bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP6.6 Improving Opioid Stewardship in General Surgical Practice
Authors: Reid Rebecca , Vijayagopal Kesav , Htet Win , Butler Rebecca , Wilson Jeremy , Magee Conor 
Published: August 2023

Abstract

Aim
The last 30 years has demonstrated a steady increase in drug-related deaths, with opioids implicated in at least 2,219 deaths in 2021 in England and Wales1. Inpatient opioid prescribing in surgery has been demonstrated to correlate with long-term use post-discharge2. We aim to improve opioid stewardship at our DGH to reduce ‘opioid-load’ in the community, thereby reducing likelihood of long-term post-operative use.

Method
Intervention included teaching for junior doctors, audit meeting presentation and posters designed collaboratively with acute pain team. Prospective data collected for 92 patients discharged from general surgery from October 2022 and compared to previous data pre-intervention from June 2020. Opioid prescriptions were converted to Milligrams of Morphine Equivalence (MMgEq) for analysis.

Results
Following intervention, max average 58.64 MMgEq/day compared to 85.88 MMgEq/day previously. Max PRN prescription now 49.77 MMgEq/day compared to 57.18 MMgEq/day. Increased involvement of acute pain team (15.9% to 20%) and improved use of multimodal analgesia (PCA - 3% to 13%, NSAIDS - 2% to 16.5%, rectus sheath blocks – 1% to 4.2%). Discharge prescribing also improved; only 57.6% discharged with opioids, 89% had documented plan for GP and 49% had specific duration.

Conclusions
Our results demonstrate marked improvement in surgical opioid prescribing. There is potential for further improvement including introduction of opioid misuse risk calculator and formalising opiate prescribing guidelines in surgery.
1 ONS. Deaths related to drug poisoning in England and Wales: 2021 registrations. August 2022
2 Vijayagopal et al. (2022). SP1.1.4 Caveat Chirurgicus - Opioid use following surgery. British Journal of Surgery. 109.
ThTP6.7 Are we getting it right first time: a three hundred patient audit of operation note documentation
Authors: Ibrahim Mohamed , Shirsath Sayali , Tari Paniz , Dogan Mehmet , Shakir Taner , Jose Paul 
Published: August 2023

Abstract

Aims
Collaborative recommendations from the RCS, ASGBI, and GIRFT have been published regarding documentation for inguinal hernia repair, laparoscopic cholecystectomy and appendicectomy. This is built upon foundations which aim to mitigate litigation. A series of recommendations have been made to ensure the most salient points are covered. We retrospectively audited documentation in our local unit.

Methods
Data was retrieved from electronic medical records for operation notes coded to inguinal hernia repair (laparoscopic or open), laparoscopic appendicectomy and laparoscopic cholecystectomy at our District General Hospital. Documentation was evaluated according to the 26 point GIRFT Best Practice recommendations. Data collected was grouped into standard RCS note taking conventions: pre-operative, incision, findings, procedure, closure and post-operative.

Results
300 electronic operation notes were collated from medical records for a period spanning four months. The majority (71%) of notes were written by registrars. Overall compliance with documentation for pre-operative and incision groups were 40% and 65% respectively. Documentation rates for operative findings were 60% and procedural technique was 48%. Adherence to recommendations for closure and post-operative plans were 75% and 59% respectively. Subgroup analysis revealed 96% compliance in sections which were built into the electronic operation note template compared with 44% of free text responses.

Conclusions
Documentation plays a pivotal factor in preventing litigation. We have identified inconsistencies in our local unit with regards to common general surgical procedures. Templated fields improved adherence to recommendations by over two fold. With digital operative notes becoming more commonplace, questions are raised as to whether documentation should adopt a partially templated format.
ThTP7.5 An Assessment of Outcome in Patients with Anaemia (Iron Deficient and Non-Iron Deficient) Who Have Colon Cancer - Effect of treatment with Oral / IV Iron
Authors: Sukumar Aiswarya , Khan Kashuf , Khalid Wardah , Singh-Ranger Deepak 
Published: August 2023

Abstract

Aim
Treatment of iron deficiency anaemia in patients undergoing colon cancer resection improves outcome defined by length of stay (LOS), recurrence and requirements for blood transfusions.

Method
Retrospective analysis of patients with anaemia and colonic cancer between January 2018 - August 2019. Anaemia categorised as – Iron Deficiency Anaemia (IDA) and Non - Iron Deficiency Anaemia(non-IDA). IDA was defined as hypochromic microcytic anaemia. Patient demographics, tumour location, pre- and post-operative haemoglobin, LOS, recurrence, requirement for blood transfusions and treatment for anaemia were collected. Comparisons made between IDA and non-IDA groups in relation to treatment for anaemia with iron (oral/IV). Non-parametric statistical tests used (median, 2-way ANOVA, Kruskal-Wallis) with significance at P &lt;0.05.

Results
150 patients with colonic cancer identified: 77 in IDA group, 46 treated (42 oral, 4 iv iron). 11 in non- IDA group, 8 treated (oral iron).
IDA oral and IV treatment versus non-IDA:
Median age 74, 80 and 78 years (P = 0.814),
Pre- and post op Hb IDA vs non-IDA: 107, 97; 109, 101 (P 0.007 significant),
Requirement for blood transfusion (units) 0.77, 0.50;0.90 (P 0.596)
Length of Stay (days) 6, 5; 7 (P 0.113),
Tumour location: mean of right colon and transverse colon 24.33, 3.667 (P &gt;0.1), and
Recurrence P &gt;0.1.

Conclusion
In our series, iron treatment does not influence recurrence, LOS, blood transfusion requirements. Tumour location is not significantly different between IDA and non-IDA groups. Patients treated with oral iron are seen to have a larger drop in haemoglobin post operatively than the other groups.
ThTP7.6 COLORECTAL SURGERY VIRTUAL WARD, AN ADJUNCT TO ERAS GUIDELINES
Authors: Ullah Muhammad Fahad , Singh Baljit 
Published: August 2023

Abstract

Enhanced Recovery after Surgery (ERAS) guidelines provide enhanced recovery protocols after Colorectal Surgery, resulting in reduced morbidity and length of stay without readmissions. A digital way of achieving this will be via Virtual Wards, which offer the use of wearable technology for symptoms and signs utilizing scoring systems at the comfort of home resulting in early discharge. Although the technology exists and is being implemented in many places no specific surgical scoring system has been developed or validated to monitor specific postoperative parameters at home. We offer “a colorectal virtual ward model” with a dedicated scoring system to virtually monitor patients at home and reduce 30 days readmissions. Secondary aim of our project is accelerated discharges in line with ERAS.

Method
A novel “Leicester Virtual ward model” was developed after a literature review. Pre tested scoring systems to categorize the common 1st 30 days post complications were merged with modified NEWS score. A software was designed utilizing a warning system to handle red flags or a combination of different green, red and amber scenarios. Patients will be trained and sent home with gadgets and app based questionnaire for daily monitoring.

Results
In the initial phase the virtual ward is being used to reduce readmission rates. In the second phase it will be used for an accelerated discharge of patients allowing remote monitoring with telephone/virtual or face to face advice as needed.

Conclusion
Virtual wards will be a technology-based solution to increase compliance with ERAS by providing support and outpatient surveillance.
ThTP8.8 Ambulatory management of acute pancreatitis
Authors: Wijeyaratne Manuk , Miller Madoc , Claxton Mary , Vaughan-Burleigh Sebastian , Hollyman Marianne 
Published: August 2023

Abstract

Aim
Acute pancreatitis is a common pathology with a spectrum of disease from mild to life-threatening. It is standard practice for all patients to be admitted due the inability to accurately predict severity. However, both considering the wellbeing of patients and pressures on acute hospitals, it may be the time to consider the role of ambulatory care.
We retrospectively reviewed patients with pancreatitis managed ambulatorily, and assessed for trends in their presentation.

Methods
Retrospective review of a prospectively maintained database between 2019-2022 identifying patients with acute pancreatitis with initial ambulatory management.

Results
There were 19 cases of pancreatitis with planned ambulatory management, with only one representing and requiring admission for 36 hours for symptom control.
Of those who had successful ambulatory management, 12 were male (67%). Median age was 55 (range 24-81). Median duration of symptoms at time of review was 5 days (range 1-21). Median number of comorbidities was 1 (0-6), with only a third (6/18) reporting no comorbidities. Median CRP was 11 (&lt;1-153) and WCC 9 (3-25); no patients had acute kidney injury. All patients had a NEWS&lt;2. All but two patients (with a background of pancreatitis) had imaging performed in an ambulatory setting; five had CT scans.

Conclusion
Patients successfully managed ambulatory were a very heterogeneous group. Our data would support that trial of ambulatory management can be considered in the absence of organ failure (renal function, or physiological instability). This should be supported by adequate safety netting, and plans for further review as appropriate.
ThTP8.11 Team-Based Discussions to Improve Preoperative Protocol Adherence in NELA Patients: A Quality Improvement Project
Authors: Aftab Muhammad , Omran Kareem , Wheatstone Sarah 
Published: August 2023

Abstract

Aim
To analyse the success of a quality improvement project (QIP) performed to improve emergency laparotomy outcomes in a tertiary hospital between NELA Year 7 and Year 8 (12/2019-11/2021).

Methods
NELA Year 7 results were presented at local meetings; following multi-disciplinary involvement, a PDSA cycle was initiated. A dedicated NELA team was established and NELA-related discussions at surgical and anaesthetic junior doctor inductions were implemented. Further, Pre-operative Care for Older People undergoing Surgery (POPS) staff were included at monthly morbidity-and-mortality meetings. We retrospectively analysed Year 7 results (156 cases) against Year 8 (162 cases) of NELA Annual Reports.

Results
Risk documentation before surgery significantly increased from 58% to 72%. Arrivals in theatre appropriate to urgency increased from 79% to 82.9%. Post-operatively, rates of unplanned admissions to critical care decreased by 40% in Year 7 relative to Year 8 (2%-1.2%). NELA mean patient length-of-stay (LOS) and risk-adjusted mortality rates were unchanged (26 days,5.5% respectively). Rates of unplanned returns to theatre increased (5%-6%).

Conclusions
This QIP displays the success of low-cost team-based interventions in significantly increasing adherence to preoperative protocol. We propose implementation of NELA-related discussion at GI-surgery trainee inductions nationally. Although successful, further changes must be considered to reduce LOS and mortality rates. NELA scores have since been incorporated into the WHO checklist and we plan to implement special discussions related to long-staying patients during ward round meetings, aiming to analyse the success of this PDSA cycle in Year 9.
ThTP8.12 Introduction of a Physician Associate (PA) led surgical ambulatory emergency clinic (SAEC) in the Highlands of Scotland
Authors: Seehafer Frances , El-Hakim Hesham , Grant Alan 
Published: August 2023

Abstract

Aim
The delivery of surgical care in the Highlands has changed. SAEC was developed to alleviate bed pressures, improve patient satisfaction and avoid unnecessary workload. We aim to identify whether SAEC is alleviating pressures in the surgical inpatient department - is it used appropriately and cost effectively.

Methods
Attendance was collected prospectively (1/9/22 to 31/10/22) using a dedicated data audit book and booking diary. Patient’s individual review outcomes were gathered.

Results
Of the 165 patients referred to SAEC, 90% were reviewed by the PA, 10% only by the consultant. On average, 3.7 patients were seen per day. The referral reasons were wide ranging: 64 referrals for abdominal pain in addition to abscesses, constipation, weight loss, vomiting, stoma reviews and more. The age of patients ranged from 20-91. 61% were female. 46% had a scan. 85% received a diagnosis. 93% received definitive management. No patients made an unplanned re-presentation within the week following their review. The average time spent in SAEC per patient was 2 hours 48 minutes. 17% of patients were admitted, preventing 116 admissions. This saved approximately £45,820 through admission prevention. In addition, approximately a further £47492 was saved as this was PA led rather than consultant.

Conclusion
Prior to the employment of a PA, SAEC did not provide a consistent service, brought all patients to its surgical ward and required employment of a second consultant. SAEC has improved patient flow and increased bed capacity whilst providing safe and high-quality care that is cost-effective.
ThTP8.13 The international PIACO study: pattern of surgical approaches for acute surgical pathologies in Spain versus UK. Was conservative treatment and open surgery during COVID-19 the way to go?
Authors: Lathan Ross , Gualajara Hector , Yiasemidou Marina , Lockwood Sonia , Chetter Ian , Garcia-Olm Damian 
Published: August 2023

Abstract
A multicentre, comparative, international study was conducted in 16 centres in Spain and four in the UK, aiming to assess the impact of the COVID-19 pandemic and associated public health measures, on presentation and management of acute surgical pathologies.
Overall, 2181 cases were analysed (Table 1). A significantly lower percentage of mild cases of appendicitis presented during the pandemic in Spain and the UK, compared with the same time interval a year before (2020, 466 (57.7 per cent); 2019, 882 (65.2 per cent), P &lt; 0.001. Surgery was less frequently employed during the pandemic (509 (62.3 per cent) versus 921 (68 per cent), P = 0.007). When it was employed, it was significantly less frequently laparoscopic (251 (70.1 per cent) versus 622 (90.8 per cent), P &lt; 0.001).
The independent predictors of non-surgical treatment of appendicitis and cholecystitis were presenting in the UK (appendicitis OR0.026, P &lt; 0.001; cholecystitis, OR0.148, P=0.031), non-severe condition at diagnosis (appendicitis OR 11.433, P = 0.036; cholecystitis OR7.944, P=0.022) and a COVID-19-positive diagnosis (OR 0.142, P &lt; 0.001). Predictors for open surgery were presenting in the UK (OR 0.152, P &lt; 0.001) and COVID-19-positive status (OR 0.112, P = 0.002). There were no differences in mortality between the two years. Severity at diagnosis was the only independent predicting factor for major complications (OR 3.148, P = 0.003).
This study demonstrates a shift towards conservative treatment and open surgery during the first wave of the COVID-19 pandemic. Surgical treatment did not correlate with higher complication rates; indicating that surgical treatment may have been as safe as conservative treatment during COVID-19.
ThTP8.14 Microbiology pus swab sampling in incision and drainage of abscesses
Authors: Paul Melanie , Redfern Victoria , Sellicks Jemima , Lund Jon , Tierney Gillian 
Published: August 2023

Abstract

Background
Obtaining microbiology swabs during emergency incision and drainage (I&D) is commonplace for general surgeons. Its necessity is controversial but despite this, abscess swabbing is still routine despite little evidence of follow up of results.

Methods
All abscess I&D procedures admitted to Surgical Assessment Unit (SAU) at RDH over the period of 3 months from May 2022 to June 2022 were reviewed. Data collection included demographics, admission white cell count (WCC), C-reactive protein (CRP) levels, temperature and co-morbid status as well as any perioperative antibiotic regime.

Results
97 patients underwent I&D either under local or general anaesthesia. The most commonly encountered abscess site was perianal (20%) followed by pilonidal (13%). 22% were admitted on antibiotics started elsewhere. 71% had a recorded microbiology swab taken. 59% of microbiology swabs demonstrated no significant growth. 2 swabs (3%) grew MRSA. There was no documented evidence of GP or patient information of this result. 11 patients who were admitted with a temperature of ⩾ 37.5°C (11%); 7 (64%) grew a named organism on pus sampling. 12 patients had a WCC ⩾13 x109/L, and samples were sent in 9. 6 patients grew the following; mixed anaerobes, E.coli, Citrobacter, and Gram positive cocci.

Conclusions
Microbiology pus sampling for I&D cases is performed ad hoc and results are not routinely chased. For well ambulatory patients I&D can be performed without the need for pus swab sampling at surgeon discretion. If it is performed there should be named clear instruction on follow up of the outstanding results.
FTP1.10 Analgesic Management of Traumatic Rib Fractures on the General Surgery Take in a Non-Trauma Unit
Authors: Ling Quake Ms Sharmaine Yen , Nasser Dr Ibrahim , Hewitt Dr Peter , Walls Mr Martin , Subramonia Mr Sriram 
Published: August 2023

Abstract

Aims
To evaluate the analgesic prescription for inpatients with rib fractures

Methods
Patients (18 years or over) who were admitted with rib fractures and underwent imaging between August 2021 and September 2022 were identified from a prospectively maintained radiology database. Those discharged or transferred to a tertiary centre were excluded. Analgesic prescription, pain scores and referral to specialist services were retrieved from a prospectively maintained electronic patient record system (Meditech, Version 6, USA).

Results
Type of analgesia Percentage of patients receiving prescription (%) Paracetamol 100% NSAIDS 29% Weak opioid (codeine/ tramadol) 54% Strong opioid 100% Patient controlled analgesia 17% Thoracic epidural 4% Regional anaesthesia blocks 0%

Conclusions
The current practice of multimodal analgesic prescription for inpatients with rib fractures needs improvement.
FTP1.13 Improving the use of chest drains in trauma - Small but perfectly formed
Authors: Awadalla Marina , Marsden Max , Mohammed Mohammed , Bernard Fiona , Sasikumar Sivanantham , Nikolopoulos Ioannis 
Published: August 2023

Abstract

Aims
The Western Trauma Association (WTA) advocates using small-bore chest drains (e.g. 14Fr) in haemodynamically normal trauma patients for management of small Haemothoraxes (HTX) or Pneumothoraxes (PTX). This quality improvement project aimed to assess implementation of this guidance.

Method
We compared the use and outcomes of small-bore chest drains for management of HTX or PTX before (Cohort 1) and after (Cohort 2) adoption of WTA recommendations in a District General Hospital in London. We included all patients admitted under the General Surgeons with rib fractures.

Results
All patients were admitted with blunt chest injuries. Cohort 1: 60 patients [36 males, mean age 72 years (range 31-96)] admitted from May–December 2021. Cohort 2: 77 patients [42 males, mean age 73 years (range 23-102)] admitted from May–December 2022.
In cohort 1, 10 patients (16%) required chest drains, all were surgically inserted large-bore drains (median size 28 Fr) there were no peri-procedural complications.
In cohort 2, 11 patients (14%) required chest drains; 5 were surgically placed large bore drains (median size 28 Fr) and 6 were small-bore drains inserted by Seldinger technique (median size 18Fr). Two large-bore drains had periprocedural complications and both required re-insertion. The mean age was 60 years. In the small-bore group there were no peri-procedural complications, no drains occluded and the mean age was 75 years.

Conclusion
After the implementation of this policy, small-bore drain use increased and appeared safe. This audit supports recent literature suggesting small-bore drains are as effective as larger bore and better tolerated.
FTP2.7 Omental-derived Stromal-vascular Cell Fraction / Alginate Gel Composite Vs Control to Improve Murine Colonic Anastomotic Leak Rate – M-OMENTUM Randomised Controlled Study
Authors: Burke Joshua , Maisey Thomas , Wong Jason , Quyn Aaron , Herrick Sarah , Jayne David 
Published: August 2023

Abstract

Aim
Colorectal anastomotic leak (AL) remains a significant challenge. The M-OMENTUM study compared omental-derived stromal-vascular cell-fraction (OSVCF) / alginate gel composite vs control subgroups to prevent murine AL.

Methods
C57BL-6 mice were subjected to an AL model with a leak rate (LR) of 40% and randomised (1:1) to OSVCF / alginate gel or control subgroups (gel alone and no treatment) powered to detect a 20% minimum difference (50% absolute reduction in LR); HO Licence PP9886008. Mice underwent laparotomy and colo-colonic anastomoses. In the intervention group, OSVCF was harvested and applied to the anastomosis in an alginate gel. Mice underwent schedule 1 killing at day 7 or earlier if they failed to meet wellness thresholds. The primary outcome was LR. Secondary outcomes included leak severity, weight, and adhesion score. An intention-to-treat analysis was performed.

Results
128 mice (M:64/F:64), mean age 13.1 weeks (SD,1.2), mean weight, 24.1g (SD,4.3) were randomised. OSVCF/Gel containing mean 3.3x103cells/mg (SD,0.3x103) was applied in the intervention group. Overall LR was 49.2%. There was a numerical difference in LRs between the intervention group (30/64, 46.9%) and control groups (33/64, 51.5%) with a LR reduction of 9.1% (RR 0.91 [95%CI:0.64-1.69]; P=0.72). 12/33(36.4%) that received gel alone and 5/33(15.2%) that received no treatment developed an abscess rather than feculent peritonitis (RR 2.26 [95%CI:1.11-5.20]; P=0.04).

Conclusions
OSVCF/gel produced a 9.1% reduction in LR, but this did not reach statistical significance. The application of gel to an anastomosis alters the severity of anastomotic leak, favouring abscess formation rather than faecal peritonitis.
FTP2.8 The impact of implementation of a colon capsule endoscopy (CCE) service on demand for lower GI endoscopy: A retrospective analysis in a large district general hospital
Authors: Callan Rory , Leong Wei Sheng , Freed Ebru , Malik Kamran 
Published: August 2023

Abstract

Aims
Demand on endoscopy services have increased due to higher numbers of 2WW referrals and the COVID-19 backlog. Alternatives to endoscopy including CT colonography and colon capsule endoscopy (CCE) have been seen as a way to reduce pressure on endoscopy services. Our centre implemented a CCE service, for patients referred via 2WW colorectal pathway with FIT of 10-100μg Hb/g, or undergoing surveillance. We analysed the impact of this service.

Methods
We retrospectively analysed patients referred for CCE, from initiation of the service in July 2021 to October 2022. We analysed presenting symptoms, findings at CCE, completion of CCE, and further investigations/treatment required. A total of 198 patients were included.

Results
68% (134/198) of CCE were complete, defined as full visualisation of the large bowel through to the anus. 66% (89/134) of these required no further investigations. Of those patients requiring further investigations, 21 underwent flexible sigmoidoscopy, 15 underwent colonoscopy and 6 underwent CT-AP. Only 1 required an operation for malignancy. Of the 64 patients with incomplete CCEs, 63 underwent further investigations, mostly endoscopic (17 colonoscopies, 31 flexible sigmoidoscopies).

Conclusions
The implementation of a CCE service resulted in 94/198 patients not requiring endoscopic investigations over a 14 month period, highlighting the role for CCE in reducing endoscopy demand. However, there was a high rate of incomplete procedures (32%). With a higher rate of completion, a greater number of endoscopies could be avoided, further reducing the pressure on endoscopy departments.