bluuebunny/crossref_metadata_2025_split huggingface dataset:
O4 Rapid Review: Management of Recurrent Sigmoid Volvulus
Authors: Shaikh Amarah Ghani 
Published: January 2025

Abstract

Aims
Sigmoid volvulus is a common emergency condition resulting from the twisting of the sigmoid colon, leading to bowel obstruction. This rapid review aims to synthesize evidence from recent studies on the management of recurrent sigmoid volvulus. Given the high rates of recurrence and associated complications, understanding effective treatment strategies is crucial for improving clinical outcomes.

Methods
A rapid review of the literature was conducted, incorporating 26 relevant articles published between 2014 and 2024. These studies included case reports, retrospective series, randomized controlled trials, and reviews that examined various treatment modalities for recurrent sigmoid volvulus.

Results
Findings indicated that endoscopic decompression, while effective for acute episodes, often led to recurrence without subsequent surgical intervention. Studies highlighted endoscopic sigmoidopexy as a viable option for inoperable patients, offering lower recurrence rates. Surgical resection, particularly laparoscopic approaches, was identified as the gold standard for preventing recurrence. Additionally, minimally invasive techniques, including percutaneous colostomy, provided options for high-risk patients.

Conclusions
Effective management of recurrent sigmoid volvulus necessitates a comprehensive, individualized approach. While endoscopic decompression serves as an initial treatment, definitive surgical resection offers the best long-term outcomes by significantly reducing recurrence rates. Minimally invasive alternatives should be considered for high-risk patients, with management strategies tailored to individual risk factors. Ultimately, prioritizing proactive surgical interventions is essential to prevent severe complications and enhance patient outcomes in cases of recurrent sigmoid volvulus.
eP10 Decision Making For and Against Emergency Laparotomy in High Risk Patients: A Prospective Trust-Wide Study
Authors: Bradley Rebecca , Krishna Amritha Priya , Blatchford Chloe , Mohamed Hamza , Nikolopoulos Ionnais 
Published: January 2025

Abstract

Intro
High Risk emergency laparotomy patients are characterised as having a NELA score &gt;5%, but this often underestimates risk. Many factors influence the decision for laparotomy in these patients. Outcomes for patients who do not proceed to laparotomy are less reported in literature.

Aims
The primary aim was to compare outcomes in high risk patients (NELA &gt;5%) who were managed with a laparotomy (Lap), vs those who were managed non-operatively (NoLap). Our secondary aim was to explore the decision making process to investigate which factors influenced the decision for a laparotomy vs non-operative management

Methods
A prospective study over 6 months was conducted across two hospitals. Patients with NELA &gt;5% and aged 65 or over warranting laparotomy were included. Fisher's and Mann-Whitney U testing was used to compare Lap and NoLap outcomes. Multivariable regression analysis was used to determine which factors were most relied upon to make the decision for or against laparotomy.

Results
A total of 62 patients were included. NoLap patients had significantly higher NELA(p=&lt;0.001), ASA (p=0.008), Clinical Frailty (p=&lt;0.001) scores, but higher mortalities (&lt;0.001). Only 32% of all cases had a full MDT involved in decision for/against laparotomy. Clinical Frailty Score was the most specific and sensitive factor influencing decision for a laparotomy (p=&lt;0.001).

Conclusions
High risk NoLap patients have worse outcomes than their Lap counterparts. Although Clinical Frailty Score is not currently included in the NELA calculation, it is a crucial variable in influencing decision making for laparotomy in high risk patients.
eP12 Identifying and Managing Surgical Site Infections in Emergency and Elective General Surgery: A Quality Improvement Project
Authors: Mostafa Omar , Khan Amnah , Reay Michael , Kumar Prajeesh 
Published: January 2025

Abstract

Background
Surgical Site Infection (SSI) pose a significant health and economic burden to healthcare services within the United Kingdom. GIRFT and PHE have strongly recommended local auditing, protocols, and systems to identify, reduce and manage SSI across surgical specialities.

Method
A newly designed electronic SSI database was used to retrospectively screen and capture adult patients who underwent an emergency or elective general surgical procedure between January 2022 and March 2024. Records were automatically screened for biochemical changes suggestive of infection or keywords documented during ward round entries. Patients who met the criteria were highlighted as ‘probable infections’. Subsequently, a manual retrospective review of patient records was carried out to assess cases of actual infection. SSI was identified as described by the Centre for Disease Control (CDC).

Results
According to the database, 699 patients were identified, of which 21.8% were probable infections (153/699). Of those with a probable infection, 13% had a true infection documented (20/153). The median length of stay of those with a true infection was 15 days (6 – 170). 60% of infected cases were emergency surgeries (12/20) and 40% were open (8/20). 7.1% had documented cases of wound dehiscence (11/153), and 56% had clear documentation of a wound assessment post-operatively (86/153). Our intervention relied on creating an electronic SSI bundle to standardise documentation and capture true rate of infected cases in general surgical patients.

Conclusion
Heterogeneity and inaccuracy in wound assessment and documentation calls for robust, standardised methods to accurately capture SSI rates.
eP15 National survey on management practices for adhesional small bowel obstruction and nasogastric tube use among general surgeons in Australia
Authors: Al-Mashat Ali 
Published: January 2025

Abstract

Background
The nasogastric tube (NGT) is considered a necessary component in the management of adhesional small bowel obstruction (ASBO) and is recommended by current guidelines. Retrospective studies indicate that ASBOs may be managed without a NGT with non-inferior outcomes. We aimed to explore the current practice of Australian General Surgeons in ASBO management and NGT use, to determine if there is surgical equipoise for a randomised controlled trial (RCT).

Methods
We surveyed all active members of General Surgeons Australia in October 2021 using an online REDCap questionnaire. It consisted of clinical scenarios and questions surrounding demographics, management and reasoning. Descriptive statistics were reported for all relevant variables.

Results
Out of 893 emails sent, we received 181 (20%) responses. The respondents were predominantly from New South Wales (47%) and had subspecialty training (71%). Forty-two percent of respondents used an NGT in greater than 90% of ASBO cases. Sixty-four percent of surgeons believed that an NGT can save an ASBO patient from an operation and 93% believed it can have a therapeutic role. Vomiting was the most common reason for NGT insertion and 69% believed an NGT reduces the risk of aspiration. Gastrograffin® was used by 96% of surgeons. Forty-two percent of respondents were willing to participate in an RCT investigating NGT use.

Conclusions
In Australia, there is a trend towards selective NGT use in the management of ASBO, with variation existing in the beliefs surrounding its use. An RCT is required to determine best practice in the non-operative management of ASBO.
eP27 Treatment Escalation Plan (TEP) Completion Rates in Emergency Surgical Admissions: A Closed Loop Audit
Authors: Riad Aya , Atkinson Isobel , Nicolay Christopher 
Published: January 2025

Abstract

Aims
We aimed to audit treatment escalation plan (TEP) completion rates, including cardiopulmonary resuscitation (CPR) decisions, in patients admitted under emergency surgery.

Methods
Data was retrospectively collected on all emergency surgical admissions in a district general hospital in March 2024. Exclusion criteria included patients under the age of 16 and patients discharged on the same day without an operation. Results were presented in a departmental meeting and a target of TEP completion on the first consultant ward round was set. The second cycle was completed in July 2024.

Results
126 patients were admitted in March 2024 and 151 in July 2024. 19 patients (15%) admitted in March had TEP forms completed during their admission compared to 26 patients (17%) in July. In the first cycle 5 TEP discussions were completed by the parent surgical team (26%) compared to 11 in the second cycle (42%). The median time to TEP form completion from admission was 2 days in March and 1 day in July. 47 patients of the those admitted in March were operated on, of whom 39 did not have a TEP form (83%) compared to 69 patients operated on in July, 56 of whom had no TEP (81%).

Conclusion
TEP form completion rates remained low across both cycles, with an increase in the proportion of TEP discussions completed by the parent surgical team from 26% to 42%. Qualitative approaches may aid in understanding barriers to CPR discussions in emergency surgical patients and identifying strategies to improve TEP completion rates.
eP37 NO-LAP - A New Expansion within NELA
Authors: Barton George , Frith Dan , Koizia Louis , Hudson Murray 
Published: January 2025

Abstract
The National Emergency Laparotomy Audit (NELA), launched in 2013, has markedly improved outcomes for emergency abdominal surgeries in England and Wales by implementing systematic reviews, preoperative risk assessments, and geriatric evaluations. This approach has resulted in reduced 30-day mortality rates and shorter hospital stays for around 22,000 annual laparotomies.
In its latest expansion, NELA now includes the NO-LAP cohort—patients with acute abdominal conditions who do not undergo surgery. This group faces high mortality rates (63%-95%) due to advanced age, comorbidities, and frailty. The inclusion of NO-LAP aims to fill critical gaps in understanding and managing these high-risk patients.
The addition of the NO-LAP cohort will provide valuable insights into the factors influencing the decision not to operate and enhance understanding of non-surgical management strategies. This will inform new quality improvement initiatives and offer a clearer picture of patient outcomes in this vulnerable group.
This expansion is especially relevant given the ageing population and increasing prevalence of frailty. It also contributes to the education of junior surgeons, shaping future practices. NELA’s proactive approach underscores its commitment to adapting to evolving healthcare needs and improving patient outcomes.
eP40 Falciformopexy as an Alternative to Omentopexy in Perforated Peptic Ulcer Repair: A Systematic Review and Meta-analysis
Authors: Abosheisha Mohamed Dorgham , Shalaby Amr , Zarad Islam , Nasr Elmoatazbellah , Abdelsalam Mohamed 
Published: January 2025

Abstract

Aim
Peptic ulcer disease, characterised by defects in the gastric or duodenal mucosa, frequently leads to complications including perforation. The Graham repair using omental patch is the gold standard surgical intervention, but the falciform ligament patch repair serves as an alternative when the omentum is inadequate. This systematic review and meta-analysis aim to compare the efficacy and safety of omentopexy and falciformopexy in patients with perforated peptic ulcers.

Methods
Following PRISMA guidelines, a comprehensive search across four databases (Web of Science, PubMed, Scopus, and Cochrane Library) was conducted up to July 5th, 2024. Eligible studies included adult patients undergoing surgical repair for perforated peptic ulcer disease comparing omentopexy with falciformopexy. Data extraction and quality assessment were performed by two independent reviewers. Meta-analyses were conducted using Review Manager (RevMan) software.

Results
Out of 58 identified articles, three retrospective cohort studies comprising 1089 patients met the inclusion criteria. Omentopexy was performed in 960 patients and falciformopexy in 129 patients. Baseline characteristics were comparable. Falciformopexy showed a shorter duration of surgery and hospital stay but had a significantly higher risk of leakage and post-operative ileus. No significant difference in mortality and other complications was found. Heterogeneity was noted in some outcomes, necessitating further research.

Conclusion
Both omentopexy and falciformopexy are viable for managing perforated peptic ulcers with comparable safety and efficacy. Further high-quality, prospective studies are necessary to clarify the relative benefits of each method.
eP55 Nela Compliance in A District General Hospital: A Clinical Re-Audit
Authors: Unadike Chinedu , Itoko Tamaraebi , Aweke Gelila , Rutter Peter 
Published: January 2025

Abstract

Background and Aim
The National Emergency Laparotomy Audit (NELA) is a national clinical audit, commissioned by the Health Quality Improvement Partnership (HQIP), under the National Clinical Audit and Patient Outcomes Programme (NCAPOP). NELA aims to enhance the quality of care for patients undergoing emergency laparotomies by providing high-quality comparative data from care providers.
The aim of this re-audit is to assess compliance with NELA data entry by the trust, compare the results with the first audit cycle post-intervention and to ensure continuous trust compliance.

Methods
A re-audit was conducted using electronic data from emergency laparotomies performed between June and September 2024. All emergency laparotomies performed within this period were included, while non-emergency laparotomies and those outside the timeframe were excluded. The re-audit compared data from an initial audit cycle (which assessed data collection over a year), identifying compliance rates for data entry into the NELA database.

Results
In the initial audit, 111 laparotomies were performed, with 66% (n = 73) entered into the NELA database, while 34% (n = 38) were not. This re-audit revealed an increase in compliance, with 71% (n = 10) of 14 laparotomies entered, and 28% (n = 4) not entered.

Conclusion
The re-audit showed an improvement in compliance. Key interventions such as incorporating surgical registrars into the NELA team, redesigning the theatre booking form, and ensuring continuity of team roles during doctors' inductions were effective in boosting data entry rates. Continuous audits and improvements will help ensure sustained compliance and improved patient outcomes.
eP77 What does it take to drain an abscess?: A quality improvement project to optimise the Incision and Drainage pathway for simple abscesses at Homerton Hospital
Authors: Denfhy Jonathan , Karimi Roham , Hari Tushar 
Published: January 2025

Abstract

Background
A quality improvement project (QIP) with the goal of enhancing the efficiency of the next-day SDEC incision and drainage (I&D) pathway by characterising and improving the surgical team’s effect on wait times, cancellations and related documentation.

Methods
Pre-intervention data was collected retrospectively using the hospital record system and then following intervention for a further two weeks.
The intervention consisted of sending a departmental email outlining the pre-intervention data as well as clarifying the I&D pathway. To accompany this a proforma was developed to aid documentation, pre-op planning and patient communication.

Results
Pre-intervention data showed that 29% of next-day I&Ds were cancelled, with an average wait time of 16 hours from admission to theatre, with one patient waiting 72 hours. Additionally, 33% of patients were not booked or consented the day before admission.
Post-intervention, 86.5% of patients were booked and consented the day before, cancellations dropped to 12.5%, and mean wait time decreased to 11.2 hours.

Conclusions
While there was a reduction in wait times and cancellations, the improvements did not clearly relate to proforma use and may have been attributable to the email and department-wide clarification of the existing I&D pathway. Going forward there is further scope to improve surgical team efficiency but a broader focus with the inclusion of the theatre team would be useful in building on these gains as it seems there is a limit to the influence that surgical team practice can have on reducing delays and cancellations in this context.
eP84 The good, the bad, and the ugly - use of a care bundle reduces surgical site infection after all grades of contaminated emergency laparotomy
Authors: Williams Ruby , Brewster Oliver , Swain Cara , Thornton James , Pullyblank Anne 
Published: January 2025

Abstract

Aim
The following care-bundle has halved surgical site infection (SSI) after elective colorectal surgery from 20% to 10%.2% chlorhexidine skin preparationSecond dose of antibiotics after 4 hoursDual-ring wound protectorAntibacterial sutures for deep closure and skin
The bundle was adapted for emergency laparotomy and two elements added:Glove changeBetadine wound wash
Overall, SSI rates were reduced. However, this analysis will assess whether the bundle is effective at all levels of intra-operative contamination.

Methods
30-day patient reported SSI was measured using the Health Security Agency questionnaire with a response rate of 71%. For 25% of patients with a length of stay &gt;30 days, SSI was measured by in-hospital surveillance. Data was collected for 178consecutive patients before, and 604 patients after intervention. Patients who had trauma, enterocutaneous fistulae, death before 30 daysor who never had skin closure were excluded. Contamination code assigned using OPCS guidelines.Infection rates were compared pre and post intervention across clean, clean contaminated and dirty surgeries. Chi2 test was used to test significance at p&lt;0.05.

Results
Pre-intervention Post-intervention Classification SSI No SSI Infection % SSI No SSI Infection % p= Clean 3 10 23% 7 54 11.5% 0.266609 Clean-contaminated 17 47 26.5% 18 105 14.6% 0.047232 Dirty 17 14 55% 15 68 18% 0.000101 Overall 37 71 34% 40 227 15% 0.000029

Conclusion
This bundle is associated with a significant reduction in SSI across all degrees of contaminated emergency laparotomy. This was most effective in dirty cases.
eP112 "Beyond Age: Unveiling the Real Drivers of Complications in Emergency Laparotomy"
Authors: Shaikh Amarah Ghani , Sultan Tabinda , Khalifa Khali 
Published: January 2025

Abstract

Background
The aging population presents unique challenges in healthcare, particularly concerning surgical outcomes and associated risk factors. This retrospective study aims to compare outcomes after Emergency laparotomies in geriatric versus non-geriatric populations, highlighting the specific risk factors that influence these outcomes.

Methods
We analysed data from 40 patients who underwent Emergency Laparotomies between November 2023 to February 2024. Patients were categorized into geriatric (aged 65 and older) and non-geriatric groups. Key outcomes measured included complication rates, length of hospital stay, and mortality rates.

Results
Our findings indicate in general 30% of patients (12/40) were below 65 years of age, rest were above 65 years of age. Geriatric patients experienced significantly higher complication rates including wound infection, ileus, intra-abdominal collection, as well as medical complications like development of pneumonia and catheter associated infection and longer hospital stays compared to their non-geriatric counterparts which is obvious but that is because a greater population of patients undergoing emergency laparotomies are above 65 years of age. More-over it was noted that more than age, type of primary pathology like level of perforation/obstruction, severity of sepsis and type of surgery played more significant role in recovery and complication rates.

Conclusion
The study highlights differences in outcomes between geriatric and non-geriatric populations undergoing emergency laparotomy with primary pathology and type of surgery playing more important role in post-operative complications and delay recovery rather than age alone.
eP115 ‘Use of Artificial Intelligence in Predicting Outcomes of Emergency Surgical Procedures’
Authors: Shaikh Amarah Ghani , Saunders Jada , Khalifa Khalid 
Published: January 2025

Abstract

Introduction
Artificial Intelligence (AI) is rapidly transforming healthcare, particularly in surgery, by enabling data-driven decision-making. By predicting risks and potential complications before, during, and after surgery, AI assists clinicians in making more informed decisions and enhancing patient care. This review examines the application of AI across various surgical types, from general and emergency procedures to specialized fields like laparoscopy and colorectal surgery, aiming to improve predictions regarding outcomes such as mortality rates and surgical complications.

Methods
A thematic analysis of seven recent articles (2019-2024) was done, extracted from Pubmed database, on AI's role in predicting general surgery outcomes. Studies focusing on use of AI in emergency surgery cases were evaluated for their ability to predict key outcomes like postoperative complications, mortality, and hospital stay length.

Results
The studies revealed that AI models consistently outperformed traditional methods in predicting surgical risks and outcomes. They emphasized AI's ability to anticipate complications, mortality prediction for emergency surgeries and in assessing wound complications and refining laparoscopic surgery techniques.

Conclusion
AI tools are proving essential in surgery by enhancing outcome predictions and improving care quality. However, further research is needed for comprehensive integration into emergency surgical practices, ultimately aiming for personalized surgical care and reduced complications.
eP119 Improving the Management of Frailty in Emergency General Surgery at a Tertiary Centre: An Audit of Current Practice and Quality Improvement Project
Authors: Abbas Rahma , Jauniaux Benoit , Selvachandran Haran , Peasegood Joshua , Neill Callum , Chan Anthony 
Published: January 2025

Abstract

Background
Frailty is present in many older patients that present as a surgical emergency. The physiological decline from frailty is associated with poorer outcomes, thus it is crucial that these patients are identified early in the surgical pathway. The National Emergency Laparotomy Audit (NELA) stipulate that patients over age 65 should have a clinical frailty score (CFS) assessment and documentation at the first encounter with the clinical team. This allows Older Person's Assessment and Liaison (OPAL) teams to be consulted early to help guide a holistic overview of care needs. This audit assesses the implementation of the NELA recommendations at a tertiary surgical centre.

Methods
Two audit cycles were performed (May and September 2024) assessing all emergency general surgical admissions at Manchester Royal Infirmary for patients over age 65. Electronic patient records (EPR) were used to determine whether CFS was recorded and if OPAL were consulted. Quality improvement interventions included implementation of standardised rapid-use EPR documentation templates and staff education.

Results
Eighty-five patients were included in the audit. Prior to interventions, no patients admitted (0/47) had a CFS recorded and 13% (6/47) were reviewed by the OPAL team during their inpatient stay. Following intervention, a second audit cycle showed an improvement of CFS documentation to 50% (19/38) and OPAL review to 34% (13/38).

Conclusion
This audit demonstrates the effectiveness of EPR templates and staff training to improve early frailty identification and documentation in emergency surgical patients as well as better early OPAL involvement to improve clinical outcomes.