bluuebunny/crossref_metadata_2025_split huggingface dataset:
eP88 The Cost Burden of Diverticular Disease in the UK: A Retrospective Analysis at a Tertiary Referral Centre
Authors: Mehmi Krisha , Williams Sophie , Haji Amyn 
Published: January 2025

Abstract

Aims
Diverticular disease (DD) is highly prevalent. Management largely targets complications with surgical intervention frequently used in recurrent, complicated disease. DD poses a significant burden on healthcare systems, warranting thorough cost-analysis for informed resource allocation and policy decisions. Current UK data on the cost of DD is lacking. We aim to establish the cost burden of DD at a UK tertiary referral centre.

Methods
Data were collected retrospectively from our centre between 2012 and 2021. Parameters collected included demographics, comorbidities, clinic attendances, clinical interventions and emergency and elective surgical procedures. Cost burden was quantified using Healthcare Resource Groups cost codes for each intervention, adjusted for variables including comorbidities and length of stay (LoS).

Results
470 patients were analysed. There was a mean of 8 clinic appointments per patient, with 523 total hospital admissions. Hospital bed stays totalled £600,000. Emergency surgical procedures cost approximately £225,000 (8% of total DD cost). The most frequent elective surgical procedure was sigmoid colectomy or Hartmann's procedure, costing approximately £932,000 (32% of total DD cost). The total cost burden of DD in this period exceeded £2.9 million.

Conclusions
This study revealed the substantial financial burden associated with DD. Emergency and elective surgical procedures, though utilised in only a quarter of patients, represented much of the cost. Areas for potential cost savings include reducing the repeat utilisation of CT imaging and a focus on preventative measures. Future research should be aimed at ascertaining the nationwide cost of DD and establishing cost-effective measuresfor more sustainable DD management.
eP92 Impact of a ‘Peri-operative Care of Older People undergoing Surgery (POPS)’ service on length of hospital stay in older patients undergoing emergency laparotomy
Authors: Beach Timothy , Tennant Anna , Hollyman Marianne 
Published: January 2025

Abstract

Aims
Older and frailer patients undergoing emergency laparotomy face increased morbidity, mortality, and length of hospital stay (LOS). Multidisciplinary teams, such as POPS (Peri-operative Care of Older People undergoing Surgery), aim to address these issues. We assessed the impact of our POPS team on LOS in older patients undergoing emergency laparotomy.

Methods
We conducted a retrospective analysis comparing LOS in patients aged 65 and above from the NELA database who met NELA criteria for geriatric review before (2014–2017) and after (2019–2020) the introduction of the POPS service at our hospital.

Results
In patients aged 65 and over undergoing emergency laparotomy between 2019 and 2022 (n=396), clinical frailty score significantly increased with age (P &lt; 0.001), and higher frailty scores were associated with increased LOS (P = 0.047). NELA criteria mandate perioperative geriatric review for all patients aged 80 and above, regardless of frailty. Given the lack of frailty data before 2019, we compared LOS in patients aged 80 and over before (n=137) and after (n=111) the introduction of the POPS service. Eighty-eight percent of patients aged 80 and over were reviewed by the POPS team between 2019 and 2022, and LOS decreased from 19 to 16 days (P = 0.17), equating to over 300 ‘bed days’ saved.

Conclusion
The introduction of the POPS team has reduced LOS for older emergency laparotomy patients. Future assessment of additional measures, including discharge destination or time to mobilisation, may further demonstrate the team's positive impact on patient care.
eP96 Negative Pressure Wound Therapy and Surgical Site Infection in Emergency Laparotomies - A Single Centre Experience
Authors: Pringle Heather , Whitcroft Alex , Sinha Surajit 
Published: January 2025

Abstract

Introduction and Aims
The impact of surgical site infection (SSI) can include increased length of stay, quality of life, cost and pain for the patient. Some patients have a greater risk of wound breakdown including those who are elderly. The aim of this study was to observe the use of negative pressure wound therapy (NPWT) in our hospital in relation to SSI and to determine whether there is a group of high risk patients who may benefit more from NPWT.

Methods
Retrospective data collection using the NELA database followed by interrogation of medical records to establish incidence of SSI and choice of dressing following emergency laparotomy for the year 1st June 2022-31st May 2023.

Results
141 patients were included in this study. The mean age was 66.7 years with a mean frailty score of 3. There were 66 males and 75 females. The mean NELA score was 7.5%. The mean length of stay was 16.3 days (ranging from 3 to 65 days). NPWT was only used on 4 occasions during the data collection period and there were 4 recorded SSIs (2.8%) none of which used NPWT.

Conclusions
The finding of 2.8% SSI is higher than the literature which states 1.9% although the numbers are small. The use of NPWT is surgeon dependent rather than related to intraoperative findings and no significant difference in SSI. Huge numbers would be required to demonstrate a difference in SSI between NPWT and standard dressing and could be performed in a large multicentre trial.
eP97 Management of acute diverticulitis in the modern EGS setting
Authors: Singh Urvashi , Peckham-Cooper Adam , Ng Oliver 
Published: January 2025

Abstract

Introduction
This retrospective audit assesses diverticulitis management in a modern tertiary EGS unit against 2023 GIRFT guidelines. Differences in the management of patients presenting with diverticulitis in a surgical assessment unit (SAU) and an ambulatory/hot surgical clinic (ASC) environment were assessed.

Method
All patients with CT proven diverticulitis presenting on SAU between February-April 2024 were included. Data from ASC was prospectively collected as a direct comparison over June 2024 only and was included based either on CT confirmation or a clinical diagnosis of diverticulitis.

Results
58 patients presented to SAU with CT-proven diverticulitis. 62% had uncomplicated diverticulitis, 31% had complicated diverticulitis with abscess or contained collection &lt;3cm, 7% had complicated diverticulitis with collection &gt;3cm or free perforation. 70% uncomplicated diverticulitis patients received intravenous antibiotics, 50% had outpatient endoscopy follow-up and 25% were prescribed further antibiotics on discharge. High CRP, longer hospital stays, and surgical management was correlated with complicated diverticulitis – with 100% receiving IV antibiotics on admission but only 18% having follow-up endoscopy arranged.
6 patients presented to ASC with acute uncomplicated diverticulitis. 50% had a CT proven diagnosis, and 50% patients were diagnosed clinically. 85% of patients were conservatively managed without antibiotics, with only 1 of 6 patients receiving home antibiotics and OP colonoscopy.

Conclusion
In SAU, uncomplicated diverticulitis was overtreated with antibiotics and OP colonoscopy contrary to GIRFT guidance. Ambulatory management adhered to guidelines better with majority being managed conservatively. Complicated diverticulitis was treated with IV antibiotics and IR drainage/surgery in line with GIRFT guidance.
eP99 Abdominal Wall Abscess: An Exceedingly Rare Case of Cholecysto-cutaneous Fistula
Authors: Maharajh Sandeep , Jacob Roshan , Iqbal Affan , Lambert Joel , Jegatheeswaran Santhalingam 
Published: January 2025

Abstract

Aims
Cholocysto-cutaneous fistulae are exceedingly rare in modern surgical practice. Their aetiologies range from cholecystitis to carcinoma. Such patients require emergent resuscitation, sepsis management and diagnosis of underlying cause. We present a case of a cholecysto-cutaneous fistula in a patient with known gallstones, emergency management, radiological investigations and further definitive care.

Methods
A 70-year-old male presented to the emergency department with a 3-week history of an enlarging mass of the abdominal wall in the right hypochondrium. This was associated with 6 weeks of intermittent abdominal pain and fever. Serology showed an elevated C-reactive protein of 275 mg/L and white-cell count of 16 X 10*9/L. Emergency CT revealed a 20 cm subcutaneous collection and pneumobilia with poorly visualized gallbladder.

Results
Clinical photographs and radiological investigations are presented. The patient was resuscitated. Initial percutaneous drainage was unsuccessful due to high viscosity. For source control of infection, incision and drainage under local anaesthetic followed, with drainage of 2.2 litres of pus and bile. Interim MRCP confirmed tethering of contracted gallbladder to anterior abdominal wall. Antibiotics were continued for 10 days and patient was discharged well with definitive plan for open cholecystectomy and fistulectomy.

Conclusion
This unique case presents a rare cause of a relatively common presentation to the emergency department; cutaneous abscess. Surgical trainees commonly manage abscesses but can utilize this case as a learning point for differentials and management of an anterior abdominal wall mass. Such patients require comprehensive investigation, differentiation between benign and malignant aetiology and definitive treatment once well.
eP102 Review of delays during emergency operating (CEPOD) theatre
Authors: Moore Alexander 
Published: January 2025

Abstract

Introduction
The running of an emergency operating theatre can lead to unnecessary delays and a source of misused resources. We observe there are multiple negative outcomes from this, which affect patients, healthcare workers and society. We try to quantify this via time lost between operating.

Methods
We observed the functioning of the emergency theatre and followed patients from ward to post-op recovery during a 10-day period during the hours 08:00-20:00, finishing at this time or whenever all patients were operated on. The process was divided into steps, noting the time elapsed between these. Events affecting this time were observed. Finally, this data was compared to useful theatre time (spent in theatre/anaesthetic room).

Results
In 10 days, 1802 minutes passed between cases, corresponding to £36,040, compared to 4449 minutes of useful theatre time. Of the time between cases, 30% was spent waiting for the patient to leave the ward. This corresponds to an average of 14.08 minutes per case, although this varies from 23.75 to 7.5 minutes per case.

Conclusion
Factors such as good communication, individual motivation and having a dedicated waiting area for patients to stay prior to surgery gave better results. When patients were taken to recovery before theatre, absolute numbers of time lost per case was lower. However, when this happened, multiple cases were briefed together, having a knock-on effect on time lost elsewhere – this did not greatly change the proportion of time lost in each step of the theatre process, but did reduce the absolute numbers.
eP116 The Carbon Footprint of Energy Use in Emergency Operating Theatres: A Prospective Observational Study
Authors: Richardson Philippa , Bashaireh Leila , Eng Abigail , Khan Umar , Spence Cathy , Chan Anthony 
Published: January 2025

Abstract

Introduction
The NHS is responsible for 4% of the UK’s total carbon footprint. Typically, surgical operating theatres consume 3-6 times the energy when compared to a hospital ward. Considerations for emergency theatres include a rapid response time for critically unwell patients who require surgery. The aim of this study is to quantify areas of energy consumption within an emergency operating theatre over a 24-hour period to develop a framework to measure environmental impact.

Methods
A prospective observation study using a bottom-up approach was designed to quantify the energy usage in an emergency theatre complex in a tertiary hospital in September 2024. An inventory of all electrical devices dependent on mains electricity, their power rating and times of operation (including standby, active, or charging modes) were recorded. Daily energy consumption from heating, ventilation and air conditioning (HVAC) was estimated using previous published data (Chien et al 2022).

Results
The estimated average energy consumption of an emergency theatre over a 24-hour period was 891 kWh. Energy consumption was stratified into 4 domains: the theatre complex (795 kWh; 89.3%), anaesthetic devices (9.2%), surgical equipment (1.4%), and patient devices (1.2%). HVAC systems attributed to 87% of total usage, translating to a carbon footprint of 245 kgCO₂, equivalent to the daily energy use of 33 homes.

Conclusion
The carbon footprint of an emergency theatre exceeds elective theatres due to the ‘always available’ requirements. We identify the theatre complex (mainly the HVAC system) and anaesthetic devices as areas for sustainability quality improvement.
eP117 The Accuracy of Clinical Coding in Electronic Patient Records Systems in Emergency General Surgery
Authors: Yasmin Amina , Yau Christopher , Chan Anthony 
Published: January 2025

Abstract

Introduction
Clinical coding is a process that converts healthcare information into a machine-readable format. Accurate coding is clinically essential as an integral part of the electronic patient record (EPR) as well as underpinning the data used for healthcare research, service planning and revenue. The nature of emergency general surgery (EGS), however, introduces coding challenges due to significant individual variation in clinical presentation and management. This audit evaluates the accuracy of clinical coding in EGS at a large UK acute tertiary centre.

Methods
A retrospective audit was designed to evaluate the accuracy of clinical coding of unselected EGS patients. A ‘gold standard’ coding for past medical (PMH) and surgical history (PSH) was defined for each patient by an experienced surgeon from any information available within the EPR. This standard was compared to the EPR coding, and clerking entries from both Emergency Department (ED) doctors and the admitting surgeon.

Results
Fifty patients admitted in January 2024 were included. On average, EPR coding contained 48% of PMH and PSH elements when compared to the gold standard. Clerking documents from ED doctors and admitting surgeons averaged 49% and 58% respectively. Drug history recorded in the EPR was concordant in 71% of patients compared to ED (47%) and surgical (53%) clerkings.

Conclusion
This audit highlights the need for quality improvement in clinical coding accuracy. The data transformation benefits of EPRs are well established but are dependent on good quality data input. Inaccurate coding can have wide ranging implications inside and outside the direct care setting.
eP122 A Tertiary Center Audit on SDEC Acute Appendicitis Pathway
Authors: Oo Zon Poe , Oladeji Ibrahim , Gull Sadaf 
Published: January 2025

Abstract

Aims
To improve the management of surgical SDEC pathway in patients presenting with clinical suspicion of appendicitis to Surgical Triage Unit STU in Nottingham University Hospital by following SDEC acute appendicitis pathway recommended by GIRFT.

Methods
This retrospective study enrolled 50 patients aged 16 years or older presenting with RIF to STU in June 2024. Data about patient demographics, clinical presentation and findings, investigation results, operative details, and post-operative/ post-discharge management plans were obtained from Electronic medical records of NUH. Acute appendicitis score AAS was calculated. Second cycle was carried out by collecting data from 26 patients in September 2024 after implementing interventions and developing local guidelines.

Results
On the first cycle, 85% of patients presenting with low AAS had imaging scans (CT/US) among which 2 presented with complicated appendicitis. 17 out of 50 (34%) underwent laparoscopic appendicectomy (12 within 24 hours) among which 14 had uncomplicated appendicitis. Antibiotics were only stopped in 53% of uncomplicated appendicitis patients after surgery. Only 34 out of 50 (68%) had recommended open access and safety netting instructions. Second cycle showed 93% of low AAS patients had imaging scans, 8 out of 9 patients underwent urgent surgery within 24 hours, antibiotics were stopped in 42% of uncomplicated appendicitis patients after surgery, and 92% of patients gained open access to STU.

Conclusion
This audit cycle improved post-discharge plans of SDEC pathway and highlighted the importance of imaging in clinically suspected cases in low AAS patients, and the continued need of improvement for antibiotic prescribing.
eP124 Perianal Abscess Rupture and Incidence of Fistula Formation After Surgery - PARIS Study
Authors: Shaikh Amarah Ghani , Saunders Jada , Shah Isran Ali 
Published: January 2025

Abstract

Aim
Perianal abscesses are common anorectal conditions that can lead to significant complications, including perianal fistula formation. This study aims to assess the impact of abscess rupture status on the incidence of fistula formation following incision and drainage (I&D) procedures.

Method
This retrospective cohort study analysed data from 1,835 patients treated for perianal abscesses at a District General Hospital between June 2019 and June 2023. Patients were categorized into two groups: those presenting with spontaneously ruptured abscesses and those with intact abscesses requiring I&D. The primary outcome was the incidence of fistula formation within one-year post-procedure. Chi-square tests and multivariate logistic regression were used to identify predictors of fistula formation.

Results
The incidence of fistula formation was significantly higher in patients with spontaneously ruptured abscesses (54%) compared to those with intact abscesses (28.9%). Younger patients, particularly those under 50 years of age, were more likely to develop fistulas. Additionally, 67% of patients who developed fistulas had the external opening at the site of the original incision, indicating that the location of the incision may influence the type and complexity of the fistula.

Conclusions
Spontaneous rupture of perianal abscesses is associated with a higher risk of fistula formation. Early surgical intervention, careful incision placement, and consistent follow-up are recommended to reduce this risk and improve patient outcomes. The findings of the PARIS study highlight the importance of proactive management strategies in preventing long-term complications in patients with perianal abscesses.
eP125 Who does the Laparoscopic Appendicectomy: Struggles of the Modern-Day Core Surgical Trainees and Junior Clinical Fellows
Authors: Tjhin Yovita , Swe Thin Thin , Smith Jason , Pawa Nikhil 
Published: January 2025

Abstract

Background
In the early 2000s, the shift to laparoscopic surgery led to a significant decrease in appendicectomies performed by Core Surgical Trainees/Junior Clinical Fellows (CST/JCFs). Previously, CST/JCFs conducted 33% of open appendicectomies; however, this dropped to 8.7% by 2002. Alarmingly, by 2006, a district hospital reported that no CST/JCFs had conducted laparoscopic appendicectomies. This trend raises serious concerns regarding the diminishing opportunities for CST/JCFs to acquire essential experience in this critical surgical procedure. The current study assesses the training opportunities for CST/JCFs in minimally invasive surgery.

Methods
Emergency laparoscopic appendicectomy (ELA) in one University Hospital from September 2022 to August 2024 were identified retrospectively. Grade of the operating surgeon was categorized into Consultant, Registrar, or CST/JCF.

Results
Out of 574 identified ELAs, 572 were included after excluding two given missing digital notes. Documentation of the surgeon's level was ambiguous in 41 cases. The analysis revealed Consultants performed 52% (n=298) while CST/JCFs conducted only 11% (n=65). Among 126 paediatric cases, Consultants performed 64% (n=85), while CST/JCFs accounted for 10% (n=13).

Conclusion
The opportunity for CST/JCF to perform appendicectomy has significantly declined, affecting recruitment into higher surgical training programs that now mandate documented appendicectomy experience. Studies have shown no significant morbidity or mortality rates differences between appendicectomy performed by consultant/registrars and CST/JCF. CST/JCF involvement is crucial in fostering their competency in essential surgical skills and further national evaluation is required to assess quality of CST/JCF training.
eP126 Outcomes after emergency surgery in the elderly – implications for the organisation of an acute service
Authors: Hassan Kiran , Wong Chloe , Saha Arin 
Published: January 2025

Abstract

Aims
Few studies have assessed ‘whole service’ requirements for a safe model of care for emergency operations in elderly patients. This study aimed to describe outcomes after emergency surgery in elderly patients.

Methods
All patients who had emergency abdominal surgery from January-March 2024 were identified. Outcomes in patients aged 80 or above were compared with those in younger patients. Minimum follow-up was 6 months.

Results
There were 529 operations; 51 (10%) were in patients aged 80 or above. There were 12 urology and 39 general surgery procedures. 14 cases were eligible for entry onto NELA database.
Time between admission and decision to operate was longer in older patients (median 2.5 days vs. 1 day, P&lt;0.005) with a greater proportion of patients having an initial non-operative treatment plan. Older patients had a greater burden of co-morbidities (Charlson score 9 vs. 4, P&lt;0.005) and required more time in the anaesthetic room (median 16 minutes vs. 7 minutes, P&lt;0.005) and the recovery room (median 68 minutes vs. 36 minutes).
There were three returns to theatre (bladder washout-2, planned relook-1) and no post-operative deaths. Eight patients had died (16%) within 6 months as compared with 2% in younger patients.

Conclusions
Emergency surgery in elderly patients comprised almost 10% of all acute operations, and were associated with greater co-morbidity, longer pre-operative preparation, and longer recovery. There was a greater likelihood of death within six months. Surgical and anaesthetic teams should provide extra capacity for elderly patients and ensure full understanding of longer term risks.