bluuebunny/crossref_metadata_2025_split huggingface dataset:
1019 Timing of Laparoscopic Cholecystectomy in Patients with Acute Cholecystitis at a District General Hospital
Authors: Kronberga M , Cartner E , Suresan S , Saha A , Peter M , Khawgali M , Bonner C , Matias M 
Published: August 2023

Abstract

Aim
Early laparoscopic cholecystectomy (LC) is recommended in the treatment of acute cholecystitis (AC) as a balance between reducing gallstone-related complications and surgery-related complications. NICE guidelines recommend LC within a week of diagnosis for adults with AC or to be delayed once acute episode has subsided at least 4 weeks after diagnosis. This audit aimed to assess our Trust's compliance to these recommendations.

Method
A retrospective analysis was conducted on all patients who received cholecystectomy following a diagnosis of acute cholecystitis between June 2021 - July 2021. After implementation, a re-audit was conducted from May 2022 - July 2022.

Results
A 100% compliance rate was achieved in the first cycle of the audit. Out of the 35 patient sample of newly diagnosed AC, only 16 patients underwent surgery in 2021. Out of these 16 patients, 81.3% had LC within a week and 18.7% had the procedure performed after 4 weeks. The re-audit, with a sample size of 52 patients, had an overall compliance of 96.8%. Out of the 31 patients who had surgery, 71% had surgery within a week of diagnosis and 25.8% had surgery after 4 weeks of diagnosis. Only 1 patient (3.2%) had surgery outside of the recommended timeframe as the surgery took place 9 days from diagnosis.

Conclusions
This audit demonstrated that our Trust has very good compliance with the guidelines where &gt;95% of patients received their surgery within the recommended time frame. Our Trust demonstrated high rates of LC during acute admission, which aims to improve long waiting lists for elective LC.
1021 Documentation in Laparoscopic Appendicectomy: Are We Getting It “Write” First Time?
Authors: Monaghan E , Coles H , Sivasothy N , Bath M , Thin N 
Published: August 2023

Abstract

Aim
The Get It Right First Time (GIRFT) initiative was introduced to improve unwarranted variations in practice and improve patient care. GIRFT have published a series of recommendations for surgeons nationwide, which includes operative documentation. We aimed to assess completeness of documentation for laparoscopic appendicectomies in a district general hospital and identify methods of improvements, based on the GIRFT recommendations.

Method
We retrospectively searched prospectively maintained theatre lists for all “Laparoscopic Appendicectomy” performed from July to November 2022, then confirmed operations against the hospital’s electronic coding. All patients of any age were included; patients with an operation note not available online were excluded. Operation note documentation was analysed against the 34 GIRFT guideline recommendations.

Results
A total of 49 patients were included in the study. 38% of operation notes concorded with the recommendations outlined by GIRFT guidelines on laparoscopic appendicectomy documentation. 43% of the operation notes did not document in accordance with the 34 points and 8% documented incompletely. The 34 GIRFT recommendations were broken down into pre-operative, intra-operative and post-operative documentation sections. Highest levels of concordance were seen within intra-operative documentation, with 46% correctly including all necessary GIRFT recommendations. Pre-operative documentation had the poorest results – 56% not documenting in accordance with GIRFT.

Conclusions
Surgeons had varying levels of concordance with the GIRFT guidelines when recording laparoscopic appendicectomy notes. We have introduced a standardised proforma, based on the GIFT guidelines, to our practice and plan to re-assess compliance to ensure optimal documentation.
1056 Are Post-Operative Instructions Clearly Explained in Operation Notes? - Developing the Abscess Pathway
Authors: Hinchcliffe Z , Khalid S , Soares L 
Published: August 2023

Abstract

Aim
“Good Surgical Practice” guidance states that operation notes must include “detailed postoperative care instructions” to facilitate continuity of care by clinicians, alongside the patient themselves. This is especially important for abscess incision and drainage (I&D); a common day-case procedure where patients are left with complex, inaccessible wounds requiring frequent dressings. This study aimed to investigate and improve the compliance of post-operative documentation for I&D procedures.

Method
Retrospective analysis of 100 consecutive abscess I&D procedures performed at a district general hospital between August–November 2022. The operation note for each procedure was screened for post-operative guidance on antibiotics, analgesia, dressing management, showering, returning to daily activities and follow-up.

Results
On average, 55-62 I&Ds were documented each month. 38 operation-notes did not clarify antibiotic choice/duration; 12 were in penicillin allergic patients. Guidance on analgesia was missing from 27 operation-notes; 8 patients reported analgesia-related constipation without laxatives prescribed. Showering and dressing management was excluded from 53% and 19% notes respectively. 62% failed to provide advice on the first dressing change, and Aquacell was not prescribed in 68 cases for community management. Information on returning to daily activities was only included in 6 notes. Follow-up was not mentioned in 67% cases.

Conclusions
Documentation of post-operative instruction for abscess I&D is inconsistent, increasing risks of patient anxiety, pain, infection, and re-presentation to hospital. Data collected will be used to create the ‘Abscess Pathway’ to standardise information provided to patients in the pre-/post-operative period in the form of leaflets and personalised proformas.
1083 Evaluating Adherence to Best Practice for Tissue Sampling in Diabetic Foot Surgery: A Quality-Improvement Study
Authors: Proctor D , Shea J , Lewis S , Howard T , Ahmad M , Obuh O , Shalhoub J 
Published: August 2023

Abstract

Aim
To evaluate adherence to national guidelines (National Institute for Health and Care Excellence – NICE) in tissue sampling during diabetic foot surgery, and to assess the clinical course of minor diabetic foot amputations in relation to bone microbiology and antibiotic therapy.

Method
Between 2020 and 2022, three separate cycles of a plan-do-study-act (PSDA) audit were completed to evaluate the efficacy of a teaching programme and an online operation note proforma. Data were collected retrospectively with the primary outcome measures being the proportion of clinically clean bone samples sent and subsequent impact on changes to targeted antibiotic therapy. Secondary outcomes included the rates of re-infection and re-intervention.

Results
A total of 106 patients were sampled (PDSA 1, n = 52; PDSA 2, n = 27; PDSA 3, n = 27). Following the implementation of a departmental teaching programme the proportion of clinically clean bone samples increased from 68% (PDSA 1, n = 40) to 75% (PDSA 2, n = 12) with a further increase to 89% (PDSA 3, n = 24) after implementation of the online proforma (p = 0.140). Microbiology results prompted necessary changes to targeted antibiotic therapy in 58% of patients (PDSA 1, n = 33) increasing to 95% throughout the study (PDSA 3, n = 19). Targeted antibiotic therapy was associated with comparable rates of re-infection compared to non-targeted therapy (PDSA 3, 5% / 12.5%, respectively) but overall lower rates of re-intervention (PDSA 3, 63% / 47%, respectively).

Conclusions
Both interventions were associated with increased rates of clinically clean intra-operative bone sampling. Lower rates of re-intervention were observed in patients who subsequently received targeted antibiotic therapy.
1097 Assessing the Compliance with RCS Operative Note Content Guidance in the General Surgical Department at a DGH With a Hybrid Note System
Authors: James S , Arbis A , Harshen R 
Published: August 2023

Abstract

Aim
To assess the compliance with the RCS operation note content guidance at Conquest Hospital, Hastings. Ensuring the accuracy of operation notes cannot be overstated, allowing adequate information to be obtained by team members and for medico-legal purposes. Previously, operative notes were completed on paper, with sub-headings for prompts. A few years ago, this process moved online with a blank template.

Method
Using theatreman, we retrospectively collected data beginning 13/9/22 for 100 consecutive elective or emergency operations performed by any general surgeon at Conquest Hospital. Each operation note was observed for compliance with each of the 19 points of the RCS guidelines with data compiled using an excel spreadsheet with simple statistical analysis.

Results
Overall compliance with the 19 points of the RCS guidance was 65.3%. No single operative note contained all the required 19 points. No operative note recorded estimated blood loss.

Conclusions
Compliance with the prescribed guidelines varied greatly. No single operative note contained all the required information. Moving forward, we plan to work alongside the IT team to produce a prepopulated template for the writing of operative notes. Unfortunately, due to complex nature of IT systems, this will likely take some time. In the meantime, we plan to use a template operative note adjacent to each computer screen in theatres where the notes are completed to act as a guide for surgeons when completing their documentation. Following the implementation of each of these changes, we will complete a further audit to assess for compliance.
1135 Evaluation of Management of Fifth Metatarsal Fractures in University Hospitals of North Midlands Fracture Clinics from March to May 2021
Authors: Nasr H , Banks T , Narayana Murthy S , Ali A 
Published: August 2023

Abstract

Aim
The primary objective is to ascertain if fracture clinic follow-up of simple, isolated fifth metatarsal fractures is required, or if discharging patients from Accident & Emergency and Minor Injury Units with clinical advice and a contact number is a safe, cost-effective alternative. We also aim to design a protocol and treatment pathway to enable safe discharge and patient-initiated follow-up (PIFU) where required.

Method
All patients with metatarsal fractures between March and May 2021 had their radiographs, e-records and clinic letters retrospectively reviewed with a one-year follow up. Patients with neuropathy, open fractures and polytrauma patients were excluded. The remaining patients with simple, isolated fifth metatarsal fractures were evaluated.

Results
75 patients with an isolated fifth metatarsal fracture were reviewed across three months, with 165 appointments dedicated to them (in person and via telephone). 72% were treated with a metatarsal shoe and 17.3% with a walker boot. One patient required surgery for non-union. £12,018 was spent by the trust for the above appointments, either in person (£152 per unit) or via telephone (£20 per unit).

Conclusions
Simple, isolated fifth metatarsal fractures should be discharged directly from A&E in a metatarsal shoe with an information leaflet and PIFU. Neuropaths, open fractures or polytraumas should follow a referral protocol which has been designed for our department based on our findings.
1180 Indications for Day One Postoperative Blood Tests After Emergency Appendicectomy
Authors: Kho J , Kuan J Y , Derbyshire C , Ward J , Rajendran I 
Published: August 2023

Abstract

Aim
Appendicitis accounts for 47,000 admissions/year in England, and commonly involves patients aged 10 to 65 years. A cost-effectiveness study was conducted to assess the need for routine ‘day-one postoperative’ (D1) blood tests following ‘emergency appendicectomy’ (EA).

Method
Retrospective review of all EAs was carried out between January 2022 and October 2022. Data was collected from local hospital database. Elective appendicectomies were excluded. D1 blood tests were deemed necessary in complicated EAs, with clear documentation of the indication for blood tests. Costs of blood samples (FBC = £12, U&E, LFT and bone profile = £23 and CRP = £12) were verified by local/national (NICE and CCG) sources.

Results
Fifty EAs were reviewed. 39 (78%) cases were completed laparoscopically, 9 (18%) were laparoscopic converted to open and 2 (4%) were open appendicectomies. 36/50 (72%) patients had D1 bloods, 30 (83%) of which had an uncomplicated recovery. 6 (17%) patients developed postoperative complications; diabetic ketoacidosis (DKA) (n = 1), ileus (n = 2), superficial wound dehiscence (n = 1) and infected intra-abdominal collection diagnosed two weeks post-op (n = 2) (one patient was managed conservatively with intravenous antibiotics and the other underwent radiological-guided drainage). Only 1 (2%) patient (postoperative DKA) had a clear clinical indication for D1 bloods. This translates to potential cost savings of £2350.

Conclusions
Study demonstrates potential significant cost savings if clinicians rationalise blood test requests following EAs. These findings may be extended to other emergency and elective cases. In a resource-constrained environment, it is worth considering the need for postoperative tests, which could influence length of hospital stay and further cost savings.
1258 Audit of Environmental Costs for Bariatric Face to Face Clinics: A Single Centre Study – Interim Findings
Authors: Sow K , Wallace A , Malek H , Kourounis G , Musbahi A 
Published: August 2023

Abstract

Aim
The NHS has committed to delivering a net zero national health system by 2045. Patient travel accounts for approximately 20% of carbon footprint amongst resource use within outpatient appointments. The increased acceptability of digitalized healthcare during the COVID-19 pandemic has helped in reducing this. The study aims to look at the carbon cost of in-person bariatric clinics over a two-month period.

Method
A prospective review of all in-person bariatric clinics in a single high-volume bariatric center was carried out from October 2022 to December 2022. Patient’s postal codes were used to estimate mileage and duration of travel to the hospital via Google Maps. The Centre for Sustainable Healthcare Patient Travel Emission Calculator was used to estimate carbon dioxide emissions of different travel modes. Calculations were adjusted for the number of people attending with the patient and mode of travel.

Results
Between October and December 2022, there were a total of 48 in-person bariatric clinics. Of which, 87.5% traveled by car and 4.2% by bus or taxi. The total distance traveled was 2727 km, equivalent to 58.5 hours of travelling time. The total CO2 emissions and estimated travel-related costs were 277.4 kg and £534.98. Travels by car had the highest impact on travel costs and carbon emissions, followed by taxi and bus.

Conclusions
Significant cost and emission reduction could be potentially achieved by remote consultation rather than in-person clinics. Data collection is ongoing with the aim of collecting information from at least 100 patients.
1169 Zinc and Copper Deficiency in Bariatric Patients: Time to Revise Guidelines?
Authors: Kainth R , Burton K , Sufi P 
Published: August 2023

Abstract

Aim
The number of bariatric surgeries performed is increasing due to the rising incidence of obesity. It is known that mineral deficiencies can occur in the postoperative period for these procedures. We examined the prevalence of zinc and copper deficiencies before and after various bariatric procedures, with the aim of assessing the relevance of current recommendations, specifically the American Society for Metabolic & Bariatric Surgery (ASMBS) and the British Obesity and Metabolic Surgery Society (BOMSS) guidelines, regarding monitoring and supplementation.

Method
We retrospectively analysed data of 327 patients who underwent one of three bariatric operations: Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and mini-gastric bypass (MGB) between January 2018 and December 2019. Copper and zinc serum levels prior to surgery, and at 3-, 6-, and 12-months post-operation were collected.

Results
Preoperatively, 56.7% of patients undergoing bariatric surgery were zinc deficient and 32.4% had hypercupraemia. Twelve months post-surgery, 42.9% of RYGB, 35.3% of SG, and 57.7% of MGB patients with preoperative zinc deficiency presented again with a zinc deficiency requiring supplementation. Only 1 patient displayed copper deficiency preoperatively, and 6 postoperatively.

Conclusions
Screening for zinc and copper deficiencies at 6 and 12 months postoperatively, rather than at 3 months, is a more clinical and cost-effective strategy.
153 The Martin-Gruber Anastomosis: Prevalence and Morphology
Authors: Dennis D , Choudhury B 
Published: August 2023

Abstract

Introduction
The Martin-Gruber anastomosis (MGA) is an anatomical variant characterised by an anastomotic branch between the median and ulnar nerves in the forearm. The MGA can cause changes to the innervation of the hand in 6% to 47.3% of the population. However, this change in innervation remains asymptomatic unless the MGA co-exists with a peripheral neuropathy, such as carpal tunnel syndrome (CTS).

Aim
This study aimed to investigate both the prevalence and morphology of the MGA in a cadaveric population.

Method
Fourteen embalmed right-upper limbs were dissected to the level of the MGA, using standard dissecting techniques, and evaluated for the presence of the characteristics of the MGA.

Results
The results showed the MGA was present in 14.4% (2/14) of the population. One case was found to originate directly from the median nerve. The second case originated from the anterior interosseous nerve.

Conclusions
This study emphasises the need for medical professionals to recognise and understand the implications of the anastomosis on common peripheral neuropathies, particularly CTS, whose co-existence can create unusual innervation of the upper limb.
190 Relationship Between Tumour Characteristics and Margin Involvement for Skin-Sparing vs Simple Mastectomy: A Single Institution Experience
Authors: Cheah W , Ang K S , Ang K L , Rizkalla S , Luther A , Cutress R I 
Published: August 2023

Abstract

Aim
Skin-sparing mastectomy (SSM) are increasingly performed to facilitate breast reconstruction. Published data shows varying rates of margin involvement with SSM. We reviewed the relationship between clinicopathological characteristics and margin involvement after SSM versus simple mastectomy (SM).

Method
Retrospective case-series of breast cancer patients who underwent SM between June 2021-2022 or SSM (Dec 2019-Mar 2022) in a single tertiary centre. Demographic and clinicopathological data were retrieved from Trust systems. Margin involvement was defined as &lt;1mm. Student’s t-test and Chi-square test were used to compare continuous and categorical variables.

Results
Study included 156 patients (n = 59 vs 97 [SSM vs SM]). Patients undergoing SSM tend to be younger (mean age = 47 vs 63, p&lt;0.001 [SSM vs SM]), less often had high grade disease (22% vs 38% G3, p = 0.04) and involved lymph nodes (19% vs 48%, p&lt;0.001), more often had DCIS only (24% vs 15%, p&lt;0.001). Mean tumour size was similar (40.6 vs 38.7mm, p = 0.32[SSM vs SM]) as well as receptor status (61% vs 61% ER+, p = 0.125; 10% vs 18% HER2+, p = 0.21; 12 vs 16% triple negative, p = 0.43 [SSM vs SM]). Both groups had similar tumour margin involvement (8.47% vs 6.19%, p = 0.588).

Conclusions
The SSM cohort tend to be younger, had lower incidence of nodal involvement and higher rates of DCIS. The SSM and SM cohort showed similar mean tumour size, receptor distribution and tumour margin involvement rates. With appropriate planning, SSM does not increase the likelihood of margin involvement.
207 Does Adjuvant Radiotherapy Lead to Increased Survival in Patients with Adenoid Cystic Carcinoma of the Breast? a Systematic Review and Meta-Analysis
Authors: Lastoria D A 
Published: August 2023

Abstract

Aim
Adenoid cystic carcinoma (ACC) of the breast accounts for approximately 0.1% of all breast tumours (Zhang et al, 2021). The aim of this systematic review and meta-analysis was to determine whether adjuvant radiotherapy provides an additional benefit when compared to surgery alone in terms of overall survival in patients with ACC.

Method
A total of 3,330 records were identified and screened following database, conference proceedings, and currently registered studies search. Data from 5 case series was extracted. A random-effects meta-analysis of overall survival (OS) at 1, 2, 3-, 4-, 5- and 10-years post-intervention was performed.

Results
Adjuvant radiotherapy and surgery alone led to similar OS at all points post-intervention. For instance, 5-year survival following use of adjuvant radiotherapy was 92.8% (95% CI: 90.5%-94.7%), compared to 88.7% (95% CI: 81.9%-94.2%) with surgery alone. The confidence intervals overlap, which was the case for all points post-intervention.

Conclusions
Similar OS for both adjuvant radiotherapy and surgery alone (and overlapping confidence intervals), suggest the former may not provide an additional benefit in terms of OS in patients with ACC. Considering the negative side effects of radiotherapy, it could be argued that surgery alone should be used for the treatment ACC. However, this conclusion is hindered by the low number of studies included in this meta-analysis and their low level of evidence. This could be attributed to the low incidence of ACC. Further data should be collected to more reliably determine their optimal treatment.
620 Re-Operation Following Initial Breast Conservation Surgery for DCIS and Invasive Breast Cancer at ELHT Breast Unit, in 2021
Authors: Ahmed A , Jamal S , Yip C 
Published: August 2023

Abstract

Aim
Breast conserving surgery (BCS), as an alternative to mastectomy, in appropriately selected patients with early-stage breast cancer is recommended. Cancer specimens from BCS can be reported as involved or close margins; this finding might increase patients’ future risk of local and distant recurrence.
Association of Breast Surgery advises re-excision of breast if disease is present at radial margins (&lt;1mm). The reported (2014-2018) national re-excision rates for invasive disease and DCIS were 13% and 22% respectively. This audit reviewed our Breast Unit BCS re-excision rates in 2021.

Method
All breast procedures performed at ELHT in 2021 were retrospectively reviewed. Patients who underwent BCS for invasive and DCIS were included in our audit. We examined the total number of patients who required further surgery following BCS, secondary to incomplete excision margin and reviewed their subsequent pathological finding and management following their re-excision surgery. Patients who had incidentally found invasive/ DCIS disease at diagnostic excision were excluded.

Results
633 breast procedures were performed in the study period: 232 were BCS for invasive disease and DCIS. Re-excision rate for invasive disease was 15.1% (31/205) and 33.3% (9/27) for DCIS. Some patients (7.5%) required more than one re-excision surgery. Among these patients, a few opted for completion mastectomy.

Conclusions
We reported a comparable BCS re-excision rate for invasive cancer but higher than national standard re-excision rate for DCIS. This might be explained by the overall small number of BCS for DCIS. We aimed to make changes to our practice and re-audit.