bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP4.2 Saving inpatient beds: Are day-case total parathyroidectomies possible and safe?
Authors: Sultana Emiko , McDonald Sophie , Al-Saadi Nina , Chang Jessica , Sandhu Kanwaljit , Houghton Andrew 
Published: August 2023

Abstract

Introduction
Total parathyroidectomy on patients with hyperparathyroidism traditionally required an inpatient hospital stay to monitor patients for postoperative hypocalcaemia. Our centre developed a safe protocol in 2015 which enables total parathyroidectomies to be carried out as a day-case procedure. This protocol, developed in conjunction with the renal physicians, involves giving the patient oral alfacalcidol preoperatively for 5 days and close monitoring of the calcium levels postoperatively to permit safe same day discharge.

Methods
A single centre retrospective study was carried out on all patients who underwent a total parathyroidectomy for hyperparathyroidism between 2005 and 2022. A comparison study was done before and after the protocol was introduced in 2015. Data were collected regarding the patient comorbidities, peri-operative calcium level, post-operative calcium, potassium and parathyroid levels, length of hospital stay, operative procedure details, hospital readmission, and 30-day morbidity.

Results
57 patients underwent total parathyroidectomy during the study period (22 before protocol and 35 after the protocol). After introduction of the protocol, 40% of patients were discharged on the same day, compared to only 4.54% previously. The duration of inpatient hospital stay was reduced from 0-13 days to 0-3 days. Reasons for prolonged hospital stay in the remaining patients included refractory hyperkalaemia requiring dialysis, complications secondary to anaesthesia, as well as hypocalcaemia in a few cases. No patient required readmission during the 30-day post-operative period.

Conclusions
Day-case surgery for total parathyroidectomy can be achieved safely in patients with a preoperative regimen of alfacalcidol and close monitoring of calcium levels post-operatively, emulating a virtual ward round.
SP5.5 Peri-operative, Oncological and Functional Outcomes of Robotic versus Transanal Total Mesorectal Excision in patients with Rectal Cancer: A Systematic Review and Meta-analysis
Authors: Mohamedahmed Ali Yasen , Zaman Shafquat , Wuheb Ali Ahmed , Yassin Nuha 
Published: August 2023

Abstract

Background
To evaluate comparative outcomes of robotic low anterior resection (RTME) and spinal Trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer.

Methods
A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies comparing RTME versus TaTME for low rectal cancer were included. Primary outcomes were post-operative complications namely, anastomosis leak, SSI, overall complications rate, and Clavien-Dindo complications rate. Operative time, conversion to open, Intra-operative blood loss, ITU and hospital length of stay (LOS), post-operative complications, oncological outcomes, and functional outcomes were the evaluated outcome parameters.

Results
Twelve studies with a total number of 3025 patients divided between the Robotic group (n=1881) and TaTME group (n=1144) were included. There was a significant difference between the two groups regarding Operative time (P=0.39), conversion to open (P=0.29) and intra-operative blood loss (P= 0.62). Clavien-Dindo ≥ 3 complications rate (P=0.25), anastomosis leak (P= 0.89), re-operation (P=0.62), re-admission rate (P=0.92), R0 resection (P= 0.52), ITU LOS (P= 0.63) and total LOS (P=0.30) showed similar results between the two groups. RTME group showed a higher rate of harvested lymph nodes (P= 0.04) and completed TME (P=0.05). Wexner and LARS scores showed significantly better functional results in the RTME group compared to the TaTME group (P= 0.0009) and (P= 0.00001), respectively.

Conclusion
Compared to TaTME, RTME provides significantly better functional outcomes, a higher number of harvested lymph and complete TME with a similar postoperative complications rate.
SP5.6 A UK-wide audit on peri-operative practices during deceased donor kidney transplantation: Results from a prospective National Transplant ACcess to Theatre (NTACT) Audit
Authors: Borbas Balint , Mujeeb Mariyam , Tanase Andrei , Aroori Somaiah 
Published: August 2023

Abstract

Background
The outcomes of deceased donor kidney transplants are mainly affected by donor and recipient factors. There is little data on standard perioperative practices across the UK and whether variations in perioperative practices could affect the outcomes. This national audit aims to identify current perioperative practices.

Methods
We conducted a multicentre, prospective audit of adult deceased donor kidney-only transplants across 14 UK transplant centres between February and September 2022. Data was collected on pre-operative antibiotic use, clinician’s grade, fluid management, central/arterial line insertion, post-operative destination, crossmatch and advanced haemodynamic monitoring use. Data was recorded on RedCap and analysed using descriptive statistics.

Results
476 kidney-only transplants were recorded (59 were excluded for incomplete/incorrect data), leaving 417 transplants. In 98.6% of transplants, patients received antibiotics pre-operatively. A wide range of antibiotics were given; the three most used were co-amoxiclav (n=135), ciprofloxacin (n=92) and amikacin (n=62). Most operations were led by a consultant surgeon (91.1% n=380). However, only 60.1% of cases were led by consultant anaesthetists. Central lines were used in 65.5% (273/417) of patients, 41.0% (171/417) used an arterial line, and 25.4% (106/417) had advanced haemodynamic monitoring. A total of 289 cases (69.3%) received goal-directed fluid therapy, of which 74.4% (215/289) used static parameters. Most common post-operative destinations were the transplant ward, 75.3% (n=314), ICU, 9.4% (n=39) and HDU, 10.1% (n=42).

Conclusions
We identified wide variations in certain perioperative practices. In the future, we would like to assess whether there is any relationship between the variations in practice and postoperative outcomes, such as graft function and mortality.
SP5.12 Pancreas Graft Outcome dictates the Renal Graft outcomes and overall patient survival in Simultaneous Kidney Pancreas (SPK) Transplant recipients. A UNOS/OPTN Transplant Registry Big Data Analysis over the last 20 years. An Epidemiology In Transplant Study Group (ETrSG) Initiative
Authors: Sharma Hemant , Mehra Sanjay , Kapoor Kunal , El-Bakry Adham , Devkaran Bhavesh , Sharma Abhishek 
Published: August 2023

Abstract

Purpose
Pancreatic graft outcomes affect the cumulative outcomes of SPK transplant, yet the impact of pancreas graft loss on renal graft and overall patient survival is yet to be reported.

Methods
We harmonized the UNOS/OPTN SPK Transplant data (1996-2019) reported to the U.S. Dept. of Health and Human Services to analyze survival outcomes of recipients who had all cause pancreas graft loss. The demographics report and survival analysis (renal graft/ patient survival) at 1,3, and 5 years post-transplant were data mined. Logistic Regression was done to identify predictors of survival.

Results
N=7036 all-cause pancreatic graft losses were reported from a cohort of N=64815 SPK Transplant recipients during the first five years of transplant. The renal graft survival was 99%, 97%, and 95% in functioning SPK transplant; 77%, 68%, and 54% in recipients with pancreatic graft loss at 1,3, and 5 years respectively. (Log-rank &lt;0.001). The overall patient survival was 84%, 75%, and 66% in recipients with pancreatic graft loss at 1,3, and 5 years, respectively (Log-rank &lt;0.001). Recipient age &gt;45 years (p=0.008), recipient smoking history ( p&lt;0.001), recipient history of hypertension ( p&lt; 0.001), Recipient BMI &gt;30 (p=0.01), cardiac events ( p=0.02) were the variables of importance on univariate analysis affecting renal graft and patient survival. Recipients with functioning Pancreas had a renal transplant survival benefit (0.22; 0.45) at 1 and 5 years & overall patient survival (0.15; 0.33) at 1 and 5 years respectively.

Conclusions
Functioning pancreas graft confers survival benefit to renal graft and overall patient survival. The survival deteriorates over time since pancreas graft failure.
SP6.3 Prognostic significance of Socio-Economic Deprivation on OGD outcome
Authors: Eley Catherine , Hawkes Neil , Barlow Emma , Herbert Geraint , Egan Richard , Lewis Wyn 
Published: August 2023

Abstract

Introduction
Socio-Economic Deprivation has long been associated with many gastrointestinal diseases yet its influence on OesophagoGastroDuodenoscopy (OGD) findings has not been evaluated. The aim of this study was to investigate the influence of deprivation on outcomes of OGD irrespective of referral reason.

Method
Two-thousand consecutive patients presenting to four Health Boards in Wales (June 2019-) were studied retrospectively with deprivation scores calculated using the Wales Indices of Multiple Deprivation (WIMD). Patients were subclassified into Quintiles for analysis (Q1 most, Q5 least Deprived).

Results
Inhabitants of the most deprived areas were more likely to be diagnosed with Peptic Ulcer (Q1 7.9%, Q5 4.7%; OR 0.498, p=0.018), Severe Oesophagitis (LA4, Q1 2.7% v Q5 0%, OR 0.089, p=0.002), Helicobacter Pylori infection (Q1 5.4%, Q5 1.7%; OR 0.284, p=0.002), but less likely to be diagnosed with Barrett’s Oesophagus (Q1 6.3% v Q5 12.3%, OR 2.146, p=0.004) than those from least deprived areas. New cancer diagnoses numbered 53 and were proportionately higher after Urgent Suspected Cancer (USC) referral (n=35, 4.6%) with three diagnosed after routine OGD (0.6%, p&lt;0.001). Deprivation was associated more advanced radiological perceived Stage III Cancer (Q1 16.1% v Q2 55.6% v Q5 5.6%, OR 0.007, p=0.005).

Conclusion
Deprivation was associated with two-fold more peptic ulcer disease, three-fold more Helicobacter Pylori infection, and 12-fold more severe oesophagitis, which correlated with up to 10-fold more advanced cancer stage at diagnosis.
SP7.8 Qualitative exploration of gastrointestinal recovery following surgical admission: Phase I of the PRO-diGI study
Authors: Baker Daniel ,   PRO-DIGI Steering Group
Published: August 2023

Abstract

Background
Patients admitted to hospital for abdominal surgery often experience gastrointestinal dysfunction. Recovery of gastrointestinal function is poorly measured and only briefly assessed by clinicians. There is a need for a patient reported outcome measure to assess gastrointestinal recovery. The first stage of development requires qualitative methodology to identify key concepts.

Methods
Adult patients admitted to hospital for major gastrointestinal, urological, or gynaecological surgery, in an emergency or elective setting were eligible to participate. Patients treated non-operatively for small bowel obstruction were also eligible. Interviews were conducted by telephone, audio-recorded and transcribed. Interviews were coded and analysed in the NVivo software by two researchers and reviewed by lay members of the steering group. Interviews continued until saturation was reached. Ethical approval was gained prior to interviews (21/WA/0231).

Results
Twenty-nine interviews were completed (17 male, median age 64) across three specialties (20 gastrointestinal, 6 gynaecological, 3 urological). Two overarching themes of ‘general recovery’ and ‘gastrointestinal symptoms’ were identified. General recovery included 3 themes of; ‘life impact’, ‘mental impact’ including anxiety, and ‘physical impact’ including fatigue. Gastrointestinal symptoms included 3 themes of; ‘abdominal symptoms’ such as pain, ‘diet and appetite’, and ‘expulsory function’ such as stool frequency. A total of 18 gastrointestinal symptoms were identified during patient recovery – many of which lasted several weeks following discharge.

Discussion
This study highlights a broad range of gastrointestinal and non-gastrointestinal symptoms experienced by patients during their gastrointestinal recovery. Patients remain symptomatic following discharge. Clinicians should consider assessing recovery thoroughly at discharge and follow up.
SP8.7 Long-term outcomes after stoma siting in emergency surgery – a retrospective multi-centre cohort study
Authors: MacDonald Scott , Ng Jene , Clark Maggie , Quasim Tara , Moug Susan 
Published: August 2023

Abstract
Pre-operative stoma siting has been shown to reduce stoma-related complications in the elective setting and may improve patient quality of life (QoL). However, there is less evidence regarding the effect of stoma siting in patients undergoing Emergency Laparotomy (EmLap), when stoma siting rates may be lower due to time constraints of emergency surgery. This retrospective multi-centre cohort study aimed to compare the long-term outcomes of patients undergoing EmLap who had pre-operative stoma siting with those who didn’t.
A retrospective review of a prospectively maintained database of EmLap patients from 3 hospitals across 2 years (Dec ’19-’21) was performed in Dec ’22. Patients with emergency stoma formation per NELA criteria were included and clinical notes were reviewed, including prospectively maintained follow-up from stoma practitioners. Any patients lost to follow-up within a year were excluded.
n=381 patients were identified (Mean age-65years, Median follow up-21 months). n=185(48.6%) were marked for a stoma pre-operatively (89.2% by stoma nurse; 10.8% by surgeon). Those not marked pre-operatively had a higher incidence of 30-day overall morbidity (77% v 67%, p=0.0388), stoma-related skin problems (28.1%v18.9%, p=0.0357), ischaemia/necrosis (16v1%, p&lt;0.005) and muco-cutaneous separation (12v3%, p=0.044). There was no significant difference in stoma-related complications between those marked by a stoma nurse compared with those marked by a surgeon (79.4%v66.7%, p=0.1851).
Stoma siting in emergency laparotomy is associated with reduced early stoma complications. There are similar outcomes whether the patient is sited by a stoma CNS or a surgeon. Additional education and training should be aimed at surgeons in order to improve frequency of stoma siting in order to improve patient outcomes.
SP9.5 Outcomes after Emergency Cholecystectomy: A Multicentre Retrospective Cohort Study
Authors: Borakati Aditya , Hughes Frances , Kocher Hemant , Malik Humza 
Published: August 2023

Abstract

Aims
Gallstone disease affects 10-15% of the UK population and represents a significant proportion of emergency general surgical admissions. Consensus international guidelines recommend cholecystectomy for all stable patients within 7 days of admission for emergency biliary pathology. This study sought to evaluate the outcomes of emergency cholecystectomy at a regional level over a 5 year period.

Methods
Retrospective multicentre study of all patients undergoing cholecystectomy at 4 acute hospitals in East London, UK, covering a population of 2.9 million, between 2016 and 2021. All previous hospital attendances with biliary pathology were retrieved to 2010 from prospectively maintained electronic patient records. The primary outcomes were time to surgery (TTS) from index attendance and total length of stay (TLOS) stratified by timing of surgery. Multivariable linear regression was used to identify independent predictors of TTS and TLOS.

Results
2056 patients were identified. 1786 (86.9%) underwent elective cholecystectomy and 270 (13.1%) cholecystectomy during an emergency admission. Median TTS was 108.3 days overall with 5.8 days for emergency cholecystectomy, median TLOS was 5.0 days overall and 7.6 days for emergency cholecystectomy. After adjustment with linear regression, emergency cholecystectomy reduced TTS by 112.3 days (95% CI 140.2-84.4), whilst each year of age increased TTS by 0.80 days and male gender was associated with 38.1 days greater TTS. For TLOS, emergency cholecystectomy was associated with an increase in admission time by 3.54 days (95% CI 2.04-5.03).

Conclusions
Emergency cholecystectomy significantly reduces time to cholecystectomy from index attendance with biliary pathology at the cost of increased overall time admitted.
SP9.6 Effectiveness and safety of prophylactic mesh closure in emergency Gastrointestinal surgery
Authors: Albendary Mohamed , Mohamedahmed Ali Yasen Y , Alamin Amin , Rout Shantanu , George Anil , Zaman Shafquat 
Published: August 2023

Abstract

Background
Wound complications are frequent in emergency Gastro-Intestinal (GI) surgery increasing morbidity and cost of care. Although laparotomy closure using a prophylactic mesh has been proven to limit Incisional Hernia (IH) occurrence, the literature lacked a high-quality assessment in the setting of emergency GI laparotomy. This review offers an up-to-date evaluation of the prophylactic mesh closure in these conditions.

Methods
A systematic review was executed via literature database: PubMed, Cochrane database, Science Direct and Google Scholar. Studies were examined for eligibility and included if they managed to compare prophylactic mesh closure to the conventional laparotomy closure in GI emergency surgeries. Both early postoperative fascial dehiscence and late incisional hernia were examined as primary endpoints. Secondary outcomes incorporate Surgical Site Infection (SSI), seroma/hematoma formation, complications of Clavien-Dindo score ≥3, operative time, and hospital stay.

Results
2 Randomised controlled trials (RCTs)(1, 2) and 2 comparative studies,(3, 4) which studied 562 patients, met the inclusion criteria. The hernia rate was significantly reduced in the mesh group (Odds Ratio 0.14 [0.05, 0.36], P value &lt; 0.0001), while there was no statistically significant difference in fascial dehiscence between the studied groups (Odds Ratio 0.49 [0.01, 47.02], P value= 0.76). In addition, there was no significant outcome favouring one group over the other in terms of SSI and rest of the screened endpoints.

Conclusion
Despite the promising reduction in IH rate, a solid outcome was not obtained due to the limited number of relevant studies, paucity of RCTs and diversity in surgical techniques and mesh positions. A wider-scale RCTs may offer reliable results.
SP9.12 The Global Practice of Inguinal Hernia Repair Study (GLACIER): A survey of 1014 hernia surgeons
Authors: Liyanage Nanayakkara Kushan Dhanuja , Viswanath Nakul , Madhok Brijesh , Mahawar Kamal , Sheen Aali , Wilson Michael 
Published: August 2023

Abstract

Introduction
There are many variations in practices and preferences for inguinal hernia repair among surgeons globally. The purpose of the Global Practice of Inguinal Hernia Repair Study (GLACIER) was to capture these variations related to open, laparoscopic, and robotic inguinal hernia repair.

Method
A questionnaire-based survey on Survey Monkey® was created, and the link was shared freely on various social media platforms, personal email network of authors and email to members of the endorsed organisations, which include British Hernia Society (BHS), The Upper Gastrointestinal Surgical Society (TUGSS), and Abdominal Core Health Quality Collaborative (ACHQC).

Results
A total of 1014 surgeons from 81 countries completed the survey. Open and laparoscopic approaches were equally preferred (43% and 47% respectively). Transabdominal pre-peritoneal repair (TAPP) is the favoured minimally invasive approach. Bilateral and recurrent hernia following previous open repair were the most common indications for minimally invasive approach. Repair with a mesh was preferred by 98% of the surgeons and synthetic monofilament light weight mesh with large pores was the most common choice. Lichtenstein repair was the most favoured open mesh repair technique (90%), while Shouldice repair was the favoured non-mesh repair technique. The risk of chronic groin pain was quoted as 5% after open repair and, 1% after minimally invasive repair. Only 10% of surgeons preferred open repair with local anaesthesia.

Conclusion
This survey identified similarities and variations in practice globally along with some discrepancies in inguinal hernia repair compared to best practice guidelines. It also identifies several key areas where more focus future research is required.
SP10.4 Pre-operative use of exclusive enteral nutrition in adult patients with Crohn’s disease: a single centre experience
Authors: Goh Ee Teng , Luthra Pavit , Syme Graeme , Kok Klaartje , Hancorn Kate , Mehta Shameer 
Published: August 2023

Abstract

Introduction
Exclusive enteral nutrition (EEN) in the management of adult patients with Crohn’s disease (CD) is thought to reduce post-operative complications but is under-utilised. This study aims to assess the use of EEN and post-operative outcomes in patients undergoing surgery for CD.

Methods
Consecutive adult patients at a single NHS Trust with CD undergoing surgery for stricturing, penetrating and medication-refractory disease from January 2018 to December 2021 were included. Patients prescribed at least 6 weeks of EEN prior to surgery (EEN) were compared to those who were not (non-EEN). Outcomes included intestinal failure (IF) requiring parenteral nutrition, post-operative complications, length of stay (LOS), unplanned readmission at 3 months and disease recurrence at 6 months.

Results
142 patients were included, comprising 22 EEN and 120 non-EEN patients. There were no cases of postoperative IF in the EEN cohort, whilst 18.3% of non-EEN patients (22/120; p=0.04) developed type one IF. The mean LOS (days) was significantly less in the EEN group (8.3±3.6 vs. 15.9±17.3, p=0.04), as were the complication rates when using a Clavien Dindo score of ≥2 (13.6% vs. 36.7%, p=0.04). Outcomes for unplanned admission at 3 months (OR 0.44, p= 0.3) and disease recurrence at 6 months (OR 0.45, p= 0.3) favoured the EEN cohort but were not significant.

Conclusion
Consistent with other studies, our study demonstrated a potential benefit in post-operative outcomes in adult patients treated with at least 6 weeks of EEN. To fully utilize the benefits of EEN, potential candidates for surgery who will benefit from EEN need to be identified early.
SP11.5 Maximising Efficient Endoscopy Training: a MEET tool initiative
Authors: Eley Catherine , Hawkes Neil , Egan Richard , Lewis Wyn 
Published: August 2023

Abstract

Background
Endoscopy training is sub-optimal (two thirds of dedicated training lists fall short of demand) and if competency trajectories are to improve, capacity must amplify. The aim was to develop a semi-automated web-based Application (App) to maximise training.

Methods
A blended Clinical and Digital Services App team used integrated list planning, built with open-source PHP framework Laravel and TALL Stack, and cloud hosted with Microsoft Azure. User profiles were aligned with Joint Advisory Group on Endoscopy (JAG) Training terminology - six users with diverse functionality (Planner, Training Lead, Trainer, Trainee, Viewer, and Administrator) supplying endoscopy list planning linked to e-invitation, to create a prototype MEET tool.

Results
Real time prototype testing proved MEET was accessible on all modern web browser platforms (on-line wired, Wi-Fi and broadband) with an App icon available on iOS and Android. Endoscopy list use was assessed prospectively over two months, one before (114 lists, 22.8% training dedicated) and one after MEET tool introduction (108 lists, 22.2% training dedicated). MEET could improve full training list use from 19.2% (5 lists) before, to 41.7% (10 lists) after introduction (Chi2 46.4, p&lt;0.001; Cramer’s V 0.457, p&lt;0.001). Moreover, the potential for ad-hoc training improved from 10.4% (10 lists) to 48.9% (44 lists, p&lt;0.01).

Conclusion
MEET tool assessment within a development test area was workable with two- to four-fold better training opportunity. MEET has important promise and roll-out potential to all medical training - an opportune COVID recovery tool.