bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP6.9 - Endoluminal vacuum-assisted closure (EndoVAC) therapy in spontaneous duodenal perforation: a novel approach to an undertreated problem
Authors: Roberts Geoffrey , Sienes Alexa 
Published: September 2024

Abstract

Introduction
Duodenal perforation is a rare but critical condition, with management ranging from conservative to surgical depending on timing of presentation, patient status, and clinician preference. In recent years, minimally invasive techniques have been emerging alternatives for their safety and efficacy. Notably, there have been cases promoting endoluminal vacuum-assisted closure (EndoVAC) therapy as a viable alternative for use among patients with iatrogenic oesophageal perforations. To our knowledge, there has been no reported use of this novel approach specifically in spontaneous duodenal perforations.

Case presentation
A 55-year-old female with no history of trauma, surgery, NSAID use, or gastrointestinal conditions presented with epigastric pain and vomiting. A CT scan revealed a contained duodenal perforation at the D2/3 junction, accompanied by a complex retroperitoneal collection unsuitable for imaging-guided drainage. Initial management was conservative with intravenous hydration, antibiotics, proton pump inhibitors, and nasogastric tube decompression. She underwent oesophagoduodenoscopy and EndoVAC therapy resulting in complete resolution of collection and a small diverticulum on repeat CT.

Discussion
Current standard of care for duodenal perforations would be conservative management, though this carries the risk of deterioration due to biliopancreatic leakage and slow resolution of sepsis. Surgical management, when needed, is often technically challenging with high morbidity. EndoVAC gives the benefit of providing targeted drainage and negative pressure therapy to the site of perforation, reducing ongoing contamination, and promoting wound granulation.

Conclusion
EndoVAC therapy offers a minimally invasive alternative to treatment of duodenal perforations and has the potential for broader application in specialist and tertiary healthcare settings.
ThP6.15 - 1, 3, and 5-year mortality following emergency laparotomy, can the National Emergency Laparotomy Audit (NELA) or the American College of Surgeons National Quality Improvement Program (ACS-NSQIP) risk calculators predict it? – a retrospective, multi-center, observational, cohort study
Authors: Moscalu Andrei , Timofeiov Sergiu , Perumal Mohit , Sinclair Martin 
Published: September 2024

Abstract

Background
Emergency laparotomy (EL) comprises a high-risk group of surgical procedures, associated with a significantly increased risk of death in the following 5 years. EL are performed on a heterogeneous population, of which at least 50% are ≥ 70 years old. Accurate preoperative risk prediction is vital for planning care, patient shared decision, and improving outcomes. To date, no prediction tool can reliably estimate long-term outcomes, including mortality, following an EL.

Methods
This is a multicenter, retrospective, observational, cohort study that investigated the correlation between actual mortality at 1, 3, and 5 years and predicted 30-day mortality (30-dm) using NELA and ACS-NSQIP risk prediction tools, following EL, in adults aged ≥18, over 2 years, in two UK centers. The sample size was calculated at 385 cases. GraphPad-Prism 10.1.1. was used for statistical analysis.

Results
626 cases were analyzed. The male/female ratio was 0.85, age 70 years (55;78); BMI 24.94kg/m² (22;29); preoperative lactate 1.7 mmol/L (1.2;2.6), clinical frailty score 3 (2;4); and Charlson Comorbidity Index 4(2;5) (all data is expressed as median+IQR). The 1, 3, and 5-year survival were 76%, 67%, and 61%, respectively. A perfect positive correlation between NELA and ACS-NSQIP 30-dm and the 1-year actual mortality was found (R²=1). At 3 years only NELA correlated positively to actual mortality (R²=0.23, p&lt;0.05). The 5-year mortality correlated positively with both predictors - NELA: R²=0.61, p&lt;0.001; ACS-NSQIP: R²=0.31, p&lt; 0.05.

Conclusion
Both NELA and ACS-NSQIP risk calculators can predict mortality at 1,3 and 5 years after an emergency laparotomy, with NELA expressing a stronger correlation.
ThP7.4 - Splenic trauma in the West of Scotland: a seven year analysis of management and outcomes
Authors: Mapara Rahee , Cole Elaine , Schyma Barry 
Published: September 2024

Abstract

Aim
To evaluate admission characteristics and management of traumatic splenic injuries in the region over a seven-year period and investigate differences in clinical outcomes.

Methods
Data was obtained from the Scottish Trauma Audit Group (STAG). Retrospective cohort analysis was performed of adult patients who sustained splenic injuries between 2015 and 2022 and received operative (OM), embolization (EM) or conservative management (CM) at a multiple-site single NHS trust in the West of Scotland. Primary outcome was all-cause inpatient mortality, secondary outcomes was length of stay (LOS).

Results
129 patients were included. Majority of patients were male (73.6%, n=95). A third (34.1%) underwent OM (n=44), 4.7% underwent EM (n=6) and 61.2% (n=79) were managed conservatively. Median age was highest in the EM group at 61 years, versus 35 and 40 years in OM and CM groups (p=0.039). OM group patients had the highest median admission lactate (3.0) and median H+ ions (48.5) versus the CM group with a median lactate of 2.0 (p=0.050) and H+ of 45.9 (p=0.010). CM failed in 4.8% (n = 4) and required either OM or EM. Overall mortality was 3.9%, and exclusively observed in the CM group. Longest median LOS was observed in the EM group (17 days), versus 10 and 9 days in OM and CM groups (p=0.207).

Conclusion
Mortality from splenic injury in the region is low. Patients who were shocked on admission were more likely to be managed operatively. Few patients were managed with embolisation, but this cohort had a significantly longer LOS.
ThP7.5 - District General Hospital Management of Chest Trauma in Frail Adults: A Need for National Guidelines for Frailty in General Surgery
Authors: Yao Siliang , Coombes Zara , Okocha Michael , Gaskell Natalie 
Published: September 2024

Abstract

Annually, 16,000 adults face chest trauma, with blunt injuries in the elderly leading to high mortality rates. In TARN Chest trauma ranks as the second deadliest trauma in older adults, following head injuries. There's significant inconsistency, nationally, in the General Surgical management of these patients.

Aims
This study evaluates outcomes at a DGH to establish a basis for national guidelines

Methods
Single centre retrospective review of patients over the age of 65 presenting with chest trauma from Jan 2022 to Jan 2023.

Results
114 Patients were included. Median age was 81 with a male predominance of 57.9%. Mortality was 17/109 (15.6%). Mechanisms of injury were fall from standing height (71.9%), fall from height &gt;2m (18.8%) and RTA 9.3%. Median Rib fractures sustained were 4 (range 0 - &gt;10). 51.8% of the patients had an associated pleural injury, 14 patients required a drain. 70 (61.4%) had isolated chest injuries, 29 (25.4%) had one other injured body region and 15 (13.2%) had three or more injured body regions. Median STUMBL score was 25 (9 – 52), 42.6% had a score of ≥ 27. 16.4% of patients were vulnerable and 51% were frail. Median Charlson co-morbidity index was 5 (range 2-11). 39% of patients had timely Geriatric review during admission and 14% were not referred.

Conclusion
DGH General Surgery teams admit high volumes of frail patients with chest trauma. Nationally there is an absence of general surgery chest trauma guidance (BOASTs now archived). These patients are complex requiring early support from Geriatricians to guide the goals of care. Careful consideration should be given to referral pathways, MDT and priorities of care.
ThP7.7 - Investigating Trauma Patient Undertriage in Riyadh's Prehospital System
Authors: Khan Lubna , Aldarsouni Fayez , Alsubaie Norah 
Published: September 2024

Abstract

Aims
This study aims to analyze the extent of prehospital undertriage by assessing the transfer rates of critically ill trauma patients to non-trauma centers in Riyadh, Saudi Arabia.

Methods
We analyzed 102,895 incident reports from 50 prehospital dispatch centers in Riyadh using data from the Saudi Red Crescent Authority between January 2021 and March 2023. Inclusion criteria comprised all adult trauma cases classified under red criteria. We mapped regional distribution and delineated trauma center service areas reachable within specific timeframes using QGIS. Dispatch centers were grouped based on these service areas to evaluate undertriage. Data analysis was performed using SPSS 26 and R statistics.

Results
Approximately a third of the red criteria cases (n=5105/17983, 28.8%) were undertriaged to a non-trauma center primarily involving blunt traumatic injuries (n=3316, 65%) and, to a lesser degree, penetrating injuries (n=1604, 31.4%). Undertriage rates were higher in the 45- and 60-minute service areas (n=930/2917, 31.9% and n=20/45, 44.4%, respectively), particularly in the east (n=2013/5105, 39.4%) and north (n=1522/5105, 29.8%). Nearly a third of undertriaged cases (n=1601/5105, 31.4%) experienced delays, ranging from 4.5% to 66.8% across dispatch centers. The highest undertriage rates were observed in specific dispatch centers, such as Alkharj and Alamana, located in the 30- and 45-minute service areas, respectively.

Conclusions
The study reveals higher undertriage rates in areas farther from trauma centers, indicating a greater likelihood of non-trauma center transfers. To enhance access to trauma care for critically ill patients, there is a need for infrastructure expansion and stricter implementation of triaging protocols. Further research should investigate the impact of non-trauma center transfers on mortality in the region.
ThP7.17 - Improving completeness of operative notes for laparoscopic appendicectomy
Authors: Ahmad Awais , Fernando John , Gull Sadaf 
Published: September 2024

Abstract

Aim
This study aimed to compare the quality of laparoscopic appendicectomy operation notes in the emergency setting to 'Get It Right First Time' (GIRFT) guidelines. To evaluate the effect of the teaching session and operative note checklist in improving the completion rate of operation notes for laparoscopic appendicectomy.

Method
Retrospective analysis of 19 consecutive operation notes of patients undergoing emergency laparoscopic appendicectomy. Prospective data was then collected on 15 consecutive appendicectomy operation notes post-intervention. 34 recommendations based on GIRFT recommendations 'Best practice for laparoscopic appendicectomy documentation' were used to audit laparoscopic appendicectomy operation notes. Documentation was reviewed by two independent reviewers and scores were given based on GIRFT recommendations. Student's T-test was used to calculate the significance of overall scores and Chi-Squared to calculate the difference between individual categories.

Results
Mean completeness of operation notes improved from the first cycle (58.5%) to the second cycle (85.5%, P&lt;0.001). There was a significant improvement in documentation of patient positioning (P=0.001), skin preparation (0.035), diagnostic findings (P&lt;0.001), health of caecum (P&lt;0.036), extraction port (P=0.01) and follow-up plan (P=0.03).

Conclusion
There were many domains of the GIRFT recommendations not addressed prior to this audit. Teaching sessions and checklist distribution lead to a significant improvement in overall completeness of the operation note. Movement towards digitised templates should be made to further comply with guidelines.
FP2.12 - 'To Evaluate Lower Threshold of Polyp Size for Tattooing Routinely, a Single Trust Observational Study.'
Authors: Riad Mahmud , Moosvi Raza , Bailey Charles , Joshi Sanjay , Gupta Sneha , Birchall Cara , Henrika Bonor Elisabeth , Iordanov Iordantcho 
Published: September 2024

Abstract

Aim
The goal of the study is to establish the lowest polyp size for clinically effective tattooing routinely.

Method
Retrospective data collection of colonoscopy and flexible sigmoidoscopy for bowel screening and non-bowel screening patients; 450 patients underwent polypectomy of &lt;20mm from September 2021 to September 2022 in MTW NHS Trust. Patients were included according to 'single patient single polyp' criteria. We excluded 20+ mm polyps, multiple polyp, known FAP, lynch syndrome and other genetic predisposed colorectal polyps. Histology was obtained from electronic patient records (Allscripts). SPSS version 25.0 was used for the statistical analysis, which also included ROC curve analysis and Chi-Square test.

Results
A total of 450 participants, 288 males (64.0%) and 162 females (36.0%), were enrolled. Polyp sizes: 0-9mm (42.2%) and 10-19mm (57.8%). 8.0% were tattooed. Polyps found in right- hemicolon, transverse, left-hemicolon, sigmoid and rectum accordingly 29.78%, 20.5%, 9.1%, 28.4% and 12.22%. Pedunculated polyps were found in 143 individuals (31.8%), while sessile polyps were observed in 256 individuals (56.9%). Furthermore, in histological analysis, 251 individuals (55.8%) exhibited tubular adenomas and the majority of the cohort (77.6%) presented with low-grade dysplasia. Malignant invasion was detected in 27 subjects (6%). Receiver operating system (ROC) curve analysis indicated that polyp size was a predictive factor for malignancy development, with a cut-off lower point identified at 8.5 mm.

Conclusions
The findings confirm the advice to tattoo polyps bigger than 8-9 mm to make tracing and follow- up easier.
FP4.11 - Patient Reported Outcome Measures (PROMs) of Altemeier’s Procedure
Authors: O’Sullivan Arun , Manku Bhagat , Bleehen Laura , Abdelgalel Khaled , Ramcharan Sean , Singh Sandeep 
Published: September 2024

Abstract
Rectal prolapse (RP) is a debilitating condition that can be managed using Altemeier’s procedure (AP). We aimed to evaluate patient-reported long-term outcomes following AP focusing on symptoms, post-procedure pain and overall satisfaction.
Patients who underwent AP in a District General Hospital between January 2015 and December 2022 were reviewed. Patients were contacted by telephone and interviewed using a standardised questionnaire. Likert scores and a Numeric Rating Scale (NRS) were used to assess functional outcome and pain respectively. Indication for surgery, recurrence, and data on further procedures were also collected.
Out of 38 patients identified, 20 who underwent AP over the study period (mean age 78 years, s.d. 7.44, Female=20) were contactable and included in our study. In combination with RP, indications for surgery included faecal incontinence, obstructive defaecation symptoms, pain and rectal bleeding. At the time of follow up, 75% of patients reported their initial symptoms to be slightly or much better, 10% reported no change and 15% reported slightly worse symptoms. Prior to AP, 45% of patients reported no pain compared to 70% post-procedure. Severe pain was reported by 30% of patients pre-Altemeier’s compared to five percent post-procedure. Recurrence of RP occurred in 40% patients. 30% of patients required a second procedure. Overall, 80% of patients were satisfied with their outcome and 90% would recommend AP to friends and family.
Most patients reported better functional outcome and good overall satisfaction, despite 30% requiring a further procedure. Our study was limited by small sample size and subjectiveness of patient reporting.
FP5.4 - Improving Assessment of General Surgical Trainees in Multidisciplinary Team Working as a Capability in Practice: Perceptions of General Surgical Trainees and Trainers
Authors: Johnston Judith , Quinton Naomi 
Published: September 2024

Abstract

Aim
To explore how Higher Surgical Trainees (HST) and Trainers feel multidisciplinary team (MDT) working as a capability in practice (CiP) can be improved.

Methods
Within a deanery, 8 General Surgical HST and 4 Consultants were recruited to participate in virtual semi-structured interviews. Once transcribed, reflexive thematic analysis was performed. Ethical approval was granted.

Results
MDT is not worked into most trainees’ rotas. Participants felt that by formalising MDT, as with other CiP, it could be better assessed. Trainers, half of whom are MDT leads, stated that responsibility for MDT training and assessment should be placed on all consultants, rather than solely the leads. Participants explored how pathways could be instituted for HST to maintain ‘ownership’ of some patients from assessment clinic to MDT meetings to fully engage. In order to build to this level, a baseline of preparing patients but not presenting was suggested by one of the consultants. While, with one exception, no participants favoured a further work-based assessment, it was advocated by all that further clarification from ISCP regarding expectations of trainees at MDT would allow for more comprehensive assessment in the future. Most participants proposed that all members of MDT contributed to an assessment rather than relying on the Multi-Consultant Report. To prevent issues with timing or resources, a shadow or simulated MDT was suggested for HST.

Conclusion
General HST and consultants expressed concerns with the current way in which MDT is assessed as a CiP however they proposed ways in which it could be improved in the future.
FP5.9 - Improving the pre-operative administration of medications for patients requiring emergency surgery who are ‘nil-by-mouth’ (NBM)
Authors: Patel Nishita , Wentworth Elizabeth , Nanda Akriti , Kumar Arvind , Fong Agnes , Rothnie Alex 
Published: September 2024

Abstract
The statement ‘nil-by-mouth’ can be misleading with regards to drug administration. Inappropriate pre-operative drug omission or administration can lead to poor patient outcomes, experiences and increased hospital stays. The aim of this quality improvement project was to reduce the number of patients who had regular medications incorrectly administered, omitted or experienced pre-operative medication-related complications.
Two interventions were delivered targeted at educating junior doctors and nursing colleagues. Electronic records of general surgical patients requiring emergency surgery in a district general hospital were reviewed. Data on incorrect medication omission, administration and medication-related perioperative complications was retrospectively collected.
The percentage of patients who had medications incorrectly administered was 11% pre-intervention, 11% after intervention 1, and 6% after intervention 2. There was a reduction in the number of medications incorrectly omitted from 57% pre-intervention, to 40% after intervention 1 and 0% after intervention 2. One peri-operative medication-linked complication was recorded prior to the interventions which fell to zero cases following both interventions.
A sustained reduction in incorrect drug omission and medication-related perioperative complications has been shown following interventions 1 and 2 together, highlighting the importance of involving all members of the multidisciplinary team when aiming to improve how medications are handled preoperatively. No statistically significant change was made to the incorrect administration of medications pre-operatively. This is likely a reflection on the prescribing clinicians within the on-call team who rotate twice weekly. Other interventions targeting a consistent member or process within the on-call team should be explored to ensure follow-through going forward.
FP6.2 - A survey of the estimated cost of consumables amongst UK medical students
Authors: Divekar Omkaar , Stephen Sarah , d'Souza Hanna , Pandya Krushi , Kumar Abhinav , Kanegoankar Rahul 
Published: September 2024

Abstract

Aims
With increasing financial difficulties for the NHS, clinician’s awareness of the cost of consumable items utilised is vital. Despite this, clinician’s cost-awareness and exposure to health economics amongst students is limited. We hence undertook this survey to assess cost-awareness amongst medical students.

Methods
An online questionnaire was distributed to London medical students. Participants were asked their demographic data and to estimate the cost of 10 consumable items. Each item’s actual cost was compared with the average, median and interquartile range of the estimated price. An estimate was deemed ‘correct’ if it was within 20% of the actual price.

Results
Across all items 9.63% of estimates were ‘correct’. There was no correlation between medical school or academic year and accuracy of cost-estimation. The most accurately estimated item cost was the ‘10ml syringe’ (19.55%), the least was the ‘1 litre bag of intravenous normal saline’ (0.50%). The most overestimated item cost was the ‘vial of 1.2g intravenous co-amoxiclav’ (median estimate/actual cost = 9.43), the ‘pair of standard sterile surgical gloves’ was the only underestimated item cost (median estimate/actual cost = 0.97).

Conclusions
We found a poor understanding of the cost of consumables amongst medical students. Whilst a lack of year 6 students and the London geographic limited this study, we believe this is the first large-scale survey assessing the cost of consumables amongst UK students. By providing a benchmark of current knowledge, this survey could serve as a catalyst for the inclusion of health economics in medical school curricula, improving cost-awareness amongst students and doctors.
FP7.18 - Early Operative Risk Assessment Using Modified Mannheim Peritonitis Index in Patients with Generalised Peritonitis at a Tertiary Hospital in Abuja, Nigeria
Authors: Situ Oladele , Okoye Onyedika , Olaomi Oluwole , Akhigbe D i 
Published: September 2024

Abstract

Aim
This study assessed the usefulness of a modified Mannheim Peritonitis Index (MPI) as a risk stratification tool in predicting surgical outcomes in the management of patients with generalized peritonitis in Abuja, Nigeria.

Methods
This is a prospective study of consecutive adult patients managed for generalized peritonitis at a tertiary hospital in Abuja Nigeria within a one-year duration. The MPI was modified using respiratory rate and SpO2. Patient characteristics and outcome of treatment obtained were entered into a structured proforma, checked and analysed using the SPSS, version 25. The threshold score of the modified MPI, as well as the accuracy, sensitivity, and specificity, were derived from the receiver-operator characteristic (ROC) curve analysis and its coordinates.

Results
There were 49 patients with generalised peritonitis during the study period with a male-to-female ratio of 2.5:1. The commonest cause of peritonitis in this study was penetrating abdominal injury (30.6%) followed by complicated appendicitis (24.5%). This study's mortality and morbidity rates were 14.3% and 63.3%, respectively. On the ROC curve, the modified MPI best predict mortality at a threshold score point of ≥26 (Accuracy of 79.4%, sensitivity of 85.7% specificity of 61.9%, P-value = 0.013), and morbidity at a threshold score of ≥23 (Accuracy 78.4%, sensitivity of 77.4%, specificity of 72.2%, P-value = 0.001).

Conclusion
The modified MPI can be used as a risk assessment tool in predicting postoperative outcomes in adult patients operated for generalised peritonitis within 30 days of operative intervention at Abuja. This modification can be useful in low-resource centres with limited access to arterial blood gas analysers.