bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP2.1.1 Safety of Bariatric Surgery in The Older Patients During the COVID-19 Pandemic
Authors: Singhal Rishi , Omar Islam , Madhok Brijesh , Rajeev Yashasvi , Graham Yitka , Mahawar Kamal 
Published: November 2022

Abstract

Background
The progressive growth of the older patients with obesity represents a challenge to the weight management teams. Although initially, old age was a relative contraindication to the surgical option, current advances in laparoscopic techniques and perioperative optimization protocols have changed the old notion. However, the performance of bariatric procedures in the older patients during the ongoing COVID-19 pandemic carries a potential risk. This study aimed to assess the safety of bariatric surgery (BS) in older patients during the pandemic.

Methods
We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - older patients ≥65-year-old (Group I) and young &lt; 65-year-old (Group II). Two groups were compared for 30-day morbidity and mortality.

Results
We included 7084 patients, the mean age was 40.35±11.9 years, and 5197 (73.4%) were females. The mean preoperative weight and BMI were 119.49±24.4 Kgs and 43.03±6.9 Kg/m2, respectively.
The overall comorbidities were significantly higher in Group I, p= &lt;0.001. In Group II, 14.8% were current smokers, compared to 7.4% of Group I. The complications in Group I were significantly higher (11.4%) compared to Group II (6.6%), p= 0.022. However, the mortality rate and COVID-19 infection within 30 days were not significantly different between the two groups.

Conclusions
Bariatric surgery during the COVID-19 pandemic in the older patients (≥65 years old) is associated with a higher complication rate than the younger age group. However, the mortality and postoperative COVID-19 infection rates are comparable to the younger age group.
SP2.1.3 Effect of laparoscopic sleeve gastrectomy on vasoactivemediators in obese hypertensive patients: A prospective study
Authors: Salman Mohamed , Noureldin Khaled , Issa Mohamed , Badawi Marwa , Tourky Mohamed 
Published: November 2022

Abstract

Introduction
The relationship between obesity and high blood pressure is established; however, detailed pathways for such association are still under research. This work aims to assess the changes in neprilysin, vasoconstrictor and vasodilatory molecules in obese hypertensive patients undergoing laparoscopic sleeve gastrectomy (LSG).

Patients
Prospective study was done on 59 hypertensive obese patients in whom LGS was performed. Blood pressure, as well as blood samples for neprilysin, angiotensinogen, angiotensin II, renin, endothelin-1 “ET-1”, aldosterone, atrial natriuretic peptide “ANP” and B-type natriuretic peptide “BNP”, were assessed before and 15 months after surgery. Patients were divided into two groups according to the remission of hypertension (HTN).

Results
After 15 months, remission of hypertension was seen in 42 patients (71%). The declines in the following measurements were higher in patients with remission than those with persistent HTN: aldosterone (p = .029567), angiotensin II (p &lt; .000001), angiotensinogen (p = .000021), n eprilysin (p = .000601), renin(p = .000454) and endothelin-1(p = .000030). There was a significantly higher incrementin ANP (p = .000002) a nd a n on-significant increment i n B NP (p = .081740).Angiotensin II 15 months after LSG and Δ ANP % were significant independent predictors of persistent HTN.

Conclusion
In setting of LSG, aldosterone, angiotensinogen, angiotensin II, renin and neprilysin were significantly lower in patients with remission of HTN after 15 months than those with persistent HTN, and natriuretic peptides were significantly higher. lower postoperative level of angiotensin II and a larger percentage increment of ANP are independently associated with hypertension remission after LSG.
SP2.2.4 Structured prehabilitation reduces physical deconditioning and improves emotional and physical well-being during neo-adjuvant chemotherapy prior to surgery for oesophageal cancer
Authors: Knight William , Zylstra Janine , White Greg , Lane Andy , Browning Mike , Davies Andrew 
Published: November 2022

Abstract

Introduction
Neo-adjuvant chemotherapy (NAC) prior to oesophagectomy is associated with a decline in cardiovascular fitness, sarcopenia and reduced health related quality of life. This study aimed to determine if a structured exercise programmed mitigated these effects.

Methods
A prospective non-randomised trial compared a standard care pathway to a structured prehabilitation exercise programme undertaken before and during NAC and surgery for oesophageal cancer. Cardiopulmonary Exercise Testing (CPEX), body composition analyses and Health Related Quality of Life questionnaires were performed at multiple time points.

Results
Comparison of the Intervention (n=22) and Control (n=20) groups demonstrated a decline in patient fitness following NAC, measured by VO2peak. This was blunted by 7.86% in patients undergoing the structured exercise prehabilitation program (-21.40% Control vs -13.54% Intervention p=0.02). Fat Free Mass increased (intervention 16.1 vs. 17.3 kg/m2; control 15.4 vs. 14.8 kg/m2, p=0.056) and Fat Mass Index to Fat Free Mass Index ratio (-5.51% Intervention, 10.74% control p=0.043) decreased in the treatment group. An overall improvement in Mental Wellbeing and Cognitive and Emotional function in HRQL after neo-adjuvant chemotherapy was seen in the intervention group.

Conclusion
A structured exercise programme prior to neoadjuvant chemotherapy blunts cardiopulmonary deconditioning, reverses sarcopenia and improves the quality of life in patients undergoing a highly debilitating treatment regimen. Further studies will be needed to validate these findings.
SP3.1.10 The use of predictive severity scoring for lower gastrointestinal bleeding in a tertiary colorectal unit
Authors: Yao Sarina , Balfour James , Boyle Connor , Ventham Nicholas 
Published: November 2022

Abstract

Introduction
Lower GI bleeding (LGIB) has an estimated 1-year prevalence of 10% in the UK, accounting for 3% of emergency surgical referrals. The British Society of Gastroenterology (BSG) recommend risk scoring for LGIB to categorise severity and plan management. Experience in a tertiary colorectal centre suggests this potentially overestimates the severity of bleeding and the requirement for inpatient admission.

Method
Data was retrospectively collected for all patients referred from primary care or emergency departments with LGIB from 01/05/20–01/04/21. Demographics and an Oakland score (OS), recommended in BSG guidelines, were collected. OS &gt;8 suggests admission. Outcomes following referral, including admission, discharge, blood transfusion and radiological/surgical intervention, were assessed.

Results
294 patients were assessed. 176 patients (59.9%) were admitted for further management. The median OS for admitted patients was 12 (IQR 9–17). 30 patients (10.2%) required blood transfusion, 3 required radiological/surgical intervention (1%). 118 (40.1%) patients were discharged. The median OS was 10 (IQR 8–12). 80 patients discharged had a score &gt;8, recommending admission; 4 patients required readmission (5.0%), however, none required intervention. 38 patients were discharged with a score ≤8; again, 4 patients (10.5%) required readmission for LGIB, with none requiring intervention. Fisher's exact test showed no statistical significance between OS and readmission (p=0.22).

Conclusion
Risk assessment scoring recommended admission for a large cohort of patients safely discharged after initial assessment in our centre. A small number required readmission, however, none suffered significant adverse outcomes. Further investigation should assess whether such scoring systems are too cautious for use in specialist colorectal centres.
SP4.2.1 Emergency management of lower GI bleeds: a full-cycle audit of practice at a district general hospital
Authors: Khanderia Esha , Patel Riana , Chandegra Rohit , Gass Harriet , Doshi Akshay , Morsy Hesham , Cheetham Drostan 
Published: November 2022

Abstract

Introduction
Lower GI bleeds (LGIB) are a common cause of emergency surgical admission. National Guidelines on the management of LGIB were published by the British Society of Gastroenterologists (BSG) in 2019. The aim of our audit was to determine whether local practice of managing LGIB adhered to these guidelines.

Method
Our initial audit cycle retrospectively reviewed 47 patients with LGIB who had presented to our Hospital. Subsequently, a departmental teaching session was conducted and posters outlining BSG guidelines were placed on surgical wards and the surgical assessment unit. A re-audit of local practice was prospectively undertaken with 30 patients.

Results
In the initial audit cycle 37/47 (78.7%) patients had a major LGIB (Oakland score &gt;8) where admission is advised. Of these, 6 (16%) were discharged on the same day. Of the 10/47 (21.3%) patients who had a minor LGIB, 6 (60%) were discharged on the same day. In the re-audit cycle, 29/30 (96.7%) patients had a major LGIB and 1/30 had a minor LGIB, none of these patients were discharged on the same day. The re-audit population had a higher rate of inpatient endoscopy, 66.7% vs 14.9%. 50% of unstable patients had a CT angiogram on admission in the re-audit vs 0% patients in the first cycle.

Discussion
Following education, compliance to BSG guidelines improved. Discharges in patients with major LGIB reduced to zero following this audit and more patients received appropriate inpatient investigations. Further work is required to see if change in local practice has an impact on clinical outcomes.
SP10.2.1 The FLIP Study – Fluid Resuscitation in Pancreatitis
Authors: McGovern Julia , Tingle Sam ,   Northern Surgical Trainees Research Association (NOSTRA), Moir John , Robinson Stuart 
Published: November 2022

Abstract

Aim
Acute pancreatitis (AP) is an emergency surgical presentation which can range in severity from mild to life-threatening. Intravenous fluids are the cornerstone of management. However, there is poor quality evidence regarding optimal intravenous fluid administration. We aimed to establish clinical practice regarding intravenous fluid administration in AP and the effect this has on mortality.

Methods
Prospective multi-centre audit of patients with AP. Data was collected on intravenous fluid administration within 72-hours of admission. Primary outcome was 30-day mortality and multivariable logistic regression was used to identify predictors of this.

Results
254 participants were included. Volume of intravenous fluid delivered over the first three days (median and range) are as follows; Day 1=2L (0–10.5L), Day 2=1L (0–5L), Day 3=0L (0–7.5L). Those with severe pancreatitis (Glasgow score&gt;=3) received more fluid; median 5.7L versus 4L in 72hrs (P=0.003). The following factors were significant predictors of 30-day mortality in our multivariable model: age, Glasgow score, CRP, IHD and pancreatitis aetiology. Overall, volume of intravenous fluid was not associated with mortality in this model (adjusted OR=0.932;0.766–1.134;P=0.483). However, the effect of intravenous fluid volume on mortality differed significantly depending on pancreatitis severity (interaction term P=0.042). In the severe pancreatitis group increased volume of intravenous fluid was associated with significant reductions in mortality (OR=0.655;0.459–0.936;P=0.020).

Conclusion
In severe pancreatitis more aggressive fluid prescribing is associated with decreased mortality. This is not the case in milder disease. The lack of published literature regarding the impact of fluid regime on outcomes in acute pancreatitis is reflected by the variation of fluid prescribing.
TU5.4 ‘Learning lessons, inspiring change and driving improvements’ - A review of morbidity and mortality meetings in General and Vascular surgery
Authors: Byrne Hannah , Krishnan Arya , Couderq Delphine , Marcu Vasilica , Paseda Bim , Zayda Ayman 
Published: November 2022

Abstract

Aim
According to RCS/ASGBI guidance all surgeons should regularly attend Morbidity and Mortality meetings (M&Ms), as they are a key activity for reviewing the performance the team and ensuring quality of care. We aimed to review General and Vascular Surgery M&Ms at our site – are they in keeping with guidelines and can improvements be made?

Methods
A retrospective review of General and Vascular Surgery M&Ms was performed. Presentations were assessed against 12 key performance indicators (KPIs) as recommended by RCS/ASGBI. Following audit Cycle 1, a standardized M&M presentation proforma and an M&M outcome form were introduced, with subsequent second and third audit cycles completed.

Results
In comparison to Cycle 1, overall improvements were seen in 9/12 KPIs in both General and Vascular Surgery M&Ms. 100% compliance was demonstrated in both General and Vascular Surgery M&Ms in 7 KPIs. Improvements can still be made in the completion of Clavien-Dindo scoring, NCEPOD classification, as well as M&M outcome forms. Literature review discussions were not included in any General Surgery M&Ms in either cycle and in only 14% of Vascular Surgery cases.

Conclusion
Significant improvement in RCS/ASGBI compliance was demonstrated with the introduction of an M&M presentation proforma. Emphasis and encouragement should still be placed on the importance of literature reviews to promote learning, although we appreciate time limitations can have an impact on this. By improving the quality of M&Ms, surgical teams can learn lessons, inspire change and drive improvements.
TU5.7 The Nutritional Management of Emergency and Elective Surgical Patients – Are we doing enough in the COVID-19 pandemic?
Authors: Desai Chaitya , Hern Daniel , Ghassemi Nader , Veliah Supanki , Rao Vittal 
Published: November 2022

Abstract

Aim
Malnourished patients make poor surgical candidates, with an increased risk of post-operative complications. We assessed the peri-operative nutritional status of patients undergoing elective and emergency general surgical operations.

Methods
Data was collected from 1 September 2021 to 1 November 2021. The inclusion criteria included: underwent surgery for gastro-intestinal pathology, length of stay ≥5 days, and high risk of malnutrition as per the Malnutrition Universal Screening Tool (MUST).

Results
50 emergency patients were identified. In the pre-operative to post-operative period, these patients had a mean albumin decrease from 30.5 to 23.7, against a decrease in CRP of 146 to 105.5, suggesting worsening nutrition rather than worsening inflammation. 48% of these patients had dietician referrals in-place with 54% of these on oral supplementation. Post-surgical complications increased in these patients without a dietician referral, with wound infection the most common cause (n=4).
50 elective patients were identified. 40% of these patients had dietician referrals in-place with 70% of these on oral supplementation. Post-surgical complications increased in these patients without a dietician referral with the most common complication being acute kidney injury followed by wound infection.

Conclusion
Optimal nutrition is key to optimal recovery. Most patients with dietician referrals had a plan of oral supplementation. This intervention can be commenced by the immediate surgical team. 56% of patients meeting the MUST tool criteria for high risk of malnutrition had no dietician referral. This can be addressed through early consideration for dietician referral, teaching sessions and educational posters distributed across surgical wards.
TU6.2 A review of feedback on simulation sessions while following Covid-19 SOPS
Authors: Gulnaz Nadia , Siddique Khurram 
Published: November 2022

Abstract

Aims
To assess the usefulness of simulation sessions with social distancing in managing critical issues on a surgical ward.

Methods
Simulations sessions were run from September 2020 to April 2021 for the foundation doctors and medical students following standard social distancing rules and using mannequins for patients. A feedback questionnaire was sent over to the candidates after each session and the data was analyzed.

Results
4 sessions were held with a total of 20 participants. The feedback response rate was 100%. On the Likert scale of 0–10, the majority (Score range 9–10) responded that they were likely to recommend these sessions. 90% were likely to change and improve their daily practice based on their responses.70% rated the sessions as excellent and all the rest as very good no negative response was received. A 100% agreement was seen among all participants on the arrangements to be well co-ordinated and organised.95% found the training staff very helpful.75% of the participants thought the allocated time was just about right while 15% thought it was slightly short. In response to an open question, the majority of participants appreciated the concept of simulation while following social distancing rules and enjoyed the session as a whole.

Conclusions
Overall we received positive feedback. Although the number of participants was limited in each session but positive responses from the participants imply that sessions could be easily carried out with social distancing without compromising the learning outcome. Carrying out more sessions was strongly favored by a vast majority.
WE1.2 Introducing the “Safe-Anastomosis” Checklist to Reduce Overall Anastomotic Leak Rates post Right Hemicolectomies
Authors: Alamin Nadeen , Jeyarajah Maathusha , Cook Esther , Harinath Gandra , Shrestha Ashish 
Published: November 2022

Abstract

Aims
The ‘Safe-anastomosis’ Quality Improvement Intervention has been demonstrated with an overall reduction in anastomotic leak rates post right colectomy. Our study aims to demonstrate this reduction rate at a district general hospital.

Methods
This is a retrospective analysis of post-anastomotic leak rates in the hospital prior to the introduction of the anastomotic checklist as part of an international collaborative study (EAGLE study). Patient eligibility criteria included patients aged 18 and above who underwent a right hemicolectomy between February 2019 and June 2021. The inpatient mortality, 30-day re-admission and 30-day re-operation rates were included in the analysis. Results were compared with the prospectively collected EAGLE Study intervention data.

Results
A pre-interventional cohort of 57 patients was included. 12% (5 elective, 1 non-elective) were found to have an anastomotic leak. The median length of inpatient stay was 8 days. No patients were re-admitted within 30 days. 11% were re-operated on within 30 days. Mortality rate was 6% (none associated with a leak). When compared to the EAGLE study results, there was a 46.9% reduction rate in anastomotic leaks. No change was demonstrated in inpatient mortality rates.

Conclusion
Post-surgical anastomotic leaks create a drastic health and economic burden on hospitals. Working on reducing their rate can significantly improve outcomes. Hence, introducing the anastomotic safety checklist is an effective intervention which may reduce anastomotic leak rates. Hopefully, EAGLE study final outcomes may be able shade a light on this matter.
WE7.13 Blunt Hepatic Trauma at a Major Trauma Centre in the North West of England between 2000 and 2020
Authors: Reader Harriet , Lunevicius Raimundas 
Published: November 2022

Abstract

Background
Our institution became a Major Trauma Centre (MTC) in 2012, currently serving a population of 2.3 million. This study aims to evaluate the trends in blunt hepatic trauma (BHT) and the changes in management strategy over time (pre- and post- MTC era).

Methods
This was a single-centre, retrospective cohort study. Data were obtained from the Trauma Audit and Research Network (TARN) database across a 20-year period (2000–2020).

Results
209 patients presented with BHT: 31 in 2000–2011 and 178 in 2012–2020. The median age was 35.6 and M:F ratio was 2.8:1. Road traffic accidents (RTAs) were the most common mechanism (n=124, 59.3%), followed by fall from height (n=44, 21.1%). Patients had a median ISS of 25 (range 4–75). 109 patients were managed conservatively (52.5%), with 10 of these patients having angioembolisation. Although 100 patients (47.8%) underwent operative management, only 7 patients underwent liver surgeries such as liver laceration repair (n=7, 3.3%) or resection (n=2, 1%). Mortality rate was 13.8% (n=44) in the conservative group and 21% in the operative group. The overall mortality was 16.7% (n=35). The subgroups analyses revealed no significant difference in mortality for patients managed non-operatively.

Conclusions
BHT patients frequently present as a polytrauma. Only 3.3% required a laparotomy and intervention to the liver parenchyma. The establishment of the MTC was associated with a significant increase in BHT presentations. The proportion of conservatively managed patients was similar pre- and post-MTC eras. The mortality rates were not significantly different.
TH2.2 Optimum Timing of Emergency Cholecystectomy for Acute Cholecystitis - A Single Sited Retrospective Cohort Study
Authors: Ravi Prabhu , Husain Najam , Marzook Himaz , Muras Zbigniew , Thomas Pradeep 
Published: November 2022

Abstract

Aim
To evaluate timing of emergency cholecystectomy performed at one of the hospital in West Midlands.

Methods
This is a retrospective single centre study conducted from September 2019 to August 2020. The patients were divided into two groups with those operated within 1 week as emergency group (EG) and those operated after a week but within 6 weeks as delayed group(DG). The outcome is to evaluate post-operative complications, conversion to open, re-admissions, hospital stay, intra-operative blood loss, surgery duration and level of surgeons.

Results
Among 176 patients, only 88 patients underwent LC. Only 40.9% (36) underwent LC within 1 week of index admission and 12.5% (11) underwent LC after 1 week but within 6 weeks of admission. The remaining 46.5% (41) underwent delayed LC after 6 weeks. 10.6% (5) developed post op complications. Among which only one developed complication in EG and 8.5% (4) developed in DG. Total number of readmissions after LC in both group was 5.5% (5) and 10.2% (9) respectively. Median Length of hospital stay in days (4.03 versus 8.72 days respectively), Duration of surgery was 81(23–153) mins versus 69 (28–122) mins respectively), Intra operative blood loss (64 ml versus 166 ml respectively). Level of surgeon by consultant and Registrar in both groups were 21:6 and 15:5 respectively. None of the patients were converted to open surgery in both group.

Conclusion
Early LC within 1 week can be performed safely in most patients with AC to minimise the intra-operative blood loss, total hospital stay, post-op complication and readmissions rate.