bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP6.8 A Decade of NHS Never Events – Has formal reporting made a difference?
Authors: Petrosyan Vahe , Tsakalidis Michail , Ameerally Phillip 
Published: August 2023

Abstract

Introduction
NHS England defines “Never Events” (NE) as 'patient safety incidents that are wholly preventable where guidance or safety recommendations that provide strong systemic protective barriers are available at a national level and have been implemented by healthcare providers'.
NHS Organisations were required to publish data on NE from April 2012. This project aims to identify changes in NE patterns to help inform future learning.

Methods
All published data between April 2012 and March 2022 was collected from NHS England.
Data processing and manipulation was carried out using Microsoft Excel.

Results
A total of n=4,055 NE and n=175,920,530 procedures were reported. During the 2020-2021 year there were significantly less (p=0.029) NE compared to 2019-2020, however the rate of NE per million procedures (25 vs 27) remained unchanged p=0.18. Overall, there appears to be an increasing trend in NE, p&lt;0.001.
The majority of NE related to wrong site surgery, n=1,628(40%), retained foreign objects, n=1,090(27%) and wrong implant/prosthesis, n=506(12%), p&lt;0.001. Within wrong site surgery, the most common NE was wrong procedure, n=529(32%), followed by laterality errors, n=391(24%), p&lt;0.001.

Discussion & Conclusion
The results demonstrate that despite systemic protective barriers such as the WHO Checklist, overall rate of NE has not reduced. This is likely to be confounded by changes in reporting as well as definitions, for example from April 2021 wrong tooth extraction was not considered a NE.
The importance of Human Factors must not be overlooked, and NHS Trusts should consider formal provision of such training for all those in clinical roles.
WTP6.12 Registrars Perceptions on Performance and Patient Outcome with regard to Appendicectomies
Authors: Richardson Tom , Ahmad Adil , Datta Uttaran , Kamal Mona , Naqvi Mushal 
Published: August 2023

Abstract

Aims
Trainees are encouraged to reflect on performance on a personal level as well as formally by work based assessments such as the procedure based assessment. The Joint Committee of Surgical Training state “There is no place for a PBA form to be completed days, weeks or months after the event. It must be immediate”.
Although an operation may have appeared to go well - early or late complication may still occur or unexpected result may be obtained on histology. Therefore it may also be beneficial to reflect after a period of time when final outcomes are known.
We assessed registrars perceptions on performance and outcomes compared to actual figures with regard to appendicectomies performed.

Methods
Data on all appendicectomies over 9 months obtained from electronic patient and theatre records. Questionnaire regarding registrar perceptions on performance, complications and outcomes given to registrars to complete. Quantitative and qualitative analysis through Microsoft excel.

Results
8/9 middle grade registrars participated with the study. Of which 7 were male and 4 trained within the UK holding national training numbers. The majority overestimated number procedures performed whilst underestimating time taken to perform. The majority underestimated post op complications, post op interventions required as well as post op re-attendance/readmission. There was no significant difference between trainees and non trainees with regard to over or underestimating.

Conclusions
Insight into performance and outcomes post appendix surgery is poor amongst registrars. Such insights may be better in other procedures especially elective and cancer surgery. Systems to notify registrars of post op problems may aid reflection and learning.
WTP7.1 Outcomes of Surgical Repair of Incisional Hernia in The Old Patients ≥70 Years
Authors: Omar Islam , Townsend Abby , Hadfield Oliver , Khogali Moataz , Wilson Jeremy , Magee Conor 
Published: August 2023

Abstract

Aims
Incisional hernia (IH) is a common complication after abdominal surgery. Increasing age and frailty may be associated with poor outcomes after surgical interventions. This study aims to assess the safety of surgical repair of IH in patients ≥ 70-Year-old.

Methods
A retrospective study of patients who had surgical repair of IH on an elective and emergency basis in a UK District Hospital. The patients were divided into two groups, Group I &lt;70 and Group II ≥70 years. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes.

Results
262 patients were included with a mean age of 61.8 SD± 14.2 years, and 152 (58%) were females. Group I included 173, and Group II had 89 patients. Group I had more morbidly obese patients, 46 (28.8%) compared to 12 (15.2%) in Group II; p= 0.021. Group II had more patients with at least one comorbidity and COPD than Group I; p= 0.004 and 0.003, respectively. There were no significant differences in overall or wound-related complications, p= 0.587 and 0.125, respectively. The 30-day mortality rates were 3 (1.7%) and 3 (3.4%), and the 90-day mortality rates were 4 (2.3%) and 3 (3.4%) in Groups I and II, respectively, without significant differences between both groups. There were no significant differences in the recurrence rate (with a mean follow-up of 56 months) or 90-day readmissions between the two groups.

Conclusions
Surgical repair of IH is safe and effective in patients ≥ 70 years, with comparable outcomes in younger patients.
WTP8.4 Head and Neck Surgical Site Infections: A Quality Improvement Project
Authors: Seago Imogen , Dunne Henry , Bidaye Rohan , Masterson Liam 
Published: August 2023

Abstract

Aim
Audit incidence of Surgical Site Infection (SSI) and early post-operative infection in open head and neck surgery in a tertiary centre and identify opportunities for improvement.

Method
We performed two 6-month audit cycles of rates of post-operative infection in elective open head and neck surgery against national rates. Cycle 1 was from August 2021-January 2022, and Cycle 2 from March-September 2022.
Between cycles we introduced a flow-chart antibiotics prophylaxis protocol as an improvement measure and presented findings at a local meeting.

Results
172 open head and neck operations were performed in Cycle 1. 7 patients developed SSIs. 169 open head and neck operations were performed in Cycle 2. 6 patients developed SSIs.
Cycle 1 included 14 diabetic patients, of whom 7 received prophylactic antibiotics. Cycle 2 included 19 diabetic patients, of whom 16 received prophylactic antibiotics. In Cycle 1, 2 diabetic patients developed early post-operative infections, one of which was an SSI, compared with 0 in Cycle 2.
SSI was more likely in patients who had surgical drains placed (8 out of 94 patients with drains, p = 0.008498*) and prophylactic antibiotic practice in this group was inconsistent in both cycles.

Conclusion
Our tertiary centre had comparable rates of SSI to national standards. We identified low rates of prophylactic antibiotic prescription for patients with diabetes and introduced a prophylaxis protocol which, despite not reaching statistical significance, appears to have improved rates of infection in diabetic patients. Additional changes should be introduced to reduce rates of infection in patients with surgical drains.
WTP8.6 Contralateral symmetrising mastectomy: A systematic review of clinical and patient reported outcomes
Authors: Griffin Cora , Stables Imogen , Brunsden Sam , Fairhurst Katherine , Potter Shelley 
Published: August 2023

Abstract

Background
Breast reconstruction is offered in the UK to restore symmetry after unilateral mastectomy (UM) for cancer but not all women want (or are suitable for) reconstruction. Contralateral symmetrising mastectomy (CSM) to provide ‘flat symmetry’ is an excellent alternative, but no NICE guidelines to support the offer of the procedure exist. Furthermore, symmetrising mastectomy is often mislabelled as ‘prophylactic’ mastectomy. As this is not recommended for women at population breast cancer risk surgeons are often reluctant to offer the procedure.

Methods
A systematic search in MEDLINE, PubMed, CINAHL and PsycINFO identified studies published in English 01/01/2000 - 30/08/2022 evaluating clinical and/or patient-reported outcomes of women receiving CSM after/with UM for breast cancer. Analysis included simple summary statistics for quantitative data and content analysis for qualitative data.

Results
After de-duplication, 1872 abstracts remained, 89 full-text articles were reviewed and 15 studies (13 quantitative, 1 qualitative and 1 study with both components) reporting outcomes in 1,954 women undergoing CSM were included in the review. Surgical complication rates were the same or higher in bilateral mastectomy versus UM, but far lower than those following reconstruction. A theme of ‘flat denial’ amongst surgeons emerged but patients universally reported high levels of satisfaction with their decision.

Conclusions
High-quality evidence of the clinical and patient-reported outcomes of CSM is needed to inform evidence-based surgical decision making, but such data are currently lacking. CSM is safer than reconstruction and associated with high patient satisfaction making it an excellent option for women who choose to go flat.
WTP8.8 Granulomatous Mastitis: A Service Evaluation
Authors: Rampal Ritika , Macinnes Emma 
Published: August 2023

Abstract

Introduction
Granulomatous mastitis (GM) is a benign, recurrent, inflammatory disease affecting the breast. There is a lack of strong evidence to support guidelines for management of this distressing condition. We performed an exploratory review of assessment and management of GM over a five-year period in a large teaching hospital breast unit.

Methods
This retrospective, observational cohort study included all cases of GM diagnosed from 2015-present. Data collection included patient demographics, presentation, assessment and management. Patient breast clinic attendance, total time spent in outpatient appointments related to GM, and other speciality input was also noted.

Results
19 patients were identified with GM on tissue biopsy (median age 41 years). 53% belonged to black and other ethnic minorities, 47% were Caucasian. 63% had no co-morbidities. 90% were non-smokers. 10% had bilateral and 38% multifocal disease. Most patients scored R3/ U3 or above on imaging. 58% of the cohort attended outpatients for a period greater than 7 months. There was also considerable heterogeneity in both assessment and management approaches.

Conclusion
The results demonstrate the significant morbidity and burden of care associated with Granulomatous Mastitis. Multidisciplinary care is necessary for both diagnosis and management. Bespoke, individualised patient information including a record of all medical input into assessment and management may help to alleviate patient anxiety and streamline care between multiple medical teams.
WTP8.12 Measurement of a panel of biological markers in breast cancer, a comparison between core needle biopsy and surgical excision samples
Authors: Parks Ruth , Green Andrew , Cheung KL 
Published: August 2023

Abstract

Aims
ER, PR and HER2 are routinely measured in breast cancer in clinical practice. Numerous other biomarkers exist which are only utilised in a research setting, but may have a potential role in breast cancer. The majority of research in breast cancer is conducted in surgical excision (SE) specimens due to the availability of tissue; however, it is important markers can be measured in core needle biopsy (CNB) samples in patients undergoing neoadjuvant or non-operative treatment.

Methods
A panel of 15 biomarkers was measured in 202 CNB and paired SE samples in a series of older women with primary breast cancer using immunohistochemistry and H-scores: ER, PR, EGFR, HER2, HER3, HER4, VEGF, p53, BRCA1, LKB1, Ki67, BCL2, CK5/6, CK 7/8, MUC1. Concordance rates were calculated between positive/negative cut-offs for each marker measured in the two samples.

Results
The percentage concordance rates between positive/negative cut-offs were &gt;60% for ER, PR, EGFR, HER2, VEGF, p53, Ki67, BCL2, CK 7/8, MUC1 and &lt;45% for HER3, HER4, CK 5/6, BRCA1 and LKB1. In general, cases were more likely to be positive in the SE sample. This could suggest SE result is an overestimation of the true value and CNB is more accurate, or at least not likely to overestimate.

Conclusions
The biomarkers most frequently studied in breast cancer (ER, PR, EGFR, HER2, VEGF, p53, Ki67) did show good concordance between SE and CNB samples. This may suggest that for markers less frequently studied, there is disagreement with interpretation of staining, leading to greater variation.
ThTP1.4 Should surgical candidates with a pancreatic head malignancy undergo resection within twenty-eight days of staging or undergo a repeat scan prior to surgery?
Authors: Russell Thomas , Labib Peter ,   RAW Study Collaborators, Aroori Somaiah 
Published: August 2023

Abstract

Aims
Suitable patients with a suspected pancreatic head malignancy should undergo timely pancreatoduodenectomy (PD) as pancreatic cancer is aggressive and recurrence rates are high. This study aimed to compare the outcomes of patients who did and did not undergo PD within 28 days of staging.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective study of PD outcomes (29 centres from eight countries, n=1484). Pancreatic ductal adenocarcinoma patients (PDAC) were included. Patients were excluded if: they had staging data missing, they underwent neoadjuvant chemo-/radiotherapy, or if radiological staging was performed for another malignancy.

Results
595 patient were included; median time from staging computed tomography (CT) to PD was 32 days (IQR: 38). The groups were similar in terms of age, sex and radiological stage. A similar number of patients in each underwent preoperative magnetic resonance imaging, positron emission tomography-CT and/or endoscopic ultrasound (EUS). However, those who underwent delayed PD had more often undergone staging laparoscopy (13.6% vs 5.9%, p=0.002) or preoperative biliary stenting (PBS, 69.2% vs 45.6%, p&lt;0.00001). This group also had higher rates of histological T3 disease (85.4% vs 72.5%, p=0.0001) and R1 resection (57.8% vs 46.5%, p=0.01). Five-year recurrence/survival rates were similar.

Conclusions
Patients who underwent delayed PD had more often undergone staging laparoscopy or PBS. These investigations/interventions should only be performed when necessary. Although those with a delayed CT were more likely to have at least one positive resection margin, five-year outcomes were similar.
ThTP2.4 Long-Term Changes in Leptin, Chemerin, and Ghrelin Levels Following Roux-en-Y Gastric Bypass and Laparoscopic Sleeve Gastrectomy
Authors: Salman Mohammed , Noureldin Khaled , Issa Mohammed , Agwa Hisham , Fadlallah Elhaj Mujahid Gasemelseed , Shalaby Ahmed 
Published: August 2023

Abstract

Aim
Published reports showed conflicting results regarding the sustained alterations in leptin, chemerin, and ghrelin concentrations after metabolic surgery. Therefore, we performed the present work to contrast the alterations in leptin, chemerin, and ghrelin levels one year after Roux-en-Y gastric bypass (RYGB) versus laparoscopic sleeve gastrectomy (LSG).

Methods
The present research is a prospective, comparative one that followed 100 cases for whom RYGB or LSG was done. We assessed the serum values of adiposity-associated mediators, including adipokcytokines (leptin and active chemerin) and gastrointestinal hormones (total ghrelin). The primary outcome in the present study was the alterations in leptin, chemerin, and ghrelin values at 12 months after RYGB and LSG.

Results
The serum leptin level decreased significantly in the LSG group with a mean change of − 170.8 ± 29.4 ng/mL (p &lt;0.001). Similarly, the serum leptin concentration decreased significantly in the RYGB group, with a mean change of − 165.42 ±53.4 (p &lt; 0.001). In addition, the mean reduction in baseline chemerin levels 12 months after the operation was considerable in the LSG cohort (− 23.24 ± 9.5 ng/mL) and RYGB group (− 22.12 ± 15.9 ng/mL). The ghrelin values demonstrated a notable reduction in the LSG cohort (− 0.083 ± 0.11 pg/mL) and RYGB group (− 0.068 ± 0.097 pg/mL). However, the changes in the three hormones were not substantially different between both groups (p &gt; 0.05).

Conclusion
Both RYGB and LSG result in a considerable, comparable decrease in the postoperative serum concentrations of leptin, chemerin, and ghrelin.
ThTP2.7 A 5-year retrospective review of intra-operative cholangiogram utilisation: do we need a pathway?
Authors: Bezzaa Sabrina , Kapsampelis Panagiotis , Murabit Ferass , Khalifa Khalid , Gerogiannis Ioannis 
Published: August 2023

Abstract

Aim
Current guidance gives no clear consensus on using routine vs selective intra-operative cholangiograms (IOC) during laparoscopic cholecystectomy. This is a controversial area with underuse risking bile-duct injury but overuse wasting theatre time and resources. The study aimed to review our local practice of IOC.

Method
Data was collected from electronic records for all patients undergoing IOCs from 2017 to 2022 at a single District General Hospital (DGH). Statistical analysis was performed using R.

Results
Ninety-six patients underwent IOC (74 elective, 22 emergency). In 64 (67%), use of IOC was decided pre-operatively (planned), 28 (29%) was decided intra-operatively (unplanned), and unclear in four cases (4%). All patients underwent pre-operative imaging. Imaging was negative for choledocholithiasis in 61 cases (64%). Indications for IOCs were abnormal anatomy (18%), deranged biochemistry (32%), abnormal imaging (21%) and confirmed choledocholithiasis (7%). The indication for IOC was unclear in 21 patients (22%). IOCs revealed abnormal findings in 21 cases; 10 required post-operative ERCP/EUS, 6 required further imaging and three were referred to a tertiary centre (for potential bile duct injury). On average, elective cases with unplanned IOC lasted 28 minutes longer (95% CI 4 to 52, p=0.013) than planned IOC.

Conclusions
Our study revealed that IOC indication was not documented consistently, and unplanned elective IOC cases lasted significantly longer. Therefore, we propose a local pathway to identify, pre-operatively, the patients who need IOC. This will result in safer patient care and less operating time and resources. Furthermore, dedicated IOC lists may help DGHs streamline theatre lists and improve efficiency.
ThTP4.5 Outcomes of colorectal cancers can be improved - 10 year Results from a South Asian Tertiary Center
Authors: Kazi Mufaddal , Raj Prudvi , Nadkarni Shravan , Sharma Vivekanand , Saklani Avanish 
Published: August 2023

Abstract

Introduction
Colorectal cancers are the most common gastrointestinal cancers and continue to rise in numbers. We aimed to compare the outcomes of all colorectal cancers after a five year period of change in practice.

Methods
We compared the demographic, clinical, treatment, and outcomes parameters of all rectal cancer patients registered at our hospital in the year 2013 to those in 2018. A total of 1442 patients, 511 in 2013 and 931 in 2018 were included.

Results
Median age reduced from 46 years to 40 years, with the proportion of young rectal cancers (≤45 years) increasing from 49% to 70% in 2018. A shift towards low rectal cancers, poorly differentiated and signet-ring cell histology was also observed in 2018. More patients in 2018 presented with advanced T and N stage with similar rates of distant metastatic disease at initial diagnosis. Curative intent treatment was offered to 1179 patients, and neoadjuvant radiation was offered to similar proportions with an increasing use of short-course radiation in 2018. Higher default and progression rates were observed in 2018 (30.2% vs 40.8%), and fewer patients could receive definitive surgery. At a median follow up of 96 months for the 2013 group and 32 months for the 2018 cohort, the 3-year OS was 47.5% and 73.3% for the 2013 and 2018 registered patients, respectively.

Conclusions
The increase in survival for every stage of rectal cancer in five years interval despite more advanced and aggressive tumours, suggest the augmentation and improvement in services offered at the colorectal unit.
ThTP5.3 Outcome of weekend physiotherapy input post emergency laparotomy
Authors: Ng Hwei Jene , Burke Mhairi , Clark Maggie , Moug Susan 
Published: August 2023

Abstract

Aims
Early ambulatory has been shown to reduce risk of morbidity and length of stay. It is evident in elective laparotomy patients but there is limited data on emergency laparotomy patients. We aim to explore the outcome of morbidity and physiotherapy input over weekend.

Methods
Patients ≥18 years old underwent emergency laparotomy (EmLap) as per NELA criteria from July 2021 to Dec 2021 in a busy district hospital were reviewed. Data on demographics, physiotherapy input and morbidity (post-operative ileus and pneumonia) were analysed. P-value of &lt;0.05 was considered significant.

Results
A total of 81 patients were included with 56% female and median age 69 years. Ratio of smoker: Non-smoker: Ex-smoker was 1:4:1. 74% were seen by physiotherapist over the weekend (POW) and 48% had chest physiotherapy post-operative day 1. The overall rate of post-operative ileus was 18.5% (19% no-POW vs 18.3% POW; p= 0.942) while the rate of post-operative pneumonia was 11.1% with 2/3 non-smoker (9.5% non-POW vs 11.7% POW; p= 0.855). Median post-operative length of stay was 10 days (8 days No-POW vs 11 days POW).

Conclusion
Physiotherapy input post EmLap over the weekend did not significantly improve morbidity. Weekend input is provided by the oncall physiotherapist and the requirement of the service could reflect the high risk status of patients. Besides physiotherapists, ward nurses play an important role in continuous encouragement of mobilisation post-operative to reduce morbidity rate.
ThTP5.6 Decision to Incision Time: Can the principle be applied to emergency general surgery in order to tackle delays in patient care?
Authors: Smith Charlotte , Aly Emad 
Published: August 2023

Abstract

Introduction
General surgical patients who require emergency surgery should have timely access to operating theatre to ensure optimal outcomes. It is important to evaluate delays to identify contributing elements and help to improve standards of surgical care. The decision to incision time interval is a benchmark used in obstetric practice. This study aimed to assess the use of this time interval in the emergency general surgical setting to consider whether the principle may be translatable.

Methods
Prospective data were collected on patients undergoing emergency general surgery in a tertiary care centre over four weeks. Data were extracted from patient notes and anonymised for statistical analysis.

Results
No statistically significant associations were found with the studied variables and decision to incision time. However, this study identified clear delays, with 66% of emergency operations taking place after target time assigned by NCEPOD classification. It identified trends in varying decision to incision time in patient and procedure type. It also identified issues with documentation and an association between longer decision to incision time and post-operative length of stay.

Conclusion
This study highlights important delays in emergency general surgery. Decision to incision time reveals important trends and, with larger sample sizes, may identify areas which hinder time-sensitive procedures. This study recommends that decision time could be more formally incorporated into surgical documentation to better monitor delays. The findings of this study could inform future research, which is required to determine the true potential of using decision to incision time interval in emergency general surgery.