bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH4.10 Prophylactic cholecystectomy offers best outcomes following ERCP Clearance of Common Bile Duct stones
Authors: Geehan Gearoid Mc , Melly Conor , O'Connor Niall , Bass Gary , Bucholc Magda , Sugrue Michael 
Published: November 2022

Abstract

Aims
Clearance of choledocholithiasis reduces recurrent cholangitis, but following clearance of the CBD, cholecystectomy is required. This meta-analysis evaluated outcomes in patients undergoing ERCP with or without sphincterotomy to determine if cholecystectomy post ERCP clearance offers more favourable outcomes than a wait-and-see approach.

Methods
A Prospero-registered meta-analysis of the literature using PRISMA guidelines incorporating articles relating to ERCP, choledocholithiasis, cholangitis and cholecystectomy was undertaken for papers published between 1st January 1991 and 31st May 2021. Existing research demonstrating outcomes of ERCP with no cholecystectomy versus ERCP and cholecystectomy was reviewed to determine key events, complications, and mortality. Odds Ratios (OR) were calculated using Review Manager Version 5.4 and meta-analyses using OR with either fixed- or random-effect models, depending on heterogeneity of studies.

Results
13 studies (n=2,598), published between 2002 and 2019 were included in this meta-analysis: six retrospective studies, two retrospective propensity score matched studies, three prospective studies and two randomised control trials from a total of 11 countries. There were 1,433 in the no cholecystectomy cohort (55.2%) and 1,165 in the prophylactic cholecystectomy cohort (44.8%). Cholecystectomy resulted in a decreased risk of cholecystitis (OR= 0.15; CI, 0.07–0.36; p&lt;0.0001), cholangitis (OR= 0.51; CI; 0.26–1.00; p=0.05) and mortality (OR= 0.38; CI; 0.16–0.9; p=0.03). In addition, prophylactic cholecystectomy resulted in a significant reduction in biliary events, biliary pain and pancreatitis.

Conclusions
In patients undergoing CBD clearance consideration should be given to performing prophylactic cholecystectomy to optimise outcomes.
TH5.4 Robustness of morbidity and mortality documentation before emergency laparotomies
Authors: Muehlschlegel Charlotte , Rees Chantal , Borgas Pia , Taheem Muhesh , Bedwani Nader , Kalidindi Venugopala , Bhanot Kunal 
Published: November 2022

Abstract

Introduction/Aims
Participation in the National Emergency Laparotomy Audit (NELA) is a national requirement, highlighting areas for improvement in patient care and service provision . When consenting for emergency laparotomy, NELA Morbidity and Morality scores (NMMS) should be clearly documented, informing the consent process and guiding surgical intervention.

Aims

Method
A retrospective (C1) (13/02/21–06/07/2021) and ongoing prospective (C2) (24/10/2021-present) analysis of emergency laparotomies in our local hospital was performed before and after implementation of interventions respectively. Laparotomies were categorised by operation time, NMMS documentation time, patient age and gender. Results were presented locally. Interventions included departmental education and a bright orange supplementary sticker placed on consent forms, providing fields for NMMS documentation. Fischer's exact t-test was used to calculate p values.

Results
30 and 21 patients were included in C1 and C2 respectively. More patients had clear NMMS documentation in C2 (10/30 vs 16/21; p&lt;0.005). Within C2, sticker use was associated with more frequent NMMS documentation (7/7 vs 8/13; p=0.1107).

Conclusion
Use of NMMS informs consent, guides surgical decision making and improves accountability. Whilst important for both legal and governance reasons, utilisation and documentation of clinical decision-making tools whilst managing unwell patients can be onerous. We found combining both education and a visual adjunct has improved compliance with the NMMS documentation NELA standards.
TH5.7 Spontaneous pneumomediastinum case series: Lessons learnt in assessment and management
Authors: Manku Bhagat , Krishnamoorthy Ashwin , Thomson Luke , McLaughlin Euan 
Published: November 2022

Abstract

Aims
Spontaneous pneumomediastinum (SPM) is usually a self-limiting condition in clinically stable patients with no obvious causative factor. SPM can be difficult to distinguish from important secondary causes such as tracheobronchial injury or oesophageal perforation. Therefore, thorough clinical history and examination is of paramount importance. We aim to highlight lessons learnt from our experience to improve rapid diagnosis and clinical management of these patients.

Methods
Patients were identified through hospital records between October 2019 – December 2021. Data was collected on clinical presentation, precipitating events, radiological confirmation of SPM and compared with current reported literature.

Results
11 patients were identified, 8 males (72.7%), 3 females (27.3%) with a mean age of 29 ± 17 years. The most frequent symptom was retrosternal chest pain 27.3%; and vomiting the most common precipitating event (54.5%). Mean white cell count was 14×109/l on admission. All patients underwent plain film chest radiography, and subsequent computerised tomography of thorax, abdomen and pelvis. Patients underwent gastroscopy selectively, showing no acute pathology. Mean length of stay was 4.6 days. No patients required operative intervention or any other intervention beyond antibiotics. No complications or recurrence were found in patients at follow up.

Conclusion
SPM is a self-limiting condition with low morbidity and mortality. If life-threatening causes have been excluded, SPM can safely be managed expectantly at a local level, without the need of transfer to tertiary centres and prolonged hospital admission. We propose a structured approach to aid in the management of SPM and help address these challenges.
TH5.8 Use of Botulinum Toxin A infiltration in conjunction with negative pressure wound dressing and mesh-mediated traction in the management of the ‘open abdomen’
Authors: Mohamed Imran , Egeler Christian , Ford Simon , White Thomas , Harris Dean , Harries Rhiannon 
Published: November 2022

Abstract

Aims
Botulinum Toxin A (BTA) is widely used in complex abdominal wall reconstruction (CAWR). It temporarily paralyses the oblique muscles allowing medialisation of the rectus sheath and decreases tension on the closure. This analysis presents the use of BTA in management of the ‘open abdomen’ (OA).

Methods
Retrospective series of patients with OA where BTA was used in conjunction with AbtheraTM negative pressure wound therapy (NPWT) and polypropylene mesh-mediated traction (MMT) to attempt fascial closure. BTA was performed by Anaesthetists with experience of BTA use in CAWR using Dysport® 600 IU.

Results
We include 5 patients since 2020. Median age at index operation was 55 years (range 39–81); four were male. Index operations were intra-abdominal catastrophe where fascia closure impossible (n=2), dehiscence after Vertical Rectus Abdominis Myocutaneous (VRAM) flap for pelvic malignancy (n=2) and colectomy for obstructing colorectal cancer complicated by rectus sheath necrotising fasciitis (n=1). There were no immediate complications from BTA infiltration. All patients achieved primary fascial closure with a median of five re-looks (range 3–7). There were no full-thickness dehiscences after final closure. One patient died within 1 month from unrelated cause. One patient had no clinically palpable incisional hernia at six months and a further two had no incisional hernia at six and 12 months, respectively, on cancer surveillance CT.

Conclusion
BTA in the setting of the OA in conjunction with NPWT and MMT appears safe and effective in achieving fascial closure, and can potentially reduce the risk of incisional hernia. Further studies are welcomed.
TH5.9 Role of Ultrasound in Management of Acute Appendicitis
Authors: Morsy Hesham , Elkorety Mohamed , Massias Samuel , Salsabil Sharaf , Owera Anas 
Published: November 2022

Abstract

Aim
Assess the outcomes of suspected appendicitis patients who had an abdo-pelvic ultrasound, and whether the scan made a difference to their management.

Method
Cycle 1: we collected data retrospectively for confirmed appendicitis patients admitted for the period betweeen 03/06/2021–01/09/2021. Clinical coding department supplied a database of EAU admissions diagnised with appendicitis based on histology. Cycle 2: we collected data retrospectively for all surgical patients with acute abdominal pain during the period between 1/11/2021–30/11/2021. Ultrasounds requested were provided by the Radiology department. Admission summaries were used to assess patients' management.

Intervention
Presentation of Audit results in departmental teaching, Teaching to junior doctors on the NICE guidelines for management of Appendicitis.

Results
Cycle 1: Out of 60 patients, only 10 were included as most patients had CT scan. 25% of which suggested appendicitis and 25% suggested different pathology. The appendix couldn't be visualised in 75%. Cycle 2: Out of 83 patients, 23 patients were included as suspected appendicitis. Confirmed cases were 4.34%, not visualized were 86.96% and NAD 8.70% (their final diagnosis on discharge: Appendicitis). Other suspected pathologies of biliary, gynaecological and post-op collections were mostly correctly confirmed/denied.

Conclusions
Ultrasound was very informative in Biliary pathology, Gynae Pathology, Other pathology like Hematoma, post-op collection. However, in terms of suspected appendicitis, it was only informative in a rare occurrence. Of the patients who were diagnosed as Appendicitis in the final diagnosis, only an eighth were confirmed by US. Ultrasound didn't change the management plan in majority of patients with suspected appendicitis.
TH5.10 Results of a pilot programme of Care of the Elderly inreach in Emergency General Surgery patients
Authors: Nair Nandu , Kalatzis Vasileios , Gaunt Anne , Dawson Julian , Rao Vittal , Browne Marilyn 
Published: November 2022

Abstract

Introduction
Due to adverse outcomes in patients age &gt;65years who undergo emergency laparotomy NELA suggests surgical units engage with care of the elderly inreach services. This twelve week pilot programme ran during the summer of 2021.

Aim
To assess the feasibility and benefits of elderly care review of acute general surgical patients aged &gt;65 years.

Methods
Surgical team identified elderly patients requiring medical input which were reviewed by the elderly care team. Outputs of consultations were recorded and standard proforma developed.

Results
129 reviews (male- 63, female- 66) of 121 patients, aged 65–94, were seen between 1st June and 31st August 2021. There were 13 patients more than 90 years old. 54 patients had undergone an emergency operation and 36 had bilio-pancreatic disease. 23 patients needed modification of medications for management of heart failure, fluid balance and Parkinson's disease. Further medical investigations for pre-existing medical conditions were arranged and acted upon. There was significant help in managing patients with delirium and in organizing follow up in memory clinic. SNPs were trained in comprehensive review of elderly patients including clinical frailty score and delirium wheel app to aid in assessment.

Conclusion
There was evidence that review by the elderly care team helped in preventing call out to the on call medical team and in optimisation of medical comorbidities in complex older patients. Referral criteria to elderly care around medical optimisation and polypharmacy for complex pre-existing disease, management of delirium, discharge planning and end of life care have been developed.
TH6.1 Fasting times and medication administration in ‘nil by mouth’ emergency surgery patients
Authors: Oxley Catherine , Lingam Gita , Metcalfe Matthew 
Published: November 2022

Abstract

Aims
1) To determine whether ‘nil by mouth’ (NBM) emergency surgery patients are fasted for longer than the recommended 6 hours for food and 2 hours for clear fluids. 2) To establish whether oral medications are being correctly administered/omitted in these patients.

Methods
Fasting and medication administration data were collected prospectively on patients who received emergency surgery over a 2- week period. Drug administration decisions were categorised as ‘correct’ or ‘incorrect’ by comparison with local guidelines.

Results
A total of 65 patients were identified with the average preoperative fasting times being 24 hours for food and 14 hours for clear fluids. However, the range of fasting times exceeded 110 hours. Notably, only 16 (25%) patients had a drink while they were NBM and 29 (45%) patients were incorrectly administered medications, including several instances of omission of critical drugs.

Conclusions
Further work is needed to establish the cause of prolonged fasting periods. However, likely factors include; operation scheduling difficulties, lack of understanding of NBM guidelines, inadequate communication with patients, and patient choice. This is resulting in poor preoperative optimisation of patients (e.g. dehydration of patients), as well as a significant risk to patient safety with critical medications being omitted.
In order to rectify the severe lack of adherence to the guidelines, we are introducing further NBM training for medical professionals in our trust, in addition to updating the current trust guideline to reflect a wider range of medications and keep up to date with current national guidance.
TH6.2 Day Case Laparoscopic Appendicectomy for Acute Appendicitis In Adults: A Retrospective Case Series Study
Authors: Peristeri Dimitra , Jaunoo Shameen 
Published: November 2022

Abstract

Aims
Laparoscopic appendectomy (LA) is nowadays considered the standard of care as it is associated with shorter hospital stay and fewer complications. The purpose of this study was to assess the safety of same-day discharge after laparoscopic appendectomy for acute appendicitis at a tertiary Care Center.

Methods
A retrospective chart review was performed for patients &gt;18 years old who underwent LA for acute appendicitis in 2021. Patients were categorized into 2 groups: discharge in &lt;24h or admission for &gt;24-h. Demographic data, postoperative length of stay, histology report, complications and readmission rates were abstracted from patient medical records.

Results
A total of 303 laparoscopic appendicectomies were included. Of these, 71 patients had Length Of Stay (LOS) less than 24 hours. Pathology, comorbidities, and readmission were recorded. Average LOS for all patients was 7 hours with a minimum stay of 4 hours and a maximum stay of 23 hours. For patients discharged in less than 24 hours, there was no readmission and 58 (19.1%) of these patients had simple appendicitis on pathology. A total of 26 patients (8.58%) were discharged in less than 7 hours (from the recovery room). There was no significant difference in complications or readmission between patients discharged in less than 24 hours and those who stayed longer.

Conclusion
Day case LA is a safe and effective practice for treating selected patients with non-perforated appendicitis, as it decreases the length of stay and hospital charges.
TH6.3 Establishing a sexually transmitted infection (STI) testing programme in an ambulatory surgical clinic for female patients aged 18–44 years presenting with abdominal pain
Authors: Please Helen , Mahon Ciara , Hughes Michael , Ewans Michael , Hartley Anna , Peckham-Cooper Adam 
Published: November 2022

Abstract

Introduction
Young females presenting to hospital with acute abdominal pain (AP) are often discharged without clear diagnoses. Gynaecological causes including chlamydia and gonorrhoea (C&G) are increasing, however STI testing remains underutilised. This study aims to:
1. Establish robust STI testing in an ambulatory surgical clinic (ASC), utilising collaborative pathways between GUM and EGS services.
2. Identify barriers.

Methods
This pilot ran from October to December 2021. GUM-led training for all ASC staff was delivered. All females (18–44yrs) presenting to ASC with AP were offered vulvo-vaginal self-swabs (VVS) and a patient information leaflet. Positive results were referred to GUM for treatment and contact tracing. Following the pilot, a focus group was facilitated to identify barriers and potential improvements.

Results
Twelve eligible patients (mean 28yrs) consented to testing. All results were negative for C&G. Fifteen patients declined (mean 33yrs). The remaining eligible population were not approached. Barriers identified included: nursing staff concerns that offering VVS could make patients feel judged regarding sexual promiscuity; male staff being uncomfortable discussing VVS; concerns regarding other patients overhearing; and a single toilet being inadequate for testing.

Conclusions
The pilot confirmed a robust STI testing programme can be delivered within ASC, which we believe is the first in the country. Strong collaborative working between EGS & GUM teams delivered clear mutually beneficial pathways. However, low numbers of patients undertook testing, accounting for the lack of positive results. Clear barriers were identified which are being addressed prior to delivery of a second pilot period and pathway rollout.
TH6.4 Clinical Audit on the Assessment and Management of Lower Gastrointestinal Bleeding: A Single Centre Experience
Authors: Ling Quake Sharmaine Yen , Johnson Charles , Coulson Alastair , Courtney Michael 
Published: November 2022

Abstract

Aim
To audit our local practice in the management of patients with lower gastrointestinal bleeding (LGIB) against the 2018 British Society of Gastroenterology (BSG) acute LGIB guideline

Method
Patients aged ≥18 years presenting with LGIB at our local trust between January 2020 – May 2020 were included. Data were collected via electronic documentation to identify the following: shock index (SI), whether patients with high-risk Oakland score (&gt;8) were admitted and inpatient investigations received including CT angiogram (CTA), OGD and colonoscopy. Data were analysed according to two patient groups: unstable bleed (SI &lt;1) and stable major bleed (SI&gt;1 with Oakland score &gt;8).

Results

Conclusion
There are potential barriers to implementation of the BSG LGIB guideline, such as reduced awareness of the BSG recommendations, resource availability and economic implications.
TH6.6 Characteristics of Cervical Lymph Node Involvement in Papillary Thyroid Carcinoma
Authors: Rezkallah Emad , Elsaify Wael 
Published: November 2022

Abstract

Background
Papillary thyroid carcinoma (PTC) accounts for 80–85% of all thyroid carcinoma. The SR reaches over 90% over a 10-year of follow-up. The frequency of cervical lymph node metastasis ranges from 40–90%.
We analyzed the data of 37 PTC patients who underwent thyroidectomy and neck dissection to illustrate the pattern of cervical lymph node metastasis in PTC.

Methods
Retrospective review of 37 patients who underwent thyroidectomy with neck dissection for PTC. Preoperative assessment included FNAC, US +/- CT/MRI scans.

Results
The patients’ average age was 44± 19.5 years. Female to male ratio was 1.5:1. The incidences of lymph node metastasis according to the neck level were; 40.5% (15) at level II, 67.6% (25) at level III, 45.9% () at level IV, 16.2% (6) at level V, 54% (20) at level VI, while no metastasis was found at level I. 29 cases (78.4%) had multiple levels involvement, while 6 patients had single level metastasis; 5 at level VI and one at level II. Two patients had no metastatic lymph nodes.

Conclusion
Selective neck dissection has proven to reduce the potential morbidity associated with more extensive neck dissection without affecting the oncological outcomes. Levels III and IV are commonly involved, and usually dissected in continuity. Level II dissection is recommended whenever there is extensive involvement of levels III/IV. Level VI is usually dissected, even as a prophylactic procedure due to the high frequency of microscopic metastases. Level V dissection is usually not recommended unless involved. Involvement of Level I is rare.
TH6.7 Direct Streaming of Acute Surgical Patients to an Advanced Nurse Practitioner-led Service: A Prospective Audit of a Pilot Service to Improve Patient Flow
Authors: Riley Anna , Aherne Aileen , Box Joe , Grady Natalie , Maria Jashmin , Chan Anthony 
Published: November 2022

Abstract

Aims
The ongoing uncertainty of the COVID-19 pandemic and recovery to re-establish elective services presents a major challenge to the NHS. Patient flow and bed capacity is now a priority for acute hospitals. We have implemented a new service model aimed at improving patient flow from A&E, where acute surgical patients are triaged and referred directly to the Advanced Nurse Practitioner (ANP) team for assessment and management. A criterion based on the presenting complaint and clinical observations was developed to identify suitable patients. The utilisation of this service was audited for its safety and impact on the Emergency General Surgical provision.

Methods
The setting is a busy University Teaching Hospital with a diverse catchment population of 75,000. A prospective audit identified the number of patients utilising the new care pathway and details of any adverse events or delays in treatment identified. All patients presenting with a General Surgical condition were included.

Results
Between August and December 2021, 361 patients were referred directly from A&E (81% within first 2 hours of presentation) to the surgical ANP team for assessment. Of these, 85 (24%) were admitted for emergency treatment and 276 (76%) were discharged the same day for either ambulatory or outpatient follow-up, or back to Primary Care. There were no adverse events identified during the audit period.

Conclusion
Direct streaming of acute surgical patients within a defined criteria to an ANP-led service is safe and effective in helping to improve patient flow and experience within an acute care model.
TH6.8 The Utility and Impact of Advanced Nurse Practitioners in Unplanned Surgical Admissions: A Review of the Literature
Authors: Riley Anna , Tod Angela , King Rachel , Chan Anthony , Robertson Steve 
Published: November 2022

Abstract

Aims
Advanced Nurse Practitioners (ANP) are well established within acute medical and Critical Care environments. The evolution of surgical ANPs have tended towards preoperative roles, such as anaesthesia or scrub, with few clinical roles involving the assessment of acute patients or inpatient care. The Royal College of Surgeons of England have recently recognised, by professional membership, the roles of non-medical members of the surgical team, such as ANPs and physician associates. This review explores the areas of impact of ANPs on the emergency General Surgery service provision to help develop the role of the modern surgical ANP.

Methods
A scoping literature review was performed to identify themes of ANP function and outcome. Search terms such as “Advanced Nurse Practitioners”, “Surgical Assessment Units” and “outcomes” were combined with Boolean operators to query PubMed, BNI, CINAHL, Google Scholar and HMIC databases. Studies in the last decade were included.

Results
We identified and screened 54 unique articles. 40 articles were reviewed for eligibility and 21 were included in this review. A thematic analysis identified the impact of ANPs on the process of care (such as assessment and treatment waiting times and patient satisfaction) and outcomes of care (readmission rates, length of stay and cost-effectiveness).

Conclusion
Research into the impact of ANPs are largely focused on objective outcome measures and within non-surgical specialties. Whilst this review demonstrates the positive aspects of ANP care on emergency care, we identify a paucity of evidence on patient-focused outcomes and the impact of ANPs on the patient journey within surgery.