bluuebunny/crossref_metadata_2025_split huggingface dataset:
P04 Bibliometric study in global sugery
Authors: Soh TCF , Yip HM , Ong QJ , Lim ZZ , Azam B 
Published: November 2022

Abstract

Background
In 2015, The Lancet Commission on Global surgery (LCoGS) published a report highlighting the growing burden of surgical disease worldwide. The need for Global surgery research was emphasised in developing high-quality surgical care, especially in lower and middle-income countries (LMICs). We aim to assess the current state of global surgery research, illuminate trends within and discuss the impact of the report.

Methods
A literature search identified all clinical research in the global surgery field published between 2015 and 2019. Three databases - MEDLINE, Web of Science and the Cochrane Library were used to identify articles screened by a minimum of two independent authors against eligibility criteria, using a method adapted from the PRISMA guidelines. These articles were categorised to describe trends including number of articles published, surgical conditions, study types, and geographical author distribution. All methods utilised have adhered to an a-priori protocol.

Results
1,495 from 5,272 eligible articles were analysed. The number of global surgery research articles increased from 288 in 2015 to 314 articles in 2019. 65% focused on surgical conditions treatable with basic interventions. 49% of Global surgery research articles involved authors from high income countries.

Conclusion
We have summarised the current state of global surgery research since publication of the LCoGS 2015 report. Though research output is still minimal from countries with greatest clinical need, the overall trend highlights progression in research made by LMICs, notably through establishing global research collaborations. Our findings demonstrate additional efforts are necessary to further improve research output in LMICs.

Take-home message
Research output is still minimal from countries with greatest clinical need, the overall trend highlights progression in research made by LMICs, notably through establishing global research collaborations.
P05 Quality of surgical post take ward round documentation by on-call team
Authors: Angamuthu N , Chowdhury S , Brothwood K , Boyle D 
Published: November 2022

Abstract

Introduction
Documentation of clinical assessment and care plans is integral to patient safety, continuity of care and has medico legal implications.

Methods
A retrospective study of the quality of documentation of post take ward rounds (PTWR) by the on-call surgical team was performed.

Results
Among the key factors reviewed (18 randomly selected emergency admissions), history of presenting complaints, past history and medical history were recorded in 66%, 72% and 44% of the records respectively. National early warning score (NEWS) was recorded in 66% notes and clinical findings in 88% of patients. The key lab and imaging findings were entered in a subset of patients only (27% and 33% respectively). Based on the initial audit, the PTWR quality could be improved with increased compliance of NEWS score entry, medical history, key lab and imaging results. A standardised ward round template was designed and circulated. This was disseminated to the surgical team by email. Posters were displayed in the surgery office. A presentation was made during teaching session for the junior doctors. The re-audit (34 emergency admissions) showed that the quality had improved based improvement noted in all the key parameters. Documentation of presenting history improved from 66% to 100%. Similarly medical history (44% to 85%), vital signs (66% to 79%), key lab results (27% to 55%), and key imaging (33% to 78%), the management plan was documented in all patients (94% to 100%).

Conclusion
In summary, a standardised PTWR entry ensures better quality and compliance; this should be reiterated during junior doctor change over phase.

Take-home message
Standardised post take ward round entry ensures quality and better compliance during a busy surgical ward round.
P06 A quality improvement project to improve use of bowel charts in surgical wards
Authors: Bharmal A 
Published: November 2022

Abstract

Introduction
To improve the documentation of bowel movements.

Methods
We performed a closed loop audit examining how well patients’ bowel movements are documented in nursing and medical notes across all adult surgical wards at a district general hospital. We collected snapshot data on whether a bowel chart was present, whether bowel movements were recorded regularly and whether doctors documented bowel movements during ward rounds. We then changed the colour of bowel chart paper from white to yellow, with identical contents. This data was prospectively collected again 5 weeks later.

Results
The sample size included 62 inpatients. Prior to the change in bowel chart, 79% of patients’ nursing folders had a bowel chart. Documentation of bowel movements in nursing and medical notes was 25% and 30% respectively. Following the introduction of yellow coloured charts, 90% of patients’ nursing notes had a bowel chart present, with an increase in documentation in nursing and medical notes to 74% and 69% respectively.

Conclusion
In a surgical patient, the importance of good bowel movements is essential to management decisions and discharge planning. Locally, this has been inhibited by the difficulties of locating white bowel charts in a folder of white paper, leading to incomplete documentation and poor recognition of problems in bowel movements. Changing the colour of the bowel charts made it easier to recognise the charts, allowing nurses and doctors to use the bowel chart more efficiently, hopefully improving patient care. This change has been recognised as effective and has been rolled out trust-wide.

Take-home message
Bowel movements are vital to surgical decision making, but are frequently overlooked in practice; impacting patient care. Hence, the need for better recognition made by a simple intervention.
P08 Routine group and save for elective laparoscopic cholecystectomy
Authors: Jenkin I , Sulutaura L , Skan O , Angheleanu R , Pizanias M , Howlader M , Chohda E , Lee H 
Published: November 2022

Abstract

Introduction
Laparoscopic cholecystectomy is the gold standard management for symptomatic cholelithiasis. Intraoperative vascular injury necessitating blood transfusion is a serious but rare complication, typically occurring during dissection around Calot's triangle or trocar insertion. Despite this, standard practice continues to incorporate the obtainment of historic and repeat group and save (G&S) samples to facilitate potential intraoperative transfusion of cross-matched blood. These are relatively expensive (£6.93/sample), time-consuming, and potentially distressing to patients. We review the requirement to obtain routine preoperative G&S samples whilst maintaining patient safety.

Methods
We performed a retrospective analysis of all patients having undergone elective laparoscopic cholecystectomy in a single centre during a six-month period in 2021. Seventy-nine patients were identified (53 female; 26 male), with a mean age of 52 years (range 22–80).

Results
All patients underwent historic G&S and 73% underwent same-day confirmatory samples. No patients required intraoperative or postoperative blood transfusion. Intraoperative bleeding occurred in two cases but neither required transfusion. Nineteen patients (24%) were admitted postoperatively for reasons including conversion to an open procedure (6%), uncontrolled pain, damage to surrounding structures, and the presence of multiple comorbidities.

Conclusion
As such, we propose that routine preoperative G&S samples are not required to undertake safe elective laparoscopic cholecystectomy. In the event of major vascular injury necessitating emergency intraoperative blood transfusion, the major haemorrhage protocol may be activated, and universal donor blood administered. However, routine G&S is recommended in the presence of significant comorbidities (e.g., bleeding diathesis), high likelihood of conversion to an open procedure, or preoperative anaemia.

Take-home message
Group and save samples are routinely obtained prior to elective laparoscopic cholecystectomy despite there very rarely being a need for intraoperative or postoperative blood transfusion. Based on our single centre, retrospective cohort study, we propose that such samples need not be obtained aside from in higher risk cases.
P10 Adherence to vte prophylaxis guidelines in general surgical patients: a single-centre study
Authors: Hussein A , Songra L , Baker D 
Published: November 2022

Abstract

Introduction
Hospital acquired venous thromboembolism (VTE) is potentially preventable yet still accounts for 60% of all VTE seen. This study aimed to establish adherence to guidelines on VTE prevention including completion of VTE risk assessment within 24 hours of admission and appropriate prescription of mechanical and pharmacological VTE prophylaxis.

Methods
A database of all general surgical inpatients in our hospital at any point during the 48-hour period from 21/12/2021 to 22/12/2021 was obtained. Electronic records were examined to check for the presence of 11 established risk factors for VTE and to check for adherence to VTE guidelines. Every surgical patient was reviewed to check whether they were wearing anti-embolic stockings. Standard statistical analyses were undertaken.

Results
There were 107 general surgical patients in hospital during the study period. Of these, 33 (31%) had 3 or more risk factors on admission for VTE. 106 (99%) patients had VTE assessments completed within 24 hours of admission. Of these 107 patients, 93 (87%) had appropriate pharmacological VTE prophylaxis or had a documented reason why this was not prescribed. 14 (13%) patients had no pharmacological VTE prophylaxis prescribed. 84 patients were assessed as requiring anti-embolic stockings. Of these, 57 (68%) of patients were prescribed stockings, and 30 (36%) were physically wearing stockings.

Conclusion
This study has shown that adherence to VTE guidelines among surgical patients in our hospital is substandard. We suggest having a VTE safeguard during the ward round responsible for identifying any deficits in VTE prophylaxis and ensuring recommendations are acted upon.

Take-home message
VTE guidelines among surgical patients is substandard. We suggest having a VTE safeguard during the ward round responsible for identifying any deficits in VTE prophylaxis and ensuring recommendations are acted upon.
P11 Variations in subjective and objective metabolic equivalents in patients undergoing aortic surgery
Authors: Yang PZ , Choy B , Hamid H 
Published: November 2022

Abstract

Introduction
Metabolic equivalents (METs) are measures of patient's functional capacity. It provides insight into patient's risk of perioperative complications. METs are usually obtained from estimation based on patient's history or by cardiopulmonary exercise testing (CPET). However, the validity of estimated METs has been questioned in multiple studies. In this study, we sought to compare the subjective METs from preoperative evaluation and objective METs derived from CPET, to investigate the reliability and validity of subjective METs.

Methods
A retrospective study was carried out for patients scheduled for aortic surgery from March 2017 to September 2018. Patients were classified into 3 subjective categories: Poor (&lt; 4 METs), Moderate (4–10 METs) and Good (&gt; 10 METs), whereas objective METs values were obtained from CPET. Comparative analysis between patient's objective METs and subjective METs was carried out to identify any variations.

Results
Subjective METs correlate with objective METs. Although subjective METs tends to overestimate patient's functional capacity, leading to 44.4% misclassified in the Moderate category. In contrast, Poor category only misclassified 5% by underestimation. In addition, the results confirmed significant differences between the Moderate and Poor categories as expected.

Conclusion
Although subjective METs categories correlate with objective METs, it tends to overestimate patient's METs. They are more accurate in identifying patients with Poor functional capacity (&lt; 4 METs). Therefore, it is a convenient tool for clinician to effectively exclude patients with Poor METs. However, use of subjective METs should be considered carefully due to its limitation in estimating Moderate or Good METs.

Take-home message
Subjective metabolic equivalents correlate with objective metabolic equivalents.
P13 Understanding unwarranted variation in surgical outcome - a Delphi study with perioperative professionals.
Authors: Stubbs DJ , Bashford TH , Nourallah B , Ercole A , Clarkson PJ , Levy N 
Published: November 2022

Abstract

Introduction
Current assessment of perioperative risk relies on patient and surgical factors. However, risk stratification is imperfect and significant unwarranted variation in outcome persists. We sought to identify factors that may influence outcome, but which are under-represented in the literature.

Methods
We used process mapping of stereotyped surgical pathways to identify participants for a multidisciplinary, three round Delphi across two United Kingdom hospitals. A three-round Delphi of 91 stakeholders, from 23 professional groups was conducted. Using a 5-point Likert-scale consensus was defined as a median of &gt;3.5 or &lt;2.5 with an interquartile range of &lt;1.

Results
Response rates were Round one: 51%, round two: 38%, round three: 19%. In round one free text panel suggestions were combined with variables from existing risk scores. This yielded 410 variables. With new suggestions from round two, 468/519 (90%) of the statements ultimately presented to the panel reached consensus. These included patient factors (such as ethnicity and socio-economic status); organisational or process factors related to the hospital (such as policies, staffing, and organisational culture). 66/160 (41%) of the new suggestions did not feature in systematic reviews of perioperative risk scores or key process indicators. No factor categorised as ‘organisational’ (such as organisational culture or external pressures) was present in any examined perioperative risk score.

Conclusion
We identified broader insights into additional factors that may underlie variation in outcome based on the expertise of perioperative professionals. These results could support future research into how organisational structure and performance influences patient outcome.

Take-home message
Perioperative professionals view factors outside of patient and clinician control as relating to surgical outcome. Such factors appear to be absent from many commonly used risk stratification tools.
P14 Evaluation of clinical prognostic variables on short-term outcomes for colorectal cancer surgery: an overview and minimum dataset
Authors: Cheong CM , Golder A , Horgan P , Roxburgh C , McMillan D 
Published: November 2022

Abstract

Introduction
Colorectal cancer resection remains a cause for morbidity and mortality despite the potential curative intent. Multiple systematic reviews have reported on individual factors affecting short term outcome following surgical resection. This umbrella review aims to synthesize the available evidence on host and other factors associated with short-term post-operative complications.

Methods
A systematic search identified systematic reviews reporting on short-term outcomes following colorectal cancer surgery. PubMed, Cochrane Database of Systematic Reviews and Web of Science were search from inception to 8 September 2020. All reported clinicopathological variables were extracted from included systematic reviews.

Results
This overview has identified multiple validated factors affecting short-term outcomes in patients undergoing colorectal cancer resection. There are multiple prognostic factors that affect the short term outcome following colorectal cancer resection although the association differs dependent on the type of complication; infective; non-infective or mortality. The presence of diabetes and measurements of body composition were both factors consistently associated across the short term outcome measures. Despite the large body of literature available, the heterogeneous nature of included prognostic factors and reported outcomes create a challenge for comparing outcomes.

Conclusion
A minimum dataset of mandatory, recommended, and potential baseline variables to be included in studies of patients undergoing colorectal cancer resection is proposed. This will maximize the benefit of such study databases.

Take-home message
The reported effect of prognostic risk factors associated with colorectal cancer resection vary dependent on outcome of interest. This highlights the shortcomings of the current literature and understand of outcomes in colorectal cancer which could be improved with a minimum dataset of baseline variables in future studies.
P15 Audit of outcome of ambulatory care emergency surgery patients
Authors: Walker H , Freer R , Angamuthu N , Hart C 
Published: November 2022

Abstract

Introduction
A proportion of emergency surgical patients are discharged with outstanding tasks (clinical review, imaging to be requested or results followed-up) pending. The turnaround time of these tasks typically placed at the bottom of the emergency surgical on-call list is dependent on the on-call registrar or house officer. The aim was to analyse the outcomes of pending tasks on ambulatory care emergency surgical patients and explore means to improve.

Methods
A retrospective audit of emergency surgical patients from October to December 2021 was performed using the daily on-call list database.

Results
Among the 149 patients with pending tasks on an ambulatory care basis, 80 were excluded (duplicate entries, unclear tasks, non-valid reasons). 38% of patients remained on the list for more than 24 hours with pending tasks. Only 75% of patients had pending tasks completed. Patients waited for 3.3 hours on average (59 to 350 minutes) for clinical review by the registrar or house-officer. The reasons for the delay in clinical review and task completion narrowed down to inappropriate timing (scheduled return in the mornings, when the on-call team are either busy with the ward round or in theatres) and time restraints.

Conclusion
Based on the above findings, it would be beneficial for our hospital to have a surgical hot clinic with staggered appointments rather than ad hoc return to the ambulatory unit. This would improve waiting times and would allow outstanding tasks to be completed by the surgical registrar or clinical fellow during clinic, increasing patient satisfaction.

Take-home message
A dedicated surgical hot clinic will reduce patient waiting times, increase overall patient satisfaction and ensure completion of outstanding clinical tasks.
P19 Audit of completion and documentation of neurovascular assessment prior to, and after Bier's block for distal radius fracture
Authors: Nwose S , AkiiBua A , Hussein M 
Published: November 2022

Abstract

Introduction
The BOAST guideline's standard of practise for the management of distal Radius Fractures states that assessment of circulation and sensation should be documented prior to and after MUA for distal radius fractures. We measured the compliance of the completion and documentation of the neurovascular assessment prior to and after Bier's Block for MUA of distal radius fractures.

Methods
We assessed electronic medical records of these patients during the period November/December 2020. Focusing on the completion of the neurovascular assessment and documentation prior to Bier's Block and compared the results to our first cycle audit done in July/August 2020 following our intervention.

Results
58 patients were analysed for this study compared to 50 in the initial study. 88% had neurovascular assessment done and documented in the Emergency Department compared to 98% in the initial study. However, 60.3% had documentation of neurovascular assessment prior to Bier's block compared to 34% previously. 39.7% had vascular assessment after Bier's block and 64% had neurovascular assessment done in fracture clinic in this second cycle compared to 22% and 76% for vascular assessment and Neurovascular assessment in the facture clinic respectively after the MUA.

Conclusion
This re- audit shows an improvement in the assessment and documentation of neurovascular Status prior to and following MUA of distal radius fracture. There is however a need for improvement. Suggested methods include teaching of upper limb neurological assessment to orthopaedic juniors, Aide memoire such as a small sticker to attach to the notes/ Stamp in the fracture clinic notes.

Take-home message
Assessing and documenting neurovascular status before and after an MUA is very important.
P20 Pre-operative checklist to improve pathway for carotid endarterectomy (CEA) patients: a single centre audit
Authors: Wilcock D , Marzouqa N , Weerakkody R , Baker DM 
Published: November 2022

Abstract

Introduction
The SARS-COV-2 pandemic has led to the redistribution of NHS services. In our sector, CEA surgery moved to an NHS hospital where it had not previously been undertaken. To ensure safety a new standard operating procedure (SOP) was proposed. An audit was undertaken to evaluate the SOP, construct a pre-operative checklist, subsequently measure its effectiveness and identify improvements.

Methods
To ascertain key pre-operative steps to include in the checklist a questionnaire was completed by 9 SpR/Consultants. The form consisted of a ranking score from 0 (never done) to 10 (always done). Once the checklist was established the questionnaire was re-sent additionally asking for feedback on its impact on the service and suggestions for improvement. Using these results, the checklist was incorporated as a smart text to EPIC (electronic patient notes).

Results
The following key steps were identified: MDT decision, vascular review, imaging, anaesthetic review, relevant results (bloods, COVID swab and echo), theatre/bed booking, on-admission steps and post-op care. All 9 doctors felt the checklist improved the service in all domains, except bed availability and subsequent surgical delay, likely because this depended on HDU bed availability and need for on-the-day prioritisation.

Conclusion
The CEA surgery checklist is now an established part of the electronic patient record in the form of a simplified flowsheet with tick-boxes and space to insert results. This has ensured a standardised contemporary record of each patient's progress. All members of the team including new/temporary staff can follow this, ensuring a safe care pathway.

Take-home message
With the move of CEA surgery to an alternative London site it is important to establish a safe standard operating procedure. This has been facilitated by the use of a new pre-operative checklist ensuring a standardised contemporary record of each patient's progress.