bluuebunny/crossref_metadata_2025_split huggingface dataset:
TH7.3 Is CT a valid tool for diagnosing acute appendicitis in patients aged 40 or older?
Authors: Stockdale Thomas , Lam Angela , Thiruppathy Kumaran 
Published: November 2022

Abstract
To establish whether computerised tomography abdomen and pelvis (CTAP) with contrast is a necessary tool in the diagnosis of acute appendicitis in those aged 40 years or older compared to clinical assessment alone.
The study was performed in a district general hospital in England. A retrospective analysis included 314 patients aged 40 years or older who presented between 3rd October 2020 and 31st October 2021 and received a CTAP with contrast where the request queried appendicitis. An Alvarado score was calculated for each patient as a measure of clinical likelihood of appendicitis based on documentation from their initial assessment by a General Surgeon.
CTAP demonstrated evidence of acute appendicitis in 46.1% of patients. CTAP diagnosed alternative pathologies in 41.1% of patients. These included diverticulitis (10.5%), gynaecological pathology (4.5%), urological pathology (3.2%), malignancy (2.9%) and others (19.4%). 11.8% demonstrated no cause for symptoms. Furthermore, those with an Alvarado score of 9 or more, 94.9% had a CTAP reporting appendicitis. With scores of 3–8, only 49.4% had a CT finding of appendicitis and this dropped to 5.0% with scores of 0–2.
This study supports using CTAP to aid in diagnosing appendicitis in patients aged 40 years or older with Alvarado scores of 8 or less. However, patients scoring 9 or more had a 94.4% positive finding of acute appendicitis on CTAP, thus potentially negating the need for a CTAP scan pre-operatively. Alvarado scores of 2 or less suggest an alternative diagnosis is more likely, however CTAP may still be a valid investigation.
TH7.9 A retrospective audit of the investigation and management of acute pancreatitis (AP) in a tertiary referral hospital in Ireland
Authors: Ankatiah Sarita , Julius Barbara , Falusi Juliana , Baban Chwanrow , Merrigan Anne , Tormey Shona 
Published: November 2022

Abstract

Aims
This audit aims to determine if standards of best practice according to NICE guideline pancreatitis (September 2018) are being met.

Methods
Using the Hospital In-Patient Enquiry (HIPE) system, 129 admissions with AP during 2020 were retrospectively identified. Audit targets included adequate fluid resuscitation and nutritional support, frequency of radiological investigations, emergency cholecystectomy, lifestyle advice and appropriate follow up.

Results
Aetiologies identified were biliary (33.3%), alcohol (33.3%), idiopathic (7.8%), hypertriglyceridemia (3.8%), autoimmune (1.6%), medication (0.8%), anatomical variant (0.8%) and the remainder (18.6%) were unidentified since not fully investigated (NFI). 47.3% (n=61) had ultrasound while 61.2% (n=79) had computed tomography of abdomen and pelvis (CTAP) during hospital-stay. Out of 33.3% (n=43) with biliary aetiology, 25.6% (n=11) had successful ERCP and 41.9% (n=18) were referred for outpatient clinic or already awaiting outpatient laparoscopic cholecystectomy. No emergency cholecystectomies were performed. Out of 28 readmissions, biliary pathology accounted for 35.7% (n=10), alcohol 25% (n=7) and NFI 17.9% (n=5). 37.2% (16) of alcoholic pancreatitis admissions had documented cessation advice either as in-patient or on discharge. There was no documentation for HbA1C in 6 months or DEXA scan in 2 years’ time, or a yearly fecal elastase for chronic pancreatitis patients.

Conclusion
Audit of current practice identified areas for improvement, including bettering access to emergency theatre, increased focus on encouraging lifestyle modification and monitoring pancreatic endocrine and exocrine function. We aim to create an institutional standard operating procedure for investigating and managing pancreatitis, and re-audit next year to discern if management has moved closer to the established standard.
TH7.11 Developing a new TAMIS service at a district general hospital. A dual consultant experience
Authors: Lord Ian , Ward Nicholas , Mishra Ami 
Published: November 2022

Abstract

Aim
To evaluate the development of a Transanal Minimal Access Surgery (TAMIS) service at a district general hospital.

Method
In 2017, a TAMIS service was set up at our hospital by 2 consultants trained in single port laparoscopic and transanal endoscopic techniques. Benign rectal polyps and early cancer cases were performed as dual consultant procedures. All cases were reviewed in the colorectal MDT pre-operatively. Data was collected prospectively for patient demographics, co-morbidity, length of stay, complications, pathology and surveillance outcomes.

Results
Between May 2017 and July 2021, 31 TAMIS procedures were performed. The median age was 73(34–87) with 17(55%) male and 14(45%) female patients. The indication for resection was adenomatous polyps in 20(65%) patients and adenocarcinoma in 11 (35%) patients. The median diameter of benign polyps was 44mm(25–105mm). At a median follow up of 8 months (0–48 months) there were no recurrent polyps.
Rectal cancers had a median size 23mm (11–32mm). Nine cancers were T1 (82%), one T2 (9%), and one T3(9%). All cancers were R0 resections. At a median follow up of 15 months (3–43) there were no locoregional or distant recurrences. The median length of stay was 1 day (0–2). There was no post operative mortality. The readmission rate was 5% with two Clavien-Dindo grade 1 complications.

Conclusions
Dual consultant operating in the early phase of this service's development has allowed for experience to be concentrated and shared problem solving, resulting in encouraging early outcomes with no local recurrence, short inpatient stay and minimal morbidity.
TH8.3 Single incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy- A rural center experience
Authors: Ravindran Sharanya , Venkat Shruthi 
Published: November 2022

Abstract

Aim
Single Incision Laparoscopic Surgery (SILS) is a new technique of minimally invasive surgery using a single incision to minimize all ports to one site for a perceived scar less abdomen compared to conventional laparoscopic surgery in terms of complications and patient satisfaction.

Materials & Methods
We report our study conducted in southern India from September 2015 to October 2016, evaluating the possible advantages of SILS versus CLC through a randomized controlled trial. The study population includes patients diagnosed as cholelithiasis. A total of 50 patients underwent cholecystectomy, Patients were randomly assigned to either SILS cholecystectomy or conventional cholecystectomy in 1:1 ratio. Primary end points were operative time, postoperative pain quantified using visual analogue scale, post operative hospital stay and patient satisfaction.

Results
The pain scores measured at 48 hours were significantly lower in SILS (1.3) group than CLC group (2.03). Patients had significant satisfaction score in terms of cosmesis in SILS group (4.25) than Lap cholecystectomy group (3.08) measured at 6 weeks after cholecystectomy. However the post operative stay was similar in both the groups. There was no conversion to open cholecystectomy in both the groups. Patient satisfaction score in SILC (4.25) as found to be higher than CLC (3.08). Operating time was significantly more in SILC (85mins) and post operative stay was lower in SILC.

Conclusion
Based on this SILS offers better cosmetic outcome, however, due to prolonged operating time and steep learning curve CLC is considered a better procedure.
TH8.6 Thoracic sarcoma: three-year data from a tertiary referral centre
Authors: Saifuddin Sarah , Hoppe Solveig , Williams Matthew , Cosker Thomas , Stavroulias Dionisios , Di Chiara Francesco 
Published: November 2022

Abstract

Aims
The rarity of thoracic sarcomas leads to challenges in their diagnosis and evidence-based management. We aim to investigate the management and outcomes of primary thoracic sarcoma patients under the care of our tertiary centre Sarcoma Service over a three-year period.

Methods
Data of all thoracic sarcoma patients discussed at the tertiary centre multidisciplinary meetings from 2017–2019 were collected from the local electronic database.

Results
65 patients met the inclusion criteria. The most common histological subtypes were chondrosarcomas and spindle cell sarcomas. 60% of cases were high-grade sarcomas. 14 out of 19 deaths occurred in patients with high grade sarcomas (p=0.0586). 78.3% of patients underwent surgical resection, with 35.4% undergoing surgical resection as their sole treatment modality. Surgical intervention was associated with a statistically significant improvement in survival (p &lt; 0.0001*). Clear marginal status was associated with better survival outcomes (p = 0.026*). Local recurrence was seen in 15 cases, and 93.3% of these were in high-grade sarcomas. There was no association between recurrence and marginal status. 8 of the 15 cases with recurrence received surgical intervention for the recurrence. 4 of the cases with recurrence passed away within the study time frame.

Conclusion
Primary resection should remain the gold standard for treatment of thoracic sarcomas due to its significant improvement in survival. Variability between outcomes and overall survival is likely multifactorial – diversity of histological subtypes, predominance of high-grade sarcomas, and a wide range of age at diagnosis. Prospectively maintained databases and cross-centre collaboration would be beneficial for future study in thoracic sarcomas.
TH8.7 Impact of routine G&S in Laparoscopic Cholecystectomy on the Trust Resources
Authors: Afonso Matias Mariana Rita , Elnabil-Mortada Ahmed , Money-Taylor John , Gill Emma , Rees Ben , Boyes Simon 
Published: November 2022

Abstract

Background
Despite consistently low bleeding rates in laparoscopic cholecystectomy (LC) (0.1 – 0.46%), preoperative testing of ABO group and Rh (D) – G&S – remain common practice throughout UK hospitals. Current NICE guidelines for routine pre-operative tests for elective surgery don't include routine G&S. Additionally, there have been few recently published articles regarding elective and emergency LC suggesting that the routine practice of G&S are unnecessary, potentially delaying surgeries with significant financial impact. Based on published data, if a patient undergoing LC requires perioperative blood transfusion there is no time to cross match, therefore the major hemorrhage protocol is activated and patient is transfused O negative.

Aim
This project aimed to assess the need for routine G&S in laparoscopic cholecystectomy including impact on Trust resources, national shortage of blood tubes.

Methods
Retrospective data collection regarding 448 patients that underwent LC at Northern General Hospital, Sheffield in 2020.

Results
Between January and December 2020 401 G&S samples were taken during the preoperative assessment, and 425 second G&S samples taken on the day of surgery. Antibodies were identified in 8 patients, although they were not cross matched. Furthermore, none of the 448 patients required blood transfusion during the perioperative period.

Conclusions
Our results highlight that current compliance with NICE guidelines/recent published data is suboptimal. Overall, collecting G&S samples perioperatively takes up resources, time and can delay surgery. Furthermore, Trust savings could be in excess of £8000 in one year. Hence, we are currently reviewing our local policy.
87 Surgical Versus Conservative Management of Acute Achilles Tendon Ruptures; A Systematic Review and Meta-Analysis
Authors: Damisa J 
Published: November 2022

Abstract

Aim
To compare the functional outcomes including re-rupture rates, number of participants failing to return to work or sports and scoring scales between surgical and conservative treatment in a systematic review.

Method
A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement (PRISMA) protocol. Studies were identified from these databases: PubMed, Cochrane and CINAHL. Risk-ratio analysis to compare rupture rates and failure to return to work/sports, whilst a standard mean difference analysis compared the functional outcome scores from both treatment groups.

Results
Seven randomised controlled trial studies included with a total of 486 participants involved in the trials, comprising of 245 participants for surgical intervention and 209 participants for conservative management. There is a higher re-rupture rate in the conservative group compared to the surgical group with a risk ratio (RR) of 0.38 (95% CI 0.16–0.92, P = 0.03). Statistically, there was no significant difference in number of individuals failing to return to work/sports in both treatment modalities, RR for all the three studies were 0.85 (95% CI 0.51,1.41, P = 0.52). A standardised mean analysis with an overall effect Z of 0.40 (std MD 0.09; P 0.69; 95%CI -0.35,0.53) indicate no statistically significant difference in the functional outcomes between the three different studies.

Conclusions
Surgical intervention only shows an advantage over conservative treatment in terms of re-rupture rates but similar results with conservative treatment when other outcomes including number of participants returning to previous activity levels, plantar flexion and functional scoring systems were assessed.
327 To Fuse or Not to Fuse: The Elderly Patient with Lumbar Stenosis and Low-Grade Spondylolisthesis. Systematic Review and Meta-Analysis of Randomised Controlled Trials
Authors: Abdel-Fattah AR , Bell F , Boden L , Ferry J , McCormick C , Ross M , Cameron I , Smith T , Baliga S , Myint P 
Published: November 2022

Abstract

Aim
The optimum surgical intervention for elderly patients with lumbar spinal stenosis(LSS) and low-grade degenerative-spondylolisthesis(LGDS) has been extensively debated. We conducted a systematic review and meta-analysis of randomised-controlled-trials(RCTs) comparing the effectiveness of decompression-alone against gold-standard decompression-with-fusion(D+F) in elderly patients with LSS and LGDS.

Method
A systematic literature search was performed on published databases from inception to October-2021. English-language RCTs of elderly patients (mean age over-65) with LSS and LGDS, who had undergone DA or D+F were included. The quality and weight of evidence was assessed, and a meta-analysis performed.

Results
Seven RCTs (n=581; mean age:65.9 years; 59.9% female) were included. There was no difference in visual-analogue-scale(VAS) scores of back-pain(BP) or leg-pain(LP) at mean follow-up of 28.6 months between both DA and D+F groups (BP: mean-difference (MD)-0.22, 95%CI:-0.76–0.32; LP: MD:-0.26, 95%CI:-0.79–0.27). In addition, subgroup analysis of long-term follow-up (&gt;3 years) showed lower VAS scores for BP and LP in patients who underwent DA (BP MD:-1.70, 95%CI:-2.8-(-0.60); LP MD:-1.00, 95%CI:-1.77-(-0.23)). No difference in disability, measured by Oswestry-Disability-Index(ODI) scores, was found between both groups (MD:0.50, 95%CI: -3.31–4.31). However, patients in DA group had less hospital complications and fewer adverse events (total-surgical-complications OR:0.57, 95%CI:0.36–0.90), despite a higher rate of post-operative DS (OR:8.63, 95%CI:3.35–22.26).

Conclusions
DA is not inferior to D+F in elderly patients with LSS and LGDS. DA has better pain outcomes at three-years follow-up and carries lower risk hospital-complications and fewer adverse-events. Surgeons should weigh these findings with increased risk of DS-progression.
532 Safety in Pregnancy for Female Surgeons: A Pilot Study
Authors: Magill Hayley , Kazzazi Fawz , Noton Toby 
Published: November 2022

Abstract

Aim
With an increasing number of female surgeons, it is important to ensure that the workplace is safe for pregnant women, or appropriate adjustments are made. The aim of this study is to ascertain how knowledgeable female surgeons are about potential risks during pregnancy, adaptations they have made, and to guide the design of a bigger study.

Method
A literature search was carried out to identify potential risks to pregnant female surgeons. A survey was created to ascertain women's understanding of key which activities are safe in pregnancy, and adjustments some had made whilst pregnant.

Results
100 women responded to the survey, ranging from SHO to consultant. 40% of respondents had children, whilst 78% of those who did not, hoped to have them someday. Only 44% of all respondents felt that they knew what was safe at work during pregnancy, with the majority being unaware of increased risk of complications such as miscarriage, intrauterine growth restriction, placental abruption and gestational hypertension.

Conclusions
There is a lack of knowledge of potential risks amongst female surgeons, and most information acquired comes from personal research. Many female surgeons reported complications during their own pregnancies, and many were unaware of these risks prior to pregnancy. A more detailed study including fertility issues, and variations between subspeciality alongside a detailed literature search could start to provide more detailed guidance for female surgeons.
589 Reducing Single-Use Surgical Instruments During Laparoscopic Appendicectomy: Using Sustainable Quality Improvement as a Catalyst to Encourage Wider Behavioural Change in a Surgical Department
Authors: Ford Bryony , Labib Peter , Kanwar Aditya , Sanders Grant , Douie Walter , Winfield Michelle 
Published: November 2022

Abstract

Aim
Consumables are responsible for 32% of surgery associated CO2 emissions after excluding anaesthetic gases. We aimed to reduce the carbon footprint of laparoscopic appendicectomies by addressing equipment issues whilst also meeting the triple bottom line of financial, environmental, and social impacts.

Method
In a single-centre, a questionnaire was distributed to establish the frequency of, and reasons for, single-use instrument use. A separate questionnaire identified areas for improvement within existing appendicectomy sets.
An evaluation of 25 appendicectomies was undertaken, documenting single-use instrument usage. New appendicectomy sets were developed, including additional reusable instruments, and procuring new ports, trialling these in subsequent appendicectomies.
Financial impact was calculated based on current procurement prices. Environmental impact was calculated by carbon costing the production, transport and disposal of consumables using published emission factors. Social impact was assessed using staff surveys.

Results
110 single-use instruments were opened in 25 appendicectomies. Our trust performs ∼500 appendicectomies/year, therefore equating to ∼2180 instruments/year that could be avoided by using reusable alternatives. Based on an estimated 75% reduction in consumables, the new set saves £34,423 and 512kg CO2e per year over the predicted seven-year life span of the instruments. Based on existing practice, the capital investment required for new instruments (£19,731) will pay for itself within six months. Reduced consumable reliance decreases the volume of waste being incinerated, tackling scope one emissions and local air pollution.

Conclusions
These results demonstrate that sustainable changes can be cost saving and reduce carbon emissions. This approach has translational potential across all surgical specialities using single-use instruments.
224 One-Year Outcomes in Patients with Colorectal Malignancy and Low Functional Capacity on CPET
Authors: Tay Tricia , Ryska Ondrej , Johnson T 
Published: November 2022

Abstract

Aim
Many patients with colorectal carcinoma (CRC) undergo Cardio-Pulmonary Exercise Test (CPET) to risk-stratify their suitability for surgery. This study aims to evaluate the 1-year outcomes of patients with colorectal malignancy and low functional capacity on CPET. The secondary aim is to evaluate the correlation between P-/CR-POSSUM scores and one-year outcomes.

Method
All patients with stage I-IIICRC who underwent CPET between January 2013-August 2020 with Anaerobic Threshold (AT)&lt;10ml/min/kg follow-up for one year were included. Major complications were classified using Clavien-Dindo classification of Grade III or higher.

Results
We included 77patients(64%males) with median age of 77(range 53–90). Thirty-one patients received best supportive care;46 underwent elective resection with median AT of 7.9(5.3–9.5)ml/min/kg and 8.7(6.4–9.9)ml/min/kg respectively(p=0.001).Of those treated surgically,9(20%)had major complications. There was no 30-day mortality. Median postoperative length of stay (LOS) was 8(3–42) days. Median overall survival(OS) among patients with surgery versus best supportive management was longer–42(8–106)months vs.25(2–59)months(p&lt;0.0001).1-year survival rate was higher-57%vs.19%(p=0.002)in patients who had surgery compared to those with non-surgical management. Presence of major complications correlates with AT(p=0.003), LOS(p=0.007), OS(p&lt;0.0001) and death(p=0.002).
P-/CR-POSSUM scores(n=11) showed no significant correlation with major complications or LOS. One-year survival demonstrated no correlation between P-/CR-POSSUM with OS.

Conclusions
Surgical treatment of CRC showed survival benefit and should be considered for patients with low functional capacity. Due to our small sample size, P-/CR-POSSUM were not correlated with major complications, LOS and OS.
825 Local Excision Versus Total Mesorectal Excision Following Neoadjuvant Chemoradiotherapy for Rectal Cancer. a Systematic Review and Meta-Analysis
Authors: McLoughlin Morgan , Creavin Ben , Early Helen , McCullough Peter , Cooke Fiachra , Neary Peter 
Published: November 2022

Abstract

Aim
Total mesorectal excision with or without neoadjuvant chemoradiotherapy remains the gold standard treatment for rectal cancer. This systematic review aims to establish if Local Excision (LE) in conjunction with neoadjuvant therapy can be used to improve morbidity and functional outcomes without significantly impacting oncological outcomes.

Method
A systematic review and meta-analysis was performed using the PRISMA guidelines. All studies comparing neoadjuvant chemoradiotherapy and local excision versus TME were included from 2000 to 2020. Primary endpoint included local recurrence rates. Secondary outcomes included distant recurrence, disease free survival and overall survival. Subgroup analysis was performed on randomised control trials (RCT).

Results
Of the 9 studies included, 2 were RCTs. A total of 1161 patients underwent neoadjuvant chemoradiotherapy and surgical excision (LE n=252, TME n=909). Local recurrence was 10% in the LE group compared to 7% in the TME group (OR 0.60, 95% CI 0.33–1.09, p=0.09). Furthermore, there was no significant difference in distant metastasis (OR 1.37, 95% CI 0.84–2.26, p=0.21), Disease Free Survival (DFS) (OR 1.08, 95% CI 0.65–1.82, p=0.76) or Overall Survival (OS) (OR 1.14, 95% CI 0.56–2.35, p=0.71). In subgroup analysis of RCTs, local recurrence rates of 7.2% were seen in the LE group compared to 6.6% in the TME group (OR 0.90, 95% CI 0.34–2.43, p=0.84).

Conclusions
Neoadjuvant chemoradiotherapy and local excision is oncologically safe in select patients. A higher non-significant local recurrence rate was seen in the LE group; however, this may be due to heterogeneity in patient selection. Similar local recurrences and oncological outcomes were verified in the RCTs.