases, the “clean ward” model appears to be effective in reducing COVID-19 transmission for elective general surgical patients. When the R number was at its highest, the only COVID positive case developed symptoms after moving from the “clean ward” system. Extrapolation of this model could be considered in re-establishing elective operating lists across the region.
EP.WE.381Daycase Parathyroidectomy for Primary Hyperparathyroidism: Our Experience
Authors: Jayawardena P A , Turner P D , Shetty V D 
Published: October 2021

Abstract

Aims
Concerns due to postoperative complications following parathyroid surgery have precluded its consideration as a Daycase procedure. However recent BAETS guidelines have supported Daycase parathyroid surgery. To assess the outcomes of Daycase parathyroidectomy pathway we established in our Hospital since April,2018.

Methods
Retrospective review of all patients who underwent parathyroidectomy for Primary Hyperparathyroidism between April,2018 and October,2020. Patients with ASA 3 and above and patients undergoing total-parathyroidectomies were excluded. Outcome measures include length of stay, prerequisite for overnight stay, complications, and readmission rates. All patients were assessed and counselled for suitability for Daycase in surgical clinic and given detailed information leaflets.

Results
In this period, 40patients underwent surgery for primary hyperparathyroidism. Of these, 30 patients (75%), 8 males and 22 females with a median age of 59years fulfilled the criteria for Daycase surgery. 19 patients (63.3%) were successfully discharged on the day of surgery. 11 patients (36.7%) were discharged the following morning. The reasons for overnight stay are - 5patien ts(16.7%) developed post-anaesthetic nausea and drowsiness; in 5patients(16.7%) surgery started after 2pm and delayed postoperative return to ward lead to inadequate time for safe discharge; 1patient(3.3%) needed hospital transport. The readmission and postoperative complication rates were nil.

Conclusions
Daycase parathyroidectomy is safe in carefully selected patients. Adequate preoperative counselling, robust perioperative management to minimize postop morbidity and clear patient support package upon discharge are vital for wider acceptance. All Daycase patients should be operated first on the list and prior to 2pm to ensure safe discharge allowing adequate time for postoperative recovery.
EP.WE.446Adequacy of Endoscopic Photo-documentation in OGD, a retrospective audit
Authors: Fatima Iayla , Elnabil-Mortada Ahmed 
Published: October 2021

Abstract

Background
The technical competence of oesophagogastroduodenoscopy (OGD) is rapidly acquired but to support the practice of complete examination, the British Society of Gastroenterology (BSG) and Association of Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS) strongly recommend photo-documentation of 8 standardized set stations in an OGD. Photo-documentation ensures complete examination, opportunity to inspect area of interest and serves as a legal record of adequate procedure.

Methods
Retrospective single center study involving review of randomly selected 100 OGD reports from 1/1/2018 till 31/3/2020 from the Endorad system. The reports on online Endorad system were reviewed for photo-documentation of 8 set stations and was also used to collect data on age, sex and the endoscopist. Microsoft Excel was used for data entry and analysis.

Results
Out of the 100 OGDs reviewed, 58% were males and 42% females. The mean age being 62.7 +/- 13.5. 60% of OGDs were done by surgeons, 25% by gastroenterologist and 15% by Advanced Nurse Practioner. No report had photo-documentation of all 8 stations. Most (40%) had photos of 5 stations, most common was photo evidence at retroflexion (95%) followed by photographic evidence of intubation to D2 (84%).

Conclusions
OGD is the gold standard test for the investigation of upper gastrointestinal symptoms, the importance lies in the early detection of cancers which maybe amenable to endoscopic treatment. For this reason its important to adhere to guidelines to improve quality in OGD
EP.WE.453Impact of COVID 19 pandemic on colorectal rapid access investigations
Authors: Maye J , Sen R , Sebastian B , Ward N , Athisayaraj T 
Published: October 2021

Abstract

Aim
The impact of the COVID-19 pandemic on delays in diagnosis of cancer has been highlighted at a national level. Such a delay represents an ongoing source of mortality and morbidity missing from the COVID-19 statistics. This study examines the delay in investigation of patients referred to the urgent colorectal cancer referral service at a single centre.

Method
Retrospective data was collated from prospective database for all 1,894 referrals to the urgent colorectal cancer referral service for the period 21 January to 24 December 2020. The time to appointment (TTA) was compared by date of referral and outcome type (endoscopy, CT abdomen pelvis (CT-AP), CT colonography (CT-C), clinic appointment).

Results
Across 2020, fewer than 25% of patients met the NICE recommendation of appointment within 14 days (median TTA 30 days, first quartile 19). TTA increased dramatically in the first months of the pandemic (February median: 19; March: 80.5). TTA remained high, not falling below a median wait of 28 days until November. CT-C tests were particularly delayed (median TTA: 86) due to concerns regarding aerosol generation and COVID-19 transmission. Patients were offered CT-AP tests while awaiting their delayed CT-C, as CT-AP had a significantly better wait of 15 days.

Conclusion
COVID-19 was a major disruptor of colorectal cancer diagnosis in 2020, with patients waiting more than twice as long as NICE recommends. This will likely continue into 2021, with further research required to assess the impact of this disruption on mortality and morbidity.
EP.WE.484Conservative management of post-operative chyle leak after surgery for a large adrenal cavernous haemangioma
Authors: Quake Sharmaine Yen Ling , Chua Yunli , Elsaify Wael 
Published: October 2021

Abstract
Post-operative chyle leak is a rare but recognised complication after abdominal surgeries particularly those involving dissection adjacent to the retroperitoneal lymph nodes and/or lymphatic systems. There are limited cases of post-operative chyle leak associated with adrenal surgery reported in the literature with no consensus on its management. Lymphatics of the adrenal gland drain into the thoracic duct via regional lymph nodes or directly into the cisterna chyli, posterior to the aorta. If not adequately managed, chyle leak can be associated with hypovolemia, electrolyte imbalances, malnutrition and immunosuppression. These consequences can be attributed to the loss of fluid, electrolytes, lipids, proteins, and immunoglobulins. We hereby report a case of post-operative chyle leak in a 79-year-old male who underwent an open left adrenalectomy, left nephrectomy, splenectomy and distal pancreatectomy for a large, 20.8cm left adrenal cavernous haemangioma. Chyle leak was confirmed on post-operative day 7 based on high levels of triglycerides in the abdominal drain output. Intra-operatively there was no evidence of lymphatic damage. However, the major abdominal surgery involving retroperitoneal viscera close to the lymphatic trunk predisposed the patient to this complication. The patient was managed conservatively with the aim of decreasing chyle production by dietary manipulation and use of somatostatin. Enteral nutrition was continued with a strict low-fat diet and regular dietician input. These strategies contributed to the gradual resolution of chyle leak and the patient’s recovery.
EP.WE.485An Audit to Investigate the Incidence of Face-to-Face Patient Review by GPs Prior to Referral to Surgical Assessment Unit
Authors: Murray Hannah 
Published: October 2021

Abstract

Aims
Since COVID-19, GP’s have been encouraged to do fewer face-to-face consultations to prevent unnecessary patient contact1. Anecdotally, this initially resulted in many patients being referred to SAU who had not been seen by a GP, and then being discharged back to the community the same day, causing potentially increased risk of contracting COVID-19 through hospital attendance.
The aim of this audit was to investigate the incidence of patients referred to SAU not seen by a GP and discharged the same day.

Methods
GP referrals were identified over a 7 day period through the surgical take electronic system Aramis©. The case notes and GP documentation were reviewed to identify whether a face-to-face GP consultation occurred, and then whether the patient was admitted to SAU or discharged the same day.

Results
During a 7 day period, there were 24 (n = 24) GP referrals of which only 3 (12.5%) were not seen by the GP, all of whom were admitted for at least one night. However, of the patients referred and seen by GP, 7 (29%) were discharged the same day.

Conclusions
This demonstrates that during this 7-day period, there was no incidence of inappropriate GP referral to SAU of patients not seen by a GP, and the majority of GP referrals warranted admission. This suggests that in most cases, GPs are avoiding unnecessary emergency surgical referrals and attempt to review patients face-to-face prior to referral, thus reducing patient risk of contact with COVID-19 in the hospital setting.
EP.WE.490Influence of age on post-operative outcomes from adrenalectomy for phaeochromocytoma
Authors: Mir S A , Lansdown M J , Collins Emma , Fraser Sheila 
Published: October 2021

Abstract

Methods
A retrospective search of institutional databases for histologically and biochemically confirmed cases of phaeochromocytoma, at a single tertiary care institution, from 2012 to 2020.
Clinical parameters, adrenal function, intra and postoperative data were obtained. Patients &gt; 60 years were classified as elderly and outcome data within 30 days of operation compared to &lt; 60 years.

Results
Patients &gt; 60 years constituted 31% (n = 17) of the cohort, mean age 70 ± 6 versus 43 ± 13 years for &lt; 60 years (n = 38).
There was no difference in tumour size, 4 ± 2.5 cm and 4.6 ± 2.6, p = 0.3. Frequency of laparoscopic resection was similar at 65% in both groups.
Intra-operatively 5% of &lt; 60 years required blood transfusion compared to none in &gt; 60 years group with 12% in older group undergoing en-bloc resection and nephrectomy and 6% experiencing cardiac dysrhythmias.
Postoperatively all patients were managed in level two care except 7% of &lt; 60 years requiring level 3 care reflecting extent and complexity of resection. There was no difference in requirement and duration of vasoactive medication or length of stay in level 2, 1.6 ±1.2, 1.6 ±1.0 days.
Proportion of patients graded ASA 3 in &gt; 60 years was 53% compared with 41% in &lt; 60 years.
Postoperative complications in &gt; 60 were 29% vs 13%, p = 0.003, with HAP being commonest. Length of hospital stay was also significantly longer at 5.8 ± 2.4 versus 4.5 ± 2.2, p = 0.02. There was no mortality.

Conclusions
Age of the patient alone does not influence post-operative outcomes from adrenalectomy in phaeochromocytoma.
EP.WE.555Impact of COVID 19 on Renal access surgery
Authors: Abdelwahed Abdallah , Gambhir Raghvinder , Mistry Hiren , de'figededu Fatima , Valenti Domenico , Rankin Alex 
Published: October 2021

Abstract

Aims
To assess the impact of COVID -19 on renal access surgery.

Methods
Electronic patient records and renal ware were accessed to obtain data of all renal access activity during the COVID period.

Results
There as a shutdown of all elective activity which affected the renal access surgery as well. No new Arterio venous fistulas (AVFs) were created in the time period 14 March to 05th May 2020. No pre-fistula mapping scans were performed. All new starters started with a tunneled dialysis line. In the recovery phase special theatre sessions were asked for and procedures carried out in Day surgery and in independent sector (n-18). A total of 203 new AVF’s were created compared to 272 the year before a fall of 25%. There were 48 patients admitted with blocked access, 70% of whom underwent radiological intervention compared to 52% in 2019. Surgical intervention was offered to just 4% compared to 25% in 2019. The number of access abandoned was 27% in 2020 vs 19% in 2019.

Conclusion
COVID-19 adversely affected the renal access population and none of the British Renal access surgery targets were met for 2020.
EP.WE.568Compliance with the Royal College of Surgeons of England Guidelines on the Surgical Consenting Process in the Era of the COVID-19 Pandemic
Authors: Ayantunde Boluwatife , Clyde Danielle , Ekatah Gregory 
Published: October 2021

Abstract

Aims
Due to the current COVID-19 pandemic, The Royal College of Surgeons of England released guidelines advising on additional considerations which should be discussed with patients as part of the informed consent process prior to surgery.
We conducted a prospective audit on whether COVID-19 infection was mentioned as a possible complication during the consenting process for patients undergoing emergency and elective general surgical procedures at a District General Hospital.

Methodology
We prospectively collected data on the patients admitted for surgical procedures over a 2-week period. Consent forms were reviewed noting whether COVID-19 infection was listed as a possible complication.

Results
35 patients were audited with a median age of 54 (12-94) years including 17 males and 18 females. Patients presented with varying surgical diagnoses, with 16 and 19 undergoing emergency and elective operations, respectively. 77.1% (27) of patients had COVID-19 infection mentioned as a possible complication on their consent forms. Five out of six consent forms completed by Clinical Fellows or CT trainees, 10 out of 13 by Registrars, 12 out of 16 by Consultants mentioned COVID-19 infection. We found no significant correlation between the grade of the consent taker and COVID-19 infection being mentioned as a possible complication.

Conclusion
Most of the consent takers were aware of the guidelines and mentioned COVID-19 infection as a possible complication during consenting. However, this awareness could be expanded. The results will be presented to the department before a plan to re-audit and close the loop in a few weeks.
EP.WE.726A snapshot audit of cholecystectomy for gallstone pancreatitis during the first wave of COVID-19
Authors: David Bryony , Aiynattu Sony , Jones Katie , Gallucci Antonio 
Published: October 2021

Abstract

Aims
COVID-19 has caused difficulties in providing efficient surgical care. We aimed to audit cholecystectomy provision for gallstone pancreatitis from January 2019 to June 2020. We audited time from admission with gallstone pancreatitis to cholecystectomy in pre-COVID and COVID cohorts in order to assess the effect of the first wave of the pandemic on service provision.

Methods
Patients with confirmed gallstone pancreatitis plus their age and gender were included using information software Cerner. We analysed length of stay, time to surgery and number of patients planned for surgery. We also looked at readmissions whilst awaiting surgery. Patients with previous cholecystectomies or deemed not fit for surgery were excluded.

Results
68 patients were included; 42 admitted from Jan 2019 to Feb 2020 (non-COVID group) and 26 from March 2020 to June 2020 (COVID 19 group). Average length of stay was 11.8 days for non-COVID group and 8.8 days for COVID group. Average time to surgery for non-COVID group was 47.4 days. 25 patients underwent surgery. Average time to surgery was 56.7 days and 9 patients received surgery, in the COVID group. In this group, 3 patients had index admission surgery compared to 15 in the non-COVID group.

Conclusions
Albeit small, our data set shows a longer wait to surgery in the COVID group with fewer operations performed at index admission, compared to the non-COVID group. Future surgical services will require careful planning to ensure that urgent cholecystectomies continue to be performed in acute gallstone pancreatitis.
EP.WE.739Antibiotics Prescriptions in Elective Laparoscopic Cholecystectomy
Authors: Abouelazayem Mohamed , Coles Sophie , Tsironis Dimitrios 
Published: October 2021

Abstract

Aim
To assess our compliance to the trust and national guidelines for antibiotic usage and prescription in elective laparoscopic cholecystectomy and to assess whether prophylactic antibiotics are prescribed appropriately and identify areas of improvement.

Method
Medical records for patients who underwent laparoscopic cholecystectomy over 3 months were collected (May – July 2019). Urgent laparoscopic cholecystectomies were excluded, and medical records were reviewed retrospectively for operative note details, patient risk factors, antibiotic prescribed, concomitant procedure, and complications.

Results
Appropriate antibiotic prescription represented 50% (Patient had at least one risk factor and prescribed antibiotic or no risk factors and wasn't prescribed antibiotics) and inappropriate prescription 50% (Patient had no risk factors and prescribed antibiotic or had risk factors and wasn't prescribed antibiotics). In the group with risk factors and wasn't prescribed antibiotics, Age was a risk factor in 17 patients, BMI in 25, Bile spillage in 10, and Diabetes in 3.

Conclusion
We are not compliant with the current guidelines for antibiotic prophylaxis in elective laparoscopic cholecystectomy, some patient with no risk factors received antibiotics while other with risk factors did not. We plan to disseminate this information in the governance meeting and print guidelines posters in theatres and then re-audit in 3 months’ time to assess progress.