bluuebunny/crossref_metadata_2025_split huggingface dataset:
AHP SO01 - Establishing Physiotherapy led Prehabilitation for patients undergoing major hepatobiliary surgery in a Regional Centre - A Service Improvement
Authors: Kindness Gemma 
Published: November 2024

Abstract

Background
Prehabilitation is increasingly on the agenda for major surgical patients and will be an essential service in an ageing population with increasing cancer prevalence. By 2040 5.3 million people in the UK will be living with cancer physical fitness can have an impact on both treatment options and survival rates. Prehabilitation has been mentioned in both the Major Conditions Strategy and the Long-Term Plan.
Currently within the trust, there are no established multiprofessional prehabilitation services. New funding allowed a service improvement project to develop a ‘model’ for a specialist physiotherapy prehabilitation pathway pilot in patients undergoing major hepatobiliary surgery.

Method
Patients undergoing major surgery complete Cardiopulmonary Exercise Testing, providing data indicating fitness levels and guides risk stratification. Patients deemed to be at high risk due to poor fitness, (anaerobic threshold 10.9 or below), were referred to the prehabilitation physiotherapist.
Patients attended a 1:1 assessment with a Physiotherapist, were provided with an individualised home exercise programme, including cardio-vascular and muscle strengthening. Weekly follow up virtual follow was provided.
Outcome measures taken at initial appointment included five sit to stand (5STS) time, Grip strength and EQ-5D. These were repeated before surgery, and after hospital discharge. Patients had the opportunity to provide feedback.

Results
Average improvement in all outcome measures was demonstrated. Outcome MeasuresPre-intervention averagePost intervention averageAverage changeEQ-5D Score8.17.30.8EQ-5D Health score687465 STS (seconds)14.711.5-3.1Grip (kg)29.831.31.5Sarcopenic 5 STS (seconds)20.913.1-7.9
Patient and staff feedback was positive, finding patients reported they felt prepared for the post operative period, and staff noted and increased in their patients preparedness.
It is too early to say if Prehabilitation has had an impact on hospital length of stay or post operative complications, though early results are promising.

Conclusion
Physiotherapy led prehabilitation is beneficial for patients undergoing major HPB surgery, demonstrating improvements in physical strength and fitness following an individualised home exercise programme with regular virtual support, especially those who have sarcopenia.
AHP SO04 - ''Effectiveness of a surgical wound care bundle for reducing surgical site infection after emergency abdominal surgery''
Authors: Saha Gobinda Chandra , Selim Abdur Rahman , Sikder Dhiman Kanti 
Published: November 2024

Abstract

Background
Surgical site infection (SSI) imposes a considerable financial burden to both hospital and patient by increasing the hospital stay, utilization of resources and readmission rates. This study compared the effectiveness of surgical wound care bundle concept with traditional ongoing wound care for reduction of SSI after emergency abdominal surgery.

Method
This cross-sectional analytical study was carried out with a total of 120 patients who underwent emergency abdominal surgery were included after taking informed written consent and divided into two groups: Group-A (n=60, surgical wound care bundle) and Group-B (n=60, traditional ongoing care). A detailed history and thorough clinical examination were carried out in each patient. Data were collected in separated case-record form and analyzed by SPSS 24.

Results
Mean age of Group A and Group B was 44.88 ±11.2 years and 44.82±13.3 years accordingly (p=0.391) with male majority in both groups (70% in Group-A and 80% in Group-B, p&lt;0.292). Both groups were statistically similar regarding comorbidities, baseline laboratory parameters and pre-operative diagnosis (p&gt;0.05).Group-B patients had higher frequency of SSI development compared to Group-A(43.3% vs. 15%, p-0.001). Besides, patients having traditional ongoing care had longer hospital duration than surgical wound care bundle (10.1±2.7 vs. 6.9±1.9 days, p&lt;0.01). Though not significant, 30-day readmission rate was also higher in Group-B than Group-A (16.7% vs. 5%, p=0.075).

Conclusion
Surgical wound care bundle reduce surgical site infections in patients with emergency surgery. However, further multicenter studies are warranted.
AHP SO05 - First year experience of running a specialist pre-op clinic for patients undergoing a Whipple procedure that focuses on patient education and improving theatre utilisation
Authors: Clarke Hannah , Mcdonnell Declan , Takhar Arjun 
Published: November 2024

Abstract

Background
The Whipple’s pre-operative clinic was organised to ensure patients were fully aware of the impact of this operation. Additionally, it was implemented to reduce the risk of preventable theatre cancellations and unfilled operating theatre slots arising given the challenges currently faced in the current NHS climate.
The primary aim of the clinic is to improve education to ensure the patients are aware of what the procedure and aftercare entails. A secondary aim is to identify correctable issues in the pre-operative period which could prevent surgery from proceeding safely.

Method
The clinic ran over 12 months in the tertiary HPB centre at University Hospital Southampton. The clinic has two elements: a 30min video appointment with a specialist nurse for each individual patient to provide comprehensive information regarding the procedure This was followed by a checklist to ensure there was appropriate up-to-date imaging available, as well as a review of the latest blood tests and current medications.

Results
There were a total of 105 patients reviewed in the clinic. Due to this new service, 21 (20%) essential interventions were made. These included requesting or reviewing new imaging (n=14) correcting anticoagulation plans (n=2) and admitting patients for optimisation prior to surgery (n=2).
A total nine all day theatre lists were saved as a direct result of this clinic. Costing of each theatre is estimated at £12,000. Five (5%) patients had their surgeries cancelled in advance and all theatre slots were subsequently re-allocated. Four (4%) patients had interventions which directly prevented an on the day cancellation.

Conclusion
These results show that there are significant benefits from running a specialised pre-operative Whipple’s clinic. Multiple interventions have led to improving patient safety, optimising theatre utilisation and improving patient experience.
AHP SO08 - Weekend physiotherapy pilot for patients on hepatobiliary enhanced recovery pathways: Examining the impact of a 7-day service
Authors: Wilkinson Hannah , Turner Catherine 
Published: November 2024

Abstract

Background
Enhanced recovery after surgery (ERAS) is a safe, multi-disciplinary, evidenced-based approach to optimise the perioperative management and outcomes after hepatobiliary (HPB) surgery. Despite the adoption of the ERAS mobilisation protocols to improve recovery time, one limitation is a traditional 5-day service model (Monday-Friday). This can result in an inequality of service provision for those patients operated Thursday or Friday and lead to increased length of stay (LOS) in hospital. Mobilisation across 7 days can ensure improved compliance with ERAS mobilisation protocols, better continuity of care, facilitate improved outcomes and timely discharge from hospital.

Method
Data was collected pre-introduction of the 7-day physiotherapy service from May-October 2022. During November 2022 – April 2023 a 7-day physiotherapy service was piloted. This service included 1 qualified physiotherapist and 1 non-qualified physiotherapist on Saturday and Sunday. This 7-day service provided continuity of care for patients from intensive care or post-anaesthesia care unit to the ward, facilitating discharges and accelerating return to independence. Data was collected during the 7-day service as well as 6 months post intervention (May 2023-October 2023). Acceptability of the intervention was assessed among the HPB multi-disciplinary team (MDT) using a survey consisting of 5 qualitative questions.

Results

The table illustrates that a reduction in mean LOS was seen in all 4 HPB surgeries that follow ERAS protocols during the 7-day physiotherapy service. It was also shown that 6-months post intervention (returning to a 5-day service) all 4 HPB ERAS surgeries mean LOS increased. To determine the acceptability of the 7-day physiotherapy service, 22 members of the MDT responded to a survey (5 consultants, 4 physiotherapy staff, 4 sisters, 5 staff nurses, 1 nursing assistant, 2 healthcare assistants). All 22 members of the MDT agreed that a 7-day physiotherapy service was acceptable and improves recovery.

Conclusion
A 7-day physiotherapy service has shown to reduce mean LOS in comparison to a 5-day physiotherapy service within HPB ERAS pathways. From an MDT perspective the 7-day physiotherapy service was also deemed to be beneficial and improves patient recovery.
EDI&S SO03 Replacing Single-use Chloraprep with Low Carbon Cost-effective Surgical Skin Preparation: A QI Project for Sustainability in Surgery
Authors: Sivananthan Mathoorika , Joseph Moyenda , Nip Lawrence , Sabato-Ceraldi Serena 
Published: November 2024

Abstract

Background
Operating theatre waste accounts for approximately 50% of all hospital waste produced in the NHS [1] and two-thirds of carbon contributions come from single-use items [2]. With a major goal of the NHS being net-zero, surgeons have a collective responsibility for reducing the carbon footprint through eliminating single-use equipment and plastic waste such as Chloraprep wands. The aim of this quality improvement project was to introduce the use of chlorhexidine solution poured into reusable gallipots and applied using reusable sponge-holders into local practice, which is more environmentally friendly, significantly cheaper and is the first-line skin preparation recommended by NICE [3].

Method
Chloraprep use in consecutive operations performed by the trust in a month before and after the intervention was retrospectively collected and categorised based on specialties. The intervention was a series of local oral presentations, leaflets and posters to highlight the benefits of chlorhexidine solution over Chloraprep. The change in percentage of Chloraprep use in all cases completed in 1 month pre- and post-intervention was retrospectively collected and analysed. Further qualitative data was obtained through pre- and post-intervention surveys.

Results
There was a reduction in use of Chloraprep across all specialties targeted by the intervention, with 27% of cases pre-intervention and 24% of cases post-intervention using Chloraprep. The highest percentage reduction was seen by the local upper gastrointestinal surgery team (37%). The percentage reductions in the cases using Chloraprep 10 days post intervention were general surgery 9%, upper GI 3%, colorectal 1% and vascular 6%. The pre- and post-intervention surveys also showed a decrease in Chloraprep use from 94.1% to 80% and corresponding increased use of swabs and antiseptic solution. 100% of the responders agreed with using the sustainable option.

Conclusion
The educational intervention has proven to be effective in achieving the aims of this project. Critical analysis of the literature has shown no difference in surgical site infection rates between the two options [2]. However, there is a need for high quality trials that directly compare the clinical effectiveness of both methods of application. We hope to encourage surgeons and theatre staff to opt out of using Chloraprep and consider the use of swabs dipped in chlorhexidine alcohol solution. Thus, we recommend the re-usable low carbon low-cost alternative method and encourage efforts to promote sustainability in surgery.
BS SO02 - A systematic review to summarise and appraise the reporting of surgical innovation: A case study in robotic Roux-en-Y gastric bypass
Authors: Huttman Marc , Smith Alexander , Robertson Harry , Purves Rory , Biggs Sarah , Dewi Ffion , Dixon Lauren , Kirkham Emily , Jones Conor , Ramirez Jozel , Scroggie Darren , Pathak Samir , Blencowe Natalie 
Published: November 2024

Abstract

Background
Robotic Roux-en-Y gastric bypass (RRYGB) is an innovative alternative to the laparoscopic approach, however its clinical benefits are uncertain. The Idea, Development, Exploration, Assessment and Long-term follow-up (IDEAL) framework was developed to improve the evaluation of surgical innovations alongside their adoption into clinical practice. Studies investigating the benefits of RRYGB have been published, however the reporting quality and robustness of literature has not been assessed. The aim of this systematic review was to summarise and appraise the reporting of RRYGB as a case study of a surgical innovation in relation to the IDEAL framework.

Method
Systematic searches for primary studies evaluating totally RRYGB were undertaken. Their IDEAL stages were determined using a standardised algorithm. Information pertaining to study characteristics, governance/ethical factors, patient selection, demographics, surgeon expertise/training, technique description and outcomes were extracted. A narrative summary was formulated, with descriptive statistics and data arranged chronologically. All methodology was done in accordance with PRISMA guidance.

Results
Fourty-seven studies published between 2005-2024 were included: case report (n=1), case series (n=11), non-randomised comparative (n=28) and retrospective analysis of registry databases (n=7). IDEAL stages were assigned as follows: stage 1 (n=1), stage 2a (n=6), stage 2b (n=40), stage 3 (n=0), stage 4 (n=0). There was a lack of sequential progression through IDEAL stages as time progressed since the inception of RRYGB. There was incomplete and inconsistent reporting of governance, ethics, patient selection criteria, surgeon expertise/training and technique description. Outcomes were heterogenous and rarely corresponded to progress through the IDEAL model of surgical innovation.

Conclusion
Reporting of RRYGB literature correlated poorly with IDEAL recommendations. This indicates poor reporting quality of available literature, impeding the ability for surgeons to draw meaningful conclusions from available evidence. This also complicates patients’ ability to take part in shared decision-making and give informed consent. Future studies should report findings in a structured way using IDEAL guidance or a similar reporting standard. This will ensure future research is transparent, robustly designed, prospective, uses COSs and follows an ethos of incremental learning. This may reduce research waste and the premature adoption of surgical innovations, ensuring their safe introduction into clinical practice.
BS SO04 - Intragastric Balloons - are they for the long term?
Authors: Hammett Felix , Foley Sinead , Asarbakhsh Mariam , Salih Tamir 
Published: November 2024

Abstract

Background
Intragastric balloons are a bridging therapy to bariatric metabolic surgery. When sufficient weight loss to facilitate surgery is not achieved, a second balloon may be considered. Traditionally, balloons were used for 6 months prior to removal. The COVID-19 pandemic limited patient interactions and treatment duration was doubled.
We assessed outcomes (weight loss trends and safety) in patients with severe obesity undergoing sequential balloon treatment. The study period accounts for changes in balloon protocol instigated during the pandemic, addressing a current literature gap.

Method
Consecutive patients who underwent balloon treatment between May 2014 and February 2023 were identified. Only patients deemed fit enough for potential adjuvant bariatric surgery at presentation were included in the study. Outcomes recorded included: weight and BMI at 3-monthly intervals until balloon removal, progression to surgery and morbidity.

Results
45 patients were identified. Median BMI on balloon insertion was 62kg/m2.
Median weight loss with the first balloon was 15.2kg (8.8% weight loss). 11 patients (24.4%) had a second balloon, with median weight loss of 3.3kg (1.9%).
22 patients (48.8%) met criteria for surgery, only one had multiple balloons.
Weight loss was observed during the first three quartiles of balloon treatment, however median 2kg was gained during months 9-12.
16 (35.6%) first balloon patients had complications. 2 (18.2%) second balloon patients had complications. Median time from insertion to complication was 14 days.

Conclusion
The present study concludes that, although not associated with increased complication risk, sequential IGB use as a bridging treatment to definitive bariatric surgery does not significantly contribute to weight loss in super obese patients. Optimal treatment is achieved with a single IGB, although weight loss is not uniform across a 12 month treatment period and weight gain can result after 9 months.
BS SO08 - Prospective audit of weight loss and resolution co-morbidities of various bariatric surgeries and Comparisions of weight loss and ORM resolution between bypass and sleeve-1 years follow up- Audit outcomes from Jan 2019-2023
Authors: Haider Ijlal , Kaur Mandeep 
Published: November 2024

Abstract

Background
Bariatric surgery is the gold standard in managing bariatric patients. There are various bariatric surgeries that have been approved. Sleeve gastrectomy is the most common procedure to be done globally. RYGB is considered the gold standard surgery as it gives the best weight loss and comorbidity resolution. OAGB is now a well-established procedure. Other procedures which are offered to the patients are duodenal switch and SADIS.

Method
We prospectively analysed the patients who underwent bariatric surgery at our center. All the bariatric surgery patients were included.

Aim
To calculate EBWL at 6 m, 1 year Resolutions of obesity related morbidity Comparision of the outcomes between Sleeve and Bypass

Results
1024 patients underwent bariatric surgery. All the patients undergo MDT discussion and the decision of choice of surgery is made based on MDT discussion and patients' preference. For the first 6 months both sleeve and bypass fair equal in terms of weight loss and resolution of comorbidities. Subsequently weight loss is better with bypass. It is also better sustained with the bypass. Resolution of comorbidities is the best within the first 6 months post-surgery.

Conclusion
There is a direct relationship between weight loss and resolution of co-morbidities. These patients are under follow up for outcomes at 2 years. Results will be published at the time of conference presentation
BS SO18 - Small bowel intussusception after Roux-en-Y gastric bypass: A case report and review of literature
Authors: Kannan Shanmuga , Haque Afrida , Askari Alan , Adil MdTanveer , Munasinghe Aruna , Al-Taan Omer , Rashid Farhan , Whitelaw Douglas , Jain Vigyan , Jambulingam Periyathambi 
Published: November 2024

Abstract

Background
Small bowel obstruction after RYGB for obesity can occur due to various common causes like internal hernia and adhesions. One of the rare complications of RYGB is retrograde intussusception of jejunum at the common channel. Since it does not present with typical symptoms of small bowel obstruction, it is often challenging to consider it as differential diagnosis at initial presentation. Also, managing the intussusception at non bariatric centres could prove difficult due to location of it in the common channel, which will require understanding of orientation of alimentary and biliary limbs as well as reconstruction after resection of the intussusception.

Method
We collected the details of our patients admission episode from a different centre where she was admitted initially to understand the clinical behaviour of the condition. Also, we conducted a systematic search of literature databases like PubMed, Embase, CINAHL, ProQuest Dissertations & Theses using MeSH terms and keywords Intussusception, Retrograde intussusception, J-J intussusception, Intestinal Obstruction, Small bowel obstruction, Bowel obstruction, Obesity, Morbid obesity, Gastric Bypass, Roux-en-Y gastric bypass, Jejunojejunostomy, Jejuno-jejunostomy, Gastric by-pass, RYGB, Roux-en-Y. Data were extracted on to Excel sheet for analysis.

Results
The search yielded 41 case reports. Patients were operated in most instances except in seven cases where they had multiple episodes. The average age of presentation was 38 mostly in females and few instances being during pregnancy including our patient. Intussusception happened between 5 to 360 months after the initial operation with the average time after the operation being 66 months. Pain was the principal mode of presentation without classical symptoms of bowel obstruction. There were few instances of coffee ground vomiting. CT was the diagnostic modality in almost all cases. Recurrence was invariable when not managed with resection.

Conclusion
Small bowel intussusception after RYGB occurs retrogradely and does not present with classical symptoms and signs of small bowel obstruction. It can be reliably diagnosed with CT abdomen. Of note, medical management and no-resectional surgical management results in recurrence of this condition.
EGS SO08 - How best to time the operative management of acute cholecystitis: Is there a difference in outcomes between hot and smouldering cholecystectomy?
Authors: Marks Bertram , Sow Karmen , Owen Lucy , Haddington-Ahmed Aysha , Carr William 
Published: November 2024

Abstract

Background
Laparoscopic Cholecystectomy (LC) is the main treatment for symptomatic gallstone disease. Acute cholecystitis (AC) is a common emergency presentation in the UK and the 2015 AUGIS guidelines recommend emergency cholecystectomy within 72 hours of admission if the patient is fit. On a practical level this can sometimes be difficult to implement and often patients are discharged to return for an elective procedure (the smouldering gallbladder). We aimed to analyse our practice at a large district general hospital for the management of patients with AC and their post-operative outcomes.

Method
All patients undergoing LC between 1st July 2020 and 30th June 2022 were identified. Patients with an ICD-10 code of K81 (AC) associated with an inpatient stay within a year of their operation were included. Those admitted and operated on during that admission were classified as hot cholecystectomies (HC), whereas those admitted and discharged for an elective procedure were termed smouldering cholecystectomies (SC). Patient and operative details were retrieved from their electronic record and a Charlson co-morbidity index was calculated. Statistical analysis was performed using SPSS with Chi-squared tests performed for categorical data and ANOVA for continuous data.

Results
276 patients underwent cholecystectomy for AC with 52.2% elective and 47.8% emergency (91% within 72 hours of admission). HC patients were younger (52.3 vs. 57.5, p&lt;0.01) and less-comorbid (1.67 vs 2.12, p&lt;0.05). The subtotal cholecystectomy rate was comparable between the groups (9.8% vs 16.0%, p=0.131). HC patients had more post-operative drains (38.6% vs 27.1%, p&lt;0.05) and thick-walled gallbladders (92.4% vs 64.6%, p&lt;0.001). Median post-operative length of stay was 1 day for HC and 0 days for SC. No difference was observed for 30-day readmission (4.5% vs 7.6%, p=0.286), morbidity (12.9% vs 11.8%, p=0.786) or mortality (0.8% vs 0.7%, p=0.951).

Conclusion
This study adds to the evidence that emergency cholecystectomy is as safe an option as discharging patients to return for an elective procedure in the future. Although a proportion of those discharged to return for an elective operation will have thin-walled gallbladders, the rate of subtotal cholecystectomy remains similar, if not slightly higher in the elective group (although not reaching statistical significance). Most emergency cholecystectomy patients were discharged the following day, therefore demonstrating that they do not significantly contribute to bed blocking and reduce the burden on already strained elective waiting lists.