bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP2.6 - Improvements in patient discharge efficiency and safety: the impact of a dedicated Clinical Pharmacist in an Emergency General Surgery team
Authors: Small Janet , Davies Brooke , Guy Richard 
Published: September 2024

Abstract

Introduction
Efficiency in management of acute surgical admissions is related to safe clinical practice combined with good patient flow, optimising use of limited capacity. Preventable morbidity and discharge delays may significantly compromise outcomes for Emergency General Surgery (EGS) teams managing increasing numbers of admissions.

Aim
To investigate the effectiveness of a prescribing pharmacist employed within an EGS team in a DGH, with specific focus on patient discharge times by facilitating discharge prescription efficiency, including venous thromboembolism (VTE) prophylaxis.

Methods
Data was collected for two separate 1-month time periods in 2021 (Period A), before the appointment of a pharmacist and in 2023 (Period B), after pharmacist appointment. Data was analysed for (i) differences in times related to ‘to take home’ (TTH) medication prescription and (ii) prescribing of post-operative extended enoxaparin prophylaxis (EEP) following discharge.

Results
Mean time for prescription of TTH medications during working hours in Period A was 100 minutes (n=133, range 0-433 minutes) compared with 67 minutes (n=120, range 0-416 minutes) in Period B. Pharmacist prescribing accounted for 51.6% of TTH prescriptions with a mean prescription time of 18.6 minutes (range 0-389 minutes).
During Period A, 36% of patients (n=48) who had a VTE assessment mandating EEP received this on discharge compared to 100% in Period B (n=31).

Conclusions
This data highlights an improvement in prescribing of TTH medications since appointment of a dedicated EGS pharmacist. The consequences of such improvements include more rapid patient flow, better patient experience and heightened patient safety by prevention of post-operative VTE through EEP.
SP4.1 - Incidence of recurrent bile duct stones following 6140 laparoscopic cholecystectomies and bile duct explorations: management and evaluation of risk factors
Authors: Hayyawi Israa , Al-Shaye Ahmad R A , Omran Asmaa , Nassar Ahmad H M 
Published: September 2024

Abstract

Aim
To evaluate the rate of bile duct stone recurrence and possible risk factors in patients undergoing laparoscopic cholecystectomy (LC) and bile duct exploration (LCBDE) on a unit adopting routine cholangiography and LCBDE.

Methods
A prospective database of LC and LCBDE with confirmed ductal clearance spanning 30 years was reviewed. Those returning with clinical and laboratory suspicion of recurrence were included whether or not MRCP confirmation was obtained or intervention required. Apart from annual follow up electronic records were examined in 2020 and 2023 to capture unreported episodes.

Results
1447 patients underwent LCBDE. 56 (3.8%) had suspected recurrence after a mean of 36.6 months (5-144). Mean age was 67.6 years and 57.1% were females. 12 (21.4%) settled on conservative management, including Glucagon administration, and MRCP was negative. 44 patients (78.6%) had 59 confirmed recurrence episodes; 53 needing 63 ERCPs and 6 settling conservatively. 12/44 (21.4%) had repeat recurrences. Only one biliary-enteric anastomosis was required.
Only 11 of 4693 LC (0.23%) had recurrent stones (5 repeatedly) after a median interval of 30 months (5-120). 19 recurrence episodes occurred during which 13 settled spontaneously and 6 needed 9 ERCPs.
In spite of average rates of ERCP morbidity no biliary related deaths resulted from stone recurrence. Compared to the rest of LCBDEs those with recurrence were more male, older, with more dilated CBD on USS & required more choledochotomies for larger stones.

Conclusions
CBDS recurrence occurs in 3.8% after LCBDE with 3% confirmed and requiring intervention, significantly lower than after sphincterotomy. Glucagon may help small stones pass. 21.4% have repeat recurrences justifying stone dissolution agents. Identifying recurrence risk factors require further studies.
SP4.7 - Intraoperative pancreas consistency and evidence of pancreatitis during pancreatoduodenectomy, and the incidence of postoperative pancreatic fistula
Authors: Jordan Caitlin , Rees Jonathan , Russell Tom , Aroori Somaiah ,   RAW Study Collaborators, Mavroeidis Vasileios K 
Published: September 2024

Abstract

Background
Soft/normal pancreas consistency is a known risk factor for postoperative pancreatic fistula (POPF) in patients who undergo pancreatoduodenectomy (PD) for malignancy. A hard pancreas is considered less technically challenging to work with and generally allows the formation of a more robust pancreatic anastomosis. This study aimed to investigate the impact of pancreas consistency and intra-operative pancreatitis on the incidence of POPF in PD patients.

Methods
Data was extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes following PD performed for malignancy (29 centres in 8 countries, n=1484). Patients with operation notes which documented a subjective assessment of pancreas tissue consistency and whether there was intra-operative evidence of pancreatitis were included. The incidence of POPF and clinically relevant POPF (CR-POPF) was calculated and comparisons were made using the chi-squared test. The 2016 International Study Group of Pancreatic Fistula definitions were used.

Results
Of the 40.6% patients included, 41.5% had a soft/normal pancreas and 58.2% had a firm/hard pancreas. Both POPF (OR: 5.2, 95% CI: 3.3-8.3) and CR-POPF (OR: 4.7, 95% CI: 2.5-8.9) were significantly more common in the former (both p&lt;0.0001). A soft/normal pancreas was most common in patients with cholangiocarcinoma and least common in those with pancreatic cancer (56.4% vs 33.4%). 32.6% had their intra-operative pancreatitis status documented. Of these, 22.8% had evidence of pancreatitis and 77.2% did not. POPF (11.8% vs 16.1%, p=0.3) and CR-POPF (8.2% vs 9.4%, p=0.7) rates were similar in these groups.

Conclusion
In our multicentre study of PD outcomes, POPF and CR-POPF were significantly more common in those with a soft/normal pancreas. This may have implications for postoperative management planning.
SP4.10 - Comparison of the Global Leadership Initiative on Malnutrition (GLIM) Phenotypic Criteria in Patients with Oesophagogastric Cancer
Authors: Brown Leo R , Soupashi Maria , Yule Michael S , Laird Barry J A , Wigmore Stephen J , Skipworth Richard J E 
Published: September 2024

Abstract

Aim
The Global Leadership Initiative on Malnutrition (GLIM) consensus proposed that patients should meet one of three phenotypic criteria for a diagnosis of malnutrition. This study examined the association between these criteria and survival in oesophagogastric cancer.

Methods
Consecutive patients newly diagnosed with oesophagogastric cancer were identified from a prospectively maintained regional database between 2019-2020. Data were collected regarding the GLIM phenotypical criteria: involuntary weight loss (≥5% in 6 months or ≥10% in &gt;6 months), body mass index (&lt;20kg/m2 (&lt;70 years) or &lt;22kg/m2 (&gt;70 years)) and reduced muscle mass via body composition analysis. Cross-sectional area of skeletal muscle was measured at mid-L3 on staging CT imaging. This was normalised for height to create skeletal muscle index (SMI), with low SMI being defined as per Martin et al. The outcome of interest was overall survival.

Results
Overall, 465 patients (median 71 years, n=311 males) were identified. Weight loss (p=0.022), BMI (p&lt;0.001) and SMI (p=0.005) cut-offs were all associated with reduced ECOG performance status. BMI and SMI were also associated with increased age. A higher proportion of patients with advanced stage malignancy met the weight loss threshold (p=0.001). Each phenotypical criterion was associated with worsened overall survival (all p&lt;0.001). While all three were prognostic, following adjustment for confounders, low SMI (aHR:1.76 (95%CI:1.39-2.22)) was more strongly associated with poor survival than low BMI (aHR:1.57 (95%CI:1.18-2.08)) or weight loss (aHR:1.46 (95%CI:1.17-1.81)).

Conclusion
While each of the GLIM phenotypical criteria are adversely prognostic in oesophagogastric cancer, low SMI is most strongly associated with poor survival.
SP4.14 - Mild acute biliary pancreatitis: still a surgical disease. A post-hoc analysis of the MANCTRA-1 international study
Authors: Bernardo Cioffi Stefano Piero , Spota Andrea , Altomare Michele , Virdis Francesco , Di Martino Marcello , Pata Francesco , Ielpo Benedetto , Pellino Gianluca , Damaskos Dimitris , Podda Mauro 
Published: September 2024

Abstract

Aims
The current standard of care for mild acute biliary pancreatitis (MABP) involves early laparoscopic cholecystectomy (ELC) reducing the risk of early recurrence. The MANCTRA-1 project disclosed a discrepancy in translating this evidence into clinical practice, estimating a 35 to 70% probability of narrowing this gap within 2025. This study assesses the safety of suboptimal ELC implementation in MABP, looking for risk factors for recurrent acute biliary pancreatitis (ABP) in patients awaiting interval cholecystectomy after an uneventful episode of MABP.

Methods
We conducted a post hoc analysis of the MANCTRA-1 registry. Clinicaltrials.gov ID NCT04747990. We included MABP patients who did not undergo ELC during the index hospitalization, excluding those who experienced disease-related complications. The primary outcome was the 30-day hospital readmission rate due to ABP recurrence. We performed univariable and multivariable logistic regression to identify risk factors for 30-day ABP recurrence.

Results
Between January 2019 and December 2020, a total of 2,253 MABP patients from 150 centres were included. The 30-day readmission rate due to ABP recurrence was 6%. The multivariable logistic regression showed that admission to a medical ward (internal medicine or gastroenterology) odds ratio (OR) 1.62 (95%[CI] 1.1;2.37), p=0.01 was an independent risk factor for 30-day ABP recurrence.

Conclusion
Our real-world analysis provides valuable insights to manage MABP, particularly in centres where ELC strategies cannot be fully implemented due to organizational and clinical constraints. Despite the admitting ward, it underscores the importance of timely access to surgical care in reducing the risk of early recurrence, disclosing the need to implement surgical consultation pathways in ABP care bundles.
SP5.5 - Is Cardio Pulmonary Exercise Testing a Predictor of Success in Colorectal Resections? An Evaluation of Two Years Practice in a University Hospital Colorectal Unit
Authors: Natale Joseph , Alwis Mithun , Gilmore Kathryn , Smolarek Sebastian 
Published: September 2024

Abstract

Aims
Cardio pulmonary exercise testing (CPET) has a well establish evidence basis in risk stratification of post operative morbidity. Frail and comorbid patients are at higher risk of complications. These patients may also have impaired aerobic fitness. Changes in UK population demographics mean that colorectal resections are now widely performed in patients with extensive comorbidity and poor aerobic fitness. In this group of patients, return to normal function at home is a key measure of operative success. The aim of this study was to investigate whether CPET performance can predict "days alive at home at 30 days after surgery" (DAH30) in patients undergoing colorectal resection.

Methods
Approval for evaluation granted by local audit team. All Colorectal resection conducted between January 2020 and January 2022 were analysed. Patients who did not undergo CPET were excluded. Electronic records and notes were screened to establish whether readmission, complications (Clavien-Dindo &gt;1) or mortality occurred in the 30 days post operatively. Data was captured in a database and analysed in JASP.

Results
Only preliminary results are available at time of writing. Full results will be available at time of presentation. We collected data on a total of 454 patients. 85% underwent CPET testing with median age of 69 years. Risk of major complication was twice as high in the poor CPET group (RR 1.97). Those in good CPET group were twice as likely to be home at 30 days (RR 1.93).

Conclusions
Preliminary results suggest cardiopulmonary exercise test is an effective means of predicting DAH30.
SP5.7 - Identifying patients for safe early discharge following robotic colorectal resection: can C reactive protein levels help?
Authors: Ahmed Marriam , Evans Charles , Helm Jessica , Patel Abhilasha 
Published: September 2024

Abstract

Aims
Current enhanced recovery protocols are mainly based on outcomes from laparoscopic surgery and do not factor in the reduced stress response seen in robotic surgery. We report our centre’s seven-year experience in managing patients undergoing robotic colorectal resections and aim to define cut-offs for inflammatory markers to allow early and safe discharge of these patients.

Methods
A retrospective single-centre UK study including patients who underwent robotic colorectal resections with primary anastomosis from 01/02/2015 to 28/02/2022. Serial white cell counts and C-reactive protein (CRP) levels from postoperative day 1 to 5 were used as surrogate markers for assessing inflammatory response. Anastomotic leak was defined as evidence of disruption on imaging or on direct visualisation at return to theatre.

Results
In total, 200 patients were included based on our inclusion criteria. Overall, 19 patients (9.5%) had anastomotic leaks postoperatively. Postoperatively, a higher day 3, 4, and 5 white cell count and CRP were seen in patients with anastomotic leak. ROC curve analysis revealed a day 3 CRP of &lt; 95.5 mg/L had a sensitivity of 94.4% in predicting no anastomotic leak with an AUC of 0.842. In our study, 94/200 patients met this cut-off and could have been safely discharged from hospital at day 3.

Conclusion
A day 3 CRP of &lt; 95.5 mg/L was found to be a sensitive marker in ruling out anastomotic leak in patients undergoing robotic colorectal resection which is lower than the threshold described in the literature for open/laparoscopic procedures. Enhanced recovery protocols need to be redesigned to factor in the relative reduction in inflammatory response conferred by robotic surgery.
SP5.11 - The Impact of Total Pelvic Exenteration on Surgeon Fatigue: Is it time we monitor our surgeons?
Authors: Khalil Miriam , Burke Joshua , Quyn Aaron , Tiernan Jim 
Published: September 2024

Abstract

Aims
Total pelvic exenteration surgery (TPE) is a radical procedure requiring significant surgeon mental and physical stamina. Literature surrounding surgeon fatigue remains minimal. This study investigated impact of performing high complexity TPE on surgeon fatigue.

Methods
Two surgeons ([#1]/[#2]) delivering high complexity TPEs between 1st November 2022 – 1st September 2023 in a tertiary centre (110/annum) were assessed using a predefined protocol. Surgeon heart rate, concentration performance (d2 Brickencamp test) and Surgery Task Load Index (SURG-TLX) were measured across intraoperative stages (mobilisation, dissection, reconstruction). Surgeons underwent baseline cardiopulmonary exercise testing.

Results
All-cause mortality rate was 0% at median follow up of 3 (1-11) months. Baseline VO2 max and anaerobic thresholds: #1 = 37.6 mL/kg/min, 50% and #2 = 54.3 mL/kg/min, 70%. Mean error rate (ER): d2 test 1 and 2: #1 = 3.58% [0.91%–8.60%] [SD = 3.16, 95% CI = 0.27 to 6.91], #2 = 4.46% [1.37%–7.23%] [SD = 2.55, 95% CI = 1.79 to 7.14]. Greater HR deviation correlated with higher test 2 ER for both subjects (p&gt;0.05). During dissection, mean HR increased from baseline: mean of 70% [#1] and 51.9% [#2]; max HR 106.7% [#1] and 111.5% [#2]. Subjects demonstrated smaller mean HR increase from baseline during dissection operating together versus with junior trainees (#1 = 46.7% [p&lt; 0.001] and #2 = 48.1% [p&gt;0.05]). SURG-TLX situational stress domain was most impacted.

Conclusions
Surgeon HR fluctuations corresponded with significant intraoperative events. Assistant dependent HR fluctuation and increased average d2 ER was demonstrated by greater HR deviations during dissection. Further investigation optimising strategies minimising surgeon fatigue is required.
SP6.1 - Use of Endomag (Magseed® and Magtrace®): our initial experience at Midyorks trust
Authors: Ravindran Sharanya , Tahir Wasif , Glassman Daniel , Kryjak Zbignew 
Published: September 2024

Abstract

Introduction
WLE is a cornerstone in breast surgery post MILAN trail.
Breast lesions undergo wire guided localisation.
Drawbacks are scheduling, patient dissatisfaction, wire movement and discomfort, SLNB: Combined technique.
Radioactive (TcM99m) labelled nanocolloid and 2mls of diluted Patent V blue dye. NEWSTART and ALMANAC, largest UK SLNB datasets- 1% allergy rate Whereas in endomag, Magseed® Marker- Tiny Magnetic seed Less intrusive than guide-wire- flexible and precise. Can be inserted anytime before surgery. Only becomes detectable when Sentimag Probe passes over it. Magtrace® Lymphatic Tracer Non radioactive and non toxic- safer compared to blue-dye Can be injected up to 28 days prior to surgery.

Aim
Demonstrate the feasibility of Magseed® marker localisation and Magtrace® tracer injection for breast lesions and sentinel lymph nodes in our unit.

Methods
All patients who underwent breast WLE from 12/21 to 03/22 using endomag. Sample size identified 63 Total number of procedures: 64 Diagnostic excisions 8 WLE 16 WLE and SNB 39 WLE and ANC 1 Technique of magseed insertion: Stereo 41, U/S 22.
Eight patients had clear margin after second surgery One patient needed third surger Magseed not retrieved in original specimen but retrieved via intra-operative shave during same surgery: 4/ 64 (6.25%) Magseed not retrieved during surgery: 3/ 64 (4.68%) Two patients required redo surgery and one completion mastectomy.Magtrace Tracer Failed SNB requiring sampling: 7 / 39 (17.9%).

Conclusion
Endomag is safe and accurate with comparable surgical endpoints (margins) to traditional localisation.
With time (learning curve) intra-operative magseed localisation and sentinel node detection will improve.
WP2.1 - New Sarcoma Hub and Spoke Service Can Timely Exclude Malignancy and Effectively Cut Patient Waiting Time for Removal of Benign Lesions
Authors: Tjhin Yovita , Swe Thin Thin , Patell Naoroz , Pawa Nikhil 
Published: September 2024

Abstract

Aims
To assess efficiency of the newly established Sarcoma Hub and Spoke Service (SHSS) through assessment of the length of duration on the Sarcoma 2 week-wait pathway (2WW) and time to surgery for patients already cleared from suspicions of malignancies within one Trust’s Spoke Service.

Methods
Patients referred to our SHSS on the 2WW who have been cleared from suspicions of malignancies and subsequently underwent removal of lumps/lesions between July 2022 and December 2023 at our Trust were identified from the Hospital Information System. Data is collected on first appointment, time of surgery, as well as time from exclusion of malignancy (Off 2WW) to surgery.

Results
We identified 119 patients referred to 2WW within the 18-month period, and 90 having had surgery after being taken off 2WW. The median duration from their first appointment to Off 2WW was 37 days (Q1=21d, Q3=61d). The median time from Off 2WW to surgical excision was 132 days (Q1=81d, Q3=202d).

Conclusion
Given how the ‘traditional’ Sarcoma Pathway at tertiary centres discharges patients cleared from suspicion of malignancies back to GP for them to then refer on on routine pathways to local surgical services, the new SHSS model can investigate and timely exclude malignancies. It is also able to effectively cut waiting time to surgery within the same unit for patients as shown through the acceptable surgery waiting time despite backlog from the recent pandemic and industrial actions. This can also mean decreased workload for both GPs and local General Surgery services.
WP2.4 - Association between Gallbladder Polyp Size and Risk of Malignancy: A single centre retrospective study
Authors: Khalid Muhammad Abdullah , Mallon Ciara , Aktas Mikail , Kassem Ahmed , Junkin Amy , Marzouk Ahmed 
Published: September 2024

Abstract

Aims
To investigate ultrasound image findings in patients with gallbladder polyps requiring cholecystectomy and assess the risk of gallbladder malignancy associated with polyps.

Methods
Patients with ultrasound diagnosis of gallbladder polyps who underwent cholecystectomy between January 2019 and September 2023 were included. Histology reports were thoroughly reviewed to find possible diagnosis of gallbladder malignancy.

Results
A total of 701 patients’ records who had cholecystectomy were reviewed, 45 patients were included as per the inclusion criteria, of whom 73% were women. Mean age was 52±15 years. Average size of the polyps on ultrasound was 7.26mm and approximately 26.7% of polyps were noted to be bigger than 10mm. Overall analysis of the data showed that none of the histology confirmed malignancy.

Conclusion
Literature review and current ESGAR guidelines suggest that gallbladder polyps, particularly with size &gt;10mm have significant risk of conversion to malignancy. Nearly a quarter of the patients who underwent cholecystectomy for gallbladder polyp had a polyp size &gt;10mm however none of them were proven malignant on histology. This study was conducted on small cohort of patients, further studies on larger cohorts are needed in order to draw conclusions.
WP3.16 - Comparing Outcomes in Acute Upper Gastrointestinal Bleeding: Initial Presentation versus In-hospital Incidence - A Single-Centre Investigation
Authors: Ng Shou Kee , Nemade Mitesh J , Adeoti Olayiwola M , Khan Khurram S 
Published: September 2024

Abstract

Aims
Acute upper gastrointestinal bleeding (AUGIB) is a gastrointestinal emergency with varied patient outcomes. We aimed to compare the outcomes of patients whose primary admission presentation was AUGIB versus inpatients who subsequently developed AUGIB as a complication.

Methods
This was a retrospective study of all adult patients receiving endoscopy for AUGIB in a single surgical unit from September 2021 to September 2022. Patient demographics, laboratory results, medical history and clinical progress, 30 and 90-day mortality were compared.

Results
145 patients were identified, 75 (51.7%) were male and median age was 65 years (IQR 53-75). 117 presented to hospital with AUGIB (group 1) and 28 developed AUGIB as an inpatient (group 2). Median length-of-stay was 3.3 vs 10 days, respectively (p=0.014).
Group 2 were more likely to present with symptomatic anaemia (p=0.001), higher National Early Warning System scores (p&lt;0.001), shock (p&lt;0.001), higher Glasgow-Blatchford score (p&lt;0.001) and require blood transfusions (p&lt;0.001).
Group 2 had higher ASA Scores (p&lt;0.001) and higher 30-day and 90-day all-cause mortality. No statistical correlations were noted regarding the distribution of endoscopic diagnoses obtained between both groups.Group 1(n=117)Group 2(n=28)P-Value30-Day all-cause Mortality4 (3.4%)4 (14.3%)0.02490-Day all-cause Mortality9 (7.7%)8 (28.6)0.002

Conclusion
Our results echo previous studies that patients who develop AUGIB whilst an inpatient have significantly poorer outcomes. Causation is likely multifactorial and warrants further study. It remains important to closely apply the AUGIB care bundle and early critical care input to optimize outcome.