bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE2.10 Regional vessels wrapping following pancreaticoduodenectomy reduce the risk of post-operative extra-luminal bleeding. A systematic review
Authors: Nour Hussameldin M , Shafique Shehram , Peristeri Dimitra V , Khan Mansoor , Singh Krishna K , Sajid Muhammad S 
Published: November 2022

Abstract

Aim
Post-pancreatectomy bleeding which may be a potentially fatal complication, usually resulting from the erosion of the regional visceral arteries mainly the hepatic artery and stump of the gastro-duodenal artery, caused by a leak or fistula from the pancreatic anastomosis. The objective of this article is to assess whether regional vessels wrapping omentum or falciform/teres ligament following pancreaticoduodenectomy reduce the risk of post-operative extra-luminal bleeding.

Method
Standard medical electronic databases were searched with the help of local librarian and relevant published randomized controlled trial (RCT) and any type of comparative trials were shortlisted according to the inclusion criteria. Summated outcome of post-operative extra-luminal bleeding in patients undergoing pancreaticoduodenectomy was evaluated using the principles of meta-analysis on RevMan 5 statistical software.

Result
One RCT and 6 retrospective trials on 4100 patients undergoing pancreaticoduodenectomy for any indication were found suitable for this met-analysis. There were 1404 patients in the wrap-group (WG) group and 2696 patients in the no-wrap group (NWG). In the random effects model analysis, the incidence of extra-luminal hemorrhage rate was statistically lower in WG [odd ratio 0.51, 95%, CI (0.31, 0.85), Z=2.59, P=0.01]. There was moderate heterogeneity between the studies; however it was not statistically significant.

Conclusion
The wrapping of regional vessels (using omentum, falciform ligament or ligamentum teres following pancreaticoduodenectomy seems to reduce the risk of post-operative extra-luminal bleeding. However, more RCTs of robust quality recruiting higher number of patients are required to validate these findings because current study presented combined data of one RCT and 6 retrospective studies.
WE2.11 Optimal Utilisation of Cross-Sectional Imaging in Patients with Painful Jaundice Undergoing Bile Duct Exploration or Conservative Management for Suspected Bile Duct Stones on a Specialist Unit
Authors: Ibrahim Basil , Tait Sophie , Nassar Ahmad 
Published: November 2022

Abstract

Aim
Laparoscopic management of bile duct stones relies on intraoperative cholangiography, optimising utilisation of preopertative imaging. This study aims to determine whether such a policy is justifiable in jaundiced patients over 50 years of age with no risk factors for malignancy.

Methods
Prospectively collected data of patients presenting with gall stones and painful jaundice undergoing biliary surgery or treated conservatively was analysed. The presentation, preoperative imaging, cholangiography/ choledochoscopy findings and postoperative outcomes were recorded. Patients with risk factors for malignancy were excluded.

Results
1220 jaundiced patients over 50 years were referred over 24 years.
684 underwent surgery having had CT in 15.3%, MRCP 10% and ERCP 2.5%. 536 unfit patients were managed conservatively (CT 15.7%, MRCP 27.8% and ERCP 29.5%). Most had these investigations under the care of other departments prior to referral.
21/684 (3%) presenting with painful jaundice associated with acute cholecystitis or bile duct stones and no risk factors for malignancy were diagnosed with malignancy on IOC and choledochoscopy. 7 patients had preoperative cross sectional imaging, one with ERCP showing no evidence of malignancy. The remaining 14 patients underwent postoperative imaging; 7 had radiologically undetectable disease, 6 had advanced disease and only one was suitable for a “curative resection”. 21/536 (3.9%) cancers were diagnosed in patients who were treated conservatively.

Conclusion
Based on the little diagnostic yield of curable biliary malignancies, a policy of no cross sectional imaging in patients with obstructive jaundice and no risk of malignancy is justifiable in units adopting single session management of bile duct stones.
WE3.2 Analgesia Prescription in Surgical Patients
Authors: Morsy Hesham , Patel Miraj , Zimmerman Matthew , Kukreja Madhav , Salsabil Sharaf , Sivarajah Vernon 
Published: November 2022

Abstract

Aim
We objectively re-assessed prescribing of analgesia for surgical admissions at Watford General Hospital, in accordance with Trust Guidelines

Method
Total of 117 Patients. We collected data prospectively in the 1st Cycle 21/09/2021 – 04/10/2021 and in the 2nd Cycle 04/01/2022 – 17/01/2022.
Intervention was through virtual poster and daily reminders to on-call team

Results & Conclusions
When patients were prescribed analgesia, compliance to Analgesia Trust guidelines vastly improved from 50% to 79%. Most non-compliant prescriptions were prescribed more strong opioids excessively.

Action Plan
We plan to disseminate audit findings to clinical staff in acute services and provide Junior doctors a teaching session on guidelines
WE3.13 Friday Handover Flow
Authors: Jhass Aneka , Kamal Nahid Mohammed Abu , Efiannayi Anthonia , Shrestha Ashish K , Fernandes Roland , Asnani Kusum 
Published: November 2022

Abstract

Aims
Handover between teams is a requirement between colleagues to ensure patient safety. An electronic weekend handover Friday noon with the whole surgical team was implemented in 2017. This is the second cycle to close the loop.

Methods
The implementation of ‘Careflow’ software had all been initiated in 2017 to modernise handover from paper to e-handover. Anonymised questionnaires were sent to all surgical doctors 6 months following the initial intervention. An additional intervention of a Friday afternoon handover prior to the weekend was started following this. For the second cycle a similar questionnaire was distributed to observe whether the changes have been sustained and the impacts beneficial.

Results
From the first cycle 97% felt e-handover was better than paper handover. Comparing first and second cycles; 97% vs 80% reported adequate handover time, 97% vs 57.1reported handover incorporated into the working day, 42% vs 97.2% reported handover usually consultant led, 41% vs 48.6% were aware of RCS handover guidelines 81% vs 85.7% reported ‘Caredlow’ as having a positive impact. Overall 91.1% of staff were more than 60% satisfied with Friday midday weekend handover, and 100% wanted the practice to continue.

Conclusions
A prioritised handover, dedicated room, adequate time and senior presence are all required for an effective handover. To modernise and improve continuity of care, an electronic handover system is a positive, effective tool. In addition a Friday noon handover prior to the weekend enables the modern NHS to provide the best and safest practice for our patients.
WE4.2 Audit of pre-operative blood tests for Elective General Surgery at Northampton General Hospital
Authors: Kumaran Naren , Bin Tariq Muhammad Saad , Bangash Faaraan , Habib Helai 
Published: November 2022

Abstract

Aim
Annually 9.9 million people undergo elective surgery in the NHS. The National Institute of Health and Care Excellence (NICE) published guidelines on ‘Routine pre-operative tests in elective surgery’ in 2016. It aimed to reduce unnecessary testing by taking into account patient comorbidities and the complexity of surgery. Excessive testing can cause significant anxiety in patients, delays in treatment and exposure to COVID caused by unnecessary hospital visits. Additionally, unnecessary blood tests can exacerbate blood bottle shortages.
We are auditing the compliance of NICE guidelines when requesting blood tests for elective general surgical patients in pre-operative assessment clinics at Northampton General Hospital (NGH)

Method
The audit team at NGH provided details of the first 64 patients undergoing elective general surgery (categorised into 22 Minor, 23 Intermediate, 19 Major procedures), from May to July 2021. Electronic records were used to determine patient ASA grades and blood tests requested at pre-operative assessment clinics. These were checked against NICE (2016) guidelines.

Results

Conclusion
There is poor compliance with NICE guidelines. NGH Anaesthetic team have implemented changes in November 2021, as part of MyPreOP online app, to ensure these guidelines are followed. We will re-audit in February 2022 and consider implementing changes across all surgical specialties.
WE4.7 Is Routine Histopathological Examination Required for all Surgically Resected Gallbladders?
Authors: Jones Stacey , Mikhael Youhana , Altabari Mohammad , Bahgat Boules , Parrott Alexandra , Shaaban Hossam 
Published: November 2022

Abstract

Aims
The aim of this study was to identify both pre- and intra-operative factors in individuals diagnosed with incidental gallbladder malignancy on histopathology following a cholecystectomy for symptomatic gallstone disease.

Methods
Retrospective records were analysed from October 2018 to December 2020 of all individuals who underwent a cholecystectomy in a single surgical unit. Demographic data (age, gender), presenting complaint, pre-operative imaging (USS/CT/MRCP/ERCP),pre-operative blood results, type of surgery (laparoscopic/open), intra-operative finding (macroscopic appearance of gallbladder) and histopathological findings were noted.

Results
829 individuals underwent cholecystectomy for symptomatic gallstone disease within the study period. 73.5% were female. Mean age of patients was 51.2 years. Commonest presenting complaint was pain in all cases followed by nausea (33.5%) and vomiting (26.9%). Chronic cholecystitis was found to be the most common histopathological finding (84.4%), followed by cholelithiasis (31.8%) and cholesterolosis (10.3%.) Gallbladder carcinoma was incidentally found in 3 cases (0.4%), of which 2 were female with a mean age of 75.3 years. A thickened gallbladder was found in all cases on pre-operative imaging and macroscopic abnormalities were noted in all cases intra-operatively with each individual having T2 disease on TNM staging. No individual with normal macroscopic appearance had gallbladder malignancy.

Conclusion
Pre- and peri-operative findings play a key role in determining incidental findings of gallbladder malignancy and we advocate a more selective approach in the gallbladders that are sent for histopathological examination based on pre-operative imaging, intra-operative macroscopic appearance and age of individual thereby, reducing both cost and the workload of the pathologist.
WE5.5 Does use of laparoscopy in emergency surgery improve mortality rates? A single centre experience
Authors: Gurowich Louise , Dru Rebecca , Hollyman Marianne 
Published: November 2022

Abstract

Aims
With the progression of minimally invasive surgery across surgical specialties in the elective setting, we aimed to assess the translation of laparoscopic surgery into emergency surgery in our district general hospital. The National Emergency Laparotomy Audit (NELA) provides us with an excellent database to review our single-centre's experience over time.

Methods
Using data collected as part of the NELA, we reviewed available operations between 2013 and 2021 at our centre, and compared outcomes between open, laparoscopic, laparoscopic-assisted (LA), and laparoscopic-converted-to-open (LCTO) operations. The primary outcome was mortality. Our secondary outcomes were variables that guided decision to operate laparoscopically versus laparotomy.

Results
1236 operations were identified; 205 (17%) were either laparoscopic, LA, or LCTO. 60-day mortality in all laparoscopic groups was significantly lower at 4.4% compared with 10.0% in the open group (p-value 0.008). This finding was lost when variables of age, ASA grade, or pre-operative P-possum mortality were adjusted for.

Conclusion
Laparoscopic surgery was performed on a small, selected group. It is a safe and valuable choice for many patients, particularly with upper-GI pathology and may contribute to improved mortality. However, whilst at first glance laparoscopic approaches to the emergency surgical abdomen appear to improve mortality, this likely represents a well-known clinician-led process of selecting patients with greater fitness and lower predicted pre-operative mortality, therefore muddying the significance of this apparent benefit. This is comparable with national data.
WE5.11 Intra-abdominal actinomycosis - an indolent masquerader of malignancy
Authors: Jayasankar Balaji , Abdelsaid Kirolos , Aal Yasser Abdul , Papadopoulos Andreas 
Published: November 2022

Abstract

Introduction
A 54 years old lady who presented with constitutional symptoms of lethargy, weight loss and asthenia. She had been extensively evaluated for a possible gynaecological malignancy but with no definitive outcome. The symptoms were persistent and a decision had to be made towards surgery in the present climate of the covid19 pandemic.

Method
Following oncology multi disciplinary meeting outcome she was taken up for a total abdominal hysterectomy and bilateral salpingo-oophrectomy. She was noted to have an incidental finding of an extensive tumour infiltrating the liver, colon, anterior abdominal wall and the urinary bladder. A surgical resection with ileostomy was performed on suspicion of an underlying malignancy.

Results
The histopathological diagnosis revealed a picture of actinomycosis which had evaded us previously. Following this she was treated with prolonged course of antibiotics and has recovered well, thus altering our entire management plan.

Conclusion
Actinomycosis albeit rare is an interesting mimic of tumours. This case also delves into the on-table decision making when in doubt about cancer.
WE5.13 Improving Pre-operative Risk Score Assessment In Patients Undergoing Emergency Laparotomy
Authors: Patel Maitreyi , Thomas Joel Joy , Sarwary Haschmatullah 
Published: November 2022

Abstract

Aim
This audit was conducted with the aim to assess the compliance of recording of risk (P-POSSUM) scores in patients undergoing emergency laparotomy, with the objectives being to establish how many patients required ITU/HDU admission, documentation of P-POSSUM in patients requiring post-operative critical care admission and, pre operative P-POSSUM documentation in elderly patients aged &gt;70 years.

Methods
Data of all emergency laparotomies at a DGH were obtained from electronic theatre records. The first cycle was from 14/02/2021 to 07/03/2021. The results were presented in the Divisional Audit meeting. Following this, audit cycle was completed with data from 20/06/2021 to 15/08/2021. Patient notes and theatre booking forms were reviewed to assess if P-POSSUM score was recorded and analyzed with Microsoft Excel.

Results
Twenty- three emergency laparotomies were performed between 14th February 2021 and 7th March 2021. Of these, P-POSSUM scores were recorded in 21.7% (5 of 23 patients). During the second cycle, 50 patients underwent emergency laparotomy. Following the presentation of our audit the compliance to recording P-POSSUM increased to 64% (32 of 50 patients). Of those patients requiring critical care admissions, there was a significant increase in the pre-operative recording of risk scores from 13.33% (2 of 15 patients) to 51.61% (16 to 31 patients).

Conclusion
Our compliance with documentation of risk score pre operatively in patients undergoing emergency laparotomy has improved over time. However, there remains a room for improvement. We recommend encouragement to record P Possum Scores compulsorily as standard prior to Laparotomies and to standardize the location of recording scores.
WE7.8 Neck of Femur Fractures with Co-existent History of Malignancy: Do Full-length Femur X-Rays Change Fixation Method?
Authors: MacKinnon Thomas , Ahmed Mosab , Hashim Sophia , Bhattacharya Raj 
Published: November 2022

Abstract

Introduction
In neck of femur (NOF) patients presenting with co-existent history of malignancy, it is regarded as good practice to obtain pre-operative full-length femur X-Rays (FLF-XRs) to identify metastatic disease distal to the fracture site and aid operative planning. Whether the availability of pre-operative FLF-XRs in the trauma meeting influences the surgeon's choice of fixation method between intramedullary nail (IMN) or dynamic hip screw (DHS), is unclear.

Methods
We performed a retrospective analysis of all NOFs that underwent surgical fixation at a major London hospital over a 3-year period (2018–20), and collected data on history of any malignancy, FLF-XR status and fixation method (IMN vs DHS). Our results showed that of the 308 extracapsular NOFs during this time period, 23% had a history of malignancy, and of these, 55% had undergone FLF-XRs. NOFs with co-existent history of Ca who had undergone FLF-XR were more likely to undergo IMN fixation than DHS to a statistically significant degree (p&lt;0.05) than those who did not, despite only 3% of these radiographs demonstrating distal femoral metastases.

Results
The findings of this preliminary audit raise questions around the value of FLF-XRs in NOFs with co-existent malignancy, particularly if IMN fixation is opted for in the majority of cases despite normal radiographs. The next phase of this study is to establish whether IMN/DHS fixation, with or without pre-operative FLF-XRs, amongst this cohort correlate to better or worse complication rates.
WE7.9 Triage in Terror-Related Major Incidents
Authors: Malik Nabeela , Xu Yuanwei , Chernbumroong Saisakul , Bowley Douglas , Hodgetts Timothy , Gkoutos Georgios 
Published: November 2022

Abstract

Introduction
Recent major incidents (MI) in the UK have involved intentional explosions or indiscriminate attacks by perpetrators with bladed weapons. At a MI, on-scene triage vitally identifies those needing time-critical surgery and/or resuscitation (Priority 1, or P1, casualties), facilitating urgent transfer to specialist care. Currently, the National Ambulance Resilience Unit (NARU) Triage Sieve is used. We interrogated the Trauma Audit and Research Network (TARN) registry to compare performance of MI triage tools in predicting P1 status amongst adults.

Methods
TARN patients aged ≥16 years with penetrating and blast injury (January 2008-December 2017) were assigned triage categories (P1, P2, P3, Expectant or Dead) using pre-defined, intervention-based criteria. Ten MI triage tools were applied to patients’ first pre-hospital observations. Tool-predicted and intervention-based P1 assignments were compared.

Results
Of 5,660 patients, 5,635 (92%) suffered penetrating injuries, 25 (0.4%) sustained blast injuries. Mortality was 3.1% (n=171); median Injury Severity Score was 9 (IQR 9–16). 2,639 (46.6%) patients fulfilled P1 criteria: 1,170 (44.3%) required life-saving and 209 (7.9%) required limb-salvage surgery within 4 hours. The NARU Triage Sieve demonstrated sensitivity of 32.2%, over-triage 40.3% and AUC 0.566 (95%CI 0.555–0.578). The tool best-able to identify P1 casualties was the Battlefield Casualty Drills (BCD) Triage Sieve (sensitivity 68.0%, over-triage 47.3%, AUC 0.573 [95%CI 0.561–0.586]).

Conclusions
Terrorist attacks characteristically yield a high proportion of patients requiring urgent surgery. The current UK MI triage tool in use, the NARU Triage Sieve, exhibits unacceptably low detection of P1 casualties; we recommend it is superseded by the BCD Triage Sieve.
WE7.14 Penthrox is effective but is it patient approved?
Authors: Dias Ana , Zeidan Ziad , Copp Matthew , Eslabra Frances , Hassan Rawan , Middleton Rory 
Published: November 2022

Abstract

Background
Penthrox® is a handheld inhaler that administers methoxyflurane, approved for analgesia in moderate-to-severe trauma-related pain in adults in the emergency department (ED). The literature currently lacks methodologically robust qualitative data on the individual patient experience. Using a structured qualitative study, this project set out to address this shortcoming.

Methods
A focus group of five patients was initially contacted to identify key themes deemed integral to incorporate into the study questionnaire. All uses of Penthrox® in ED from March to August 2021 were retrospectively identified. Qualitative data was gathered using the Trickett short interview method with responses grouped into positive and negative descriptors. In addition, quantitative data using a 5-point-Lickert scale was also gathered.

Results
The focus group felt that side effects and overall satisfaction with Penthrox® should be explored. Thus far, 77 respondents have completed the survey. 91% reported an overall satisfaction ‘≥ Good’, while 95% reported ease-of-use as ‘≥ Good’. The analgesic effectiveness of the device was rated as ‘Excellent’ by 52% of respondents and ‘≥ Good’ by 88%. The most reported side effects were drowsiness (14%) and nausea (18%); however, most patients (71%) reported no side effects. Furthermore, 94% of respondents reported they would use Penthrox again. An NVIVO word cloud was created visually confirming an overall positive experience.

Conclusions
This study highlights that Penthrox® is a well-tolerated and user-friendly method of managing acute trauma pain in ED. Furthermore, it highlights the importance of considering the individual patient journey alongside robust evidence-based data on safety and efficacy for the development of a holistic treatment.
WE8.1 Index admission cholecystectomy with or without single session bile duct exploration for emergency gall stone complications neutralised the adverse effects of COVID
Authors: Tait Sophie M , Katbeh Tarek Z , Ibrahim Basil , Nassar Ahmad H M 
Published: November 2022

Abstract

Aims
The COVID-19 pandemic impacted surgical practice globally. We aim to study the effects this had on the presentations, practice and results of biliary surgery on a unit adopting index admission laparoscopic cholecystectomy (LC) and single session management of bile duct stones for emergency presentations.

Methods
Prospectively collected data of biliary surgery over a period of 12 months pre-COVID (PRE) and 12 months post-COVID (POST) was analysed. The presentation, type of admission, type of operating list and operative and postoperative data were compared.

Results
257 LCs were done PRE and 270 POST. All emergency presentations increased; acute cholecystitis 8.5% to 25.9%, acute pancreatitis 6.2% to 11.8% and jaundice 22.5% to 27.7%. Elective LC decreased from 53% to 20%. With an increase in patients with previous admissions (13.6% PRE vs 20.7% POST), 87% of PRE vs 80% POST had index admission LC, utilising 192 emergency theatre sessions and 29 CEPOD lists. In spite of increased LC difficulty grades (grades 4 and 5 from 20.2% to 30.5%), bile duct explorations (34%), operating time and median total hospital stay the morbidity, mortality and median presentation to resolution intervals were not affected.

Conclusions
Covid-19 caused an increase in all acute biliary presentations requiring emergency admissions, almost certainly the result of a significant decline in elective LC. However, similar numbers of LC PRE and POST were maintained due to a policy of index admission surgery and bile duct exploration, utilising emergency theatre scheduling, optimised clinical outcomes in spite of some logistical parameters being affected.