bluuebunny/crossref_metadata_2025_split huggingface dataset:
O146 Natural history and clinical outcomes in patients with groove pancreatitis: an observational study
Authors: Oyende O , Sanyal S , Jackman J , Mitchell W K , Adiamah A , Clarke C , Bannur U , Zaitoun A M , Lobo D N 
Published: May 2023

Abstract

Introduction
Groove pancreatitis (GP) is a rare and focal form of pancreatitis affecting the para-duodenal groove area. Diagnosis is usually made by radiological imaging or histological analysis. This study aimed to determine the disease pattern, treatment modalities and outcomes.

Methods
Data were retrospectively collected for patients diagnosed with GP radiologically and/or histologically at our tertiary hospital from 2010 to 2019. A search of our imaging database was conducted using the term groove pancreatitis totalling 1,040 patients. Duplicates (95) and reports mentioning only groove or only pancreatitis (945) were eliminated. All included patients were then re-assessed by two expert hepatopancreaticobiliary radiologists and a specialist histopathologist to confirm inclusion.

Results
Our cohort comprised of 54 patients, 39 males and 15 females. The mean age was 67 years (range 39-101 years). Of the 54 patients, 11 had pancreatic cancer (20%). Pain as a main presenting complaint occurred in 78% and jaundice in only 13%. 26% had elevated lipase and 37% had deranged LFTs. 69% were managed conservatively as first line. 11% of patients failed conservative management and proceeded to endoscopic treatment. Surgical intervention occurred in 24%. 11% of all patients had complete symptom relief, and 76% showed symptom improvement. Mortality at 2years of follow-up, was 45% and 28% in those with and without cancer.

Conclusion
GP is a benign disease with a non-specific natural history. It remains unclear if there is a transition between GP and GP-associated mass. This emphasises a high index of suspicion in diagnosis, using radiological, endoscopic, and cytological analysis.
O154 Outcomes of bariatric surgery among patients with obstructive sleep apnoea: a systematic review, meta-analysis and a retrospective database analysis
Authors: Katasani T , Aldafas R , Holt G , Alkhyatt W , Idris I 
Published: May 2023

Abstract

Introduction
Obstructive sleep apnoea (OSA) is highly prevalent among patients undergoing bariatric surgery. Previous studies have reported a higher risk of complications, longer hospital stays and ICU admissions among OSA patients following general surgery but clinical outcomes following bariatric surgery remain unclear. Therefore, we evaluated the risk of adverse outcomes among OSA patients undergoing bariatric surgery.

Methods
We undertook a systematic review and meta-analysis followed by retrospective database analysis. Searches were performed using PubMed and Ovid Medline. Bariatric surgery studies that compared OSA and non-OSA patients that utilised outcome measures that included length of stay, risk of complications, readmission within 30 days and need for ICU admission were selected. Retrospective data analysis of patient records was conducted from the Royal Derby Hospital (RDH) bariatric surgery database by comparing OSA patients (N=49) and non-OSA (N=86) patients using the same outcome measures.

Results
Patients with OSA are at greater risk of complications after bariatric surgery (RR=1.23; CI:1.01,1.5, P=0.04), driven largely by an increased risk of cardiac complications (RR=2.44; CI:1.26,4.76, P=0.009). There were no significant differences between the OSA and non-OSA cohorts in the other outcome variables. Clinical evaluation at RDH showed no significant differences between OSA and non-OSA patients in terms of length of stay, need for ICU admission, risk of complications and 30-day readmission.

Conclusion
Following bariatric surgery, patients with OSA must be managed carefully due to the increased risk of cardiac complications. However, patients with OSA are not more likely to require a longer length of stay or readmission.
O155 Effects of oral feeding on gastric emptying and gastrointestinal hormone secretion in males with obesity compared with those of healthy weight
Authors: Simpson E J , Althubeati S , Cordon S , Bush D , Hoad C , Eldeghaidy S , Gowland P , Macdonald I A , Lobo D N 
Published: May 2023

Abstract

Introduction
Hormones released in response to nutrients in the gastrointestinal (GI) tract, act as physiological signals to regulate appetite and play a role in feeding behaviours. Altered secretion of these ‘appetite’ hormones after feeding in those with obesity (‘Obese’), compared to those with healthy weight (‘Lean’), may drive over-consumption of energy. This study assessed whether gastric emptying rate was implicated in this altered response.

Methods
Twenty healthy males attended the laboratory once in the morning after an overnight fast. Volume of gastric contents (GCV) and small bowel water (SBW) were assessed using MRI (Philips 3T Ingenia and dStream Anterior Coil) pre, immediately post and every 30-minutes for 4-hours after a standard meal (2.5MJ, 78g Carbohydrate, 24g Protein, 21g Fat). Concurrently, arterialised-venous blood was taken for insulin, ghrelin, GLP-1 and PYY evaluation. Gastric emptying (T50) was derived from GCV. Data are presented as the mean (SD) or standardised effect size (ηp2).

Results
10 Lean [38(14)y, 24(2) kg/m2] and 10 Obese [38(13)y, 34(3)kg/m2] were studied. Fasting insulin [12.5(5.8) vs. 17.6(11.3) mIU/l], Ghrelin [3.2(2.1) vs. 2.9(0.9) ng/ml], GLP-1 [7.2(11.5) vs. 13.3(2.5) pmol/l], PYY [102.3(46.7) vs. 88.4(32.4)pg/ml], SBW [121(96) vs. 168(125)ml] and GCV [59(33) vs. 59(30)ml] did not differ between ‘Lean’ and ‘Obese’. Response of Ghrelin (ηp2=0.005), GLP-1 (ηp2=0.103), PYY (ηp2=0.050) and SBWC (ηp2=0.145) to eating, and T50 [148(51) vs. 170(49) min] did not differ between groups. However, postprandial insulin secretion was greater in obese (ηp2=0.286; P&lt;0.05).

Conclusion
Gastric emptying and incretin hormone secretion were not altered in participants with obesity. However, postprandial hyperinsulinemia, associated with insulin resistance, was observed.
O159 Nonselective alpha blockade alone is associated with a significant decrease in ICU/CCU requirement following phaeochromocytoma resection
Authors: Viani Walsh D , Calpin G , O’Reilly M , Hill A , Sherlock M , Thompson C 
Published: May 2023

Abstract

Introduction
Preoperative treatment with alpha blockade is key to optimisation of patients with phaeochromocytoma. Beta blockers may be employed after optimal alpha blockade to prevent reflex tachycardia. The principle of treatment is to avoid severe intraoperative hypertension or hypotension, but the optimal perioperative regimen is unclear. Recent studies have suggested that dual blockade may increase the rate of intraoperative haemodynamic instability We hypothesized that nonselective alpha blockade alone, without addition of beta blockers, would reduce the need for postoperative ICU/CCU supportive care.

Methods
A retrospective study of all patients undergoing pheochromocytoma/paraganglioma resection between 1998 and 2022 was performed. Patients were categorized into two cohorts: Group 1 patients received alpha and beta blockers preoperatively while Group 2 patients received nonselective alpha blockade alone. The primary endpoint was the need for ICU/CCU support.

Results
Of 40 patients identified, adrenalectomy was performed in 36. Median age at resection was similar for both groups (63 v 56 years). Of 22 Group 1 patients 8 (36.4%) required ICU/CCU admission due to haemodynamic instability, (MLS 1.22 days) compared to 3 (21.4%) of the 14 Group 2 (MLS 0.21, p=0.035; one-tailed Two-Sample t-test assuming unequal variance). Median maximum diameter of lesions in Group 1 was 5.4cm, while Group 2 was 4.2cm. In Group 1 59% showed right adrenal disease (n=13), Group 2 43% (n=6).

Conclusion
Our study suggests that nonselective alpha blocker alone, without the addition of beta blockers, is associated with a significantly decreased requirement for post-operative support in the ICU or CCU following pheochromocytoma resection.
O168 A review of oral and oropharyngeal subsite classification and the impact on long-term speech and swallow function of patients with oncological reconstruction
Authors: Awad L , Langridge B , Sinha D , Govender R , Noy D , Butler P , Kalavrezos N 
Published: May 2023

Abstract

Introduction
The oral cavity and oropharynx can be divided into subsites by function or anatomically. The impact on function following reconstruction of one or more subsites with flap surgery is largely unknown. This systematic review aims to assess how subsites are classified, which assessment tools are used to assess speech and swallow, and long-term outcomes following reconstruction.

Methods
A systematic review of PubMed, Web of Science and Embase was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All types of articles were included which contained speech and swallow follow up for oncological flap reconstruction of the oral cavity and oropharynx, except case reports.

Results
The search resulted in 26 studies with a total of 2,270 patients. Subsites were variably classified ranging from 2-18 per study. Most articles classified subsites anatomically and less commonly functionally grouped subsites. Fewer than half considered the impact of unilateral/bilateral/combination defects. Poorer post-operative function was found for reconstruction of base of tongue, floor of mouth and defects crossing the midline with the best results for lateral reconstruction. The University of Washington Quality of Life Questionnaire (UW-QOL) was the most prevalent measure of function. Subsite was considered impactful for speech and swallow in 76% and 57% of articles respectively.

Conclusion
Subsite categorisation is extremely variable within the current literature. Subsite reconstruction with flap surgery significantly affects swallow and speech. A consistent and formalised approach, risk stratifying for multiple contributing factors would be useful in clinical pre- and post-operative management.
O169 A systematic review on the effect of bone wax application in cardiac surgery
Authors: Shah A , Kuma N S , Raja S , Bhudia S 
Published: May 2023

Abstract

Introduction
Limited and conflicting evidence exists on whether bone wax usage in cardiac surgery increases risk of infection. A systematic review was conducted to examine the cardiac surgery postoperative outcomes following bone wax application.

Method
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were adhered to in this review. The EMBASE, MEDLINE and Scopus databases were searched for studies evaluating perioperative bone wax usage, excluding non-English papers. All relevant synonyms of Cardiac Surgery, Bone Wax, Infection, and Healing were used for paper identification. Wound infection, sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality were outcomes of interest.

Results
From the 66 articles identified, 5 were included following full-text screening. No statistically significant difference in infection risk between the bone wax (BW) and comparator groups existed. However, the evidence suggests bone wax significantly increases sternal dehiscence risk. Studies reporting postoperative bleeding showed a significantly greater mean volume in the BW group. All studies reporting postoperative chest drainage (n=3) showed a greater mean volume in the BW group, of which two were significant. Of the three papers reporting mortality, two showed increased risk in the BW group.

Conclusion
Current evidence indicates no significant association between bone wax and wound infection. Bone wax is associated with increased risk of sternal dehiscence, postoperative sternal bleeding, postoperative chest drainage and mortality. Greater emphasis should be placed on bone wax alternatives in clinical practice. Limited data necessitates larger studies, and for clearer guidelines to be established around them.
P02 Surgeon's narcissism, hostility, stress and meaning in life
Authors: El Boghdady M , Ewalds-Kvist B 
Published: May 2023

Abstract

Introduction
Disruptive physician behaviour can affect patients’ safety. If surgical trainees throughout higher education experience disruptive behaviour, impaired work-life may follow. Therefore, we studied if surgeons were prone to disruptive behaviour in form of narcissism (N), hostility, perceived stress and the presence of meaning in life.

Methods
General surgeons in UK National Health Service from 2 hospitals participated with 3 level of training: senior house officer (SHO), specialist registrars (SPR) and consultants (CONS). Participants completed 52 VAS-formed questions plus demographics. Modified questionnaires were used for assessments of ‘Hostility’, ‘Narcissism’, Meaning in life, Quality of work-life and bullying.

Results
Altogether 33% of surgeons displayed narcissism and 22% could exhibit disruptive behaviour. By MANOVA significant differences between low, medium and high N groups was revealed in hostility (p&lt;.01), perceived stress (p=.001), presence of meaning in life (p&lt;.05). Regression analyses explained hostility both by N-scale (p=.000) and ‘being bullied during training’(p=.009) but negatively by ‘presence of meaning in life’(p=.004). Surgeons’ perceived stress was explained both by N-scale (p=.000) followed by ‘seeing others bullied during training (p=.000) and negatively by ‘working extra days beyond schedule’ (p=.007). Presence of meaning in life was explained mostly by ‘(eu)stress’ (p= .000) but negatively both by ‘doing extra work beyond schedule’ (p= .016) and hostility (p= .003).

Conclusion
Surgeons may exhibit disruptive behaviour in a challenging situation. Being bullied during surgical training predicted hostility. Seeing others being bullied during surgical training predicted stress. Eustress explained best surgeons’ experience of presence of meaning in life.
P04 The relationship between air travel and postoperative venous thromboembolism: a systematic review and meta-analysis
Authors: Ghosh A , Shea J , Turner B , Onida S , Davies A 
Published: May 2023

Abstract

Introduction
Surgery is a well-established risk factor for venous thromboembolism (VTE), with fatal pulmonary embolism (PE) remaining the most common preventable death in post-operative patients. Air travel has also been identified as an independent risk factor for VTE, however, there is no guidance on whether air travel in addition to surgery exacerbates this risk. With the increased rates of health tourism, patients increasingly fly to seek surgical intervention. This systematic review and meta-analysis pools published literature to estimate the additional risk of recent air travel after surgery.

Methods
Articles reporting post-operative VTE incidence in adults with recent air travel were included in our review with data pooled using fixed and random effects. Our primary outcome measured the pooled VTE risk.

Results
Seven retrospective studies were included with a total of 24975 patients. The odds ratio (OR) of VTE in the flying plus surgery group was 1.96 (95%CI 0.54-7.08). In subgroup analysis of patients with over 4 hours of air travel, odds of VTE were 2.35 (95%CI 0.29-19.36). The incidence of DVT and PE specifically was 0.67% (95%CI 0.31%-1.51%) and 0.41% (95%CI 0%-1.29%) respectively in the flying and surgery group and 0.45% (95%CI 0.10%-2.00%) and 0.55% (95%CI 0.31%-0.86%) in the surgery alone group.

Conclusion
The meta-analysis demonstrates heterogeneity in studies and a very low certainty of evidence overall considering imprecision and observational study designs. Whilst results did not demonstrate significant increase in VTE risk, further studies should propensity match patients in the cohort to reduce the effect of confounding.
P06 Prediction of surgical-site infection (SSI) in adult patients undergoing gastrointestinal surgery: a systematic review of prognostic risk models
Authors: McLean K , Goel T , Lawday S , Riad A , Simoes J , Knight S , Ghosh D , Glasbey J , Bhangu A , Harrison E 
Published: May 2023

Abstract

Introduction
Surgical site infections (SSI) are among the most common postoperative complications following gastrointestinal surgery. This review aimed to identify and evaluate prognostic tools for prediction of SSI in gastrointestinal surgery.

Methods
Studies describing the development or validation of prognostic models for 30-day SSI after gastrointestinal surgery were identified (PROSPERO: CRD42022311019). An English language restricted search of MEDLINE, EMBASE, and EBSCO was undertaken from 1st January 2000 to 31st December 2021. Studies were excluded if prognostic models included postoperative parameters, or were procedure-specific. Quality assessment was undertaken using TRIPOD and PROBAST guidelines, with narrative synthesis comparing discrimination (area under the curve [AUROC]) and prognostic accuracy between models.

Results
Of 2953 records reviewed, 23 eligible prognostic models were identified. Thirteen (56.5%) reported no internal validation, and only 4 (17.4%) had undergone external validation. Most identified operative contamination (54.5%, n=12) and duration (54.5%, n=12) as important predictors, however, there remained substantial heterogeneity in other predictors identified (range: 2-28). All models demonstrate a high risk of bias due to analytic approaches, with overall low applicability to an undifferentiated gastrointestinal surgical population. Model discrimination was reported in most studies (86.4%, n=19); however, calibration (22.7%, n=5) and prognostic accuracy (18.2%, n=4) was infrequently assessed. Of externally validated scores (n=4), none displayed “good” discrimination (AUROC ≥0·70).

Conclusion
The risk of SSI following gastrointestinal surgery is insufficiently described by existing risk prediction tools, which are not suitable for routine use. Novel risk stratification tools are required to target perioperative interventions and mitigate modifiable risk factors.
P20 An audit of the effectiveness of a prehabilitation programme in patients having surgery for cancer
Authors: Truslove E , James M , Beed M , Lobo D N , Haywood A , Burrows A , Morgan B , Wilson V , Evans D 
Published: May 2023

Abstract

Introduction
Three prehabilitation programmes for patients undergoing surgery for cancer, based around initial physical activity scores, commenced April 2022. An audit of key outcomes was undertaken on patients enrolled onto the main programmes.

Methods
Patients with cancer requiring surgery were initially assessed (April to Oct 2022) and offered 2-3 sessions per week at one of: a community-based gym with registered trainers, a hospital-based gym, or a programme to train at home. Here we report physical activity scores and incremental shuttle walk test at the beginning and end of the programme, in addition to the hospital length of stay (LoS).

Results
The mean (±sem) physical activity score for hospital gym patients (54.4±18.3, n=23) was significantly lower (p&lt;0.001) than for those attending the community gym (180.5±26.5 n=47), but both groups showed a significant improvement (p&lt;0.001) at the end of the programme (216.7±18.3 and 362.0±31.0, respectively). The initial mean (±sem) incremental shuttle walk test score for the hospital gym patients (126.5±19.8, n=17) was significantly lower than for those attending community gyms (415.6±30.1, n=34), but only those at the latter (487.1±29.1) managed a significant increase (p&lt;0.001). Thirty-seven patients requiring colon surgery completed the prehabilitation programme. The median (IQR) LoS [5.2 (3.4-7.3) days] was significantly lower for these patients (p&lt;0.05) compared with those at NUH who did not enter the programme [5.6 days (4.3-8.2) n=567].

Conclusion
The prehabilitation programme increased physical activity for both normal and frail patients with cancer prior to surgery and this was associated with a reduction in LoS.
Healthcare Utilization After Respiratory Tuberculosis: A Controlled Interrupted Time Series Analysis
Authors: Romanowski Kamila , Law Michael R , Karim Mohammad Ehsanul , Campbell Jonathon R , Hossain Md Belal , Gilbert Mark , Cook Victoria J , Johnston James C 
Published: May 2023

Abstract

Background
Despite data suggesting elevated morbidity and mortality among people who have survived tuberculosis disease, the impact of respiratory tuberculosis on healthcare utilization in the years following diagnosis and treatment remains unclear.

Methods
Using linked health administrative data from British Columbia, Canada, we identified foreign-born individuals treated for respiratory tuberculosis between 1990 and 2019. We matched each person with up to four people without a tuberculosis diagnosis from the same source cohort using propensity score matching. Then, using a controlled interrupted time series analysis, we measured outpatient physician encounters and inpatient hospital admissions in the 5 years following respiratory tuberculosis diagnosis and treatment.

Results
We matched 1216 individuals treated for respiratory tuberculosis to 4864 non-tuberculosis controls. Immediately following the tuberculosis diagnostic and treatment period, the monthly rate of outpatient encounters in the tuberculosis group was 34.0% (95% confidence interval [CI]: 30.7%, 37.2%) higher than expected, and this trend was sustained for the duration of the post-tuberculosis period. The excess utilization represented an additional 12.2 (95% CI: 10.6, 14.9) outpatient encounters per person over the post-tuberculosis period, with respiratory morbidity a large contributor to the excess healthcare utilization. Results were similar for hospital admissions, with an additional 0.4 (95% CI: .3, .5) hospital admissions per person over the post-tuberculosis period.

Conclusions
Respiratory tuberculosis appears to have long-term impacts on healthcare utilization beyond treatment. These findings underscore the need for screening, assessment, and treatment of post-tuberculosis sequelae, as it may provide an opportunity to improve health and reduce resource use.
Quantifying changes in umbilicus size to estimate the relative age of neonatal blacktip reef sharks (Carcharhinus melanopterus)
Authors: Debaere Shamil F , Weideli Ornella C , Bouyoucos Ian A , Eustache Kim B , Trujillo José E , De Boeck Gudrun , Planes Serge , Rummer Jodie L 
Published: May 2023

ABSTRACT
Sharks can incur a range of external injuries throughout their lives that originate from various sources, but some of the most notable wounds in viviparous shark neonates are at the umbilicus. Umbilical wounds typically heal within 1 to 2 months post-parturition, depending on the species, and are therefore often used as an indicator of neonatal life stage or as a relative measure of age [e.g. grouping by umbilical wound classes (UWCs), according to the size of their umbilicus]. To improve comparisons of early-life characteristics between studies, species and across populations, studies using UWCs should integrate quantitative changes. To overcome this issue, we set out to quantify changes in umbilicus size of neonatal blacktip reef sharks (Carcharhinus melanopterus) around the island of Moorea, French Polynesia, based on temporal regression relationships of umbilicus size. Here, we provide a detailed description for the construction of similar quantitative umbilical wound classifications, and we subsequently validate the accuracy of our classification and discuss two examples to illustrate its efficacy, depletion rate of maternally provided energy reserves and estimation of parturition period. A significant decrease in body condition in neonatal sharks as early as twelve days post-parturition suggests a rapid depletion of in utero-allocated energy reserves stored in the liver. Back calculations of timing of birth based on the umbilicus size of neonates determine a parturition season from September to January, with most parturitions occurring during October and November. As such, this study contributes valuable data to inform the conservation and management of young-of-the-year blacktip reef sharks, and we therefore encourage the construction and use of similar regression relationships for other viviparous shark species.