bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThP7.8 - What is the gap in operative trauma surgical skills needed for humanitarian and military deployment? A systematic narrative review of surgeons in high-income countries
Authors: Sertedakis Dimitrios Bousoulas , Griffin Damian 
Published: September 2024

Abstract

Aims
The incidence of armed conflict, terrorist attacks and environmental disaster is increasing and death from traumatic injury remains a leading cause of mortality globally, posing complex challenges in surgical care. Despite advancements in trauma systems development, practice in high-income countries (HICs) is characterised by low trauma volumes, evolving non-operative strategies and increasing sub-specialisation, raising concerns about surgical preparedness for managing diverse injuries. This systematic review aims to assess the operative trauma skills of surgeons in HICs mapped against core military and humanitarian procedures. Examination of the breadth of skills acquired and identification of areas where further experience is required will inform the development of more comprehensive and adaptable surgical training programs.

Methods
A systematic literature review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE and EMBASE. Inclusion criteria targeted general and trauma surgery consultants or trainees in HICs, analysing quantitative and qualitative data on operative workload and skills acquisition.

Results
Twelve studies from the USA, UK, Netherlands, Ireland, Australia, and New Zealand were included. Trainees demonstrated experience in general surgical trauma but lack exposure to critical skills in orthopaedic, vascular and obstetric and gynaecological surgery.

Conclusion
This review highlights a gap in the operative trauma surgical skills of surgeons in HICs and the need for re-evaluation of surgical training curricula to address the dynamic challenges posed by contemporary trauma care. Emphasising a versatile skillset and exploring avenues for enhanced exposure through didactic courses and global surgery partnerships might prove crucial for better preparing surgeons for the diverse and demanding scenarios in the field of trauma care
ThP7.16 - Multidisciplinary management of elderly patients undergoing emergency laparotomy: an audit at a small district general hospital
Authors: Govind Garima , Jayasankar Balaji , Di Franco Filippo 
Published: September 2024

Abstract

Aims
The National Emergency Laparotomy Audit (NELA) suggests early involvement of the multidisciplinary geriatrician team for preoperative care of elderly patients aged over 80, or 65 and frail.

Methods
we audited our unit against the NELA guidelines for elderly patients. We looked at all emergency laparotomies carried out at our hospital over a 6 month period against the audit standards as set out by NELA.

Results
A total of 55 laparotomies were carried out in 6 months. 17 patients fit the criteria of patients needing early geriatrician involvement. Of the 34 patients aged 65 and above, 22 patients had their frailty score recorded in the notes (64%). Less than 10% of patients had early geriatrician input. Overall, six patients (11%) died within 30 days of their initial operation, and all were aged over 65.

Conclusions
we must take the perioperative care of elderly patients seriously and work with the Geriatric Medicine teams for early perioperative review, including accurate clinical frailty score assessments. We will initiate a project with the Geriatric Medicine department to implement an Elderly Laparotomy Perioperative Pathway for these patients.
ThP8.1 - Long-Term Impact of COVID-19 related disruption of NHS Elective services on Emergency Major Lower Limb Amputations
Authors: Jain Shubham , Choi Jean Yu , Cooper Benjamin , Renwick Bryce , Mohamed Mirghani M , Makris Sotirios 
Published: September 2024

Abstract

Background
The COVID-19 pandemic has affected the healthcare systems worldwide since the dawn of 2020. In March 2020, the United Kingdom government announced the first national lockdown which severely disturbed all NHS healthcare elective services. Our aim is to assess the long-term impact of COVID-19 related disruption of NHS elective services on emergency major lower limb amputations.

Method
Patients' data for emergency major lower limb amputations (MLLA) for critical limbthreatening ischemia and diabetic foot infections performed at Aberdeen Royal Infirmary was collected through Trakcare® and divided into the control pre-pandemic group (April 2018 to March 2020) and the pandemic group (April 2020 to March 2022). The statistical analysis was conducted using the IBM SPSS software [v28.0.1.1 (14)].

Results
A total of 358 patients underwent MLLA and 206 (57.5%) of these had diabetes mellitus. There was a 17% increase in the number of urgent referrals and every one in five of these finally underwent an amputation. There was an increase in the absolute number of Above- and Below-Knee amputations. There was a statistically significant increase by 33% in emergency MLLAs during the pandemic period (p-value &lt;0.05). A total of 165 postoperative deaths up to December 2022 were recorded with 30-day mortality rate of 7.26% (n=26).

Conclusion
NHS vascular management groups should update themselves with evolving technologies to optimise the care provided during future unprecedented times. Furthermore, more effective measures should also be implemented to avoid delayed presentations, which can potentially lead to higher rates of major limb amputations.
ThP8.8 - Role of Lymphoscintigraphy in Lymphoedema
Authors: Sivakanthan Mathumie , Maharjan Surina , Slim Hani , Valenti Domenico , Adrien Peters , Gambhir Raghvinder Pal Singh 
Published: September 2024

Abstract

Aim
Lymphoscinigraphy (LSG) is a gold standard of investigation in patients with Lymphoedema, though not all patients with Lymphoedema are offered LSG and some who are offered decline to have the test. The aim of the present study was to do a clinico-radiological correlation of Lymphoscintigraphic findings.

Methods
All patients who underwent Lymphoscinti scans at a tertiary vascular centre over a 3 year period were included in the study. The technique was standardised and involved injection of a radioactive tracer in the Ist web space of both feet and uptake of the tracer at the groin at 2 hours was determined. Uptake less than 8% at 2 hours was considered abnormal. Clinical findings were compared with scan findings.

Results
207 patients underwent LSG scans for suspected lower limb lymphoedema. 53 (26%) scans were normal. Of those with abnormal scans, 24 had mild lymphatic dysfunction (uptake 5-8%); 57 (28%) had moderate lymphatic dysfunction (uptake 2-5%) and 73 (35%) had severe lymphatic dysfunction with an uptake of &lt;2%.
Male to female ratio was 1:3. Median age at presentation was 60 years (range 3-89). Median BMI was 37Kg/m2 (range 17-71).
Clinical profile based on the worst leg having moderate to severe Lymphatic dysfunction on LSG showed a 78-93% match between the leg affected and the LSG findings. This dropped to 29% in those with mild dysfunction.

Conclusion
Lymphoscintigraphy can objectively confirm and grade lymphoedema. It can be used to guide patients and their carers in following preventative measures to prevent complications.
FP1.3 - SPEC MDT in Aneurin Bevan University Health Board
Authors: Niina Ayako , Elnaghi Mohamed , Khan Usman , Jones Huw G 
Published: September 2024

Abstract

Aims
The SPEC (significant polyp and early cancer) multi-disciplinary team (MDT) meeting was started in ABUHB in 2022 to discuss complex colonic and rectal polyp cases, such as polyps &gt;20mm, likely to be sessile, or difficult to remove endoscopically. The aim was to evaluate the effectiveness and clinical role of the SPEC MDT.

Methods
Data for patients discussed in SPEC MDT since its conception in January 2022 until September 2023 was retrospectively collected from the SPEC MDT database, a prospectively collected database. This included patient demographics, reason for referral, polyp characteristics and MDT outcomes.

Results
In 21 months, there have been 38 SPEC MDTs, with 355 cases discussed (average of 9 cases per MDT). There was at least one laparoscopic colorectal surgeon, gastroenterologist and a histopathologist in every MDT in accordance with BSG guidelines. Main referral reasons included endoscopy findings (72%) and re-discussion post-procedure (22%). Twenty-three patients had adenocarcinomas and three had NETs. MDT outcomes were EMR (23%), endoscopic surveillance (21%), clinic to discuss (no) surgery (19%), TAMIS (16%), urgent endoscopy (13%) or other (8%).

Conclusion
As the busiest Health Board in Wales for Colorectal Cancers, the formation of SPEC MDT has been an important step in improving the detection and treatment of advanced polyps and early cancers. Although too early to measure the impact on early cancer detection rates and improved decision making for these patients, formalising the MDT process in line with BSG guidelines has been an important step in improving the service offered to patients.
FP1.4 - Re-audit of perioperative outcomes after colorectal cancer surgery evaluating the impact of ward based level 1 critical care facility in a DGH
Authors: Udayasankar Sujatha , Obiechina Sylvester , Deans Andrew , Rao Pawan Kumar Dhruva , Mohamed Usama 
Published: September 2024

Abstract

Aim
To evaluate the perioperative outcomes after colorectal cancer surgeries in a ring-fenced pathway and compare the outcomes pre and post implementation of a ward based level 1 critical care facility in a DGH.

Method
Two retrospective audits were conducted, each over 6-month period, between July – December, 2020 (audit 1) and between July – December, 2022 (re-audit after the introduction of fully functional ward based enhanced care unit - ECU). Data collection tool included – patient demographics, tumour staging, ASA, intra-op access, ITU stay, ECU stay, return to theatre, unplanned re-admissions, LOS in hospital, 30-day & 90-day mortality rate.

Results
Audit-1 had 65 cancer surgeries, 66% being recto-sigmoid resections. 66% had laparoscopic and 34% had open procedure. 72% of these patients used ITU bed with a total of 252 bed days. Median length of stay in-hospital was 8 days. The unplanned return to theatre was 2.9%, readmission was 1.5% and 90 day mortality was 1.5%.
Re-audit had 91 cancer surgeries, 65% being recto-sigmoid resections. 79% had laparoscopic and 21% had open procedure. 29% of these patients used ITU bed with a total of 87 bed days. Median length of stay in-hospital was 6 days. The unplanned return to theatre was 1%, readmission was 1% and 90 day mortality was 1.1%.
The ECU was utilised by 55% of patients with a total of 186 ECU bed days and median stay of 4 days.

Conclusion
With the introduction of ECU facility, the perioperative outcomes have improved and there is a significant reduction in the ITU bed days.
FP2.1 - The accuracy of radiological staging in rectal cancer patients post-long course chemoradiotherapy treatment
Authors: Photiou Dana , Lenzi Elisa , Boereboom Catherine , Walter Catherine 
Published: September 2024

Abstract

Aim
Accurate post Long-course chemoradiotherapy treatment (LCCRT) allows safe selection of patients to rectal preservation without delaying resection in those with residual cancer. The aim of this study was to assess the accuracy of radiological staging in these patients.

Methods
Demographic and treatment data from consecutive patients receiving LCCRT for rectal cancer between May 2020 to December 2021 was collected. Local radiological staging post-LCCRT treatment was compared to pathological staging. Where patients had complete radiological response (CRR) and opted for watch and wait (WW) those with demonstrable local recurrence, within 12 months, were assumed to have been under-staged.

Results
Of 61 patients, 37 underwent surgical resection following LCCRT and 24 watch and wait for CRR. Post-LCCRT imaging was taken at a median of 10.86 weeks (IQR, 8.86- 13.00) post completion of treatment and resections 16.57 weeks (IQR 9.71 – 23.00) post-imaging.
Four WW patients were diagnosed with local recurrence at a median of 56.54 weeks of follow-up (IQR, 39.9 – 67.90).
The ratio of patients radiologically staged as T0:T1:T2:T3:T4 was 15%: 0%: 28%: 46%: 10%; whilst the pathology specimens demonstrated 20%: 5%: 12%: 49%: 15% respectively. Nodal staging (N0:N1:N2) was 78%: 20%: 2% with histology showing 71%: 24%: 5% respectively.

Conclusion
In our low-numbered study T-staging of patients with T0 and T1 disease had highest rates of over-staging such that 2 (5%) patients for potential watch and wait were not recognised as CCR by MRI alone. Nodal staging appeared more accurate although a tendency to under-stage N0 disease was seen.
FP2.5 - Predictors for anastomotic leak (AL) in inflammatory bowel disease (IBD) patients and its associated postoperative (PO) complications; A cohort of a single institution experience
Authors: Issa Mohamed , Yeung Antoinette , Singhal Graciaa , Brar Manpreet , Gore Stephen , Sarma Diwakar , Thomas Olivia 
Published: September 2024

Abstract

Introduction
IBD patients are highly susceptible to PO morbidities. This study aimed to look at the predictors of AL and the associated morbidities during hospital stays to increase the awareness of these patients.

Methods
A 5-year retrospective study in DGH. All variables were evaluated:patient-dependent (Age, Gender, BMI, ethnic group, comorbidities),disease-dependent (type of IBD, disease location, disease duration), surgery-dependent (duration, CEPOD type, approach, type of resection),Postoperative(CRP level, VTE, ITU admission, LOS, complications).All data were analysed using SPSS22, and Chi-square test.

Results
131 patients were admitted for IBD resection. Median age 37 years. 76 (58%) were female, Chron’s disease was 98 (74.8%). 101 (77.1%) were done laparoscopically, 87 (66.4%)were elective, and the median LOS was 7days.63 (48.1%) has bowel anastomosis and 15 (23.8%) have AL. The median CRP on PO day3 for AL patients was 118. There was no significant association between PO day3CRP and IBD type with AL (P=0.4, 0.7); however, DVT and PE were associated with AL (P=0.001 and 0.039). Patients with AL had a high tendency for ITU admission with longer LOS (P=0.000).Long stays were seen in patients with leaks post-emergency than elective resections (P=0.047, 0.112). AL was associated with chest infection (P=0.001), collection (P=0.006),wound infection (p=0.000), and a higher rate of re-operation within 30 days (p=0.019).

Conclusion
PO day3CRP is not an independent predictor for AL. Our cohort of IBD patients who had bowel anastomosis showed a significant correlation between VTE and AL.AL was associated with chest and wound infections, high chance of a long ITU stay and subsequently, a long hospital stay. IBD patients with AL are vulnerable to VTE so need high care on these regards.
FP2.6 - Opportunities for Improvement in Venous Thromboprophylaxis (VTE) of High-Risk Patients Hospitalized for Inflammatory Bowel Disease (IBD) Related Bowel Resection
Authors: Issa Mohamed , Yeung Antoinette , Singhal Graciaa , Brar Manpreet , Thomas Olivia , Sarma Diwakar , Gore Stephen 
Published: September 2024

Abstract

Background
IBD had a relative risk of 2.2 for VTE compared to the normal population. In May 2020, an international consensus created a statement on VTE prevention in IBD patients. 28days of extended thromboprophylaxis was recommended after discharge only in high risk patients. We aimed to identify high-risk patients for VTE post-IBD-related bowel resection.

Methods
Retrospective review of 131 patients over 5 years of surgical admissions for IBD-related resection at DGH. Examined factors included patients’ demographics, risk factors for VTE, disease history, and compliance with extended thromboprophylaxis. SPSS22 and Chi-square test were used for analysis.

Results
The median age was37years.76(58%) were female,74(56.5%) were white-British, Chron’s disease (CD) was98(74.8%), median disease duration was65 months, 101(77.1%) were done laparoscopically, 87(66.4%) were elective, and the median LOS was7days. 5 patients (3.7%) had VTE events. No postoperative stroke happened. DVT and PE were associated with failure of extended thromboprophylaxis prescription (P=0.004,0.000). All VTE events were seen in the 1st 10 days post-discharge. Occurrence of DVT was associated with white-British ethnicity(P=0.000), CD&gt; ulcerative colitis (P=0.001), emergency &gt; elective surgery (P=0.026), bowel anastomosis &gt;stoma formation (P=0.029), ITU admission (P=0.000), Post-operative leak (0.0001), postoperative wound complications(P=0.000). Surgical approach, previous VTE event, and site of diseases weren’t associated with VTE occurrence (P=0.8,0.97,0.94).

Conclusion
IBD patients are vulnerable to VTE events more than the normal population. Bowel resection in this group of people needs attention for extended VTE prophylaxis, particularly in patients with CD, ITU admission, postoperative leak, and wound complications. These data outline opportunities for improvement, particularly in regard to the extended VTE prophylaxis for 28 days in the before-mentioned high-risk patients.
FP2.8 - Emergency CRC Resections: A single centre cohort Study
Authors: Gok M A , Bughio M , Akhmal Y , Khan S , Sadat M M , Khan U A , Riaz Komal 
Published: September 2024

Abstract

Aims
According to NBOCA, 20% of cases of CRC’s are emergencies, associated with high rates of post-operative morbidity and death (11.3 % within 90 days, NBOCA annual report 2023). Emergency CRC commonly presents as obstruction and perforation, less commonly with other constitutional symptoms. Aim of study is to assess surgical outcomes in emergency malignant CRC resections.

Methods
Cohort study carried out from Jan'2008 to Jan'2023. Descriptive demography & post-operative surgical outcomes were analysed in all emergency CRC resections. All elective CRC resections were recruited as controls.

Results
Em CRC (n = 365) Elective CRC (n = 1349) Mann Whitney U test (p value) Age(yrs) 70.0 70.5 NS Sex(M:F) 193 : 172 764 : 585 NS ASA(median) 3 2 &lt; 0.0001 BMI(kg/m2) 25.7 26.7 &lt; 0.0005 Op time(mins) 134.1 186.1 &lt; 0.0001 LOS(days) 11 7 &lt; 0.0001 Complications (n) Leaks 7 59 NS Ileus 68 207 NS HAP 53 132 NS Anaemia (Tx) 8 47 NS Wound infections 41 115 NS Collections 29 67 NS Sepsis 31 55 NS Mortality (n) 30 day 32 26 NS 60 day 46 38 &lt; 0.01 90 day 54 44 &lt; 0.005 TNM stage (n) 0 10 16 1 20 351 2 107 456 3 158 446 4 45 52 Survival rates 1st year 71.1 92.3 5th year 48.3 77.1 10th year 41.1 68.5 Logrank p &lt; 0.05 15th year 39.5 65.1

Conclusions
Emergency CRC patients had a worse pre-operative functional limitation (ASA 3), prolonged hospitalization, greater 90-day mortality rate, thus poorer survival. Despite national bowel cancer screening initiatives, emergency CRC presentations remain a challenge. Our study supports prompt diagnosis and early surgical intervention.
FP3.12 - Peri-operative causes of lap-Open Malignant Colorectal Resections: A cohort study
Authors: Gok M A , Bughio M , Zaidi M , Mathieson N O M , Sadat M M , Khan U A 
Published: September 2024

Abstract

Aims
Laparoscopic CRC resection has evolved as main surgery in colorectal malignancies (66 % NBOCA report 2022). Lap-open conversion reported in &lt; 21 % cases. Aim of study is to assess causes of lap-open conversions at a single centre.

Methods
Cohort study carried out from Jan'2008 to Jan'2023; evaluations of demographics & postoperative outcomes in lap-open CRC resections. Laparoscopic and open colorectal CRC resections were recruited as controls

Result
Lap-open (n = 121) Laparoscopic (n = 839) Open (n = 751) Kruskal-Wallis test (p value) Age(yrs) 69.2 70.0 71.0 NS Sex(M:F) 86 : 35 454 : 385 415 : 336 &lt; 0.005 ASA(median) 2 2 2 NS BMI(kg/m2) 27.6 26.3 26.6 &lt; 0.01 Operation time(mins) 235.1 191.4 146.5 &lt; 0.0001 Elective(CRC(n) 113 774 462 &lt; 0.0001 Emergency CRC(n) 8 65 289 &lt; 0.0001 Complications(n) Leaks 4 27 35 NS Ileus 16 124 134 NS HAP 17 74 94 &lt; 0.05 Anaemia(Tx) 7 60 28 &lt; 0.05 Wound infections 21 60 74 &lt; 0.001 Collections 8 39 49 NS Sepsis 8 34 44 NS LN harvest(median) 17 18 16 &lt; 0.001 LOS(days) 8 6 10 &lt; 0.0001 Mortality(n) 30 days 1 22 35 &lt; 0.05 60 days 2 34 48 &lt; 0.05 90 days 2 39 57 &lt; 0.001 Survival rates 1styear 94.1 90.8 83.5 5thyear 81.2 7.2 63.1 Logrank 10thyear 77.2 70.0 54.1 p &lt; 0.005 15thyear 77.2 68.9 50.0

Conclusion
Lap-open conversion rate was 12.6 %. Lap-open conversion resulted in prolonged operation and hospitalization, survival was unaffected. Causes of lap-open conversions characterized into pre-operative cause (high BMI, multiple operations, comorbidities), intra-operative causes (access, adhesions, fatty mesentery, tumour factors, anatomical difficulties, equipment failure).
FP4.2 - Does colonic endoscopic tattooing affect radiological staging?
Authors: Reid Rebecca , Magee Conor , Wilson Jeremy 
Published: September 2024

Abstract

Aim
Evidence exists of radiological upstaging of rectal cancers due to fibrosis caused by endoscopic tattooing. We review investigated whether endoscopic tattooing for colonic lesions resulted in subsequent radiological upstaging.

Methods
A retrospective review was performed of patients endoscopically diagnosed with colonic cancer and undergoing surgery over three years at a single centre. This included patients who underwent both CT imaging prior to, and after colonoscopy with biopsy +/- tattoo. Radiological and operative staging was subsequently compared.
Emergencies, those with no colonoscopy or pre-operative imaging and rectal cancers were excluded. Data were obtained from Somerset register and electronic care records. Data were analysed using chi squared test.

Results
A total of 175 patients were included. 49 patients had CT imaging prior to their colonoscopy, 51 patients had colonoscopy and biopsy prior to imaging; a further 75 patients had biopsy and tattoo prior to imaging. Patients with pre-endoscopy imaging were considered the control group, and patients with biopsy only were calculated separately as they were considered potential confounders (Table 1).Table 1:UpstagedDownstagedSame stagingPre-endoscopy imaging191713Biopsy only131622Tattoo and biopsy212727
Overall, there was no significant difference between groups (p=.429), although 7 reports specifically mentioned potential impact of recent biopsy and tattoo affecting image interpretation.

Conclusion
Our results do not suggest biopsy or tattooing alters pre-operative staging, although it is possible that radiologists may have evolved their interpretation to account for any potential differences.