bluuebunny/crossref_metadata_2025_split huggingface dataset:
1068 Are There Delays to Emergency CEPOD Theatre Times? a Closed-Loop Audit Before and After Having a Dedicated CEPOD Registrar
Authors: Datta U , Ahmad A , Kamal M , Richardson T 
Published: August 2023

Abstract

Aim
To evaluate delays to Emergency Theatre (CEPOD) start times, “knife-to-skin” times, turnover between cases, and whether having a separate Registrar for CEPOD has improved theatre flow.

Method
This was a closed-loop retrospective audit at Walsall Manor Hospital with data collected using the electronic system, in two 4-week blocks; from 13/06/2022 – 10/07/2022 and then again from 18/07/22 – 14/08/22. 4 days were excluded due to external factor delays which could not be attributed to the theatre team. The target for patients being sent for was 08:40 AM, and arrival was 09:00 AM as per hospital policy.

Results
90.4% (47/52) of patients who were the first case of each day were sent for after 08:40 AM. 88.5% (46/52) arrived in the anaesthetic room after 09:00 AM. 94.2% (49/52) had “knife-to-skin” after 09:30 AM and 71.2% (37/52) after 10:00 AM. 36.5% (19/52) had a turnover time of more than 30 mins between cases. There were statistically significant differences between the mean times for the following categories when there was a single on-call Registrar vs when there was a dedicated CEPOD registrar: Time sent for (09:33 vs 09:08, p-value 0.015), Arrival Time (10:00 vs 09:32, p-value 0.010) and turnover time between cases (00:39 vs 00:11, p-value 0.018).

Conclusions
There are significant delays to CEPOD start times, anaesthetic times, “knife-to-skin times, and turnover times. Having a separate dedicated CEPOD registrar made a difference to the flow of emergency cases.
1079 SARC-F Questionnaire: A New Predictive Tool in Emergency Laparotomy Patients
Authors: Brzeszczyński F , Brzeszczyński M , Kusiński M 
Published: August 2023

Abstract

Introduction
Sarcopenia is associated with increased morbidity and mortality after emergency laparotomy skeletal muscle mass index (SMI) has been previously used to diagnose sarcopenia preoperatively. SARC-F (Strength, assistance, rising from a chair, climbing stairs, and falls) questionnaire is a new tool used to assess sarcopenia presence. The aim of this study was to evaluate the predictive role of SARC-F questionnaire on postoperative outcomes.

Method
This prospective observational single center study recorded SARC-F questionnaire scores in patients undergoing emergency laparotomy between September and November 2022. SMI scores were also recorded by dividing CT derived psoas muscle area by patient’s height2. Postoperative mortality rates and severity of complications were graded using Clavien–Dindo classification. SARC-F score and SMI were correlated to postoperative outcomes.

Results
A total of 20 patients were recruited with a mean age of 60. Indications for emergency laparotomy included: perforated viscus, bowel obstruction, spleen injury and appendicitis. Median SARC-F score was 3 (IQR: 6) and median SMI was 13.7 cm2/m2 (IQR: 5.8). The mortality rate was 20% and 50% of patients had post-operative complications. Results of multivariate regressions show that SARC-F score has a statistically significant positive relation and statistically significant effect on post operative complications (p value = 0.04) and mortality (p value = 0.03), while SMI has no statistically significant effect on post operative complications (p value = 0.08) and mortality (p value = 0.59).

Conclusions
SARC-F questionnaire may be a more accurate method of assessing sarcopenia in patients undergoing emergency laparotomy and may be a useful prognostic tool.
1202 National Emergency Laparotomy Audit (NELA): Difficulties Achieving the Best Practice Tariff (BPT) Criteria
Authors: Chkir B , Patel P , Peris R , Lee G , Handa S 
Published: August 2023

Abstract

Aim
BPT is granted to trusts if “80% of their NELA-high-risk-patients have a Consultant Surgeon (CS) and a Consultant Anaesthetist (CA) present during surgery and were admitted directly to critical care–the same patient needs to have received both elements of care.” The aim is to assess the difficulties in achieving the BPT &compare outcomes of high-risk-NELA-patients in a DGH.

Method
Retrospective review of all emergency laparotomy admissions from April 2019-August 2021.Only high-risk patients included. Data extracted from NELA-website &various sections across the hospital’s e-system.

Results
Total of 166 cases;99 of which were classified as high-risk. 48-males & 51-female patients (age range 40-95). 100% of cases had CS present in theatre. 63% of cases had CA in theatre compared to 37% which had SAS-grade-anaesthetist. 87% were admitted to critical-care,9% to Patient-Progression-Unit (PPU/HDU) & 4% to wards. 82% of patients survived the admission:63% had CA in theatre compared to 37% which had SAS-grade-anaesthetist.86% patients admitted to critical-care,11% to PPU/HDU & 3% to wards.

Conclusions
57% of high-risk cases have met the BPT criteria compared to 43% which didn't:29-cases had no CA in theatre,6-cases were not admitted to critical-care & 8-cases were not admitted to critical-care & had no CA in theatre.
18-total mortalities:9 met BPT & 9 didn't meet BPT (7 had no CA in theatre and 2 were not transferred to ICU post-op).
81% of total cases supervised by SAS-grade-anaesthetist survived.82% of total cases supervised by CA survived.
The survival outcomes of both anaesthetist-grades are almost identical but isn't audited in NELA-reports (Changes to criteria if otherwise).
1085 The Core Surgical Training Attainment (CoSTA) Study: Analysis of Differential Attainment in Early Surgical Training Using the UK Medical Education Database (UKMED)
Authors: Vinnicombe Z , Smith D , Little M , Super J , Gunnee M , Anakwe R 
Published: August 2023

Abstract

Aim
Core Surgical Training (CST) represents the earliest rung of the surgical training ladder. The CoSTA study aims to outline demographic differences in attainment in this cohort of applicants using the UK Medical Education database (UKMED).

Method
As part of a retrospective, longitudinal cohort study, using data available from UKMED, CST applications for 3,365 doctors who were F2 between 2013 and 2016 were analysed. Univariate analyses were conducted, followed by a logistic regression model that included the statistically significant variables from the univariate analyses. The outcome measure was successfully obtaining a place on a CST programme.

Results
Univariate analysis found that a lower proportion of black candidates had successful applications (54% compared to 68% for white N = 3,365, P &lt;0.001). Applicants whose parents had attended university were more likely to be successful (67% compared to 59% N = 3,365, P &lt;0.001). Logistic regression found that white applicants were 1.26 times more likely to be successful and applicants whose parents went to university were 1.20 times more likely to be successful (N = 1,935). The model controlled for other relevant variables including applicant behaviour (only applying to CST), medical school attended and performance at medical school (deciles in the Educational Performance Measure).

Conclusions
There is evidence of differential attainment in those applying for the CST programme. It is vital that this information is highlighted to those responsible for the training pathway so these issues can be addressed.
685 Consent for Emergency Laparotomy - Factors Affecting Discussion of Risk of Mortality With Patients and Their Families, and Use of NELA Preoperative Risk Scores as a Tool for Enabling Informed Consent
Authors: Geary G , Waterman J , Shah P 
Published: August 2023

Abstract

Introduction
Emergency Laparotomy (EL) carries a high risk of morbidity and mortality. Preoperative predictive tools can be a useful means of calculating and communicating this risk. Patients and their families should understand the risk of mortality during the consent process for an EL; clinicians are legally and ethically obliged to provide them with such information. Our aim was to assess whether discussions with patients and their family’s surrounding mortality are adequately documented as part of providing informed consent, and factors affecting this.

Method
A retrospective cohort study was performed in a single district general hospital between July 2020 and December 2021. All adult patients undergoing EL of any indication were included. The NELA mortality risk tool was used to estimate the risk of postoperative mortality. Binary logistic regression analysis was performed to investigate the predictors of documented discussion regarding the risk of mortality with patients and their families. All statistical tests were two-tailed and statistical significance was assumed at P &lt; 0.05.

Results
There were a total of 111 patients. Documented discussion regarding NELA risk score with patients and their families were seen in 42% and 32% of cases, respectively. NELA mortality risk score was an independent predictor of documented discussion regarding the risk of mortality with patients (OR: 1.04, 95% CI 1.00, 1.09, P = 0.039) and their families (OR: 1.05, 95% CI 1.01, 1.09, P = 0.014).

Conclusions
There is a need to improve discussions regarding the risk of mortality during the consent process in patients undergoing EL whether such risk is high or low.
154 A Scoping Review of the Management of Benign Prostate Hyperplasia in Africa
Authors: Zubair A 
Published: August 2023

Abstract

Aim
Benign prostatic hyperplasia (BPH) is a non-malignant prostate gland enlargement of unknown cause that affects more than 50% of men over 60 and is the most common cause of bladder outlet obstruction and voiding symptoms. BPH is treated primarily with watchful waiting, phytotherapy, and medical or surgical options. In this study, we sought to examine the different management practices in African urological centres, outcomes of management, and complications.

Method
A literature search was conducted using PubMed, African Journal Online, and Google Scholar regarding the management of BPH from inception till date. Articles were selected based on their relevance to the management of benign prostatic enlargement in Africa. Results are reported according to the PRISMA extension for scoping reviews.

Results
Exactly 2999 patients were included in the study. Seventy-three (73.49%) percent of these patients totalling 2204, underwent surgical management of BPH, 124 (4.13%) patients were treated with phytomedicines, and 684 (22.80%) patients were treated with medical therapy. A total of 808 patients opted for non-surgical treatment for BPH in the included studies. In this group, 124 were treated using phytochemicals or natural herbs, and 648 were treated with standard prescription medications.

Conclusions
While surgical treatment for benign prostatic enlargement is shifting towards minimally invasive procedures in the developed world, open prostatectomy is still quite popular in Africa. Further research should focus not only on the reason for these disparities in management but also on the rationale for the selection of medical, surgical, or phytotherapy in African urological centres.
275 The Declining Elective Workload of a Consultant Surgeon
Authors: Blake I , Mason P F 
Published: August 2023

Abstract

Aim
The elective workload of a consultant surgeon has changed considerably over time. We aimed to describe these changes and explore possible reasons behind them.

Method
All elective procedures performed by a single consultant vascular and general surgeon at a district general hospital were identified for the years 2000 and 2019. Cases were classified by complexity (major, moderate or minor) and specialty (general, vascular, colorectal, upper GI, plastics, endocrine, breast, urology or other).

Results
In 2000 there were 41 full and 50 half day theatre lists compared to 24 full and 47 half day lists in 2019. The total number of procedures fell by 39.25% (400 in 2000 versus 243 in 2019). The mean number of procedures per full and half day list was 5.46 and 3.50 in 2000 compared to 4.67 and 2.80 in 2019.
There were 51 major (12.75%), 189 moderate (47.25%) and 160 minor (40%) procedures compared to 8 major (3.29%), 99 moderate (40.74%) and 137 minor (56.37%) in 2019. Most cases were general or vascular (82.5% in 2000, 97.53% in 2019) but the breadth was greater in 2000 (9 versus 4 specialties).

Conclusions
The number of lists, total procedures performed and mean cases per list are lower despite increasing demand. The breadth and complexity of cases has also decreased. The reasons for this are likely multi-factorial but may include the use of varying anaesthetic and scrub teams, the introduction of checklists, changes to consent procedures, centralisation of services, the presence of a trainee in theatre and changes to specialty training.
1228 Predictors of Re-Intervention Following Index Cholecystectomy
Authors: Kuan J Y , Kho J , Shetty V , Date R , Rajendran I 
Published: August 2023

Abstract

Aim
Index Cholecystectomy (IC) is safe and reduces patient morbidity. However, IC can be challenging due to inflammation of hepatocystic triangle, increasing the risk of postoperative complications. Study was conducted to evaluate factors influencing postoperative complications following IC.

Method
Retrospective review of consecutive IC performed as a primary procedure was carried out between February 2021 and July 2022 in our trust. Primary outcome was postoperative Grade 3 Clavien-Dindo (CDC) complication, in comparison to patients with uncomplicated recovery. Pre-operative factors including age, CRP, WBC, LFT, surgeon grade, modality (laparoscopic/open) and number of previous admissions were included for analysis. Categorical and continuous data were analysed using Chi-Square and Mann-Whitney-U tests respectively. P-value &lt;0.05 was statistically significant.

Results
100 IC were included. Most IC were consultant-led [80/100(80%)]. 11/100(11%) patients developed Grade 3 CDC complication; 4/100(4%) bile leak requiring ERCP and stent insertion, 3/100(3%) post-operative collection requiring radiological-assisted drainage, 2/100(2%) retained bile duct stones requiring ERCP, 1/100(1%) incision and drainage of port site seroma and 1/100(1%) biloma requiring laparoscopic washout. Re-intervention was common in older patients (61±18years vs 55±22years,p = 0.04) and higher median peak CRP levels (312±178 vs 154±284,p = 0.01). There were no differences in LFT parameters, number of previous admissions or timing of operation from day of admission between the two groups.

Conclusions
Age&gt;65 and higher pre-operative CRP were associated with increased risk of postoperative procedural intervention. Larger prospective studies are needed to confirm these findings. Surgeons should consider these factors for consenting and risk assessment purposes.
1301 What Can Be Done to Minimise the Mucosal Complications of Surgical Intervention Involved in the Treatment of Corneal Blindness Through Osteo-Odonto-Keratoprosthesis
Authors: Bukhari S R 
Published: August 2023

Abstract

Introduction
Osteo-odonto-keratoprosthesis (OOKP), “tooth-in-eye surgery”, is a rare, complex surgery offered to certain patients with bilateral corneal blindness. Indications for the surgery include and range from: Steven-Johnson syndrome to end-stage ocular surface diseases. OOKP consists of two stages undertaken four months apart. Surgical complications can be divided into intraoperative and following stages 1 and 2. The most common postoperative complications include: Mucosal thinning/ulceration, mucosal overgrowth, and infection. We discuss, preventive methods which can be considered before the stage 2 intervention to minimise the rate of complications post OOKP surgery.

Method
A literature search was conducted in PubMed and Research gate to determine the main complications following involvement of maxillofacial surgery. Our key search criteria included mucosal complications post maxillofacial and oculoplastic surgical involvement. We selected for complications, post harvestation and transfer of the buccal mucosa onto the eye surface in OOKP.

Results
Three studies were selected, with a total of 130 patients. 58% experiencing surgical complications following stage 2. Study 1 demonstrated mucosal graft complications (22%), mucosal overgrowth(28%), mucosal thinning and ulceration(22%). Notably, 38% experienced no complications following the second stage. In the remaining studies, post-operative complications were divided into mucosal necrosis (33%) and mucosal overgrowth(13%), showing how complications can often interplay.

Conclusions
OOKP is a complex and laborious multi-disciplinary surgery, amenable to postoperative complications. Mucosal complications occur in a significant number of cases; therefore, it is important to anticipate these and endeavour to avert them. We outline how through prudent patient selection and pre-operative patient care (promotion and correction of dentition and oral health, examination of oral mucosa and maintenance of good mucosal graft health), outcomes for this surgery can be significantly improved.
34 Susceptibility Vessel Sign (SVS) for Assessment of Intra-Arterial Thrombus and Thrombus Burden in Patients with Acute Ischemic Stroke: An Institutional Study
Authors: Paudel S , Phuyal S 
Published: August 2023

Abstract

Background
SWI can help in the diagnosis of thrombus within the vessel in acute ischemic stroke (AIS) known as susceptibility vessel sign (SVS) and detection of SVS within the vessel can predict treatment modality and outcome. In this study, the purpose is to correlate the SVS on SWI with different parameters of stroke.

Method
It was a retrospective cross-sectional study, where consecutive stroke patients with vessel occlusion on magnetic resonance angiography (MRA) were included for the study for one year. The relation of SVS on SWI with risk factors and territory involved and length of thrombus was correlated with the NIH stroke scale (NIHSS).

Results
A total of one hundred and five patients were enrolled for this study. 62% (66 out of 105) of patients showed SVS on SWI with MRA positive occlusion. A positive correlation was observed between SVS on SWI with the risk factor (p = 0.003) with 86% of heart disease and 47% of hypertension had SVS. A positive correlation was also observed between the SVS on SWI with territorial occlusion (p = 0.000). There was moderate positive correlation was observed between the NIHSS and thrombus length (p = 0.002) with a Pearson coefficient of 0.367.

Conclusions
SWI can be useful in identifying the location of the thrombus, and NIHSS can determine the thrombus length in acute stroke. A higher incidence of SVS can be associated with risk factors and it also depends upon the site of occlusion of the vessel.
146 WHO Surgical Checklist Compliance and Attention Rates Among Different Specialties and Years
Authors: Ng W H , Yeatman W , Kim D , Molyneux M 
Published: August 2023

Abstract

Aim
This study aims to evaluate the compliance of surgical staff to the WHO surgical safety checklist, excluding sign-out. The quality of surgical marks and inattentive rates of surgical staff during me-out were also investigated.

Method
Data was collected over 3 weeks using a fixed criteria in September 2022 within 3 hospitals consisting of 5 sites. A total of 105 procedures were observed. Mean and confidence intervals were calculated using SPSS.

Results
The mean compliance rate of the checklist was 97%. Sign-in (97%), Time-Out (96%), and Surgical mark rates (98%) all scored similarly.
Among specialties observed, interventional cardiology scored the highest compliance rates, at 100%, while cardiothoracic surgery scored the lowest at 91%. In 38% of procedures observed, surgical staff were found to be inattentive during me-out. Among the inattentive surgical staff, 73% of surgical staff had mild inattentiveness (e.g. filling up drug charts), 18% had moderate inattentiveness (e.g. talking to other staff), 9.1% of them had severe inattentiveness (e.g. scrubbing in).
Among the audit cycles from 2014 to 2022, there was an increase in sign-in rates from the previous cycle held in 2019 to 2022 from 82% to 97%. Inattentive rates increased from 33% in 2019 cycle to 38% in 2022 cycle.

Conclusions
This study reports high compliance rates and improvement with the checklist among all specialties, but also high inattentive rates by surgical staff. Improvements such as fostering a good culture among surgical staff on the WHO checklist and paying attention are key in never reducing events.
209 Cochlear Implant Referral Time in Deaf Children: Are They Different Due to Parental Deafness?
Authors: Shukla J , Adegboye O , Oremulé T 
Published: August 2023

Abstract

Aim
95% of deaf children are born to hearing parents (DCHP) and 5% are born to Deaf parents (DCDP). Traditionally, Deaf parents have opposed cochlear implants (CIs) in deaf children as they believe CIs medicalise deafness. Delayed referral and implantation owing to parental hesitation may affect linguistic and educational outcomes. There is a lack of literature regarding the factors that may affect care provision for DCDP. Consequently, this study aimed to investigate whether DCDP were referred for cochlear implantation and underwent surgery at an older age compared to DCHP.

Method
This was a retrospective study carried out at a tertiary referral centre. 22 DCDP who underwent cochlear implantation between 1999 to 2021 were identified and matched to 22 DCHP. An unpaired t-test compared the differences between the age at referral and age at implantation between the 2 groups. A Pearson’s correlation determined the relationship between months till referral and months between referral and implant. SPSS v28.0 was used for statistical analysis.

Results
DCDP had an older mean age at referral (22.5 months) than DCHP (17.5 months, p = 0.552) and had an older mean age at implantation (33.4 months) than DCHP (31.0 months, p = 0.767) albeit this was statistically insignificant. DCDP had a significant negative correlation with the months till referral and the months between referral and implantation (r = -0.514, p = 0.017).

Conclusions
Future research should aim to use a larger patient sample and consider the effect of delayed referral and surgery on clinical outcomes between DCDP and DCHP.