bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP5.2 - Reducing Elective Colorectal Surgical Site Infections with Change of Gloves and Instruments Prior to Abdominal Closure; A Multicycle Audit
Authors: Walsh Kyle 
Published: September 2024

Abstract

Aims
Surgical site infections (SSI) carry a significant impact on patient morbidity, length of stay and antibiotic resistance. Our local colorectal unit has made several interventions over many years with no significant nor sustained improvement in the rate of SSI. The ChEETAh trial (Lancet, 2022) demonstrated a reduction in the rate of 30-day SSI by 13% with routine change of gloves and instruments (COGI) prior to abdominal closure. We aim to reduce our rate of SSI through implementation of COGI prior to abdominal closure; involving whole scrub team change of gloves and use of sterile instruments.

Methods
Adults undergoing elective colorectal surgery with an abdominal wound greater than 5cm were eligible for this study. Diagnosis of SSI was made based on at least one clinical indicator of infection or at least one symptom of SSI with data collection over 3 cycles spanning 11 months using clinical notes, imaging and microbiology results. The primary outcome was the diagnosis of a SSI involving the skin, subcutaneous, muscle or fascial layer up to 30 days post-operatively.

Results
The baseline SSI rate prior to intervention was audited at 29%. After implementation of COGI the rate fell to 23%. Further reinforcement of COGI and team education has demonstrated a further decrease in SSI to 15%. This has been sustained across a 6-month period post intervention.

Conclusions
Change of gloves and instruments is an effective, reliable and sustainable method to reduce the rate of surgical site infection in elective colorectal abdominal surgery.
SP5.8 - A survey of the actual incidence of Low Anterior Resection Syndrome in our patients and its effect on their quality of life
Authors: Umenze Franklin , Saraee Danial , Kaur Geetinder 
Published: September 2024

Abstract

Aim
Following rectal surgery, bowel function is often affected and leads to a constellations of symptoms called Low Anterior Resection syndrome (LARS). Whilst several risk factors have been identified from previous studies, the most important question is how these symptoms impact the quality of life (QOL) of our patients. The aim of our study was to gain an overview of LARS among our patients, identify risk factors, quantify how it affects their daily lives and recommend preventive and management options.

Method
We contacted all patients who had undergone anterior resections 01/10/2020-01/10/2023 via a telephone consultation carried out by a single doctor. Using the LARS questionnaire which has been internationally validated, we quantified the severity of LARS symptoms and effects on QOL in our patients.

Results
A total 36 patients were included in the study. We found 75% patients had no LARS, 25% had minor LARS; no patients had major LARS. 15 patients experienced tenesmus, 11 urgency, 11 accidental leakage of stool, 10 inability to control flatus and 8 frequency. Only 8.33% reported their symptoms affecting their QOL; in this group, accidental leakage of stool was the common symptom. We found no correlation between the incidence of LARS and post-operative time period. None of our LARS patients had had pre-op radiotherapy; only 10% patients who had post- op chemo developed LARS.

Conclusion
In our cohort of Anterior resection patients, most had no LARS; none had major LARS. Though some patients had some symptoms, QOL was affected in only 8.33%. Those who had symptoms were directed to our LARS clinic in Lower GI physiology for further management.
SP6.11 - What the Doctor Said: Evaluation of Discharge Information to Inpatient Colorectal Patients
Authors: Johnston Judith , Kostiw Alessia , Sadiq Miriam , Hunter Iain 
Published: September 2024

Abstract

Aims
To establish clarity of post operative information for patients for elective colorectal patients.
To establish comprehensiveness of discharge information for elective colorectal patients.

Methods
100 consecutive discharge summaries were collected from a busy elective colorectal unit. These were evaluated against NHS England’s discharge standards as well as a defunct local “After Care Advice’ form. Anonymous data were collated on Google Sheets and analysed.

Results
Patients had a median age of 68, with 54% being female. Operations ranged from EUA to exenteration with the most common operations being reversal of ileostomy (9%), laparoscopic right hemicolectomy (8%) and laparoscopic anterior resection (8%). The mode of length of stay was 9 days. Two patients were given the incorrect name of procedure on their discharge paperwork. 61% were not given details of investigations performed during admission with only 12% given details and timescales of tests to be performed on discharge. Follow up details were relayed to 77% on their discharge summaries. Of those that has wounds closed, 77% were not given details on how, with 97% receiving no wound care advice. Patients did not receive advice on return to activity (99%), bleeding (96%), anaesthetic limitations (100%) or driving (99%). Only 8% received information regarding VTE prophylaxis while 94% were not given infection advice. Despite these being colorectal operations, 94% did not receive any advice regarding bowel function or use of laxatives.

Conclusions
These results indicate that patients are not receiving adequate information regarding their time in hospital, their procedures or what to expect afterwards. This must improve.
SP8.4 - Retrospective comparison of core surgical trainee procedural experience gained in Scottish rural, general and tertiary hospitals
Authors: Hussein Israa , Cleland Jennifer , Walker Kenneth , Vella Mark , Yalamarthi Satheeth , Fergusson Stuart 
Published: September 2024

Abstract

Introduction and Aims
Core surgical trainees are placed across all hospital types in Scotland, including rural, general and tertiary hospitals. The extent and nature of the procedural experience gained in these different settings has not been previously compared in the Scottish context. Two recent studies concluded that trainees in rural hospitals have access to high case numbers across several surgical specialties. (1,2) The aim of this study is to compare the procedural experiences obtained by core surgical trainees in Scotland, across 3 different settings: in rural, district and tertiary hospitals.

Methods
Core surgical trainees who undertook training in Scotland between August 2012 to 2022 were identified through digital records (eLogbook data). Operative experiences in 6-month core surgical placements were compared between Rural General (R1), District General (A2, A3) and university/tertiary including children (A1, A4) Hospitals.

Results
After data cleaning, 241 trainees’ data were available for analysis. The mean number of procedures completed by trainees in a standard 6-month placement was 112 in R1 hospitals, 169 and 94 in A2 and A3 hospitals respectively and 140 and 116 in A1 and A4 hospitals respectively. There was no statistically significant difference between hospital settings (p = 0.072).

Conclusion
Core surgical trainees have equivalent access to surgical caseloads across all hospital settings in Scotland.

References
1. Hughes D, Wood R, Woods R, Sarap M. Resident Perspectives on the Value of Rural General Surgery Rotations: It’s Not Just About the Cases. Am Surg. 2022 Oct 1;31348221114056.
2. Sanders DL, Bell DC. Worlds apart: training in rural South Africa. Clin Teach. 2012 Apr;9(2):99–104.
SP9.1 - Enhancing Personalised Care by Introducing Frailty Management On Lower GI 2ww Pathway
Authors: Sargsyan Narek , Arunachalam Ganesh , Bernardo Janice , Sreekanth Sakthi , Humphries Francesca , Vijay Vardhini 
Published: September 2024

Abstract

Introduction/Aim
Increasing number of patients with suspected lower GI cancer are being sent Straight-To-Test to achieve the 28Day Faster Diagnosis Standards (FDS) following GP referral. This means that elderly frail patients may not get personalised care unique to their needs and undergo unnecessary investigations. Since 2022, we have piloted a frailty pathway incorporated into the protocol for management of LowerGI 2ww referrals. Aiming to provide a holistic and personalised geriatric assessment to improve outcomes and reduce health inequality. This study analyses the outcomes.

Methods
A prospectively maintained database of all 2ww lowerGI cancer referrals between January2022-November2023 was analysed. Patients age&gt;75 with a frailty score&gt;=5 or performance status&gt;=3, dementia, poly-pharmacy or from care home were referred straight to the frailty-unit for assessment and discussion of the value of further investigation, based on a locally designed SOP. The patient journey was mapped and outcomes compared to the standard pathway.

Results
Over 22 months-period, 228 patients with suspected cancer were seen on the frailty pathway. The average number of investigations per referral was0.5 for frail patients compared to 1 for other patients on the standard pathway. 49.5% (113 patients) were found to be unfit for further investigations or declined/self-discharged. 5 patients required optimisation prior to investigation. Only 1patient was diagnosed with cancer. The 2ww standard was met in 80% of frail patients compared to 55% in &gt;75s who were sent straight-to-test on the standard pathway. The 28-day FDS standard was met in 50% of frail patients compared with 18% in &gt;75s.

Conclusion
The frailty pathway is an effective initiative in reducing unnecessary invasive investigations. Frail patients benefit from holistic geriatric assessment prior to invasive investigations, ensuring suitability and appropriateness.
SP9.10 - The Sarcoma Hub and Spoke Diagnostic Service Can be Safely and Effectively Rolled-Out and Continued
Authors: Tjhin Yovita , Swe Thin Thin , Patell Naoroz , Pawa Nikhil 
Published: September 2024

Abstract

Aims
To understand the safety and effectiveness of the newly established Sarcoma Hub and Spoke Service (SHSS) in detecting malignancies through assessment of the performance of one Spoke Service in triaging lesions of concern.

Methods
Patients referred to our Diagnostic Service on the 2 week-wait pathway (2WW) and have had their lesion(s) of interest removed between an 18-month period were identified from our Hospital Information System. Data was collected for post-op histology, suspicion of diagnosis in the pre-op MDT, compatibility between the two, and whether patient was cleared from suspicion of malignancy before removal of the lesion.

Results
119 patients meeting the criteria were identified. 90 had been cleared of suspicion for malignancy prior to surgery. 83/90 of these had samples sent for histology, yielding 82 benign and 1 malignant (dermatofibrosarcoma protruberans) results. Of the 29 patients who had excision biopsy on the 2WW, 5/29 returned histology for risk of (e.g. possible sarcoma or atypical lipoma) or confirmed malignancies. 46/119 cases were discussed at our SHSS MDT and have both pre-op MDT diagnosis records and histology results; 37/46 of these were compatible – all correctly predicted benign pathologies. Where pre-op MDT diagnosis and histology were incompatible, 1/9 predicted benign diagnosis but returned malignant histology.

Conclusion
Our SHSS Diagnostic Service’s process of triaging lesions concerning for sarcoma, including our MDT and surgical excision biopsies, is accurate. Preliminary data shows that the Sarcoma Hub and Spoke Service is a safe way to aid in diagnosing or ruling out soft tissue sarcoma.
WP1.7 - A systematic review and a meta-analysis of randomised control trials of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair
Authors: Singh Anurag , Khan Nida , Krasicka Dominika , Gulab Adil , Singh Krishna , Sajid Muhammad 
Published: September 2024

Abstract

Objective
The objective of this meta-analysis is to compare the outcomes of prophylactic ilioinguinal neurectomy versus ilioinguinal nerve preservation for open inguinal hernia repair.

Methods
Studies reporting the patient outcomes were selected from medical electronic databases and meta-analysis was conducted by following the guidelines of the Cochrane Collaboration using statistical software RevMan version 5.

Results
Seven studies on 1,333 patients reporting post-operative outcomes were included. In the random effect model analysis, the severe pain at the end of the follow-up period [odds ratio (OR) 0.45, 95%, CI (0.10, 2.08), Z = 1.03, p = 0.30] was similar in both the groups with high heterogeneity (Tau2 = 0.97; Chi2 = 4.45, df = 1 (P = 0.03; I2 = 78 %) among included studies. Hypoesthesia at 6-month follow-up period [odds ratio 1.00, 95%, CI (0.47, 2.15), Z = 0.00, p = 1.00] suggests comparable outcomes in both groups with no heterogeneity among the included studies. The absence of pain reported by patients at the 6-month follow-up period [odds ratio 0.96, 95%, CI (0.72, 1.27), Z = 0.28, P = 0.78] suggests comparable outcomes in both groups with no heterogeneity among the included studies.

Conclusion
Post-operative outcomes like chronic groin pain, hypoesthesia or no pain reported by patients were similar in both groups. There was a paucity of data, therefore a major multicentre randomised control trial is recommended to strengthen the findings of this meta-analysis.
WP1.12 - Unveiling Evidence Gaps in Emergency Umbilical Hernia Repair: A Scoping Review
Authors: Walshaw Josephine , Kuligowska Anna , Smart Neil J , Blencowe Natalie S , Lee Matthew J 
Published: September 2024

Abstract

Aim
Umbilical hernias may become acutely symptomatic, strangulated, or obstructed, necessitating emergency intervention. Robust evidence is required for high-quality care in this field. This scoping review aims to elucidate the existing evidence gaps in emergency care of umbilical hernias.

Methods
A systematic search of EMBASE, MEDLINE, and CENTRAL databases was conducted using a predefined strategy. Primary research reporting on any aspect of emergency umbilical hernia care and published in the English language were eligible for inclusion. Two independent authors screened abstracts and full texts, resolving disagreements through consensus or a third author. Data was charted according to core concepts addressed by each study and a narrative synthesis was performed.

Results
The search generated 299 abstracts, with 32 full texts assessed and 14 included in the final review. This encompassed 52,042 patients undergoing emergency umbilical hernia care. Studies were predominantly retrospective cohort designs (10/14), evenly distributed between single (6/14) and multi-centre (8/14), with only one randomised trial. Most multi-centre studies utilised national databases (7/8). Themes arising included risk profile (n=4), timing of surgery (n=4), investigations (n=1), repair method (n=8, 4 mesh vs suture; 4 laparoscopic vs open), and operative outcomes (n=11). Commonly reported outcomes were mortality (n=9), morbidity (n=7), and length of hospital stay (n=5).

Conclusion
This scoping review demonstrates the paucity of high-quality data concerning emergency umbilical hernia care. The significant evidence gaps highlight a pressing need for randomised trials addressing timing and technical aspects of repair, incorporating patient-reported outcomes.
WP1.18 - A Surgical Post-Take Ward Round Checklist Proforma: A Prompt for Improved Documentation
Authors: Broadhurst Damian , Safi Mohannad , Abadi Porya Hasan , Masri Ahmad 
Published: September 2024

Abstract

Aims
Surgical ward rounds are often swift, therefore documentation of diagnostic and management decisions is frequently incomplete. The Royal College of Surgeons of Edinburgh (RCSEd) devised a ward round checklist toolkit to improve documentation of surgical post-take ward rounds.

Methods
We conducted a baseline audit of our district general hospital general surgery post-take ward round documentation, based on the RCSEd checklist. Documentation in each domain was recorded for each ward round entry for both pre and post intervention groups. Control patients were identified from the surgical take list across 7 different days in a month. The checklist toolkit was then adapted into a proforma for our institution and used on post-take ward rounds for a trial period of 7 days.

Results
40 patients were included in the pre-intervention group, 17 in the post intervention group. Following the introduction of the post take ward round proforma, documentation of most recent observations improved from 40% to 82%, admission blood results from 27.5% to 94%, and imaging results from 42% to 90%. Areas of existing good practice improved; history and examination findings were documented in 100% of patients, an improvement from 80% pre-intervention. Nil by mouth status was documented in 80% of cases, up from 50%, and IV fluid requirement in 58%, up from 10%.

Conclusions
A proforma for post take ward rounds improved documentation of key diagnostic and management information. As a result, we recommend a standardised approach to documentation to encourage consistency of recording key information in the patient record.
WP4.1 - Costs of acute appendicitis in COVID-19 pandemic period: a cohort study
Authors: Gok M A , Bughio M , Khan S , Mahajan L , Sadat M M , Khan U A , Riaz Komal 
Published: September 2024

Abstract

Aims
During COVID 19 pandemic, aerosol generating procedures were deemed high risk for patients & staff. NHS England set guidelines on appendicitis management, thus acute appendictomy rates were reduced. Aim of study is to assess cost implications of appendicitis management at a single centre.

Methods
Cohort study carried out from Mar'2020 to Jan'2024. Descriptive demography & post-operative outcomes were evaluated in appendicitis in COVID19, post-COVID19 appendicitis were controls. Costing calculated using the standardised NHS cost ledger for resources, procurement and services

Results
COVID (n = 306) Post COVID (n = 446) Interval (n = 45) Kruskal Wallis (p value) Age(yrs) 35.2 38.0 47.9 &lt; 0.0005 Sex(M : F) 155 : 151 216 : 230 19 : 26 NS BMI(kg/m2) 25.4 25.8 26.5 NS GP 49 162 A & E 257 284 WCC(x109/L) 12.5 13.1 6.5 &lt; 0.0001 CRP(mg/L) 67.2 70.9 3.4 &lt; 0.0001 Conservative(n) 148 87 0 &lt; 0.0001 Surgery(n) 158 359 45 &lt; 0.0001 Open(n) 6 2 0 NS Lap(n) 300 444 45 &lt; 0.0001 ASA(median) 2 1 2 NS Uncomplicated 178 170 42 &lt; 0.0001 Complicated 128 276 3 &lt; 0.0001 Clinical 0 21 USS scan 89 113 CT scan 334 312 Op time(mins) 72.8 75.9 74.4 NS LOS(days)(med) 2 2 0 &lt; 0.0001 IP AB(days) 2 2 0 &lt; 0.0001 Post-op AB(days) 5 3 0 &lt; 0.0001 Appendix HPA(mm) Length 66.8 66.5 55.7 &lt; 0.005 Diameter 11.5 11.1 9.9 NS Cost(£) 2160 4422 1046 &lt; 0.0001

Conclusion
Clinically & radiologically grading of appendicitis (uncomplicated or complicated) has allowed safe conservative management (antibiotic therapy). Non surgical management is cheaper for index admission, but there are additional costs & workload.
WP4.4 - Is it appendicitis? Keeping it SIMPLE
Authors: Janjua Zia , Gourrege Anick , Lau Jiaying 
Published: September 2024

Abstract

Aims
Several appendicitis scoring systems have been described, criteria used for these are subjective leading to interobserver-bias. Existence of many scores instead of one suggests most of them are not clinically useful. We describe a SIMPLE score that is based on objective parameters as listed in Table 1.

Methods
A sample size for prospective evaluation was performed based on analysis of 118 patients of all ages with suspected appendicitis assessed at a University Hospital (area under ROC-curve of 0.7, null AUC 0.5, alpha 0.05, power 0.95). Each variable point weightage was calculated using multivariate analysis. ROC-analysis was used to define cut-offs for Leukocytes and CRP (GraphPad Prism-V9) as listed in Table -1. A SIMPLE-score was devised and prospectively validated.

Results
Table-1 SIMPLE-score Variable Odds ratio (95% CI) P-value Points Shift of abdominal pain 3.8 (1.3 – 12.1) 0.02 1 Impaired Oral intake 6.0 (1.5 – 31.5) 0.02 2 Mid-cycle 0.3 (0.0 – 2.1) 0.27 -1 Pyrexia of ≥37.5°C 2.5 (1.0 – 6.1) 0.04 1 Leukocytosis ≥10 5.5 (2.1 – 16.1) 0.00 2 Elevated CRP ≥9 4.0 (1.5 – 11.2) 0.01 2
SIMPLE score was calculated prospectively for 128 patients. Median age was 26.5 (range 4-85 years). Of these 62.5% (80) were females 37.5% (48) were males. A SIMPLE score of 2 or less was unlikely to be appendicitis (93.5% Negative Predictive Value), while a score of 3-6 was possibly appendicitis and a score of 7 or more was strongly associated with appendicitis (85% Positive Predictive Value).

Conclusions
SIMPLE score is objective, reliable, reproducible and indeed SIMPLE to use.
WP4.9 - Audit on writing outpatient clinic letters in the general surgery department at a tertiary care hospital
Authors: Singh Anurag , Toh Wei , Siby Jayas , Elzahed Nada , Fatima Anam , Sajid Muhammad , Khan Nida 
Published: September 2024

Abstract

Background
Clinic letters are crucial medical notes for a patient’s medical history and medico-legal purposes. We assessed the quality of clinic letters with the guidelines from the Academy of Medical Royal College suggested for writing a clinic letter.

Method
A retrospective collection of data was done from January – May 2023 and a total of 166 clinic letters were collected by independent authors and then analysed to avoid any bias in the collection.

Results
Multiple parameters were poorly documented and are mentioned in increasing order of missing data – Plan for patient/carer (37.5%), Care planning arrangements (44.6%), Complications (67.5%), Anaesthesia issues (89.4%), Allergies (94%), Diagnosis (94%), Time (99.4%), Preferred name (100%) and Personal identifiers (100%).
These findings were presented in the clinical governance meeting and to improve the quality of the clinic letters, we created a generic clinic letter including mandatory parameters suggested by the guidelines.

Conclusion
There were a few parameters missing from the analysed clinic letters. An adequate intervention after being discussed in the clinical governance meeting, in the form of a generic clinic letter has been introduced. A repeat cycle is planned in 3-5 months to assess the improvement in the quality.
There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.