bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP5.8 Gall bladder service developments to improve outcomes based on national guidelines
Authors: Bajomo Oreoluwa , Dickson-Lowe Richard 
Published: August 2023

Abstract

Introduction
Nationally, acute gallstone disease accounts for over 1/3rd of emergency general surgery admissions and referrals. Guidelines recommend laparoscopic cholecystectomy within 1 week for acute cholecystitis, on index admission for acute gallstone pancreatitis and within 18 weeks for uncomplicated gallstone disease. Presently, NHS Trusts struggle to meet these targets due to unrelenting demand for limited resources.
We present interventions to improve a laparoscopic cholecystectomy service which nearly halved the elective surgery waiting time.

Method
Retrospective data was collected on patients who underwent elective laparoscopic cholecystectomy at a DGH pre- and post-intervention (March-July 2021 & January-April 2022). Data collected from electronic medical records included patient demographics, waiting list times, operation details and post-operative outcomes.
Interventions included introduction of a boarding card which included Cholecystectomy As A Day-case (CAAD) scoring and laparoscopic cholecystectomy standard operating procedure (SOP). The SOP specified criteria for preoperative investigations, theatre list organisation, post-operative admission and high-risk patients requiring specialist surgeon input.

Results
Pre-intervention cycle included 82 patients, with 78 patients booked as day-case operations and 40.2% unplanned postoperative admissions rate. The post-intervention period assessed 72 patients, with 46 patients booked as day-cases and 30.6% unplanned postoperative admissions. The median day-case LOS remained at 0 days pre- and post-intervention.
Median elective laparoscopic cholecystectomy waiting time significantly decreased from 140 to 75 days (p&lt; 0.0001).

Conclusion
Our study demonstrates interventions to restructure a laparoscopic cholecystectomy service significantly shortened waiting times, with national targets of 18-week wait for uncomplicated gallstone disease surgery met. Additionally, fewer unplanned postoperative admissions allows better bed management therefore reducing disruption to elective and emergency service delivery.
FTP6.2 Utility of Ultrasound Imaging in a Successful Ambulatory Emergency Surgical Unit
Authors: Claxton Mary , Quinn Marcus , Williams Lian , Barton Jessica , Hollyman Marianne 
Published: August 2023

Abstract

Aim
Drives towards ambulatory management in emergency surgery have been supported by same day imaging to expedite decision making. We aimed to assess the frequency of surgical pathology identified by ultrasound, and subsequent requirement for operation.

Methods
All acute general surgery referrals to the ambulatory clinic of a large District General Hospital between 01/01/2021 and 22/07/2022 were included. Information regarding presentation, imaging, and diagnosis were collected in prospectively maintained databases, and subsequently analysed.

Results
Over an 18-month period, 3154 patients were seen, with a 91.7% successful ambulation rate (n=2938). 1099 patients (34.8%) underwent ultrasound, the majority were upper abdominal (63.7%, n=698); a further 33.1% (n=364) were pelvic.
Ultrasound diagnosis was suggested in 52.7% of scans (n=588); upper abdominal ultrasound provided a diagnosis in 54.9% (383/698), compared to 28.8% (105/364) of pelvic ultrasounds (p&lt;0.001).
61 patients (5.6%) were admitted following ultrasound, of whom 36% (n=22) had no ultrasound diagnosis. Admission rate for diagnostic ultrasound was 6.9% (39/567).
Some 204 (18.6%) patients proceeded to operation; 25 (2.3%) underwent an emergency operation, 88 (8%) were operated on ambulatory lists, and 91 (8.3%) were listed electively.

Conclusions
Ultrasound is a commonly used adjunct in the ambulatory setting, particularly for assessment of biliary pathology. It has an acceptably high pathology pick up rate, and significant proportions go on to require surgical intervention, which can be ambulatory for the majority.
FTP6.10 Acute Pancreatitis complicated with splanchnic vein thrombosis; our 12 months experience
Authors: McGurk Catherine , Bradley Angus , Peristeri Dimitra , Kenington Cleo 
Published: August 2023

Abstract

Objectives
Splanchnic vein thrombosis (SVT) is a relatively common observation in severe acute pancreatitis (AP) and is associated with pancreatic necrosis and peripancreatic collections. Currently, there is no consensus on whether patients presenting with splanchnic vein thrombosis in the setting of AP should receive therapeutic anticoagulation. We aimed to determine current practices in the management of splanchnic vein thrombosis complicating AP, in our hospital.

Methods
An audit of retrospectively collected data for all patients presenting with AP was conducted. Patients with splanchnic vein thrombosis were grouped according to vessel involvement and whether or not systemic anticoagulation was administered.

Results
Of 172 consecutive patients admitted with AP between January and December 2022, 10 had splanchnic venous thrombosis; in all cases, the thrombosis was associated with a severe attack of AP. Involvement of the splenic vein (SV), portal vein (PV) and superior mesenteric vein (SMV) was observed in 3, 2 and 3 patients, respectively. Involvement of more than one vessel was observed in two patients (SV and PV). The most common etiological factor for AP was alcohol. Seven patients received systemic anticoagulation with therapeutic LMWH initially, followed by oral DOAC for 3 months. No complications associated with systemic anticoagulation occurred. None of the patients developed liver failure, and we did not observe any fatal outcomes.

Conclusions
SVT represents a diagnostic and therapeutic challenge. Based on limited evidence, treatment decisions should be individualized with the evaluation of bleeding risks versus SVT recurrence or extension. Additional research is needed to further assist prompt management.
FTP6.11 The Quality of Service of Emergency Appendicectomy in Children in a Rural General Hospital between 2013 and 2022
Authors: Mohamed Samy , Sganga Mailen , Saleh Francesca , Lee Stanley , Unais Mohamed , Khan Kausik 
Published: August 2023

Abstract

Aims
To evaluate our service of emergency appendectomy for children (3-16 years) against the quality indicators identified by the Association of Surgeons of Great Britain and Ireland commissioning guidelines and the British Association of Paediatric Surgeons. This study was carried out between January 2013 and September 2022. We evaluated 5 main qualities; time to surgery, operative techniques (laparoscopic, open), length of stay (LOS), 30 days post-operative re-admission rate, and the rate of “negative” appendicectomy.

Methods
A retrospective analysis was conducted. Patients were identified from the hospital database. Data including demographics, above qualities and histology were collected from the hospital clinical information system “Myrddin” and Welsh Clinical Portal.

Results
Total number of children who had emergency appendicectomy over this 10 years period of time was 194, age range between 3-16 years old, 87 females, and 107 males. Mean time from admission to surgery was 12.8 hours. Total in-hospital stay was 2.7 days. There has been an increase in rate of laparoscopic appendectomy from 17.4% in 2013 to 84.6% in 2021. Total laparoscopic appendicectomy was performed in 40.2% of this cohort (7-16 years old) without conversion. Negative appendicectomy was 14.9%. Re-admission rate was 4.6% and it was mainly due to wound infection.

Conclusions
These results showed that these children are accurately diagnosed and treated in a timely manner according to the published guidelines & recommendation. Laparoscopic technique is increasingly used safely in appropriate cases.
FTP6.12 The Quality of Service & “Negative Appendicectomy” Rate in a Rural General Hospital between 2013 and 2022
Authors: Mohamed Samy , Sganga Mailen , Saleh Francesca , Lee Stanley , Unais Mohamed , Mohamed Omnia 
Published: August 2023

Abstract

Aims
This annual audit was carried out to assess the quality of emergency appendicectomy service in our hospital between January 2013 and September 2022. We audited 5 main qualities; time to surgery, operative techniques (laparoscopic, open), length of stay (LOS), 30 days post-operative re-admission rate, and the rate of “negative” appendicectomy. These parameters were compared against the available national audit outcome.

Methods
A retrospective analysis was conducted. Patients were identified from the hospital database. Data including demographics, above qualities and histology were collected from the hospital clinical information system “Myrddin” and Welsh Clinical Portal.

Results
Table shows the outcome of emergency appendicectomy between January 2013 and September 2022.

Conclusions
The increase of rate of laparoscopic appendicectomy over 10 years time reaching 98% was associated with decrease in the 30 days re-admission rate. Rate of “Negative Appendecectomy” is comparable to national outcome and has decreased significantly during COVID time.
FTP7.3 Retrospective Cohort Study of the Efficacy of Magnetic Resonance Cholangiopancreatography in the Diagnosing Choledocholithiasis in Risk-Stratified Patients
Authors: Stevenson Carla , Ng Shou Kee , Stewart Brian , Di Rollo Domenic , Mahmud Sajid , Khan Khurram 
Published: August 2023

Abstract

Aims
National guidelines emphasise the role of magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of choledocholithiasis to guide further management. The aim of this study was to determine the risk factor(s) associated with choledocholithiasis on MRCP.

Methods
A retrospective cohort study of all consecutive adult MRCPs was conducted in a single centre from October 2021 to September 2022. Patient demographics, laboratory results, other imaging modalities and MRCP results were analysed. Peak liver function test values were used pre-MRCP. Patients found to have hepatopancreatobiliary malignancies were excluded.

Results
A total of 442 patients were identified, 278 (62.9%) were female. Median age was 63 (IQR 50-74). 293 (66.3%) were inpatient scans whilst 178 (40.3%) were urgent requests. Median time from admission to MRCP performed for inpatients was 2.2 days (IQR 1.4-4.1). 121 (27.4%) MRCPs reported positive for choledocholithiasis.
Choledocholithiasis on MRCP was positively correlated to raised alkaline phosphatase (p=0.004), hyperbilirubinaemia (p&lt;0.001), jaundice (p&lt;0.001) and evidence of ductal dilatation on ultrasound and/or CT imaging (p&lt;0.001). It was not correlated to upper abdominal pain, age and gender.

Conclusion
The incidence of choledocholithiasis on MRCP in this study is comparable to recent published data. Patients should be risk-stratified and MRCP performed only if they have high-risk features to maximise the utility of MRCP.
FTP7.6 Management of Colorectal Cancer with Synchronous Liver Metastases: A systematic review of national and international clinical guidelines (CoSMIC-G)
Authors: Chan Anthony , Siriwardena Ajith 
Published: August 2023

Abstract

Introduction
The contemporary management of patients with colorectal cancer and synchronous liver metastases is complex. Variation in interpretation of the limited body of evidence may introduce inequality in practice. This study appraises the recommendations made by national/international guidelines on the management of patients with synchronous liver metastases from colorectal cancer.

Methods
A systematic review of national and international professional body guidelines published between 2012-2022 was carried out using PubMed and Guidelines International Network and evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument. Guidance in was assessed for strength of recommendation and levels of evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. The protocol was registered with PROSPERO (CRD42021243744).

Results
Searches returned 385 articles with 11 guidelines eligible for inclusion. One (9%) guideline defined ‘synchronous disease’ at outset, 2 (18%) recommended neo-adjuvant chemotherapy. Two guidelines provided “moderate” support for synchronous liver and bowel resection, 5 recommended against synchronous hepatic and colorectal resection and four made no comment. No guidelines described either hepatic or colorectal criteria for synchronous surgery.

Discussion
This study demonstrates important variations between clinical guidelines on management of synchronous liver metastases in colorectal cancer.
FTP7.10 Preoperative C-reactive protein-to-albumin ratio and its ability to predict outcomes of pancreatic cancer resection: a systematic review
Authors: Romman Saleh , Ghassemi Nader , Hajibandeh Shahin , Hajibandeh Shahab , Laing Richard , Bhatt Anand 
Published: August 2023

Abstract

Aim
To evaluate the ability of c-reactive protein-to-albumin ratio (CAR) in predicting outcomes in patients undergoing pancreatic cancer resection.

Methods
We conducted a systematic search of multiple electronic information sources and bibliographic reference lists. We applied a combination of free text and controlled vocabulary search adapted to thesaurus headings, search operators and limits in each of the above databases. Survival outcomes and perioperative morbidity were the evaluated outcome parameters.

Results
Eight observational studies reporting a total number of 1,056 patients undergoing pancreatic cancer resection were identified. The median cut-off value for CAR was 0.05 (range 0.0003- 0.54). Using multivariate analysis, all the included studies demonstrated that a higher CAR value was an independent and significant predictor of poor overall survival in patients undergoing pancreatic cancer resection. The estimated hazard ratio provided by the included studies ranged from 1.4 to 3.6. There was significant heterogeneity among the included studies; for example use of neoadjuvant or adjuvant chemotherapy, pTNM staging, lymph node metastasis, preoperative Ca19-9 and CEA levels, neutrophil-to-lymphocyte ratio, and modified Glasgow prognostic score. Furthermore, important prognostic characteristics such as tumour site and size, pathological T factor, and vascular involvement were poorly reported.

Conclusions
Preoperative CAR value seems to be an important prognostic score in predicting survival outcomes in patients undergoing pancreatic cancer resection. However, the current evidence does not allow determination of an optimal cut-off value for CAR considering the heterogeneous reporting of cut-off values by the available studies and lack of knowledge of their sensitivity and specificity. Future research is required.
FTP7.11 The role of percutaneous cholecystostomy in the management of acute cholecystitis in critically ill surgical patients, a single-centre experience, UK
Authors: Dhillon Syra , Hamed Adel , Saleem Mohamed , Khan Mansoor , Sajid Muhammad 
Published: August 2023

Abstract
Percutaneous cholecystostomy (PC) is a minimally invasive procedure that aims to stabilise critically unwell patients with acute cholecystitis. Particularly important for poor surgical candidates, PC facilitates therapeutic benefit with fewer complications and allows patient stabilisation before definitive cholecystectomy. A large 2018 study demonstrated the role of PC to be as effective as emergency laparoscopic cholecystectomy, with no significant difference in mortality. There are no UK national guidelines for the safe practice of PC. This study reports the outcomes in patients admitted as emergency cases undergoing PC for acute cholecystitis.
This was a retrospective descriptive study evaluating 24 consecutive patients admitted with acute cholecystitis to a tertiary centre, and underwent PC from 1st May 2019 to 27th January 2021. The data was collected and analysed on Microsoft Excel.
The mean age of patients was 76.1 (range 56-107 years) and predominantly female (67%). Mean duration of antibiotics therapy was 13.1 (7-24) days. The most common indication for PC was failed antibiotic therapy (16 patients) followed by gallbladder empyema (4 patients) and severe frailty (4 patients), with 21 patients ASA grade III or above. Mean duration for PC drain in-situ was 31.9 (3-164) days. In five patients, the PC drain fell out spontaneously and 9 patients underwent tubogram before removal. Interval cholecystectomy was performed in 7 patients. No patients died during their acute admission.
PC is a safe, established technique to manage acute cholecystitis in critically ill and high-risk surgical patients with favourable outcomes. More research to develop guidelines that identifies suitable patients through emergency admission would be beneficial.
FTP8.1 International expert opinion on the mitigation of the effects of the COVID-19 pandemic on surgical training
Authors: Kwan Jing Yi , Long Judith , McClean Adam , Chetter Ian , Lockwood Sonia , Yiasemidou Marina 
Published: August 2023

Abstract

Background
The declaration of the SARS-CoV-2 pandemic imposed population-wide measures to contain the virus. This had a knock-on effect on surgical training. An international survey by our group highlighted the need for consultant mentor to lead the recovery of training. Therefore, this project assesses the perspective of trainers on the impact of COVID-19 on surgical training and to explore ways of mitigating this.

Methods
This is a quantitative study encompassing semi-structured interviews of international educationalists. The verbatim transcriptions, underwent thematic analysis.

Results
Eleven educationalists were interviewed. Thematic analysis revealed ten topics: (1) Main areas affected (2) Intensity of impact (3) Causes of impact (4) Pro-activeness (5) National guidance (6) Ways to mitigate impact (7) Effects on minimally invasive training (8) Staff morale, mental health and staff support (9) Mentorship and (10) Recovery of training. The following mitigation techniques were suggested: (i) supervised training throughout the patient journey (ii) trainer led simulation training (iii) use of immersive technologies (iv) individualised training targets (v) dedicated training lists (vi) trainee proactiveness, enhanced by the introduction of a chief resident (vii) structured mentorship (viii) need for national guidelines.

Conclusion
Although surgical services and training are normalising, surgical trainees have a significant gap of surgical exposure accounting for the two years of the pandemic. The current qualitative study explores the perceptive of international experts on effective ways of bridging that gap and provides a practical pathway to achieving recovery of training in the post pandemic era.
FTP8.2 The Development of a Peer Led Plastic Surgery Teaching Programme for Junior Doctors working in a University Based Teaching Hospital
Authors: Tan Wei Wen , Hughes Dominique , Saghir Mohammed , Al-Masri Kazem , Mills Kelsey , Wensley Katherine 
Published: August 2023

Abstract

Background
The busy nature of Plastic Surgery departments often means that formal teaching and learning opportunities can be somewhat scarce. This can result in junior doctors struggling to manage their work duties effectively. The aim of this study was to assess the impact of implementing a peer led teaching programme on the ability of junior doctors to manage their workload.

Methods
A teaching programme including elective and trauma topics on Plastic Surgery aimed at the level of junior trainees was implemented following discussion with our five juniors. The sessions were led by the registrar team and varied from formal lecture-based teaching to case-based discussions. After each session attendees completed a survey which included questions regarding their knowledge on the topic and their confidence on managing these cases before and after the session and on general aspects of the session.

Results
There were 8 teaching sessions included. The feedback rate for each was 100%. The results showed that all trainees either agreed or strongly agreed that the sessions were useful, and the content was delivered clearly and effectively. All trainees reported an improvement in confidence in their knowledge following the sessions. Trainees agreed and strongly agreed that the knowledge they gained would help them manage their elective and on-call duties more effectively.

Conclusion
This study shows that the establishment of a peer led teaching programme by utilising ideas from junior and senior members of staff, can allow trainees to be more confident in managing their workload. Thereby, potentially, allowing for delivery of a more effective service within Plastic Surgery Departments.
FTP8.3 Staff Reported Experience Measure (SREM) survey highlight discordance
Authors: Riyazati Mahta , Gouaalla Hafsah , Ali Fizza , Nyantakyi Maame , Gambhir Raghvinder Pal Singh 
Published: August 2023

Abstract

Aims
Our study aimed to assess the results of the Staff Reported Experience Measure (SREM) survey compared to the Patient Reported Experience Measures (PREM) survey in renal care and evaluate if there was a difference in perception of care received and delivered.

Methods
Following on from our initial study on PREMS for patients on Dialysis, we adapted the same survey for the staff to get the provider's perspective. The 38-question SREM survey covered the same 14 domains and measured experience using a 1-7 rating scale. The results from the surveys were analysed and compared to results from the patient surveys.

Results
We had 49 PREMs and 20 SREMs in the study period of 3 months. On average, staff responses were 0.8 points higher than patients’, with their greatest difference seen in questions for emotional wellbeing (on average, staff responses were 1.95 points higher), kidney support groups (2.08 points higher), and efficiency of communication between the renal team with the GP (1.41) and non-healthcare workers such as social workers (1.64). Questions relating to communication of the patients’ kidney disease treatment, complications and addressing anxieties were consistently scored lower by patients than staff (difference of 0.83, 1.19 and 1.01, respectively).

Conclusions
Our study found a discrepancy between the perception of the patients' experience of the renal care they receive to what the staff thinks they provide. The disconnect between staff and patients’ perception can be addressed through more patient focus group support and staff education.
FTP8.11 Impact of COVID-19 on operative timing for plastic surgery hand trauma in a plastic surgery tertiary referral centre
Authors: Ishak Lisa , Bramhall Russell , Murphy Adrian 
Published: August 2023

Abstract

Aim
To evaluate the impact of COVID-19 on operative timing for hand trauma in a plastic surgery tertiary referral centre.

Methods
Data was collected retrospectively on 80 patients who underwent surgical management for closed hand fractures, digital nerve injuries, and tendon injuries. Forty patients were in the pre-covid group (Jan-Mar 2019) and 40 in the post-covid group (Jan-Mar 2022).
Outcome measures:

Results
There was a statistically significant difference in operative delay time between the pre-covid group and the post-covid pre-vaccine group for hand fractures (2.5 vs 3.9, P=0.0503), tendon injuries (1.4 vs 2.2, p=0.016), and overall (1.9 vs 3.3, p=0.0024). There was no significant difference between the 2 groups for nerve injuries (3.8 vs 1.8, p=0.3062).
In the post-covid group, BSSH operative timing requirements were met for a lower proportion of patients than the pre-covid group for hand fracture fixations (85% vs 100%), nerve repairs (87% vs 100%) tendon repairs (85% vs 100%). Overall, there was a statistically significant difference between the 2 groups (85% vs 100%, p=0.0214)
Operative delays were documented as being related to COVID-19 in 100% of patients who did not meet BSSH operative timing requirements.

Conclusion
COVID-19 has had a significant impact on operative timing for plastic surgery hand trauma. Further studies are needed to evaluate the usefulness of various interventions in the recovery of services following the COVID-19 global pandemic.