Profile of Post-Tonsillectomy Bleeding Requiring Return to Theatre

s / International Journal of Surgery 8 (2010) 501–578 576 PROFILE OF POST-TONSILLECTOMY BLEEDING REQUIRING RETURN TO THEATRE I. Amir, S. Broomfield, M. Timms, P. Morar, A. Belloso. Royal Blackburn Hospital Since the introduction of coblation in our department in 2002, we have been perceived to have high rate of return-to-theatre for control of tonsillectomy haemorrhage. Therefore, we perform this audit to investigate this aspect of bleeding following the procedure. All tonsillar haemorrhages cases that required return-to-theatre in 48months period were evaluated retrospectively. 2557 tonsillectomies were performed in the study period, 2,069 (81 %) by coblation and 488 (19 %) by other techniques. The overall haemorrhage rate requiring return-to-theatre was 1.7 % (45 cases). Primary haemorrhage occurred in 16 patients (0.6 %). Secondary haemorrhage occurred between 2 and 15 days post-operation, peaking at the 7th and 11th days. Of these, 20 cases occurred within the first week post-operation. 11 cases occurred in the second week and were all performed by coblation. All cases are more common in adult and occur predominantly females except for primary haemorrhage that has equal gender distribution. Three of four cases that required blood transfusion occurred in the second week of operation. Our return-to-theatre rate is higher than published studies. Late secondary haemorrhage (after first week post-operation) occurs in cases involving coblation. We have possibly identified a new tertiary form of haemorrhage associated with coblation tonsillectomy. IMAGING IN DIAGNOSIS OF ACUTE APPENDICITIS DELAYS SURGERY AND INCREASES MORBIDITY Maziar Navidi, Thomas Hamilton, Hazim Sadideen, Radu Mihai. Oxford Radcliffe Hospitals NHS Trust Aims: This study explored whether obtaining radiological information (USS/CT) delays surgery in patients with acute appendicitis and its possible impact on morbidity. Methods: A retrospective analysis of consecutive patients who underwent emergency appendicectomy during a 6 months period. Results: Of the 90 patients presenting with possible appendicitis 16 underwent USS and 13 had CT scans. Only 6/16 USS were diagnostic. All CT scans were diagnostic. The use of USS and CT scans delayed surgery by a mean of 21hrs (STD 15.1 hrs, p<0.01) and 11hrs (STD 13.8 hrs P<0.01) respectively. Histology confirmed acute appendicitis in 82 of 90 patients. Length of postoperative stay for patients operated on within 6 hours of admission or within 18 hours after onset of symptoms was significantly shorter compared to those who had delayed surgery (median 35 vs 78 hours, p<0.05; median 44 vs 100 hours, p<0.05). The mean length of antibiotic use was shorter for patients operated within 18 hrs 3.5 days (STD 2.7) versus those operated after 18 hours 6 days (STD 3.2), p <0.03. Conclusions: Use of imaging was associated with longer inpatient stay and increased antibiotic usage. Routine diagnostic laparoscopy could provide a more definitive and timely alternative to imaging. STRATEGIES TO IMPROVE THE MANAGEMENT OF HIP FRACTURES WITHIN A LARGE TEACHING HOSPITAL Simon Matthew Graham, Nicholas Frew. Leeds Teaching Hospital, Orthopaedics and Trauma Introduction: The British Orthopaedic Association Standards for Trauma (BOAST) recommend that hip fractures in patients over 60 years require surgery within 48 hours of admission, unless there are clear reversible medical conditions. An audit of patients admitted to our institution with hip fractures in 2008 highlighted a significant problem in meeting the BOAST guidelines. Several changes were implemented to improve the management of these patients including a daily dedicated hip fracture trauma list, extra Saturday hip lists and the introduction of the Fractured Neck of Femur Pathway. Methods: Completed audit cycle of hip fracture patients over the age of 60 years admitted to our unit over a 4 week period in November/December 2008 (24 patients) and November/December 2009 (26 patients). Results: In200846%of patients (11/24) underwent surgerywithin48hours of admission. Following implementation of the above changes, re-audit in November/December 2009 showed that 77% of patients (20/26) were operated onwithin 48 hours of admission (p1⁄4 0.01) and only 5% of patients (2/26) waited longer than 48 hours without a medical reason (p 1⁄4 0.01). Conclusion: Implementation of dedicated hip lists and a hospital Fractured Neck of Femur Pathway have significantly improved the management of hip fractures in our unit. A STUDY TO EVALUATE THE ACCURACY OF MAGNETIC RESONANCE IMAGING IN THE STAGING OF PROSTATE CANCER Tafafzwa P. Makarawo, Joshua Phillips, Edward Gee, Jane Carter, Jonathan Eaton, Adel Makar. Alexander Hospital Department of Urology Background: Magnetic Resonance Imaging (MRI) is the standard modality for pre-operative local staging of prostate cancer (CaP), despite its previously exposed limitations in detecting locally-advanced disease. Our aim was to evaluate the accuracy of MRI staging scans at our centre compared to the pathological specimens following radical prostatectomy. Patients and methods: 189 patients with clinically organ-confined CaP who underwent radical prostatectomy at our centre during a six year period between May 2003 and September 2009 had pre-operative MRI scans for local staging. The MRI findings were compared with the final prostate and lymphadenectomy specimen results. Results: MRI scanning correctly diagnosed 123 out of 135 cases of organconfined disease whilst identifying 8 out of 54 with locally-advanced CaP. The overall accuracy of MRI scans was 67.7%, with a low sensitivity of 14.8% but high specificity of 91.1%. The positive predictive value was 40% and negative predictive value was 72.8%. Notably, MRI failed to identify any of the seven patients with node positive disease. Conclusion: OurMRI scan findings demonstrate a low sensitivity and high specificity for the detection of locally-advanced CaP, consistent with contemporary evidence. More robust modalities for staging CaP patients therefore remain an important target for future research. VALIDATED ELECTRONIC PERSONAL ASSESSMENT QUESTIONNAIREPELVIC FLOOR (EPAQ-PF) AS AN ASSESSMENT TOOL IN THE TREATMENT OF FAECAL INCONTINENCE WITH SACRAL NERVE STIMULATION Himanshu Wadhawan , Steven R. Brown. 1 Sheffield Teaching Hospitals NHS Fondation Trust; University of Sheffield, Sheffield, UK Aims: Sacral nerve stimulation (SNS) has been shown to be effective in the treatment of faecal incontinence (FI). We examined whether stimulation improves global pelvic floor function by utilising a unique assessment tool.