bluuebunny/crossref_metadata_2025_split huggingface dataset:
FTP2.1 Management settings and follow-up of acute diverticulitis
Authors: Albendary Mohamed , Yiannikouride Maria , Tuttle Christopher , Al-Aghbari Maram , Deeknah Abdulqudus , Bhandari Santosh , Besali Mina 
Published: August 2023

Abstract

Aims
This audit evaluated our management of acute diverticulitis against the NICE and ACPGBI guidelines. We explored follow-up luminal investigations to ensure patients safety, and practicality of ambulatory management to potentially improve bed capacity and reduce costs.

Method
Retrospective data of patients presented acutely with CT-proven diverticulitis from 01/06/2021 to 31/10/2021 was collected. We focused on clinical, biochemical and radiological severity, management, and follow-up investigations.

Results
Records of 142 patients were evaluated, most of them had mild clinical disease with significant qSOFA score in only 8 patients. Most of patients had WCC of less than 15 and CRP of less than 100. Even in radiological severity, class 1a of modified Hinchey classification (uncomplicated disease) dominated with 96 patients.
Interestingly, only 22 patients were treated via ambulatory care, while the remaining 120 received inpatient care. 10 of the inpatient treated patients required HDU/ ITU support and most of the hospital stays were 7 days or less. The treatment was predominantly non-operative, with only 4 patients required surgery and 6 others required radiological drainage. The 1-year follow-up showed only 16 readmissions.
As for the follow-up investigations, 45 did not have any follow-up investigations or clinic reviews, 14 of them had complicated diverticulitis. Of the 97 patients who were followed up, 88 patients had endoscopic evaluation and 8 underwent CT colonography.

Conclusion
Since most patients of acute diverticulitis present with clinically, biochemically, and radiologically mild and uncomplicated disease, ambulatory management should be encouraged where possible. While 1-year readmissions remain low, it is crucial that patients, especially those with complicated disease, receive luminal investigations.
FTP2.4 Colorectal Resections at an Elective Hub; A service evaluation
Authors: Shukla Yash , Blacker Sarah , Trivedi Prateesh , Trickett Jonathan , Nisar Pasha 
Published: August 2023

Abstract

Aim
Rising acute hospital bed pressures that have persisted post-pandemic have led to increased surgical cancellations and growing waiting lists. Ashford and St Peters Hospital Trust set up a unique elective surgical hub at Ashford Hospital to ensure the continued provision of surgical services, unaffected by the capacity pressures of an acute hospital site. The introduction of a level 1.5 Enhanced Care Unit (ECU) has enabled many colorectal resections to be performed at the elective hub. We aim to evaluate elective colorectal resections at this hub since the introduction of ECU.

Methods
Evaluated all elective colorectal resections in the 12 month period since the introduction of ECU (1st April 2021 - 31st March 2022). Procedure, surgical approach, histology, length of stay, post-operative complications and inter-hospital transfers were recorded for each case. Statistical analysis was performed on the data collected.

Results
In 12 months,169 and 36 colorectal resections took place at the acute site versus the elective respectively. At the elective hub, 50% of patients were male, the median age was 62.5 yrs, 89% were ASA 2. Right hemicolectomy was the most common procedure (50%) followed by high anterior resection (36%). The open conversion rate was 8%. Three patients (8%) required transfer to St Peter’s, 2 of which had an anastomotic leak.

Conclusions
An elective hub provides a safe location for colorectal resections. Appropriate case selection involving consultant surgeons and anaesthetists ensures low transfer rates. Expanding this service will relieve bed pressures at St Peters and reduce waiting lists.
FTP3.2 Differences in the Acute Phase Response in Right-Sided Colorectal Surgery: Evaluation of the Kono-S Anastomosis
Authors: Kapur Ajay , Hassan Sarah , Malcomson Lee , George Bruce 
Published: August 2023

Abstract

Aims
CRP monitoring has become routine post-operative practice in resectional colorectal surgery and is useful as a predictive tool for identification of anastomotic leak. Day 3 CRP &gt; 150 has been shown to be highly predictive of anastomotic leak. The acute phase response observed in surgery for Crohn’s disease (CD) is often more pronounced compared to malignancy and this is not accounted for in post-operative monitoring. This study looks at the difference in CRP in patients undergoing right hemicolectomy for cancer versus CD and evaluates any difference in CD patients who have conventional versus Kono-S anastomosis.

Methods
A single-center retrospective analysis of patients undergoing right hemicolectomy for malignancy and CD was undertaken, including CD patients with conventional and Kono-S anastomosis. Primary outcomes included CRP on Day 1 and 3 post-surgery. Length of stay, leak rate and post-operative infections were recorded. Analyses were carried out including and excluding patients with post-operative leak and infection.

Results
Day 1 CRP was significantly higher in patients undergoing surgery undergoing surgery for CD compared to malignancy (p &lt;0.001). Day 3 CRP was significantly higher in patients undergoing surgery for CD compared to malignancy (p = 0.017). There was no significant difference between CD patients undergoing surgery with Kono-S anastomosis compared to conventional anastomosis. Kono-S anastomosis was not associated with any difference in leak, infection, or length of stay.

Conclusions
The rise in post-operative CRP is more pronounced in CD patients compared to cancer patients. CD patients with Kono-S anastomosis do not have significantly different post-operative CRP from patients with conventional anastomoses.
FTP3.8 Are we doing enough to get patients moving after colorectal cancer surgery?
Authors: Paul Melanie , Lund Jon , Phillips Bethan 
Published: August 2023

Abstract

Background
Enhanced recovery after surgery (ERAS) is a widely implemented, multi-disciplinary pathway designed to reduce perioperative stress, maintain postoperative physiological function and accelerate recovery after surgery. Postoperative movement, as advocated by ERAS, reduces postoperative muscle wasting and the risk of complications such as chest infections and ileus and should be encouraged in all colorectal cancer patients.

Methods
Nine adult patients undergoing elective colorectal cancer resection had their physical activity assessed using an ActivPAL™ accelerometer applied to the anterior right thigh from the first postoperative day for 7 days or until discharge (if sooner). Time in bed and step count was collected.

Results
Patient age ranged from 54-87 years (median = 71). Mode of access included laparoscopy (n=7), robotic (n=1) and open (n=1), and no patients required intensive care postoperatively. The median length of hospital stay was 6 days (interquartile range (IQR): 3 days) and patients wore the accelerometer for a median time of 6 days (IQR: 2 days). The median step count on postoperative days 1, 3 and 5 was 128 (IQR: 236), 506 (IQR: 532) and 438 (IQR: 1256) steps/day, respectively. The median time spent in bed was 10 (IQR: 2.2), 10 (IQR: 8.5) and 9 (3.4) hours, respectively.

Conclusions
Even in those patients engaged in an ERAS programme, time spent performing physical activity is variable and does not appear to increase during the postoperative inpatient period. Step count targets may be a useful goal setting, patient-led directive to improve the consistency of postoperative mobilisation.
FTP3.10 Does Anti-Thrombotic Medication affect the PPV of the Feacal Immunochemical Test: A Single Centre Retrospective Study
Authors: Peters Paul , Manu Nichola , Butler Rebecca , Zardab Mohamed , Magee Connor , Wilson Jeremy , Digne-Malcolm Holly 
Published: August 2023

Abstract

Aims
Our aim of this study was to determine whether anti-thrombotic medication (i.e. anit-coagulative's such as DOACS and anti-platelets) had a causal relationship to the outcome of the FIT score by looking at the PPV in its detection for malignancy and significant neoplasm.

Methods
We analysed records of 500 patients over 2 years (June 2020 - June 2022) from a single centre database of patients who are FIT positive and we reviewed all their endoscopy and CT images to determine the proportion of patients with a diagnosis of Colorectal Malignancy and advanced colorectal neoplasm.

Results
The key finding from our data we discovered that the PPV of having a Colorectal Malignancy/Advanced Neoplasm was significantly lower for patients who were on anti-thrombotic medication (33.1%) when compared to patients who were not on any anti-thrombotic medication (48.8%).

Conclusion
Our findings display that the use of anti-thrombotic medication lowered the incidence of significant colorectal neoplasms and malignancies detected on colonoscopy or CT imaging for patients who are FIT positive in our local population. It is the first out of the United Kingdom to demonstrate data that is consistent with current literature, thus we can suggest that these medications increase the number of False Positives from the FIT (with a FIT cut-off score of &gt;10ugHb/g). From further analysis we will look to answer to the question. ‘Whether having anti-thrombotic medication can increase the likelihood of smaller cancers bleeding?'
FTP3.13 Patients undergoing major abdominal cancer surgery should receive 28 days of VTE prophylaxis: a single-centre audit of patients treated surgically for colorectal cancer
Authors: Epanomeritakis Ilias , Radhakrishnan Ramila , Bevan Katharine 
Published: August 2023

Abstract

Aims
The incidence of venous thromboembolism (VTE) following major abdominal cancer surgery is reduced by extended post-operative VTE prophylaxis using low molecular weight heparin, without an associated increase in bleeding risk. The National Institute for Health and Care Excellence (NICE) issued guidance in 2018, recommending 28 days of post-operative VTE prophylaxis for these patients. We audited local compliance for patients undergoing major surgery for colorectal cancer.

Methods
Clinical records of patients with colorectal cancer were retrieved from a local registry. 104 patients treated surgically between 01/08/2021–24/01/2023 were included in the first audit cycle. Retrospective analysis investigated the nature of operations (elective or emergency) and whether extended VTE prophylaxis was prescribed. Records were examined for documented plans for prophylaxis post-discharge. Data was presented locally and strategies to increase compliance were implemented. Second cycle data is being collected prospectively from 25/01/2023 until the presentation date.

Results
Of the included patients, 89% underwent elective operations and 11% required emergency surgery. Our first cycle demonstrated 84% compliance with guidance across all patients (88% for elective and 55% for emergency procedures, respectively). An explicitly documented plan for extended prophylaxis was observed for 82% of recipients and 12% of those who did not receive it.

Conclusions
Compliance to guidance was particularly high for electively treated patients. This should not differ between elective and emergency cases. Documenting post-discharge anticoagulation plans may act as a simple quality improvement measure. We plan to re-audit and present second cycle results following implementation of interventions, including education, posters, and improving electronic discharge processes.
FTP6.1 A little respect! A closed-loop audit increasing awareness of ReSPECT forms in a busy general surgical department
Authors: Bruno Paris , McKinlay Ailsa , Eva Charlotte , Roe Thomas 
Published: August 2023

Abstract

Aims
ReSPECT forms have been introduced by Resuscitation Council UK to provide recommendations for patients’ emergency care. The primary aim of the audit was to assess the completion rate of ReSPECT forms on a busy surgical ward. Secondly, the audit aimed to both increase the awareness and the completion rate of ReSPECT forms.

Methods
Data was collected in the form of random spot-checks of completed ReSPECT forms for all general surgical inpatients at our general hospital. The first intervention involved the addition of a column to the surgical ‘take’ list to highlight the presence or absence of ReSPECT forms. Team education using a novel poster, prioritising the urgency of completion of ReSPECT forms dependent on patient’s co-morbidities, and a teaching session was the intervention for the second cycle.

Results
The initial completion rate of accurate ReSPECT forms was 31%. Following the first intervention the ‘ReSPECT column’ on the list had been completed for 15% of inpatients and the overall completion rate of ReSPECT forms was 35%. After the ReSPECT poster and teaching the usage of the ‘ReSPECT column’ increased to 39% and overall completion rate was 33%.

Conclusions
The addition of a column to the acute, surgical list was a simple and effective way of increasing awareness of completed ReSPECT forms. Increased compliance may be achieved by finding more efficient methods of monitoring completion. Overall completion of ReSPECT forms had improved with the interventions, however, due to the high turnover of surgical patients, there are still further improvements possible.
FTP6.4 Management and Outcomes of Acute Diverticulitis in Immunosuppressed Patients
Authors: Farrow Emily , Dean Harry , Britton Emily , Abdel-Khaleq Sameerah , Bennett Joanne , Cook Tim 
Published: August 2023

Abstract

Aims
Previous studies have suggested that immunosuppressed patients with acute diverticulitis are at high risk of failing conservative management and many will require urgent surgical intervention. Some series have shown mortality rates as high as 39% and 56% with medical and surgical management respectively. The aim of this study was to analyse the management and outcomes of immunosuppressed patients presenting with acute diverticulitis.

Methods
Data were collected on patients admitted as an emergency with acute diverticulitis over a 2-year period (1st January 2018 to 31st December 2019). Immunosuppressed patients were identified and divided into 5 groups according to the cause: group 1, chronic corticosteroid use; group 2, transplant patients; group 3, malignant neoplasm; group 4 chronic kidney disease; group 5, other immunosuppressant treatments. Outcomes were recorded.

Results
Sixty-one patients with immunosuppression were admitted with acute diverticulitis. The number of patients in groups 1-5 were 23, 2, 11, 16 and 9 respectively. Fifty-one patients (83.6%) had a CT during their admission and thirteen (21.3%) presented with complicated diverticulitis. Two patients (3.3%) underwent emergency surgery, both of whom were on chronic corticosteroid therapy and were alive at 1-year post-op. All fifty-nine patients (96.7%) managed conservatively survived admission.

Conclusions
This study has shown a lower rate of emergency surgery than previously observed and lower mortality with both medical and surgical management. Conservative management appears to be safe for the majority of immunosuppressed patients with acute diverticulitis.
FTP6.5 A review of a District General Hospital's performance in meeting Emergency Cholecystectomy guidelines
Authors: Gallagher Charles , Dwebi Mohammed , McAree Barry 
Published: August 2023

Abstract

Aims
Due the Covid pandemic and resultant decrease in elective cholecystectomies there has been an increase in the emergency presentation of gallstone disease to our DGH. The NICE guidelines recommend &gt;25% of Acute Cholecystitis (AC) should receive emergency cholecystectomy on admission and the AUGIS Commissioning Guide: Gallstone Disease 2016 recommends all patients with mild Gallstone Pancreatitis should have an emergency cholecystectomy on admission or within two weeks of discharge. We wanted to see was our department meeting these guidelines.

Methods
187 patients identified with AC and pancreatitis from admission records over a three month period. Review of online records narrowed this down to 53 patients with AC (without secondary complications i.e. perforation, Mirizzi) and 18 with Gallstone Pancreatitis. We followed these patients up over a six month period.

Results
AC patients: 28% (15) were deemed high risk or not suitable (13: &gt;75yo), 26% (14) emergency cholecystectomy on admission, 23% (12) awaiting clinic/ pre-assessment, 7.5% (4) Elective surgery (3 had readmissions pre elective surgery), 7.5% (4) surgery on readmission, 7.5% (4) opted out of surgery. Separately, 24.5% (13) readmitted with gallstone disease.

Gallstone Pancreatitis
44% (8) deemed not suitable (4: &gt;85yo, 4: multiple co-morbidities), 33.3% (6) emergency cholecystectomy on admission and 1 each: severe pancreatitis/ opted out/ done on readmission (2.5months later)/ done privately.

Conclusions
Our DGH is hitting the target for emergency cholecystectomies although the majority of patients presenting with AC are not suitable for surgery and there is a high readmission rate for gallstone disease. Improvement required in following up patients with gallstone pancreatitis not receiving surgery on admission.
FTP6.6 Same Day Emergency Care Satisfaction Survey, Patients and Staff Respond
Authors: Gurung Ganga , Ullah Muhammad Fahad , Oo Myo Kyaw , Chituku Tsitsi , Rao Milind 
Published: August 2023

Abstract

Surgical Same Day Emergency Care (SDEC) Satisfaction Survey - SDEC was introduced to the hospital in 2021.

Aims

Methodology

Results

Conclusion
Abstract presented at World Society of Emergency Surgery, 2022.
FTP6.8 Impact of frailty on patients undergoing emergency surgeries under general anaesthesia in a district general hospital
Authors: Jalali Uzma , Turi Mubasher , Irfan Sana 
Published: August 2023

Abstract

Aims
To assess the impact of frailty on the outcome of elderly patients underwent emergency surgical procedures in a district general hospital.

Methods
All patients above 65 years who underwent moderate/ major risk emergency surgical procedures from 1st of January 2022 to 31st of Dec 2022 were included in retrospective study. Data was collected from on call hand over and hospital electronic patients record system. Their ASA (American society of anaesthesiologist physical status classification) and P-POSSUM (Portsmouth- Physiological and operative severity score for the enumeration of mortality and morbidity) was calculated.

Results
Eighty-five patients (males:47, females:38) underwent emergency procedures in one year period. Age range was 65 to 90 years with mean age was 80.6 years. We performed 57 laparotomies, seven had laparoscopic bowel surgery. Other procedures were incarcerated hernias repair, appendectomies, lap/ open cholecystectomy/ cholecystostomy, debridement of necrotising fasciitis. Twenty-eight patients were frail (CFS 5-7) with mean ASA 3.4 and mean P-POSSUM mortality was 14.89. Fifty-seven patients were non frail with mean ASA 2.59 and P-POSSUM mortality was 16.12. Length of hospital stay was from 1 to 106 days, average being 13.7 days. Average length of stay for frail patients was 15.8 days and for non-frail was 12.9 days. Twelve patients died within 30 days of surgery or during the same admission, among them 54% were frail. Seventy five percent of mortalities were after bowel surgeries, mainly after stoma formation (both open and laparoscopic approach).

Conclusions
Clinical frailty scale is one of the predictors of prognosis along with other parameters and must be calculated at the time of admission.
FTP6.9 Death is not the worst that can happen: exploring extreme-risk in the National Emergency Laparotomy Audit
Authors: Javanmard-Emamghissi Hannah , Doleman Brett , Hare Sarah , Lund Jon , Moug Susan , Tierney Gillian 
Published: August 2023

Abstract

Background
A National Emergency Laparotomy Audit (NELA) mortality risk score of &gt;5% is considered high-risk. A threshold for very high-risk or extreme-risk has not been defined, and the outcomes of these patients are unknown.

Method
All adult patients enrolled in the NELA database December 2012-2020 were included. Patients were categorised into groups based on predicted mortality score; 50-59% (Group A), 60-69% (Group B), 70-79% (Group C) and &gt;80% (Group D). These groups were compared for demographics and outcomes such as length of hospital stay (LOS), rates of unplanned return to theatre and 90-day survival rates.

Results
Of 161,337 patients, 5196 had a predicted mortality of ≥50% (3.2%). Group A accounted for 2437 (47%) of patients, Group B 1484 (29%), Group C 843 (16%) and Group D 432 (8%). Patient age decreased with increasing predicted mortality, with a median age of 77 in Group A and 75 in Group D (p&lt;0.05). LOS increased from 26 [16-44] days in Group A to 35 [20-54] days in Group D, compared to the NELA median of 15 days. Rates of unplanned return to theatre were double in all extreme-risk groups when compared to the NELA average (11.3% vs 4.8%). The ninety-day survival was 43% in Group A, 34% in Group B, 27% in Group C and 17% in Group D.

Conclusion
The NELA score accurately predicted mortality in the extreme-risk group. In addition, for those that survive, they experience double the rate of unplanned theatre returns and double the LOS than the average NELA patient.
FTP7.5 Accuracy of the END-PAC model in predicting the risk of developing pancreatic cancer in patients with new-onset diabetes: a systematic review and meta-analysis
Authors: Carrington-Windo Eliot , Hajibandeh Shahab , Intrator Christina , James Rhodri , Hughes Ioan , Hajibandeh Shahin 
Published: August 2023

Abstract

Objectives
to evaluate the accuracy of END-PAC model in predicting the risk of pancreatic cancer in patients with new-onset diabetes (NOD).

Methods
A systematic review in accordance with PRISMA statement standards was conducted to identify all studies evaluating the accuracy of END-PAC model in predicting the risk of pancreatic cancer in patients with NOD. The number of true positives, false negatives, true negatives, and false positives were used to construct two-by-two tables, coupled forest plots and the summary receiver operating characteristic plots. We estimated summary sensitivity and specificity points using diagnostic random effects model.

Results
We analysed 26752 patients from four studies. The pooled risk of pancreatic cancer was 0.8% (95% CI 0.6%-1.0%) with median follow-up of 3 years. END-PAC score ≥3 [sensitivity: 55.8% (43.9%-67%); specificity: 82.0% (76.4%-86.5%)] which classifies the patients as high risk was associated with better predictive performance than END-PAC score 1–2 [sensitivity: 22.2% (16.6%-29.2%); specificity: 69.9% (67.3%-72.4%)] and END-PAC score &lt;1 [sensitivity: 18.0% (12.8%-24.6%); specificity: 50.9% (48.6%-53.2%)] which classify the patients as intermediate and low risks, respectively. The quality of the available evidence was moderate to high.

Conclusions
END-PAC model is promising in predicting the risk of pancreatic cancer in patients with new-onset diabetes. END-PAC score ≥3, which classifies the patients as high risk, has the best predictive performance and should be considered as optimum cut-off value. Future comparative studies are required to evaluate whether application of END-PAC model could improve pancreatic cancer early detection rate, pancreatic cancer resection rate, and pancreatic cancer treatment outcomes.