bluuebunny/crossref_metadata_2025_split huggingface dataset:
O043 The outcomes after emergency appendicectomy in patients with liver cirrhosis: a population-based cohort study from England
Authors: Adiamah A , Rashid A , Crooks C.J , Hammond JS , Jepsen P , West J , Humes DJ 
Published: November 2022

Abstract

Introduction
The mortality risk after appendicectomy in patients with liver cirrhosis is predicted to be higher than in the general population given the associated risk of perioperative bleeding, infections, and liver decompensation. This population-based cohort study aimed to determine the 90-day mortality risk following emergency appendicectomy in patients with cirrhosis.

Methods
Adult patients undergoing emergency appendicectomy in England between January 2001 and December 2018 were identified from two linked primary and secondary electronic healthcare databases, the clinical practice research datalink, and hospital episode statistics data. Length of stay, re-admission, Case fatality, and the odds ratio of 90-day mortality were calculated for patients with and without cirrhosis, adjusting for age, sex, and co-morbidity using logistic regression.

Results
A total of 40353 patients underwent appendicectomy and of these 75(0.19%) had cirrhosis. Patients with cirrhosis were more likely to be older (p &lt;0.0001) and have comorbidities (p&lt;0.0001). Proportionally, more patients with cirrhosis underwent an open appendicectomy (76%) compared with 64% of those without cirrhosis (p = 0.03). The 90-day case fatality rate was 6.67% in patients with cirrhosis compared with 0.56% in patients without cirrhosis. Patients with cirrhosis had longer hospital length of stay (4 (IQR 3–9) days versus 3 (IQR 2–4) days and higher readmission rates at 90-days (20% vs 11%, p=0.019). Most importantly, their odds of death at 90-days were 3 times higher than patients without cirrhosis, adjusted odds ratio 3.75 (95% CI 1.35–10.49)

Conclusion
Patients with cirrhosis have a 3-fold increased odds of 90-day mortality after emergency appendicectomy compared to those without cirrhosis.

Take-home message
Patients with cirrhosis have a 3-fold increased mortality risk than those without cirrhosis. They also have longer hospital stays and higher risk of readmissions.
O045 A systematic review of observational management of cutaneous basal cell carcinoma
Authors: Goodall R , Chicco M , Wietek N , Borsky K , Harrison C , Rodrigues J 
Published: November 2022

Abstract

Background
Cutaneous basal cell carcinoma (BCC) is the commonest cancer in the United Kingdom. Surgical excision is the most common treatment. This review summarises all published outcomes of observational/non-interventional management of BCC.

Methods
This PRISMA-compliant systematic review searched MEDLINE, EMBASE and CENTRAL databases from inception-June 2021. All studies reporting outcomes of observational management for BCC were included.

Results
From 2529 titles, four full-text articles reporting on 2298 individuals were eligible. Two studies were randomised controlled trials (RCTs) comparing histological clearance rates and adverse events following treatment with an inactive strategy (placebo cream) versus topical 5%-imiquimod (at different frequencies) for 6–12 weeks. Clearance rates ranged from 52–100% for imiquimod and 2–19% for placebo, with more adverse events associated with imiquimod. The other two studies used prospective cohort designs. One study assessed the natural history of BCCs managed expectantly in 39 individuals aged ≥80years. During the 15.8-month follow-up, 46.2% of lesions did not increase in size and 10.3% resolved. The remaining study compared treatment patterns of 1360 patients with non-melanoma skin cancer (NMSC) in individuals with or without limited life-expectancy (LLE). The LLE subgroup had a 5-year mortality rate of 43.3%, with no deaths attributed to NMSC. Only 3.3% of individuals with LLE underwent observational treatment. No study examined quality-of-life or cost-effectiveness.

Conclusion
There has been limited investigation of observational management of BCC, despite possible advantages of this strategy. Future RCTs should compare quality-of-life outcomes and utility adjusted survival following interventional or observational management of BCC.

Take-home message
This systemic review identifies a lack of data reporting outcomes following observational management of BCC, despite possible advantages of this treatment strategy. Future RCTs should compare quality of life outcomes and utility-adjusted survival following interventional or observational management of BCC.
O046 Incidental appendicectomy in pancreas transplantation: a single-centre study
Authors: Hussein A , Gill-Barman B , Karydis N , Callaghan C 
Published: November 2022

Abstract

Introduction
Pancreas transplantation is associated with a significant rate of surgical complications, some of which have similar clinical features to acute appendicitis. An incidental appendicectomy (IA) at the time of pancreas transplantation could reduce future diagnostic uncertainty. This study aimed to establish the number of IA undertaken during pancreas transplantation in our unit and examine outcomes. Of those patients that did not undergo an IA, we identified those that subsequently required intervention for their appendix.

Methods
A database of patients who underwent a pancreas transplant in our unit from 01/01/2012 to 10/12/2020 was obtained and patients were followed up until 01/03/2021. Electronic records were examined. Standard statistical analyses were undertaken and death-censored graft survivals were compared using the log-rank test.

Results
243 patients underwent a pancreas transplant. Of the 227 (93%) patients that had not previously had an appendicectomy, 53 (23%) underwent an IA during transplantation. There were no complications and 2 carcinoid tumours were identified. Of the 174 (77%) patients that did not undergo an IA, 3 (2%) patients required subsequent intervention for the appendix. There was no statistically significant difference in operative time (p=0.06), index inpatient length of stay (p=0.50), ICU stay (p=0.80), pancreatic graft survival (p=0.50), or kidney graft survival (p=0.70) between patients who had an IA and those who did not.

Conclusion
IA during pancreas transplantation appears to be safe, and does not significantly prolong pancreas transplantation or adversely affect other outcomes. Surgeons should consider whether incidental appendicectomy should become standard practice.

Take-home message
Appendiceal complications after pancreas transplantation can be challenging and surgeons should consider whether incidental appendicectomy should become standard practice.
O049 FRAX score assessment of long term follow up thyroid cancer patients
Authors: Chauhan V , Mohamed E , Lee M , Gouni R , Alasttal S , Fouad M , Chadwick D , Christakis I 
Published: November 2022

Abstract

Introduction
Thyroid stimulating hormone (TSH) suppression with Levothyroxine (LT4) following thyroid cancer surgery is recommended in some patients under long term follow up. However, LT4 may cause reduced bone mineral density. We aimed to assess patients in our long-term thyroid cancer follow up clinic for risk to bone health.

Methods
We conducted a review of all patients in the thyroid cancer follow-up clinic and calculation of FRAX score for those that are &gt;40 years old who are followed up in the Endocrine Surgical Service of NUH. Subsequently patients were categorised into risk groups according to the Osteoporosis Group Guideline (2017) and managed accordingly.

Results
78 patients were identified and had ongoing follow up. 23 patients were excluded as they were &lt;40 years old. 10 patients did not want to participate in the study. 45 patients were assessed with the FRAX score. There were 31 female and 14 male patients, mean age 60.8 (±12.3) years. The mean follow up was 75.0 (±78.9) months. 11% (five patients) were found to require treatment for Osteoporosis without a bone mineral density (BMD) scan, 38% (17 patients) were recommended to assess their BMD, 4% had borderline risk to measure BMD, and 47% required lifestyle and dietary modification.

Conclusion
Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.

Take-home message
Thyroid cancer patients aged 40 and above represent a cohort in whom osteoporosis is a substantial risk and warrant assessment with a FRAX score.
O052 A retrospective analysis of a single-centre experience with administration of neoadjuvant chemotherapy prior to surgical removal of breast tumour
Authors: Reveendran D , Tait C , Hogan B 
Published: November 2022

Abstract

Introduction
Neoadjuvant chemotherapy (NACT) is increasingly used to aid breast preservation surgery for patients with non-conservable disease at presentation. NICE guidelines recommend offering primary systemic therapy to patients with ER- disease and/or HER2+ disease and for those with ER+ disease to reduce tumour size. This retrospective study aimed to analyse the incidence of local and systemic recurrence post NACT.

Methods
A retrospective analysis of NACT usage was conducted from January 2011 to December 2020 at the breast surgery unit. Clinical data of patients who received NACT were collected using the local Breast Unit database, Electronic Patient Record (EPR) and Systm1. Data included patient demographics, type of breast and axillary surgical procedure, histopathology of breast tumour, pathological response to NACT and time to local and/or systemic recurrence.

Results
202 patients received NACT for breast cancer between January 2011 to December 2020. Analysis showed an increasing use of NACT ranging from 2.19% of all cancers in 2013 to 14.5% in 2020. 89/202 patients underwent breast preservation surgery. 1 patient developed local recurrence at median follow up of 26 months. 42 patients developed systemic recurrence, and 40 of them had residual disease found at surgery post NACT at median follow up of 24 months.

Conclusion
Our unit has been increasingly using NACT over the last 8 years in line with guidance. Breast conserving surgery post NACT is associated with a low risk of local recurrence. The risk of systemic disease progression post NACT is very low for patients who have complete pathological response.

Take-home message
Breast conserving surgery post NACT is associated with a low risk of local recurrence. The risk of systemic disease progression post NACT is very low for patients who have complete pathological response.
O054 A novel hyaluronic acid hydrogel as an extracellular matrix to improve adipose tissue graft survival in autologous transfer for breast cancer reconstruction
Authors: Bechar J , Bastie C , Dallmann R , Worch J , Gharanei S , Shabir S , Dove A , Hardwicke J 
Published: November 2022

Abstract

Introduction
Adipose tissue transfer is used for correcting breast contour defects after cancer surgery. Graft survival can be as poor as 15% at four years follow-up. Hyaluronic acid (HA) hydrogels can be used to suspend adipocytes to aid survival.

Methods
A unique HA gel with cross-linked aldehyde and hydrazine groups allowing self-healing around cells after injection was engineered. The gel's rheology and degradation properties in vitro were characterised. 3T3-L1, murine and human adipocytes were encapsulated within HA hydrogel, with survival and gene expression interrogated. A murine animal model underwent subcutaneous injection of primary murine adipocytes mixed with HA gel, with survival and gene expression examined.

Results
The novel HA hydrogel can be degraded by tissue hyaluronidases in 4–5 days. Self-healing occurred in 30 minutes and the gel is robust enough to be injected through a needle. 3T3-L1, murine and human adipocytes were encapsulated within HA hydrogel and showed a &lt;15% deduction in survival compared to control. Mature adipocyte gene expression markers compared to control showed no difference. Primary murine adipocytes injected in vivo showed no difference in survival at higher gel volumes compared to control.

Conclusion
The novel engineered HA hydrogel has suitable mechanical characteristics for injection and can support adipocyte survival in vitro and in vivo and is ready for a pilot human trial.

Take-home message
Our novel HA gel can support adipocytes in vivo and in vitro, and offers a potential method for augmentation of adipose tissue transfer.
O056 Achieving optimal clinical outcomes in autologous fat grafting (AFG): a systematic review of processing techniques
Authors: Langridge B , Khan H , Awad L , Mosahebi A , Butler PEM 
Published: November 2022

Abstract

Introduction
AFG is an increasingly popular technique in reconstructive and cosmetic surgery but significant variability in long-term graft retention continues to be a limitation. This results in unreliable clinical outcomes and revision procedures. There is no consensus on the optimal methodology of graft processing. This systematic review identifies the latest evidence base supporting different processing techniques.

Methods
A systematic literature search was conducted using PubMed, SCOPUS, and the Cochrane electronic databases. Studies comparing AFG processing techniques and reporting long-term patient outcomes (≥3 months) were identified. Data collected included the technical aspects of techniques, cohort characteristics, complication rates, volume retention. Systematic assessment of study quality was also performed.

Results
Twenty-four studies (2928 patients) providing at least level three evidence were included. Processing techniques evaluated included centrifugation, decantation, washing, filtration, gauze rolling, as well as commercial devices and ASC enrichment methods. There was variable reporting of complications and volume retention rates. Complications were infrequent; palpable cysts (0–18%), cellulitis (0–8%) and fat necrosis (0–36.4%) were the most commonly reported. No significant differences in long-term volume retention between techniques were found in AFG in the breast. In head and neck patients, greater volume retention were documented in ASC enrichment (64.8–95.8%) and commercial devices (41.2%) compared to centrifugation (31.8–76%).

Conclusion
The quality of AFG research has improved significantly in recent years but has heterogeneity in reporting outcomes. ASC (adipose derived stem/stromal cells) enrichment methods and commercial devices results in superior long-term volume retention in facial but not breast fat grafting.

Take-home message
Adipose derived stem/stromal cell enrichment methods and commercial devices have superior long term volume retention in facial but not breast autologous fat grafting [level of evidence II]. Randomised control trials are necessary to identify if certain processing methods are superior to others in volume retention and complication rates.
O057 The association between computed tomography-based body composition metrics and outcomes after aortic aneurysm repair
Authors: Koh AL-Y , Yang QZC , Hanna L , Boshier P , Gibbs R 
Published: November 2022

Abstract

Introduction
Computed tomography-based body composition (CTBC) metrics can provide a reliable measure of muscle and fat distribution. Their role in predicting outcomes following abdominal aortic aneurysm (AAA) repair has yet to be investigated. This study explored the associations between CTBC and short-term postoperative outcomes after AAA repair.

Methods
This single-centre retrospective study included patients who had undergone either elective or emergency AAA repair, via open or endovascular routes, from 2015 to 2020. The cross-sectional surface areas of skeletal muscle (SMI), and intramuscular (IMAT), visceral (VAT), and subcutaneous (SAT) adipose tissues were measured at the L3 vertebral level of a preoperative CT scan. Sarcopaenia was defined as SMI ≤38.5cm2 in women and ≤52.4cm2 in men. Cut-points for IMAT, VAT, and SAT were defined as the sex-specific median or mean for this study population.

Results
In total, 265 patients were included. SMI was higher in the open surgery group compared to the endovascular group (p=0.011). For infrarenal aneurysms, IMAT was higher in the endovascular group (p=0.021), however, for juxtarenal aneurysms, it was higher in the open surgery group (p=0.002). 76.6% of all patients had sarcopaenia but this was not associated with mortality (p=0.259), Clavien-Dindo class ≥2 complications (p=0.559), or length of stay (p=0.920). IMAT, VAT, and SAT were not associated with any measured outcomes.

Conclusion
Body composition differences between open and endovascular patients highlight the potential for CTBC as a tool for patient stratification. However, at present, CTBC cannot predict short-term postoperative outcomes.

Take-home message
There are significant differences in body composition between patients undergoing open and endovascular aortic aneurysm repair, highlighting the potential for CTBC to be used as a tool for patient stratification. However, at present, CTBC cannot predict short term postoperative outcomes.
O059 Efficacy and safety of embolo-sclerotherapy of arteriovenous malformation based on the experience from a single specialist centre
Authors: Pang C , Arasakumar DRB , Evans N , Papadopoulou A , Khalifa M , Hamilton G , Lim CS , Brookes J 
Published: November 2022

Abstract

Introduction
To evaluate the efficacy and safety of EST, particularly foamed STS 3% in the treatment of arteriovenous malformations (AVMs) in a single specialist centre.

Methods
All patients with AVMs who underwent EST from 01 January 2015–31 December 2019 were retrospectively reviewed. Types of AVM were grouped into Schobinger's classification. All ESTs were performed either with foam sclerosants (STS 3% and polidocanol), ethanol, coils and/or other substances including Onyx and Gelfoam. Outcome measures included treatment effects and complications. Continuous variables were compared using ANOVA F test. Other discrete variables were compared using Chi-squared tests. Differences were considered significant at p&lt;0.05.

Results
A total of 65 patients with AVMs, with a mean age of 36 years (range 1–74 years) were included. The age of patients with Type IV AVM were significantly (p=0.014) higher than others. The use of EST with foam STS was significantly lower for type IV AVM (0.0%) (p=0.003). Complications were significantly higher in type III AVM (21.1%)) (p=0.009). A total of 6 (9.2%) patients experienced complications for example, upper lip necrosis and partial facial weakness. The number of days in follow-up was not significantly different across all types of AVM. However, type II AVM showed a significantly lower number of days in follow-up (p=0.038).

Conclusion
EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs.

Take-home message
EST, in particular foam sclerotherapy with STS 3%, was clinically effective and safe to treat patients with AVM. This study showed that foam sclerotherapy with STS 3% may be used as an alternative to ethanol in the treatment of AVMs.
O060 Staged hybrid single lumen reconstruction (TIGER) in management of chronic symptomatic complex type B aortic dissection
Authors: Sultan S , Acharya Y , Hynes N 
Published: November 2022

Abstract

Introduction
We aim to report an innovative technique - Staged Hybrid Single Lumen Reconstruction (TIGER) in the management of chronic symptomatic complex type B aortic Dissection (CS -TBAD). TIGER technique was adopted as a tool for total aortic remodelling with true lumen expansion, false lumen regression and complete thrombosis with stabilization of overall aortic diameter.

Methods
Aortic dissection cases (n = 5) were managed by the TIGER technique, which included creating a single lumen from the supra celiac, infra-diaphragmatic aorta to both common iliac arteries with open surgical patching of the visceral arteries; followed by TEVAR three months later (mean follow-up 16 months). All had aneurysmal dilation, while 60% had acute pan aortic dissection and 40% CS-TBAD.

Results
Sixty percentages of the patients required a left subclavian artery chimney graft, while 20% required bilateral subclavian to carotid artery transposition. No spinal drainage was needed and all patients had intra-operative trans-oesophageal ECHO for wire guidance. There was no aortic rupture or retrograde type A dissection, and renal, visceral, cardiac, pulmonary, or spinal complications. All, but one patient, went off their antihypertensive medication. 100% of the patients maintained normal eGFR postoperatively with accelerated aortic modulation.

Conclusion
Our experience showed that TIGER is effective at the semi acute stage to initiate remodelling and prevent malperfusion, facilitating straightforward TEVAR at stage two, which was made easier by avoiding visceral branch stenting. Moreover, the stented aortic segment's length was decreased, avoiding critical shattering, branch dislodgment, and visceral compromise, including spinal ischaemia and negative cardiovascular consequences.

Take-home message
Staged Hybrid Single Lumen Reconstruction (TIGER) is an effective technique in the management of chronic symptomatic complex type B aortic dissection at the semi acute stage to initiate remodelling and prevent malperfusion, facilitating a straightforward thoracic endovascular aortic repair (TEVAR) made easier by avoiding visceral branch stenting.
O061 A single-centre retrospective study in a large tertiary renal centre on the management of infected arteriovenous grafts
Authors: Chow BJ , Chowdary P , Khurram MA , Mohamed IH 
Published: November 2022

Abstract

Introduction
Prosthetic arteriovenous grafts (AVGs) are often used as tertiary vascular access for haemodialysis in patients with exhausted autogenous options. AVGs are associated with an increased risk of infection which can lead to excess morbidity and life-threatening complications. Infected AVGs are challenging to manage, and the current evidence remains unclear on optimal strategy with arguments for conservative management, salvaging with revision or surgical excision (subtotal or total). This study sought to evaluate the management of infected AVGs by examining the clinical outcomes of patients with infected AVGs managed in our institution.

Methods
We conducted a single-centre retrospective study of all AVG infections managed (conservative management via antibiotics; graft revision; surgical excision) between June 2016 to May 2021. Primary outcome was mortality at 1 year. Secondary outcome was functional vascular access at 6 months and 1 year. Data were extracted from electronic patient records, radiology imaging and reporting.

Results
34 patients were included in our study (14.7% conservatively managed; 14.7% revision; 70.6% surgical excision) with a mean age of 60.4 ± 14.4 years (67.6% males). Average time from AVG placement to presentation was 11.8 months. 1 year mortality was 14.7%. Functional vascular access at 6 months in the three groups was 60%, 60% and 10% and 1-year functional vascular access was 60%, 75% and 42% respectively.

Conclusion
Surgically excised infected AVGs are associated with poor 6-month and 1-year vascular access outcomes. The findings suggest that conservative management and/or revision are more prudent given their higher probability of subsequent functional access.

Take-home message
Provision of a definite vascular access within the first year of graft infection is highly challenging. As such, conservative management and graft revision present as superior options to manage infected arteriovenous grafts.