bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP6.2.1 Dysphagia in the perioperative period: Preliminary audit of pre-operative weight loss in patients undergoing oesophago-gastrectomy for primary locally advanced oesophageal cancer
Authors: Russell Claire , Patel Pranav H , Lane Carol , Chaudry Asif , Allum William , Kumar Sacheen 
Published: November 2022

Abstract

Background
Malnutrition and dysphagia are highly prevalent in patients with oesophageal cancer. The International Dysphagia Diet Standardisation Initiative (IDDSI) is a global standard to describe oral intake for dysphagic individuals. Greater weight loss (WL) after oesophago-gastrectomy is associated with increased length of stay (LOS), rate of post-operative complications and worse five-year survival, placing a burden on resources. This audit aimed to determine associations between pre-operative IDDSI scores, WL and post-operative morbidity.

Methods
A retrospective audit of patients undergoing oesophago-gastrectomy for locally advanced oesophageal cancer was conducted in a single tertiary cancer centre between 2017 and 2018.
Pre-operative WL was compared with IDDSI scores, post-treatment WL, post-operative complications, Critical Care Unit (CCU) and inpatient LOS.

Results
78 patients were included, 65 male and 13 female with mean age 64 (range 40 to 80). Median pre-operative percentage WL was greater in patients with moderate dysphagia (IDDSI 5-6) than those with a normal swallow (IDDSI 7), though not statistically significantly.
There were 26 Grade 3/4 Clavien-Dindo complications. Pre-operative WL correlated with rate of complications, and WL five to seven months post-operatively (p=0.04, p=0.001). Greater pre-operative WL correlated with a longer CCU LOS and total inpatient LOS, but this was non-significant (p=0.09, p=0.07).

Conclusions
IDDSI scores 5/6 may be early indicators for nutritional intervention in the peri-operative pathway. Each clinical interaction in the cancer pathway provides an opportunity to identify and correct malnutrition and improve outcomes.
A criteria-specific nutritional pathway has been implemented to optimise patients peri-operatively. A prospective re-audit will indicate improvements on patient-related and oncological outcomes.
SP6.2.2 Oesophageal Perforation: The Experience of a Tertiary Referral Centre 2009–2021
Authors: Alasmar Mohamed , Shehata Zak , Altarawni Mohammad , Casey Patrick , Melhado Rachel , Sultan Javed 
Published: November 2022

Abstract

Aim
Oesophageal perforation is a relatively rare surgical condition associated with a high mortality risk. Currently there is no clear consensus on a superior approach to treating this condition, and the rarity of oesophageal perforation has led to a great variability in treatment between centres. This study aims to report the experiences of a tertiary referral centre over 12 years.

Methods
We collected data on patients presenting with oesophageal perforation at a tertiary referral centre from 2009–2021 (n=83). Demographics, presenting symptoms, length of stay and complications were collected retrospectively using the electronic patient record.

Results
The most common cause of perforation in our dataset was Boerhaave's (50.6%), followed by Iatrogenic (37.4%); other causes included trauma, malignancy and foreign body ingestion. Typical signs/symptoms included chest pain (54.2%), vomiting (48.2%), and pleural effusion (42.2%). For all aetiologies, operative intervention was required in 49.4% of patients. Patients presenting with Boerhaave's were more likely to be treated surgically (73.8%). Of these, thoracotomy/laparotomy with t-tube repair was the most common procedure performed (59.5%). The 30 day and 90 day mortality rates were 16.9% and 21.6% respectively. The median length of hospital stay was 40 days.

Conclusion
Here we show the experience from a high intake tertiary referral centre over 12 years. Our data confirms the severity of oesophageal perforation and its association with prolonged hospital stay and mortality. Further collaboration with other centres is needed to understand more about this condition.
SP7.1 Virtual classroom proficiency-based progression for robotic surgery training (VROBOT): a prospective, cross-over, effectiveness study
Authors: Patel Sonam , Nathan Arjun , Georgi Maria , Hang Man Kien , Fricker Monty , Sridhar Ashwin 
Published: November 2022

Abstract

Aims
Robotic surgery is an evolving surgical technique, requiring specialist training. The standardised Fundamentals of Robotic Surgery (FRS) curriculum incorporates proficiency-based modules to certify the skills of novice trainees. However, the curriculum is self-directed and non-interactive. We aim to determine the effectiveness of interactive virtual classroom training (VCT) in concordance with the FRS for robotic skills training.

Methods
11 novice surgical trainees were randomly allocated to two training groups. Both groups completed a one-week robotic skills induction. In week two, Group A received training with the FRS curriculum and adjunctive VCT; Group B only received access to the FRS curriculum. In week three, the groups received the alternate intervention.
The primary outcome was measured using the validated R-OSAT score. This was collected post-intervention at time point 1(end of week two) and time point 2(end of week three).

Results
Participants attained higher mean proficiency scores with both the FRS curriculum and VCT, compared to the FRS curriculum alone. At timepoint 1, Group A achieved a greater mean proficiency score compared to Group B (44.80 vs 35.33, p=0.006). At timepoint 2, there was no significant difference in mean proficiency score in Group A from timepoint 1. In contrast, Group B, who received adjunctive VCT showed significant improvement in mean proficiency by 9.67points from timepoint 1 (95% CI 5.18–14.15, p=0.003).

Conclusion
VCT is an effective training adjunct to the FRS curriculum for learning basic robotic skills. With the steep learning curve in robotic surgery training, VCT offers interactive learning and can increase training effectiveness and accessibility.
SP7.6 The SUNRRISE Trial – Lessons learned from International Collaboration by Trainees
Authors:   SUNRRISE Study Group
Published: November 2022

Abstract

Background
Trainee led collaborative research in surgery has become widely accepted and highly effective in the UK in the last decade. SUNRRISE is the first trainee led and delivered randomised controlled trial to run across the UK and Australia.
SUNRRISE is an international, multi-centre, trainee devised, led and delivered randomised controlled trial, funded by the NIHR (UK) and MRFF (Australia). It investigates whether a Single Use Negative Pressure Device (SUNPD) reduces the risk of surgical site infection within 30 days of an emergency laparotomy. We present lessons learned from running this study.

Methods
840 patients were 1:1 randomised between SUNPD (PICO7©, Smith and Nephew) and surgeon's choice at 12 centres in Australia and 22 centres in the UK between 2019 and 2021.

Results
International collaboration enabled the trial to continue when the pandemic threatened to stop it entirely.
We believe that this collaboration has benefited all stakeholders; research skills and knowledge have been successfully transferred to trainees, clinician researchers have become established and research professional staff have gained in experience and expertise in both Australia and the UK. Importantly, patients will benefit from more reliable and faster delivered results.
International RCT collaboration requires commitment, perseverance and an acceptance of setbacks, inconvenient working hours and misunderstandings which result from different systems, language and research environments.

Conclusion
International collaboration has made the trial more successful and increased the enjoyment and enthusiasm for the study. SUNRRISE has demonstrated the resilience and efficacy of multi-national, multi-centre trainee delivered RCTs.
SP7.7 Open Appendicectomy Confidence and Experience Study (OACES): a multicentre survey of UK non-consultant grade surgeons
Authors: Cheung Fang Yi , Bretherton Katherine , Wong Nicholas 
Published: November 2022

Abstract

Aims
Minimally invasive technique has eclipsed open in most cases, and reserved only when clinically necessary. However, surgeons must remain able to employ and deploy open technique at will with efficacy. This study aims to assess non-consultant grade surgeons’ confidence and experience to perform open appendicectomy.

Methods
Retrospective cohort study via digital survey consisting of 14 questions distributed to non-consultant grade surgeons in 3 UK deaneries and a professional surgery association.

Results
40 responses ranging from CT1 to ST8 surgeons below consultant totalling 431 cases. 55% respondents disagreed to strongly disagreed they felt confident to perform open appendicectomy independently. 32.5% respondents agreed to strongly agreed they were confident to convert from laparoscopic to open appendicectomy independently if required. Table 1 summarises open and laparoscopic appendicectomy quantitative experience.

Conclusion
Laparoscopic overwhelmingly exceeds open appendicectomy confidence and experience amongst the cohort of trainee surgeons. The majority have not assisted or performed open appendicectomy, and those that have constitute low single digit case numbers. This may translate into lower ability to perform open appendicectomy when required. The decline in open experience and confidence could continue increase as the minimally invasive uptrend continues. Programme directors and trainers should be aware of this phenomenon to safeguard training to mitigate lack of confidence and experience, as this could jeopardise future surgical patient care and safety.
SP7.8 The SUNRRISE Trial – Single Use Negative pRessure dressing for Reduction in Surgical site infection following Emergency laparotomy
Authors:   SUNRRISE Study Group,   Australian SUNRRISE Group,   NorthWest Research Collaborative,   West Midlands Research Collaborative
Published: November 2022

Abstract

Background
Surgical Site Infections (SSI) are common after abdominal surgery, and more so after emergency laparotomy. Despite Single Use Negative Pressure Dressings (SUNPDs) having mixed evidence regarding effectiveness, they are recommended in the WHO SSI Prevention guidelines.
SUNRRISE is an international, multi-centre, trainee devised, led and delivered randomised controlled trial, funded by the NIHR (UK) and MRFF (Australia). It investigates whether a SUNPD reduces the risk of SSI within 30 days of emergency laparotomy.

Method
Patients were randomised between SUNPD (PICO7©, Smith and Nephew) and surgeon's preference of dressing. Patients were eligible if they underwent an emergency laparotomy with an incision of at least 5cm that was primarily closed at the end of the operation. SSI was assessed at day 5–10, via a patient diary while the patient was at home and at day 30–44 by a blinded, trained wound assessor.

Results
840 patients were randomised from 34 centres across the UK and Australia.
Intention to treat analysis showed no difference in SSI between the two groups (SUNPD-28%, Control-27%, p=0.75). There was also no difference in all secondary outcomes- length of stay (9 vs 11, p=0.14), hospital readmission for wound related complications (3% vs 3%, p-0.96, rates of wound related complications (19% vs 18%, p-0.79), pain (1.8 vs 1.8, p-0.61) and quality of life (SF-12 & EQ5D-5L).

Conclusion
SUNRRISE is a multicentre, assessor blinded, phase III RCT that provides robust evidence that single-use negative pressure dressings are not effective in reducing surgical site infections in patients undergoing an emergency laparotomy.
SP7.9 A systematic review and meta-analysis of potentially contaminated and contaminated abdominal wall hernias/defect repair using synthetic versus biological mesh
Authors: Imsirovic Anja , Baig Mirza K , Khan Mansoor , Singh Krishna K , Sains Parv , Sajid Muhammad S 
Published: November 2022

Abstract

Objective
The objective of this article is to evaluate the role of synthetic mesh versus biological mesh in repair of potentially contaminated and contaminated abdominal wall hernias/defects.

Method
Analysis was conducted according to PRISMA guidelines. Systematic search of medical databases like MEBASE, MEDLINE and pubmed was performed to find studies exclusively comparing the use of synthetic mesh versus biological mesh in repairing the potentially contaminated and contaminated complex abdominal wall hernia/defects. Standard medical electronic databases were searched with the help of local librarian and relevant published randomized controlled trials (RCT) were shortlisted according to the inclusion criteria. The analysis of the pooled data was done using RevMan statistical software.

Result
Three RCTs and 10 comparative studies on 1138 fulfilled the inclusion criteria. In the random effects model analysis, the use synthetic mesh for complex abdominal wall hernia/defect repair in contaminated or potentially contaminated zones reduce the risk of hernia recurrence [odds ratio 0.44, 95% CI (0.33–0.60), z= 5.37, p=0.00001] compared to implantation of biological mesh. Moreover, risk of surgical site infection was statistically higher [odds ratio 0.66, 95% CI (0.47–0.92), z=2.44, p=0.01] following the use of biological mesh. There was no heterogeneity (Tau2 = 0.10; Chi2= 16.15, df = 9 (p=0.06; I2 = 44%) among included studies.

Conclusion
Use of biological mesh for complex abdominal wall hernia/defect repair in potentially contaminated and contaminated situations failed to demonstrate any superiority over conventional synthetic mesh in both benchmark variables of surgical site infection and hernia recurrence.
SP7.12 Patient Initiated Follow-Up (PIFU)
Authors: Dholoo Farzan , Moore Emily , Dinneen Alex , Solan Matthew 
Published: November 2022

Abstract

Introduction
There is a drive within the National Health Service towards a more personalised approach to healthcare. Patient-centred care gives individuals more control over their mental and physical health. We have implemented a patient-initiated follow-up (PIFU) system, within our trust. This provides patients with autonomy for arranging follow-up appointments when needed and saves unnecessary routine reviews.

Methods
Two consultant surgeons have offered a ‘PIFU style’ follow-up. Selected patients seen in clinic were discharged but provided with a PIFU card. Patients returned this card if they needed to be seen again in clinic for the same complaint.

Results
During the study period 149 patients were discharged with a PIFU card. There were 1370 appointments (New and Follow-up) over the same period. Only 17% of PIFU patients (twenty-six) returned within six months. One hundred and twenty-three patients (83%) sought no further appointments. This reduced unnecessary, routine follow-up visits. If a greater proportion of patients were discharged in a timely fashion and offered a PIFU card, then outpatient clinic efficiency would be further improved.

Conclusion
The potential benefits of a PIFU system include: financial savings, patient autonomy, more clinic availability and fewer wasted GP appointments for re-referrals. Adopting a PIFU based system, helps to reduce service waiting times. PIFU is an important tool both for improving outpatient clinic efficiency and increasing patient autonomy. PIFU should be used widely, to help recovery after COVID-19.
SP8.1.3 Biliary tract disease and deprivation: a Scottish retrospective study
Authors: Dick Lachlan , Young Jamie 
Published: November 2022

Abstract

Introduction
Deprivation and poor health is a recognized association. However, the impact of deprivation on biliary disease is less understood. We aimed to determine the effect of deprivation on admission with biliary tract disease at a Scottish district general hospital.

Methods
Patients admitted with biliary tract disease were included from June 2016 to June 2019. Carstairs Deprivation scores were assigned to each patient by postcode with 5 being least deprived and 1 being most deprived. Statistical analysis was used to compare patient demographics, diagnoses, and outcomes.

Results
1116 patients were included. The majority (57.4%) were in decile 4. Only 2 patients were in decile 1 and so were excluded from the analysis. When comparing from decile 5 to 2, acute cholecystitis was more likely in patients with a lower decile (19.3 vs 23.1 vs 22.2 vs 28.4%, p=&lt;0.05) however there was no difference when comparing age (63.3 vs 61.6 vs 62 vs 63 years, p=0.337), female gender (58 vs 60.7 vs 55.7 vs 56.7%, p=0.609) or mortality (0.6 vs 1.6, 1.3 vs 0.8%, p=0.687).

Conclusion
Whilst acute cholecystitis appears to be more prevalent in patients from the most deprived areas, there is no difference in demographics or outcomes when comparing them with those from the least deprived areas. Given the relatively affluent cohort in our study, future work should include a more balanced mix of patients across the deprivation spectrum.
SP8.1.4 Iatrogenic gallbladder perforation during laparoscopic cholecystectomy and outcomes: a systematic review and meta-analysis
Authors: Sams Emily , Evans Louis , Naguib Andrew , Hajibandeh Shahin , Hajibandeh Shahab 
Published: November 2022

Abstract

Aims
to compare the outcomes of iatrogenic gallbladder perforation versus no gallbladder perforation in patients undergoing laparoscopic cholecystectomy.

Methods
In compliance with PRISMA statement standards, electronic databases were searched to identify all studies comparing the outcomes of iatrogenic gallbladder perforation versus no gallbladder perforation in patients undergoing laparoscopic cholecystectomy. The outcome of interest included surgical site infection (SSI), postoperative collection, operative time and length of hospital stay. Random effects modelling was applied to calculate pooled outcome data. The certainty of evidence was assessed using GRADE system.

Results
A total of 5366 patients from 11 studies were included. Analysis of 5366 patients from 11 observational studies suggested that iatrogenic gallbladder perforation during laparoscopic cholecystectomy does not increase the risk of SSI (OR 1.48, 95% CI 0.57–3.86, P=0.42) and postoperative collection (RD 0.00, 95%CI -0.00–0.01, P=0.41) but may result in longer operative time (MD 10.28, 95% CI 7.40–13.16, P &lt;0.00001) and length of hospital stay (MD 0.51, 95%CI 0.15–0.87, P=0.005). The results remained consistent through sensitivity analyses. The quality of available evidence was judged to be moderate and the GRADE certainty of the evidence was judged to be high.

Conclusions
Relatively robust evidence with high level of certainty suggests that iatrogenic gallbladder perforation during laparoscopic cholecystectomy may not increase the risk of SSI and postoperative collection but may result in longer operative time and length of hospital stay. Whether prompt retrieval of spilled stones, adequate peritoneal irrigation, and intraoperative use of prophylactic antibiotic contribute to the above findings remains unknown.
SP8.2.2 Neoadjuvant chemoradiotherapy (CRT) versus immediate surgery for resectable and borderline resectable pancreatic cancer: meta-analysis and trial sequential analysis of randomised controlled trials
Authors: Latif Sadia , Hajibandeh Shahin , Satyadas Thomas , Hajibandeh Shahab 
Published: November 2022

Abstract

Aims
To compare resection and survival outcomes of CRT and immediate surgery in patients with resectable and borderline resectable pancreatic cancer

Methods
In compliance with PRISMA statement standards, electronic databases were searched to identify all randomised controlled trials (RCTs) investigating outcomes of neoadjuvant CRT versus immediate surgery in patients with resectable and borderline resectable pancreatic cancer. Two treatment strategies were compared using direct comparison meta-analysis model. Random effects modelling was applied to calculate pooled outcome data. The risks of Type1 or Type2 error in the meta-analysis model were assessed using trial sequential analysis (TSA) model. The certainty of evidence was assessed using GRADE system.

Results
400 patients from 4 RCTs were included. When resectable and borderline resectable diseases were analysed together, neoadjuvant CRT resulted in higher R0 resection rate (RR: 1.55, P=0.004), longer overall survival (MD: 3.75, P=0.009) but lower overall resection rate (RR: 0.83, P=0.008). When resectable and borderline resectable diseases were analysed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, P=0.004) and overall survival (MD: 6.64, P=0.004) in patients with borderline resectable pancreatic cancer but it did not improve R0 resection rate (RR: 1.18, P=0.13) and overall survival (MD: 0.94, P=0.57) in patients with resectable pancreatic cancer.

Conclusions
Evidence from RCTs suggests that neoadjuvant CRT improves R0 resection rate and overall survival in patients with borderline resectable pancreatic cancer but not in patients with resectable pancreatic cancer. Nevertheless, the best available evidence does not include the contemporary chemotherapy regimens; therefore, more definite conclusions would depend on the results of future RCTs.
SP8.2.3 Serial CRP in post operative elective general surgery patients: analysis of usage and value
Authors: Abdelrahman Shadi , Shahzadi-Sohail Rabbiya , Singh Priya , Khan Amir 
Published: November 2022

Abstract

Aims
The aim of this project is to investigate the current practice in measuring C-reactive protein (CRP) in the post-operative patients in elective general surgery, to determine the current trends in using it and its potential value in detecting post operative complications.

Methods
A retrospective analysis of a 100 consecutive patients admitted for elective general surgery between January and July 2021 was conducted. This included analysis of patient demographics and post-operative interventions including return to theatres and interventional radiology. The CRP levels of the patients who required interventions were compared against those who did not.

Results
40 males; 60 females with a mean age of 61.1 years were included, 11% of these patients had post-operative interventions. This analysis showed CRP values were measured routinely post operatively for at least 5 days in 91% of patients. There was a rise in CRP in all patients in the early post-operative period (first three days). If CRP continued to rise after this, it was more associated with a need for post-operative interventions.

Conclusions
There is no diagnostic value for measuring CRP in the first three days of the post operative period, as it will always show a rise in that period. Continued rise after day 3 may indicate post operative complications. Setting up pre-determined blood tests profiles for elective surgical patients may help save time, effort and resources.