bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP6.16 - Small bowel obstruction (SBO) in NELA patients: A cohort study
Authors: Gok M A , Bughio M , Yim S , Khan S , Sadat M M , Khan U A , Zaidi Marium 
Published: September 2024

Abstract

Aims
SBO is characterized as mechanical or functional obstruction of intestines, accounting for 15% of acute abdomens & 50% (NASBO 2017) of emergency laparotomies each year in the UK. Aim of study is to assess the surgical management of SBO amongst NELA patients at a single centre.

Methods
Cohort study carried out from Jan’2014 to Jan’2023. Descriptive demography & post-operative outcomes were evaluated for SBO NELA patients. Other non SBO NELA patient were controls.

Results
SBO NELA(n = 560) Non SBO NELA(n = 306) Mann Whitney U(p value) Age(yrs) 68.7 65.7 &lt; 0.005 Sex(M:F) 235 : 325 157 : 149 BMI 25.5 26.0 NS ASA 3 3 NS Op time(mins) 112.1 133.0 &lt; 0.0001 ITU stay(n) 229 171 ITU stay(days) ± ± LOS(days) 11 16 &lt; 0.0001 Lap(n) 176 60 Open(n) 384 246 Lactate(mmol/L) 2.0 ± 0.1 2.3 ± 0.2 NS WCC(x109/L) 12.4 ± 0.2 12.4 ± 0.4 NS CRP(mg/L) 62.2 ± 3.9 90.6 ± 5.9 &lt; 0.0001 Physiol score 21.9 ± 0.3 23.5 ± 0.5 &lt; 0.05 Op score 15.4 ± 0.2 19.5 ± 0.3 &lt; 0.0001 Pre possum score 10.4 ± 0.8 21.0 ± 1.7 &lt; 0.0001 PP mortality score 7.3 ± 0.5 9.7 ± 1.1 NS PP morbidity score 60.7 ± 1.4 75.6 ± 1.7 &lt; 0.0001 Adhesions(n) 277 Hernias(n) 48 Other(n) 235 SB resection(n) 115

Conclusion
Early radiological diagnosis & management is essential in SBO including nutritional support. Surgery is indicated in SBO where there is potential perforation, strangulation & failed conservative managements. SBO was treated laparoscopically in 31.4% of cases, adhesions (49.4%) was most causes, SB resection was undertaken in 20.5 % cases. Other causes include hernias, FB (gallstones), tumours, intussusception & volvulus.
ThP7.11 - Does Hypoalbuminaemia Increase the Risk of Surgical Site Infection in Neck of Femur Fracture Patients? A Systematic Review and Meta-analysis
Authors: Mostafa Omar Ezzat Saber , Al-Allaf Omar , Tahir Muaaz , Hossain Fahad , Blackwell John 
Published: September 2024

Abstract

Aim
Serum albumin plays an important role in physiological and inflammatory haemostasis; low serum levels are linked with an increased incidence of surgical site infections (SSI). Although this has been demonstrated in spinal and elective arthroplasty surgeries, there is a paucity of evidence with regard to the effect of low preoperative serum albumin on rates of SSI following surgery for adult patients suffering from traumatic, acute hip fractures.

Method
A systematic review was conducted using the PRISMA guidelines. Four databases were searched for randomised controlled trials, cohort and case-controlled studies. The risk of bias was assessed using the Newcastle-Ottawa Score (NOS). Data was collected and pooled using RevMan Web Software. Results were reported as Odds Ratio (OR) with 95% Confidence Intervals (CI) and statistical significance of p &lt;0.05. An Inverse-Variance model was used in meta-analysis.

Results
Six retrospective studies (five cohorts, one case-control) with a total of 43,059 patients were included. 45.3% (n=19,496) had low serum albumin (&lt;3.5 g/dL). Hypoalbuminemia was associated with a significantly higher risk of any form of SSI (OR 1.25, p=0.008) and deep SSI (OR 1.76, p=0.05). There was no statistical significance between hypoalbuminemia and the incidence of superficial SSI (OR 1.06, p=0.77). Organ-space SSI was associated with hypoalbuminemia, albeit only one study reported this with poor statistical significance (OR 8.74, p&lt;0.054).

Conclusion
Hypoalbuminemia increases the risks of most forms of surgical site infections; superficial and deep infections. There is a weak conclusion to draw between incidence of deep-space organ infections and low serum albumin.
FP1.7 - Colorectal Anastomotic leaks after malignant resections: A cohort study
Authors: Gok M A , Bughio M , Mathiewson N O M , Aris R , Sadat M M , Khan U A 
Published: September 2024

Abstract

Aims
Colorectal anastomotic leaks (AL) is serious complication in restorative colorectal cancer surgery, reported incidence of &lt;10%. AL can adversely affect long term survival. Aim of study is to assess management of colorectal anastomotic leaks at a single centre.

Methods
Cohort study was carried out from Jan2008 to Jan2024. Descriptive demography and post-operative outcomes were evaluated for AL, non-leaks recruited as controls

Results
A L (n = 66) Non Leaks (n = 1644) Mann Whitney U test (p value) Age(yrs) 67.8 70.5 &lt;0.05 Sex(M:F) 41 : 25 915 : 729 NS ASA(median) 2 2 NS BMI(kg/m2) 27.3 26.5 NS Emerg : Elec(n) 7 : 59 355 : 1289 &lt;0.05 Lap : Open(n) 31 : 35 927 : 717 &lt;0.0001 LN harvest(n) 16 17 NS Leaks Rx Type A (antibiotics) 29 Type B (drainage) 10 Type C (surgery) 27 Days to Leak(Med) 6 Leak day Day 6 WCC(10x9/L) 14.1 9.4 &lt;0.001 CRP(mg/L) 226.5 118.1 &lt;0.0001 Op time(mins) 178.3 174.9 NS LOS(days) 14.5 &lt; 0.0001 Complication(n) Ileus 14 260 NS HAP 7 178 NS Anaemia(transfusion) 1 52 NS Wound infections 5 150 NS Collections 31 65 &lt;0.0001 Sepsis 13 73 &lt;0.05 Mortality(n) 30 day 1 57 NS 60 day 2 82 NS 90 day 3 95 NS Survival rates(%) 1st year 88.7 86.0 5th year 79.7 68.8 Logrank 10th year 72.0 60.7 p=NS 15th year 67.7 57.8

Conclusion
AL occurred in 3.8 % all colorectal cancer resections, 40.9 % requiring surgery (type C-1.6 %). AL associated with rise in WCC & CRP, but early radiological diagnosis is essential. Despite prolonged hospitalization, there was no reduced survival.
FP1.9 - Evaluating outcomes of multi-visceral resections for locally advanced colorectal cancer
Authors: O’Connell Elizabeth , Javed Ahsan , Wyatt James , Choi Marcus 
Published: September 2024

Abstract

Introduction
Multi-visceral resection for colorectal cancer invading into adjacent organs is often difficult and involves serious complications. The aim of this study is to evaluate the short- and long-term outcomes of patients undergoing multi visceral and beyond TME (total mesorectal excision) resections for locally advanced CRC.

Methods
Patients undergoing elective surgery for advanced or recurrent CRC between October 2018 and October 2023 were identified. Demographic and clinical data were recorded, and outcomes analysed. Primary outcome was R0 resection rate and post-operative complication rate.

Results
Thirty-three patients (51.5% male, 48.5% female) were included, with a median age of 66.8 years (IQR 38-82) and median BMI was 26.7 kg/m2 (13.8-50). Majority of patients (n = 29, 87.8%) had surgery for primary, locally advanced CRC and most were referred from external Trusts (n=25, 75.7%).
Thirteen patients (39.3 %) had robotic resections, one case was completed laparoscopically, and the remaining were open procedures (n= 19, 57.5%). Seventeen individuals had previous abdominal surgeries with no differences between open (8/20 = 40%) and robotic approach (9/13 = 69.2%) (p=0.207). Median LOS in open and robotic groups were 16 and 10 days respectively (p=0.047). There was no post-operative mortality. Proportion of CD I-II complications was 9/33 (27.3%) and CD III-IV 18/33 (54.5%). R0 resections rate was 63.6 % and eight patients (24.2%) developed recurrence during the follow up period (median = 47.6 months).

Conclusions
An aggressive surgical approach as part of a multimodal strategy affords the best prospect for long-term survival in selected patients. Robotic multi-visceral resection for locally advanced CRC is a safe and feasible, minimally invasive approach in selected cases.
FP1.11 - An audit of post colonoscopy Colorectal cancers within a Northern Ireland Health and Social Care Trust
Authors: Stevenson Sarah , Clements Jake , Coulson Rachael , Johnston Dorothy , McElvanna Kevin , Neill Adrian 
Published: September 2024

Abstract

Background
Post colonoscopy colorectal cancer (PCCRC) is defined as colorectal cancer found within 48 months of a colonoscopy in which no cancer was found. The British Society of Gastroenterology (BSG) proposes PCCRC rates as a key quality indicator of colonoscopy. Rates documented vary between 2-8%, with higher rates shown in Inflammatory Bowel disease (IBD). The English National Post Colonoscopy Colorectal Audit was established after recommendations from the World Endoscopy Organisation (WEO). We aim to establish the rates of PCCRC within this Health and Social Care Trust (HSCT).

Method
All CRCs diagnosed in our HSCT between January 2021 to December 2022 were retrospectively reviewed. Our definition for a PCCRC was one diagnosed between 0-48months after a colonoscopy. Information included whether the colonoscopy was complete, quality of bowel preparation, lesions detected, if resection of lesion was complete and if IBD was present.

Results
In this timeframe 524 CRCs were diagnosed in this HSCT, with 33(6.3%) having had a colonoscopy within the previous 48 months. Of the 33 PCCRCs, 21(63.6%) had a complete colonoscopy, 22(66.6%) had at least fair/satisfactory bowel preparation, 24(72.7%) had a lesion detected and 3(9%) had a prior diagnosis of IBD. Of those who had a lesion detected (n=24), 13(54%) had a complete resection and 10(41.6%) had a biopsy only or incomplete resection.

Conclusions
Our PCCRC detection rate is in keeping with previous published literature. Further analysis of the 33 cases should provide information on how we can reduce future PCCRCs.
FP2.3 - Is the Oakland score a reliable tool for safe discharge in lower gastrointestinal bleed patients?
Authors: Whiteway James , Yim Ho Yu Stephanie , Leong Ka Tung Natalie , Shah Ankur 
Published: September 2024

Abstract

Aim
There are no NICE guidelines regarding safe discharge of patients with lower gastrointestinal bleeds (LGIB). The aim of this study was to investigate the effectiveness and safety of the Oakland score, as suggested by the British Society of Gastroenterology guidelines, in patients presenting with LGIB at William Harvey hospital.

Methods
Patients with LGIB who presented to A&E or inpatient referral from January to December 2023 were included in this retrospective study. Data was extracted from patient’s Sunrise documentation. The Oakland score for each patient was calculated. Those with a score of ≤8 were deemed safe for discharge; those with a higher score were deemed unsuitable. Patients’ admission, safe discharges and adverse outcomes, such as representation, blood transfusion, or further intervention, were investigated. The area under the receiver-operating characteristic curve (AUROC) for the Oakland score and adverse outcome was calculated.

Results
123 patients were included. A total of 144 presentations to hospital, 29 had an Oakland score ≤8; 17 (58.6%) cases were safely discharged, 8 (27.6%) admitted and 4 (13.8%) represented. 115 had a score &gt;8; 37 (32.2%) were safely discharged, 72 (62.6%) admitted and 41 (35.7%) experienced at least one adverse outcome. The AUROC for safe discharge was 0.84.

Conclusion
The Oakland score seems to be a safe and reliable tool for identifying LGIB patients who could be safely discharged home without hospital intervention. However, further research is required to assess whether a score &gt;8 could be used as many higher risk patients did not experience adverse outcomes.
FP3.3 - Sensitivity of Faecal Immunochemical Testing
Authors: Karim Seiver , Moolamannil Mathew , Kumarakulasingam Priyanga , Bevan Katharine 
Published: September 2024

Abstract

Aim
The use of faecal immunochemical testing (FIT) in the diagnosis of colorectal cancers (CRC) has become a routinely utilised and reliable investigation. In the symptomatic population, FIT may identify those patients who require urgent colorectal investigation. It is also commonly used as a triaging tool in bowel cancer screening.
In this study we sought to assess the sensitivity of FIT in detecting CRC in our centre.

Method
Patients with histologically confirmed CRC were identified from a data set gathered from the hospital colorectal specialist services between January 2021 to January 2022. Thereafter, the hospital electronic systems were used to retrospectively gather the value of FIT tests for each CRC patient found.

Results
From 407 patients with CRC identified, only 256 patients who we successfully managed to obtain their pre diagnosis FIT result were included. From those, 235 patients were FIT positive and 21 patients had a false negative result. Therefore, this suggests a FIT sensitivity of 91.79%.
Furthermore, we identified 14 patients who had a repeat FIT preformed. From which, one patient who was originally fit negative had a positive result on the repeat test.

Conclusion
While faecal immunochemical testing is highly sensitive and a useful screening tool, it's important to remember that it is not always accurate. Therefore if a patient has convincing history or symptoms, we should keep a high index of suspicion and investigate further. It also remains to be seen if the use of double FIT will help increase the sensitivity of detecting CRC.
FP3.15 - Are non-colorectal surgeons more likely to make a stoma in an emergency right hemicolectomy for cancer?
Authors: Campbell Tim , Mandal Piya , Bisheet George , Fernandes Roland 
Published: September 2024

Abstract

Introduction
Right sided colonic cancers can often cause bowel obstruction and present as an emergency. The decision to perform an anastomois following a right hemicolectomy resection is frequently multifactorial. There is controversy as to whether colorectal cancers should be operated on by non-colorectal surgeons in the emergency setting. This study explores whether there are differences in stoma formation rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy.

Methods
A retrospective study was conducted at a 3 site Trust in South East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon.

Results
There were 281 patients included in the study, in a 152:129 female:male ratio. The mean age was 68 (34-86 IQR). 13% (37/281) of operations were conducted by Upper Gastro-intestinal Surgeons. 54% (20/37) of these patients had stoma formation as part of their operation. 47% (115/244) of operations undertaken by colorectal surgeons also had stoma formation. There was no significant difference between the stoma formation between colorectal and non-colorectal surgeons (p=0.108)

Conclusion
The study shows that although the decision to form a stoma following a right hemicolectomy multifactorial and is dependent on a wealth of patient and operative factors, there is no statistical difference between colorectal and non-colorectal surgeons in the emergency setting.
FP5.2 - Skills-fade pilot study, inclusion of Return to Training Trainees in the ST3 General Surgical Bootcamp
Authors: Richards Eleanor , Clarke Rory 
Published: September 2024

Abstract

Aims
The concept of skills fade after time out of training is well recognised but there is a paucity of objective assessment of this in returning trainees. We sought to assess the utility of inclusion of returning trainees in a bootcamp by measuring performance and confidence.

Methods
In this pragmatic pilot study 8 General Surgery trainees returning from time out were offered a place on the ST3 Bootcamp of whom 3 agreed to participate. These trainees had been out of programme for a medical education fellowship, non-clinical research and parental leave respectively. Trainees received a 3 day period of intensive reskilling, covering open and laparoscopic skills, proctology, endoscopy, ward round managing the OP list and stressful environment. Their confidence and competence were assessed pre and post Bootcamp completion.

Results
Returning trainee confidence improved across the board. Trainees fed back that they found the open and laparoscopic simulation sessions most useful. All trainees objectively improved in laparoscopic skills although not in open skills or endoscopy and proctoscopy. The pressure of being assessed may have affected these finding or this may reflect a need for consistency of faculty and a more robust method of objectively assessing competence.

Conclusion
Inclusion of RTT trainees in surgical bootcamp improves confidence and enhances their return. Simulation should be included in a return to training programme. If objective assessment is used to evaluate their progress then this should be with predefined criteria or computer software to ensure that the evaluation is unbiased.
FP5.5 - Simulated Abdominal Wall - a valuable educational tool for Abdominal Wall Reconstruction and Small Bite closure techniques.
Authors: Smith Olivia , Ritchie Coral , Aylward Kathryn , Green Susie , Chintapatla Srinivas , Chitsabesan Praminthra , Chua WeiYing 
Published: September 2024

Abstract

Background
Incisional hernia is a common complication following laparotomy (31.8% at 2 years, HART collaborative, 2022) and this may require complicated reconstructive techniques. Studies suggest that poor closure technique contributes to incisional hernia formation. Junior trainees are often left to close the abdominal wall. European and American guidelines have suggested closing the abdomen with the "small bites technique".
Simulated training has gained traction. Reduction in theatre training hours necessitates simulated training.
This study aims to:generate a synthetic model that anatomically represents the layers of the abdominal wall.use this model as a simulated training tool for general surgical and plastic surgical trainees who are often left to close the abdominal wall in laparotomy cases / abdominal wall reconstruction.use this model to teach reconstructive abdominal wall repair techniques.

Methods
2021: literature search and research. Theatre observation of complex abdominal wall procedures and techniques. Cadaveric lab attendance at Leeds University.
2022: prototype - first model produced from medial grade silicone.
2022: amendments - alterations to the prototype.
2023: accreditation and delivery - Small Bites Course delivered and accredited by RCS Edinburgh.

Results
86% of course attendees found the abdominal wall models "as realistic as possible". Attendees felt more confident to perform small bites closure and simple abdominal wall reconstruction. Total cost saving per model compared with competitors = £1109.50.

Conclusions
Our simulated abdominal wall model has proved to be realistic and cost effective. It is an ethical and improved way to train junior surgeons in the small-bites technique and some elements of abdominal wall reconstruction. These models have been implemented on training courses for surgical trainees within the deanery.
FP6.13 - A Quality improvement project to reduce the number of readmissions to surgical assessment unit (SAU) in East Sussex hospitals (ESHT) following laparoscopic cholecystectomy
Authors: Ali Elmurtada Ahmed , Jenner Deborah , Al-Robaei Basim 
Published: September 2024

Abstract

Aim
This is a QI project aiming to reduce the number of readmissions following laparoscopic cholecystectomy in ESHT from the current rate of 8.1% to the UK national average rate of 5%. This proposal followed an audit I conducted previously. About two-thirds of those readmissions occurred on day one following discharge, half of them due to pain, and almost 90% of them discharged without any intervention needing only reassurance, pain control, and analgesia.

Methods
Problem identified, SMART objectives followed, which means our intervention is: specific, measurable, achievable, relevant, and time specified.
Set up a process map showing areas where intervention is desirable/beneficial. These include time allowed for consent, preoperative assessment clinic, and postoperative discharge information.
Then a driver diagram is drawn to indicate the primary and secondary drivers we need to tackle in order to achieve our goal. In summary, the proposed changes include allowing more time in clinic for patients to explain procedure and consent, junior doctors and nurses’ education, resources, and provision of leaflets and websites for information.
Identification of stakeholders including managers, anaesthetists’ nurses, and patients, and dealing with them according to their influence and interest. PDSA (plan do study and act) cycle, TQM (total quality management), SPC (statistical process control), and lean methodology were implemented.

Conclusion
This project is aimed primarily at reducing readmissions numbers to SAU following laparoscopic cholecystectomy from 8.1% to 5% within a year. Areas in the process map were identified to achieve this objective,
and since about 90% of patients were discharged without any intervention, we believe this should be achievable.
FP7.5 - 90- day mortality rate post emergency laparotomy for frail and sarcopenic patients
Authors: Ng Hwei Jene , Quasim Tara , Moug Susan 
Published: September 2024

Abstract

Aims
High mortality and morbidity rate post emergency laparotomy (EmLap) has been well documented in frail or sarcopenic patients. Although frailty and sarcopenia can be present concurrently, they can also occur independently. We aim to explore the relationship between 90- day mortality, frailty and sarcopenia.

Methods
Prospectively collected data from EmLap patients age ≥40 years between May 2022 to July 2023 including 3 months follow-up from a district hospital was analysed. Clinical Frailty Scale was used to assess frailty with score &gt;4 as frail. Total psoas index (TPI) [TPI=total L3 psoas area on CT (cm2)/ patient’s height (m2)] was measured on pre-operative CT to assess sarcopenia, stratified according to gender with lowest quartile as sarcopenic. Logistic regression was performed and p-value of &lt;0.05 was considered significant.

Results
150 patients were recruited, 55% were female and median age was 69 years. The overall 90- day mortality rate was 13.3%. Frailty was present in 10% and 90-day mortality rate was 13.0% (OR 1.00, p= 1.000) while 23.6% were sarcopenic and 90- day mortality rate was 25.7% (OR 3.21, p= 0.0197). 4% were both frail and sarcopenic with 90- day mortality rate of 33.3% (OR 3.50, p= 0.1648).

Conclusion
The 90-day mortality rate is higher when frailty and sarcopenia are both present in EmLap patients. Early evaluation of frailty and/ or sarcopenia in emergency setting is crucial to improve EmLap outcomes and aid shared decision making.
FP7.13 - Is There A Difference In Anastomotic Leak Rates Requiring Re-Operation Following Emergency Right Hemicolectomy Between Colorectal And Non-Colorectal Surgeons?
Authors: Mandal Piya , Campbell Timothy , Bisheet George , Fernandes Roland 
Published: September 2024

Abstract

Aim
Right sided colonic cancers can often obstruct and present as an emergency. The decision to perform an anastomosis following the right hemicolectomy resection is often multifactorial. This study explores whether there are differences in leak rates between colorectal and non-colorectal surgeons in the context of emergency right hemicolectomy operations performed for malignancy.

Methods
A retrospective study was conducted at a 3-site Trust in South-East England between 2017 and 2022. Theatre and Infoflex Cancer records were used to obtain patients who had undergone an open right hemicolectomy for malignancy and their operating surgeon. Discharge summaries and clinic letters were then used to ascertain return to theatre for an anastomotic leak.

Results
There were 281 patients who had undergone an emergency right hemicolectomy in this time interval. There was a 152:129 female:male ratio. 17 out of 37 patients had an anastomosis undertaken by an Upper Gastrointestinal Surgeon. 2 out of the 17 (12%) had an anastomotic leak. 129 out of 244 had an anastomosis undertaken by a Colorectal Surgeon. 17 of the 129 (13%) had an anastomotic leak. There was no significant difference between the leak rates between colorectal and non-colorectal surgeons (p=0.888).

Conclusion
The study shows that there is no statistical difference in right hemicolectomy anastomotic leak rates between colorectal and non-colorectal surgeons in the emergency setting.