bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP11.16 Development and Validation of a Novel Simulation-Based Assessment of Operative Skill for Higher Specialist Trainees in General Surgery
Authors: Toale Conor , Morris Marie , Roche Adam , Voborsky Miroslav , Traynor Oscar J , Kavanagh Dara O 
Published: August 2023

Abstract

Introduction
Simulation is an established training modality, though its use in high-stakes assessment is under-explored. This study sought to develop and validate a novel assessment of operative competence for higher specialist trainees in general surgery.

Methods
Content validity was derived from a previously conducted Delphi consensus study of trainers. Eight stations were created using a combination of virtual reality and bio-hybrid models. The assessment was designed to assess performance at the end of ‘phase 2’ of training. Performance was scored using an equally weighted Objective Structured Assessment of Technical Skills (OSATS) tool and a modified Procedure Based Assessment (PBA) tool. Validity evidence was analysed in accordance with Messick's validity framework. Both ‘junior’ (ST2 - ST4) and ‘senior’ trainees (ST 5 - ST8) were included to allow for comparative analysis.

Results
Thirteen trainees (six ‘junior’ trainees and seven ‘senior’ trainees) were observed and scored by a total of ten assessors across eight stations. Inter-station reliability was high (Cronbach's alpha 0.81). Inter-rater reliability was acceptable (inter-class correlation coefficient 0.77). A significant difference in mean station score was observed between junior and senior trainees (44.82 vs 58.18, p = .004). Mean scores were moderately correlated with increasing training year (rs = .74, p = .004, Kendall’s tau-b .57, p = 0.009). A pass-fail score generated using borderline regression methodology resulted in all ‘senior’ trainees passing and 4/6 (66.66%) of junior trainees failing the assessment.

Conclusion
This study demonstrates the validity, reliability and feasibility of a novel simulation-based assessment, designed to assess the operative competence of higher specialist trainees in general surgery.
SP11.17 The predictive paradigm: examining the validity of a national selection process in surgical training
Authors: Toale Conor , Morris Marie , O'Keeffe Dara , Doherty Eva M , Traynor Oscar J , Kavanagh Dara O 
Published: August 2023

Abstract

Introduction
Selection processes should conform to a ‘predictive paradigm’, identifying candidates who will become competent professionals. This study investigates the ability of a centralised, multi-modal national selection process to predict the future performance of surgical trainees.

Methods
A retrospective analysis of prospectively collected data from successful applicants to the Royal College of Surgeons in Ireland (RCSI) Core Surgical Training (CST) programme from 2016-2020 was conducted. Performance in subsequent assessments, attrition rates, and rates of progression to Higher Specialist Training (HST) were recorded. Selection decisions were based on a total score, composed of technical aptitude assessments, undergraduate academic performance, and a four-station multi-interview. CST performance was assessed using workplace-based and simulation-based assessments. Associations between selection and assessment measures were explored using Pearson correlation, binary logistic regression, and multiple linear regression analyses.

Results
Data was available for 303 trainees. Composite scores were positively associated with likelihood of progressing to HST (Exp(B) 1.09, 95% CI 1.05 – 1.13, p&lt;0.001), and were significantly associated with performance across all CST assessments (r .23 - .34, P&lt;0.001). On multivariate analysis, technical aptitude scores were the strongest predictor of future operative performance, both in the workplace (B 0.31, 95% CI .14 - .48, p&lt;0.001) and simulated environments (B .57, 95% CI .33 - .81, p&lt;0.001). The ‘interpersonal skills’ interview station was the strongest predictor of performance in simulated non-technical skill assessments (B .55, 95% CI .22 - .87, p&lt;0.001).

Conclusion
Performance at the time of national selection, measured across technical and non-technical domains in a multi-modal fashion, is associated with future performance in the workplace and in simulation-based assessments.
WTP1.2 Quality of Life concerns in patients undergoing operations for diabetic foot disease during the COVID-19 pandemic
Authors: Ali Lara , Restrepo Laura Lopez , Bates Kersten Morgan , Metcalfe Matthew 
Published: August 2023

Abstract

Aim
To evaluate QOL of diabetic patients following diabetic foot surgeries during the Covid-19 pandemic.

Method
Single Centre retrospective data collected from hospital systems between 01/01/2021- 31/12/2021.
30 patients requiring surgery for diabetic foot disease identified and were called for QOL questionnaire, 23 participated.

Results
56% (13/23) patients were &lt;70 years. 52% (12/23) underwent major limb amputations.
Pre-operatively, 54% (7/13) of the &lt;70 years and 40% (4/10) &gt;70 years had mainly physical concerns and 46% (6/13) &lt;70 years and 60% (6/10) of &gt;70 years emotional concerns.
Post-operative concerns were divided into 7 groups. The commonest were the “ability to mobilise and loss of independence” 65% (15/23), “wound healing duration & worries about tissue healing” 48% (11/23) and “further hospitalisation or re-intervention” 43% (10/23). These were similar when divided by age groups. Additionally, feeling abandoned post discharge was frequently described.

Conclusion
QOL concerns in our diabetic population following foot operations highlighted important issues that need to be addressed. The majority voiced concerns regarding their loss of independence/mobility, fear of the wound site not healing and worry regarding the need for further re-intervention. This further highlights the need of patient education and support and enhancing service provision pre- and post –op.
WTP1.6 Unmask Latent Lymphoedema through bipedal Lymphoscintigraphy
Authors: Sivakanthan Mathumie , Odiase Ruth , Gambhir Raghvinder Pal Singh 
Published: August 2023

Abstract

Aim
Lymphoscintigraphy (LSG) is the gold standard investigation in Lymphoedema. The study aimed to determine the presence of Latent Lymphoedema (LL) in the unaffected limb when a patient presents with unilateral lymphoedema.

Methods
All new and follow up patients seen in the Lymphoedema clinic between the January and May 2023 by either a vascular consultant or a lymphoedema nurse were included in the study. Their electronic patient records were retrospectively reviewed. Clinical presentation and findings were compiled from clinic letters and if the signs and symptoms were suggestive of lymphoedema they were then offered an LSG scan. Protocol involved determining the uptake of nano colloid tracer at the ilio-inguinal lymph nodes 2 hours post subcutaneous injection in the 1st web space of each foot. Quantitative uptake of &lt; 8% at 2 hours was considered abnormal.

Results
114 patients with a median age of 63.2 (Range 24-83) were seen in the Lymphoedema clinic. Of those, 62 patients had LSG scans. About 37% (n = 23) patients presented with unilateral swelling of lower limb. On LSG scan they had average uptake of 1.6 1.6% in the clinically affected limb. However 57% (n = 13) of these patients had an average of 2.7 2 % uptake in the unaffected Ilio-inguinal lymph nodes, unmasking latent Lymphoedema on that side.

Conclusion
Presence of lymphatic dysfunction on the unaffected limb should be considered as unmasking of LL. This will allow initiation of preventative measures to prevent development of gross disease in future.
WTP1.7 Long-term Outcomes After Repair of Paediatric Traumatic Lower Limb Arterial Injury: Systematic Review
Authors: Giorga Andrea , Hughes Michael , Cai Paris , Stansfield Tim 
Published: August 2023

Abstract

Aims
Paediatric vascular injuries account for 1% of paediatric major trauma cases with 30% of arterial injuries located in the lower limb. Current management of paediatric lower limb arterial injuries have been extrapolated from adult injuries. The aim was to review studies specific to paediatric population due to the anatomical and physiological differences, particularly limb length discrepancy (LLD) following injury.

Methods
A literature review was conducted. Study PICOS - Population: Patients &lt;18 years old with traumatic lower limb arterial injury. Intervention: Surgical, endovascular or no intervention. Comparison: Primary repair or Conduit repair using autologous vein or synthetic material or endovascular repair. Outcomes: Rate of success of revascularisation, amputation, graft infection, long term limb function, LLD, mortality.

Results
7 studies were included for data extraction, resulting in 15 male patients, aged 4-14. The popliteal artery was most commonly injured (60%), followed by the femoral (40%). The most common repair was with reversed Great Saphenous Vein graft (GSV)(13/15) for which good long-term outcomes were reported (85% success rate). One endovascular repair was identified which was successful and one with synthetic material which resulted in a minor complication.

Conclusions
There is a preference for the use of autologous vein grafts in paediatric lower limb arterial repair with good outcomes. Endovascular procedures are becoming more common whereas synthetic grafts are not favoured due to their inability to lengthen as vessels grow. Further research is required to evaluate the long-term outcomes as the current reported cases are scarce.
WTP1.8 The diagnostic test accuracy of remote or virtual follow up for detecting wound infection in surgical wounds
Authors: Lathan Ross , Sidapra Misha , Yiasemidou Marina , Totty Joshua , Smith George , Chetter Ian 
Published: August 2023

Abstract

Background
The Sars-CoV-2 pandemic catalysed integration of digital health models worldwide. This review appraises literature investigating digital methods of identifying SSI post discharge, and summarises effectiveness using diagnostic test accuracy measures.

Methods
Databases were searched for telemedicine and wound infection studies. Titles and abstracts, followed by full texts, were screened by two independent authors and mediated by a third. QUADAS-2 was used to assess methodological quality. The primary outcome was summary sensitivity and specificity.

Results
Of 1400 studies identified by searching, 17 studies were included in meta-analysis. There were 11,437 observations available with a weighted mean age of participants of 47.1 years. Risk of bias was present in all included studies, and there were high applicability concerns in nine studies. The mean sensitivity of all methods of telemedical follow up for detecting SSI was 88% (95% CI 68%-96%) and the mean specificity 97% (95% CI 94%-98%). The overall rate of SSI was 5.6% across studies.

Conclusion
Telemedicine is highly specific for SSI diagnosis, with potential as a screening tool post discharge. However, participants were young, and may under-represent the surgical population. Work is required to maximise engagement with telemedicine in the elderly and digitally naive before widespread adoption can occur.
WTP1.10 Infra-malleolar bypass in patients with chronic limb threatening ischaemia
Authors: Moody Nick , Chong Rosemund , Potdar Tejal , Hussey Keith 
Published: August 2023

Abstract

Introduction
There is clinical equipoise surrounding the optimal strategy for revascularisation of infra-popliteal arterial disease. The BASIL-2 trial is attempting to address this. The trial has been designed to try and define whether a ‘vein bypass first’ or ‘best endovascular first’ strategy is superior. We have sought to explore the outcomes associated with ultra-distal bypass in a single Scottish Health Board.

Methods
This was a retrospective review of a single surgeon’s ultra-distal bypass practice over a 7 year period. Index cases were identified from a prospectively maintained logbook. Outcomes included were primary graft patency and amputation free survival.

Results
There were 22 procedures performed over the 7-year period of interest. Mean age of 66 years. 15/22 (68%) were diabetic. The dorsalis pedis was the most common arterial target (n=14). The primary graft patency at 3-years was 54%. During the follow-up period 50% of the patients had a major limb amputation. There was 1 death in the post-operative period prior to discharge.

Discussion
Primary patency and limb salvage at 3-years are acceptable, although they are less than that described in the contemporary literature. It is likely that this may a consequence of selection bias given the local prejudice for an endovascular ‘first strategy’.
WTP1.13 The A-HeAD Study: Effects of socio-economic deprivation on modifiable preoperative health behaviours and outcomes after aortic aneurysms repair. A retrospective review
Authors: McCone Emma , Prentis James , Sandip Nandhra , Sillito Sarah , Nesbitt Craig 
Published: August 2023

Abstract

Aims
Social Deprivation is associated with health inequalities and poor clinical outcomes. As yet outcomes for aneurysm surgery are not well understood. This study aims to explore the association of Abdominal Aortic Aneurysm (AAA) surgery and socio-economic status on postoperative complications and outcome.

Methods
All elective AAA repair (open and endovascular) performed between January 2015 and January 2020 at a tertiary vascular centre were analysed. Deprivation (index of multiple deprivation (IMD)) data was sourced from the English indices of deprivation 2019, by postcode. Primary outcome was overall survival by Kaplan-Meier. Secondary outcomes included comparison of pre-operative fitness assessments, and comorbidity. Clinical outcomes included length of hospital stay (LOS) and complications. Cox-proportional hazard analyses were conducted.

Results
Patients (n=472) were divided into two groups (IMD 1-3 (n=171) and IMD 4-10 (n=301)). Gender ratios were comparable, with similar AAA size, other co-morbidities and CPET assessment results. IMD 1-3 participants were younger (72.4(8.1) vs 74.6 (7.8), p=0.011), had higher smoking rates (61.4% vs 19.6%, P=0.03) and more frequent history of stroke (18.1% vs 11.3%, P=0.036).
There was no difference in survival based upon IMD but patients from IMD 1-3 spent longer in level 2/3 care (2(2-3) vs 1(1-2), P=0.022) and experienced more re-admissions (14% vs. 6%. P=0.003). In addition, cox-regression indicated that patients without COPD were twice as likely to survive (HR 0.54 (0.31-0.94 P=0.03).

Conclusion
IMD was not associated with poor outcome. Smoking was more prevalent in lower IMD groups. As COPD was associated with increased likelihood of death, pre-operative optimisation can be targeted towards higher risk groups.
WTP1.14 A Regional Audit of Carotid Endarterectomy Symptom to Surgery Target Times within the North-East of England
Authors: Sillito Sarah , Stansby Gerry , Dunlop Paul , Wong Peng 
Published: August 2023

Abstract

Aim
The National Institute of Health and Care Excellence (NICE) recommend a target time for symptomatic carotid stenosis symptom onset to surgery of 14-days so to minimise the chance of high-risk patients developing a major stroke. A regional audit of Vascular Units within the North-East of England to meet this target was undertaken to review performance and identify causes for delays.

Methods
The performance of three North-East based Vascular Units for the period of October 2021-March 2022 has been assessed retrospectively using Carotid Endarterectomy data from the National Vascular Registry (NVR). Data was collated and reviewed as per the distinct time phases in the CEA treatment pathway outlined in the NVR Annual Reports.

Results
66 CEAs were performed, with the region achieving 45.45% within the 14-day target (median time from symptom onset to surgery 16 days; IQR 4-102). Patients referred to Vascular Surgery in &lt;7 days of symptom onset was achieved in 69.70% of patients (median 4 days; IQR 0-56); patients receiving surgery within &lt;7 days of the referral to Vascular Surgery was achieved in 25.76% of patients (median 11.5 days; IQR 0-82).

Conclusion
The North-East region is struggling to meet the 14-day symptom to CEA target. Understandably, there is variation in CEA pathway workings across the Units but improvements can be made regionally. A delay between patients being referred to Vascular Surgery and then receiving surgery accounts for the biggest delay. A questionnaire identifying possible barriers to meeting the 14-day target has been distributed amongst the region’s Vascular Consultants and Registrars with a view to improvements being made.
WTP2.5 Improving the Recording of Thoracic Surgeries on Dendrite Database – Departmental Quality Improvement Project
Authors: Lakshmipathy Gokul R , Hall Sheila , Shatila Mohamed , Fallouh Hazem , Kalkat Maninder 
Published: August 2023

Abstract

Objectives
Well-maintained database of thoracic operations is critical for quality improvement, service provision and driving research forwards. We examined adequacy of operative recording on clinical database.

Methods
Thoracic operations were uploaded onto Dendrite database. Operative entries on Dendrite were compared with surgeries performed from October 2021 to June 2022. Missing operative records were identified. Incomplete entries were categorised into missing procedure names, procedure dates and operation notes. Personal reminders, published league table of best performers in weekly departmental meetings were introduced in February 2022 to encourage surgeons to record data accurately.

Results
599 thoracic surgeries were performed in the nine-month period. 20% of operations were not recorded on Dendrite. 5% of records lacked, procedure names, 2% lacked operation notes and 0.2% lacked procedure date. Table below demonstrates monthly data before and after improvement measures. Missed and incomplete entries were significantly lower in the post-intervention period (42) compared to pre-intervention (104) (p=0.002).

Conclusion
Maintaining complete and accurate database is paramount in most services. However, the level of compliance can be variable. This study demonstrates that motivational approach to completing database can increase engagement and compliance. Furthermore, we plan to introduce virtual dendrite training programme and re-evaluate effect on data recording.
WTP2.6 Early experience and short-term outcomes of Robotic Assisted adrenalectomy in a high volume tertiary referral centre
Authors: Maharajh Sandeep , Ashoush Fouad , Ramsingh Jason 
Published: August 2023

Abstract

Aim
Robotic assisted surgery has become the standard of care in most surgical specialties, however, in the UK, endocrine surgery has not fully adopted robotics. This paper presents the experience in seventeen (17) patients who had robotic assisted adrenalectomies performed at a tertiary referral endocrine surgery department in the northeast of England. Outcomes were compared to national and international performance standards.

Methods
Seventeen elective cases were performed at tertiary hospital over a 5-month period. Patient demographics including age, comorbidities, operative indications and technical details such as docking time, time on operative console, rates of conversion to open procedure, complications, length of stay and tumour size were analysed.

Results
Over a 5-month period, 17 robotic assisted adrenalectomies were performed. Seventy-one percent (71%) (n=12) of the patients were female with median age of 60 years. Median BMI was 28. Functional tumours accounted for 82%(n=14) of patients with the most common being pheochromocytomas and cortisol producing adenomas (n=6 respectively). Median docking time was 7 minutes with a median intra-operative time on the console of 48 minutes. Resected tumour size ranged between 1cm to 14cm. There were no conversions, complications or mortalities. Median length of stay postoperatively was 1 day.

Conclusion
This cases series demonstrates robotic assisted adrenalectomies to be a safe and feasible approach with similar outcomes to laparoscopic surgery. Adoption of robotic assisted surgery will improve outcomes for patients, however large clinical trials and longer follow up are needed.
WTP2.7 Short and Long term Kidney Transplantation outcomes in Severely Obese Recipients. A UK NHSBT Transplant Registry Big Data Analysis over the last 20 years. An Epidemiology in Transplant Study Group (ETrSG) Initiative
Authors: Ng Oon-Hui , Devkaran Bhavesh , Kapoor Kunal , Sharma Abhishek , Mehra Sanjay , Sharma Hemant 
Published: August 2023

Abstract

Purpose
Outcomes of renal-transplant-recipients with Class 3 obesity (severely obese) is extremely limited. An outcome-analysis of severely- obese transplant recipients reported to UK-NHSBT-Transplant-Registry was performed.

Methods
We harmonized the NHSBT-UK-Data to shortlist the renal-transplants performed on Class 3-obese recipients in the UK from 2000-2019. The demographics-report and survival-analysis at 1,3 and 5 years post-transplant were data-mined. Cox-Regression was done to identify predictors of survival.

Results
N=163 recipients with Class-3 obesity underwent renal-transplant since year 2000 (N=60 DBD, N= 48 DCD & N=55 Living Donor Kidney). The median-recipient-age was 47 years - DBD, 51 years DCD, and 43 years LRD transplants. The odds of females getting renal-transplants were OR 2.44(1.14- 5.19) p=0.01. Median-eGFR at 3 months was 40, 38, and 46.5 mL/min/1.73m2 for DBD, DCD, and LRD recipients, Median-eGFR at 12 months was 42, 46.5, and 51.5 mL/min/1.73m2 for DBD, DCD, and LRD recipients, respectively. The median-KDRI of transplanted kidneys was 1-07 and 1,08 for DBD & DCD kidneys, respectively. The commonest cause of graft-failure was acute-rejection within the first 12-months of transplant. The technical failure-rate was 1.8%. DCD-Grafts were more likely to suffer rejection (OR 2.25(1.13-3.89) p=0.002. The Graft-survival for DBD-kidneys was 97%, 92% and 89% at 1,3 & 5 years, The Graft-survival for DCD-kidneys was 89%, 86%, and 76% at 1,3 & 5 years, Graft-survival for LRD-kidneys was 98%, 95% and 86% at 1,3 & 5 years. (Log-Rank- 0.48).

Conclusions
Renal-Transplantation for severely-obese patients can be safely done with acceptable survival outcomes. Living donor kidneys have better results, but there is no statistical difference in graft-outcomes from DCD versus DBD-Kidneys.