bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP8.3 - Institutional initial experience and outcomes for the first 100 robotic upper gastrointestinal cases: A single tertiary centre results
Authors: Brooks Benjamin , Harrington Bertram , Elshaer Ahmed , Athanasiou Antonious 
Published: September 2024

Abstract

Background
Robotic surgery is a widespread technique with potential benefits including shorter admissions, fewer complications as well as better surgeon ergonomics and precision. Evidence suggests that robotic surgery has a rapid learning curve, with number of cases linked to operative time. In this study, we report our preliminary results after initiation of upper gastrointestinal robotic assisted surgery.

Methods
This retrospective study included all robotic elective upper gastrointestinal cases, performed by two surgeons using Da Vinci XI from August 2022 to May 2023. Cholecystectomy and anti-reflux surgeries were performed. Demographics, console timing, number of cases per list and post-operative complications (Clavien-Dindo Scale) were analysed.

Results
100 Robotic UGI cases were analysed consisting of 86 cholecystectomies and 14 anti-reflux surgeries. Females represented the majority of cases (68%). Mean age was 53.0 years (18-78) while mean ASA and BMI were 2 and 30.3 kg/m^2 respectively. Cholecystectomies required 43.0 minutes while anti-reflux surgeries required 119.3 minutes on average. The mean length of stay was 0.90 days for cholecystectomies, and 1.46 days for anti-reflux surgery. There were two readmissions post cholecystectomy for pneumonia and liver bed collection. Only one patient developed a Clavien-Dindo grade &gt;3 complication for port site hernia repair post cholecystectomy.
Average console time fell with increasing case number, creating a tangible impact on efficiency as surgeons increased the number of cases per list from three to four.

Conclusion
Our initial experience has shown favorable outcomes of robotic surgery. There was a noticeable rapid learning curve, encountering only one major post-operative complication. This high effectiveness should stimulate the swift introduction of robotic surgery to other hospitals.
SP8.8 - Inspiring Overseas Surgeons for a Life in the NHS: Results from an International Cohort
Authors: Matwala Kabir , Shakir Taner , Mota Laura , Djemil Talya , Lingam Gita , Lovett Bryony 
Published: September 2024

Abstract

Aims
Entry into the NHS can be fraught with difficulty, especially when entering from outside of the UK. Numerous socioeconomic and cultural barriers exist, which can be prohibitory. Currently only extremely limited methods of motivating international medical graduates (IMG) exist. Surgical specialist training recruitment has decreased over the past few years. We instigated an innovative introduction to the NHS with the aim of inspiring overseas doctors to pursue a career within surgery in the NHS.

Methods
An agenda was created targeted at medical students and IMG. Speakers were recruited based upon these including students and doctors who had visited the NHS or are current workers. Collaboration was sought with international students who aided with distribution. Individuals were invited to sign up via an electronic link. The session was delivered with free online video conferencing software. Participants answered a series of 5-point Likert scale questions.

Results
102 registrations were received. Participants attended from Brazil (64.3%), USA (14.3%), India (7.1%) and the UK (7.1%). The event attracted a wide range of seniority from medical students (35.7%) to residents (7.1%). 100% of participants stated they had a better understanding of the NHS and 100% were more likely to attempt to enter the NHS after attending the event.

Conclusions
Chronic staffing shortages are a ubiquitous problem in the NHS. Application rates for surgical posts have been declining. Our innovative method of inspiring surgeons of the future has been shown to be effective in our international cohort.
SP8.12 - Evaluating the pig tissue model for acute proctology simulation at General Surgery ST3 Bootcamp
Authors: Clarke Rory , Kuligowska Anna , Scott Patrick , Biyani Shekar , Cooper Adam Peckham 
Published: September 2024

Abstract

Evaluating the pig tissue model for acute proctology simulation at General Surgery ST3 Bootcamp

Background
Acute proctology is an important skill for any general surgical trainee; however it is a skill which often is overlooked when it comes to training. Most, if not all teaching happens during patient procedures. Simulation in this area is underdeveloped and there is a lack of validated models for simulation. These models are also usually expensive and difficult to obtain. The aim of this study was to assess face validity of a low-cost model for teaching acute proctology during the ST3 general surgical bootcamp.

Methods
We created a model using a pig rectum and perineum. This provided two uses. Firstly, we were able to teach relevant clinical anatomy. Secondly, we were able to simulate EUA, rigid sigmoidoscopy, decompression of volvulus and haemorrhoidal banding. The models allowed for repeated use.

Results
Twenty-five trainees took part in this simulation. Overall, the trainees felt the rectal examination was realistic (76%), the sigmoidoscope moved realistically in the model (72%) as did the proctoscope (88%).
In terms of ability, trainees felt the simulation improved their confidence in EUA (68%), rectal examination (72%) and banding (80%). A total of 80% of trainees thought the model was overall “Good or Excellent”.

Conclusions
Our study demonstrates that this low-cost, high-fidelity simulation model has a high face validity and may be explored for the use for training new general surgical registrars.
SP9.7 - Emergency vs. elective biliary admissions in the elderly on a unit adopting index admission cholecystectomy and bile duct exploration. Patients over 70 years with biliary emergencies have more acute cholecystitis and empyema and need significantly more bile duct explorations
Authors: Omran Asmaa , Al-Shaye Ahmad R A , Hayyawi Israa , Khan Khurram S , Nassar Ahmad H M 
Published: September 2024

Abstract

Aim
To compare operative and postoperative outcomes of benign biliary surgery in elderly patients.

Methods
A prospective database of cholecystectomies and bile duct explorations was analysed, comparing index admission surgery for biliary emergencies (Group I, 559, 63.2%) to elective surgery (Group II, 325, 36.8%) in the over 70.

Results
Group I Group II Females 312 (55.8) 210 (64.6) ASA grade 3 0r 4 236 (42.2) 102 (31.4) Presentations: Acute cholecystitis 132 (23.7) -- Pancreatitis 97 (17.4) -- Jaundice/Cholangitis 323 (57.8) -- Previous episodes Pain 40 (7.2) 7 (2.2) Cholecystitis 33 (5.9) 45 (13.8) Pancreatitis 9 (1.6) 24 (7.4) Jaundice 51 (9.1) 35 (10.8) Ultrasound findings GB Thick wall or contraction 162 (29) 53 (16.3) Bile duct dilatation 247 (44.2) 56 (17.2) Operative GB findings Acute 41 (7.3) 4 (1.2) Empyema 119 (21.3) 12 (3.7) Contracted 89 (15.9) 64 (19.7) Cholecystectomy Difficulty Grade I & II 188 (33.6) 183 (56.3) III 140 (25) 77 (23.7) IV 183 (32.7) 56 (17.2) V 46 (8.2) 9 (2.7) Abnormal IOC 314 (56.2) 122 (37.5) Bile Duct Exploration 308 (55.1) 97 (29.8) Operative time; median/range) 90 min/ 23-345 78.6min/ 21-270 Open conversion 7 (1.25) 2 (0.6) Morbidity 40 (6.7) 30 (10) Readmissions 49 (8.7) 12 (3.7) Reoperations 4 (0.6) 2 (0.6) Hospital stay; median/range 12 days/ 1-100 3 days/ 1-160 Mortality 6 (1.1) 0 Resolved in one episode 350 (62.8) 175 (53.8) * bold &gt; statistically significant.

Conclusions
In spite of increased difficulty and higher incidence of bile duct exploration more emergencies than electives resolve in one episode. Other outcomes compare favourably with elective surgery. Index admission surgery is justified in the elderly.
SP9.11 - Characteristics and predictive factors associated with on table mortality in emergency laparotomy: insights from the National Emergency Laparotomy Audit
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Lund Jon , Pearce Lyndsay , Moug Susan , Tierney Gillian 
Published: September 2024

Abstract

Aims
Mortality during emergency laparotomy is a rare but significant event that can have a profound impact on patient’s families and the healthcare team. The aims of this study were to define the frequency of this occurrence within the National Emergency Laparotomy Audit (NELA) database and to investigate predictive factors.

Methods
All patients entered into the database between 2013-2020 were included. Multilevel logistic regression was used, with clinically important factors identified a a priori, to identify variables associated with intra-operative mortality.

Results
The overall incidence of intra-operative mortality was 1 in 400 cases (450/180,985). There was no difference in mortality rate between day-time and night-time operations. These patients presented critically unwell with signs of shock (50%, 225/450) and an ASA grade of ≥4 (76%, 343/450). Their baseline function status was good with a high proportion residing in their own home (97%, 437/450) and minimal signs of frailty. Acute mesenteric ischaemia was the indication for laparotomy for 46% of patients (207/450) and was associated with a threefold increase in the risk of intra-operative death (OR 2.97 (95% CI 2.35-3.75)). Other important predictive factors were hypotension at presentation (OR 1.56 (95% CI 1.22-1.99)) and a blood lactate of 4-6 (OR 3.89 (95% CI 2.62-5.76)).

Conclusions
Intra-operative mortality during emergency laparotomy is rare but remains a significantly higher occurrence than in other emergency surgical specialities. The strong association with acute mesenteric ischaemia necessitates optimisation of UK emergency department assessment pathways and more nuanced discussions about the risks of surgery in such high-risk patients.
SP9.14 - Gastro-oesophageal reflux disease outcomes in patients with obesity following gastric bypass surgery: a systematic review and meta-analysis
Authors: Ali Iihan , Namgoong Christopher , Das Bibek , Fehervari Matyas , Fadel Michael G , Sargsyan Narek 
Published: September 2024

Abstract

Introduction
Obesity is associated with increased incidence of gastro-oesophageal reflux disease (GORD). Gastric bypass is one of the most common bariatric procedures and has favourable weight loss outcomes leading to a decrease in morbidity and mortality. However, the exact impact of gastric bypass on GORD symptoms remains less well understood. This systematic review and meta-analysis aimed to investigate the relationship between gastric bypass surgery and GORD.

Methods
A literature search of MEDLINE, Embase, Emcare and CINAHL was performed for studies that reported on GORD outcomes following gastric bypass from January 2000 to June 2023. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. The study was registered in the PROSPERO database (CRD42023495567).

Results
16 studies with 28,438 patients (follow-up ranging from 6-100 months), with laparoscopic Roux-en-Y gastric bypass being the most common procedure performed (25,567; 90%). The mean operative time for gastric bypass was 101 ± 14.0 minutes, with a re-operation rate of 0.025% ± 0.005. Sixty percent of patients permanently stopped proton-pump inhibitors following surgery. Overall, gastric bypass surgery led to a significant improvement in GORD symptoms (OR 5.31%; 95% CI: 1.77-15.91; p&lt;0.003), with a postoperative mortality rate of 0.037% ± 0.009.

Conclusions
The findings of this systematic review and meta-analysis showed that gastric bypass surgery is an effective and safe treatment for GORD. This has significant implications for counselling patients with obesity and GORD for bariatric surgery. Further research is required to understand the precise mechanism of the improvement in GORD symptoms following bariatric surgery.
WP1.15 - Advances in remote electronic monitoring of patient-reported outcomes following discharge after surgery: a systematic review
Authors: Anderton Nathan , Richards Hollie , Shah Maximilian , Blazeby Jane , Avery Kerry 
Published: September 2024

Abstract

Aims
Standardising post-discharge care is critical to improving surgical recovery. The COVID-19 pandemic caused major changes to in-person visits and surgical follow-up. An earlier review examined the pre-pandemic capture of electronic patient-reported outcomes (ePRO) post-discharge after surgery. This updated review explores how the pandemic has influenced the use of ePRO systems.

Methods
Databases (Medline/Embase/PsycINFO/CINAHL/Cochrane) were searched from July 2019-August 2023 using terms for ‘patient-reported outcomes’, ‘electronic’, ‘surgery’ and ‘at home’. Primary research studies collecting ePROs in adult surgical patients post-discharge were included. Data extraction/analyses characterised study design, patient characteristics, ePRO system features, the scope within which ePROs are used post-discharge, what PRO data is collected, adherence to ePRO monitoring, impact on primary/secondary outcomes and the patient and clinician experience of using ePRO systems.

Results
12,805 articles were identified, of which 81 were included. Emerging findings indicate an increase in research examining ePRO systems in the post-discharge care of surgical patients, with ∼20 articles/year published post-pandemic, compared to ∼3/year in the 5 years pre-pandemic. Usage of ePROs seems to be most prevalent in orthopaedic and gastrointestinal surgery. Full findings will be available for presentation at the conference.

Conclusions
Interest in using ePROs to support post-discharge care of surgical patients is growing, in response to service provision changes. Important advances in the capabilities of ePRO systems include real-time clinician feedback and integration with hospital electronic records. The findings of this review will highlight important directions for improving the design of ePRO systems and future research examining the effectiveness of ePRO systems at improving post-surgical recovery.
WP3.2 - Craniectomy With Soft Tissue Reconstruction for Locally Advanced Non-Melanoma Skin Cancer of Scalp with Calvarial Invasion: the Nottingham experience
Authors: Wong Zhen Yu , Wickham Neil , Bagirathan Shenbana , Pollock Jonathan 
Published: September 2024

Abstract

Introduction
Locally advanced non-melanoma skin cancer (NMSC) involving the periosteum or calvarium remain clinically challenging for patients unfit for immunotherapy due to medical comorbidities and/or frailty. This case series aims to explore outcomes for patients that underwent craniectomy and soft tissue reconstruction.

Method
Patients underwent craniectomy and soft tissue reconstruction for invasive NMSC with calvarium or periosteal invasion from 2016 to 2022 were included. Data including demographics, operative details, and clinical outcomes were sourced from Nottingham University Hospitals digital health record and the histopathology electronic database.

Result
8 patients (Age: 78.4, 3F 5M) with significant comorbidities and varying degrees of periosteal or bone invasion fulfilled the inclusion criteria. These included four squamous cell carcinoma, two basal cell carcinoma and two pleomorphic dermal sarcomas. Five patients had a history of prior incomplete deep margin excision. The median soft tissue defect, tumour and bone defect size was 51.83cm2, 34.63cm2 and 42.25cm2 respectively. Intraoperative complications included one dural tear. Four patients underwent local flap reconstruction and with split thickness skin grafting, four patients underwent free flap reconstruction. Adjuvant radiotherapy was administered to three. Complications comprised partial graft loss in two and complete graft loss in one. There was partial flap loss in one case. One patient required subsequent parotidectomy due to regional progression before achieving disease control. All patients achieved lasting locoregional disease control (average follow up 29.7 months).

Conclusion
Craniectomy with soft tissue reconstruction is a safe and effective treatment option in advanced NMSC of the scalp in patients unsuitable for immunotherapy due to frailty or medical co-morbidity.
WP3.10 - Variability of frailty scoring during unplanned surgical admissions in older persons - why accuracy matters
Authors: Rothnie Alex , Hamza Mohamed , Williams Sophie , Cross Jason , Thin Katie , Mamidanna Ravi , Ramdin Ashling 
Published: September 2024

Abstract

Introduction
The Clinical Frailty Score (CFS) is a reliable predictor of outcomes for older patients in the acute hospital setting and is used to guide management decisions. Our hospital routinely calculates the CFS for older adults on admission to the Emergency Department (ED). Patients admitted under general surgery will then be referred for a Comprehensive Geriatric Assessment (CGA) by our Perioperative Medicine for the Older Patients undergoing Surgery (POPS) team who also calculate CFS. This study aimed to compare the CFS calculated in ED and CGA for these patients.

Methods
We performed a single centre prospective study of emergency general surgical admissions who were reviewed as an inpatient by our POPS team between August 2022 and September 2023. CFS from ED documentation was compared to that after CGA. A two tailed, paired t test was performed to compare the CFS on admission and after CGA using GraphPad Prism version 10.0.

Results
A total of 293 patients were identified with a mean age of 79 years(65-102). There was a difference between the admission CFS [4.2 (3.9-4.4 95%CI)] and the CFS following POPS review [4.5 (4.3-4.7 95%CI)] which was statistically significant (p&lt;0.0001). Univariate analysis showed that CFS was predictive of length of hospital stay.

Conclusion
CFS calculated in the ED can both over and underestimate the degree of frailty when compared to the CFS calculated during the CGA. As evidence suggests that CFS is predictive of outcomes in this cohort, we suggest staff are adequately trained in undertaking an accurate assessment of this score.
WP4.7 - Use of cholecystostomy to manage acute cholecystitis in high risk patients in a rural hospital
Authors: Krishna Oochit , Luke Thompson , Fultang Joshua , Maruthachalam Karthik 
Published: September 2024

Abstract

Aim
To evaluate outcomes after percutaneous cholecystostomy (PC) in patients with acute cholecystitis in a rural DGH.

Methods
Retrospective data collection on patients who underwent PC between October 2019 and January 2024. Variables collected included; Demographics, ASA grade, Charlson Comorbidity Index (CCI), inflammatory markers, length of hospital stay (LOS), complications, duration of PC, mortality and subsequent management.

Results
Complete data was available on 58 patients. 53.5% were male and mean age was 74±10.5years. 42(73%) patients were ASA III or above, 17(29%) had moderate CCI (3-4) and 35(60%) had severe CCI score of 5 or above. No difference noted in inflammatory markers from Day 1 to day of cholecystostomy (p=0.43) reflecting failure to antibiotic treatment. 15.5% of patients needed critical care. Average duration of PC in situ was 48 days; 11(19%) had PC in for &gt;80 days. 27(46.5%) patients underwent cholecystograms prior to removal and 19% were abnormal. Median LOS was 12(2-159) days. 4(6.9%) patients had complications from PC insertion. 30-day and 1-year mortality was 3.5% and 5% respectively. Care episodes needed following discharge with PC in situ was 2(Mean). 17(29.3%) patients had cholecystectomy following PC removal with 12% having open conversion.

Conclusions
Percutaneous cholecystostomy offers a safe alternative to laparoscopic cholecystectomy in managing acute cholecystitis in high risk patients. Subsequent cholecystectomy has a higher rate of conversion to open.
WP4.8 - Separating the sheep from the goat - Outcomes Based on Low, High and Extreme Risk NELA scoring
Authors: Jayasankar Balaji , Govind Garima , DiFranco Filippo 
Published: September 2024

Abstract

Background
According to the UK National Emergency Laparotomy Audit (NELA), high-risk emergency laparotomy is defined as any patient with a NELA risk score of ≥ 5%, indicating a predicted mortality rate of 5% or higher within 30 days after the procedure. However, scores ranging between 5%-100% fall within the similar ambit of requiring intensive care support. There is a lack of distinction among the patients in the high-risk group with measurable outcomes.
Given the broad margin, we stratified NELA mortality into low risk (&lt;5%), high risk (5-50%) and extreme risk (&gt;50%). The study was retrospective, involving 150 laparotomies, and looked at the outcome amongst various stratifications.

Methods
A retrospective analysis of 150 patients who underwent emergency laparotomy was evaluated against the documented NELA scoring and stratified into categories.
Baseline characteristics, encompassing age, usual place of residence, ASA physical status, and NELA score, were analyzed to compare the three groups (low, high and extreme risk). The outcomes under consideration included 30- and 90-day mortality, hospital length of stay, re-operation rates and the length of stay in critical care.

Results
There existed clear outcomes with the 30-day mortality and re-operation rates between the three groups.
Our study highlighted the gap that exists in the clinical prognosis and shared decision-making in patients with high (5-50%) and extreme risk (&gt;50%) NELA scores. Further, we worked out a risk stratification model that could guide consenting these patients.

Conclusions
Outcomes based on NELA score stratification will only strengthen the shared decision-making process for a patient with an objective understanding of the risks involved.
WP5.3 - Rejuvenating the golden patient protocol in a tertiary centre general surgical emergency theatre
Authors: Ahmed Sheheryaar , Johnston Annabelle , Mann Kulbir 
Published: September 2024

Abstract

Aims
Poor patient flow and complex sub-specialty decision making discussions lengthened time to operation of lower priority operations e.g. appendicectomy/abscesses. By prioritising start times and registrar patient selection for low complexity cases/day case discharge, we rejuvenated the golden patient protocol (GPP) and assessed the implementation and impact of a novel GPP in a tertiary centre emergency list on surgical wait times and overall theatre flow.

Methods
The GPP was agreed between surgical/anaesthetic night registrars and theatre staff which took into consideration the urgency of the surgery, fitness of patient and anaesthetic/technical difficulties. Eligible patients were identified prior to 08:00 and scheduled as the first case of the day to be huddled and sent for by 08:30. Two cycles were conducted, one month before and after GPP introduction, using the trust theatre management system (TMIS).

Results
Time series analysis was conducted for patient sent-for, anaesthetic room entry, and procedure start times during both cycles. Results indicated a median decrease of 11-minutes in patient sent-for time (Cycle 1: 08:56, Cycle 2: 08:45) and a 12-minute reduction in median procedure start time (Cycle 1: 09:42, Cycle 2: 09:30). The proportion of low complexity cases performed first-on-list also increased by 22.5% (Cycle 1: 35.5%, Cycle 2: 58.0%).

Conclusions
This analysis demonstrates a positive change by starting theatre faster with lower complexity cases, developing surgical registrar independence, improving time to treatment without complex discussions delaying first send.