bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP1.5 Mortality rate for frail and sarcopenic patients post emergency laparotomy
Authors: Ng Hwei Jene , Quasim Tara , Rattray Nicholas , Moug Susan 
Published: August 2023

Abstract

Aims
Frail patients and sarcopenic patients are predicted to have high morbidity and mortality after undergoing emergency laparotomy (EmLap). However frailty and sarcopenia can be present independently or mutually. We aim to explore the association between 30- day mortality, frailty and sarcopenia.

Methods
Analysis was performed on a prospectively collected database of EmLap patients ≥40 years in a busy district hospital. Frailty was assessed via Clinical Frailty Score with score ≥4 defined as frail. Sarcopenia was assessed via total psoas index (TPI). TPI is the total L3 psoas area on CT (cm2)/ patient’s height (m2), stratified according to gender with sarcopenia being present in the lowest quartile. Statistical analysis was performed using logistic regression and p value of &lt;0.05 was considered significant.

Results
100 patients were included with a median age of 66 years; 59% were female. The overall 30- day mortality rate was 9%.
Frailty was present in 49% and within this group, mortality rate was 16.3% (OR 9.76, p= 0.012), 24% were sarcopenic and 30- day mortality was 12.5% (OR 1.57, p= 0.545). 14% of patients were both frail and sarcopenic and the 30- day mortality was 21.4% (OR 3.64, p= 0.080).

Conclusion
Mortality rate is high in EmLap patients and is higher when patients are both frail and sarcopenic. Frailty and sarcopenia are interlinked and can be improved, hence both should be assessed in all EmLap patients to allow early identification, improvement in shared decision making and development of targeted post-operative interventions to improve EmLap outcomes in this cohort of patients.
SP1.10 Predicting unplanned readmissions after emergency laparotomy
Authors: Brindley Ellie , McDermott Katherine , Slavin Emily , Downey Candice 
Published: August 2023

Abstract

Aims
St James’s University Hospital in Leeds performs the highest number of emergency laparotomies in the UK. This operation remains one of the highest risk surgical procedures but little is known about the patient journey after discharge from hospital. This service evaluation aimed to assess the rate of unplanned readmissions after discharge, and how to predict those at higher risk of readmission, to inform the implementation of a specialist emergency laparotomy follow-up clinic.

Methods
The Leeds NELA data were used to collate the clinical details of all patients who underwent an emergency laparotomy between 1st October 2021 – 1st October 2022. The local electronic patient record was searched to identify those who were readmitted within 30 days of discharge. A univariate analysis determined the factors which most accurately predict the risk of readmission.

Results
The clinical details of 343 patients were analysed, of whom 318 survived to discharge. There were 41 unplanned readmissions to hospital within 30 days of discharge (13%). The most frequent reasons for unplanned readmission were sepsis, wound infection, post-operative pain, high-output stoma and acute kidney injury. Frailty score (OR 1.276; CI 1.031-1.579; p=0.025) and ASA score (OR 1.803; CI 1.218-2.669; p=0.003) were statistically significant predictors of readmission after emergency laparotomy.

Conclusions
St James’s University Hospital employs two dedicated NELA nurses, and has implemented a weekly outpatient follow-up clinic for patients who have been discharged after emergency laparotomy. The availability of clinic appointments should be prioritised for frail and comorbid patients to enhance the patient’s postoperative journey.
SP2.6 Histological TNM stage and five-year survival after pancreatoduodenectomy for pancreatic ductal adenocarcinoma
Authors: Russell Thomas , Labib Peter , Aroori Somaiah ,   RAW Study Collaborators
Published: August 2023

Abstract

Aims
Patients with a pancreatic ductal adenocarcinoma (PDAC) of the pancreatic head may be offered pancreatoduodenectomy (PD) providing they are suitable candidates. Unfortunately, recurrence rates are high following this operation and few patients achieve long-term survival. This study aimed to investigate and quantify the relationship between histological tumour, node and metastasis stage, and five-year survival.

Methods
Data were extracted from the Recurrence After Whipple’s (RAW) study, a multicentre retrospective cohort study of outcomes of PD performed for malignancy (29 centres from 8 countries, n=1484). PDAC patients were grouped by their T stage, N stage and M stage, and five-year survival rates were compared using Fisher’s exact test.

Results
A total of 885 patients (59.6%) had PDAC confirmed histologically. Five-year survival was 57.4%, 46.0%, 17.0% and 32.0% in patients with T1, T2, T3 and T4 disease, respectively (unavailable: 7 patients). T1-2 patients (vs T3-4) had significantly higher rates of five-year survival (OR: 4.8, 95% CI: 3.3-7.0). N0 patients (vs N1-2) had significantly higher rates of five-year survival (OR: 4.5, 95% CI: 3.2-6.3). M0 patients (vs M1) also had higher five-year survival rates but this was not quite significant due to the small sample size of the M1 group (OR: 3.8, 25.7% vs 8.3%, p=0.06).

Conclusion
In our multicentre study of patients who underwent PD for PDAC, increasing T and N histological stages were found to correlate with reduced five-year survival. The figures provided can be used to guide the consenting process and predict outcomes in individual patients.
SP2.9 An Audit on Implementation of Electronic Autofilling in Consent Forms for Liver Resections in a Tertiary Center
Authors: Iqbal Affan , Fadipe Adetokunbo , Patel Agastya , Bandyopadhyay Samik , Jamdar Saurabh , Satyadas Thomas 
Published: August 2023

Abstract

Background
As part of the GMC’s Good Medical Practice guidelines, benefits and risks should be discussed and documented accurately and in their entirety on a consent form. It is common for rarer or less significant complications or additional procedures to be missed from consent forms. Within the hepatopancreatobiliary (HPB) surgery team at Manchester Royal Infirmary, there has been a drive to evaluate the quality of the consenting process and documentation, as well as to understand the impact of the introduction of HIVE electronic patient record (EPR). Our aim is to standardize the consent forms to ensure all pertinent information are included.

Methods
We performed a comparison of documented risks and additional procedures against gold standard NICE guidance for liver resections performed by the HPB surgery department at Manchester Royal Infirmary. We evaluated paper consent forms from July to September 2022(n=9), electronically signed consent forms obtained from ‘HIVE’ from September to November 2022(n=29) and from December 2022 (n=19) we introduced ‘smart texts’ automated consent forms. Simple descriptive statistical analysis were used.

Results
Out of 20 documented risks and additional procedures, 15 were documented more frequently in consent forms following a transition to electronic patient records. Following ‘smart texts’, there was a further improvement in 14 of these risks and additional procedures. Particularly marked increase in documentation of additional procedures such as drains, lines and catheter insertion.

Conclusions
The introduction of HIVE and ‘smart texts’ have markedly improved the quality of the consenting process. We should be more comprehensive in educating patients about additional procedures that may be required.
SP3.1 80 patient series from UK renal transplant centre shows extended criteria deceased donor transplants are associated with a poorer graft function but at no increased risk of graft loss after 1 year
Authors: Abdul-Hamid Sawsan , Wong Zhen , Benaissa Mona , Lamb Rosemary 
Published: August 2023

Abstract

Aims
Between 12/2018 – 12/2021 our centre performed 163 deceased donor transplants. 30.7% of these utilised organs from so-called extended criteria donors (ECD). ECD [originally in context of donation after brain death (DBD), but later used also for donation after cardiac death (DCD)] refers to donors &gt;60yo; or &gt;50yo with ≥2 of hypertension / death from CVA / Cr &gt;133. We wanted to assess outcomes in ECD transplant recipients and compare with outcomes of our standard donor (SCD) recipients.

Methods
Retrospective analysis of 40 ECD transplants (12/2018- 12/2021) and control group of 40 age-matched (overall mean age 58.2) SCD recipients with 12 month follow up.

Results
The groups were comparable regarding proportion of DCD donors (ECD 62.5%, SCD 50%; X2= 1.270 p=0.260).
Although rate of delayed graft function (DGF) was higher in the ECD group, this was not statistically significant (ECD: 62.5%, SCD:47.5%; X2=1.257 p=0.262). There was, however a difference in creatinine at discharge (median ECD:390; SCD:221; U= 1018.500; p=0.036) and in EGFR at 1 year (mean ECD:39.62; SCD: 54.3; t=-3.780 p&lt;0.001).
There was no difference in incidence of graft loss (ECD:0%; SCD:2.5%; X2=1.013, p=0.314) or mortality (ECD:5.0%; SCD:7.5%; X2=0.213, p=0.644).
There was no difference in index length of stay (median ECD:6; SCD: 6; U=928.000 p=0.212), or total readmissions (median ECD:2.5; SCD:2.0; U=902.500 p=0.319).

Conclusions
In our sample incidence of DGF was similar between the two groups. ECD recipients had poorer graft function at 1 year but there was no evidence of increased risk of graft loss at 1 year.
SP3.10 Improvement of quality of operation notes. An audit was performed to assess operation notes in our hospital, detected multiple points commonly missed in the operation notes as well as illegibility of some. Implementation of electronic operation notes took place to improve service
Authors: El-Hakim Hesham , Gan Sylvia , Brockway Emma , Oliphant Raymond 
Published: August 2023

Abstract

Aim
An audit was performed in November 2021 to assess completion of operation notes according to national guidelines.

Methods
18 points were checked in accordance to Royal college of Surgeons guidelines.

Results
Percentage of completion ranged from 47% to 77% according to sub-specialty. Main points that were missed were time of operation, bloods loss and antibiotic prophylaxis. 29% of notes had illegible hand-writing which could not be read appropriately by two or more people. Electronic operation notes have been identified as the ideal plan to help avoid illegibility and to make sure all points are present. Multidisciplinary approach was done to implement electronic typed operation notes in the hospital involving surgical team, management, theatre staff and information technology (IT) specialist. This took place by providing extra computers in both elective and emergency theatres with appropriate software to allow for typed operation notes. Operation note templates were used to ensure all points are filled. Significant improvement in the operation notes was noticed once electronic notes have been used. The percentage of electronic notes went up from 9% to 34% in January 2023, legibility increased from 71% to 96%, time of operation documentation increased from 0% to 22%. There was 100% compliance each of the following; name of surgeons, mode of surgery, date of operation, operative procedure, operative findings and closure technique. Overall completion rate of operation notes improved from 72% to 82%.

Conclusion
it is inevitable that technology can be used to eliminate human error, provide clear documentation and create traceable information.
SP3.12 Cost effectiveness of robotic versus laparoscopic colorectal resections: a mapped systematic review of published studies
Authors: Singh Anurag , Kaur Mandeep , Sains Parv , Baig Mirza Khurrum , Swaminathan Christi , Sajid Muhammad 
Published: August 2023

Abstract

Objective
Robotic colorectal resections (RCR) have been gaining popularity recently due to several advantages in addition to the oncological safety. The objective of this review to evaluate the cost effectiveness of RCR compared to laparoscopic colorectal resection (LCR).

Materials and methods
All types of comparative studies reporting the cost of RCR versus LCR were retrieved from the search of standard medical electronic databases and analysis was conducted by using the principles of meta-analysis on the statistical software RevMan version 5.

Results
The search of medical databases yielded 14 comparative studies (one randomised trial and 13 retrospective studies) on 17961 patients undergoing oncological and non-oncological colorectal resections. Thirteen studies reported total cost whereas 7 studies reported only operative cost. In the random effects model analysis, LCR was associated with the reduced total cost [standardised mean difference -91.35, 95%, CI (-104.91, -77.80), Z = 13.21, P=0.00001] as well as reduced operative cost [standardised mean difference -4.75, 95%, CI (-9.09, -3.40), Z = 6.93, P=0.00001] compared to RCR. However, there was significant heterogeneity (Tau2 = 2.95; Chi2 = 902.27, df = 12; (p &lt; 0.00001; I2 = 99%) among included studies.

Conclusion
The LCR seems to be more cost effective compared to RCR in terms of operative cost as well as total cost (operative plus in-patient stay). However, due to statistically significant heterogeneity among included studies and paucity of the randomised trials, these findings should be taken cautiously.
SP4.3 Improving management of post operative hypocalcaemia in Total Thyroidectomy and Parathyroidectomy surgery
Authors: James Rhodri , Scott-Coombes David , Stechman Michael , Patel Neil 
Published: August 2023

Abstract

Aim
Post-operative hypocalcaemia is a serious complication of thyroid and parathyroid surgery if not recognised and treated immediately. With sub specialisation and day case surgery, on call may be unfamiliar with immediate management. This can lead to non standardised and inefficient management of patients. The aim was to develop a patient information card which outlined the symptoms of hypocalcaemia and initial evidenced based management for the managing health care professional.

Method
For this quality improvement work a questionnaire was produced and provided to service users following Total Thyroidectomy and Parathyroidectomy surgery at a regional endocrine surgery unit. Data was collected post surgery before and after the intervention was introduced.

Results
A positive response to the introduction of a card with a QR code leading to management guidelines which is an evidence-based guide for professionals assessing patients with hypocalcaemia. Furthermore, patient confidence identifying symptoms of hypocalcaemia improved.

Conclusion
The introduction of a post-operative hypocalcaemia business sized card has standardised post operative triage and management of symptoms in a regional endocrine surgery service.
SP5.10 Is there a difference in Survival Outcomes of Dual Kidney Transplants (DKTs) of Allografts Procured from DCD versus DBD Donors in absence of a Dedicated National Pathology Service? A Propensity Score Analysis of UK Transplant Registry. An Epidemiology in Transplant Study Group (ETrSG) Initiative
Authors: Khawaja Abdullah , Khawaja Ibrahim , Saedon Mahmud , Mehra Sanjay , Sharma Abhishek , Sharma Hemant 
Published: August 2023

Abstract

Background
Dual kidney transplants (DKTs) are generally from supra-marginal or small-for-size kidneys that are implanted to provide optimum total nephron-mass. Glomerulosclerosis Pathology Scoring is used globally to guide whether single or DKT are indicated for transplant. Additionally, there are reported concerns regarding donation after cardiac death (DCD) transplant outcomes’ inferiority to donation after brain death (DBD) transplants but there are no reported survival outcomes of DKT procured from DCD v/s DBD donors.

Aim
This study aims to research if there is a difference in survival outcomes of DKTs of allografts procured from DCD versus DBD Donors in the UK.

Methods
In this exploratory analysis, adults who underwent DKT in the UK between Jan 1, 2000, and December 31, 2019, were identified in the NHSBT-Transplant registry data. Post-transplantation graft survival at 1& 3 years was assessed with cox-regression analysis, with propensity scores being used to control for selection bias.

Results
51,961 renal transplants were reported to NHSBT during the study period, of whom 525 were DKT. After confounders were controlled for with propensity scores, no significant differences in survival outcomes were found between DCD and DBD transplants. Region of Transplant (OR 1.6, 1.0-2.5; p=0.02), transplant post-Year-2011 (OR 3.0, 1.7-5.2; p&lt;0.00), and non-diabetic donors (OR 2.1, 1.1-3.9, p=0.009) were associated with better graft survival, while DBD transplants were associated with low delayed graft function rates (OR 0.4, 0.27 - 0.59; p&lt;.001).

Conclusions
Survival outcomes of DKT procured from DCD versus DBD donors are equivalent. These results are admirable as the UK does not have a dedicated National-Pathology-Service to report pre-transplant renal biopsies.
SP11.4 Surgical images and Social Media - patient centred or just a search for “likes”?
Authors: Digne-Malcolm Holly , Reid Rebecca , Butler Rebecca , Wilson Jeremy , Magee Conor ,   Wirral Academic Surgical Group
Published: August 2023

Abstract

Aims
Social media platforms, such as Twitter, are an expanding space for education/interprofessional discussion. Guidance regarding doctors’ use of social media is available but much is left open to interpretation, unlike the stringent guidelines used for traditional media. Public social media postings are unpoliced and can go viral - with sometimes devastating fallout. We aimed to ascertain whether professional standards are adhered to when patient images are shared through Twitter.

Methods
Prospective review of Twitter posts with patient images. Outcomes: is there a statement of patient consent? Has confidentiality been maintained? Does the Tweet purpose justify the images included? Are professional standards maintained?

Results
61 images were identified for review from 18/12/20 to 04/01/23. Most tweets were posted by consultant surgeons (74%). Only one image had a statement of patient consent despite 46% being deemed identifiable or potentially identifiable. Location was shared for 31% of the cases and the external patient was visible in 48% of Tweets. 15% were felt to contain unprofessional content. 53% images had educational value; 31% promoted the owner of the Tweet or their colleagues; 18% were identified as posted for general interest. Only half of the Tweets were felt to justify the use of patient images.

Conclusions
Patient images are being shared through Twitter without being kept to the same rigorous standards as through traditional media. This risks breaching patient confidentiality and undermining professional standards on which patient trust depends. There is a pressing need for robust guidelines to protect both patients and healthcare professionals.
WTP1.11 The impact of the Covid-19 pandemic on discharge practices following vascular surgery
Authors: Moody Nick , Looi Wan Wen , Rushd Ahsan , Hussey Keith 
Published: August 2023

Abstract

Introduction
Standard operating procedures and patient pathways in healthcare have been greatly influenced by the Covid-19 pandemic. The aim of this study is to understand the impact of changes in discharge practices by comparing hospital length of stay and rates of failed discharge in selected common vascular procedures in the pre-Covid-19 and post-Covid-19 periods.

Methods
A single consultant surgeon’s logbook at a major vascular hub was used to identify all patients who underwent common vascular procedures in the pre-Covid-19 period (January to December 2017), and post-Covid-19 period (January 2021 to August 2022). Basic demographic data was recorded, as well as post-operative length of stay (LOS), failed discharge rates (re-admission within 24-hours) and re-admission within 30-days of the index procedure.

Results
65 cases were identified in the pre-Covid-19 period. 71 cases identified in the Post-covid-19 period. For each of the surgical procedures, patient demographics were comparable. There has been a reduction in the median post- operative LOS for each of the surgical procedures. Common femoral endarterectomy from 3-days to 2-days, femoral-popliteal bypass from 10-days to 5-days, major limb amputation from 29-days to 18-days, endovascular aneurysm repair from 4-days to 2-days and fenestrated endovascular aneurysm repair from 4-days to 2- days. There were no recorded failed discharges. There was no increase in re-admission at 30-days.

Conclusion
We have demonstrated a reduction in the median duration of hospital stay in the post-Covid-19 period, without an increase in any readmissions. Early mobilisation and a prompt discharge policy is thought to be relevant.
WTP1.12 Axillary Artery Aneurysm in a Patient of Achondroplasia
Authors: Jamal Zakir , Rauf Sidra , Sharafat Sana , Sajid Hannan , Rehab Ayesha , Sakhizada Fahim 
Published: August 2023

Abstract

Background
Axillary artery aneurysms are extremely rare mainly occurring as pseudo-aneurysms. They are most commonly caused by trauma however; fungal infections, atherosclerosis, connective tissue diseases, vasculitis and thoracic outlet syndrome are also among the etiological factors.

Case Summary
Seventeen years old, unmarried, achondroplasic (three feet height) girl presented to OPD with pulsatile swelling and pian in right axilla for six months. Pain was accompanied by weakness and numbness of hand. The swelling was initially small in size which increased over time. Patient had history of left axillary artery aneurysm back in 2015 for which left axillary repair was done. There was no history of axillary trauma.
On physical examination an approximately 4×2 cm lump was palpable in right axilla. It was round in shape, mobile, pulsatile and non-expanding with no overlying skin changes. The patient had hypotonia with power of 3/5 in all limbs. Deep tendon reflexes were reduced. Rest of systemic examination was unremarkable.
CT angiography was done which showed brachiocephalic trunck and right proximal subclavian artery normal. There was a lobulated enhancing area along the course of the Right axillary artery measuring 3.5×4.7×3.0 cm. The axillary artery aneurysm was excised and arterial continuity was restored by placement of Reverse Saphenous vein graft.

Discussion
The conventional method of axillary artery aneurysm repair is aneurysmectomy followed by placement of bypass graft. Owing to long term patency, saphenous vein graft serves as an ideal for reconstruction.

Conclusion
axillary artery aneurysms should be considered as a differential for pulsatile axillary swellings and should be promptly treated to avoid life threatening complications.