bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP10.1.9 Routine preoperative group and save is not necessary for emergency appendectomy in adults – A retrospective multicentre study
Authors: Sundarraj Karuniya , Khan Khurram 
Published: November 2022

Abstract

Aims
The use of routine Group and Save (G&S) for appendectomy is practised commonly with little evidence behind this practise. Our aim was to assess whether routine pre-operative G&S before appendectomy is required by identifying rate of perioperative blood transfusion.

Methods
A multicentre retrospective observational study of all adult patients who had emergency appendectomy across four hospitals between August 2018 and November 2020. Patients were identified through pathology records. Data was extracted for demographics, pre and post-operative imaging and operative details, G&S, cross matching and peri-operative blood transfusion.

Results
1,105 patients were identified, 635 (57.4%) were male. Median age was 37 years (IQR 26–52). 1,012 (91.6%) were ASA 1 or 2. Surgical approach: 890 (80.5%) laparoscopic, 79 (7.1%) converted to open, 119 (10.8%) open and 17 (1.5%) laparotomy. Severity of appendicitis: 804 (72.8%) inflamed, 56 (5.1%) gangrenous, 235 (21.3%) perforated and 10 (0.9%) were normal.
921 (83.3%) patients had pre-operative G&S. 42 (3.8%) patients also had cross match (36 patients had 1 unit and 6 patients had 2 units). None of the patients required blood transfusion in 30 days post appendectomy. The total cost of G&S is estimated to be £56,733 in this cohort.

Conclusions
The need for peri-operative blood transfusion is rare in patients undergoing appendectomy via any surgical approach. It has significant cost impact as well as it causes unnecessary delays if not done in timely manner. Our study suggests that routine G&S policy is not necessary and we suggest a more ‘selective’ G&S policy.
SP10.1.11 What happens when you VAC?
Authors: Abdalazeez Tasabeeh , McDonald Rosie , Miller Andrew 
Published: November 2022

Abstract

Aims
Abdominal VAC dressings are part of the surgical armamentarium in the management of the open abdomen. This study examined the number, indication and outcomes of patients with VAC dressings in a tertiary surgical unit.

Methods
Retrospective review of the operating theatre database identified all patients with abdominal VAC dressing between February 2016 and July 2021. Medical records were reviewed for demographics, operative, outcome and discharge data.

Results
76 patients had abdominal VAC dressings. 40 (53%) were female and 57 (75%) were aged &gt;50 years. For 54 (72%) the primary surgery was an emergency. Major indications for VAC included intra-abdominal sepsis 41 (53.9%) and wound dehiscence 16 (21.1%). Mean VAC changes under GA 2.07 (range 0–10). Mean VAC changes on the ward 2.1 (range 0–11). Mean length of hospital stay 48.6 days (range 4–258). 49 (70%) had the VAC removed in hospital, in this cohort mean duration of VAC therapy was 22 days. 11 (15%) were discharged to community hospitals and 56 (77%) directly home. 4 (5.3%) patients developed entero-atmospheric fistulae, 1 (1.3%) bleeding and 1 (1.3%) wound infection.

Conclusions
Abdominal VAC therapy is safe. However, it comes with significant immediate and medium-term burdens, in terms of hospital bed days, theatre time and specialist staff input, all of which are costly. Longer term, incisional hernias are associated with morbidity for patients and a financial cost for the Trust. The authors therefore advocate an attempt at early fascial closure where possible, through techniques such as mesh mediated fascial closure.
SP11.1 What happens to hernias if we don't operate? A Covid-19 waiting list study
Authors: Bruce Nikki , Young Jamie 
Published: November 2022

Abstract

Aims
Many patients with symptomatic abdominal hernias have suffered delays and cancellations due to the reduction of elective operating lists. This waiting list study looks to examine what has happened to patients who were on the waiting list on the day of the first lockdown in March 2020, and whether there were any adverse outcomes.

Methods
We used coding data, TrakCare IT information and op notes to identify the outcomes of those patients between March 2020 and December 2021. We looked at whether elective surgery had been done, waiting times, if the patient had presented as an emergency, and if they had been removed from the list. We included any symptomatic abdominal hernia ie inguinal, incisional, paraumbilical, ventral.

Results
There were 78 patients included. 33 had elective repair, min waiting time 6 months, max 18 months. There were 5 emergency presentations for operative repair (6.4%) including 1 death (3 inguinal, 2 incisional). A further 3 required expedited repair at 5, 8 and 9 months. 4 patients removed themselves due to improvement in symptoms and 27 patients remained on the list (min 19 months, max 27 months).

Conclusions
Waiting lists for benign surgery have been adversely affected by the pandemic and this difficulty is seen clearly in our small district general. Patients who have been waiting a long time are at risk of emergency presentations and ongoing symptoms. Those with the fewest symptoms are waiting over two years and are at risk of continued waits due to ongoing service pressures.
SP11.3 Impact of Covid on emergency laparotomy activity
Authors: Kronberga Madara , Saha Arin 
Published: November 2022

Abstract

Aims
National surgical guidance during the Covid-19 pandemic cautioned against surgical intervention with subsequent unsurprising falls in emergency activity.
Our unit, in contrast to national guidance, treated patients normally but with enhanced quality measures and without withholding surgery where indicated; key measures introduced included two-consultant operating, early consultant decision-making and daily consultant ward rounds to facilitate early discharge. This study outcomes from these locally developed guidelines.

Methods
All emergency laparotomies are entered contemporaneously on to the NELA database. Activity and outcomes from two time periods, from before and after the advent of Covid-19 (March 2019–2020 vs. March 2020–2021) were compared.

Results
Emergency laparotomy activity increased from 154 cases to 192 cases (24%). There were no pre-operative differences in frailty scores, ASA, pre-operative predicted mortality (7.4% vs. 6.9%) or predicted morbidity between the two periods.
Although 2% of patients developed Covid-19 infection, there was no increase in crude mortality (9% to 8%) or post-operative complications. The proportion of patients who went to critical care after surgery fell though post-operative length of stay also fell (mean 18.8 days vs. 12 days).

Conclusions
With local guidelines and enhanced consultant-delivered care, emergency surgery was increased during the Covid pandemic without increased complications. This may reflect the marked reduction in activity in neighbouring hospitals and additional capacity due to falls in elective activity. Given the reduction in emergency surgery nationally, it is likely that guidance which cautioned against surgery has led to patients unnecessarily missing out on operative treatment with subsequent poorer outcomes and greater mortality.
SP11.4 Imaging recommendations during the Covid pandemic for the investigation of right iliac fossa pain: an unachievable and unnecessary burden on radiology services?
Authors: Doughty Alice , Cheetham Stephanie , Kenber Melisa , Smellie Eloise , Saha Arin 
Published: November 2022

Abstract

Aims
Initial Covid-19 surgical guidance, produced without radiological input, recommended that patients with right iliac fossa (RIF) pain should have imaging before intervention. This study quantified the burden on imaging services from these guidelines.

Methods
Patients who presented to our surgical unit with RIF pain from March to October 2020 were identified. Clinical parameters, radiology and final diagnosis were recorded. Minimum follow-up was 12 months to identify re-admissions and morbidity.

Results
There were 417 patients. There was a drop in admissions in the first months of each new wave of Covid (March/April, September/October) compared with intervening months (36% vs. 64%, P=0.036). 266 patients (64%) had a CT scan increasing from 42% of patients in March to 75% in September (P=0.019). The proportion of patients with normal imaging increased correspondingly with over a third (34%) of CT scans being normal. 93 CT scans (35%) showed appendicitis, which was the suspected diagnosis in all but 7 of these patients.
Patients with normal imaging had lower white cell counts (Mean 10.1×109 vs. 14.8×109/L, P&lt;0.001) and CRPs (Mean 21 vs. 99, P&lt;0.001). Patients seen first by a consultant were less likely to require imaging.

Conclusions
During the first year of Covid-19, two-thirds of patients with RIF pain had a CT scan with a third being normal. Most scans showing appendicitis had clinical parameters consistent with this diagnosis. Current guidelines may lead to unsustainable pressures on radiology services; ensuring consultant assessment prior to imaging requests may reduce the burden on these teams.
SP11.5 Effect of COVID-19 Pandemic on Thyroid Surgery
Authors: Rezkallah Emad , Elsaify Wael 
Published: November 2022

Abstract

Introduction
The rapidly expanding COVID-19 pandemic has affected all aspects of daily life, including health care systems. The impact on COVID 19 on thyroid surgery is clear due to the delay in most thyroid related activities, including the delay in the thyroid investigations, screening and surgery.
The aim of the current study is to illustrate the impact of COVID 19 on thyroid surgery.

Methods
Retrospective review of our activities during 7 months (January – July) in 2021 during COVID-19 pandemic and comparing it with a similar period in 2019.

Results
During the period of seven months in 2019, we performed 69 thyroid surgeries, while during the same period in 2021 we performed 16 thyroid operations. In 2019, 35 patients had diagnostic thyroidectomy (malignancy was found in 9 of them), while only one case in 2021 had diagnostic thyroidectomy. Six patients in 2019 had completion thyroidectomy; one of them had thyroid cancer, while four patients in 2021 had completion thyroidectomy; all were benign. Malignancy was diagnosed in 26 patients in 2019 and in 10 patients in 2021. Most patients in 2019 had early stage disease (T1: 14 patients, T2: 4 patients, and T3: 6 patients), while most patients in 2021 had high stage disease (T1: 3, T2: 1, T3: 5, and T4: 1). Lymph node involvement was found in 9 patients from 24 in 2019, and in 9 patients of 10 in 2021.

Conclusion
Because of the COVID pandemic, most thyroid cancer patients presented with advanced disease with high incidence of lymphatic metastasis.
SP11.6 End of Life Care and Advance Care Planning for Outpatients with Inoperable Abdominal Aortic Aneurysms – A Retrospective Cohort Study
Authors: Davies Henry , Vleugels Marie-José , Kwan Jing Yi , Aerden Alexander , Wyld Lucy , Mees Barend , Scott D Julian A 
Published: November 2022

Abstract

Introduction
A proportion of patients with aortic aneurysms (AA) do not proceed to intervention after reaching treatment threshold diameter due to a combination of poor cardiovascular reserve, frailty and aortic morphology. This patient cohort has a high mortality, however, there exist no studies on the palliative care (PC) and advance care planning (ACP) they receive following discharge from the clinic.

Methods
We conducted a multicentre cohort study of 220 conservatively managed AA patients referred to centres in Leeds and the Maastricht for intervention between 2017 and 2021, from a combined total of 1506 patients - a non-intervention rate of 15%. Demographic details, mortality, cause of death, ACP and PC outcomes were analysed to examine predictors of PC referral and consultation efficacy.

Results
There was a 3-year mortality rate of 60%. Rupture was the reported cause of death in 17% of the decedents. Only 9% of all patients received PC referrals - a median of 3.5 days before death. Patients over 80 were more likely to have PCCs. Almost half of the decedents were readmitted to hospital before death and 37% died in hospital. Only 5% of patients had a documented preferred place of death. Patients with PCCs were more likely to have preferred place of death and care priorities documented.

Conclusion
Only a small proportion of conservatively treated patients with AAs had ACP, far below 2019 NICE end-of-life care guidance. It is also far below the level offered to oncology patients. Pathways and guidance should be implemented to ensure patients not offered AA intervention are offered end-of-life care and ACP.
SP11.7 Cost-effectiveness of carotid endarterectomy in symptomatic patients
Authors: Thapar Ankur , Perez-Troncoso Daniel , Hossain Mohammad , Davies Alun 
Published: November 2022

Abstract

Aims
In recent years, improvements in medical therapy for stroke prevention have emerged. Recent analyses of medically treated cohorts have suggested that early rates of stroke may have reduced, whilst reports for safety of carotid surgery have also shown improvements. Since the effectiveness of carotid surgery versus medical therapy was established in 1990s, it is important to evaluate whether surgery remains cost-effective.

Methods
A decision model was developed to estimate the lifetime costs and utilities of modern medical therapy with and without carotid endarterectomy in patients with symptomatic stenosis from perspective of the UK National Health Service. The base-case population consisted of adults 65 years of age with 70–99% stenosis. Costs and utilities were obtained from National Health Service tariffs and the literature. Univariate and probabilistic sensitivity analyses were carried out. Data on surgical safety was taken from the 2020 National Vascular Registry Report. Data on modern medical therapy was taken from Fisch et al. 2020.

Results
In the base-case scenario, the 5-year absolute risk reduction with endarterectomy was 5%, and incremental cost-effectiveness ratio was £23,632 per quality adjusted life year. Surgery was more cost-effective if performed rapidly after presentation. In patients with 50–69% stenosis, surgery appeared clinically ineffective.

Conclusion
In symptomatic patients with 70–99% stenosis, carotid endarterectomy would remain cost-effective if performed rapidly after presentation. Surgery may have lost clinical efficacy in those with moderate stenosis. However, these results are uncertain because of limited data on modern medical therapy. A new randomised controlled trial of surgery versus modern medical therapy is needed.
SP11.8 Postoperative outcomes are significantly worse among patients undergoing repair of ruptured versus unruptured iliac artery aneurysms – a 10-year longitudinal cohort study
Authors: Laloo Ryan , Aimar Kelsey , Khanom Johura , Bailey Marc , Scott Julian 
Published: November 2022

Abstract

Aim
The European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study assessed outcomes following IAA rupture as their natural history is poorly understood with treatment recommendations based on low-level evidence.

Method
Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included aneurysm rupture, rupture diameter, post-operative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.

Results
Of the 203 patients included, 90.6% were men and median(IQR) age at detection was 77 (71–83). Co-morbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4)cm for CIA and 4.6 (3.0)cm for IIA. Post-operative major adverse cardiovascular events (MACE) more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).

Conclusion
Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.
SP11.9 Balancing Risk of Haematoma and Venous Thrombosis in VTE Prophylaxis for Breast Cancer Surgery: A Systematic Review and Meta-Analysis
Authors: Dhannoon Amenah , Balasubramanian Ishwarya , Hill Arnold 
Published: November 2022

Abstract

Introduction
Venous thromboembolism (VTE) is a largely preventable cause of morbidity and mortality in post-operative patients, however Guidelines for VTE prophylaxis in breast cancer surgery are not well-established.

Methods
A comprehensive search was undertaken of all studies that described the role of VTE prophylaxis in breast cancer surgery. Comparative studies that reported on postoperative outcomes between patients who received VTE prophylaxis (prophylaxis) and those who did not (no prophylaxis) were included in the analysis. A meta-analysis using random-effects model was used to analyze key outcomes, with data presented as odds ratio (OR).

Results
A total of 2470 patients from 6 studies were included in this study. Of these patient, 60.9% (n: 1504) received prophylaxis. The haematoma rate in this study is 0.05% (n: 133). The incidence of haematoma was significantly associated with the use of prophylaxis (6.85% versus 3.11%, p: 0.001). Surgical intervention for haematomas was also significantly associated in this group (3.15% versus 0.83%, p: 0.004). However there was no difference in VTE events between both groups (0.26% versus 0.36%, p: 0.88).

Conclusion
The use of VTE prophylaxis in breast cancer surgery is associated with increased haematomas without any benefit in preventing venous thromboembolic events. Further studies that examine the use of risk assessment tools for VTE prophylaxis in high risk patients may be beneficial.
SP11.11 Developing the Mobile App ‘ABCs of Breast Health’ - Pioneering Digital Innovation to raise awareness of Breast Health in India
Authors: Pillarisetti Sai , Pillarisetti Raghu Ram 
Published: November 2022

Abstract

Aims
Breast cancer is the most common cancer affecting women, both in India & the world. Due to a lack of awareness and the absence of an organised population-based screening programme in India, more than 60% of breast cancers present in the advanced stages, with most succumbing to the illness within a year of being diagnosed.
This mobile app aims to empower people about various aspects of Breast cancer & Benign breast disease explained in simple, easy-to-understand format.

Methods
To help address these striking realities, I worked with a Breast Cancer Charity based out of India, to create the Mobile App - ‘ABC's of Breast Health’ - available in English and 11 regional Indian Languages.
The app has an interactive ‘Myths & Facts’ section which is aimed at debunking many of the common myths surrounding breast cancer and ensuring that users are well informed with accurate information, thus filling a huge void in the delivery of Breast Health Care in India where counselling is not given much importance.
A dedicated breast health helpline was launched in 2021 to further support users.

Results
This App is South Asia's First Mobile App on Breast Health and is also the World's first breast health app available in so many languages. Within the first month of its launch, it recorded 9000+ downloads.

Conclusion
The content of the app in 11 commonly spoken regional languages has ensured that accurate information relating to breast health is accessed by women in rural India, where 70% of the population resides.
TU1.2 Revisional Bariatric Surgery: 7-Year Experience from a Tertiary Institution
Authors: Panesar Harrypal , Desai Chaitya , Mohamed Guleed , Ghassemi Nader , Davies Sian , Cheruvu Chandra 
Published: November 2022

Abstract

Background
Revisional surgery is an expanding area in bariatric surgery which reflects a rising need to treat adverse sequelae of primary procedures. Despite the increase, their safety and efficacy remain unclear. We aimed to review revisional bariatric surgery indications and outcomes at our tertiary centre.

Methods
Data on revisional bariatric surgery was collected prospectively from 2013 and analysed retrospectively, including indications and postoperative outcomes.

Results
From January 2013 to December 2021, 80 patients (mean age: 51.4 years) undergoing revisional surgery were identified: 38 laparoscopic gastric band (LGB) to Roux-en-Y gastric bypasses (RYGB), 34 sleeve gastrectomies (SG) to RYGB, 6 mini-gastric bypasses (MGB) to RYGB and 2 RYGB revisions. The most common indication for revision was weight regain (56.4%) followed by intolerable reflux (21.3%). Other indications included band complications (15%), obesity-related problems (2.5%), excessive weight loss (2.5%), corkscrewing of sleeve (1.3%), and dumping syndrome (1.3%). There were 11 post-operative complications, with mean length of stay of 2.8 days. In addition to treating primary complications, the mean change in BMI at 12 months for LGB to RYGB revisions and SG to RYGB revisions was -9.5 and -5.3 respectively. Average change in BMI at 24 months for LGB to RYGB revisions and SG to RYGB revisions was -9.4 and -8.6 respectively.

Conclusion
Revisional bariatric surgery effectively treated the undesirable results from primary surgery. Laparoscopic revisional surgery can be performed after both failed open and laparoscopic procedures with minimal complications. In experienced hands, with careful patient selection & education, satisfactory additional weight loss can be achieved.
TU1.3 A pilot survey of surgeons’ knowledge regarding vagus nerve injury
Authors: Dunstan Matt , Kaur Vasha , Bezzaa Sabrina , Nehra Dhiren 
Published: November 2022

Abstract

Aims
Vagus nerve injuries occur in up to 42% of patients following anti-reflux operations. Vagal nerve injuries may have a significant impact on patients’ quality of life after benign Upper GI hiatal surgery, and may go unrecognised. We aimed to explore surgeons’ knowledge and practice regarding consenting, identifying the vagus nerve intraoperatively, and managing vagus nerve injuries.

Methods
A pilot survey was distributed to General Surgical Trainees and Consultants in South East England via social media groups and Twitter. Respondents from other regions were permitted.

Results
Nineteen respondents comprised 1 SHO, 14 Registrar grades/fellows and 4 Consultants. Seventy-four percent reported routinely discussing vagus nerve injury, of whom over 70% discussed symptoms of fullness and/or bloating, but only 36% discussed the need for further procedures. Eighteen respondents were involved in anti-reflux and paraoesophageal hernia procedures, of whom 94% routinely visualised the posterior vagus nerve during these procedures, whilst around 60% visualised the anterior vagus nerve. Ten respondents were involved in gastric band insertion, of whom 60% did not identify either vagus nerve. Only 7 respondents had experience of managing patients with vagus nerve injury.

Conclusions
Work is required to guide education around informing patients of the risk of vagus nerve injury, and around managing this complication. This pilot survey informs wider national work to explore this topic.