bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP1.13 Improving Practice in Acute Pancreatitis Management at University Hospital Wishaw
Authors: Slater Gabrielle , Mittal Sagar 
Published: August 2023

Abstract
Acute pancreatitis has an incidence of 150 to 420 cases per million population in the UK and appropriate management is essential given its high early mortality rate.
This clinical audit aimed to improve the initial management of acute pancreatitis in patients presenting to UHW between June 2021 and August 2022.
Retrospective analysis was performed for all acute pancreatitis patients discharged between 01/06/21 and 01/12/21. Management was compared against NICE, BSG and RCS audit standards which encompassed risk stratification, investigations, non-operative and operative management. Initial results were presented at the surgical monthly meeting in April 2022 to raise awareness of standardising care. An acute pancreatitis sticker was implemented to drive change. To assess the intervention impact, prospective data collection was performed from May to August 2022.
Results revealed an improvement in nine out of ten of the audit standards. Suitable investigation into pancreatitis aetiology improved from 25% to 50%, with a notable 83% reduction in clinicians assuming alcohol induced pancreatitis without prior investigation of cause. Initial risk stratification of patients improved from 36% to 52% and severity assessment was bettered from 4% to 36%. The provision of nutritional support to relevant patients rose from 11% to 46%. Comparison of sub-cohorts revealed that adherence with the pancreatitis sticker showed measurably better compliance with standards.
Raising awareness through departmental teaching and a pancreatitis sticker have demonstrated an improvement in standardisation of care, benefiting patient outcomes. Use of a visual aid has been shown to better standards therefore, future cycles should focus on compliance with sticker implementation.
ThTP2.13 Improving analgesia on discharge after Oesophagectomy: A three cycle quality improvement project
Authors: Fiander Louis , Lunt Adam , Easter Jacqueline , Carr William , Berrisford Richard 
Published: August 2023

Abstract

Introduction
Oesophagectomy is a painful operation. Poorly controlled post-operative pain increases the risk of complications including pneumonia and venous thromboembolism. On discharge, patients become more active and have less regular reviews, both increasing the risk of uncontrolled pain. Adequate analgesia is essential. We aimed to assess practice relating to discharge analgesia following oesophagectomy, implement interventions to improve discharge prescribing, then re-assess.

Methods
Retrospective data were collected for patients discharged following oesophagectomy between 22/03/2021 and 09/11/2021. Data were analysed in three subgroups: pre-intervention; following education programme; and following introduction of e-prescribing “order-sets”. Intervention comprised of the formulation of a guideline for discharge analgesia (see Table 1), an education programme and implementation of an order-set. Discharge prescriptions from each subgroup were then compared to the guideline.

Results
Data for 53 patients were analysed. Subgroups contained 18, 17 and 18 patients respectively. Pre-intervention, 14% of discharge prescriptions met the guideline standard, 14% prescribed no analgesia and 38% prescribed Paracetamol alone. Following education, 82.4% of discharge prescriptions adhered to guidelines. Following order-set introduction, adherence was 83.3%.

Conclusions
Effective analgesia is essential following oesophagectomy. By formulating and disseminating guidelines, alongside an education programme and introducing order-sets we have demonstrated significant and sustained improvement in discharge prescriptions for oesophagectomy patients.
THTP3.4 Performances measures in Robotic-Assisted Surgery- A Systematic Review
Authors: El-sayed Charlotte , Yiu Andrew , Burke Josh , Todd James , Munsch Chris , Bach Simon P 
Published: August 2023

Abstract

Background
Robotic-Assisted Surgery (RAS) has seen a global rise in the past 30 years. Despite the increased adoption, there is no current standardised training curricula or measure of performance. The aim of this systematic review was to define the RAS metrics used to assess technical performance across the surgical specialities.

Methods
Using the PRISMA 2020 guidelines, Pubmed, Embase and the Cochrane Library were searched systematically for full texts published 31st January 2020 – 31st January 2022. All randomised controlled trials (RCTs) and observational studies were considered. Review articles and systematic reviews were excluded. The papers’ quality and bias score were assessed using the Newcastle Ottawa Score for the observational studies and Cochrane Risk Tool for the RCTs.

Results
The initial search yielded 1189 papers of which 74 were eligible. The majority were published in urology (45% n=33). 27 unique metrics were identified and categorised as “task based”, “procedural based”, “cognitive assessments” and “global assessments”. Global assessments were the most common category of assessment (n=12); the most frequently used was GEARs (Global Evaluative Assessment of Robotic Skills). Only 4 metrics (automated, Proficiency Based Progression (PBP), pupillary measures and time to completion) used quantitative measures to assess performance whilst the remaining relied upon Likert scales thereby creating variability amongst users.

Conclusion
There is wide variation in tools used to assess performance in RAS. The majority of tools are subjective which increases the risk of bias amongst users and therefore accuracy in the measure of performance. A validated, objective global assessment tool that utilises quantitative measures is required.
ThTP3.7 Video-Based Coaching for Surgeons in the UK: Consensus on Essential Elements
Authors: Gunn Eilidh G M , Johnson Adam P , Pius Riinu , Smink Douglas S , Tambyraja Andrew L , Yule Steven 
Published: August 2023

Abstract

Aims
To determine consensus on essential elements of a video-based surgical coaching program for general surgeons in the United Kingdom.

Methods
A modified e-Delphi study was designed with three sequential rounds utilising cross-sectional survey design, distributed using REDCAP software. A purposeful sample of international experts from affiliated disciplines were invited to participate. Survey statements were rated on level of importance for inclusion in a coaching program using a 7-point Likert scale (1=extremely unimportant, 7=extremely important). Consensus criteria was defined as 70% of participants rating a given statement at 6 or 7.

Results
Fifty-nine experts participated. Round 1 consisted of 8 open questions developed from a systematic review of audiovisual coaching. Analysis of responses generated 92 novel statements regarding surgical coaching, categorised within 8 domains: infrastructure (9), coaching session components (9), audio-visual technology (22), program (20), formation of coaching pairs (11), coaches (8), coaches (4), and outcome criteria (9). In round 2, participants rated each statement, with a total of 22 statements reaching consensus criteria, 32 statements for reconsideration, and 38 statements rejected. Currently in round 3, a further 4 statements have met consensus criteria. Overall, the highest rated statements were: Clear and formal training for coaches prior to participation (90.6%) and Coaches should be good communicators (90.6%).

Conclusions
Prior surgical coaching work has predominantly been implemented in North America. This consensus study has established 26 essential elements for a video-based surgical coaching program in the UK. These results will inform a user-centered design of a video-based coaching pilot.
ThTP3.11 Abscess Incision and Drainage Under Local Anaesthetic: Greener, Faster, Cheaper
Authors: Innes Ailsa , Kammath Vipin , Arora Ankita , Ali Oroog , Dent Barry 
Published: August 2023

Abstract

Introduction
It is standard practise for incision and drainage (I+D) of abscesses in our general surgery department to be performed under general anaesthetic (GA), despite evidence that local anaesthetic (LA) drainage is safe and effective.

Aims
To evaluate the acceptability and environmental benefits of LA abscess I+D.

Methods
Data were collected for abscesses assessed from January-July 2022. Abscesses that were &gt;5cm, perianal/perineal, on multiple sites, or drained during another procedure were deemed unsuitable for LA. Questionnaires to evaluate patient opinions on sustainability were distributed to 26 patients requiring I+D from November-December 22. Carbon footprints were calculated using published carbon footprint estimates for patient travel and healthcare activity.

Results
130 of the 162 patients seen with abscesses underwent I+D, with 119 done under GA. Of those who had GA I+D, 71 were possibly suitable for LA. Of these 71 patients, 66 were done the following day, requiring admission or the patient to go home and return. The estimated additional carbon footprint of performing these procedures under GA was 1,806kgCO2e. 84% of patients surveyed thought it was ‘important’ or ‘very important’ that their procedure was cost effective, and 57% thought it was ‘important’ or ‘very important’ that their procedure was good for the environment.

Conclusion
Performing suitable abscesses under LA could save 3,096kgCO2e per year: equivalent to driving 19,000km. It would also save money, emergency list space and be more convenient for patients. It is important to many of our patients that their treatments are sustainable.
ThTP4.7 Laparoscopic Appendicectomy Consent Form Audit
Authors: Manson David , Jones Tabitha , McKnight Gerard , Morris Christopher , Poh Jian Zi 
Published: August 2023

Abstract

Aims
Surgical consent forms are difficult for patients to interpret. Surveys show that patients struggle to grasp surgical concepts. Procedure specific consent forms (PSCFs) improve surgical consent because they provide a standardised list of complications. However, PSCFs are nationally underutilised. Laparoscopic appendicectomies are one of the most common operations. Our aim was to assess the variability of appendicectomy consent forms in preparation for the inception of a PSCF.

Methods
A prospective audit on patients requiring laparoscopic appendicectomy. Their consent forms were assessed for legibility, abbreviations and complications included. Lastly, all were checked to see if the patient had been offered alternative treatment option in the form of antibiotics. Subsequently, each patient was contacted and asked a series of standardised questions.

Results
17 consent forms were assessed. 100% included infection and bleeding; 88% conversion to open; 82% bowel resection and damage to local structures; and 76% blood clots. 18 separate complications were used in total, with highly variable inclusion. Of the 17 forms 76% were legible, with 65% of them containing acronyms. 82% indicated that alternative therapies had been discussed. In the post-op questionnaire, approximately 80% of patients gave details surrounding their operation and what it entailed, however only 64% were able to successfully recall some of the basic potential complications. Interestingly, only 43% remember being given options on alternative treatments.

Conclusion
The use of PSCFs would be beneficial in standardising complication lists and also in ensuring patients are fully aware of alternative therapies.
ThTP4.9 Adherence to extended venous thrombo-embolism prophylaxis for post operative resection of colorectal malignancies
Authors: Yeung Thomas , Ng Sherwin , Sidhu Resham , Ali Muhammad 
Published: August 2023

Abstract

Aim
Patients undergoing cancer resection abdominal surgery are at high risk of developing venous thrombo-embolism (VTE) in the post-operative period. To reduce this risk, these patients should be considered for extended pharmacological VTE prophylaxis for 28 days post-surgery as per NICE guidelines (NICE NG89). In our surgical department, we give all colorectal cancer resection patients 5000 units of Deltaparin for 28 days post resection unless it is contraindicated. We aimed to evaluate adherence to this guideline.

Method
This is a single-centre retrospective audit study. We included 100 colorectal cancer resection cases between 1st October 2021 and 28th February 2022 (n=100). Retrospective data was collected including the type of procedure, histology and whether post-operative Deltaparin was prescribed for 28 days. All consecutive colorectal cancer resections were included in the study. The data was collected from the patient electronic records, electronic prescribing system and the electronic discharge summaries.

Results
The most common operation was anterior resection of the rectum (42%) followed by right hemicolectomy (40%). The Adherence to the NICE guidelines for extended VTE prophylaxis was 87%.

Conclusion
The adherence to the NICE guidelines in our department falls below the national target of 90% adherence. To improve the compliance, we will carry out staff education on appropriate anticoagulation prescribing and also display informative posters in the surgical wards to increase the awareness. We will aim to re-audit the adherence to the guidelines after implementing these measures.
ThTP6.1 Unplanned Admissions following Elective Laparoscopic Cholecystectomy Day Cases
Authors: Haidar Omar , Tabassum Tanzin , Kim Hyun-Kyung , Gupta Sanjay 
Published: August 2023

Abstract

Background
Laparoscopic Cholecystectomy (LC) represents a significant proportion of surgical caseload in the United Kingdom with over 50,000 operations per year (1). LC is recommended for patients with symptomatic gallstone disease (2). For appropriately selected patients, day case LC is recommended. British Association of Day Surgery (BADS) suggests a benchmark rate of 75% LC to be performed as day cases (3).

Aim
Retrospective audit of patient outcomes following elective day case LC, compared with national standards, to identify areas of improvements.

Method
Retrospective analysis of 100 elective planned day case LC at a District General Hospital between May 2021 - May 2022.

Results
29 out of 100 patients had unplanned admissions. The most common reason for unplanned admission was intraoperative drain insertion (20/29, 69%), with 85% of these drains removed day 1 or 2 post op. Higher ASA grade patients were more likely to have unplanned admissions; 12.5% of ASA 1 patients vs 32.2% of ASA 2 patients vs 41.2% of ASA 3 patients. Patients with unplanned admissions had higher rates of subsequent re-admission (4/29; 13.8%), compared with day cases (3/71; 4.2%).

Conclusion
Our audit found the majority of ‘failed day cases’ were a result of intraoperative drain insertion. Drain insertion did not instigate further interventions, but did lengthen patients' stay. BADS recommend avoiding routine use of drains in LC and state that they can also be removed on the day of surgery (3). Our audit also highlights that high ASA cases should be performed earlier in the operative list, allowing for more time for observation to aid same-day discharge.
ThTP6.2 Comparison of length of post-operative hospital stay following robot-assisted laparoscopic nephrectomies with traditional laparoscopic nephrectomies: a single-centre retrospective study
Authors: Trung Le Ha Bao , Park Eunsoo , Cheah Michael , Richards Colin , Wilson Ian 
Published: August 2023

Abstract

Aim
The study aims to compare the length of post-operative hospital stay following robot-assisted laparoscopic (RAL) nephrectomies with stays following traditional laparoscopic (LAP) nephrectomies at a district general hospital.

Method
This study retrospectively compares the post-operative length of hospital stay using information documented on patient’s paper notes scanned onto an online system. Between January 2021 and December 2021, 25 patients underwent LAP nephrectomies in this unit. Following the introduction of RAL at our unit, all patients requiring a nephrectomy had this procedure done using RAL. Between January 2022 to November 2022, 33 patients underwent a RAL, 3 of which required conversion to open and excluded from this study. Additionally, data on age, BMI, tumour size and ASA score was collected to identify any evidence of systemic bias.

Results
Mean post LAP hospital stay was 3.60 (±3.24) nights, while post RAL was shorter at 2.07 (±1.44) nights to a statistically significant degree (p-value=0.0357). There was no significant difference in any of the demographic factors between the two groups (LAP and RAL). When including data for partial nephrectomies (n=20; LAP=11, RAL=9) and pyeloplasties (n=9; LAP=5, RAL=4), length of post-operation hospital stay was still significantly shorter for patients who had undergone robot-assisted laparoscopy. Mean post-LAP hospital stay was 3.56 (±2.62) nights, while post-RAL was shorter at 2.21 (±1.68) nights to a statistically significant degree (p-value=0.00666).

Conclusions
The use of robot-assistance during laparoscopic nephrectomies was associated with significantly shorter post-operative hospital stays over traditional laparoscopic procedures in this cohort of patients.
ThTP7.8 Laparoscopic to Open Conversion in Malignant Colorectal Cancer Resections (CRC): A 15-year cohort study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A 
Published: August 2023

Abstract

Aims
Colorectal cancer is 3rd most common & 2nd leading cause of cancer deaths. Laparoscopic resection has evolved as main surgical technique in management of colorectal malignancies (66 % NBOCA 2022). Laparoscopic to open conversion is reported in &lt; 21 %. Aim of study is to assess implications of laparoscopic to open conversions.

Methods
Single-centre cohort study was carried out from January 2008 to February 2023; with evaluations postoperative outcomes in laparoscopic to open conversions. Laparoscopic and open colorectal CRC resections were recruited as controls.

Results

Conclusion
Over 15 years, lap-open conversion rate was 12.1 %. Lap-open conversions had higher BMI’s, prolonged operations & hospital stay (p &lt; 0.05.), but this did not adversely affect survival. Lap-open conversion should not be deemed as failure of laparoscopic surgery but as implementation of safe surgery in presence of intra-operative challenges.
ThTP7.10 Does robotic anterior resection improve the outcomes for patients with rectal cancer over standard laparoscopic surgery?
Authors: Nwabueze Maureen , McPherson Symon 
Published: August 2023

Abstract

Background
Currently, laparoscopic anterior resection (L-AR) is the standard approach for rectal cancer (RC) treatment. Increasingly, AR procedures have been conducted robotically using the Da Vinci Surgical System (DVSS).
Its design has the potential to improve upon the operative outcomes of L-AR. However, the DVSS’s controversial price of $2,000,000 has slowed its clinical adoption. There has been speculation as to whether the clinical outcomes conferred by robotic-assisted AR (R-AR) merits the cost of the DVSS.

Aims
To review the literature on R-AR and L-AR surgery for RC, primarily comparing the clinical outcomes of each approach, with an auxiliary evaluation of cost-effectiveness.

Methods
A literature search was performed using the databases OVID Embase, MedLine, and Web of Science. The keywords ‘anterior resection’, ‘rectal neoplasm’, ‘robotics’, ‘robotic surgical procedures’, and ‘laparoscopy’ were entered into each database.
141 records were initially retrieved and screened for relevance. The remaining texts that were fully available and adhered to the eligibility criteria were included in this review.

Results
Ten studies were identified. R-AR resulted in higher quality TME specimens in three studies, (p=0.02, 0.03, 0.033). and in shorter hospital stays and longer operative times in four studies: (p=0.03, 0.0001&lt;, 0.001&lt;, 0.001). Overall, R-AR had lower rates of intraoperative complications.

Conclusions
Generally, R-AR seemed to deliver better outcomes, but there is insufficient evidence to establish its superiority over L-AR. Longitudinal studies with extended research periods are required to evaluate the long-term oncological benefits of R-AR.
ThTP7.11 Comparison of oncological outcomes of patients having colorectal surgeries: During lockdown vs post lockdown
Authors: Gowda Manoj Srinivas , Mesut Erel , Peter Bennett , Venkatesan Gowtham , Thulasiraman Sri , Jha Madan 
Published: August 2023

Abstract

Aims
When the UK entered the lockdown, the cancer pathways changed to deal with the pandemic and protect cancer patients from infection. The objective of our study is to compare the oncological outcomes of patients having surgery for colorectal cancer (CRC) during and after lockdown.

Methods
Patients who underwent surgery for CRC between March-2020 to February-2022 were included in the study. All patient related and disease specific details were collected from the prospectively maintained database. Patients were divided in to two groups: Surgeries before (group-A: during lockdown) and after 22/2/21 (group-B: after lockdown). Patient demographics such as age, tumour and nodal staging, and survival outcome was calculated. Log-rank test and Kaplan-meir survival curve was used to analyse the survival outcome.

Results
A total of 450 patients underwent surgeries during this period, of which 358 had cancer resections. During lockdown 171 patients had cancer resections (Group-A) and 187 patients had surgery for cancer after lockdown (Group-B). The median age of patients is 72 and 73 years in group-A and B respectively(p-value:0.29). There is no difference between the two groups with respect to tumour and nodal staging. In group-A, 13 patients had recurrence and 26 died due to disease with a median follow up of 23 months. In group-B, 22 patients had recurrence and 18 died due to disease with a median follow up of 13 months (p-value:0.42 log rank test).

Conclusions
The patients undergoing treatment of CRC during lockdown had similar oncological outcomes compared with patients having treatment after the lockdown.
ThTP8.4 What is the longer-term impact of emergency laparotomy for older people living with frailty? A mixed-methods study protocol
Authors: Price Angeline , Smith Johnathan , Pearce Lyndsay , Martin Peter , Griffiths Jane 
Published: August 2023

Abstract

Introduction
A third of emergency laparotomies performed in the United Kingdom (UK) are in older people living with frailty (OPLWF). Despite high risk of adverse clinical outcomes for this group, there is a lack of research into patient experience. Longer-term outcomes have also not been fully explored. This data is essential in enabling informed shared decision making and robust post-operative care tailored to the holistic needs of this group.

Study aim
This study aims to understand the impact of emergency laparotomy for OPLWF in two ways. Qualitative interviews will explore patient experience following surgery. A retrospective analysis of the National Emergency Laparotomy Audit (NELA) database will examine longer-term outcomes including death and hospital readmission.

Methods
Phase One: 30 participants (≥ 65yrs, CFS ≥ 5) are being recruited from hospital sites across the UK to undertake interviews within one month of surgery. Data is being analysed using thematic analysis. The results will enable targeted data collection in phase two.
Phase Two: 12 participants (≥ 65yrs, CFS 5/6) will be recruited to undertake interviews at 3-, 6- and 12-months. Longitudinal Interpretative Phenomenological Analysis will facilitate in-depth understanding of lived experience following surgery.
In the NELA analysis, the primary outcome measure will be time to all-cause mortality, secondary outcome measure will be time to hospital readmission.
The results from phase one are expected by April 2023.

Discussion
This study will provide much needed knowledge of longer-term impacts of emergency laparotomy for OPLWF, informing future service delivery and providing context to shared decision-making