bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH6.9 Does the management of right iliac fossa pain vary between men and women?
Authors: Smellie Eloise , Doughty Alice , Cheetham Stephanie , Kenber Melisa , Saha Arin 
Published: November 2022

Abstract

Aims
Recent studies have suggested that women are more likely to suffer a bad outcome after surgery compared to men with similar findings in healthcare areas including pain management and diagnosis. This study aimed to assess the management of female patients with right iliac fossa (RIF) pain.

Methods
Patients who presented to a DGH general surgical unit with RIF pain from March to October 2020 were identified from a prospectively maintained database of admissions. Clinical parameters, management and final diagnosis were recorded. Minimum follow-up was 12 months (October 2021) to identify re-admissions and morbidity.

Results
There were 417 patients; 274 (66%) were women. Women were more likely to have an ultrasound (39% vs. 4%, P&lt;0.001) and less likely to have a CT (60% vs. 67%, P=0.250), though they had the same proportion of normal CT imaging (33% vs. 34%). Men were more likely to undergo surgery (49% vs. 29%, P&lt;0.001) but, despite this, women were more likely to have a diagnostic laparoscopy alone or a normal appendix after appendicectomy (15% vs. 4%). The proportion of women without a definitive diagnosis was greater (39% vs. 32%, P=0.024) and only 4 women were referred on for further investigations leading to a greater proportion of re-admissions with ongoing pain amongst women.

Conclusions
More women than men with RIF pain did not have a diagnosis and women were more likely to have ‘unnecessary’ surgery. Closer attention to gynaecological past medical history or symptoms may improve diagnostic yield and management of women with RIF pain.
TH6.11 Successful Relaunching of NELA at an inner City District General Hospital: Need for Multidisciplinary Approach
Authors: Sarodaya Varun , Gohil Bhavesh , White Alastair , Garg Arti 
Published: November 2022

Abstract

Introduction
The national case ascertainment rate for National Emergency Laparotomy Audit (NELA) over 179 hospitals is 84.5%. Our hospital is one of the few hospitals despite being eligible, had not submitted any data to the NELA for the past three years.

Methods
We retrospectively collected data for all the patients that underwent laparotomy for a period of 2 years. The mean age of patients was 58 years. We found 83 patients who fit the NELA inclusion criteria from January 2020 to November 2021.

Results
The 83 patients were divided into low risk (&lt;5%) and high risk (&gt;5%) and further analysed. The results of the high risk group are illustrated in Table 1.

Discussion
There were various factors which resulted in a low compliance rate. These included a lack of surgical / anaesthetic trainees, a poor understanding of NELA and an overall reluctance to engage in data collection. By re-engaging with NELA data collection, we have facilitated discussion and education regarding laparotomy care at NUH on a multidisciplinary level. We hope to demonstrate improvements in care with subsequent re-audit.

Conclusion
NELA is a useful audit for the comparison of national care. It allows for reflective practice at local level with aim to deliver a uniform standard of care.
TH6.12 Predicting Mortality and Morbidity in Oesophageal perforation: A Review of Current Tools
Authors: Alasmar Mohamed , Shehata Zak , Altarawni Mohammad , Casey Patrick , Melhado Rachel , Sultan Javed 
Published: November 2022

Abstract

Aim
Oesophageal perforation is a challenging condition associated with high mortality and morbidity. There is a lack of consensus regarding the optimal treatment strategy, when and whom to operate on.
The aim of this study is to identify the optimal morbidity and mortality risk prediction tool for patients with oesophageal perforation.

Methods
We compared and validated commonly used risk prediction models, including the Pittsburgh Severity Score (PSS), the National Emergency Laparotomy Audit score (NELA score), the Portsmouth Physiological and Operative Severity Score for the enumeration of Mortality (P-POSSUM), and the Surgical Outcome Risk Tool (SORT) using a dataset of 83 patients ranging from 2009 to 2021. The ability to predict morbidity was assessed using the comprehensive complication index (CCI). The CCI was calculated for both operative and non-operative cohorts.

Results
Of the scores assessed, NELA showed the most robust predictive value for in-hospital mortality, 30-day mortality, and 90 mortality (AUROC 0.812, 0.8602, 0.8302, respectively). The PSS also showed significant predictive value for in-hospital mortality, 30-day mortality, and 90 mortality (AUROC 0.792, 0.856, 0.813 respectively). Furthermore, NELA had the strongest correlation between score and CCI (rs 0.644 p&lt;0.001).

Conclusion
Despite not being validated for oesophageal pathology, NELA appears to be the optimum scoring model to predict mortality and morbidity for this patient population. This is the first study to compare the efficacy of different risk prediction models in oesophageal perforations and could be used to inform shared decision making and peri-operative outcomes. Further large-scale validation of risk prediction tools is required to corroborate these findings.
TH6.13 Post-Operative Pain Management Following Emergency Laparotomy
Authors: Shepherd Thomas , Butterworth James , Islam Rafiza , Asante Kirsty , Oke Olatokunbo 
Published: November 2022

Abstract

Aims
Post-operative pain is a common yet challenging presentation. Although an expected part of the acute recovery phase, uncontrolled pain is associated with poorer patient experience, delayed functional recovery and increased morbidity. Up to 40% of patients report severe pain that negatively impacts on their post-operative recovery. We aimed to determine whether post-operative complications and length of hospital admission were associated with choice of analgesic agents.

Methods
We conducted a retrospective observational study of 42 patients who underwent a laparotomy between March – May 2021. Data was extracted from patients electronic medical records and summarised in Microsoft Excel. Statistical analysis was performed using the Chi-Squared and Mann-Whitney U tests.

Results
22 patients (52.4%) experienced post-operative complications whilst 20 (47.6%) did not. In those without post-operative complications, a greater proportion received Patient Controlled Analgesia (PCA) compared to those with post-operative complications (17, 85% vs 11, 50%, p = 0.02). We also observed a trend towards greater use of Oxycodone (11, 55% vs 6, 27%) and Meptazinol (11, 55% vs 7, 32%) in those without post-operative complications (p= 0.07 and p = 0.13 respectively). The length of hospital admission was significantly shorter for patients who received PCA (median = 11 days) compared to those who did not (median = 15 days) (U = 111.5, p = 0.04).

Conclusions
This study emphasises the importance of effective post-operative analgesia in reducing post-operative complications and improving speed of recovery. We suggest that the use of PCA should be encouraged for post-operative analgesia following emergency laparotomies.
TH7.1 Patient Reported Outcomes and Experiences Following Emergency Laparotomy: A Mixed-Methods Patient Survey
Authors: Silva Louise , Abbas Sarah Mohammed , Watts Tessa , Torkington Jared , Cornish Julie 
Published: November 2022

Abstract

Aims
Emergency laparotomy (EmLap) is a “life-saving” procedure, but little is known about how “life-changing” it can be.
This study aims to establish the impact of EmLap using PROMs and PREMs.

Methods
All surviving patients who had an EmLap from 2016–2019 were included. Eligible patients were invited to complete a postal questionnaire. Responses underwent qualitative and logistical regression analysis.

Results
Response rate was 42.6% (n=310). 11.3% reported that they had not resumed intimacy post-op. Patients were less likely to resume intimacy if they were &gt;80 years (OR 10.500, p0.003), had a return to theatre (OR 5.111, p0.017), IBD diagnosis (OR 5.00, p0.009) or stoma (OR 4.906, p0.003). Patients were more likely to change employment if female (OR 2.858, p0.009), more comorbid (ASA3 OR 5.000, p0.024), had a stoma (OR 4.006, p&lt;0.001), or incisional hernia (OR 4.228, p&lt;0.001).
Qualitative analysis revealed deconditioning, lack of employer support, and delays to reconstructive surgery were the main reasons for not returning to work.
Qualitative analysis of experience exposed a number of unmet needs: surgical “debrief” and “what to expect” (33.6%), surgical aftercare (25.2%), mental-health support (22.6%), and timely restorative surgery (11.7%). 88.1% felt a specialist nurse would have improved their experience. Patients were more likely to have reported a negative experience if they had benign disease (p0.010).

Conclusion
This is the first study to describe PROMS and PREMS following EmLap, and also to identify patients at risk of poor outcome. It advocates the need for an EmLap specialist nurse to facilitate holistic aftercare.
TH7.2 The EXTEND trial: EXTENDed antibiotics to improve outcomes in patients with complicated Intra-Abdominal Infection (cIAI)
Authors: O'Connor Olivia , Ahmed Shadia , Burke Dermot , Kirby Andrew , Pinkney Thomas , Szakmany Tamas 
Published: November 2022

Abstract

Introduction
Complicated intra-abdominal infections (cIAI) pose a major challenge in surgical patients. Despite the heterogenous aetiology they have a common disease process, which is bacterial infection of the peritoneal space. Hence, all cIAIs are managed with source control, plus antibiotic therapy. However, there is uncertainty regarding the optimal antibiotic treatment strategy in order to prevent relapse or extra-abdominal spread of infection. Presently, there is no UK guidance on the management of cIAIs. For other serious infections outside the abdomen microbiologists often advise at least 28-days of antibiotics. Currently the effectiveness of extended duration antibiotics in patients with cIAI is unknown. This trial aims to compare the clinical and cost effectiveness of 28-day duration antibiotics with standard care with respect to rate of treatment failure in patients with cIAIs. Secondary outcomes include complications and quality of life.

Method
A multicentre, open label, two-arm, parallel group, pragmatic, randomised controlled trial with internal pilot. A total of 1166 consenting adult patients with cIAI will be recruited over 3 years and randomised on a 1:1 basis between 28-days antibiotics and standard care antibiotics. Patients will be recruited from ICUs and hospital in-patient wards across 30 sites.

Trial management and funding
EXTEND is sponsored by University of Leeds and hosted by York Trials Unit. It is funded by the NIHR. The Trial Management Group will oversee design and running of the trial. Each site will have a Principal Investigator (PI) with local responsibility. The NIHR Associate PI scheme will be adopted to enable trainees to participate in the trial.
TH7.4 Improving quality of message taking for on-call surgeons unable to answer calls during emergent operating
Authors: Walters Anna , Sanders Katie , Marsh Robyn , Malik Mariam , Stonelake Stephen 
Published: November 2022

Abstract

Aims
Responding appropriately to messages taken by theatre staff whilst the on-call surgeon is performing emergency operations is an important aspect of emergency care. As part of a quality improvement project we produced a standardised proforma aiming to ensure messages had sufficient information to enable the on-call surgeon to prioritise referrals according to clinical urgency

Methods
Written messages from emergency theatre were collected from February to December 2021. A new proforma for message taking was introduced in May 2021. This consisted of a pre-printed A5 sheet with space for eight specified informatics to be recorded alongside the free-text message; namely, patient name, DOB, PID, location, name and role of caller and time of message. Additionally, the urgency and early warning score could be recorded. The presence or absence of the above 8 key pieces of information was examined and the score was recorded pre and post intervention.

Results
There was 60% (32/53) uptake of the new proforma following its introduction. The mean quality of information score for 60 messages pre-intervention was 2.6/8 (range 1–6) compared with 3.9/8 (range 1–8) in 53 messages collected post-intervention (P = &lt; 0.01). One out of 60 (2%) versus 11/53 (21%) had the level of urgency stated in the pre-intervention and post-intervention group respectively. Three of the 11 urgent messages additionally included patient's observations and early warning score.

Conclusions
This simple and reproducible proforma produced a quantifiable improvement in the quality of messages received, enabling the on-call surgeon to better prioritise care for emergency surgery patients.
TH7.5 De Garengeot hernia: a combination of niche presentation, diagnostic, and anatomical factors
Authors: Sylvester Rochelle , Singh Gautam , Haque Ali 
Published: November 2022

Abstract

Background
De Garengeot hernias occur in almost 1% of femoral hernias and are diagnosed when the appendix is also present within. They are more commonly observed in post-menopausal women, but their pathogenesis remains controversial. Theories involve abnormalities in bowel rotation during embryological growth, caecum mobility or size, and increased abdominal pressure. Most are diagnosed intra-operatively and are otherwise incidentally discovered on imaging. An advised surgical technique has not been determined due to its rarity; however, most literature suggests laparoscopic hernioplasty and appendicectomy in absence of infection.

Case report
A 77-year-old female presented with a three-day history of a painless, right groin mass. Blood results were within normal range, and sonography identified a De Garengeot hernia suggesting appendiceal inflammation. She underwent emergency laparoscopic surgery that discovered a strangulated appendiceal tip within an incarcerated femoral hernia, which then unexpectedly divided during manipulation. Additional findings included a broad mesoappendix and lack of appendicitis. The team proceeded with a hernioplasty and appendicectomy, and the patient was discharged two days later without complications.

Conclusion
This case report highlights a few niche aspects of De Garengeot hernias. Firstly, it is unusual our patient's diagnosis occurred preoperatively via ultrasound; secondly, the ischaemic tip of the appendix unexpectedly self-detached upon mobilisation; and thirdly, the widened mesoappendix likely contributed towards her predisposition to De Garengeot hernias. Overall, our case represents laparoscopic surgery being optimal in treating De Garengeot hernias that are diagnosed preoperatively, and that they should remain a differential diagnosis for non-specific groin lumps, regardless of pain.
TH7.8 Delayed Diagnosis of Duodenal Injury in Blunt Abdominal Trauma following a normal initial Computed Tomography scan: A Systematic Review
Authors: Westerman Robyn , Stathakis Panos , Goldsmith Paul , Smith Stella , Macutkiewicz Christian , Chan Anthony 
Published: November 2022

Abstract

Aims
Isolated duodenal injury and perforation can result from blunt abdominal trauma (BAT) in approximately 5% of patients with intrabdominal injuries. Modern major trauma pathways mandate computed tomography (CT) as part of the primary assessment. The evolution of a duodenal injury to a perforation can be delayed. The aim of this review is to ascertain the proportion of false negative CTs for duodenal perforation in BAT.

Methods
A systematic review of the literature was conducted using PubMed, Embase and OvidSP databases to include search terms “blunt abdo*”, “duoden*”, “trauma”, and “computed tomography” combined with Boolean operators. Data were extracted from studies that report data on patients following BAT with a normal initial CT who subsequently develop a perforation. Studies were limited to the last 10 years.

Results
There were 315 articles identified, which after excluding duplicates and screening, 18 articles were reviewed in detail and 6 articles (3 case studies and 3 retrospective cohort studies) included in the final review. Across the 6 studies, a total of 159 patients suffered BAT with 29 patients (18%) having a normal CT on admission. The majority of patients underwent a repeat CT within 24 hours which then subsequently revealed radiological signs of a duodenal injury/perforation.

Conclusion
Patients who present with following BAT should be closely observed for delayed clinical signs of visceral perforation. CT (preferably with oral contrast) should be performed if there is any clinical suspicion of perforation, even if the timeframe is within 24 hours of the initial CT scan.
TH7.10 Extraction site hernias following Laparoscopic Right Hemicolectomy: Does location matter?
Authors: Smith Laurie , Filby Joseph , Coxon Harriet , Cornish Julie , Torkington Jared 
Published: November 2022

Abstract

Introduction
Laparoscopic colorectal surgery is the gold standard treatment for patients requiring colorectal resection, however the need to exteriorise the specimen and perform extracorporeal anastomosis leads to a risk of incisional hernia. Robotic surgery may facilitate intracorporeal anastomosis which could potentially negate the need for an umbilical extraction site. This study compares current practice of transverse versus midline extraction sites for laparoscopic right hemicolectomy and the incidence of incisional hernia.

Methods
A retrospective collection of all patients undergoing laparoscopic right hemicolectomy between 2018 and 2020 was performed using OPCS theatre codes. Only those undergoing laparoscopic right hemicolectomy, who had cross-sectional imaging post-operatively were included. Operation notes were scrutinised to identify extraction site and closure method. Post-operative CT scans were reviewed by a radiologist to identify presence of incisional hernia.

Results
Of 103 patients, 50 met the inclusion criteria. 25 were male. The mean age was 67 (Range = 21–85). 31 patients had midline extraction sites, with 19 having transverse. The average time from operation to CT was 662 days (314–1094) and 34% (n=17) had incisional hernia identified on a CT scan post-operatively. Midline extraction sites were associated with a significantly higher rate of incisional hernia when compared to transverse sites (n=16/31, 1/19; p&lt;0.01).

Conclusion
Transverse extraction sites are associated with a lower risk of incisional hernia after laparoscopic right hemicolectomy and should be preferred to midline incisions where possible. As intracorporeal anastomosis becomes a more established technique, further work is needed to determine optimum extraction site to further reduce the risk of incisional hernias.
TH7.12 Improving electronic prescribing of mechanical VTE prophylaxis in general surgery patients
Authors: Gunn Christopher , Alam Imran 
Published: November 2022

Abstract

Aims
Mechanical VTE prophylaxis forms part of NICE guidance in general surgical patients. Locally, thromboembolic deterrent (TED) stockings are used but not available as a prescription item on the electronic system. They are often prescribed verbally or via noted plans but do not appear on the medication administration record. Importantly, multiple incidents of patient harm through pressure damage have been seen due to poorly checked TEDs. Our aim was to audit and improve safe mechanical VTE prophylaxis prescribing.

Methods
At each cycle, we retrospectively collected data from two weeks of admissions. Data relating to VTE assessment completion, VTE score, TEDs in use, TEDs prescription and LMWH prescription was collected. Our initial intervention consisted of departmental education regarding a work around enabling TEDs to be prescribed as a freehand extra-formulary item. This was reaudited at 12 months.

Results
All patients in both cycles had VTE assessments completed. TED stocking use increased significantly from 5.1% to 26.4% and prescription of TEDs, when used, increased from 0% to 61.1%. However, documentation regarding daily checks was non-existent.

Conclusions
Our QIP showed a significant improvement in TEDs use and prescription. However, the intervention is difficult and time consuming. Subsequently from this project, a TEDs stocking item is in the final approval phase for integration into the online prescribing system and will come with associated safety checks built into the nursing medication administration system. Once this is live, we will complete a third cycle to assess uptake and again at 6 months to assess for lasting change.
TH8.1 Radiological incidence of donor-site incisional hernia and parastomal hernia after Vertical Rectus Abdominus Myocutaneous Flap-based reconstruction following colorectal surgery
Authors: Tang Alethea , Spencer Naomi , Parkins Kristie , Bevan Victoria , Drew Peter , Harries Rhiannon 
Published: November 2022

Abstract

Aims
The vertical rectus abdominis myocutaneous (VRAM) flap is commonly used to reconstruct perineal defects for low rectal and anal cancer. The incidence of midline incisional hernias after VRAM reconstruction varies from 3.6% when detected clinically to up to 50% when detected radiologically. The aims of this study is to accurately determine the radiological incidence of donor-site incisional and parastomal hernia following VRAM reconstruction.

Methods
Retrospective cohort study of patients undergoing colorectal surgery requiring VRAM reconstruction over 10 years. Data were collected on patient demographics, indication for surgery and surgical procedure including details of any hernia repair. Images from surveillance CTs were reviewed for presence and size of midline incisional and/or parastomal hernias. Parastomal hernias were classified based on the European Hernia Society (EHS) classification.

Results
173 patients were included in the analysis. The median age was 67 years (range 29 – 88 years) and median length of follow up was 49 months (IQR 24.3 – 71.0 months). The overall radiological incidence of incisional hernia was 27.6%. The radiological incidence of donor-site incisional hernia after VRAM at 1, 2 and 5 years was 16.8%, 25.2% and 18.5%. The parastomal hernia incidence at 1, 2 and 5 years was 37.9%, 44.1% and 29.8% (48.6% overall).

Conclusions
The majority of patients who develop donor-site incisional hernia and parastomal herniation following VRAM tend to do so within the first two years. Although the use of CT imaging improves the diagnosis of donor-site incisional and parastomal hernias, the clinical significance of this is unknown.