bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP2.11 Delay to elective colorectal cancer surgery
Authors: Ekong Tolu , Zadeh Delaram Mostowfi , Shirsath Sayali , Reay-Jones Nicholas 
Published: August 2023

Abstract

Aim
To determine whether a delay to elective surgery of 12 weeks or more results in upstaging of colorectal cancer

Method
We looked retrospectively at all patients who had undergone elective colorectal cancer surgery over a 3-year period, from January 2020 - December 2022. We identified those patients who had delayed surgery. We defined delayed elective colorectal surgery as 12 weeks or more from the date of diagnosis. Patients who underwent endoscopic excision or those delayed due to neoadjuvant chemoradiotherapy were excluded from our study. TNM stage recorded by CT or MRI scan at the time of diagnosis and just before the delayed surgery were compared to determine if upstaging of the cancer had occurred.

Result
406 patients underwent elective colon or rectal cancer resections from January 2020 to December 2022. After excluding those who had neoadjuvant chemoradiotherapy, the number of patients who had their surgery delayed by 12 weeks or more was 13. The median time delay was 16 weeks (12-30). All 13 patients had a staging scan at time of diagnosis, however only 7 out of the 13 had a re-staging scan prior to their delayed surgery. The pre-operative stages ranged from T0-T3, N0-N2, one patient had a single liver metastasis that resulted in a combined hemicolectomy and hepatectomy. None of the patients who were re-staged had a worse TNM stage.

Conclusion
In our cohort of patients, although a small total number, delaying elective cancer surgery by 12 weeks or more did not cause upstaging of their cancer.
FTP2.13 Outcomes of emergency and elective colorectal resections in a busy DGH
Authors: Enver Muqeet , Nijran Kirandip , Shams Marvi , Goh Yan Li , Akingboye Akinfemi , Waterland Peter 
Published: August 2023

Abstract

Aims
Evaluate outcomes of emergency and elective colorectal resections in a busy DGH.

Methods
Single-centre retrospective study of emergency and elective colorectal resections between December 2021-November 2022.Each patient’s hospital records were reviewed, and data were collected on patient demographics, type of operation performed in the emergency or elective setting, ASA, post-operative complications encountered based on Clavien-Dindo classification, mortality rates, and length of hospital stay.

Results
A total of 201 cases were performed (132 elective,69 emergency), 57 cases were open,136 laparoscopically and 8 were converted. Median age was 70(range 20 – 92) years old, 114males:87females. The median length of hospital stay was 8(range 3–105) days. ASA grade of most (57.2%) patients were ASA 3. Missing data were unavailable in 20.4% of cases. Pre-operative VTE compliance rates were prophylactic clexane (92.5%) and TEDS (91.5%) respectively.
The elective operations performed include right hemicolectomy (46.2%), extended right hemicolectomy (4.5%), anterior resection (23.5%), ultra-low anterior resection (6.1%), left hemicolectomy (2.3%), APER (7.6%), Subtotal colectomy (2.3%), Total colectomy (2.3%), Panproctocolectomy (2.3%), Proctocolectomy (1.5%) and Hartmanns (1.5%). Four patients returned to theatre for pouch resection (1 case), laparotomy + stoma formation (2 cases) and closure of burst abdomen (1 case). Our elective mortality rate was 1.5%.
The emergency operations performed include right hemicolectomy (43.5%), extended right hemicolectomy (2.9%), anterior resection (5.8%), subtotal colectomy (8.7%) and total colectomy (2.9%). Four patients returned to theatre for relook laparotomy and refashioning of stoma with a 5.8% mortality rate.

Conclusions
This snapshot audit demonstrates low morbidity and mortality rates in our centre, despite our patient cohort having co-morbidities of ASA III.
FTP3.1 Impact of Covid-19 on Emergency Laparotomies due to Cancer
Authors: Ehsan Aisha , Javed Anum , Anderson Helen , Trivedi Prateesh 
Published: August 2023

Abstract

Aim
To study the effect of the COVID-19 pandemic on the number of emergency laparotomies for bowel cancer.

Methods
Emergency laparotomies undertaken at St Peter’s Hospital (SPH) from August 2018 to August 2021 were identified. Pre-Covid era (PCE) was defined as August 2018 to January 2020; Covid-19 era (CE) was defined as February 2020 to August 2021. Electronic records were examined to identify the indication for surgery (cancer vs non cancer), length of stay and mortality. Patients undergoing multiple laparotomies in a single admission were only counted once.

Results
The total number of emergency laparotomies was 473 (PCE= 233, CE = 240). Emergency cancer laparotomy numbers in CE were significantly increased compared to PCE (68 vs. 44, p-value &lt;0.05). CE emergency cancer laparotomy patients had a longer median length of stay. There was no significant difference in 30-day mortality (PCE 9 vs. CE 8 days).

Conclusion
There were an increased number of emergency laparotomies for cancer during CE. Possible causes include not presenting due to national lockdown and concerns regarding COVID-19.
Further regional and nationwide data needs to be studied to establish whether this finding has been replicated on a wider scale or whether it is a local issue. Further analysis of data to determine the TNM staging will be useful to see the level of disease pathology.
FTP3.5 Patients undergoing elective colorectal surgery are at increased risk of surgical site infections: a single centre experience
Authors: Koh Amanda , Ng Oliver , Calderbank Tom , Das Kieran , Smith Katherine , Tierney Gillian 
Published: August 2023

Abstract

Introduction
Surgical site infections (SSIs) account for 16% of all healthcare-associated infections and pose a considerable burden on the NHS due to prolonged hospital stay, comorbidities, and increased costs. Due to the nature of colorectal surgery, SSI rates in this patient cohort are even higher. The aim of this audit is to establish our colorectal SSI rates and identify associated risk factors with a view to create and implement an SSI bundle.

Methods
A retrospective audit, from a large institution, of all patients who underwent elective colorectal surgery were collected between April 2019 to March 2022. Data from the operation were extracted, including the operation date, procedure performed, surgical approach, and stoma formation. SSI was recorded if any of the following were present at 30 days: purulent discharge, clinical or imaging diagnoses, microbiology, wound dehiscence with pain, swelling, redness or pyrexia.

Results
Five hundred and fifty-seven patients were included in the preliminary analysis; 62.3% of which were open, 20.8% laparoscopic and 7.9% robotic. A total of 116/557 (20.8%) had an SSI. This increased the length of stay by 4.3 days. Open approach was associated with higher SSI rates (21.2% in open, 18.9% laparoscopic, and 10.4% robotic). The formation of stoma also increases SSI rates (17.4% in patients without stoma, 25.4% colostomy and 28.1% ileostomy).

Conclusions
Further data analysis will be conducted to identify patients at a higher risk of developing an SSI. An SSI bundle has been created within the department, and a re-audit will be performed following its implementation.
FTP3.7 Influence of neoadjuvant treatment strategy on operability in locally advanced rectal cancer
Authors: McFeetors Carson , O'Connell Lauren , Regan Mark , Joyce Myles , Hogan Aisling , Nugent Emmeline 
Published: August 2023

Abstract

Background
Neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer facilitates tumour downstaging and complete pathological response (pCR). Neoadjuvant systemic chemotherapy (total neoadjuvant chemotherapy, TNT) further improves pCR rates. While some patients forgo surgery, total mesorectal excision (TME) remains the standard of care. While TNT appears to be non-inferior to nCRT with respect to short-term oncological outcomes, little data exists on perioperative outcomes. Factors such as conversion, sphincter preservation and anastomosis rates do not impact oncological outcomes but affect quality of life (QOL).

Methods
An institutional colorectal oncology database was interrogated from inception (2009) to November 2022. Inclusion criteria comprised patients with histologically confirmed rectal cancer who had undergone neoadjuvant therapy and TME. Exclusion criteria comprised patients with a non-colorectal primary, those operated on emergently or who had local excision only. Primary outcomes were rates of conversion to open, sphincter preserving surgery and anastomosis formation.

Results
In total 156 patients were eligible for inclusion (standard nCRT, n= 111, TNT, n=45). Sphincter preservation and anastomosis formation were more frequent in the nCRT cohort, while conversion rates were higher in the TNT cohort. Although these differences were not statistically different, the conversion value approached significance (sphincter preservation, 70% vs 62%, p=0.3484; anastomosis, 72% vs 64%, p=0.4632, conversion, 34% vs 17%, p=0.0501).

Conclusions
In this series TNT appears to be associated with higher conversion rates and lower rates of anastomosis formation. While larger studies will be required to confirm these findings, QOL factors should be considered alongside oncological benefits when selecting treatment strategies.
FTP3.14 Comparing thoracic epidural anaesthesia to rectus sheath catheter induced analgesia in reducing postoperative pain following major abdominal surgery. A systematic review
Authors: Nour Hussameldin M , Abogabel Sameh , Peristeri Dimitra V , Bhaskaran Premjithilal , Singh Krishna , Sajid Muhammed S 
Published: August 2023

Abstract

Aims
Effective analgesia is mandatory for achieving optimum post operative recovery. The aim of this study is to compare between thoracic epidural analgesia and rectus sheath catheter analgesia in reducing pain score after open major abdominal surgery.

Methods
Standard medical electronic databases were searched with the support of a local librarian. Relevant published randomised controlled trials (RCT) comparing thoracic epidural analgesia and rectus sheath catheter analgesia after open major abdominal surgery, were shortlisted according to the inclusion criteria.

Result
Four RCTs on 351 patients undergoing major abdominal surgery were included in this meta-analysis. There were 176 patients in the thoracic epidural group (TEA) and 175 patients in the rectus sheath catheter group (RSC). In the random effect model analysis, there was no significant difference in VAS pain score in 24 hours at rest [SMD -0.46; 95% confidence interval (95% CI) -1.21 to 0.29; z =1.20 P=0.23] and movement [SMD -0.64; 95% confidence interval (95% CI) -1.69 to -0.14; z = 1.19 P= 0.23] between TEA and RSC. Similarly, there was no significant difference in pain score in 48 hours at rest [SMD -0.14; 95% confidence interval (95% CI) -0.36 to 0.08; z = 1.29 P= 0.20] and movement [SMD -0.69; 95% confidence interval (95% CI) -2.03 to 0.64; z = 1.02 P= 0.31].

Conclusion
There was no significant difference in pain score between TEA and RSC following major abdominal surgery and both approaches can be used safely according to the choice and expertise available.

Acknowledgement
This work was previously presented.
FTP4.7 A stitch in time; Surgeon learning curve in Robotic Assisted Colorectal Cancer Resection Operating Times
Authors: McGuire Carina , Khopekar Faid , Saldanha James , Komolafe Segun , Maxwell Fraser 
Published: August 2023

Abstract

Aims
We began performing Robotic Assisted (RAS) colorectal cancer (CRC) resections in our hospital in 2022. In order to understand whether we could demonstrate a surgeon learning curve, we assessed for any difference in median length of operating time (OT) in RAS CRC resections from their implementation to present time.

Method
We performed a retrospective review of theatre logs for RAS CRC resections from 2nd May 2022 until 17th January 2023. We recorded ‘knife to skin’ and ‘close’ time for each case alongside resection type. We included the 4 highest volume resection types and identified the median OT for the first half of cases, from which we subtracted the median OT from the second half of cases performed. We then calculated median time difference between the sets.

Results
As table 1 demonstrates, the median OT decreased for all included RAS CRC resections (n=51) from the first data set to the second. The median time saved over all resection types was 26.5 minutes.

Discussion
In surgery, demonstrating a learning curve involves looking at a marker of progress (such as operating time) and assessing it against exposure to, for example, a new technique or instrument. RAS represents a unique opportunity for this. We were able to demonstrate an early surgeon learning curve with a decrease in median OT across our highest volume RAS CRC resections within 8 months of their implementation at our centre.
FTP4.9 An audit to measure if &gt;5% reduction in weight occurred, as recommended by the National Institute of Health and Clinical Excellence (NICE), for patients suffering from osteoarthritis before their scheduled total joint replacement surgery, at Darwen Health Link Surgery
Authors: Sarma Akanksha , Mustafa Syed 
Published: August 2023

Abstract

Aim
Osteoarthritis causes damage to synovial joints, manifesting as pain, loss of function, and disability. A high BMI is correlated with an increased incidence of osteoarthritis, for which NICE recommends a &gt;5% (ideally &gt;10%) decrease in baseline weight to improve pain and functionality. This audit aims to measure Darwen Health Link’s adherence to NICE guidelines 226 “Osteoarthritis in over 16s: diagnosis and management” for the management of osteoarthritis patients regarding weight-loss.

Method
This audit analysed 15 osteoarthritis patients with a BMI&gt;30 who underwent total joint replacements from November 2021 to November 2022. Patient records were analysed for their weight management from 3-12 months prior to surgery, up till their surgery period to assess: if weight-loss advice was provided and if &gt;5% weight-loss took place. Standards were designated per clinician recommendations and NICE guidelines.

Results
All osteoarthritic patients (n=15) were given weight-loss advice at presentations before surgery. However, only 20% (n=3) of patients lost &gt;5% of their baseline weight before their joint replacements, against the 50% standard. Therefore, interventions to improve weight-loss in patients and clinician guidance were implemented. These include a targeted poster, detailed weight-loss advice packs for patients, and clinician education about weight-loss programmes available locally.

Conclusion
The first part of the audit indicates suboptimal performance by Darwen Health Link. Their performance will be re-audited in 3 months post-interventional implementation. Reducing osteoarthritis’s burden on patients in primary care can significantly reduce pain and the need for surgery.
FTP5.1 Incidence of hyponatremia in general surgical patients at a district hospital in NHS
Authors: Arifuzaman Mohammed , Shah Jigar , Dalmia Sanjay 
Published: August 2023

Abstract

Aims
To understand the perioperative Na values in general surgical patients. To understand factors and predictors for Na imbalance.

Methods
Retrospective analysis of all patients admitted under general surgery, elective and emergency, from 15-4-2022 to 15-10-2022 were included. Daycase patients who were discharged on POD0 were excluded. A total of 462 patients studied. Collected data included hospital number, age, sex, ASA grade, co-morbidities, IVF and NBM status, Na values over the admission period. Statistical analysis performed in StatsDirect3.

Results
Median day 1 Na value was 131 (SD 2.50). On day 1, patients with severe hyponatremia (Na&lt;125) were 0, moderate hyponatremia (125-129) 28, mild hyponatremia (130-135) 395, reference range of Na were 59 and 0 hypernatremia patients. The day 2 Na value was a median of 129.5 (SD 2.84).
On day 2, patients with severe hyponatremia (Na&lt;125) were 1, moderate hyponatremia (125-129) 32, mild hyponatremia (130-135) 398, reference range of Na were 31 and 0 hypernatremia patients.
Multivariate regression analysis comparing day 2 of Na with day 1 Na, sex, type of IVF (Hartmanns vs NS) and age resulted in a P &lt; 0.0001 for day 1 Na, P &lt; 0.0001 for type of IVF. Patients on Hartmann's have a predicted day 2 Na of 137 and those on NS 130 (243 patients received NS and 217 Hartmann's on admission day 1).

Conclusion
Majority of surgical patients present with hyponatremia (91.3 %). Hyponatremia more common on day 2 of admission. First day Na value is statistically significant in predicting the 2nd day Na values.
FTP5.2 Functional deficits in older patients undergoing major gastrointestinal surgery
Authors: Daniels Sarah , Lee Matthew , Moug Susan , Wilson Tim , Brown Steve , Wyld Lynda 
Published: August 2023

Abstract

Aim
Gastrointestinal surgeons face an increasingly complex patient population. Patients are older, often with co-morbidities, frailty, nutritional, functional, and cognitive impairments. The aim of this study was to compare functional outcomes of a cohort of older patients following emergency and elective major gastrointestinal surgery.

Methods
A prospective cohort study in 3 NHS trusts was performed (NCT04545125). Baseline comprehensive assessment including quality of life, physical activity levels, functional, nutritional, and cognitive status was performed. Functional status (WHODAS v2, & Activities of Daily living questionnaire) and quality of life (EQ-5D-5L) were assessed at baseline, 6 weeks, 3 months, and 6 months following surgery.

Results
Ninety-eight patients were recruited; median age 74 years, 56% male. Eighty-two patients underwent elective surgery and 16 underwent emergency surgery. At baseline, 13.9% elective vs 68.8% emergency patients were considered vulnerable or frail on frailty testing; 35.9% elective vs 62.5% emergency were identified as malnourished or at risk of malnutrition. Emergency patients had lower Independent Activities of Daily Living score median 6 versus 8 (p=0.007). Baseline activity was lower in emergency patients compared to elective; 1,386 vs 3,882 MET minutes per week (p=0.06). Functional status and quality of life appeared to recover in elective patients by three months, however this was lower at baseline in emergency patients and this persisted over follow-up.

Conclusion
High levels of baseline functional, cognitive and nutritional deficits were found in this study. Whilst elective patients appear to recover within 3 months, emergency patients have persistent deficits in functional capacity and quality of life.
FTP5.4 Ethical Considerations Within Paediatric Bariatric Surgery: A Systematic Review
Authors: Shah Aishwarya , Kumar Niraj 
Published: August 2023

Abstract

Aims
With childhood obesity prevalence increasing rapidly, bariatric surgery is being given greater consideration in the paediatric population. Paucity of long-term evidence, physical and emotional risks, and reliance on parental decision-making are factors constituting this moral complexity, forming debate around eligibility and timing of offering the procedure. To evaluate these ethical considerations, a systematic review was conducted.

Methods
All relevant synonyms of “Ethics”, “Bariatric Surgery” and “Paediatric” were used to identify papers for inclusion in the systematic review and reference lists were also scanned. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed.

Results
10 papers were included. A key ethical dilemma frequently explored was the issue of consent, and ensuring the child is at the forefront of the decision. Paediatric bariatric surgery causes controversy as children are exposed to surgical risk early in life, and thus prolonged preventative measures are encouraged with the aim to mitigate obesity by adulthood causing unnecessary harm. Children without a strong support network have additional obesity risk, whereby withholding surgery may be viewed as inequitable and non-beneficent. There is also conflict between delaying surgery until the child is Fraser-competent versus increased complication risk.

Conclusions
Further evidence to guide assessment criteria are needed to facilitate informed consent. Post-operative support should be audited, with sustained health outcomes and inclusive care monitored. Although preventative methods are important in the paediatric population, clinicians must not discriminate against those for whom it proves ineffective, with bariatric surgery being a last resort for high-risk obese patients.
FTP5.7 Championing Benign Biliary Patients in a UGI Tertiary Referral Cancer Centre. Results from a 3 year Quality Improvement Project
Authors: Forsyth Katrina , Johnson Roison , Boghdady Michael El , Wheatstone Sarah , Tomasi Ivan , Knight William , Atkinson Simon , Ebied Husam 
Published: August 2023

Abstract

Background
A biliary quality improvement project (QuIP) was established in 2019 following 3 audit cycles highlighting delays to laparoscopic cholecystectomy (Lap-C) in patients with gallstone pancreatitis. Limited theatre space and prioritisation of high volume cancer work hindered previous efforts to improve the service between 2015 and 2019. The latest phase of the QuIP has introduced a dedicated consultant lead biliary service, a live biliary admission tracking system, increased in-patient Lap-C, implementation of ambulatory pathways and a patient centred integrated care approach.

Methods
Prospectively collected data from a live biliary tracking system was compared with retrospective audit data from 2015-2019. Key performance indicators were; average time to Lap-C, rate of Lap-C with-in 2 weeks following pancreatitis, inpatient Lap-C rate and out-patient appointments saved.

Results
343 patients were managed through inpatient and ambulatory biliary pathways from November 2021-2022. 2 week Lap-C post pancreatitis improved from 27% to 69% (41% as inpatients) with average time to Lap-C improving from 68 days to 13 days. 103 outpatient appointments were save by counselling and pre-assessing patients for Lap-C as inpatients, saving £12360 in outpatient costs. In-patient Lap-C rate improved from 2% to 19% for fit and consenting patients.

Conclusion
Patients with biliary pathology may be at risk of lower standards of care when treated in centres with a high tertiary UGI cancer burden. A higher quality of care can be achieved for biliary patients through effective patient prioritisation, increasing inpatient Lap-C, the establishment of ambulatory pathways and a robust outpatient tracking system.