bluuebunny/crossref_metadata_2025_split huggingface dataset:
090 Transarterial Haemorrhoidal Dearterialization Versus Open Haemorrhoidectomy for Symptomatic Haemorrhoids- a Meta-Analysis of Randomized Controlled Trials
Authors: Kaur I , Sahebally S 
Published: August 2023

Abstract
Although effective, open haemorrhoidectomy (OH) is associated with significant postoperative pain. Novel non-excisional techniques such as transarterial haemorrhoidal dearterialization (THD) are increasingly advocated due to a lower incidence of pain and complications. We aimed to compare short and long-term outcomes of THD and OH in the present meta-analysis.
A PRISMA-compliant systematic review and meta-analysis was performed including randomised controlled trials (RCTs) from inception until June 2022. The primary objective was recurrence, whilst secondary objectives included complication rates, mean length of stay (LOS), operative time and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. A p-value &lt; 0.05 was considered statistically significant.
6 RCTs encompassing 474 patients were captured. There were 129 (54%) males in the THD group and 142 (59%) in the OH group. On random effects analysis, OH had a lower recurrence rate (OR = 2.76, p = 0.04) whereas THD was associated with a quicker return to baseline (MD = -14.05 days, p &lt; 0.0001). There were no differences in bleeding (OR = 0.58,p = 0.09), urinary retention (OR = 1.01, p = 0.99), incontinence (OR = 0.49, p = 0.41), anal stenosis (OR = 0.14, p = 0.19), number of patients with chronic pain (OR = 1.30, p = 0.40), operating time (MD = 11.79 mins, p = 0.20) or LOS (MD = -0.23 days, p = 0.22).
THD is a safe technique that affords a quicker return to baseline post procedure but is associated with a higher recurrence rate compared to OH.
1179 Analysis of the Staging of Colorectal Cancer Before and During the COVID-19 Pandemic in a UK District General Hospital
Authors: Hussain S , Adhya S , Andelic M , Callan R , Shamardal A , Zaidi S 
Published: August 2023

Abstract

Aim
The COVID-19 pandemic has had significant implications for delays in diagnosis and treatment of colorectal cancer. We set out to investigate the impact of the COVID-19 pandemic on the stage of colorectal cancer in operatively managed patients in our district general hospital in the United Kingdom.

Method
We retrospectively collected data for patients with colorectal cancer who underwent surgery pre-COVID-19 lockdown in the UK (January 1st, 2019 – March 22rd 2020) and compared with those who underwent surgery during the COVID-19 pandemic (March 23rd 2020 to January 2021). Pre-operative and post-operative TNM classification were assessed.

Results
318 patients underwent surgery for colorectal cancer from January 1st, 2019, to 31st January 2021: 136 in 2019, 90 in 2020, and 92 in 2021. There was a rise in proportion of T4 cancers during the COVID-19 pandemic (27%) vs pre-pandemic levels (15.7%). There was an increase in nodal positivity, with 42% of patients presenting with N1/N2 disease during the COVID-19 pandemic, compared to 38.8% in pre-COVID-19. However, we did not see a change in metastatic disease during the Covid-19 pandemic - 91.3% of patients in 2019 had M0 classification, 94% in 2020, and 93.4% in 2021.

Conclusions
There was a large reduction in patients undergoing operative management for colorectal cancer since the start of the pandemic – this may be secondary to late presentations or delays in diagnosis. There is a need for continued research to establish the long-term impacts of the COVID-19 pandemic on the diagnosis and treatment of colorectal cancer.
305 Facial Nerve Outcomes Following Malignant Lateral Skull Base Surgery at a Tertiary Centre
Authors: Prasansapakit K , Fleming J 
Published: August 2023

Abstract

Background
Although a rare malignancy, lateral skull base tumours often present a challenge to head and neck surgeons due to complex neurovascular anatomy. Patients also tend to present late with advanced disease. With lateral skull base tumours being a rare occurrence, there is limited knowledge on facial nerve outcomes following surgery.

Method
Data from 44 patients were collected and analysed. The main outcome collected in this study was facial nerve function at presentation and post op (both immediately and long-term) according to the House-Brackmann scale.

Results
90% of patients presented without signs and symptoms of facial nerve involvement. Patients who had no facial pain or paralysis at presentation are more likely to maintain normal facial functions after surgery (20 out of 26 that scored House-Brackmann 1 pre-op maintain a score of 1 in long term post-op review). 80% of those who presented with signs and symptoms of facial nerve involvement required intraoperative nerve sacrifice.

Conclusions
Patients who presented with facial pain or paralysis tend to have more advanced disease. The majority (80%) of those presenting with facial deficits pre-operatively underwent nerve sacrifice. The purpose of this study is to offer insight into facial nerve outcomes of patients who underwent lateral skull base surgery at a tertiary centre. We collected and analysed the outcomes of surgery for 44 patients, with main outcome measures including facial nerve functions based on the House-Brackmann scale, as well as any postoperative complications, recurrences, types of adjuvant therapy required and survival after the operation.
410 Is a Single Dose, Single Agent Peri-Operative Antibiotic Protocol Adequate for Endoscopic Endonasal Skull Base Surgery? A 14-Year Review of 574 Cases
Authors: Tan J Y , Mahmood A , Nix P 
Published: August 2023

Abstract
Post-operative meningitis is a rare but potentially fatal complication of endoscopic endonasal skull base surgery. As endonasal approaches to the skull base are clean-contaminated procedures, peri-operative antibiotics are routinely used. We sought to analyse the safety and efficacy of a single agent, single dose protocol in cases of endonasal anterior skull base surgery. Database of all endonasal anterior skull-base procedures performed in ENT Department at Leeds General Infirmary between 2008 and February 2022 was prospectively recorded. The primary outcome measure was development of meningitis within 30-days of surgery. Our protocol uses single dose of IV co-amoxiclav 1.2g (or teicoplanin if allergy precludes co-amoxiclav). The data was further divided according to primary or revision surgery, the presence or absence of intra-operative CSF leak, and the development or not of a post-operative CSF leak. Over the 14-year period, 574 endoscopic endonasal operations that fulfilled inclusion criteria were performed. The overall rate of post-operative meningitis across the entire cohort was 2.6%(n = 15). Among the 15 cases:80% (12/15) had intra-operative CSF leak47% (7/15) were revision cases73% (11/15) had extended endoscopic approach as pathology that required an intentional opening of the arachnoid80% (12/15) had post-operative CSF LeakThere were no cases of meningitis following repair of long-standing CSF fistula or encephalocele and surgery for sinonasal tumours with skull-base involvement.
In conclusion, a single dose of 1.2g intravenous co-amoxiclav (or teicoplanin) is safe in the context of sellar-centred pathologies, repair of pre-existing spontaneous CSF leaks, and surgery on sinonasal tumours with skull base involvement.
413 Percutaneous Bone Anchored Hearing Rehabilitation in Adults - the Nottingham Experience Over a 5 Year Period
Authors: Hao T , Cho W S , Kasbekar A 
Published: August 2023

Abstract

Aim
Percutaneous bone anchored hearing aid (BAHA) is an effective hearing rehabilitation option. However, complications including granulation, skin overgrowth and infections may lead to revision surgeries. This study aim was to assess the complication rate and potential contributing factors leading to revision surgeries.

Method
Adult patients who underwent BAHA connect (Cochlear Corp) operations between 2016 to 2021 were included. Patient notes were retrospectively reviewed.

Results
166 patients received a BAHA connect. Twenty-nine (17.5%) patients required revision surgery; 2 for granulation, 10 for skin overgrowth, 9 for infection, 7 for traumatic extrusion and 1 for failure of osteointegration. Excluding traumatic extrusion patients, 22 (13.3%) required revision surgery. 56% of patients were performed under local anaesthetic, with no difference in complication rate compared to general anaesthetic. 70% patients with Holger’s grade 4 changes and 40% patients with grade 3 findings required revision. 31% cases required revision when primary surgeon was trainee, compared with consultant (17%). There was no difference in post-operative skin problems between skin incisions made in-line vs separate from abutment. Cases with intra-operative complications, including re-siting of initial hole due to bleeding or loose fixture, had higher rate of revision. Of revision surgery patients, 14% were active smokers and 21% ex-smokers. 31% required multiple revision operations.

Conclusions
Percutaneous BAHA insertion can be performed under local and general anaesthetic. Grade of primary surgeon and intra-operative problems appear to be risk factors for requiring revision surgery. Smoking and site of incision does not appear to be risk factors for postoperative skin problems.
1208 Post-Tonsillectomy Re-Admissions – a Real Pain in the Mouth for Our Patients
Authors: Al-Hity S , Rajdev K , Giblett N 
Published: August 2023

Abstract

Aim
Uncontrolled post-tonsillectomy pain is detrimental to patient safety and recovery, increasing the risk of morbidity from complications such as infection and secondary haemorrhage. A closed-loop audit of the adult and paediatric population evaluated operative and post-operative factors, and readmission and return to theatre rates against the National Prospective Tonsillectomy Audit (NPTA) and ENT UK Tonsillectomy Commissioning standards.

Method
Data from seventy-one and forty-three patients were collated over two treatment quarters in 2019/2020, including operative indication, surgical grade, dissection technique, estimated blood loss and local anaesthetic infiltration, in addition to post-operative analgesia instruction, length-of-stay, and discharge medications. Incidences of re-presentation within thirty days were reviewed, assessing the nature of complaint and indication for readmission. Inter-cycle intervention involved departmental education and dissemination of post-operative verbal/written patient education.

Results
Overall readmissions (15.5%), pain readmissions (1.4%/n = 1) and return to theatre cases (2.8%) exceeded national standards in cycle one (&lt;15%, &lt;1%, &lt;1%), improving to standard in all domains bar pain readmission in cycle 2 (9.3%, 2.3%/n = 1, 0%). Length-of-stay was compliant throughout (0.2, 0.1 days). Documentation of post-operative analgesia instruction and simple and opiate discharge medication prescription in both adult and paediatric populations improved post-intervention (83% to 98%).

Conclusions
Scheduled, multimodal analgesia and discharge education that sets realistic expectations post-operatively are key in optimising the post-operative safety of our patients. In addition to verbal and written education, collaborative work with pharmacist colleagues to create and standardise a post-operative pain protocol and discharge analgesia pack will support and empower patients to enhance post-operative recovery and minimise avoidable hospital admission.
70 Decision to Incision Time: Can the Principle Be Applied to Emergency General Surgery in Order to Tackle Delays in Patient Care?
Authors: Smith C , Aly E 
Published: August 2023

Abstract

Aim
General surgical patients who require emergency surgery should have timely access to operating theatre to ensure optimal outcomes. It is important to evaluate delays in order to identify contributing elements and help to improve standards of surgical care. The decision to incision time interval is a benchmark used in obstetric practice. This study aimed to assess the use of this time interval in the emergency general surgical setting to consider whether the principle may be translatable.

Method
Prospective data were collected on patients undergoing emergency general surgery in a tertiary care centre over four weeks. Data were extracted from patient notes and anonymised for statistical analysis.

Results
No statistically significant associations were found with the studied variables and decision to incision time. However, this study identified clear delays, with 66% of emergency operations taking place after target time assigned by NCEPOD classification. It identified trends in varying decision to incision time in patient and procedure type. It also identified issues with documentation and an association between longer decision to incision time and post-operative length of stay.

Conclusions
This study highlights important delays in emergency general surgery. Decision to incision time reveals important trends and, with larger sample sizes, may identify areas which hinder time-sensitive procedures. This study recommends that decision time could be more formally incorporated into surgical documentation to better monitor delays. The findings of this study could inform future research, which is required to determine the true potential of using decision to incision time interval in emergency general surgery.
351 A Service Evaluation of Emergency Laparotomy and Total Parenteral Nutrition at a Single Teaching Hospital
Authors: Ashmore D , Lee M , Wilson T 
Published: August 2023

Abstract

Aim
Malnourished patients undergoing emergency general surgery (EGS) have a greater risk of mortality than those not malnourished. There is often a need for nutritional support in EGS. This study investigated the risk factors for total parenteral nutrition (TPN) in patients undergoing emergency laparotomy, and whether there is an association with the NELA risk score.

Method
A five-year review (June 2016-2021) of the local NELA database and referrals to the Nutrition Support Team was performed. Pre-operative, operative and post-operative data for patients who received TPN and those who did not was collected. Associations between risk factors including NELA score and TPN use were examined using chi squared test and Mann Whitney U, as appropriate.

Results
There were 931 NELA patients, of which 22.8% (n = 173) received TPN. Intestinal obstruction was the commonest indication for surgery at 51.3% (n = 478) with no difference in age or sex. Despite patients receiving TPN being more likely to be frail (0.004), have higher ASA scores (0.001), lower albumin levels (&lt;0.001), and worse pre- and post-operative NELA scores (both 0.002), stoma formation (0.002) and mortality (&lt;0.001) was half that in patients without TPN. Sub-analysis reveals this was irrespective of when TPN was administered.

Conclusions
Two mutually exclusive explanations exist. TPN may be a predictor of disease severity and subsequent clinical intervention, or it may indeed improve the nutritional and clinical outcomes in this high risk EGS group. Further studies are needed to clarify this, in addition to the most appropriate method of identifying malnutrition in NELA-eligible patients.
508 Appendicoliths – Time to Operate: The Temporal Relationship Between Pre-Operative CT Confirmed Appendicolith and Time to Develop Complicated Appendicitis
Authors: Prayle M , Taib A , Kler A , Kanakalingam D , Asaad P 
Published: August 2023

Abstract

Aim
Evidence suggests delaying an appendicectomy for up to 24 hours does not increase the risk of complicated appendicitis. Appendicoliths are a risk factor for perforation. However, no study has explored the temporal relationship between appendicolith presence and time to perforation. This study aims to review pre-operative Computer Tomography (pCT) confirmed appendicoliths and their correlation with a shorter time to complicated appendicitis.

Method
Retrospective single centre study of patients admitted between 2018-2020. Inclusion criteria: age ≥18 years, appendicitis on histopathology following an operation and pCT scan. Complicated appendicitis was defined intra-operatively as an appendicular abscess, gangrenous or perforated appendix.

Results
310 patients were included in the study (45.5% with complicated appendicitis). Appendicoliths were present in 79 (25.5%) patients. Multivariate logistic regression identified an appendicolith as a significant risk factor for perforation (Odds Ratio 4.2, 95% Confidence Interval [CI] 1.3-13.6, p = 0.018). Within the first 12 hours of admission, those with an appendicolith accounted for a significantly greater proportion of patients with complicated appendicitis intra-operatively than those without (57.7% vs 42.3% respectively, p = 0.039). Within 12 hours of admission, those with an appendicolith were 2.2 times more likely to suffer from complicated appendicitis than those without (95% CI 1.4-3.7).

Conclusions
Patients with an appendicolith found on CT should be prioritised for theatre within 12 hours of admission.
895 A Retrospective Analysis of National Emergency Laparotomy Audit (NELA) Data at a Tertiary Hospital
Authors: Omran K , Aftab M , Wheatstone S 
Published: August 2023

Abstract

Aim
To audit emergency laparotomy outcomes in a tertiary hospital and identify areas for improvement.

Method
Retrospective analysis of 148 cases from Year 8 (12/2020-11/2021) of NELA patient data. Categorical and continuous data were analysed through chi-squared and t-tests, using R (version:4.2.2).

Results
Our NELA patient length-of-stay (LOS) was 2.2x the national mean (33.59 vs.15.1 days). 14 statistical outliers in LOS were identified which compounded the discrepancy between our median (15 days) and mean (33.59 days). Patients with stomas formed had a significantly higher mean LOS compared to those without (42 vs 26 days). Frail patients did not have a higher LOS, and much higher mean rates of review by geriatricians was noted (87% vs. 24% nationally).
A greater percentage of our patients had high pre-operative mortality risk scores compared to nationally (51.5% vs. 43.5%). A higher percentage of our patients had ischaemia (20.8% vs. 8.9%) and haemorrhage (5.6% vs. 2.6%) as indications for surgery. However, our 30-day mortality rate was lower on average (5.5% vs. 9.7%).

Conclusions
Our hospital's high rates of complicated cases and low mortality rates suggest a high-quality of patient care. Length of stay has been identified as an area for improvement, and we propose implementation of special discussion of long-staying patients in weekly ward round meetings as a potential intervention. While there may be various factors contributing to our higher mean LOS, we postulate that our status as a major stoma centre and tertiary referral centre for complicated cases as likely the primary cause.
905 To Operate or Not to Operate? a Clinical Audit in the Management of Adhesional Small Bowel Obstruction
Authors: Karagiannidis G , Khaliq T , El-Farran M , Youssef F 
Published: August 2023

Abstract

Aim
To compare our current management of adhesional small bowel obstruction (ASBO) with the National audit for small bowel obstruction 2017 and Bologna guidelines, to produce a flow chart which will indicate:First line management should be with intravenous fluids, analgesia, anti-emetics, and nasogastric tube (NGT).Patients diagnosed with ASBO should first undergo a trial conservative management with a water-soluble contrast.Operative management should be considered after 72 hours of non-resolving SBO.

Method
The medical records of all SBO patients admitted to Ipswich Hospital NHS trust between 1/4/2020 and 1/4/2021 were screened. All patients above 16 years of age and with a clinical diagnosis of ASBO were included in the audit.

Results
43 patients were diagnosed with ASBO.All patients were prescribed IV fluids. 38 (88.4%)and 36 patients (83.7%)received analgesia and anti-emetics respectively.21 patients(72.1%) had a NG tube inserted.24 patients (53.5%) were treated conservatively while 19 patients were taken to theater.37% of the ASBO patients, who were managed conservatively, were given a water-soluble contrast(Gastrograffin),which caused resolution of the obstruction in 20 patients(83.3%),while the rest were taken to theater.The average time to theater was 4 days(96 hours).

Conclusions
Our results are in line with the comparing standards. Our first line management for ASBO could be improved.The use of a water-soluble contrast should be used more regurarly in the conservative management of ASBO. A step-by-step ASBO flow chart could help the admitting surgical team follow the appropriate steps for the better management of ASBO.
1011 Chemical VTE Prophylaxis for Adults with Abdominal Trauma: A Systematic Review
Authors: Virdee P K , Walsh U , Ibrahim M 
Published: August 2023

Abstract

Aim
The increased incidence of VTE following blunt and penetrating abdominal trauma is well documented due to trauma induced coagulopathy and immobility. Whilst guidance often advocates early chemical thromboprophylaxis with low molecular weight heparin, clinical practice varies. This systematic review aims to evaluate evidence regarding VTE chemical prophylaxis in the adult trauma population (16+) presenting with blunt and penetrating abdominal trauma.

Method
A search of MEDLINE, EMBASE and PubMed databases was conducted, and additional references were identified from a review of literature citations. Search results were limited to English language and human studies. Co-existing severe head injuries defined as AIS&gt;3 was excluded. Data was summarised in data extraction tables, along with level of evidence and bias scores for each study.

Results
A total of 9 retrospective trials exploring the timings of VTE chemoprophylaxis were included. All but 3 studies showed late VTE chemoprophylaxis initiation (&gt;48hrs) was linked with a higher incidence of VTE, with significant results in 4 studies. Early VTE chemoprophylaxis was not associated with increased risk of NOM failure. Early VTE chemoprophylaxis was also not found to be associated with an increased risk in bleeding in most studies, with non-significant differences in blood transfusion requirements.

Conclusions
Research favours early initiation of VTE chemoprophylaxis in the abdominal trauma population, without significant risk of complications and supports results from other trauma populations. Further prospective studies are needed in the abdominal trauma population, as well as its sub-populations, to directly compare VTE agents and dosing regimens and provide higher quality evidence to support chemical thromboprophylaxis.