bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP11.1 A co-ordinated approach to trainee quality improvement projects to reduce mortality and length of stay in patients undergoing emergency laparotomy
Authors: Bateman Kellie , Cripps Peter , Hanratty Daniel 
Published: August 2023

Abstract

Aim
To support trainees in completing specific and achievable quality improvement projects (QIP) that are beneficial to patient care and aligned with clinical priority areas in emergency general surgery.

Method
A fishbone analysis of factors contributing to poor outcomes in patients undergoing emergency laparotomy was created. From this, key priorities for improvement were identified by a multidisciplinary team, enabling multiple QIP with clear aims to be developed. QIP included National Emergency Laparotomy Audit (NELA) data capture, risk scoring and documentation of mortality, identification and management of sepsis, pre-operative antibiotics, infection prevention and early radiological imaging. QIP were allocated to groups of trainees comprising of at least one foundation doctor, one core trainee and one specialty registrar. Mortality and length of stay data was collected over 6 months using the run charts for the hospital site available at data.nela.org.

Results
In 6 months, 9 QIP were started, with the first cycle of data collected in all projects and 3 projects completed by trainees. Initial QIP results have been presented locally for 5 projects and 2 QIP have been presented nationally, thus supporting completion of ARCP requirements and specialty job applications, as well as the sharing of outcomes. Although not statistically significant a downwards trend in length of stay and mortality has also been observed.

Conclusion
Having a focused and co-ordinated approach to quality improvement with clear aims and objectives can support training and improve patient outcomes. Further study is required to assess the sustainability and longevity of these results.
SP11.8 Deep learning for performance assessment of laparoscopic sleeve gastrectomy (LSG): validation against objective structured assessment of technical skills (OSATS) and clinical outcomes
Authors: Lam Kyle , Patel Sajan B , Darzi Ara , Lo Benny , Purkayastha Sanjay , Kinross James M 
Published: August 2023

Abstract

Background
Current methods of surgeon performance assessment are unstructured, labour-intensive and subjective. Machine learning could provide rapid, automated and subjective assessment. We design a custom deep learning model to output performance metrics from videos of LSG and validate these against OSATS and clinical outcomes.

Methods
A novel dataset of 3210 images from videos of LSG was annotated to train an instrument segmentation framework based on Mask R-CNN, a state-of-the-art deep learning algorithm. Spatial outputs of detected instruments were used to determine workflow through a Markov chain and secondly to determine instrument metrics for assessment of surgical performance. Metrics including time spent in stage and instrument time, distance, smoothness, concentration, and efficiency were then validated against OSATS ratings from 2 independent scorers and clinical outcomes from 35 LSGs.

Results
Grasper and ligasure efficiency and smoothness were higher in videos rated within the top quartile by OSATS score when compared to those in the bottom quartile and when comparing consultants to trainees. Videos in the top quartile for grasper smoothness had higher total OSATS scores (17.31±2.27) compared to those in the lowest quartile (15.69±2.93) and across all 5 individual OSATS domains in addition to higher percentage of total weight loss at 3, 6, and 12 months.

Conclusions
This study demonstrates how vision based deep learning can be used for surgeon performance assessment. Future work will aim to validate this against a large number of videos, expand upon the range of metrics produced, and look towards the steps needed for clinical translation.
SP11.12 Improving Radiology Scan Requests in Acute General Surgery
Authors: Sanmugam Kischentaran , Rutherford Georgia 
Published: August 2023

Abstract

Background
Junior doctors submit majority of requests for radiological scans in most surgical departments. We aimed to evaluate the accuracy of clinical information entered by referring doctors based on five define parameters recommended by a consultant radiologist in a tertiary hospital.

Method
All scans requested by clinicians within 48 hours of admission to the acute surgical receiving unit across two weeks were reviewed. Outpatient and ambulatory requests were excluded. The five required parameters were: clinical presentation, relevant past medical history, relevant blood results, clinical examination findings and clinical question. Education, in the form of posters and an online tutorial, were provided with the aim of improving scan requests. Data was collected on Excel and statistical analysis was performed using a paired t-test.

Results
Over two weeks, majority of 127 scan requests (21% USS, 64% CT scans, 15% MRCP) were made by doctors. Prior to our interventions, 60% of the defined parameters were included in scans request, with 83% of patients receiving their scans within 24 hours. This increased to 80% following delivery of medical education but this did not increase the number of scans performed within 24 hours. A paired t-test demonstrated a statistical significance between pre and post intervention scan requests (p=0.0471), however this did not correlate to shorter scan times.

Conclusion
Quality of scans improved following medical education in the form of posters and online tutorials. An induction tutorial on submitting quality scan requests would benefit referring clinical and radiologist on highlighting critical information required for timely scans.
SP11.13 A Systematic Review on the Effectiveness of Augmented Reality for Medical Students’ Surgical Training
Authors: Shah Aishwarya , Kaka Anaiya , Kumar Niraj , Patel Arpit , Yunus Azedah , Patel Akash 
Published: August 2023

Abstract

Aims
Interest in augmented reality (AR) technologies within an educational setting has surged in recent years. However, few studies evaluate the use of AR in a primarily medical student population. This systematic review with meta-analysis was conducted to evaluate the existing literature on this topic.

Methods
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to during this review. Using relevant synonyms for the terms “augmented reality”, “medical students” and “surgery”, the databases Embase, Medline and Scopus were searched. Data was extracted for outcome measures such as errors/fails, attempts/retries, time for task completion, motion sickness/nausea and focus shifts.

Results
826 records were initially retrieved; 19 studies were included in the final review, with a total of 485 participants. The AR group performed better than the comparator group in 84% of the statistically significant main outcomes. The groups showed no statistically significant difference in likelihood of failing assessment, with a pooled odds ratio of 1.76 (95% CI:0.06-51.71, p=0.74, I2=81%). One study reported 57% fewer critical errors in the AR group than the comparator group. Two studies reported nausea/motion sickness as an outcome (12% (n=3) and mean Likert-scale score of 3 (out of 10) in the AR groups).

Conclusions
AR can be an effective surgical teaching and training tool for medical students. However, the limitations of AR, including visually induced motion sickness, have not been explored extensively by primary studies. Gradual integration of AR is therefore proposed until further studies elucidating benefits and risks can be undertaken.
WTP2.8 There are Acceptable Allograft Survival outcomes Of Kidney Transplants In recipients From the Black population In The UK, But Are The Outcomes At Par With Caucasians Receiving Renal Transplants?
Authors: Ng Oon-hui , Devkaran Bhavesh , Arora Anoushka , Gunawardena Thilina , Mehra Sanjay , Sharma Hemant 
Published: August 2023

Abstract

Purpose
Those of black descent make up 22.7% of people in the UK receiving dialysis. A UK Registry data analysis of transplant outcomes on the Black-Population (BP) was done and a comparative assessment with the Caucasian-Population (CP) renal transplant recipients was performed.

Methods
We harmonized the UK Renal-Transplant Registry Data to shortlist the renal transplants done on Black and Caucasian patients from the year 2000-2019. The demographics and survival analysis at 1,3 and 5 years post-transplant were analyzed. Regression was done to identify survival predictors.

Results
Renal-Transplant rates in the BP have improved &gt;10 times since the last decade. 18% of transplants in the UK are performed on black-minorities. N=1878 Transplants have been done on the BP since the year 2000 compared to N=28960 on CP cohort. Both Cohorts had similar donor and recipient characteristics with normal distribution. BP was most likely to receive a cadaveric kidney-transplant, while CP had odds of 2.3 times (1.19-4.66) p=0.009 higher to receive a living donor kidney. The eGFR at 3 & 12 months post-transplant was similar in both groups (p=0.77). The median-CIT for cadaveric kidneys was 832 min for BP and 855 min for the CP cohort (p=0.15). The Graft survival was similar in both cohorts at 1,3 and 5 years post-transplant. (CP-87%, 81%, 66%; BP - 87,80%, 64%). Immunologically high-risk (p=0.02), KDRI &gt;1.1(p=0.003), rejection within first 3 months (p=0.01), and CIT&gt;14hrs (p&lt;0.01) predicted poor graft-survival.

Conclusions
There were no noted differences in renal-transplant outcomes in both black and Caucasian populations. The Transplantation-rates in the BP cohort have impressively increased over the last 10-years.
WTP3.3 Percutaneous cholecystostomy: an intervention requiring re-admission and re-intervention?
Authors: Baggus Elisabeth , Henry-Blake Connor , Chrisp Benjamin , Coope Ashley , Gregory Andrew , Lunevicius Raimundas 
Published: August 2023

Abstract

Aims
A national database study reported a 723% increase in cholecystostomy procedures in England between 2000 and 2019 (Lunevicius, 2022). We aimed to evaluate short and long-term clinical outcomes following percutaneous cholecystostomy for acute cholecystitis (AC) at our centre.

Methods
A single-centre, retrospective cohort study was conducted utilising data from a tertiary centre database, 2012–2020. Tokyo guidelines were used to grade AC severity. Outcomes were evaluated.

Results
Seventy-six patients were included. The median age was 76 (IQR 67.5-83.3). The M:F ratio was 1.1:1. Twenty-nine patients (38.2%) had Tokyo Grade 3 AC. The remaining 47 patients (61.8%) had Tokyo Grade 2 AC. Forty-seven patients (61.8%) experienced at least one post-cholecystostomy complication. During index admission, seven patients (9.2%) required admission to ITU, seven patients (9.2%) died, and six (7.9%) required emergency cholecystectomy. The median length of stay was 12 days (IQR 9.33-17.0).
Of the 69 patients who were discharged, 23 (33.3%) required emergency readmission due to AC recurrence; 12 of these (17.4%) were readmitted within 30 days. Eleven patients (15.9%) had recurrence of AC whilst the gallbladder catheter remained in-situ, and a further 15 patients (21.7%) had recurrence of AC after catheter removal. Twenty patients (29.0%) required additional percutaneous drainage, of which 11 (15.9%) received repeat cholecystostomy. Twelve patients (17.4%) underwent elective cholecystectomy, with a median interval between PC and elective cholecystectomy of 62.5 days (IQR 20.3-118).

Conclusions
PC is associated with high post-procedure mortality and morbidity. Clinicians should be discerning in patient selection criteria for PC.
WTP3.12 Value of magnetic resonance cholangiopancreatography (MRCP) in acute gallstone pancreatitis
Authors: Ng Shou Kee , Stevenson Carla , Ansari Fraz , Khan Khurram 
Published: August 2023

Abstract

Aims
Magnetic resonance cholangiopancreatography (MRCP) is commonly performed in acute pancreatitis to rule out bile duct stones (BDS). The aim of this study was to determine if MRCP is required to rule out BDS in patients admitted with gallstone pancreatitis (GS).

Method
A retrospective cohort study of all consecutive MRCPs in a single surgical unit from October 2021 to September 2022 was conducted. Patient demographics, laboratory results and MRCP result data was analysed. Patients with MRCP proven BDS were compared to those without.

Results
Sixty-one patients were identified, 39 (63.9%) were female. Median age was 62 years (IQR 45-75) and median Scottish Index of Multiple Deprivation was 4 (IQR 3-7). 55 (90.2%) MRCPs were inpatient and 30 (49.2%) were urgent requests.
Median wait time for inpatient MRCP was 1 day (IQR 0.7-1.8) and 17.1 days (IQR 14.6-28.3) for outpatient requests. 14 (23%) patients had BDS proven on MRCP. Of these, 6 (42.8%) had evidence of dilated bile ducts on preceding imaging and 8 (57.1%) had hyperbilirubinaemia and raised alkaline phosphatase levels. Median wait time for MRCP for patients with BDS was 0.8 days (IQR 0.35-1.5) compared to 1.2 days (IQR 0.85-2.85) in MRCPs with no evidence of BDS.

Conclusion
We conclude that MRCP is not required for low-risk patients with acute gallstone pancreatitis. However, MRCP will be beneficial in patients with jaundice and preceding radiological evidence of ductal dilatation. Intraoperative cholangiography is recommended in patients who proceed to laparoscopic cholecystectomy where MRCP has not been performed.
WTP4.1 Can Deep Stomal Fixation and Extraperitoneal Stoma Creation Improve Stoma Morbidity? Systematic Review and Meta-Analysis
Authors: Albendary Mohamed , Mohamedahmed Ali Yasen Y , Peravali Rajeev , George Anil 
Published: August 2023

Abstract

Aim
This systematic review evaluates the efficacy and safety of two operative techniques: deep stomal fixation (fixation of stoma to the sheath of abdominal wall muscles and/or peritoneum) and extraperitoneal approach of stoma creation.

Method
PubMed, Medline, Cochrane, and Google Scholar were searched for studies comparing stoma fixation to the sheath and/or peritoneum to the conventional skin-only fixation and extraperitoneal to transperitoneal approaches of stoma formation. Clinical endpoints included parastomal hernia (PSH), stoma prolapse, retraction and associated adverse effects.

Results
2 randomised and 2 retrospective studies investigated deep stomal fixation. There was no statistically significant benefit of this technique in terms of PSH (OR 1.19, P=0.82), prolapse (OR 0.62, P=0.53) or retraction (OR 1.16, P=0.80). Some technical difficulties on stoma reversal were reported in one of the studies.
As for extraperitoneal stoma creation, 2 randomised and 8 retrospective studies compared it to the conventional transperitoneal approach. A statistically notable reduction in PSH was identified in extraperitoneal stomas (OR 0.29, P=0.004). This technique showed statistically insignificant reduction in prolapse (OR 0.74, P=0.53) and retraction (OR 0.48, P=0.36). There was no significant difference in operative time (MD 3.45, P=0.71) or the associated risk of small bowel obstruction (OR 0.68, P=0.57).

Conclusion
Stoma fixation to the abdominal muscle sheath and/or peritoneum does not lower stomal complications, and conversely it may make stoma reversal technically challenging.
Extraperitoneal approach minimises PSH occurrence with no remarkable adverse effects; yet more randomised trials are required for further evaluation.
WTP4.6 Assessment of the Over 75’s undergoing Emergency Laparotomy
Authors: Banks Philippa , Edginton Oscar , Harper Alexander , Mehrem Anna , Yiasemidou Marina , Clarke Rory 
Published: August 2023

Abstract

Introduction
The National Emergency Laparotomy Audit (NELA) 2019 reported 55% of patients undergoing emergency laparotomies were over 65 years old. 19% had formal frailty assessments and 37% had geriatrician input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk and may require intensive rehabilitation. NELA and The Centre for Preoperative care recommend patients over 65 should have clinical frailty assessments and be reviewed by an MDT with early Care of the Elderly (COE) input. This audit reviewed use of these recommendations at a large District General Hospital (DGH).

Methods
We performed an audit on all patients over the age of 75 who had an emergency laparotomy between September 2020 to September 2022. We collected data from their admissions, including clinical frailty scores, AMTS and if COE reviews had occurred.

Results
We collected data on 57 patients. The average age was 82 (75-96), and the average length of stay was 22 (5-80) days. No patients had either clinical frailty or AMTS scores documented. 16% had a COE review. 16% (9) patients died before 30 days.

Conclusion
The DGH failed to meet the recommendations for frailty assessment and COE input for patients over 75 having an emergency laparotomy. Suggested improvements may include: a referral pathway to prompt elderly care reviews, or the creation of the “general surgery geriatrician” similar to that of ortho-geriatrician role may be of benefit. Documenting clinical frailty assessments could improve patient outcomes, reduce mortality/morbidity, and provide a more holistic patient approach.
WTP4.14 Major Trauma Amongst E-scooter and Bicycle Users: A Nationwide Cohort Study
Authors: Clough Richard , Platt Esther , Cole Elaine , Wilson Mark , Aylwin Christopher 
Published: August 2023

Abstract

Aims
To determine the number of E-Scooter related admissions due to significant trauma in comparison to bicycle related trauma within England and Wales. To compare morbidity and mortality associated with each form of transport.

Methods
A retrospective cohort study based on data which has been prospectively collected and submitted to the UK Trauma Audit and Research Network (TARN) registry. Patients of any age who were admitted to major trauma centres or trauma units in England and Wales with injuries following E-Scooter or bicycle incidents between the dates 01/01/2021- 31/12/2021. All patients must have met TARN database inclusion criteria.

Results
There were 293 E-Scooter trauma incidents compared to 2538 bicycle incidents. E-Scooter users were more likely to be admitted to a major trauma centre (p=0.019) or an intensive care unit (p=&lt;0.001). Amongst e-scooter users, serious head injury (Abbreviated Injury Scale &gt;2) was almost twice as common (p=&lt;0.001) and the rate of serious limb trauma was also higher in this group (p=&lt;0.001). Rates of serious chest and pelvic trauma were greater in the bicycle cohort (p=&lt;0.001 and p=0.003 respectively). Over a third of E-Scooter injuries were incurred outside the remit of current legislation by patients who were under the influence of alcohol and drugs (75/293) or under the age of 17 (41/293).

Conclusions
The relative incidence of moderate to severe injury amongst E-Scooter users is likely to outweigh bicycle users. These early results suggest an alternative pattern of injury amongst E-scooter users compared to bicycles.
WTP5.5 A 6 year Review of Pilonidal Operations in a DGH
Authors: Bruce Nikki , Berlansky Martin 
Published: August 2023

Abstract

Aims
Pilonidal Disease can be difficult to manage and operative management carries well known risk. We aimed to review all pilonidal operations from a 6 year period in our DGH, especially complications and reoperations.

Methods
An excel database was created and hospital coding data pulled for any pilonidal operation including elective and emergency over a 6 year period from 2015-2020. Hospital electronic and paper notes were used to cross reference coding data with op notes and discharge paperwork. Complications were then categorised as “Major” or “Minor” and type of complication documented. Number of reoperations was counted.

Results
183 operations were carried out on 151 individual patients (103 male and 48 female). There were 33 reoperations on 21 patients. 78 formal elective operations were done with 68 primary closure and 10 laid open. Of primary closure there were only 13 complications – 5 major and 8 minor. Major complications included return to theatre for wound dehiscence, and wound sepsis. Those with major complications mainly had pre-existing complicated disease and all had previous emergency I&D. All patients who had primary closure had ongoing symptomatic disease prior to operation with 29 having previous emergency I&D.

Conclusions
Most patients with ongoing symptomatic disease benefit from definitive management in the form of elective primary closure eg Bascom procedure. Despite the well recognised risks of this surgery, most complications are minor and major complications are often reflective of a history of problematic pilonidal disease.
WTP5.7 The use of porcine dermal acellular matrix mesh for ventral and parastomal hernia: an evaluation of outcomes from a tertiary centre
Authors: Daniel Sudin , Solkar Maseera , Sehgal Rishab , Riyad Kallingal 
Published: August 2023

Abstract

Aims and Objectives
Despite advancements in techniques for abdominal wall closure, 15-20% develop incisional hernia. Synthetic meshes are ill-advised for ventral-hernia repair at risk of wound-complications. Biologic grafts are an alternative given their biocompatible safety-profile. We evaluated the outcomes of fascial closure using a Porcine Dermal Acellular Matrix (PDAM) mesh (Cellis®).

Methods
A retrospective PDAM-mesh review was performed between 01/05/2016-30/09/2022, focusing on midline/parastomal hernias. Electronic charts were reviewed to obtain demographic and surgical data. Immediate/short-/long-term complications and radiological recurrence rates were collected.

Results
71 cases (acute/elective 10/61, F:M 4:3) were included in the study, median age 62yrs (25-93yrs), follow-up 12-72mos. Majority (69%) of the elective group had ASA2 vs. 70% acutes had ASA3. Of the 61 elective repairs, midline hernias constituted 37 (60%) and parastomal hernias in 24 (40%). Of the 10 acute cases, there were 8 midline-hernias and 2 parastomal-hernias. Component separation (CS) were performed in 29 cases (16-bilateral anterior-CS, 11-unilateral anterior-CS and 2-bilateral posterior-CS). Median LOS was 11d (1-180d)/15d (1-159d) for elective/acute groups. Seromas and minor wound infections were the commonest short-term Cx in both groups. There were 5 deaths within 90-days. From the elective group 6/37 (16%) midline repairs and 8/24 (33%) parastomal hernias had CT recurrences. In the acute group, one recurrence each were noted from 8 midline repairs (12%) and 2 parastomal hernias.

Conclusion
Our PDAM-mesh cohort demonstrates acceptable results regarding managing midline-ventral and parastomal-hernias in the elective/acute setting. Further comparative studies with synthetic mesh are warranted to fully evaluate the effectiveness of PDAM meshes.