bluuebunny/crossref_metadata_2025_split huggingface dataset:
WP2.8 - Patient experience of surgeon-patient communication in general surgery in Northern Ireland: a qualitative analysis
Authors: Montgomery Michael 
Published: September 2024

Abstract

Aims
This project explores the patient experience and perception of surgeon-patient communication in general surgery in Northern Ireland. Through qualitative analysis of patient feedback, this project aims to identify pertinent aspects of communication that significantly impact the patient experience within the context of inpatient surgical care, and compare this to existing literary consensus.

Methods
Patient feedback data was collected from Care Opinion, accessed at https://www.careopinion.org.uk. Search parameters included stories about general surgery and communication, spanning a period of twelve months, submitted from the five health and social care trusts in Northern Ireland. 121 of 178 search returns met the inclusion criteria for analysis. Braun and Clarke’s Thematic Analysis framework was selected for coding data and identifying themes and understand participant experiences within the data set.

Results
Three themes emerged from analysis of patient feedback. These themes were the aspects of patient-doctor communication that were valued most by patients during admission. They include the pitch at which information is delivered, the frequency of updates patients were given regarding their care, and provision of question and answer opportunity with their surgeon.

Conclusions
The important discovery from this analysis is that contemporary literary knowledge does not fully represent the patient experience of doctor-patient communication in Northern Ireland. Instead, analysis of patient feedback has identified new aspects of communication that most impact patient experience, and has yielded new means of understanding and achieving patient-centred practice.
WP2.10 - The Future of Artificial Intelligence (AI) in Surgery
Authors: Cheruvu Chandra , Davies Alexander , Lu Yanqiang , Mak Richard , Ingley Paul 
Published: September 2024

Abstract

Aims
Artificial intelligence (AI) has revolutionised many industries, especially in the field of medicine. However, its application in medical surgery has been limited.
Our study aims to review current literature surrounding AI’s use in surgery and identify potential future application of this new technology. We look at the preoperative, intra-operative, and postoperative phases of a patient’s surgical journey and see how AI can improve each component.

Methods
A selective literature review was conducted by gathering 19 relevant research papers of interest related to AI in surgery. These studies were collected from PubMed and papers only published from the past 5 years were included. Of the 19 papers 11 were included in the final review.

Results
This review reveals numerous applications of AI in surgery, primarily showcasing its accuracy in preoperative patient data analysis with high sensitivities of 89%. Secondly intra-operatively AI can provide guidance through supervised machine learning and computer vision with accuracies as high as 95%. Finally, postoperatively AI has been shown to have a high accuracy at preoperative prediction of surgical site readmission rates, diabetes remission and personalised weight loss trajectories.

Conclusions
The findings of this review demonstrate the transformative ability of AI on various stages of the surgical journey. While demonstrating significant promise, challenges such as ethical considerations and regulatory frameworks need to be addressed to ensure responsible and safe integration. The new advancements shown in AI provide the foundation for future research into the technology.
WP3.12 - The influence between frailty, sarcopenia and physical status on mortality in patients undergoing emergency laparotomy
Authors: Thu May Myat , Ng Hwei Jene , Moug Susan 
Published: September 2024

Abstract

Aims
Frailty and sarcopenia predict mortality in emergency laparotomy (EmLap) and both can be indicative of poor physical status. We aim to assess the prevalence of frailty, sarcopenia and physical status in EmLap and explore the relationship between these factors and 30-day, 90-day and 1-year mortality.

Methods
Retrospective analysis was performed on two Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA) databases (2017-2019) which included patients ≥18years. Clinical frailty scale was used to classify frailty (score ≥4 as frail). Sarcopenia was assessed via total psoas index. Poor physical status (PPS) was defined by American Society of Anaesthesiologists physical status classification (ASA)≥4. One-way ANOVA and logistic regression were used for statistical analysis.

Results
215 patients were included with 57.2% female and median age of 64years. Frailty was present in 17.2%, sarcopenia in 25.1% and 14.5% had PPS; 3.3% had all three factors. Frail patients had significantly higher risk for 30-day (p=0.003), 90-day (p=0.006) and 1-year mortality (p=0.032). Sarcopenic patients did not show significant differences in mortality risks up to 1 year. Patients with PPS had significantly higher mortality rates at 30-day (p&lt;0.001), 90-day (p&lt;0.001) and 1-year (p=0.001). Patients with all three factors had higher 30-day (p&lt;0.001), 90-day (p=0.005) and 1-year mortality (p=0.049) than patients who have none of the factors.

Conclusions
Frailty, sarcopenia and PPS are prevalent in EmLap. Frailty and PPS were independently associated with short and long-term mortality but not sarcopenia. While overlap exists between frailty, sarcopenia and PPS, more studies are required to understand the complex interplay.
WP5.13 - National Emergency Laparotomy (NELA) critical care admissions: A cohort study
Authors: Gok M A , Bughio M , Mathieson N O M , Zaidi M , Sadat M M , Khan U A 
Published: September 2024

Abstract

Aims
NELA is committed to enhancing quality of peri-operative care of patients undergoing emergency laparotomy. NELA emphasizes importance of identifying high risk patients, who are associated with significant morbidity & mortality. Critical care allows close monitoring, organ (basic/advanced) support. Aim of study is to review the NELA critical care patients.

Methods
Cohort study of NELA patients that received post-operative ITU care (direct/indirect admission) at single centre. Descriptive demography, and outcomes were evaluated. NELA parsimonious risk & CCMDS ITU scores used. NELA patient that did not require ITU care were controls.

Results
NELA critical care (n = 400) NELA non critical care (n = 466) Mann Whitney U (p value) Deaths (n) - (n) Age(yrs) 71.8 64.0 &lt; 0.0001 Sex(M:F) 173 : 227 220 : 246 NS ASA 3 2 &lt; 0.0001 BMI(kg/m2) 26.3 25.0 NS Lap(n) 67 168 Open(n) 333 293 Op time(mins) 131.0 109.4 &lt; 0.0001 LOS(days) 18 9.5 &lt; 0.0001 Deaths 30 day 50 25 60 day 66 37 90 day 73 40 Lactate(mmol/L) 2.4 1.8 &lt;0.01 WCC(x109/L) 13.0 11.8 &lt;0.05 CRP(mg/L) 90.1 56.6 &lt;0.0001 Physiological-score 25.6 19.8 &lt;0.0001 Operative-severity-score 17.9 15.9 &lt;0.0001 Prepossum-score 21.6 7.5 &lt;0.0001 PPmortality-score 11.9 4.9 &lt;0.0001 PPmorbidity-score 77.3 55.7 &lt;0.0001 Survival Rate (%) 1styear 75.4 86.2 5thyear 53.8 70.8 Logrank 10thyear 41.1 58.7 p&lt;0.0001

Conclusion
NELA critical care patients had poorer survival rates in our study. Theatre return or indirect critical care transfers can adversely affect survival. These patients were older, frail, multiple co-morbid status. NELA parsimonious mortality risk score &gt;5% should encourage consultant level supervision, mortality risk score &gt;10% should encourage direct critical care involvement.
WP7.9 - Evaluation of outcomes of early laparoscopic cholecystectomy for acute gallstone disease using Traffic Light Booking system
Authors: Ehigie Naomi , Fallaha Mohammad , Osuchukwu Joshua , Forster Henry , Gray Jack , Ayantunde Abraham 
Published: September 2024

Abstract

Introduction
Delayed cholecystectomy leads to recurrent admissions with potential increased preoperative, operative, and postoperative complications.

Aim
To evaluate the outcomes of early laparoscopic cholecystectomy using traffic light booking system.

Methods
A quality improvement early gallbladder service was designed using the weighted scores of patients’ demographics, BMI, comorbidities, LFTs, imaging findings, confirmed diagnosis and associated gallstone complications. The scores were stratified into traffic light system colours of green (0-3), amber (4-6) and red (&gt;7) to predict the operative difficulty and allocated operative time. Early cholecystectomy was performed within 6 weeks of the onset of symptoms. Operative difficulty grading use was by Nassar et al.
Prospectively data was analysed using SPSS to present the outcomes.

Results
207 patients had early cholecystectomy from February 2022 to January 2024. Median age was 50.5 years and 71.5% were females. Diagnoses were 60 biliary colic, 102 acute cholecystitis, 41 pancreatitis and 4 cholecystitis with biliary obstruction.
Traffic light scores were 114 green, 76 amber and 17 red while operative difficulty grading was 44 mild, 73 moderate, 54 severe and 36 extreme difficulties. Median time to surgery was 21 (21-42) days and median operative time was 75 (25-205) minutes. 13.5% of the patients were operated at the index admission, 67.1% as day cases, 20.3% stayed overnight and 12.6% as inpatient stays.
None were converted to open but four procedures were abandoned. Complication and readmission rates were 4.8% and 5.3% respectively with one patient returning to theatre.

Conclusion
Early laparoscopic cholecystectomy service can be safely delivered with the majority done as day cases.
WP7.11 - An Audit of Geriatric Input and Analysis of The Barriers For Elderly Patients Undergoing Emergency Laparotomy
Authors: Govind Garima , Jayasankar Balaji , DiFranco Filippo 
Published: September 2024

Abstract

Background
Older people over the age of 65 years are recognized as higher risk surgical candidates and it is therefore recommended that their care should be coordinated through a multidisciplinary team (MDT) approach involving senior geriatricians, anaesthetists and surgeons. We audited 150 geriatric patients for medical input. Further in addition to the liaison services we analysed the characteristics of this group that would have benefitted from a liaison service.

Methods
An audit of 150 geriatric patients undergoing emergency laparotomy was carried. Our primary outcome was to look at input from geriatricians following laparotomy. Further we assessed the clinical characteristics of these patients and analysed the complexity of medical needs to benefit from a physician input.

Results
Only around 10% patients received a medical/geriatric input following an emergency laparotomy. Our audit highlighted the gap that exists in the clinical care for geriatric population against the NELA recommendations. Further we were able to work out a model of implementation for a geriatric liaison service.

Conclusions
Management of older patients with complexity requires surgical, critical care and geriatricians to collaborate. Implementing a local service with regular MDT’s will only serve to improve care and outcomes.
WP7.16 - Usefulness of Cross-Sectional Imaging and Biochemical Markers in Diagnosing Necrotising Soft Tissue Infections
Authors: Pha Sai Yan , Asfour Aref , Christie Hannah , Burke Joshua , Peckham-Cooper Adam 
Published: September 2024

Abstract

Introduction
Diagnosis of Necrotising Soft Tissue Infections (NSTI) remains clinical, however pre-operative investigations and radiology may be useful for cases of diagnostic uncertainty or pre-operative planning.

Aims
To identify if cross-sectional imaging is useful in the diagnosis of NSTI's. To identify if Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score supports the diagnosis of NSTI’s.

Methods
Retrospective data collection of all relevant clinical data for all histologically confirmed NSTI’s in a single centre from 2012 to 2022 inclusive.

Results
73 total cases of NSTI were confirmed. 27 patients underwent CT imaging as a direct result of their presenting complaint. CT was performed for the following reasons,Patient NoReason for CT10Clinically confirmed - CT to assess extent of involvement4Clinically suspicious – CT to confirm diagnosis5No clinical diagnosis – CT features of NSTI8Incidental findings – CT for alternative diagnosis
Only 3 patients had a prospective documented LRINEC score. As such retrospective LRINEC scores were calculated for each case in this cohort. Average scores were 7.71 (Range 4-13), which is above the reported threshold value of 6.

Conclusion
CT scans are useful in clinically confirmed or suspected NSTIs for further assessment, however with regards to diagnosing NSTIs, clinical diagnosis remains the preferred modality. There remains limited data to suggest that a CT scan should be gold standard in identifying and confirming NSTI’s.
LRINEC scoring however should be utilized for all suspected NSTI’s, it remains poorly utilized but would provide significant value and diagnostic guidance when above threshold values.
WP8.15 - Systematic Review and Meta-Analysis of Non-Interactive multimedia interventions used In the Informed Consent Process
Authors: Clements Joshua Michael , Clements Jake Simon , Clarke Mike , Kirk Stephen 
Published: September 2024

Abstract

Introduction
Non interactive multimedia interventions in the form of educational videos regarding a proposed intervention have been increasingly used to enhance information given during informed consent. This review aimed to assess the impact of this modality.

Methods
This was a subgroup analysis of a larger systematic review and meta-analysis conducted in accordance with a predefined protocol registered on PROSPERO (CRD42023380406). Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of non-interactive multimedia interventions designed to improve the informed consent process. Adults &gt; 18 years with the capacity to consent were included. The Cochrane risk of Bias (ROB) tool was used to assess study quality. Effect measurements were assessed using standard mean differences and risk ratios for continuous variables and dichotomous variables respectively. Meta- analyses were performed using Review Manager (RevMan) version 5.4.

Results
49 studies contributing 6149 patients met the inclusion criteria. 43 studies were conducted in an elective setting across a variety of surgical, radiological, endoscopic, oncological, and medical disciplines. Statistically significant Improvement was demonstrated, in subjective understanding (SMD 0.31, 95% CI 0.07 to 0.54 I2 = 0%), immediate (SMD 0.97, 95% CI 0.78 to 1.17, I2=75%), short (SMD 0.77, 95% CI 0.21 to 1.34, I2 = 90% ), long-term knowledge (SMD 1.23, 95% CI 0.26 to 2.19, I2=86%) and satisfaction the informed consent process. (SMD 0.32, (95% CI 0.16 to 0.49, I2 = 74%).

Conclusions
This review provides a global overview of the impact of non-interactive multimedia interventions demonstrating improvement in numerous outcomes measures. These intervention types should be considered as an informational adjunct during the informed consent process.
ThP1.3 - Oncoplastic Surgery and Magseed Markers: A five-year snapshot of ambition and evolution in breast conserving surgery
Authors: Bell Emma , Gray Karen , Lang Anne , Lannigan Alison , Murphy Dermot , McIlhenny Jennifer 
Published: September 2024

Abstract

Aim
Oncoplastic surgery and localisation markers allow breast conservation in patients who might previously have been treated with mastectomy.
We aimed to evaluate breast conservation across a five-year period spanning widening adoption of oncoplastic conservation, and the introduction of Magseed localisation.

Method
All patients diagnosed with breast cancer or DCIS, screening or symptomatic, in NHS Lanarkshire during the first 6 months of 2017 and 2022 were reviewed. These dates were chosen to eliminate the effects of Covid-19 on practice as much as possible.

Results
531 patients (244 in 2017; 287 in 2022) were diagnosed within the study period.
Groups were comparable for age (median 62 (32-96) and 61 years (28-94); P=0.4), and tumour size (median 19 (3-150) and 21 mm (4-123); P=0.4).
Breast conservation as first operation rose from 69.1% to 85.5%. Use of localisation also increased, from 52.7% of procedures using wires in 2017, to 71.2% using one or more Magseeds in 2022 (P&lt;0.001). Oncoplastic breast conservation rose from 3% to 7% of procedures.
Re-excision rates remained in line with national outcomes (20.4% in 2017 and 20.0% in 2022); and ‘failure’ of breast conservation resulting in completion mastectomy also reduced from 8.0% to 4.7%.
Overall mastectomy rate (+/- reconstruction) fell from 36% to 18% (P&lt;0.001). A reduction in mastectomy for multifocal or diffuse disease requiring localisation or bracketing was also observed, from 56.2% to 35.5%, though this didn’t reach statistical significance (P=0.13).

Conclusion
Increasing success in breast conservation has coincided with greater adoption of oncoplastic breast conservation and novel localisation technology. Reassuringly, this has not resulted in an increase in re-excision, nor completion mastectomy rate.
ThP2.12 - Evaluation of hand-assisted laparoscopic surgery of small intestine neuroendocrine tumors as an alternative surgical treatment for open surgery
Authors: Klimacek Branislav , Stalberg Peter , Norlen Olov , Hellman Per 
Published: September 2024

Abstract

Aims
Small intestinal neuroendocrine tumor (SI-NETs) is the most common malignancy of the small bowel. Curative treatment is exclusively operative and explorative laparotomy is still considered to be the standard procedure. The purpose of this retrospective cohort study was to assess the outcome of minimally invasive surgery in patients with SI-NETs, at our endocrine surgery unit in 2019, compared to the open approach.

Methods
Patients who underwent surgery for SI-NETs between 2013 and 2023 were included. Descriptive variables such as operative time, length of hospital stay, use of analgesia and radiciality were compared primarily between groups of patients operated before and after 2019 and secondarily between open and hand-port assisted laparoscopic surgery (HALS).

Results
Of 97 patients with SI-NET included in the study, 58 (59.8 %) had an open and 39 (40.2 %) minimal invasive surgery. While difference in the operative time, 121 min (91.3-150.3) vs 108 min (83-141), the length of hospital stay, 6 days (4-7) vs 5 days (4-8) and surgical radicality in patients with stage II-III, 79.3% vs 85%, (p-value 0.313) was not significant, 86.2% of patients with explorative laparotomy required epidural analgesia compared to 23.1% with HALS (p-value = &lt;0.001).

Conclusion
Hand-port assisted laparoscopic surgery of SI-NETs was assessed to be a feasible approach without compromising radical resection and enhancing postoperative recovery with lower amount of required analgesia postoperatively.
ThP2.14 - Staged laparoscopic traction orchidopexy (SLTO) for impalpable testes
Authors: Keene David , Elmousili Mahmoud , Wilkinson David , Melling Charlotte 
Published: September 2024

Abstract

Aim
SLTO enables elongation of the testicular vessels without division by Shehata (JPS 2015).
We presented first UK data in 2020 assessing SLTO. It was suggested that a single stage traction procedure may be possible in some patients. We now present follow up data including the single stage traction technique.

Methods
Data was collected prospectively from a single centre and grouped into 2 time periods: Group A (March 2017 to July 2019), Group B (November 2020 to December 2023).
The gubernaculum was divided. If the vascular pedicle was long enough to allow the testis to reach the contralateral inguinal ring the testis was brought down to the scrotum using an 11mm STEP port and secured in a subdartos pouch with 2/0 Ti-cron. If the vascular pedicle was short, 2-stage traction was performed by securing the intra-abdominal testis to the contralateral anterior abdominal wall using a 2/0 Ti-cron stitch. 3-6 months later the testis was brought down to the scrotum as described above.
A prospective database was used for data collection and analysis. Outcome measures included presence of a palpable testis in the scrotum at follow-up, ultrasound determined testicular volumes and percentage difference compared to contra-lateral testis where applicable and complications. Follow up was 6 months following the 2nd stage procedure.

Results
The later cohort (Group B) demonstrated a higher proportion (32%) of single stage procedures compared to Group A (0%). The success rates for both groups were high 95-100%, with a significantly reduced complication rate (9%) seen in Group B compared to Group A (33%) p=0.048.
ThP4.1 - Benign biliary emergencies in the elderly: Does age influence the outcomes of index admission surgery and one session management of bile duct stones
Authors: Hayyawi Israa , Omran Asmaa , Al-Shaye Ahmad , Khan Khurram S , Nassar Ahmad H M 
Published: September 2024

Abstract

Aim
To study operative and postoperative outcomes of biliary emergencies in the elderly two age on a unit adopting index admission surgery and one session management of bile duct stones.

Methods
A prospective database of 6140 patients had 1089 (17.7%) over 60 years. Two age groups were analysed.

Results
Group I (60-69 years)N=530 (48.7%) Group II (over 70 years)N=559 (51.3%) Females 314 (59.2) 312 (55.8) Age Median 65 77 ASA 3 0r 4 174 (32.8) 236 (42.2) Presentations Acute cholecystitis 136 (25.6) 132 (23.7) Pancreatitis 96 (18.1) 97 (17.4) Jaundice/Cholangitis 218 (41.1) 323 (57.8) Ultrasound Bile duct dilatation 39 (7.4) 247 (44.2) Suspected CBD stones 388 (73.2) 461 (84.2) Preoperative ERCP 21 (3.9) 34 (6.1) Operative Acute/Empyema 147 (26.3) 160 (30.2) Difficulty Grading III 130 (24.5) 140 (25) IV 163 (30.7) 183 (32.7) V 29 (5.4) 46 (8.2) Difficult cystic pedicle 321 (6.5) 210 (37.5) Fundus first dissection 31 (5.8) 36 (6.4) Abnormal IOC 255 (48.1) 314 (56.2) Bile Duct Explorations 244 (46) 308 (55.1) Choledochotomy 74 (30.3) 153 (27.4) Choledochoscopy 186 (35.1) 261 (46.9) Biliary drains 98 (18.5) 167 (29.8) Operative time; median/range) 80 min/ 24-370 90 min/ 23-345 Open conversion 2 (0.37) 7 (1.25) Morbidity 63 (11.8) 40 (6.7) Readmissions 27 (5.1) 49 (8.7) Reoperations 3 (0.6) 4 (0.6) *Hospital stay; median 8 days 12 days Mortality 1 (0.2) 6 (1.1) *Resolved in one or two episodes 471 (88.8) 499 (90) *Including all previous and readmissions. BOLD : statistically significant

Conclusions
A policy of index admission surgery and one session management of bile duct stones is safe in the over 70s.