bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP7.7 - A 6-month retrospective re-audit of “Code Red” trauma requiring surgical intervention in a regional major trauma centre
Authors: Winter Jonny , Yoong Susan 
Published: September 2024

Abstract

Aim
Major trauma (MT) is a significant cause of morbidity and mortality in the United Kingdom, with an estimated incidence of 20,000 cases annually in England. A certain proportion of patients presenting following MT require immediate operative intervention. This study is a re-audit of the process for managing these patients in order to assess the impact of introduction of a Damage Control Surgery (DCS) pathway.

Methods
Data were reviewed for all patients presenting as Code Red MT and requiring immediate operative intervention from May to November 2023. This accounts for all patients since the implementation of the DCS pathway. Patient details were taken from a MT database, Electronic Care Records were used to determine aetiologies of trauma and outcomes, and Theatre Management System software was used to determine timings.

Results
9 patients were identified, with a median age of 30.33. 89% of patients underwent preoperative CT imaging, with an average time to CT of 15 minutes (range 5 to 57 minutes). Median time to theatre was 88 minutes (range 39 to 325 minutes). Specialties involved included General Surgery, Vascular, Cardiothoracics and Trauma and Orthopaedics, with multispecialty involvement in some cases. Overall mortality was 22%. Seven cases were the result of road traffic collisions.

Conclusions
MT remains a significant cause of mortality in our cohort, but implementation of a DCS pathway has led to significant improvements in both time to CT and time to theatre compared with our initial audit cycle (32 minutes/144.5 minutes).
SP7.11 - Long term mortality risk factors for patients that underwent a Carotid surgery
Authors: Olivier Axel , Thawabeh Abdullah , Slim Hani , Odiase Ruth , Valenti Domenico , Pal Singh Gambhir Raghvinder 
Published: September 2024

Abstract

Aims
Carotid endarterectomy is the gold standard intervention to reduce carotid stenosis induced embolic cerebrovascular events. Current literature lacks long-term large sample analysis for post-carotid surgery mortality risks. The aim of this study was to determine long term all-cause mortality after carotid surgery.

Method
Single centre 10-year retrospective observational study of CEA mortality evaluating pre, intra and post-operative factors between 2010 and 2020. The data was manually extracted from the hospital’s database. Odds ratios and mortality rates were calculated and adjusted for age by adapting linear regression.

Results
970 patients’ data were identified with an average follow up of 6.65 ±3.37 years for an average mortality rate of 31.9%. There was a non-significant (p&gt;0.05) age adjusted odd of survival between gender (aOR 1.81 ±0.298) elective admission (aOR 0.932 ±0.321) and symptomatic patients (aOR 1.274 ±0.47). There was a significantly (p&gt;0.05) decreased chance of survival for current smokers (aOR 0.433 ±0.54) and patients on ACE/ARB (aOR 0.516 ±0.091). On the other hand, single (aOR 2.934 ±0.531) and dual anti-platelet (aOR 4.964 ±0.286) showed a significant (p&gt;0.05) protective effect. The 5-year age-adjusted death rate was elevated for all patients at 1.42.

Conclusion
The results highlight the smoking cessation, DAPT and appropriate prophylaxis remain important factors in increasing survival odds post carotid surgery. 30% mortality at 5 years is similar to those after Aortic interventions in these arteriopathic patients with extensive co morbidities.
SP8.6 - Exploring Barriers of Entry for Women Pursuing Surgery: Impact of a Conference on the Confidence, Understanding, and Preparedness of Attendees
Authors: Tagalpallewar Samruddhi , Melloul Lara 
Published: September 2024

Abstract
In the UK, women are underrepresented in surgery. Women make up only 16% of consultant surgeons and 34% of surgical registrars in the UK, whilst 59% of medical students are female. This project aims to explore the impact of conferences on perceived barriers and attitudes of female medical students aspiring to become surgeons.
A survey was administered to 130 attendees, yielding 95 eligible responses, at a national student-led conference held at UCL encompassing speaker events, workshops, and speed mentoring. Pre- and post- questionnaires were provided. This included an open ended question on personal barriers, and a 5-Point Likert Scale to assess opinions on barriers of entry, confidence in surgical skills, preparedness for a surgical career, and understanding of challenges faced by women in surgery. Wilcoxon Signed-Ranks Test was used to assess statistical significance.
The study included participants aged 18-30 from 23 universities and NHS trusts, representing 7 ethnic groups and 12 medical professions, with medical students comprising 87% of the cohort. Following the conference, 14 barriers of entry were analysed and there was a notable average increase in measured outcomes: confidence in surgical skills by 175%; preparedness by 192%; and understanding of the challenges faced by 177%. Overall, an average increase of 181% across reported metrics.
Overall, the study data has demonstrated the effectiveness of the UCL Women in Surgery conference in empowering students pursuing surgical careers. Specialised conferences offer safe spaces for networking, mentorship, and field insights, while also mitigating financial barriers through low registration costs. Representation matters, and supporting aspiring surgeons by addressing barriers of entry for women is crucial.
SP8.7 - The Impact of Covid-19 on ARCP Outcomes issued to Higher Specialty Trainees in General Surgery
Authors: Barter Charlotte , Humes David , Lund Jon 
Published: September 2024

Abstract

Aims
To quantify the impact of the Covid-19 pandemic on the Annual Review of Competency Progression (ARCP) outcomes of higher specialty trainees in General Surgery in the UK.

Methods
All ARCP outcomes awarded to higher specialty trainees in General Surgery between 2017 and 2022 were collated from Intercollegiate Surgical Curriculum Programme (ISCP). Associations between year, trainee sex, age, stage of training, and outcome were explored using multivariate logistic regression models.

Results
A total of 7,414 outcomes issued to 1,874 trainees were analysed. The Adjusted Odds Ratio (AOR) of receiving a non-standard outcome in 2020 (compared to 2017) was 3.07 (95% CI:2.47–3.81, P&lt;0.001) and this remained elevated through 2022 (2.11, 95% CI:1.69–2.64, P&lt;0.001). Female (AOR 1.27 (95% CI: 1.13–1.43, P&lt;0.001) and older trainees (1.51 (95% CI:1.34–1.70, P&lt;0.001) were more likely to receive non-standard outcomes. Being at a later stage of training during the pandemic did not increase the chances of receiving non-standard outcomes (AOR 1.09, 95% CI:0.97-1.22, P=0.134), but more outcomes advising extra training time were issued to this group (15.5% versus 4.3% in 2021). There was significant regional difference in the use of Covid-19 outcomes. The awarding of non-standard outcomes rose most years, even outside of the pandemic.

Conclusions
The Covid-19 pandemic had significant impact on the training trajectory of UK General Surgical trainees. Female and older trainees were more likely to receive non-standard ARCP outcomes before and during Covid-19. Urgent efforts are required to restore surgical training, and addressing differential attainment is essential for success.
SP8.11 - Conflict Resolution in Surgery
Authors: Castelhano Rute , Riding David 
Published: September 2024

Abstract

Aim
In our study, we dive into perspectives gathered from academic and public investigations, shedding light on how patient safety is at risk when communication and professional behaviours crumble within surgical teams. Despite clear evidence, current educational paths for both undergraduates and postgraduates prioritise surgical knowledge and skills, sidelining the crucial aspects of effective teamwork and conflict resolution. The increasing diversity in the surgical workforce, paired with a spectrum of personalities, emphasises the urgency of evaluating the evidence base on how interpersonal conflict impacts and exploring effective interventions. This evaluation is pivotal for shaping the direction of future curricula.

Methods
We took a systematic approach, exploring databases using keywords like "conflict resolution," "surgery," and "healthcare professionals," and related terms. Following PRISMA guidelines, we analysed identified studies, resolving any discrepancies through collaborative discussions among reviewers.

Results
Sixty-three studies reveal the adverse effects of interpersonal conflict on healthcare professionals (HCPs), leading to stress, burnout, job dissatisfaction, and compromising team effectiveness and patient safety. Conflict causes were categorised into systemic and interpersonal factors, with resolution interventions focusing on improving communication skills, organising team-building workshops, and facilitating debriefing sessions. Despite recognising the value of conflict resolution, variations in strategies were noted across different surgical specialties.

Conclusion
This systematic review underlines interpersonal conflict within surgical teams as a significant threat to patient safety and the well-being of healthcare professionals. The literature exposes strategic diversity in reported educational interventions, advocating for the integration of formalised training in teamworking and conflict resolution—an often overlooked yet vital component in surgical curricula.
SP9.4 - Post-operative outcomes after emergency stoma surgery in frail older adults in the West of Scotland
Authors: Venkata Sujashree Yadala , Bayne Fraser , Kulasekaran Ajitha , MacDonald Scott , Moug Susan , Creamer Felicity 
Published: September 2024

Abstract

Aim
An emergency laparotomy (EmLap) is a common surgical procedure in the United Kingdom for older adults aged 65 and above. A significant proportion of the EmLap population is frail (20%), which is associated with increased post-operative mortality and care requirements. Stoma formation is often preferred over a bowel anastomosis in this frail population, as an anastomosis is often considered too high risk. However, there is a lack of research describing post-operative outcomes after emergency stoma surgery for this frail older adult population.

Methods
A retrospective review of a prospectively maintained EmLap database (ELLSA) across 3 hospitals was performed between December 2019 to 2022. Older adults undergoing emergency stoma formation per NELA criteria were included. All patients had 1-year minimum follow-up. A Rockwood frailty score of more than 4 was considered ‘frail’.

Results
234 older adults were identified (Median age: 74 years (Range: 65 to 91 years); 23% frail; Median follow-up: 27 months). 30% of frail patients died within 30-days, compared with 19% of non-frail patients (p=0.04). Of the frail survivors, only 47% were managing their stoma independently (compared with 76% of those without frailty, p&lt;0.001) and 20% were in new long-term care (compared with 6% of those without frailty, p=0.002).

Conclusion
Frail older adults experience unfavourable outcomes after emergency stoma surgery, indicated by higher mortality rates and a limited ability to manage their stomas independently. Therefore, in selected cases, these patients may benefit from discussion around a higher risk anastomosis rather than a stoma. This study underscores the importance of further research to identify such patients and enhance pre-operative supported decision-making processes.
WP1.8 - No, we can’t repair your hernia: An audit to assess pre-operative optimisation for umbilical hernia repair
Authors: Kabir Tahmid , Lingam Gita , Sivarajah Vernon 
Published: September 2024

Abstract

Aims
The European Hernia Association recently published guidelines which clearly outline the importance of pre-operative optimisation for those undergoing elective umbilical/epigastric hernias. The main factors of importance are: smoking cessation and BMI &lt;35. This audit aimed to identify if we are adequately optimising our patients.

Methods
We retrospectively evaluated all elective umbilical hernia repairs from 1st January 2022- 31st December 2022 within a district general hospital setting. Clinic letters and pre-operative records were used to ascertain smoking status, BMI and diabetic control (HbA1c).

Results
60 umbilical hernias were performed in our district general hospital setting from 1st January 2022- 31st December 2022. Of these patients, 12% (N=7) were known smokers and 13% (N=8) had a BMI of over 35 documented. Additionally, only in 15 cases, was there clear documentation of the patient smoking status. Out of these patients, 9 were subsequently found to be non-smokers and 6 remained smokers despite being given smoking cessation advice. Furthermore, in 10% (N=6) of these cases, there was poor diabetic control (HbA1c &gt; 48), which was not addressed in clinic pre-operatively.

Conclusion
Patient factors such as smoking, obesity and diabetic control have been shown to significantly increase the rate of post-operative wound infections and complications. Patients are not being adequately optimised for elective procedures which puts them at increased risk of complications and increases the burden on limited NHS resources.
WP1.9 - An audit of prophylactic antibiotic use in elective inguinal hernia repair
Authors: Hume Claire Johnston , Dunlop Hannah 
Published: September 2024

Abstract

Aims
National guidance states that antibiotic prophylaxis is not indicated in low-risk patients undergoing inguinal hernia repairs and that high-risk patients require a single dose. This audit aimed to compare the use of prophylactic antibiotics by general surgeons in a district general hospital performing elective inguinal hernia repair, to the current national guidance. The rate of post-operative wound infection was also recorded.

Method
All patients who underwent an elective inguinal hernia repair in the six months between January and June 2023, were identified retrospectively via the hospital database. Data was collected via the electronic patient record system on whether patients were prescribed antibiotics prophylactically at the time of surgery. Data was also collected on patient demographics including sex, age, BMI and rate of post-operative wound infection.

Results
The patient cohort was 94% male with an average age of 64. 94.79% of repairs were open. 53.33% of patients received antibiotics in line with national guidelines. Overall, 50.00% of patients in this audit had prophylactic antibiotics.
The rate of post-operative wound infection was 1.04%, with 0% in patients who received prophylactic antibiotics and 2.08% in those who did not, which is not a statistically significant difference (P = 0.175).

Conclusions
Current evidence for antibiotic use is weak and therefore auditing local practice is essential in antibiotic stewardship. This audit is limited by the reliance on accurate record keeping, with regards to antibiotic prescribing and documentation of post-operative wound infections. Furthermore, patients may have had post-operative wound infections managed in the community setting.
WP1.10 - Are we Appropriately Consenting Patients for the Risks of Post Operative Urinary Retention following Groin Hernia Surgery?
Authors: Spellar Kayleigh , Laurie Alex , Bunting David 
Published: September 2024

Abstract

Aims
Consent is a fundamental process within surgery. General Medical Council (GMC) guidance advises that any recognised risks of harm resulting from a procedure should be discussed. Post-operative urinary retention (POUR) is a frequently encountered risk following groin hernia surgery, yet it can be missed when consenting. We aimed to review how frequently POUR occurs following groin hernia surgery in our hospital, along with how frequently it was consented for.

Methods
Retrospective data was collected on all patients undergoing planned groin hernia surgery in a single centre over a 6-month period between March and August 2023 . Data was collected on demographics, post-operative complications including POUR, and any other complications requiring hospital re-admission within 30 days. Consent forms were reviewed to identify whether POUR was documented as a risk.

Results
128 groin hernia surgeries were carried out over the 6-month period. 13 patients (10.2%) experienced POUR, which was the most common complication in this group of patients. 7 of these patients did not have POUR documented as a risk factor on their consent. With only 46% overall having POUR documented as a risk factor on their consent.

Conclusion
Despite POUR being a common complication following groin hernia surgery, patients are often not being informed of this as part of the consent process. As over half of those patients who did experience POUR were not warned about this potential complication. Considering its frequency and potential impact on patients, improvements in consenting for POUR should be made.
WP1.17 - Double Trouble - A Case of Duplex Appendix
Authors: Ramadan Widad Abdelrahman , Mooney James , Jones Claire 
Published: September 2024

Abstract

Introduction
Duplex appendix, a rare anatomical anomaly is often encountered incidentally during appendicectomy procedures. It is characterised by the presence of two appendiceal lumens and can be classified using the Cave-Wallbridge classification system.

Case
An 18-year-old male presents to the Emergency Department with a two-day history of migratory right iliac fossa pain. He was consented and booked for a laparoscopic appendicectomy based on clinical suspicion of acute appendicitis. Intra-operatively, an unexpected finding surfaces—a second pendunculated mass adjacent to the inflamed appendix. Employing laparoscopic linear staples, both the appendix and the adjacent mass were divided.
One day post-discharge, the patient presents with severe abdominal pain and computed tomography imaging suggests an intra-abdominal leak. The patient underwent an emergency laparotomy and ileo-caecal resection overnight. Histology revealed the second pedunculated mass was indeed a second appendix, a phenomenon with a reported incidence of 0.004 to 0.009%.

Discussion
Addressing the nuances of using imaging modalities in the diagnosis and operative planning of acute appendicitis, our discussion raises pertinent questions regarding the necessity of definitive pre-operative imaging in suspected cases. Considering potential pitfalls of incorrect clinical diagnoses; the presence of anatomical anomalies; and other factors influencing surgical decision-making; we scrutinise the proposition of pre-operative imaging protocols in suspected acute appendicitis.

Conclusively
our case encapsulates the diagnostic and therapeutic conundrums posed by duplex appendix instances, prompting a deeper exploration into the use of imaging techniques in a traditionally clinically diagnosed presentation and the implications thereof in surgical management.
WP2.11 - Improving prescription of discharge medications for day case surgery patients using electronic patient records system (EPIC); a closed loop audit
Authors: Ahmed Haythem , Kahka Ehab , Mossaad Mafdi , Joyce Amy , Wilson Iain 
Published: September 2024

Abstract

Aim
It is important to provide patients who have undergone day surgery with appropriate analgesia, antiemetics, and laxatives. Failure to do this can result in a poor patient experience, patient requests for advice, readmission and morbidity. This study audited our adherence to the GIRFT guidelines for day case discharge prescribing.

Methods
Data was collected retrospectively on the discharge medications for all patients undergoing elective, day case laparoscopic cholecystectomy and inguinal hernia repair at two district general hospitals in our trust over a five-week period. A pre-populated discharge medication order set was then created on the Trust's electronic health records system (EPIC) to improve adherence to the GIRFT guidelines. Discharge medications were observed over a subsequent four-week period.

Results
Prior to our intervention, adherence to GIRFT guidelines was poor with 25% of patients only received the correct discharge medications. Following introduction of the pre-populated order set, 83% of patients received the correct discharge medications.

Conclusions
This audit demonstrates that utilizing electronic systems effectively can improve efficiency, ensure patient safety and enhance patient care.
WP2.13 - Local Audit based on MAGIC study to improve abscess management at Royal Devon University Healthcare Trust
Authors: Khirfan Hamzeh , Alexiadis Aris , Shams Ola , Ragatha Ram 
Published: September 2024

Abstract

Aim
To assess efficacy of current management approaches of subcutaneous abscess at the Royal Devon University Healthcare Trust (RD&E).

Methods
Our audit is based on the MAGIC (Management of Acute surGIcal absCesses) national audit which involved anonymous retrospective analysis of patient records at the RD&E during September – December 2022. We collected data on patient demographics, clinical characteristics and their management. Furthermore, we conducted a literature review to compare our results to the recommended practice.

Results
31 patients records were analysed whereby 22 underwent surgical intervention (general anesthetic 17, local anesthetic 5) whereby the most common incision type was transverse (n=7). Nine patients were diabetic, two were immunosuppressed, 29 had hidradenitis suppurativa, while 19 had a past medical history of abscesses (n=31). The most common abscess type was pilonidal sinus (n=10). Eighteen patients received antibiotics prior to hospital admission, 12 of whom underwent surgery. Furthermore, 19 patients received antibiotics upon admission to hospital (n=31). Of the surgically treated cohort, 19 underwent packing and six were discharged with antibiotics.

Conclusion
Most subcutaneous abscess are approached surgically. However, postoperative care varies widely, with prolonged packing and frequent use of antibiotic postoperatively. Literature reviews have suggested no benefit of postoperative packing and specified certain circumstances of antibiotic use. Furthermore, clear communication with primary care providers detailing clear postoperative instructions is vital for patient safety and cost effectiveness.
WP3.11 - Emergency laparotomies in the elderly: long term outcomes
Authors: Hale Emily , Davis Heather , Sert Sena , Bowling Kirk 
Published: September 2024

Abstract

Aims
Emergency laparotomy is understood to be high risk in the elderly, but there is limited long term outcome data. This study assesses long term outcomes in the elderly including: survival and functional outcomes.

Methods
Patients, aged 80 and above, were identified from the prospective National Emergency Laparotomy Audit (NELA) database, who underwent surgery between: January 2020 and August 2023 at Torbay Hospital. Surviving patients were followed up.

Results
132 cases were undertaken (22% of total emergency laparotomies performed). Mean age was 85 years. Most common ASA was 3. Preoperatively, the most common clinical frailty score was 6, i.e., moderately frail and 89% were living at home without care. The most common procedure was adhesiolysis.
50% of patients were admitted to intensive care. 5 patients returned to theatre. 17% were readmitted within 30 days of discharge. The most common reason for was fall.
20% of patients did not survive to discharge. 38% did not survive to August 2023.
After the procedure 46% of patients were able to return home independently; 5% had care at home; 26% were discharged to community hospital and 2% to care home.
By January 2024 61% of survivors were living independently at home with no functional decline. Most commonly, patients needed support with bathing/stairs/dressing (37%). 11% of respondents were completely dependent.

Conclusion
Emergency laparotomy confers a significant mortality, morbidity and risk to an elderly patient’s long term functional status. We believe this information is essential for surgical decision making and the consent process.