bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP5.7 Prognostic Value of ‘Cachexia Index’ in Patients with Colorectal Cancer Undergoing Surgical Resection
Authors: Brown Leo R , Gardner Ellen , Thompson Josh J , McGovern Josh , Dolan Ross D , Hendry Paul O 
Published: August 2023

Abstract

Aim
Numerous phenotypical features of cachexia have been associated with poorer outcomes in patients with cancer. However, at present, very few of these markers are routinely considered during the shared decision-making process. This study aims to assess the prognostic value of a novel composite marker of cachexia, termed ‘Cachexia Index’, in patients with colorectal cancer.

Method
Consecutive patients who underwent resection of a newly diagnosed colorectal cancer, between Jan 2019 and December 2020, were identified from prospectively maintained databases across two sites. Cachexia index was calculated as (L3 skeletal muscle index) x (serum albumin) / (neutrophil-lymphocyte-ratio). The sex-stratified, cut-off values for cachexia index were determined using area under receiver operating characteristic curves (AUC) and Youden’s Index. The primary outcome of interest was overall survival.

Results
Overall 273 patients (53% male, median 67 years) underwent resection of a colon (n=178) or rectal (n=95) cancer across the study period. Optimum cut-off values for a low cachexia index were defined as &lt;50 for males (AUC=0.792, sensitivity = 0.821, specificity = 0.727) or &lt;35 for females (AUC=0.744, sensitivity = 0.700, specificity = 0.756). Patients with a low cachexia index were older (median 71 vs. 66 years, p=0.029) and had a higher proportion of cT4 (p=0.035) or cN1/2 tumours (p=0.044). Tumour site and ASA grade were comparable between groups. Following adjustment for confounders, using cox-multivariable regression, low cachexia index was associated with decreased overall survival (HR: 3.77, 95% CI: 1.93-7.37, p&lt;0.001).

Conclusion
Cachexia index may be a clinically useful marker for poor prognosis in patients undergoing surgical resection of a colorectal cancer.
SP7.5 Should we analyse all cholecystectomy specimens? An analysis of the features of incidentally discovered gallbladder cancers
Authors: Scicluna Chiara , McElroy Luke , Roberts Fiona , Gough Vivienne , Kohnen Gabriele 
Published: August 2023

Abstract

Aims
Gallbladder cancer is the commonest form of malignancy of the biliary tract, but is rare in Western countries. A large proportion of cases are incidentally diagnosed at surgery or from the cholecystectomy specimen. The analysis of gallbladder specimens costs our health board around £42,000 per year. The aim was to identify any predictive factors in incidentally discovered gallbladder cancers.

Methods
All gallbladder specimen reports at our health board between May 2012 and September 2022 were analysed and filtered so incidental cancer cases could be analysed for any predictive features. Outcomes with only dysplasia were removed.

Results
16,695 eligible reports were analysed of which 32 had malignant outcomes. The median age for malignancy was 71 vs 50 for benign. 30 were adenocarcinoma and 2 were adenosquamous carcinoma. 14 presented with cholecystitis, 9 with biliary colic, 6 with choledocholithiasis and 3 with gallstone pancreatitis. Intraoperatively, 7 had normal appearances, 20 were reported at being ‘thickened’, 2 ‘contracted’, 2 with empyema and 1 with a mucocoele. 6 patients had a subtotal cholecystectomy and in all cases this was due to intraoperative difficulty.

Conclusions
We could not identify any single feature that predicted or excluded the presence of cancer. Given that the lower age limit for malignancy was 51, a consideration could be made for not processing specimens from patients under the age of 45 as the likelihood of diagnosing incidental carcinoma is extremely unlikely and would reduce the yearly processing by 37% with a cost saving of £15,500 per year.
SP8.1 Patient perception of the informed consent process: A single centre cohort study comparing paper and digital consent
Authors: Hussain Mohammad Iqbal , Coombs Alex , Lameirinhas Claudia , Agrawal Avi , Toh Simon , John Edward St 
Published: August 2023

Abstract

Aims
NHS Digital set eConsent as a priority for 2021-2022 and digital consent is now being adopted by many hospitals. This study aims to compare how patients perceive the consenting process on both paper and digital platforms.

Methods
A prospective service evaluation was conducted in a university hospital (May 2022-December 2022), across 9 specialities, to compare paper with digital consent. as a part of an SBRI-granted project (SBRIH19P3055) to identify the economic benefits of digital consent. The digital consent solution was provided by Concentric Health. Time-motion study assessing the consultation time required to consent a patient was conducted in clinics. Patient feedback was obtained through structured questionnaires, including the CollaboRATE score (validated to measure shared decision-making, SDM).

Results
Patient feedback was compared for 151 responders from each group. 92 (60.9%) responders in the digital group scored the CollaboRATE Topscore (representative of gold standard SDM) in comparison to 71 (47%) responders in the paper consent group. 113 patients had experienced both paper and digital consent, of which 73 (64.6%) patients prefer digital consent and 40 (35.3%) prefer paper consent. Sub-analysis of consultation time (including both consent and clinic time) revealed no significant difference P=0.102 between the use of paper (n=21) and digital (n=26) consent.

Conclusion
Digital consent is favoured by patients perhaps because it enables more meaningful and detailed discussion of information before surgery. Patient satisfaction regarding their involvement in SDM is higher with digital consent than with paper consent. Further studies are needed to evaluate the value of digital consent.
SP8.10 Auditing periprocedural antibiotic prophylaxis (PAP) in emergency surgery using NAPS surgical ™
Authors: Shamiyah Khalid Adnan , Yu Hans , Yan Helen , Bond-smith Giles , Jones Nicola 
Published: August 2023

Abstract

Aim
The study aimed to investigate the compliance with guidelines and the appropriateness of periprocedural antibiotic prophylaxis (PAP) in emergency surgery at the John Radcliffe Hospital. The study also aimed to determine the usefulness of NAPS surgical™ in monitoring and evaluating PAP usage.

Methods
The study conducted a retrospective analysis of medical charts for 97 consecutive emergency general surgical operations in August 2022. Data collected included the type of surgery, antibiotics administered, and compliance with local guidelines. The data was analyzed using NAPS surgical™.

Results
In 97 cases, 40 patients did not receive PAP, 26 of which were deemed appropriate. 57 patients received 76 doses of antibiotics, 51 of which were deemed inappropriate, mainly due to the administration of PAP to low-risk cases or outside of the recommended timing. Cefazolin was the most commonly used drug and no adverse effects were reported.

Conclusions
The study highlights the value of NAPS surgical™ in monitoring prophylactic antibiotic usage and the need for ongoing monitoring and education. NAPS surgical™ provides a comprehensive evaluation of antibiotic use, is cost-effective, and allows for direct comparison with other hospitals, providing insight into best practices. The hospital found NAPS surgical™ useful in assessing antibiotic stewardship and monitoring stewardship interventions.
SP9.2 Penthrox Is Effective but Is It Patient Approved?
Authors: Dias Ana , Zeidan Ziad , Copp Matt , Eslabra Francis , Hassan Rawan , Middleton Rory 
Published: August 2023

Abstract

Aim
Penthrox is a handheld inhaler that administers methoxyflurane. Its use is approved for analgesia in moderate-to-severe trauma-related pain in adults in emergency department (ED). The literature currently lacks methodologically robust qualitative data on individual patient experience. Using a structured qualitative study, we set out to address this shortcoming.

Methods
Focus group: Five patients were selected to identify key themes they felt important to explore and these were included in the questionnaire design.

Study Design
We retrospectively identified all uses of Penthrox in ED from June to August 2021. Qualitative data was gathered using the Trickett short interview method and responses grouped into positive and negative descriptors. In addition, quantitative data concerning their experience using 5-point Lickert scales were also gathered.

Results
Questionnaires: 101 responded to the questionnaire. Penthrox® was utilised mainly for the manipulation of fractures, most commonly for that of the Ankle and Wrist. 90% reported an overall satisfaction of ‘≥ Good’. 97% reported ease-of-use ‘≥ Good’. Its analgesic effectiveness was rated as ‘Excellent’ by 52%, and ‘≥ Good’ by 89%. The most reported side-effects were drowsiness (13%) and nausea (7%). The majority reported no side-effects (74%). 94% would take it again if required. A NVIVO word cloud was created visually confirming an overall positive experience amongst the patients.

Conclusions
This study shows that Penthrox is a well-tolerated and user-friendly means of alleviating trauma-related pain in ED. It highlights the importance of taking into consideration the individual patient journey alongside robust evidence-based data on safety and efficacy for the development of a holistic treatment.
SP9.8 An Audit of Intraoperative Hypothermia Rates in Adults Undergoing Emergency Surgery in a Tertiary General Surgical Unit and Evaluation of the Efficacy of Preoperative and Intraoperative Forced-Air Warming on Achieving Intraoperative Normothermia
Authors: Foran Daniel , Bramer Solange , Pledge Alexandra , Bond-Smith Giles 
Published: August 2023

Abstract

Aims
Surgical site infections (SSIs) inflict significant economic burden on the NHS. Preoperative and intraoperative hypothermia are risk factors for SSIs. Evidence shows that maintenance of intraoperative normothermia significantly reduces SSI rates. Perioperative SSI bundles addressing factors including hair removal, antibiotic prophylaxis, skin preparation, drape positioning, and hypothermia are critical to improving SSI rates. We aim to audit rates of intraoperative hypothermia in our surgical caseload and evaluate the efficacy of preoperative and intraoperative forced-air warming through bespoke gowns in achieving intraoperative normothermia.

Methods
We conducted a retrospective audit of the intraoperative core temperatures of all adult patients undergoing surgical procedures on the emergency theatre list of a general surgery department and who had a temperature at knife-to-skin recorded (n=88). We then ran a prospective trial, outfitting patients listed for surgery (n=15) with forced-air warming gowns. Patients underwent forced-air warming with the gowns for 45 minutes on the surgical ward, throughout anaesthetic induction, and intraoperatively. Patient core temperature was measured at baseline, upon arrival at the anaesthetic room, and at knife-to-skin.

Results
Baseline audit data showed over 18% of patients were hypothermic at knife-to-skin. Contrastingly, 100% of patients wearing forced-air warming gowns were normothermic at knife-to-skin. The mean core temperature at knife-to-skin was significantly higher in patients wearing warming gowns (p=0.012).

Conclusions
Forced-air warming gowns are superior to traditional hospital gowns, blankets and surgical access forced-air warming devices in achieving intraoperative normothermia. They are an effective, sustainable, and cost-neutral, ‘all-in-one’ alternative to current perioperative protocol and will reduce SSI rates.
SP9.16 An international consensus for mitigation of the detrimental effects of the COVID-19 pandemic on laparoscopic training
Authors: De Veciana Anna Jimenez , Kwan Jing Yi , Long Judith , Sedman Peter , Chetter Ian , Yiasemidou Marina 
Published: August 2023

Abstract

Aim
Achieve an international consensus on how to recover lost training opportunities.

Background
A global survey conducted by our team revealed the factors perceived by trainees as barriers to training and gave birth to four-point framework of recovery. Their implementation, however, relies heavily on the active participation and leadership by trainers. Based on the results of the global trainee survey, the authors would like to conducted a survey, addressed to trainers on this occasion, to establish a pragmatic step-by-step approach to improve training during and after the pandemic.

Methods
A questionnaire was proposed; this was based on the results of expert semi-structured interviews. After validation, the questionnaire was disseminated to trainers across the globe.

Results
208 international surgeons replied (M:80.29%). Most were 35-44y.o. (71/208) and worked in teaching hospitals (75.96%). The topics of the questionnaire were: (1)causes of impact, with lack of theatre time (108/164) and management pressures to finish cases quickly (102/164) being identified, (2)availability of guidelines, highlighting lack thereof (93/164) and highlighting the importance of training recovery specific guidelines (112/155) (3)impact of COVID-19 on trainer’s morale, with 87/164 feeling demoralised (4)mentorship; mentorship should be provided (139/155) (5)curriculum changes; opportunities for training in each list (138/155), dedicated training lists (120/155), pairing junior to senior trainees (130/155), training should be individualised to address different levels of needs (134/155) (6)simulation training; should be integrated in the curriculum (127/155), with individualised targets (129/155) and supervised.

Conclusion
This international survey provides a straightforward guide for the recovery of training after the COVID-19 pandemic.
SP10.1 Post operative complications and functional outcome after ventral mesh and suture rectopexy for rectal prolapse: a single centre observational study
Authors: Anand Easan , Ravi Prabhu , Satti Suren , Sidhom Mark , Venkatasubramanian Arcot 
Published: August 2023

Abstract

Aims
Laparoscopic ventral mesh rectopexy (LVMR) is a technique gaining more recognition for the management of pelvic floor disorders, such as external rectal prolapse (ERP), high grade internal rectal prolapse (IRP) and rectocele. The aim of this study was to evaluate post op complications (early, late and mesh) and functional outcomes after a standardized LVMR.

Methods
All patients who underwent Rectopexy from February 2008 to April 2021 were included into the study. The patients were evaluated preoperatively, at 3 months and 1 year postoperatively. Surgical complications, mesh complications (mesh detachment, erosion and infection) and functional results in terms of faecal incontinence, recurrence and ODS were analysed.

Results
95 patients (88 – LVMR; 7 - suture Rectopexy) who underwent Rectopexy were included in the study with a mean age of 68 and female predominance of 90 patients. 30 patients had external rectal prolapse (ERP), 45 patients had internal rectal prolapse (IRP) or intussusception, 20 patients had both ERP and IRP (Table 3). 53 patients had preoperative MRI scan and 15 patients had preoperative proctogram. (Table 4).
92 patients did not have any early complications. 13 patients had late postoperative complications including recurrent prolapse, stoma formation, suture migration and incisional hernia. Mesh complications were seen in 2 patients with mesh erosion and mesh detachment, both of whom had non-absorbable stitches used. There were no post op deaths documented. During the follow up period, 12 patient developed symptoms of ODS.

Conclusion
LVMR is a safe and effective treatment for rectal prolapse. Careful patient selection, appropriate preoperative workup, and meticulous surgical technique undoubtedly transforms postoperative outcomes.
SP10.3 Colectomy for Inflammatory Bowel Disease (IBD) – use of the National Consultant Information Programme (NCIP) to highlight colorectal surgical practice in England
Authors: Galla Aashlesha , Maxwell-Armstrong Charles , Booth Matthew , Young Lucy , Bogovac Marina , Williams Norman 
Published: August 2023

Abstract

Introduction
The NCIP tool uses HES data from Trusts to understand the spread and variation of a range of surgical procedures. There are two forms of IBD; Crohn’s and Ulcerative Colitis (UC). This work uses NCIP to contextualise data and understand Covid-19’s impact and the current practice of colectomy for IBD in England.

Method
Pseudonymised data was extracted from NCIP dashboards by NHS England Improvement data analysts. Various metrics were analysed including surgical approach, frequency of cases, length of stay (LOS), incidence of stoma maturation and readmission, and mortality.

Results
3907 Crohn’s and 1942 UC cases performed from April 2019-March 2022. Decrease observed in frequency during Covid-19.
Crohn’s: 47.76% laparoscopic cases. 17.42% of total providers did &lt;10 cases in 4-year period. Average LOS was 9.01 days ± 0.16 with 95% CI [8.70, 9.32], p&lt;0.001. Mean stoma rate was 31.73% in units performing ≥20 cases. 30-day readmission was 17.33%. 90-day mortality was 0.23%.
UC: 56.54% laparoscopic cases. 47.29% of total providers did &lt;10 cases in the 4-year period. Average LOS was 10.39 days ± 0.29 with 95% CI [9.82,10.96], p&lt;0.001. Mean stoma rate was 87.09% in units performing ≥20 cases. 30-day readmission was 21.94%. 90-day mortality was 0.82%.

Conclusion
Covid-19 decreased current practice for IBD colectomies, possibly due to RCS guidance recommending temporary suspension of non-cancer surgery during the pandemic. Lower laparoscopy rates than expected. Significant centre variation and variation in stoma rate observed. Data suggests stoma creation within episode is a contributor to higher average LOS and readmission rate (p&lt;0.05).
SP10.12 Would You Like a Pus Swab Sent?
Authors: Lingam Gita , Hu Kylin , Pamma Aarondeep , Kirmani Naveed 
Published: August 2023

Abstract

Aim
The Association of Coloproctology of Great Britain and Ireland (ACPGBI) consensus guidelines in emergency colorectal surgery states that microbiology sampling is of limited value in the management of anorectal abscesses. Several centres continue to send intra-operative swabs routinely for microbiology. This study aims to identify (1) if sampling changed postoperative management and (2) quantify the financial cost of sending unnecessary swabs within a district general hospital setting.

Methods
Retrospective study investigating intraoperative clinician use of microbiology swabs. Study sample included patients who underwent an incision and drainage of an anorectal abscess from 1st October 2021 to 1st October 2022 in a district general hospital setting.

Results
A review of patient data obtained 59 patients who underwent an incision and drainage of an anorectal abscess. Swabs were taken in 54 (91.5%) cases. At 2 months, 40.7% of the swab results had not been reviewed by a clinician. 89% of swab results were reported after the patient was discharged. No documentation mentioned reviewing microbiology results in a follow-up clinic. There was no documented change of antibiotics nor correlation found between swab results and magnetic resonance imaging (MRI) requests/findings. Each microbiology swab costs £3 and labour costs are a minimum of £10 per swab analysed by a band 6 biomedical scientist. Total cost incurred per year was therefore estimated at £702.

Conclusions
Surgeons tend not to review microbiology results at follow-up appointments. Furthermore, there was no evidence that microbiology sampling resulted in change in patient management. Unnecessary use of swabs contributes to the NHS economic burden with no additional clinical benefit.
SP11.9 A Vascular Surgeon's Dilemma - Biodegradable Versus Non-Biodegradable Drug Eluting Stents: A Systematic Review and Meta Analysis
Authors: Shah Aishwarya , Kumar Niraj 
Published: August 2023

Abstract

Aims
Vascular stents are the best-known interventional treatment for cardiovascular disease, with variation in available stents increasing significantly over time. Despite the rapidity of new prototype releases, critical cross-comparisons fail to maintain the same rate, therefore causing confusion for vascular surgeons. Research is most notably lacking between biodegradable-polymer sirolimus-eluting stents (BP-SESs) and permanent-polymer sirolimus-eluting stents (PP-SESs). Therefore, a systematic review with meta-analysis was conducted evaluating clinical outcomes.

Methods
Using relevant synonyms of “biodegradable”, “sirolimus” and “stent”, the databases Medline, Embase, and Scopus were searched, with the final search being conducted on the 4th of November 2022. Reference lists were also screened. The clinical outcomes investigated were stent thrombosis (ST), myocardial infarction (MI), target vessel revascularisation (TVR), target lesion revascularisation (TLR), and death. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results
Five clinical trials directly comparing clinical outcomes between BP-SESs and PP-SESs were ultimately identified for inclusion. For all five outcomes investigated, no statistically significant difference (p&gt;0.05) was found between the BP-SES and the PP-SES recipients. Pooled odds ratios of 0.86 (95% CI:0.44-1.65), 0.75 (95% CI:0.32-1.74), 1.12 (95% CI:0.54-2.32), 1.14 (95% CI:0.38-3.38) and 0.95 (95% CI:0.51-1.77) were calculated for ST, MI, TVR, TLR and death respectively.

Conclusions
Although there is some evidence to suggest BP-SESs are noninferior to PP-SESs, concrete conclusions cannot yet be drawn due to the paucity of research in this field. Further clarity from randomised control trials will aid additional examination and improvement in stent materials and outcomes.
SP11.10 Assessment of Heart Rate Variability as A Marker of Stress and Cognitive Load During Vascular Surgery: Surgical Training
Authors: Mandal Manish , De Louche Calvin , Fernandes Lee , Lawson Jason , Pouncey Anna Louise , Bicknell Colin D 
Published: August 2023

Abstract

Introduction
Decreased heart rate variability (HRV) correlates with subjective stress (STAI-6 score) and demonstrates increased stress at challenging steps during vascular surgery. This observational study aimed to examine HRV utility as an objective measure of stress and satisfaction during intra-operative vascular surgical training; hypothesising detrimental HRV change is associated with: (1) low training satisfaction, (2) operating compared to assisting, and (3) lower surgical experience.

Methods
Change from baseline (%) in HRV (SDNN - overall variability and LFHF - sympathetic tone) was calculated during arterial cutdown and arterial closure training points in 7 trainers and 10 trainees during 9 femoral vascular procedures. Pearson’s correlation coefficient was used to investigate association between training satisfaction and operative HRV in trainees, and overall operative experience and training point HRV. Mann-Whitney-U was used to investigate HRV difference in operating trainees with high versus average training satisfaction and operating versus assisting/supervising training points.

Results
Data (median (IQR)) included 13 cutdowns and 12 closures. Training satisfaction did not relate to STAI-6 or HRV. LFHF was significantly lower in trainers when operating (n=2) compared to supervising (n=10) cutdown (-18.96(-27.87--10.05) vs 36.96(10.83-147.2) p=0.0409*). No difference was seen during closure or in trainees. Operative LFHF non-significantly decreased with experience overall (r=-0.342, p=0.0944) and during cutdown (r=-0.498, p=0.0833), no association existed for assisting.

Conclusion
HRV may objectively measure stress during in-theatre training. This study suggests trainers may experience more stress when supervising rather than operating. Larger studies are required to demonstrate a more definitive relationship between training, stress and HRV.