bluuebunny/crossref_metadata_2025_split huggingface dataset:
OGBN P19 Tackling a post-COVID-19 cholecystectomy waiting list, are we meeting the challenge?
Authors: Hamid Mohammed , Mirtorabi Neginsadat , Ghumman Abdul , Khalid Ayesha , Noor Saleem , Kapoulas Spyridon , Singhal Rishi , Nijjar Rajwinder , Richardson Martin , Wiggins Tom 
Published: December 2022

Abstract

Background
The COVID-19 pandemic has led to a tremendous backlog in elective surgical activity, with over six million people on waiting lists and only 64% of patients meeting the 18-week elective standard. Our Hospital Trust adopted an innovative approach to dealing with elective waiting times for cholecystectomy during the recovery phase from COVID-19. This study aimed to evaluate trends in overall cholecystectomy activity and the effect on waiting times.

Methods
A prospective observational study was undertaken investigating patients who received a cholecystectomy at large UK hospital Trust, between February 2021 and February 2022. There were multiple phased strategies to tackle a 533 patient waiting list: private sector, multiple sites including emergency operating, mobile theatre, and seven-day working. An additional 364 patients were added and 145 removed, for multiple reasons, from the list during the study period. Correlation of determination (R2) and Kruskal-Wallis analysis were used to evaluate trends in waiting times across the study period.

Results
657 patients underwent a procedure, of which 628 (95.6%) were completed electively. The median age was 49 years, 602 (91.6%) patients had an ASA of 1–2, and 494 (75.2%) were female. Thirty (4.6%) patients were listed post gallstone pancreatitis, 380 (57.8%) for cholelithiasis, and 228 (34.7%) for cholecystitis. The median length of stay was zero days (IQR 0–1), with 30-day complication (C-D ≥3, 1.8%), readmission (3.0%) and mortality (0.0%) rates noted. The current waiting list includes 95 patients, with median waiting times reduced from 428 days (IQR 373–508) to 49 (IQR 34–96), R2=0.654, p&lt;0.001. For pancreatitis specifically, waiting times have dropped from a median of 218 days (IQR 139–239) to 28 (IQR 24–40), R2=0.613, p&lt;0.001.

Conclusions
We have safely and effectively tackled the cholecystectomy waiting list locally utilising a number of phased strategies. Significant progress is being made towards once again meeting the gold-standard target for gallstone pancreatitis patients. The approach utilised here has potential to be adapted to other units, or other operation types in order to reduce elective waiting times.We have safely and effectively tackled the cholecystectomy waiting list locally utilising a number of phased strategies. Significant progress is being made towards once again meeting the gold-standard target for gallstone pancreatitis patients. The approach utilised here has potential to be adapted to other units, or other operation types in order to reduce elective waiting times.
EGS P01 The diurnal and seasonal relationships of pedestrian injuries secondary to motor vehicles in young people
Authors: Akhtar Amina , Brooks A , O'Connor R 
Published: December 2022

Abstract

Background
There remains a significant morbidity and mortality in young pedestrians hit by motor vehicles, even in the era of pedestrian crossings and speed limits. The aim of this study was to compare incidence and injury severity of motor vehicle-related pedestrian trauma according to time of day and season in a young population, based on the supposition that injuries would be more prevalent during dusk and dawn and during autumn and winter.

Methods
Data was retrieved for patients between 10–25 years old from the national Trauma Audit and Research Network (TARN) database, who had been involved as pedestrians in motor vehicle accidents between 2015–2020. The incidence of injuries, their severity (using the Injury Severity Score [ISS]), hospital transfer time and mortality were analysed according to the hours of daylight, darkness and season.

Results
The study identified a seasonal pattern, showing that autumn was the predominant season and lead to 34.9% of injuries, with a further 25.4% in winter in comparison to spring and summer, with 21.4% and 18.3% of injuries respectively. However, visibility alone was not a sufficient factor as 49.5% of injuries occurred during time of darkness, while 50.5% occurred during daylight. Importantly, the greatest injury rate (number of injuries/hour) occurred between 1500–1630 correlating to school pick up times. A further significant relationship between injury severity score (ISS) and daylight was demonstrated (p-value= 0.0124) with moderate injuries (ISS 9–14) occurring most commonly during the day (72.7%) and more severe injuries (ISS&gt;15) occurred during the night (55.8%).

Conclusions
We have identified a relationship between time of day and the frequency and severity of pedestrian trauma in young people. In addition, particular time groupings correspond to the greatest injury rate, suggesting that reduced visibility coupled with school pick up times may play a significant role . This could be addressed through a targeted public health approach to implement change. We recommend targeted public health measures to improve road safety that focus on these times and that increase the visibility of children combined with education for drivers.
EGS P14 Can preoperative Neutrophil-lymphocyte ratio predict post-operative complications in appendicectomy?
Authors: Galbraith Norman , Khan Khurram , Gall Lewis , Macdonald Andrew 
Published: December 2022

Abstract

Background
Complications after appendicectomy remain common. Neutrophil-lymphocyte ratio (NLR) measures inflammation by incorporating the innate and adaptive components of the circulating immune system. We hypothesised that pre-operative NLR could predict post-operative complications after emergency appendicectomy.

Methods
A multicentre retrospective observational study was performed investigating all adults undergoing emergency appendicectomy across four hospital (2 teaching centres and 2 district general hospitals) between August 2018 and November 2020. Patients were identified through pathology records. Electronic records were studied for patient demographics, pre-operative routine laboratory tests, imaging, operative details, and post-operative complications. Neutrophil-lymphocyte ratio was calculated by dividing the pre-operative neutrophil count value by the lymphocyte value. A threshold of 8 was used based on previous literature.

Results
There were 1130 patients identified who underwent emergency appendicectomy, with 43.6% female. ASA level was I or II in 93.8% of patients, and 82.3% underwent a laparoscopic approach. Perforated appendicitis was observed in 21.7% of patients and two patients died. Mean NLR was 10.3 (SD 8.2), with 50.9% of patients with an NLR of &gt;8. NLR &gt;8 was associated with deep surgical site infections (SSI) (p &lt; 0.001). NLR &gt; 8 was predictive of deep SSI with an odds ratio of 3.455 (CI 1.840–6.488, p &lt; 0.001).

Conclusions
The NLR is an easy to calculate parameter which, when higher than 8, predicts deep surgical site infection following emergency appendicectomy and may help guide perioperative decision making such as antibiotic duration.
EGS P16 Management of Acute Gallstone disease at an urban acute Trust during the pandemic
Authors: Sharif Mohammad , Osilli Dixon , Darren Patten , Amalesh Thangadorai , Di Maggio Francesco , Mukherjee Samrat , Mukherjee Dipankar 
Published: December 2022

Abstract

Background
Acute gallstone disease is a surgical emergency. Management has evolved over the years with emphasis on early surgery to improve outcomes. However, due to resource limitations, cholecystectomy is often delayed leading to repeated admissions, interval complications and increased costs.
Despite several nationwide initiatives to implement acute cholecystectomy pathways, the SWORD (Surgical Workload Outcomes Audit Data Tool) quality improvement project reports emergency Cholecystectomy rates for gallstone disease as low as 1.2% to 36.5% in NHS acute hospital trusts between 2012 and 2017.
We analysed the current situation at Barking, Havering and Redbridge NHS Trust serving a population of 750,000 during the pandemic.

Methods
Patients presenting with acute gallstone disease (acute cholecystitis, biliary colic, and gallstone pancreatitis) between September and December 2021 were retrospectively audited. We measured re-admission rates, number of emergency and elective cholecystectomies performed, post-operative complications and interval between operation and initial admission.

Results
240 patients were admitted with acute gallstone disease during the audit period. 133 (55%) patients were admitted with acute cholecystitis, 77 (32%) for biliary colic and 30 (13%) with gallstone pancreatitis. 91 (35%) were re-admissions while waiting surgical management. 110 (46%) patients had a definitive management, either during or following their initial admission.
At 3 months following end of audit period, 49 (44.5%) patients underwent cholecystectomy, of which only 10 (20%) were performed acutely. However, 70% of acute operations were performed during re-admissions. The average time between admission and operation was 63.57 days for new presentations, compared to 49.89 days for re-admissions. 47 of the 240 patients re-presented to hospital with symptoms before their operation during the study period: 11 (23%) with biliary colic, 29 (62%) with acute cholecystitis and 7 (15%) patients with acute gallstone pancreatitis.
From the main cohort of 240, 31 (13%) patients were either not deemed fit for surgery or lost to follow-up) while 99 (41%) patients were still awaiting decision about definitive management.

Conclusions
Provision of emergency cholecystectomies does not comply with national guidelines. Frequent re-admissions worsen patients’ experience. Cholecystectomies took place in very few patients at index admission during pandemic. More financial and cultural resources need to be allocated nationwide to surgically face the gallstone epidemic.
EGS P31 A Rare Case of Jejunal Obstruction Secondary to Necrotic Peripancreatic Abscess (CASE REPORT)
Authors: Likoscorbett Marina , Kudchadkar Shantata , Mathema Sina , Egboka Ejike Aloysius , Ayathamattam Joseph , Harris Guy 
Published: December 2022

Abstract

Background
Acute pancreatitis is one of the major causes for emergency hospital admissions worldwide. Bowel obstruction following acute pancreatitis usually occur as a result of retroperitoneal inflammation and mesenteric infiltration in the inflammation; especially at duodenum, transverse colon and splenic flexure due to the proximity to pancreas. We hereby, present a rare case of jejunal obstruction secondary to sterile necrotic peripancreatic abscess. Through this case report, we aim to emphasize increased awareness required among general surgeons and the need for appropriate clinical judgement in the management of bowel obstruction - medical versus surgical intervention.

Methods
Case Report: A 65-year-old lady presented in emergency with an acute 10-hour history of epigastric pain with nausea. She drank no alcohol, was otherwise well and had no other significant co-morbidities. On examination, she was tender in the epigastrium with no signs of peritonitis. She had raised serum amylase diagnostic of acute pancreatitis. All other blood investigations and an ultrasound abdomen was unremarkable. The cause of pancreatitis was unclear. She was admitted and treated in a conventional fashion.
Over next 2 days, the patient's C-reactive protein increased and she became hypotensive warranting HDU care. Computed Tomography of abdomen and pelvis (CTAP) confirmed acute pancreatitis with no associated complications. She made slow progress. A Nasojejunal tube was inserted for nutritional support. Over the next five days, she had abdominal distention with absolute constipation and was treated for ileus. Further CT imaging suggested partial small bowel obstruction. Clinical condition failed to progress despite 48 hours of conservative management and decision was taken for a diagnostic laparoscopy.

Results
Intra-operatively, multiple small bowel loops were found densely adherent to the inferior border of pancreas, each with a clear evidence of upstream bowel dilatation. The cause was a peripancreatic necrotic abscess cavity. Laparoscopic division of adhesions allowed access to the cavity. A washout was performed and a drain inserted. Post-operatively, she had an uneventful recovery. She was gradually built on enteral nutrition and her bowels started working normally. She was discharged on post-op day 5 and drain removed as an outpatient. She had no complications at 60-day follow-up.

Conclusions
Bowel complications of acute pancreatitis (paralytic ileus, mechanical obstruction, bowel ischaemia and perforation) are relatively infrequent, with few cases reported in literature. Prediction of disease severeity is crucial to guide the treatment plan. In majority of cases, abdominal distention and absolute constipation is usually ileus and managed conservatively. Care should be taken in unsettling patients and diagnostic laparoscopy should be undertaken to evaluate the cause and manage accordingly.
HPB P03 Oncological outcomes are comparable between octogenarians and younger patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma
Authors: Pande Rupaly , Attard Joseph , Al-Sarireh Bilal , Bhogal Ricky , Farrugia Alexia , Fusai Giuseppe , Harper Simon , Hidalgo-Salinas Camila , Jah Asif , Marangoni Gabriele , Mortimer Matthew , Pizanias Michail , Prachialias Andreas , Roberts Keith , Hee Chloe Sew , Soggiu Fiammetta , Srinivasan Parthi , Chatzizacharias Nikolaos A 
Published: December 2022

Abstract

Background
Oncological outcomes are comparable between octogenarians and younger patients after pancreatoduodenectomy for pancreatic ductal adenocarcinoma

Methods
A multicentre case-control study of octogenarians matched on complexity of surgery with consecutive younger controls who underwent PD for PDAC (2008–2017).

Results
Some 220 patients were included, 110 octogenarians (age 81 (80–83)) and 110 controls (age 69 (62–74)). Charlson Comorbidity Index score was higher in octogenarians than controls (7 (6–8) vs 5 (4–6)), p&lt;0.0001) but Eastern Cooperative Oncology Group performance status (Groups 0–1: 99 vs 98; 2–3: 5 vs 4, p=0.756) and ASA (ASA 1–2: 72 vs 77; 3–4: 20 vs 18; p=0.635) were comparable. Adjuvant therapy was delivered more commonly in the younger cohort (76.2 vs 58.0%, p= 0.007). Tumour stage, lymph node ratio and resection margin status were comparable between groups. There was no difference between octogenarians and controls in OS (20 (14–26) vs 29, (24–24) months p=0.095) or DFS (19,(13–24) vs 22,(15–29) months p=0.742). On multivariate analysis, age was not a risk predictor.

Conclusions
In selected fit octogenarians, equivalent survival is achievable. Centralisation and multimodal therapy are key. Pre-operative risk stratification using at ECOG and albumin level can be used to identify an appropriate population.
HPB P09 Forgotten ERCP Stents: Is a National Registry Required
Authors: Clements Caterina , Bezzaa Sabrina , Curwen Oliver , Kersey James , Nehra Dhiren , Jamal Karim , Lewis Trystan 
Published: December 2022

Abstract

Background
Pre-operative endoscopic retrograde cholangiopancreatography (ERCP), stone removal and interval cholecystectomy is the widely practiced management for choledocholithiasis with concomitant gallstones.
Biliary stenting is performed with plastic or metallic stents which require removal after 3–6 months.
The sequelae from the forgotten biliary stent following laparoscopic cholecystectomy, stent occlusion, migration or cholangitis, carry significant morbidity and cost implications.

Methods
Pre-operative endoscopic retrograde cholangiopancreatography (ERCP), stone removal and interval cholecystectomy is the widely practiced management for choledocholithiasis with concomitant gallstones.
Biliary stenting is performed with plastic or metallic stents which require removal after 3–6 months.
The sequelae from the forgotten biliary stent following laparoscopic cholecystectomy, stent occlusion, migration or cholangitis, carry significant morbidity and cost implications.

Results
308 laparoscopic cholecystectomies were performed in the study period. 25 (8%) underwent pre-operative biliary stenting, of these 16 underwent successful stent removal.
7 patients are still awaiting removal and 2 were discharged without stent removal and lost to follow up. One of these required emergency admission and removal of the stent at a tertiary centre due to stent complication.
The average time from biliary stenting with ERCP to cholecystectomy was 99 days. The average time from cholecystectomy to removal of biliary stents was 113 days. The average length of time from insertion of biliary stent to removal was 195 days.

Conclusions
Where common bile duct exploration at the time of cholecystectomy is not possible we recommend ERCP units provide a stent registry system with a deadline for biliary stents in the registry system for each patient.
HPB P32 Cancellations of elective theatre on the scheduled day of surgery at a tertiary referral hospital
Authors: Nessa Ashrafun , Pawloy Karola , Ganeshamoorthy Kajenthiny , Tan Jiaying , Weston Oliver , Maclean Duncan , Ghazanfar Mudassar , Radhakrishnan Ganesh 
Published: December 2022

Abstract

Background
Cancellations of elective theatre has negative impact on patients, hospital staff and training of surgical trainees. It reduces the efficiency of theatre and causes significant financial loss for the health care system. The cancellation rate in the developed country ranged from 2 to 40%.The objective of current study was to report the rates and reasons for elective theatre cancellation.

Methods
The data of cancelled cases were collected by Department of eHealth. The report was used to identify the cancelled cases and further demographic details and waiting time and outcome were collected and simple descriptive and basic analysis was done.

Results
121 cases were cancelled over 9.5 months from 1/12/2020–16/09/2021. The incidence rate of cancellation is ---. 2 most common cancelled cases were Lap chole (27.3%, n=33) and EUA rectum (8.3%, n=10). 24% (n=20) of the cancelled cases were cancer. Commonest reason for cancellation were unavailability of bed 39% (n=47) and not enough time 32% (n=39). 82%(n=100) reasons for cancellation were deemed avoidable. 7% patients had cancellation twice. The mean waiting time since cancellation to surgery was 52 days, median 35 days. 5% patients were admitted to hospital while awaiting surgery. 3% had passed away while waiting.

Conclusions
This study identified the most common reasons for theatre cancellation at a tertiary hospital in Scotland which include unavailability of beds and not enough time. Improved theatre efficiency and booking schedule can help alleviate cancellation. Identification of the Potential avoidable causes can help conform interventions and formulate further research, influence national policies.
HPB P43 Stereotactic ablative radiotherapy is a safe and feasible option for non-surgical candidates with colorectal liver metastases
Authors: Barrie Jenifer , Taylor Sarah , Barwell Lynsey , Cameron Iain 
Published: December 2022

Abstract

Background
Stereotactic ablative radiotherapy (SABR) has been associated with an improvement in over-all survival in patients with oligometastatic colorectal cancer with a controlled primary tumour and one to five oligometastatic lesions. We report our centre's experience of SABR as an alternative local therapy for non-surgical candidates with colorectal liver metastases.

Methods
All patients were identified who received SABR irradiation for colorectal liver metastases in a tertiary HPB centre between June 2016 and February 2022. SABR criteria included patients with 1–3 liver metastasis with maximum tumour diameter &lt; 6 cm, liver confined disease and a suitable performance status with pre-treatment Child-Pugh status A. A retrospective review of the patient's scans, letters and MDT outcomes was performed to analyse the pathology, indications and outcomes.

Results
18 patients with oligometastatic colorectal cancer received SABR to metastases in the liver over the study period. Five were female and 13 were male. Median age was 71. Performance status was 1 in the majority of cases (10/18). Only 2 patients had synchronous disease. 4 patients had concomitant metastatic disease to the lung and all 4 had had a lung resection. Half of the patients had a previous liver resection with 2 of these having two previous liver resections and 1 having 3 liver resections. 4/18 patients underwent SABR because they were deemed unfit for surgery, 6/18 were for anatomical indications with risk of an R1 resection and one was down to patient choice. Metastases were of median size 30 mm (9–87 mm). 89% (16/18) patients had a single metastasis, 1 patient had 2 metastases and 1 patient had 3 metastases.
Overall survival was 19 months (4–60 months). 3 patients achieved complete resolution of disease and 4 patients had partial resolution. 6 patients were deemed to have stable disease and 4 patients had disease progression. Outcome data was not available in 1 patient. Only 2/18 pa

Conclusions
We observed that SABR is feasible, well tolerated and effective in this cohort of patients. Longer-term follow up data is required to assess a survival benefit.
HPB P49 Vein wall invasion is a more reliable predictor of oncological outcomes than vein related surgical margins after pancreaticoduodenectomy for early stages of pancreatic ductal adenocarcinoma
Authors: Ahuja Manish , Pande Rupaly , Raza Syed Soulat , Bartlett David C , Dasari Bobby , Marudanayagam Ravi , Mirza Darius , Roberts Keith John , Issac John , Sutcliffe Robert P , Chatzizacharias Nikolaos A 
Published: December 2022

Abstract

Background
Pancreaticoduodenectomy (PD) with vein resection is the only potentially curative option for patients with pancreatic ductal adenocarcinoma (PDAC) with venous involvement. The aim of our study was to assess the oncological prognostic significance of the different variables of venous involvement in patients undergoing PD for resectable and borderline resectable with venous only involvement (BR-V) PDAC.

Methods
Retrospective analysis of prospectively maintained PD database from 2011–2020 was performed. Standard descriptive statistical analysis; statistical comparisons with the use of the appropriate test; survival analysis with the Kaplan-Meier method and log rank test for overall survival (OS), disease-free survival (DFS) and local recurrence (LR); risk analysis for separate surgicalmargins with univariable and multivariable Cox proportional hazard model were used.

Results
One hundred and five of 372 patients (28%) required vein resection and vein wall involvement was identified in 37% of those. More vein resections were performed in female patients and as expected for BR-V disease.
OS, DFS and LR were significantly longer after R0 resection, irrespective of the need for a venous resection. Following analysis of separate surgical margins, the vein groove and the vein transection margins (the latter only applicable in patients that had a venous resection) were not identified as predictors of oncological outcomes. On the contrary, vein wall invasion was an independent predictor of OS (HR:1.947, CI: 1.228–3.089, p=0.005), DFS (HR: 2.169, CI: 1.306–3.602, p=0.003) and LR (HR: 2.365, CI: 1.089–5.133, p=0.030) after PD with venous resection.

Conclusions
Vein wall tumour invasion may be a more reliable predictor of oncological outcomes compared to traditionally reported parameters. Future studies should focus on possible pre-operative investigations that could identify these cases and management pathways that could yield survival benefit, such as the use of neoadjuvant treatments.