bluuebunny/crossref_metadata_2025_split huggingface dataset:
964 Cheques and Balances: A Five-Year Review of Surgical Settlements
Authors: Clements C , Bezzaa S , Curwen O , Vance-Daniel J , Lewis T , Nehra D 
Published: November 2022

Abstract

Aim
The litigious burden in the NHS has been increasing yearly, costing an estimated £2.5 billion per year in financial settlements. We investigated the causes of general surgical settlements and attributed costs at a district general hospital over a five-year period.

Method
A retrospective analysis of all general surgical claims between 2016–2021 using the NHS Resolutions Case Management System. Selected cases were those which resulted in out of court financial settlements; whilst these claims have been settled, the trust admitted no negligence in each case.

Results
A total of 12 settlements were made with a total cost of £249,918 (£8000-£60,000, mean £20,827). Eight of the claims (67%) related to elective cases with four (33%) emergency cases. Of the total cases, 41% and 33% related to management of gallstones and appendicitis respectively.
The majority of claims (58%) related to delays in treatment with a total cost of £103,500 (£8000-£35,000), accounting for 41% of total settlement costs. Five cases (42%) were due to harm with a combined total of £146,418 (£9000-£60,000), 59% of the total settlement. Of the claims due to harm, 80% suffered recognised complications of the procedure.

Conclusions
Increasing litigation in the NHS over the last decade now accounts for 2% of the total NHS budget. The majority of settlements reviewed here were for avoidable delays in elective treatment, with higher financial settlements for well documented surgical complications related to the consent process. Better access to investigations, earlier clinical review, and reductions in delays to elective surgeries may reduce the financial burden of litigation.
991 5 Year Re-Operation Rates Following Implant Breast Reconstruction: The Ethical Consideration for Individual Patients and Healthcare Systems During a Global Pandemic
Authors: Walshaw J , Nargund A , Wilkins A 
Published: November 2022

Abstract

Aim
To compare the reoperation and implant loss rates following implant breast reconstruction after 3 months and 5 years in a single unit cohort included in the large multicentre iBRA study1.

Method
Patients undergoing implant breast reconstruction for breast cancer or risk reduction mastectomy were recruited as per the iBRA protocol. Electronic patient records were reviewed in December 2021 and reoperation and implant loss was recorded.

Results
The records of 26 patients were analysed, all were recruited to the iBRA study. 3-month implant loss (9%) and reoperation rates (18%) were similar to the initial overall study. By 5 years, implant loss rates and reoperation rates had increased to 19% and 77% respectively. 10 patients (39%) underwent 2 or more further operations during this period, with 3 of these patients requiring 5 operations. We acknowledge this cohort is small and any revision procedures performed outside our trust would be missed.

Conclusions
Following Montgomery Vs Lanarkshire2 and the Paterson Inquiry Report3, it is vital that patients are aware of any material risk during the consent process before surgery. Quoting 3-month implant loss and reoperation rates in isolation is potentially misleading and there is a need for robust real-life data to guide informed consent. Covid-19 related disruption to elective surgery is inevitable4 and difficult prioritisation decisions are required. Patients undergoing breast reconstruction in 2022 may experience similar complications to the 2016 cohort, however access to revision surgery is uncertain.
117 Comparative Study Between Laparoscopic and Open Rectosigmoid Cancer Resection in Two Laparoscopic Naïve Centers in a Middle-Income Country
Authors: Balbola M , El-Ramah AF , Ibrahim AMR 
Published: November 2022

Abstract

Aim
The aim was to compare the short-term, oncologic, outcomes of laparoscopic and open resection for recto-sigmoid /upper rectal cancer in two centers with relatively newly adopted laparoscopic techniques in cancer.

Method
Our patients were recruited from two centers in Damietta, Egypt; one of them is a laparoscopic naïve center which has not introduced MIS surgery until recently and the other has the main laparoscopic experience reserved primarily for benign Upper GI and Bariatric work. 50 patients with recto- sigmoid and upper rectal cancer diseases in the period between December 2016 and December 2018 were included. Patients were randomly divided into two groups: (LR Group: “25 patients”) subjected to laparoscopic interventions, and (OR Group: “25 patients)” subjected to open surgery. Data were collected and Short-term outcomes were analyzed.

Results
The mean operative time was significantly increased in the LR group than OR group (LR 198.88± 18.7, OR 183.4± 20.5 minutes, p =0.01) as well as the hospital stay (LR 8.8± 2, OR 7.4± 2.9 days, p =0.013).
However, LR group was quicker to recover in term of mobilizing early, recovery of bowel function, and early toleration of diet and fluid and this difference was only statistically significant for oral fluid but not for diet (p= 0.078; 0.17 respectively). There was no significant difference between both groups in tumor characteristics as locations, gross tumor morphology, staging, and distance to the distal margin. Also, both groups had comparable intraoperative and post-operative adverse events.

Conclusion
Laparoscopic technique represents a feasible and sound oncological approach and should be considered as standard in low resource setting.
284 Effectiveness of Webinar to Provide an Insight on the UK Surgical Training Pathways for the International Medical Graduates (IMGs) From Lower- & Middle-Income Country (LMIC)
Authors: Karki BB , Gurung D , Bista A , Raj Shrestha O , Limbu R , Malla S , Khanal P , Aryal K 
Published: November 2022

Abstract

Aim
To provide an insight on the UK- Surgical Training Pathways for the International Medical Graduates (IMGs) from Lower- & Middle-Income Country (LMIC's). To eliminate the barriers for the effective and safe patient care.

Method
A webinar “PLAB & Beyond” was organised by Nepalese Doctors Association-UK on 11thDec.2021 to provide an insight on various aspects of NHS and Training application process for Aspiring Surgeons from LMIC's. Virtual sessions were designed to share the first-hand experience by IMG's on varied NHS roles. A tailored session on Surgical Training pathways and application process was delivered by the IMG currently on the General Surgery Training Pathway.

Results
There were 70 participants of various grades joining from 3 different continents. The pre-webinar questionnaire suggested that almost 85% of the IMG's were not oriented regarding the General Surgery Training Pathways. Only 30% had a very limited idea about the Surgical-Portfolio Scoring system. 55% thought it was impossible to get into the Surgical Training Pathway in the UK for an IMG. Post webinar feedback suggested that majority of the attendees (∼95%) acknowledged that the webinar enhanced their understanding of NHS and Surgical Training Pathway meeting the aims & learning outcomes.

Conclusion
As IMGs from LMIC's contribute to major work force in the NHS, proper orientation to the training pathways must be added during local hospital induction. These session in broader sense will also aid to provide improved and equitable surgical care across international health system advocating Global Surgery, the ‘Neglected stepchild of global health’.
584 Characterisation of Global Gastric Cancer Surgery Epidemiology: An International Prospective Cohort Study
Authors: Riad A , Knight S , Skipworth R , Griffiths E , Griffin M , Harrison E 
Published: November 2022

Abstract

Aim
We aimed to characterise the global surgical gastric cancer population and variability in disease presentation across different resource settings.

Method
GlobalSurg3 was a multicentre, international prospective cohort study of patients undergoing surgery for cancer. Primary outcomes were death or major complications (Clavien-Dindo III/IV) within 30 days of surgery. Income levels were defined using the World Bank classification. Patient characteristics, presentation and disease factors were analysed across income levels. Multilevel logistic regression models were used to explore the effect of patient factors on outcomes.

Results
This analysis included 1337 patients from 263 hospitals (high income countries (HICs) N = 712, upper middle income countries N = 289, low and lower middle-income countries (LMICs) N = 336). Most patients presented with gastric adenocarcinoma (81.4%, N=1088) in the distal third of the stomach (43.2%, N=578). Patients undergoing surgery were on average 10 years younger in LMICs compared to HICs (55.4 vs 67.4), and proportion presenting with &gt;10% weight loss was double (64.3%, N=216 vs 30.8%, N=219). Patients in LMICs were twice as likely to require emergency surgery (10.7%, N=36 vs 4.2%, N=30), as did those operated on with palliative intent (21.1%, N=71 vs 11.1%, N=79). Having an increased Eastern Cooperative Oncology Group performance status (ECOG) was associated with significantly increased 30-day mortality (ECOG 2 aOR= 7.99 (2.67–23.94, p&lt;0.001), ECOG 3/4 aOR= 13.31 (4.04–43.89, p&lt;0.001)).

Conclusion
Functional status is independently associated with 30-day mortality after cancer surgery. Variation in outcomes across income levels may be influenced by inherent differences between surgical populations.
261 The Adequacy of Consenting for Inguinal Hernia Repair Relative to Surgeon's Grade of Training
Authors: Quefferus M , El Boghdady M 
Published: November 2022

Abstract

Aim
Inguinal hernia repair is known to be one of the most commonly performed general surgery procedures in the UK. Pre-operative consenting is essential to be aware of potential complications and for patients to make fully informed decisions. We aimed to assess the adequacy of consent for elective inguinal hernia repair in a UK-teaching hospital.

Method
A 4-months retrospective data analysis of consent forms was performed. Elective open and laparoscopic inguinal hernia repairs were reviewed for consent forms, including demographic data, date of surgery, grade of consenting surgeon, re-admissions, and complications.

Results
A total of 132 operations were included, 108 open and 24 laparoscopic. The most commonly recorded risks were bleeding (97%) and recurrence (96%). Serious testicular complications such as testicular artery injury/orchidectomy were consented in 35% of patients. The consultants consented 63% of overall complications, specialist registrars (SpR) 66.9% and senior house officers (SHO) consented the most with 77.1%. Testicular complications were mostly consented by consultants 66.7% vs registrars 16.3% and 12% SHOs. Consultants consented for the fewest complications overall (63.7%). Six patients were readmitted with postoperative complications, 2 were readmitted for orchidectomies, 3 haematoma and 1 had recurrence.

Conclusion
There are significant shortcomings in consenting patients for serious testicular inguinal hernia complications. SHOs consented for the most complications, followed by SpRs then consultants with the least. To mitigate these shortcomings, we would envisage having a standardised format for consenting, including patient information leaflets provided to the patients prior to their operations.
502 Emergency Giant Hiatus Hernia Surgery: Experiences with Post-Operative Complications
Authors: McKechnie I , Alasmar M , Chaparala R 
Published: November 2022

Abstract

Aim
Patients with giant hiatus hernias can present acutely with volvulus or strangulation. Early emergency surgical intervention with reduction of the hernia and hiatal repair is shown to reduce the mortality rate. However, surgery is not without risk or complications. This study assessed the rate of complications and length of hospital stay in patients requiring emergency surgery.

Method
A retrospective study was done looking at all patients who underwent emergency hiatal hernia surgery at a tertiary oesophagogastric centre. Over an eight-year period, 80 patients were identified. Their clinical course was evaluated from medical records, collecting data on their length of stay, complications, and mortality.

Results
Of the 80 patients, 30 patients (37.5%) had no documented complications from the surgery. 62.5% did have complications, of which respiratory complications were the most frequent (43%). 10% of patients had symptomatic recurrence of the hiatus hernia that required operative correction either during index admission or a subsequent admission. Median length of hospital stay was 8 days (IQR 5–16). There was a positive correlation between number of complications and length of stay. Post-operative mortality was 9%.

Conclusions
Emergency surgery for hiatus hernias has a high morbidity rate, as expected for an emergency procedure in acutely unwell patients. Despite the high rate of post-operative complications, the length of hospital stay was relatively short with low mortality, showing emergency surgery to be an effective lifesaving treatment.
813 Giant Inginoscrotal Hernias: Considerations for Optimisation of Patient Outcomes
Authors: Madhavan A , Sheng Z 
Published: November 2022

Abstract
Giant inguinoscrotal hernias (GISH) are unique and complex surgical challenges due to their rare presentation in the western world and the high risk of post-repair complications such as abdominal compartment syndrome and multi-organ failure. They are defined as inguinoscrotal hernias that extend below mid inner thigh. Due to the potential complications, optimising these patients throughout their hospital admission is crucial.
Here, we present a 30-year-old Caucasian male who was admitted to our surgical unit in a public health system with a painful giant inguinoscrotal hernia, the complications he encountered and the lessons we learned.
His CT scan demonstrated a strangulated hernia, for which he underwent an emergency open mesh repair. Post-operatively, he experienced severe respiratory compromise due to lower lobe collapse, which was attributed to the concomitant pneumonia present on admission, sub-optimal utilisation of analgesia and loss of domain. The complications were compounded by anxiety about medical intervention which delayed investigations and treatments.
We highlight the importance of early identification of GISH, ensuring cardio-respiratory function is optimised pre- and post-operatively, and a multi-disciplinary approach to improve compliance with treatment including extensive counselling to increase engagement with healthcare services.
1061 Is There Potential for Prevention of Emergency Open Hernia Repairs?
Authors: Yang P 
Published: November 2022

Abstract

Aim
Emergency hernia repairs are associated with increased post-operative complications. We aim to compare symptoms and healthcare contacts prior to surgery in patients undergoing emergency hernia repair to those who underwent elective hernia repair.

Method
Retrospective study of all patients with acutely strangulated/obstructed hernias between October 2019 and October 2021. Emergency repairs were compared with cohort of elective repairs carried out over the same study period.

Results
41 patients required emergency open hernia repairs. The median age was 79(range 44–91) years. 25 were inguinal hernias, 7 para-umbilical, 4 incisional, and 4 femoral. 14/41(35.4%) patients had healthcare consultation for hernia prior to acute presentation. Of these, 11(27.1%) were already awaiting elective surgery.
25/41(60.4%) patients were asymptomatic prior to acute presentation. 28/48(68.7%) patients were not aware of hernia diagnosis prior to emergency surgery.
There was significantly higher presence of hernia symptoms, healthcare contact, and awareness of diagnosis, in the elective patients compared to the emergency group (P&lt;0.05).
There was significantly higher rate of in-patient stay and need for small bowel resection in emergency patients (P&lt;0.001). We found significantly higher rates of wound infection, haematoma/seroma, and urinary retention in emergency repair patients compared to the elective group (P&lt;0.01).

Conclusion
Early diagnosis and hernia repair is required to prevent need for emergency surgery and reduce risks of post-operative complications. Improved patient education regarding early presentation would allow earlier detection and intervention. Lack of symptoms prior to incarceration, however, would hinder early presentation, and therefore potential for emergency surgery prevention remains limited.
323 Post-Take Pause Quality Improvement Project
Authors: Noyes J , Crozier J 
Published: November 2022

Abstract

Aim
To introduce a structured review of important clinical factors on the post-take surgical ward round for each patient, to reduce their risk of adverse events.

Method
In a surgical assessment unit of a district general hospital, QI methodology was used to gather baseline data from 31 post-take interactions; monitoring 13 clinical domains. Additionally, surveys were circulated among staff. Cycle two implemented the ‘Post-Take Pause’, a ten-point checklist requiring a consultant signature, with all medical staff receiving information about its use. Cycle three incorporated further involvement of the nursing and advanced nurse practitioner team. The final fourth cycle implemented a revised checklist based on feedback from users.

Results
Baseline data collection and surveys showed that a number of important clinical factors were not being routinely reviewed on the post-take surgical ward round. Areas of particular concern included: medicine reconciliation, venous-thromboembolism prophylaxis, and prescription chart review. Inadequate time for documentation was also highlighted. Cycle two and three reviewed 21 post-take interactions each and found completion of 33% and 66% respectively. Cycle four reviewed 18 interactions with 72% of checklists completed. Common themes identified through the Post-Take Pause included: anticoagulant and steroid use, missed thromboprophylaxis and regular medicines, hyperglycaemia, ECG review and escalation plans.

Conclusions
The Post-Take Pause ensures a consultant led systematic review of important clinical information in the post-take surgical ward round. Our results show that the involvement of the wider surgical team, alongside checklist edits based on feedback, significantly improved the compliance of the Post-Take Pause.
366 Using a Serious Incident and Methods from High Reliability Organisations to Make Communications Safer Between A&E and Surgery
Authors: Gami M , MaCafferty S , Emmanuel J 
Published: November 2022

Abstract

Aim
Healthcare is a high-risk environment and for patients’ safety, requires high reliability. Poor communication is one of the leading causes of healthcare error worldwide and was one of the reasons that led to an adverse event in A&E. High Reliability Organisations (HROs) have set in place effective standards of safety where the probability of serious errors is very low. What translatable features can make the job of a Junior Surgical Doctor receiving patients from A&E safer?

Method
The root cause analysis of the serious incidence was discussed in a Surgical Morbidly and Mortality meeting. Focus groups and observational studies were carried out over a period of 6 months. The results formed the basis of a Task Analysis. A literature review of the evidence of safe communication method was performed and its translatability to healthcare.

Results
A “work as done” against “work as imagined” task analysis of the handover process showed multiple areas of potential “work system” error with references to the SEIPS 101 model. Combining the literature review and task analysis, standardisation (using SBAR), a handover checklist, read-back, dual-modality communication and a handover zone may prove to increase redundancy and slack in the system – making it safer.

Conclusions
There are HRO evidenced methods in making communication safer in healthcare. The aviation industries “sterile cockpit” and “crew management resource” methods are proven and effective. Their use of the above techniques can be implemented in healthcare communication. A designated “Handover Zone” could address potential errors. A QI project is required hereafter.
972 Communication During the Pandemic
Authors: Herron J , Radotra I , Kay A 
Published: November 2022

Abstract

Aim
Since the COVID-19 pandemic facemasks have become compulsory in UK hospitals impacting on the visual and vocal (93%) aspects of communication. This QIP looks at the difference a clear mask made to patients.

Method
ClearmaskTM was used in place of a surgical mask and patients were asked to rate the difference on a likert scale. 100 patients were seen at two appointments, once with a Clearmask and another with a surgical mask. Dragon voice recognition software was used as a control.

Results
95% of patients rated communication better with the clearmask, Patients felt more engaged and were more likely to engage with the clinician. The effect was amplified when English was not the first language.

Conclusions
Clear facemasks improved communication and allow patients to become more engaged in consults and are more likely to allow information to be divulged to a clinician.
66 Multicentre Study on Management of Right Iliac Fossa Pain in Young Females: A Need for Recommendation
Authors: Mackenzie K , Baban A , Elamin A , Shalli K 
Published: November 2022

Abstract

Introduction
Right iliac fossa (RIF) pain in young women remains a diagnostic challenge. It is one of the commonest surgical emergency presentations, however a sub-group of patients have no definitive diagnosis. Current tools used includes observations, routine investigations, ultrasound, and laparoscopy. Specific recommendations for a better management of this cohort are required.

Method
Retrospective multi-centre (two different cultural backgrounds) analysis of females aged 17 to 35 acutely admitted with RIF pain over a five-month period was conducted. The length of stay, current tools used for investigation (including laparoscopy) and cost were calculated. Pregnant women and those with a definitive picture of appendicitis were excluded.

Results
A total of 154 patients with RIF pain were studied. 77 (50%) were sent home within 24 hours. Of the remaining 77 patients, 21 laparoscopies were performed, 10 had positive findings (47.6%), 9 appendicitis and 1 carcinoid tumour. Only two CT scans were performed, both indicated positive cases that required surgery. Patients without a definitive diagnosis had an average hospital stay of 4 days compared to 2 when successfully managed conservatively. Cost calculated for negative laparoscopy was £2915 and £469 for CT scan combined with one-day stay.

Conclusion
This study demonstrated that a sub-group of young females with RIF pain would benefit from early CT scan, to definitively diagnose or rule out appendicitis. This would be more cost effective and help to avoid un-necessary invasive procedure and prolonged hospital stays. Guidelines are needed for more timely diagnosis and optimization of management in this cohort.