bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP5.11 The positive impact of our efficient Surgical Assessment Unit use on general surgery emergency readmission rates
Authors: Yahia Shuker , Wu Ting-Wei , Haji Altaf , Marimuthu Kalimuthu , Piramanayagam Bala 
Published: August 2023

Abstract

Aim
Hospital readmission rates are a general indicator of quality of care, however these rates are currently variable nationally. Lowering these rates will not only alleviate the financial burden of the National Health Service but will improve patient outcomes. Our primary aim was to establish if implementing a senior-led Surgical Assessment Unit would reflect positively on reducing the rates of avoidable emergency readmissions within 30 days of discharge, in our General Surgery department at a district general hospital.

Method
We compared two 3-month cycles of all General Surgery emergency readmissions in our department within 30 days of discharge from June to August 2022 versus August to October 2021. Data of 361 patients in cycle 2 versus 389 patients in cycle 1 were collected and analysed to determine the readmission rates and to prevent the potential avoidable factors.

Results
A total of 6.6% of patients were readmitted with various surgical conditions, and the number of extra days of hospital stay totalled to 26 extra days collectively. This is compared to 11%, and 69 days respectively from the previous cycle. The main reasons for readmission were recurrences of the original problem (namely pancreatitis), and post-operative infections.

Conclusion
Overall, our implemented action plan has reduced the rate of emergency surgical readmissions by 4.4%. However, the main factors for readmissions remained similar. We will continue to provide an efficient use of the Surgical Assessment Unit and senior-led discharge to ensure we minimise the rates of surgical readmissions.
ThTP6.5 Long term major adverse cardiovascular events following myocardial injury after non-cardiac surgery (MINS): A systematic review and meta-analysis
Authors: Quintela Ella , Strickland Scarlett , Wilson Matthew , Lee Matthew 
Published: August 2023

Abstract

Aims
Myocardial injury after non-cardiac surgery (MINS) is diagnosed following asymptomatic troponin elevation in the perioperative period. MINS is associated with high mortality rates and significant rates of major adverse cardiac events (MACE) within the first 30 days following surgery. However, less is known regarding its impact on mortality and morbidity beyond this time. This systematic review and meta-analysis aims to establish the rates of long term morbidity and mortality associated with MINS.

Methods
This review was registered with PROSPERO (CRD42021283995). Medline, EMBASE and Cochrane CENTRAL were searched, and abstracts screened by two reviewers. Observational studies and control arms of trials reporting mortality and cardiovascular outcomes beyond 30 days in adult patients diagnosed with MINS following non-cardiac surgery were included. Risk of bias was assessed using the Quality in Prognostic Studies tool (QUIPS). A random effects model was used for meta-analysis of outcome subgroups.

Results
Searches identified 40 studies. Meta-analysis of 37 cohort studies found a rate of MACE associated MINS of 21% and mortality following MINS was 25% at one year follow-up. A non-linear increase in mortality rates was observed up to 1 year post surgery. MACE rates were also lower in elective surgery compared to a subgroup which included emergency cases. Analysis demonstrated a wide variety of accepted MINS and MACE diagnostic criteria within the included studies.

Conclusions
A diagnosis of MINS is associated with high rates of poor cardiovascular outcomes up to one year. Work is needed to standardise diagnostic criteria and reporting of MINS related outcomes.
ThTP6.8 Incidence and management of non-resolution of Biliary Colic or Right Upper Quadrant pain Post Laparoscopic Cholecystectomy
Authors: Tabassum Tanzin , Lu Yanqiang , Sabri Atikah , Gupta Sanjay 
Published: August 2023

Abstract

Background
The pathogenesis and risk of chronic pain after laparoscopic cholecystectomy are not well understood. Post-cholecystectomy syndrome describes persistence of biliary colic or right upper quadrant pain with a variety of GI symptoms, similar to features prior to cholecystectomy. It is attributed to biliary (retained stone, biliary stricture), extra-biliary (pancreatitis, gastritis, IBS) and psychiatric or neurological disorders.

Aim
To find out (1) the incidence of post laparoscopic cholecystectomy pain. (2) if patients were counselled on non-resolution of pain during consenting for surgery. (3) if patients were investigated for non-resolution of pain.

Methodology
Retrospective cohort study was performed by interviewing patients undergoing laparoscopic cholecystectomy from April2022-October2022. Direct telephone consultation to enquire about non-resolution of pain. Digital case notes were reviewed for subsequent admissions.

Results
A total of 50 cases met the audit inclusion criteria over the period of 7months. Mean age of the selected population was 47.98 years (SD 15.47). Male:female ratio was 11:39. 24%(n=12) patients were reported non-resolution of pain post-op. 48%(n=24) patients were counselled on non-resolution of pain while consenting for surgery.

Discussion
The study suggested a significant number of patients experience non-resolution of pain post-cholecystectomy. However, less than half of the study population were counselled during consenting. Limitations include low number of patients and risk factors like urgent surgery like ‘hot gallbladders’ and choledochotomy could not be assessed. To improve clinical practice, non-resolution of pain should be mentioned during consenting. Additionally, a potential follow-up system should be introduced to review non-resolution of pain and guidelines on investigation of the residual pain should be produced.
ThTP7.9 The Optimal Timing of Colectomy for Acute Severe Ulcerative Colitis
Authors: Ryan Elliot , Tyrrell-Price Jonathan , Phillips Jennifer 
Published: August 2023

Abstract

Aims
Acute severe ulcerative colitis (ASUC) is a medical emergency which, if left untreated, can be fatal. Some cases require colectomy. The timing of this operation is important to reduce post-operative morbidity. The primary study aim is to assess whether the timing of this operation impacts upon post-operative outcome. The secondary aim of this study is to determine whether pre-operative blood albumin level may be able to predict post-operative complication rates.

Methods
All patients who underwent colectomy and ileostomy formation for ASUC at Bristol Royal Infirmary between 2010-2020 were identified. Patient demographic information, duration of pre-operative hospital stays, blood results and post-operative complications up until the most recent follow up were recorded. Patients undergoing elective colectomy for ulcerative colitis were analysed separately.

Results
Twenty-one ASUC admissions were identified who were all treated with intravenous steroids for a median of 9 (range 1-18) days before colectomy. 16 patients (76%) received either ciclosporin or infliximab rescue therapies. Median admission CRP was 41 (range 4-231). Median admission blood albumin was 29 (range 16-38). &lt;30-day and &gt;30-day post-operative complication rates were 52% (11/21) and 25% (5/20) respectively.

Conclusions
Previous literature shows significant association between the length of pre-operative medical therapy and post-operative complications. Surgeons can learn from the, so far, negative findings of our study. A surgeon’s own clinical judgement is the most important factor in the decision of when to take an ASUC patient to theatre. Biomarkers can aid a decision, but cannot be used as a solitary justifier for the timing of colectomy.
ThTP8.9 The SARS-CoV-2 first wave impact in the acute inflammatory surgical pathologies
Authors: Lathan Ross , Guadalajara Hector , de Nova José Luis Muñoz , Yiasemidou Marina , Rico María Recarte , Garcia-Olmo Damian 
Published: August 2023

Abstract
Anecdotal evidence suggests that community infection control measures during the COVID-19 outbreak have modified the number and natural history of acute surgical inflammatory processes (ASIP-appendicitis, cholecystitis, diverticulitis and perianal abscesses) admissions. This study aims to evaluate the impact of the COVID-19 pandemic on the presentation and treatment ASIP and quantify the effect of COVID-19 infection on the outcomes of ASIP patients. This was a multicentre, comparative study, whereby ASIP cases from 2019, 2020 and 2021 (March 14th to May 2nd) were analyzed. Data regarding patient and disease characteristics as well as outcomes, were collected from sixteen centres in Madrid, and one in Seville (Spain). The number of patients treated for ASIP in 2019 was 822 compared to 521 in 2020 and 835 in 2021. This 1/3rd reduction occurs mainly in patients with mild cases, while the number of severe cases was similar. Surgical standards suffered a step back during the first wave: Lower laparoscopic approach and longer length of stay. We also found a more conservative approach to the patients this year, non-justified by clinical circumstances. Luckily these standards improved again in 2021. The positive COVID-19 status itself did not have a direct impact on mortality. Strikingly, none of the 33 surgically treated COVID positive patients during both years died postoperatively. This is an interesting finding which, if confirmed through future research with a larger sample size of COVID-19 positive patients, can expedite the recovery phase of acute surgical services.
FTP2.3 A Systematic Review and Meta-Analysis Comparing Outcomes of the Common Perineal Procedures for Rectal Prolapse -Delorme Vs Altemeir
Authors: Bhattacharya Pratik , Zaman Shafquat , Hussain Mohammad Iqbal , Peravali Rajeev 
Published: August 2023

Abstract

Introduction
There is no consensus yet as to the best surgical option for treatment of rectal prolapse. In this systematic review and meta-analysis we compared the outcomes for the two most commonly employed perineal operations for rectal prolapse – Delorme’s and Altemeier’s procedure.

Methods
A systematic search of multiple electronic databases was conducted. Peri- and post-operative outcomes following Delorme’s and Altemeier’s procedures were extracted. Primary outcomes included total operative time, anastomotic leak rate, post-operative wound infections and length of hospital stay. The analysed secondary outcomes were operation time, volume of blood loss and length of hospital stay. Revman 5.3 was used to perform statistical analysis.

Results
10 studies including a total of 605 patients were selected; 286 patients had Altemeier procedure, 39 patients had Altemeier and Plasty (perineoplasty or levatoroplasty) whilst 280 patients had Delorme procedure. Recurrence was found to be significantly lower in the Altemeier group compared to the Delorme group (OR: 0.66; 95% CI [0.44 – 0.99], P= 0.05). Anastomotic leak was found to be significantly less in the Altemeier group than in the Delorme group (RD: 0.05; 95% CI [0.00 – 0.09], P= 0.03). Hospital stay was significantly more after Altemeiers procedure than after Delorme procedure (MD: 3.05, 95% CI [0.95 – 5.51], p=0.004).
No significant difference was found with respect to operative time, Intra operative blood loss and mortality rates.

Conclusion
Our study indicates that between the two common perineal procedures, Altemeier’s operation has better outcomes. Future high quality RCTs with long follow up are required to corroborate these findings.
FTP2.6 Topical skin adhesive 2-octylcyanoacrylate dressing reduces the risk of superficial surgical site infections (SSI) in colorectal stoma surgery
Authors: Bukhari Ishtiyaq , Afzal Zeeshan , Judkins Nicholas , Summers Dominic , Dennis Robert 
Published: August 2023

Abstract

Background
Superficial surgical site infection is a common morbidity following bowel resection surgery involving stoma formation with clinical and financial implications. The aim of the study was to evaluate the role of topical skin adhesive, 2-octylcyanoacrylate (2-OCA) in reducing wound infections following colorectal stoma surgery.

Methods
We performed a retrospective, single centre, cohort study using clinical notes. Patients over the age of 18, undergoing bowel resection (elective or emergency) with stoma formation over a period 5 years from January 2015 to December 2019 were included. The primary endpoint was surgical site infection. Patients either received wound dressing with 2- OCA or standard wound dressing.

Results
604 patients were included. Median age was 69 (Range 18- 97). 187 (31%) patients received 2-OCA (group 1) and 417 (69%) received standard care (Group 2). 288 (47%) patients were female, 134 (22%) had body mass index &gt; 30, 87 (14%) were diabetic and 90 (15%) were smokers. 279 (46%) patients had ASA score of 3 and 4 (37% vs 50% p=0.0006). 282 (47%) patients went through emergency surgery (34% vs 53% p&lt;0.0001). 279 (64%) patients underwent dirty surgery (17% vs 32% p&lt;0.0001). 220 (35%) patients developed SSI (28% vs 40% p&lt;0.0015). BMI greater than 30 (OR 2.32, p&lt;0.0001), Diabetes (OR 0.54 p&lt;0.0241), dirty surgery (OR 0.43p&lt;0.0001), standard care, no 2-OCA use (OR 1.52 p=0.0343) were associated with SSI.

Conclusion
Our study demonstrates that there is association between 2-OCA use and reduced SSI in colorectal surgery involving stoma formation when compared to standard methods of wound dressing. Further randomised clinical trial is recommended to demonstrate causation.
FTP2.10 Use of ICG in Assessing Anastomotic Perfusion – The First 100 Cases in a Tertiary Colorectal Cancer Unit
Authors: Dunlop Hannah , Coyne Peter 
Published: August 2023

Abstract

Aims
This project aimed to investigate if using intra-operative indocyanine green (ICG) fluorescence imaging to assess anastomotic perfusion in colorectal surgery affected the rate of anastomotic leak.

Methods
Data was prospectively collected for the first 100 patients who underwent colorectal surgery with ICG used to assess the perfusion of the anastomotic ends. The rate of anastomotic leak was calculated.

Results
ICG was used in 100 patients undergoing colorectal procedures with anastomosis, from June 2016 to May 2022. 98 were elective cases, 53 patients were male with a median age of 65 years. After infusion of ICG and assessment of perfusion, the resection margin was changed in 13 procedures (13%). In cases where the resection margin was changed, there was 2 anastomotic leaks (leak rate 15%). In cases where the resection margin was unchanged, there was 3 anastomotic leaks (leak rate 3%). There was not a significant difference in the leak rate when a change in resection margin was made based on the use of ICG (p=0.065).

Conclusions
The results demonstrate that the use of ICG did not significantly change the rate of anastomotic leaks in patients undergoing bowel surgery with anastomoses. However, this information indicates that poor perfusion at ICG fluoroscopy can help identify those patients at risk of leak, which can be used in post-operative monitoring of patients with cancer undergoing major colorectal surgery. It also raises the question of whether we should be changing the resection line by even more when ICG indicates poor perfusion at the resected end.
FTP3.6 Robotic Assisted Surgery – the future for patients with increased BMI?
Authors: Massie Eleanor , Hughes Rebecca , Saldanha James , Renwick Andrew , Vella Mark , Moug Susan 
Published: August 2023

Abstract

Introduction
Obesity increases the technical difficulty of laparoscopic colorectal surgery. The ROLAR trial concluded robotic assisted surgery (RAS) did not significantly reduce the risk of conversion to open surgery in rectal cancer resections. In Scotland, in 2021, 30% of adult population were obese (BMI ≥30kg/m2) and 4% morbidly obesity (BMI ≥40kg/m2.) We describe local experience of laparoscopic surgery and RAS in the obese population.

Methods
Retrospective review of patients with obesity (BMI ≥30kg/m2) undergoing laparoscopic and robotic colorectal surgery by three colorectal surgeons. Conversion to open, 30-day morbidity and mortality and length of stay were assessed.

Results
30 patients undergoing laparoscopic surgery and 37 patients undergoing RAS. Procedures include anterior resection; Hartmann’s procedure; left and right hemicolectomy, sigmoid colectomy, APER, subtotal colectomy, panproctocolectomy and completion proctectomy for benign and malignant conditions.

Conclusions
RAS resulted in fewer conversions to open procedures compared to laparoscopic surgery in the obese population. Fewer complications and returns to theatre in RAS group. The increased length of stay in RAS group can be explained by geographic considerations (25 RAS patients live &gt;2 hours from hospital).
FTP4.2 Keeping it Simple: An Ongoing Near-Peer Teaching Programme Success for Surgical Skills and Simulation
Authors: Bruce Nikki , Smith Charlotte , Irvine Laura 
Published: August 2023

Abstract

Aims
Over 2 years in our DGH we developed a programme of surgical simulation for medical students including acute scenarios and basic surgical skills. We aimed to roll this out on a bigger scale to include near-peer teaching between medical students, PAs, and FYs, and gain feedback to assess our progress.

Methods
The previous programme involved simulated acute scenarios with the Sim Man run by registrars for medical students with help from FY1s. We invited FYs involved in delivering sessions, to write new scenarios and take over leadership. We linked sessions with a weekly Surgical Skills Club and handed ownership of specific sessions to FYs to run near-peer teaching on suturing, knot tying and US guided vascular access. Electronic feedback from trainers and trainees rated satisfaction with teaching, confidence in skills, and enjoyment.

Results
Feedback was gained from 24 students for 4 Sim sessions over 4 months. 100% of students rated the scenarios very good or excellent. 100% felt they improved their skills in management of acutely unwell surgical patients, eg pancreatitis, appendicitis. 6 FY trainers took part and 100% rated the experience as “excellent”. Weekly feedback from Surgical Skills session attendees was consistently rated Very Good or Excellent, and trainer feedback was highly rated for improving confidence and leadership.

Conclusion
Near Peer Teaching of a combined programme of surgical simulation and skills is an excellent tool to improve confidence in managing acutely unwell patients in a safe environment, develops surgical skills, and promotes leadership roles at an early stage.
FTP4.3 Improving awareness of total parenteral nutrition administration in general surgical patients: a tertiary care hospital experience
Authors: Grodzinski Benjamin , Rajput Jaikishan , Swaminathan Christie , Sajid Muhammad 
Published: August 2023

Abstract

Introduction
Dieticians on the general surgical ward are valuable in providing recommendations to optimise patient nutrition, including the administration of total parenteral nutrition (TPN). Prescribing TPN is time-intensive as patients' clinical status and biochemical profile are assessed to avoid re-feeding syndrome. This needs adjustment of the dieticians’ recommendations, highlighting the importance of clinician awareness of patients recommended for TPN.

Methods
We carried out a quality improvement project (QIP) on the general surgical ward of a tertiary centre teaching hospital which involved two plan-do-study-act (PDSA) cycles. We used primary and secondary qualitative surveys to collect data. In the first cycle, we implemented a daily whiteboard handover system in the doctors’ office which displayed the patients recommended for TPN. In the second cycle, we added a TPN recommendation section to the daily patient handover / ward patient list.

Results
Pre-intervention respondents reported lack in awareness of patients recommended for TPN, and felt prescription was often delayed. Use of a whiteboard was well accepted by junior doctors as well as dieticians and improved awareness of patients on TPN. However, this duplicated the workload and information sources for dieticians and doctors. Use of the patient handover list resulted further improved awareness and subsequently quicker timeliness of TPN prescribing.

Conclusions
Both whiteboard displays & highlighting the potential TPN patients in the handover lists were well-accepted and effective ways to improve awareness of patients on TPN. Sustainable interventions should not result in duplication of workload or information. Future work could include quantitative analysis of the above interventions.
FTP4.4 Feel Good Factor: Simple initiatives to improve team morale and mental wellbeing in the surgical workplace
Authors: Jeong Sue , Burford Charlotte , Zarsadias Prizzi , Shah Ankur 
Published: August 2023

Abstract

Aims
Healthcare professionals are vulnerable to stress and burnout. NICE guidelines on mental wellbeing in the workplace first recommend organisational-level approaches followed by individual approaches. Since December 2019, we have implemented monthly Feel Good Factor meetings to promote a culture of appreciation and improve moral in our surgical department. Previously, we found these meetings had a great impact on trainees feeling acknowledged and included, with no time taken off work due to mental health reasons for 20 months. However, participation in these meetings plateaued. Therefore we implemented a Feel Good Factor nomination box to improve involvement.

Methods
Everyone in the surgical department is encouraged to nominate colleagues who they have enjoyed working with. Previously, nominations were sent via messages or email. Since December 2022, we have implemented a physical box with nomination slips that are placed in every communal area of the surgical department. The surgical team is reminded once a month about the upcoming Feel Good Factor Meeting.

Results
Prior to the implementation of the Feel Good Factor box, the average number of nominations was 17.15 per month. Since the implementation, the average number of nominations has been 42 per month, an increase to over 240%.

Conclusion
Mental wellbeing should be a priority in the workplace. Our Feel Good Factor initiative has shown much success over 3 years. The simple implementation of a nomination box has greatly increased the level participation throughout the department. We believe this can be implemented in other departments to encourage a positive work environment.