bluuebunny/crossref_metadata_2025_split huggingface dataset:
P02 Utilising electronic PROMs to measure a change in health following elective laparoscopic cholecystectomy: a feasibility study
Authors: Daliya P , Carvell J , Lobo DN , Parsons SL 
Published: November 2022

Abstract

Introduction
The collection of Patient Reported Outcome Measures (PROMs) has many benefits for clinical practice. However, there are also many barriers that prevent them from becoming a part of routine clinical care. The aim of this feasibility study was to pilot the use of a digital platform to facilitate the routine collection of pre- and postoperative electronic PROMs (ePROMs) in patients undergoing elective laparoscopic cholecystectomy, and to validate the use of existing PROs for our population.

Methods
Patients listed for elective laparoscopic cholecystectomy were asked to complete digital versions of the Otago gallstones Condition-Specific Questionnaire (CSQ), and the RAND 36-item health survey (SF36). An assessment of methodological quality of ePROM questionnaires was also performed.

Results
Preoperative ePROMs were completed in 200 patients undergoing laparoscopic cholecystectomy. Despite participant drop out a significant improvement in quality of life was seen across all health domains postoperatively when compared with baseline preoperative values for both disease specific (emotional functioning; preoperative: 48.9, 30-days: 15.6, 3-months: 16.7, 6-months: 7.9, p &lt; 0.05) and generic (emotional well-being; preoperative: 60.1, 30-days: 73.7, 3-months: 74.3, 6-months: 73.5, p &lt; 0.05) PROMs. Methodological quality was assessed as good to excellent in both digital questionnaires used.

Conclusion
The collection of ePROMs is possible with current technological advances. Although it may be an acceptable and convenient process for patients, and a useful measure of quality-of-life trends for clinicians, further developmental work is necessary to improve accessibility for patients and to reduce reporting bias.

Take-home message
ePROMs are an acceptable and useful measure of quality-of-life trends for patients and clinicians, however further development is required to improve its usability in the clinical setting.
P16 Endoloop ligatures in the retrieval of urethral foreign bodies: a narrative review
Authors: Narroway H , Parkin C , Latif E 
Published: November 2022

Abstract

Introduction
Self-insertion of foreign bodies into the urethra has been described previously in patients presenting to hospital emergency services. Treatment typically involves procedural retrieval under local anaesthesia using basket or forceps, cystoscopy, or open surgery. An Endoloop is a device designed to snare colonic polyps during endoscopy with nylon loops. It is not traditionally used for retrieval of urethral foreign bodies. Our objective was to determine the incidence, safety and efficacy of this approach.

Methods
A narrative review was performed. Primary outcomes were technical success, defined as uncomplicated retrieval of foreign body, and adverse events related to pain, bleeding, infection, and damage to structures. Electronic searches were performed using PubMed, Embase and Google Scholar. Reference lists of selected studies were searched manually.

Results
2 case studies met inclusion criteria for analysis, both describing self-insertion of urethral foreign bodies for purposes of sexual arousal. These comprised a 30-year-old male (magnets) and a 29- year-old female (metal urethral sound). Both patients underwent successful retrieval of foreign body using an Endoloop ligature. There were no symptoms post-operatively and no procedural complications were reported.

Conclusion
An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval. Follow-up is mandatory to monitor for complications due to foreign body insertion such as urethritis, incontinence, fistula and diverticulum formation. Referral to psychological services is encouraged to reduce the risk of recurrence. Further studies are required to validate the efficacy and safety of this technique.

Take-home message
An Endoloop ligature should be considered in conjunction with endoscopy when difficulties are experienced or anticipated with basket or forceps retrieval of urethral foreign bodies.
P18 Assessment of da Vinci robotic system for paediatric laparoscopic procedures
Authors: Johnson PA , Johnson JC , Mardon AA 
Published: November 2022

Abstract

Introduction
We aimed to evaluate the da Vinci surgical system in its application for robotic-assisted laparoscopic surgery in paediatric patients.

Methods
A narrative review of the literature on the use of this technology was performed following ENTREQ guidelines using PubMed/Medline, EMBASE, and Google Scholar databases with no setting or language restrictions.

Results
A total of 16 publications were selected for inclusion. Although the literature on the accuracy and precision of this technology are encouraging, its use in paediatric patients are still in its early stages and has yet to be explored in great detail. In addition to the technical intricacies, training and learning curve, port placement complications, cost, we identified concerning shortcomings including its bulkiness and lack of force feedback, which lead to procedural injuries notably, tearing of muscles, blood vessels, and nerves, as well as surgical error. For both, we propose sensory haptic feedback systems, soft tissue model, image-guided or virtual reality simulation training to reduce these injury-related complications. However, this does not replace the necessity for “supervised trial and error” operation of the robotic system in surgical settings.

Conclusion
Innovations in educational training for robotic surgery include tele-presence surgeries and robotic tele- mentoring, whereby expert surgeons share the same surgical field of view and controls as the training surgeon. In spite of this, there are inevitable risks associated with training when training surgeons must practice through trial and error on real patients and an emphasis must be placed on apposite pre-procedural surgical training.

Take-home message
Though promising, the use of the Da Vinci robotic system in children is still emerging and thus warrants further evaluation, training, and development prior to its routine implementation for use.
P21 Textbook outcome following oesophagectomy for cancer: an international cohort study
Authors:   Oesophago-Gastric Anastomotic Audit (OGAA) Collaborative
Published: November 2022

Abstract

Introduction
Although textbook outcome (TO) has been proposed as a tool for the assessment of oncological surgical care, an international assessment in patients undergoing oesophagectomy for oesophageal cancer has not been reported. This study aimed to assess TO in an international setting.

Methods
Patients undergoing curative resection for oesophageal cancer were identified from the international Oesophagogastric Anastomosis Audit (OGAA) from April 2018 - December 2018. TO was defined as the percentage of patients who underwent a complete tumour resection with at least 15 lymph nodes in the resected specimen and an uneventful postoperative course, without hospital readmission. A multivariable binary logistic regression model was used to identify factors independently associated with TO, and results are presented as odds ratio (OR) and 95% confidence intervals (CI95%).

Results
Of 2,159 patients with oesophageal cancer, 39.7% achieved a TO. The outcome parameter ‘no major postoperative complication’ had greatest negative impact on a TO for patients with oesophageal cancer, compared to other TO parameters. Multivariable analysis identified male gender and increasing Charlson comorbidity index with a significantly lower likelihood of TO. Presence of 24-hour on-call rota for oesophageal surgeons (OR: 2.05, CI95%: 1.30–3.22, p=0.002) and radiology (OR: 1.54, CI95%: 1.05–2.24, p=0.027), total minimally invasive esophagectomies (OR: 1.63, CI95%: 1.27–2.08, p&lt;0.001), and chest anastomosis above azygous (OR: 2.17, CI95%: 1.58–2.98, p&lt;0.001) were independently associated with a significantly increased likelihood of TO.

Conclusion
TO is achieved in less than 40% of patients having oesophagectomy for cancer. Improvements in centralisation, hospital resources (i.e. daily 24-hour on-call esophagogastric surgeons and radiologists), access to minimal access surgery, and adoption of newer techniques for improving lymph node yield could improve TO. Understanding how these individual parameters help improve quality of patient care should be the focus of future research.
O002 Diabetes-associated HLA donor genotypes and pancreas transplant outcomes
Authors: Owen RV , Counter C , Shaw JA , Wilson CH , White SA 
Published: November 2022

Abstract

Introduction
The genotypes HLA DR3/DR4, DR3/DR3, DR4/DR4 are associated with a predisposition to diabetes. This study evaluated UK recipient outcomes after pancreas transplantation from donors with a diabetes-associated genotypes.

Methods
Data on all UK pancreas transplants from 2004–2019 was obtained from the NHSBT-UK Registry, n=2,938. HLA-DR type was recorded for all organ donors. Re-transplants and those missing patient (PS) or graft (GS) survival were excluded, resulting in a final cohort of n=2,661. We further delineated our categories into SPK, PTA and PAK as a previous study suggested different recipient categories may be adversely affected. Univariate analyses were conducted using Kaplan-Meier plots and multi-variate analysis using Cox-regression models. Complications were analysed using chi-squared analyses.

Results
The majority of grafts were from donors not associated with diabetes genotypes (90.1%, n=2397) whereas 5.4%(n=145) came from HLA DR3/DR4 donors, 1.6%(n=43) from DR3/DR3 and (n=76)2.9% from DR4/DR4. Comparable outcomes for GS at 1yr (SPK p=0.980, PTA p=0.759, PAK p=0.244) and 3yrs (SPK p=0.708, PTA p=0.744, PAK p=0.275) and PS at 1yr (SPK p=0.553, PTA p=0.527, PAK p=0.756) and 3yrs (SPK p=0.728, PTA p=0.928, PAK p=0.424) were seen. Multivariate analysis also showed no statistically significant difference in GS (p=0.604, HR 1.041, 95%CI 0.895, 1.211) or PS (p=0.623, HR 1.045, 95%CI 0.876, 1.248). There were comparable complication rates.

Conclusion
This multicentre UK study has found comparable survival outcomes and complication rates within our donor-HLA-genotype groups. We do not believe that the presence or absence of a diabetes associated HLA-genotype influences outcomes for any category of pancreas transplant.

Take-home message
We do not believe that the presence or absence of a diabetes-associated HLA-genotype influences outcomes for any category of pancreas transplant.
O011 An analysis of cost effectiveness and clinical outcomes of elective abdominal aortic aneursym repair in a tertiary centre over one year
Authors: Songra L , Baker D , Davis M , Constantinou J , Hamilton H , Agu O , Hynes N 
Published: November 2022

Abstract

Introduction
Endovascular aneurysm repair (EVAR) is an alternative to open surgical repair (OSR) of abdominal aortic aneurysms (AAA) and has a superior short-term safety profile. However recent guidelines have questioned its long-term cost-effectiveness. We retrospectively compared EVAR, Fenestrated EVAR (FEVAR) and OSR of non-ruptured AAA in a tertiary centre over 12 months, to determine whether FEVAR represents an affordable, clinically efficacious option in aortic repair

Methods
Data was collected from the National Vascular Registry and hospital records.73 patients underwent primary elective AAA repair. Patients were followed up for one year post-operatively. The primary outcome was cost per QALY. Secondary outcomes included 30-day mortality and morbidity, aneurysm-related mortality, re-intervention rates, length of hospital stay and all-cause mortality at one year.

Results
Cost per QALY was calculated as £19134.75, £15408.00 and £12118.16 for FEVAR, EVAR and OSR respectively (FEVAR vs EVAR p= 0.438, FEVAR vs OSR p= 0.001, OSR vs EVAR p= 0.589) OSR was associated with a longer overall hospital and ITU stay, and significantly higher incidence of respiratory complications post-operatively compared to FEVAR and EVAR. FEVAR was associated with significantly higher operative costs, and higher re-intervention and readmission rates compared to EVAR and OSR. There was no significant difference between perioperative and one year mortality between the repair options.

Conclusion
FEVAR is more expensive than OSR but based on NICE willingness-to-pay thresholds, it still presents a viable alternative for aortic repair, when performed in specialist centres. However, long term data is required to make informed decisions on cost-effectiveness.

Take-home message
FEVAR represents a viable alternative for elective abdominal aortic repair. Long-term RCT data are required to make informed decisions on cost effectiveness
O014 Oxidised zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multi-centre prospective double-blinded randomised controlled trial with 10-years follow-up
Authors: Kayani B , Baawa J , Fontalis A , Tahmassebi J , Wardle N , Middleton R , Hutchinson J , Haddad FS 
Published: November 2022

Abstract

Introduction
This study reports the ten-year polyethylene liner wear rates, incidence of osteolysis, clinical outcomes and complications of a three-arm, multicentre randomised controlled trial comparing Cobalt-Chrome (CoCr) and Oxidised Zirconium (OxZr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) versus highly cross-linked polyethylene(XLPE) liners in total hip arthroplasty (THA).

Methods
Patients undergoing THA from four institutions were prospectively randomised into three groups. Group A received a CoCrfemoral head and XLPE liner; Group B received an OxZrfemoral head and XLPE liner; and Group C received an OxZr femoral head and UHMWPE liner. Patients and observers recording study outcomes were blinded to the treatment groups at each follow-up interval. The outcomes of 262 study patients were analysed at ten years follow-up after THA.

Results
At ten years follow-up, increased linear wear rates were recorded in group C compared to group A (0.133 ± 0.21 mm/yr vs 0.031 ± 0.07 mm/yr respectively, p&lt;0.001) and group B (0.133 ± 0.21 mm/yr vs 0.022 ± 0.05 mm/yr respectively, p&lt;0.001). Patients in group C were associated with increased risk of osteolysis and aseptic loosening requiring revision surgery compared with group A (7/133 vs 0/133 respectively, p=0.007) and group B (7/133 vs 0/135 respectively, p=0.007).

Conclusion
The use of UHMWPE was associated with progressively increased annual liner wear rates after THA. At ten years follow-up, this translated to UHMWPE leading to an increased incidence of osteolysis and aseptic loosening requiring revision THA, compared with XLPE.

Take-home message
THA using XLPE liners is associated with improved long-term implant survivorship and reduced revision surgery compared with UHMWPE liners at long-term follow-up.
O021 Evaluating the impact of neurosurgical rotation experience in Africa on the interest and perception of medical students towards a career in neurosurgery: a continental, multi-centre, cross-sectional study
Authors: Ooi SZY , Dada OE , Bukenya GW , Kenfack YJ , Chi L , Ohonba E , Adeyemo E , Narain K , Awad AK , Barrie U , Sichimba D , Ogunfolaji O , Kitonga LM , Oriaku AJ , Bamimore MA , Okor DE , Rominiyi O 
Published: November 2022

Abstract

Introduction
Africa has the second-highest neurosurgical workforce deficit globally, and many medical students in Africa lack exposure to the field. This study aims to assess the impact of a neurosurgical rotation during medical school in shaping the perception and interest of students towards a career in neurosurgery.

Methods
This is a continental, multi-centre, cross-sectional study. A Google Form e-survey was disseminated to African clinical medical students between February 21st and March 20th, 2021. Data was analysed using descriptive statistics and adjusted logistic regression modelling.

Results
Data was received from 539 students in 30 African countries (n=30/54, 55.6%). The majority of participants were male (n=289/539, 53.6%) and were from Kenya (n=83/539, 15.4%). Most students had undertaken a clinical neurosurgery rotation (n=278/539, 51.6%); the majority reported a rotation length of four weeks or less (n=181/278, 65.1%). Students with clinical experience were less likely to pursue the specialty (p=0.02) and had a stronger perception that it is more difficult for women to pursue neurosurgery (p=0.0001) when compared to those without clinical experience. However, after adjusting for other factors, students with greater than four weeks of neurosurgical exposure were more likely to express a career interest in neurosurgery (odds ratio [OR]=1.75, p&lt;0.04) and men were more likely to express interest in a neurosurgical career compared to women (OR=3.22, p&lt;0.001).

Conclusion
Our findings support standardised, continent-wide, curriculum development, and advocacy supporting improved gender inclusivity in education and policy-making to improve the quality of neurosurgical exposure during medical school and tackle the workforce deficit across Africa.

Take-home message
A continent-wide, standardised curriculum guide to neurosurgical rotations, and advocacy for gender inclusivity in education and policy-making efforts across the African continent is required to shape the perception and interest of medical students towards a career in neurosurgery.
O026 Post-operative mortality following planned versus on-demand relaparotomy for secondary bacterial peritonitis: a literature review
Authors: Hinchcliffe Z , Hargest R 
Published: November 2022

Abstract

Introduction
Post-operative peritonitis is a life-threatening complication of surgical care, whereby early relaparotomy is paramount in diagnosing and controlling the infective source. Currently, there are no clear guidelines on surgical strategies for re-laparotomy. This study aimed to evaluate the current evidence on the mortality rates and length of hospital admission associated with planned (PR) versus on-demand re-laparotomy (ODR) in patients with secondary peritonitis.

Methods
Literature review was conducted using Ovid MEDLINE and PubMed to identify English-language papers directly comparing ODR and PR in adults over 18 years. Case reports, reviews and papers including individuals with peritonitis post-pancreatitis or abdominothoracic surgery were excluded. Eight of the 154 studies identified met inclusion criteria following abstract screening.

Results
No significant difference was found between post-operative mortality in PR and ODR for patients with secondary peritonitis (mean mortality rates 30.0% and 31.7% respectively). ODR was shown to have better overall outcomes in avoiding unnecessary surgeries, reducing infection-related complications and length of ITU admissions. ODR is favoured provided there is no operation delay. However, in patients with extensive peritonitis and high APACHE-II scores, PR is preferred to effectively control infection source.

Conclusion
Literature analysis shows there is still much debate regarding whether PR or ODR is favoured for post-operative peritonitis. Further randomised control-trials across multiple international centres are required to improve the evidence base for future surgical practice.

Take-home message
Mortality and complication rates are comparable following planned and on-demand re-laparotomy in patients with post-operative peritonitis. Further international research is required to construct evidence-based guidelines for re-laparotomy and improve our future care for critically unwell surgical patients.
O029 Long term outcomes of renal transplants in kidneys with multiple arteries
Authors: Seet C , Clementoni L , Mohamed IH , Khurram M 
Published: November 2022

Abstract

Introduction
Variations in kidney arterial anatomy may affect decisions regarding implantation, and in some cases require multiple anastomoses or reconstruction. We aimed to assess the effect of multiple arteries on transplant outcomes.

Methods
We performed a registry analysis of UK kidney transplants from 2000–2018. Univariate and
Multi-variate analyses were performed to assess the effect of multiple arteries on graft outcomes including graft function and the incidence of DGF and vascular thrombosis.

Results
13240 living donor (LD) and 28095 deceased donor (DD) transplants were analysed. Warm ischaemic times in single artery kidneys was lower than kidneys with multiple arteries (LD 42 vs 45mins, p=0.025, DD 40 vs 43mins, p&lt;0.001). Donor characteristics were similar between both groups. When adjusted for age, sex, diabetes, cold and warm ischaemic time, there was no difference in mean creatinine at 3, 12 or 60 months in LD and DD with single or multiple arteries. There was an increased incidence in vascular thrombosis seen in LDs with multiple arteries (2.2% vs 4.5%, p=0.008), but not in DDs (3.7% vs 4.0%, p=0.584). There was no difference in DGF or PNF. In LDs, multiple arteries had no effect on transplant survival time (p=0.473), but DDs with multiple arteries had poorer survival (5493 vs 5649 days, p=0.007).

Conclusion
While multiple arteries may pose technical challenges and are associated with longer warm ischaemic times, the clinical implications of this are minimal. The increased risk of graft thrombosis in LDs is clinically relevant but long-term graft survival and graft outcomes remain excellent.

Take-home message
Kidneys with multiple arteries can make transplantation more technically challenging, but this has minimal effects on long term graft outcomes.
O030 Image-analysis algorithm to determine quality of cold perfusion in kidney transplantation
Authors: Tingle SJ , Thompson ER , Bates L , Connelly C , Colenutt S , Turner M , Ugail H , Hodgetts R , Thomson BM , Sheerin N , Wilson C 
Published: November 2022

Abstract

Introduction
Surgeon assessment of visual ‘quality of perfusion’ (QOP) influences kidney discard and predicts transplant outcome. However, this assessment is subjective and bias-prone.
We aimed to design an application utilising a smartphone camera to make this assessment objective and enhance decision making.

Methods
The QOP in photographs of backbench kidneys was graded from 1 (ideal) to 5 (very poor) by three independent surgeons. A training cohort was used to develop an image-analysis algorithm, which was validated in a separate cohort.

Results
Analysing surgeon scores of 174 kidney images revealed that inter-rater agreement was good for kidneys displaying the best (rated 1) and worst (rated 4 or 5) QOP. However, for intermediate scores inter-rater agreement was poor. Inter-rater agreement between surgeons decreased as they graded more images; as surgeons fatigued, their ability to classify images worsened. A training cohort (n=174 kidneys) was used for algorithm development. First, small regions within each image were mapped within the CEILAB colour-space, where well-perfused and poorly perfused areas show clear separation. To generate a score for each kidney these regions are compared with ideally flushed kidney tissue. Testing our algorithm (validation cohort - n=29 kidneys) revealed strong correlation between image-analysis QOP score and surgeon assessment, r=0.789 (0.587–0.899), P&lt;0.001.

Conclusion
Surgeon inter-rater agreement on kidney QOP is low for kidneys with borderline QOP and worsens with fatigue. We provide a QOP score utilising an image-analysis algorithm, which correlates with surgeon scoring. With additional images and training this could provide an objective, numerical, point-of-care assessment of organ quality.

Take-home message
Current visual assessment of transplant organ quality is subjective and bias-prone. This body of work attempts to create a point-of-care image-analysis application to provide an objective numeric organ quality score.