bluuebunny/crossref_metadata_2025_split huggingface dataset:
407 Surgical Site Infection of Renal Transplant Patients Stratified by BMI
Authors: Berjaoui N , Haq I , Hunter J , Roy D , Imray C , O'Callaghan J 
Published: November 2022

Abstract

Aim
Surgical site infection increases with BMI with values ranging from 20% to greater than 40%. There are increasing numbers of obese patients (BMI &gt;30) undergoing transplants and this audit aims to review the incidence and grade of surgical site infection (SSI) of renal transplant recipients stratified by BMI.

Method
65 renal transplants were performed between April 2020-March 2021 with 58 kidneys from deceased donors and 7 kidneys from live donors. A retrospective review of clinical attendances, GP letters, prescriptions, imaging, and re-admissions was completed. Nearly one-third of the patients had pre-transplant diabetes (32%), and their median BMI was 28 (range 19–40.7). The incidence of SSI was reported after 3 months follow up and graded using the Clavien-Dindo Classification.

Results
The overall rate of SSI was 15%. SSI was 12.8% in patients with BMI&lt;30, 15.8% in BMI 30–34.9, 33.3% in BMI 35–35.9, and 0 in BMI&gt;40 (only one recipient). There was no significant correlation between diabetes and SSI, with 19% of SSI reported in diabetic patients versus 14% in patients without diabetes (p-value=0.7). Two patients had a Clavien-Dindo grade I infection, 1 grade II, and 7 Grade III, with no grade IV or V SSI. No patients required operative management of SSI.

Conclusions
The overall rates of SSI stratified by BMI were within expected limits. Diabetes was not an independent predictor of SSI. No complication required general anesthesia or surgical treatment. When SSI did occur in obese patients it did cause considerable morbidity through number of attendances for dressing changes over 3 months.
668 Introduction of a Pre-Operative Assessment Clinic for Elective Procedures in a Renal Replacement Therapy Unit - Analysis of Effect on Cancellation of Procedures
Authors: Waldram R , Ho GC , Premakumar Y , Gabor C , Richards C , Kumar A , Colemeadow J , Kunduzi B , Clark K , Oddy J , Sran K , Barnett N 
Published: November 2022

Abstract

Aim
In September 2020, our Renal and Transplant unit introduced a new formalised protocol for Pre-Operative Assessment Clinics (POACs), led by SHO-grade junior doctors. This study aims to investigate the efficacy of the new protocol.

Method
All elective operations including dialysis access procedures, transplant urology, parathyroidectomies and hernia repairs conducted by a single renal replacement therapy unit were examined over an 18-month period prior to POAC implementation, then a 12-month period following implementation. Living donor transplants and nephrectomies were excluded.
On-the day (OTD) cancellation causes were analysed and categorised into:

Results
Total cases performed:
Pre-implementation = 921, post-implementation = 415.
OTD cancellations:
Pre-implementation - total of 211/921 (22.9%). 90 (9.8%) were due to predictable patient factors, 54 (5.9%) for unpredictable patient factors and 67 (7.2%) for hospital factors.
Post-implementation - total of 58/415 (11.6%). 32 (7.7%) for unpredictable patient factors and 12 (2.9%) for hospital factors. Four (1%) were cancelled for predictable patient factors, two due to patients presenting with hypertension.

Conclusions
Patients with renal failure have multiple co-morbidities. Optimising pre-operative care is crucial to ensure they receive timely treatment. This audit has demonstrated that a redesigned POAC led to a reduction of OTD cancellation rates from 22.9% to 11.6%, with a marked reduction in predictable causes for cancellations. Further improvements and re-audit are planned.
945 Are Extended Criteria Donor Kidneys from 70 years-old and above Good Enough to Accept? A Single Centre Experience
Authors: Khudr J , Sharma H , Ridgway D , Hammad A , Elmghrbee A 
Published: November 2022

Abstract

Aim
As a result of increasing demand in recent years in organ donation and transplantation, the transplant community has been utilizing organs previously considered unsuitable for transplantation, including organs from extended criteria donors (ECD) and donors after circulatory arrest (DCD). This has led to higher rates of non-functioning and poorer outcomes, increasing the uncertainty when to accept or decline a donor organ. Our objective is to measure patient and graft outcomes of kidney transplants from ECDs aged 70 years and older.

Method
A retrospective study of 104 renal transplanted patients from ECDs between April 2010 and March 2014. Recipients referred to other centres were excluded from the study. Follow-up period was 7 years.

Results
At 7 years follow up, graft survival among recipients from ECDs older were 42.5%(n=17/40) while from ECDs younger were 58% (n=37/64) (P = 0.1594). Death censored graft survival (patient died with functioning graft). ECDs older death censored graft survival was 80% (n=32/40) and 82.8% (n=53/64) for ECDs younger (P = 0.7963).

Patient survival
70.3% of recipients from ECDs younger and 60% of recipients from ECDs older were alive at seven years post-transplant. (P = 0.2945).

Conclusions
There was no significant difference between the two cohorts in graft and patient survival. The use of kidneys from donors aged ≥70 years has yielded generally satisfactory results when compared to younger ECDs 50–69 years old donors.
103 Investigating Whether Coronal Alignment Changes at the Knee Joint After Medial Opening Wedge High Tibial Osteotomy Influences the Coronal Alignment Changes at the Hip Joint
Authors: Patel J , Patel R , Melton J 
Published: November 2022

Abstract

Aim
High tibial osteotomy (HTO) is used as an effective treatment for varus knee osteoarthritis (OA). However, the biomechanical relationship between the hip and knee is important. An observation was made by the senior author of this paper that patients reported a change in their hip function after a medial opening wedge high tibial osteotomy (MOWHTO). The effect of a MOWHTO on the hip joint has not been well documented. Therefore, we analysed coronal alignment changes at the hip after MOWHTO.

Method
We retrospectively analysed lower limbs imaging of patients who underwent MOWHTO for varus OA. Pre-operative and follow up standing bilateral full leg length anteroposterior radiographs were taken. The medial proximal tibial angle (MPTA) and mechanical axis deviation (MAD) were measured to assess the coronal alignment of the knee. The coronal alignment of the hip was evaluated using the mechanical greater trochanter angle (MGTA).

Results
After exclusion criteria were applied 31 osteotomies in 29 patients were included in this study. A positive correlation between the changes in MPTA and MAD with MGTA were found. The change in the MGTA had a stronger correlation with the MAD than with the change in MPTA (r = 0.749 vs 0.589). It was found that age, weight, height, and BMI had little influence on these correlations.

Conclusions
Increased correction by the MOWHTO lead to increased change in the MGTA at the hip. These changes are likely to result in an alteration in the weight bearing portion of the femoral head and the function of the abductors.
124 Nightstick Fractures: To Fix or Not to Fix?
Authors: Easwaran A , Easwaran P 
Published: November 2022

Abstract

Background
A nightstick fracture is an isolated fracture of the ulnar shaft. Non-operative treatment is preferred for simple, non-displaced fractures (&lt;5mm displaced or &lt;50% translation). However, these fractures are associated with a high non-union risk, hence there is a clinician bias towards internal fixation.

Aim
To review outcomes of treatment of non-displaced nightstick fractures in our unit

Methods:
Between 2015 and 2020 we identified 90 appropriate patients. 67 patients were treated non-operatively; 23 had surgery. Outcome measures included radiological healing, functional recovery, and complications.

Results
The mean healing time was similar between the two groups (10 weeks in the non-operative group; 9 weeks in the operative group). The complication rate was similar (26.9% in the non-operative group; 26.1% in the operative group).
Following presentation of our findings, we re-audited our nightstick fracture management. Between 2020 and 2021, we identified 19 patients. 16 were treated non-operatively; 3 patients had surgery. This translated to an increase in the proportion of patients managed non-operatively from 74% to 84%.

Conclusions
With a simple presentation on the outcomes following operative versus non-operative management, we increased the proportion of patients not having surgery. Of the 12 patients who experienced non-union, 6 opted for surgery later, of which only 1 patient had persistent non-union. Offering surgery at the 6-week review if needed provides patients with more time, without adversely affecting their functional outcome. This study advocates the use of non-operative management for non-displaced nightstick fractures initially. The 6-week review could be used to discuss any change in management.
893 Predictors for Infection Severity in Open Tibial Fractures
Authors: Zhang J , Lu V , Zhou A , Thahir A , Krkovic M 
Published: November 2022

Abstract

Aim
Open tibial fractures can be difficult to manage - many factors could affect treatment and outcome, including being complicated by infection. We present a cohort of 244 patients and analyse which factors are significantly associated with infection outcome.

Method
Open tibia fractures treated at a major trauma centre between 2015–2021 were included.
Infection status was categorized into no infection, superficial infection, osteomyelitis. Data collected were Age, mode of injury, polytrauma, fibula status, Gustilo-Anderson (GA) classification, wound contamination, time to first procedure. time to definitive plastics procedure, time to definitive fixation, type of definitive fixation, smoking/diabetic status, and BMI.
Multicollinearity was calculated, with highly correlated factors removed. Multinomial logistic regression was performed. Chi-Squared test, with Post-Hoc Bonferroni correction was performed for complex categorical factors.

Results
244 patients were included. Polytrauma and fibula status, and type of definitive fixation were excluded from the multivariate model due to strong multicollinearity. Compared to non-infected outcome, patients with superficial infection had higher BMI (p&lt;0.01), higher GA grade (p&lt;0.01), and osteomyelitis patients had longer time to definitive fixation (p=0.049) and longer time to definitive plastics procedure (p=0.013), higher GA grade, and wound contamination.
Post-hoc analysis showed “no infection” was positively associated with GA-I (p=0.029) and GA-II (p&lt;0.01), and negatively associated with GA-IIIC (p&lt;0.01). Osteomyelitis was positively associated with GA-IIIc (p&lt;0.01)

Conclusions
This study investigated associations between injury and presentation factors that may have been associated with infection. We suggest clinicians should give extra consideration to the factors highlighted during management and take preventative measures to mitigate the infection risk.
1017 Early Mobilisation After Stable Distal Radius Fracture – an Audit of BOAST Guideline Adherence
Authors: Stewart RJ , Abdelghafour K , Abdelhakim-Edres K , Sokota S , Narang K , Ray A 
Published: November 2022

Abstract

Aim
Distal radius (DR) fractures are among the commonest fractures seen by orthopaedics. The management of these fractures is dependent on the stability of the fracture, and conservative management is usually favoured for stable fractures. Mobilisation of the wrist following this stable fracture is necessary to avoid the risks of wrist stiffness, complex regional pain syndrome and limitation of function. According to BOAST guidelines for management of DR fractures: patients with a stable fracture should be considered for early mobilisation with a removable support once pain allows. The aim of this study was to determine our unit's adherence to guidelines and review the period of immobilisation of stable DR fractures.

Method
Retrospective analysis of virtual fracture clinic referrals, ED and clinic notes, imaging and any further correspondence of patients referred to our orthopaedic team between 1/2/20–30/7/20 with isolated DR fracture.

Results
Of 163 patients referred with DR fracture, 49.7% were deemed to have a stable fracture. Of these patients, only 37% were mobilised early, with the remainder fully immobilised for 6 weeks without active mobilisation protocol.

Conclusions
A large proportion of patients with stable fractures are not being managed in accordance with BOAST guidelines, therefore a standardised intervention is needed to ensure patients regain maximum possible function. We propose that a new protocol is put in place to screen all DR fractures within our virtual fracture clinic into stable v. unstable pattern and if deemed stable to ensure patient is seen for early physiotherapy face to face or virtually.
254 Driving Improvement for Testicular Cancer Patients within a Urology Unit at a District General Hospital
Authors: Hayes J , Nayak A , Pullar B , Vasdev N 
Published: November 2022

Abstract

Aim
Assess the proportion of patients undergoing: (1) Preoperative assessment of the testicle, including serum tumour markers (STM) and testicular ultrasound (US), (2) Orchidectomy within 3 weeks of US diagnosis, and (3) Radiological staging (CT) within 3 weeks of surgery.

Method
Patients who had a radical inguinal orchidectomy for probable testicular malignancy were identified, between January and October 2021, via the electronic theatre system. Clinical data, including blood results, imaging, and histopathology, were obtained via the ICE reporting system.

Results
21 patients underwent orchidectomy during the 10-month period. The median age was 37 (26–89) with the majority (81%) presenting with a painless testicular lump. On final histopathology, 11 (52.3%) demonstrated classical seminoma and 6 (28.6%) a mixed germ cell tumour. Testicular US was performed on all patients prior to surgery and 95.2% had the full complement of STM taken. Unfortunately, the Lactate Dehydrogenase (LDH) in 65% of these patients had haemolysed. The mean time from US diagnosis to orchidectomy was 20.1 days (4–29), with 66.6% of patients operated on within 3 weeks. A staging CT was performed on 84.6% of patients within 3 weeks of surgery.

Conclusions
Delays from testicular cancer diagnosis to surgery can impact on both disease stage and ultimately outcome. Following local presentation of our results, whilst liaising with biochemistry, various factors have been addressed to help mitigate the risk of STM sample haemolysis (including sample drawing, transport, and processing). In addition, a more formal pathway has since been instigated to ensure patients are undergoing orchidectomy in a timely fashion.
582 Transperineal Prostate Biopsies: Complication Rates and Predictors of Significant Malignancy
Authors: Maikovsky Z , Gan C 
Published: November 2022

Abstract

Aim
To ascertain the risks of undergoing a transperineal biopsy. To investigate the relationship between assessment tools and biopsy result.

Method
100 consecutive patients who received a transperineal biopsy between January and June 2021 in Lister Hospital completed a questionnaire. Their investigation results were recorded, and data analysed.

Results
Complication rates revealed 10% sustained heavy bleeding, 2% went into urinary retention, and 2% were treated with antibiotics for suspected urinary tract infection.
Erectile dysfunction was not included on the questionnaire, however 4% raised this as a concern.
Average number of cores appeared to be higher in those with complications compared to the whole sample.
Pain score generally decreased with age, over 75s averaged 3.9/10 whilst under 65s averaged as 5.4/10.
High PSA density and high PIRADS scores are well correlated with risk of positive biopsy
PIRADS 2 was an exception to this trend, showing 14% had Gleason &gt;6 compared with 9% in PIRADS 3. Not all PIRADS 2 patients will routinely receive a biopsy and therefore this could be down to preselection bias.
All Gleason &gt;6 cases in PIRADS 2 and PIRADS 3 had PSA density &gt;0.15.

Conclusions
Overall complication rate is low with no readmissions. The procedure is tolerated reasonably well and 85% would be willing to have the procedure again. Possible correlation between number of cores and complications. High PSA density and high PIRADS scores are well correlated with risk of positive biopsy. PIRADS 3 with low PSA density have a low proportion of positive biopsy.
658 The Use of AlliumTM Stents in the Management of Ureteric Strictures
Authors: Skinner H , Please H , Young M , Khan A , Burbidge S , Biyani CS 
Published: November 2022

Abstract

Aim
Stents are widely used in the management of ureteric strictures but require changes every 6–12 months and stent related symptoms are commonly reported. AlliumTM ureteric stents are large calibre, metallic stents that aim to reduce the incidence of stent-related complications, with an indwelling time up to three years. These were introduced within our local hospital trust for patients requiring frequent stent changes and this study aims to review the early use of AlliumTM stents and associated complications.

Method
An electronic database of patients was searched for records including the words “Allium stent” between 01/01/17–01/01/21. The resulting patient electronic records were then interrogated to extract data.

Results
13 patients were included in data analysis. Mean age was 62.7 years and male:female ratio was 6:7. 5 underwent antegrade insertion and 8 retrograde. 3 were inserted under local anaesthetic and 10 under general. Median follow-up time was 459 days.
No cases of renal deterioration were noted, and no patients sought medical attention with pain or irritative symptoms. The majority remained in situ, however one patient reported spontaneous passage of the stent; and one patient later required a nephrectomy, necessitating stent removal. Three patients developed post-operative urinary tract infections (two requiring hospital admission); two patients required further intervention for urolithiasis causing stent blockage; and two patients died from other disease processes prior to analysis.

Conclusions
There are clear advantages in reducing repeated admission and anaesthesia for patients. Initial results demonstrate good patency and tolerability of AlliumTM stents though further investigation is required to analyse the long-term benefits.
895 Ensuring Quality Standard in the Introduction of a New Prostate Biopsy Service
Authors: Ong A , Chedgy E 
Published: November 2022

Abstract

Aim
With the introduction of a fusion-guided prostate biopsy service at a university hospital, it was important to ensure that quality standards were being maintained. Cancer detection rates (CDR) of fusion-guided prostate biopsy were compared against the established precision point prostate biopsy service in the quality improvement project.

Method
Data was collected from patients undergoing precision point prostate biopsy between April - December 2020 to identify the quality standard. Data was collected for patients undergoing fusion-guided prostate biopsy at University Hospital Southampton between May - September 2021. Clinically significant cancer was defined according to Epstein criteria.

Results
The study included 514 precision point and 25 fusion-guided biopsies. 202 prostate cancers were identified from precision point biopsies setting a quality standard cancer detection rate of 39%, of which 88.6% were clinically significant. Fusion-guided biopsy detected 17 cancers giving a CDR of 68%, of which 32% were clinically significant.

Conclusions
This study demonstrated that fusion-guided prostate biopsy has a high cancer detection rate. However, more cancers were detected at earlier stages when compared with previous precision point biopsy. Further study is required to assess the long-term effects this will have on the cancer service.
979 Emphysematous Pyelonephritis in a Diabetic Patient with Horseshoe Kidney: Case Study and Literature Review
Authors: Mian A , Khan S 
Published: November 2022

Abstract
We present to you the case of a 54-year-old female with a background of horseshoe kidney presenting with a fever, right-sided flank pain, and raised inflammatory markers. This presentation was on a background of recurrent urinary tract infections which were managed conservatively with antibiotics. CT-KUB revealed pockets of gas in both kidneys and within the pelvis, with wall thickening of the left renal pelvis. She subsequently received broad spectrum antibiotics and a suprapubic catheter. Bilateral JJ stents were inserted, and ultrasound was performed in the days following to rule out hydronephrosis. Subsequently, a nephrostomy tube was inserted. The patient clinically improved over time. Horseshoe kidney is a rare anomaly, presenting multiple challenges when managing emphysematous pyelonephritis in these patients.
Emphysematous pyelonephritis (EPN) is a necrotising renal infection that leads to the formation of gas in the renal parenchyma, collecting ducts, and surrounding tissue. In the past, multiple eponyms have been used to describe these conditions: ‘renal emphysema’, ‘pneumonephritis’. The pathophysiology of this benign condition is multifactorial. The gas formation that occurs can be either focal or diffuse and has the capability of tracking into perinephric and paranephric spaces.
Approximately 90% of these patients have an underlying diagnosis of uncontrolled diabetes mellitus with pathogens that can produce gas, whilst 10% have urinary tract obstructions. EPN is rare, and the occurrence in a diabetic patient with horseshoe kidney has rarely been reported. The presence of a horseshoe kidney makes management more difficult. Few cases have been reported in the literature.
547 Postoperative Outcomes Are Significantly Worse Among Patients Undergoing Repair of Ruptured Versus Unruptured Iliac Artery Aneurysms – a 10-Year Longitudinal Cohort Study
Authors: Laloo R , Aimar K , Khanom J , Jamjoom A , Bailey M , Scott J 
Published: November 2022

Abstract

Aim
The European Society for Vascular Surgery defines iliac artery aneurysms (IAA) as beyond 1.5 times its normal diameter. Common iliac arteries (CIA) beyond 1.8cm in men and 1.5cm in women are considered aneurysmal. This study aimed to assess outcomes following IAA rupture as their natural history is poorly understood and treatment recommendations based on low-level evidence.

Method
Patients with IAAs at a single vascular centre between 1st January 2010 and 31st August 2021 were identified from a prospectively collected departmental database and Caldicott-approved data collection performed. The primary outcomes included aneurysm rupture, rupture diameter, post-operative complications, 30-day, 1-year and 5-year mortality rates. Statistical analysis with SPSS® was performed using chi-squared tests.

Results
Of 203 patients included, 90.6% were men and median(IQR) age at detection was 77 (71–83). Co-morbidities included hypertension (54.2%), hyperlipidaemia (42.9%) and ischaemic heart disease (35.5%). IAA were in the CIA (85.2%), IIA (21.7%) and EIA (2.0%), mostly asymptomatic (78.8%). Overall IAA rupture rate was 7.9% with CIA (81.2%) and EIA (18.8%). Mean (SD) diameters at rupture were 4.6 (2.4)cm for CIA and 4.6 (3.0)cm for IIA. Post-operative major adverse cardiovascular events (MACE) more frequently occurred following repair of ruptured compared to unruptured IAA (33.3% vs 3.5%, p=.011). Mortality at 30-days, 1-year and 5-years postoperatively were higher following repair of ruptured vs unruptured aneurysms (88.9%, 88.9%, 100% vs 1.2%, 10.6%, 36.1% respectively).

Conclusions
Early detection and elective treatment of IAA aneurysms before they approach 4.6cm may reduce rupture risk, morbidity and mortality associated with emergency repair following rupture.