bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP6.4 - Psoas Sarcopaenia as a Predictor of Mortality in Patients Over 65 with PR Bleeding: A Retrospective Case Controlled Study
Authors: Cunningham Brian , McConnell Megan , Daly Aisling , Kilkenny Jane , Rice Paul , McElvanna Kevin 
Published: September 2024

Abstract

Aims
Sarcopaenia has been examined as a predictor for functional baseline and frailty in surgical patients and may predict mortality. The hypothesis of this study is that sarcopaenia is associated with increased risk of death after per rectal (PR) bleeding.

Methods
Patients over 65 who were admitted between January 2017 and December 2022, having had an episode of PR bleeding, that underwent cross sectional imaging were identified from the Southern health and social care trust database. Cross sectional imaging was accessed via PACS and total psoas area (TPA) calculated at the third lumbar vertebra by a radiology trainee and validated by a consultant radiologist. Clinical, mortality and demographic data was obtained from Northern Ireland Electronic Care Record (NIECR). Psoas muscle index (PMI) was then calculated by TPA and standardising for height in mm2/m2. Sarcopaenia was defined as PMI male &lt; 545 mm2/m2 female &lt; 385 mm2/m2.

Results
77 Patients were included in this study. Patients were excluded based on the ability to standardise TPA for height. 27% (n 21) of patients were identified as sarcopaenic, 66% (n 14) of these patients have died. The median PMI showed differences between female mortality (490.44 mm2/m2) and non-mortality (559.49 mm2/m2) groups. Male patients also showed lower median PMI between mortality (599.79 mm2/m2) and non-mortality (643.05 mm2/m2 ) groups.

Conclusions
Sarcopaenia as a predictor for frailty is an important risk factor for all-cause mortality in PR bleeding. Cross-sectional imaging provides an opportunity to quantify risk as well as investigate aetiology for PR bleeding. Although radiation risk and cost effectiveness may limit use, it should be considered when imaging is available.
ThP6.14 - The Diagnostic Utility of C-Reactive Protein in Acute Appendicitis
Authors: Khalid Hammaad , Boyle Abbey , Iqbal Rizwan , Gokhale Jay , Bhogal Rayna , Mahmood Hijab , Amjad Wasif , Mohammed Mohammed I , Jassal Arun , Ayub Navyan 
Published: September 2024

Abstract

Aim
This study sought to determine the value of C-Reactive Protein (CRP) as a diagnostic marker in acute appendicitis.

Methods
All patients &gt; 18 years presenting to the surgical assessment unit with acute appendicitis in 2022 were retrospectively identified. Data including patient demographics, admission CRP, CT results and operative findings were analysed.

Results
This study identified 130 patients with a median age of 35 years. Operative management was undertaken in 85% of patients (n=110) and conservative in 15% (n=20). Of these, four required conversion to operative management. No significant difference in CRP was identified between conservative and operative management. CT was performed in 84% of patients. Of these, 98% (n=107) were suggestive of acute appendicitis - 85% uncomplicated (n=91) and 15% (n=16) complicated. CRP was significantly higher in patients with CT- diagnosed complicated appendicitis (p&lt;0.001). Operative assessment demonstrated 76 patients (58%) with uncomplicated and 38 (29%) with complicated appendicitis, with CRP significantly elevated in complicated appendicitis (median 119.5 vs 21, p&lt;0.001). A CRP cut-off of 96mg/L showed reasonable predictive value of complicated appendicitis (sensitivity=61%, specificity=88%) with AUC value of 0.76 (95%CI: 0.66-0.87). CRP also showed value as a predictor of perforation and abscess (AUC=0.79 (95%CI: 0.67-0.90) and 0.76 (95%CI: 0.63-0.89) respectively. Optimal CRP cut off for perforation was 84mg/L (sensitivity=73%, specificity=88%) and 96mg/L (sensitivity=73%, specificity=81%) for abscess. CRP was not significantly elevated in necrotic or gangrenous appendicitis.

Conclusions
CRP levels correlate with appendicitis severity in both CT and operative assessment and may be a useful predictor of perforation and abscess formation.
ThP7.9 - Enhancing Access to Psychological Support for Major Trauma Patients: A Comprehensive Approach
Authors: Nightingale Katie , Knight Chris , Dawson Matthew , McCarthy Eilis , Smith Stella 
Published: September 2024

Abstract

Introduction
One in three major trauma (MT) patients experience acute stress disorder (ASD) following physical trauma. Patients experiencing ASD are at increased risk of developing longer-term mental health conditions, including PTSD, which can impede physical recovery. Early identification of these patients and timely psychological interventions, reduce the impact of long-term mental health conditions. Access to specialist psychology services is therefore imperative for holistic patient recovery.

Methods
Referral rates to a Major Trauma Psychology service were collected for MT patients (Injury Severity Score ≥9) admitted October to December 2022. Following this, a prompt for healthcare professionals to offer the psychology service was added to the Tertiary Trauma Survey (TTS) proforma in March 2023. The TTS is a top-to-toe examination conducted within 24 hours of admission to ensure all injuries have been identified. Educational sessions were delivered to MT healthcare professionals to support their discussions with patients and a patient information leaflet was designed. Data collection was then repeated April to June 2023.

Results
Prior to these interventions, 14.18% of MT patients were referred to the psychology service with a median time from admission to referral of 4 days.
Following the interventions, 31% of patients were referred to the service, with a median time from admission to referral of 1 day.

Conclusion
Raising awareness of the importance of providing early and focused psychological support improved the rate and speed of referral to the psychology service. Earlier intervention in patients with psychological distress following trauma can reduce long-term mental health conditions and promote active recovery.
ThP8.3 - From red coded report to Fistula salvage in 2 weeks
Authors: Anton Jeny , Freedman Ben , De Figueiredo Fatima , Gambhir Raghvinder Pal Singh 
Published: September 2024

Abstract

Aim
Fistulas and grafts are life line for patients with End stage renal disease (ESRD). However, they frequently fail, and early intervention is recommended to prevent loss of access. The present study aimed to establish waiting times between identification of significant stenosis/thrombus on duplex scan to intervention.

Methods
In this study we looked at all red coded reports in 2022 to establish their waiting time from red report to a radiological or surgical intervention.
We have a traffic light system where patients with fistulas with no stenosis and good volume flow (VF) over &gt;600ml/min are labelled green, labelled amber when there is a &lt;50% stenosis or minor thrombus with VF still around/above 600 ml/min. Red where there is significant stenosis/thrombus.

Results
291 patients were identified, 178 patients with significant &gt;50% stenosis/thrombus in fistula, 82 patients with occluded fistulas, 15 patients with significant inflow +/-outflow stenosis/occlusion, 16 patients with e.g. very high VF fistulas/pseudoaneurysms/small vein size +/- &lt;600ml/min VF (maturing fistulas). As a result of red report, 9% of patients received a new fistula and 57% of patients received an intervention to salvage their existing fistula. Interventions included 112 fistuloplasty/venoplasty, 43 surgical thromb ectomy procedures. 58% of patients received an intervention within the first 2 weeks with 3.6% of patients receiving intervention on the same day as red coded report. 34% of patents however did not receive any intervention.

Conclusion
There is room for further improvement to salvage more fistulas, though 60% of patients did have an intervention within 2 weeks.
FP2.7 - Results of Lower Rectum Cancer Treatment
Authors: Lamara Abdelhak , Nini Badreddine 
Published: September 2024

Abstract

Objective
The objective of this study is to evaluate oncological outcomes, specifically, the rate of locoregional recurrences in lower third rectum cancers treated with concurrent radio-chemotherapy and radical surgery.

Methods
Locoregional and metastatic recurrences were analyzed based on the initial tumor stage, response to neoadjuvant treatment, and the type of surgery. We utilized the biomedical statistics software SPSS24 and Microsoft Excel. Statistical analysis was performed using the chi-square test, with the calculation of the P-value (Pearson's test).

Results
During the period from 2000 to December 2021, 638 consecutive resections for lower third rectum cancer were conducted. One hundred and sixty-one patients (25.23%) underwent abdominoperineal amputation (AAP), while 477 (74.76%) underwent conservative surgery. There were 389 men and 249 women, with an average age of 51 years (ranging from 20 to 88). Thirty of our patients were classified as T1, 163 as T2, 420 as T3, and 25 as T4. One hundred and thirty-five patients (21%) received preoperative radiotherapy, and four hundred and eighty-six (76%) underwent concurrent preoperative radio-chemotherapy. Two hundred and six patients (43%) had an ultralow colorectal anastomosis, and 252 (52.8%) had a coloanal anastomosis. Local resection was performed in nineteen patients. The mortality rate was 0.78%, and the morbidity rate was 34%, including twenty-seven anastomotic fistulas (5.6%). Forty-one local recurrences were observed (6.4%).

Conclusion
During surgery for lower rectal cancer, the surgeon's primary concern is to achieve a valid oncological resection, preserve sphincter function, and ensure patients a recurrence-free survival.
FP2.11 - Management of Acute Sigmoid Volvulus – a 10-year retrospective review
Authors: Seager Eden , Philip Ken , Hutton Michael , Griffith David 
Published: September 2024

Abstract

Aims
This study aims to review the management and outcomes of acute sigmoid volvulus within our Trust.

Methods
This was a retrospective study conducted at our NHS Trust. All adult patients presenting with SV between January 2012 and January 2022 were included. Data was collected from electronic patient records. Admission data included management (conservative only, CM, emergency surgery, ES, or planned surgery, PS), episode number, and 30-day mortality. Surgical data included ASA grade, complication rates, and bowel continuity rates.

Results
219 patients (54.8% male, median age 72yrs) presented with acute SV. 87.2% patients were managed conservatively at index presentation, 44% of whom experienced recurrent SV. 27.4% patients received surgical management during follow-up (18.3% ES, 9.1% PS), none of whom experienced recurrence following surgery. The rate of ES increased linearly with total number of episodes, from 11% at index presentation to 25% at ≥5 episodes.
30-day mortality was 13.4% in the CM group, 15% in the ES group, and 0% in the PS group. Post-operative complication rate was 42.5% in the ES group and 5% in the PS group. Bowel continuity was achieved in 22.5% of ES patients and 60% of PS patients.

Discussion
Conservative management of SV was associated with a significant recurrence rate in our cohort. Repeat admissions were associated with an increasing incidence of ES, which was associated with worse outcomes compared with PS. We recommend all patients are considered for planned surgical intervention at index presentation to reduce recurrence and minimise the rate of emergency intervention.
FP3.9 - Loop ileostomy reversal in anterior resection: A single centre cohort Study
Authors: Gok M A , Bughio M , Aris R , Mahajan L , Sadat M M , Khan U A 
Published: September 2024

Abstract

Aims
Defunctioning loop ileostomy is commonly undertaken in &lt;40% of anterior resections especially mid and low rectal cancer resections. Loop ileostomy allows early enteral nutrition and rehabilitation and reduces the impact of post operative ileus, anastomotic leaks and pelvic sepsis complications Closure of loop ileostomy is usually advocated after 3 months of the index malignant colorectal resection. The aim of this study was to assess the reversal intervals and delays in ileostomy reversal.

Methods
This is a cohort study carried out since January 2008 to December 2023 at a single centre. Descriptive demography & surgical outcomes were evaluated for all Anterior Resections with loop ileostomy. All anterior resections without covering loop ileostomy carried out since 2008 were recruited as controls.

Results
AR loop ileostomy (n = 152) AR no stoma (n = 297) Mann Whitney U (p test) Age(yrs) 67.0 ± 0.8 68.4 ± 0.7 NS Sex(M:F) 96 : 56 180 : 117 NS ASA(median) 2 2 NS BMI 26.5 ± 0.4 27.2 ± 0.3 NS Lap : Open(n) 94 : 58 220 : 77 &lt; 0.05 Op time(mins) (index op) 256.3 ± 6.8 219.2 ± 4.7 &lt; 0.0001 LOS(days)(index op) 10 ± 4.5 6 ± 3 Reversal (n) 111 Days to reversal 262 ± 102 Reverse op time(mins) 84.3 ± 4.9 LOS reversal(days) 6 ± 3.5

Conclusion
Delays in loop ileostomy reversal in our intuition were due to: progressive CRC disease diagnosis, adjuvant treatments, patient frailty/death, patient choice, delays in anastomotic integrity checks, & theatre availability. To avoid delay, reversal should be planned at time of defunctioning loop ileostomy.
FP3.13 - Acute Complicated Diverticulitis: Colorectal Cancer in Disguise? Five Years of Follow-up Practice at a 600-bed Hospital
Authors: Jones Benjamin , Watt David 
Published: September 2024

Abstract

Aims
Complicated diverticular disease is associated with colonic neoplasia rates of 7.8% to 10.9%. ACPGBI guidelines recommend optical or virtual colonoscopy six weeks following an attack of acute complicated diverticulitis unless performed within the preceding two years. It has been posited that flexible sigmoidoscopy may be sufficient to rule out malignancy given that diverticulitis predominantly affects the sigmoid colon. Five years of practice at a 600-bed hospital was audited to the ACPGBI standard and malignancy rates and locations investigated.

Methods
All emergency admissions coded for acute complicated diverticulitis from January 2017 to December 2022 were included. Patient electronic records were reviewed retrospectively for demographic data, operation notes, as well as radiology, endoscopy and histology reports.

Results
A total of 197 patients were included in the study period. 97 cases underwent emergency or semi-elective resection within one year. 8 patients had colonic visualisation in the two years prior to their attack, leaving 92 cases in whom colonic visualisation was indicated. 44 patients had colonoscopy, 22 had flexible sigmoidoscopy, 2 had CT colonography and 24 had no further imaging. 7 malignancies were identified, 5 from resection specimens and 2 from endoscopy. All tumours were in sigmoid colon.

Conclusions
The ACPGBI standard was met in 50% (46/92) of cases. If flexible sigmoidoscopy were deemed acceptable this would increase to 74% (68/92). Malignancy was identified in 4% (7/197) of cases. All malignancies were in the range of flexible sigmoidoscopy, suggesting full colonoscopy may be superfluous. Less extensive endoscopy may reduce procedure duration, bowel preparation and patient discomfort.
FP4.9 - Adherence to post Colonic polypectomy surveillance guidelines
Authors: Khattak Muhammad Ali , Waheed Aimen , Demetriou George , Bedford Matthew 
Published: September 2024

Abstract

Aims
The British Society of Gastroenterology updated its guidelines in 2020 regarding polyps follow-up following colonoscopy. The surveillance depends on type, size, number, and histology criteria. Our aim was to assess adherence of our hospital's endoscopy department to these new guidelines.

Methods
A retrospective analysis of all consecutive adult patients who underwent colonoscopy were included between January and March 2022 at our hospital. Data were collected and analyzed on excel. The endoscopy report was identified from MediLogik-EMS.Histology from PICS system. Demographics including the specialty of endoscopist was also included. Non-parametric data were expressed in their Median and IQR.

Results
Out of the 108 patients examined 50/108 (49%) were found to have polyps and were included in the analysis. F: M =1:2, median age 64 with IQR 18.5(59-77.5). Tubular adenoma was found in 58%, hyperplastic polyps in 12%, sessile serrated polyps in 10%, tubulovillous adenoma in 8%, adenocarcinoma in 8%, and inflammatory polyps in 4%. Histopathology revealed tubular adenoma with LGD in 58%, inflammatory polyps in 16%, adenocarcinoma in 8%. Polyps were removed using cold biopsy in 58% and hot snare in 38%. BSG guidelines were followed in 92% (46/50). The reason for not adherence was either histologically incomplete excision, requiring a site check within 2-6 months which was not performed in6%(3)or high-risk features requiring 3 yearly surveillance colonoscopy follow-ups not requested in 2%(1).

Conclusion
There is high adherence to the guidelines but still not 100%. Our aim is to achieve 100% adherence in the re-audit.
FP4.13 - Intravenous morphine negatively affects length of stay following minimally invasive colorectal surgery
Authors: Moolamannil Mathew , Rajaratnam Kanapathi , Bevan Katharine , Georgiades Fanos 
Published: September 2024

Abstract

Aim
Investigate the impact of intravenous (IV) morphine administered as patient controlled analgesia (PCA) following minimally invasive colorectal resections.

Method
Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre.

Results
Our cohort included 38 colorectal resections completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform and 57 consecutive laparoscopic colorectal resections. 7 patients were excluded due to incomplete data. 51/88 (57.9%) of patients underwent a left sided resection and 24/88 (27.3%) had a stoma formed. We observed a median IV morphine dose of 15.5mg (IQR 15.5-43.5mg) and we sub-divided the cohort into those who received &gt;15 mg of IV morphine and &lt;15mg of morphine via PCA. Patients who received &lt;15mg IV morphine were older (median age 75 Vs 67 years; p&lt;0.001). There was no statistical difference in the body mass index, ASA grade, total operative time, or type of minimally invasive resection. The median length of stay was 4 days for the &lt;15mg IV Morphine cases compared to 5 in the &gt;15mg IV Morphine group (p&lt;0.001). As expected, there was a quicker time to first flatus in the &lt;15mg IV Morphine group (median 2 days Vs 3 days; p&lt;0.001) and a shorter time to opening bowels (median 3 days Vs 4 days; p=0.003). There was no statistically significant difference in post-operative complications between the two groups.

Conclusions
Reducing postoperative IV Morphine dosing following minimally invasive colorectal resections may lead to prompter recovery.
FP5.14 - Enhancing Patient Communication in Surgical Care: an Audit of Practice at a DGH
Authors: Dinarvand Daniel , Thiruchelvam Tharanya , Kassem Mohamed , Kerans George , Ratnasingham Kumaran 
Published: September 2024

Abstract

Aims
This audit aimed to evaluate current communication standards at a DGH (based on inpatient feedback) and assess the alignment with NICE Guidelines for improving the experience of care in adult NHS-services. The standards assessed included: providing clear information on diagnosis, oral and written communication, and communication in the presence of family or next of kin.

Methods
Inpatient feedback on surgical wards was collected to assess guideline adherence, with a pre-intervention survey designed to assess opinions before implementing an intervention. Two assessment cycles were conducted, with 12 responses in Cycle 1 (1-15 Nov 2023) and 13 responses in Cycle 2 (16-30 Nov 2023). The intervention included providing clear written information on imaging results and ongoing plans, and encouraging patients to use an information sheet throughout their admission, which could also be relayed to family members.

Results
Pre-intervention data revealed a diverse age distribution, predominantly in the 55-64 age group. Understanding of diagnosis varied pre-intervention but showed improvements post-intervention. Post-intervention, the majority (n=9) felt the information was appropriately pitched. Thirteen respondents received accessible information, finding the universally distributed information sheet helpful. A written response highlighted its utility in explaining clinical information to families. Healthcare professionals received improved 'clarity' and 'helpfulness' ratings post intervention, indicating positive outcomes.

Conclusions
Effective communication is integral to exceptional patient care. This audit underscores the potential to enhance patient understanding, alleviate concerns, and improve communication in surgical settings. The intervention, a simple information sheet, proved effective and emphasised the need for accessible, clear and standardised patient communication.
FP5.15 - Who’s in the club? Higher General Surgical Trainees and Trainers perceptions of who and what comprises multidisciplinary team working
Authors: Johnston Judith , Quinton Naomi 
Published: September 2024

Abstract

Aim
To explore who Higher General Surgical Trainees (HST) and Trainers perceive as being members of Multidisciplinary teams.
To explore what HST and Trainers perceive to be a MDT meeting.

Methods
Following ethical approval, virtual semi structured interviews were conducted with 8 HST and 4 Trainers within one deanery. These interviews were then evaluated using reflexive thematic analysis.

Results
The majority of those interviewed expressed the dichotomy of the professionals involved in day-to-day care patient compared specific meeting relating to disease processed. While most recognised the former as a definition, when specifically discussing MDT, all referred to meetings. This duality was particularly pertinent in discussion of assessment of MDT as a Capability in Practice (CiP). Junior HSTs self-assessed using day-to day MDT but Senior HSTs and Trainers regarded the meeting as the arena for assessment. Despite participants working in different general surgical specialities with benign components, all perceived cancer MDT meetings to be the ‘true’ or most relevant definition. However, there was a consensus that the definition of MDT is evolving. When elucidating members of cancer MDTs, every participant named all clinical and support staff that routinely attend, but Trainers did not reference their HST.

Conclusion
Despite an evolution of MDT definition to include benign meetings such a pelvic floor or day-to-day working, there is a persistence among General Surgical Trainers and trainees to interpret MDT as purely cancer meeting. This can cause confusion in assessment of MDT as a CiP.