bluuebunny/crossref_metadata_2025_split huggingface dataset:
EGS P18 A single centre retrospective audit into the early management of acute pancreatitis in an UK District General hospital
Authors: Karagiannidis Georgios , Abdallah Mohamed , Patel Roshni , Youssef Fahed 
Published: November 2023

Abstract

Background
In the UK, the incidence of acute pancreatitis is approximately 56 case per 100,000 people per year. It is a complex disease, and the treatment of pancreatitis can vary significantly between different regions regardless of the numerous national and international guidelines.The purpose of this audit is to compare the diagnosis and management of pancreatitis at Ipswich hospital with other hospitals that have participated in the PANC study. We also compared the ideology and mortality rate. By doing so, we can establish a foundation for future management plans and guidelines at Ipswich hospital.

Methods
This audit was conducted at Ipswich hospital for four months, from November 1st, 2022 to April 30th, 2023. It was a single-centre prospective cohort study that included all patients diagnosed with pancreatitis in accordance with the Modified Atlanta Classification and presented within the four months. Data was collected from the time of admission to discharge or death and included patient demographics, bloods on admission, investigations, aetiology, management and complications.

Results
A total of 87 patients were admitted to Ipswich hospital with a diagnosis of pancreatitis during this time frame.The most common etiology was gallstones(45%,PANC 50.6%),followed by idiopathic(33%,PANC 22.4%)and lastly EtOH(18%).Only 45% of those with idiopathic pancreatitis underwent further idiopathic pancreatitis screen and 10% had EUS.The most common imaging used was CT scan (51%, PANC 53%), majority of those scans were performed within the first 24 hours of admission and 33% of patients with diagnostic amylase underwent a CT. 55% of patients were started on antibiotic in the first 48 hours of admission (PANC 34.6%).

Conclusions
The data collected from within Ipswich hospital was similar to that found in the PANC study. This suggests that the diagnosis and management of pancreatitis is somewhat similar across the UK. The rate of Idiopathic pancreatitis was much higher than expected and higher than the PANC study. Similar to the PANC study, there is an overuse of CT scan for diagnosis of pancreatitis which is not in accordance with the royal college of radiology guidelines.
EGS P20 Registrar-led theatre lists: A safe and effective way to provide a consistent Hot Gallbladder service
Authors: Chhabra Raunaq , Lorenzi Bruno , Bhatti Sumbal 
Published: November 2023

Abstract

Background
Dedicated Hot Gallbladder lists are proven to be cost effective and provide greater patient satisfaction. Unfortunately, the high volume of cases and the lack of available hospital resources make it very challenging to provide a consistent service. The aim of this study is to evaluate the safety and efficacy of the Registrar/SAS doctor led Hot Gallbladder service introduced in our Hospital over a year ago.

Methods
A system was developed with a middle grade doctor reporting to an UGI consultant surgeon and one SPOC in the waiting list office to streamline the service. A dedicated scoring system questionnaire (GalBAG form – Galbladder Booking and Grading form) was validated in retrospective and prospective series, and subsequently used to assess and grade patients into GOLD, SILVER & BRONZE cases based on expected difficulty and predicted length of the operation. Cases were listed based on surgeon compatibility. Outcomes measured include complications, unplanned admissions and re-admissions, need for further procedures, efficiency of the theatre lists and compared to national averages.

Results
Our registrar-led lists have successfully performed over 100 hot laparoscopic cholecystectomies. Complication rates, unplanned admissions, readmissions, and need for additional procedures align with national averages. Only one biliary injury occurred but was successfully treated endoscopically. The efficiency of the lists has improved with time as well as the ability to schedule progressively more complex cases Theatre utilization increased for patients referred through the Hot Gallbladder pathway. The GalBAG form accurately predicted difficulty and aided decision-making. Our Hospital now offers a secure and reliable Hot Gallbladder service, receiving positive feedback from patients and GIRFT.

Conclusions
In the current climate of increased waiting lists and lack of resources to provide dedicated urgent surgical services, a Registrar-led theatre list service with adequate backup/supervision could represent a safe, efficient, consistent and cost effective model to offer a Hot Gallbladder service.
EGS P28 Analysis of referring process from the emergency department to general surgery
Authors: Marchese Salvatore , Abdelrahman Abdelrahman , Dias Rachel , Uzkalnis Aleksandras 
Published: November 2023

Abstract

Background
Referring patients from the emergency department to specialty doctors is a crucial but often frustrating process. The aim of this study was to identify discrepancy and common ground in the referring process between emergency doctors and general surgeons.

Methods
A prospectively daily-maintained database of surgical referrals was statistically analysed. In addition, a ten-question survey was sent to both emergency and surgical doctors who had referred or had been referred to during the month of the study.

Results
In May 2021, at our Trust, 280 patients were referred to general surgery. 52 referrals were deemed inappropriate (19%), with a rate as high as 50% in 24 hours. The most common inappropriate diagnosis was appendicitis (23%), followed by small bowel obstruction (15%).
The survey showed frustration with the referral process was reported more by surgeons (P &lt;.05). They believed patients are not yet sufficiently assessed when referred (P &lt;.05). However, focused assessment on the patient’s main complaint would seem mutually well-accepted. Eventually, there was a common consensus on the need for specific criteria to guide surgical referrals.

Conclusions
Improvement of communication is recommended, especially with regard to the attitude used during referrals. Specialties’ relevance for specific conditions needs to be clarified. Criteria and guidelines on common surgical presentations should be designed to define appropriateness of referrals. Eventually, a specific system is required to formally report inappropriate referrals and unprofessional behaviour.
EGS P30 Audit on the assessment of upper abdominal pain for cardiac and respiratory differentials (AUPCR)
Authors: Lakshmipathy Gokul R , Wiggins Tom 
Published: November 2023

Abstract

Background
In multi-morbid ageing population, cardiac and respiratory differentials of upper abdominal pain should be ruled out. In patients presenting to surgical units with upper abdominal pain, we evaluated proportion undergoing chest assessments and in patients older than 40, we identified proportion having Electrocardiograms (ECGs.) We planned to install quality improvement strategies and close the audit loop.

Methods
According to our trust’s protocol, all patients with upper abdominal pain require chest assessment, and those older than 40, require ECG. We collected data retrospectively from patients’ notes between January and February 2022. We educated healthcare staff to perform chest assessments and interpret ECGs. We circulated the trust protocol as flyers and affixed posters in A&E and SAU. We changed patient’s electronic system so that ECGs can be uploaded. Re-audit happened between May and June 2022.

Results
100 patients were included in first cycle and 75 patients in the second. Three-quarters of patients were female and one-quarter were male. Around two-thirds of patients were older than 40. The most common region of pain was the right hypochondrium followed by the epigastrium. Proportion of patients having chest assessments rose from 48% to 85% in re-audit. Number of patients older than 40 having ECGs more than doubled from 28% to 61% in the re-audit.

Conclusions
We identified that chest assessments and ECGs were not being performed to adequately investigate patients with upper abdominal pain. We trained staff, used visual aids and made changes to electronic systems; which resulted in significant improvement in assessment of differentials for upper abdominal pain. No life-threatening cardiac or respiratory conditions were missed in the re-audit.
EGS P31 Small bowel obstruction in an elderly female secondary to congenital Ladd’s band. A rare case presentation
Authors: Adnan Naqqash , Agarwal Prachi , Zagorac Zoe , Jamal Zohaib , Alam Imran 
Published: November 2023

Abstract

Background
Intestinal malrotation is a congenital anomaly which arises during embryonic development. This can be associated with peritoneal tissue known as Ladd’s bands which can cause predisposition to intestinal obstruction. The incidence of intestinal malrotation is reported to be approximately 0.2% in the adult population [G]. Cases of intestinal obstruction secondary to malrotation commonly present in the paediatric population, but rarely may only be detected at adulthood. We present an elderly women who presented with features suggestive small bowel obstruction.

Methods
We present a rare case of a 78 year old female presenting with a three day history of coffee-ground vomiting, abdominal pain and dizziness. The patient had a notable background of a hiatus hernia and atrial fibrillation for which she was being treated with edoxaban. An abdominal X-ray film showed faecal loading. CT imaging revealed a high-grade small-bowel obstruction with an acute transitional point at the terminal ileum secondary to congenital Ladd's band which was confirmed at laparotomy. Subsequently, a Ladd’s procedure was performed and the patient was discharged after making a good recovery.

Results
In this case report, we highlight the importance of considering congenital anomalies in patients presenting with symptoms of bowel obstruction. We discuss the importance of appropriate investigations as well as multidisciplinary care to help facilitate early diagnosis.

Conclusions
Congenital Ladd’s band is a rare cause of small bowel obstruction in an elderly population. Although the diagnosis of intestinal malrotation can be challenging in adulthood, congenital anomalies should be considered as a differential in patients presenting with symptomatic obstruction.
EGS P32 Audit for evaluation of using the National Emergency Laparotomy Audit (NELA) as risk assessment calculator for high-risk surgical patients undergoing emergency laparotomy
Authors: Hobeita Wesam , Mohamed Hussam , Karar Karar , Di-Rollo Domenic 
Published: November 2023

Abstract

Background
A high-risk surgical operation called an emergency laparotomy has significant mortality and morbidity rate up to 10 times greater than the one performed electively. This entails a significant clinical and financial burden. The National Emergency Laparotomy Audit (NELA) was established in response to the aforementioned data in order to enhance the quality of care for patients having emergency laparotomies and to assist surgeons in reaching the best possible medical choices for their patients. The Emergency, Laparoscopic and Laparotomy Scottish Audit (ELLSA) is an equivalent system in Scotland. However, ELLSA is still not widely used as NELA.

Methods
This is a single-centre, retrospective audit to evaluate proper risk assessment and NELA registration for patients who had an emergency laparotomy in CEPOD between January 2022 and December 2022. The data was gathered from electronic clinical records via the hospital portal system. This analysis has included the following clinical data (Age, gender, indication of laparotomy, CEPOD form completion, NELA Score, hospital stay, and postoperative surgical outcome). The data was retrieved and analysed using a standard Excel data collection sheet. This audit aims to review and appraise our practise in relation to the NELA guidelines for risk assessment and emergency laparotomy.

Results
This analysis includes a total of 58 patients.35(60.3%) Males,23(39.7%) females. The included patients had an average age of 62. Almost 48% of these individuals had longer hospital stay more than 10 days. Approximately 21% of CEPOD booking forms had a recorded NELA score. A missing NELA registration form/risk assessment score was found in up to 97% of patient files and operation notes. A retrospective NELA assessment revealed a mortality rate of more than 20% for some included patients. The mortality rate was found to be high, at 21%, for NELA score of &gt;20% mortality and &gt;70% morbidity.

Conclusions
This Audit has shown that in order to completely comply with NELA guidelines, our practise must be significantly improved. We also need to give risk assessment documentation in patient records more consideration. The high death rate is attributed to patient and family requests for last-ditch surgical interventions, which can be difficult for surgeons to pull off.
EGS P34 CEPOD Booking Audit in General Surgery
Authors: Kitsikosta Loukiani , Diaz Maria Hernandez , Galides Chloe , Morsi Mai , Morrison-Jones Victoria , Rahman Saqib , Berry David 
Published: November 2023

Abstract

Background
Repeated internal audits suggested 20% of patients booked into the emergency general surgery theatre list failed to achieve their allotted time to theatre. We wished to investigate this further, identify potential reasons and whether any delay resulted in patient harm.

Methods
We retrospectively reviewed 760 consecutive adult patients over a 12 month period booked for appendicectomy, hernia repair, laparoscopic cholecystectomy or abscess I+D. We excluded laparotomies and patients under 18yoa.
We recorded pre-operative CEPOD classification, adherence to the timeframe and reasons for delays. Outcome measures included total length of stay(TOLOS), post-op length of stay (POLOS) and unexpected intraoperative findings.

Results
Of 760 emergency procedures, 638 (84%) achieved the desired time frame and 122 (16%) were delayed. Of the 122 delayed cases, 99 (81%) were appropriately booked (clinical review). Most delays were caused by a higher priority emergency but in one third of delays no reason was recorded.
There was no difference in median POLOS or unexpected findings between the two groups of those achieving expected time to theatre and those delayed.

Conclusions
Despite our initial concerns regarding delays to theatre this only occurred in 16% of the study group with no discernible difference in outcomes as measured.
The repeated clinical review of potentially delayed emergency patients accessing the operating theatre appears to be safe.
EGS P35 Spontaneous rupture of the spleen: Is it caused by COVID?
Authors: Khan Rehan , Osborne Vaz , Krishnamohan Nitya , Pursnani Kishore , Ward Jeremy , Paul Turner , Shetty Vinutha 
Published: November 2023

Abstract

Background
Spontaneous rupture of spleen (SSR) is rare but known entity in patients with underlying pathology of spleen1. However, there are reports of spontaneous splenic rupture in patients with no known underlying pathology2. With the onset of COVID pandemic, rising incidence of various disease conditions were linked to either COVID infection or vaccine. Similarly, we are presenting three cases of spontaneous splenic rupture managed by our team in last one year which could be attributed to COVID infection or vaccine.

Methods
The data of all the patients admitted in an urban tertiary Upper GI Unit with spontaneous splenic rupture in last one year was collected prospectively from online data storage software called Flex Prod. The data was extracted from this software and analysed retrospectively maintaining patient confidentiality throughout the process.

Results
Three patients of spontaneous splenic rupture received treatment post COVID in this trust. 2 out of 3 patients had COVID infection in the past and all three had received vaccine. Two patients presented to A&E with hypotension and tachycardia, were appropriately resuscitated, and then underwent successful angio-embolization. Both were monitored in the critical care in the periprocedural period and subsequently transferred to the ward. Third patient presented to A/E with upper abdominal pain and tachycardia, CT scan showed high grade rupture of spleen with low haemoglobin. Hence, angioembolization was carried out, patient recovered well postoperatively and was discharged.

Conclusions
Spontaneous rupture of spleen is rare but potentially life-threatening condition more common in patients with underlying spleen pathology3. The etiology of SSR is uncertain, however, recent case reports of patients with COVID presenting with spontaneous splenic rupture4 has led to increased interest in COVID as a cause of SSR in the post COVID era.
EGS P40 Validating the Alvarado Score as a Diagnostic Tool for Acute Appendicitis in a UK District General Hospital
Authors: Gupta Sakshi , Sheth Hemant , Soggiu Fiammetta 
Published: November 2023

Abstract

Background
Acute appendicitis (AA) remains one of the most common causes of an acute abdomen, requiring surgery. However, ruling out AA remains clinically challenging and has both economic and medico-legal implications for hospital trusts. The 2019 World Society of Emergency Surgery (WSES) guidelines endorsed the use of the Alvarado score to limit diagnostic uncertainty. Particularly, a score below 5 was deemed sufficiently sensitive to exclude AA without imaging. This audit aimed to retrospectively assess the use of the Alvarado score to exclude AA in patients referred with suggestive symptoms to the on-call general surgery team at a UK District General Hospital.

Methods
All patients referred to the on-call general surgery team between 2nd January 2023 and 5th February 2023 with right-lower-quadrant (RLQ) abdominal pain or an incidental diagnosis of AA were included. Patient demographics, clinical data, and an admission Alvarado score were retrospectively collected. An average admission Alvarado score was calculated for patients with confirmed AA and those without. As recommended in the WSES guidelines, a cut-off score of &lt; 5 was employed. The sensitivity and specificity were then calculated in order to validate the Alvarado score’s use as a diagnostic tool in patients with suspected AA.

Results
Of the 63 patients referred with RLQ abdominal pain, one self-discharged and 11 (17.7%) had confirmed AA on imaging or histology (Figure 1). The average Alvarado score was 4.9 (95% CI 4.2 – 5.5). In patients with confirmed AA, the average score was 7.5, statistically significantly ≥ 5 (p-value &lt;0.01). Patients without AA averaged a score of 4.3, statistically significantly &lt; 5 (p-value = 0.013). The sensitivity and specificity were 91% (95% CI 58.7% – 99.8%) and 47% (95% CI 32.9% – 61.5%), respectively. The positive and negative predictive values were 27% (95% CI 13.8% – 44.1%) and 96% (95% CI 79.7% – 99.9%), respectively.

Conclusions
This retrospective audit highlighted that the Alvarado score could have been safely used to exclude AA in patients with scores below 5, avoiding the need for further investigations and treatment. A second, prospective study will aim to further validate and implement the routine use of the Alvarado score in the department to improve the diagnostic work-up of patients with suspected AA. The economic impact of its use should also be investigated with a health economics multi-centric study.
EGS P42 Prospective diagnostic accuracy of Alvarado score and CT scan in evaluation of suspected appendicitis
Authors: Adnan Naqqash , Khan Jahangir Sarwar , Jamal Zohaib 
Published: November 2023

Abstract

Background
Appendicitis is most common general surgical emergency with a life time risk of 7%.Appendicitis is considered as disease of the younger age group with only 5-10% of cases occurring in the elderly population. Ultrasound and CT scan are helpful in diagnosing acute appendicitis.The rationale of this study is to find out the group of patients based on the Alvarado score that will certainly benefit from the use of city scan. As CT is the preferred imaging modality in diagnosing acute appendicitis. Alvarado score is used to stratify patients into a subgroup that will certainly benefit from CT use.

Methods
Cross-sectional validation study was conducted for six months from (30/03/2017) to (30/09/2017) in Surgical unit-1, holy family hospital, Rawalpindi. Alvarado score was calculated, and the patients then underwent a contrast-enhanced CT scan. For the data of CT scan, patients were divided into two groups Positive and negative of appendicitis. All selected patients underwent an appendectomy. Histological specimens were collected and interpreted. All the collected data was entered and analyzed on SPSS version 19.

Results
The mean age of the patients was 28.93±10.21 years. The male to female ratio was 1:1.1. The mean Alvarado score was 6.05±0.68. The sensitivity, specificity and diagnostic accuracy of CT scan for diagnosing acute appendicitis was 84.75%, 78.69% & 81.67% respectively taking histopathology as the gold standard.

Conclusions
According to our study CT scan is a reliable and useful diagnostic tool at Alvarado score of 5-6 in males and 6-7 in females, in predicting acute appendicitis keeping histopathology as a gold standard.
BS P03 The burden of bariatric tourism on the Health and Social Care System in Northern Ireland: a descriptive analysis
Authors: Hraishawi Ihab , Abduljalil Aalaa , Caldwell Sharon , Harris Andrew , MacAulay Graeme , Kennedy Raymond , Kennedy Andrew 
Published: November 2023

Abstract

Background
The lack of public bariatric surgical services in Northern Ireland has favoured the growth of bariatric tourism. This retrospective study aimed to analyse the data extracted from the records of bariatric patients who presented with complications to Belfast Health and Social Care Trust following their surgery abroad and investigate the costs associated with managing these complications. It also aimed to explore other factors, such as emotional trauma, that may be associated with bariatric tourism.

Methods
This was a retrospective study including all patients, who had their bariatric procedure abroad, presenting acutely to our hospital between August 2016 and February 2023. Data were collected from hospital records and included demographic characteristics, type of surgery, nature of complications, and costs associated with managing these complications. Descriptive statistics were used to analyse the data.

Results
42 patients included in the study. Majority were female (n=35, 83.3%) with a mean age of 46.6 years. Sleeve gastrectomy was the most common surgery (n=22,52.3%), followed by AGB (n=11,26.1%), Gastric bypass (n=6,14.2%) and Gastric balloon (3,7.1%). Operations were performed in 7 countries, majority were done in Turkey (n= 22). The most common complication was leak (n=14), followed by band erosion (n=7) and nutritional failure (n=7). The total cost was estimated to be (£737,126), which includes hospital-stay costs (£553,179), non-surgical intervention (£55,607), scans (£41,728), and surgical intervention (£75,413). The total cost of dietetic inputs were about £17,390,including 410 hours.

Conclusions
Most patients experienced emotional trauma related to lack of adequate perioperative care, and difficulties in communication with their overseas surgeons. The results of this study highlight significant costs associated with managing such complications in Northern Ireland. The findings suggest investing in public bariatric surgical services may be more cost-effective than relying on bariatric tourism. Furthermore, Bariatric care is delivered by MDTs which are actively involved in management of these patients throughout their care-pathway. The study highlights lack of perioperative care and follow up needed to minimize complications and associated costs, as well as addressing the emotional trauma of those patients.