bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP3.1.6 Robotic versus Laparoscopic and open colorectal resections – comparison of short term postoperative outcomes over 3 years
Authors: Nair Nandu , Kobylarz Matthew , Gaunt Anne , Garimella Veerabhadram , Roy Sudipta , Varghese Philip 
Published: November 2022

Abstract

Aim
To compare the short terms surgical and oncological outcomes of elective robotic versus laparoscopic and open colorectal resections done over a period of 3 years at a single centre.

Methods
All robotic colorectal resections performed during a three year period (2017–2019) at a single centre were compared with laparoscopic and open resections from the same period. Data including patient demographics, preoperative and postoperative oncological staging, length of stay, 30 day readmission, need for critical care stay, 30 day complication rate (using clavien dindo classification) and immediate oncological outcomes were collected from electronic patient records.

Results
During the three year period, 188 robotic resections (82.9% - rectal resections, 17.1% colonic resections) of which 178 were cancer resections were performed. In the same period 585 laparoscopic and 116 open colorectal resections were performed. Conversion rate for robotic resections was 3.72%. Median lymph node harvest for the robotic resections was 20. Major complication rate in the robotic group was 5.3% as compared to 6.1% for the open and laparoscopic group. Median length of stay in the robotic group was 5 days which was significantly lower than for open rectal resections (11 days, p&lt;0.0001). Although there was no statistically significant difference in length of stay between robotic (5 days) and laparoscopic rectal resections and colonic resections (7 and 6 days respectively).

Conclusion
Robotics is a safe approach for colorectal resections with good oncological outcomes and our experience demonstrates a shorter length of stay and reduced complications.
SP3.1.7 Does using intra-operative indocyanine green impact the clinical suspicion of anastomotic leak?
Authors: Ng Samantha , Komolafe Olusegun 
Published: November 2022

Abstract

Aims
To see if the beneficial impact of indocyanine green (ICG) angiography on anastomotic leak (AL) rate was reflected in the “suspicion” of leak in patients undergoing rectal or sigmoid cancer resection.

Methods
Patients who have intra-operative ICG fluorescence have reduced clinical AL rates, with a shorter length of stay (LOS). Recent publications have suggested stricter criteria to categorize AL. A prospectively-maintained database was reviewed to see if there was a difference in the suspicion of AL between patients who did and did not receive intra-operative ICG. A total of 159 rectal and sigmoid cancers were diagnosed between 1 April 2020 and 31 March 2021 in our health board, with 75 patients proceeding to surgery. Only patients receiving primary anastomosis were included in this study (n=33). Post-operative CT scans performed, diagnosis of AL, Clavien-Dindo complication rates, use of antibiotics beyond 48 hours, and LOS, were studied.

Results
39.4% (n=13/33) received intra-operative ICG whilst 60.6% (n=20/33) did not. The median LOS was 3 days in the ICG group and 6.5 days in the non-ICG group. There were less CT scans, antibiotic use, complications, and post-operative interventions in the ICG cohort.

Conclusion
This is a small-sized snapshot audit, however it demonstrates that the reduced AL rate in patients having intra-operative ICG is reflected in their post-op journey of care, with a clear difference in interventions, and no greater number of “sub-clinical” leaks in the ICG cohort. The study will be expanded to see if this data is consistent in a larger study.
SP3.1.8 2ww Colorectal referral proformas: is the inclusion of recent bowel investigations relevant?
Authors: Nunn Rebecca , Hassan Adil , Allgrove Carol , Vivekanandan Shanmugam , Vijay Vardhini 
Published: November 2022

Abstract

Aims
Straight-to-test (STT) decisions are made on the basis of the details contained within the referrer's documentation. This is particularly important for Two-week wait (2ww) referrals where incomplete or missing information may result in unnecessarily duplicating investigations- incurring a cost to resources as well as exposing patients to potential harm. Through reviewing GP 2ww referrals, we highlight the prevalence of incomplete information relating to recent bowel investigations.

Methods
A prospectively maintained database consisting of 2ww Colorectal referrals from primary care was analysed over a 12-month period (January 2021- December 2021). The agreed local standard is that any bowel investigations within the last 3 years are included on the referral proforma. Proformas compliant with this requirement were marked as ‘Yes, complete’. A total of 3410 referrals took place during this period- 36 were excluded from analysis as no information regarding their status was available.

Results
Only 37% of proformas included a complete history of recent bowel investigations over the past 3 years, and 62% had no documentation regarding this information. Between January-April 2021 the proportion with complete documentation was 42%, which fell to 30% by September-December 2021.

Conclusions
Including details of recent bowel investigations over the past 3 years appears to be an area that is commonly overlooked by referring local GPs. Given that patients may have had investigations at different Trusts, in the absence of a cohesive data sharing network between Trusts, GPs are best placed to collate this important information when referring to the Colorectal unit.
SP3.2.1 Management and outcomes of patients with small bowel obstruction in Denmark – a multicentre prospective cohort study
Authors: Smith Henry , Skovsen Anders Peter , Jensen Thomas Korgaard , Lolle Ida , Tolver Mette Astrup , Nielsen Liv Bjerre 
Published: November 2022

Abstract

Aims
The optimal management of small bowel obstruction (SBO) remains a matter of debate and treatment varies internationally. In Denmark, the traditional approach to patients with SBO is less conservative than that of the UK, but to what extent patient outcomes differ is unknown. This study aimed to describe the current management and outcomes of patients admitted with SBO in Denmark.

Methods
This was a prospective cohort study conducted at 6 acute hospitals in Denmark over a 4-month period. Patients aged &gt; 18 years with a clinical or radiological diagnosis of SBO were eligible. Primary outcomes were 30-day mortality and major complication rates.

Results
316 patients were included during the study period. The median age was 72 years and 56.0% were female. Diagnosis was made by computed tomography (CT) in 314 patients (99.1%), with the remaining 2 diagnosed clinically. Non-operative management was the initial strategy in 152 patients (48.1%) and successful in 120 (78.9%). Immediate surgery was performed in the remaining 164 (51.9%), with a laparoscopic approach used in 84 patients (51.2%). The 30-day mortality rate was 7.3% with major complications occurring in 61 patients (19.3%).

Conclusions
The management of SBO in Denmark differs significantly to that of the UK, with more liberal use of CT, a higher proportion of patients undergoing immediate surgery and a higher success rate of non-operative management. Despite these differences, patient outcomes are broadly similar. Adoption of the best components of both strategies may improve patient outcomes in both nations.
SP3.2.2 Improving Acute Surgical Services and Establishing Same Day Emergency Care Clinic in a District General Hospital
Authors: Swamad Mohamed , Badawi Marwa , Vitkauskas Raimundas , Cutcu Dilan , Klimovskij Michail 
Published: November 2022

Abstract

Introduction
Surgical Same Day Emergency Care (SDEC) clinic service is a new challenging trend nationwide. We would like to share our experience establishing SDEC in a DGH setting. Our clinic runs two sessions daily Monday to Friday with capacity of 16 patients.
The patients presented for; clinical follow-up post-discharge, radiological imaging and blood tests. All referrals are triaged by specialist nurses, seen by doctors of different grades - core surgical trainees and specialty doctors and supervised by the Consultant on-call.

Methods
Prospective ongoing audit carried out in SDEC monitoring the number of patients reviewed, diagnosis, investigations and outcome. We audited the documentation on the hospital's electronic system.

Results
In October 2021, 62 patients were reviewed, 97% had decisions made same day and only 3% required admission to SAU, 50% were allocated to a named consultant, 69% had blood tests, 53.2% had radiological investigations, 25% of patients were discharged with plans to follow up in elective clinics, and 1 patient was booked for elective operation.
Our recommendations to improve quality of service were to allocate a dedicated staff nurse and healthcare assistant for more efficient workflow. Improving documentation of outcomes and allocating patients to named consultant for follow up.

Conclusion
Our model demonstrated successful service to provide semi-urgent care to surgical patients. SDEC has the capacity for more patients and subsequently will offload pressure from the emergency services provided by A&E and surgical admissions unit. This also makes a significant impact for on-call team to allow more focus on treatment of acute emergencies.
SP4.1.2 Management and Ambulation of Uncomplicated Acute Diverticulitis during the COVID-19 Pandemic – A Clinical Audit in a District General Hospital
Authors: Elghazaly Hussein , Dahaghin Payman , Drymousis Panagiotis 
Published: November 2022

Abstract

Aims
To audit the management (ambulation versus admission) of acute diverticulitis presenting to a London DGH.

Methods
A retrospective clinical audit. Data on cases of acute diverticulitis presenting to the general surgical department at Ealing Hospital were collected over a period of 92 days. The medical notes were screened and the indication for admission in hospital was recorded. Each admission was then assessed for compliance with standard criteria for appropriate admission, derived from national guidelines by NICE. Patients admitted despite not meting these criteria were deemed as inappropriate admissions.

Results
mAll patient referrals to General Surgery at Ealing Hospital were screened from 1/7/21 to 30/9/21. 618 patients were identified. A total of 18 patients presented with radiologically-confirmed diverticulitis in this period (2.9%). Of these, 14 patients were admitted (77.8%). None of the patients ambulated met the criteria for admission. If the admitting teams were to adhere to National Guidelines, 15 of the 18 patients presented and 11 of the 14 patients admitted could have been safely ambulated. In inappropriately-admitted cases, none received surgical intervention. The mean number of days spent in hospital for inappropriate admissions was 3.27 (Range 1–8 days). This translates to 49 patient-days that could have been safely avoided according to national guidelines. The cost incurred by the NHS by the inappropriate admission of these patients is estimated at £78,400 p.a.

Conclusions
Safe ambulation of patients presenting with acute uncomplicated diverticulitis can improve departmental efficacy, patient flow and ultimately reduce bed pressures and expenditure associated with hospital admissions.
SP4.1.4 Bowel injury in gynaecological laparoscopic surgery: a systematic review
Authors: Westby Kealan , Mannion Evan 
Published: November 2022

Abstract

Aims
Often general surgical opinion or assistance is sought in the presence of an iatrogenic bowel injury. The objective of this review was to analyse the literature on bowel injury in those undergoing laparoscopic gynaecological surgery and determine incidence rate, nature & site of injury and treatment.

Methods
Data sources included Pubmed, EMBASE, ClinicalTrials.gov and the Cochrane library databases. Timeframe for studies included was from 1990–2021. All studies in English reporting the incidence of bowel injury were included. Those not in English, case reports or that did not define bowel injury were excluded. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used when assessing the studies.

Results
Two reviewers extracted data from each study. A total of 515 papers were initially identified, 134 met inclusion criteria. Total of 512,098 laparoscopic gynae procedures were represented with 720 bowel injury reported giving an incidence rate of 1/711 (0.14%, 95% CI 0.13–0.15%) The rate of bowel injury varied with type of procedure, highest being in a hysterectomy. Small bowel was most common structure injured and the majority of bowel were identified intraoperatively. Delayed recognition of bowel injury led to high mortality rate.

Conclusion
The incidence for bowel injury in laparoscopy gynaecological procedures is 1/711. There is a variation in incidence rate & complexity of procedure. Early recognition and collaboration between gynaecologists and general surgeons is essential for a favourable outcome.
SP5.1.1 Novel in vitro model of neurotrauma to study neurotherapeutics
Authors: Basit Raja Haseeb , Wiseman Jessica , Chari Divya Maitreyi 
Published: November 2022

Abstract

Introduction/Aims
Penetrating traumatic brain injury (pTBI) is a surgical emergency, with poor clinical outcomes. Management is supportive including surgical wound debridement, anti-epileptic administration and infection prophylaxis; no clinical neuroregenerative therapies exist. Surgical biomaterial scaffolds have therapeutic potential, but developmental testing relies heavily on highly invasive live animal injury models which are low throughput, expensive, technically challenging, and present significant ethical challenges. We recently developed a high throughput, multi-glial and facile in vitro pTBI model within which neural cell interactions with a surgical grade scaffold, DuraGen PlusTM could be investigated. A key limitation was the lack of a neuronal component, meaning axonal transection and regeneration could not be assessed. Here, we report an advanced version of the model, which (i) encompasses all the major neural cell types including neurons; (ii) within which penetrating lesions can be induced and biomaterials implanted.

Methods
Cerebral cortices from postnatal mice were extracted and cultured in vitro with a novel supporting medium. Cultures were transected at 8 days post-culture simulating penetrating injury in vitro, with immunocytochemistry used to analyse neural-cell responses/interactions.

Results
We demonstrate the utility of the model in reproducibly simulating pTBI in vitro with key pathological features such as glial scarring, microglial invasion and axonal outgrowth, p&lt;0.05, n=5). The benefit of the model to study nanomaterial-neural cell interactions is demonstrated.

Conclusion
Our new model offers significant benefits for high throughput, facile developmental testing of novel nano/biomaterials in preclinical studies.
SP5.1.2 Splenic Artery Embolisation: Reviewing 10 years of practice at a Major Trauma Centre
Authors: Jones Benjamin , Elbakri Adil Salim , McLaughlin David , Murrills Christopher , Patil Pradeep , Scollay John 
Published: November 2022

Abstract

Introduction
Splenic Artery Embolisation (SAE) has transformed the management of splenic trauma. The aim of this project was to review the outcomes and post procedural management of splenic trauma patients managed by SAE at a Major Trauma Centre over a 10-year period.

Methods
Details of all patients undergoing SAE for trauma between 2011–2021 were acquired from a prospectively maintained database. Patient records were reviewed for demographic information and details of mechanism / grade of splenic injury, success of embolisation, complications, associated injuries and mortality. Data relating to post-procedural practice (vaccinations, antibiotic prescribing, follow-up imaging) were also obtained.

Results
26 patients (19 male, 7 female) with a median age 44 years (range 13–97) were identified. 25/26 injuries were due to blunt trauma. AAST splenic injury grades were III (n=5), IV (n=16) and V (n=5). SAE succeeded first time in 25/26 cases, and upon second attempt in 1/26 case. 3 patients died prior to discharge; 2 due to associated traumatic injuries and 1 from multi-organ failure. Complications secondary to SAE occurred in 4/26. Vaccinations were administered in 12/26 cases, and long-term antibiotics initiated in 11/26 cases. Formal follow up imaging was arranged in 5/26 cases.

Discussion
These data shows SAE is an effective means of controlling splenic haemorrhage with no patient requiring subsequent laparotomy. Complications occurred in 15% of cases. Great variance was found in terms of follow up practice regarding further imaging, antibiotics, and vaccinations. Increasing knowledge about SAE offers the opportunity to standardise post-procedure care for these patients.
SP5.1.3 Early initiation of chemical venous thromboembolism (VTE) prophylaxis following traumatic spleen injury is safe and effectively reduce VTE events
Authors: Lee Sheah Lin , Rizkallah Georges , Mahmoud Adel , Long Joe , Modi Sachin , Elberm Hassan 
Published: November 2022

Abstract

Aims
Within the first 48 hours (h) of trauma, hyper-coagulation state occurs which put trauma patients at risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE), leading to an increase rate of mortality. Non operative management (NOM) is now the standard of care for traumatic splenic injuries (TSI). However, timing of initiating chemical venous thromboembolism (VTE) prophylaxis, heparin or low molecular weight heparin (LMWH), remains controversial due to concern of rebleeding. This study examines the safety and timing of initiating VTE prophylaxis post TSI.

Methods
Patients with TSI were identified from prospectively maintained Trauma Audit and Research Network (TARN) database from 2015–2020 in a single tertiary trauma centre. Clinical and radiological information were collected retrospectively. TSI were graded using AAST classification. VTE prophylaxis initiation were categorised as not given, &lt;48h and &gt;48h following the injury.

Results
In total 102 patients were included. Fifty-three percent (54/102) had Grade 3 injury and above. Majority 90/102 (88%) of patients were treated non-operatively. VTE prophylaxis was not given for 31 (30.4%), initiated for 37 (36.3%) within 48h and given to 34 (33.3%) patients after 48h. Seven (7%) patients developed thromboembolic events, majority of which (6/7) received VTE prophylaxis after 48h. None of the patients who received VTE prophylaxis had rebleeding.

Conclusions
This study showed that early initiation of chemical VTE prophylaxis (&lt;48h) is safe, resulted in lower incidence of DVTs/PEs without increase risk of bleeding. Results from this study supports recommendation from other studies to initiate chemical VTE prophylaxis after TSI as early as 24h post injury.
SP5.1.4 Prevention, Diagnosis, and Management of Fracture Related Infections in accordance with the BOA FRI Guidelines
Authors: Lu Victor , Zhang James , Thahir Azeem , Krkovic Matija 
Published: November 2022

Abstract

Aim
Fracture related infections (FRI) are common and serious complications of musculoskeletal trauma. With average hospital health care costs for infected patients being 6.5 times higher than uninfected patients, FRI poses a significant social-economic burden to the patient and healthcare system.
We aim to audit current practice in preventing and diagnosing FRIs, and improve management of infections in patients with fractures. The guidelines covered are the British Orthopaedic Association (BOA) FRI guidelines.

Method
Our sample included patients who suffered an infection as a direct consequence of fracture and/or subsequent surgical management procedures over a seven-year period. Surgical procedures were performed for fractures in 8826 patients. In total, 102 patients with a FRI were reviewed. Audit results and recommendations have been presented at a clinical governance meeting.

Results
Seven out of sixteen items had poor compliance (&lt;80% compliance). Ultrasound-guided aspiration was done in 21.6% (22/102), even if debridement surgery is delayed. 1.96% (2/102) received adequate advice about responding to a suspected FRI. 56.9% had recommended 2-week antibiotic-free duration before sampling. Our recommendations include pre-written template in discharge documentation providing guidance on responding to a suspected FRI, better communication between microbiology, surgical team, and GPs regarding antibiotic prescription timing, including weekly bone and joint infection MDT review for FRI patients.

Conclusions
Lowering FRI-related burden requires a three-pronged approach: uniform set of standards for infection prevention in trauma and orthopaedic surgery, robust diagnostic workup for suspected FRI cases, effective management scheme for confirmed FRI cases. These systems should be a key element of orthopaedic trauma service.
SP5.1.5 Risk factors for Septic Arthritis and need for Arthroscopic Washout: Minimum two year follow-up at a major trauma centre
Authors: Lu Victor , Zhou Andrew , Hussain Hassan , Thahir Azeem , Krkovic Matija 
Published: November 2022

Abstract

Introduction
A hot swollen joint is commonly encountered in orthopaedics and rheumatology. With a broad range of differentials, septic arthritis (SA) is perhaps the most concerning, with delayed treatment leading to osteonecrosis, loss-of-joint-function, and mortality. To facilitate clinical decision making, we aimed to determine the risk factors for development of SA.

Methods
All patients presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2020 and January 2021 with a hot, swollen joint were retrospectively evaluated.
The frequency of variables of interest in the three-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariate analysis. A multiple logistic regression model was formed for covariates that were significantly associated with SA (p&lt;0.05), which underwent a backwards elimination process to identify a predictive model for SA. Multi-collinearity was assessed between covariates and variables with significant intercorrelation were removed. Statistical significance was set at p&lt;0.05.

Results
221 patients were included (SA: 28; periprosthetic joint infection: 24; pseudogout: 32; gout:26; other conditions: 111). Multivariate analysis showed that RA, skin infection, and liver disease were risk factors for SA, with odds ratios of 2.656 (95%CI:1.090–6.475;p=0.032), 3.162 (95:CI:1.269–7.883;p=0.013), 4.993 (95%CI:1.156–21.559;p=0.031), respectively.

Conclusion
With a high mortality and morbidity rate, early diagnosis of septic arthritis is crucial. This requires understanding what the risk factors are, namely RA, skin infection, and liver disease. We believe that the models in this study are of prognostic value to clinicians who are presented with the common presenting compliant of a hot swollen joint.