bluuebunny/crossref_metadata_2025_split huggingface dataset:
WTP2.10 A retrospective study of effect of donor obesity on fibrosis and kidney outcome in live donor kidney transplantation
Authors: Aswad Mayar Ghazal , Ismail Wisam , Hosgood Sarah , Brunskill Nigel , Nicholson Michael 
Published: August 2023

Abstract

Aims
Donor obesity has increased over the last decade. The aim of this study was to assess the effect of donor obesity on fibrosis in pre-implantation biopsy and kidney outcomes in live kidney transplants.

Methods
A series of 288 live kidney donors between 1998 and 2010 were studied. The series was divided into three groups according to the donor Body Mass Index (BMI); Normal BMI 17-24.9 (n=119), overweight BMI 25–29.9 (n=118) and obese BMI ≥30 (n=51). Donor and recipient demographics were gathered and recipient post-transplant renal function up to five years was retrieved. Fibrosis level in pre-implantation biopsies was analysed and graft and recipient survival were assessed.

Results
Hypertension and live kidney donor profile index LKDPI were statistically significantly higher in obese donors compared with non-obese donors (p=0.004 and p&lt;0.001 respectively). Donor creatinine levels for obese group were comparable to the other two groups over three post-operative years (p=0.933). Fibrosis analysis showed no statistically significant difference among the three BMI groups (p=0.063). Donor obese group had statistically significant higher 5 year graft and patient loss rate compared with non-obese BMI groups (p=0.018 and p=0.015 respectively). Recipient post-operative creatinine levels showed no statistically significant differences among the three BMI groups (p=0.393). Similarly, fibrosis in pre-implantation biopsies had no statistically significant impact on recipient post-operative creatinine levels (p=0.243).

Conclusions
Donor obesity has no significant impact on fibrosis in the pre-implantation biopsy and on recipient post-operative kidney function. However, Donor obesity results in lower five-year graft and patient survival rate.
WTP3.2 Audit of percutaneous cholecystostomy practice against Tokyo Guidelines, 2012 – 2020
Authors: Baggus Elisabeth , Henry-Blake Connor , Chrisp Benjamin , Coope Ashley , Gregory Andrew , Lunevicius Raimundas 
Published: August 2023

Abstract

Aims
Percutaneous cholecystostomy (PC) is employed to improve prognosis when cholecystectomy is deemed inappropriate in high-surgical-risk patients with severe acute cholecystitis (AC). Tokyo guidelines (TG) 2013 and 2018 provide specific guidance on indications for PC. We aimed to audit the percutaneous cholecystostomy service at an adult tertiary centre to assess compliance with Tokyo Guidelines.

Methods
This was a single-centre, retrospective cohort audit. Patients with PC performed for AC during index admission between 2012 and 2020 constituted the study cohort, identified using the ICD-10 and OPCS-4 code the Trust business intelligence unit provided. Data was collected by inspection of electronic records. Patients were stratified into sub-groups by TG severity of AC, Charlson comorbidity index (CCI), ASA class, and NELA score. Management features of each subgroup were analysed to assess adherence to TG.

Results
Seventy-six patients (52.6% male) with a median age of 76 (IQR 67.5-83.3) were included. The median duration of acute biliary symptoms was 6.7 days (IQR 3.0-12.4). Seventy-three (96.1%) patients had at least one comorbidity. Fifty-three (69.7%) had a CCI of ≥4, and 56 (73.7%) had an ASA grade of ≥3. All 76 patients had appropriate pre-procedural imaging, and all had blood/bile cultures taken. Sixty-three (82.9%) patients received antibiotics immediately. When assessing for indications for PC, 29 patients (38.2%) met the severity grading (severe AC, grade 3). Twenty-eight patients (36.8%) met all Tokyo criteria for emergency PC.

Conclusions
PC is overperformed compared to the TG gold standard. Further evaluation of clinical outcomes in this cohort of patients is needed.
WTP3.4 Improvement of biliary service in hospital by altering the management of suspected or confirmed bile duct stones. Confirmed bile duct stones can be managed by single-stage procedure of laparoscopic cholecystectomy (LC) plus common bile duct exploration (CBDE). Intra-operative cholangiogram (IOC) can be used to avoid delays waiting for MRCP
Authors: El-Hakim Hesham , Seehafer Frances , Penman Gemma , Thomas Ian 
Published: August 2023

Abstract

Background
Significant delays can follow the process of emergency admissions with biliary problems in hospitals. Routine pathway for gallstones and abnormal liver functions tests (LFTs) is ultrasound (US) followed by MRCP. Pathway for confirmed common bile duct (CBD) stones has been routinely an ERCP followed by LC either as inpatient or outpatient. Significant delays take place awaiting MRCP considering that there is no out-of-hours or weekend service, while ERCP lists only occur twice weekly for both emergency and elective which can lead to unnecessary delays.

Methods
An audit was performed for 2 months period from 1st October 2022 to 30th November 2022 to assess how patients were managed in the department.

Results
A total of 16 emergency LCs were done in this period. 3 of them had ERCP prior to operation while 5 had MRCP prior to exclude CBD stones. Average length of stay (LOS) for these 8 patients was 7 days. It was estimated that LOS for these patient would have been reduced to 4 days if IOC +/- CBDE were done. A total of 37 ERCPs were done in the same period. 22 of them were done as emergency of which 12 were for CBD stones, 7 for cancers and 3 for bile leak. 7 of the 12 emergency ERCPs for CBD stones would have benefited from one stage procedure of LC + CBDE reducing their LOS and leaving space for other cases in ERCP lists.

Conclusion
A dedicated weekly IOC/CBDE list was proposed to overcome this problem.
WTP3.7 Are we using antibiotics appropriately in acute pancreatitis?
Authors: Akhtar Amina , Asarbakhsh Mariam , Schuijtvlot Nicolaas 
Published: August 2023

Abstract

Aim
To re-evaluate antibiotic use in the management of acute pancreatitis at our hospital.

Method
This retrospective closed loop audit incorporated patients with acute pancreatitis admitted to our hospital between 01/04/22 and 30/06/22. The initial audit was conducted in 2020. The gold standard was guidelines published by the World Society of Emergency Surgery (2019). Data sources included patient paper notes, and clinical results and prescribing software.

Results
44 patients presented with acute pancreatitis during the re-audit period; 80 patients were included in the initial audit. 22 of the re-audit patients (50%) received antibiotics, compared with 47 patients (59.1%) in the initial audit. Co-amoxiclav was the most used antibiotic (10 re-audit patients, 46.2%). 19 of the re-audit patients (86.3%) receiving antibiotics had mild or moderate acute pancreatitis (on Modified Glasgow Score); whereas most patients (29, 61%) in the initial audit had severe pancreatitis. Procalcitonin was not measured prior to commencing antibiotics in either audit. Also, no re-audit patient had CT-confirmed evidence of infected pancreatic necrosis. 5 re-audit patients (21.4%) were treated appropriately with antibiotics for extra-pancreatic infection, including acute cholecystitis and hospital-acquired pneumonia.

Conclusion
Decisions to commence antibiotics in acute pancreatitis have generally been inattentive to guideline recommendations, with greater focus on clinical impression of patient condition and inflammatory markers, such as C reactive protein. However, inappropriate antibiotic use may not bring patient benefit and negatively affect clinical care, for example yielding Clostridium Difficile infection and antimicrobial resistance. Hence, we will now change practice and measure procalcitonin to inform decision-making about antibiotics in acute pancreatitis.
WTP4.8 Management of Acute appendicitis during the COVID-19 pandemic A single centre retrospective cohort study
Authors: Bukhari Ishtiyaq , Afzal Zeeshan , Mitrasinovic Stefan , Chan Onton , Francis Francesca , Satheesan Stephen 
Published: August 2023

Abstract

Background
Management of Acute appendicitis changed significantly in the UK during COVID-19. The aim of study was to compare management of Acute appendicitis before and during COVID-19 pandemic.

Materials and Methods
We performed a single centre retrospective cohort study in UK comparing the management of acute appendicitis before the pandemic from March - August 2019 and during the Pandemic from March- August 2020.

Results
Over period of 6 months, a total of 179 patients were diagnosed with Acute appendicitis in 2019 versus 152 in 2020. In 2019, median age was 33 and 52% (n=93) patients were female. In 2020, median age was 37 and 48% (n=73) of the patients were female. At first presentation, in 2019, 97% of the patients (174/179) received surgical treatment compared to 70% (107/152) in 2020. 3% of the patients (n=5) were managed conservatively in 2019 as compared to 30% (n=45) in 202. Pre-Pandemic only 32% of the patients received imaging to confirm the diagnosis as compared to 53% during pandemic. During 2019, 92% (n=161) of the patients who received surgical treatment underwent laparoscopic surgery as compared to only 74% (n=95) in 2020. Post op complications occurred in 5% (n=9/176) of the surgical patients in 2019 as compared to 13% (n=16/128) in 2020. Mean length of hospital stay in 2019 was 3 (1-11) days versus 5 (1-35) in 2020. 30-day readmission rate was 5% (8/179) versus 19% (29/152).

Conclusion
Our study shows that the change in management of acute appendicitis during Pandemic was associated with longer length of hospital stay, more readmissions and increase in post-operative complications.
WTP4.9 Use of the American Association for Surgery and Trauma (AAST) Scale as a Predictive Tool in the Laparoscopic Approach to Adhesive Small Bowel Obstruction in a Tertiary Hospital
Authors: Aguilera Beatriz Carrasco , Cueto Emilio López-Negrete , Garcia Miguel Martinez-Cachero , Rodicio Miravalles Jose Luis , Vico Tamara Diaz , Alvarez Lourdes Sanz 
Published: August 2023

Abstract

Aims
The laparoscopic approach (LA) in treating adhesive small bowel obstruction (ASBO) has been shown to be a beneficial technique. Despite being a minimally invasive procedure, it is still not a widespread technique.
Tools to identify which patients with ASBO may benefit from LA are needed. The AAST scale classifies ASBO into five grades of obstruction, differentiated by radiological, intraoperative, and pathological findings.
The correlation between AAST-radiological and AAST-intraoperative is evaluated, as well as the association between the AAST scale and the rate of conversion to open surgery.

Methods
Observational, descriptive, retrospective, single-center, retrospective study from January 2011 to April 2022 of patients undergoing emergency laparoscopic surgery for suspected ASBO.

Results
43 patients were analyzed. By CT scan 13.5% of patients had AAST-I, 43.2% AAST-II, and 43.2% AAST-III. Intraoperatively 11.6% of patients had AAST-I, 46.5% AAST-II, 25.5% AAST-III, 13.9% AAST-IV, and 2.3% AAST-V. The overall conversion rate was 27.9%. Using the univariate logistic regression model, an association was found between conversion rate and intraoperative AAST, as patients with an AAST≤II were less likely to convert to open surgery (OR 0.03, 95%, CI 0.00-0.26, p=0.03). This association was not observed between conversion rate and AAST-radiological. The degree of agreement between radiological-AAST vs intraoperative-AAST was moderate (Kappa coefficient 0.532).

Conclusions
Although radiological AAST is a guiding tool in selecting patients in whom the entire LA can be performed, it is the intraoperative findings that increase conversion, which encourages a laparoscopic approach in these cases.
WTP4.10 Utility of CT Imaging in a Successful Ambulatory Emergency Surgical Unit
Authors: Claxton Mary , Quinn Marcus , Williams Lian , Barton Jessica , Trent Neil , Hollyman Marianne 
Published: August 2023

Abstract

Aim
Drives towards ambulatory management in emergency surgery have resulted in increased availability of urgent imaging to expedite decision making. This review of CT usage aimed to assess frequency of surgical pathology identified, and subsequent management.

Methods
All acute general surgery referrals to an established ambulatory clinic 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
3154 patients were seen over an 18-month period with a 91.7% successful ambulation rate (n=2938). CT was performed in 577 patients (18.2%); the majority were contrast CT abdomen/pelvis (CTAP, 58.3%, n=331), or CT Kidney/Ureter/Bladder (CTKUB, 40.1%, n=228).
The majority of CTAPs were diagnostic (77.0%, 242/331), with 16.0% (n=53) resulting in admission; admission rate for non-diagnostic CTAPs was 4.5% (n=4/89). Subsequent operations occurred in 9.6% (32/331) who underwent CTAP; 5.1% (17/331) underwent emergency operation, urgent ambulatory operations in 3.0% (10/331), and 1.5% (5/331) were listed electively.
CTKUBs identified urological pathology in 40.4% (n=92), whilst 7.4% (n=17) identified other pathology. Diagnostic CTKUB led to a 17.5% admission rate (n=17, including 5 non-urological).

Conclusion
Selective ambulatory CT scanning is a useful adjunct to diagnosis, and admission avoidance. CTKUBs identify lower, but acceptable levels of pathology including non-urological conditions.
Judicious use of CT is important to balance resource utilisation, whilst limiting admissions.
WTP4.12 Treating the cause of Acute Pancreatitis: lessons from NCEPOD guidelines
Authors: Seth Shatadru , Boghdady Michael El , Boven Carine 
Published: August 2023

Abstract

Aim
The objective of this study was to facilitate in identifying remediable factors in the quality of care provided to patients being treated for acute pancreatitis and assess compliance to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) guidelines.

Method
All emergency surgical admissions for patients aged 16 or older, diagnosed with acute pancreatitis at the period between August and October 2021 were included. A retrospective analysis in juxtaposition with 8 cardinal NCEPOD recommendations: management of co-morbidity & involvement of relevant specialists, adherence to antibiotic policies, assessment of risk of malnutrition, exclusion of gallstones in all index presentations, early surgical intervention, alcohol liaison support, further investigation - MRCP / ERCP and retrospective morbidity & mortality discussions. Each of the domains were scored based on adherence to the above standards, and subsequently coded as Red–Needing Urgent Attention, Amber–Scope for Improvement and Green–Satisfactory Compliance.

Results
A total of 79 patients were included in this study. Compliance towards the recommendation of routine nutritional assessment of patients was found to be in the RED category, scoring 23.7%. Management of medical co-morbidity & inclusion of specialists, early surgical intervention and alcohol liaison support were all found to be in the AMBER category, scoring 44.8%, 28.0% and 57.1% respectively. The rest of the recommendations showed satisfactory levels of compliance.

Conclusion
Many patients did not receive adequate nutritional assessment. The RED and AMBER areas will need urgent attention. To minimise the risks of severe morbidity and mortality from acute pancreatitis, we envisage a better compliance to NCEPOD recommendations.
WTP5.2 Length of stay and it’s predictors after elective general surgical procedures at a district hospital in NHS
Authors: Arifuzaman Mohammed , Bhattacharya Sayan , Jalal Sadic 
Published: August 2023

Abstract

Aims
To study the length of stay of patients following elective general surgical procedures at a district hospital in NHS and the predictors for long stay. To be able to better predict the pattern of hospital stay and discharge. To understand the patients which stay longer in the hospital.

Methods
Retrospective analysis of elective general surgeries conducted at a busy district hospital in NHS from December 2021 to May 2022. Emergency cases were excluded. Data was collected form the theatreman app, which was hospital number, age, sex, ASA category, surgical time, anaesthesia time, list number of the patient in the theatre list. Statistical calculations were done on the StatsDirect 3 software.

Results
A total of 181 patients were studied of which 90 male and 91 female patients. Total admission days utilised were 318 and a median of 1 day per elective surgical patient. 94 patients (52 %) got discharged on the 0 post operative day (POD), 67 (37 %) were discharged on POD 1, 12 (6.6 %) on POD 2, 1 (0.55 %) on POD 3, 2 (1.1 %) on POD 4, 1 (0.55 %) on POD 5, 3 (1.65 %) on POD 6, 1 (0.55 %) on POD 12. Multiple linear regression analysis resulted in a p &lt;0.0001 for surgical time and ASA grade and 0.0231 for age.

Conclusion
Surgical time, ASA grade and age have a statistically significant correlation on the length of stay after elective surgeries. Patients aged &gt; 60 years, ASA &gt;2 and Surgical time &gt; 100 minutes will stay for 2 days or more in the hospital and such patients must be booked as inpatient.
WTP5.4 The Sheen Paajanen groin Recommended Treatment ‘SPoRT’ score for groin pain
Authors: Biswas Sayan , Pilkington James , Stathakis Panos , Harwood Rachel , Paajanen Hannu , Sheen Aali 
Published: August 2023

Abstract

Aim
Evaluating groin pain still evades many clinicians with at times difficulty in determining the cause of pain when no true hernia exists. This study’s aim was to evaluate a simple and novel scoring system which is reproducible, to help determine whether conservative measures or surgery is recommended for the management of groin pain attributable to inguinal disruption.

Methods
A retrospective analysis of all patients from 2018 - 2020 that underwent surgery or conservative management for inguinal disruption with at least a 1 year follow up were evaluated. The scoring system is based on MRI and ultrasound imaging as well as clinical findings, with scores given from -2 to +2 based on the defined findings listed. Sensitivity and specificity analysis was conducted for each potential score cut off point.

Results
A total of 172 patients were evaluated with 33 patients (19%) undergoing conservative management and 139 patients (81%) undergoing surgery. The mean SPoRT score of the physiotherapy group was statistically significantly lower than that of the surgery group (-1.33 vs 1.84, p = 3.55 x 10-25). An optimal cut off of ≤ 0 for physio and ≥ 1 for surgery was established, yielding a sensitivity of 90.9% (95% CI: 75.7% - 0.981%), a specificity of 89.2% (95% CI: 82.8% - 93.8%) and an area under the curve (AUC) of 0.9356 (95% CI: 0.874 – 0.997).

Conclusion
SPoRT score of ≤ 0 can recommend a patient should undergo conservative measures or physiotherapy as a mainstay of treatment with a score of ≥ 1 recommending surgery.
WTP5.6 Enhanced Monitoring for Better Recovery and Cancer Experience in Greater Manchester (EMBRaCE-GM): A Qualitative Study of Clinician Experiences on Deploying and Supporting Consumer Wearable Devices
Authors: Chan Anthony , Balata Haval , Tholouli Eleni , Merchant Zoe , Kitchen Gareth , Wilson Anthony 
Published: August 2023

Abstract

Introduction
Consumer wearables such as smart watches and rings have the potential to provide continuous monitoring of patients receiving cancer treatment in their prehabilitation and rehabilitation phases of care. Enhanced Monitoring for Better Recovery and Cancer Experience in Greater Manchester (EMBRaCE-GM) is a multi-centre prospective trial evaluating feasibility and acceptability of wearable technologies for patients undergoing treatment for colorectal cancer, lung cancer or lymphoma within Greater Manchester (ClinicalTrials.gov NCT05099237). We report the initial findings of the clinician’s perspective on deploying and supporting the use of wearable devices.

Methods
A qualitative study was conducted to ascertain the experiences of researchers who recruited participants to EMBRaCE-GM. Three interviewers conducted structured interviews and a thematic analysis was performed.

Results
Thirteen researchers were interviewed, and 3 major themes identified. The first identifies the importance of the device set-up phase, such as integration into the patient’s existing technological ecosystem, and the training provided to clinical teams. The second theme was patient engagement with the technology, such as the burden of interacting with the device (‘digital load’), and comfort and aesthetics. The final theme involved the support infrastructure for technical issues and device maintenance as well as safe protocols and governance for responding to device alerts, particularly if patients were unwell.

Discussion
Wearable technologies have the potential to provide ongoing benefit through continuous monitoring outside the hospital setting for patients receiving cancer treatment. This study, as part of the EMBRaCE-GM project, identifies important themes critical for future patient and clinician adoption of wearable devices.
WTP5.9 Does anti-reflux surgery offer durable symptom remission in a tertiary centre?
Authors: Fairbrass Dominic , Hammett Felix , Wilkins Alexander , Dexter Eloise , Pellen Michael , Patel Fatema 
Published: August 2023

Abstract

Aims
Anti-reflux surgery success can be affected by multiple factors. We sought to evaluate pre-operative and technical factors influencing medium-term outcomes.

Methods
A retrospective analysis of laparoscopic anti-reflux surgery in a tertiary centre between 2016 and 2019. Patients were identified through clinical coding. Electronic patient records were reviewed with minimum follow up of 3 years. Outcomes analysed included pre-operative work-up, type of fundoplication, remission and relapse of symptoms at follow up and revision surgery.

Results
104 patients underwent fundoplication. The majority were Nissen 68 (65%) and the remaining were partial wrap configuration.18 (19%) of these patients were revisional anti-reflux procedures.
Pre-operative investigations noted most underwent endoscopy 85 (81.7%) and oesophageal physiology in 74 (71.2%) with barium swallow in 34 (32.7%). 15/104 (14%) underwent all three studies.
50 (48.1%) patients were symptomatic at initial follow up with dysphagia (21.3%) and dyspepsia (13.5%) most prevalent.
Of these 104 patients, 15 (14.4%) required revisional surgery. 6/36 (17%) partial and 9/68 Nissen (13.2%) fundoplications underwent re-operation. Timing of revision varied: 8 (53.3%) within one year including early 30-day re-operation for complications. 3 (20%) at 1-3years and 4 (26.7%) after 3 years.
Subsequent revision rate was higher for revisional patients: 4/18 (22.2%) compared to primary 11/86 (12.7%).

Conclusion
Almost half of the patients had at least one symptom at initial follow up, however only 14.4% patients required revisional surgery by 3 years follow up. Partial fundoplication and previous fundoplication surgery had higher revision surgery rates.