bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP5.1 - The importance of weekly Radiology-General Surgery Multi-Disciplinary Meetings (MDMs) in the management of Emergency General Surgery (EGS) patients
Authors: Pal Shreya , Ng Zoe , Shrestha Anuj , Bartolome Lesleen Abigaelle , Bareli Leonardo , Shrestha Ashish 
Published: September 2024

Abstract

Aims
Most patients in Emergency-General-Surgery (EGS) require radiological investigations as part of their management plan. However, unlike cancer services where structured multi-disciplinary-meetings (MDMs) form an integral part of patient management, MDMs are not commonly practised in EGS. Our aim is to identify if having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS patients.

Methods
A prospective study involving weekly 1-hour MDM focusing on Radiology and General Surgery was conducted from May to November 2023. These sessions were led by consultant radiologists where discussions amongst general surgical consultants and junior doctors took place. Factors taken into consideration were clinical presentation, original scan report, any missed findings on imaging and any changes to the initial management plan.

Results
A total of 85 cases were discussed during the study period, majority were initially reported by the out-of-hours radiologists. Out of those, 40 (47%) had changes to the management plan as well as missed findings that were noted as a result of Radiology-GeneralSurgery-MDM. Informal feedback gathered from junior doctors who attended revealed a significant impact in their knowledge on interpreting radiological scans in EGS.

Conclusion
Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions have seen to improve overall patient outcome as a result of having a second opinion and recommending change in management plan in significant proportion of patients. It also had a positive impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.
SP5.3 - Systematic review and meta-analysis of the management of acute uncomplicated diverticulitis: Time to change the traditional practice
Authors: Mohamedahmed Ali Yasen , Zaman Shafquat , Vakis Stelios , Eccersley James , Thomas Pradeep , Husain Najam 
Published: September 2024

Abstract

Background
To evaluate comparative outcomes of outpatient versus inpatient treatment and antibiotics versus no antibiotics approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis. The protocol of this review was registered in PROSPERO (CRD42023488826).

Methods
A systematic online search was conducted using electronic databases. Comparative studies of outpatient (OP) versus inpatient (IP) treatment and antibiotics (ABX) versus no antibiotics (NABX) approach in the treatment of uncomplicated (Hinchey 1a) acute diverticulitis were included. The primary outcome was diverticulitis recurrence. Emergency surgical resection, elective surgical resection, development of complicated diverticulitis, mortality rate, and length of hospital (LOS) were the other evaluated secondary outcomes.

Results
The literature search identified 14 studies (n=3,875) comparing NABX (n=2,008) versus ABX (n=1,867). The NABX group showed a lower disease recurrence rate and shorter LOS compared with the ABX group (P=0.01) and (P=0.004). No significant difference was observed in emergency resections (P=0.33), elective resections (P=0.73), development of complicated diverticulitis (P=0.65), hospital re-admissions (P=0.65) and 30-day mortality rate (P=0.91).
Twelve studies (n=2,286) compared OP (n=1,021) versus IP (n=1,265) management of uncomplicated acute diverticulitis. The two groups were comparable for the following outcomes: treatment failure (P=0.10), emergency surgical resection (P=0.40), elective resection (P=0.30), diverticulitis recurrence (P=0.22), and mortality (P=0.61).

Conclusion
Compared with the use of ABX, the NABX approach seems to provide similar clinical outcomes and shorter LOS. Moreover, OP treatment of Hinchey 1a acute diverticulitis is comparable with IP management and presumably leads to cost savings in depleted healthcare systems
SP6.2 - Oncological outcomes following sentinel lymph node biopsy in patients with node positive breast cancer at diagnosis who achieve an axillary pathological complete response to neoadjuvant systemic therapy
Authors: Marinescu Iulia , Wehrmann Fabian , Prichard Ruth , Boland Michael , Rutherford Claire , McCartan Damian 
Published: September 2024

Abstract
De-escalation of axillary surgery following neoadjuvant chemotherapy (NACT) for patients with node positive breast cancer at diagnosis have focused on ensuring a low false negative rate for those who undergo sentinel lymph node biopsy (SLN) only with limited data to date on oncological outcomes. This study aimed to assess the medium-term oncological outcome in patients who have an axillary pCR following NACT and undergo de-escalation of axillary surgery with only a SLN performed post NACT.
A consecutive series of patients with cytologically proven node-positive breast cancer who received NACT and achieved a nodal pCR on SLN between 2013-2021 were retrospectively analysed. Eligible patients underwent an end of treatment axillary ultrasound and if axillary nodes appeared sonographically normal a sentinel node biopsy was performed, with dual modality mapping (radioisotope and blue dye) at the time of breast surgery. The primary outcome of interest was disease free recurrence (DFS), and the secondary outcome was isolated axillary recurrence.
79 patients (median age 48 years) received NACT and had cytologically proven node-positive disease at diagnosis and attained an axillary pathological complete response (pCR) post NACT. The median nodal yield at SLN was 4 (range 1-9). Median follow up was 4.4 years. Only 1 patient experienced an axillary recurrence. Triple negative subtype had the lowest overall DFS.
In this cohort, axillary recurrence remains uncommon. The optimal surgical strategy for safe de-escalation of axillary surgery post NACT remains in focus with adjuncts such as nodal marking and targeted axillary currently under study.
SP6.13 - Management of Older Major Trauma Patients: Impact of a dedicated guideline for facilitating older trauma care within a Pan London Trauma Network
Authors: Park Stephen 
Published: September 2024

Abstract

Background and Aim
Older age trauma is an increasing challenge for trauma networks with many clinical protocols needing to adapt and reflect age-related changes in physiology and management. In 2018, our older trauma guidance was introduced into our trauma system to improve early recognition of injury, admission pathways, clinical management and outcomes for those aged ≥65yrs (LMTS Older Trauma Guidance). The aim of our study was to assess the impact of the guideline on our trauma processes and patient outcomes.

Methods
This retrospective analysis of TARN compared process and outcome data for patients aged ≥65yrs admitted to hospitals within the North East London and Essex Trauma Network, pre (01/01/2016-31/07/2018) and post (01/08/2018-31/07/2020) guidance introduction. The primary outcome was mortality at 30 days post injury.

Results and conclusions
There were 4317 patients pre and 3992 patient post guidance. Time to CT reduced on average by 57 minutes, Neurotrauma transfers decreased from 2116 patients to 1519 patients and more older patients were discharged for rehabilitation. Older trauma mortality reduced across the network post guidance (13.59% vs 10.64%). The greatest mortality reductions were seen in Trauma Units, (19.20% pre vs 6.99% post) with increasing benefit seen with advancing age: reduced 75-84 years by 2.20%; 85-94 years 2.41%; 95+ years by 7.44%.
This analysis suggests that dedicated guidance highlighting the special needs and risk profiles of older trauma patients significantly improves processes and outcomes. Improvements in early assessment and time to imaging appear to result in enhanced survival. Further research at a system level is required.
SP7.1 - Risk Profile of Administration of 3- and 4-factor Prothrombin Complex Concentrate in Adult Anticoagulated Trauma Patients: A Systematic Review and Meta-Analysis
Authors: Newman Charles , Melhuish Jake , Spence-Jones Helen , Shepherd Joanna 
Published: September 2024

Abstract

Aims
To establish thromboembolic complication (TC, primary outcome) and mortality (secondary outcome) Odds Ratios (ORs) following 3-factor Prothrombin Complex Concentrate (PCC3, Comparator Group [CG] 1) and 4-factor Prothrombin Complex Concentrate (PCC4, CG2) administration, compared to Fresh Frozen Plasma (FFP) alone, in adult Vitamin K antagonist-anticoagulated trauma patients.

Methods
Systematic database and grey literature searches were performed. Random effects model meta-analyses were undertaken for each of this study’s outcomes, producing ORs and 95% Confidence Intervals (95%CIs). The I2 statistic was used to quantify interstudy heterogeneity. Inverse Variance, Mann-Whitney U and Kruskal-Wallis tests were used to examine interstudy demographic/treatment differences. Risk of bias was assessed with the Newcastle-Ottawa Scale, study quality with the GRADE tool.

Results
8 papers met inclusion criteria (CG1 n=3, CG2 n=3), 2 were excluded due to insufficient reported information. TC incidence was not significantly increased following PCC3 administration (ORcombined effect1.57, 95% CI 0.24-10.51, p=0.64). Meta-analysis was not performed on TC incidence in CG2 owing to only 1 paper reporting this outcome. Mortality risk was not significantly increased following PCC3 (ORcombined effect1.61, 95%CI 0.27-9.51, p=0.60) or PCC4 (ORcombined effect2.19, 95%CI 0.96-4.98, p=0.06) administration. Admission Injury Severity Score (ISS) and age varied significantly between papers included in CG1 (mean­ISS=15.5, 95%CI=12.0-20.1, p&lt;0.05, meanage=75.3years, 95%CI=65.5-86.7, p&lt;0.05) and CG2 (meanISS=15.1, 95%CI=13.4-17.0, p&lt;0.05, meanage=79.2years, 95%CI=74.7-84.1, p&lt;0.05).

Conclusion
TC risk is not overtly increased following PCC3 administration, compared to FFP. The same is true for mortality risk following PCC3 and PCC4 administration. There is substantial room for bias in the results reported, further research is warranted.
SP8.1 - Emergency Robotic General Surgery in the UK: Operations, Staff, and Missed Opportunities
Authors: Smith Emily ,   Moynihan Academy Collaborative, Wohlgemut Jared , Okocha Michael 
Published: September 2024

Abstract

Aims
The primary aim was to determine the volume of emergency robotic general surgery performed in the UK. Secondary aims were to determine compatible operations with opportunities for training and the availability of robotic-trained staff.

Methods
Freedom of Information (FOI) requests were sent to 122 UK Acute Trusts, asking for data on general surgery procedures (open, laparoscopic, robotic) from January 2019 to January 2023. Data on common emergency procedures, in-patient length of stay, robotic complications, and availability of robotically trained staff was requested.

Results
Of the 122 Acute Trusts, 22 did not respond (82% response rate), 32 had no general surgery robotic access, 16 could not comply due to cost (under section 12 of FOI Act), and 52 provided data. Fifteen Trusts performed emergency robotic surgeries: cholecystectomy (262 cases), hernia repair (140), and appendectomy (3). 86% of these Trusts utilized the DaVinci system, while the CMR Versius system was employed by the remaining 14%. There was a median of 12.5 (range 2-40) robotic-trained staff in-hours, versus a median of 0 (range 0-4) out-of-hours.

Conclusions
Emergency robotic general surgery in the UK is limited by financial constraints, staff availability, and selective procedural use. Compatible emergency operations that have been performed were cholecystectomies, hernias, and appendectomies. To expand its role, there's a need for training, infrastructure investment, and further research into the cost-effectiveness and outcomes of robotic surgery in emergency cases.
SP8.2 - Single centre experience in establishing a robotic colorectal surgery programme in a UK district hospital
Authors: Moolamannil Mathew , Rajaratnam Kanapathi , Bevan Katharine , Georgiades Fanos 
Published: September 2024

Abstract

Aim
To describe our centre’s experience in establishing a robotic programme for colorectal surgery procedures.

Method
Demographic, peri-operative and follow-up data from a prospectively maintained database were collected for all laparoscopic and robotic assisted colorectal procedures carried out at our centre.

Results
38 colorectal resections were completed with the DaVinci Xi (Intuitive Surgical, USA) robotic platform between April-December 2023. These were compared to a laparoscopic cohort of 57 consecutive colorectal resections. 37% (n=14) of the robotic cases were proctored and all were resections for malignancy. There were 57.9% (n=22) males in the robotic cohort and 50.9% (n=28) in the laparoscopic cohort. There was no statistical difference between the demographics of the two cohorts in terms of age, body mass index and ASA grade. 21/38 (55.3%) robotic resections were left sided compared to 35/57 (61.4%) laparoscopic resections. No robotic cases were converted to open or laparoscopy, but 8.8% (n=5) of laparoscopic cases were converted to open. Laparoscopic procedures were shorter (median operative time 277 min compared to 412 min, p&lt;0.001). A stoma was formed in 13/38 (34.2%) robotic cases and 16/57 (28.1%) laparoscopic cases. All bowel anastomoses performed in the robotic cohort were stapled with 16/32 (50.0%) being intra-corporeal. The median length of stay was 5 days for both cohorts. 5.3% (n=2/38) Vs 12.3% (n=7/57) had a significant post-operative complication (Clavien-Dindo ³3). No mortalities were recorded within 90 days of the procedures.

Conclusions
Other than longer operative times, robotic colorectal resections in a district hospital setting is comparable to laparoscopic resections.
SP8.5 - Enhancing the confidence of FY1 Doctors in managing General Surgical Patients through the introduction of an online handbook– A quality improvement project
Authors: Sims Oliver , Abishek Joshua , Manji Ali , McCarthy Deirdre , Mallappa Sreelakshmi 
Published: September 2024

Abstract

Background
Emerging as a Foundation Year 1 (FY1) doctor from undergraduate training can be daunting. Furthermore, working in Colorectal Surgery can pose challenges: managing both elective and acute surgical patients with complex needs. We designed a General Surgery and Colorectal Surgery handbook to help FY1 doctors navigate training. This Quality Improvement Project aimed to assess the impact of and alleviate some of the uncertainty experienced by FY1 doctors during this transitional phase.

Methods
An electronic handbook was compiled with contributions from across the Multidisciplinary Team which was reviewed and approved for distribution within our Trust. An online questionnaire was distributed to assess pre-placement confidence in key domains on a 10-point Likert scale. This was sent to FY1 doctors who had previously completed a rotation within colorectal surgery without the handbook. The handbook was distributed to new cohort of FY1 doctors a week prior to the start of their rotation in Colorectal Surgery. An identical questionnaire was sent to the new cohort of FY1s within a month of their rotation and results were compared with previous cohort.

Results
In all surveyed areas, there was an improvement in confidence in the post-intervention group compared to that shown in the pre-intervention group. The average improvement in median score across all areas was 3.8 points.

Conclusion
This project demonstrated an overwhelmingly positive response to a formalised handbook by FY1 doctors in training. This intervention has helped FY1 doctors manage colorectal and general surgery patients with enhanced confidence thus paving way for safer patient care.
SP8.10 - Systematic Review and Meta-Analysis of Interactive multimedia Interventions used in the Informed Consent Process
Authors: Clements Joshua Michael , Clements Jake Simon , Clarke Mike , Kirk Stephen 
Published: September 2024

Abstract

Aim
The use of digital technology to improve the informed consent process has increased over the past decade. A wide range of multimedia modalities are now available. This review aimed to assess the impact of interactive multimedia interventions on the informed consent process.

Methods
This was a subgroup analysis of a larger systematic review and meta-analysis conducted in accordance with a predefined protocol registered on PROSPERO (CRD42023380406). Five databases were searched using pre-defined search criterion in December 2022 for randomised trials of interactive multimedia interventions designed to improve the informed consent process. Adults &gt;18 years undergoing invasive interventions with the capacity to consent were included. The Cochrane Risk of Bias (RoB) tool was used to assess study quality. Standardised mean difference for continuous variables and risk ratios for dichotomous variables were used to assess effect. Meta-analyses were performed in RevMan5.

Results
21 studies (22 interventions arms) with 2090 participants were included. All studies involved patients undergoing informed consent in an elective hospital setting for various surgical, cardiological and radiological procedures. Statistically significant improvement in immediate (SMD 0.40, 95% CI 0.18 to 0.62, I2=55%) and short-term knowledge (SMD 0.47, 95% CI 0.16 to 0.79, I2=45%) were demonstrated. No statistically significant differences were found for long term knowledge, generalised anxiety, satisfaction with the consent process or length of consultation.

Conclusions
Interactive multimedia interventions improve immediate and short-term knowledge in patients undergoing invasive interventions and could be considered as an adjunct to enhance patient knowledge during the informed consent process.
SP9.2 - Changes in frailty and discharge destination post emergency laparotomy
Authors: Ng Hwei Jene , Quasim Tara , Moug Susan 
Published: September 2024

Abstract

Aims
Frailty affects morbidity and mortality post emergency laparotomy (EmLap). Studies have shown that some frail patients do not return to baseline post EmLap. We aim to explore the change in frailty status at 90-day post EmLap and the association between pre-EmLap frailty and changes in home environment on discharge.

Methods
EmLap patients age ≥65years from a district hospital were recruited from May 2022 to April 2023. Discharge data were collected prospectively, and frailty was assessed using Rockwood Clinical Frailty Scale at pre-EmLap and day-90 post-EmLap with score &gt;4 as frail. EmLap patients with no complete 90-day follow-up were excluded. P-value of &lt;0.05 was considered significant.

Results
63 EmLap patients were included, 57.1% were female and median age was 75years. 17.5% were frail pre-EmLap and on day-90 post-EmLap, 33.3% were found frail (15.9% developed frailty). Pre-EmLap, all patients came from home with 13.6% had package of care service (POC) already in place. On discharge post-EmLap, 27% had change of home environment; 1 to care home, 1 still an inpatient at 90-day post EmLap, 2 had new POC and 13 had increased POC. Of this cohort, 52.9% were frail pre-EmLap. There was a significant association between pre-EmLap frailty and change in home circumstances on discharge (p&lt;0.00001).

Conclusion
About 16% developed frailty post-EmLap with almost a third had a change in home environment on discharge. Frailty should be assessed in all EmLap patients to improve shared decision making and development of post-EmLap discharge strategies.
SP9.6 - Introduction of a Dedicated Motivational Movement Rehabilitation Service to Reduce Length of Stay in Emergency Laparotomy Patients
Authors: Watson Hannah , Payne Christopher , Gray Carol 
Published: September 2024

Abstract

Aim
Emergency laparotomy patients represent a high-risk group with the need for both physical and emotional recovery post operatively. National audit data demonstrated our institution has a longer length of stay than other health boards. The need to proactively support postoperative mobilisation within this patient group was identified and funding achieved for a period of one year to employ two heath care support workers to provide a dedicated motivational movement service with the aim to reduce overall length of stay (LOS).

Method
Feedback was sought from staff and patients to inform the roles. The team provide daily individual patient centred movement goals with 1:1 movement support, gain an understanding of 'what matters to you' for every patient and bring positivity, encouragement and enthusiasm to recovery by providing daily motivation and wellbeing support.

Results
First quarter data since implementation, from March to May 2023, demonstrated a reduction in average and median LOS by 9.5 days and 5.8 days respectively compared to same quarter data from 2022. This was reproduced for the second quarter with average LOS reducing by 9.0 days and median LOS by 6.2 days compared to previous year. 95% of patients were asked ‘What matters to you?’. Feedback from patients and staff about this service has been overwhelmingly positive.

Conclusion
The introduction of a dedicated 7-day motivational movement service has reliably reduced LOS in this patient group for the first two quarters since implementation. The service has received universally positive feedback indicating the increased quality of recovery felt by patients.
SP9.13 - Influence of Gastrojejunostomy Diameter on Weight Reduction Following Roux-En-Y Gastric Bypass Surgery
Authors: Al-Fagih Othman , Niaz Osamah , Razzaq Ahsen , Askari Alan , Munasinghe Aruna , Al-Taan Omer 
Published: September 2024

Abstract

Introduction
The debate on whether the diameter of the gastrojejunostomy in Roux-En-Y Gastric Bypass (RYGB) affects long-term weight loss was addressed in this study by comparing outcomes between two different anastomosis diameters.

Methods
This retrospective study analysed primary RYGB performed from January 2017 to July 2021, comparing 30mm and 45mm gastrojejunostomy diameters. Weight loss was assessed at 12, 24, and 60 months post-operatively.

Results
Of the 1,081 patients who had RYGB, 79.6% were female, with a median age of 48 (IQR 40-55). The median starting BMI was 44.6 Kg/m2 (IQR: 40.4-50.1). The 30mm group comprised 36.6% (396/1,081) of the participants. There were no notable differences in baseline demographics such as gender, age, ASA classification, and medical history between the groups. At the 12-month follow-up, the average BMI reduction was 12.8 Kg/m2 (IQR: 9.3-17.9), with no significant differences between the 30mm (median: 13.0 Kg/, IQR: 9.4-23.5) and 45mm groups (median: 12.6 Kg/m2, IQR: 9.1-16.9, p=0.053). At 24 months, the BMI reduction was more substantial in the 30mm group (median: -16.2 Kg/m2, IQR: 11.6-40.5) than in the 45mm group (median: -15.3 Kg/m2, IQR: 10.0-35.6, p=0.006). A greater divergence was observed at 60 months, with the 30mm group showing more weight loss (median: -17.2, IQR: 11.3-31.1) compared to the 45mm group (median: -15.8, IQR: 11.9-28.3, p=0.003).

Conclusion
A smaller gastrojejunostomy diameter of 30mm is linked with greater BMI reduction up to five years post-RYGB. Further study is necessary to evaluate the anastomosis size's impact on long-term weight maintenance and regain.