bluuebunny/crossref_metadata_2025_split huggingface dataset:
WE6.2 The true cost of pre-operative investigations
Authors: Dholoo Farzan , Shabana Amanda , Burrows Abigail , Horsnell Jonathon 
Published: November 2022

Abstract

Introduction
Pre-Operative Assessment (POA) is an integral part of surgery. It is essential for pre-operative investigations including bloods and COVID-19 swabbing. There was concern within the Breast-Unit that patients may be having unnecessary blood-tests as part of their POA. This was likely due to POA not having one unified resource to refer to. Guidance suggests POA uses the patient's American Association of Anaesthesiologist's (ASA) grade, type of surgery they are undergoing and additional conditions for determining pre-operative investigations.

Methods
This QIP consisted of 2 cycles. During cycle-1 data was audited against national guidance to see which blood tests were performed unnecessarily. After developing a universal-guidance poster and teaching sessions, a second cycle was performed. Cycle-2 assessed whether there was a reduction in unnecessary blood tests being performed.

Results
During cycle-1, 216 pre-operative blood tests were undertaken. Of these only 99 were required. Therefore 54% of the tests were unnecessary. This equates to £690.77 over 2-months and if extrapolated £4144.62 spent, unnecessarily per-year. This represents a significant cost to the trust and puts needless pressure onto the laboratory. During cycle-2, after our intervention, there were 57 fewer tests and 40 fewer, incorrect blood tests. Our intervention therefore resulted in a £183.46 saving, which over a year equates to £1110.76 saved.

Conclusion
The potential benefits of improving POA include financial savings, patient autonomy, increased appointment availability and reduced pressure on the laboratory. In these unprecedented times, trying to tackle the COVID-19 backlog; we advise all departments to ensure that clear guidance exists.
WE6.3 This isn't going to hurt - an ambulatory model of management of patients with subcutaneous abscesses reduces use of general anaesthetic and bed days
Authors: Dru Rebecca , Ermiah Asem , Amr Bassem , Barton Jessica , Williams Lian , Hollyman Marianne 
Published: November 2022

Abstract

Aim
Management of patients with subcutaneous abscesses is challenging. Once in hospital, the majority require incision and drainage (I&D), often under general anaesthetic (GA). Patients placed on emergency lists are frequently superseded, due to being systemically well, often staying overnight in hospital.
We assessed how the establishment of a nurse-led, ambulatory service for I&D of abscesses reduced the need for GA, and impacted inpatient stay.

Method
Multiple digital sources were used to retrospectively collect data for all patients attending our centre for I&D of subcutaneous abscess during two time periods: August-October 2019 (prior to establishment of the ambulatory service) and August-October 2021 (a year after implementation of the service). Location I&D performed, mode of anaesthesia and length of stay were collected.

Results
In 2019, 102 patients underwent I&D; 87(85%) were drained under GA. In 2021, 73 patients were managed with I&D, but only 41(56%, p&lt;0.001) required GA; 6(15%) cases were accommodated on a day surgery list.
In 2019, 37(36%) patients were managed without overnight stay; in 2021 this rose to 46(63%, p&lt;0.001).
Extrapolating if an average of one patient requiring I&D attended each day, estimated bed days used per year dropped from 440 in 2019, to 215 in 2021.

Conclusion
Establishment of a nurse-led ambulatory pathway for I&D of skin abscesses safely and effectively reduces the number of general anaesthetics and inpatient bed days, potentially by half. Patients requiring anaesthetic support should be accommodated on planned day case lists where possible.
WE6.6 Does Nexobrid improve healing outcomes in treatment in adults with partial thickness burn compared to standard of care? A meta-analysis
Authors: Imsirovic Anja , Butler Ceri , Drake Paul 
Published: November 2022

Abstract

Aims
Burns are usually associated with significant morbidity and mortality due to dysfunction and disfigurement. Non-fatal burns usually contribute to morbidity via burn wound infection, systemic sepsis, multiple organ failure, pneumonia etc. leading to prolonged hospitalization. The objective of this study is to present a systematic review of the role of enzymatic debridement in healing outcomes compared to standard of care (debridement and skin grafting) in adult patients with burns.

Methods
A systematic review of randomized controlled and case-control studies reporting and comparing healing outcomes of Nexobrid with the standard of care, published on Embase, Medline, PubMed, Google Scholar and Cochrane databases in the period from 1946 until August 2021 was performed. Relevant studies were extracted and analysed with the help of Review Manager.

Results
The database search identified thirteen articles that met inclusion criteria. A combined number of 441 patients were included. Nexobrid application average time was one day. The combined mean of total body treated mean surface was 6.5%. Studies investigating Nexobrid mention the combine average success of debridement of 82.8%. The forest plots favour the current evidence of Nexobrid shortens time from injury to intervention, reducing the need for surgery, hence shortening the length of hospital stay.

Conclusions
This systematic review provides the current results of Nexobrid usage for enzymatic debridement of partial thickness to deep dermal burns. Further randomized controlled trials or feasibility studies are warranted to open new horizons for this modality of burns treatment.
WE6.8 An audit to look at the current practice of treating ureteric stones and compare it to NICE/ BAUS guidelines
Authors: Minhas Avneet , Moss Basil 
Published: November 2022

Abstract

Aim
An audit to look at the current practice of treating ureteric stones and compare it to NICE/ BAUS guidelines.

Methods
A retrospective audit looking at treatments given to patients presenting to the emergency department with renal colic. We looked at the time it took for patients to get a CT scan from the time of admission, the treatments provided to them as an inpatient, the subsequent outpatient follow-up, and the timescale within which these were provided.

Results
A total of 50 patients were included. The average time it took for patients to get a CT scan from the time of admission was 16hours and 31 mins. Only 6% (3) of patients received definitive surgical treatment during their inpatient admission. 62% (31) of patients were treated conservatively, 26% (13) were treated with a ureteric stent, and 4% (2) with a nephrostomy. At follow-up, in patients managed conservatively, stone had passed spontaneously in 58% and remained in 35.5% of patients. Patients treated with interim measures like stent or nephrostomy had to wait approximately 7 weeks on average after their inpatient treatment for definitive management.

Conclusion
Majority of patients were able to get a CT scan within the 24-hour target. Reasons for delayed definitive management could be not having access to suitable operating theatres or lack of trained staff to use the laser or assist with emergency stone treatments. Overcoming these obstacles could potentially lead to substantial cost savings on a population level and avoid subjecting patients to unnecessary second procedures and longer waiting periods.
WE6.9 Enoxaparin venous thromboembolism prophylaxis in bariatric surgery: A best evidence topic update
Authors: Pathmaraj Bavin , Parmar Chetan , Sufi Pratik 
Published: November 2022

Abstract

Aim
To examine the literature and identify the best dosing regimen of enoxaparin for perioperative venous thromboembolism (VTE) prophylaxis in patients undergoing bariatric surgery. This presentation reviewed publications from 2015 to 2021 to determine whether previous recommendations based on a similar examination of evidence conducted in 2015 needed to be updated, considering new evidence.

Method
A literature search was conducted in accordance with a structured format. One hundred and one papers were identified using a standardised literature search from 2015 to 2021 on Medline and EMBASE using the same search terms “bariatric surgery” AND “venous thromboembolism” AND “enoxaparin”. The author, date and country of publication, patient groups and VTE prophylaxis strategy, level of evidence, outcomes, key results and study weaknesses were tabulated.

Results
Three studies were selected as the best available evidence to answer the question. All three articles were non-randomised cohort studies analysing VTE and major bleeding rates following different bariatric thromboprophylaxis regimens. There was still no level 1 evidence available to answer this question.

Conclusion
Enoxaparin 40mg/day starting 12 hours after the operation, continuing for at least one week post-discharge may be the best enoxaparin dosing regimen for VTE prophylaxis in bariatric surgery patients based on the best evidence available to 2021. New evidence suggests that the previously recommended 40mg enoxaparin twice daily for in-hospital patients may increase major bleeding risk. A Randomised Controlled Trial would probably require 3500 patients in each arm to identify the best enoxaparin dosing regimen.
WE6.10 Gender Balance at Surgical Meetings in Ireland
Authors: Aketch Martin Safari , Leon Ryan , Qaoud Yazan , McGuire Andrew , Hill Arnold D K 
Published: November 2022

Abstract

Aim
To assess the genders of lead authors and primary investigators in major surgical research meetings over a 10-year period in Ireland.

Method
We gathered data from the 3 main surgical conferences in Ireland. We looked at the abstracts of each of the plenary sessions over the last 10 year. We used the Irish Medical Council, previous published research from these authors and ResearchGate to help identify the gender of the author. We complied and analysed the data using Excel.

Results
We analysed 306 papers over the last 10 years. We found that the primary investigator was male in 78% of the papers and female in 20%. The primary author was male in 52% and was female in 46% of the papers. There has been little change over each 5-year interval for who was the primary investigator. In 2010–2015, it was 77% male and 23% female while from 2016–2020, it was 82% male and 18% female.
Furthermore, in relation to the primary author, it has shifted from being relatively equal to becoming more male dominant. In 2010–2015, it was 52% female and 48% female while from 2016–2020, it was 57% male and 43% female.

Conclusion
The gender gap has appeared to have widened at the non-consultant hospital doctor level and it is very apparent that there is a large inequality at consultant level regarding surgical research in Ireland.
WE7.1 Getting it right first time: a standardised approach to closure of trauma laparotomy
Authors: Allan Jennifer , McGuinness Etain , Yoong Susan 
Published: November 2022

Abstract

Aims
Surgical site infection (SSI) has been reported between 12–14% following trauma laparotomy. It became apparent in a regional trauma center that 25% of trauma patients required an MRI within 10 days of admission and point of potential trauma laparotomy leading to the morbidity of non-MRI compatible clip removal and reclosure of the wound. The aim was to ensure all trauma laparotomies underwent closure with MRI compatible clips.

Methods
A retrospective data collection was performed of patients undergoing trauma laparotomies between July and December 2021. Data was collected on wound morbidity, if an MRI was required and if patients required clip removal.

Results
16 patients underwent trauma laparotomy between July-December 2021. 25% of these patients had an MRI performed within 10 days of their laparotomy, (median 3days), 3 of these required removal of clips. 1 of these patients developed a SSI requiring negative pressure therapy.

Conclusion
This QI project led to the introduction of a unit approved damage control laparotomy trolley with all potential essential equipment to allow instant availability including only MRI compatible clips. The project also led to a qualitative improvement of improved team morale due to teaching sessions for theatre nursing staff on importance and use of all these instruments. Outcome measure data is currently being collected to ensure compliance with trolley usage and MRI compatible clips negating the morbidity of reclosure of wound as well as the process measure of staff satisfaction of equipment knowledge and availability during a trauma laparotomy.
WE7.2 The development of a rib fracture pathway in a district general hospital to improve patient care
Authors: Collis Justin , Farquharson Barnaby , Dickson-Lowe Richard , Chan Shirley 
Published: November 2022

Abstract
Our aim was to evaluate the management of rib fractures under the general surgical team over a 1-year period. To compare our practice against a standard we reviewed rib fracture pathways from several NHS teaching hospitals. In doing so develop a rib fracture pathway that addressed the needs of our hospital.
A retrospective review of paper notes and electronic databases of patients with a recorded diagnosis of ‘rib fractures’. We collected data points on; mechanism of injury, analgesia strategy, pain team review, dietician review, whether a nerve block was used and baseline characteristics. Our project used the rib fracture STUMBL to determine prognosis and collected the relevant data for this score.
A total of 42 were included in our statistical analysis. Of the patients analysed 44% were older than 65 years old. The average length of stay for each patient was 5 days. For analgesia 89% received regular paracetamol, 41% received regular NSAIDS and 69% received regular opioids. Advanced analgesia such as PCA and nerve blocks were poorly used, for instance a PCA was used in only 13% of cases. Only 6% of patient received daily pain team review and 44% of patients were seen by physiotherapist within the first 24hours. Additionally 93% of patients that were admitted under general surgery had a STUMBL score &gt;11.
We attributed areas of poor compliance to certain areas of best practice as a lack of awareness on how to access resources within our hospital. As a result we developed a pathway outlined best practice.
WE7.4 A Systematic Review of Splenic Viability Following Arterial Embolisation in Trauma
Authors: Dhital Ketan 
Published: November 2022

Abstract
The spleen is the most commonly injured organ in blunt abdominal trauma. Patients with these injuries are increasingly being managed nonoperatively, with use of Splenic Artery Embolisation (SAE). Many of these patients receive lifelong prophylactic antibiotics as though they were asplenic.
The aim is to seek robust evidence of splenic vascular integrity and immunocompetence following SAE, and consider whether lifelong antibiotic prophylaxis is necessary for trauma patients managed in this way.
2 separate literature reviews were carried out using the Medline database. One to assess literature pertaining to splenic tissue viability following embolisation, the other to find literature reviewing splenic immune function after embolisation.
In the vascular viability arm, 21 articles were reviewed. 12 studies observed no splenic infarcts at all. 18 of the studies noted &lt;10% splenic infarcts in their populations. Distal embolisation resulted in more infarcted areas of splenic tissue than proximal. 9 studies performed follow-up imaging and confirmed splenic tissue viability post-procedure.
For the review of immunocompetence, the literature search resulted in 13 full text articles. There was no consistency of the immunologic marker used to test splenic immunocompetence post-SAE, but 11 of 13 studies confirmed preserved immunocompetence by their respective markers.
The data do suggest preserved tissue viability and immunocompetence. Agreement is yet to be reached as to which immune marker definitively assesses immunocompetence, and the length of follow-up needed to investigate it. More research is required to confirm the suggestion from these data that lifelong antibiotic prophylaxis is unnecessary for trauma patients treated with SAE.
WE7.7 Bone transport using the Monorail External Fixator over an Intramedullary Nail for Post-Traumatic Femoral Defects
Authors: Lu Victor , Zhang James , Zhou Andrew , Krkovic Matija 
Published: November 2022

Abstract

Aim
The management of limb-length discrepancy secondary to traumatic bone loss poses an unique challenge for surgeons. The Ilizarov technique is popular, but is associated with long external fixator time and many complications. This retrospective study assessed outcomes of post-traumatic femoral defects managed by monorail external fixation over an intramedullary nail.

Method
Eight patients were included from over a four-year period with post-traumatic femoral defects, that underwent treatment with monorail fixator-assisted intramedullary nailing. Mean follow-up time was 232.83 weeks. Five were open fractures (Gustilo-Anderson type 3A:n=4, 3B:n=1), one had closed fracture. Average bone defect size was 8cm. Primary outcomes were lengthening index, consolidation time and index, external fixator index. Secondary outcomes were time to full weight bearing (FWB), time to union, complications. Patient reported outcome measures including EQ-5D-5L, SF-36, Oxford knee scores (OKS), Oxford hip scores (OHS) were recorded after recovery.

Results
Average consolidation time and index were 11.35months and 1.24months/cm, respectively. Mean lengthening and external fixator index were 20.2days/cm and 23.88days/cm, respectively. On average, patients achieved FWB and bone union 56.25 weeks and 68.83 weeks after bone transport initiation, respectively. Two patients had docking site non-union, treated by reamed intramedullary exchange nailing. Two patients had osteomyelitis. EQ-5D-5L and EQ-VAS scores were compared to UK population norms (p=0.104, p=0.238, respectively). Average OKS was 32.17 and OHS was 34.00.

Conclusions
Monorail external fixation over an intramedullary nail is an effective option for post-traumatic femoral defects, reducing external fixator time, lowering complication rate, returning patients’ quality of life to a level comparable with the normal population.
WE7.10 Traumatic abdominal wall hernia and CT missed severe intra-abdominal injuries
Authors: Afonso Matias Mariana Rita , Hunt Leslie 
Published: November 2022

Abstract
Despite traumatic abdominal wall hernia (TAWH) being a rare entity, the incidence of associated intra-abdominal injuries is extremely common. With only few cases published, TAWH remains a diagnostic as well as a therapeutic challenge.
We present an obese 47-year-old female, front seat passenger, that was transferred to our hospital from a neighbouring DGH with a diagnosis of TAWH after a 30mph road traffic collision. On arrival, she was haemodynamically stable, abdominal examination showed a large hernia, extensive bruising but the abdomen was otherwise unremarkable. The CT performed before transfer showed a large hernia but no obvious other injury, no free fluid or gas was identified. Hernia repair was planned for the following day. Overnight there was a transient period of hypotension responsive to transfusion of multiple RBC units. The surgical approach was over the hernia site. Within the sac a transected end of small bowel was found and so laparotomy was undertaken, which demonstrated a bucket handle mesenteric tear of terminal ileal mesentery with infarction of 20 cm of small bowel and a complete transverse tear of mid sigmoid colon and its mesentery. Remarkably there was no intraperitoneal contamination from either injury.
Our clinical case highlights that although the CT scan is the gold standard for initial diagnosis of intra-abdominal injuries in TAWH, these can still be missed. To note that failure to make a timely diagnosis can result in delayed complications with significant morbidity and mortality. Therefore, a high clinical suspicion, despite of negative imaging, is crucial to provide appropriate management.
WE7.11 Robotic-assisted versus conventional total knee arthroplasty: A Systematic Review and Meta-analysis
Authors: Qayum Kaif , Kar Irfan , Nawaz Ghulam 
Published: November 2022

Abstract

Aim
To compare robotic-assisted total knee arthroplasty (TKA) and conventional TKA on both long-term and short-term follow-up.

Methods
For conducting this study, we searched four electronic databases. The outcomes were pooled as mean difference (MD) or risk ratio (RR), and 95% confidence interval. We used RevMan for performing the analysis.

Results
We included nine studies. The data showed a significant favoring of robotic-assisted TKA than the conventional one in mechanical alignment, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and femoral coronal outliers (MD= -1.10, 95% CI [-1.51, -0.69], p&lt;0.00001), (MD= -1.19, 95% CI [-2.35, -0.03], p=0.04), and (RR= 0.49, 95% CI [0.30, 0.80], p=0.004) respectively. On the other hand, the conventional TKA was better in range of motion-flexion (long-term) than the robotic-assisted one (MD= -3.02, 95% CI [-3.68, -2.37], p&lt;0.00001). However, there were no significant differences between them in knee society score-knee score, knee society score-function score, change in hospital for special surgery, and change in range of motion-extension (MD= -0.36, 95% CI [-2.43, 1.70], p=0.73), (MD= -0.34, 95% CI [-2.36, 1.68], p=0.74), (MD=0.78, 95% CI [-0.84, 2.40], p=0.34), and (MD=0.16, 95% [-1.32, 1.64], p=0.83) respectively.

Conclusion
Robotic-assisted TKA had better outcomes than conventional TKA regarding mechanical alignment and WOMAC. However, the conventional approach showed a better range of motion-flexion in the long term. More data is needed for the long-term outcomes.
WE7.12 The changing management of penetrating liver trauma at a tertiary referral centre in the North West of England over a 20-year period
Authors: Reader Harriet , Lunevicius Raimundas 
Published: November 2022

Abstract

Background
In the context of penetrating liver trauma (PLT), the liver is the second most commonly injured intra-abdominal organ. Our institution has served as a regional Major Trauma Centre (MTC) since 2012. This study aims to review trends in PLT presenting to our institution and how management has changed over time.

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

Results
77 patients presented with PLT; 21 prior to MTC status in 2012 and 56 after. Median age was 26.8, M:F ratio was 6.9:1 and median Injury severity score (ISS) was 14. Stabbing was the most common mechanism of injury (n=53, 68.8%), followed by shooting (n=22, 28.6%). 24 patients were managed conservatively (31.2%) and 5 patients underwent angioembolisation. Prior to becoming an MTC in 2012, 19% of patients (4/21) were managed non-operatively and this increased to 50% (28/56) when the MTC was established (P &lt; 0.05). Understandably, there was a significant increase in injury severity in the post-MTC era (mean ISS 11.75 with SD=2.8 vs 17.9 with SD=2.1). The mortality in the conservative group was 20.7% (n=6) vs 8.3% in the operative group. Overall mortality from PLT was 11.7%.

Conclusion
There was a statistically significant increase in non-operative management of PLT since the MTC was established, there has been no observed increase in mortality during this period.