bluuebunny/crossref_metadata_2025_split huggingface dataset:
ThTP5.8 Single centre, single surgeons’ experience of laparoscopic emergency surgery from a tertiary care NHS hospital: delay in surgery is associated with higher mortality and morbidity
Authors: Subramanian Atreya , Swaminathan Christie , Siby Jayas , Singh Anurag , Sajid Muahmmad 
Published: August 2023

Abstract

Aims
The objective of this article is to present a single centre experience of laparoscopic emergency surgery reporting outcomes influenced by delay in surgery.

Methods
A retrospective review of case notes to evaluate postoperative outcomes in patients undergoing laparoscopic emergency gastrointestinal surgery.

Results
There were 172 major laparoscopic emergency procedures over a span of 5 years. Forty-one colorectal resections were performed within 48 hours of admission (group A) compared to 50 resections (group B) after 48 hours. Mean hospital stay was shorter in group A (10.57 versus 19.97) days. No mortality reported in the group A whereas 4 patients died (8%) in group B. Lower morbidity percentage was also observed in group A (14.6 % versus 22 %). Twenty small bowel resections were performed within 48 hours of admission (group C) compared to 6 resections (group D) after 48 hours. Mean hospital stay was shorter in group C (8.6 versus 29.5) days. 3 patients died (15%) in group C whereas no mortality reported in the group D. Lower morbidity was also observed in group C (14.6 % versus 22 %). Laparoscopic adhesiolysis was performed in 28 patients and significant reduced hospitalization (3.6 versus 12.5 days) and reduced morbidity (0 versus 0) was noted in patients undergoing surgery within 48 hours of the admission. Laparoscopic hernia repair was performed in 20 patients and significant reduced hospitalization (4.5 versus 8.2 days) and reduced morbidity (13.7% versus 20%) was noted among patients who underwent surgery within 48 hours of admission.

Conclusion
Early laparoscopic surgery in acutely ill surgical patients is associated with better surgical outcomes
ThTP6.9 Assessing the Quality & Completeness of Discharge Summaries
Authors: Thorold Colette , Cooper Danni , Badrinath Krishnamurthy , Hope Carla 
Published: August 2023

Abstract

Objective
A review of the timeliness, accuracy, and completeness of surgical discharge summaries.

Aims
To assess whether discharge summaries are sent within 24hours of discharge and if they contain accurate information for the patient and the GP in terms of case summary, follow up plans and post-operative instructions.

Methods
Patients admitted under General Surgery/Urology at a DGH during February and May 2022 were identified. 162 patients were identified, and a random sample of 45 patients was analysed.
The discharge summary was compared to inpatient notes and rated against a pre-determined standard including accuracy of operative details, use of patient friendly language and safety netting advice. Data was collected by two independent doctors.

Results
43/45 (96%) of discharge summaries were completed on the day of discharge. 44/45 completed operative details which was accurate in 40/44. 83% specified a follow up plan. 50% described a follow up investigation, but these were only requested in 33% of cases. When relevant, instructions regarding stitches were given in 38% of cases, wound care instructions in 0% and in 50% instructions were given regarding indwelling drains. Overall, 51% of summaries were rated as using patient friendly language. 22% had inadequate safety netting advice.

Conclusions
Overall, discharge summaries were completed within 24hours. The use of patient friendly language, safety netting advice and post-operative instructions needs improvement. It is important that ongoing investigations are requested at the time of discharge to avoid delays or omissions in patient care. We recommend additional training for rotating doctors at induction and propose a discharge template for common surgical conditions.
ThTP6.10 A multi-specialty clinical audit to assess true surgical site infection incidence at a district general hospital in Kent
Authors: Gardner Alvin , Tamrakar Abhishek , Wates Emma , Atherley Isabella , Nebo Vivien , Fernandes Roland 
Published: August 2023

Abstract
A surgical site infection (SSI) is a healthcare-associated infection which occurs within 30 days of surgery, or within 90 days of surgical implantation. SSIs cause significant morbidity and mortality. 3 types of SSI are recognised: superficial incisional, deep incisional and organ/space.
Our audit aim was to assess our hospital performance against established national targets: SSI rates &lt;1% following clean procedures and &lt;10% following clean-contaminated surgery.
Retrospective data collection was carried out. Patients who underwent surgery in theatres throughout 12/7/22 - 31/8/22 were included. Clinical records were reviewed, and follow-up telephone calls were made to capture any additional SSIs.
955 patients were included in the 1st cycle. Overall SSI rate was 14.5% (n = 138). This varied across specialties, being 18.1% for general surgery (n = 45/249) to 4.3% for paediatric surgery (n = 2/47). Incidence of SSIs in the elective and emergency settings for general surgery were 12.84% (n = 14/109) and 22.14% (n = 31/140) respectively. SSI rates also varied within each specialty according to procedure type. Within orthopaedics, Spearman’s correlation coefficient for procedure type and association with SSI showed statistical significance, Rs 0.961, P &lt; 0.001. 38 SSIs were identified from follow-up telephone calls.
This audit has demonstrated that the true incidence of SSIs is likely to be significantly higher than anticipated if hospital admission is the only criteria to capture data. Our results show there is scope for improvement to reduce SSIs. We have since implemented Oxford’s 8-point SSI reduction bundle. A re-audit is scheduled for 2023.
ThTP7.1 An audit of outcome of rectal cancer patients who were offered primary surgery. Are we following NICE guidelines for management of rectal cancer? –A retrospective cross sectional study at a District General Hospital
Authors: Wani Ishfaq , Husain Najam , Alam Abu , Narayanasamy Sangara , Thomas Pradeep 
Published: August 2023

Abstract

Aims
The aim of this audit was to analyse whether we are following NICE guidelines regarding management of the rectal cancer. We also analysed the outcome of rectal cancer patients who were offered primary surgery.

Methods
It was a retrospective study in design. We evaluated 47 patients out of 266 patients who were registered as rectal cancer between 2017 to 2022. Only patients who were offered primary surgery were included. Patients with metastatic cancer, those unfit for chemoradiotherapy and those who were offered neoadjuvant therapy were excluded.

Results
We identified 47 patients with rectal cancer for evaluation. The mean age at presentation was 72 years. 65.95% (n=31/47) were men, 34.05 % (n=16/47) were women. After a median follow of 34 months, local recurrence rate was noted in 24% and distant metastasis in 32%. We also noted that 52% of the patients were disease free and total mortality of 12%.

Conclusion
Preoperative chemoradiotherapy comprises a vital part of the management part for rectal cancer patients. Evidence has showed that it decreases the local recurrence rate and increases the overall disease free survival. In our study, we found that compliance to the NICE guidelines was not satisfactory and outcome results were not at par with National Cancer Excellence centre's of the United Kingdom. The recommendation was to follow the updated NICE guidelines in order to standardize the treatment throughout the United Kingdom and for better outcome results.
ThTP7.2 For T4 rectal cancers (low) undergoing abdominoperineal resection (APER), should surgery be based on baseline MRI or Preoperative scans?
Authors: Saklani Avanish , Desouza Ashwin , Kazi Mufaddal , Raj Prudvi , Sharma Vivekanand , Janesh M 
Published: August 2023

Abstract

Background
Neoadjuvant therapy is standard of care for locally advanced rectal cancer. For low Rectal cancer which are T4 and require surgery after neoadjuvant treatment, there is a dilemma whether plane of surgery should be based on primary MRI or restaging MRI. At our institute surgery is based on Preoperative MRI scans.

Methods
To test this hypothesis, we compared outcomes of low Rectal cancers which were T3MRF (mesorectal fascia) positive (high risk) i.e group A to T4 rectal cancers, i.e group B who underwent APER after neoadjuvant therapy. Patients who underwent pelvic exenteration for persistent disease, or those who went on wait and watch programme were excluded.

Results
Between June 2010- July 2022, 953 APER were performed for low rectal cancers (adenocarcinoma) at our institute. Keeping follow-up in mind, we included 311, T3 MRF-positive patients and 101 T4 patients operated between 2010-2018.
Group B patients included a higher number of females, lower BMI, and had a higher incidence of consolidation chemotherapy and short-course radiation. They were more likely to undergo extended TME compared to Group A (33.33%) vs (50.16%). This group also had higher blood loss and morbidity.
In terms of oncological outcomes, circumferential margin involvement and local recurrence (isolated + systemic) in 2 groups were similar, Group A(37.12%) and (9.35%) compared to group B (11.11%) and (6.93%).
There was no difference in 5 year disease free or overall survival.

Conclusion
T4 low rectal cancers, APER after neoadjuvant therapy can be based on preoperative MRI scans with no detrimental outcomes.
ThTP7.3 Do patients receive written information? An overview of the management of acute uncomplicated diverticulitis
Authors: Robertson-Jones Beatrice , Rahman Atiqur , Elzaafarany Ahmed , Chu Ee Earn , Thomas Kerushan , Mostafa Mohamed 
Published: August 2023

Abstract

Background
The management of acute uncomplicated diverticulitis was audited in compliance with NICE, the World of Society of Emergency Surgery and the Association of Coloproctology of Great Britain and Ireland guidelines. Included was the advice for appropriate written information. The initial cycle found no consistency in written advice if given at all.
This audit analysed the compliance of providing written information to patients with acute diverticulitis. Following the initial cycle identifying significant discrepancies between patients, a secondary aim was formed to publish a standardised patient information leaflet.

Method
50 consecutive patients presenting to A&E with CT-proven uncomplicated acute diverticulitis were included. If any, advice on discharge was assessed for topics and consistency. Other factors were considered including if discharged directly from A&E or antibiotic administration.

Results
The mean age of patients was 58.4 years. 30 patients were admitted, 20 were discharged from A&E. 41 patients received antibiotics. All patients were Modified Hinchey Classification 1a or 1b.
21 patients had no documented written advice on discharge. Most commonly, the advice given was to seek medical attention or return to hospital if increasingly unwell (eight) or dietary advice while in acute infection (12).

Conclusion
Almost half of patients had no written advice and there was no consistency in the other half. A standardised approach was required hence the need for the patient information leaflet to be created. This includes all topics recommended by guidelines and ensures no information is missed for patients. The leaflet is now published.
ThTP8.6 A novel method for stoma isolation in a complex abdominal wound treated with vacuum assisted closure
Authors: Browning Nick , Thornton James , Smith Andrew 
Published: August 2023

Abstract

Introduction
Vacuum assisted closure (VAC) is a well established method in the treatment of abdominal wounds where the fascia is intact. The presence of one or multiple intestinal stomas or fistulae may present challenges in successful application of VAC therapy. Key concerns with the presence of intestinal stomas alongside open abdominal wounds is the risk of contamination with stoma effluent or the potential for the negative pressure to create enterocutaneous fistulae. Here we describe a novel method for isolating a small bowel stoma existing within a large abdominal wound, allowing successful resolution having failed conventional management.

Method
No device currently exists to allow a functioning stoma to be isolated within an abdominal wound requiring VAC therapy. This method relies on modification of a standard silicone fistula crown, this is then integrated into the standard VAC dressing, using stoma seals to provide successful vacuum. Stoma output is then successfully isolated, protecting surrounding tissue and supporting wound granulation without concern of wound effluent contamination.

Discussion
Of key importance in this case is the proximity of clean wounds with skin grafts done by plastic surgeons also being managed with VAC therapy and the importance of preventing contamination to allow successful granulation without further debridement of an already large wound.

Conclusion
Although this situation is rare with the increasing use of vacuum assisted closure devices for the management of wounds across many specialities this scenario is certainly not unprecedented. The technique described allowed successful treatment of a complex wound with significant existing comorbidities allowing resolution of a very challenging situation.
FTP1.2 Delay in ankle fracture fixation against BOAST guidelines for ankle fractures
Authors: Hassan Rawan , Divekar Manish 
Published: August 2023

Abstract

Aim
Ankle fractures are common, and the majority are the result of low energy torsional trauma. The aim of treatment is to restore and maintain stability and alignment of the joint, ideally with normal anatomy of the ankle mortise. According to BOAST guidelines for ankle fractures, Early fixation within 24-48 hours is recommended in the majority of patients under 60 years when the ankle mortise is unstable. This study aimed at assessing our practice in managing ankle fractures against BOAST guidelines and infection rate assessment.

Methods
Data was collected respectively from electronic patient records for three months period and entered excel. First cycle results were presented in a departmental audit meeting and recommendations to improve practice were acted upon. Second cycle data was collected three months later and for three months period. Final re-audited results were presented in a departmental audit meeting.

Results
First cycle results: only 11% of patients had their ankle fractures fixed within 48 hours and none of them had surgical site infection. 65.2 % of patients had their operations over a week with an Infection rate of 10.6%.
Second cycle results: 19% of patients had their ankle fractures fixed within 48 hours and none had surgical site infection. 47.6 % of patients had their operations over a week with an Infection rate of 4.8%.

Conclusions
Second cycle results showed improvement in operative timing and surgical site infections rate against BOAST guidelines compared to initial first cycle results. Early fixation for ankle fractures is associated with lower infection rates.
FTP1.3 Woodcast is Ecologically Sound and Tolerated by Majority of Patients
Authors: Hassan Rawan , Darke Emma , Duncombe Justin , Dias Ana , Anderson Kerry , Middleton Rory 
Published: August 2023

Abstract

Aim
NHS England has set itself the task of delivering a “Net Zero” National Health service by 2040. It is incumbent upon all health care practitioners to work towards this goal. Orthopaedic surgeons are no exception. Distal radial fractures are the most common fractures sustained by the adult population. However, studies are shortcoming on individual patient experience. The aim of this study was to assess the patient’s satisfaction and outcomes with woodcast in the conservative management of distal radius fractures compared to the standard synthetic cast.

Methods
For all patients managed with woodcast in our unit, we undertook a structured questionnaire that included the The Oxford cast experience score, the numerical pain scale and qualitative open-ended questions about individual patient experience at the time of injury and six weeks after.

Results
30 patients were initially managed with woodcast. 80% of patients tolerated woodcast for the full duration of their treatment. Of these, 20% didn’t tolerate woodcast and had their casts removed within 48 hours. Of the remaining, 79.1% were satisfied about woodcast comfort, 66% were very satisfied about woodcast weight, 70% were satisfied with temperature and sweatiness, 62.5% were very satisfied about the smell/odour, and 75% were satisfied about the level of support woodcast provided. During their treatment, 83.3% of patients rated their pain as five or less.

Conclusions
For those who completed their treatment in woodcast, none required any further intervention or utilised the open appointment because of ongoing wrist problems. In conclusion, when woodcast is tolerated, patients’ satisfaction and outcome levels were good.
FTP1.6 Epidemiology of Medial Tibial Plateau Fractures and Factors Associated with its Outcomes
Authors: Sanmugam Kischentaran , Keating John 
Published: August 2023

Abstract

Background
Medial tibial plateau fractures (TPFs) are reported to be difficult to treat and are subject to higher levels of postoperative complications. The aim of the study was to evaluate the results of management of medial and bicondylar TPFs and determine the factors influencing its outcomes.

Method
143 patients with TPFs were included in this study during a total period of 6 years. The groups were divided into medial TPFs (B-type) and bicondylar TPFs (Ctype), according to the AO/OTA Classification and Schatzker Type IV, V and VI classification. Patient information including basic demographics, duration of followup, mechanism of injury, comorbidities, management, and post-operative complications were included in this study. Analysis of this data was done to determine a correlation between the outcomes of both fracture groups.

Results
The mechanism of injury profile showed no significant difference with high energy trauma seen in 48% of B-type and 59% in C-type fractures. Age has no influence on the fracture outcomes. Most patients in both groups were mainly treated with ORIF. The incidence of infection, compartment syndrome and post-traumatic arthritis are higher in bicondylar TPFs compared to medial TPFs, with a similar number of patients with CPN Palsy in both groups. No significant difference was found between both fracture types in every aspect of patient information that was compared in this study.

Conclusion
The outcomes of medial TPFs are similar to bicondylar TPFs in terms of complication rates, even though one would generally assume medial TPFs to be less severe than bicondylar TPFs
FTP1.9 Two-Stage flexor tendon repair versus Primary repair: An evaluation of subjective and functional outcomes at a Regional Centre for Plastic Surgery
Authors: Mitchell Robert , Jones Rowan Pritchard 
Published: August 2023

Abstract

Aims
The hand, as the primary executing organ, is at the centre of nearly all daily activities. In the anatomical extremity, the hand is frequently exposed to the potential risk of injury. If a flexor tendon is injured and recognized as needing surgical intervention, two main options are available; Two-stage Flexor Tendon (TSFT) repair or Primary repair. We evaluated the subjective and functional outcomes of the two surgical methods described above in patients presenting with flexor tendon injury in Zone I or II over a 5-year period.

Methodology
A retrospective study employing 35 patients (and a total of 42 tendon injuries) requiring TSFT repair over a 5-year period and 190 patients requiring primary flexor tendon repair between 2012-2014. Data collected included patient demographics, injury details, intraoperative findings and post-operative outcomes.

Results
Of the 35 digital injuries assessed, 15.8% had a good outcome, 21.1% with a fair outcome and 63.2% with a poor outcome, based upon the Strickland grading system. In comparison, of those undergoing primary flexor tendon repair, 51.5% had a good / Excellent outcome, leaving 48.5% with a poor outcome. Rupture rates post-surgery were higher in those undergoing TSFT repair than primary repair; 23.8% versus 12.0% respectively.

Conclusion
A damaged flexor tendon requiring surgery should ideally be repaired within 72 hours of initial insult via primary repair. Delayed presentation and subsequent scar formation with proximal stump retraction warrants a two-stage approach. It is widely accepted that a reconstruction in two-stages can yield effective results in restoring digital function, but these results are often superseded by a primary repair.
FTP1.11 Retroperitoneal injury is associated with anastomotic leak after colonic injury
Authors: Sullivan Thomas , Marsden Max , Devenport Ross , Hancorn Kate 
Published: August 2023

Abstract

Background
The aim of this retrospective observational study was to investigate the association between concomitant retroperitoneal injury and colonic repair failure. Operative repair of perforating colonic injury should ideally maintain bowel continuity. Diversion may be preferable where the repair is likely to fail. To make this decision surgeons must be aware of factors associated with risk of operative failure. Concomitant retroperitoneal injury (RPI) may represent an occult risk factor for post-operative colonic complications.

Methods
Single-centre study of adult patients admitted to a Level 1 trauma centre between June 2015 and July 2020. Trauma patients with full thickness perforation of either the colon or intraperitoneal rectum were included. We compared clinical outcomes and specifically the incidence of colonic repair leak in patients with or without retroperitoneal injury (RPI).

Results
Seventy-seven patients met inclusion criteria, of whom 33/77 (43%) had RPI. Mechanism of injury was penetrating in 61/77 (79%) and 49/77 (64%) had isolated abdominal injuries. Patients with RPI had significantly more leaks compared to patients without (9/33 [27%] versus 3/44 [7%], RR 2.0, 95%CI 1.2 to 3.1 p=0.024). Post-operative leak was higher in shocked patients (shock 3/11 [27%] versus not-shocked 9/65 [14%], p=0.37) or those requiring damage control surgery (DCS) (DCS 6/23 [26%] versus non-DCS 6/54 [11%], p=0.17) but neither reached statistical significance.

Conclusions
RPI is associated with an increased incidence of complications after colonic repair. When selecting operative strategy for perforating colonic injury, surgeons should be aware of increased risk of operative failure in the presence of concomitant RPI.