bluuebunny/crossref_metadata_2025_split huggingface dataset:
SUS 2 - Routine histological examination of haemorrhoidal tissue – an unnecessary environmental and economic expense?
Authors: Warner Naomi , Karunatileke Chatura , Hurst Katherine , Singh Anjana 
Published: September 2024

Abstract

Background
Modern, less invasive methods of haemorrhoid treatment, such as haemorrhoid artery ligation and radiofrequency ablation, are increasingly employed. These do not yield specimens for histological analysis. However, when open haemorrhoidectomy is performed, even in the absence of suspicious operative features and in low-risk patients, the haemorrhoid specimen is routinely sent. This has both environmental and financial costs in an increasingly pressured NHS, and negatively impacts sustainability with no clinical advantage.

Methods
We retrospectively studied 112 open haemorrhoidectomies performed at our UK hospital from February 2018 to June 2023, reviewing clinic letters, operation notes and post-operative histology.

Aims
To assess the frequency of incidental pathology identified during routine histological assessment, and the associated financial costs and carbon footprint generated.

Results
112 open haemorrhoidectomies were performed in the 5-year study period. In total, two patients with risk factors for AIN/Anal cancer were identified. There were no documented concerns of abnormal intra-operative findings. Histology mainly revealed haemorrhoid tissue alone (103) and benign polyps (8). AIN3 was detected in one of the high-risk patients. The cost per histology specimen was £93.32 (Total cost £10,451.84). Each specimen is estimated to generate 0.29kg of Carbon Dioxide equivalents (Total 32.48kg CO2e).

Conclusion
Routine histological assessment of haemorrhoidectomy specimens is time-consuming, expensive and has an avoidable carbon footprint for a low detection of incidental pathology. Our study suggests that histology should be reserved for patients with risk factors for AIN/Anal cancer, or concerning intra-operative findings. Larger scale studies, and development of national guidelines would aid clinician decision-making.
SP1.3 - Surgical Practices in Emergency Umbilical Hernia Repair and Implications for Trial Design
Authors: Walshaw Josephine , Kuligowska Anna , Smart Neil J , Blencowe Natalie S , Lee Matthew J 
Published: September 2024

Abstract

Aims
There is variation in the investigation, management, and surgical technique of acutely symptomatic abdominal wall hernias and optimal strategies remain to be established. This survey aimed to identify key variables influencing decision-making and preferred surgical techniques in emergency umbilical hernia care to help inform trial design and understand potential challenges to trial delivery.

Methods
A survey was distributed to surgeons through social media, personal contacts, and ASGBI lists. It comprised five sections: (i) performer of repair, (ii) repair preferences, (iii) important outcomes, (iv) antibiotic use, and (v) trial design.

Results
There were 105 respondents, of which 49 (46.6%) were consultants. The median largest defect surgeons would attempt to repair with sutures alone was 2cm (IQR 2-4cm). In the acute setting, the most common mesh preferences are preperitoneal plane placement (n=61, 58.1%), with synthetic non-absorbable mesh (n=72, 68.6%), in clean (n=41, 39.0%) or clean-contaminated (n=52, 49.5%) wounds. Respondents believed suture repair to be associated with better short-term outcomes, and mesh repair with better long-term outcomes. The trial design felt to most likely influence practice is comparing mesh and suture repair, and also comparing post-operative antibiotics versus no post-operative antibiotics. Respondents indicated that to change their practice, the median difference in surgical site infection rate and recurrence rate would both need to be 5%.

Conclusion
This survey provides insight into surgical preferences in emergency umbilical hernia management, offering guidance for future trial designs. Such designs should align with existing evidence and incorporate patient and public involvement to ensure a meaningful impact.
SP1.9 - Management of cutaneous abscesses and infected sebaceous cysts using inhaled methoxyflurane Penthrox®: a 12 month prospective observational study
Authors: Carney Alex , Birkin Rebecca , Whitehead Nicola , Heath Jennifer , Dawson Julian , Laing Richard 
Published: September 2024

Abstract

Aims
Incision and drainage of abscesses contribute a significant burden upon emergency general surgical theatres. The purpose of this study was to look at the safety and effectiveness of incision and drainage using inhaled methoxyflurane (Penthrox®) to reduce reliance upon surgical theatres and provide an effective alternative to local anaesthetic.

Methods
After a successful pilot of 20 patients, adults with ‘simple’ abscesses were enrolled over a 12-month period and given inhaled methoxyflurane for ward-based incision and drainage. Pilonidal and perianal abscesses, patients with ASA ≥3 and abscesses greater than 5cm in size were excluded. Length of admission and outcomes at 1 week, 1 month and 3 months post procedure were compared to previously audited data on simple abscess drainage in theatre to determine safety, efficacy and cost-savings.

Results
130 patients had an abscess drained using Penthrox® inhaled analgesia. 93.8% (122/130) had successful drainage with a mean admission time of 99 minutes. Eight patients reattended for further treatment (3&lt;3 months, 3&lt;1 month and 2&lt;1 week); two patients required antibiotics and five required further drainage. Patients taken to theatre spent on average 34.5 hours in hospital compared to 1.65 hours for those performed using Penthrox®. A patient feedback tool captured very positive comments with no negative experiences recorded.

Conclusion
Penthrox® is a safe, effective analgesic for the incision and drainage of simple abscesses and patient experience is overwhelmingly positive. In addition, it significantly reduces the burden on emergency theatres and the hospital bed-base with an estimated minimum saving of £1704 per patient.
SP2.3 - Environmental and non-technical factors influence surgical trainees involvement in laparoscopic appendectomy in Northern Italy: a propensity score matching and survey based multicenter analysis
Authors: Cioffi Stefano Piero Bernardo , Altomare Michele , Spota Andrea , Granieri Stefano , Virdis Francesco , Cimbanassi Stefania 
Published: September 2024

Abstract

Aims
Laparoscopic appendectomy (LA) is an index procedure for surgical residents (R). The trends of R involvement in LA can be a quality benchmark for residency programs. The impact of clinical and non-clinical factors on such trends is still undisclosed. We aimed to investigate the prevalence of LA performed by R in the largest Italian educational network and explore the decision-making behind R involvement in LA.

Methods
We extracted data from the RESIDENT-1 (R1) multicenter trial registry and performed a propensity score matching (PSM) analysis to identify clinical and environmental differences according to the operator, surgeons(S) vs R. Additionally, to explore environmental and non-technical factors influencing the choice of the primary operator, we administered a survey to S and R in the R1 network.

Results
We enrolled 653 LA from October 2019 to October 2022, 234 (35.89%) were performed by R. We compared 231 per group after PSM. In academic hospitals and dedicated emergency surgery units LA were more frequently approached by R (57.14%vs26.84%, 51.08%vs19.05% p&lt;0.001, respectively). The survey showed discrepant perspectives, R prioritize clinical factors, as the presence of complicated disease (25.53%vs.8.33%, p&lt;0.015), whilst non-technical and environmental factors such as year of residency (63.1%vs.44.7%,p=0.05) and punctuality (47.2%vs.23.4%,p=0.041) were more important for S. Both groups agreed that a perioperative feedback system would improve the process of R involvement in LA.

Conclusion
Our study report a low rate of LA performed by R in northern Italy, primarily influenced by non-clinical factors. Furthermore, dedicated pathways and a well-structured perioperative teaching method could optimize the teaching process.
SP3.2 - Investigating pre-operative anaemia optimisation in patients on the colorectal cancer pathway
Authors: Sarkar Shuvam , Payne Christopher , Gray Carol 
Published: September 2024

Abstract

Aims
Colorectal cancer (CRC) is becoming increasingly prevalent in the United Kingdom, with over 42,000 cases diagnosed every year. CRC is most commonly diagnosed at colonoscopy. Patients are often found to have iron deficiency anaemia during pre-assessment and may require intravenous iron (IVI) replacement for preoperative optimisation. Our aim was to determine the percentage of patients on the CRC pathway requiring optimisation of anaemia and to review the pathway for patients requiring IVI preoperatively, to identify opportunities for improvements.

Methods
This study investigated 85 patients who were referred to the pre-assessment clinic (PAC) under the CRC pathway. The percentage of patients requiring IVI to optimise their anaemia was identified. The time taken to refer patients for IVI, and the time taken to infusion appointment was then established.

Results
This study found 24% of patients were anaemic, with 12% showing severe anaemia requiring IVI. The average waiting time between colonoscopy and PAC review was 24 days. Patients requiring IVI waited a further 8 days on average to be referred for replacement. There was a delay of 10 days from referral for iron before patients were given the first dose of iron, with patients waiting up to 4 weeks before the course of intravenous iron was complete.

Discussion
Patients on the CRC pathway currently face significant delays in optimising iron deficiency anaemia pre-operatively. Investigating patients for anaemia at the time of colonoscopy and referring for iron replacement earlier could reduce this delay and ensure patients are optimised in a timely manner for surgery.
SP3.7 - Patient experiences of using wearable health monitors during cancer treatment: A qualitative study
Authors: Collinson Sophie , Ingram-Walpole Shannon , Jackson Corie , Chan Anthony , Merchant Zoe , Wilson Anthony 
Published: September 2024

Abstract

Introduction
Wearable health monitors (WHM) are being used in healthcare with increasing popularity, and offer a minimally invasive, ambulatory method of 24-hour monitoring. The aim of this study explores the patient experience of using WHMs during cancer treatment, including barriers and enablers of WHM use.

Methods
A phenomenological qualitative approach was used with single semi-structured interviews conducted in the form of focus groups with individuals enrolled in the EMBRaCE-GM study where WHMs are worn in the perioperative period of at least 6 months during treatment of either colorectal cancer, lung cancer, leukaemia/lymphoma or head & neck cancer.

Results
We identified 3 major themes of perceived patient benefit, treatment partnerships between patients and healthcare professions and barriers to the adoption. WHMs promoted positive behaviour change, prioritisation of own health and represented a form of “digital advocacy”. Potential barriers were aesthetic, experiential and technological. WHM introduction was time-sensitive, with patients finding their use acceptable at differing stages in their cancer pathway. Patients desired reciprocal interaction with WHMs and were less concerned with data accuracy.

Discussion
Our study identifies factors influencing a patient’s decision to use WHMs and their importance as a patient-centric interactive component of management. Novel findings include the optimal time to start wearing WHMs and that validity of measurements appears less of a concern for patients (in contrast to clinicians) who use wearable data and trends with their own experiences as part of a sense making exercise. Future work should focus on balancing patient and clinician expectations to provide guidance on the feasibility of WHM use in routine clinical practice.
SP3.10 - Utilisation and Outcomes of Emergency Laparoscopic Resection for Colon Cancer: A Population-based Study in England
Authors: Rashid Adil , Kuryba Angela , Braun Michael , Fearnhead Nicola , Van Der Meulen Jan , Walker Kate 
Published: September 2024

Abstract

Aims
To evaluate the current use and outcomes of urgent or emergency laparoscopic resection of colon cancer in the National Health Service in England.

Methods
11,182 patients from the National Bowel Cancer Audit diagnosed with colon cancer from April 2017 to March 2022 in England, who underwent urgent or emergency resection, were included. Multivariable logistic and linear regression was used to quantify factors associated with use of laparoscopic surgery and compare risk-adjusted postoperative outcomes between laparoscopic and open surgery.

Results
The use of emergency laparoscopic resection increased from 33.0% in 2017 to 47.5% in 2022, with a temporary stabilisation during the first wave of the COVID-19 pandemic (38.9% 2020/21). In risk-adjusted analyses of 9,579 patients, patients with poorer physical status [ASA 4/5 vs 1, aOR 0.35 (95% confidence interval 0.27-0.44) P &lt; 0.001], more advanced T-stage [T4 vs T1-T2, aOR 0.26 (0.21-0.32) P &lt; 0.001] and M-stage [M1 vs M0, aOR 0.87 (0.76-0.99) P &lt; 0.036] were less likely to undergo laparoscopic surgery. No association was found with age, socioeconomic deprivation, or nodal stage. Patients undergoing laparoscopic resection had a shorter length of stay [adjusted mean difference -2.55 days (-3.23, -1.87), P &lt; 0.001], lower 90-day mortality [aOR 0.75 (0.63-0.89), P = 0.001], and lower 30-day unplanned reoperation [aOR 0.82 (0.70-0.96), P = 0.014] than patients undergoing open resection.

Conclusion
There has been an increased utilisation of laparoscopic surgery in the emergency setting, and it is associated with reduced hospital stay, postoperative mortality and unplanned reoperation.
SP4.4 - Gallbladder Cancer: Radical Surgery and Prognosis
Authors: Lamara Abdelhak , Nini Badreddine 
Published: September 2024

Abstract

Introduction
The prognosis for gallbladder cancer remains unfavorable, with advanced forms not being uncommon. This prospective study aims to assess outcomes based on the tumor stage and prognostic factors.

Materials and Methods
Patients with gallbladder cancer were included in a retrospective study, during which factors influencing the type of resection were considered, and prognostic factors were analyzed. We used 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
One hundred and eighty-five patients were included in this retrospective study, with an average age of 62 years. In 24 patients, simple cholecystectomy was deemed sufficient, while radical cholecystectomy involving the gallbladder bed with lymphadenectomy was performed in 27 patients. Seventy-nine patients underwent hepatic resection (S4b–S5), and bile duct resection was necessary in 12 patients. Due to local and metastatic extension, 43 patients received palliative treatment. R0 resection was possible in 71.3% of cases. Two early reoperations were necessary, one for bleeding from the hepatic edge and the other for an abscess. T3 or T2 tumors with lymph node invasion underwent adjuvant treatment. The recurrence rate was 14.5%. The three-year survival, across all stages, was 73.4%.

Conclusion
Radical surgery of gallbladder cancer is not always possible. The tumor stage and type of resection influence the survival rate.
SP5.13 - Assessing the use of electronic QLIK app in Mortality and Morbidity meetings compared with traditional manual hand collected data in colorectal surgery
Authors: Soon Justin , Moriaty Karmena , Jones James , Grimble Sarah , Allen Ultan , Humes David 
Published: September 2024

Abstract

Aims
To validate and compare the effectiveness of the QLIK app as an electronic method of data collection compared to traditional manual methods for mortality and morbidity meetings (M&Ms).

Methods
All data from the theatre operating management system was linked in the Trust Data Warehouse to clinical test and vital statistics data and displayed using a QLIK App. A retrospective study was conducted comparing the manual collection of data of elective colorectal M&M with the QLIK app data for the years 2021 and 2022. Data collected included: total operations, number of deaths, readmissions, reoperations and post-operative complications. The combined data was then analysed in three different rounds of validation.

Results
There was a high level of concordance between the manual data and the QLIK app, with both correctly identifying the same number of deaths. In 2021 the app recorded 569 total operations compared to 584 in the manual data, and 127 post operative complications to 126 respectively. In 2022, the app recorded 607 operations to 489 in the manual data, and 120 complications compared to 149. Of the complications recorded in the manual data but not the app, 96.8% of these were Clavien-Dindo Grade 1 and 2 complications. Manual data collection of the M&M data was estimated to take approximately 250 hours per year from collection to analysis, whilst the app displayed the data in near real time.

Conclusions
Use of data visualization tools and coded electronic hospital data for M&Ms can minimise errors and allow for greater efficiency. This approach gives real time surgical performance data.
SP6.4 - Were QR codes to distribute information to patients following a consultation beneficial in a clinical setting?
Authors: Murthy Neel , Murthy Krishnamurthy S 
Published: September 2024

Abstract

Aims
To investigate whether the use of QR codes to distribute information from brochures online would be accepted and preferred by patients compared to physical paper brochures; If paper waste can be reduced - fewer brochures being printed and discarded and hence eco-friendly and cost effective

Methods
Benign breast conditions were chosen for this project and QR codes generated with specific URLs for each booklet linked to a scannable QR code. At the end of clinical consultation, the Consultant invited and guided patients to scan the QR code brochure specific for their symptoms. 60 patients, from October 2022 to March 2023 were invited to take part in this original study, as a part of their consultation, with their responses gathered and analysed.

Results
60 patients completed the feedback form with a 100% response rate. The age range was 20 to 70 (mean age = 45 years), of which 76.7% were aged under 50 years, and 96.7% were female. The majority (78.3%) preferred accessing an electronic leaflet via a QR code instead of a paper leaflet, and 88.3% found it easier to access information online via the QR code over other methods to access websites.

Conclusions
The majority of the patients were satisfied/very satisfied with the use of QR codes to access the online brochures. Although this was a simple study, it provides the basis to design a larger trial with a standardised methodology procedure, so that we can draw meaningful results from appropriate statistical analyses.
SP6.7 - Exploring the Mechanistic Basis of the Adipose Derived Stem Cell Secretome on Extracellular Matrix Remodelling in Radiation Induced Fibrosis
Authors: Wai Jasmine May Yen , Cui Xiangmei , Frommer Marvin , Langridge Benjamin , Butler Peter 
Published: September 2024

Abstract

Background
Radiation-induced fibrosis (RIF) is a debilitating complication following radiotherapy, characterised by fibroblast proliferation and excessive extracellular matrix (ECM) deposition, leading to functional and aesthetic impairments. Although autologous fat grafting (AFG) has shown promise in reversing RIF, the mechanisms, largely attributed to adipose-derived stem cells (ADSCs), remain elusive. This study aimed to investigate ADSCs’ and their secretome on ECM remodelling in RIF management.

Methods
The anti-fibrotic potential of the ADSC secretome on HDFs subjected to ionising radiation was assessed via a series of in vitro experiments. Control HDFs were compared with irradiated HDFs to assess any phenotypical changes. Irradiated HDFs were treated with ADSC pre-conditioned media (CM) or ADSC co-culture (CC). Gene expression (COL1A1, TGF-β1, CCN-2, MMP-1, MMP-3, TIMP-1, ACTA2, TNC) was assessed via real-time quantitative PCR (RT-qPCR). ProCollagen1a1 and CCN2 protein concentrations were assessed by ELISA.

Results
Irradiated HDFs demonstrated changes in fibrotic gene expression. ADSC-CM treatment significantly reduced COL1A1 expression, although protein levels remained unchanged. TGF-β1, CCN2, MMP-3, TIMP-1 and ACTA-2 exhibited reduced expression post-ADSC-CM treatment whereas TNC expression was found to be significantly increased. Co-culture with ADSCs led to a general, but not statistically significant, decrease in pro-fibrotic gene expression. Notably, CCN-2 protein expression significantly increased.

Conclusion
This study demonstrates that ionising radiation results in a pathological pro-fibrotic phenotype in HDFs. The ADSC secretome potentially mitigates this, reducing pro-fibrotic gene expression. Unexpectedly, co-culture experiments highlighted a complex interaction with upregulation of fibrosis-associated genes. Further research is needed to clarify these interactions to improve therapeutic interventions for RIF.
SP7.5 - Time to CT for Acute General Surgery and Trauma in patients undergoing emergency laparotomy. A major trauma centre experience
Authors: Green James , Yung Diana , Frith Daniel 
Published: September 2024

Abstract

Introduction
In our institution separate care pathways exist for patients presenting with major trauma and acute abdomen (AA). Trauma patients activate a Consultant led trauma team attendance on arrival and CT imaging within 30 minutes where indicated. Our acute abdomen pathway attracts ST3+ general surgical review within 2 hours of emergency department referral and CT within a further 1 hour. We aimed to compare the two laparotomy cohorts with respect to clinical outcomes.

Methods
A retrospective analysis was performed on patients that underwent an emergency laparotomy following CT at our institution between December 2020 and February 2022. Patients were identified from the NELA and TARN databases.

Results
66 trauma and 64 AA patients were identified. The mean time to CT in trauma was 56.1 minutes ± 24.8 and in AA 390.7 minutes ± 306.1 (p&lt;0.001). There was no difference in length of ITU stay (mean days 3.1 ± 8.1 vs 4.2 ±9.8 p=0.260) or hospital stay (mean days 13.7 ± 19.2 vs 13.8 ±11.7 p=0.494). no correlation between time to CT and length of hospital stay (r=0.233 p=0.97) or ITU stay (r=0.224 p=0.964) in trauma patients or AA (r=0.217 p=0.58 and -0.001 p=0.562 respectively for hospital and ITU stays) was detected. However, there was a trend towards lower mortality in the trauma cohort (3% vs 7.8% p=0.227).

Conclusion
Trauma patients were scanned quicker than acute abdomen presentations likely due to greater personnel resource and better care pathways. This was associated with a trend towards lower mortality because of earlier pathology detection and Consultant directed care from hospital arrival.