bluuebunny/crossref_metadata_2025_split huggingface dataset:
TU7.6 Comparing Cholecystectomy Day Case Rates during the pre-COVID and COVID Era at a Rural District General Hospital
Authors: Chituku Tsitsi , Lim Eammon , Nithiyabhaskaran Raekulan , Anderson Catherine , Ali Mahmoud , Rao Milind 
Published: November 2022

Abstract

Aims
67 000 cholecystectomies performed every year in the UK and 92% are laparoscopic. 75% of operations should be done as day cases. National rates vary between 6–50% with the most successful centres at 70%. Our aim was to audit the day case rate at our Trust pre-COVID and compare it to during COVID.

Methods
A retrospective audit of patients identified via clinical coding who had an elective cholecystectomy at one hospital in the Trust between 1 December 2018 to 31 November 2019. During COVID we did a prospective audit of patients identified via Theatreman who had an elective cholecystectomy at the Trust's designated “Green Hospital” between 21 September 2020 to 21 December 2020. Data for all patients was collected from electronic discharge summaries, clinic letters and patient notes.

Results
Pre-COVID our day case cholecystectomy rate was 73% compared to 54.7% during COVID. Pre-COVID conversion rate from planned day case to inpatient stay was 16.3% and during COVID the conversion rate increased to 44%. The waiting time for a cholecystectomy doubled during COVID to 26.3 weeks from 13.6 weeks pre-COVID. Average re-admission rate with symptomatic gallstones was 0.79 pre-COVID and 0.95 during COVID, with 64% of patients having at least one admission prior to surgery. The average length of stay pre-COVID was 0.75 days compared to 0.57 days during COVID.

Summary
COVID adversely affected our day case cholecystectomy rates with resultant increased waiting times for surgery and re-admissions with symptomatic gallstones however the average length of hospital stay was reduced.
TU7.7 Cheques and Balances: A Five Year Review of Surgical Settlements
Authors: Clements Caterina , Bezzaa Sabrina , Curwen Oliver , Vance-Daniel Joseph , Lewis Trystan , Nehra Dhiren 
Published: November 2022

Abstract

Aim
The litigious burden in the NHS has been increasing yearly, costing an estimated £2.5 billion per year in financial settlements. We investigated the causes of general surgical settlements and attributed costs at a district general hospital over a five-year period.

Method
A retrospective analysis of all general surgical claims between 2016–2021 using the NHS Resolutions Case Management System. Selected cases were those which resulted in out of court financial settlements; whilst these claims have been settled, the trust admitted no negligence in each case.

Results
A total of 12 settlements were made with a total cost of £249,918 (£8000-£60,000, mean £20,827). Eight of the claims (67%) related to elective cases with four (33%) emergency cases. Of the total cases, 41% and 33% related to management of gallstones and appendicitis respectively.
The majority of claims (58%) related to delays in treatment with a total cost of £103,500 (£8000-£35,000), accounting for 41% of total settlement costs. Five cases (42%) were due to harm with a combined total of £146,418 (£9000-£60,000), 59% of the total settlement. Of the claims due to harm, 80% suffered recognised complications of the procedure.

Conclusions
Increasing litigation in the NHS over the last decade now accounts for 2% of the total NHS budget. The majority of settlements reviewed here were for avoidable delays in elective treatment, with higher financial settlements for well documented surgical complications related to the consent process. Better access to investigations, earlier clinical review, and reductions in delays to elective surgeries may reduce the financial burden of litigation.
TU7.8 Pay Per View: Cost and Satisfaction of Virtual Video Clinics
Authors: Clements Caterina , Bezzaa Sabrina , Graham Gemma , Tharmarajah Emmanuel , Jamal Karim , Lewis Trystan 
Published: November 2022

Abstract

Aims
The Covid-19 pandemic necessitated use of video consultations to provide continued patient care. It is not clear if video clinics are well received by patients, or if they are cost efficient. We evaluate the benefits of video consultation and review the impact on waiting times and cost implications to a trust.

Methods
100 patients referred between January - December 2021 with gallstones were invited to complete a patient satisfaction questionnaire after initial clinic consultation. Patients were divided into three groups based on consultation type; face-to-face, telephone and video consultation (via the Attend Anywhere platform). Secondary outcome measures included time from referral to appointment, time to final outcome and cost implications.

Results
93 patients responded; 33 video, 30 face-to-face and 30 telephone consultations. Of these patients 62% were female and 38% male with an average age of 51 (25–84).
Average time from referral was 22 days in the video cohort, 22 in the telephone cohort and 32 for face-to-face appointments. Of the video cohort, 44% were booked for cholecystectomy from initial consultation and 56% sent for further investigation. The conversion rate from video to face-to-face consultation was zero.
50% of respondents stated face-to-face consultations as their preferred method of future consultation, 49% of patients opted for video and 1% preferred telephone consultation. 79% reported increased satisfaction due to convenience of consultation.

Conclusion
This study demonstrates video consultations decrease costs and waiting times. Patient satisfaction is comparable to in-person visit. Specific referral criteria and patient selection is essential to maximise the benefits of video consultations.
TU7.9 Validation and comparison of new scoring clinical systems to predict uncomplicated versus complicated appendicitis
Authors: McGuire Andrew , Clifford Siobhan , Dhannon Amenah , Hill Arnold 
Published: November 2022

Abstract

Aims

Methods
This was a retrospective review of a sample of patients whom underwent appendicectomy between 2018 and 2021 in a tertiary university teaching hospital. Inclusion criteria consisted of CT imaging prior to surgery to confirm diagnosis, along with clinical and laboratory data needed to analyse the two scoring systems. Final histological diagnosis of complicated versus uncomplicated appendicitis was employed as the gold standard. Positive predictive (PPV) and negative predictive values (NPV) were calculated for CT, Atema and APSI scoring systems.

Results
In total, 92 patients were included in the study, whereby 55 patients (59.8%) presented with uncomplicated and 37 patients (40.2%) with complicated appendicitis. With regards to predicting complicated appendicitis: Atema score had a PPV of 47.5% and a NPV of 73%. APSI had a PPV of 43.9% and a NPV of 62.7%. CT had a PPV of 50% and NPV of 65.5%.

Conclusion
The accurate diagnosis of uncomplicated versus complicated appendicitis may aid in selection of patients to conservative versus surgical management of acute appendicitis. Our study has shown that radiological findings alone have low positive and negative predictive values. The use of the new Atema scoring system was found to have a higher NPV when compared to radiology findings and the APSI scoring system. This may improve accuracy in discriminating uncomplicated versus complicated appendicitis when selecting treatment pathway.
TU7.10 Short and medium-term symptom response to fundoplication in reflux-associated chronic cough in a UK Centre
Authors: Dexter Eloise , Siracusa Francesca , Brown Ayla , Wilkins Alexander , Dolan Ciaran , Pellen Michael 
Published: November 2022

Abstract

Aim
To identify whether anti-reflux surgery is an effective treatment for reflux-associated cough in a single specialist unit.

Method
A retrospective analysis of patients referred for suspected reflux-associated cough undergoing anti-reflux surgery over a 12 month period in a single centre. Pre-operative oesophageal physiology and imaging, operative technique and follow up records were examined. Symptom resolution and relapse was assessed four years postoperatively.

Results
15 patients underwent anti-reflux surgery following referral with suspected reflux-associated respiratory symptoms. 6 patients had hiatus hernia (40%). There was no correlation between symptom improvement and presence of hiatus hernia, lower oesophageal sphincter (LOS) pressure or DeMeester score (DS).
13 of 15 patients attended initial follow-up. 12 (92.3%) reported complete or partial resolution of symptoms. Acid suppression medication was discontinued in 7 (53.8%) patients at follow up. 100% of patients with marked oesophageal dysmotility (OD) and elevated DS reported their symptoms either partially or fully resolved. One patient who reported no symptom improvement had normal LOS pressures and normal DS but marked OD.
At four-year follow up, 7/13 reported symptoms (53.8%). Of these 3 have been re-referred for recurrent cough (23.1%), 1 for dysphagia (7.7%) and 2 experienced symptomatic reflux (15%). The final patient (7.7%) underwent revision surgery (partial reversal of Nissen Fundoplication) and was satisfied postoperatively.

Conclusion
Patients referred by the respiratory service for reflux-associated cough show good symptom improvement which is largely maintained following anti-reflux surgery. Relative contraindications of dysmotility did not appear to be predictive of worse outcome in this group.
TU7.11 Skin Grafts Vs. Local Skin Flaps in Management of Contracted Scar Finger
Authors: Noureldin Khaled , Issa Mohamed , Maryosh Sally , Xerri Samuel 
Published: November 2022

Abstract

Introduction
In our study, we reviewed the outcome of using skin grafts and different regional flaps of the hand in order to correct flexion contractures of the Proximal Interphalangeal (PIP) joints of fingers. In both techniques, vigorous postoperative exercises were advised for an interval of time between 3–6 months.

Patients and Methods
16 patients were included. All the scar tissue was excised, and the resultant raw area was covered. In Group A consisting of 8 patients, skin grafts were used. Split thickness grafts were selected in 3 cases and full thickness grafts in 5 cases. While in group B, Z-plasty and Cross finger regional flaps were used in 4 cases per each flap. The cause of the contracture was thermal burn in 8 patients, mechanical trauma in 7 cases, and a case of contracture secondary to dupytrene's disease. The mean follow-up period was 6 months.

Results
The mean flexion contracture/further flexion in the joints were improved markedly at the last follow-up. More extension was gained by exercising after the operation. Near full ROM was achieved in 15 cases with strong hand grip and cosmetic satisfaction. There were no major complications.

Conclusion
Wise selection between different skin grafts and regional skin flaps is important, to achieve best outcome in managing finger contractures and gain satisfactory ROM. Choosing the best reconstruction method depend on the size, extent and depth of the raw area. Exposure of the deep structures is an indication to use skin flaps over grafts. Vigorous extension exerc
TU8.1 Evaluation of drain insertion after appendicectomy for complicated appendicitis: A systematic review and meta-analysis of 17 studies
Authors: Abbakar Malaz , Mohamedahmed Ali Yasen 
Published: November 2022

Abstract

Introduction
Surgical drains are used to reduce post-appendicectomy collections. However, they can cause considerable discomfort or increase the risk of surgical site infection (SSI), among other problems. Our aim is to review the literature systematically and conduct a meta-analysis to assess the advantages of using drains (DG) versus no drain (NDG) in complicated appendicitis.

Methods
This systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. All randomized control trials, comparative observational studies comparing outcomes of drain or no drain after appendicectomy for patients with complicated appendicitis were considered.

Results
Seventeen studies (n=4255 patients) who underwent appendicectomy for complicated appendicitis with drain (DG=1580) without a drain (NDG=2657) were included. There was no difference between the two groups regarding abdominal collection [Odd ratio (OR)=1.41, P=0.13] and mortality [ risk difference (RD)= 0.01, p= 0.18]. NDG was superior to the DG regarding SSI [OR=1.93, P= 0.0001], faecal fistula [OR=4.76, P= 0.03], Intestinal obstruction [OR=2.40, P= 0.04], and ileus [ OR=2.07, P=0.01]. The No-drain group showed statistically significant shorter LOS when compared to the drain group [MD 1.79, 95% CI (1.25, 2.34), P= 0.00001].

Conclusion
In conclusion, this meta-analysis has shown that drains have no effect on the development of intra-abdominal collections in complicated appendicitis, but it can significantly increase the risk of post-operative complications such as fistula, surgical site of infection (SSI), bowel obstruction, ileus, and prolonged hospital length of stay.
TU8.2 Percutaneous cholecystostomy for acute calculous cholecystitis an observational study from a single institute
Authors: Abdelsaid Kirolos , Jeilani Milad , Hassan Mohamed , Jayasankar Balaji , Ali Haythem 
Published: November 2022

Abstract

Introduction
Although percutaneous cholecystostomy (PC) is generally accepted as a bridge to definitive therapy for acute cholecystitis (AC), which remains cholecystectomy, some patients did not undergo cholecystectomy mostly due to contraindications to surgery. Here, we aimed to audit our clinical practice from a single institute.

Methods
153 patients presented with AC and initially managed with PC were included. The proportion of patients who did not undergo subsequent LC and their characteristics were analysed.

Results
27% (41/153) of the study cohort underwent LC while the remaining patients (n=112) did not receive any surgical intervention.22/122(20%) were presented with AC and coexisting hepatobiliary malignancy. The mean age of the remaining patients (n=90) was 75±13 years and the median length of drain insertion of those patients 40 days.
The majority (57%) was presented with sever AC while 8% had AC with adjacent liver abscess. 55% of those patients did not develop any further attacks of AC after PC removal while 25% deemed unfit for surgery. The rest of the patients (20%) either refused the operation or died before LC. The American Society of Anaesthesiologists (ASA) score was 3 IV in 9% of patients (8/90).
15% (13/90) experienced post PC complications including either blocked stent, pain and cellulitis around tube. The 60-day mortality rate of patients who did not underwent LC was 11% (10/90).

Conclusion
The majority of AC patients treated initially with PC did not undergo subsequent LC. PC in high surgical risk patients with AC could be consider as definitive treatment.
TU8.3 The optimal timing of Laparoscopic cholecystectomy following percutaneous cholecystostomy in Acute cholecystitis
Authors: Abdelsaid Kirolos , Sultan Majid , Rae Thomas , Hassan Mohamed , Jayasanakar Balaji , AbdulAal Yasser 
Published: November 2022

Abstract

Introduction
Percutaneous cholecystostomy (PC) is an effective option for high risk and/or delayed presented Acute cholecystitis (AC). However, the optimal timing for subsequent laparoscopic cholecystectomy (LC) as a definitive treatment remains controversial.

Methods
This study includes 41 patients underwent LC following PC for severe AC. We compared the length of tube insertion, period from PC till LC and period from PC removal till LC against co-morbidities, another attack of AC, subsequent pancreatitis/jaundice and operative difficulties in terms of intraoperative adhesions, drain insertion, conversion to open, length of operation.

Results
The median time of length of tube insertion was 36 days (range 5–208) while the median time of PC insertion till LC was 144 days (range 31–744) and for period from PC removal till LC was 78 days (range 0–714). Patients with prolonged tube insertion (more than a month) showed higher risk of developing subsequent pancreatitis and or jaundice (P=0.04) while intraoperative adhesions was associated with prolonged time from tube insertion till operation (more than 4 months). There was no significant association between neither the length of tube insertion, period from PC insertion till LC nor period from PC removal till LC and other studied parameters.

Conclusion
Prolonged time of PC insertion and/or prolonged time form PC insertion till LC in patients with AC have higher risk of pancreatitis and surgical difficulties. Further studies including larger number of patients’ sample is warranted to confirm the outcomes and determine the optimal time of LC following PC in those patients.
TU8.4 Standard of Operation Notes in General Surgery
Authors: Agboro Stephen , Yomi-orungbe Esther 
Published: November 2022

Abstract

Aims
To assess the quality and precision of operation notes, as well as, ensure that they were written in accordance to requirements and standards set by the Royal College of Surgeons England as stated in “Good surgical practice”.

Method
It was a retrospective local audit and re-audit of patients admitted under the General Surgery department where 50 & 30 patients were selected randomly in May 2021 and October 2021 respectively. Data was extracted from applications on secure trust servers and analyzed on Microsoft Excel with patient information carefully anonymized.
To establish the standard of best practice for this audit, guidelines published in The Royal College's “Good Surgical Practice” were used to devise a comprehensive list of criteria that should be present on every operation note. These can be found at: http://www.rcseng.ac.uk/standardsandguidance.

Results
The results of the initial audit were compared with that of the re-audit. Significantly noted in the re-audit, was the 50% improvement in documentation of criteria such as the name of anesthetist, anticipated blood loss, operative diagnosis, and antibiotic prophylaxis. There was also more clarity in the documentation of post-op plans in the re-audit (e.g duration of post-op antibiotics/VTE prophylaxis and wound care) for each patient as recommended in the initial audit.

Conclusion
The improvement in clear and precise documentation of operation notes noted in this re-audit helped to improve the quality and safety of patient care delivered. Further audits and re-audits, as well as, quarterly re-education of surgeons have been recommended to attain and maintain targets.
TU8.5 Management of acute lower gastrointestinal bleeding (LGIB) remains largely conservative and the impact of BSG recommendations largely unseen: results of a 4 year audit
Authors: Ahmed Salma , Patten Alan , Guy Richard 
Published: November 2022

Abstract

Background
LGIB accounts for 3% of all emergency referrals in the UK. BSG Guidelines for management were recently published, largely based upon the findings of the 2015 UK Nationwide Audit. A retrospective 4-year audit was conducted to assess the impact of these guidelines.

Methods
All patients presenting to an EGS service with LGIB, 2 years before and after BSG guidelines, were identified. Data on demographics, mode of presentation, investigation,management and diagnoses were retrieved. A comparison was then made with The UK Audit and BSG Guidelines.

Results
Some 98 patients were identified. Re-admission rate was 19% and median length of stay 2.7 days compared with 3 days and 21.4%, respectively, in the UK audit. Diverticular disease accounted for the majority of known diagnoses but with a higher proportion of malignancies. The usage of Oakland score as a criterion for safe discharge was significantly evident following BSG guidelines, an increase from 7.1% to 14.6% was noted (P. value 0.005). 41.8% of the patients underwent CT scans compared with 25.9% in the UK audit. Similarly, higher percentages of colonoscopy/ flexible sigmoidoscopy were noted, 65.3% compared with 25.4%. Surprisingly, 0% of the patients underwent angioembolization, not very different from the national average of 0.8%.

Conclusion
This audit demonstrates a practice that is largely in line with national experience but with variations potentially related to social deprivation. Access to urgent inpatient colonoscopy remains a problem but CT rates are high and need for surgical intervention is low. A significant impact of the BSG guidelines is not demonstrable.
TU8.6 Pharmacological management of post-operative pain following appendicectomy: a meta-analysis
Authors: Alam Benyamin , Akbari Amir Reza , Awodiya Afolarin , Alali Bader , Ekhlacy Shaida 
Published: November 2022

Abstract

Introduction
Appendicectomy is an increasingly common procedure internationally, and is the most frequent emergency surgery performed in the UK. Post-operative pain is common after surgery, if poorly controlled it can cause many negative outcomes for patients. Despite the large number of patients that undergo appendicectomy and the potentially severe outcomes of post-operative pain, there is no clear guidance on how best to control pain following appendicectomy. The aim of this meta-analysis is to compare the efficacy of different modalities of analgesics following appendicectomy, to identify which is best at controlling post-operative pain

Methods
A literature search was conducted across online libraries for trials assessing pain scores after appendicectomy with different analgesics administered. These were grouped based off modality. Using the data in these trials a forest plot was created for each modality with an effect estimate and confidence intervals calculated for each trial

Results
6 studies investigated nerve-blocks; an estimated effect of -1.01 with CIs of -1.39 to -0.4 was calculated. 3 studies investigated NSAIDs; an estimated effect of -0.46 with CIs of -0.70 to -0.23 was calculated. 3 studies investigated local anaesthetics; an estimated effect of -0.83 with CIs of -1.91 to 0.26 was calculated. 1 study investigated opiates with an estimated effect of -0.82 with CIs of -1.47 to -0.17 was calculated

Conclusion
Nerve-blocks were the most effective modality of analgesic followed by NSAIDs. No clinically significant effect was proved for local anaesthetics as the CIs crossed the null hypothesis. Opiates were not compared due to insufficient data