bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP5.3 The Use of High Risk MDT in Assessing Patients for Elective Surgery
Authors: Dunlop Hannah 
Published: August 2023

Abstract

Aims
The High-Risk MDT is an opportunity for patients to meet with consultants in surgery, medicine and anaesthetics who are involved in their care and come to a joined decision about their care. The aim of this audit was to review the patients referred and their outcomes over a year, particularly the mortality of those recommended for surgery verses those not and use of objective risk scores.

Methods
Data was collected for all patients referred to the MDT from March 2021 to February 2022, including patient demographics, comorbidities, if there was an objective morbidity or mortality risk documented to be explained to the patient, as well as the MDT recommendation and subsequent mortality. 65 patients were referred; one repeat referral was excluded as were eight patients where no notes from the MDT meeting could be found and two that were referred to tertiary centre, leaving 54 patients for analysis.

Results
17% of patients had a documented risk of morbidity or mortality, with 4 patient notes documenting a validated objective risk score (POSSUM, SORT, NSQIP). 54% of those referred to the high-risk MDT were deemed not fit for surgery, with a mortality rate of 33%. 46% of those referred to the high-risk MDT were recommended for surgery, with a 2% mortality rate.

Conclusions
The high risk MDT is a helpful process for patients and staff but there is a lack of standardisation in the risk assessment used and documentation at these meetings, meaning that there is much variation in patient experience.
FTP5.5 Zinc and Copper Deficiency in Bariatric Patients: Time to Revise Guidelines?
Authors: Kainth Rupinder , Burton Katarina , Sufi Pratik 
Published: August 2023

Abstract

Aim
The number of bariatric surgeries performed is increasing due to the rising incidence of obesity. It is known that mineral deficiencies can occur in the postoperative period for these procedures. We examined the prevalence of zinc and copper deficiencies before and after various bariatric procedures, with the aim of assessing the relevance of current recommendations, specifically the American Society for Metabolic & Bariatric Surgery (ASMBS) and the British Obesity and Metabolic Surgery Society (BOMSS) guidelines, regarding monitoring and supplementation.

Method
We retrospectively analysed data of 327 patients who underwent one of three bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and mini-gastric bypass (MGB) between January 2018 and December 2019. Copper and zinc serum levels prior to surgery, and at 3, 6, and 12 months post-operation were collected.

Results
Preoperatively, 56.7% of patients undergoing bariatric surgery were zinc deficient and 32.4% had hypercupraemia. Twelve months post-surgery, 42.9% of RYGB, 35.3% of SG, and 57.7% of MGB patients with preoperative zinc deficiency presented again with a zinc deficiency requiring supplementation. Only 1 patient displayed copper deficiency preoperatively, and 6 postoperatively.

Conclusion
Screening for zinc and copper deficiencies at 6 and 12 months postoperatively, rather than at 3 months, is a more clinical and cost-effective strategy.
FTP5.9 A review of post-operative outcomes following Cholecystectomy - Emergency vs Elective
Authors: Kuan Jen Yee , Kho Jason , Shetty Vinutha , Date Ravindra , Rajendran Ilayaraja 
Published: August 2023

Abstract

Aim
NICE (CG188) 2014 recommends index cholecystectomy (IC) for patients admitted with gallstone disease, particularly “acute cholecystitis”, within one week of diagnosis. Conversely, elective cholecystectomy (EC) patients are pooled via various pathways, from elective to emergency. Safety of ICs is well-established. A study was conducted to investigate difference in outcomes between IC and EC.

Methods
Retrospective study of prospective database of cholecystectomies performed as primary procedure was carried out between February 2021 and July 2022 in our trust. The primary outcome was hospital readmission, while secondary outcomes included postoperative complications graded by Clavien-Dindo classification (CDC), length of stay (LoS) and intensive care (ICU) admission. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value &lt;0.05 was statistically significant.

Results
202 patients underwent cholecystectomy. There were similar numbers in the studied groups; IC-49.8% (n=100/202) and EC-50.2% (n=102/202). Hospital readmission rates were higher in the IC – 11/100(11%) vs EC – 3/102(2.9%), p=0.02. Postoperative interventions (grade-3-CDC) (IC-11.0%, n=11 vs EC-2.9%, n=3, p=0.02) and ICU admission rates (IC-7.0%, n=7 vs EC-1.0%, n=1, p=0.03) were higher in IC compared to EC. Uncomplicated recovery (grade-1-CDC) was significantly higher in EC (p&lt;0.0001). Postoperative LoS was significantly longer in IC (p&lt;0.0001). There was no recorded mortality in either group.

Conclusion
Study confirms that IC is safe. However, postoperative procedural interventions were more common in IC, which is highly indicative of complex pathology (perforated/necrotic gallbladder/inflamed hepatocystic triangle) and may be contributed by timing of procedure. Further studies to assess underlying factors contributing to these outcomes are warranted.
FTP5.11 Consenting for Elective Surgical Procedures
Authors: Nishijo Mai , Sivasothy Niroshan , Gurunaidu Subramaniam 
Published: August 2023

Abstract

Background
Guidelines by the Royal College of Surgeons, Department of Health and General Medical Council state that consenting for surgical procedures should be a process, rather than a one-off event, for patients with capacity to make a fully informed decision. Consent should be gained well in advance and this decision reconfirmed on the day. This audit aimed to investigate whether patients undergoing elective surgeries at a hospital were consented sufficiently in advance to surgery.

Method
Over a two-week period, consent forms for patients undergoing elective surgeries in General Surgery and Urology in a hospital were reviewed prospectively. Consent was defined as formal consent form signed by the patient and surgeon.

Results
Total of 76 consent forms were reviewed (n=38 for General Surgery, n=38 for Urology). Only 26.32% of patients overall were consented in advance to surgery. 52.63% of General Surgery patients were consented prior to day of surgery and reconsented on the day, whereas 0% of Urology patients were consented prior to day of surgery. 0% of patients overall were provided written information when consented, and 2.63% consented with an interpreter.

Conclusion
All patients seen in outpatient clinic or ward with plan for elective surgery should be formally consented when the procedure is initially proposed, to allow sufficient time for reflection on the decision. Adequate time should be provided in clinic to accommodate this. Patients’ understanding should be maximised with written information and interpreter if required. Consent forms may be stored online if patients are consented months prior to surgery.
FTP6.3 In Hospital Delay to Laparoscopic Appendicectomy in CT Proven Appendicitis
Authors: Farrow Emily , Phillips Simon , Arvind Nitin 
Published: August 2023

Abstract

Aims
The ability to deliver emergency general surgery (EGS) is often limited by access to emergency theatres. The Royal College of Surgeons suggests that clinical audit of EGS activity will establish evidence that can contribute to service change. Laparoscopic appendicectomy is one of the most frequent EGS operations performed. The aim of this study is to quantify in hospital delay to theatre for CT proven appendicitis and examine clinical outcomes.

Methods
In a large major trauma and transplant centre, where emergency theatre space is shared with several specialties, data were collected on patients admitted with CT proven appendicitis over a 6-month period (01/06/2022 to 01/12/2022). Details of CT findings, intra-operative findings, as well as time of booking, operation and discharge were recorded.

Results
65 patients presented with CT proven appendicitis. The average time to theatre from time of booking was 16.7 hours. 60.0% (39/65) patients took &gt;12 hours to get to theatre. Of these, 7.7% (3/39) had perforated appendicitis on CT. 33.3% (13/39) had perforated appendicitis at the time of surgery. The average stay of patients with perforated appendicitis at the time of surgery was 4.1 days longer than those with uncomplicated appendicitis.

Conclusions
In hospital delay of more than 12 hours has previously been shown to be an independent risk factor for perforation. A large proportion of our patients took more than 12 hours to get to theatre and those with perforated appendicitis had an increased length of stay. Delays in delivering EGS results in increased length of stay, exacerbating the bed crisis.
FTP7.8 Has Endoscopic retrograde cholangiopancreatography (ERCP) management of acute biliary obstruction due to gallstones been affected during the Covid-19 pandemic? – A single unit experience
Authors: Yang Peiming , Singh Gautam , Peter Mark 
Published: August 2023

Abstract

Introduction
British Society of Gastroenterology (BSG) guidelines advised for ERCP procedures to be continued for emergency biliary pathologies during the Covid pandemic. We aim to compare the performance and outcomes of ERCP for acute gallstone biliary obstruction before, during, and post first and second covid waves at our unit.

Methods
Retrospective study of all patients with acute biliary obstruction secondary to gallstones who underwent ERCP from January to December 2020 (covid), compared with those between January to December 2019 (pre-covid), and between January to December 2021 (post-covid).

Results
65 patients underwent ERCP for obstructed gallstones in the covid group, compared to 64 in pre-covid and 64 in post-covid group. Higher proportion of patients presented with severe jaundice (bilirubin &gt;100) in the covid group, compared to pre-covid (P=0.031) and post-covid (P=0.028) groups. Proportion of patients with biliary sepsis requiring antibiotics was higher in covid group compared to pre-covid (P=0.031) and post-covid groups (P=0.047).
The median waiting time for ERCP was 3 days in covid group, 4 days in pre-covid, and 5 days in post-covid. Compared to both pre-covid and post-covid groups respectively, there was no statistically significant reduction in the covid group in any of: proportion of complete CBD clearance (P=0.26 P=0.40), sphincterotomies performed (P=0.22, P=0.49), or successful CBD stent insertion (P=085. P=0.52).
There was no statistical difference in post-ERCP complication rates comparing Covid with pre-covid (P=0.47), or post-covid (P=0.24) groups.

Conclusions
Quality of ERCP management of acute gallstone biliary obstruction has been maintained throughout the covid pandemic at our unit.
FTP8.4 Trends in Exception Reporting (ER): Medicine vs Surgery
Authors: Richardson Tom , Naqvi Mushal 
Published: August 2023

Abstract

Aim
ER was introduced with the new junior doctor contract in 2016. This was a mechanism to ensure compensation for all work performed and to uphold all educational opportunities. Literature regarding ER is limited and focuses on barriers to reporting. The aim of this study was to assess how ER practices have changed over 5 years and to highlight differences between grade and speciality.

Methods
A retrospective cohort study was carried out. 5 years of reports from 1/1/2017 to 31/12/2021 were downloaded from Medic Online, Allocate Software. Quantitative and qualitative data were analysed in Microsoft Excel.

Results
125 doctors submitted 549 reports. The number of reports submitted per year have decreased over time whilst the number of doctors submitting at least one report has increased. The number of male doctors submitting reports has not changed in contrast to female doctors which has increased with a correlation of 0.76. Overall there is no difference in number of reports submitted by sex (p=0.1). F1s are more likely to report than any other grade (p&lt;0.001) and are most likely to report for hours worked rather than educational opportunity lost. ER in medicine has remained constant whilst it has declined within surgery.

Conclusions
Numbers of reports are declining but more doctors, especially females, are prepared to report. This suggests working conditions are improving and suggested barriers to ER are being broken down. Hospital specialties should learn from each other’s ER data to improve patient care as well as working conditions and educational opportunities for junior doctors.
FTP8.10 Impact of COVID-19 vaccination-based triaging on recovery of services for Plastic Surgery Hand Trauma in a Plastic Surgery Tertiary Referral Centre
Authors: Ishak Lisa , Bramhall Russell , Murphy Adrian 
Published: August 2023

Abstract

Aim
Evaluate the impact vaccination-based-triaging on recovery of operative services.

Method
Data was collected retrospectively on 120 patients who underwent surgical management for closed hand fractures, nerve injuries, and tendon injuries. Forty were in the pre-covid group (Jan-Mar 2019), 40 in the post-covid pre-vaccine group (Jan-Mar 2022), and 40 in the post-covid post-vaccine group (Jul-Sep 2022).
Outcome measures:

Results
In the post-covid post-vaccine group, operative delay was shorter than in the post-covid pre-vaccine group for hand fractures (3.6 vs 3.9) nerve injuries (3.8 vs 2.5), and tendon injuries (2.1 vs 2.2). Overall, the difference was not statistically significant (3.3 vs 2.7, p=0.2526).
BSSH operative timing requirements were met in a higher proportion of patients for hand fractures (93% vs 85%), nerve repairs (100% vs 87%), tendon repairs (89% vs 85%) and overall (89% vs 85%).
In the pre-covid group, operative delay was shorter than both post-covid groups for hand fractures (2.5), nerve injuries (1.8), and tendon injuries (1.4). Overall, the difference was statistically significant compared to the post-covid pre-vaccine (1.9 vs 3.3, p=0.0024) and pre-covid post-vaccine groups (2.7 vs 1.9, p=0.0238).
Overall, BSSH operative timing requirements were met for a higher proportion of patients than both pre-covid groups (100% vs 89%)

Conclusions
Plastic surgery hand trauma services have not yet fully recovered. Further interventions are required to aid recovery to pre-pandemic standards.
2 Medical student learning in the operating room: Through the lens of the surgical teacher
Authors: El-hassan Mohammed 
Published: August 2023

Abstract

Aims and Objectives
The aims were to deduce surgeons' experiences and challenges of teaching medical students in the operating room and solutions to overcome them. The objectives to achieve this was using pre-existing published and grey literature relating to surgeons' experiences teaching medical students in the operating room.

Methods
A systematised literature review based on a comprehensive search strategy, including quality assessment, was conducted. Two databases, MEDLINE and EMBASE, were searched since inception until March 2022. Grey literature was searched for in The Royal College of Surgeons in Ireland (RCSI) bulletin, as they publish relevant manuscripts related to surgical education. Title and abstract review was performed by two reviewers on 220 papers. The identified studies were then assessed against the eligibility criteria.

Results
A total of 8 papers were included in this review. Following the analysis of the literature, the commonalities captured were categorised into themes for thematic analysis. Themes included student preparation and organisational aspects, attitudes towards active participation of learner, student learning priorities, undergraduate curricula awareness and learning objectives, educational environment of the operating room and teaching techniques and engagement in the operating room.

Conclusion
Numerous commonalities were captured in the literature, replicable in multiple countries, highlighting the need for a standardised undergraduate surgical curriculum. Many of the challenges of teaching identified by surgeons are modifiable, therefore more initiatives need to be in place to extract the educational potential in the operating room.
60 Mesenteric defect closure and the rate of internal hernia in laparoscopic Roux-en-Y gastric bypass: A systematic review and meta-analysis
Authors: Muir Duncan , Choi Byung , Clements Caterina , Ratnasingham Kumaran , Irukulla Shashi , Humadi Samer 
Published: August 2023

Abstract

Introduction
Laparoscopic Roux-en-Y gastric bypass (LRGB) is an increasingly popular operation as rates of obesity rise. Internal hernias pose a worrying complication. This meta-analysis aimed to determine if internal hernia rates were reduced by closure of the mesenteric defects at primary operation.

Method
A systematic review was performed identifying all observational and randomised studies comparing internal hernia rates in patients whose mesenteric defects were closed vs not closed during LRGB.

Results
14 studies were included, totalling 20,553 patients undergoing LRGB. There was a significant reduction in internal hernia rate at both Petersen’s and the Jejunojejunostomy (J-J) defect when closed at operation. The rate of re-operation for suspected small bowel obstruction was also lower in the closure cohort. There was no difference in anastomotic leak or perioperative bleeding between closure and non-closure patients. Similar efficiency was observed when sutures were used to close the defects compared to clips and staples.

Conclusion
Mesenteric defect closure is reducing internal hernia rate as well as re-operation for suspected small bowel obstruction. The closure method of choice remains debatable, and further studies are required to determine this.
118 Bouveret Syndrome: A Rare Case of a Huge Gallstone causing Gastric Outlet Obstruction
Authors: Sabir Alifa , Mushtaq Ruqia , Arshad Rabia , Khalid Noor , Khan Aurangzeb , Hanif Muhammad 
Published: August 2023

Abstract

Introduction
Bouveret syndrome is a rare case of gallstone ileus resulting from an acquired fistula connecting the gallbladder and either the stomach or duodenum and cause intestinal obstruction.

Case Summary
A 85-year-old female presented with epigastric pain non-bilious vomiting and absolute constipation for five days. She patient was tachycardiac and was dehydrated. Abdomen was distended. Bowel sounds were absent. Digital rectal examination was unremarkable.
Abdominal radiography did not demonstrate pathological air-fluid levels, rather revealed a dilated gastric shadow, suggestive of gastric outlet obstruction. The patient was immediately managed with nasogastric intubation and intravenous hydration. Subsequent esophagogastroduodenoscopy (EGD) was planned to rule out carcinoma owing to the age of the patient.
EGD revealed a dilated stomach and a hard, golf-ball-sized gallstone in the third part of the duodenum. The scope could not be passed beyond the impacted stone, nor could it be extracted endoscopically. CT tomography revealed a distended stomach with a large gallstone obstructing duodenum and pneumobilia . One-stage surgical procedure was planned. Intraoperative findings included a thick-walled gallbladder with surrounding inflammation and a fistulous tract connecting the gallbladder with the duodenum. A gallstone measuring 3.7cm in diameter was retrieved from the third part of duodenum via enterotomy. The fistulous tract was closed, and cholecystectomy was performed and drain was placed. Patient was discharged on 4th postop day.

Conclusion
Bouveret syndrome is an infrequent presentation causing gastric outlet obstruction and is often overlooked owing to its rarity. High index of suspicion is necessary when patients present with bowel obstruction and a history of gallstones to prevent morbidity and mortality from Bouveret syndrome.
131 Cholecystectomy operation notes - a review and core trainee survey
Authors: Kho Jason , Kuan Jen Yee , Shetty Vinutha , Date Ravindra , Rajendra Ilayaraja 
Published: August 2023

Abstract

Aim
The “Good Surgical Practice” document by Royal College of Surgeons (RCS) England, in line with GMC’s “Good Medical Practice” emphasises the importance of “clear operative notes for every procedure”. The importance of clear documentation is well-established, facilitates effective handover and represents a legal document. A study was conducted to assess current documentation standards, including a survey amongst core surgical trainees on the use of a proforma for documenting cholecystectomies.

Methods
A retrospective review of cholecystectomy operation notes collected from hospital database was performed between February 2022 and July 2022. Operative documentation was compared to the guideline published by RCS England. Specific information relevant to cholecystectomy operation were reviewed; critical view of safety/Calot’s triangle, number and type of clips, gallbladder dissection difficulty and spillage of bile/stones. Compliance to RCS standards was considered satisfactory at ≥80%.

Results
109 typed operation notes were reviewed. Majority of information including date and time (100%), procedure name (99%), name of surgeon and assistant (100%), operative findings (100%) and post-operative care instructions including VTE prophylaxis (92%) were clearly documented. Shortfalls in documentation included priority of operation (63%), intraoperative complications (66%), gallbladder dissection difficulty (53%), anaesthetist name (52%), removal of ports under vision (33%) and local anaesthetic details (70%). Survey of eight core surgical trainees found a consensus that a proforma would improve understanding and documentation of the procedure.

Conclusion
The use of an operation note proforma in cholecystectomies could improve patient care and compliance with RCS guideline, and act as a learning modality for surgical trainees.
133 A review of analgesia prescription in patients admitted with Neck of Femur Fractures
Authors: Kukreja Madhav , Satar Zabina , Jalal Seyed Ramin , Makki Daoud 
Published: August 2023

Abstract

Background
Analgesics are amongst the most commonly prescribed drugs within a hospital setting. Often prescribed based on clinical judgement and perceived pain, without formal evaluation. They are integral to patients comfort and experience. A study in 2008 showed that when patients had moderate to severe pain, they had only about a 50 percent chance of obtaining adequate pain relief, while another study in 2010 showed that the average cost per patient for readmission due to pain was $1,869 (≈£1,571) per visit.

Aim

Methods
Review of drug charts of all the neck of femur patients admitted from 04/10/2022 to 22/10/2022 (30 in total). Recorded patient pain score extracted from admission clerking.

Results

Conclusion
Pain score tends not to be recorded at the time of admission and analgesia is prescribed based on clinical judgement. Therefore, a poster of new Trust guidelines for patients admitted with Neck of Femur Fractures (NOF) was circulated amongst Orthopaedics department and A&E in Watford General Hospital, United Kingdom.