bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP9.7 A Quality Improvement Project to Optimise the Emergency Department to General Surgery Referral Process
Authors: Bangi Shifa , Boardman Charlotte , Ihedioha Ugochukwu 
Published: August 2023

Abstract

Introduction
Optimising the process of referrals from the Emergency Department (ED) can improve patient care. Currently, referrals to General Surgery (GS) are accepted by the Senior House Officer (SHO) and Registrar (SpR) on-call. This leads to two ongoing lists of referrals and the possibility of patients being missed. ED uses symphony to track referrals, but GS does not currently use this system.

Method
A survey was sent to all GS SHOs/SpRs to assess the process and tracking of referrals. Symphony was implemented as a virtual system to streamline the referral process. A repeat survey to evaluate the effectiveness of this intervention was conducted 1 month later.

Results
In the pre-intervention survey, 36% of doctors used a paper list to track referrals. The referral system was rated on average as 2.6/5 (1 – terrible, 5 - excellent). 50% reported feeling that patient safety had been compromised &gt;5 times in the last month due to miscommunication between ED and GS. In the post-intervention survey, there was a significant decrease in the number of times patient safety was reported as being compromised in the last month (p=0.047). Pre-intervention, the theme of the majority of suggestions for improvement included an electronic system for tracking referrals, whereas post-intervention, most suggestions were about the history/ investigations done for each referral.

Conclusion
The use of the same system, symphony, by ED and GS has improved patient safety, although the Symphony program itself as well as the quality of referrals could be improved.
SP9.9 Protocolised Care Pathways in Emergency General Surgery: A systematic review and meta-analysis
Authors: Harji Deena , Griffiths Ben , Stocken Deborah , Pearse Rupert , Blazeby Jane , Brown Julia 
Published: August 2023

Abstract

Background
Emergency abdominal surgery is associated with significant post-operative morbidity and mortality. The delivery of standardised pathways in this setting may have the potential to transform clinical care and improve patient outcomes.

Methods
The OVID SP versions of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials were searched between January 1950 and October 2022. Comparative studies reporting on care pathways in emergency laparotomy in adult patients were included. Risk of bias was assessed using the ROBINS-I for non-randomised studies and the RoB-2 for randomised controlled trials. Meta-analysis was performed using a random effects model.

Results
Seventeen studies consisting of 20,927 patients were included, with 12,359 patients undergoing protocolised care pathways and 8,568 patients undergoing standard care pathways. Thirteen unique protocolised pathways were identified, with a median of 8 components (range 6 – 15), with variable compliance of 24-100%. Protocolised care pathways were associated with a shorter hospital stay compared to standard care pathways (SMD -2.028, 95% CI -3.28 – -0.88, p = &lt;0.01). Protocolised care pathways were associated with reduced mortality (OR 0.78, 95% CI 0.71 – 0.86, p&lt;0.00001)) and morbidity (OR 0.80, 95% CI 0.649 – 0.94, p=0.005), including post-operative pneumonia (OR 0.43 95% CI 0.29 – 0.64, p&lt;0.0001) and surgical site infection (OR 0.43, 95% CI 0.29 -0.65, p&lt;0.0001). There were no observed differences in re-operation (OR 1.24, 95% CI 0.72 – 2.16, p=0.44) or readmission rates (OR 1.15, 95% CI 0.83 – 1.59, p=0.41).

Discussion
Protocolised care pathways in the emergency setting currently lack standardisation, however, despite this are associated with short-term clinical benefits.
SP9.13 Biological or synthetic mesh for parastomal hernia repair: An evidence synthesis by a systematic review
Authors: Shafique Muhammad Salman , Tahir Irtesam , Qasim Muhammad , Sains Parv , Baig Mirza Khurrum , Sajid Muhammad S 
Published: August 2023

Abstract

Objective
Parastomal hernia (PSH) is a common colorectal condition which needs surgical repair. The objective of this study is to compare the postoperative surgical outcomes in patients undergoing PSH repair using biological versus synthetic mesh.

Materials and methods
Comparative studies reporting postoperative outcomes in patients undergoing PSH repair using biological versus synthetic mesh were selected 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
Four comparative studies (one RCT, one retrospective and two prospective studies) on 252 patients were found suitable for meta-analysis according to the inclusion criteria. In the random effects model analysis, surgical site infection rate [risk ratio 0.84, 95%, CI (0.54, 1.31), Z = 0.76, p &lt; 0.46], mesh erosion leading to re-operation rate [risk ratio 1.01, 95%, CI (0.21, 4.89), Z = 0.01, p = 0.99] and PSH recurrence rate [risk ratio 1.06, 95%, CI (0.61, 1.86), Z = 0.21, p = 0.83] were statistically similar between biological mesh and synthetic mesh groups. There was no heterogeneity (Tau2 = 0.00; Chi2 = 1.38, df = 3; (p = 0.71; I2 = 0 %) between included studies.

Conclusion
PSH repair may be performed by using synthetic mesh without higher risk of infective complications and mesh erosion. However, stronger evidence in the form of major, multicentre, randomised, controlled trial is needed before recommending a routine use of synthetic mesh in PSH repair.
SP9.14 “Happy to close?”: The relationship between surgical experience and incisional hernia rates following abdominal wall closure in colorectal surgery
Authors: Smith Laurie , Coxon-Meggy Alexandra , Shinkwin Michael , Cornish Julie , Fegan Greg , Torkington Jared 
Published: August 2023

Abstract

Introduction
There is an association between surgeon volume and outcomes in hernia surgery, yet little evidence regarding impact of the experience of the surgeon performing abdominal wall closure (AWC) on IH rate.
Our aim was to assess the rates of IH at 1 year following surgery between Registrar and Consultant surgeons in patients undergoing elective colorectal surgery.

Methods
Patients undergoing elective surgery for colorectal cancer between 2014-2018 were identified through the Hughes Abdominal Repair Trial (HART). Grade of surgeon performing AWC was categorised into “Trainee” and “Consultant” and compared with IH detected at clinical examination at 1 year following surgery.

Results
663 patients were included. 44% were closed by registrars (n=289). Groups were comparable in BMI, previous surgery and pre-operative IH. The rate of IH in patients closed by registrars was significantly higher than those closed by consultants (20% vs 12%, p&lt;0.01). Patients who underwent AWC by a registrar were 88% more likely to develop IH at 1 year (OR 1.88, 95%CI 1.23-2.86, p&lt;0.01). When comparing AWC methods, IH rates were significantly higher in the Hughes closure arm (20% vs 12%, p=0.03), but not high enough in the mass closure arm to reach significance (21% vs 13%, p=0.05).

Conclusion
Patients who undergo AWC by a registrar have an increased risk of developing IH compared to those closed by a consultant. This work suggests the importance of training during AWC. Further work is needed to determine the impact of supervised and un-supervised trainees on IH rates, but AWC should be treated as training time rather than coffee time.
SP9.15 Rates of COVID-19 infection and mortality following elective surgery at a tertiary NHS Trust in relation to operative caseload
Authors: Lewis-Lloyd Christopher , Humes David 
Published: August 2023

Abstract

Aims
Elective surgery globally has been halted by COVID-19 due to apparent significant mortality rates with changes in planned surgery pathways. This audit examines COVID-19 infection and mortality rates at key intervals throughout the UK COVID-19 pandemic in relation to operative elective caseload at an NHS Trust.

Methods
Prospective cohort of elective surgical patients at a tertiary NHS Trust between March 2020-March 2022, examining three time periods. Period 1: 1st UK Lockdown (April-July 2020). Period 2: 2nd-3rd UK Lockdowns (November 2020-March 2021). Period 3: Omicron wave (December 2021-February 2022). Post-operative PCR positive COVID-19 infection rates within 30-days, proportion fully “double-jabbed” vaccinated, 90-day mortality and any COVID-19 related deaths are reported. Audit registration 20-190C.

Results
Between March 2020-2022, of 50,247 operations, 518 (1.03%) developed COVID-19 infection of which 62 (11.97%) died giving an overall COVID-19 death rate of 0.12%. Between Periods 1 and 3, despite a 53% increase in operations per week (294 to 450) the proportion of COVID-19 infected patients remained similar (1.12% and 1.14%). Between Periods 2-3, despite an almost 6-fold increase in fully vaccinated patients (9.80% to 57.74%), the proportion of vaccinated COVID-19 positive patients increased (4.20% to 55.38%). However, the overall proportion of COVID-19 infections decreased (2.53% to 1.14%) as well as the mortality of those infected (15.97% to 9.23%).

Conclusions
Overall COVID-19 infection and mortality rates are low. These have been maintained despite increases in operative caseload, suggesting further sustained elective surgery can re-commence. This may relate to an increase in fully vaccinated patients undergoing surgery.
SP9.17 Adherence to fluid guidelines in surgical patients and impact on complication rate
Authors: Wong Tiffany , Murugan Veylamuthen , Adiamah Alfred , Sanyal Sudip 
Published: August 2023

Abstract

Aims
Up to 95% of intravenous fluid prescription requests for surgical patients are executed by Foundation Year-1(FY1) doctors. This, notwithstanding the plethora of studies suggesting FY1 doctors are inadequately equipped to be prescribing fluids unsupervised. Poor intravenous fluid therapy is associated with an approximate 20% complication rate, including electrolyte abnormalities, dysrhythmia and fluid overload.

Methods
A closed-loop audit was performed at a large teaching hospital to examine compliance with fluid prescribing guidelines and associated complications. This involved a 4-week retrospective review of drug prescription charts against NICE guidelines followed by a targeted intervention that involved a dedicated teaching session on fluid management in the surgical patient, alongside posters and crib sheets of fluid management on surgical wards. The re-audit using the same criteria compared proportion of prescription errors, over- or under-hydration, and total complications before and after intervention.

Results
308 patient records were reviewed (pre-intervention n=185; post-intervention n=123). Documentation of fluids indication (31% vs 46%(p&lt;0.0414)), contingency plans (3% vs 38%(p&lt;0.0001)) and glucose prescription for nil per os patients on maintenance fluids (10% vs 25% (p=0.0029)) improved post-intervention. Fluid balance monitoring (29% vs 9%(p=0.0001)) worsened. The proportion of patients receiving insufficient potassium (91% both rounds), excess sodium (90% vs 92% (p=0.6212)), and the average rate of complications (1 in 1.67 vs 1 in 1.54, p=0.4652) remained unchanged.

Conclusion
Didactic educational intervention for FY1 doctors on fluid therapy improved documentation on fluids indication, but failed to resolve significant prescription failures and resulted in similar complication rates pre-and post-intervention.
SP10.7 Robotic versus laparoscopic surgery for colorectal cancer treatment – a comparison of outcomes in the quest for superiority
Authors: Grewal Callum Singh , Karri Rama , Yassin Nuha 
Published: August 2023

Abstract

Background
This research analysed short-term outcome results of robotic and laparoscopic surgery for colorectal cancer patients. The objective was to determine the advantages of using robotics in minimal invasive surgery and to investigate if there is a significant variation in outcomes based on the surgical method utilised.

Methods
The study conducted a retrospective analysis of all patients who received robotic and laparoscopic surgery for colorectal cancer treatment between 2020 and 2022. The data collected included demographics, as well as information on pre-, intra-, and post-operative periods.

Results
This study evaluated 120 surgeries for colorectal cancer patients, 83 were robotic and 37 were laparoscopic. The rate of stoma formation was higher in laparoscopic procedures (48.6%) compared to robotic surgeries (30.1%). Robotic surgery had a slightly longer average length of operation (279.6 minutes) compared to laparoscopic procedures (254.8 minutes), but the average length of hospital stays for patients who underwent robotic surgery was approximately 5 days shorter. Furthermore, the rate of readmission within 30 days was 12% higher for patients who underwent laparoscopic procedures compared to those who underwent robotic surgery. No patients in the robotic group required conversion to open surgery whereas one laparoscopic procedure necessitated conversion to open. Globally, the mortality rate was 0%.

Conclusion
This study suggests that robotic surgery can be a safe and effective option for approach to surgical colorectal cancer treatment. Robotic surgery offers shorter hospital stays compared to laparoscopic surgery with fewer complications and readmissions. Overall, these findings suggest that robotic surgery may be a superior approach to minimally invasive surgery for colorectal cancer patients.
SP10.8 An overlooked step in colorectal cancer anastomosis: a potentially small step in prevention of exfoliated malignant cells
Authors: Haq Iram , Kemp Alison 
Published: August 2023

Abstract

Introduction
Recurrence after potentially curative surgery has a significant clinical impact with a related poor prognosis. There is an abundance of literature surrounding efficacious techniques for anastomosis. However, to our knowledge comparatively there is minimal evidence reviewing the use of simple anti-septic agents with concurrent cytotoxic properties (ie. betadine or cetrimide) in prevention of anastomotic recurrence. This is despite both historic and newer evidence demonstrating tumour implantation of exfoliated malignant cells (EMCs) at the site of anastomosis leading to recurrence. This is also evident in low grade cancers.

Methods
A literature search was conducted between January 1980 to January 2022. The studies were to incorporate the use of simple anti-septic agents that were swabbed on the ends of the bowel before anastomosis. The search was restricted to articles published in English. Further more the selected publications were searched for additional studies.

Results
A result of 243 papers were reviewed, observational studies were found, n- 24. The reported reduction in EMCs was significantly lower at only 2 -7% compared to 16 to 55% in the control groups. Also evidenced were multiple papers providing significant experimental evidence of EMCs on staplers, gloves and the bowel anastomosed. We excluded rectal irrigation from this review article, as it is not employing the method of delivery suitable for all colonic anastomoses.

Conclusion
These results supporting the theory that cleansing with a cytocidal agent is associated with significantly reduced incidence of local luminal recurrence. We propose that this overlooked step in anastomotic techniques should be revisited.
SP10.9 Impact of sarcopenia on prognosis following neoadjuvant chemotherapy and resection for locally advanced rectal cancer
Authors: Hatt Jacob , Smart Thomas , Hardy Edward , Doleman Brett , Lund Jon , Phillips Bethan 
Published: August 2023

Abstract

Aims
Sarcopenia is characterised by the progressive and generalised loss of muscle mass and function. There is an increasing body of evidence to suggest that cancer patients with pre-existing sarcopenia are at a greater risk of both short- and long-term clinical complications. The aim of this review is to examine the impact of pre-existing sarcopenia on prognostic outcomes in patients with locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) prior to surgery.

Methods
Medline, PubMed and Embase databases were searched from inception to October 2021. Any comparative studies relating to the prognostic outcomes of sarcopenic versus non-sarcopenic patients with LARC who received nCRT prior to surgery were included. Risk of bias was assessed using ROBINS-I. Meta-analysis was performed on reported hazard ratios (HR) and 95% confidence intervals (CI) using DerSimonian–Laird random-effects models.

Results
A total of 598 patients from 5 studies were included in the analysis of hazard ratios for overall survival, whilst 505 patients from 4 studies were available for analysis of HR for disease-free survival. Meta regression analysis showed a significant association between pre-existing sarcopenia and worse overall survival (HR: 1.69, 95% CI: 1.15-2.48). The association between pre-existing sarcopenia and shorter disease-free survival was not statistically significant (HR: 1.07, 95% CI: 0.63-1.82).

Conclusions
The review highlights the role body composition can play on prognostic outcomes in patients undergoing multi-modal cancer treatment. Given the complex underpinnings of sarcopenia progression, more research is needed to develop strategies to mitigate this impact in a physiologically vulnerable population.
SP10.10 Assessment of coronary artery calcification on pre-operative imaging to predict cardiovascular complications in colorectal cancer patients
Authors: Hughes Rebecca , Moug Susan , Good Richard , Shelley Benjamin 
Published: August 2023

Abstract

Background
All patients undergoing operative management of colorectal cancer have pre-operative Computer Tomography (CT) imaging of thorax to exclude metastatic disease. Incidental coronary artery calcification is rarely reported on CT. There are a variety of risk scores to predict cardiac complications in the peri-operative period. Current cardiac risk stratification tools do not incorporate radiological evidence of coronary artery calcification in their scoring systems.

Methods
A retrospective review of 100 patients with confirmed or suspected colorectal cancer. Demographic data was collected. A review of pre-operative CT thorax imaging was completed to ordinal score coronary artery calcification into none, mild, moderate and extensive. Peri-operative and post-operative cardiac and non-cardiac complications were documented.

Results
Seventy-nine percent of patients had evidence of coronary artery calcification on pre-operative CT thorax. 29 mild, 21 moderate, 29 extensive. Seven percent of patients had a cardiac complication and all of these had coronary artery calcification on CT pre-operatively. Twenty-six had non-cardiac complication and 22 of these had evidence of coronary artery calcification on pre-operative CT.

Conclusions
There is significant burden of coronary artery calcification in this patient population. This corresponds positively with peri- and post-operative cardiac and non-cardiac complications. Identification pre-operatively can help predict cardiac risk and therefore allow pre-operative cardiac optimisation.
SP10.11 Does Specialised training reduce the recurrence rate of pilonidal sinus disease surgery?
Authors: Issa Mohamed , Kausar Maria , Adeyera Victor , Easwaran Archana , Kawesha Anthony 
Published: August 2023

Abstract

Background
Pilonidal sinus surgery is challenging, and its recurrence rates have been reported to be high as 30% in a number of series. Long-term morbidity, recurrent infection, non-healing, and chronic wound discharge affect patients’ quality of life. This study aimed to compare the recurrence rate of the different surgical techniques of pilonidal sinus disease in our institution.

Methods
A retrospective study was done of adults who had elective pilonidal surgery from 2016-2021. Recurrence was defined as an active disease that required surgical intervention &gt;30 days after surgery. Results were analysed for the different operative techniques used.

Results
208 patients were included,167 (80.3%) were male with a mean age of 31.2 years. The mean follow-up was 47 months. The recurrence was reported in 19 cases (9%). Out of 17 cases done by excision and lay-open technique, 11.8% had a recurrence, while 9.8% of 143 recured after simple excision and closure. Only 3 of 48 cases with the flap technique had a recurrence. When the surgeon specialty was analysed as a factor of recurrence, colorectal surgeons did 38% (19/208) of the cases including flap technique, and their recurrence rate was 6.3% (5/79). In comparison, non-colorectal general surgeons operated on 50.5% (105/208) of the cases with no flap technique, and their recurrence rate was 11.4% (12/105). Only 2 out of 24 cases were operated by plastic surgeons had a recurrence.

Conclusions
Flap reconstruction yields a low recurrence rate in pilonidal sinus disease surgery. Specialised training for this procedure should be encouraged for the colorectal trainees, that may improve the outcome.
SP10.15 Review of the Two-Week-Wait Suspected Lower GI Cancer Referral Process: Incomplete Information Delays Investigation
Authors: Sargsyan Narek , Hassan Adil , Vijay Vardhini 
Published: August 2023

Abstract

Aims
With a rise in lower-GI2ww referrals compared to pre-pandemic levels, straight-to-test (STT)pathways in secondary-care are increasingly relied on to achieve the 28day faster diagnosis standard. Incomplete referral forms can delay the diagnosis. This study analyses lower-GI2ww referrals to a DGH to assess the impact on the straight to test pathway.

Methods
A prospectively maintained database of 2ww lower-GI cancer referrals between January2021to June2022, was analysed. Key referral criteria were identified as essential to make a STT decision (haemoglobin, renal function, ferritin, performance status/frailty index, FIT). With prior agreement with primary care partners, incomplete referrals were returned to GPs with request for further information, with patient remaining on the pathway.

Results
In an 18month period, 4740 2ww referrals were received. The cancer diagnosis rate was 3.1%. Assessing NG12 symptoms, 64.1%of patients were triaged STT. Incomplete referrals formed 22.6% of referrals. Upon requesting more information 4.1%of incomplete referrals were withdrawn from the 2ww pathway by GP. 10.4% of incomplete referrals were downgraded to routine pathways once more information was provided. 7.9% had no symptoms noted, 21.8% did not have blood tests and 73.7% lacked frailty score/performance-status. The median time to receive requested information was 7days. The median number of reminders required was 2. In those diagnosed with cancer, there was an average delay of 5 days in diagnosis when inadequate information provided. The proportion of patients requiring more information reduced over the 18month period from 25.7% in first 6months to 19.4% in final 6months.

Conclusion
Submission of complete referral forms facilitates faster diagnosis, enabling secondary care clinicians to make timely informed decisions about STT investigations for suspected cancer in accordance with BPTPs (BestPracticeTimedPathways) to achieve the Faster Diagnosis standard.