bluuebunny/crossref_metadata_2025_split huggingface dataset:
SP9.1.7 The effect of the COVID-19 pandemic on Colorectal Cancer (CRC) diagnosis, management and outcomes
Authors: Harris Matthew , Kuhdr Jamal , Rooney Paul 
Published: November 2022

Abstract

Aim
We studied differences in stage, treatment modality, morbidity and mortality, two week wait referrals (2WW) and rate of 2WW cancer diagnosis.

Method
All 2WW referrals to the NHS trust colorectal department were analysed and their rate of diagnosis of any cancer. Using data extracted from the Somerset Cancer Database, we compared CRC patients diagnosed in the NHS trust 6 months prior to (Pre-PAN) and following (PAN) national lockdown on 23/02/2020.
Outcome measures included: cancer stage, resection rate, stoma rate, Clavien-Dindo score and 90 day mortality. Statistical analyses included Chi-squared and Mann-Whitney-U tests.

Results
2WW referrals dropped significantly during the pandemic (p=0.02). However, the rate of diagnosis of cancer of any kind was not significantly different (PAN=12.4%, Pre-PAN=11.4%,p=0.89).
There were significantly fewer CRC diagnoses during the pandemic (Median monthly diagnoses: Pre-Pan=13.5, Pan=8.5 p=0.010). There was a significantly higher proportion of Dukes A cancers in Pre-Pan compared to Pan (Pre-PAN=31.3%, PAN=14.3%, p=0.036). There was a significantly higher proportion of Dukes B cancers in Pan compared to Pre-Pan (Pre-PAN=13.8%, PAN=33.9%, p=0.032). There was no excess morbidity or mortality between the two groups.

Conclusion
There was no excess mortality or morbidity, demonstrating the efficacy of COVID surgical protocols. PAN patients presented with advanced tumour stage. There were fewer 2WW referrals from GP and fewer diagnoses of CRC in the PAN group. However, the proportion of cancers picked up from 2WW referrals was not significantly different. Decreased diagnoses and stage migration may be due to loss of investigative resource or patient factors such as fear precipitating late presentation.
SP9.2.2 Implementation of a straight to test colorectal cancer referral pathway significantly improves cancer targets and reduces outpatient requirements
Authors: Satti Suren Reddy , McKenzie Sevra , Yao Caroline , Arnold Steve , Venkatasubramaniam Arcot , Di Fabio Francesco 
Published: November 2022

Abstract

Aims
The main aim of this study is to determine the impact of the “Straight to Test” (STT) colorectal cancer pathway on the NHS England 28-day faster diagnosis and 62-day-treatment targets. The secondary aim is to evaluate the effect of the pathway on reducing outpatient clinic appointments and the proportion of colorectal cancers diagnosed within 2 week wait (2WW) referrals.

Methods
This case-controlled single-centre study included 1000 patients. Five-hundred consecutive patients were managed through the STT colorectal cancer pathway between February 2021 to May 2021 (study group), with a dedicated colorectal nurse triaging the referrals for straight to colonoscopy or outpatient clinic, for complex cases that do not fit the STT criteria. This group was compared with 500 consecutive patients referred on the 2WW colorectal cancer pathway prior to the implementation of the STT pathway and therefore all reviewed in outpatient clinic, between April 2019 to July 2019 (control group).

Results
The 28-day time-to-diagnosis and 62-day time-to-treatment targets improved after the introduction of STT pathway from 59% to 86% (p&lt;0.0001) and from 35% to 60% (p=0.095), respectively. In the study group, 234/500 (47%) patients were triaged for straight to colonoscopy, freeing up an equal number of outpatient colorectal clinic appointments. The proportion of colorectal cancers diagnosed within the 2WW referrals was 5.2% in the study group and 4.2% in the control group.

Conclusion
Implementation of a STT 2WW colorectal cancer pathway has significantly improved our colorectal cancer targets and reduced outpatient clinic requirements.
SP9.2.3 Role of single or double ringed circumferential wound protectors in reducing surgical site infections following colorectal resections: an evidence synthesis by the meta-analysis of randomized controlled trials
Authors: Nour Hussameldin M , Ahsan Amiya , Baig Mirza K , Sains Parv , Sajid Muhammad S 
Published: November 2022

Abstract

Objective
The objective of this article is to explore whether the use of single or double ringed wound protectors (WP) in patients undergoing colorectal resection (CRR) is associated with reduced risk of surgical site infections (SSI).

Method
Analysis was conducted according to PRISMA guidelines. With the help of expert local librarian, systematic search of medical databases like MEBASE, MEDLINE and pubmed was conducted to find appropriate randomized controlled trials (RCT) according to predefined inclusion criteria. The analysis of the pooled data was done using the principles of meta-analysis on statistical software RevMan.

Result
Eighteen RCT on 3744 patients fulfilled the inclusion criteria. There were 1885 patients in the WP group and 1889 patients in the no-WP group. In the random effects model analysis, the use of WP during CRR was associated with the reduced risk of SSI [odds ratio 0.63, 95% CI (0.47–0.86), z= 2.94, p=0.003]. However, there was significant heterogeneity (Tau2 = 0.18; Chi2= 34.77, df = 17; (p=0.007; I2 = 51%) among included studies.

Conclusion
Use of WP seems to reduce the risk of SSI and therefore, may routinely be used during both open and laparoscopic CRR.
SP10.1.2 Novel Predictors of Mortality in Emergency Bowel Surgery: A Single Centre Cohort Study
Authors: Darbyshire Alexander , Kostakis Ina , Meredith Paul , Toh Simon , Prytherch David , Briggs Jim 
Published: November 2022

Abstract

Aims
Pre-operative risk stratification is a key part of the care pathway for emergency bowel surgery, as it facilitates the identification of high-risk patients. A limitation of current risk models is that they utilise operative data in their calculation and are not designed to provide pre-operative risk-predictions. This study aimed to investigate the ability of variables that are routinely available pre-operatively to predict 30-day mortality after emergency bowel surgery.

Methods
A single centre cohort study was performed using local National Emergency Laparotomy Audit database (01/12/2013 to 31/01/2020). Further data was then extracted from electronic hospital records (n=1,561). The National Early Warning Score (NEWS), Laboratory-Decision-Tree-Early-Warning Score (LDTEWS) and Hospital Frailty Risk Score (HFRS) were then calculated. The most abnormal NEWS/LDTEWS scores in the 24/72-hours prior to surgery were used in analysis.

Results
Individual NEWS, LDTEWS and HFRS scores were reasonable predictors of mortality (c-statistic 0.689–0.735) but all poorly calibrated. NEWS scores of ≥4 were associated with a high overall mortality rate (&gt;10%). A logistic regression model (Pre-Op) was developed using age, NEWS, LDTEWS and HFRS scores as predictor variables. The Pre-Op model demonstrated good discrimination (c-statistic 0.778) and excellent calibration, but was outperformed by the NELA score (c-statistic 0.855). Interestingly, APACHE II and P-POSSUM displayed poor calibration and fair-to-good discrimination (c-statistic 0.687–0.789).

Conclusion
Pre-operative patient vital signs, blood tests and markers of frailty can be used to accurately predict the risk of 30-day mortality after emergency bowel surgery.
SP10.1.4 Association between public holidays and acute admission with biliary colic: a retrospective analysis
Authors: Dick Lachlan , Young Jamie 
Published: November 2022

Abstract

Introduction
Biliary colic symptoms are often post-prandial, particularly following fatty foods. Public holidays and festive periods are frequently celebrated using such foods. We aimed to determine the rates of admission following public holidays at a Scottish district general hospital.

Methods
Emergency admissions with biliary colic from June 2016 to June 2019 were included. Public holiday dates were extracted from the Scottish government website. To include those with delayed presentation, the 3-days following a public holiday were also considered to be public holiday-related (PHR). Statistical analysis was performed to determine any differences in demographics or outcome.

Results
Of the 273 patients included, 1 (0.4%) was admitted on a public holiday with a further 27 (9.9%) admitted on a PHR day. PHR days accounted for 104 (9.2%) of the 1125 days included in the study. Comparing those admitted on a PHR and non-PHR day, there was no difference in age (61.6 vs 61.1 years, p=0.895), female gender (75 vs 66.5%, p=0.365), length of stay (6 vs 4 days, p=0.250) or operative intervention (53.5 vs 37.6%, p=0.09).

Conclusion
The majority of PHR admissions with biliary colic occur during the 3-days following a public holiday. It is therefore likely that the need for radiological investigation and access to emergency theatre will be greater during this period. Future work could assess the impact of other cultural holidays which are not reflected in public holidays.
SP10.1.5 Hajibandeh Index and intraperitoneal contamination: A cohort study and meta-analysis
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Evans Louis , Miller Bethany , Waterman Jennifer , Maw Andrew 
Published: November 2022

Abstract

Aims
To validate the performance of the Hajibandeh Index (HI) in predicting the presence and nature of intraperitoneal contamination in patients with acute abdominal pathology.

Methods
The STROCSS guidelines and the PRISMA statement standards were followed to conduct a cohort study and a meta-analysis, respectively. All adult patients undergoing emergency laparotomy for acute abdominal pathology were eligible. The accuracy of the HI was evaluated using ROC curve analysis in the cohort study and using weighted summary AUC under the fixed and random effects modelling in the meta-analysis. The QUADAS-2 criteria were used for methodological quality assessment of the included studies.

Results
A total of 1437 patients were included (700 from the cohort study and 737 from the literature search). ROC curve analysis of the cohort study showed that the AUC of HI for presence of contamination was 0.79 (P &lt;0.0001) and meta-analysis showed that the pooled AUC of HI was 0.79 (0.75–0.83). In terms of nature of contamination, the cohort study showed that the AUC of HI for purulent and feculent contamination was 0.76 (P&lt;0.0001) and 0.83 (P&lt;0.0001), respectively. The pooled AUC of HI for purulent and feculent contamination was 0.78 (0.74–0.81) and 0.80 (0.77–0.83), respectively.

Conclusions
The HI is a strong and accurate predictor of the presence and nature of intraperitoneal contamination. We encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
SP10.1.7 Assessment of interhospital transfers of acute surgical patients within an NHS trust
Authors: Hazemi-Jebelli Yasmin , Weigel Katharina , Gunnell Rachel , de Wolf Maisie , Patel Mital , Patten Darren 
Published: November 2022

Abstract
Acute surgical services at our trust were moved from two sites to a single site, due to COVID-19. This project was inspired by cases of transfer whereby significant time delays resulted in poorer patient clinical outcome.

Aims

Methods

Results

Conclusion
Interhospital transfer must focus on maintaining optimal health and outcomes for the patient. A guideline and framework for safe transfers must be implemented and adhered to strictly.
SP10.2.2 Emergency Management of Incisional Hernia
Authors: Omar Islam , Townsend Abby , Williams Catrin , Jones Annabel , Wilson Jeremy , Magee Conor 
Published: November 2022

Abstract

Introduction
Incisional hernia is a common complication after abdominal surgery. Operating on a hostile field renders the management of incisional hernia quite challenging. Presentation with incarcerated or obstructed incisional hernia can further complicate the picture. This study aims to describe the outcomes and burden of emergency management of incisional hernia.

Methods
A retrospective study has been conducted. We reported the patients' demographics, primary surgery details, hernia characteristics, and mode of presentation and management.

Results
Forty-five patients were included in the analysis. Mean age was 66.78;SD±15.32. Thirty-one (69%) were females. Mean BMI was 35.49;SD±10.46. They had significant comorbidities including diabetes, CKD, COPD, and malignancy; 31.1%, 13.3%,11.1%, 11.1% respectively.
Twenty-two (48.8%) had incisional hernia after midline incision. 25(55.6%) presented with bowel obstruction. Thirty-two had a surgical repair, and ten were managed conservatively. The mean time from admission to surgery was 1.4;SD±2.1. Meshes were used in 10(31.25%) patients. The mean duration of surgery was 114.03;SD±60.55 minutes.
Ten patients needed HDU/ITU; 9 of them were managed surgically. Complications rate (CD≥III) was 20%. The 30-day mortality rate was 8.89%. Six (18.75%) patients had recurrence after surgical repair.
Thirty patients had CT, 7 had X-rays, and one had US. The mean hospital stay was 8.71;SD±8.8, with an overall hospital stay of 392 days. Fifteen patients were readmitted, and seven came back without staying &gt;24 hours.

Conclusion
Emergency presentation of incisional hernia carries a high risk of morbidity and mortality and represents a high burden.
SP11.10 Assessing the utility of surgical instruments in breast surgery at a tertiary referral centre
Authors: Knight Lucinda , Khun Ng James Chean , Haigh Constance , Cash Julie , Isherwood Jennifer , Oni Georgette 
Published: November 2022

Abstract

Introduction
Most surgical specialties have standardised surgical trays, which are used for a variety of their operations. Any unused instruments require re-sterilisation, with costs relating directly to the number of instruments. This has further environmental implications. In 2019, we performed over 1600 breast surgeries in our unit. This study aimed to look at the utility of the breast reconstruction tray (BRT), which is the most commonly used surgical tray, in the unit to see if there was scope for cost efficiencies.

Methods
All BRTs (averaging 55 instruments) used for breast operations were recorded from October to November 2021. Data collection included operation type, individual instruments used and additional instruments requested during the procedure. Quantitative analysis was performed on the collected data.

Results
A total of 55 BRTs were used during the study period. 17 were bilateral cases. An average of 42% (n=23, range 10–33) of instruments were used from each tray, with 16% (n=9) of instruments never used. There was no difference in instruments used in relation to the type of surgery performed (range 42%-46% across operation types). 67% (n=12) of bilateral cases required an additional tray to allow simultaneous operating on both sides. Despite this, 20% (n=11) of the operations required specific additional instruments to be opened.

Conclusions
This study has shown a significant number of instruments remaining unused but being re-sterilised. If a reconfiguration of the standard instruments were to occur this could lead to a potential cost saving of over £25000 per annum purely on sterilisation costs.
TU1.1 Applying Lessons from MI6 and the Stockmarket to the Management of Paraoesophageal Hernias: Creation of a Bayesian Computer Model to Support Clinical Decision-Making
Authors: Bradley Alison , Dougal Jennifer , Wong Li Siang , Vakeesan Branavan , Buter Anton 
Published: November 2022

Abstract

Aims
Decision-making in the management of paraoesophageal hernias is complex. Surgery carries the risk of significant complications yet a ‘watch-and-wait’ approach can result in the need for emergency surgery. The aim of this study was to create computerised models that makes personalised predictions of morbidity and mortality for patients undergoing both elective and emergency surgery for their paraoesophageal hernia.

Method
Using AgenaRisk software, Bayesian Network models were created that made personalised predictions of postoperative morbidity and mortality. Bayesian Networks are based on probability theory and have been widely used in military intelligence and finance to perform risk assessment and predict outcomes across competing strategies. Through Baye's theorem, they can explicitly represent the conditional probability of dependencies between multiple variables. The prior probabilities within these model algorithms were calculated from published studies that identified variables associated with morbidity and mortality following paraoesophageal hernia repair (n=22483). The model's performance was validated against a prospectively maintained dataset of 35 patients.

Results
The model had an area under the receiver operator curve of 0.875 (P value 0.0027; standard error 0.125, 95% confidence interval 0.717 – 0.962) and a sensitivity of 75% and specificity 100% for predicting significant postoperative morbidity (Clavien-Dindo grade 3+). There were no cases of 30day or 90day mortality in the dataset and the model correctly predicted this.

Conclusion
This study marks a move towards the delivery of more personalised realistic medicine by potentially supporting better shared decision-making. The predictive performance of these models was strong but further prospective validation is required.
TU1.12 Video Presentation: The OVESCO Clip for Endoscopic Treatment of Gastrocutanoeus Fistula
Authors: Zugaj Konrad , Fernandes Roland , Black Rebecca 
Published: November 2022

Abstract

Background
Percutaneous endoscopic gastrostomy (PEG) is an important route of nutrition in many patients. PEG removal usually leads to spontaneous closure in a few days. Gastrocutaneous fistula (GCF) after PEG removal is an uncommon complication occurring in 2% of patients. Despite its rarity, it is responsible for significant morbidity and reduced quality of life. Treatment is initially focused on medical management and endoscopic clipping, with advanced endoscopic techniques and surgery reserved for selected cases.

Method
We present a video presentation demonstrating successful endoscopic treatment of GCF using the OVESCO Over the Scope clip with resolution of symptoms and closure of the fistula tract. The device is a novel innovation designed to achieve tissue apposition and compression without ischaemia. It is licensed for Gastrointestinal iatrogenic defects, endoscopic perforation, bleeding and GCF. The 72 year old patient had debilitating symptoms of gastric leakage for over a year despite previous attempts at endoscopic clipping, fibrin glue and curettage of the fistula tract.

Results
As shown in the video, the clip achieved good opposition with no post procedural leak. The patient was reviewed at 3 and 12 months with no recurrence of their symptoms. The external cutaneous opening had closed at 3 months. The patient reported an increase in weight, improved mood and a greater quality of life following the intervention.

Conclusion
The OVESCO clip has been proven to facilitate successful endoscopic closure of GCF in selected patients in whom initial treatment measures have failed. This mitigates the need and risks of surgical closure.
TU2.5 Compliance of colonic polyp surveillance with British Society of Gastroenterology (BSG) and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines
Authors: Ali Muhammad , Heyes Adam , Stephen Annly , Ng Sherwin , Hanif Zulfiqar 
Published: November 2022

Abstract

Introduction
The guidelines for post-polypectomy and post-colorectal cancer resection have recently been changed after consensus by the British Society of Gastroenterology, the Association of Coloproctology of Great Britain and Ireland and Public Health England. The aim of our study is to evaluate the rate of compliance with the recommended guidelines following polyp removal.

Methods
The data was collected retrospectively by reviewing the colonoscopy database in a single centre district general hospital for all patients who underwent polypectomy during April-September 2021. We excluded patients who had prior history of colorectal malignancy. The frequency of subsequent colonoscopic surveillance were evaluated against the BSG/ACPGBI guidelines based on the clinico-histological characteristics of the removed polyps.

Results
There were 104 colonoscopies with polypectomies performed during April-September 2021. The patient cohort had a mean age of 65 years (range, 35–85 years), with the most common diagnosis being tubular adenoma with low grade dysplasia (n=86, 82.7%). Adherence to BSG/ACPGBI colonoscopic post-polypectomy surveillance guidelines, based on the characteristics of the colonic polyps at colonoscopy and histology, was 86.5% (n=90). There were 5 (4.8%) patients who had their surveillance endoscopy requested earlier than recommended and 8 (7.7%) patients had a surveillance colonoscopy requested but did not require any surveillance. 1 patient had colonoscopy requested later than recommended. There was no significant difference in compliance between physicians (87.5%) and surgeons (86.1%).

Conclusion
There is a high compliance with post-polypectomy surveillance guidelines. However more efforts and staff training are required to improve compliance even further.
TU2.7 Surgical Management of Synchronous Colorectal Liver Metastases – A Systematic Review and Meta-Analysis
Authors: Allu Veera 
Published: November 2022

Abstract

Aims
Surgery with curative intent is the mainstay in management of Colorectal cancer, with timing and sequencing of the surgical resection of tumour and the metastases highly important in improving prognosis in patients diagnosed with synchronous Colorectal liver metastases. The current review aims to identify data around simultaneous and staged resection to evaluate if there is a significant difference in either approach.

Methods
PubMED and EASE's searcher® database were searched, a modified PRISMA checklist used to identify relevant data from the search results and fifteen studies were included in the quantitative analysis, defined by inclusion and exclusion criteria, and scored with the use of MINORS criteria. Meta-analysis is performed with the use of Odds Ratio or Weighted Mean Difference.

Results
There is significant heterogeneity within the pooled studies potentially due to varied techniques and surgical skills. There was no significant statistical difference in postoperative morbidity, with a slight skew in favor of the staged procedure. There was a statistically significant skew towards a higher mortality in the simultaneous resection group. Intra and Post Operative Complications showed no statistically significant difference in either group. Lack of randomization was observed in underlying studies.

Conclusion
The analysis does not show a statistically significant difference in outcomes with either intervention. There are distinct methods of thought around which method to employ in various patient scenarios, left to the discretion of the treating specialist. Research suggests further enquiry into use of neoadjuvant and adjuvant chemotherapy to treat the underlying metastases associated with primary tumor.