bluuebunny/crossref_metadata_2025_split huggingface dataset:
744 Indications for Emergency Department Resuscitative Thoracotomy in Blunt and Penetrating Trauma: A Survey of UK Major Trauma Centre Guidelines
Authors: Oliver M , Bennet J , Nassr N , Marson B , Freij R , Brooks A 
Published: November 2022

Abstract

Aim
Traumatic Cardiac Arrest (TCA) is a potentially fatal consequence of penetrating or blunt trauma. Emergency-Department Resuscitative Thoracotomy (ED-RT) is the last resort procedure to restore cardiac output following TCA. This study reviews current UK guidelines of Major Trauma Centres (MTCs) to identify common indications for ED-RT and chest compressions following TCA.

Method
Departmental policies were requested from all UK MTCs. Data was extracted by three reviewers. A planned subgroup analysis was performed for blunt/penetrating trauma.

Results
20 guidelines were identified covering 22 MTCs. All guidelines included recommendations regarding indications for ED-RT.
Time thresholds from loss of output to undertaking RT in blunt trauma were given in 12 (60%) guidelines. Ranging from 5 (25%), 10 (50%) and 15 minutes (10%). Prehospital loss of output was a contraindication for blunt trauma ED-RT in 6 guidelines.
ED-RT in penetrating trauma was indicated within 10 (50%) or 15 minutes (45%) from loss of output. Fewer than 50% of guidelines identified specific contra-indications including massive head injury and asystole.
3 guidelines stated chest compressions were not indicated in TCA. 8 stated that chest compressions may not be contra-indicated and 1 advised chest compressions to be restricted to blunt trauma.

Conclusion
In a survey of UK guidelines, we have found inconsistency in the indications for ED-RT, particularly associated with blunt trauma. A maximum time from loss of output to ED-RT for penetrating trauma of 15 minutes is compatible with most guidelines. This is less consistent with findings for blunt trauma. There is little consensus regarding use of chest compressions.
767 Group & Save- Are They Required for Laparoscopic Appendicectomies?
Authors: White F , Armstrong L 
Published: November 2022

Abstract

Aim
Laparoscopic appendicectomy (LA) is the gold standard surgical management of appendicitis. Serious intraoperative complications, including bleeding, are rare, however in the absence of a local established guideline, it is standard practice to send two group and save (G&S) samples prior to theatre. We aimed to review our post-operative transfusion risk for LA and to establish if routine group and save testing is required as part of the preoperative workup.

Method
All patients who underwent a laparoscopic appendicectomy in a single centre were reviewed over a 3-month period (April- June 2020). Data was retrieved from an institutional database and up to date electronic records were reviewed for operative details and transfusion history.

Results
Forty-three appendicectomies performed during audit window, twenty-one of which were laparoscopic. 100% of cases had a single group and save recorded pre-operatively, with 76.2% having a second sample sent, totalling 37 samples. Zero patients in the cohort required a post-operative transfusion. Average cost of a group and save equals £26, a total cost of £962 over a 3-month period.

Conclusion
Whilst a small study, we have illustrated LA to be a safe procedure with zero incidence of blood transfusion. There are clear benefits of producing a local guideline that G&S are not routinely required for LA, including financial and resource savings, potential reduction in theatre delays, and reduction of workload for staff.
812 Evaluating the Impact of Surgical Subspecialisation on Patient Outcomes Following Adhesional Small Bowel Obstruction
Authors: Stienstra R , Green L , Brown L , McLean R , Crumley A , Hendry P 
Published: November 2022

Abstract

Aim
Small bowel obstruction (SBO) is the most common indication for laparotomy in the UK. While general surgeons have become increasingly subspecialised in their elective practice, emergency admissions frequently remain undifferentiated. This study aimed to assess temporal trends in the management of adhesional SBO and explore the influence of subspecialisation.

Method
Data was collected for patients admitted acutely with SBO across Northern England between 01/01/02 and 31/12/16, including demographics, co-morbidities and procedures performed. Patients were excluded if a non-adhesional cause was identified and were grouped by the responsible consultant's subspecialty. The primary outcome of interest was 30-day inpatient mortality.

Results
2818 patients were admitted with adhesional SBO during a 15-year period. There was a consistent female preponderance (55.9%), while age and comorbidity increased significantly over time (both p&lt;0.001). The proportion treated conservatively decreased (47.1% vs. 40.4%, p=0.009), as did the time to operation (median 2 vs. 1 day, p&lt;0.001). There was an increased propensity for patients to be managed by gastrointestinal (colorectal & upper gastrointestinal) subspecialists (69.9% vs 51.6%, p&lt;0.001). While a trend towards laparoscopy was evident (p=0.005), particularly amongst gastrointestinal subspecialists, uptake remained limited. Length of stay (p&lt;0.001) and 30-day mortality (p&lt;0.001) have improved over time, with the best outcomes seen in colorectal (2.6%) and vascular subspecialists (2.4%). However, following adjustment for confounding variables, consultant subspecialty was not a predictor of mortality.

Conclusions
Outcomes following adhesional SBO have improved despite the increasing burden of age and co-morbidity. While gastrointestinal subspecialists are increasingly responsible for their care, mortality is not influenced by consultant subspecialty.
951 Boerhaave's Outcome in a Single Tertiary Oesophago-Gastric Centre Over 5-Years
Authors: Hashi A , Gutale A , Elnour A , Madhavan A , Singh P , Preston SR , Abbassi-Ghadi N 
Published: November 2022

Abstract

Aim
To present modern day outcomes for Boerhaave's in a single tertiary oesophago-gastric centre.

Method
This study retrospectively analysed the records of consecutive patients diagnosed with Boerhaave's between June 2016 and June 2021.

Results
In this case series (n=18) patients were included, male (n=14) and female (n=4), with a mean age of 61. Treatment was commenced within 24 hours of symptom onset in (n= 7;38.8%), and after (n=11; 61.1%).
All Patients had an OGD performed on arrival in theatre to plan operative management. The site of the oesophageal perforation was identified as: distal third (n=14;77.8%); middle third (n=4;22.2%). Majority of patients were treated surgically (61.11%), with only seven non operatively. Within the surgical group the most common operative technique was primary repair over T-tube with intercostal drains via Thoracotomy (n=8;72.72%), followed by a trans-hiatal primary repair via a laparotomy (n=2;18.18%) or laparoscopy (n=1;9.1%).
There were three major complications requiring unplanned return to theatre. One patient required a redo-thoracotomy, decortication, and evacuation of an empyema. One patient had a consistent leak post primary repair from oesophageal perforation requiring Eso-sponge vacuum therapy for further healing and closure of the tear. Another patient required a revision of feeding Jejunostomy.
There was zero mortality both in hospital and in 30- and 90-days following admission. The average hospital stay was 34 days, of which 11 days was in Intensive care.

Conclusion
With this data, we can conclude that aggressive medical management coupled with surgical management as well as mediastinal debridement and washout resulted in no mortality.
1022 Early Cholecystectomy in the Ageing Population
Authors: Sturges P , Gupta A , Rashid U , Rupasinghe SN , Adjepong S , Parampalli U , Kirby GC , Jain RK , Rink J , Riera-Portell M , Pattar J 
Published: November 2022

Abstract

Background
The age group of patients presenting acutely with biliary pathology is rising and gallstone disease can no longer be said to be a disease of the young. The World Health Organisation classifies those aged 65 and over as elderly. Early cholecystectomy is accepted as a safe and effective method of managing acute biliary pathology, reducing further admissions, and reducing in-hospital stays. Our unit does not use age as barrier but uses performance status and co-morbidity to identify potential candidates for cholecystectomy.

Method
Patients over the age of 65 who underwent acute cholecystectomy (AC) via the emergency cholecystectomy lists, were audited from 31st December 2019 to 31st June 2021. Patient demographics, co-morbidities and surgical factors were recorded. The primary outcome measures were in-hospital stay and re-admission, secondary outcomes were complications and perioperative mortality.

Results
41 elderly patients underwent AC during the audit period, (Female 56%, Male 44%). 30 patients had acute cholecystitis (73%). The median inpatient stay following surgery was 2 days (range 2–5 days) and the median admission to surgery time was 6 days (range 5–12 days). Three patients had a subtotal cholecystectomy. There were 3 complications from surgery which were all between a Clavien-Dindo score of 2 and 3. There were 3 immediate post-operative readmissions, with one 30-day mortality from ERCP pancreatitis and not from the operation.

Conclusion
Early cholecystectomy appears to be a safe and effective treatment for this group of patients and based on this evidence we should continue to offer this treatment to patients irrespective of age.
295 Open Minimally Invasive vs Video-Assisted Minimally Invasive Parathyroidectomy for Solitary Adenomas: A Systematic Review and Meta-Analysis
Authors: Saleki M , Abul A , Ashhad Noor M , Alhajri M 
Published: November 2022

Abstract

Aim
To conduct a meta-analysis comparing two minimally invasive techniques; Video Assisted Minimally Invasive Parathyroidectomy (VAMIP) and Open Minimally Invasive Parathyroidectomy (OMIP).

Method
A systematic review and meta-analysis were carried out in line with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines. Databases from MEDLINE, EMBASE, CINAHL identified Randomised Controlled Trials (RCTs), cohort and observational studies that compared VAMIP and OMIP. The primary outcome measures assessed were the VAS score 24 hours after surgery, conversion of the operation to open, failure rates and analgesic consumption. Secondary outcomes were operative time, hospital stay length, and scar length. These studies' data were extracted and statistically analysed.

Results
The literature search yielded 104 studies of which 4 were included, enrolling 903 patients in this analysis. A significant difference was found regarding rates of conversion to open parathyroidectomy between the two groups, with the OMIP group demonstrating fewer conversions (MD= 3.52, CI= (2.04–6.08), P&lt; 0.00001). No statistically significant differences were found between the two groups when comparing VAS score post-op 24hrs (MD= -1.75, CI= (-9.8–6.3) P= 0.67), consumption of analgesia (OR= 0.49, CI= 0.07–3.54, P=0.48) or failure rates (OR= 1.81, CI= 0.58–5.72, P= 0.31). OMIP had quicker operative times and similar complication rates and scar lengths to MIVAP.

Conclusions
OMIP was seen to require less need to convert to open parathyroidectomy with shorter operative times and similar complication rates and scar lengths to MIVAP. More studies are required to evaluate the superior technique for parathyroidectomy.
307 Primary Hyperparathyroidism: Patient Outcomes and Success of Repeated Imaging After Initial Negative Radiological Parathyroid Localisation
Authors: Karunaratne N , Kirkland P , Sathiskumar P , Howlett D 
Published: November 2022

Abstract

Aim
Radiological localisation imaging may achieve gland localisation in primary hyperparathyroidism, thereby allowing minimally invasive surgery. However, initial imaging sometimes fails to identify the abnormal gland. This study explored the outcomes of patients undergoing repeated imaging at our institution, after a negative initial set of scans.

Method
Data was retrospectively collected and analysed for patients undergoing repeated imaging between 2015 and 2020 at an institution providing parathyroid endocrinology services.

Results
45 patients who had repeated localising scans after a first localising scan that was negative, were identified. Of these, 39 did not undergo surgery. 11 out of these 39 patients (28%) had subsequent positive localisation scans, but no particular patient factors were predictive of gland localisation success. A large proportion of patients were managed conservatively, despite repeated sets of negative scans being done. Patients undergoing three or four sets of scans did not have imaging or surgical success.

Conclusion
A dedicated, streamlined parathyroid pathway should be followed whereby patients should be triaged for suitability for surgery prior to repeated imaging. A second set of scans should be offered when patients are unsuitable for conservative management and are willing and fit to undergo surgery. There is no merit to repeating scans more than twice.
461 A Retrospective Audit of the Success Rate and Complications of Parathyroidectomy in Primary Hyperparathyroidism
Authors: Sandhar P , Bidaye R , Ahmed I 
Published: November 2022

Abstract

Aim
Primary hyperparathyroidism (pHPT) is a clinical disorder which presents with hypercalcaemia. The definitive management for such cases is a Parathyroidectomy. Few centres have reported their success rate for this procedure. We conducted a retrospective review to compare the success rate and complications in Parathyroidectomy at our centre.

Method
After approval from the ethical committee, data was collected from the case files of the patients. Inclusion criteria was a Parathyroidectomy performed for pHPT between 2013 and 2020 at our institute. The Data included the demographics with pre- and post-operative Calcium / Parathyroid hormone levels to calculate the success rate. The procedure was defined as successful if the calcium levels returned to normal ranges (&lt;2.6 mmol/L) according to NICE guidelines.

Results
246 pHPT patients with a mean age of 61 years were included. 222 patients (90.24%) had their calcium level return to normal indicating a successful procedure. 24 cases (9.75%) had persistence or recurrence of hypercalcaemia indicating a failure of the surgery. The rate of success was significantly higher (96.84%) in the last 2 years (2019 – 2020) of the audit suggesting an improvement in outcomes.
Five patients (2.03%) out of the 246 had complications related to the surgery. Two patients reported post-operative cord paresis, two had a post-operative neck haematoma and one experienced hypocalcaemia from hungry bone syndrome.

Conclusions
The surgical outcomes especially in the last 2 years are comparable to other specialized centres mentioned in the review. This Audit helps us demonstrate the improvement in the surgical results over the years at our centre.
858 Parathyroid Adenoma Manifesting as Acute Pancreatitis: A Case Report and Literature Review
Authors: Ayathamattam J , Rotherham M , Bosman D 
Published: November 2022

Abstract

Introduction
Pancreatitis is commonplace on the acute surgical take. It is usually caused by gallstones or alcohol excess. Parathyroid adenoma causing hypercalcaemia is a rare cause of pancreatitis.

Case report
Here we describe a case of a 45-year-old gentleman with no past medical history who presented with epigastric pain and vomiting. A CT scan revealed acute pancreatitis. After a normal biliary tree ultrasound scan, the cause was initially proposed to be alcohol although he reported an average intake of only 4–6 units/day. However, on closer inspection of blood tests, it was apparent that he had a severe hypercalcaemia at 3.45mmol/L and a hypophosphataemia. This raised the suspicion of a primary hyperparathyroidism. Accordingly, a parathyroid hormone level was measured and shown to be 90pmol/L! An ultrasound scan of the neck confirmed the underlying cause to be a parathyroid adenoma. Due to the severity of electrolyte imbalances, this adenoma was excised during the same admission. The patient's symptoms resolved, and he was discharged with planned follow up after genetic testing for multiple endocrine neoplasia syndromes.

Literature review
There have been many similar cases reported in the last 10 years but primary hyperparathyroidism causing pancreatitis remains rare. Multiple cases involved recurrent acute pancreatitis before parathyroid lesions were diagnosed.

Conclusion
This case highlights the importance of investigating other causes of pancreatitis where gallstones and alcohol excess have been ruled out. Furthermore, it is pertinent for surgical trainees, who usually check blood tests initially, to be able to interpret electrolyte imbalances in the context of surgical disease.
215 Examining the Benefits of One-To-One African Caribbean Mentoring for Prospective Medical Students
Authors: Carey C , Jordan C , Wheatle M , Edward S 
Published: November 2022

Abstract

Aim
African Caribbean people are underrepresented in UK medical schools. African Caribbean Medical Mentors (ACMM) is a UK registered charity that provides one-to-one mentoring to prospective African Caribbean medical students. Mentors consist of current African Caribbean medical students and doctors. This study aimed to investigate the specific benefits provided by ACMM and the attributes of successful mentoring relationships.

Method
Participants were identified using ACMM's database of mentees and mentors enrolled within the last 3 years and an online questionnaire was distributed via Qualtrics. Questions were scored on a scale between 1 and 10 and participants were asked to explain their rankings.

Results
11 mentees and 7 mentors responded to the surveys. 63.6% and 72.7% of mentees gave a score between 8 – 10 regarding the importance of having a mentor and having a mentor that was African Caribbean respectively. All mentees reported satisfaction with their mentor, with 45.5% citing individualised interview practice and 63.6% reporting mentor support and availability as positive aspects of their mentoring relationship.
All mentors reported being satisfied with the program, with 57.1% and 71.4% giving a score between 8 – 10 regarding the importance of having a mentor and having a mentor that was African Caribbean respectively. 42.9% of mentors reported that improved methods and proactivity with communication could have improved their mentoring relationship.

Conclusion
This study suggests that one-to-one mentoring between African Caribbean mentors and mentees was helpful during medical school applications. Interview practice proved particularly useful, whilst methods and timescales of communication represent areas for improvement.
226 Temporal Variation in Consent Litigation in General Surgery
Authors: Sebastian A , Wyld L , Morgan J 
Published: November 2022

Abstract

Aim
Issues with consent is one of the most common causes of litigation within General surgery. The guidance surrounding informed consent in surgery has changed following the Montgomery vs Lanarkshire Health Board (2015) court ruling. The aim of this study was to examine the time trends in medico-legal cases related to consent between 2011–2020.

Method
Data on the numbers of litigation cases in general surgery were obtained from NHS resolutions for the period of 2010–2020. Chi-squared analysis was performed using SPSS to compare the proportion of litigation cases that were due to consent before and after 2015.

Results
There were a total of 10,027 general surgery claims made between 2010–2020, of which 580 (5.8%) were related to issues with consent. The number and proportion of claims related to consent rose during the study period, with 208/2817 (3.76%) consent-related cases before 2015, versus 372/3267 (8.12%) after 2015; a 116% increase (p&lt;0.001).

Conclusions
These data illustrate a significant rise in medico-legal claims related to consent in General surgery in the post-Montgomery era. This may be due to legal precedent being established following the Montgomery case, and the increased awareness of these issues as a result.
578 Is the Scope of the Physician's Duty to Warn the Patient About the Risks Associated with a Surgery Sufficiently Clear?
Authors: Kazzazi F , Noton T , Magill H 
Published: November 2022

Abstract

Aim
To critically analyze the concepts and cases that led to the seminal rulings in Montgomery and Sidaway

Method
A medical and legal literature review was performed. Case history was identified and critically analysed to understand the progression of consent law in England.

Results
The physician's duty to warn the patient about the risk associated with medical intervention has been developed through the cases identified to involve:
The process of consent is of chief importance in surgery and yet only a single case (Chester) directly involves consenting during a surgical procedure.

Conclusion
The definition of material risk is expected to cover a plethora of medical interventions from minor procedures to major surgery. It was generated predominantly from non-surgical cases. The physician's scope to disclose risks to patients is broad and encompasses a skillset that incites core clinical skills of empathy, honesty, and information transfer. It has evolved alongside advances in medical and legal judgement, albeit reactively to cases of inadequate care. With regard to its clarity, one has to consider the acceptable boundary of prescriptivism that both respects patient autonomy and creates a transparent working environment. It can be argued that the current scope is not direct enough for healthcare professionals.
723 Should Radiation Exposure and Surgeon Safety Be Considered in Decision Making? a Single Centre Retrospective Analysis of Radiation Exposure During Intra Medullary Nailing of Proximal Femur Fractures
Authors: Noton T , Khanom S , Bagouri E , Abd Wahab EH , Vasireddy A 
Published: November 2022

Abstract

Aim
Short intra medullary (IM) and long intra medullary nails are fixation methods used for proximal femur fractures. Both require fluoroscopic assistance within the operating theatre, therefore exposing the surgeon and patient to ionising radiation. There is minimal literature investigating radiation exposure. Aims of this study are to compare the radiation doses in each procedure and to estimate a normalised dose.

Method
Retrospective data analysis was carried out for patients who underwent surgical management of proximal femur fractures with IM nail fixation over a 3-year-period. Data was sourced using electronic operative records and Sectra PACS imaging software. Radiation dose parameters collected were the cumulative dose in milligrays (mGy), cumulative dose area product (DAP) (Gy.cm2) and time of exposure in minutes and seconds. Statistical analysis was performed using SPSS statistical software.

Results
A total of 108 patients were included in analysis. 42% were treated with a short IM nail (TFNA - Synthes), while 58% had a long IM nail (RAFN, LFNA or TFNA - Synthes). Mean cumulative radiation dose for the short IM nail group was 7.350mGy versus 10.915mGy for the long IM nail (P=0.012). Mean exposure time was 01:32 for short IM nail compared to 02:32 for long IM nail.

Conclusions
The results confirmed a significant difference in radiation dose and exposure time between both procedures. As the radiation exposure in long nails is almost two-fold, we recommend the use of the short IM nail when the fracture pattern and clinical scenario allow.