bluuebunny/crossref_metadata_2025_split huggingface dataset:
179 The Predictive Role of APACHE II Score in Patients with Peritonitis at National Hospital Abuja
Authors: Situ O , Badejo O , Gwaram U 
Published: August 2024

Abstract

Aim
This study assesses the predictive role of APACHE II in surgical outcomes of patients managed for peritonitis in Abuja, Nigeria.

Method
This is a prospective study of consecutive adult patients managed for peritonitis by the general surgery unit of National Hospital Abuja (NHA) within a 19-month study duration (September 2020 through March 2022). Patient characteristics and treatment outcomes were recorded in a structured proforma and analysed using the SPSS, version 25. The accuracy, sensitivity, specificity, and threshold of the APACHE II were derived from the ROC curve analysis and its coordinates.

Results
There were 54 patients with peritonitis during the study period with a male-to-female ratio of 2.6:1. Complicated appendicitis and trauma were the two leading causes of peritonitis. This study's mortality and morbidity rates were 13.0% and 63.0%, respectively. APACHE II score at admission positively correlated with the likelihood of post-operative mortality, morbidity, number of post-operative complications, ICU admission and length of hospital admission. The average APACHE II score of patients in this study was 7.1±5.2. APACHE II best-predicted mortality by the ROC curve at a threshold point of 9 (sensitivity of 85.7%, specificity of 70.2%, accuracy of 86.8%, P-value 0.002). At a threshold score of 6, APACHE II was significantly associated with the occurrence of post-operative morbidity (sensitivity of 74.3%, specificity of 73.7%, accuracy of 75.2%, P-value= 0.043).

Conclusions
This study confirms that APACHE II score at admission can predict the outcome of surgery within the first 30 days post-surgery among adult patients who had peritonitis at NHA.
226 CT Tractography as a Last Option for Penetrating Abdominal Wall Injurieswith Equivocal Contrast CT findings
Authors: Ewedah M , Bassiony M , Asal M 
Published: August 2024

Abstract

Aim
The goal of this study is to evaluate the effectiveness of using CT tractography as an option in the management of penetrating abdominal trauma. Does CT Tractography function as a useful technique for assessing patients with Anterior Abdominal Stab Wounds (AASW)?

Method
The study included 82 patients admitted to the trauma centre at Alexandria Main University Hospital in Egypt who had penetrating anterior abdominal wall injuries, were in stable condition, and had a contrast CT scan of the abdomen and pelvis that was inconclusive about peritoneal penetration.

Results
A total of 57 patients underwent exploration after showing positive findings of contrast leak into the peritoneal cavity. 25 patients with CT Tractography results that demonstrated no leak into the peritoneal cavity were treated conservatively without the necessity for surgical intervention.

Conclusions
In the study, CT tractography correctly identified 100% of the patients who needed laparotomies, and none of the patients without peritoneal penetration required surgical intervention during follow-up. The examination of patients with AASW can be done efficiently by CT tractography.
818 Acute Appendicitis: Why the Wait? – a Retrospective Analysis of Timings Associated with the Most Common Emergency General Surgery Operation
Authors: Marks B , Karim M H , Jones R 
Published: August 2024

Abstract

Aim
Getting it right first time (GIRFT) analyses hospital data nationally, identifying areas to improve patient care. Their latest report suggests reducing appendicectomy length of stay (LOS) could result in significant cost savings, proposing a benchmark figure of 36.2% being discharged within two days. GIRFT data shows James Cook University Hospital discharges only 25.7%. Additionally, the World Society of Emergency Surgery recommends performing all emergency appendicectomies within 24 hours of admission. Our aim was to identify delays in patient care to meet these two standards.

Method
Emergency appendicectomies performed between 01/06/2021 and 30/05/2023 were included, with admission data for 354 patients being analysed. Calculations were performed to provide the following metrics: time to decision to operate, admission time to theatre arrival, time from decision to operate to theatre arrival, post-operative LOS; and total LOS. We further reviewed pre-operative imaging and histology to differentiate between uncomplicated and complicated appendicitis.

Results
33.5% of patients were discharged within 48 hours of admission, with a median LOS of 2.4 days. 78.2% had an operation within 24 hours of admission. Median post-operative LOS was 1.4 days with a notably large third quartile (1.4 - 3.1). Within this quartile 60.7% were found to have uncomplicated or normal histology.

Conclusions
Our audit demonstrated a discrepancy from the GIRFT data; however, it identified opportunities to decrease LOS, especially in the uncomplicated appendicitis sub-group. It is important to remember that LOS is only one factor in providing high quality patient care, however, timely flow is important to running an effective emergency general surgery service.
1084 Clinical Audit of Surgical Site Infection in Emergency General Surgery Unit at London North West University Healthcare NHS Trust
Authors: Asogwa A , Anyaele N , Ilham A , Mazhar M 
Published: August 2024

Abstract

Aim
To reduce the rate of wound infection in surgical patients in Emergency General Surgery Unit of Northwick Park Hospital. To access adherence to national guidelines by Emergency General surgery unit. To access the rate of Surgical site infection in Emergency General surgery unit at Northwick Park Hospital. To check if the rate of Surgical site infection in Emergency General surgery unit is in line with the national standard.

Method
This was an audit of NICE guideline((NG125)) undertaken in a retrospective manner. Data was collected through questionnaires and patient hospital records. Questionnaires where populated by contacting patients for feedback.

Results
Nice prescribed a target of 100% in the categories audited. The only exception is perioperative showering that NICE recommended should be carried out whenever possible.
Pre-op Nose Swab 61%
Perioperative showering 44%
Theatre Wear 100%
Informed to remove all jewelleries 97%
Informed about pre-op antibiotics 66.67%
Informed about intra-op antibiotics 14.29%
Informed about closure method 77.14%
Post op wound dressing services 44%
Wound dressing education 49.29%
Post op surgical site infection 6.76%

Conclusions
Overall, Northwick Park hospital maintain a commendable adherence to NICE guideline. This is evident from the very low rate of surgical site infection observed. Strict adherence could be seen in areas that are routinely recommended by NICE. Shortcomings recorded are due to failure in certain levels of communication than non-adherence to guidelines. To ameliorate this, it was concluded that checklist with all the shortcomings should be discussed with every patient and given leaflets to cover these before discharge.
1178 A Study to Audit the Breach of CEPOD Guidelines in Emergency General and Colorectal Surgeries
Authors: Blinkhorn-Conroy O , Hussain I , Rahman K R , Wong Sik Hee J R , Tun San N , Norwood M 
Published: August 2024

Abstract

Aim
Is to audit any breach of local CEPOD guidelines by comparing the time of booking to the time of surgery, for emergency general and colorectal operations.

Method
The audit was done by gathering data about theatre booking time, comparing it to when the surgery took place, and calculating whether time to surgery breached the CEPOD guidelines or not. Study was conducted in the general and colorectal surgery department in Leicester Royal Infirmary, over a span of 2 weeks. All general surgical abscesses, appendicectomies, and emergency bowel operations were included in the study.

Results
A total of 90 emergency cases were selected for this study. These included 30 abscesses (perianal, perineal, gluteal, etc) of which 27% breached the CEPOD time to surgery. 33 appendicectomies (laparoscopic and open combined) were recorded, and 30% breached CEPOD time to surgery. There were 27 emergency bowel operations divided into 21 colorectal and 6 upper GI surgeries. Out of the colorectal operations, 67% required bowel resection, and 43% needed a stoma. 33% of all colorectal surgeries breached the CEPOD time to surgery guidelines. As per CEPOD categories, 18% of category 2, 31% of category 3, 26% of category 4, and 37% of category 5 breached the CEPOD guidelines. Overall, 28% of cases breached the CEPOD category.

Conclusions
This audit reveals there is scope of improvement in adhering to CEPOD guidelines while booking emergency general surgical cases.
1268 Evaluating the Use of Prophylactic Antibiotics in Patients with Chest Trauma
Authors: Attafi W , Noble A , Morrison T 
Published: August 2024

Abstract

Aim
Current evidence on the use of prophylactic antibiotics for patients with rib fractures is heterogenous, reflecting the complexity of chest trauma. This audit aims to assess the use of prophylactic antibiotics for patients with traumatic rib fractures.

Method
Radiological reports were used to identify injury severity, presence of pneumothorax and flail segments for all patients admitted to a DGH with trauma management capability. Rib scores were calculated, and admission records were assessed to determine if antibiotics were given. An electronic patient database was used to identify the presence of significant co-morbidities such as Asthma or COPD and associated complications.

Results
Of 6,991 patients admitted between September 2022-23, 109 were treated for traumatic rib fractures. 33 (30.2%) were given antibiotics during admission. Average rib score for those given antibiotics was 7.69, with an average age of 74.4. 2 (14.3%) patients with flail chest received antibiotics. 15 (13.8%) patients had a history of Asthma or COPD and 5 (4.59%) of these received antibiotics. The average hospital stays of patients admitted with rib fractures was 7.9 days for those who did not receive antibiotics versus 6.4 days for those who did.

Conclusions
The decision to administer antibiotics continues to be guided by clinical correlation, inflammatory markers, and radiological severity, rather than via a prophylactic approach. Our data shows patients administered antibiotics experienced a shorter average hospital stay. It remains crucial to approach each patient on an individual basis, considering a comprehensive set of factors for optimal rib fracture care.
203 Peer-to-Peer Surgical Suturing, an Initiative to Inspire the Next Generation of Surgeons?
Authors: Singh Sokhal B , Swift C , Lindley J , Zope P , Rao V 
Published: August 2024

Abstract

Background
Royal College of Surgeons defines the surgical knowledge students require. Studies suggest there is a lack of surgical skills teaching resulting in medical graduates not having the surgical competencies as per General Medical Council guidance. The benefits of early exposure to practical skills are well recognised but underutilised in medical students.

Aim
This study evaluated the effectiveness of peer-led surgical skills sessions organised by a university surgical society, focussing on students' confidence in surgical theory, knot tying, and suturing.

Method
The suturing sessions were conducted by trained medical students from a university surgical society, trained by consultants. Attendees were medical students with limited prior exposure to surgery and suturing. After each session, feedback forms with Likert scales were distributed to assess students' confidence in various aspects of surgical skills.

Results
Feedback forms from 27 participating students were analysed. Remarkably, 100% of students reported that the sessions met their learning objectives. The mean confidence in identifying surgical equipment increased from 3.6 (range 1-10) before the session to 8.4 (range 5-10) after the session. Similarly, students' confidence with suturing ability rose from a mean score of 2.7 (range 1-7) to 8.0 (range 5-10), and their confidence with surgical knot tying improved from a mean score of 2.9 (range 1-10) to 7.9 (range 4-10) after the session.

Conclusions
This initiative underscores the efficacy of peer-led-teaching in basic surgical skills to medical students. Future research may explore the integration of surgical training into the formal medical school curriculum, further enhancing students' surgical competencies and readiness for clinical practice.
406 A Service Review of the Tongue-Tie Clinic and Its Outcomes
Authors: Barrie E , Winter G 
Published: August 2024

Abstract

Aim
The surgical management of ankyloglossia is a widely debated topic. The purpose of this project was to carry out a service review of the tongue-tie clinic in NHS Grampian looking at parental expectations and experiences, as well as outcomes focussing on breastfeeding rates, following tongue-tie division.

Method
This study was carried out over 5 months and split into pre-and post-clinic data. Pre-clinic questionnaires were completed by parents/carers and post-clinic telephone calls were conducted between 6 weeks - 5 months post-clinic for patients who underwent frenulotomy.

Results
The pre-clinic cohort included 129 participants. In regard to feeding problems, 73% (n=94) experienced latch issues, 56% (n=72) maternal discomfort and 31% (n=40) milk spillage. 63% (n=81) thought that tongue-tie division would improve feeding, 35% (n=45) thought that latch would be improved and 3% (n=4) thought that future speech issues could be avoided. Additionally, 60% (n=77) were given support prior to clinic by the infant feeding team, 54% (n=70) by health visitor, 53% (n=68) by midwife and 5% (n=6) by speech and language therapy.
The post-clinic cohort included 82 participants. 77% (n=63) who were breastfeeding before the procedure continued to breastfeed after. 1% (n=1) experienced post-procedural issues and 84% (n=69) experienced an improvement in feeding.

Conclusions
This service review provided a thorough analysis of the tongue-tie clinic by gaining information on the experiences of different participants. Additionally, the outcomes were shown to be positive as breastfeeding rates post-tongue-tie division remained high and feeding was improved with no issues for the majority of patients.
532 Patient Journey Posters Reduce Pre-Procedural Anxiety in Day Surgery
Authors: Patrick S , Patel R , Hanibal G , Murphy Lonergan R 
Published: August 2024

Abstract

Background
Multi-factorial anxiety is common prior to undergoing a surgical procedure and may contribute to poor post-operative outcomes. Aside from operation-related concerns, anxiety may be driven from uncertainty relating to procedures, logistics and reporting arrangements on the day, therefore improving patient understanding of the peri-operative pathway can reduce this anxiety.

Aim
To explore patients’ understanding and emotion surrounding the peri-operative pathway prior to surgery. To implement patient guides to improve understanding of the peri-operative pathway.

Method
We opportunistically sampled day surgery patients in waiting room prior to their procedure via a structured questionnaire. We undertook quantitative and thematic analysis of results, focusing on patients' emotions and understanding. We produced a poster displaying the departments and areas a patient will move through in their peri-operative pathway, with a text-explanation of what occurs at each stage, from the consent process to recovery. Patients were followed up with another questionnaire to assess the usefulness of the poster.

Results
Following intervention, there was an increase in percentage of patients understanding of the peri-operative journey. Most patients reported anxiety in trying to locate the surgical department before surgery, as well as the recovery process. Patients reported pre-procedural information was brief and unclear, therefore reading a guide with images of the areas helped reduce anxiety.

Conclusions
It is evident that patients feel unsure and anxious about peri-operative journey on the day of their operation. Patients particularly want more information on recovery and the discharge process. Having a past procedure in day surgery was correlated with reduced anxiety.
715 Outcome of Surgically and Conservatively Managed Spinal Cord Herniation
Authors: Whittle C , Roy D , Hollingworth M , White B 
Published: August 2024

Abstract

Aim
Spinal Cord Hernia (SCH) is a rare cause of progressive myelopathy and pain relating to protrusion of the cord through a dural defect. We describe the characteristics and outcomes of surgically and conservatively managed patients treated at our institution.

Method
A retrospective case review of patients treated from 2005 to 2021 was conducted and combined with contemporary telephone follow-up using objective measures of disability and pain (the Spinal Cord Independence Measure and Numerical Analogue Pain Scale).

Results
42 patients were included in our review (mean age 52.4 years; SD = 15.1 years). The mean time from symptom onset to diagnosis was 3 years (SD = 5.43 years). 64% of patients were female, and 88% had a neurological deficit at presentation. Surgery was performed in 52.3% of patients. Brown-Séquard syndrome at presentation was a predictor of receiving surgical management. Patients treated surgically were more likely to develop postoperative paraesthesia, weakness, and sphincter abnormalities. We acquired contemporary telephone follow-up in 64% of patients. Spinal Cord Independence Measure scores in the surgically and conservatively treated patients were equivocal at 82.6/100 and 85.1/100 respectively (95% CI [17.360, -22.493]; p = 0.396).

Conclusions
Patients with spinal cord hernia face a prolonged period between symptom onset and diagnosis. Minimally symptomatic patients can be managed conservatively, and many may improve or stabilise. Early post-operative weakness is common, but most patients remain independent and improve beyond or return to their pre-operative status.
737 Zero Percent Posterior Capsule Rupture (PCR) Incidence: Inaugural Year Analysis at a New NHS Cataract Hub
Authors: Vilkelyte V , Roberts H 
Published: August 2024

Abstract

Aim
The objective of this audit was to evaluate the incidence of posterior capsular rupture (PCR), a widely accepted safety measure of cataract surgery, within the inaugural year of operation at a novel high volume low complexity cataract unit known as the Centre of Eye Excellence, located within Nightingale Hospital under the Royal Devon University Healthcare NHS Foundation Trust.
This specialised unit is led by a team of four senior cataract surgeons, comprising three consultants alongside a dedicated cornea fellow from the Royal Devon and Exeter Hospital. The consultants conduct a full-day surgical list on alternate weeks, while the cornea fellow performs a weekly full-day list.

Method
Retrospective data from the first 12 months of operation (1/9/22 to 1/9/23) of the four surgeons at the Nightingale Hospital was collected using the 'Blue-Book' theatre log and cross-checked against each surgeon’ personal complication audit with respect to posterior capsule rupture/vitreous loss/anterior vitrectomy. Patient information was documented in Excel and supplemented by patient notes.

Results
Between September ’22 and ’23 there were 1099 cataract operations performed at the Nightingale Unit. There were 0 cases of posterior capsule rupture/vitreous loss/anterior vitrectomy identified from the four surgeons.

Conclusions
The audit reveals no cases of PCR/vitreous loss/anterior vitrectomy at the Centre of Eye Excellence, Nightingale Hospital in its opening year. Nightingale's successful first year highlights high-quality cataract surgery for patients.
1222 Successfully Showcasing How Digital Clinical Innovation and Enterprise Can Be Used to Improve Complex Challenges Facing the NHS - 'Creation of the ViewOP Application to Improve Theatre Utility and Efficiency'
Authors: Ayirookuzhi S , Aydemir C , Alhalabi O , Alahmad A , Lee V 
Published: August 2024

Abstract

Aim
Solve a persistent complex challenge facing the NHS. The NHS faces persistent challenges related to surgical theatre utility and efficiency as highlighted in the NHS Improvement report ‘Operating theatres: Opportunities to reduce NHS waiting lists’ (Briggs, 2019). With passive surgical theatre costs of up to £28,000 daily these issues contribute to delays in operations and strain waiting lists (Andersen, 2023).

Method
ViewOP is a digital clinical innovation enterprise developed by a group of 3rd year medical students in response to this challenge by increasing communication between theatre staff, wards, and porters through a web-based application prototype developed for both desktop and mobile devices.
It utilises 4 core features that integrate seamlessly to provide improved communication and increased theatre efficiency and utility.Real time push notifications: These notifications provide instant updates on surgical schedules and patient statuses.Surgical scheduling conveyor belt system: Quick at a glance notification of the surgical schedule.Traffic light patient flow system: A simple universal user interface system to track and move patients from pre-op to post op recovery.Integrated checklists: A comprehensive pre, intra and post op checklists that provide comprehensive and integrated checklists that promote patient safety and surgical success.

Conclusions
Working closely with Buckinghamshire Health Research and Innovation Centre and the Buckingham Enterprise and Innovation Unit using Google's 'Design Sprint' methodology we have successfully created, showcased, and pitched a prototype application and have secured £1000/- of funding to advance the development of this application.
667 Enhanced Recovery in Cranial Surgery (ERACraS) – a Single-Centre Qualitative Improvement Study
Authors: Abul M H , Sescu D , White M A , Robson M , Ferguson J , McDermott F , Kaliaperumal C 
Published: August 2024

Abstract

Aim
To establish an Enhanced Recovery After Cranial Surgery (ERACraS) protocol for patients as part of a quality improvement project (QIP) with the intention of reducing hospital length of stay (HLOS), similar to the evidence-based Enhanced Recovery After Surgery (ERAS) protocol.

Method
This QIP was carried out in the Department of Neurosciences (DCN), Edinburgh, over two four-month periods. A total of 40 patients over 18 years of age undergoing elective craniotomy surgery under a sole neurosurgeon were invited to take part in this QIP. Subsequently, data was retrospectively collected through our institution’s online documentation system.

Results
19 patients received conventional perioperative care (pre-ERACraS group) during December 2021-March 2022, and 21 received care according to the novel ERACraS (ERACraS group) during June-September 2022. Regarding supra-tentorial surgery, there was a reduction of 73% in HLOS in the ERACraS group. No change was observed in infra-tentorial surgery. Overall, the ERACraS protocol reduced HLOS by 50% in cranial surgery.

Conclusions
The QIP data from ERACraS in our unit has shown that implementing ERAS protocols is feasible. A reduction in HLOS has implications for patient morbidity, mortality, and quality of care. We endeavour to collect long-term data by collaborating with neurosurgical units across the UK and Ireland to validate its feasibility and sustainability as part of a major QIP in neurosurgical practice. This can be potentially adopted by neurosurgical centres across the globe in a safe and sustained manner.