bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH3.5 Completeness of operative reports for rectal cancer surgery
Authors: Bae Inmook , Spinks William , Saravanan Balakrisanan , Moscalu Andrei 
Published: November 2022

Abstract

Introduction and Objectives
Synoptic operative reporting has been shown to improve completeness and consistency in surgical documentation, which ultimate improves quality of care. We set out to assess whether post-operative reports, made at the JPUH, include the primary components recommended by the National Accreditation Program for Rectal Cancer. The JPUH does not currently use synoptic templates to guide post operative note making.

Methods and materials
We retrospectively looked at the post-operative reports for 71 patients who had undergone surgery for rectal cancer from March 2018 to October 2020 at the James Paget University Hospital. These reports were evaluated to establish how many of the primary components were included.

Results
Of the 71 reports assessed, none included all 23 components. The areas well documented included the nature of the operation (100%), completeness of resection (93%), the type of reconstruction (85%) and anastomosis testing method (97%). The areas that were poorly documented included en bloc resection (8%), metastectomy (0%), intra-operative complications (0%) and blood transfusion (0%).
Overall there was 53% completeness of documentation.

Conclusion
Rectal cancer post-operative note making at the JPUH does not meet the standard expected by the NAPRC. Some points were documented well and others were infrequently documented. Plans are in place to introduce accessible templates to guide note making and re-audit will be completed.
TH3.6 Comparison Between Preoperative MRI and Postoperative Histopathological Staging in Rectal Cancer Surgery (RCS)
Authors: Rehman Masood , Gendia A , Nasir M T , Ahmed J , Gupta Nishil 
Published: November 2022

Abstract

Aim
To evaluate diagnostic values of preoperative MRI imaging staging in comparison to postoperative histopathological staging (HPS) in rectal cancer surgery.

Methods
A retrospective chart auditing was performed on all RCS patients from 2019 till 2021. Data collected included patient demographic, preoperative MRI imaging and postoperative histopathological analysis.

Results
A total number of 83 rectal surgeries were performed during the given period, mean age was 67(±11) and 60% were males. 62.7% (52) of patients underwent anterior resection (low AR 27.7%). APR and Hartmann's procedure were performed in 27.7% and 6% of patients. Complete resection was achieved in 95.2% with average LN harvest of 20.5 (±5.8) nodes. The most common Tumour (T) burdens on preoperative MRI and postoperative HPS were T2 (45.6%) and T3 (44.5%) respectively with MRI diagnostic accuracy of 47%. Lymph nodes analysis showed diagnostic preoperative predictive values of 56.6%. Extramural vascular invasion (EMVI) was accounted in 68 Pre-MRI with diagnostic accuracy of 50.6%. Pre-MRI evaluated 69 CRM and accurately commented in 73.5%. Although Pre-MRI staging had tendency to over-stage tumour burden, lymph nodes analysis and EMVI in around 30% of reported cases. It showed accuracy in diagnostic values in CRM prediction with around 73%.

Conclusion
Preoperative MRI diagnostic values showed differences when compared with postoperative histopathological analysis. Pre-MRI showed a tendency to over-staging in tumour size, LNs and EMVI. However, Pre-MRI showed favourable values in accurately describing CRM which is the main factor affecting the outcome of surgery and the ongoing treatment.
TH3.7 Is There a Benefit for Routine Doughnuts Histopathological Examination After Anterior Resection (AR) in Colorectal Cancer Surgery?
Authors: Rehman Masood , Gendia A , Nasir M T , Ahmed J 
Published: November 2022

Abstract

Aim
To evaluate the oncological benefits and cost-effectiveness of routine histological examination of the doughnuts from stapled anastomoses in patients undergoing colorectal cancer surgery.

Methods
A retrospective chart auditing was performed on all consecutive rectal cancer surgery (RCAS) patients performed in NGH from January 2019 till August 2021. Data collected included patients' demographic, procedure performed and postoperative histopathological analysis including doughnuts examination.

Results
Fifty-two patients underwent AR during the given period. 37 (71%) patients had doughnuts histopathological examination. median age was 68.59 (±11) years old and 62.1% were male. The histopathology of all resected specimens was adenocarcinoma. 48.6% and 51.4% underwent low anterior resection and high anterior resection respectively. Proximal doughnuts sent in 70.2% patients whereas distal doughnuts were sent in all resections. Mean distal resection margin from tumour was 21.7 mm and the shortest distance from the tumour to resection margin was 6 mm. All the doughnuts as well as resection margin were negative for any malignancy. Additionally, each doughnut costs our pathology laboratory around 150 pounds with total preparation time of 72hours and around 10 mins of microscopic examination. This makes total costs and time of examining all specimens of around 9,300 pound and 4,470 hours in resources.

Conclusion
There was no additional oncological benefit in sending routine examination of doughnuts. It should only be sent in those deemed of a higher risk of a positive margin. This will result in significant reduction in cost and time burdens on our resources.
TH3.8 Retrospective study on the use of colonic stents in malignancy; a bridge to surgery or the end of the line?
Authors: Williams N , Reeves N , Chandler S , Jones H 
Published: November 2022

Abstract

Aim
Colonic stenting is a management option for obstructed left sided colorectal malignancy in the emergency and elective setting. Stenting can provide a bridge to curative surgery or to adjuvant treatment. The aim of this study was to assess the role of colonic stenting in management of obstructed colorectal cancer.

Methods
This retrospective cohort study analyses prospectively collected data from two centres within one Health Board in Wales. Patients were recorded in a cancer database, who underwent colonic stenting for left sided colonic malignancy between January 2008 and December 2021. Patient demographics, treatment pathways, length of admission, stoma formation rates and morbidity were recorded.

Results
In total, 98 patients, with a mean age of 73.5 years (range 37–97) underwent a colonic stent. The majority were elective 55% (n=54). The sigmoid colon was the commonest site of tumour in 33 patients, with metastatic disease in 82% (n=80). The study found 86% (n=84) of patients were successfully stented. The mean length of admission was 13 days. The complication rate was 23% (n=23), most commonly stent obstruction (n=6). Stenting was a bridge to curative surgery for 3 patients, and 47% (n=46) received adjuvant treatment. Five-year survival was 19.3% (n=19). The overall stoma rate was 10.2% (10 patients).

Conclusion
This study shows colonic stenting is a viable alternative in surgical management for advanced obstructing colorectal malignancy but not as a bridge to surgery. The majority of this cohort returned home following stenting, had a low overall stoma rate and 19% survival at 5 years.
TH3.9 Cleft closure is an effective procedure for the treatment of pilonidal disease with low recurrence rate
Authors: Ali Ambeur , Di Fabio Francesco , Yao Caroline , Venkatasubramaniam Arcot , Arnold Steve , Daniel Mahesh 
Published: November 2022

Abstract

Aims
The surgical treatment of pilonidal sinus disease has evolved over time, with reported time to healing, post-operative complications and disease recurrence rates still significant. The modified Karydakis procedure such as the Bascom's cleft lift operation or “cleft closure” flattens the cleft and has shown promising results. The purpose of this single-centre study is to analyse outcomes of this technique.

Method
This is a retrospective study of 192 patients undergoing cleft closure as a day case over 10 years. The technique involves an off-midline cleft closure with an advancement flap and primary closure. Outcome measures were postoperative complications, time to healing and recurrence requiring surgery.

Results
The median age at surgery was 25 years (IQR 21–33), with males representing 76%. Overall, 91 (47%) were smokers. 141(73%) patients had previous emergency treatment. The median numbers of pits/sinuses were 3 and in 71% of patients were localized in the midline. The median time to wound healing was 3 weeks (IQR 2–6). Twenty-five (13%) patients had postoperative complications including infection (n=21) and hematoma (n=4). Disease recurrence requiring surgery occurred in 7 (3.6%) patients. Median time to recurrence was 9 months (IQR 5–15).

Conclusion
Cleft closure is an effective procedure for the treatment of pilonidal disease, with a low rate of postoperative complications and recurrence.
TH3.11 Standardised Follow-up for Patients with Acute Diverticulitis – Quality Improvement Project
Authors: Gavrila Ana , Mehta Chaitanya , Siddiqi Najaf Nawaz 
Published: November 2022

Abstract

Aims
Historical guidelines recommended routine colonoscopy some weeks after an episode of acute diverticulitis. Our project aimed to analyse outpatient follow up in our unit for patients with a clinical diagnosis of uncomplicated diverticulitis who did not require any inpatient investigations or intervention. Following on from this we proposed a pathway to standardise follow up care in this group of patients.

Methods
A retrospective audit was undertaken of outpatient follow up received by all patients coded with a primary clinical diagnosis of diverticulosis or uncomplicated diverticulitis in 2015, 2017 and 2019. Follow up investigations included a colonoscopy, flexible sigmoidoscopy, CT colonogram (CTC) or none of the above due to frailty or recent endoscopic investigation within the previous 2 years.

Results
Overall 118 patients were included in the audit. There was a reduction in patients who had a clinical diagnosis of uncomplicated diverticulitis in the second and third cycle of the audit from 67 to 22 and 29 respectively. This overall led to less outpatient endoscopic evaluation.

Conclusion
Departmental consensus guided the formation of a standardised pathway whereby appropriate patients without any colonic investigation within the last 24 months were investigated with an outpatient CTC six weeks after discharge. This led to a significant reduction in outpatient colonoscopy numbers.
TH4.3 Walk the extra mile!!
Authors: Griffiths Aimee , Archer James , Singh Gambhir Raghvinder Pal 
Published: November 2022

Abstract

Aim
Limb salvage and mortality remain high in patients with critical limb ischaemia. The present study looks at outcomes of a multimodality 24x7 service at a major diabetic foot centre.

Methods
We retrospectively reviewed surgical outcomes of bypass procedures done to identify patients that needed to go have further procedures within the same admission for limb salvage. Electronic patient records were reviewed and data analysed to assess the outcomes of overall limb salvage rates and mortality.

Results
68 patients underwent bypasses in the study period. 38 (55%) of patients who had procedures performed in the study period needed to have an additional intervention after the index procedure. 9 needed redo surgery (thromebctomy and further extension of graft with jump grafts), 27 needed angioplasties and 2 patients needed both. Majority of the intervention were done within 24–72 hours. Among those grafts which failed one of the causes identified was prolonged hypotensive episodes in perioperative period. All these additional interventions delayed discharge, prolonged hospital stay but were essential for limb salvage.
64 patients (94%) had intact limbs at discharge, 4 required a major amputation - 1 below knee and 3 above knee. At 1 year follow up 56 patients (82%) were alive.

Conclusion
If the patients have to retain the ability to walk we have to be prepared for some extra effort. Additional procedures planned or unplanned are sometimes necessary to save the limb. A multimodality 24x7 service willing to go the extra mile goes a long way in preventing major amputations.
TH4.4 Real-world mid to long term mortality after Abdominal Aortic aneurysm (AAA) repair
Authors: Muthukumar Ananya , Nair Meghna , Singh Gambhir Raghvinder Pal 
Published: November 2022

Abstract

Aim
Centralisation of vascular services has decreased 30-day AAA mortality from 7% to 3% across UK, but does it have an effect on their long term survival?

Methods
Electronic patient records for 264 patients with AAA repair between 2009–2018 submitted to national vascular registry (NVR) from a single centre were analysed.

Results
231 of 264 patients (88%) had endovascular aneurysm repair (EVAR) while 19 (12%) had open repair (OR). Male to Female ratio 8:1; Mean age 76.5 years at time of surgery (TOS). 251 elective, 13 were emergency repairs. 192 (72%) of patients have died since surgery- a median survival of 4 years (IQR 2–7) post-surgery. Of these, 171 were male, with a median survival of 4 years (IQR 2–7); 21 were female, with median survival 3 years (IQR 1–5). Cause of death could be ascertained only in 27 & 23 were attributable to non-aortic reasons. Median survival post-surgery in 70–80 years age group (n-89) and 80+ (n-82), was 5 years (2–7) and 3 years (1.25–5), respectively. Cohorts of patients who lived either greater or less than median survival years were aged similarly at TOS; 79.7 and 80.4 years, Mean survival post-EVAR was 4.5 years, while post-OR was 2.3 years.

Conclusion
With a median and mean survival post surgery of about 4 years, is it time we had mandatory involvement of Geriatric physicians/older person assessment units like POPS (Perioperative medicine for Older People Undergoing Surgery) in patient risk assessment preoperatively especially in those that require costly customised stent grafts.
TH4.5 The introduction of a custom made endograft service for patients with complex thoracoabdominal aneurysm
Authors: Duncan Nicola , Pilkington Antony , Dearie Larissa , Hennessy Martin , Hussey Keith 
Published: November 2022

Abstract

Introduction
Custom made endografts represents a technological advance that has been widely adopted across vascular centres in the United Kingdom. The most recent National Vascular Registry report describes in-hospital mortality for complex as 2.3%. We have reviewed the outcome associated with the introduction of a custom made endograft program in a single Scottish Health Board.

Methods
Index cases were identified from a prospective radiology database with cases identified from 2008 to 2021. We collected patient demographics, pre-operative assessment, peri-operative and procedure related details and information on surveillance and re-intervention.

Results
There have been 49 cases performed. Most patients were males over the age of 70-years with significant medical co-morbidity. The mean AAA size was 5.8cm. Most of the procedures have been performed under general anaesthesia with percutaneous common femoral access. Procedural complications have included inability to stent target arteries (coeliac axis twice and right renal artery twice). Other complications have included limb ischaemia and haemorrhagic complications from access. Two critical care bed days have been used. The mean duration of hospital stay is 9-days. There have been no deaths on the index admission. During the follow-up period there have been 6 deaths. One of these deaths was from rupture of abdominal aortic aneurysm (secondary to Type III endoleak).

Conclusion
These data suggest that the case selection for custom made endografts is good. The cost of the device may be off set by a reduction in critical care utilization/hospital bed stay.
TH4.6 Is major limb amputation the most appropriate means of palliation for patients with non-reconstructable arterial disease?
Authors: Trinder Thomas , Rodger Chloe , Fatima Kinza , Dearie Larissa , Hussey Keith , Orr Douglas 
Published: November 2022

Abstract

Introduction
Major limb amputation (MLA) is the highest risk lower limb surgical procedure performed in the United Kingdom with reported in hospital mortality 9.1%. For patients with non-reconstructable arterial disease it offers palliation of symptoms. The primary aim of the current work was to define if surgical palliation with major limb amputation is being offered to patients who may have been best managed medically

Methods
Retrospective review of major limb amputations (March 2019 to October 2021). Historical datasets have also been scrutinised (2008–2010). Specific variables of interest included the annual number of major limb amputations, mortality on the index admission and place of discharge.

Results
A complete dataset was available for 282 patients during the Covid period. Patient demographics were as anticipated - 206 (73%) male, mean age 63-years (range 23 to 90-years). Peripheral arterial disease (190) and diabetes mellitus (149) were common. The number of major limb amputations was comparable with the historical series. In-hospital mortality was 7% (n=20). The median duration of admission for patients who survived was 26-days and 38% of patients were limb-fitted (which was also comparable with historical data). Most patients (71%) were discharged to their own home.

Conclusion
The outcomes described are better than the comparable local historical and national data both in terms of in-hospital mortality and place of discharge. These data imply that we make the correct decision about MLA more often than we don't.
TH4.7 Seventeen years experience of surgical management of Thoracic Outlet Syndrome at a District General Hospital
Authors: Jaskani Sadia , Farquharson Barnaby JMc , Collis Justin , Andrews Brian 
Published: November 2022

Abstract

Aims
To evaluate the outcomes of patients who underwent first rib resection (FRR) for Thoracic Outlet Syndrome (TOS) over a period of 17 years at a single District General Hospital (DGH).

Methods
Retrospective review of patient notes of individuals treated with FRR from August 2004 to August 2021.

Results
Sixty patients underwent 65 subclavian approach FRR for indications neurogenic (n=45 (69%)), venous (n=6 (9%)), arterial (n=14 (22%)) TOS. Forty-four female patients underwent FRR (68%) and mean age at time of surgery 34 years (range 27 to 64 years). Five patients (7.6%) had bilateral FRR and seven patients (10.6%) diagnosed with cervical rib. Mean length of time from initial symptoms to diagnosis 24 months (range 2 to 60 months). Forty patients (62%) underwent a failed trial of conservative management with physiotherapy before proceeding to surgical management. Fifty-two patients (80%) reported complete resolution of symptoms at follow up. Complications included wound infections 2(3%), pneumothorax 4(6%), haemothorax 1(1.5%), phrenic nerve complications 3(4.6%) and chronic pain 1(1.5%). One patient with phrenic nerve injury underwent diaphragmatic plication procedure with resultant resolution of symptoms. Mean length of stay 1.6 days.

Conclusions
This series presents the difficulty of diagnosis and management of TOS with the majority of patients enduring symptoms for a prolonged period of time before referral and definitive management. Phrenic nerve complications are an underreported complication of subclavian approach FRR, it is essential to counsel patients accordingly before proceeding to surgery. FRR for TOS can be performed safely and effectively in a DGH environment.
TH4.8 Antiplatelet therapy used in vascular patients post CEA
Authors: Zolfaghari Yasmin , Gambhir Raghvinder 
Published: November 2022

Abstract

Aims
To review antiplatelet therapy of vascular patients who had undergone CEA post TIA over a 1-year period and to compare their antiplatelet therapy to European Society of Vascular Surgery (ESVS) guidelines for atherosclerotic carotid disease.

Methods
We reviewed all patients admitted under the vascular team who underwent elective CEA from 1/1/20 to 1/1/21 (n=65). We reviewed the antiplatelet therapy that were prescribed on discharge summaries, and compared to current ESVS guidance. According to ESVS guidance, it is stated that dual antiplatelet therapy (DAPT) is not recommended in patients undergoing carotid endarterectomy unless indicated for cardiac reasons.

Results
Out of the 65 patients who were discharged over one year, 55% were discharged on DAPT, with the remaining 45% prescribed either aspirin or clopidogrel alone. Additionally, there was heterogeneity in the treatment duration for antiplatelet therapy across patients. However, on 3 month follow up appointments, 100% of patients were advised to continue on SAPT long-term in accordance to guidance.

Conclusions
Given the heterogeneity in treatment plans for CEA patients over the studied time period, we believe there is value in introducing weekly teaching sessions for MDT members of all grades, to keep all members up to date on current guidance. Additionally, use of posters incorporating up to date antiplatelet therapy guidance may also serve as a useful tool for doctors discharging post CEA patients. Despite the heterogeneity noted on discharge summaries, 100% of patients were advised to continue on SAPT long term in follow up clinic appointments.
TH4.9 Patient Reported Outcome Measures (PROMs) – A Key to Understanding Laparoscopic Cholecystectomy Outcomes?
Authors: Melly Conor , McGeehan Gearoid , O'Connor Niall , Donohoe Claire , Bucholc Magda , Sugrue Michael 
Published: November 2022

Abstract

Aims
Healthcare requires patient feedback to improve outcomes and experience. This study undertook a systematic review of the depth, variability, and digital suitability of current patient reported outcome measures PROMS in laparoscopic cholecystectomy.

Methods
A PROSPERO registered (ID: CRD42021261707) systematic review was undertaken of English language articles, published from January 1st, 2011 to June 2nd, 2021, and underwent MINORS grading, using PubMed version of Medline, Scopus, and Web of Science electronic databases in June 2021. The search used Boolean operators and wildcards including key words: laparoscopic cholecystectomy AND patient outcome OR patient reported outcome OR patient reported outcome measure OR PRO OR PROM.

Results
A total of 4960 individual articles were reviewed, 44 were found to evaluate PROMs in patients undergoing laparoscopic cholecystectomy. 21 articles spanning 19 countries and 4 continents were included in the qualitative data synthesis. There was significant heterogeneity in PROMs, with eight different PROM tools used in 21 studies. Wide variation in the time points at which PROMs were recorded. Fourteen of twenty-one studies recorded PROMs pre- and post-operatively, seven of twenty-one recorded PROMs post-operatively only. Follow up periods ranged from 3 days to 2 years post-operatively. All PROMs detected changes in quality-of-life over time.

Conclusions
This study identified that while post laparoscopic cholecystectomy PROMs are infrequently measured currently, tools are widely available to achieve this in clinical practice. PROMs may not capture all the outcomes but should be incorporated into future cholecystectomy outcome research. EuroQOL EQ-5D provides a simple platform for the modern digital era.