bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP8.5 Bacterial profile and antimicrobial susceptibility patterns of isolates among patients diagnosed with surgical site infection at a tertiary teaching hospital in Pakistan
Authors: Sabir Alifa , Rauf Fatima , Javed Muhammad Umar , Malik Naveed Akhtar , Hanif Muhammad 
Published: August 2023

Abstract

Objective
The study aimed at assessing the bacterial profile and antimicrobial susceptibility patterns of the pathogens isolated from patients diagnosed with surgical site infection.
This study will help identify the organisms and will guide in formation of protocols to prevent and treat surgical site infections.

Methods
This descriptive cross-sectional study was conducted in the Department of Surgery from May 2021 to May 2022, using convenient sampling technique. Wound samples were taken from patients diagnosed with surgical site infection and cultured on Blood and MacConkey agar. Antimicrobial susceptibility was performed on Muller Hinton agar. Data was entered and analyzed using SPSS v.23.

Results
A total of 101 samples from 78 patients were analyzed. Out of the bacteria from positive growth cultures, Escherichia coli (19,18.8%) was the most common isolate followed by Pseudomonas aeruginosa (17,16.8%) and Klebsiella pneumoniae (15,14.9%). Acenitobacter baumanni was isolated from 11 (10.9 %) patients, methicillin-resistant Staphylococcus aureus from 4 (4 %) patients and Proteus mirabilis from 2 (2 %) patients. However, 9.9% samples showed no growth on cultures. Escherichia coli was the most sensitive to amikacin (89.5%) and meropenem (78.9%). While Pseudomonas aeruginosa showed maximum susceptibility towards meropenem (82.4%).

Conclusion
Escherichia coli was the most commonly isolated pathogen from surgical site infection sites, followed by Pseudomonas aeruginosa, Klebsiella pneumoniae and Acenitobacter baumanni as causative agents for SSI’s. This study demonstrates the increasing incidence of infections from once uncommon organisms like Klebsiella pneumoniae and Acenitobacter baumanni. This calls for action and formation of protocols to fight the menace of SSI’s.
ThTP8.7 Streamlining ambulatory management of emergency general surgery
Authors: Waggett Helena , Claxton Mary , Wijeyaratne Mnuk , Hollyman Marianne 
Published: August 2023

Abstract

Aims
There is a trend to increase ambulatory management of general surgical patients, both improve the experience and outcomes for patients, as well as reduce need for inpatient beds.
Prior to 2019, our trust had no ambulatory service; during 2019 a clinic was opened, which was located remotely from the admissions ward, and as a result we were unable to direct the majority of patients to the clinic to support ambulatory management. We sought to assess the benefit of the clinic, and to co-locate the ward and ambulatory triage clinic to increase access of ambulatory management.

Methods
Admission rates were assessed before and after the ability to run virtually all patients through the ambulatory ‘triage’ clinic before making a decision to discharge or admit. Data have been used from electronical hospital systems.

Results
In 2019 the average number of patients reviewed was 18, with a 81% admission rate.
Practice was variable during the COVID pandemic, once things stabilised in 2022, 25 patients were reviewed between clinic and the ward daily, with 16.2(65%) admission rate.
The move of the ward and the clinic in 2022 did not change the total number of clinical contacts a day (25), however there is a reduction in the average percentage of patients staying overnight to 13.5(54%).

Conclusions
We have demonstrated that we can reduce the number of inpatient stays and reduce the length of stay of patients. The same day discharge rate was improved by allowing the majority of patients to be reviewed in the clinic, before a decision regarding admission was made.
ThTP8.10 Creating a Team Culture of Building a reliable NELA Database in a District General Hospital
Authors: Tsiourva Evangelia Ioanna , Dunstan Matthew , West Nicholas 
Published: August 2023

Abstract

Introduction
In St Helier Hospital, Surrey, we run a busy Emergency General Surgery Service, performing almost 200 laparotomies annually. It is remarkable that in our Department every laparotomy case is consultant-led and that the percentage of HDU admission of high perioperative risk cases reaches 100%, leading to survival rates that are above the UK average. However, the NELA database has not been updated consistently with cases missing and others entered erroneously. As a result, the NELA database does not reliably reflect the quality of care we provide to our patients and undermines the Department’s CQC metrics.

Methods
We established a multidisciplinary QI Project involving the Departments of General Surgery, Anaesthetics and Intensive Care to create a team culture of commitment to NELA collection data.

Interventions

Results

Conclusion
Simple measures as well as raising awareness among the implicated professionals has led to great improvement in adherence to updating NELA database.
FTP1.5 The forgotten tribe in healthcare? Mechanism of injury and outcome of injured adolescents in a UK Major Trauma Centre
Authors: Miller Eleanor , Morris Louise , Wood Damian , Kurien Thomas , Brooks Adam 
Published: August 2023

Abstract

Aim
Trauma is the leading cause of mortality in the adolescent and young adult population. Adolescents, particularly those aged 16-17 years often fall between provisions of traditional adult and paediatric services. This study examines the outcomes for injured adolescents treated at one combined adult/paediatric UK major trauma centre.

Methods
An observational study included patients aged 10-24.99 years treated at a single MTC between April 2020 and April 2022. Demographic and injury mechanism and severity (ISS) data were recorded for three subgroups: paediatric (10-15 years), transitional (16-17) and young adult (18-24). Outcomes were compared including length of stay, surgical procedures and mortality.

Results
343 patients were included (78.4% male). 16-17 year olds were significantly more likely to be victims of violence and require a longer stay in hospital. Mortality was 4.1% overall.

Conclusions
It is vital that the specific needs of young people aged 16-17 are recognised in terms of violence reduction and injury prevention strategies, and in planning and delivery of hospital services.
FTP2.2 Retrospective analysis of potentially missed right-sided colon cancer
Authors: Albendary Mohamed , Ojha Soumya , Badh Manpreet , Foley Jordan , Shinwari Husna , George Anil 
Published: August 2023

Abstract

Background
Right colon cancer can be missed due to either inadequate assessment or suboptimal investigations. This audit evaluated a present clinical practice and highlighted points to improve the diagnostic ability of clinicians.

Methods
Records of patients diagnosed with right colon malignancy between 2015 till 2020 were screened for missed diagnostic opportunities in the 3 years preceding their cancer diagnosis. Reasons were categorised as: a critical miss (includes inadequate investigations of a significant encounter with suggestive symptoms or lost follow up) and a potential miss (encounters with less suggestive symptoms or insufficient investigations).

Results
While 116 patients (49%), out of the included 235 patients, had at least 1 previous encounter with suggestive symptoms, only 83 (71.5%) of them were investigated. 56 patients had a previous colorectal investigation, with CT imaging being the most frequent test requested, and performed for approximately half of the patients.
30 (13%) incidents of critical diagnostic miss, and 28 (12%) incidents of potential diagnostic miss were identified. (Table 1)

Conclusions
Clinicians should adequately investigate suggestive symptoms of right colon cancer, including patients older than 40 with appendicitis.
Our results conform with the reported less than optimal sensitivity (75-100%) of non-targeted CT to pick up early colonic cancer, and with the probable false sense of reassurance after unremarkable flexible sigmoidoscopy for potential symptoms of right colon cancer.
FTP2.12 The National Consultant Information Programme (NCIP) and its effect on current Colorectal surgical practice, specifically looking at Exenteration of Pelvis for Lower Gastrointestinal Cancer
Authors: Galla Aashlesha , Maxwell-Armstrong Charles , Booth Matthew , Young Lucy , Bogovac Marina , Williams Norman 
Published: August 2023

Abstract

Aim
Extract and contextualise relevant data from NCIP tool, focusing on exenteration of pelvis for lower gastrointestinal (GI) cancer. Understand Covid's impact on surgical practice, and any variations seen at trust and national level, to gain insight into current colorectal surgical practice in England.

Method
Pseudonymised data extracted from NCIP dashboard by NHS England Improvement data analysts. NCIP data is primarily from Hospital Episode Statistics, and other relevant databases and registries. Various metrics were analysed including pre-Covid-19 or during Covid-19, frequency of cases, procedure sub-group, length of stay (LOS), readmission and mortality. Data contextualised by comparing observed data with previous literature, if possible.

Results
687 cases from April 2018-March 2022. All elective, all 17+ years. 340 cases between April 2018-March 2020 and 347 cases between April 2020-March 2022.
4 procedures: 11 Lateral Lymphadenectomies, 20 Other Exenterations, 161 Posterior Exenterations, 495 Total Exenterations. Decrease in frequency of cases post-covid for all procedure sub-groups except total exenteration (5% increase).
40 centers across England, 99.27% of cases performed at NHS trusts. Center variation observed with numerous providers doing less than 10 cases in the 4-year period.
Average length of stay (LOS): 23.65 days ± 0.75 with 95% CI [22.18, 25.12], however maximum LOS of 154 days.
30-day readmission was 21.83%. 90-day mortality was 2.47%.

Conclusion
Impact of Covid-19 pandemic not observed in the data. Significant variation observed at provider level for each procedure sub-group, possibly contributing to variation seen in metrics such as LOS. Data suggests the need for further exploration into observed variation.
FTP3.12 Can pre-operative MRI predict the extent of surgery in Deep Infiltrating Endometriosis – An Observational Study
Authors: Sarodaya Varun , Blake-James Benedict , Birkett Victoria , Petty Daniel , Sanaullah Fawzia , Bandyopadhyay Dibyendu 
Published: August 2023

Abstract

Aims
Deep Infiltrating Endometriosis (DIE) surgery is complex & the interventions involving multi-specialties can be unpredictable. Frequently it depends on the extent of the bowel/bladder involvement. We aim to study the role of MRI in predicting such involvement & in pre-operative multidisciplinary planning of DIE surgery.

Methods
All consecutive patients between Jan 2021 & Dec 2022 who underwent MRI scan & subsequent DIE surgery in an accredited endometriosis center were included. Correlation was studied especially with reference to the bowel/bladder involvement between MRI findings & operative interventions.

Results
A total of 19 patients were included. Mean age of the patients was 41.83 years (range 27-55 years). Five out of 19 (26%) & 2 of 19 (10%) patients showed measurable (length & depth) endometrial deposits rather than adhesions/endometrial scarring on MRI in bowel (rectum &/or sigmoid) & bladder wall respectively. Two patients had anterior resection and primary anastomosis and 6 had either shaving or disc excision of the bowel wall. Both patients with bladder wall involvement required full thickness resection of bladder wall. The sensitivity, specificity and positive & negative predictive values of MRI depicting the extent of bowel and bladder intervention were 71%, 90%, 90% & 69% respectively.

Conclusion
MRI helps predict the extent of DIE surgery & facilitates pre-operative planning of multi-specialty approach. Specific volume categorization of the measurable deposits may influence the nature of bowel/bladder surgery (resection vs shaving). A large scale multicenter prospective study would be useful for further evaluation.
FTP4.8 A survey on enhanced recovery after surgery (ERAS) in Pakistan
Authors: Rauf Fatima , Rauf Sidra , Sannan Abdul , Hanif Muhammad 
Published: August 2023

Abstract

Introduction
ERAS protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the stress response following surgery. Despite a significant body of evidence indicating that ERAS protocols lead to improved outcomes, implementation has been slow, and is not yet universal.
The aim of this study was to evaluate current implementation of enhanced recovery protocols among Pakistani surgeons.

Methods
A survey questionnaire consisting of 23 items was created to assess current trends in perioperative management of patients undergoing major surgery, and to ascertain the extent to which ERAS is understood and implemented.

Results
The survey was answered by 100 individuals. 32 % of participants were familiar with ERAS protocols. All participants gave pre-operative counselling. 26% performed preoperative nutritional assessment with provision of pre-operative nutritional support in 24 % cases. Anaemia was managed in 84 % cases and smoking cessation done in 70 %. Patients were kept nil per oral for &gt; 6 hrs in about 80 % cases. Antibiotic prophylaxis given in 94 % cases. Preoperative loading with carbohydrate drinks is carried out in only 2% of cases with 90 % being unfamiliar with the term; nasogastric tube done (58 %), transurethral drainage (42%). opioid analgesia use 54 % and multi modal analgesia used in only 32 %. Prophylaxis for postoperative nausea and vomiting (34%), VTE prophylaxis 26 %. Early mobilization (84%) and early feeding in only 32 % was performed.

Conclusion
An ERAS program requires a dedicated multidisciplinary team willing to abandon out-dated paradigms and embrace new ideas.
FTP5.12 Incidence and Root Causes of Surgical Site Infections After Gastrointestinal Surgery at a Public Teaching Hospital in Sudan
Authors: Hassan Rawan , Osman Sarah , Mohamed Walid , Hassan Razan , Mohamed Sagad 
Published: August 2023

Abstract

Aim
Surgical site infections (SSIs) are common healthcare-associated infections and associated with prolonged hospital stays and additional financial burden. Patients undergoing gastrointestinal tract procedures carry a high risk of SSIs. This study aimed to determine the prevalence, associated factors, and causing microorganisms of SSIs among patients undergoing gastrointestinal tract surgeries.

Methods
Hospital based, cross-sectional study conducted at Soba University Hospital in Khartoum, Sudan. We included all patients from all age groups attending the gastrointestinal tract surgical unit between September-December 2017. A Chi-square test was conducted to determine the relationship between the independent categorical variables and the occurrence of SSI. The significance level for all analyses was set at p &lt; .05.

Results
80 participants were included in the study. (67.5%) did not have any chronic illness prior to the surgical operation. Most of them (46.3%) underwent large bowel surgery. 27.5% developed SSI post operatively and superficial SSI was the most common type of SSIs (81.8%). Occurrence of SSI was found to be associated with long operation time (p &gt; .001), malignant nature of the disease (p &gt; .001), intra-operative blood loss (p &gt; .001), and intra-operative hypotension (p = .013). The most prevalent microorganism isolated was E coli (47.8%), followed by Enterococcus faecalis (13.0%) and combined Pseudomonas aeruginosa + E coli infection (13.0%).

Conclusions
The results showed a high prevalence of SSIs among patients attending the gastrointestinal tract surgical unit and the most prevalent microorganism isolated from them was E coli. Measures should be taken to reduce the magnitude of SSI by mitigating the identified associated factors.
FTP5.13 Laparoscopic cholecystectomy is more cost effective than robotic cholecystectomy: a systematic review of published studies
Authors: Singh Anurag , Kaur Mandeep , Swaminathan Christi , Sains Parv , Singh Krishna , Sajid Muhammad 
Published: August 2023

Abstract

Objective
Robotic cholecystectomy (RC) has been proven safe and postoperative outcomes have also been quoted to be equivalent to conventional laparoscopic cholecystectomy (LC). The objective of this review to evaluate the cost effectiveness of RC compared to LC.

Materials and methods
All types of comparative studies reporting the cost of RC versus LC were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.4.

Results
Four comparative studies (one randomised trial and 3 retrospective studies) on 817 patients undergoing RC versus LC were found and deemed suitable for analysis. There were 559 patients in the LC group and 258 patients in the RC group. In the random effects model analysis, LC was associated with the reduced cost [standardised mean difference -5.39, 95%, CI (-8.97, -1.81), Z = 2.95, P=0.003] compared to RC. However, there was significant heterogeneity (Tau2 = 13.06; Chi2 = 583.52, df = 3; (p &lt; 0.00001; I2 = 99%) among included studies.

Conclusion
The LC seems to be more cost effective compared to RC in terms of procedural cost. However, due to statistically significant heterogeneity among included studies and paucity of the randomised, controlled trials, these findings should be taken cautiously. A Major multicentre randomised, controlled trial is needed to validate these findings.
FTP5.14 A comparison of robotic and laparoscopic surgery in the management of benign and malignant general surgical conditions
Authors: Grewal Callum Singh , Karri Rama , Yassin Nuha 
Published: August 2023

Abstract

Background
Robotic surgery is a relatively novel approach to minimally invasive surgery. The ability for greater precision, control and visualisation offers an advanced treatment option. This study compared the clinical outcomes for general surgical patients undergoing robotic and laparoscopic surgery.

Methods
A retrospective analysis of 172 surgical patients undergoing surgery for malignant and benign conditions was conducted. Analysis of demographics, pre-, intra-, and post-operative care and complication rate was studied. Patients were divided into three groups: Colorectal cancer (CRC), inflammatory bowel disease (IBD), and general (diverticular disease, rectal prolapse and hernia repairs).

Results
This study compared 114 robotic surgeries to 58 laparoscopic procedures for general surgery patients. Among the robotic patients, 83 were treated for CRC, 20 for IBD and 11 in the general group; sigmoid cancer (42.2%) and Crohn's disease (75%) were the most common pathologies respectively. In the laparoscopic group, 69% were treated for CRC and 31% for IBD. Robotic surgery had a longer median operation time of 255 minutes compared to 250 minutes for laparoscopic surgery, but shorter average hospital stays (6.2 days vs 11 days) and lower 30-day readmission rates (7.9% vs 17.2%). Fewer robotic patients required blood transfusions (1.8%) than laparoscopic patients (8.6%). One laparoscopic patient required conversion to open surgery, and the mortality rate was 0% across all groups.

Conclusion
Robotic surgery has been found to have shorter hospital stays, fewer complications, and fewer readmissions compared to laparoscopic surgery for a variety of pathologies. These findings suggest that it may be a superior approach to minimally invasive surgery.
FTP6.13 Do prophylactic antibiotics on general anaesthetic induction improve surgical site and intra-abdominal infection post emergency laparoscopic cholecystectomy?
Authors: Yang Peiming 
Published: August 2023

Abstract

Background
The role of prophylactic antibiotics in reducing surgical site infection (SSI) and intra-abdominal infection rates in emergency laparoscopic cholecystectomy remains controversial. New antimicrobial Trust guidelines at our unit introduced in May 2022 stated that all emergency “hot” laparoscopic cholecystectomies should receive single dose of IV antibiotics on general anaesthetic induction. We aim to assess whether SSI and intra-abdominal infection rates have improved since introducing these new guidelines.

Methods
Retrospective study comparing SSI and intra-abdominal infection rates within 30 days of all emergency laparoscopic cholecystectomy cases between February and April 2022 (before new guidelines), to those between August to October 2022 (post new guidelines).

Results
Total of 56 emergency “hot” laparoscopic cholecystectomy cases prior to, and 44 cases after introduction of new guidelines. 91% cases received IV antibiotics on induction post new guidelines, compared to 35% prior to new guidelines (P=0.038). Proportion of patients who continued with antibiotics post-surgery between 2 cohorts was not statistically significant (P=0.69). There was no statistically significant improvement in overall SSI rates post introduction of new guidelines (P=0.61). Skin closure method (P=0.044) and operating time (P=0.031) were statistically significant in contributing to SSI. There was further no statistically significant difference in rate of intra-abdominal infection post introduction of new guidelines (P=0.83).

Conclusion
Prophylactic antibiotics at induction do not appear to improve either SSI or intra-abdominal infection rates post emergency lap cholecystectomy cases. Further evaluation is needed over a longer study period, however, in order to ascertain whether these guidelines should be altered for future practise.
FTP7.2 Case report: Percutaneous Transgastric Endoscopic Retrograde Cholangiopancreatography for common bile duct stones
Authors: Duncan Tobias , Campbell Stewart , Sutherland Diarmid , Mahmud Sajid , Khan Khurram 
Published: August 2023

Abstract

Introduction
Post-operative patients with head and neck cancers do not have easy endoscopic access to the gastrointestinal tract to preform endoscopic retrograde cholangiopancreatography (ERCP) for stone disease. However, by gaining percutaneous access to the stomach via Radiologically Inserted Gastrostomy (RIG), ERCP can be safely performed.

Case presentation
This was a 68 years old man with symptomatic common bile duct (CBD) stones with multiple episodes of self-limiting cholangitis. Previous history of oral cancer requiring tongue resection complicated by oesophageal/pharyngeal stricture, radiation necrosis of mandible with subsequent resection and reconstruction. Patient had RIG inserted for feeding three years ago. Conventional endoscopy failed due to previous operations.
Transgastric ERCP via existing RIG tract was undertaken under general anaesthesia as combined procedure. RIG tract was gradually dilated with progressively larger laparoscopic ports (5mm, 11mm and 15mm). Once sufficiently dilated, gastroscope was passed via the tract into stomach to ensure intra-luminal position. This was replaced by the side viewing scope and ERCP carried out as standard. Patient underwent successful sphincterotomy and stone extraction. Skin over the RIG tract was then partially closed to narrow the tract and 18Fr gastrostomy tube placed. The procedure was completed in 35 minutes and RIG feeding recommenced 3 days later. There was no post-operative complications. He remained well with no further episodes of cholangitis two years post procedure.

Conclusion
ERCP via RIG tract is feasible and should be considered in patients where upper gastrointestinal tract is not amenable to endoscopy. This requires multidisciplinary approach between Upper GI surgeons and gastroenterologists.