bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP3.12 Green Surgery: Save the Suture, Save the Future
Authors: Ong Chon Sum , Rahman Khandakar Rezwanur , Saqib Muhammad Waleed , Jesudason Edwin 
Published: August 2023

Abstract

Aim
To reduce the number of unnecessary openings of suture packs and suture wastage to reduce environmental, social, and financial costs in general surgical procedures.

Method
A prospective audit was conducted at a District General Hospital by collecting data on the number of suture packs opened and unused for general surgical procedures for 2 weeks in November 2022. The intervention was done by raising awareness using posters and sustainability education. The data was collected again for 2 weeks and analysed using GraphPad Prism.

Results
For laparoscopic surgery, there was a reduction in redundant suture packs opened (P=0.86) and subsequently unused (P=0.86) but the result was insignificant. In contrast, for open surgery, the reduction in the suture pack opened (P=0.028) and subsequently unused (P=0.034) was significant. The financial savings were extrapolated to be £2799 yearly. The yearly environmental savings including transport and waste incineration totalled approximately 367kg CO2e. The survey used for social impact showed improved staff sustainability awareness and the development of new sustainable practices.

Conclusions
The health sector is pivotal to mitigate climate change due to its responsibility for 4-5% of global greenhouse gas emissions. The building of a global regime for the mitigation of climate change is vital but the small scales of positive action like reducing suture wastage need to also be encouraged. The emergence of a polycentric system to reduce greenhouse gas emissions will become the inspiration for the national ambition of delivering a net zero NHS.
ThTP4.2 Complications Following Emergency Colorectal Cancer Resections: A single centre cohort Study
Authors: Gok M A , Mughal H N , Bughio M , Khan U A 
Published: August 2023

Abstract

Aims
Colorectal Cancer (CRC) is 3rd prevalent & 2nd lethal malignancy in UK. Emergency CRC presents &lt; 30% cases (NBOCA 2022) & associated with high post-operative morbidity & mortality. Aim of study is to assess post-operative complications in emergency CRC resections.

Methods
A cohort study carried out from Jan'08 to Feb'23, post-operative surgical outcomes were evaluated in emergency CRC resections. Elective CRC resections recruited as controls.

Results

Conclusion
Emergency CRC resections had higher ASA 3. There was a greater early post operative mortality rate, but no difference in post operative complications & anastomotic leakage. However, emergency CRC resections was associated with prolonged hospital stay (p &lt; 0.001) & poorer survival rates (Logrank p &lt;0.0001) (worse in perforated cancers). Emergency CRC presentations remain a challenge, accounting for 20% of all CRC’s for the last decade. Therefore, our study supports prompt diagnosis and early intervention of emergency CRC mitigate the poor survival.
ThTP4.4 Textural Analysis as a Predictive Biomarker in Rectal Cancer
Authors: Alrahawy Mahmoud , Aker Medhet , Issa Mohamed , Noureldeen Khaled , Gaber Ahmed , Zeinaldine Ashraf 
Published: August 2023

Abstract

Background
Colorectal cancer (CRC) is common and accurate staging enhances a better prognosis. Pelvic MRI is the gold standard for Rectal cancer staging. Textural analysis (TA) is a radiomic process that quantifies lesions’ heterogenicity by measuring pixel distribution in digital imaging. MRI TA of rectal cancer images is considered a future predictor of its outcomes. This review summarizes the potential role of TA in rectal cancer’s prognosis.

Methods
Searches were done using Medline, Embase, and PubMed. Only English articles and human studies were included. Key findings and future research suggestions were highlighted to delineate the gap in TA use.

Review analysis
Some studies established a correlation between TA and rectal cancer outcomes, such as treatment response, survival, and distant spread.
Research showed that TA of MRI could differentiate complete from partial responders to Neo-adjuvant radio-chemotherapy. The response was higher in the mid-treatment MRI but lower in the pre-treatment.
The pre-and post-treatment MRIs were significant markers of overall survival, disease-free survival, and relapse-free survival in Locally Advanced Rectal Cancer patients.MR morphological features showed the ability to define either local or distant recurrence.
TA showed an ability to predict liver metastasis in CRC; Entropy and uniformity were significant predictors of patients’ liver metastases compared to patients with normal liver.

Conclusion
Medical images TA could predict important clinical outcomes in rectal cancer; eventually, this could change rectal cancer management into more personalized treatment options (watchful waiting). More prospective and randomized trials are mandatory to overcome TA standardization challenges.
ThTP4.6 Which FIT level is fit for purpose?
Authors: Oyewole Bankole , Sacaleanu Maria , Song Mosea , Elgharably Noura , Elwes Caitlin , Animasahun Victor 
Published: August 2023

Abstract

Aims
To assess the diagnostic performance of faecal immunochemical test (FIT) in patients referred under the two week-wait (2WW) pathway and to test colorectal cancer (CRC) detection thresholds.

Methods
All patients referred under the 2WW pathway for a study period of 2 months were identified; referring symptoms, FIT levels, investigations and final diagnosis were collected via the electronic patient records. Exclusion criteria were patients who were not under the 2WW pathway, patients without FIT, those that declined or unfit for further investigations. Data was anonymized and analysed using the SPSS software.

Results
438 patients were referred to the colorectal team during the study period, 335 patients (157 males and 178 females) met the inclusion criteria, age range 25-93 years, mean age 69.33 years (SD 12.66).
14 patients had a final diagnosis of colorectal cancer.
All 14 patients had a FIT &gt;6.9 (p 0.012), that was also the case with a FIT of 10 and above (p 0.002) which had a stronger association, FIT test 11 and above, 15 and above and 20 and above being the positive threshold detected 13 of 14 patients with CRC with a p value 0.008, 0.002 and 0.001 respectively.

Conclusions
Our data shows that a FIT threshold of 10 and above detected all patients with CRC and even a slight increase of the threshold to 11 missed 7.1% (1/14) of patients with CRC. Hence patients with ‘slightly positive FIT’ should be considered for further investigations if appropriate.
ThTP4.8 Day 1 post-operative discharge following RAS Colorectal Cancer Resections; exciting potential in helping solve the NHS bed crisis
Authors: McGuire Carina , Khopekar Faid , Saldanha James , Komolafe Segun , Maxwell Fraser 
Published: August 2023

Abstract

Aims
The NHS is under significant bed strain. Optimising safe, early discharge of elective patients post-operatively should form part of the response to these pressures. We present the results of a single centre retrospective study looking at day 1 post operative (PO) discharge and 30 day readmission rate (RR) in patients who had undergone robotic assisted (RAS) colorectal cancer (CRC) surgical resection.

Methods
Using the hospital’s theatre database, we identified all RAS CRC resection patients from 2nd May 2022 until 17th January 2023. We documented PO LOS using data from ‘Trakcare’ and separated those patients discharged day 1 from those discharged &gt;day 1 to compare RR.

Results
The median LOS for patients undergoing RAS CRC resections (n=56) was 3 days with a bimodal distribution (1,2). 19.3% (n=11) of patients were discharged on PO day one. 1 patient from this cohort was readmitted within 30 days representing a 9.1% RR. From those patients discharged after day 1 (n=45), 5 were readmitted representing a 11.1% RR. All readmissions from both cohorts were managed at ward level.

Discussion
Our study shows that PO day one discharge of RAS CRC resection patients results in a decreased rate of 30 day readmissions compared to those discharged later than day one. It has not traditionally been the practice within our heath board to consider discharge within 24 hours of CRC resection. We hope this practice, as demonstrated in our robotic patients, can be considered and may help increase bed availability at our hospital and elsewhere.
ThTP4.13 Discrepancy between preoperative MRI staging and post-operative histopathology staging in rectal cancer patients who had primary surgery. A retrospective study at a District General Hospital
Authors: Wani Ishfaq , Husain Namaj , Thomas Pradeep , Alam Abu , Narayanasamy Sangara 
Published: August 2023

Abstract

Aim
The aim of this retrospective study was to analyse the discrepancy between preoperative MRI staging and post-operative histopathology staging of rectal cancer patients who had primary surgery.

Methods
A retrospective cohort study analysed the records of 47 patients with histology confirmed rectal cancer over the period of 5 years from 2017 to 2022. Data was collected from the hospital database.

Results
Forty-seven patients were evaluated. The mean age of presentation was 72 years. Out of 47 patients 65.95% (n=31/47) were men; 34.05 % (n=16/47) were women. Discrepancy in T staging and N staging were found in 44% (n=21/47) and 49% (n=22/45) patients respectively. Two patients had inconclusive N staging on preoperative MRI. In T stage discrepancy, 86 % ( n=18/21) were upstaged and 14% (n=3/21) were downstaged. In N stage discrepancy, 73%(n=16/22) were upstaged and 27% (n=6/22) were downstaged.

Conclusion
There was significant discrepancy in preoperative MRI staging and post-operative histopathology staging in our study. Discrepancy in rectal cancer staging has critical effects on management, outcomes, and survival rates of patients. Appropriate and accurate clinical radiological staging enables multi-disciplinary teams to plan optimal management approaches.
ThTP5.1 Laparoscopic cholecystectomy on index admission – are we following AUGIS guidelines?
Authors: Reid Rebecca , Shahjahan Mohammed 
Published: August 2023

Abstract

Background
Laparoscopic cholecystectomy is the gold standard in management of acute cholecystitis, biliary colic and gallstone induced pancreatitis. AUGIS has produced guidelines recommending optimal timing during index presentation for surgery.

Aim
To identify if our local acute surgical unit was following AUGIS guideline recommendations and performing laparoscopic cholecystectomy on index admission for recurrent/ongoing biliary colic, mild gallstone pancreatitis and for acute cholecystitis within 72 hours of onset of symptoms.

Methods
Prospective review of surgical patients admitted to DGH in Northern Ireland with acute cholecystitis, biliary colic and gallstone pancreatitis over six-month period between April and September 2021.

Results
103 patients were admitted during 6 months with gallstone disease. Of these, only 20 underwent inpatient lap cholecystectomy during their admission. 21 patients were deemed unfit for surgery and 3 declined surgery. 10 patients with acute cholecystitis had surgery; only 4 had symptom onset within 72 hours as recommended.

Conclusion
This unit was not following AUGIS recommendations on the timing of laparoscopic cholecystectomy for patients presenting with gallstone disease. During this data collection a pathway was started for day case laparoscopic cholecystectomy at a satellite site to help expedite patients who were unable to have their operation as inpatient.
ThTP5.2 Outcome of polypharmacy in frail patients post emergency laparotomy
Authors: Ng Hwei Jene , Quasim Tara , Rattray Nicholas , Moug Susan 
Published: August 2023

Abstract

Aims
The causal effect relationship between frailty and polypharmacy is not clearly established. Medications are used to treat co- morbidities that cause frailty but the side effects of the drugs could also be the stressors leading to frailty. Moreover, high risk of mortality is associated with frail emergency laparotomy patients. We aim to explore the association between 30- day mortality and frailty with polypharmacy.

Methods
A prospective database of emergency laparotomy (EmLap) patients in a busy district hospital was analysed. Patients ≥40 years old who underwent EmLap as per NELA criteria were included. Frailty was assessed via Clinical Frailty Score with score ≥4 as frail. Polypharmacy was defined as ≥5 daily medications. Statistical analysis was performed using logistic regression and p value of &lt;0.05 was considered significant.

Results
100 patients were included with 41% male and median age of 66 years. The overall 30- day mortality rate was 9%. Frailty was present in 49% and mortality rate was 16.3% (OR 79.76, p= 0.0121). Polypharmacy was found in 36% and mortality rate was 16.7% (OR 4.07, p= 0.045). There was significant association between frailty and polypharmacy (p=0.012). When both frailty and polypharmacy were present (25%), the mortality rate was 20% (OR 5.55, p= 0.026).

Conclusion
Frailty increases risk of polypharmacy and polypharmacy poses risk of worsening frailty, Mortality rate post EmLap is higher when EmLap patients are both frail and have polypharmacy. It is important to rationalise and review patient’s drug therapy in the community as well as in hospital.
ThTP5.4 Fasting times and medication administration in ‘nil by mouth’ emergency surgery patients
Authors: Oxley Catherine , Lingam Gita , Metcalfe Matthew 
Published: August 2023

Abstract

Aims
In ‘nil by mouth’ (NBM) emergency surgery patients, to 1) reduce the proportion of oral medications incorrectly administered/omitted and 2) reduce the proportion that are fasted for longer than the recommended 6 hours for food and 2 hours for clear fluids.

Methods
Medication administration and fasting data were collected prospectively on patients who received emergency surgery over two 2-week periods (n=169). Between these rounds of data collection, interviews were conducted with a range of staff members to understand reasons for poor compliance with guidelines. Based on this, local guidelines were updated to reflect a wider range of medications, and a range of methods were used to educate staff about best practice.

Results
In the first round of data collection, 45% of drug administration decisions were not compliant with guidelines. By the second round, these drug errors were reduced by 60%. On average fasting times were reduced by 25%, from 14.4 hours to 10.9 hours for clear fluids and from 24.2 hours to 18.5 hours for food. However, in both rounds, the range of times exceeded 110 hours.

Conclusions
Education about ‘NBM’ can significantly improve preoperative optimisation of patients and reduce the risk to patient safety associated with critical medications being omitted. The reduction in medication errors was so significant because lack of understanding of guidelines was highlighted as the major cause of non-compliance. Impact on fasting times was smaller, likely due to the other factors contributing to the prolonged times, such as patient choice, operation scheduling difficulties, and inadequate communication between teams.
ThTP5.5 The Emergency laparotomy – “scans, tubes and scalpels”. A report from the UK’s first collaborative National Emergency Laparotomy Audit (NELA) training meeting
Authors: Mitchell Robert , Govindarajah Narendranath , Loh Ee-Neng , Robson Michael , Tsironis Dimitrios , Wale Anita 
Published: August 2023

Abstract

Background & Aims
Time-critical emergency laparotomies are routinely performed nationally. These complex patients often require multi-disciplinary discussion of pre-operative imaging and intra-operative and post-operative status. NELA is designed to improve patient outcomes, encouraging regular audit and quality improvement.
We report the outcomes of the UK’s first collaborative NELA training meeting from a Major Trauma Centre in London
This unique meeting aimed to:

Methods
Three complex laparotomy patients were discussed using case-based discussions involving General Surgery, Anaesthetics and Radiology and involving imaging, intra-operative photographs and anaesthetic information. Pre- and post-meeting participant questionnaires were disseminated for comparative analysis.

Results
39 attended the evening (50% radiologists, 25% surgeons, 25% anaesthetists); two thirds’ trainees. 100% attendee satisfaction rate was recorded. 46% of attendees were not aware of NELA prior to the meeting.
Post meeting, 95% of attendees were confident in their understanding of the NELA process. There was a 25% increase in the knowledge of NELA reporting outcome measures (to 95%) and 90% correctly named the specialities involved.
96% of attendees reported interest in attending a subsequent meeting.

Conclusion
Complex emergency patients require expert cross-specialty input to drive improvements in patient outcomes. We believe this to be the first multidisciplinary NELA education meeting. Improvement in attendee understanding demonstrates the success of shared learning via case-based discussion to improve patient care. We aim to continue local meetings with aspirations to future national events.
ThTP5.7 Laparoscopic Management of Adhesional Small Bowel Obstruction: Is it Feasible?
Authors: Spyropoulou Liana Evangelia , Hadjicosta Olympia , Hamza Yasser , Ubaide Hassan , Aker Medhat , Arulampalam Tan 
Published: August 2023

Abstract
Despite advances in laparoscopic surgery, there is limited evidence on its application and outcomes for the management of adhesional small bowel obstruction(aSBO). Literature defines indications for surgery, without addressing the appropriate approach, traditionally involving laparotomy. This study investigated the feasibility of laparoscopic adhesiolysis for aSBO.
This retrospective cohort study included electronic data of patients admitted with aSBO, in a large laparoscopic centre over 3 years. Exclusion criteria applied to non-adhesional SBO, large bowel pathology and conservative treatment. Outcomes included the rate and reason for conversion to laparotomy, complications and length of stay (LOS).
85 patients with CT proven aSBO were included, over 3 years. 69(81.2%) of patients were approached laparoscopically and there was a 32%rate of conversion to laparotomy, due to technical difficulty(54.6%), planned “laparoscopy-first”(22.7%) or intraoperative emergency(18.2%).Those managed laparoscopically had 5 days median LOS compared to 9 in the converted subgroup.
Operation note review, revealed a standard operative approach using naso-gastric tube, right sided ports, and collapsed small bowel manipulation to identify the adhesion point. Enterotomy rate was 13.0% and 14.5%of patients required bowel resection from an extraction site. Post-operatively, 20.3%of patients suffered prolonged ileus, 5.8%anastomotic leak, 5.8%required re-operation, 8.7%were readmitted with recurrence and there were 10(14.5%) in-hospital deaths.
Our study indicated that laparoscopic adhesiolysis could be feasible for selected patients, with a CT proven transition point. Given the observational findings of this single centre study, further research in laparoscopic units is required, including direct comparison with laparotomy, and converted subgroups, aiming to generate standardised guidelines for the laparoscopic management of aSBO.
ThTP5.12 Assessment of malnutrition and nutritional interventions in patients presenting with acute small bowel obstruction – are we ‘getting it right first time’?
Authors: Yadu Shirley , Laouris Panayiotis , Bhandari Santosh , Makhija Rohit , Mallappa Sreelakshmi , Besali Mina 
Published: August 2023

Abstract

Aims
High levels of morbidity and mortality are associated with small bowel obstruction (SBO), a common general surgical emergency. Assessment of malnutrition and introduction of early nutritional interventions are of paramount importance in the management algorithm of these patients. We audited our practice of managing acute small bowel obstruction at a busy district general hospital comparing our practice against National Audit of Small Bowel Obstruction (NASBO) recommendations.

Methods
Data were gathered for all patients presenting with bowel obstruction to our Trust between 01/08/2022 and 30/11/2022. In depth review of patient case records was undertaken using electronic patient record systems (e-Track and Evolve).

Results
195 patients were admitted with acute bowel obstruction. 68 patients (35%) had acute SBO (M: F; 34:34). 58 (85%) had no documentation of duration for which they had been ‘nil by mouth’ (NBM) prior to hospitalisation. Malnutrition universal screening tool score (MUST score) was completed in 29 (43%) patients.
59% of patients had an emergency computed tomography (CT) which confirmed diagnosis of SBO. 60% of patients were managed non-operatively. On an average, patients were kept ‘NBM’ for two days (range; 1-16 days). Average waiting time for peripherally inserted central catheter (PICC) was 9.6 days.

Conclusions
Evaluating our practice of managing patients with acute SBO has highlighted multiple areas for improvement to ‘get it right first time’. We have included stakeholders; nursing staff, dieticians, surgeons, junior doctors and vascular access team to implement action plan to optimise management in this cohort of patients in line with NASBO guidelines.
ThTP6.4 A systematic review of the impact of postoperative aerobic exercise training in patients undergoing surgery for intra-abdominal cancers
Authors: Paul Melanie , Smart Thomas , Doleman Brett , Toft Suzanne , Phillips Bethan , Lund Jon 
Published: August 2023

Abstract

Introduction
Enhanced recovery after surgery (ERAS) programmes which advocate early mobility after surgery have improved immediate clinical outcomes for patients undergoing abdominal cancer resections with curative intent. However, the impact of continued physical activity on patient-related outcomes and functional recovery is not well-defined. This review aims to assess the impact of postoperative aerobic exercise training, either alone or in conjunction with another exercise modality, on patients who have had surgery for intra-abdominal cancer.

Methods
A literature search was performed of electronic journal databases. Eligible papers needed to report an outcome of aerobic capacity in patients &gt;18 years of age, who underwent cancer surgery with curative intent and participated in an exercise programme (not solely ERAS) that included an aerobic exercise component starting at any point in the postoperative pathway up to twelve weeks.

Results
Ten studies were deemed eligible for inclusion consisting of one inpatient, one mixed inpatient/outpatient and eight outpatient studies. Meta-analysis of 4 outpatient studies, each reporting change in 6-minute walk test (6MWT), showed a significant improvement in 6MWT with exercise (MD: 74.92 m, 95% CI: 48.52 to 101.31m). The impact on health-related quality of life was variable across studies.

Conclusion
Postoperative exercise confers benefits in improving aerobic function post-surgery and can be safely delivered in various formats (home-based or group/supervised).