bluuebunny/crossref_metadata_2025_split huggingface dataset:
MOY 3 Management of acute cholecystitis in Scotland: A population wide cohort study
Authors: Rajan Sendhil , Bekheit Mohamed , Wohlgemut Jared , Watson Angus , Ramsay George 
Published: August 2023

Abstract

Aims
Acute cholecystitis (AC) is a common Emergency General Surgery presentation, and is managed either by a cholecystectomy or conservatively. Surgery during the acute inflammatory phase has been shown to be safe and superior, however, operative rates vary widely. Also, medium-long term survival rates with each approach are still not definitively established. This real-world population analysis aims to describe the current management and outcomes of patients with AC across Scotland.

Methods
This was a national cohort study using data obtained from Information Services Division, Scotland. All adult patients with the admission diagnostic code for AC were included. Patient level data were used to identify all patients admitted to Scottish hospitals between 1997-2019 and outcomes tracked for inpatients or after discharge through the unique patient identifier. This was mapped to mortality data to establish date and cause of death.

Results
47558 patients diagnosed with AC, admitted in one of 46 hospitals were included. These patients accounted for 58824 episodes (27.2% of patients encountered &gt;1 episode). The study population had a median age of 58 years (IQR=43-71), 64.4% were female, and most had no comorbidities. 28741(60.4%) patients had an operative intervention during the index admission. Patients who had an operation during their index admission had a lower risk of 90-day mortality compared to non-operative management (OR 0.62, 95% CI 0.55-0.70).

Conclusions
In this comprehensive analysis of AC in Scotland, 60% of patients had an index cholecystectomy. Patients undergoing surgery had a superior survival to those managed conservatively, further advocating for an operative approach in this cohort.
NELA 1 Sarcopenia versus clinical frailty scale in predicting the risk of postoperative mortality after emergency laparotomy: A retrospective cohort study
Authors: Saji Alwin Puthiyakunnel , Hughes Ioan , Mitra Kalyan , Hajibandeh Shahin , Hajibandeh Shahab 
Published: August 2023

Abstract

Aims
To compare predictive significance of sarcopenia and clinical frailty scale in terms of postoperative mortality in patients undergoing emergency laparotomy.

Methods
In compliance with STROCSS statement standards a retrospective cohort study with prospective data collection approach was conducted. The study period was between January 2017 and January 2022. All adult patients with non-traumatic acute abdominal pathology who underwent emergency laparotomy in our centre were included. The primary outcome was 30-day mortality and secondary outcomes were in-hospital mortality and 90-day mortality. The predictive value of sarcopenia and clinical frailty scale were compared using the Receiver Operating Characteristic (ROC) curve analysis and multivariable binary logistic regression analysis.

Results
A total of 1043 eligible patients were included. The risk of 30-day mortality, in-hospital mortality, and 90-day mortality were 8%, 10%, and 11%, respectively. ROC curve analysis suggested that sarcopenia is a significantly stronger predictor of 30-day mortality (AUC: 0.87 vs 0.70, P&lt;0.0001), in-hospital mortality (AUC: 0.79 vs 0.67, P=0.0011), and 90-day mortality (AUC: 0.79 vs 0.67, P=0.0009) compared with clinical frailty scale. Moreover, multivariable binary logistic regression analysis identified sarcopenia as an independent predictor of mortality (coefficient: 4.22119, P&lt;0.0001) but did not identify clinical frailty score as independent predictor (coefficient: 0.066311, P=0.5544).

Conclusions
Sarcopenia is a stronger predictor of postoperative mortality compared with clinical frailty score in patients undergoing emergency laparotomy. It cancels out the predictive value of clinical frailty scale in multivariable analyses; hence among the two variables, sarcopenia deserves to be included in preoperative predictive tools.
SP1.3 Implementation of a care bundle to sustainably reduce surgical site infection after emergency laparotomy
Authors: Thornton James , Swain Cara , Brewster Oliver , Gane Dawn , Rogers Jodie , Pullyblank Anne 
Published: August 2023

Abstract

Introduction
Surgical site infection (SSI) after emergency laparotomy (EL) is reported in up to 35% of patients. Implementation of the PreciSSIon bundle; 2% chlorhexidine preparation, second-dose antibiotics after 4 hours operating, wound protector (WP), antibacterial sutures for deep and superficial layers, halved SSI after elective colorectal surgery. This project aimed to implement an adapted bundle for EL.

Method
For patients in hospital at 30 days, notes were reviewed. For those discharged before 30 days patient-reported 30-day SSI was measured using the Public Health England Questionnaire. Baseline data was collected for 1 year with bundle implemented 2020. Additions to bundle were glove change and betadine wound wash.

Results
677 patients had EL over 4 years. Average mortality was 10%. A further 10% had laparostomy and temporary VAC dressing. Average response rate to questionnaire was 71%. Compliance with bundle elements were 100% for chlorhexidine, 96% for antibiotic 2nd dose, 83% and 90% for deep and superficial antibacterial sutures, 85% for glove change and betadine. Use of WPs was only 50%. After implementation of the bundle at the beginning of 2020, both patient-reported and in-patient SSI reduced, and total SSI has halved.

Conclusion
We have demonstrated reliable implementation of a care bundle (excluding WPs) sustainably reduced SSI after emergency laparotomy.
SP1.8 Comparing the efficacy of povidone-iodine versus normal saline in laparotomy wound irrigation to prevent surgical site infections: A meta-analysis
Authors: Magsi Abdul Malik , Shafique Muhammad Salman , Sains Parv , Baig Mirza Khurrum , Singh Krishna K , Sajid Muhammad S 
Published: August 2023

Abstract

Objective
Surgical site infections (SSIs) are associated with increased mortality, morbidity and cost to provide healthcare in patients undergoing laparotomy and abdominal surgery. The objective of this study is to evaluate the role of laparotomy wound irrigation either by povidone-iodine (PVI) or normal saline (NS) in patients undergoing laparotomy for various gastrointestinal operations and assess their role to reduce SSIs.

Materials and methods
Randomized controlled trials (RCTs) reporting the role of laparotomy wound irrigation with PVI versus NS in patients undergoing laparotomy for various gastrointestinal operations and assess their role to reduce the risk of SSIs were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results
The search of medical databases yielded 13 RCTs on 3816 patients undergoing laparotomy for various gastrointestinal operations. There were 1900 patients in the PVI group whereas 1916 patients received NS wound irrigations prior to the laparotomy skin wound closure. In the random effects model analysis, the use of PVI for laparotomy wound irrigation was associated with the reduced risk [odds ratio 0.54, 95%, CI (0.30, 0.98), Z = 2.04, P=0.04] of SSIs. However, there was significant heterogeneity (Tau2 = 70; Chi2 = 40.19, df = 12; (P = 0.0001; I2 = 70 %) among included studies.

Conclusion
Laparotomy wound irrigation with PVI has shown clinically proven advantage of reducing the risk of SSIs.
SP2.8 AnTIcoaGulation afteR pancreatic surgery with vEnouS reSection (TIGRESS): what should we do? Results from an international survey
Authors: Russell Thomas , Ciprani Debora , Aroori Somaiah 
Published: August 2023

Abstract

Aims
Patients who undergo pancreatic surgery with venous resection/reconstruction (PSVRR) have high rates of morbidity/mortality and are at risk of postoperative venous thromboembolism (VTE). It is unknown if this group should be routinely anticoagulated. We developed a survey to establish current anticoagulation practices among pancreatic surgeons.

Methods
A JotForm.com survey was sent to members of various hepatopancreatobiliary societies. Questions covered: centre volume, venous resection/reconstruction techniques, and anticoagulation policies.

Results
Sixty-five centres from 17 seventeen countries responded. Following a “side-bite” venous resection and patch repair, 40% use an autologous vein patch, 27% use peritoneum and 27% use a bovine patch. When formally resecting a segment of vein, 17% of centres use an interposition graft (IG). Left renal vein (41%) and polytetrafluoroethylene (PTFE, 73%) grafts are the most commonly used autologous and prosthetic IGs, respectively. Following a prosthetic IG, an autologous IG, and a “side-bite” resection with patch repair, 59%, 28%, and 19% of centres provide therapeutic anticoagulation (TAG), respectively. Among the units that provide TAG, most (66%) use low molecular weight heparin. The duration of therapy provided varies from inpatient stay only (14%) to six months (32%).

Conclusions
Our global survey indicates that anticoagulation practices following PSVRR are highly variable. The centres do not agree on when or how to anticoagulate, or the duration of therapy. A robust trial is required to provide clarity on these issues.
SP3.5 Trends in systematic reviews of kidney transplantation: a 10-year analysis of the evidence base
Authors: Salih Sarah , Knight Simon , O'Callaghan John , Salih Marwah , Walker James , Pengel Liset 
Published: August 2023

Abstract

Background
Systematic reviews (SRs) are the highest form of evidence for all types of clinical questions in evidence-based practice. For the first time in 2018, the number of SR publications in transplantation outstripped those from randomised controlled trials (RCTs). This raises concerns of duplication or increased use of poor-quality evidence. We aimed to analyse the trends, strength and quality of evidence in SRs in kidney transplantation over a 10-year period.

Methods
Systematic reviews in kidney transplantation were identified from the Transplant Library, without language restriction. All full-text citations were exported to a custom Research Electronic Data Capture (REDCap) database prior to evaluation. The quality of evidence in all included SRs was assessed using AMSTAR-2.

Results
We included 454 reviews, of which, only 3 scored as ‘high quality’. We found 96.70% of SRs were identified as ‘critically low quality’, which increased in number over time. The number of reviews comprising non-RCT data increased in the most recent 5 years. Only 14.12% of SRs had made a clear recommendation for practice.

Conclusions
This review highlights several concerning statistics that need to be addressed. In the last 10 years, only 3 SRs in kidney transplantation were ‘high-quality’. The weaknesses identified in critical domains, alongside the increased use of non-RCT data and lack of conclusive recommendations, undermines the confidence in the results of the reviews and purpose of publication. As these reviews are instrumental to clinical decision-making and patient care, we advocate for improved reporting quality among SRs in the field of kidney transplantation.
SP3.9 The role of urinary biomarkers in predicting post operative kidney function
Authors: Dirie Jamal , Singh Rishabh , Singh Toolika , Rockall Timothy , Forni Lui 
Published: August 2023

Abstract

Aims
Post-operative Acute Kidney Injury (AKI) has implications on recovery, conferring a significant risk of morbidity and mortality. A previous study of 488 major abdominal surgery patients demonstrated that urinary biomarkers could predict peri-operative AKI. The aim of this follow-up study was to assess the biomarkers (NGAL, KIM-1, DKK-3 and IGFBP-7*TIMP-2) for their ability to predict long-term changes in renal function.

Methods
Predictive ability for long term renal function derangement was assessed by classifying the participants change in their ‘CKD’ stage from the pre-operative status, determined by the measured eGFR at follow up as per the KDIGO criteria (at least 6 months from their operation). Biomarker performance was assessed utilising AUROC analysis. Biomarkers were also interrogated for their ability to predict mortality at one year.

Results
Follow up measurement of renal function was obtained in 446 of 488 patients. 40 patients died within 1 year of their operation. Median time of follow up renal function measurement was 398 days post operatively (IQR: 366 – 490 days).
169 patients developed an increase in their CKD stage. No biomarker showed good predictive ability for such a rise – all displayed AUC values of &lt;0.6. Similarly, AUC values for the prediction of mortality within one year were low, with all AUC values &lt;0.65.

Discussion
This study has determined that urinary AKI biomarkers are poor predictors for long term derangement in renal function and mortality at one year in the surgical patient. Such evidence suggests that biomarkers are best suited to detect changes in the immediate post operative period.
SP4.4 A Prospective Diagnostic study investigating Urinary Biomarkers of AKI in Major Abdominal Surgery (The AKI-BioMAS Study)
Authors: Singh Rishabh , Maclean William , Singh Toolika , Mackenzie Paul , Rockall Timothy , Forni Lui 
Published: August 2023

Abstract

Aims
To characterize biomarker performance in predicting Acute Kidney Injury (AKI) in Major Abdominal Surgery using both the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine (AKISCr) and urine output (AKIUO) criteria. Post-operative AKI is associated with increased morbidity and mortality. Research assessing AKI biomarkers has focussed on cardiac, vascular and transplant surgery cohorts. Few studies have addressed Major Abdominal Surgery.

Methods
This prospective observational diagnostic study was conducted on 488 major abdominal surgery patients. Urine was collected four hours post-surgery. Biomarkers measured were NGAL, KIM-1, DKK-3 and IGFBP-7*TIMP-2. Diagnostic performance was assessed utilizing Receiver Operating Characteristic (ROC) curve analysis.

Results
242 participants developed AKIUO (49.5%) and 43 AKISCr (8.8%). The area under the receiver operating characteristic curve (AUC) values for stage 1 AKISCr using NGAL was 0.741 (95%CI 0.699-0.770, p&lt;0.001) and 0.871 (95%CI 0.838-.899, p&lt;0.001) for stage 2. AUC values for IGFBP-7*TIMP-2 for stage 1 were 0.655 (95% CI 0.611-0.697, p0.003) and stage 2 0.803 (95%CI 0.764-0.837 p0.002). The AUC for KIM-1 was statistically significant for stage 1 (0.68, 95%CI 0.637-0.722) but not for stage 2. No AUC values for DKK-3 were statistically significant. Biomarkers performed poorly for stage 1 and 2 AKIUO with AUC values of &lt;0.65.

Conclusions
AKI rates following Major Abdominal Surgery are dependent on criteria used. Given the numerous confounders affecting urine output post-operatively it may be that current AKIUO criteria in patients undergoing Major Abdominal Surgery may be inappropriate. This is reflected in poor diagnostic performance of biomarkers in this context. Biomarkers performed better when assessing AKISCr, with NGAL returning the highest AUC values.
SP4.5 Expression of trans-membrane mucins is associated with poor outcomes after chemotherapy in breast cancer
Authors: Hebden Sophie , Jones Stacey , Al Amri Waleed , Maisey Tom , Verghese Eldo , Hughes Thomas 
Published: August 2023

Abstract

Aims
Chemoresistance is a key barrier to breast cancer cures, particularly in the triple-negative subtype. Mucins are O-glycosylated proteins that may drive therapeutic resistance and oncogenic progression in carcinomas. Somatic mutations in mucin 3 (MUC3), 12 (MUC12) and 16 (MUC16) have been identified in breast tumour samples, however their impacts on chemoresponse are poorly explored. We aimed to explore whether breast cancer cell expression of transmembrane mucins MUC3, MUC12 and MUC16 correlates with chemotherapy outcomes.

Methods
Immunohistochemistry was performed on tissue microarrays of primary breast tumours resected from patients subsequently treated with adjuvant chemotherapy (n=303). Tumour cores were semi-quantitively scored based on proportion and intensity of tumour cells staining for MUC3, MUC12 and MUC16. Receiver Operating Characteristic curves were used to dichotomize into relatively high and low expressing groups. Kaplan-Meier analyses were used to determine correlations with disease-free or overall survival.

Results
Relatively high expression of MUC3 was significantly associated with poor outcomes after adjuvant cytotoxic chemotherapy, in terms of shorter disease-free (p=0.001) and overall survival (p=0.016). Interestingly, higher expression of MUC3 was also associated with this apparent chemoresistance in the triple-negative breast cancer subtype specifically, with reduced disease-free (p=0.041) and overall survival (p=0.032). High expression of structurally-related mucins MUC12 or MUC16 also showed possible weak trends towards poor outcomes after chemotherapy, although significance was not reached.

Conclusions
In the future, mucins may offer promise as novel predictive biomarkers, or as targets for inhibition using monoclonal antibodies, for example, to enhance chemoresponse and improve survival outcomes in breast cancer patients.
SP4.6 12 months analysis of the PROM-Q study: Comparison of Patient Reported Outcome Measures using the BREAST-Q questionnaire in pre- versus sub-pectoral implant based immediate breast reconstruction
Authors: Rampal Ritika , Jones Stacey , Young Clare , Hartup Sue , Savage Jessica , Kim Baek 
Published: August 2023

Abstract

Introduction
There is a lack of comparative data on clinical and patient perceived outcomes on pre- versus sub-pectoral implant-based breast reconstruction (IBR). We investigated whether these different surgical approaches influenced clinical or patient perceived outcomes.

Methods
This prospective non-randomised longitudinal cohort study (ClinicalTrials.gov identifier: NCT04842240) recruited patients undergoing immediate IBR (Sep 2019-Sep 2021). Data collection included patient characteristics and post-operative complications. Patients completed BREAST-Q questionnaire at baseline, 2 weeks, 3 and 12 months post-surgery.

Results
We recruited 78 patients (46 pre-pectoral; 59% vs. 32 sub-pectoral; 41%). Patient characteristics were comparable (Table 1). Similar complication rates were observed (15.2% pre-pectoral vs. 9.4% sub-pectoral; p=0.44). Overall implant loss rate was 3.8% (6.5% pre-pectoral vs. 0% sub-pectoral; p=0.14).
Median Breast-Q scores were similar between pre- and sub-pectoral IBR at 3 months; breast satisfaction (58 vs. 48; p=0.12), psychosocial well-being (60 vs. 57; p=0.9), physical well-being (68 vs. 76; p=0.53), and Animation Q scores (73 vs. 76; p=0.45). Similar findings were observed at 12 months; breast satisfaction (58 vs. 53; p=0.3), psychosocial well-being (59 vs. 60; p=0.9), physical well-being (68 vs. 78; p=0.18), and Animation Q scores (69 vs. 73; p=0.4).

Conclusions
This study demonstrates equivalent clinical and patient perceived outcomes between pre- and sub-pectoral IBR, thereby aiding informed decision making regarding either surgical option.
SP4.7 Improving the documentation of breast surgery operation notes: Closing the loop on a quality improvement project
Authors: Wu Fiona , Atkins William , Ghurahoo Linsley , Abdelmawla Ahmed , Trapszo Pawel , Seetharam Seema 
Published: August 2023

Abstract

Aims
The operative note is an important document for ensuring patient safety and effective communication between the MDT. This quality improvement project (QIP) audited the completeness of the breast surgery operative note against the recommendations outlined in the Association of Breast Surgery (ABS) Summary Statement (2015). We developed an operative note proforma to address the deficiencies identified and evaluated the effectiveness of this tool.

Methods
31 operative notes were retrospectively reviewed in our baseline audit (cycle 1) against the recommendations. We audited 17 parameters per note. Questionnaires were also circulated amongst 8 of our nursing colleagues to gather their feedback on the current operative note. An electronic proforma was devised from published recommendations and MDT feedback. We performed a prospective re-audit (cycle 2) of 33 notes following our intervention.

Results
Our baseline audit (cycle 1) identified that 7/17 of the parameters failed to meet the audit standard. 61% (19/31) of the operative notes were electronic. 63% (5/8) of our nursing colleagues agreed the handwritten operative notes were often illegible and all preferred an electronically written document. 1/17 of the parameters failed to meet the audit standard in the re-audit (cycle 2) post-intervention. 97% (32/33) of the notes were electronic and 52% (17/33) was documented using the proforma.

Conclusions
This QIP has demonstrated that improvements in the operative note documentation can be achieved through simple interventions. The proforma has been uploaded onto the local intranet for universal access. The outcome of this QIP is likely to be sustained by our departmental surgeons as documentation now meets recommended standards.
SP5.3 The risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury: A meta-analysis and meta-regression analysis
Authors: Carrington-Windo Eliot , Hajibandeh Shahab , Alessandri Georgio , Duncan Trish , Kumar Nagappan , David O'Reilly 
Published: August 2023

Abstract

Aims
To determine the risk of hepatic pseudoaneurysm after liver trauma in relation to the severity of liver injury.

Methods
We performed a systematic review and meta-analysis in compliance with PRISMA statement standards. A search of electronic information sources was conducted to identify all studies reporting the risk of hepatic pseudoaneurysm after liver trauma. The JBI assessment tool was used to assess the risk of bias of the included studies. Random-effects models were applied to calculate pooled outcome data.

Results
A total of 2030 patients from six studies were included. Based on the American Association for the Surgery of Trauma classification system, 21% had grade I injury; 33% grade II injury; 28% grade III injury; 12% grade IV injury; 5% grade V injury. The pooled risk of hepatic pseudoaneurysm was 1.8% (95% CI 1.1-2.5%). The risk was 0.4% (0-1.2%) in patients with grade I injury, 0.7% (0-1.7%) in patients with grade II injury; 1.5% (0.4-2.7%) in patients with grade III injury; 4.6% (1.4-7.7%) in patients with grade IV injury; 10.6% (1.8-22.9%) in patients with grade V injury. The average time between liver injury and detection of hepatic pseudoaneurysm was 6 days (1-10).

Conclusions
The risk of hepatic pseudoaneurysm after liver trauma increases as the severity of liver injury increases. Hepatic pseudoaneurysms are rare after grade I or grade II injuries, and increasingly common after grades III, IV and V injuries. We do not hesitate to recommend routine surveillance imaging in patients with grade III to V injuries.