bluuebunny/crossref_metadata_2025_split huggingface dataset:
255 International Variation in Intraperitoneal Drain Placement and Outcomes After Elective Colorectal Surgery: A Matched, Prospective, Cohort Study
Authors: Collaborative EuroSurg 
Published: November 2022

Abstract

Background
Currently, many surgeons place intraperitoneal drains after elective colorectal surgery. However, Enhanced Recovery After Surgery (ERAS) guidelines recommend against their routine use due to a lack of clear clinical benefit. This study aimed to describe international variation in intraperitoneal drain placement and the safety of this practice.

Method
COMPlicAted intra-abdominal collectionS after colorectal Surgery (COMPASS) was a prospective, international, cohort study which enrolled consecutive adult patients undergoing elective colorectal surgery (February-March 2020). The primary outcome was the rate of intraperitoneal drain placement. Secondary outcomes included: rate and time-to-diagnosis of postoperative intraperitoneal collections; rate of surgical site infections (SSIs); time-to-discharge; 30-day major postoperative complications (Clavien–Dindo grade ≥3). After propensity-score matching, multivariable logistic regression and Cox proportional hazards regression were used to estimate the independent association of the secondary outcomes with drain placement.

Results
Overall, 1805 patients from 22 countries were included (798 [44.2%] female; median age 67.0 years). The drain insertion rate was 51.9% (n=937). After matching, drains were not associated with reduced rates (OR 1.33, 95% CI: 0.79–2.23, p=0.287) or earlier detection of collections (HR 0.87, 95% CI: 0.33–2.31, p=0.780). Although not associated with worse major postoperative complications (OR 1.09, 95% CI: 0.68–1.75, p=0.709), drains were associated with delayed hospital discharge (HR 0.58, 95% CI: 0.52–0.66, p&lt;0.001) and increased risk of SSIs (OR 2.47, 95% CI: 1.50–4.05, p&lt;0.001).

Conclusions
Intraperitoneal drain placement after elective colorectal surgery remains widespread. Drains were not associated with earlier detection of collections but were associated with prolonged length of stay and increased SSI risk.
67 Does a National Lockdown Affect the Characteristics of Deep Vein Thromboses in Patients in the Community?
Authors: Aden N , Shahid A , Howard M , Narayanamoorthi S , Khan T 
Published: November 2022

Abstract

Aim
Has lockdown and COVID-19 led to a change into the characteristics of DVT's and patients who have them alongside a review of the DVT service.

Method
Data was collected retrospectively from electronic patient records system for the following periods: 1st April until 30th June 2019 and 1st April until 30th June 2020. These were the key months during the first United Kingdom national lockdown. Data was analysed for patient demographics, risk factors, characteristics of the DVT, management and DVT reoccurrence. Statistical analyses were preformed using GraphPad Prism 8.

Results
227 patients sustained community DVT's in 2019 and 211 patients in 2020 during the study period. 13 of these patients in 2020 were COVID-19 positive. There was a difference in gender distribution (p= 0.0128) with 128 males and 99 females in 2019, 93 males and 118 females in 2020. No significant difference was noted for the incidence of thrombophilia with 9 in 2019 and 3 in 2020 (p=0.1437). Fewer long-haul journeys were made (p=0.012) with 16 in 2019 and only 2 in 2020. Fewer patients had immobility as a risk factor with 79 in 2019 and 55 in 2020 (p=0.0494). However, there were more patients using the contraceptive pill (p=0.0086) with 1 in 2019 and 9 in 2020.

Conclusion
There is no significant difference in the characteristics, extent, and management of DVT's prior to and during Lockdown during COVID-19. National Lockdowns do not affect community DVT's however it is important to highlight the surrounding inpatient numbers.
106 Local Anaesthetic Toxicity and its Treatment in the Plastic Surgery Minor Op Theatre
Authors: Shah R , Herieka M , Dalal M 
Published: November 2022

Abstract

Objectives
Local anaesthetics (LA) are frequently used in Plastic Surgery; hence knowledge of the recognition and treatment of LA toxicity is vital amongst all staff members. Our study aimed to identify and improve the understanding of local anaesthetic toxicity and its treatment amongst plastic surgery staff in our minor operations theatre.

Method
The BNF and AAGBI guidelines on LA toxicity were used as our audit standards. In the initial cycle, we performed 1–1 interviews, using an 11-point questionnaire, with 11 doctors and 7 nurses over two days. Interventions to improve our service included organising a structured departmental teaching on LA toxicity; displaying official AAGBI posters around the department; and including information on LA toxicity in the junior doctor's handbook. A re-audit was performed 1 month later.

Results
After the interventions, the knowledge on safe doses of LA improved from 57% to 100%. All staff knew signs and symptoms of LA toxicity (up from 67%). An improvement was also seen in the knowledge about monitoring and treatment of LA toxicity, from 39% to 100%. Surprisingly, only 17% knew the location of intralipid within the department during the initial cycle, however this figure improved to 100% after the interventions.

Conclusions
Knowledge of LA toxicity and its treatment is vital for all Plastic Surgery staff, especially in a minor operations theatre. The use of structured teaching sessions, posters about LA toxicity, and information in junior doctor's handbook, are useful interventions in improving the know-how amongst all staff members.
113 Prevention, Diagnosis, and Management of Fracture Related Infections in Accordance with the BOA FRI Guidelines
Authors: Lu V , Zhang J , Thahir A , Krkovic M 
Published: November 2022

Abstract

Aim
Fracture related infections (FRI) are common and serious complications of musculoskeletal trauma. With average hospital health care costs for infected patients being 6.5 times higher than uninfected patients, FRI poses a significant social-economic burden to the patient and healthcare system.
We aim to audit current practice in preventing and diagnosing FRIs and improve management of infections in patients with fractures. The guidelines covered are the British Orthopaedic Association (BOA) FRI guidelines.

Method
Our sample included patients who suffered an infection as a direct consequence of fracture and/or subsequent surgical management procedures over a seven-year period. Surgical procedures were performed for fractures in 8826 patients. In total, 102 patients with an FRI were reviewed. Audit results and recommendations have been presented at a clinical governance meeting.

Results
Seven out of sixteen items had poor compliance (&lt;80% compliance). Ultrasound-guided aspiration was done in 21.6% (22/102), even if debridement surgery is delayed. 1.96% (2/102) received adequate advice about responding to a suspected FRI. 56.9% had recommended 2-week antibiotic-free duration before sampling. Our recommendations include pre-written template in discharge documentation providing guidance on responding to a suspected FRI, better communication between microbiology, surgical team, and GPs regarding antibiotic prescription timing, including weekly bone and joint infection MDT review for FRI patients.

Conclusions
Lowering FRI-related burden requires a three-pronged approach: uniform set of standards for infection prevention in trauma and orthopaedic surgery, robust diagnostic workup for suspected FRI cases, effective management scheme for confirmed FRI cases. These systems should be a key element of orthopaedic trauma service.
193 Audit on Effectiveness of Theatre Handover to the Critical Care Team
Authors: Bushra R , Shahjahan S , Salaunkey K 
Published: November 2022

Abstract

Aim
Immediate handover of a postoperative patient to a critical care team is vital for in-patient management. Smooth and accurate exchange of information avoids unnecessary clinical incidences. Local trust guidelines direct towards 100% completeness of handover sheet in the electronic system. Goal to achieve 100% completeness of theatre handover form. To receive all relevant information from personnel involved in care.

Method
A total number of 100 post-cardiac surgery patients were admitted to Critical Care immediately after surgery in both cycles from June to July and October. Data were collected retrospectively, which includes both elective and emergency procedures.

Results
In 1st cycle, information from surgeon to CCA doctor accounts for around 50%. Information from anaesthetists and theatre nurses were 88% and 90%, respectively. In the 2nd cycle, handover from the surgeon, anaesthetist, and theatre nurse was approximately 60%, 95% and 90% gradually. Specific postoperative instruction was recoded 30% for 1st round, whereas it was around 45% in reaudit.

Conclusions
A proper handover is crucial for managing postoperative cardiac surgery patients because inadequate pre-and postoperative information can lead to a serious error. Considering the audit finding, it seems advisable to take a more multidisciplinary approach to improve the standard of postoperative patient handover care with complete information transformation.
199 An Audit Cycle of Antibiotic Prophylaxis for Laparoscopic Cholecystectomy
Authors: McMaster D , Shaikh M , Singh S , Elghazaly H , Dahaghin P , Sheth H 
Published: November 2022

Abstract

Aim
Due to the lack of clinical benefit and the risks of unnecessary antimicrobial use, current national guidelines do not recommend prophylactic antibiotic use in low-risk elective laparoscopic cholecystectomies, reserving their use for high-risk patients only. The aim of this audit was to assess compliance with local and national guidelines for antibiotic usage for laparoscopic cholecystectomies, to identify areas of improvement, implement change and re-audit to assess the effectiveness of this change.

Method
Data was collected retrospectively between 01/05/2021 and 01/08/2021 for patients undergoing elective laparoscopic cholecystectomies. Following the initial data collection, we implemented change by attaching pre-printed stickers of local antibiotic prophylaxis guidance to pre-operative notes. We prospectively re-audited between 01/11/21 and 01/12/21 to assess the effectiveness of this change.

Results
In the initial three-month period, 24.4% (10/41) of elective cases received correct antibiotic prophylaxis, with 58.5% of patients prescribed unnecessary post-operative antibiotics in the post-operative plan. Following the implementation of change, in the re-audit period there was a significant improvement, with 55% (11/20) of elective cases receiving correct antibiotic prophylaxis, and only 25% prescribed unnecessary post-operative antibiotics.

Conclusions
We show that pre-printed stickers are a simple intervention that can improve adherence to local guidance and reduce injudicious use of antibiotics in the pre- and post-operative periods. Improving antibiotic prescribing for laparoscopic cholecystectomies, one of the United Kingdom's most common surgical procedures, highlights the potential for significant cost savings and improved antimicrobial stewardship. We will re-audit again in the coming months to assess if this improvement has been sustained.
201 Compliance to New BOAST's Guidelines for Paediatric Supracondylar Fractures in the Middle of COVID Pandemic
Authors: Oo KK , Richards T , Khurana A 
Published: November 2022

Abstract

Aim
Amid COVID pressures, standards of surgical practices need constant reviewing to maintain patient safety and streamline care pathways. Newly published BOAST (British Orthopaedic Association Standards for Trauma and Orthopaedics) guidelines for paediatric supracondylar fractures became a benchmark against which a restructured DGH trauma unit's performance can be appraised.

Method
Theatre records were analysed between April-2020 and September-2020. Data were collected to reveal time to theatre, operative techniques, documentations of ulnar nerve protection, complications, follow-up plans, time to first post-op radiograph and to wire removal.

Results
90% of patients underwent operations within 24–48 hour. Although there was no incidence of iatrogenic nerve injury, documentation of ulnar nerve protection was not identified in 45% of crossed wire fixations. Wire size was not mentioned in 14%. 33% did not have first follow-up with radiograph within 4–10 days, and 43% of patients did not have the wires removed till 4 weeks post op.

Conclusion
This re-audit highlights the need to improve in documentation for ulnar nerve protection and to identify the delays in follow-up appointments. Although BOAST no longer recommends a fixed timeframe for follow-up plan, first radiograph within 4–10 days and wire removal within 4 weeks are still reasonable locally.
205 A Closed Loop Audit of CT Hip Scanning at Our District General Hospital
Authors: Gompels B , Limb R , Ralte P 
Published: November 2022

Abstract

Aim
This audit aimed to determine whether there was a delay beyond 36 hours in theatre cases due to delayed neck of femur fracture diagnoses for non ambulatory patients with no diagnostic abnormality identified on plain film. We examined the indications for CT scans to ensure a full examination had been documented and a trial of mobilisation had been attempted.

Method
CT hip scan requests audited retrospectively against whether they delayed surgery, if the scan was discussed with the T&O team, hot reporting prior to the scan request and if there was a full examination with documented weightbearing status. Data was compared with NICE guidelines on hip fracture management (CG214) and expected compliance was 95%. Following the initial audit cycle, teaching was given at A&E induction on the referral process and pathway and subsequently re-audited.

Results
Documented full examination improved from 85 to 93%. Weightbearing status was documented in 33% initially and 76% following the re-audit. There was a 44% improvement in the number of patients who had scans hot reported prior to CT scan occurring. In 95% of patients CT scan did not delay surgery beyond 36 hours.

Conclusion
CT scan delays did not lead to a delay in the 95% of patients going to theatre. However, with normal plain films it is crucial to have a documented attempt to weight bear prior to the CT request being made. Hot reporting of hip radiographs can be useful prior to requesting CT scans though reporting times and clinical workload can limit this factor.
239 Neurovascular Assessment in Fracture Patients Admitted in a Major Trauma Centre, a Comparison of Emergency Department and Orthopaedic Admission Documentation
Authors: Gilmore C , Toner E , McHenry S 
Published: November 2022

Abstract

Aim
The December 2021 British Orthopaedic Association Standards for Trauma for peripheral nerve injuries clearly state “An examination to assess all the functions of a peripheral nerve should be performed and recorded in sufficient detail to allow confident comparison with preceding and subsequent examination”.
Early accurate neurovascular assessment should first be performed to identify patients requiring urgent surgical intervention, clear documentation is essential to facilitate monitoring over time. The aim of this study was to evaluate the neurovascular documentation in trauma patient's presenting to a Major Trauma Centre and compare quality of Emergency doctors (ED) documentation against Orthopaedic surgeons.

Method
A retrospective analysis of A&E and orthopaedic admission proforma paperwork was performed, 77 patients were identified over 4 weeks from Nov – Dec 2020. Following the introduction of vascular examination section to the admission paperwork a repeat cohort of 75 patient notes were reviewed in Oct – Nov 2021.

Results
Orthopaedic surgeons were more compliant with neurovascular assessment than ED (96% vs 77%), this was maintained in 2021 (96% vs 70%). Orthopaedic surgeons were more specific when documenting components of vascular, motor function and sensation examination (75% vs 39%). Significant numbers of patients had only ‘neurovascularly intact’. Poor documentation post manipulation/splinting was noted, with no documentation in 63% of cases.

Conclusions
Neurovascular documentation remains a challenge in the care of orthopaedic trauma patients. Orthopaedic surgeons were consistently more compliant at documentation compared to Emergency doctors. Many patients had a gross assessment with only ‘neurovascularly intact’ documented, falling below the BOAST standard.
252 Plastic Surgery Venous Thromboprophylaxis for Abdominal and Thigh Based Free Flap Breast Reconstruction Surgery
Authors: Bahadori D , Eiben I , Eiben P 
Published: November 2022

Abstract

Aim
Correct Venous Thromboprophylaxis (VTE) assessment and prescription is at basis of patient safety when considering patient hospital admission. Current local Guy's and St Thomas Hospital guidelines are in keeping with National Institute for Health and Care Excellence (NICE) guidelines recommending all patients to be assessed and prescribed VTE prophylaxis within 24 hours of admission. There are no specific local or national guidelines however that would recommend VTE prophylaxis specific to free flap breast reconstruction surgery.
We assessed therefore adherence to VTE prophylaxis guidelines for patients undergoing abdominal and thigh based free flap breast reconstruction surgery. Patient outcomes were reviewed and VTE prophylaxis proforma was recommended.

Method
Patients who underwent abdominal or thigh based free flap breast reconstruction surgery between October 2017 and February 2019 were identified. Data was collected retrospectively and analysed via SPSS Statistics (IBM, USA).

Results
51 patients were included in the first audit cycle; 50 patients in the re-audit. Overall improvement and 100% of patients received LMWH on admission. The timings of correct prescription versus actual administration of LMWH decreased however from 71% to 49%.

Conclusion
There is good adherence to assessment and administration of VTE prophylaxis across the patients. Unfortunately, the prescription of VTE prophylaxis itself is mostly incorrect. It is therefore with gratitude to the ward staff VTE is administered correctly. Further improvements in the communication therefore between theatre, ward and surgical staff and implementation of VTE prophylaxis proforma need to be considered.
276 Documentation for Follow Up ENT Outpatients at University Hospital of Wales
Authors: Lam CM , Owens D 
Published: November 2022

Abstract

Aim
Clinic appointment documentation for follow up patients in ENT may not meet BMA Ethics documentation standards for health records. This is important as dictated clinic letters can lack sufficient information or be subject to technical errors. Our audit aim was to determine if follow-up patient consultations in ENT clinics at University Hospital of Wales are being appropriately documented.

Method
Retrospective audit. All ENT outpatient clinic documentation for follow up patients over a one-week period in January 2020 were reviewed. New patients to the clinic were excluded. The documentation was audited to see if all relevant clinical findings, the decisions made, information given to patients, and drugs or treatment prescribed were included. This was the audit gold standard and was taken from the BMA ethics Access to health records (2014) publication. The audit target was 100% on all categories.

Results
Clinic appointment records for 133 patients met the inclusion criteria. 73.7% of records included all relevant clinical findings, 80.5% included the decisions made, 23.3% included the information given to patients and 65.4% included the drugs or treatments provided. 21.8% of clinic appointment records were compliant with all 4 of the above categories.

Conclusions
The majority of clinic appointment note documentation were not compliant with all 4 of the categories advised by the BMA publication. A stamp was designed to provide a template for clinic appointment documentation for follow up patients to make the process easier for clinicians.
317 Preoperative Fasting in Adults – A Quality Improvement Project at Macclesfield District General Hospital
Authors: Saad D , Mughal H 
Published: November 2022

Abstract

Aim
Our primary endpoint was to evaluate staff awareness of preoperative fasting guidelines. Our secondary endpoint was to evaluate patient preoperative fasting times.

Method
Data were collected using online close-ended survey questions from surgical ward nurses and healthcare assistants before and after implementing a multimodal campaign to raise awareness. Data were collected for patient fasting times before and after the same interventions.
Interventions:

Results
Staff: Our interventions increased staff awareness of preoperative fasting guidelines for food by 20.6% (from 50% to 70.6%) and for clear fluids by 28.8% (30% to 58.8%).

Patients
Average preoperative fasting times for food before and after intervention were 12.7 and 12 hours respectively (p=0.736). For clear fluids, average fasting times before and after intervention were 6.2 hours and 4.5 hours (p=0.415).

Conclusions
Staff were generally unaware of the guidelines and viewed preoperative fasting solely as a safeguard against aspiration, causing adoption of a risk-averse attitude. The benefits of adequate hydration and nutritional support before surgery were overlooked. Our interventions helped raise awareness in the short term.
For our next cycle, we plan to assess the efficacy of implementing long-lasting changes such as local trust guidelines and improved staff training to drive a change in attitude and awareness of preoperative fasting.
338 Establishing Ceilings of Care in Elderly Frail Patients with Acute Fractures
Authors: Madden-McKee C 
Published: November 2022

Abstract

Aim
The British Orthopaedic Association Standards for Trauma and Orthopaedics (BOAST) document ‘Care of the Older or Frail Orthopaedic Trauma Patient’ advocates early discussion and documentation of ceilings of care. The aim of the study was to assess whether cardiopulmonary resuscitation (CPR) status was being discussed and documented at the time of admission in this patient cohort.

Method
At two separate time points (September and October 2021), a sample of current inpatients admitted under the acute fractures service were selected who met inclusion criteria of having sustained a low-energy fracture and having a clinical frailty score of 5 or greater. Patient notes were examined to determine whether any decisions or discussions regarding CPR status had been documented at the time of admission. Between time points, a teaching presentation was sent to all FY2-CT2 doctors who covered acute fractures admissions and a reminder box was added to the fracture's admissions sheet template.

Results
The mean age was 82 years (range 65 to 97 years) and 85 years (range 70 to 94 years) at the first and second time point, respectively. Successful documentation regarding ceiling of care at the time of admission improved from 26% (5/19) to 64% (14/22) between study periods.

Conclusions
Early discussion and documentation of ceilings of care in elderly frail patients sustaining acute fractures is important to avoid unsuccessful, undignified attempts at resuscitation in the event of deterioration.