bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP1.1 Ruptured AAA pathway time audit within East Kent Hospitals University foundation trust (EKHUFT)
Authors: Ashoor Yasser , Senaratne Jawaharlal 
Published: August 2023

Abstract

Background
With ruptured abdominal aortic aneurysms (rAAA) without rapid intervention, there is almost 100% mortality. Even with intervention mortality remains high and It is intuitive that more rapid access to specialist care might reduce this, though the choice of which patients are transferred lacks evidence. Kent and Canterbury hospital (K&CH) is the vascular hub for rAAAs in Kent, serving 4 spoke hospitals.

Aim
To assess the current speed of management of rAAA within Kent Hospitals.

Methods
An audit of 50 rAAA patients from 11/2019-10/2021 was conducted. 26 patients (52%) died without intervention, 10 of them after the transfer to the vascular facility. 11 patients (22%) underwent open surgical repair and 13 patients (26%) underwent EVAR. Of those who underwent intervention (24 patients), only 11 survived. From hospital attendance to CTA and from CTA clinching diagnosis to transfer to K&CH, the median times were 95(9-1140) and 70(27-370) minutes, respectively. Median time from arrival to K&CH to theatre was 90(11-190) minutes.

Conclusions
There are no current explicit UK guidelines on the emergency management of rAAA, with variation in practice and our audit shows room for improvement, including patient selection for referral, diagnostic tools and the conditions under which the transfer is made. Thus, we have created a pathway to improve the rapid diagnosis and transfer between the Kent hospitals. A re-audit will be conducted to assess the effectiveness of this.
WTP1.5 The Effect of Health Literacy and Socio-Economic Deprivation on Outcomes After Lower Limb Revascularisation for Chronic Limb Threatening Ischaemia - The HeaLTHI Study
Authors: Bishop Chloe , Wunnava Sai , El-Sayed Tamer , Nandhra Sandip 
Published: August 2023

Abstract

Aims
Health literacy is the ability to obtain, process and understand health-information needed to make health-related decisions. Research has suggested a relationship between health literacy, socio-economic status, and health-related outcomes. This study aimed to assess how health literacy and socio-economic status interact for patients undergoing bypass surgery for chronic limb threatening ischaemia (CLTI).

Methods
Patients with CLTI undergoing lower limb surgical bypass graft operations were included in a cross-sectional observational study. The HLS19-Q12 questionnaire categorised participant’s Health Literacy as inadequate, problematic, sufficient, or excellent. Socio-economic status was assess using the Index of Multiple Deprivation. Primary outcomes were major adverse cardiovascular and limb events.

Results
Fifty patients (mean age±SD: 70±8.7 years) were included. Participant’s health literacy was inadequate (28%), problematic (38%), sufficient (24%) and excellent (10%). 40% lived in areas of highest deprivation. All health literacy groups were comparable for post-operative outcomes, but poorer health literacy was associated with a lower socio-economic status (r = 0.308 (P = 0.029)) which was also a significant predictor for amputation (P = 0.017).

Conclusions
This study suggests that a lower health literacy is associated with greater social deprivation which in turn maybe a predictor for amputation following bypass surgery. Health Literacy is a potentially modifiable factor and improving it could have a mediating role in health inequalities created by social deprivation, addressing a vascular James-Lind Alliance priority.
WTP2.1 Predictors Of Non -Adherence To Immunosuppression In Transplant Patients At A University Teaching Hospital
Authors: Devkaran Bhavesh , Ohia Ernest , Koufopoulos Georgios , Bandara Chameera , Mehra Sanjay , Sharma Hemant 
Published: August 2023

Abstract

Introduction
To assess the degree of immunosuppressive medication adherence in kidney transplant patients (KTPs) and to determine the predictors of non-adherence.

Methods
From a total of 106 KTPs treated at the RLBUHT (Jan 2020- June 2021), N= 20 (18%) patients were identified as being non-adherent on two or more hospital incident episodes identified by the continued care clinic, clinicians, and pharmacy. Statistical analysis was performed using the Student t-test. The predictors were data mined with Cox Regression, with the time-variable being time to graft dysfunction or Tacrolimus level abnormality &gt; 50% variance of average trough level (6-8 ng/ml).

Results
Non-Adherence was observed in 20 (18.6%) patients; the estimated glomerular filtration rate was significantly lower in the no-adherence group (28.52 ± 17.62 ml/min) than in the adherence group (62.43 ± 11.72 ml/min, p &lt; 0.05). About the Tacrolimus trough level, a significant difference was found between the adherers and the Nonadherers (5.10 ± 2.19 vs. 3.06 ± 1.04 ng/ml, p &lt; 0.05). Non-adherers were interrogated during clinical encounters by clinicians and interpreter requirements. Polypharmacy (N=15), (Interpreter requirement) (N=11), young patients age 18-21 (N=05), and old age&gt;70 (N=04) were the predictors of non-adherence. The patients were re-counseled and social services were involved to minimize recurrence.

Conclusion
The KTPs in this study demonstrated that non-adherence was associated with worse graft function and a lower Tacrolimus level. Knowledge about the degree of adherence could help identify non-adherent patients early and develop strategies to improve outcomes.
WTP2.3 Incidence of intrathyroid parathyroid adenoma - last 9 years in a teaching hospital
Authors: Kho Jason , Kuan Jen Yee , Turner Paul , Shetty Vinutha 
Published: August 2023

Abstract

Aim
The incidence of intrathyroid parathyroid adenoma (iTPA) is estimated to be 0.7-5.7% of hyperparathyroidism cases. Thyroid lobectomies may be performed when an adenoma cannot be clearly identified and isolated. We aimed to review the incidence of iTPA and outcomes after surgery within our practice.

Methods
We retrospectively reviewed consecutive parathyroidectomies performed by two experienced upper gastrointestinal surgeons (VS and PT) in a teaching hospital between April 2013 and December 2022. Preoperative radiological imaging was reviewed, and cases of iTPAs were diagnosed intraoperatively and on histopathology. These were further evaluated to review the outcomes after surgery.

Results
Total of 211 parathyroidectomy surgeries were performed, 11 (5.2%) of which were found to be iTPAs. These were confirmed on histopathology. Median age of patient cohort was 57±13 years. Patients were predominantly female (n=10, 90.9%). None underwent previous neck exploration. There was radiological (SPECT and Ultrasound) suspicion of iTPAs in 3 (1.4%) cases; peri-operative decision was made to explore for iTPA in the remaining 8 cases. 9/11 (81.8%) patients had hemithyroidectomy performed; in the remaining two cases, adenoma was successfully isolated from thyroid tissue and resected. Preoperative methylene blue infusion was utilised in all cases, of which uptake was evident in 8 (72.7%) cases. Calcium normalised in all patients postoperatively and none required further neck exploration.

Conclusion
Our 9-year series of parathyroid surgery revealed 5.2% incidence of iTPA, the majority of which was diagnosed intraoperatively. Diagnosis of iTPA should be considered if there is suspicion on radiological imaging and where no obvious adenoma is identified after full neck exploration.
WTP3.6 Comparison of complications and benefits of retrieval of gall bladder with and without bag
Authors: Ayubi Azaz , Rauf Sidra , Mujahid Sheeza , Ajaz Hamda , Akhtar Fahad , Sakhizada Fahim 
Published: August 2023

Abstract

Aim
To compare the outcomes of gallbladder extraction with versus without using retrieval bag in laparoscopic cholecystectomy.

Methods
The duration of the study was six months after approval of synopsis. After meeting the inclusion criteria a total of 130 patients were enrolled. Informed consent and demographic detail were noted. Patients were randomly assorted in two groups by lottery method. In group A, the gallbladder was extracted using an endobag. In group B, extraction of the gallbladder was done without using endobag. All patients were followed-up in OPD after one week and were evaluated for postoperative wound infection at port site.

Results
The mean age of the patients was 40.44±10.884 years, 52(40%) patients were male and 78 (60%) patients were females. In patients with bag retrieval group the port site infection was not noted in comparison with those without bag retrieval group the port site infection was found in 9 (13.8%) patients (p-value=0.002).

Conclusion
Gallbladder extraction with retrieval bag showed significantly better outcome in terms of port site infection as compared to without retrieval bag patients in laparoscopic cholecystectomy.
WTP4.5 An Evaluation of the Introduction of a Perioperative Care Bundle to Reduce Surgical Site Infections after Bowel Resection Surgery in a DGH Setting
Authors: Audei Wafa , Peck Mariska , Lal Nikhil , Hamdan Mohammed 
Published: August 2023

Abstract

Background
The surgical site infection (SSI) rate for colonic resections at a District General Hospital (DGH) in South-Central England was 25.3%. The UK national average is 8.6%. The aim of this study was to evaluate if the implementation of a perioperative care bundle based on NICE guidance improved SSI rates.

Methods
Retrospective data was collected prior to the bundle implementation (Group 1) and prospective data following bundle introduction (Group 2). Inclusion criteria were all emergency and elective bowel resections. The primary outcome assessed was the development of an SSI within the 30-day postoperative period. The secondary outcomes were related to confounding variables, such as diabetes and immunosupression. Data was collected from the electronic patient record system and follow-up telephone consultations using a standardised questionnaire.

Results
The SSI rate in Group 1 (n=55) was 30.9% (95% CI,19.0%-43.1%) as opposed to 19.2% (95 CI, 8.5%-30.0%) in Group 2 (n=52), p=0.16. Interestingly, for patients of a BMI &gt;30 the SSI rate dropped from 45.5% (95% CI, 16.7%-76.6%) to 20.0% (95% CI, 4.3%- 48.1%).

Conclusion
The 10-step perioperative care bundle did not significantly reduce the SSI rate. However, bundle uptake was moderate (73%), and only 65.4% of prospective cases achieved complete bundle compliance. Further research is required to investigate the effectiveness of this bundle on high-risk groups, as well as implementation barriers.
WTP4.7 Evidence-Based care for Acute Uncomplicated Colonic Diverticulitis. Effects on Bed Occupancy, Broad Spectrum Antibiotic Therapy and Cost savings
Authors: Bose Sayantan , McWhirter Derek , Carlson Gordon 
Published: August 2023

Abstract

Aims
To investigate the impact of failure to adhere to best-practice guidelines in the management of acute uncomplicated colonic diverticulitis on use of hospital resources.

Methods
Retrospective study from January 2019 till December 2021. The clinical pathway, including disposal (admission vs discharge), imaging, time course, illness severity, treatment and outcome of all adult patients (18 years and older) attending as an emergency with acute colonic diverticulitis were identified from ICD-10 coding data. All radiology reports were reviewed and a modified Hinchey classification of disease severity recorded.

Results
339 patients were identified during the study period. 79 were excluded because of incorrect coding. In 260 cases (222 patients) median (range) age 56 (23-92) years, the diagnosis was confirmed by CT scan in 247 (95%). Of these, 174 (67%) had uncomplicated (Hinchey 1a) acute colonic diverticulitis. 235 (90%) of all attendances resulted in an acute hospital admission. However, 149/174 (86%) of all patients with Hinchey 1a disease were admitted to hospital and 142 of these (95.3%) were treated with broad spectrum IV antibiotics, despite evidence-based guidance indicating that this treatment is unnecessary. 605/1268 (48%) of all bed days for the management of acute diverticulitis over the study period were used to treat patients with Hinchey 1a disease.

Conclusion
Almost half of all patients admitted with acute diverticulitis could have been managed on ambulatory pathways without antibiotics. Adherence to evidence-based guidance and development of appropriate patient pathways provide an opportunity for considerable improvements in efficient use of hospital resources and improved antibiotic stewardship.
WTP5.1 Perioperative hypothermia in elective surgical patients
Authors: Arifuzaman Mohammed , Shah Jigar , Bhattacharya Sayan 
Published: August 2023

Abstract

Introduction
Perioperative hypothermia is an under-reported, yet well recognized complication of surgery. Normal thermoregulatory mechanisms are disrupted in anesthetized patients. Up to 70% of surgical patients develop perioperative hypothermia, with serious consequences including coagulopathy, sepsis and cardiac events.

Methods
In this single centre study, we collected prospective data from 100 elective operations in urology, gynaecology, general and breast surgery. The pre-operative, pre-induction, intraoperative, post-procedure and in recovery temperatures (in Celsius) were recorded. Any temperature below the 36°C was regarded as hypothermia and the total incidence of hypothermia during all the 5 phases were calculated.

Results
Incidences of hypothermia in pre-operative, pre-induction, intraoperative, post-procedure and in-recovery were 4 %, 5%, 12 %, 11 %, 8 % and 6 % respectively. Multiple regression analysis of pre-operative, pre-induction and intra-operative temperatures resulted in a p value of 0.237 for pre-operative temperature and 0.000032577 for pre-induction temperatures respectively. This suggests that pre-induction temperature was the most statistically significant parameter for intra-operative hypothermia. Furthermore, regression analysis predicted the intra-operative temperature for a given pre-induction temperature. Regression analysis line fit plot between preinduction and intra-operative temperatures predicted that for intraoperative temperature to be 36.74 °C, mean preinduction temperature is to be raised to 37.2 °C.

Conclusion
This study highlights the incidence of intraoperative hypothermia and need for active interventions to prevent the same. It paves the way for a single blinded randomized controlled trial for comparing different modalities to pre-warm patients and prevent intraoperative hypothermia.
WTP6.4 Influence of Annual Record of Competence Progression panel profile on Differential Attainment
Authors: Barlow Emma , Luton Oliver , Eley Catherine , Hemington-Gorse Sarah , Egan Richard , Lewis Wyn 
Published: August 2023

Abstract

Introduction
Differential Attainment (DA) refers to divergent achievements when related to protected traits. Annual Review of Competency Progression (ARCP) panels play a key role which compositions should reflect, yet no guidance exists on panel profile related to protected traits. This study aimed to evaluate the influence of panel profile on DA.

Methods
Anonymised ARCPs numbering 1090 in a UK Statutory Education Body (SEB) were examined and primary effect measure was ARCP Outcome (ARCPO) with satisfactory ARCPO classified as 1, 2 or 6, and unsatisfactory as 3 or 4.

Results
Satisfactory ARCPOs numbered 1005 and unsatisfactory 85. Median panel number was 7 (range 1-15, p&lt;0.001). Median female percentage consultant representation was 18.2% (0% (Urology, Plastic & Paediatric Surgery) to 40% (Core Surgery) and median ethnicity (BME) consultant representation 14.3% (0% (Vascular & Neurosurgery) to 80% (Cardiothoracic Surgery). Multivariable analysis revealed: Trainee seniority (OR 0.800, p&lt;0.001), SAC Liaison Member gender (OR 0.720, p=0.013) and Panel gender balance (N ARCP panel females, OR 10.695, p=0.003) to be independently associated with adverse ARCPO.

Discussion
Important two to five-fold variance in ARCP panels were found related to gender and ethnicity profile respectively with apparent significant impact on DA.
WTP6.9 Post-operative Management Study Day: Improving knowledge and confidence of senior medical students when managing post-operative patients
Authors: Powell Harriet , Bridgeman Joseph 
Published: August 2023

Abstract

Aim
Focus groups run by teaching facilitators with medical students highlighted a lack of confidence around how best to assess and manage post-operative patients.
In response we aimed to provide a focussed study day covering key aspects of post-operative management, and complications for undergraduate medical students at St George's University.

Methods
A study day dedicated to the assessment and management of post-operative patients was created. The day incorporates different types of learning including case-based discussions, game-based learning and simulation. Topics covered are aligned with the curriculum for senior medical students at St George's University, including post-operative pain, bowel obstruction/ileus and haemorrhage. Information gathered from local clinical guidelines.

Results
Pre-course confidence scores on management of common post-operative complications were on average a 2 out of 5 (5 being very confident, and 1 being not confident at all). Post-course confidence scores increased to an average of 4 out of 5 for managing the majority of common post-operative complications. Feedback on the teaching and content of the course was good, with 95% of participants rating the session as 5 out of 5.

Results
Post-operative assessment and management is an area of teaching that students feel has been neglected within their prior years of study. This dedicated study day allows for in-depth discussion and practice at assessment of post-operative complications. Future development of the course may include opening the participants to foundation doctors, involvement of senior surgical staff in facilitation and assessment, and use in other local hospitals.
WTP7.6 Novel ambulatory surgical pathways can reduce operation waiting times whilst maintaining patient outcomes
Authors: Johnson Nathan , Nassr Noon , Freimane Katrina , Manford Evelyn , Peckham-Cooper Adam , Rajput Ibrahim 
Published: August 2023

Abstract

Introduction
A record number of patients are currently awaiting NHS treatment. A novel ambulatory surgical pathway (Rapid Access Theatre (RAT) lists) can reduce patient wait times for common operations such as cholecystectomies and ease the burden on the traditional elective operating list. However, it is important that this approach does not jeopardise patient safety.

Method
All non-inpatient cholecystectomies carried out in a large teaching hospital from 01/10/21 – 31/01/22 were analysed. Operations carried out on RAT lists were compared to those on elective lists for time to surgery from listing, post-op length of stay (LOS), number of patient returns within 30 days and rate of post-op complications.

Results
There were 85 cholecystectomies carried out on RAT lists and 86 carried out on elective lists. The average time to surgery from listing was 70.56 days for RAT lists and 152.19 for elective lists (p = 0.0005). The average post-op LOS was 0.73 for RAT lists and 1.00 for elective lists (p = 0.43). The number of patients who returned to hospital within 30 days of their operation was 8 (10.39%) for RAT lists and 11 (14.86%) for elective lists (p = 0.751). The number of post-op complications was 10 (13.33%) for RAT lists and 13 (17.81%) for elective lists (p = 0.52).

Conclusions
The introduction of a novel ambulatory surgical pathway (RAT lists) has reduced the waiting time for cholecystectomies whilst maintaining outcomes and patient safety. This pathway is therefore cost effective and an important tool for reducing length waiting lists.
WTP7.11 CEPOD Booking Audit in General Surgery
Authors: Kitsikosta Loukiani , Diaz Maria Hernandez , Galides Chloe , Morsi Mai , Morrison-Jones Victoria , Berry David 
Published: August 2023

Abstract

Introduction and Objectives
Repeated internal audits suggested 20% of patients booked into the emergency general surgery theatre list failed to achieve their allotted time to theatre. We wished to investigate this further, identify potential reasons and whether any delay resulted in patient harm.

Materials and Methods
We retrospectively reviewed 748 consecutive adult patients over a 12 month period booked for appendicectomy, hernia repair, laparoscopic cholecystectomy or abscess I+D. We excluded laparotomies and patients under 18yoa.
We recorded pre-operative CEPOD classification, adherence to the timeframe and reasons for delays. Outcome measures included post-op length of stay (POLOS), prolonged hospital stay, and unexpected intraoperative findings.

Results
Of 748 emergency procedures, 632 (85%) achieved the desired time frame and 116 (15%) were delayed. Of the 116 delayed cases, 94 (81%) were appropriately booked (clinical review). Most delays were caused by a higher priority emergency but in one third of delays no reason was recorded.
There was no difference in mean POLOS or unexpected findings between the two groups of those achieving expected time to theatre and those delayed.

Conclusions
Despite our initial concerns regarding delays to theatre this only occurred in 15% of the study group with no discernible difference in outcomes as measured.
The repeated clinical review of potentially delayed emergency patients accessing the operating theatre appears to be safe.
Improved documentation for delays and accurate pre-operative bookings across all surgical teams will aid running and assessing the emergency provision.
WTP7.12 Investigating the duration of empirical antibiotic treatment and subsequent reduction in hospital readmission rates for perforated appendicitis in the paediatric patient population
Authors: La Costa Francesca , Haq Iqraa , Hammer Clare , Lahiri Rajiv 
Published: August 2023

Abstract

Background and Aim
Acute appendicitis is the most common surgical emergency in the paediatrics. Complicated appendicitis often involves perforation, requiring a longer course of antibiotics post-appendicectomy [1]. There is considerable variability on post-operative antibiotic regimes and duration within hospital trusts with no national guidelines. Local Trust-based consensus [2] recommends a 5-day course IV co-amoxiclav with American Paediatric Surgical Association guidelines suggesting oral conversion if IV antibiotic duration is less than 5 days [3, 4]. Therefore, we measured compliance with local and international guidelines.

Methods
Paediatric patients aged 5-17 years were selected for the study using ICD-10 codes for ‘Perforated Appendicitis’ (K35.2 and K35.3). Patients were included if they had operative management for perforated appendicitis between 1 April 2021 and 31 March 2022. Key parameters collated included; re-admission, duration of re-admission, complication, post-operative antibiotic use (selection, intravenous/oral dose and duration of use).

Results
Twenty-six paediatric appendicectomies for perforated appendicitis occurred within the time frame. Nine had IV antibiotics for &gt;5 days, of this cohort, 7 had oral conversion and completed 2-5 days of oral antibiotics with re-admission rate 33%. Eleven had IV antibiotics for &lt; 5 days with oral conversion for 4-7 days, readmission rate was 18.2% on days 4 & 5 respectively. Six had IV antibiotics for &lt;5 days with no oral conversion and no patients were re-admitted.

Conclusions
A longer duration of antibiotics with an earlier conversion from IV to oral, reduced readmission rates. However, greater research with more participants and standardised antibiotics can explore other influencing factors.