bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU3.3 Impelling Factors for Contracting COVID-19 Among Surgical Professionals During the Pandemic: a Multinational Cohort Study
Authors: Yang Wah , Bangash Ali Haider , Abouelazayem Mohamed , Parmar Chetan , Cheruvu Chandra , Viswanath Yirupaiahgari , Konjengbam Alakh 
Published: November 2022

Abstract

Background
Medical workers, including surgical professionals working in COVID-19 treating hospitals, were under enormous stress during the pandemic. This global study investigated factors endowing COVID amongst surgical professionals and students.

Methods
This global cross-sectional survey was made live on the 18th of February, 2021, and closed for analysis on the 13th of March, 2021. It was freely shared on social and scientific media platforms. It was also sent via email groups and circulated through a personal network of authors. Chi-square test for independence, binary logistic regression analysis was carried on determining predictors of surgical professionals contracting COVID-19.

Results
This survey captured the response of 520 respondents from 66 countries. 92.29% (503/545) were working in a hospital receiving patients with COVID-19. More than one-fourth (25.5%) caught COVID-19, which was more frequent in participants working in public sector hospitals (P=0.001). 75.7% of those who did not contract Covid (283/376) were vaccinated (P&lt;0.001). Surgical professionals undergoing practice in the private sector (OR: 0.33; 95% CI: 0.14–0.77; p=0.011) and getting two doses of vaccines (OR: 0.55; 95% CI: 0.32–0.95; p=0.031) had decreased odds of contracting COVID-19. Only 6.9% of those who reported not contracting COVID-19 (26/376) were calculated to have the highest Level of Harm score (LH4) (P&lt;0.001).

Conclusions
High prevalence of respondents caught COVID-19, which was more frequent in participants working in public sector hospitals. Self-isolation or shield, getting two doses of vaccines decreases the odds of contracting COVID-19. Those who reported contracting COVID-19 were calculated to have the highest Level of Harm score.
TU4.1 Single-center experience in robotic-assisted colorectal surgery during COVID pandemic: First 72 cases
Authors: Mansuri Ahmer , Butnari Valentin , Kaul Sandeep , Huang Joseph , Rajendran Nirooshun 
Published: November 2022

Abstract

Aim
To present an analysis of the first 2-years’ experience of robotic-assisted colorectal procedures (RACP) using the DaVinci Xi platform.

Methods
This data were prospectively collected and include 72 RACP between February 2020 and December 2021.Indications were: malignancy in 74.3%, diverticular disease 10%, inflammatory bowel disease 8.6%, rectal prolapse 4.3%, intussusception 1.4% and recurrent volvulus 1.4%.

Results
Over the 13-month study period, 72 RACP were performed including elective 57 cases and 15 semi-elective cases. These comprised: 25 right hemicolectomies, 25 high anterior resections, 6 extended right hemicolectomies,4 low anterior resections, 4 subtotal colectomies 2 restorative proctectomies, 3 abdominoperineal excisions of the rectum, 3 rectopexies that were performed. 51.2% were female and 48.6% were male with a median age of 45 years (22–85 years) and the median body mass index was 31 (18–46) kg/m2. Preoperative American Society of Anaesthesiology scores were reported as 1–2 in 72.9% (n=51) of patients and 27.1%(n=19) as 3. The median length of stay was 5 days (1–35), with readmission rate within 30 days of 8.6% (n=6) that were resolved conservatively. The mean operating time was 268 minutes and the mean console operative time was 158 minutes, with only 3 (4.3%) reported cases of conversion to open. The incidence of postoperative complications was 24.3% (Clavien–Dindo (CD) I/II- 12.9%, CD III- 10%, and CD V-1 case with superimposed COVID 19 within 30 days.

Conclusion
RACP is a safe and viable modality in the treatment of colorectal conditions and can be introduced safely with appropriate guidance and proctorship.
TU5.9 Do Surgical In-patients prefer to use first names or titles when greeting and being greeted by Surgical Doctors?
Authors: Dunlop Lucia , Steele Kathryn , Minford Eunice 
Published: November 2022

Abstract

Aims
Using first names between staff and patients could potentially help in reducing medical paternalism and encourage a shift to an equal partnership relationship. A survey was performed to determine surgical patients preference for greeting and being greeted by Surgical Doctors.

Methods
100 surveys were distributed around three surgical wards over two time periods and collected anonymously.

Results
67 surveys were returned and analysed, 21 males, 45 females, 1 unspecified with age range 20 to &gt;80 years.
The majority of surgical in-patients prefer junior (85%) and senior doctors (87%) to greet them by their first names. Yet only 27% wished to greet Senior surgical doctors by their first name, compared to 57% for Juniors. In contrast 51% preferred to address seniors by title, but only 22% for juniors. Remaining patients preferred to address doctors by their full name or role only. 50% surveyed believed first names could improve patient-doctor relationships, making it easier to raise concerns but 12% felt tradition restricted them, with 27% believing it would devalue the medical profession.

Conclusions
Majority of surgical in-patients prefer to be addressed by their first name. However, many are reluctant to address Senior surgical doctors by their first name and are more comfortable doing so for juniors. Although half realise it could improve doctor-patient relationships and ease voicing concerns, some recognise that they are curtailed from doing so by tradition. The shift to equal partnership doctor-patient relationship may be curtailed by the persistence of power differential that occurs through using titles.
TU6.3 Limited geriatrician input is better than none: Geriatrician led team meetings improve understanding of frailty and medical management of older general surgical patients, meeting NELA standards of care
Authors: Hudson Murray , Luo Rong , Reese George , Koizia Louis , Fertleman Michael , Sritharan Ganan 
Published: November 2022

Abstract

Aims
General surgical teams are treating an increasing number of frail, older patients.1 Geriatrician involvement has shown improvement in length of stay.2
We sought to demonstrate that even with limited geriatrician involvement we could meet NELA targets of completing frailty scores, increasing frequency of geriatrician reviews and improving team education.

Methods
We introduced twice-weekly geriatrician-led team meetings followed by selected patient reviews to best optimise the care of older patients. Surgical trainees, nurses and allied health staff attended each meeting. The team was educated by the geriatrician about geriatric medicine and the importance of recognising frailty. They were also supported in performing independent frailty assessments.
We measured frequency of frailty score recorded and geriatrician involvement pre- and post-set up of this limited service. We also conducted semi structured interviews of staff pre- and post-intervention related to educational impact.

Results
94% (29/31) of patients aged over 65 had a clinical frailty score recorded post intervention compared to 9% (3/35) originally. All 31 had geriatrician involvement. Comments from the surgical team included: ‘pro-active approach to identifying frailty’, ‘early identification of barriers to discharging complex patients' and ‘improvement in understanding of geriatric giants’.

Conclusions
The Emergency Laparotomy and Frailty (ELF) study recognised that frailer individuals were vulnerable to adverse outcomes and longer hospital stays.3 Our limited geriatrician-led service supported surgical doctors and the MDT in understanding frailty and considering its impact. Within a short space of time we aligned with NELA recommendations, improved patient outcomes and improved MDT understanding of geriatric medicine.
TU6.8 An Audit of Day case surgery for cholecystectomy
Authors: Gulnaz Nadia , Akram Farhan , Dixon Michael , Siddique Khurram 
Published: November 2022

Abstract

Aims
To compare the trust-wide performance with the standard by the British Association of Day Surgery in the management of cholecystectomy

Methods
4 months of Electronic data of patients undergoing elective laparoscopic cholecystectomy in 2020 was analyzed. Those who had emergency cholecystectomy were excluded.

Results
112 of 145 total patients were female and 33 were male. The age range was 18–82 Around 65% of patients were sent home the same day. 51 Patients ended up being admitted. 33 of these were Pre-booked as inpatients' intent. 39% (13/33) had no specific reason for being booked as an inpatient. The rest Majority had medical issues quoted as the reason for booking.35% (18) of the 51 admitted patients were actually brought in as day-case lap-chole. 6 of these were admitted for perioperative surgical issues and 8 had no documented reason. The Mean length of stay was 2.56 days(0–13). Our Performance was noted to be 10% lower than the BADS standard.

Conclusion
Relatively more patients are being treated as inpatients than the recommended standard. About 1/4th of those who were inpatient had no specific/genuine grounds to be kept in. There is a need for improvement in pre and perioperative documentation to explain the reason for inpatient management. Development of inpatient surgery booking criteria and adherence to set criteria.
TU8.10 Should patients with a predicted NELA mortality of 5–10% be managed on ICU? An audit of the management of high-risk laparotomies as per NELA Guidelines
Authors: Banks Jessica , Macadam Robert 
Published: November 2022

Abstract

Aims
The National Emergency Laparotomy Audit (NELA) has been pivotal in improving the care of patients undergoing emergency laparotomy. One key recommendation is ‘high-risk’ patients are managed on ICU post-operatively. We aimed to identify if there was a difference in outcomes between ‘high-risk patients’ (predicated NELA mortality &gt;5%) managed on ICU or a surgical ward post-operatively.

Methods
We retrospectively analysed all patients registered to our hospitals NELA database from January 2019-September 2021, assessing if ‘high-risk’ patients were managed on ICU or general surgery wards post-operatively and the difference in outcomes between these two groups.

Results
249 patients were included (138 Female). Over 80% of ‘high-risk’ patients were admitted to a ICU bed over the three-year period, as per NELA guidelines. 46 high-risk patients were managed on the ward post-operatively. Although there was no difference in age between the two groups, those admitted to ICU had a significantly higher predicated NELA mortality and higher mortality rate.

Conclusions
NELA predicted mortality helps to guide which patients may need a higher level of post-operative care. However, this study indicates that for some patients with a predicted mortality of 5–10%, ward-based care may be appropriate. In the context of increasingly stretched ICU resources, we believe further research is needed to identify whether some patients with a NELA mortality over 5% would be appropriate for ward management.
WE1.4 Laser haemorrhoidoplasty (LHP) is an efficacious alternative to excisional treatment of haemorrhoidal disease: Results from a single centre retrospective study
Authors: Essiet Edidiong , Kalaskar Shrinivas , Wu Fiona , Atif Qurrat 
Published: November 2022

Abstract

Purpose
LASER haemorrhoidoplasty (LHP) is a novel procedure in the management of the symptomatic haemorrhoidal disease. LHP is a non-excisional procedure to treat haemorrhoids in which hemorrhoidal arterial flow feeding the hemorrhoidal plexus is abrupted by laser coagulation.

Methods
We conducted a retrospective review on 121 consecutive patients treated with LHP over 2018 to 2020 at a District General Hospital. A diode laser device is used to seal the terminal branches of the hemorrhoidal plexuses. Routine follow-up was at 12 weeks. Our aim was to investigate the efficacy and safety profile of LHP. Efficacy was associated with symptom resolution, the degree of patients’ perception of improvement, and the number of procedures required to treat recurrence. Safety was determined by more than one hospital follow-ups and complications necessitating treatment.

Results
Follow-up was achieved in 100 patients. 21 patients with incomplete data were excluded. The mean age was 45 years old. LHP was utilised in 2% of patients with grade I haemorrhoids, 24% with grade II, 67% with grade III and 7% with grade IV. At follow-up, 57% reported complete symptom resolution and 94% reported symptom improvement. Residual symptoms were observed in 29% of patients. Only 9% underwent a re-operation. 38% attended hospital for more than one outpatient visits and 5% of those required antibiotics to treat local infections.

Conclusion
LHP is a safe and efficacious non-excisional surgical alternative to the management of the haemorrhoidal disease. Our patients reported a high degree of symptom resolution and satisfaction.

Key words
haemorrhoids, benign anorectal conditions, bleeding, laser haemorrhoidoplasty
WE1.8 Is colon capsule effective at reducing the requirement for colonoscopy in symptomatic patients with a faecal immunochemical test (FIT) &lt;100? Do patients find this an acceptable investigation?
Authors: Lord Ian , Fajardo Winona , Owen Ruth , Durango Nichole , Basavaraju Krishna , Wells Antonia 
Published: November 2022

Abstract

Aim
To assess the effectiveness of colon capsule in reducing the need for colonoscopy and to review patient satisfaction for this investigation.

Method
Potentially suitable patients for colon capsule were identified from 2 week wait referrals and patients referred to colorectal clinic. Inclusion criteria for consideration were; FIT &lt;100, performance status 0–1 and aged 18–75. Data was collected for our first 20 patients for age, gender, FIT result, quality of the bowel preparation, pathology and the follow up outcome. Following completion of the investigation patients were invited to complete a feedback questionnaire.

Results
The median age of patients was 58 (IQR 50–64) with 12 (60%) female patients. The median FIT result was &lt;7 (IQR &lt;7 to 33). The bowel preparation was excellent to good for 18 (90%) patients. Colon capsule was able to avoid colonoscopy for 14 (70%) patients. 6 (30%) patients required flexible sigmoidoscopy to complete the investigation or assess identified pathology. 15 (75%) patients completed patient satisfaction questionnaires, with all patients reporting little to no pain and little to no embarrassment. 9 of 13 (69%) respondents would choose to have a colon capsule again if further investigation was required. Overall patient experience was positive with a median satisfaction score 8/10 (IQR 5–10) with 10 being very satisfied.

Conclusions
Our units initial experience supports the findings of other pilot studies, that the majority of symptomatic patients with a FIT &lt;100 do not require a colonoscopy following colon capsule. Patients appear to find this an acceptable method to investigate their symptoms.
WE1.9 The learning curve for stoma care; can it be shortened by Stoma CNS input at weekends or affected by day of surgery?
Authors: Shah Priya , Hill Michelle , McDonald Rosie , Miller Andrew 
Published: November 2022

Abstract

Aims
Length of hospital stay for colorectal patients can be prolonged by stoma training. This study explores the impact of 2 variables on time to stoma competency; day of the week that surgery is performed and whether stoma education was available at the weekends.

Methods
Retrospective review of a prospectively maintained stoma database identified all patients who had a GI tract stoma formed between 1st January and 31st December 2020. Demographics, operative details and time to stoma competence data was collated.

Results
158 patients had a stoma formed. Mean age was 59 years (range 13 – 94).

Conclusions
Time to stoma competence was shorter when stoma education was available at the weekends, despite similar numbers of reviews being provided. This suggests that length of hospital stay could be reduced for this cohort by providing stoma education 7 days a week. The day that surgery was performed did not have a clear impact on time to stoma competence.
WE2.4 Optimal timing of Laparoscopic Cholecystectomy for symptomatic gallstone disease: the importance of symptom duration
Authors: Dey Abhishek , Lal Nikhil , Otunla Afolarin , Singh Sandeep , Gilmour Jeffrey 
Published: November 2022

Abstract

Aims
This study aims to assess outcomes of laparoscopic cholecystectomy (LC) performed in patients presenting with acute cholecystitis or symptomatic gallstone disease within 7 days of onset of symptoms compared to 7 days of diagnosis.

Methods
A prospective case note analysis was conducted for all patients undergoing laparoscopic cholecystectomy in a tertiary center between February and April, 2018. Outcome measures were compared between 2 patient cohorts: A- those undergoing laparoscopic cholecystectomy within 7 days of diagnosis and B-within 7 days of onset of symptoms.

Results
86 patients met inclusion criteria. The mean duration between LC and diagnosis was 5 days, and 16 patients (18%) had surgery over a week after diagnosis. The mean duration between LC and symptom onset was 9 days, and 44 patients (51%) underwent LC over 7 days after symptom-onset.
There was a statistically significant reduction in the number of pre-operative ERCPs(p-0.08) and MRCPs(p&lt;0.01) in patients of group B compared to A. A similar decline was noted in surgery length(p&lt;0.01) and incidence of complicated gallbladder disease (characterised by adhesions, empyema, retrograde dissection, perforation, necrosis, pancreatitis) (p&lt;0.01) in the former group when measured against the latter. We further observed significantly better post-operative outcome in group A with reduced rates of complications(p&lt;0.01) (urinary retention, bile leak and hepatic artery pseudoaneurysm) and readmission(p-0.03).

Conclusions
This is the first study to demonstrate the advantages of using symptom onset to guide practice, and whilst higher power studies are needed to confirm our findings, could represent the beginning of an important shift.
WE2.8 Improving Management for Acute Cholecystitis and Biliary Pancreatitis – the ‘Hot Gallbladder Pathway’
Authors: Kam Cheuk Tung , Abdelsaid Kirolos , Jayasankar Balaji , Balasubramaniam Dinesh , Abdulaal Yasser 
Published: November 2022

Abstract

Aim
There is a wide variation between National Health Service (NHS) hospitals in the management of patients with acute cholecystitis and biliary pancreatitis. 20–33% of patients will make repeat visits to hospital with gallstone-related symptoms before any surgical intervention performed. We established a ‘Hot Gallbladder Pathway’ with the aim for improving outcome and decreasing complications of these patients. The aim of this quality improvement project was to assess if a district general hospital (DGH) could provide a safe and effective ‘hot gallbladder’ service with a clear pathway.

Method
Quality improvement methods were used to integrate the ‘hot gallbladder pathway’ to manage patients with acute calculous cholecystitis and biliary pancreatitis. A prospective observational study with strict inclusion/ exclusion criteria and secure online data was conducted during a 13-month period. The data were then compared against existing National Institute for Health and Clinical Excellence (NICE) guidelines and further changes were recommended.

Results
We achieved almost 70% of the patients undergoing emergency laparoscopic cholecystectomy in both group of patients who met the pathway criteria within the expected time frame, compared with the pre-implementation result of 23% and national average of only 16% in England. None of the patients suffered from intraoperative complications or 30-day mortality.

Conclusion
A clear ‘hot gall bladder pathway’ is effective at improving care for patients requiring emergency laparoscopic cholecystectomy and potentially useful for other acute Trusts which their standard is below the NICE guideline.
WE2.12 Prognostic Factors and Predictive Models in Hot Gallbladder Surgery. Results of a High-Volume Tertiary Centre
Authors: Shabana Amanda , Samra Benjamin , Chetwynd Alan , Nixon Michaela , Tebala Giovanni , Bond-Smith Giles ,   Oxford SEU Juniors
Published: November 2022

Abstract

Introduction
Gallstone disease is a significant worldwide problem constituting almost one third of emergency general surgery admissions. This study aimed identify the prognostic factors and create statistical models to predict the outcomes of having an emergency laparoscopic cholecystectomy (LC) during the acute symptomatic phase.

Methods
A prospective, cohort study was conducted on all patients that underwent a LC for a hot gallbladder between January 2019 to August 2020. Patients were divided on prognostic variables such as: age, comorbidities and time to operation. The primary outcome measured was suboptimal treatment, defined by: abandoned procedure, conversion to open and subtotal cholecystectomy. Secondary outcomes measured were biliary leak, postoperative morbidity, readmission rate, and length of postoperative stay.

Results
A total of 466 patients were included. A multivariate analysis using a backward stepwise linear regression was used to conduct predictive models based on the significant prognostic factors from a univariant analysis. Approximately 10% of patients had suboptimal treatment predicted by age (p&lt;0.0001) and low albumin (p=0.0034). 17.2% of patients had post-operative morbidity predicted by age (p=0.0201), admission day (p=0.0238), and male gender (p=0.0481). 20.8% of patients were re-admitted, predicted by an ASA &gt;3 (p=0.0096), thin-walled gallbladder (p=0.0491) and greater admission to operation time (p=0.0351). Post-operative length of stay was predicted by age (p=0.0048), low albumin (p=0.0048) and greater admission to operation time (p=0.0169).

Conclusion
Several predictive prognostic factors were found to be related to poor emergency LC outcomes which can be used to inform patients of risks pre-operatively and select patients suitable for a delayed cholecystectomy.
WE3.1 Compliance of Prescription of Intravenous Fluid Resuscitation in Surgical Patients According to NICE Guidelines
Authors: Morsy Hesham , Li Michael , Davidson Chris , Patel Dharti , Ali Maryam , Hollingshead James , Gu Kat 
Published: November 2022

Abstract

Aim
Assess compliance of prescription of for intravenous resuscitation fluids in accordance with NICE Guidelines in the acute surgical admissions population.

Method
We collected data prospectively for surgical patients admitted between 25/02/21–18/03/21 (first cycle) & 12/09/2021–4/10/2021 (2nd cycle). Maximum of 5 patients daily randomly selected. Data collected on wards after clerking on Day 1 of admission. Surgical Proforma was used to identify time of admission, presenting history and co-morbidities of patients. NEWS Charts used to identify observations of patients on admission. Drug charts used to assess volume and types of intravenous fluids prescribed. Admissions by audit authors were excluded to prevent selection bias.

Intervention
Posters in Emergency Assessment Unit and Wards, Teaching to junior doctors, Regular reminder messages to on-call teams.

Results
72 patients included in audit. Prescription of Intravenous resuscitation fluids in Acute Surgical Patients in compliance with NICE guidelines rose from 49% to 69% between cycle 1 and 2, respectively. Correct prescriptions in volume and type of fluid rose from 2% (cycle 1) to 44% (cycle 2).

Conclusions
Almost one third of acute admissions met the criteria for resuscitation IV fluids. In indicated patients, nearly one half of patients were correctly prescribed resuscitation fluids in accordance with guidelines.