bluuebunny/crossref_metadata_2025_split huggingface dataset:
28 Review of Operative and Non-Operative Time-Use During General Anaesthetic Cases in a Busy Surgical Oncology Service
Authors: Bell A. , Razzaq Z. , Mustafa H. , Redmond H.P. 
Published: February 2022

Abstract

Aim
To review theatre running times of all general anaesthetic cases performed in a single theatre during a set six-week period. We intend to assess the division of theatre time between operative and non-operative tasks and review areas of improvement in our department.

Method
The data was collected concurrently by a member of the surgical team (AB) at the time of surgery. Date, surgical procedure, and time elapsed from knife-to-skin (KTS) to skin closure were monitored between the hours 08:30–17:00. Results were reviewed and presented graphically using Microsoft Excel. Instances of theatre over-running were identified, and these outliers were reviewed in more detail.

Results
We identified two main time management issues in our department. The first occurs prior to the first procedure which highlighted significant delays with only one instance of KTS at 08:30 during the period of data collection. The second notable issue is the pattern of delays. There was a trend toward longer delays between cases as the day proceeds.

Conclusions
Upon review of our data, we were able to identify possible areas of improvement in the time management of our theatre group. These improvements will allow for accurate theatre planning which should be a priority for all stakeholders given the significant waiting lists created by the COVID19 pandemic. There are many peer-reviewed methods of improving the efficiency of departments such as ours. Further work is required to discuss targets for improvement with relevant stakeholders and to implement PDSA cycles to assess the impact of implemented changes in our theatre.
49 Accurate Hip Reduction and SPICA Application for DDH – the Case for Intraoperative CT
Authors: Redfern J. , Hughes T. , George H. 
Published: February 2022

Abstract

Aim
Accurate reduction of the hip joint and SPICA application for treatment of developmental dysplasia of the hip (DDH) is crucial for long term success – for those undergoing surgical intervention, or closed reduction only. In Alder Hey Children’s Hospital we compared two methods of confirming reduction for patients undergoing SPICA application for DDH. Those receiving either post-operative departmental computed tomography (CT) or an intra-operative CT. Specific outcome assessed were, need for repeat CT and SPICA application, return to theatre (RTT), repeat general anaesthetic (GA) (with associated risks), as well as effect on overall length of stay (LOS).

Method
Patient lists were attained from the radiography department, information regarding RTT and LOS were derived from Meditech V6. CT scans were checked on PACS imaging system.

Results
Retrospective analysis of all SPICA application cases performed, included 102 patients from 2015–2018 undergoing a departmental CT, after GA. Of these, 6 patients required a second GA, 1 patient required 3 GA’s. Mean LOS was 6 days in those requiring repeat SPICA application.
Analysis of the second group of intra-operatively CT scanned patients, included 72 patients from 2018–2020. Of these, 0 patients required a repeat GA and RTT, despite 1 patient requiring change of SPICA. Mean LOS was 4 days for these patients.

Conclusions
Intra-operative CT is crucial for getting it right first time, reducing risks of GA and cost of theatre time. It reduced the LOS for those requiring SPICA change from 6 to 4 days and reduced mean LOS by 1 day overall.
54 A Novel, Cost-Effective and Easily Reproducible Simulation Method for Teaching Fascia Iliaca Blocks Significantly Improves Peri-Operative Administration Rates in Neck of Femur Fracture Patients
Authors: Li M. , Dardak S. , Al-Wattar Z. 
Published: February 2022

Abstract
Despite high-level evidence supporting early fascia iliaca block (FIB) administration in patients sustaining neck of femur (NOF) fractures, administration remains suboptimal, restricted primarily by limited training opportunities. We present a novel, cost-effective and easily reproducible simulation session designed to teach the landmark technique during the Covid-19 pandemic.
A simulation mannequin was used with four absorbent swabs, two banana skins and a clear dressing were applied to the inguinal region to recreate the “two-pop” texture of the landmark technique. Ten participants attended, limited by social distancing. A 1 (poor) to 5 (excellent) feedback sheet was handed to all participants for the five domains of content, delivery, interaction, usefulness, and quality of the practical skills session, with opportunities for qualitative feedback. The FIB administration rates in all NOF fracture patients between August -October 2019, before the simulation session, were statistically compared to November-December 2020, following it.
All participants gave a 5/5 (excellent) rating for all five domains, confirming good acceptability amongst practitioners. In the time period before the session, 9/29 NOF fracture patients received a FIB, improving to 18/31 patients following it (p = 0.042; two-tailed Fisher’s exact test), a statistically significant increase in administration. The average cost per participant for the single-use materials in the session was £1.56, whereas the multiple-use items costed £7.88 per participant.
Adoption of this novel, cost-effective and widely reproducible simulation method is deemed highly useful and acceptable by a diverse range of healthcare professionals, resulting in a statistically significant increase in FIB administration in NOF fracture patients.
61 Use of Ketamine Sedation for the Treatment of Minor Plastic Surgery Procedures in the Paediatric Emergency Department
Authors: Bradley A. , Faulkner J. , Jatan A. , Stewart C. 
Published: February 2022

Abstract

Aim
To determine if ketamine sedation is a safe and cost-effective way of treating paediatric patients presenting with minor injuries, requiring plastic surgery procedures, in the emergency department.

Method
A retrospective cohort study was carried out over a 9-month period in children between ages 18 months and 16 years old, presenting to the paediatric emergency department at Chelsea and Westminster Hospital with minor injuries requiring plastic surgery input. The data collected included previously validated co-primary outcome measures of surgical site infection at 7 days and cosmetic appearance summary score at a minimum of 4 months. Parental satisfaction surveys were completed at 4 months to assess perceived quality of treatment. A cost analysis comparison against procedures completed under general anaesthetic was also undertaken.

Results
During the 9-month period of study, 24 minor procedures were performed under ketamine in the paediatric emergency department. There were no serious adverse events recorded. Three cases exceeded the recommended 20-minute maximum procedure duration, but there was no associated adverse outcome. No cases required further procedures under general anaesthesia and there were no cases of surgical site infections at 7 days. Parents reported extremely favourable outcomes using this technique, with an average overall satisfaction score of 9.2 (assessed over a number of parameters, where 10 is complete satisfaction).

Conclusions
Ketamine procedural sedation in the paediatric population is a safe and cost-effective method for the treatment of minor plastic surgery procedures, with low risk for surgical site infection post-operatively, and high parent satisfaction rates
64 An Audit of Same Day Theatre List Cancellations
Authors: Ramjeeawon A. , Bulstrode N. 
Published: February 2022

Abstract

Introduction
Given the reduction in elective operating during the Covid pandemic, efficient use of theatre time is paramount to reduce elective waiting list times. The aims of this audit were to identify the proportion of patients who were cancelled from theatre lists on the day, reasons for cancellation, and the proportion of patients who were cancelled due to non-adherence to pre-operative fasting rules.

Method
The previous 30 patients on a single surgeon’s elective operating list were reviewed using electronic patient records, admissions teams list, and surgeon recall to identify numbers of and reasons for on the day cancellations.
The standards used were the perioperative fasting in adults and children guideline from the European Society of Anaesthesiology, and a local trust guideline on pre-operative fasting.

Results
30 patients had been scheduled for elective surgery on a single surgeon’s paediatric plastic surgery list between April and May 2021. 3 patients (10%) cancelled on the day of their planned procedures. Of these patients cancelling on the day, 2 (66%) cancelled due to non-adherence to pre-operative fasting rules, 1 (33%) cancelled due to parents choosing to defer the operation.

Conclusions
Non-adherence to pre-operative fasting rules was an important reason for on the day cancellations on this elective operating list. A pre-operative fasting information sheet was developed for patients and parents to explain the fasting rules and timings. Once sufficient patients and parents receive the information sheet, the audit will be repeated. If successful, it may be sent to patients and parents for all elective operating lists.
65 A Retrospective Cohort Study of the Use of Vivostat PRF Autologous Platelet-Rich Fibrin in Patient Outcomes in Total Knee Replacement Surgery
Authors: Conchie H. , Rayner A. , Fenton R. , Warrington K. , Ali S. , McDermott I. 
Published: February 2022

Abstract

Aim
Vivostat PRF is an autologous platelet-rich fibrin spray that is prepared in theatre from the patient’s own blood and has shown that its use as a biological sealant intra-operatively reduces transfusion rates and decreases haemarthrosis after total knee replacement (TKR).
We undertook a retrospective time-based comparative cohort study examining relevant patient outcomes, comparing patients undergoing TKR surgery with Vivostat PRF versus without.

Method
106 patients undergoing TKR surgery between 2008 and 2017 were studied. Patients were selected for inclusion via hospital records and divided into two groups: those who had received Vivostat PRF intra-operatively (n = 59), and those who hadn’t (n = 47) (the control group).
Primary outcomes included haemoglobin drop pre- vs post-operatively, range of movement (ROM) at follow-up appointments, number of days post-operatively in hospital until the patient was able to manage stairs, post-operative pain scores and transfusion rates.

Results
There was a statistically significant difference in the haemoglobin drop between the two groups, with a drop of 27.5g/L in the study group compared to 31.9g/L in the control group (p = 0.019). ROM at day 3 post-operatively was better in the Vivostat group by 5.0o (p = 0.0018), and at 3 months post-operatively there was 7.8o greater movement (p = 0.004). No statistically significant differences were seen in the pain scores; however, early rehabilitation performance was improved in the Vivostat group, with a quicker time to being able to manage stairs post-operatively (p = 0.04). There was no statistically significant difference in transfusion rates.

Conclusions
This study showed that there are benefits in using Vivostat PRF in TKR surgery.
76 Many Forms of Bariatric Surgery Can Be Used to Treat Obese Patients. Is Laparoscopic Gastric Plication the Next Gold Standard?
Authors: Cameron F. 
Published: February 2022

Abstract

Aim
Obesity is growing in prevalence in today’s world. Conservative treatment methods often fail; however, bariatric procedures have been developed to help patients lose weight. While bariatric surgery takes various forms, these are often highly invasive or have high rates of complication, leading to further development by surgeons of new procedures. One of the more recently developed procedures is laparoscopic gastric plication- a surgery involving imbrication of the greater curvature of the stomach to narrow the gastric lumen. It has been hypothesised that this could be the next gold standard in the management of obesity. This paper seeks to address such hypotheses by comparing laparoscopic gastric plication with the already established laparoscopic gastric sleeve in the treatment of patients and their comorbidities.

Method
By analysing meta-analyses, systematic reviews and case studies on both laparoscopic gastric plication and laparoscopic gastric sleeve, it has been possible to compare the safety, efficacy, and cost of the two procedures.

Results
The results of the literature review undertaken indicate no significant difference when the efficacy and cost of the two procedures is compared. Laparoscopic gastric sleeve is, however, a safer procedure with fewer postoperative complications than laparoscopic gastric plication.

Conclusions
In conclusion, it is unlikely that laparoscopic gastric plication will be the next gold standard in bariatric surgery unless the procedure is standardised, and its safety record is improved.
91 Intestinal Malrotation Identified on Diagnostic Laparoscopy in a 79-Year-Old Male Presenting With Symptoms of Sub-Acute Bowel Obstruction
Authors: Procter A. , Osborne M. 
Published: February 2022

Abstract
Congenital malrotation of the midgut in the adult population is most likely to present with non-specific abdominal symptoms that can pose a diagnostic dilemma. If left untreated the symptoms of malrotation can have a significant impact on patients’ quality of life and the condition can lead to significant morbidity and mortality. We report a case of malrotation identified in a 79-year-old male who presented with a chronic picture suggestive of sub-acute small bowel obstruction. The patient underwent thorough clinical review including CT and MRI scan which showed evidence of dilated small bowel but failed to show an underlying cause. The absence of findings with initial tests prompted the team to consider surgical investigation. Diagnostic laparoscopy identified evidence of congenital malrotation, and this was successfully treated with a Ladd’s procedure. This case adds to the evidence that malrotation is a more common finding in adults than previously thought and emphasises the importance of pursuing a definitive diagnosis when routine tests do not demonstrate sufficient cause for a patient’s symptoms.
93 Are NSAIDs Being Prescribed First Line to Manage Renal Colic Pain? A Complete Audit
Authors: Aly K. , Aly M. , Broome J. 
Published: February 2022

Abstract

Introduction
NICE recommends NSAIDs as first line analgesia for renal colic pain. The aim of this audit was to evaluate NSAID prescribing at Salford Royal Hospital in this patient cohort against NICE guidelines.

Method
Using electronic patient records, patients admitted with renal colic pain over a 3-week period were identified. Data regarding the type and order of analgesia prescriptions from the time of surgical clerking were collected retrospectively. Patients with a documented contraindication to NSAIDs were excluded. A local renal colic pathway was published by the Urology Department, and we followed this with additional interventions, namely an email reminder to the juniors and a poster with a renal colic analgesia ladder illustration as an aide-memoire. Subsequently, a re-audit was undertaken.

Results
Cycle 1 identified 22 patients admitted with renal colic pain with most diagnoses supported radiologically. Only 38% of patients were found to be prescribed an NSAID for analgesia around the time of surgical clerking. In the re-audit, 50% of patients had an NSAID prescribed at the time of surgical clerking.

Conclusions
NSAIDs are clearly being underused as first line analgesia in renal colic pain despite NICE guidelines. A newly published trust renal colic pathway and targeted interventions have shown to increase their use, but further QI work is needed.
107 Retrospective Pilot Study in Preparation for Setting Up an Acute Pancreatitis MDT in a Medium Sized NHS Acute Trust in the UK
Authors: Pufal K. , Singh P. , Robinson S.J. 
Published: February 2022

Abstract

Aim
Within the spectrum of pancreatitis, patients with severe disease require specialist multidisciplinary care including dietician and radiology input. Therefore, certain patients would benefit from an MDT approach to coordinate their management. This retrospective study analyses data on pancreatitis admissions within our Trust, to inform the set-up of a new specialist MDT.

Method
Patients were identified using admission coding data. Relevant patient data was extracted, including demographics, disease severity (using the Atlanta classification) and relevant outcomes. Both first-time and repeat admissions were included. Incorrectly coded patients were excluded. Statistical analysis was performed using SPSS (Version 23.0).

Results
Over a study period of 489 days, 246 patients were coded as having pancreatitis.186 patients were first time admissions, and 27 patients were repeat admissions. 33 patients were incorrectly coded and excluded.
Hence, the annual acute pancreatitis admission rate was 139 patients/year, with an additional 20 readmissions. 149 (80%) admissions were mild cases, with the remaining 14 (8%) and 23 (12%) being moderate and severe respectively. 149 (80%) were acute cases, compared to 20 (11%) chronic and 17 (9%) acute-on-chronic. 52/186 cases had no cause of pancreatitis recorded; where cause was identified, gallstones were the most common aetiology.

Conclusions
Pancreatitis is a common reason for admission during a general surgery on-call in our Trust; while the majority of cases are mild, the remaining 20% of moderate–severe cases qualify for discussion at an Acute Pancreatitis MDT. This pilot has facilitated the allocation of resources in our Trust and the MDT goes live in September 2021.