bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP2.2 Subjective Assessment of Frailty Compared to Validated Frailty Assessment in Adults with Chronic Renal Failure presenting for Dialysis-Access/Transplant workup has Poor Estimation of Agreement
Authors: Sharma Hemant , Devkaran Bhavesh , Kapoor Kunal , Odugoudar Avinash , Koufopoulos Georgios , Mehra Sanjay 
Published: August 2023

Abstract

Purpose
Frailty assessment often rely on subjective frailty assessment, such as ‘the end-of-the-bed’ or ‘eyeball’ test. These assessments have traditionally been accurate in 40% of cases only. Frailty assessment is a part of our institutional clinical workup. We examined the association between subjective frailty and formal validated score aided frailty estimation in the adult renal failure population.

Methods
A cohort of all renal failure patients presenting for dialysis access/transplant assessment at a satellite unit over one year (December 2020-2021) was analyzed. Adult patients aged ≥18 years in the outpatient dialysis access/transplant assessment surgical clinic were rated with eyeball test in routine clinical assessment as either: frail, pre-frail, or non-frail, which was then compared to a formal frailty assessment using a modified version of the Frailty Phenotype. The association between clinician-estimated frailty and formal frailty assessment was examined.

Results
A total of 113 patients were approached, producing 109 paired frailty assessments. The median age of the patients was 62 years. The Composite Proportions of Agreement of clinician-estimated frailty to formal frailty was poor (0.57). The sensitivity of the Eyeball test was 0.30 & specificity was 0.43. The sensitivity of the Frailty Score was 0.70 & specificity was 0.57. The validated tool has more than twice the odds of estimating frailty OR 2.86 (1.49- 5.46). p=0.002 (2-tailed).

Conclusion
Subjective frailty assessment is not a reliable replacement for formal frailty assessment in adults with renal failure. The validated Frailty Tool provides a uniform frailty estimation.
WTP2.11 Ipsilateral allograft placement in simultaneous pancreas and kidney transplantation provides equivalent outcomes to standard techniques
Authors: Petagna Lorenzo , Khambalia Hussein , Forgacs Bence , Giuffrida Giuseppe , Moinuddin Zia , van Dellen David 
Published: August 2023

Abstract

Aims
In simultaneous pancreas kidney transplantation (SPK) grafts are conventionally implanted controlaterally (cSPK), with the pancreas allograft (PG) on right iliac fossa and kidney allograft (KG) on the left. Ipsilateral implant (iSPK) of both grafts on the right side has been previously described but remains underutilised, potentially due to concerns regarding technical complications. We aimed to assess feasibility, safety and outcomes of an iSPK implantation technique.

Methods
A retrospective analysis of a contemporaneous database of SPK transplants was performed. Grafts laterality was noted (iSPK or cSPK) with implantation decision dependent on surgeon preference and recipient factors. Recipients’ characteristics, surgical outcomes and graft and patient survival rates were compared.

Results
162 SPKs were performed (cSPK n=126 and iSPK n=36) between 2015-21. Recipient’s' demographics, indications, diabetic burden and comorbidities were comparable between the groups. Cold and and warm ischaemia times, intraoperative time, rates of complications, reoperation and readmission comparison showed no statistically significative difference between the 2 groups (p=NS). Survival rates for grafts (iSPK=97.2% vs cSPK=91.2%, p=NS) and patient (iSPK=97.2% vs cSPK=98.4%, p=NS) at 1 year follow-up was comparable as well.

Conclusions
In our experience iSPK appears to be a safe and feasible alternative, with comparable outcomes to cSPK. With increasing experience, iSPK could be offered to a larger number of recipients as there are no deterious effects on KG outcome. iSPK may provide benefit in reduction of operative time coupled with preservation of the contralateral side for future transplants, impacting on longer term patient longevity.
WTP2.12 Clinical outcomes in combined lung-liver transplants vs isolated lung-transplants: A systematic review and meta-analysis
Authors: Wong William , Sheehan Remarez , Bentley Thomas 
Published: August 2023

Abstract
The combined lung-liver transplant is an infrequent but established therapy for patients with end-stage lung and liver disease. Recent evidence suggests that the liver may reduce rates of graft rejection and increase overall graft survival for cotransplanted organs. To establish a comprehensive summary of safety and efficacy data and explore whether there may be a tolerogenic effect conferred by the liver in combined lung-liver transplants (CLuLi), we systematically searched 4 databases (Medline, Embase, Cochrane, OVID Transplant library) for all studies comparing clinical outcomes between CLuLi and lung transplants alone (LTA). The primary outcome for this study was overall survival at 1 and 5 years. 3 observational studies were deemed eligible for inclusion including a total of 21, 608 transplant patients- 86 CLuLi and 21,522 LTA. The most common indications for CLuLi included cystic fibrosis (50%) and noncholestatic liver disease (23%). 1- and 5-yr survival rates for CLuLi ranged from 80-91% and 59-84%, respectively, and were not significantly different to LTA in any of the studies. A random effects inverse variance meta-analysis demonstrated an insignificant difference in hospital stay length for CLuLi compared to LTA (95% CI -8.10 to +19.52, p=0.42). 1 study reported on acute rejection and found comparable rates between CLuLi and LTA (40% vs 46%). Overall, our study has shown CLuLi transplants to be at least as safe and effective as lung transplants alone. At present, there is insufficient quality evidence to evaluate the tolerogenic effect of the liver in CLuLi transplants.
WTP3.5 Is there microbiological justification for use of intraoperative antibiotics during cholecystectomy?
Authors: Elsamalouty Islam , Mahran Mostafa , Hollyman Marianne 
Published: August 2023

Abstract

Background
Antibiotics are commonly given during cholecystectomy, especially when bile is spilt with little evidence that antibiotics are required when washout of contamination was achieved.
Therefore, we sought to assess if microbes in bile were associated with post operative complications and what predicted their presence.

Methods
Bile samples were taken during cholecystectomy and were sent to culture and sensitivity. Data were collected on indication for operation, use of antibiotics, description of gallbladder bile and post-operative outcomes.

Results
Bile samples were analyses for 43 cholecystectomies, of which 16 (37%) were acute presentations. Bile was spilt intraoperatively in 18 cases (42%).
Eleven (25%) samples grew microbes; the most common was Clostridium perfringens. There was a statistically significant association between microbiology findings with gender (p0.0612) and age (p0.0295), but there was no correlation between the presence of pathogens and those with acute presentation (2/16), those who had antibiotics preoperatively (3/16) those with a history of cholecystitis (4/18), or active cholecystitis (4/19) or a description of turbid fluid/pus (1/4).
23 (53%) patients received antibiotics pre, intra or post-operatively. No patients developed complications related to infection except for one patient who had a wound infection (antibiotics given pre-operative and no bile spilt).

Conclusion
There was no trend correlation between pre-operative factors in identifying patients with microbes in bile, nor spilling of bile or microbes associated with post operative complications except for age and sex. We hypothesis that antibiotics use in patients where the gallbladder is perforated intraoperatively has no impact on post operative complications. Larger sample sizes are required to confirm these findings.
WTP3.9 Procedure-specific morbidity of pancreatoduodenectomy: a systematic review of incidence and risk factors
Authors: Russell Thomas 
Published: August 2023

Abstract

Aims
Pancreatoduodenectomy (PD) remains the only curative-intent treatment option for patients with a cancer affecting the head of the pancreas. It is high-risk and overall morbidity is around 40%. Due to the necessary resection and subsequent anastomoses required, multiple procedure-specific complications are possible. An in-depth understanding of the recent evidence on these will guide the consenting process and allow surgeons to evaluate their own performance. We aimed to consolidate the recent literature on pre-selected PD complications (postoperative pancreatic fistula (POPF), bile leak (BL), gastro-jejunal leak, post-pancreatectomy haemorrhage (PPH), cholangitis, and chyle leak (CL)).

Methods
A search of the PubMed database was carried out on 1st July 2021. Articles from July 2011 through to July 2021 were included. The initial search returned 297 results. After screening, 226 articles were excluded. The remaining 71 were assessed for eligibility and a further 34 were excluded. 37 were included in the final synthesis (two meta-analyses and 35 single/multicentre studies).

Results
Due to recently updated diagnostic criteria, differing definitions among authors and subclinical cases, true incidence rates are difficult to appreciate. The following were obtained: POPF (excluding biochemical leak): 10.0-25.9%, BL: 3.0-7.9%, gastro-jejunal leak: 0.4-1.2%, PPH: 7.3-13.6%, cholangitis: 0.1-21.1% and CL: 2.6-19.0%. Numerous risk factors, both modifiable and non-modifiable, were identified for each.

Conclusions
Most of the recent evidence on the studied complications comes from single institution studies of retrospective design. Robust case-control studies are required so predictive models can estimate the likelihood of specific complications in individual patients.
WTP3.11 The impact of inpatient Magnetic Resonance Cholangiopancreatography on total length of hospital stay
Authors: Ng Shou Kee , Stevenson Carla , Ansari Fraz , Khan Khurram 
Published: August 2023

Abstract

Aims
Magnetic resonance cholangiopancreatography (MRCP) is a frequently performed inpatient imaging modality to rule out bile duct stones (BDS). The aim of the study was to quantify the time delays from request of MRCP to its execution.

Methods
A retrospective cohort study of all consecutive adult inpatient MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, indications for MRCP, system timestamps for MRCP scans and length of stay (LOS) were analysed. Peak liver function test values were used pre-MRCP.

Results
A total of 302 patients were identified, 181 (59.9%) were female. Median age was 65 (IQR 50-76) and median Scottish Index of Multiple Deprivation score was 5 (IQR 3-8).
59 (19.5 %) MRCPs were performed for jaundice and 55 (18.2 %) were for gallstone pancreatitis. 104 (34.3%) had proven bile duct stones (BDS). Ultrasound and/or CT evidence of dilated bile ducts was strongly correlated with positive MRCP findings (p&lt;0.001). Patient age, gender, bilirubin and alkaline phosphatase levels were not predictive for BDS.
112 (37.1%) were urgent requests. The median wait time for urgent MRCP was 1.0 days (IQR 0.6- 1.8) compared to 1.2 days (IQR 0.9- 2.7) for routine requests. Median LOS was 5.9 days (IQR 3.6-10.9).

Conclusion
Inpatient MRCP does not significantly impact total LOS. We conclude that patients with high risk factors for BDS should undergo MRCP as inpatients to mitigate complications of BDS.
WTP3.13 Management of early complications of liver transplantation from a living related donor
Authors: Lamara Abdelhak , Boudjema Karim , Lakhal Mohamed , Nini Badreddine , Boukhane Mohamed , Debbar Brahim 
Published: August 2023

Abstract

Aim
The aim of this study is to highlight the importance of the development of adequate surgical technique, the proper selection of donors, the preparation of recipients and the introduction of new molecules of Immunosuppressants in improving liver transplant (LT) outcomes. The study also shows that early complications, occurring within the first 3 months, are responsible for two-thirds of deaths.

Methods
All LT candidates were assessed for contraindications to immunosuppressants, social and psychiatric assessment, and operative and infectious risk assessment. Patients who received LT were followed according to a rigorous pre-established protocol that allowed the detection of early postoperative complications and surgical revision in some cases.

Results
Post-operative surgical complications occurred in 04 patients who required immediaterevision surgery for hemoperitoneum, portal thrombosis that required unblockage of the TP, thrombosis of the hepatic artery requiring new arterial anastomosis and liver resection, and one patient developed an infectious complication (MAT). Three patients experienced complications related to immunosuppressants. One patient required renal dialysis. Two patients developed biliary stenosis; treated endoscopically in one patient, and biliary repair after failure of endoscopic treatment in another.

Conclusion
Hemorrhage, primary graft non-function, multiple organ failure and infection, acute rejection and surgical complications dominate post-LT follow-up. Immunosuppressive treatments are responsible for a significant morbidity rate. Early detection of complications and their immediate management reducing morbidity and mortality.
The living related donor LT program remains an option in our country due to the impossibility of LT as part of an ODB.
WTP4.2 Reasons for delays in Emergency General surgery services at Night
Authors: Amankwah Dennis , Chukwurah Uchenna , Odo Ezekiel , Bajamo Ore , Pangeni Anang , Chowdhury Ashim 
Published: August 2023

Abstract

Introduction
There are at least 33000 Emergency General Surgery (EGS) cases in the UK annually, with 80-90% of all deaths in general surgery noted in patients undergoing EGS. Delays in undergoing EGS are associated with increased patient morbidity, mortality and increased length of stay. We conducted a study to investigate reasons behind delays in emergency general surgery patients undergoing surgery during the night shift.

Methodology
Prospective data was collected on all surgical activity in the Emergency theatre after 20:00 hours between 26th February 2022 and 16th April 2022 (50 days). Data was collected from paper medical records.

Results
338 patients were booked to undergo surgery during the night shift over the specified time period. 68% (n=230) of cases scheduled for overnight operating had been booked during the day shift (08:00-20:00) whilst 32% (n=108) were booked during the night shift (20:00- 08:00).
70% of cases (n= 236) were rescheduled for surgery the following day. 47% of rescheduled cases were postponed due to surgical decision-making however 31% were postponed due to unavailability of theatre space (Other surgical specialties utilising theatre). All other postponements (22%) were due to anaesthetic team unavailability.

Conclusion
Our study identifies 3 main reasons for reduced emergency theatre utilisation in the night. Modifiable causes for delay include unavailability of theatre space and anaesthetic team. We recommend dedicated staff and theatre for EGS to improve patient outcomes. We recommend discussion with the on call surgical Consultant prior to postponement for surgical reasons. By improving overnight theatre utilisation, hospital pressures and patient outcomes stand to be improved.
WTP5.3 Setting up a Complex Abdominal Wall Reconstruction Unit: Our first 12 months’ experience in a District General Hospital
Authors: Bhandari Mayank , George Jefferson , Chakravartty Saurav , Parampalli Umesh , McCloud Joe , Cheetham Mark 
Published: August 2023

Abstract

Aims
Incisional hernias are distressing post-operative complications which develop in 25% of surgical incisions. We present our initial experience of setting up a Complex Abdominal Wall Reconstruction (CAWR) unit in line with international guidelines and Get It Right First Time (GIRFT) model of care.

Methods
A bespoke CAWR Multidisciplinary Team was established in our trust in January 2022, comprising 2 colorectal surgeons, 2 bariatric surgeons and anaesthetists (who performed the preoperative Botox injections and optimized high-risk patients). The unit had support from radiologists, the weight management service, and the orthotics department. We had approval from our governance, drugs and therapeutics team.
Pathways for risk stratification, risk modification with pre-optimisation, standardised surgical techniques and post-operative care were created.

Results
Between January and December 2022, 8 MDT meetings held and 52 patients were discussed. The average BMI was 34 (22-50.5) All patients underwent a preoperative CT scan to delineate the anatomy of the hernia. The median size of the defect was 6 cm (range 3 to 22 cm). Open Rives-Stoppa repair was performed in 19 patients, with transversus abdominal muscle release in 6 and 3 patients had laparoscopic repair. One recurrence and 2 superficial surgical site infections were noted. 38.4% patients had BOTOX, 40.3% advised preoperative weight loss and 5.7% for bariatric surgery before hernia repair. A high-risk anaesthetic opinion was obtained in for 7.6% and 17% were deemed unfit.

Conclusions
Our initial experience and data highlight the feasibility of delivery of CAWR service at a non-tertiary unit in line with GIRFT principles. The initial follow-up indicates improved patient outcomes and experience.
WTP5.11 Safety of Surgical Repair of Incisional Hernia in Patients with Morbid Obesity
Authors: Omar Islam , Townsend Abby , Hadfield Oliver , Khogali Moataz , Wilson Jeremy , Magee Conor 
Published: August 2023

Abstract

Aims
Incisional hernia (IH) is a common complication after open and minimal access abdominal surgery. The current practice guidelines recommend weight reduction to achieve a body mass index (BMI) &lt; 35 Kg/M2 before surgical repair of ventral hernias. However, this could be challenging to achieve, especially in emergency presentations. This study aims to assess the safety of surgical repair of IH in patients with BMI ≥35 Kg/M2.

Methods
A retrospective comparative study has been conducted to include all patients who had surgical repair of IH on an elective and emergency basis in a UK District General Hospital. The patients were divided into two groups. Group I BMI &lt; 35 Kg/M2 and Group II with BMI ≥35 Kg/M2. A comparison was made between the two groups according to demographics, comorbidities, hernia characteristics, operative data, and outcomes.

Results
The study included 239 patients, 181 in Group I and 58 in Group II. Severe obesity was associated with male patients, and they were younger than Group I, p= 0.001 and 0.013, respectively. 13.8% of Group I had DM compared to 29.3% in Group II, p= 0.007. There were no significant differences in hernia characteristics or mode of surgery between the two groups. However, Group II had more overall and wound-related complications, p= &lt;0.001 each. There were no significant differences in 30-day and 90-day mortality, recurrence rate, or 90-day readmissions.

Conclusions
Surgical repair of IH in patients with morbid obesity is associated with more overall and wound-related complications.
WTP6.1 Enhancing surgical training in the East Midlands through cadaveric simulation
Authors: Parks Ruth , Smith Katherine 
Published: August 2023

Abstract

Aims
Training during COVID presented new challenges for us all including reduced elective activity, less training opportunities, fewer formal courses and redistributing of funding. Building on a pre-existing laparoscopic cadaveric course for general surgery trainees run within our deanery, we have developed an 11-day cadaveric course to provide extra training opportunities.

Methods
Each day of the cadaveric course targets trainees from a different speciality: core surgical training (general, urology and paediatrics), colorectal, upper gastrointestinal, vascular, ENT, maxillofacial, neurosurgery, cardiothoracic, breast, orthopaedics core (orthopaedics and plastics), orthopaedics higher. Candidates perform simulated surgeries on fresh-frozen cadavers with supervision from Consultant faculty. The courses are run with support from University and industry partners to create an environment as close to the real-world as possible. Furthermore, there is time built into each course to complete simulated WBA on ISCP.

Results
The availability of fresh-frozen cadavers has decreased and the cost increased. By bringing on board multiple surgical specialities, this is a cost-effective way to deliver excellent training to the maximal number of trainees. Feedback obtained directly from the participants shows that this type of training is highly regarded and described as ‘the next best thing’ to real-life operating as well as directly contributing to successful CCT outcomes. The courses have allowed for collaboration between different surgical specialities across the region, University and industry partners.

Conclusions
We have created a reproducible programme now run on an annual basis to impact the maximal number of trainees across the region.
WTP6.5 Facile strategies implemented to improve pharmacological venous thromboembolism prescribing practices in an acute surgical assessment unit
Authors: Basit Raja Haseeb , Anwar Adeel 
Published: August 2023

Abstract

Introduction
Venous thromboembolism (VTE) represents a major cause of preventable morbidity and mortality in acute surgical admissions. Whilst previous national audits/NHS campaigns have greatly increased admission VTE prophylaxis assessment (VTEPA), critical reassessment within 24 hours of admission in high bleeding/thrombosis risk patients as advocated by NICE/SIGN/Trust guidelines remains poor; thus, serving as the study aim.

Methods
Data collection was undertaken retrospectively post-discharge (n=269) at admission (within 14 hours post-admission) and reassessment (within 24 hours post-admission). The first cycle determined baseline practices; intradepartmental poster education/sessions and discussion awareness formed the mainstay intervention with a further 2 cycles (2 months/4 months post-intervention) to assess change. An unpaired T-test determined significance (p&lt;0.05) of averaged VTEPA rates across cycles.

Results
Baseline VTEPA practices 92% (admission) and 16% (reassessment) of patients respectively. VTEPA rates significantly improved to 98% (admission, p&lt;0.05) and 86% (reassessment, p&lt;0.001) 2 months post-intervention. At 6 months VTEPA rates decreased to 96% (admission) and 62% (reassessment); p&lt;0.05, p&lt;0.001 compared to baseline practice respectively.

Discussion
VTEPA significantly improved post intradepartmental poster-education and discussion awareness at admission and reassessment, in accordance with national guidelines. We consider the decline in VTEPA at 6-months, partly attributed to the influx of the new cohort of FY1 junior doctors in August with limited exposure to the departmental VTE education sessions. Overall, however, this audit demonstrates that facile, inexpensive, and quick interventions can yield highly effective results translating into improved patient safety; particularly in preventable inpatient VTE events. Further consideration should be given to incorporate such strategies across trusts to maximise VTEPA compliance.