# ASiT Innovation Summit e-Posters

## TL;DR

This paper reviews the impact of AI in surgery, including precision, diagnostics, and training, while also addressing challenges like estates failures and AI misuse in medical writing.

## Contribution

The paper provides a comprehensive review of AI's role in surgery and highlights novel applications and challenges in healthcare settings.

## Key findings

- AI has improved surgical precision and patient outcomes through robotic-assisted surgery and machine learning.
- Estates failures in theatres cost an estimated £730k annually in downtime and lost productivity.
- AI tools are seen as potentially useful in surgical training, though concerns remain about their impact on learning and patient care.

## Abstract

1. Analyse existing literature on the application of AI models in surgery. 2. Assess the impact of AI on surgical precision and patient safety. 3. Evaluate AI driven technologies in enhancing diagnostics and surgery.

Unprecedented advancements in precision, efficiency and patient safety are the ways in which artificial intelligence is transforming surgical practice. It's integration in the provision of care via surgical procedures is a welcome move especially as healthcare systems push for innovation, directly addressing the growing demands for improved outcomes and cost-effectiveness in surgery.

This review is derived from the clinical trials, peer-viewed studies and meta-analysis focused on the application of AI in surgery. Areas examined include Robotic surgery, surgical imaging, personalized care models and predictive analytics. This review assesses the extent to which AI algorithms have been trained on large datasets to streamline complex procedures, improve diagnostics, and predict surgical outcomes thus offering a comprehensive analysis of the existing literature.

It is an undeniable fact the AI has in fact demonstrated substantial impact across various surgical specialties. Enhanced precision, reduced recovery time and minimized complication are accredited to the robotic-assisted surgery while improved diagnostic accuracy and individualized treatment plans are attributed to advancements in machine learning algorithms. AI driven imaging technologies and surgical targeting have resulted in faster and enhanced patient outcomes in multiple clinical settings.

With continued refinement and adoption the integration of AI in surgery holds the transformation potential in healthcare, poised to enhanced surgical precision, safety and efficiency thus reshaping the future.

This audit aimed to assess estates failures in theatre, assess the impact on patients and estimate the cost of lost productivity.

The audit was conducted at a major trauma centre in London. There were 2,123 reported estates failures over two years (2021 and 2022). Each failure was assessed for the potential effect they would have had on operating capacity, staff utilisation and the cost of theatre downtime.

We assessed each failure and estimated the likely theatre downtime and the associated costs for example case cancellations and staffing costs. The estimated clinical downtime costs per year were £375k for staffing costs, £205k for downstream costs and £150k for lost revenue. Overall, this summated to £730k per year.

SMART Theatres may improve current processes. For example, in theatre temperature control currently, theatre temperatures are checked and if out of range estates are alerted. After several hours the temperature may be corrected. With SMART Theatres the temperature would be automatically corrected before a critical temperature.

Current processes could be improved, and theatre downtime reduced with the introduction of SMART Theatres.

One third of patients awaiting knee arthroplasty have described their quality of life as “a state worse than death”. Hence, worsening in patient pain and function necessitates early identification for effective management. This study aims to develop a trajectory model to identify rapid pain progression and explore associated risk factors.

We assessed 3026 individuals from the MOST dataset, a prospective longitudinal study which followed patients at risk of knee osteoarthritis over a 84-month period. Group-based trajectory models are a form of unsupervised machine learning which can cluster variables over time. A model was developed to identify clusters in the pattern of pain reported using the Western Ontario and McMaster Universities Osteoarthritis Index pain scores over an 84-month period.

2056 patients were eligible for modelling. Four pain trajectories were identified. Patients who experienced the greatest increase in pain in the first 30 months (Δ: 3.39, 95%CI: 3.13-3.65, p<0.001) were older (median: 63, IQR: 55-68.25, p=0.047), more likely to be female (62.3%, p=0.044) with higher baseline KLG bilaterally and longer chair stand time (μ: 11.53, 95%CI: 11.10-11.96, p=0.005). Those with a low fluctuation in pain over 84 months were younger (median: 61, IQR: 55-67, p=0.047), less likely to be female (56.1%, p=0.044) with lower baseline KLG bilaterally.

The model identified clusters of patients with similar pain progression. Rapidly worsening pain was associated with greater baseline KLG scores, female sex, higher BMI and reduced baseline function. Future research should validate this model on external datasets and other large prospective studies.

Amidst the growing excitement over ChatGPT’s potential in medical writing, we raise two central questions regarding its place in healthcare literature: 1. How credible is the information generated from ChatGPT? 2. Does scientific writing by ChatGPT meet medical journal publication requirements (quality, ethics, and integrity)?.

A total of five medical research databases were employed in searching for research articles on 1/3/24. A total of 19 records, including titles and s, were retrieved at the end of the research process. The eligibility criterion emphasized emphasis on the research topic, the quality of employed research methodologies, and exhibited research limitations.

The study findings indicate that, while ChatGPT’s text responses were well written with coherent arguments, they were also formulaic and unreferenced. This deviates from the principles of the scientific method, raising concern regarding the credibility of the AI language models in question.

AI language systems are extremely vulnerable to misuse. Misuse encompasses intentional and unintentional egregious utilisation of AI models in medical research. There is a disparity in accountability and integrity between AI systems and human authors in medical publishing.

Whilst AI has the potential to revolutionise healthcare, concerns regarding research credibility, misuse, and publishing accountability must be addressed. To ensure the reliability of medical evidence, it is crucial to incorporate human intellectual input and establish suitable policies. By addressing issues of misuse and implementing regulatory measures, potential harm can be mitigated, and the responsible use of AI in healthcare can be promoted.

Artificial Intelligence (AI) is fast becoming common place in almost all aspects of the medical workplace. It’s role in surgical training in the UK is still in its early stage. We intend to explore how AI may have a larger role to play in the training and assessment of surgeons and in which aspects it would have the most effective impact. We have reviewed the impact of AI in the surgical training of Core Surgical Trainees in the South West of the UK.

Core Surgical Trainees (CST’s) across the South West Peninsula UK Deanery were asked about the role of AI in their surgical training, whether it would help them make diagnoses/assessments, if they would use it to write referrals/reflections and if they would consider using AI in the future.

While the majority indicated that AI has not impacted their training (81%), 65% would be open to using AI in their surgical training and education. Particularly the vast majority stated that they would consider AI tools to write referrals and reflections, however interestingly only 56% considered it to be fair to do so.

AI is clearly in its infancy in its use in surgical training, however more and more trainees are finding effective uses for it. It is important for trainees to feel confident and empowered to do so whilst ensuring it does not detract from training opportunities, a major worry amongst trainees, and importantly patient clinical care.

The advent of artificial intelligence (AI) in academic writing is set to reshape the field of surgical specialties, particularly urology. As AI technologies advance, they offer the potential to streamline research processes, improve the quality of academic work, and influence the training pathways of urologists. This examines the impact of AI-driven writing tools on urology research and the implications for trainee education.

A comprehensive review of the literature was conducted to evaluate the current applications of AI in academic writing, with a specific focus on urological research. The study analysed how AI can enhance efficiency in tasks such as literature reviews, manuscript preparation, and data interpretation. Additionally, a conceptual model was developed to illustrate how AI could be integrated into urology training programs.

AI-assisted writing tools were found to significantly reduce the time required for literature searches, drafting, and data analysis, enabling trainees to allocate more time to honing clinical skills. The increased availability of high-quality, AI-curated research could accelerate knowledge acquisition and boost the overall research output in urology. However, there is a risk that overreliance on AI could undermine the development of critical thinking and the traditional academic writing process.

AI promises to transform academic writing in urology, offering both benefits and challenges. While it can enhance research efficiency and quality, careful integration into training is crucial to preserve critical thinking and writing skills. Balancing AI advancements with traditional education will be key for the future of urology training.

Sarcopenia is characterised by degenerative skeletal muscle mass loss and has been used as a predictive marker for postoperative complications. Cross-sectional imaging such as computed tomography remains the gold standard for measuring psoas muscle area and density to quantify sarcopenia. While multiple classifications exist, we have focused on the use of Hounsfield units’ average classification (HUAC) which has proven to be effective in being independent of patient data. We have used the psoas muscle at the L2-L4 level for HUAC computation.

We aim to develop automated tools for estimating HUAC using deep learning algorithms.

A total of 41 computed tomography scans of the abdomen were obtained from two institutions after approval. The slices from the images were input into a TransUNet-based deep learning model (DLM) to segment the psoas muscles. The HUAC score was then computed, incorporating the mean HU values and the areas of the left and right psoas muscles into the formula, to diagnose sarcopenia.

We achieved an average Intersection over Union (IoU) value of 90% and a Dice coefficient of 0.90 when comparing the outputs from the deep learning model (DLM) to the corresponding ground truth images.

Our study demonstrates the precision of our deep learning algorithm in quantifying the psoas muscle's Hounsfield Unit Attenuation Coefficient (HUAC), a pivotal marker for sarcopenia. We also validate the feasibility and efficacy of training a neural natively with a compact dataset for muscle segmentation.

This study evaluated the performance of RAPID AI software in acute stroke patients. RAPID includes three functions: (i) automated ASPECTS scoring; (ii) automated CT angiography; and (iii) semi-automated CT perfusion analysis. Introduced in 2023 at our Level 3 Hospital, an interim review of its performance was conducted.

A retrospective analysis of CTP data from patients presenting with acute stroke over an 8-month period was performed. Data were obtained from imaging reports (PACS), and statistical analysis was used to evaluate outcomes. Radiologist performance was compared to the software.

41 patients underwent CT imaging with RAPID software.

ASPECT Score.

37 of 41 patients received an AI ASPECT score. Fifteen patients had scores below 10. Five false positives were noted, with two caused by old infarcts. AI sensitivity for detecting acute infarcts was 53%, specificity 72%.

RAPID CT Angiography.

AI LVO analysis was conducted on 38 patients, detecting large vessel occlusion (LVO) correctly in 12 patients. One false positive occurred, and four occlusions (3 MCA, 1 PCA) were missed. Sensitivity for LVO detection was 92%, specificity 97%.

AI CT Perfusion.

All 41 patients had CTP analysis. AI detected acute infarction (CBF <30%) in 15 cases, with one false positive. Seven small infarcts were missed, yielding a sensitivity of 68%.

CT Perfusion is valuable in acute stroke management, but radiologists must verify automated ASPECTS and LVO results, as overcalls and missed occlusions can occur. Collaboration between radiologists and neurosurgeons ensures accurate diagnosis and timely intervention.

Sarcopenia is muscle mass and function loss and associated with adverse surgical outcomes including long recovery times, hospital stay, poor physical mobility and survival.

Artificial Intelligence (AI) and Machine Learning (ML) applications are emerging to increase the efficiency of sarcopenia management. This study aims to systematically review the available literature on the utilisation of AI and ML in image-based sarcopenia assessment in vascular surgery.

A comprehensive search strategy of search engines (MEDLINE, OVID, Embase and Cochrane Library) was carried out by two independent reviewers. This review was registered within the PROSPERO database and developed in accordance with PRISMA guidelines.

1067 titles and s were screened, 106 full texts were assessed for eligibility and 41 remaining studies matched our selection criteria. One RCT was found within vascular surgery. This investigated outcomes of type B aortic dissection comparing ML-derived lean psoas muscle area at L3 vertebrae. Common themes were identified across papers that suggest sarcopenia correlates with adverse effects even with those identified as having “low procedural risk”, increased rates of early mortality within a year, early critical care stay, and prolonged ventilatory support. AI/ML measures increase the efficiency of sarcopenia diagnosis and can be done with minimal cost intervention in contrast to anthropometric measures.

Overall, the evidence base has shown favourable performance of AI and ML algorithms in the assessment and validation of sarcopenia. More research needs to be conducted on assessing use of ML and AL in vascular surgery.

This study was conducted to assess if ChatGPT Artificial Intelligence (AI) is capable of critically appraising scientific writing for the presence of spin, a form of reporting bias that overemphasises positive findings and minimises negative findings.

The 25 most recent systematic reviews (SRs) of randomised control trials (RCTs) on topics related to orthopaedic sports medicine from 3 leading journals were identified. The methodologic quality was assessed using - A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Each full article was independently assessed by 4 reviewers for the 15 most common forms of spin, with a senior author holding a casting vote on disagreements. The full text was provided to AI which using a standardized prompt was asked to assess for the presence of spin and to explain its decision. The statistical difference between surgeon and AI assessment was assessed.

There were 25 SRs published between 2024-2022, which included 392 RCTs and 27,925 patients. Using the AMSTAR criteria there were 11 SRs at a high risk of bias (44%), 10 a moderate risk (40%) and 4 at a low risk (16%). Overall, there 44 instances of spin recorded by surgeons and 107 by AI (p < 0.001). The mean instances of spin per SR was 1.7 ± 1.6 (range 0 – 6) and 4.3 ± 3.3 (0 – 11) when assessed by surgeons and AI respectively (p < 0.001).

AI may be a useful screening tool for the detection of spin in academic literature, but it is not specific and is inferior to critical appraisal by surgeons.

The aim of this study is to evaluate the use of easily accessible blood test parameters in diagnosing acute appendicitis (AA) accurately and reducing the negative appendectomy (NA) rate.

782 patients who underwent appendectomy at our hospital from March 2015 to December 2020 were retrospectively analysed. Patients with histologically confirmed appendicitis were assigned to the positive appendectomy (PA) group (n=629), those with histologically confirmed normal appendix were assigned to the negative appendectomy (NA) group (n=153). We compared the age, sex, white cell count (WCC), bilirubin count, C-reactive protein (CRP) levels, neutrophil count, neutrophil percentage, lymphocyte count, neutrophil-to-lymphocyte ratio (NLR) and eosinophil count. We performed receiver operating characteristic (ROC) analysis to calculate cut-off values of the blood parameters, and multiple logistic regression analysis (MLRA) to identify independent variables to diagnose AA.

There was a significant difference in the mean ages of the NA and PA groups (p=0.003). More females comprised the NA group (66%). There was a significant difference for the means of WCC, bilirubin, CRP, neutrophils, neutrophil percentage and NLR (p<0.001). There was no significance for the means of lymphocytes and eosinophils. ROC analysis (p<0.001) identified sensitivity, specificity for WCC (63%, 66%); bilirubin (58.3%,58.8%), CRP (60.1%, 62.1%); neutrophils (63.9%, 67.3%); neutrophil percentage (61.2%, 62.1%); lymphocytes (43.6%, 41.2%); NLR (61.4%, 61.4%); eosinophils (37.5%, 41.2%). MLRA identified CRP and neutrophils as statistically significant independent variables to diagnose AA with 80.4% accuracy.

Blood parameters can be used to accurately diagnose AA and reduce the NA rate, particularly CRP and neutrophils (p<0.001).

Patient-reported outcome measures (PROMs) are tools for assessing symptoms and care quality. Despite their increasing use, traditional data collection methods hinder widespread PROM implementation. In orthopaedics, pain is a common PROM, particularly after total knee arthroplasty (TKA). While TKA is typically successful, some patients experience post-operative pain, possibly linked to tourniquet use. Enhanced PROM data collection could address the impact of tourniquet use on post-operative pain. The PainPad, an automated self-logging device, was developed for accurate pain measurement. The aim of this study was to evaluate the feasibility and effectiveness of the PainPad in quantifying post-operative pain following TKA with or without tourniquet use.

A retrospective study of 234 patients undergoing TKA at Milton Keynes University Hospital was conducted. Patients were divided into tourniquet and non-tourniquet groups. Pain was self-reported bi-hourly using the PainPad, and data on hospital length of stay (LOS) and tourniquet time were collected.

Of 115 patients in the tourniquet group (63% females, mean age 69.2 years) and 119 in the non-tourniquet group (76% females, mean age 71 years), the PainPad device showed no significant difference in 24-hour mean pain scores (P = .53, 95% CI: −0.76 to 0.39) between the groups. No correlation was found between tourniquet time and PainPad scores, and subgroup analysis by tourniquet duration showed no significant differences in pain or LOS.

The PainPad is a feasible and effective tool for evaluating in-hospital postoperative pain after TKA, supporting the current healthcare trend towards leveraging innovative technologies and personalized data to enhance patient-centered care.

This analysis aims to address this gap and identify trends in Aesthetic breast surgery (ABS) literature to guide future research areas. This encompasses breast augmentation, breast reduction, mastopexy and mastopexy-augmentation.

The 100 most cited publications in ABS were identified on Web of Science, across all available journal years (from 1953 to 2024). Study details, including the citation count, main content focus, and outcome measures were extracted and tabulated from each publication. Oxford Centre for Evidence Based Medicine (OCEBM) & Levels of Evidence (LOE) of each study were assessed.

The 100 most cited publications in ABS were cited by a total of 11522 publications. Citations per publication ranged from 46 to 1211 (mean 115.2 ± 135.7), with the highest-cited study being the Pusic BREAST-Q paper (n = 1211). A majority of publications were LOE 4 (n = 30), representative of the large number of case series. The number of publications for LOE 5, 3, 2 and 1 was 12, 28, 21 and 9, respectively. The main content focus was ‘outcomes’ in 52 publications, followed by ‘non-operative management’ (n = 12) and ‘surgical technique’ (n = 12). Patient-reported outcome measures (PROMs) were used in 29 publications, and 53 publications reported aesthetic outcome measures.

This analysis highlights that research methodologies in ABS studies should be improved. This necessary improvement would be facilitated with vigorous, high-quality research, and the implementation of validated ABS-specific PROMs enhancing patient satisfaction, particularly in aesthetic procedures, such as BREAST-Q.

The aim of this study was to explore the optimal sternal closure technique post adult cardiac surgery.

A retrospective study of all patients undergoing cardiac surgery via sternotomy during 2021 was conducted at a quaternary hospital. Results were analysed following sternal re-approximation using wires, cables or plating in the short-term (<30 days) and at one-year follow-up.

The primary outcome measure was one year free from surgical reintervention with secondary outcome measures including rates of superficial infection, wound dehiscence, deep sternal infection and mediastinitis as well as the need for further active management or surgical re-intervention.

There was a trend towards superior outcomes regarding sternal union, reduction in long-term complications and decrease in need for surgical reintervention, IV-antibiotics or readmission following wire-closure versus cable-closure. The results were similar amongst patients who had wires versus plating. While there was a higher rate of short-term complications in the wire group, this did not result in a higher need for further active management. It was also observed that risk factors including diabetes, obesity, emergency surgery and reoperation increased the patient’s risk for short-term post-operative sternal complications including superficial and deep infections, wound dehiscence and sternal non-union.

This study supports the use of wires as the superior sternal repair technique, considering the lower cost profile of wires versus sternal-plating with similar sternal outcomes. There were higher rates of long-term complications, sternal non-union and increased need for reintervention, readmission and IV antibiotics following cable closure.

Caecal volvulus, a significant contributor to colonic volvulus cases, involves the axial twisting of the mobile caecum. While ischemic hepatitis is typically linked to specific aetiologies, its association with caecal volvulus is rarely reported. This case report presents an 80-year-old female with acute epigastric pain and laboratory evidence of acute liver injury. Imaging studies revealed features suggestive of caecal volvulus, highlighting a noteworthy instance of ischemic hepatitis precipitated by this condition.

Optimal blood management is vital in elective surgeries. Key strategies include correcting preoperative anaemia, reducing surgical time, employing intraoperative blood salvage, and minimizing blood loss. Adherence to evidence-based transfusion protocols can reduce unnecessary transfusions.

To identify predictors of intraoperative blood transfusion in elective surgeries in Addis Ababa from November 1, 2023, to April 30, 2024.

A six-month multi-centre cross-sectional study was conducted at Tikur Anbessa Specialized Hospital, Menelik II Hospital, Gandhi Memorial Hospital, and Lancet General Hospital. Hospitals were selected randomly, and data were collected from all elective surgical patients using a structured checklist. Bivariate logistic regression analysis identified predictors of intraoperative blood transfusion.

Out of 574 elective surgeries, 469 (81.7%) required blood requisitions. Of the 824 units prepared, 182 were transfused intraoperatively for 126 patients. Predictors of intraoperative transfusion included intraoperative blood loss >15% (p=0.000, AOR=20.499), ASA class III+ (p=0.000, AOR=3.926), ASA class II (p=0.018, AOR=2.303), preoperative transfusion (p=0.000), surgery duration >3 hours (p=0.017, AOR=2.041), and general anaesthesia (p=0.000, AOR=0.312). Age, platelet count, and type of surgery were not significant predictors.

Significant predictors of intraoperative blood transfusion include substantial blood loss, higher ASA classification, preoperative transfusions, longer surgeries, and general anaesthesia. Improved blood ordering protocols and regular guideline reviews are recommended to enhance efficiency and reduce wastage.

Acute appendicitis is a common problem and can be difficult to diagnose at time, several scoring systems have been developed to assist physicians in diagnosing acute appendicitis.

We aim to compare efficacy of RIPASA and ALVARADO scoring system in the diagnosis of acute appendicitis.

This study was comparative prospective study done on total number 78 patients underwent appendectomy. Histopathology findings of the operated case were collected and correlated with either score.

85.9% of our cases had Positive Histopathology, RIPASA Score cut off value 7.5 with sensitivity and specificity 95.52%,90.9% respectively. ALVARADO score cut off value 7 with sensitivity and specificity 82.09%,72.72%, respectively.

RIPASA scoring system is more accurate to diagnose acute appendicitis especially when RIPASA score is >7.5.

Comparative study to obtain the best method for treatment of chronic anal fissure by comparison outcome of lateral sphincterotomy and fissurectomy with sustained digital anal dilation.

This study included 100 patients admitted in general surgery department of AL-Zahraa university hospital. Pre-operative symptoms and signs mainly pain, bleeding. constipation, discharge and pruritis ani Laboratory investigations was done for all patients mainly PT, PC.INR. The patients in this study divided into two groups. Group A: include 50 patients was managed by fissurectomy and lateral internal sphincterotomy Group B: include 50 patients was managed by fissurectomy and digital anal dilatation.

In this study, they were 60 (60%) females and 40 (40%) males with age ranged from 18 to 66 years with mean ± SD of 36.86 ± 12.60 years. post fissure found in 85%, ant fissure found in 15% Early follow up Group A: two patients (4%) complain of bleeding, 4 patients (8%) complain of infection, 4 patients (8%) delayed healing, 3 patients (6%) Incontince to liquid and gases Group B:no patients complain of bleeding, 1 patient (2%) infection, no patients delayed healing, 2 patients (4%) Incontince to liquid and gases Late follow up Group A; stenosis in one patient (1%), recurrence in one patient (1%) Group B; no patient complicated by stenosis was recorded; recurrence found in one patient (1%).

Both anal dilatation (AD) and Lateral internal sphincterotomy (LIS) provides early pain relief and high ulcer healing rate. However, AD appears to be safer with regard to healing and infection.

Surgical drains and luminal devices are vital in healthcare, but their use in elective procedures has been questioned with the adoption of ERAS guidelines. This study investigated post-operative issues related to these devices across surgical specialties to identify evidence-based areas for improvement and innovation.

Clinicians with professional registration in the UK who insert luminal devices were eligible for inclusion. Data were collected through an electronic questionnaire distributed at a national health technology meeting with predefined questions generated through steering group consensus. A thematic qualitative analysis was performed.

Forty participants from 13 specialties responded to the survey: 45% (n=18) were in General Surgery, 32.5% (n=13) in other surgical specialties, and 22.5% (n=9) in medical specialties. Thematic analysis revealed three key themes: (1) device indication, (2) securing method, and (3) post-operative issues. The most common indications were prophylactic for anticipated blood loss (55%, n=22) and therapeutic for drainage or source control (24%, n=10). Non-absorbable sutures were used by 75% (n=30) of respondents. Drain positioning issues were reported by 21%, poor wound healing, fistula formation, and infection by 22%, with 20% observing complete drain displacement. Patient discomfort from drain insertion was reported by 38%.

This pilot study offers key insights into the attitudes and practices surrounding a common surgical intervention, highlighting issues like drain positioning, wound healing complications, and patient discomfort. These findings indicate the need for further research to inform future national studies and explore innovative techniques to reduce discomfort from surgical drains or poor luminal device fixation.

This study explores the effects of sleeve gastrectomy on hormone levels, aiming to clarify the relationship between bariatric surgery, metabolic function, and reproductive health in obese women.

This study employs a prospective observational design to evaluate the effects of laparoscopic sleeve gastrectomy on reproductive hormones and ovarian function in 32 morbidly obese women. BMI, hormone levels, and ovarian function were assessed before surgery, and at 6- and 12-months post-surgery.

Six months post-surgery, significant reductions were observed in BMI, dropping from 42.12 to 32.87 with a further decrease to 25.65 after 12 months. Anti-Müllerian hormone (AMH) levels declined from 3 ng/mL to 2.5 ng/mL, then to 2 ng/mL at 12 months. Antral follicle count (AFC) also decreased, from 11 to 9 in the right ovary and from 11 to 8 in the left ovary, further declining to 7 and 6, respectively. Following surgery, significant hormonal and metabolic changes were observed (p < 0.001). Follicle-stimulating hormone (FSH) increased from 6 to 9 mIU/mL, luteinizing hormone (LH) rose from 7 to 9 mIU/mL, and estradiol (E2) levels increased from 31 to 49 pg/mL. Sex hormone-binding globulin (SHBG) increased from 36 to 64 nmol/L, while free testosterone levels decreased from 29 to 9 ng/dL, all with statistically significant changes.

Bariatric surgery's impact on ovarian function and fertility requires careful evaluation. Monitoring changes in AMH levels post-surgery provides insights into the reproductive effects of weight loss, aiding clinical management and counselling for women of reproductive age.

Southampton General Hospital (SGH) is a high-volume HPB centre which has been using the Enhanced Recovery After Surgery (ERAS) pathway for all Pancreaticoduodenectomy (PD) patients since 2012. Initial results showed a reduced Length of Stay (LOS) with the implementation of ERAS. This study aims to determine whether the impact of ERAS has progressed over time.

Single-centre retrospective study of patients undergoing open PD from 2007 – 2023. Pancreatic reconstruction with Pancreatojejunostomy in all cases. Pre + Post ERAS data analysed, with Post-ERAS data subdivided into Early, Middle and Late phases. LOS, complications, readmissions, mortality were all examined. Data analysis with Multi-variate regression, Kruskal-Wallis and Chi-Squared tests. Data analysis using STATA.

Overall, 855 patients underwent open PD with a mean age of 66. The yearly volume of PD performed increased with time. Median LOS reduced from 13 to 9 days with ERAS implementation (p<0.01), with no increase in grade 3 complications or readmissions (p=0.93, p=0.16). Rates of pneumonia delayed gastric emptying and pancreatic fistula (Grade B and above) were not influenced by ERAS implementation (p=0.93, p=0.53, p=0.074). Grade 3 complications lead to increased LOS and readmission (p<0.01, p<0.01). Median LOS across Early, Middle and Late ERAS periods was 10, 9 and 9 respectively (Kruskal-Wallis p=0.78, Spearman p<0.05).

Overall, ERAS is able to reduce LOS without increasing complications, this effect is maintained across its phases. Therefore, ERAS can improve LOS despite changes in clinical practice and consultant body over time.

Laparoscopic cholecystectomy is a minimally invasive procedure that has largely replaced the open technique for gallbladder removal since the early 1990s. Although it is generally safe, bile duct injury (BDI) remains a serious complication, occurring in 0.25-0.74% of cases involving major lesions and 0.28-1.70% for minor lesions. This study aimed to evaluate the outcomes of laparoscopic cholecystectomy for symptomatic gallstone disease in terms of hospital stay, complications, morbidity, and mortality.

This retrospective study was conducted in the General Surgery Department of Letterkenny University Hospital. Medical records of all patients who underwent laparoscopic cholecystectomy performed by a single surgeon from January 2016 to August 2022 were reviewed. Data on demographics, surgical details, conversion to open surgery, and complications were collected. The results were compared with international data.

A total of 305 cases were reviewed, with 213 (69.83%) elective and 92 (30.16%) emergency surgeries. The mean age was 52.36 years, with the majority aged 40-49. The average hospital stay for emergency cases was 6.81 days. One patient (0.32%) required conversion to open surgery. Three patients (0.98%) experienced complications: one had a common bile duct (CBD) injury requiring primary repair with end-to-end anastomosis, another had iatrogenic CBD perforation and a laparoscopic suture was applied, and a third had a post-operative bile leak managed conservatively. There was no mortality or readmission.

Laparoscopic cholecystectomy remains a safe and effective treatment for gallstone disease in our setting, with outcomes comparable to national and international standards.

Acute Pancreatitis (AP) has always been a clinical challenge. Timely assessment of severity in patients with AP has a prime importance in guiding an optimal management for these patients. Over the years, a number of single & multi-parameter predictors have been identified & tested for assessing its severity. The main aim of this study is to test the reliability of Neutrophil-Lymphocyte Ratio (NLR) in determining the severity of AP early in the disease process.

We retrospectively analysed 200 patients with AP diagnosed during the period of 2011 – 2013, who were categorized into two groups of mild versus severe disease, based on the modified Glasgow criteria. The value of NLR as a prognostic marker was obtained at the time of admission & a comparative analysis was performed to compare the NLR values between these groups.

Out of 200 patients, 35 were graded as severe, while 165 were graded as mild cases of AP according to the modified Glasgow criteria. The severe AP group had a significantly higher NLR than the mild AP group. In predicting the severity of AP at admission, sensitivity, and specificity of NLR was 67% and 80%, respectively. There was a moderate degree of positive correlation between NLR and length of hospital stay. The association between NLR at admission and severity of acute pancreatitis proved to be statistically significant with a P value of 0.03.

Raised value of NLR at admission is significantly associated with severe AP and may be valuable in predicting the severity early in the disease process.

There is a known link between mental health and pain severity within the general population. Having scoliosis can negatively impact mental health with many scoliosis patients experiencing pain.

Physiotherapy Scoliosis Specific Exercises (PSSE) have been shown to significantly reduce scoliosis-related pain; however, it is unknown whether a reduction in pain may also result in an improvement in mental health. This study aimed to determine whether a relationship existed between mental health and pain, pre and post PSSE treatment.

79 consecutive patients with idiopathic scoliosis who attended 1-4 weeks of supervised PSSE completed the Scoliosis Research Society Questionnaire 22 (SRS-22) and a visual analogue scale (VAS) for pain, pre- and post-treatment. VAS scores, alongside SRS-22 subsections scores on mental health and pain were compared, pre and post treatment, with the results statistically analysed.

Significant post-treatment improvements were found in VAS (p=0.000059), SRS-22 pain (p=0.0084) and mental health scores (p=0.0025). Pearson's correlation analysis demonstrated a moderate negative relationship between post-course pain and mental health (r = -0.377), which was corroborated by Spearman's rank correlation (r = -0.378, p = 0.00059). Subgroup analyses indicated that this inverse relationship held regardless of gender, course type, classification, and curve size.

A course of supervised PSSE significantly reduced pain and improved mental health in scoliosis patients. The negative correlation between pain reduction and mental health improvement highlights the potential holistic benefits of this intervention and suggests that improvement in mental health is associated with reducing pain in this cohort.

This single-centre audit aims to evaluate the impact of PSA density (PSAd) on the detection of clinically significant prostate cancer (csPCa) in patients diagnosed with Prostate Imaging Reporting and Data System (PIRADS) 3 lesions identified through MRI scans.

We conducted a retrospective analysis of a cohort of 194 patients referred to our major cancer centre from January 2024 to June 2024. Inclusion criteria consisted of adult male patients with PIRADS 3 disease identified on MRI, who were subsequently referred to the Rapid Access Clinic. Descriptive statistics were employed to characterize patient demographics, clinical features, biopsy outcomes, and subsequent cancer management strategies. Univariate and subgroup analyses were performed to compare detection rates of csPCa between patients categorized by PSAd levels: those with PSAd < 0.15 and those with PSAd ≥ 0.15. Statistical significance was assessed using Chi-square tests and logistic regression models to evaluate the relationships between variables.

Among the 194 patients analyzed, 101 underwent prostate biopsies, resulting in the detection of 45 cases of prostate cancer (45%) and 56 benign findings (55%). Notably, the detection rate of csPCa was significantly higher in the PSAd ≥ 0.15 group (32.35%) compared to the PSAd < 0.15 group (10%).

The findings of this study underscore the importance of PSA density as a valuable prognostic marker for predicting clinically significant prostate cancer in patients with PIRADS 3 lesions.

Prostate cancer is a prevalent malignancy, often associated with advancing age and high androgen levels. This case report discusses a middle-aged patient with a rare occurrence of prostate cancer, following a history of cryptorchidism and hypogonadism.

A gentleman in his late sixties, with a previous unilateral orchidectomy for suspected testicular cancer and 10 years of testosterone replacement therapy for hypogonadism, presented with an elevated prostate-specific antigen (PSA) level of 5.1 ng/ml. Digital rectal examination revealed a firm lobulated prostate, and MRI indicated a 15 mm PIRAD 4 lesion in the left peripheral zone. Trans-perineal biopsy confirmed a diagnosis of prostatic adenocarcinoma (Gleason score 3 + 3 = 6), with bilateral disease.

Although hypogonadism is characterized by low testosterone, and the conventional view links elevated testosterone to prostate cancer risk, this case challenges that notion. It highlights the need for ongoing assessment of long-term effects of testosterone replacement therapy in patients with a history of cryptorchidism and hypogonadism. Current literature lacks clear associations between these conditions and prostate cancer, demanding further research.

This case emphasizes the importance of vigilant follow-up, including regular PSA testing and digital rectal examinations, for patients undergoing testosterone replacement therapy, especially those with complex histories of cryptorchidism and hypogonadism.

Common peroneal nerve palsy (CPNP) is a known complication of total knee arthroplasty (TKA). It results in motor and sensory deficits, such as foot drop and neuropathic pain, thereby diminishing function and reducing quality of life. This study aims to evaluate the outcomes of common peroneal nerve (CPN) neurolysis in patients with persistent CPNP following TKA.

A retrospective review was conducted on 24 patients (6 male, 18 females; mean age 66±10 years) who underwent CPN neurolysis between 2010 and 2022 at a tertiary referral hospital. Of the cohort, 22 had primary TKA and 2 had revision TKA. All patients exhibited no improvement in CPN function for at least three months post-TKA and were followed for a minimum of six months. Symptom resolution and improvement were analysed using Chi-Squared tests. Continuous variables (age, tibial tray overhang, and time between TKA and neurolysis) were assessed using Kruskal-Wallis and Mann-Whitney U tests, while categorical variables (sex and ASA classification) were analysed using Chi-Squared tests and Fisher’s Exact Test.

Symptom improvement was observed in 83% (20/24) of patients, with a statistically significant improvement in overall symptoms (χ²=10.667, p=0.001). However, complete symptom resolution was not statistically significant (χ²=3.000, p=0.223). All categorical and continuous variables measured did not significantly influence symptom resolution or improvement (p>0.05).

CPN neurolysis significantly improved symptoms in patients with CPNP following TKA, though full resolution was less common. Factors such as age, tibial tray overhang, time to neurolysis, sex, and ASA classification did not affect outcomes.

Cecal volvulus is a twisting of the cecum and surrounding bowel around their mesenteric pedicles. It accounts for 10-60% of the colonic volvulus. The clinical presentation is highly variable, ranging from intermittent abdominal pain to an acute abdomen due to obstruction, strangulation, or perforation. Through this study, we aim to study the outcomes of all patients diagnosed with this rare cause of bowel obstruction.

We conducted a retrospective review of all consecutive patients who presented to our hospital. A PACS database search using the keyword “cecal volvulus” over the past 10 years was done. Demographics and clinical data including the patient’s pre-, intra-, and post-operative data from the institution’s clinical database were retrieved.

A total of 10 patients were identified, with a mean age of 60 years and female to male ratio of 9:1. Four of them were ASA (American Society of Anesthesiology) Grade 3 and 4. The most common initial presentation was abdominal pain. Computed tomography (CT) of the abdomen in all these patients reported the cecal volvulus. C-reactive protein was elevated in only half the patients. Seven underwent surgery and three were managed conservatively. The median length of hospital stay was 12.2 days and there were no readmissions.

Cecal volvulus being an uncommon cause of acute abdomen, is difficult to diagnose without a clear history. Delayed treatment can lead to increased morbidity and mortality. CT is the investigation of choice. Right hemicolectomy with anastomosis is the surgery of choice depending on the patient's status.

Fournier’s Gangrene (FG) is a rare, rapidly progressive, life-threatening condition with necrotizing fasciitis of the perineum. It is a medical emergency that requires urgent surgical debridement and broad-spectrum antibiotics. The typical flora involves polymicrobial bacteria however, cases of fungal aetiology have been reported. Here, we present a case of FG with growth of Candida albicans.

A 53-year-old-male with background of uncontrolled type two diabetes mellitus and hypertension who presented with left testicular swelling and pain with fever. His observations demonstrated low-grade fever (37.7C) and tachycardia (143/min). Genitourinary examination revealed erythematous, tender, and indurated left scrotum. Labs showed leucocytosis and elevated c-reactive protein with negative blood culture. Testicular ultrasound revealed infected left hydrocele with extensive scrotal wall oedema. He was started on ceftriaxone, doxycycline and metronidazole. Examination on the 6th day on antibiotics demonstrated extension of erythema to the perineum with fluid discharge, skin erosion with no crepitus. Magnetic resonance imaging showed presence of multiple gas lobules and collection in the perineum. He underwent emergency surgical debridement. Tissue culture yielded Candida albicans and he was commenced on fluconazole. He underwent one additional debridement and application of vacuum-assisted closure dressing. His observations and inflammatory markers improved significantly. He was subsequently discharged with a referral to the plastic surgery team for skin grafting.

Early surgical debridement and aggressive antibiotic therapy are essential in the management of FG. Antifungal treatment should be considered especially in immunocompromised patients as highlighted in this case.

Postoperative pulmonary complications (PPCs) are a significant concern for patients undergoing cardiac surgery, leading to increased morbidity, extended hospital stays, and higher healthcare costs. Incentive spirometers (IS) are commonly recommended to improve lung function and prevent PPCs, but robust evidence supporting their effectiveness in cardiac surgery patients is limited.

The primary aim of this study is to assess whether the use of incentive spirometers can significantly reduce the incidence of PPCs and shorten the length of hospital stays in patients undergoing elective cardiac surgery.

This study utilises a retrospective-prospective cohort design conducted at the Royal Brompton Hospital. This approach allows for a comprehensive evaluation of the IS's impact by leveraging existing data and validating findings through ongoing patient outcomes.

All eligible patients were enrolled and categorized into two groups based on the use of IS: a retrospective cohort (patients who underwent surgery without IS) and a prospective cohort (patients using IS post-surgery). Both cohorts were assessed postoperatively with primary outcomes including the incidence of PPCs, length of hospital stay, and patient satisfaction. Data was collected using standardized forms and analysed using statistical methods to compare outcomes between groups.

This study at RBH indicates a reduction in PPCs from 52% to 30% and a 1.2-day decrease in hospital stay in the IS group. The patient satisfaction was excellent.

This study potentiates the routine use of IS as an evidence-based standard practice in postoperative care for cardiac surgery patients, potentially leading to better health outcomes and reduced healthcare costs.

PSA density (PSAD), calculated by dividing serum PSA levels by prostate volume, offers greater specificity and accuracy than serum PSA alone in detecting prostate cancer. This study aimed to evaluate the diagnostic performance of PSAD in prostate cancer detection across different PSA levels and its correlation with Gleason scores.

This retrospective, single-centre study analysed MRI scans from 154 patients suspected of having prostate cancer between July 2021 and July 2023. A total of 113 patients met the inclusion criteria and were selected for analysis. PSAD was calculated using serum PSA levels and MRI-derived prostate volume. Receiver operating characteristic (ROC) curves were used to determine optimal PSAD cut-off values for prostate cancer detection, and the relationship between PSAD and Gleason scores was assessed.

Of the 113 patients, 72 (63.72%) were diagnosed with prostate cancer. The overall PSAD cut-off of 0.158 demonstrated a sensitivity of 73.61% and specificity of 92.68%, with an area under the curve (AUC) of 0.83 (95% CI: 0.77-0.90). For patients with PSA levels between 4–10 ng/ml, the optimal PSAD cut-off was 0.155 (sensitivity 65%, specificity 85.19%). For those with PSA levels >10 ng/ml, the cut-off was 0.175 (sensitivity 96.55%, specificity 66.67%). A significant correlation was found between PSAD and Gleason scores (p < 0.01), with higher PSAD values associated with more aggressive cancers.

PSAD demonstrates strong diagnostic accuracy for prostate cancer and is significantly correlated with Gleason scores, suggesting its potential in assessing tumour aggressiveness and guiding clinical decisions.

Tracheostomy tubes are available in a fixed number of lengths and angulations. Complication rates from tracheostomies e.g., obstruction, fistulae, displacement, etc remain high which highlights the challenges associated with a limited choice of tracheostomy tube sizing.

There is a huge range of variability in neck sizes in the population that have not been explored in depth. Our study aimed to fill this gap in the literature to allow tracheostomy tube selection for a wider range of patients.

Measurements of antero-posterior neck skin diameter (AP-S), transverse neck skin diameter (T-Cs), and neck length (NL) were collected from 993 CT neck and thorax scans across seven NHS trusts from 2010 to 2021, for patients between 40 to 90 years for four neck landmarks including the tracheostomy insertion point.

We noted a large variability across all measuring points (standard deviation 25.66 AP-S, 18.4 T-Cs and 23.5 NL) with men having significantly larger necks than women: AP-S 165.9mm vs 150.8mm (p<0.001) and T-Cs 128.1mm vs 113.2mm (p<0.001) at the tracheostomy insertion point. There was no clinically significant correlation between neck size parameters and age; or between AP-SB or NC vs NL (i.e., shorter necks are not thicker).

We are the first to explore neck anatomy in such a large dataset. Our data supports the use of larger tracheostomy tubes in men. We suggest more detailed analysis of anthropometry for better choice of tracheostomy tubes to cater for the huge variation in neck sizes in the population.

The Lenke classification system categorizes Adolescent Idiopathic Scoliosis (AIS) curve patterns to guide surgical intervention(1). Limited research exists on its correlation with resumption of physical activities post-surgery(2). This study examines the relationship between Lenke classification and the timeline for returning to activities after posterior spinal fusion in AIS patients.

A retrospective review was conducted on AIS patients who underwent posterior spinal fusion at Alder Hey Children’s Hospital between 2016 and 2017. Of 90 eligible patients, 66 completed a post-surgery questionnaire. Patients were categorized into Subgroup 1 (Types 1 & 2), Subgroup 2 (Types 3 & 4), and Subgroup 3 (Types 5 & 6) based on Lenke classification. The timing of return to physical education (PE), running, and contact sports was analysed across these groups.

Among 66 patients (mean age 14.8 years), 89.3% returned to school within 1-3 months. In Subgroup 1, 92% resumed school within 2 months, with most returning to PE and running within 6 months. Overall, 31.8% resumed running within 4-6 months, and 19.6% returned to PE in 7-12 months. Additionally, 63.6% resumed contact sports, with 91% achieving pre-operative performance. Subgroups 2 and 3 had slower recovery and lower return rates.

Lenke classification correlates with the timing of resuming physical activities after scoliosis surgery. Patients with simpler curve patterns recovered faster. Further studies are needed to validate these findings in larger populations.

High ulnar nerve (UN) injuries cause irreversible loss of hand intrinsic function. Anterior interosseous nerve (AIN) to UN transfer for recovery of intrinsic muscles is a common technique used for reinnervating distal segments of injured nerves, restoring function. Hemi transfer provides a closer donor-recipient axon count match and may enable a longer reinnervation window with potential for regenerating axons from the proximal repair to reach distal targets before irreversible collapse of the intramuscular neural plexus.

Between 2015 to 2020 consecutive eligible, high ulnar nerve injury patients who underwent nerve transfer: End-to-End (ETE) or Hemi End-to-End (HETE), were evaluated with a minimum of 18 months follow-up. MRC of motor power to 1st dorsal interosseus (FDI) and abductor digiti minimi (ADM) were assessed at six, 12- and 18-months post-nerve transfer.

13 male, 1 female were recruited, average age 39yrs following high UN transection injury (1 lost to follow-up). The median time delay to transfer 2 months. For purposes of analysis separate cohorts were studied - each cohort had either ETE (n=7) or HETE (n=7). Median MRC grade higher at 6m was 1 for both groups, 12m MRC 2 for ETE and MRC 1 for HETE, 18m MRC 4 for ETE and 3 for HETE.

AIN to UN transfers associated with increased numbers of patient reaching MRC 4 score at 18m, compared to HETE following traumatic high ulnar nerve injury. Difference in clinical outcomes between the ETE and HETE transfers still need further research to determine efficacy.

Upper brachial plexus injury causes loss of shoulder abduction (SAB) and external rotation (ExtR). Spinal accessory (SAN) to suprascapular nerve (SSN) transfer restores supraspinatus and infraspinatus function. Augmentation with transfer of the long head of triceps (LHT) to the axillary nerve (AN) anterior division is previously described by Somsak Leechavongs - but can worsen inferior glenohumeral joint subluxation. The medial triceps (MT) branch has a similar axon count, longer length and branching pattern that facilitates simultaneous transfer to the AN’s divisions. This may be used as a good donor to target both deltoid and teres minor whilst sparing LHT function.

Retrospective cohort study, single tertiary centre, 2012-18. Comparing MT to AN (MTA) transfer and combined with SAN to SSN nerve transfer: range of motion (ROM) and British MRC grade for SAB and ExtR, for both groups.

Study included 22 cases, Male: female was 21:1, mean age 35 (R:16-68) and mean follow-up 9 months. Mechanisms of injury: 64% motorcycle related, 18.2% bicycle/mountain bike and pedestrian vs motor vehicle 13.6%. Our 9 cases of MTA had 66.7% SAB with MRC ≥4, 50% ExtR MRC ≥4 power, with average SAB ROM 95o (of 160) and ExtR ROM 45o (of 90); 13 cases had combined with SAN to SSN: SAB of 100% with MRC ≥4, 83.3% ExtR MRC ≥4 with average SAB ROM 140o and ExtR ROM 90o.

We propose MTA is advantageous, specifically for maintenance of shoulder stability conferred by the LHT, with comparable SAB strength and increased shoulder power and ExtR ROM.

Urinary Tract Infections (UTIs) and renal calculi frequently co-exist and are thought to be reciprocally causal. Prompt identification/management may prevent subsequent complications. Gram-negative urease-producing Proteus mirabilis has a particularly well-known association with urolithiasis and patients are frequently investigated for stones, however there is little data describing stone prevalence in UK populations. We assess presence of renal calculi in patients with P.mirabilis and E.coli UTI to guide if patients should always undergo further investigation.

Retrospective case-control study. Basic demographics were collected for all patients with P.mirabilis urine cultures from 03/01/23 to 31/03/23. Duplicate/incorrect samples were excluded and radiological imaging within 3-years was assessed for urolithiasis. Catheters, nephrostomies and foreign bodies present were noted. A similar number of patients with E.coli growth were included. Chi-squared analysis.

Of 261 patients who cultured P.mirabilis, 135 (51%) [74M:61F], median age 77, had imaging within 3 years and stones were identified in 24 patients [11M:13F], median age 75. 296 patients who grew E.coli in the same timeframe were included. Imaging was present in 93 (31%) [33M:60F], median age 77; and urolithiasis noted in 10 cases [5M:5M), median age 73.5. There was no significant difference in stone presence between the two groups imaged (18% vs. 11%, p=0.11). A higher prevalence of catheters was seen in cultures that grew P.mirabilis (11% vs. 5%, p=0.001).

We demonstrate increased urolithiasis in P.mirabilis UTI but no significance when compared with E.coli infections. Extensive additional investigations to identify stones specifically in P.mirabilis UTI may not always be warranted.

Breast-reduction surgery can be conducted within the NHS if patients fulfil strict Patient-Procedure-with-a-Threshold (PPwT) criteria. These have been formulated largely using subjective data from questionnaires, since objective outcome-data is difficult to obtain for this operation. This study aims to demonstrate use of a quantitative measure, using activity-data from patients’ smartphones.

A single-centre, retrospective cohort-analysis was conducted from patients who underwent breast-reduction surgery at Imperial College NHSHT from August 2021 to February 2024. A simple, user-friendly mobile application was used to gather walking/running data from patient’s smartphones from one month pre-operative to six-month post-operative.

56 patients provided data. 38 had undergone primary bilateral-breast-reduction (BBR) for symptomatic-hypermastia; 12 had undergone secondary breast reduction procedures (symmetrisation post breast-cancer surgery). 6 datasets were unusable. Recovery from primary BBR was estimated as taking 31.5 days cf. 13.5 days for secondary procedures. Increased weight of breast tissue removed was found to correlate with a reduction in activity over the first two weeks (p=0.027) in simple linear regression analysis. Patients achieved a higher median daily activity level (115%) in the 4–6-month postoperative period compared to baseline, but this was not found to be significant (p=0.710).

Activity data from patients’ smartphones provides the opportunity to monitor post-operative recovery objectively, in detail that is not possible by other means. Integration of this data, alongside traditional measures, into a holistic monitoring package could help to better inform patients, clinicians and policymakers regarding recovery, outcomes and NHS funding for this operation in the future.

This case report describes an unusual case of a patient with spontaneous atraumatic tension haemopneumothorax. Although rare, is a potentially life-threatening disorder a majority of which are male. Video-assisted thoracic surgery (VATS) is increasingly recognised as the preferred approach for patients and is now recognised as the gold standard treatment for spontaneous haemopneumothorax in line with BTS guidelines.

We present the case of a 23-year-old male who arrived at the emergency department with a 13-hour history of right-sided chest and upper abdominal pain, without any preceding trauma. On initial examination, his vital signs were within normal limits, though he reported significant pain, particularly on inspiration. A chest X-ray and CT revealed a large right hydropneumothorax with evidence of tensioning and complete right lung collapse. The patient was moved to resus becoming mildly tachycardic with a heart rate of 105 highlighting this cohort of patients have a propensity to compensate before becoming unstable. An open chest tube was inserted, after a period of draining air, drained 1600ml of blood over 15 minutes, leading to significant hypotension and tachycardia.

The major haemorrhage protocol was activated, and the patient was stabilised before being transferred to a tertiary centre. The patient underwent definitive management via emergency right VATS procedure. The source of bleeding was identified as vessels from the subclavian artery and RUL apex at ruptured bulla site.

This case highlights that young patients may physiologically compensate despite significant tension haemopneumothorax and the impotence of VATS as the mainstay of treatment.

Breast augmentation with implants is a commonly performed procedure however a significant number of patients request implants removal after some time. Merely removing the implant and not improving the remaining breast look can have flattened, hollow breasts, inferiorly pointing nipples resulting in low self-esteem. In this case series, we describe our experience of improving the shape and volume of breast following breast implant removal with auto augmentation with dual pedicle mastopexy.

All ladies requesting breast implant removal and undergoing this procedure in the last one year were included in this study. Surgery was performed as a day case in general anaesthetic. All patients had wise pattern incisions. Superior or superomedial pedicle was used for nipple areola complex repositioning and inferior de epithelized pedicle was used for auto augmentation for restoration of volume.

Five patients underwent this procedure following removal of implants. Four patients had implants removal bilaterally following removal of implants and one had unilateral that was placed for symmetrisation following contralateral breast reconstruction. All patients were satisfied with the volume except one who requested further augmentation for superior pole. One patient is booked for revision of scar around nipple areola complex. No patient experienced nipple areola loss, fat necrosis, or wound breakdown.

Dual pedicle mastopexy is a useful technique after implants removal in patients who do not wish to have further implants.

While extremity adiposity is known to be associated with adverse health outcomes, their impact on psychological health in individuals without central obesity, remains unclear.

This study utilised data from the United States National Health and Nutrition Examination Survey (NHANES) 2011–2018. Males with waist circumference >102 cm and females with >88 cm were excluded from the analysis. Adiposity in the arms and legs was measured via dual-energy X-ray absorptiometry (DXA) scans. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). Overestimation of BMI group and intention to lose weight were also assessed. Multivariate logistic regression was conducted across four quartiles of extremity fat percentages, stratified by gender.

The analysis included 4,253 individuals aged 18-85 (63% male, 37% female), with females having higher fat percentage in their extremities. The highest quartile of extremity adiposity was associated with an increased risk of depression in males (Arm: OR 1.99, 95% CI 1.11-3.58, p=0.021; Leg: OR 2.17, 95% CI 1.21-3.89, p<0.001) but only leg adiposity in females (OR 1.89, 95% CI 1.01-3.51, p=0.046). Males with arm adiposity (OR: 18.75, 95% CI: 5.07-69.36, p<0.001) were significantly more likely to overestimate their BMI status compared to females (OR: 5.62, 95% CI: 3.18-9.93, p<0.001), with a similar trend for leg adiposity. Extremity adiposity was associated with increased odds of intention to lose weight in both genders.

Adiposity in individuals without central obesity is associated with an increased risk of depression in males, while both genders show overestimation in weight perception and a future intention to lose weight.

Spontaneous rupture of the renal collecting system due to an obstructing ureteric stone is a rare but significant complication. We report the case of a 27-year-old female who presented with sudden, severe abdominal pain, initially suspected to be of gynaecological origin. Further investigation revealed a 3 mm obstructing vesico-ureteric junction (VUJ) stone causing calyceal rupture. Rupture due to such small stones is rare and may be overlooked on non-contrast CT; however, the presence of perinephric oedema or fluid should raise suspicion for this complication. Diagnosis was confirmed with contrast-enhanced CT, which demonstrated contrast extravasation. The patient was initially managed conservatively with analgesia, antibiotics, and alpha-blockers, but persistent pain and the risk of worsening urinary extravasation necessitated cystoscopy and JJ stent placement. Postoperative recovery was favourable, and she was discharged on the second day. Follow-up ureteroscopy revealed no residual stone, and the stent was successfully removed. This case highlights the importance of early diagnosis and timely urological intervention to prevent complications such as acute kidney injury, urosepsis, and urinoma. While conservative management may suffice for small, passable stones, stenting becomes necessary in cases of obstructive uropathy, infection, or significant rupture. This report emphasises the clinical presentation, diagnostic challenges, and management strategies for this rare but important condition. Prompt recognition and appropriate treatment are essential for achieving favourable outcomes.

The study aimed to assess the diagnostic ability of different imaging modalities for accurately predicting axillary lymph node involvement in breast cancer. The study focused on identifying N2 from N1.

A retrospective cohort of all axillary dissections for breast cancer performed in Basildon University hospital in the last 3 years (2021-2024) were assessed. Axillary lymph nodes status on pre-operative imaging were compared with histological lymph node yield. A subgroup of patients without neo-adjuvant chemotherapy was also assessed. The ability of imaging modalities to predict axillary lymph nodes, especially N2 disease (number of metastatic nodes of more than 3) was assessed using ROC curve.

There was a total of 133 patients, 131 females (98.5%) and 2 males (1.5%). 36 patients had NACT. The false negative rate of identification of any lymph node metastasis was: US (n=40/133, 30.1%), CT (n=48/125, 38.4%), MRI (60/98, 61.2%), and PET CT (n=11/34, 32.3%). The sensitivity for identifying N2 axillary nodal stage for US, CT, MRI and PET CT was 36.4%, 48.7%, 17.6%, and 53.3% respectively. The specificity for identifying those without N2 axillary nodal stage for US, CT, MRI and PET CT was 88.2%, 78.4%, 93.3% and 60.0% respectively. The AUC curve for accuracy in prediction of N2 nodal disease for US, CT, MRI and PET CT was 0.62, 0.64, 0.55, and 0.58 respectively.

None of the imaging modalities had high accuracy in prediction of axillary staging. CT and PET CT had higher sensitivity in predicting N2 axillary stage, MRI had highest specificity.

Otoplasty using traditional open techniques may lead to complications such as keloid formation, visible scarring, bleeding, and infection. Incisionless otoplasty, developed by Fritsch and modified by Haytoglu, offers a minimally invasive alternative. It eliminates the need for long-term dressings, reduces operating time, and presents a lower complication rate, making it desirable for both patients and surgeons.

The study employed incisionless otoplasty, using either Fritsch's or Haytoglu's technique, on 10 patients (7 females, 3 males) aged between 7 and 21. A total of 17 ears were operated on, with 3 to 4 sutures used for antihelical fold creation. Conchomastoid sutures and conchal excision were used as needed. The surgical process involved hydrodissection, anterior scoring, and incremental suture placement.

The duration of the surgery varied from 44 minutes to 1 hour 40 minutes, with all patients satisfied with the results. Minor complications included palpable sutures in two ears, one visible suture requiring office removal, and one patient with skin redness and blistering that healed with antibiotics. No hematomas or returns to the operating room were reported. One patient experienced partial unfurling of the antihelical fold, and another required conchal excision.

Incisionless otoplasty is a safe and effective technique for correcting prominent ears, with a low complication rate and positive cosmetic outcomes. This method should be offered as a treatment option.

Nasopharyngeal carcinoma (NPC) is a rare malignancy with distinct geographic and demographic patterns. This study aims to analyse the epidemiological characteristics, incidence trends, and survival outcomes of patients with NPC diagnosed between 2000 and 2021.

A total of 10,419 NPC cases were retrospectively analysed using data from SEER Database. Incidence rates were calculated per 100,000 population, and survival outcomes were estimated using Kaplan-Meier analysis. The NIH joinpoint regression program was used to analyse trends over time and calculate the annual percent change (APC).

Among the 10,419 cases, the majority were males (68.9%), white (51.2%), and presented with regional stage (49.5%). Male patients were significantly more likely to present with distant-stage disease (39.1% vs. 34%, p<0.001). The incidence of NPC was higher among males (0.8 per 100,000) than females (0.33 per 100,000), with Asians having the highest incidence (1.87 per 100,000). From 2000 to 2021, the overall incidence of NPC declined significantly (AAPC: -0.8%, p=0.002). The median overall survival was 78 months, with females (90 months) and Asians (118 months) exhibiting significantly better survival rates compared to other groups. The most common cause of death was related to NPC itself (43.6%), followed by other malignancies and cardiovascular diseases.

NPC is more prevalent among males and the Asian population, with males and Native Americans showing a higher likelihood of distant-stage presentation. Survival outcomes are better for females and Asians.

The relationship between abnormal Intracranial Pressure (ICP) and associated symptoms, remains poorly defined. Often, patients with an abnormality in ICP present with non-specific clinical symptoms resulting in misdiagnosis and delayed care. This study aims to clarify the association between degree and type of symptoms and ICP in vivo via use of implanted intracranial telesensor reservoirs.

Our prospective single centre study was approved by the UCLH research ethics committee. Patients who were being monitored by the Queens Square Hydrocephalus service who had a telemetric ICP device implanted and had ICP readings at a follow up clinic were administered a telephone or face-to-face survey within 24 hours of the ICP readings. Patient recruitment opened from May 2024 and is expected to close December 2024. The following patient symptoms were measured using validated scales: headache, nausea, visual disturbance, fatigue and other low or high ICP-related symptoms.

ICP and symptom data were acquired from 16 patients (9 females, 7 males). Sitting and standing positional pressures were correlated (p < 0.001, r=0.856) but not with lying pressures. Higher standing pressures specifically were correlated with increased fatigue severity (p<0.05, r=0.561), although this would not survive multiple comparison correction. No correlations were found with between pressures and migraine phenomena, mental health scales, visual disturbance and other symptoms.

No clear correlation can be deduced between ICP readings and clinical symptoms in this limited dataset, with ongoing patient recruitment. The results suggest that clinical symptoms alone are a poor indicator for determining intracranial pressure in adult CSF disorder patients.

The use of social media has gained popularity as a tool for science communication, public engagement, and dissemination of scientific research. In some specialties, engagement with social media by academic journals is linked to impact factor (IF) and similar engagement metrics. This project explores this case as applied to neurosurgery.

MEDLINE and Clarivate Web of Science were interrogated to identify all English-language journals with neurosurgery as their clinical focus. Journals that featured multiple specialties were excluded. Journals were tabulated and pages on social media platforms (Facebook, Twitter, LinkedIn, Instagram) identified and follower count extracted. Correlations between these counts and impact factor (IF) and H-index (HI) were calculated. Two-sample t-tests were performed to compare differences in IF and HI between journals that had a presence on each platform.

29 neurosurgical journals met the inclusion criteria. There was a positive correlation between impact factor and social media follower count on Facebook (r=0.296), X (r=0.558), LinkedIn (r=0.446) and Instagram (r=0.255), as was the case between H-index and follower count on Facebook (r=0.008), X (r=0.204), LinkedIn (r=0.065) and Instagram (r=0.136). The presence of journals on each platform was not statistically significantly associated with either impact factor or H-index.

Presence on included social media platforms is positively correlated with IF and HI, and this association is strongest in both cases with X. These data can support neurosurgical journals and authors in allocation of their time to the various platforms to pursue maximum dissemination.

To describe the natural progression, clinical features, and management of appendiceal mucocele at a teaching hospital.

A retrospective review was conducted from October 2009 to September 2019, involving 24 patients. Their clinical presentations and treatments were analysed.

The age at diagnosis ranged from 28 to 88 years, with a mean age of 62. Symptoms included abdominal pain (38%), weight loss (10%), changes in bowel habits (5%), palpable masses (5%), rectal bleeding (5%), night sweats (5%), vomiting (5%), and chest pain (5%), while 29% were asymptomatic. All patients were diagnosed using CT imaging. Of the 16 patients (66%) managed surgically, 6 (37.5%) underwent preoperative colonoscopy. Among the surgical cases, 10 (77%) had laparoscopic procedures, 2 (15%) converted to open surgery, and 1 (8%) had open surgery. Right hemicolectomies were performed in 6 patients (37.5%), and 9 (56%) had appendectomies. Histopathology revealed that 7 (54%) had low-grade appendiceal mucinous neoplasms (LAMNs) and 6 (46%) had benign mucoceles. Post-surgery, 71% of patients had outpatient follow-ups, 80% of whom were managed surgically.

Appendiceal mucoceles should be considered neoplastic until proven otherwise. Preoperative colonoscopy is recommended when feasible to assist surgical planning. While appendectomy is a valid first-line treatment for benign-appearing tumours, there should be a low threshold for converting to a right hemicolectomy based on intraoperative findings, particularly in emergencies. For cases involving peritoneal disease, referral to a specialized pseudomyxoma peritonei centre is advised.

Gallstone pancreatitis is a significant contributor to acute pancreatitis, leading to substantial morbidity and healthcare burden. It has been emphasized that early laparoscopic cholecystectomy (LC) following an initial episode of gallstone pancreatitis remains more beneficial in outcome compared to delayed cholecystectomy. This retrospective cohort study examines the outcomes associated with index admission versus delayed laparoscopic cholecystectomy, including the impact of delayed surgery performed within and beyond six weeks on readmission rates, length of hospital stays, and complications.

Data from 99 patients diagnosed with gallstone pancreatitis at a tertiary hospital in the UK between April 2022 and March 2023 were analysed. Patients were categorized based on the timing of their cholecystectomy: index admission, within six weeks, after six weeks, or awaiting surgery. Outcomes assessed included readmission rates, length of stay, intensive care unit (ICU) admissions.

72 patients had surgery: 15% of them had index cholecystectomy, while 85% had delayed surgery (<6 weeks: 33, >6 weeks: 28). Readmission rates were higher in the delayed group. Between the delayed groups, there was no statistical significance with reference to readmissions (<6 weeks 7, >6 weeks: 8). Those who had index cholecystectomy had longer hospital stay (p = 0.0006). ICU admissions were seen in patients who had surgery delayed beyond six weeks.

Early laparoscopic cholecystectomy during index admission, while associated with a longer hospital stay, appears to reduce readmission rates and complications, confirming it is a more effective approach in managing gallstone pancreatitis. Surgeries beyond 6 weeks are associated with more severe complications.

Immunotherapy, especially pembrolizumab, has significantly improved outcomes in treating microsatellite instability-high (MSI-H) metastatic colorectal cancer (mCRC). However, immune-related adverse events (irAEs), such as gastrointestinal perforation, present clinical challenges. This case report describes a patient with metastatic adenocarcinoma of the hepatic flexure who experienced a response to pembrolizumab, followed by a colonic perforation that required emergency surgery.

A 65-year-old male with MSI-H metastatic right-sided colon cancer received pembrolizumab. After several cycles of treatment, he developed a perforation in the colon, leading to an emergency right hemicolectomy. Despite concerns about the potential impact of immunotherapy on wound healing, a primary anastomosis was performed during surgery. Histopathological examination of the resected tissue revealed no remaining tumour-only fibrosis, indicating a complete pathological response to pembrolizumab. The patient recovered with conservative management of minor postoperative complications and remains disease-free on follow-up imaging.

This case demonstrates the feasibility of performing a primary anastomosis in patients who develop gastrointestinal perforation while undergoing immunotherapy. While the risk of irAEs is notable, this case suggests that immunotherapy may not significantly impair wound healing in all cases. It underscores the importance of individualized surgical decision making and close postoperative monitoring for patients receiving immune checkpoint inhibitors.

Further studies are needed to refine management strategies for irAEs and improve our understanding of the effects of immunotherapy on surgical outcomes. This case contributes to evidence supporting the safety of surgical interventions in patients undergoing immunotherapy.

As the demand for cosmetic procedures continues to rise, fat grafting is becoming an increasingly popular means of facial rejuvenation within aesthetics. The quality and readability of online resources regarding facial fat transfer were assessed.

The search term ‘facial fat transfer’ was entered into Google. The top 30 results were analysed for quality and readability. Quality was measured using the DISCERN questionnaire and benchmark criteria published by the Journal of the American Medical Association (JAMA). Readability was assessed with the Flesch-Kincaid reading grade, Flesch reading ease score, Gunning's fog index, and the Coleman-Liau index.

The mean JAMA and DISCERN scores were 2/4 and 31/80, respectively, suggesting poor quality. The mean Flesh reading ease score was 41.42, and the mean Gunning’s fog index was 12.5, which indicates poor readability requiring moderately high educational attainment. This corresponded with a high Gunning’s fog score of 12.5 and Coleman-Liau index of 12.2.

Facial fat transfer is an increasingly popular procedure which seeks to address volume loss associated with facial aging. An estimated 95% of patients utilise the internet for research prior to an aesthetic surgery consultation. Online patient materials relating to facial fat transfer are of poor quality and are difficult to understand. This may hinder a patient’s ability to make an informed decision, especially in the context of the UK’s reading age of 9. Avoidance of jargon, shorter wording and sentence structure could help to improve readability. Qualified authorship, up to date information and appropriate referencing could improve quality.

This retrospective observational study investigates the spectrum of trampoline-related injuries in paediatric patients referred to the trauma and orthopaedic (T&O) department from the accident and emergency (A&E) department. The study aims to explore injury patterns, treatment modalities, and outcomes associated with these injuries.

Data was collected from electronic medical records of paediatric patients referred to trauma and orthopaedics at a London District General Hospital over a six-month period. Demographic information, injury characteristics, treatment interventions, and follow-up management were collected and analysed.

Out of 1544 paediatric patients referred, 43 cases (2.8%) were attributed to trampoline injuries. The average age at presentation was 9 years, with a near-equal distribution of male (51.2%) and female (49.8%) patients. Among trampoline-related injuries, 24 cases (55.8%) involved fractures, 1 case (2.3%) involved a dislocation, and 18 cases (41.9%) involved soft tissue injuries. Upper limb fractures predominated (62.5%), with wrist fractures (46.7%) being the most common, followed by supracondylar (20%), proximal radius (20%), and finger fractures (13.3%). Among lower limb fractures, ankle fractures were the most prevalent (77.8%), followed by distal femur (11.1%) and toe fractures (11.1%). One patient required surgical management for a radial neck fracture which required manipulation and k-wire fixation under general anaesthesia. There were no recorded complications in all cases.

This study highlights the potential for significant morbidity associated with trampoline-related paediatric orthopaedic injuries. It delineates injury patterns and demographics, revealing a preponderance of upper limb injuries and an almost equal distribution between male and female patients.

Bariatric surgery is an effective treatment for obesity, though long-term weight loss and regain vary based on factors like surgery type and pre-operative demographics. This study aims to analyse weight loss trends and identify demographic predictors of weight loss and regain over a 10-year follow-up period.

This retrospective study analysed weight loss trends using the rate of weight loss for each patient as the response variable. Multivariate regression identified demographic factors influencing weight loss and regain over a 10-year period. Data were extracted from medical records, and statistical significance was set at p < 0.05.

Among 2,092 patients, %TWL peaked at 31.6% by 24 months, followed by gradual weight regain to 24.7% at 120 months. RYGB and OAGB had significantly greater %TWL than SG up to 60 months (p < 0.005). In the 1,032 patients analysed for weight loss trends (0–24 months), age, sex, pre-operative BMI, diabetes, operation type, and smoking were significant predictors. In the 605 patients analysed for weight regain (24–120 months), age, hypertension, IMD quintile, and early %TWL were significant predictors, with higher initial %TWL linked to greater weight regain (p < 0.005).

Our study highlights the complexities of long-term weight loss and regain after bariatric surgery. Key predictors of weight regain differ from those influencing initial weight loss, underscoring the need for more comprehensive research to optimize personalized pre- and post-operative care and improve long-term patient outcomes.

Magnetic Resonance Imaging (MRI) serves as a cornerstone in the diagnostic evaluation of suspected Cauda Equina Syndrome (CES). Understanding the prevalence and distribution of MRI findings in this population is crucial for optimising diagnostic accuracy and guiding clinical management decisions. This epidemiological study aimed to characterise MRI findings in patients presenting with suspected CES, assess their prevalence and distribution, and their correlation with clinical presentations.

Data was gathered over a 3-month period of MRI reports from suspected CES referrals to Trauma & Orthopaedics (T&O). MRI findings were systematically categorised and analysed to identify prevalent patterns and associations with clinical features.

Analysis revealed a diverse spectrum of MRI findings among suspected CES referrals, including degenerative changes (16%), nerve root impingement (51%), traumatic injuries (9%), and CES-specific pathology (2%). Notably, 94% of patients underwent MRI locally within hours, with only 4% requiring transfer for MRI at a tertiary centre. Importantly, MRI findings correlated well with clinical presentations, with the majority of cases demonstrating concordance between imaging findings and symptoms.

The prevalence and distribution of MRI findings in suspected CES referrals provide valuable epidemiological insights into spinal pathology patterns. By analysing the epidemiological landscape of MRI findings in suspected CES cases, this study informs clinical practice by facilitating tailored management approaches. Understanding the prevalence and significance of specific MRI findings enables clinicians to make informed decisions and optimise patient outcomes.

This study aimed to explore the correlation between anti-factor Xa levels and bleeding risk in DOAC-treated patients undergoing surgery for NOF fractures. This study aimed to assess the viability of anti-factor Xa assays for predicting the optimal timing of surgery among patients with neck of femur fractures undergoing DOAC therapy.

This retrospective case-control observational study was conducted at a single centre. Patients aged 60 years and above with neck of femur fractures on DOAC therapy were identified (n=27). They were categorized into two groups based on whether they underwent anti-factor Xa monitoring prior to surgery or not. Additionally, a matched control cohort not on DOAC therapy was included for comparison.

The three groups were matched for sex (p=0.06), ASA grade (p=0.29), type of surgery (p=0.53), and anaesthesia (p=0.90). However, a statistically significant age difference was observed between the DOAC groups and the control group (p=0.002). No significant differences were detected among the groups regarding intraoperative blood loss (p=0.29) or the need for perioperative packed red blood cell transfusions (p=0.31). Patients who underwent anti-factor Xa monitoring experienced an average surgical delay of 10 hours compared to those who did not.

Although anti-factor Xa monitoring led to surgical delays and incurred additional financial costs, it did not yield a reduction in intraoperative bleeding or the requirement for perioperative transfusions.

A variety of treatments are available for ureteral calculi, including ureteroscopic lithotripsy.

Direct comparison of pneumatic and laser lithotripsy in the management of lower ureteric.

This was a cross-sectional hospital based multicenter study, Direct interviewing questionnaire was used.

The majority of patients (76%) had stone size between 11-15 mm and 24% with stone size between 7-10 mm. There was a higher proportion of stone free rate intraoperatively in URS laser (90%) compared to URS pneumatic (84%) however this was not statistically significant. The odds of stone free rate intraoperative was increased by 1.7 folds in URS laser management option (OR=.17; 95% CI (.5-5.6). Significantly less operation pain was found in URS pneumatic 76% versus 92% in URS laser. The probability of post-operative pain was reduced by 3.6 times (OR=3.6, 95% CI (1.1-12.2)) in URS pneumatic. Also significantly less postoperative fever was found in URS pneumatic 70% versus 88% in URS laser. The risk of reduced post-operative fever in URS pneumatic was 3.1 folds (Or=3.1; 95% CI (1.1-8.9)). There was highly significant association between duration of operation and management options, p=.000. Less than one-hour duration time of operation was significantly achieved in URS pneumatic 80% versus 16% in URS laser management option.

The study concluded that both URS laser and URS Pneumatic laser are effective and safe modalities in treating lower ureteric stones, URS pneumatic is superior in reducing complications in terms of pain and fever in addition to less duration time of operation (<one hour), therefore it is recommended.

Background: Morbidity and mortality are significant risks associated with emergency laparotomies. A risk calculation tool facilitates the identification of high-risk patients and provides clinicians with information to help them make informed decisions. This study compares 30-day mortality predictions using the National Emergency Laparotomy Audit (NELA), Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (P-POSSUM), American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), and Surgical Outcome Risk Tool (SORT) risk calculators.

This retrospective study analysed data from adult patients undergoing emergency laparotomies from July 2018 to October 2019 at Maidstone and Tunbridge Wells NHS Trust. Each patient's median pre-operative mortality risk was calculated using the four risk calculators.

Among 227 patients, 101 were men (36.5%), with an average age of 65 (±16) and a median ASA of 2. NELA and P-POSSUM identified 11 (73.3%) of those who died within the high-risk group, higher than ACS-NSQIP (53.3%) and SORT (40.0%). The average 30-day mortality risk for the 15 patients who died was 25.8% for NELA, 39.6% for P-POSSUM, 17.9% for ACS-NSQIP, and 15.7% for SORT. NELA and ACS-NSQIP had the highest AUC at 0.869 and 0.877, respectively. NELA had higher sensitivity (73.3%) while ACS-NSQIP had higher specificity (88.7%).

The NELA score demonstrated the highest performance in predicting mortality in emergency laparotomy.

Granulomatosis with polyangiitis (GPA), a form of vasculitis, is a destructive inflammatory disease that affects not only the upper respiratory tract but also multiple organ systems. Prompt treatment with immunosuppressive agents is crucial to halt disease progression and alleviate symptoms. However, these medications carry significant side effects, making accurate diagnosis essential. Biopsy of the postnasal space (PNS), an area commonly involved in the disease, is often utilized for diagnostic confirmation. Nonetheless, the diagnostic utility of PNS biopsy remains controversial.

Over a one-year period, 20 cases undergoing PNS biopsy under local anaesthesia for diagnostic confirmation of vasculitis were retrospectively reviewed. Biopsy results were compared to clinical findings and anti-neutrophil cytoplasmic antibody (ANCA) status to assess their diagnostic relevance.

The majority of referrals were for patients presenting with nasal crusting. Epithelial hyperplasia was observed in 35% of biopsies. Nondiagnostic results were obtained in 15% of cases, while 15% revealed papilloma. The remaining biopsies included findings of normal mucosa, viral warts, and hyperkeratosis.

These findings suggest that the diagnostic value of PNS biopsy for confirming vasculitis is limited. To improve diagnostic yield, future studies should consider increasing the sample size and incorporating cases involving PNS biopsy performed under general anaesthesia.

Guidelines play a crucial role in improving patient care by providing clinicians with up-to-date evidence-based recommendations. A vast number of guidelines exist on the surgical management of inflammatory bowel disease (IBD).

This scoping review aimed to identify current surgical IBD guidelines, assess their quality, and identify areas of variation between the existing guidelines.

A systematic search of literature from January 2008 to September 2023 was conducted. After identifying eligible guidelines, they were assessed for quality using the AGREE-S instrument. Data was extracted on descriptive guideline characteristics and recommendations.

Fifteen guidelines were identified globally. The majority of guidelines were published between 2011 and 2023, with six focusing solely on Crohn's disease, five on ulcerative colitis, and four on both. Six guidelines focused exclusively on surgical management, while nine contained both medical and surgical recommendations. The overall mean AGREE-S score was 59%, with more recent guidelines scoring higher. The lowest scoring domain was "Implementation and Update" (45%). The highest scoring domain was "Editorial Independence" (70%).

The quality of IBD surgical guidelines varies considerably. High-quality, collaborative, international guidelines are needed to reduce duplication and ensure consistent, evidence-based surgical care for IBD patients worldwide. Future guideline development should adhere to the AGREE-S criteria to enhance methodological rigor and transparency.

Cardiac events, such as sudden cardiac arrest (SCA), arrhythmias and heart surgery, pose significant health risks to elite athletes, potentially leading to severe outcomes, including death. Although medical interventions have made substantial progress in enhancing survival rates, evidence is scarce about the long-term performance and health outcomes in this particular group.

We will assess the data of elite athletes who have experienced cardiac events including heart surgery, focusing on the immediate care received. Evaluating the impact of cardiac events/surgery on athletes' quality of life, concentrating on physical, emotional, and social well-being, determining the rate of return to sport, and short-term mortality rate.

Given the rarity of these events, we aim to collect data on cases over the last 10 years to allow for meaningful analysis. Retrospective cohort study using online resources such as Google or YouTube search, this method will facilitate the collection of specific data clips and relevant new articles from available online resources. We will also recruit collaborators from different countries ensuring a comprehensive data-based search of multiple cases globally.

This is the proposed protocol for our research team's upcoming study. By systematically collecting and analysing data on these cases, this research seeks to provide valuable insights that can improve athlete health management practices.

The recovery and return to competitive sports for elite athletes following heart surgery or cardiac arrest present complex challenges that require careful management. Tailored post-surgery & post-arrest rehabilitation plans are crucial for these athletes to resume their athletic activities safely.

The Scottish Arthroplasty Project (SAP) has been reporting complications following primary joint arthroplasties since 2002 aiming to maintain the highest quality of orthopaedic care in Scotland. By publishing annual complication rates and identifying health boards, hospitals and surgeons who produce higher rates than expected allows analysis and reflection.

The primary outcome of this study was to compare the reported complications following primary joint arthroplasties by the SAP and the Golden Jubilee National Hospital (GJNH).

This retrospective observational study compared all the primary joint arthroplasty complications reported by the SAP and the GJNH between January 2014 and December 2016. Complications were divided into joint-related infection, musculoskeletal, cardiovascular, renal, mortality within 1-year, post-operative interventions and ‘others. Prior to analysis, the data was manually validated and checked for duplicates via GJNH clinical portal.

255 were female and 233 males with a mean age of 69.4 years: ranging from 37 to 90-years-old. 488 complications were identified over this three-year period: 269 from total knee arthroplasties, 217 from total hip arthroplasties and 2 unreported. SAP reported 285 of these whilst GJNH 253 with only 50 complications reported by both.

SAP primarily reports on mortality and cardiovascular and renal complications, whereas GJNH focuses on infection, musculoskeletal disorders, and post-operative interventions.

There is a clear disparity in the recording of complications. The study identifies that SAP alone may be insufficient in monitoring orthopaedic outcomes in Scotland and assistance could be required.

Currently, there are no national guidelines for the optimal surveillance of patients who have undergone surgical treatment for lung cancer or thymoma, despite its importance in early detection. The British Thoracic Society (BTS) and the National Institute for Health and Care Excellence (NICE) recommend that trusts follow local protocols. However, the choice between using a CT scan or chest X-ray, and determining the appropriate duration of follow-up, remains a subject of debate.

A multicentric survey was conducted across the United Kingdom to collect data from various centres on which imaging method is employed for the surveillance of lung cancer and thymoma following surgical excision.

In our study, which gathered data from 29 trusts across the UK, we observed only 48.3 % have clear specific guideline for which images (Chest X-ray vs CT scan) to use in lung cancer surveillance and thymoma after resection, where 58.6 % use CT scan for lung cancer and carcinoid follow up and 72.4 % use CT scan for Thymoma follow up. All the centres agreed to encourage the British Thoracic Society (BTS) or the Society of Cardiothoracic Surgeons (SCTS) to publish recommendations for which images to use in surveillance to standardize the practice in the UK and Ireland.

There is a clear need for a national guideline to establish optimal surveillance protocols for patients who have undergone surgical treatment for lung cancer and thymoma.

Mass closure (MC) using large bites and continuous suture has been the standard of care for closure of midline laparotomy incisions. However, recent evidence suggests the use of the small bites (SB) technique in reducing the incisional hernia rate and surgical site infection (SSI). This retrospective study compares small bites versus large bites stitching techniques to analyse the complication rates in midline emergency laparotomy fascial closure.

A retrospective cohort study on patients who underwent emergency laparotomy between January 2019 and October 2019. Data collected included demographics, clinical characteristics, operative data, postoperative complications, and incisional hernia rate on 3-year follow-up. Data were retrieved through an electronic database and analysed using statistical software in Excel. Fisher’s exact test has been utilized for comparing the outcomes.

114 patients with a median age of 68 were identified as eligible for the study. Of them, 35 (32%) underwent SB while 69 (64%) had MC of their laparotomy incision. Small bowel obstruction has been the major indication for surgery in both groups. More than half of them in both groups required critical care admission. Surgical site infection (SSI) was 6 (17%) and 10 (14%) in SB and MC respectively. Incisional hernia was observed in 3 patients for the SB and 6 patients for the MC.

Our cohort reported an incisional hernia rate of 8.6% which is encouraging and below the national average of 12.8%. In addition, it is evident through our study that small bites closure is in no way inferior to the mass closure technique.

The goal of this study was to pilot a near-peer ultrasound (US) guided intravenous (IV) cannulation workshop for junior doctors (Interns) using collaborative co-production as a means of innovation.

A design team consisting of junior doctors, Anaesthesiology trainees, and ICU Consultants conducted a design session including ethnography, in-depth interview, and prototyping. The main outcomes included a homemade venous access simulation model and informal curriculum development. Kirkpatrick’s model of training evaluation was used through pre-workshop and post-workshop evaluation forms.

Before this workshop, 62.5% of interns had reported receiving 5 or more calls per shift from nurses for difficult IV cannulation during their day job. 84% of interns had reported needing to call Anaesthetics for a failed IV cannulation with more than 50% of interns reporting making the call 2 or more times.

80% of interns had not tried the technique before. After this workshop, the proportion of interns that described themselves as being at least slightly comfortable with US guided IV cannulation increased from 4% to 53%. Financially, this workshop had an overall expenditure of 60 euros and was delivered free at the point of access. The cost per attendee was 3 euros. 85% of interns would pay for a similar workshop with a mean price of 41 euros.

This feasibility study and pilot provides a foundation for the development of further critical skills workshops that are affordable, transferrable, and accessible to juniors.

Prehabilitation is reshaping elective surgical care in the NHS by proactively optimising patient health before surgery. This study examines the impact of the Surgery Hero digital platform at BHRUT, aimed at enhancing surgical outcomes through personalised prehabilitation programmes. The platform provides personalised health coaching and structured plans targeting physical fitness, nutrition, mental well-being, and sleep, offering a comprehensive, patient-centred approach to preoperative care.

We conducted a comparative study with 569 patients aged 65 or older, initially unfit for elective surgery, who participated in the Surgery Hero programme. They were compared with a control group of 1,960 patients meeting the same criteria but not undergoing prehabilitation. Key measures included changes in the Patient Activation Measure (PAM) scores, self-rated health scores, patient satisfaction, and length of hospital stay (LoS).

After using Surgery Hero, 57.47% of patients were fit for surgery, versus 33.16% in the control group. Participants saw a 5.4-point mean increase in PAM scores and significant improvements across health domains. Major surgeries, such as knee and hip replacements, showed substantial reductions in LoS, indicating clinical benefits and cost savings. Patient satisfaction averaged 8.9 out of 10.

The findings advocate for the broader adoption of digital prehabilitation tools like Surgery Hero in NHS surgical pathways to enhance patient readiness, decrease postoperative complications, and improve resource utilisation. These innovations have the potential to significantly advance surgical outcomes and efficiency, particularly for high-risk patients, marking a shift towards a proactive model of preoperative care.

Facial flaps are a fundamental skill for plastic surgeons. Due to the range available it can be difficult for trainees to gain sufficient experience to feel confident; especially when factoring in theatre time pressures and teaching limitations in local anaesthetic cases. Systematic review has highlighted the potential benefit of simulation training to offset this, although evidence to support a single model is lacking. Our aim was to create a simulation model for high-volume, low-cost simulation of facial flaps for trainees.

A model was created based on a plastic face mask at less than £5 per model, with:.

• Muscle layer formed from red felt.

• Fat from yellow felt.

• Fascia from cling film.

• Skin from micro-foam.

Attendees at a plastic surgery conference were invited to trial the model and provide feedback.

Feedback was completed by 22 attendees ranging in experience from medical students to ST8. 90% either strongly agreed or agreed that the model was useful in local flap planning, whilst over 80% agreed it was realistic for raising flaps and overall improved their confidence in the area. 79% of attendees agreed it would be a useful adjunct in specialist training.

The Mid Yorkshire skin surgery simulator offers a low-cost and accessible option for trainees to practice both planning and raising facial flaps outside of the operating theatre. While fidelity could be improved, the skills gained from deliberate practice with this model increased confidence and would be a useful adjunct when learning how to perform facial flaps.

Bony hand injuries that are referred to the VFC contribute to a major proportion of patients. A pathway was implemented in a District General hospital, based on Level 5 MDT expertise, broadly divided into metacarpal and phalangeal bony injuries. Each injury follows an algorithm which is colour coded, and different outcomes such as discharge, fracture clinic review, on-call review and hand therapy referral were organised.

Data was reviewed for patients who were referred to VFC as bony metacarpal/phalanx injuries from October 2023 to March 2024. Patients with soft tissue injuries, paediatric age group (<13 years) and carpal bone injuries were excluded from the pathway.

The pathway received 438 patients; 282 males and 156 females (mean age 36 years, Range: 16-56). 88 patients were excluded. In 350 patients who were appropriate for the pathway, 251 (72%) had the intended management. In the 99 patients who were not managed as per our guidelines, went for F2F clinic, analysis revealed 14 needed only early hand therapy, 22 needed urgent review, 11 were fit for discharge and 7 needed practitioner clinics. They eventually were referred from fracture clinic to the respective services after clinical review, which reinstates the pathway’s efficacy.

This pathway is an innovative method to manage patients with bony hand injuries. It could be implemented across all NHS Trusts to bring a standardised model to manage these challenging injuries and involve hand therapy early, to improve patient outcomes, reduce fracture clinic burden and increase the efficacy of the Trauma service.

Foundation models continue to alter the artificial intelligence landscape. These models are highly adaptable and can be used for a variety of tasks within the surgical setting. An example model includes generative pretrained transformers (GPTs). Recently, custom GPTs were released by OpenAI, allowing users to integrate domain-specific surgical information and customised instructions, thus facilitating a tailored response. We aim to highlight the use of custom GPTs in creating education tools in ENT surgery.

An interactive case-based learning tool named ‘ENT Emergency Tutor’ was created using a custom GPT. Custom instructions were provided to the GPT; 8 ENT emergency cases were created, and domain-specific information was provided. The GPT was customised to present a case vignette, followed by the provision of multiple-choice single best answer questions to the user. Following a response, the GPT was instructed to give constructive feedback.

We demonstrate the creation and use of a custom GPT in the ENT surgical education domain. The custom ‘ENT Emergency Tutor’ GPT model behaviour can be adjusted to personalise learning. Depending on local, regional, or national changes in best practice management, appropriate clinical guidelines or peer-reviewed scientific literature can be provided to the GPT.

Interactive learning tools created with custom GPTs can facilitate knowledge acquisition in the surgical specialties, as we show with the ‘ENT Emergency Tutor’. To align responses with values of evidence-based surgical practice, appropriate domain-specific knowledge can be provided. As we enter the era of foundation models, custom GPTs hold the potential to enhance surgical education.

Flexible nasal endoscopy is a key procedure in ENT, requiring proficiency in technique and anatomical recognition. Resident doctors often face inconsistent training. We developed a novel interactive video tool, built using H5P software, to assess and improve knowledge of nasendoscopic anatomy. This study evaluates the tool's effectiveness in enhancing doctors’ skills across UK hospitals, reflecting a trend towards technology-enhanced medical education.

Twenty-two resident doctors from four UK hospitals participated. They completed a questionnaire on demographic details and ENT exposure, followed by an interactive video featuring 25 anatomy identification questions and 3 procedural questions. Data on confidence in anatomy identification were collected, and assessment scores were analysed statistically using Python, exploring correlations between performance, demographics, and ENT experience.

Participants were predominantly aged 25-34, with limited ENT exposure in medical school. Twelve participants expressed interest in ENT as a career. On average, participants scored 16.41 out of 28 (mean score: 43.91%, SD: 32.94%). Confidence in anatomy identification significantly correlated with assessment scores for vocal cord palsy, normal anatomy, and nasal polyps (p < 0.05). Higher professional grade and greater FNE experience correlated positively with performance, while career interest also impacted scores (p= 0.044).

The interactive video tool effectively assessed and enhanced resident doctors' nasendoscopic anatomy knowledge. The positive correlation between confidence and performance underscores the tool's role in reinforcing knowledge and confidence. This study supports integrating technology-driven tools into medical education to standardise and improve training, particularly in skill-based specialties like ENT. Expanding such resources could significantly impact resident doctor training quality.

Bystander CPR is one of the most important links in the chain of survival for the nearly 3,000 incidents of Out-of-Hospital Cardiac Arrest (OHCA) in Ireland per year. This study aimed to further understand the quality of bystander CPR as a variable that is not yet measured in current data collection methods and co-produce new ways to improve it.

A collaborative design-led approach was undertaken as part of this study. Ethnography and auto-ethnography were used by engaging the principal investigator in the EMS response as a Community First Responder. In-depth interviews were undertaken with paramedics, advanced paramedics, bystanders, clinicians, call-takers, dispatchers, and policymakers. An inductive thematic analysis was performed using Braun & Clarke methodology and affinity diagrams were created.

The data were transformed into problem statements that included “Bystander CPR quality is not measured and correlated with outcome.” A brainstorming session was held with Doctors, Designers, and laypeople to ideate solutions to the problem statements. A gamified CPR model was co-produced and tested using medium-fidelity prototypes.

The gamified CPR model is one intervention that was created using a collaborative co-design approach. A score, generated from a set of variables including compression rate, depth, and recoil, is applied to a publicly available leader board. The gamified CPR model is made available in public buildings as a method of casual re-iterative bystander training and as a method of measuring the average quality of bystander CPR to inform further interventions.

Due to resource/technological limitations, paper-based records are used in Sri Lankan Healthcare settings. We implemented an Electronic Health Records system (EHRs) in the Surgical Oncology Unit/Cancer Multidisciplinary Team at Teaching Hospital Anuradhapura alongside the existing paper-based system. EHRs allow authorised, real-time access to patient data, digital theatre scheduling, and multidisciplinary collaboration.

Twenty-five healthcare workers were surveyed using an online questionnaire about their experience with EHRs. The time consumed for hand-written theatre lists versus EHRs and the time the patient takes to get a cancer diagnosis post-biopsy using an existing method versus EHRs were evaluated.

The majority (80%) found the EHRs easy to use, and 84% were satisfied with EHRs over the paper-based system. Key benefits included real-time data access, time savings, improved communication collaboration, and enhanced patient care. Challenges included high costs, technical issues, network limitations, patient privacy concerns, and resistance to change. Clinicians were more optimistic about EHR adoption than nursing staff, who reported unfamiliarity and increased data entry concerns.

Handwritten theatre list took average 4 minutes 6 seconds (SD = 48s), compared to 2 minutes 24 seconds (SD = 25s) on EHRs, saving 1-minute 42seconds (t=12.49, p<0.0001). The average time to receive a cancer diagnosis post-biopsy was 14.95 days (SD = 3.55) using the paper-based system versus 8.40 days (SD = 2.91) using the EHRs, reducing diagnostic delays by a significant 6.55 days.

EHRs improve communication, efficiency, and patient care while reducing diagnostic delays. However, financial costs and resistance to change need to be addressed further.

This study evaluated the prevalence and outcomes of speech surgery procedures performed at Mater Dei Hospital (MDH), Malta, from January 2021 to December 2023, focusing on patient demographics, surgical history, inpatient stay, opioid use postoperatively, repeat surgeries, and outcomes to identify trends and areas for improvement.

A retrospective analysis was conducted on patients undergoing speech surgery at MDH during the specified period. Data included age, gender, syndromic conditions, prior surgical history, and postoperative complications.

The cohort comprised six male patients aged 8 to 26 years; two required repeat surgeries. Syndromic conditions were present in 33.3% (n=2), including Kabuki syndrome and foetal alcohol syndrome. All patients had prior cleft palate repair, underscoring the multi-stage nature of treatment. Additionally, 50% (n=3) had other procedures such as accessory digit excision, bilateral myringotomy with grommet placement, and orchidopexy. No severe postoperative complications were recorded, though nausea, vomiting, and feeding difficulties were noted in 66.7% (n=4) and were effectively managed. Opioid use was low, with only 33.3% (n=2) requiring postoperative opioids. The average hospital stay was 2.5 days, ranging from 1 to 5 days.

This study highlights the need for individualized, multi-stage surgical interventions in speech surgery. Low opioid use and manageable postoperative issues suggest effective pain and recovery strategies. Ongoing comprehensive follow-up is essential to monitor long-term outcomes and enhance care strategies.

Amidst the dawn of the COVID-19 era, the precipitation of novel initiatives in surgical education was encouraged for medical undergraduates and postgraduates. To mitigate the challenges posed by national governmental restrictions on in-person teaching, surgical education turned to technological and digital innovation to facilitate synchronous and asynchronous learning. Simulation-based education has proffered a safe, interactive environment for healthcare professionals to foster/bolster skills devoid of patient implication. Thus, we aim to provide an updated overview of simulation-based education within the national surgical curriculum via a scoping review. This will supplement 'MediEdQuest', a medical education gaming platform that virtually replicates patient interaction.

The methodology consists of five stages, consistent with Arksey and O’Malley’s framework. Using a PICO model, the research question and search criteria were developed. Medical databases (PubMed/Medline, Cochrane Library, Embase, Scopus) will be searched for relevant studies. The PRISMA-ScR framework is used to guide the reporting process. Quantitative and qualitative data will be extracted, including key information: study type, demographics, and methods used. Data will be presented discursively, supported with statistics and graphs where appropriate. No ethical approval is required. Further, this scoping review will serve as an adjunct to ‘MediEdQuest’, combining simulation through gamification while encouraging user accessibility.

The findings will hopefully evaluate recent developments in virtual simulation gamification to enhance lecturer-driven surgical education and student engagement for the UKMLA, particularly honing surgical pathology and diagnoses. This will enable the identification of issues present to form the basis of future research.

Pinna haematoma and seroma are 2 distinct conditions extensively described in the medical and historic literature. There are 2 main principles of management for these conditions; to evacuate the collection and to obliterate the dead space to prevent recurrence. Most commonly, this is done by needle aspiration or incision and drainage.

We propose needle aspiration and application of a compressive silicone dressing moulded to the exact shape of the patient’s ear as an effective management option for these cases.

Patients presenting to our emergency department or referred from general practice with a fluctuant swelling of the pinna were included. Patients with a suspected or confirmed infection were excluded from recruitment.

A total of 8 patients with pinna haematoma or seroma were managed with needle aspiration and silicone moulding. Of those, 2 patients had recurrence of the swelling within 1 week; this was resolved after application of another silicone mould. None of the patients had new ear deformity after application of the dressing.

Needle aspiration and silicone moulding is a safe and effective method for managing pinna haematoma and seroma.

Otologists have traditionally relied on CT scan of petrous temporal bone to plan surgical approach, understand mastoid aeration, anatomical variation, and hazards prior to surgery. Whilst CT scans allow for 3D reconstruction from 2D slices this can still result in misleading imagery and can be of limited use pre-operatively.

In this project we have designed, tested, and printed 3D models from CT scans of patients prior to their operation. We have tested several different PLA-based printing filaments and a variety of printing techniques including traditional and suspension printing to obtain the best fidelity models possible. The models were examined using a microscope and an endoscope and images were captured. The model was then drilled pre-operatively using a handheld drill and a microscope in a controlled environment. Findings from this exercise were assessed against the actual clinical findings during mastoid surgery. All the similarities and discrepancies between the model and the surgery were noted.

Preliminary results of several patients have shown excellent accuracy of the models and have improved the primary surgeon’s confidence when operating particularly with complex patients requiring revision surgeries.

This project has many potential avenues of continuation including change of practice to preoperatively print a 3D model, the teaching of surgical techniques to trainees using low cost and easily available models, and expansion into other surgical specialities such as septorhinoplasty, functional endoscopic sinus surgery and base of skull surgery.

The aim of SyncMed is to revolutionise medical education by creating a virtual platform that bridges the gap between medical students and healthcare professionals. By providing real-time, curriculum-aligned tutorials delivered by experienced doctors, SyncMed has enhanced the clinical competency and academic performance of medical students globally.

SyncMed connects students and doctors via a user-friendly online platform. Medical students sign up for tutorials in specific areas of interest, aligned with their curriculum. Doctors from various specialties volunteer to teach these tutorials, with the sessions delivered through virtual conferencing tools. The platform also offers flexibility for both parties, allowing sessions to be scheduled at convenient times. Personalised feedback is provided immediately after each session to improve future tutorials.

Since its inception, SyncMed has facilitated numerous tutorials, significantly improving student engagement and comprehension in key medical topics. Feedback collected from students shows that over 85% reported improved understanding of complex medical concepts, and 90% noted enhanced clinical reasoning skills. Doctors involved in teaching also reported professional benefits, including portfolio enhancement and satisfaction from contributing to medical education.

SyncMed represents a novel, early-stage innovation in medical education, offering a scalable, flexible, and impactful solution for bridging the gap between medical students and healthcare professionals. The platform not only enhances student learning outcomes but also provides valuable teaching opportunities for doctors, indicating its potential to be a long-term asset in medical education. Future developments aim to expand access globally and integrate further features for assessment and feedback.

Microsurgery is critical in various surgical disciplines, particularly in plastic surgery. However, medical student access to microsurgical training is often limited by the high cost of traditional courses and equipment. This study evaluates the impact of a student-led microsurgery conference using low-cost training models on medical students' confidence in microsurgical techniques, model effectiveness, and interest in plastic surgery.

A feasibility study was conducted among 34 medical students attending a student-led microsurgery conference. The conference featured workshops on basic microsurgical skills, konjac noodle anastomosis, chicken thigh neurovascular bundle dissection, and femoral artery anastomosis. Pre- and post-conference surveys assessed participants’ confidence (scored 0-100), perceived model effectiveness (konjac noodles for anastomosis, smartphone holders as microscope substitutes), and interest in plastic surgery.

Participants showed significant improvements in confidence for all microsurgical skills: basic skills (24.27 to 55.82, p < 0.01), konjac noodle anastomosis (18.64 to 65.09, p < 0.01), neurovascular bundle dissection (18.55 to 70.95, p < 0.01), and femoral artery anastomosis (18.35 to 66.26, p < 0.01). Perceived effectiveness of konjac noodles increased from 25.52 to 61.91 (p < 0.01) and smartphone holders from 25.39 to 39.52 (p = 0.01). 88.24% of participants reported increased interest in plastic surgery.

The conference significantly improved students' confidence in microsurgical techniques and demonstrated the feasibility of low-cost models. Future directions include expanding student-led training and integrating remote learning using these models to increase global accessibility. These strategies offer a scalable, high-quality approach to expose students to microsurgery and increase career interest.

The United Kingdom Medical Licensing Assessment (UKMLA) is a new national examination being introduced for all final year medical students who will be graduating from the academic year commencing in 2024. The new examination will be a national initiative to standardize medical school exams. In this paper we aim to evaluate a novel initiative undertaken by the Royal Society of Medicine’s Academic Section which developed a national teaching series which aims to educate clinical year medical students preparing for the UKMLA.

We organised a novel 25 lecture series delivered by post CCT doctors using an online platform. A Likert scale form was created and distributed following each lecture session to evaluate the efficacy of the lecture series. A second Likert scale form was created and distributed amongst lecture audience which aimed to understand the resources medical students find useful to study clinical medicine. Both Likert scale forms were created using Google forms.

Our lecture feedback form was completed by 160 participants and the lecture series received highly satisfactory ratings across many domains. Our form which aimed to understand which resources medical students utilise was completed by 71 participants with the three most used resources being online free resources, paid question banks and clinical placements. Greater than half of the participants reported the single most useful resource was online paid question banks.

In conclusion, digital resources are being widely used by medical students and to further support clinical students in their learning the society should develop such resources.

The impact of severe lower limb trauma can be devastating, with research showing high rates of long-term disability and depression in this group. There is growing recognition of the need to enhance patient satisfaction throughout the reconstructive and rehabilitation process. Interaction Design is a discipline focused on creating intuitive user interactions during complex processes. We hypothesised that applying interaction design principles to the acute management of severe lower limb trauma could improve patient experience.

This project, led by an interaction design student, involved close collaboration with patients and the lower limb trauma team at Mater Misericordiae Hospital in Dublin. The designer employed user-centred design methods, including patient shadowing, staff and patient interviews, and emotion mapping, to understand the patient journey following severe lower limb trauma. Based on these insights, a series of patient information materials were developed, iteratively refined, and tested with patients, caregivers, and clinical staff.

The project produced an illustrated PDF book that patients access throughout their hospital and rehabilitation journey. This guide helps them understand their treatment and prepare practically and emotionally for each stage. Additionally, based on the insights from the observations, a caregiver’s book was also produced to support carers throughout the recovery journey.

The project is ongoing; a funding application is in place that would support the roll-out of the books to all patient and caregivers going through the lower limb trauma pathway. The team plans to conduct a prospective cohort study to evaluate the impact of this intervention on patient understanding and satisfaction.

Highlighting topical liposomal amphotericin B (LAmB) as a potential treatment option for patients with major burn injury who develop invasive fusariosis. These patients currently have high morbidity and mortality. Intravenous antifungal therapy is associated with significant nephrotoxicity, and topical therapy aims to reduce this effect by minimising systemic absorption.

Case report of patient with major burn injury complicated by fusarium infection. Review of existing literature. Discussion of rationale for topical administration.

This patient was initially treated with managed with intravenous LAmB following a 55% TBSA burn injury requiring extensive burn wound excision and ICU stay. The patient could not tolerate the intravenous treatment due to nephrotoxicity and overall clinical deterioration. Topical LAmB was trialled as an alternative treatment route in order to avoid the known systemic complications with a successful outcome.

There is already precedent to use topical LAmB in invasive infections with a disrupted skin barrier - this has particularly been adopted in the management of cutaneous leishmaniasis. This reduces systemic toxicity due to reduced systemic absorption of the drug, and addresses concerns that intravenous therapy does not achieve sufficient drug concentrations within burned tissue (due to damaged local vasculature). This is an innovative treatment approach for a high-risk patient group and an experimental study would be useful to investigate further.

Limb amputation is the surgical removal of all or part of a limb. Trauma has been held to be the most common indication for amputation surgery in Nigeria, however recent reports show a rise in the incidence of diabetes related amputations. This study aims to determine the indications and levels of limb amputation at a tertiary institution in South-East, Nigeria over 5 years and to ascertain the percentage attributable to complications of diabetes.

This is a retrospective study of all limb amputation surgeries performed between January 2015 and December 2020 at Alex Ekwueme University Teaching Hospital Abakaliki, Ebonyi State, Nigeria. Case notes of patients were retrieved, and relevant data extracted and analysed.

A total of 128 amputations were studied. There were 86(67.2%) males and 42(32.8%) females. Upper limb amputations were 14(11%), while 114(89%) were lower extremity amputations (LEA). LEA in 47 patients (41.2%) were due to diabetes gangrene, then 21 (18.4%) due to infectious gangrene, trauma 20(17.5%), neoplasms 11(9.6%), peripheral vascular disease 7(6.1%), with splint complications from traditional bone setters accounting for 3(2.6%). 5 cases had other random causes. 49.1% of the amputations were below knee, followed by above knee amputations in 35.1%. Above elbow amputations was the most common level of amputation in the upper limb group (10%).

Diabetes complications was the commonest cause of LEAs in this study. Measures such as patient education and establishment of care-pathways for foot ulcerations can help reduce the rate of amputations in Nigeria.

The goal of this study is to evaluate the effectiveness of using CT tractography as an option in the management of penetrating abdominal trauma. Does CT Tractography function as a useful technique for assessing patients with Anterior Abdominal Stab Wounds (AASW)?.

The stab wound was disinfected with a disinfectant solution and local anaesthesia was deeply applied around the stab wound. A Foley catheter 12 Fr was inserted into the deepest place of the wound and a balloon was slowly inflated while the patient was lying in the supine position to prevent leakage of the contrast agent. Then a plain CT was done immediately after the injection. Review of the CT tractography for all cases was done by the radiology team and surgery team.

57 patients between Jan 2020 and Jan 2022 (69.5%) underwent exploration after showing a positive contrast leak into the peritoneal cavity.

25 (30.48%) patients whose CT Tractography revealed no leak into the peritoneal cavity were effectively handled conservatively without the necessity for surgical intervention.

In the study, CT tractography correctly identified 100% of the patients who needed laparotomies, and none of the patients without peritoneal penetration required surgical intervention during follow-up. The examination of patients with AASW can be done efficiently by CT tractography. CT tractography is an effective tool in the evaluation of patients with AASW. Patients with negative tractography can be safely managed by serial abdominal examinations. Positive tractography accurately indicates peritoneal penetration and needs surgical intervention.

Peritoneal encapsulation is a rare congenital malformation characterized by a thin accessory peritoneal membrane covering all or part of the small intestine forming an accessory peritoneal sac1. Most cases are asymptomatic and diagnosed incidentally, during surgery and/or autopsy. It may also be an aetiology for an acute intestinal obstruction.

Our case is that of a 44-year-old man who presented at the emergency with a 2 day history of sudden onset colicky abdominal pain, associated with vomiting and constipation. Clinical examination reveals a middle-aged man in mild painful distress with distended abdomen with hyperactive bowel sounds, an acute intestinal obstruction was suspected and imaging via plain abdominal x-ray and abdominal ultrasound findings were in keeping.

He had exploratory laparotomy. Intraoperative findings of a peritoneal membrane arising from the mesentery encasing the entire small bowel was seen, in addition, the mesentery was rotated at its root twisting the small bowel and narrowing its lumen resulting in bowel occlusion and subsequent intestinal obstruction.

Knowledge of this condition will aid the surgeon in making prompt decision when confronted with this condition.

With Thawra Modern General Hospital in Sana’a serving as a vital provider of care for war-wounded patients, I have witnessed first-hand the challenges of managing complex trauma cases with limited resources. This study aims to examine the epidemiology of war-related injuries and evaluate the role of general practitioners in optimizing trauma care delivery.

A retrospective, cross-sectional study was conducted, analysing data from the hospital’s trauma registry over a 12-month period. Key variables included patient demographics, injury characteristics, time to definitive care, and clinical outcomes. In addition, qualitative interviews were conducted with GPs, nurses, and administrators to better understand the operational and logistical challenges faced in the provision of trauma care.

The study found that the majority of war-related injuries were due to explosive devices, such as mortars and airstrikes, resulting in complex, multisystem trauma cases. GPs played a crucial role in the initial triage and stabilization of these patients, often working in close collaboration with specialist surgeons and anaesthesiologists. However, significant delays were observed in the trauma care pathway, with a median time from injury to definitive surgical intervention of over 12 hours. Factors contributing to these delays included limited emergency medical transportation, shortages of essential medical supplies, and the need to prioritize limited operating room capacity.

The findings highlight the critical role of GPs, as well as the need for comprehensive system-level improvements to enhance the resilience of healthcare delivery. Strategies to address these challenges may include investments in prehospital care, targeted training programs for GPs, and development of adaptable trauma care protocols.

Pakistan, the fifth most populous country with 241.5 million people by 2023, faces significant health challenges, with diabetes and obesity rates at 26.7% and 43.9%, respectively. The field of metabolic and bariatric surgery (MBS) is still developing, with fewer than 100 formally trained MBS surgeons and only two fellowship programs available. This shortage of specialised training has led to complications from MBS procedures performed by inadequately trained surgeons.

The aim of this study is to identify and address the barriers in MBS training and practice in Pakistan.

A survey was distributed among surgery residents, fellows, and consultants in major hospitals across Pakistan. The questionnaire included consent and biodata forms, along with eight questions addressing barriers and solutions in MBS training and practice.

We received 55 responses from 25 hospitals nationwide between February and March 2024. Participants had an average age of 37.7 ± 10.2 years and 21.8% female representation. They included residents (38.2%), fellows (20%), and consultant surgeons (41.8%). Notably, 27.3% had formal MBS training, while 12.7% had over five years of experience. Key barriers identified were limited public and surgeon awareness, financial constraints, unclear guidelines, faculty shortages, societal stigma, and policy gaps regarding MBS. Proposed solutions included media campaigns, international collaborations, exchange programs, policy reforms, establishing a national MBS registry and centre of excellence, mentorship programs, and tailored guidelines by the Pakistan Society of Metabolic and Bariatric Surgery (PSMBS).

Implementing solutions to these barriers is crucial for improving healthcare outcomes in the face of obesity and diabetes epidemics.

Data on multinational 90-day mortality and morbidity rates after surgery for gastric cancer is limited in the literature. This study aimed to understand the 90-day mortality and morbidity outcomes according to GASTRODATA Registry for elective gastric cancer surgery patients and identify risk factors.

We conducted an international prospective study on ≥18 years patients undergoing elective surgery for gastric cancer with curative intent from 01/04 to 30/09/2022. Known metastatic disease, concurrent secondary cancers, gastrointestinal stromal tumour (GIST) and Siewert type I/II oesophagogastric junction malignancies were excluded. Univariate and multivariate logistic regression were used to identify variables associated with 90-day outcome.

380 collaborators from 47 countries submitted data on 1538 patients. The mean age was 64.2 years and 58.5% were males. 90-day morbidity and mortality rates were 38.2% (n=587) and 2.9% (n=45), respectively. Pre-operative higher Charlson Comorbidity Index, higher ASA score, pre-operative weight loss >10%, type of gastric resection, positive specimen margin, number of harvested lymph nodes, longer surgery duration and postoperative pathological IV staging (p value<0.05) were significantly associated with severe complications and mortality.

Elective gastric cancer surgery has a 90-day morbidity of 38.2% and 90-day mortality of 2.9%, globally. This study identified several factors associated with higher morbidity and highlights the importance of a unified language on surgical morbidity, prehabilitation and ongoing audits to enhance patient outcomes.

Pain, bleeding, and infection at the surgical site are major issues after haemorrhoid surgery. Our study focused on examining the impact of hair removal before surgery on postoperative outcomes. Additionally, we aimed to compare the outcomes of surgical techniques used in patients with haemorrhoids.

This is a case-controlled retrospective eminence-based study. This cohort analysis of data included a total of 83 patients who underwent surgical interventions for grade II to grade IV haemorrhoids. Among these, 41 patients underwent preoperative shaving, while 42 did not. The main outcome results were favourable postoperative results. Secondary outcomes included the occurrence of surgical site infection (SSI), recurrence, and other complications.

25 (31%) patients who were shaved had intraoperative bleeding compared to 16 (19.3%) who were not shaved (p-value=0.03). The length of hospital stay was one day longer in the shaved group (p-value=0.008), which could be due to patient preference or the surgeon's advice to monitor those patients in the context of more intraoperative bleeding. All other parameters were not statistically significant.

Preoperative shaving of surgical areas in patients undergoing surgery to treat haemorrhoids has no value in terms of reducing the risk of the outcomes discussed, which were not statistically significant. However, the amount of bleeding was statistically, although not clinically significant. Adequate postoperative wound care and patient education are crucial aspects for avoiding potentially serious complications.

Splenic cyst is a rare lesion of which findings are usually incidental from CT scan or ultrasonographic imaging. It does not render any symptoms until it becomes profoundly humongous.

A 14-year-old girl presented with anaemic symptoms and early satiety to the primary care centre with a haemoglobin level of 6.9 mg/dl. She also had increasing abdominal distension for 6 months. Clinically there was an intraperitoneal abdominal mass, extending obliquely from the left upper quadrant to the right iliac fossa crossing the midline. It was firm, non-tender and mobility was restricted. Computed tomography (CT) scan of abdomen revealed a huge cystic splenic lesion measuring 18 cm x 19 cm x 22 cm with elevated left hemidiaphragm. She was electively planned for laparotomy and splenectomy. Intraoperatively, there was a huge splenic cyst occupying the whole upper abdomen pushing the stomach, descending colon and sigmoid to the right of abdomen. The left lobe of liver is compressed and displaced superiorly. A total splenectomy was done with no catastrophic complication albeit the fibrinous adhesion of the spleen to the left hemidiaphragm and its surrounding structures. The weight of the spleen was 4.96 kg. She was discharged home well within days following surgery. Histopathological examination of the spleen reported as benign splenic epithelial cyst containing dark brownish fluid with no solid area seen within.

A surgeon should attempt to preserve the normal splenic parenchyma. However, a total splenectomy should be performed in large lesions, symptomatic and complicated cases especially those that compromise other organs.

To share our experience with the MIPH procedure performed between 2007-2022 for Grades II & III hemorrhoidal disease.

Parameters extracted and analysed from hospital EMR data included age, sex, ASA grade, previous medical and surgical history, grade of disease, surgical details (duration, integrity of the donut, haemorrhage, outcome), length of hospital stay, and immediate post-operative events (pain score, grade of haemorrhage, urinary retention at 6- and 12-hours post-surgery).

The age distribution of the 245 patients in this series was as follows:.

• Up to 30 years: 18.0% (n=44).

• 31-40 years: 22.0% (n=53).

• 41-50 years: 22.0% (n=53).

• 51-60 years: 18.0% (n=44).

• 61-70 years: 14.0% (n=35).

• 71-80 years: 6.0% (n=16).

Among patients experiencing urinary retention, 75% (n=90) were aged 50 and above, while 25% (n=29) were younger than 50 years. The two most common causes of post-operative bleeding were stapled line bleeding and minor mucosal bleeding, with all patients experiencing Grade 1 haemorrhage. Recurrences were noted in 32 patients with Grade 3 disease and 8 patients with Grade 2 disease. No patients developed life-threatening complications such as systemic sepsis, and no female patients developed recto-vaginal fistulas.

MIPH is a short procedure that reduces hospital stay and aids in early return to daily activities due to reduced post-operative pain. Recurrence rates are slightly higher compared to open surgery for haemorrhoids.

Primary malignant lesions in seminal vesicles are rarely observed in clinical practice. Seminal vesicle mainly observed with secondary tumours, and the prostate is the most common source, which is frequently caused by disseminated disease or contiguous spread from an adjacent organ.

The main presentation is hematospermia and cancer diagnosed with a CT or MRI scan, followed by surgical resection of this tumour.

This literature review concentrates on this rare cancer due to the scarcity of data regarding management techniques and the fact that the treatment is frequently customised to the individual. We summarise and analyse the data from the case reports of the main types of cancer observed in seminal vesicles.

Although there are numerous case reports for various types of seminal vesicle cancer, there is no primary study for this cancer. To collect a significant number of patients who have suffered from this cancer and to follow them up after the designated management has been implemented, a multicentre national or international corporation study may be necessary.

Seminal vesicle cancer is a rare malignancy that can be surgically treated, and early detection is crucial for long-term management. It may be beneficial to send tumour markers, particularly CA-125, which was elevated in few cases.

Primary studies with dedicated follow-up of these patients who suffered from this malignancy are necessary to determine the most effective management for them.

Total hip and knee arthroplasty are radical treatments for advanced knee and pelvic conditions, particularly osteoarthritis, due to their efficacy in improving functionality. While numerous studies have examined functional recovery post-arthroplasty, limited research has been conducted in Sudan, particularly during times of war. This study aims to evaluate the functional outcomes of hip and knee arthroplasty performed during the war, providing a foundation for treatment and rehabilitation strategies.

This is an observational-retrospective cohort study conducted at the Orthopaedics and Trauma Department of Osman Digna Teaching Hospital-Sudan. The study spanned eight months and included all patients (27) who underwent total hip/knee arthroplasty. Data were collected through records and interview questionnaires and analysed using SPSS. Approval was obtained from both the Hospital ethical committee and each participant.

(48.1%) of patients reported very mild pain, and (37%) could walk for over 30 minutes without discomfort. While (25.9%) denied experiencing severe sudden hip pain, (18.5%) occasionally felt knee instability. (37%) reported Mild pain when standing up from a chair. (48.1%) noted minor pain with housework. Only (29.6%) experienced night-time pain in bed for one or two nights. In terms of mobility, (37%) and (33.3%) had minimal difficulty with showering and car entry/exit, respectively. Additionally, (33.3%) could easily put on socks/tights, and (44.4%) were unable to do household shopping. Only (25.9%) could easily climb stairs, and (33.3%) reported rare limping.

The majority of patients who underwent hip or knee arthroplasty during the study period demonstrated good functional outcomes.

Tongue laceration resulted from fall is one of the mechanisms in paediatric soft tissue trauma. Lack of current guidelines and studies has proven to be a challenge in managing patient with this type of trauma, especially in the remote area of Indonesia.

1-year-old female presenting to the emergency room with a history of bike accident, thus injure her tongue. She remained conscious after the accident with no respiratory distress nor hemodynamic compromise. The physical examination revealed a transverse partial thickness laceration that involves two third anterior part of the tongue, sizing 4 x 0,5cm. The superior longitudinal muscle suffered complete section, meanwhile the transverse muscle suffered partial section. Debridement of the tongue was performed and repaired by layers with two-layer techniques using 4-0 absorbable chromic. Postoperative swelling was presented without respiratory compromise. Patient was discharged 72 hours postoperative, thus recovered nicely with good functional result.

Defect and ongoing bleeding are the two main concerns related to tongue laceration, followed by loss of function, infection, and swelling that might compromise the airway. Clear exploration on the injury and thorough examination is needed to decide whether a surgical repair is needed to restore a good functional result.

There has been controversy regarding materials used for augmentation rhinoplasty.

The authors reviewed the literature and summarized key points regarding materials used for augmentation rhinoplasty.

Alloplastic materials such as silicone, expanded polytetrafluoroethylene (ePTFE, Gore-Tex), and porous polyethylene (pHDPE, Medpor) can provide the augmentation needed in rhinoplasty but yet it is still associated with infection and extrusion. Homografts using cadaveric cartilage grafts can be a source of alternative options, but it is still associated with frequent notable resorption and its availability in each country. Autologous graft comes as excellent options for primary and secondary rhinoplasty materials due to their natural consistency, moldability, durability, biocompability, and low risk of infection, in which cartilage graft is found to be superior to bone graft due to their availability, moldability, and elasticity. Septal cartilage is easy to harvest and can be used especially on nasal tip rhinoplasty, whilst auricular conchal cartilage can provide structural support in patients with smaller septum or nasal valve collapse due to its elasticity. Lastly, costal cartilage is very efficient as an implant material for nasal dorsum augmentation due to its abundant amount and resistance to resorption.

Cartilage graft poses as versatile graft materials for rhinoplasty. For nasal dorsum, cartilage graft plays the role of adding the amount of augmentation desired with minimum complication . For nasal tip projection, cartilage graft defines structural support to the tip with additional smooth definition of the tip. Overall, a customized and thorough plan needs to be discussed for better, long-lasting outcome.

This review aims to evaluate current practices in the management of posterior malleolus fractures (PMF), with a focus on understanding fracture morphology, treatment strategies, and surgical outcomes. The study also seeks to explore the impact of PMFs on ankle stability, assess biomechanical implications, and determine the most effective surgical approaches for fixation.

A comprehensive review of literature was conducted, examining studies related to the anatomy, biomechanics, radiographic classification, and management of posterior malleolus fractures. Emphasis was placed on surgical approaches, including the use of computed tomography (CT) scans for fracture classification and preoperative planning. The study compared different fixation techniques such as posterior-to-anterior screw fixation and buttress plating.

The review found that accurate anatomic reduction and stable fixation are critical for optimal outcomes. The routine use of CT scans has improved the identification of fracture geometry, revealing critical features like articular impaction and loose bodies. Surgical management has shifted from relying solely on fragment size to focusing on articular congruity. Plate fixation, particularly with a buttress plate, was associated with superior clinical outcomes compared to screw fixation.

PMFs remain challenging to treat, with no clear consensus on management. However, accurate articular reduction, careful surgical planning, and the use of CT scans are essential in improving outcomes. Fixation strategies such as buttress plating and the posterolateral approach enhance stability and reduce complications. Despite advancements, the complexity of PMFs necessitates ongoing research to refine treatment protocols for better long-term results.

The effectiveness of non-surgical treatments as a common palliative care approach for lymphoedema cases remains uncertain. In this context, surgical treatments are a promising alternative for patients with lymphoedema.

The study encompasses an examination of seven lymphedema patients who received treatment at Gatot Soebroto Central Army Hospital between January 2019 up until recent, in conjunction with a comprehensive review of relevant literature.

This study evaluated seven female patients with secondary lymphedema, with a mean age of 57.4 years. All patients presented with upper limb lymphedema, with 85% undergoing lymphovenous anastomosis (LVA) and 15% undergoing a combination of LVA and debulking excision. Subjective clinical improvement was reported by 57% of patients, while the remaining patients' progress was inconclusive due to missed follow-up appointments.

Performing supermicrosurgeries like lymphovenous anastomosis (LVA) can be challenging, but it is a promising solution for improving lymphedema in patients. This study indicates that LVA surgery can be considered as a feasible option for palliative treatment. Our ongoing research for the remainder of the year will concentrate on a larger patient cohort to validate these findings further and assess its feasibility and safety.

The National Emergency Laparotomy Audit (NELA) is a pivotal initiative in the realm of global surgery, aimed at enhancing the quality and outcomes of emergency abdominal surgeries. Emergency laparotomies are high-risk procedures with significant morbidity and mortality, necessitating rigorous monitoring and evaluation to improve patient outcomes. NELA provides a comprehensive framework for collecting, analysing, and benchmarking data on emergency laparotomies, facilitating the identification of best practices and areas for improvement. An audit was conducted in a district general hospital in the United Kingdom, focussed on ascertaining the trust level of compliance to data entry of laparotomies into NELA data base, identifying drawbacks to updating the NELA records, and providing lasting suggestions/solutions to eliminate existing as well as future challenges.

Electronic data of laparotomies performed within the period of January 2023 to November 2023 was used.

A total of 111 emergency laparotomies were included in this study, of which 68% (73) were entered into the NELA data base while 32% (38) were yet to be registered on the data base.

NELA is an ongoing audit, and data collection process continues. NELA data is important in global surgery and an inclusive efficient team is necessary to ensure accomplish this. NELA is still an unpopular concept in the developing countries. Our aim is to spread its ideology to these countries and also create systems that would work through identifying challenges in data collection in developed countries and providing lasting solutions.

To understand the mechanism of injury and the options of management of penile fracture in Africa.

A systematic search through literature from PubMed, Google Scholar, and African Journal Online on the Management of Penile Fracture in Africa was made. Preferred Reporting Items for Systematic Review and Meta-analyses extension for Scoping Review was used to report the result. Fourteen studies were finally included in the review having fully satisfied the inclusion criteria.

The median age of presentation of penile fracture in Africa is 35.05years, majority of whom are married (58%) while 42% are single.

The average time to presentation to the hospital is 28hours. More than half of the patients with penile fracture presented following Masturbation (54%) while coitus (33.5%) was noted as the second commonest cause.

The review revealed that patients presented mostly with the triad of swelling, immediate detumescence and deformity.

The diagnosis of penile fracture was mostly clinical and about 50% of the authors did not use any other investigative modality, however, Ultrasound scan and Magnetic Resonance imaging were noted as supportive investigations.

Surgical intervention (99.3%) was noted to be the preferred method of care from our review, however, 0.7% of the patient had conservative treatments. Right corpora cavernosa (56%) was the most involved part of the penile shaft, 43.5% involved the left and only 0.5% had bilateral involvement.

Erectile dysfunction, penile curvature were the commonest complications noted from our review.

Penile fracture is a urological emergency that need prompt diagnosis, resuscitation, and management.

Removing large facial haemangiomas often results in significant defects affecting multiple facial subunits. Reconstructing these subunits can be challenging because of their visibility and the need for functional and cosmetic sensitivity.

The author presented a case study with a brief review of related literature.

A 53-year-old male presented with multiple masses on the left side of his face, ranging from 4x3cm to 10x4cm. These masses had been present for the past 10 years and affected half of his left nasal area, lower left eyelid, and upper left lip. After a wide excision, defects were identified in the left maxillary region, nasal area, and superior oral labium. The defects were then reconstructed using full-thickness skin grafts (FTSG) harvested from the right inguinal skin, combined with a local flap around the defect, with sensitivity to each facial subunit. The skin grafting was successful in the first week postoperative (no lysis). However, after 6 months postoperative, skin contracture was found along the margin of the previous skin grafts. Future reconstructions are scheduled to minimize contracture and improve functional and aesthetic outcomes.

Ensuring accurate identification of defects, taking into account patient preferences, and conducting a thorough exploration of facial reconstructive options are all essential steps that must be taken. For subcutaneous defects, utilizing a full-thickness skin graft can effectively mitigate significant wound contraction. Additionally, incorporating a local flap can ingeniously disguise the scar and lead to superior functional and aesthetic results for the patients.

Tuberculosis (TB), primarily affecting the lungs, is a chronic infectious disease caused by Mycobacterium tuberculosis. While pulmonary TB remains the most common presentation, extrapulmonary manifestations, particularly involving the musculoskeletal system, contribute significantly to the global burden of TB. Osteoarticular TB, encompassing infection of the bones and joints, accounts for approximately 1-3% of all TB cases, highlighting the ubiquitous nature of this pathogen. Amongst the diverse presentations of osteoarticular TB, involvement of the calcaneus is exceedingly rare, representing a diagnostic and therapeutic challenge. This case report presents a rare instance of calcaneal tuberculosis in a 16-year-old girl, emphasizing the importance of considering this diagnosis in young individuals presenting with persistent heel pain and swelling. It further underscores the need for a high index of suspicion, early diagnostic imaging, and prompt initiation of anti-tuberculosis therapy to prevent long-term sequelae and improve clinical outcomes.

Artificial intelligence (AI) has advanced significantly, with many applications established in high-income countries. However, its integration into low-income healthcare settings remains limited. Recent global discussions, including those by the United Nations, have underscored AI's potential to address critical healthcare challenges in low- and middle-income countries (LMICs) in under-resourced environments.

A cross-sectional survey was conducted among 100 physicians at the Pakistan Institute of Medical Sciences, a tertiary care hospital serving northern Pakistan and neighbouring regions. The online questionnaire covered AI applications in patient care, healthcare policymaking, epidemic forecasting, and resource allocation. The aim was to assess physicians' knowledge, attitudes, and perceptions regarding the benefits and challenges of AI integration into healthcare systems.

Results showed that most participants felt their healthcare system faced severe resource shortages, with 90% believing that this negatively impacted patient care. Physicians expressed optimism about AI's potential to improve efficiency in patient documentation, history taking, prognosis, and overall system performance. Many reported limited knowledge of AI and lacked confidence in its ability to enhance clinical judgment and decision-making. They were more confident about AI’s role in resource allocation and epidemic management. but remained sceptical about its potential to address bureaucratic inefficiencies. Additionally, participants highlighted a need for increased representation of LMICs in AI research and advancements.

This study is one of the few in the region examining physicians' perspectives on AI in LMIC healthcare systems. It underscores the necessity for greater awareness, improved skills, and more inclusive research efforts to fully leverage AI’s potential in these settings.

Angiodysplasia is one of the causes of recurrent episodes of lower gastrointestinal (GI) bleeding.

Angiodysplasia could be associated with few or multiple diffuse lesions, causing diversity in the clinical presentation of such patients demanding a high index of suspicion. We report a case of a late adolescent male presenting with life-threatening gastrointestinal bleeding due to diffuse angiodysplasia of the bowel extending from the jejunum to the sigmoid colon identified after multiple endoscopies along with Tc-99m and Meckel's scan. Laboratory investigations showed severe anaemia with unremarkable platelet count and coagulation profile. The patient's constant bleeding and low haemoglobin required multiple units of packed red blood cells (PRBC), fresh frozen plasma (FFP), and platelets, along with medical and endoscopic management to control the bleeding with no major improvement. Ultimately, the patient improved following surgical resection assisted by intraoperative endoscopy and was discharged home with complete resolution of the symptoms.

Suboptimal pain management in surgical patients is detrimental with short and long-term sequalae. A precise and reliable pain assessment and analgesia is crucial for better surgical outcomes.

Forty-eight in-ward surgical patients with moderate to severe pain (score >4/10) were assessed on the documented pain score and their current analgesia in both audit cycles separated by a series of small group discussions with medical and nursing staff on pain management in surgery based on Royal College of Anaesthesiologists and pharmacological guidelines. A modification of analgesia was done during the assessment if a patient’s analgesia was inadequate.

Nine (19%) out of 48 patients with moderate to severe pain were only recognized among which 2 (22%) had a pain score documented whereas statistically significant improvement was noted in the above statistics during the second cycle with 60% and 52% respectively. A modification of pain management was required in 45 out 48 patients (94%) in the first cycle whereas it dropped notably to 52% in the second. The commonest modification was titrating up the dosage of paracetamol and diclofenac. The intensity of pain showed a significant reduction between the cycles as well.

We note that pain in surgical setting is mostly overlooked despite its clinical implications. An active involvement of health personnel in recognizing as well as managing pain is paramount which can easily be accomplished by a periodic objective pain assessment using pain scores and simple modification of analgesia.

Global surgery aims to enhance surgical care in low- and middle-income countries. In Libya, facing political and economic challenges, little is known about medical students' awareness and attitudes. This study evaluates Libyan medical students' knowledge and perceptions of global surgery.

We conducted an anonymous online survey of Libyan medical students using a 22-item questionnaire distributed via social media. Chi-square tests were employed for bivariate analysis, with an alpha value set at 0.05. Odds ratios and 95% confidence intervals were calculated.

Among 515 respondents from 16 Libyan medical schools, 507 (mean age 24 ±2.0) were included. The sample was predominantly female (76.7%), with the majority being fourth year (24.5%) and fifth-year (21.7%) students. Awareness of global surgery was low: 25.4% had heard of it, 10.3% attended related events, and 12.2% engaged in research. Knowledge of specific global surgery initiatives was also limited: 2.8% were familiar with Disease Control Priorities (DCP3), 2% with the Lancet Commission on Global Surgery (LCOGS), and others had even lower recognition. Most (85.4%) viewed surgical interventions as more costly than medical treatments. Awareness of global surgery correlated significantly with event attendance (χ² = 31.765, p < 0.0001) and research participation (χ² = 19.601, p < 0.0001), but not with academic year (χ² = 8.472, p = 0.13).

Amid economic and political challenges, Libyan medical students show a significant lack of global surgery awareness, highlighting the need for better education and improved surgical care. They prioritize developing specialized healthcare teaching infrastructure, combating corruption, and increasing financial investment in surgical services.

To evaluate the demographic characteristics, treatment modalities, and outcomes of paediatric burns patients at Mater Dei Hospital over a five-year period to enhance care delivery.

A retrospective audit of paediatric burns patients under the age of 16 admitted between March 2019 and March 2024 was conducted using data from electronic patient storage systems and physical patient files. Variables included demographics, nationality, type and severity of burns, fluid resuscitation, length of hospital stay, surgical interventions, infection incidence, and antibiotic therapy. Statistical analysis employed descriptive statistics and appropriate tests for categorical and continuous variables.

The study included 62 patients with an average age of 3.35 years. The majority were Maltese (64.5%), followed by Syrian (12.9%), Italian (3.2%), and Nigerian (3.2%). Other nationalities included Greek, Filipino, Chinese, Albanian, Ivorian, Libyan, Croatian, Dutch, Indian, and Serbian (1.6% each). Thermal burns were most common (94.3%), with second-degree burns being the most prevalent (55.6%). Fluid resuscitation was necessary in 24.2% of cases. The average hospital stay was 8.51 days. Infections occurred in 11.3% of patients, and 12.9% received antibiotic therapy. The audit revealed significant diversity in the patient population, necessitating culturally sensitive care.

This audit provides critical insights into the management of paediatric burns at Mater Dei Hospital, highlighting the need for targeted strategies to address the multicultural patient population. Emphasising first aid education for parents and enhancing cultural competency among healthcare staff are essential for improving care outcomes. Future efforts should be targeted to optimising management and care for paediatric burn patients.

The aim is to audit urinary catheter documentation practices to enhance care standards and align with hospital guidelines, thereby reducing catheter-associated urinary tract infections (CAUTIs).

In October 2023, patient files from the surgical ward of a tertiary care hospital in Karachi, Pakistan were randomly reviewed. Files of patients with a urinary catheter inserted during their stay were checked for compliance with international guidelines. This review included the documentation of insertion date and time, catheter route, inserter identity, and insertion rationale.

The initial cycle encompassed 41 patients. Documentation of the date and time of catheter insertion was recorded in 85% (35/41) of cases. The catheter's route was noted in 66% (27/41) of instances. A mere 10% (4/41) of the files mentioned the individual who performed the catheter insertion. The reason for insertion was recorded in only 7% (3/41) of cases. Subsequently, surgical nursing staff received targeted training on the proper documentation of urinary catheters. In the subsequent cycle, which included 45 patient files, the documentation of the date and time of insertion improved to 100%. Documentation regarding the reason for insertion and the identity of the person inserting the catheter also saw improvements, though it did not achieve a 100% rate.

The audit revealed initial low compliance with catheterization documentation guidelines, which significantly improved after nursing staff training. Ongoing education and supervision of healthcare workers are essential to maintain high documentation standards, especially concerning catheterization indications.

To quantify the Enhanced Recovery After Surgery (ERAS) protocol knowledge of foundation doctors on the general surgical rotation from August 2023 to December 2023. ERAS protocol has decreased recovery time, length of stay, complications, and readmission rates. [1] ERAS protocol can be categorised into 5 domains: diet, pre-operative medications including bowel preparation, post-operative medications including nutritional drinks, mobilisation, and discharge. Foundation doctors should be aware of the details within ERAS protocol.

Survey questions were devised alongside a senior registrar to probe foundation doctors understanding of ERAS protocol. The questions were either single best answer questions out of 5 or had multiple correct answers. Foundation doctors who worked on general surgery between 2 August 2023 and 5 December 2023 undertook this survey, carried out from 6 December 2023 to 28 January 2024. There were 10 respondents to the survey, out of 21 foundation doctors.

Out of 10 surveys, foundation doctors correctly answered 47% of questions, with scores ranging from 36% to 57%. On further sub analysis the lowest scoring domains were mobilisation (21%), medication (post-op) (23%), and medication (pre-op) (50%).

Foundation doctors should have more knowledge of the ERAS protocol to improve the quality of patient care. Our proposed method of improving this involves presenting study findings and the ERAS protocol to foundation doctors at the next departmental Clinical Governance meeting, alongside ERAS nurses and senior team members. We aim to re-audit to identify whether an ERAS induction makes a difference to their understanding of ERAS.

Treatment escalation plans (TEP) aid clinicians in decision-making regarding treatment intensity, including cardiopulmonary resuscitation (CPR), for which an additional DNACPR (do not attempt CPR) form is required. To be valid, each form must be countersigned by a consultant [1] and dated, as early as possible [2]. The Royal College of Surgeons of England state that “[this] should be discussed with all patients at risk” [3]. Our aims are to quantify the number of general surgical and urology inpatients with a valid DNACPR and TEP form and quantify the documented patient/relative discussions regarding this.

We collected cross-sectional data on inpatients under general surgery and urology between 30/07/24 and 02/08/24, inclusive, on whether a valid TEP and/or DNACPR decision was made and discussed.

Out of 72 patients, 7 DNACPR and 7 TEP forms were completed. 100% of DNACPR forms were valid. Three of the 7 TEP forms were valid (total valid TEP form completion of 3.9%). From admission, the average time for endorsement of valid DNACPR and TEP forms were 6.7 days and 6.3 days, respectively. One DNAR decision was documented as being discussed with the relative.

Healthcare professionals have a duty of care to ensure that timely TEP and, where necessary, DNAR forms are completed and valid to ensure appropriate decisions can be made, especially in time-critical situations and out-of-hours. These decisions should be discussed with the patient/relative [3]. Our proposed intervention is to assign one F1 doctor to encourage these decisions and discussions.

To compare documentation of the risks for laparoscopic +/- open appendicectomy at the University Hospital of Wales with the standard risks outlined by EIDO.

A prospective closed loop audit was performed at the University Hospital of Wales from April-July 2024 for patients undergoing laparoscopic +/- open appendicectomy. The primary outcome was % compliance of documented EIDO standards in comparison to recorded documentation of risks on the consent forms. Secondary outcomes included: documentation of additional procedures, conservative options, and expansion of anaesthetic complications.

The first cycle highlighted a 38% compliance to the EIDO standards across grades of doctors ranging from FY2 to consultants. After local poster dissemination and implementation of EIDO patient leaflets, the following cycle demonstrated an increase of compliance of documented risks to 58%. Additionally, documentation of extra procedures, conservative options and expansion of anaesthetic complications increased by 14%, 27% and 33% respectively.

Informed consent is pivotal in avoiding patient dissatisfaction, complaints, and litigation. Good consenting practice involves thorough documentation of all associated risks of the procedure. In this study, local dissemination aided in highlighting awareness for consenters in uncommon risks, often not documented. Pre-filled consent forms may be one solution to avoid missing important associated risks.

This audit aims to evaluate the management of nasal fractures in a single UK centre in comparison with national ENTUK guidelines as well as to determine the proportion of patients referred to the clinic who required manipulation.

All patients referred to the ENT emergency clinic for nasal bone fractures requiring manipulation over a three-month period (January 1, 2024 - March 31, 2024) were included. Data was collected retrospectively from clinic booking lists and patients' electronic records.

The parameters reviewed included patient demographics, aetiology of injury and the time from injury to assessment or manipulation under anaesthesia. The most common cause of nasal fractures was sporting injuries (36%), falls (26%), assault (22%) and accidental injuries (10%). The mean age of patients seen in clinic was 36 years old (range 2-80 years). The mean time from injury to assessment/MUA was 20 days (range 7-42). Despite the delay to MUA, satisfactory outcomes were generally achieved. Notably, 78% (n=36) of patients referred to the clinic did not require nasal bone manipulation, indicating a high rate of unnecessary referrals.

This audit highlighted a high rate of referrals for patients not requiring manipulation, potentially leading to a delay in time to manipulation for those patients requiring it. A suggested intervention to address these issues is the implementation of telemedicine to better identify fractures requiring manipulation.

This audit investigates the completeness of clinical documentation for patients referred to the plastic surgery team by the breast surgery team, identifying gaps and proposing a standardized referral form to improve patient management.

A retrospective audit was conducted on 94 consecutive patients referred from the breast surgery team to the plastic surgery team for breast reconstruction from 01/12/2022 to 31/12/2023. Data was collected from Patient Dashboard, physical files, and iSoft Clinical Manager.

All patients in the study were female, aged 15 to 78 years. These patients were referred for breast reduction (31.5%), post mastectomy (19.6%), post wide local excision (WLE) (10.9%), and other reasons (35.9%). 2.2% had no documented indication. The history of complaints was specified in 89.4% of referrals. Previous breast history was documented in 92.6% of referrals, breast implant insertion in 95.7%, breast biopsies in 94.7%, and previous mammograms were noted in 93.6%. Allergies were documented in 91.2% of referrals, while alcohol and smoking history, were recorded in only 64.9%. Findings on breast examination were documented in 93.6% of referrals, BRCA testing in 94.7%, radiology tests in 90.4%, and clinical procedures performed were recorded in 92.6%. Notably, the location of lesions was documented in only 56.4% of referrals.

Implementing a standardized referral form could enhance the consistency and completeness of clinical information, ultimately improving patient care and outcomes. Future audits should assess the impact of such interventions and monitor documentation practices.

Diverticulitis is a condition where diverticula become inflamed and infected, typically causing severe lower abdominal pain, fever, general malaise, change in bowel habit, and occasionally rectal bleeding Uncomplicated' diverticulitis refers to diverticular inflammation that does not extend to the peritoneum, Complicated' diverticulitis refers to diverticulitis associated with complications, such as abscess, peritonitis, fistula, obstruction, or perforation 1.

we collected data from all patients admitted with CT-proven acute diverticulitis over a six-month period to determine the prevalence, to correlate CRP levels in acute complicated cases with the need for emergency surgery, and to assess the prevalence of patients scheduled for endoscopic follow-up.

a total of sixty-six patients were included, with a mean age of sixty-one years. Among these, 67% had sigmoid acute diverticulitis, and 71% were classified as Hinchey class I. Out of the 30 patients with complicated disease, 20 underwent endoscopic or radiological follow-up, and 10 had CRP levels above 200 (2 of whom died during admission, and 7 underwent emergency surgery). Additionally, 28.7% of patients with uncomplicated disease were transitioned to oral antibiotics within 48 hours. One patient (1.5% of the total) was found to have cancer during follow-up.

We found that a significant portion of patients with complicated diverticulitis required emergency surgery, highlighting the importance of CRP levels as a predictive marker and the necessity for endoscopic follow-up.

NICE recommends local anaesthetic transperineal (LATP) prostate biopsies as a safer alternative to transrectal ultrasound scan (TRUS) prostate biopsies, with significantly lower sepsis rates (below 1% vs. 1-3%) and reduced urinary tract infection (UTI) rates of approximately 2% with the use of prophylactic antibiotics. At Manchester Royal Infirmary (MRI), a single 750mg dose of Ciprofloxacin is standard before LATP biopsies to mitigate infection risk. This audit evaluated post-biopsy infection rates under this protocol.

This retrospective audit examined the records of all patients who underwent LATP biopsies at MRI between November 2023 and April 2024. Benchmark sepsis and UTI rates were set at 1% each. The audit reviewed positive urine cultures within 30 days post-biopsy and emergency department visits or hospital admissions due to infective complications during the same period.

The audit included 219 patients, aged 46 to 83 years (mean age of 67). Consultants performed 12.3% of biopsies, while registrars conducted 87.7%. On the biopsy day, 97.3% of patients had negative urinalysis results. 2.3% had a UTI in the previous year which had been appropriately treated based on culture sensitivities. Post-biopsy, 0.46% of patients developed sepsis, and 0.91% experienced UTIs.

The results indicate that LATP biopsies at MRI have exceptionally low post-biopsy infection rates, supporting their safety. Given these findings, there is a strong rationale for exploring LATP biopsies without prophylactic antibiotics to reduce antibiotic usage and combat resistance. We recommend a trial of omitting routine antibiotic prophylaxis for LATP biopsies, and a re-audit in 6 months’ time.

General practitioners (GPs) often provide a suggested diagnosis when referring patients to secondary care. However, their limited exposure to surgical specialties during training may influence the accuracy and appropriateness of these referrals to surgical assessment units (SAUs). This study aims to evaluate the diagnostic accuracy of GP referrals to an SAU and assess the appropriateness of these referrals by comparing suspected diagnoses with final diagnoses upon discharge.

We conducted a retrospective analysis of all admissions to the SAU in a district general hospital over a two-month period from January to February 2023. Data collected included patient identification numbers, admission dates, suspected diagnoses from GP referrals, and final diagnoses upon discharge. Only patients referred by a GP were included. Ethical approval was not required.

During the study period, 78 patients were referred by GPs to the SAU. Of these, 31 patients (39.7%) had accurate suspected diagnoses, while 13 patients (16.7%) had incorrect diagnoses. Notably, 35 patients (44.9%) were referred without a documented suspected diagnosis, and 28 of these patients (80%) arrived without a written or typed referral letter.

While the proportion of correct diagnoses in GP referrals (39.7%) is relatively high given the resources available to GPs, the significant percentage of referrals lacking a documented suspected diagnosis (44.9%) is concerning. This highlights the need for enhanced education on surgical pathologies during GP training, which could improve referral quality and diagnostic accuracy in SAUs.

To review the changing patterns of PNI over a period of 6 years in our Major Trauma Service (MTS).

A retrospective review of all cases of adult patients presenting with PNI to Aintree University Hospital (AUH) between Jan 2017 and Jan 2023. Cases were identified through medical coding and review of electronic medical records.

71 cases of PNI were managed at AUH between Jan 2017–Jan 2023, representing a 13% increase over previous reports. The proportion of presentations as a result of deliberate self-harm (DSH) was 27% over the previous 6-year period, compared to 51% of all PNIs presenting over the period covered by this report, representing a statistically significant increase of 89% between the two-time frames (p = 0.0008). The highest ratio of DSH to total PNI cases occurred during the first wave of COVID-19, with 77% of presentations being self-inflicted. The prevalence of mental health disorders within the cohort increased by 65% during the six years, reaching peak levels at 92% in the year 2020.

This study highlights the increasing incidence of self-inflicted PNI within the context of increasing prevalence of psychiatric disorders. Rising rates of deliberate self-inflicted neck trauma demonstrate the importance of reallocation of healthcare resources for health promotion, prevention, and treatment in mental health services.

Perioperative risk assessment has traditionally relied on subjective clinical judgment of healthcare professionals, which is often inadequate for predicting adverse events. Recognising this, the Royal College of Anaesthetists, the Royal College of Surgeons of England, and NCEPOD recommend that perioperative risk should be documented on both consent forms and in medical records. This study aims to evaluate the proportion of emergency surgery patients with explicit perioperative risk documentation in both their consent forms and medical notes.

A retrospective analysis was conducted on patients undergoing emergency general surgical procedures from August 1st, 2023, to October 31st, 2023. Following local educational interventions, secondary analysis was performed on patients treated between April 1st, 2024, and June 30th, 2024.

The initial analysis included 180 patients; 136 patients were evaluated in the follow-up. Risk scores were recorded in the medical notes for 8.3% (n=15) of patients initially and 9.4% (n=13) in the follow-up (p=0.14). No risk scores were documented on consent forms in either group. Among patients undergoing laparotomy, documentation rates in medical notes increased from 37.5% to 56.0% (p<0.001). Post-operative ITU admission documentation remained stable (47.5% vs. 47.8%, p=0.33). 50.0% of patients with fatal outcomes had risk scores documented initially, compared to 100% in the follow-up (p<0.0025).

While documentation of perioperative risk in medical notes improved for high-risk procedures, it remains consistently low in consent forms. Potential barriers include the lack of a designated section for risk scores on electronic consent forms, reliance on intuitive risk assessment, and time constraints.

Antibiotic resistance, linked to inappropriate antibiotic usage, presents a substantial public health concern. Acute diarrhoea cases in A&E often witness the misjudged administration of antibiotics. This study is aimed at addressing the inappropriate prescription of antibiotics by healthcare providers, contributing to the rise of antibiotic resistance. The project followed two Plan-Do-Study-Act (PDSA) cycles and evaluated patient data against guidelines established by the American Association of Family Physicians (AAFP).

Two audit cycles were conducted. The first cycle (PDSA-1) analysed records of 100 patients, while the second cycle (PDSA-2) scrutinized 35 patient records. Patient data was evaluated based on various variables, including symptoms, travel history, and ingestion of outside food. An intervention in the form of a teaching session was organized between the 2 cycles.

In PDSA-1, only 35% of patients received accurate antibiotic prescriptions, highlighting a significant concern. PDSA-2 saw a positive improvement, with 60% of patients receiving correct antibiotic prescriptions. This shows that with intervention in the form of teaching, an overall improvement of 25% was witnessed in the local practice of antibiotic prescription.

While progress was made, there remained room for further improvement. Analysis revealed a dearth of relevant information in patient emergency slips, signifying the need for more comprehensive history-taking.

Misuse of antibiotics is one of the leading causes of antibiotic resistance, and this challenge can be tackled by formulating a correct diagnosis and, most importantly, by appropriate prescription of antibiotics according to established guidelines.

The management options for ulnar polydactyly (UP) are either suture ligation or surgical excision. Suture ligation is only suitable for Stelling Type-1 UP. There is no established standard of care for UP, especially Type-1. The primary aim was to calculate the financial cost and complication rate of suture ligation using data from one hand surgery clinic at the Royal Free Hospital (RFH). The secondary aim was to compare our findings to surgical excision costs/complication rates from previous studies.

We established baseline costs for suture ligation and surgical excision by consulting the Department of Health's 'Healthcare Resource Group Charges'. To calculate the complication rate of suture ligation, we extracted data through the Electronic Patient Record (EPR - Cerner) at the RFH between 1st March 2015 to 31st November 2022, inclusive, for 64 infants. For comparison, we extracted data related to surgical excision from Singer et al.'s paper, the first to exclusively evaluate stelling type I postoperative outcomes. We compared the two datasets using a chi-squared test to identify any significant differences.

Suture ligation costs £102 per procedure, whereas surgical excision costs ∼£668 per procedure. The Chi-squared test suggested significantly reduced complication rates for suture ligation compared with surgical excision in type-1 UP patients <12 months old.

This audit suggests that suture ligation is a cost-effective alternative with significantly lower complication rates. Based on our calculations, treating all patients with suture ligation would save the NHS ∼£346,392 per year. Larger studies will be required to corroborate our findings.

This study reviewed acromioclavicular (AC) joint injuries over three years, evaluating imaging practices against the guidelines from "The True Axial Shoulder Projection: Diagnostic Aid for Acromioclavicular Joint Dislocation" (January 2020). It also monitored the time from injury to surgery based on standards from Fraser-Moodie et al. in "Injuries to the Acromioclavicular Joint" (J Bone Joint Surg Br, 2008).

A retrospective audit was conducted on AC joint injuries from December 2019 to September 2022, involving 33 patients (one excluded due to clavicular fracture). Data collected included diagnosis, injury date, grades, x-ray dates, AC joint measurements, management details, and implant types. Only AC joint injuries were included, excluding clavicular or humeral injuries.

Patient ages ranged from their 20s to 60s, with 78% of cases classified as grades 2 to 4. Most initial x-rays were conducted in the Accident & Emergency department, with about half receiving an axial x-ray during their first session. Of the 33 patients, 32 had an axial x-ray, but only 6 had a true axial x-ray. Additionally, 72% had face-to-face clinic visits.

The guidelines recommend surgery within two weeks of injury; however, surgeries in this study occurred between 20 to over 70 days post-injury, exceeding the recommended timeframe and complicating joint reduction. Following discussions with the radiology department, a policy change was implemented to ensure true axial x-rays are performed for all AC joint injury patients.

Flexible cystoscopy is a common urological procedure. Anecdotal reports suggested that many patients attending the haematuria clinic at Manchester Royal Infirmary were unaware they would undergo this invasive procedure, leading to rebooked appointments, increased anxiety, and a negative impact on their overall experience. This QI project aimed to assess and enhance patient awareness and preparedness for flexible cystoscopy through improved communication, including structured appointment letters and the provision of educational materials, as well as improving the informed consent process.

Pre- and post-intervention data were collected through a questionnaire distributed to patients at check-in. Pre-intervention data were gathered from 27 patients. The intervention involved providing a clear description of the procedure and a QR code linking to a British Association of Urological Surgeons leaflet. Post-intervention data were collected from 34 patients.

Pre-intervention, 63% of patients knew the purpose of their visit, and 56% were aware they would undergo a procedure. Post-intervention, these figures improved to 85% and 82%, respectively. The percentage of patients who reviewed information about the procedure increased from 37% to 65%, and those who received a leaflet rose from 37% to 82%. Statistically significant improvements were noted in patient awareness (p=0.028), reading about the procedure (p=0.041), and leaflet provision (p=0.001).

The intervention significantly improved patient awareness and preparedness for flexible cystoscopy. Improved communication and educational materials enhanced patient understanding and reduced appointment cancellations due to lack of preparation. This highlights the importance of clear, proactive communication in ensuring patient readiness and a more robust informed consent process.

In UK about 60% of the population experienced a skin condition. And at least 100,000 new cases of skin cancer reported every year. That created an increased demand of skin clinic appointments. The plastic surgery department at Wythenshawe Hospital responded with a weakened clinic. However, it was noticed that many patients attended the clinic with a preconceived impression that it’s an appointment for a surgery not a consultation and assessment which gave them some sort of disappointment by the end of the visit.

A patient experience questionnaire was used to assess the issue and gauge the satisfaction levels. Then we organized a meeting with our booking team to update them and review the appointment letters which are our first communication with our patients. A new letter template was designed clarifying that the purpose of the appointment is consultation and assessment not a surgery. We conducted a second cycle to assess the improvement.

20.6% of first-time attenders expected a surgery during their visit with an average satisfaction of 44%. The satisfaction percentage raised to 92% in the group that expected consultation as a purpose of their visit. Second cycle percentage of first-time attenders who expected surgery decreased to 2.5%.

From the previous results we could conclude that a preconceived impression could affect the level of patient satisfaction and overload doctors work by consuming more time in explaining the purpose of the visit. A small change in the first contact with your patient could create a huge impact on their satisfaction.

We aimed to audit treatment escalation plan (TEP) completion rates, including cardiopulmonary resuscitation (CPR) decisions, in patients admitted under emergency surgery.

Data was retrospectively collected on all emergency surgical admissions in a district general hospital in March 2024. Exclusion criteria included patients under the age of 16 and patients discharged on the same day without an operation. Results were presented in a departmental meeting and a target of TEP completion on the first consultant ward round was set. The second cycle was completed in July 2024.

126 patients were admitted in March 2024 and 151 in July 2024. 19 patients (15%) admitted in March had TEP forms completed during their admission compared to 26 patients (17%) in July. In the first cycle 5 TEP discussions were completed by the parent surgical team (26%) compared to 11 in the second cycle (42%). The median time to TEP form completion from admission was 2 days in March and 1 day in July. 47 patients of those admitted in March were operated on, of whom 39 did not have a TEP form (83%) compared to 69 patients operated on in July, 56 of whom had no TEP (81%).

TEP form completion rates remained low across both cycles, with an increase in the proportion of TEP discussions completed by the parent surgical team from 26% to 42%. Qualitative approaches may aid in understanding barriers to CPR discussions in emergency surgical patients and identifying strategies to improve TEP completion rates.

NICE publish guidance on important diagnostic information when referring patients with suspected colorectal malignancy. Inpatient referrals were audited against this guidance to determine percentage positive diagnosis; making comparison to referrals received from primary care and evaluating if this process could be better streamlined.

Retrospective analysis of 92 inpatient referrals was carried out over a 3-month period using electronic records, against the external referral checkbox criteria. Patients lost to follow-up were excluded.

Inpatients were assessed in clinics on a 10-day average. 20% of patients were discharged without further investigation and 48% required endoscopy. Positive cancer diagnosis was made in 12% of cases, with 73% of these patients having had abdominal CT prior. Information omitted included 26% of patients without documented medical histories. 40 Patients were referred with iron deficiency anaemia, but only 42% had iron studies and 23% had no coeliac screening. 86% of patients had not undergone digital rectal examination and 41% had no documented rectal bleeding history. 12% of patients required referral for FIT testing. Such omissions necessitate further appointments and delay.

Inpatient two-week wait referrals were assessed within the 14-day recommendation, with a higher percentage of cancer diagnosis compared with primary care referrals; perhaps due to more readily available imaging. We propose a mandated inpatient referral proforma to guide referrers on key diagnostic variables; and streamlining investigations for those with the highest likelihood of malignancy. Though this represents a single-centre study, wider application of an efficient proforma could improve adherence to cancer treatment targets and improve care.

UK experiences more than 75000 cases of fracture neck of femur yearly, making it one of the most common fractures with high morbidity and mortality in elderly population. Earliest diagnostic imaging ,analgesia and early admission is pivotal in reducing length of hospital stay, mortality and morbidity. The current target recommended by RCEM and national hip fracture database for diagnostic imaging is within 90 minutes of arrival to ED with admission within 4 hours. To meet this target and compare current level of current practice, we conducted a closed loop audit on early diagnosis and preadmission care of fracture NOF in a single DGH site.

In Frimley Park Hospital, this closed loop audit involved all patients presented with fractured NOF during winter months of 2022-2024 in 2 cycles where data was collected retrospectively using hospital IT system on 4 standard of care – earliest pain assessment and analgesia within 30 minutes of arrival, confirmation of diagnosis by imaging within 90 minutes of arrival, Admission within 4 hours of arrival and definitive nerve block before leaving ED where not contraindicated.

Following implementation of changes-clinical staff education, liaison with radiology department ,change in documentation system, we achieved 64% of diagnosis within 90 minutes of arrival which is 56% nationwide along with 39% diagnosed patient admitted within 4 hours with 100 % received nerve block before leaving ED provided not contraindicated.

The audit helped in finding proved measures for improvement of care for this cohort of patients with space for further betterment.

Accurate operation notes are crucial for patient care. The Royal College of Surgeons (RCS) developed the Good Surgical Practice guidelines in 2008 to ensure clear notes, aiding effective handovers and addressing medicolegal issues.

We assessed all elective General Surgical cases between June and August 2023. Initial findings were presented, and changes such as the use of an operation proforma were discussed. A re-audit took place between November 2023 and January 2024. Compliance was measured against RCS guidelines, with acceptable compliance set at ≥90% and poor compliance at ≤50%.

There were 107 notes during Cycle 1 and 87 notes during Cycle 2. Improvement in documentation were seen in date (cycle 1 vs cycle 2: 94% vs 100%), Time (69% vs 79%), name of operating surgeon (93% vs 99%), assisting surgeon (68% vs 99%), and anaesthetist (87% vs 95%), Incision (83% vs 91%), operative findings (92% vs 94%), anticipated blood loss (1% vs 52%), antibiotic prophylaxis (28% vs 30%), VTE prophylaxis (28% vs 30%). Details of elective/emergency surgery (0% vs 0%), Procedure (97% vs 93%), complications (36% vs 36%), additional procedures (1% vs 0%), details of operation (100% vs 99%), post-op instructions (99% vs 94%) and Signature (100% vs 100%) showed no changes or minor decline in compliance in documentation.

Overall, compliance improved from Cycle 1 to Cycle 2. Proper use of the proforma could further enhance patient care and adherence to RCS guidelines.

Urinary Catheterization is a common procedure performed by health care professionals in both acute and primary care. Trust guidelines are available on the intranet page, which provide comprehensive instructions for the proper insertion, care and removal of urinary catheters. These guidelines clearly outline how to document key findings following the procedure. The aim of this study is to assess compliance with trust guidelines.

In the first phase, retrospective data was collected from patient notes in PICS during April and May 2024.Data was collected from the notes of patients admitted in surgical wards of Heartlands and Solihull hospital. Data was collected and analysed on excel. Statistical analysis was performed where applicable. In the next phase after teachings, we will collect data prospectively to assess adherence to trust guidelines.

The median age of patients was 71, with an IQR of 57-80.5. Indication for catheterisation was documented in 38% of cases, verbal consent in 38%, and chaperone presence in 18%. The date and time of catheterisation were recorded in 83% of cases. The type and size of catheters were mentioned in 62% and 78% of cases, respectively. Instillagel was mentioned in 18%, and lot and expiry numbers in 17%. Balloon inflation volume was recorded in 28%, residual volume in 40%, and urine colour and clarity in 18%. Prepuce reduction was noted in 3%, and any difficulties were recorded in 38% of cases.

In the first phase many key details were less frequently recorded. In the next phase we aim to improve adherence.

Testicular torsion is a time-sensitive urological emergency that necessitates prompt scrotal exploration to manage and potentially salvage the affected testis. To compare current local practice against the BURST-BAUS consensus document for best practice in the conduct of scrotal exploration for suspected testicular torsion.

Retrospective review of all scrotal explorations performed for suspected testicular torsion at Medway NHS Foundation Trust was carried out between January 2024 and June 2024.

Data collected on following domains:.

1. Initial Incision.

2. Intra-operative Decision Making.

3. Fixation Technique.

4. Closure.

5. Op Notes.

6. Follow-up.

The data was compared to BURST-BAUS consensus document for these domains.

Initial incision: 100% had median raphe incision (compliant to guidelines). Intra-op decision making: torsion group (31%) and non-torsion group (69%) – considerable variability was noted in the non-torsion group. Fixation: 100% had suture fixation – non-absorbable prolene suture (compliant to guidelines). Op note: Mostly adequate with some variability among different surgeons. Closure: Dartos closure with continuous sutures, skin closure with interrupted sutures (compliant to guidelines). Follow-up: not adequate, needs improvement.

All incisions were deemed appropriate. All viable torted testes were fixed using the recommended materials and techniques. However, there was considerable variability within the non-torsion group, with some practices not aligning with the best practice guidelines. There is a need for proper Follow-up, which serves as a basis for improvement in our practice. Despite this variability, the BURST-BAUS consensus can be effectively utilised in clinical practice to provide standardised care.

To assess whether a single centre colorectal surgical team are achieving ward round medication reconciliation standards using HEPMA electronic prescribing.

A closed loop audit was performed on the use of HEPMA electronic prescribing for medication reconciliation on the colorectal surgical team's morning ward round. We looked at rates of medication reconciliation, with comments made regarding number of computers used and role allocation. The data was collated, analysed, and presented at clinical governance. Recommendations were implemented and the data was again, collected to complete the audit cycle.

A total of 249 patients were included. Following implementation of recommendations, the overall percentage of patients whose medications were reconciled using HEPMA increased 21% from 69.7% to 90.8%. The percentage of administration omissions identified decreased between cycles from 10.9% to 6.7%, thus demonstrating that less administration errors were made in the second cycle.

Medication reconciliation is a crucial part of the ward round to avoid medication errors. With the introduction of electronic prescribing, it is vital that medication reconciliation remains an important and integral part of the ward round, as it was previously with the easily accessible paper Kardex prescriptions. This study shows that role allocation and more electronic devices on the ward round led to a clear improvement in medication reconciliation rates. This has highlighted the importance of implementing new technologies into the clinical team.

Informed consent is essential in surgical practice, particularly for procedures like laparoscopic cholecystectomy. This audit aimed to evaluate the quality of the consent process, ensuring it aligned with Royal College of Surgeons (RCS) guidelines, with a focus on the documentation of risks and patient involvement.

A two-cycle audit was conducted. The first cycle reviewed the consent forms of 50 patients who underwent laparoscopic cholecystectomy between August and November 2023. Data were collected retrospectively from Clinical Record System notes. The second cycle, conducted in December 2023, assessed improvements made after implementing changes from the first cycle, including the introduction of an electronic consent system.

The first cycle revealed that while 100% of patients were involved in decision making, only 58% were given a copy of their consent form. Specific risks like bile leak and bile duct injury were inconsistently documented. Following the introduction of an electronic consent system, the second cycle showed full compliance with risk documentation and improved patient communication, it included all risks including those with least Likelihood as per Martha’s rule. Pre-formed electronic consent reduced the error of missing complications caused by human.

The audit highlighted the importance of a thorough and standardized consent process for laparoscopic cholecystectomy. The introduction of electronic consent and structured documentation significantly improved compliance with RCS guidelines, enhancing patient safety and informed decision-making. However, ongoing efforts are needed to address remaining challenges and ensure continuous improvement in the consent process.

The study was conducted to scrutinise the current approaches for management of necrotising fasciitis (NF) at our centre and aimed to formulate evidence-based guidelines to optimise care, outcomes and reduce mortality. The primary objective was refining diagnosis, early surgical intervention, antibiotics protocol and multidisciplinary approach for comprehensive management.

A comprehensive retrospective three-year review on 16 patients, diagnosed with NF was conducted. Data were extracted on the site of infection, multidisciplinary involvement, timing and frequency of surgeries, antibiotic regimen, and outcomes. This analysis provide insight to develop the management guidelines to enhance the quality of care.

In six (37.5%) patients the infection site was premium. Triple assessment by surgery, anaesthesia and critical care was received by ten (62%) patients and ten patients required intensive care admission, reflecting multidisciplinary collaboration. Inconsistencies was observed in antibiotics, mostly clindamycin and Tazocin were administered, initiated within 5 hours of diagnosis. Ten (62%) had surgical intervention, mostly within 12 hours. Multiple debridement ranging from 1 to 9 were performed in eight (50%) patients. Two patients were referred to plastic surgery. 100% cultures have shown polymicrobial growth. Mortality rate was 20% among those who had surgery. The absence of standardised protocol and variability in management in different trust was highlighted in this study.

The study highlights the need for standardised, evidence-base guidelines for management of NF. The observed variability in patients care and outcome suggest a multicentre audit, to formulate comprehensive guidelines to manage this life-threatening condition to standardised care and enhance outcomes.

A closed-loop audit was completed to investigate and improve the admissions documentation for patients admitted under the Urology service in our hospital. The Royal College of Physicians admissions audit tool was used as a standard.

A retrospective review of handover lists was used to identify patients. Venous thromboembolism (VTE) risk assessment, regular medication prescriptions, past medical/surgical history (PMH/PSH) and social history (SH) documentation were used to assess completion of the admission record. A chi-squared test was used for statistical analysis.

The first cycle included 50 patients admitted between March to May 2024. The second cycle included 51 patients admitted between June to August 2024. The intervention comprised a PowerPoint presentation emailed to all doctors working in the department.

In the first cycle, 25/50 (50%) of patients had the VTE risk assessment completed on admission. This increased to 35/51 (68.6%) for the second cycle (P=0.0567). Regular medications were prescribed on admission for 34/50 (68%) of patients in the first cycle. This increased to 47/51 (92.2%) in the second cycle (P=0.0023). PMH/PSH was recorded for 35/50 (70%) patients in the first cycle and 48/50 (96%) patients in the second cycle (P=0.0005). SH was documented in 9/50 (18%) in the first cycle and 14/51 (27.5%) in the second cycle (P=0.2575).

This audit demonstrated statistically significant improvements in regular medication prescription and documentation of PMH/PSH. A third cycle will be completed following the introduction of a urology-specific admissions proforma.

The Melanoma Institute of Australia’s online risk prediction tool incorporates a patient’s age as well as pathological features such as tumour thickness, subtype, mitosis, ulceration, and lympho-vascular invasion status to determine a patient’s long-term sentinel node metastatic risk for primary melanomas. Typically, sentinel lymph node biopsies (SLNB) are only recommended by the screening tool for patients with a risk greater than 10%, however in the UK sentinel lymph node biopsies are offered to all individuals with a pathologically confirmed melanoma grade T1b and above, irrespective of other risk factors.

This was a retrospective study which calculated the sentinel node metastatic risk for all patients with a new diagnosis of melanoma in NHS Grampian over a 1-year period via initial biopsy pathology report. Patient’s clinical notes were then used to calculate the proportion offered sentinel node biopsy, the quantity that went ahead with the surgery and the percentage of patients found to have a node positive for metastasis.

This study confirmed that contrary to the screening tool’s recommendation, there is inconsistency in which patients are offered SLNB with a tendency to offer the procedure even to those who have a very low risk of metastasis e.g., lentigo maligna melanoma.

This goes against the current international management guidance and unduly exposes patients to intra-operative complications and the long-term sequela of SLNB, as well as being an inefficient use of NHS theatre time and finances.

To assess adherence to guidance on the time allocations given to hand trauma patients when being booked onto a joint orthopaedic-plastic surgery hand trauma list via Outlook calendar. This had the long-term aim of being able to change the booking allocations from 3 patient slots per session to an allotment of time to allow for better utilisation of theatre resources.

Guidance on booking time allocation available to all of hand surgery team from previous quality improvement project undertaken within the department. Retrospective data collection over a 2-month interval for each loop, assessing compliance to guidance and accuracy of current guidelines in predicting case duration, with comparison made between the orthopaedic and plastic surgery team and by grade of booking. Intervention of updating guidance to include cases not previously listed, teaching sessions on guidance and increased visibility in clinical areas.

Large variance in practice based on grade and speciality. First loop findings of 40% compliance to guidance with average overbooking by 6 minutes per case causing cancellations. Second loop findings of greater awareness of tendency to overbook with complex patients being booked as a double slot, however overall similar levels of compliance to guidance in second loop of audit.

Further education on available guidelines is required for all grades in both plastic surgery and orthopaedics to ensure that patients are being scheduled for an appropriate length of time for their procedure. This trust is therefore not yet ready to move to a self-regulated booking format for hand trauma lists.

Acute plastics surgery patients with wounds are seen on call by junior trainees. Patients then require review by senior colleagues to make treatment decisions. Dressing changes can lead to patient discomfort/pain as well as added financial costs from multiple dressing changes. Medical photographs taken using a secure NHS AlertiveÓ mobile application allows for wounds to be reviewed without disturbing dressings. The quality of photographs, however, can impact their effectiveness.

We conducted a retrospective case note review of plastic surgery acute patients with open wounds treated over a 3-week period. We determined if photographs were taken and/or uploaded and scored them via a 6-point quality checklist. Educational posters were then placed in key clinical areas, with follow-up data collected prospectively over a 3-week period.

Initially photography was being under-utilised in the management of trauma patients with only 43% of patients having photos uploaded to their notes. Of these only 61% of the photos were deemed of suitable quality. Following departmental teaching and guidance posters, 65% of patients had uploaded clinical photographs for which the quality had much improved with 96% being deemed high quality.

Medical photography is beneficial in the management of open wounds in plastic surgery patients to reduce patient discomfort and unnecessary dressing changes. To optimise this guidance on taking medical photography was created, which was well adhered to by the department and improved the quality and usefulness of photographs uploaded to patient’s clinical notes.

Though breast conserving surgery provides better cosmetic satisfaction for women, it comes with a higher risk of insufficient margin clearance. This project aims to reduce local rates of return to theatre for re-excision for women undergoing breast conserving surgery in the form of wide local excision.

All women attending a single UK Breast Unit to undergo wide local excision for pre-invasive or invasive breast cancer in 2023 were audited. Rates of positive margins on histopathology reporting and subsequent return to theatre for re-excision of margins or completion mastectomy were recorded. Intra-operative specimen orientation and marking changed from using differing lengths of suture on superior, lateral, and deep margins to using individual-coloured inks on each of the six margins. This allows more accurate marking and clearer communication between the surgeon and pathologist. Rates of re-excision were re-audited following a two-month period of change implementation (May and June 2024).

Of 285 women undergoing wide local excision in 2023, a further re-excision surgery was required for 28.8%. Following re-audit of 22 patients who underwent intra-operative inking, 27.3% of women required further surgery for negative margins.

Intra-operative inking of margins by the surgical team has shown to minimally reduce the rate of re-excision of margins for women undergoing wide local excision but given the small sample size of patients with inked margins, further study is required. A longer period of data collection with more patients, as well as assessment across multiple centres is required.

NHS Tayside has a local antibiotic guideline, the Tayside Antibiotic Man. The guideline states that intravenous antibiotics should be reviewed daily. However, antibiotic reviews are missed frequently during surgical ward rounds, resulting in unnecessarily prolonged antimicrobial courses and an increase in patients with multidrug-resistant bacteria.

The project aim is to improve surgical ward round intravenous antibiotic reviews and documentations.

Using the Plan-Do-Study-Act (PDSA) quality improvement methodology, a meeting with the antimicrobial stewardship team was arranged to identify ways to improve local guideline compliance. Baseline data on the average percentage of documented intravenous antibiotic reviews was obtained. Only 38% of patients had a documented intravenous antibiotic plan.

An electronic poster was designed and distributed among the surgical team to encourage compliance with daily intravenous antibiotic reviews. The second intervention involved organising an antimicrobial education session to educate on the effects of global antimicrobial drug resistance and assess surgical staff’s knowledge of local antibiotic guidelines.

Compliance of daily ward round review of intravenous antibiotics improved to an average of 50% over four weeks after the first intervention. 100% of these patients had either been discussed with the consultant surgeons, microbiology, or Infectious Disease Team.

Following the second intervention, the results improved to 90% over four weeks following staff training.

Formal staff training improved the outcome of compliance with daily intravenous antibiotic reviews. This has been discussed during the General Surgery Clinical Effectiveness Meeting which the multidisciplinary team had agreed for regular education sessions regarding antimicrobial prescribing awareness.

Fragility fractures are defined as a fracture following a fall from standing height or less. They are a sign of underlying osteoporosis, are common, and increase with age. NICE CKS guidance states that patients over 50 years of age with a history of fragility fracture should be offered a dual energy x-ray absorptiometry (DEXA) scan to measure bone mineral density, to determine if bone-sparing treatment is required. Patients with fragility rib fractures secondary to trauma are often managed by the general surgical team. This audit aims to improve compliance with this guidance in the general surgery department of one district general hospital.

Data was collected for patients admitted between mid-May and mid-June 2024 under general surgery with fragility rib fractures. A department teaching session and presentation was then delivered regarding the above guidelines, as well as a department email being circulated. Repeat data collection to check for improvement was commenced at the end of August 2024.

13 patients above 50 years old and not known to have osteoporosis were admitted under general surgery during this timeframe with fragility rib fractures. None of these patients were referred for a DEXA scan.

Referring patients with fragility rib fractures for DEXA scans is important in ensuring appropriate commencement of bone-sparing treatment. This audit aims to improve compliance with this in general surgery in one district general hospital.

Renal colic affects 1–2 per 1000 people annually, contributing a significant portion of acute urology admissions. With a shift towards ambulatory care, more patients are managed by accident and emergency (A&E) and general surgery teams, without urology consultation. As a result, patients may leave without adequate discharge advice, increasing the risk of recurrence and stone-associated complications. This audit assessed junior doctors' knowledge and application of NICE guidelines on preventing renal colic recurrence.

A survey was conducted among doctors at Southend University Hospital to assess their knowledge and adherence to the NICE guidelines. A leaflet summarising these guidelines was distributed, and improvements in knowledge and practice were assessed with a follow-up survey.

Knowledge substantially improved after circulation of the leaflet, with overall correct responses increasing from 25% pre-intervention to 74% post-intervention. Reported use of the NICE guidelines rose from 14% to 70%. Notable improvements were observed in advice on encouraging fluid intake (27% to 75%), recommended daily fluid amounts (46% to 80%), adding lemon juice to drinking water (18% to 85%), avoiding carbonated drinks (4% to 70%), reducing salt intake (32% to 95%), maintaining normal calcium intake (55% to 90%), and retaining stones for analysis (1% to 55%).

The audit led to substantial improvements in junior doctors' knowledge and adherence to NICE guidelines when discharging patients with renal colic, with the goal of reducing recurrence and preventing complications. Further work includes expanding the initiative to other specialties and providing teaching for rotating junior doctors to ensure knowledge continuity.

In UK 250,000 people receive burn injuries each year,16,000 people are admitted to burn centers. Patient admitted to burns centres often report anxiety associated with their ongoing management at discharge. This anxiety extends also to the patient’s relatives and his GP. The British Burns Association (BBA) set a set of standards to reduce patient anxiety after discharge.

We aimed to review all discharges from Wythenshawe Burns Centre in March 2024. Our primary outcome was to identify adherence with the BBA standards. A smart phrase was created on our computer system that covers those 12 standards. Then we presented our idea, ensuring that our colleagues understood the purpose of it and have access to our smart phrase. A second cycle was conducted on August 10th, 2024 to assess the improvement.

By reviewing 12 discharge letters in March it was found that only 2 points from BBA standards were covered in more than 60% of the letters, 4 points were covered in less than 30% and 6 points weren’t covered at all. These results improved in the 2nd cycle, from 20 letters it was found that 2 points were covered in more than 90% of the letters, 9 points were covered in more than 50% and only one point were covered in 40% of the letters.

Comparison between the 2 cycles showed a proper improvement in covering most of the points in an ideal discharge letter. Which gave our patients a better understanding to the post discharge follow up plan.

This audit aimed to assess the compliance of emergency operative notes with Royal College of Surgeons (RCS) guidelines in Appendicectomy Cases and to evaluate the time taken from the decision to operate to theatre admission in paediatric and adult cases. The RCS recommends the operative time in paediatric cases be within 12 hours.

We retrospectively reviewed 50 patient notes from Meditech EPR for patients who underwent appendectomy. Compliance with 19 RCS guideline requirements for operative notes was measured, and the time taken from decision to theatre was analysed, particularly for paediatric cases.

Out of the 19 RCS requirements, the majority (15 items) had 100% compliance. Moderate compliance was observed in antibiotic prophylaxis (82%) and DVT prophylaxis (84.78%). Areas of poor compliance included recording the anaesthetist's name (36.96%) and anticipated blood loss (28.26%). In paediatric cases, all were operated on within the 12-hour operative window, while the average time to operate on adult patients was 17.4 hours.

Overall, compliance with most RCS guidelines was high, but improvements are needed in documenting the anaesthetist's name and anticipated blood loss. Paediatric cases met the recommended time to theatre, though there is no fixed time for adults, they exceeded the 12-hour target. To address these gaps, we propose presenting the audit findings at a departmental meeting and creating a poster for educational purposes. A re-audit will be conducted after implementing these changes to assess improvement in compliance and time management.

The Royal College of Surgeons of England national undergraduate curriculum in surgery outlines the core competencies expected of all graduating doctors. Despite this, fewer graduating doctors feel confident in their surgical skills. This quality improvement project (QIP) aimed to identify gaps in surgical education and then develop an acceptable surgical skills teaching program.

Three Plan, Do, Study, Act (PDSA) cycles were completed. Self-evaluation using a 5-point Likert scale assessed the doctor's confidence in each surgical skill. Feedback was also used to allow improvements within each cycle.

The pre-teaching questionnaire demonstrated a lack of confidence in all surgical skills, and thus, a curriculum was developed based on this feedback.

In the first PDSA cycle, teaching was delivered face-to-face, with video demonstrations of surgical skills followed by time to practice. Feedback was overall positive, with all doctors gaining confidence, but it was felt that videos provided before each session would be beneficial. Feedback in the second PDSA cycle was overall positive, but the attendees felt there needed to be more time to practice. Consequently, the session was restructured and taught across two separate sessions. Feedback was entirely positive in the third PDSA cycle, with no negative comments. Attendees also demonstrated a significant improvement in their confidence in the surgical skills taught.

The QIP allowed the development of a pilot surgical skills teaching course, which received largely positive feedback. This should be implemented on a larger scale, and its acceptability and effectiveness should be reviewed on an ongoing basis.

Temporary epicardial pacing wires are placed after cardiac surgery to help treat arrhythmias and/or optimise haemodynamics in the early postoperative period. This audit aimed to assess the quality of pacing documentation to then implement an educative intervention to improve our department’s performance.

Twenty patients were studied over a two-week period in August 2022. Patients having cardiac surgery requiring the insertion of temporary pacing wires were included. Variables recorded were the pacing mode on the pacing box and the underlying rhythm of the patient. This was done at critical care handover and at days 1-3 post-operatively on ward round. The first intervention was education sessions for staff who were not confident in pacing physiology, settings, and interpretation. Repeat analysis was completed for another 20 patients with the same inclusion criteria. After inception of the Trust’s Electronic Patient Record (EPR) system, a further twenty patients were evaluated to see the effectiveness of this second intervention.

After the first cycle, there were significant improvements in documentation for both the pacing mode and the underlying rhythm with a success rate of above 90% at each post-operative day compared to less than 25% previously. The second cycle with implementation of EPR achieved similar high success rates of 80-95%.

These results represented a significant improvement in the documentation of post-cardiac surgery cardiac pacing. It represents a success for better patient safety around the use of pacing. Education for medical staff improved confidence in this area of communication and they felt more able to raise concerns.

To assess our adherence to The Association of ColoProctology of Great Britain and Ireland “ACPGBI” guidelines regarding follow-up of Acute Diverticulitis “AD” (managed conservatively successfully) across Cwm Taf Morgannwg University Health Board “CTM UHB”.

ACPGBI guidelines presented in the Trust Audit Meeting. Data collected retrospectively over 18 months from admissions with AD in Princess of Wales Hospital “POWH” showed that ACPGBI guidelines were not followed appropriately. Following this data were collected from 2 sites across CTM UHB (POWH, and Prince Charles Hospital “PCH”) and presented again in the Trust Audit Meeting.

The 1st cycle (POWH): 55.6% of complicated AD had follow-up endoscopy, 100% follow-up endoscopy in query malignant cases, and unnecessary follow-up endoscopy done in uncomplicated AD in 60% of cases.

2nd cycle (POWH): improvement in follow-up of complicated AD 62.5%, follow-up of query malignant cases remained 100%, and reduction in unnecessary endoscopy in uncomplicated AD 27.3%.

Data from PCH (collected during the 2nd cycle): 57.1% of complicated AD had follow-up endoscopy, 33.3% follow-up endoscopy in query malignant cases, and unnecessary follow-up endoscopy done in uncomplicated AD in 66.7% of cases.

The need to improve adherence of CTM UHB to ACPGBI guidelines regarding follow-up of AD patients; further efforts must be made to avoid unnecessary investigations of uncomplicated AD, to have posters with the guidelines in clinical areas, and finally to include all 3 sites of CTM UHB in re-audit.

Testicular torsion is a time-dependent diagnosis and true urologic emergency. The salvage rate decreases significantly if treatment is delayed by more than six hours after the onset of symptoms. Early evaluation and prompt intervention prevent testicular loss. This study aimed to review the management of testicular torsion over a period of five years at a tertiary centre in sub-Saharan Africa.

We retrospectively reviewed the records of patients who were managed for testicular torsion at the University College Hospital, Ibadan between March 2017 and March 2022. The data retrieved include age, type of torsion, testicular viability at surgery, side involved in torsion, and type of surgical intervention. The data were analysed using SPSS version 25.

75 patients were managed for testicular torsion during the 5-year period. 49% of the patients were less than 21 years. Acute torsion and intermittent torsion constituted 47% and 53% respectively. Over 80% of patients had viable testes at surgery with the left testis more involved in torsion compared to the right. Our salvage rate was 75% as orchidopexy was done for the torted testis in three-quarter of the patients.

Testicular torsion is a clinical diagnosis where a high index of suspicion cannot be overemphasized. Prompt surgical intervention remains important in increasing the salvage rate. A lot of awareness should be made to the public regarding early presentation of males with scrotal pain to prevent testicular loss.

To assess and enhance the analgesia practices in adult ENT inpatients at Birmingham Heartlands Hospital (BHH).

This cross-sectional Quality Improvement Project (QIP) randomly sampled patients aged 16 years and older admitted to Ward 5. Data collection included subjective pain assessments using the Visual Analogue Scale (VAS) and reviewing patient records for demographics, reasons for admission, and analgesia use (pre-admission and during admission). Regular use of PRN (as-needed) medication was defined as usage in more than 50% of the allowed frequency, with inadequate pain control being defined as a pain score greater than 3.

Among 32 patients (17 females, 15 males, average age 52 years), 44% had inadequate pain control (pain scores less than 3), with only 9 of these patients following the WHO analgesic ladder. Moreover, 72% of patients were prescribed analgesia following the WHO ladder, while 22% reported pain scores greater than 5. Only 6% of patients regularly used PRN analgesia.

A significant portion of patients (44%) experienced inadequate pain control, highlighting the need for standardized analgesia protocols for common ENT conditions. Further, proactive communication between healthcare providers and patients regarding PRN options is essential to optimize pain management. Re-auditing after implementing these changes is recommended to assess improvement.

Urinary tract stones account for 25% of emergency urology admissions, creating a significant workload in the emergency and elective settings. In 2022, the GIRFT report concluded that too many patients were managed insensitively to their needs and with inefficient resource use. GIRFT advocates a same-day discharge policy where active stone intervention is required. Benefits of day-case surgery include reduced disruption to patients' lives, less risk of hospital infections, and lower healthcare costs. We aimed to evaluate the safety and feasibility of day-case elective ureteroscopy in our trust.

A retrospective analysis was performed of all patients undergoing elective semi-rigid and flexible ureteroscopy in the trust between 01/01/2022 and 31/10/2023. Information collected included patient demographics, length of stay, comorbidities, size and number of stones, complications, stent placement, stone clearance, need for further procedures, and 31-day readmission.

One hundred forty-one patients were included in the study, of which 108 were day-case and 33 inpatients. There was no significant difference in patient demographics, stone size or position, and type of anaesthesia. The inpatient group had a significantly increased comorbidity index, a considerably higher incidence of residual stone fragments and a need for further stone procedures. Whilst there was no statistically significant difference in 31-day readmissions, there were ten readmissions in the day-case cohort versus 2 in the inpatient cohort – primarily due to pain, stent symptoms and UTI.

Day-case ureteroscopy is a feasible option, and our results demonstrate equivalence in safety and no significant difference in readmissions. Judicious stent placement will prevent readmissions.

Guidelines for perioperative care in elective colorectal surgery have been published by the Enhanced Recovery After Surgery (ERAS) Society. Recommendations aim to accelerate recovery, reduce morbidity & length of stay (LOS). The audit aimed to improve adherence to elements of the Colorectal ERAS pathway at Salford Royal & reduce rates of delayed discharge.

ERAS patients between Jan-June 2022 & Nov-Dec 2023 were included. Data collected; demographics, clinical frailty score, type of surgery, LOS v expected, 30-day mortality, fluid balance, gut motility (GM), SSI rates, analgesia, Hospital-associated-thrombosis/mobility, & oral intake. Interventions included teaching-sessions, posters, & an electronic ward round ERAS checklist (ECL).

1st Audit (n=47). Overall adherence 64.4%. 16/47 (34%) had LOS ≤ expected. GM was the most common cause of delayed discharge (n=11). Followed by HAT/mobility (5), wound infection (5), oral intake (4), fluid balance (2) and analgesia (2).

Reaudit (n=20). Overall adherence 69.3%. 8/20 (40%) had LOS ≤ expected. GM was the most common cause of delayed discharge (n=3). Followed by fluid balance (1) and wound infection (1).

The ECL was used in 5/20 (25%) of ward rounds. A non-significant 6% improvement in rates of delayed discharge was seen.

Compared with published data we demonstrated good baseline rates of adherence to ERAS. Both adherence and rates of delayed discharge were improved post-intervention. Improving gut motility proves elusive despite many studies. Future interventions will focus on improving uptake of the ECL to improve ERAS adherence rates.

Operation notes are essential in ensuring continuity of care across different clinicians and admissions. 88% of NHS trusts have Electronic Patient Record (EPR) systems, however, 75% remain reliant on paper documentation. The Royal College of Surgeons of England details Good Surgical Practice standards which include clear and accessible operation notes. This audit aimed to measure and improve adherence to these standards in our trust, which uses a mix of paper and EPR systems.

A retrospective analysis was performed on all general surgical procedures performed in Barking, Havering & Redbridge University Hospitals Foundation Trust (BHRUT) from 1 July to 19 July 2023. Data on the type of procedure, operation note availability on EPR, and mode of documentation was collected. A decision for early intervention was made, and a re-audit was started prospectively from 16 November 2023.

197 operations were included; 64% elective and 36% emergency procedures. 54.8% (n=108) had operative notes uploaded onto EPR, and 56.4% of these were typed. Following intervention, 126 operations were included in the re-audit, with 63.5% elective and 36.5% emergency procedures. 64.3% (n=81) were uploaded, and 59.3% were typed.

Adherence to national standards for operative documentation was suboptimal. Operative notes were not consistently uploaded onto EPR for accessibility and continuity of care beyond theatre. Early intervention including education of surgical juniors and troubleshooting of IT issues can help bridge the gap caused by the mixed use of paper and EPR systems. Current re-audit data appears promising with regards to improved adherence.

To improve our clinical practice and ensure quality patient care, we assessed the quality of surgical operative notes against the standards of the Royal College of Surgeons of England. Additionally, we wanted to evaluate whether these recommendations are applicable in a developing nation with a heavy workload and insufficient medical technology.

In the first audit cycle, a sample of 75 operation notes was collected and audited by 4 reviewers according to RCS England Good Surgical Practice guidelines. We enter each of the operation notes in the Google forum application then we did a descriptive analysis of the audit data using Microsoft Excel version 2016. We tried to improve surgical operation notes in our hospital by using memorial posters and lectures. In the re-audit cycle, we collected 50 operation notes.

We found an improvement in documenting the date, and anaesthetist name in addition to the operation and incision name. There was an improvement in documenting complications, anticipated blood loss and details of the closure technique but this may require to repeat audit cycle to achieve more improvement.

Surgical operation note is crucial and fundamental in medical practice; clinical audit can be conducted in developing country with a load of surgical cases and limited resources. Our Audit can show an improvement in the first re-audit cycle, but it may require multiple cycles to achieve more improvement.

Urinary tract infections (UTIs) are a common perioperative complication among elderly patients undergoing hip fracture surgery, significantly impacting rehabilitation and recovery. UTIs are also associated with delirium, which can extend hospital stays by an average of 2.5 days and increase mortality rates (Carpintero, 2014). This quality improvement project (QIP) aimed to reduce the incidence of UTIs in patients undergoing hip fracture surgery at our trust through targeted interventions, including promoting timely catheter removal.

Interventions to encourage early catheter removal on the orthopaedic ward included educational posters, recording catheter insertion dates on nursing handover notes, and daily orthogeriatric reviews of catheter necessity. Data were collected over a 9-month period (Group B) from all patients undergoing hip fracture surgery, using the National Hip Fracture Database (NHFD). Patient demographics and post-admission infection status were compared to data from a 1-year period before the intervention (Group A). Statistical significance was assessed using the chi-squared test.

In Group A (n=258), 15.1% of patients developed a postoperative UTI, compared to 13.8% in Group B (n=224), representing a relative risk reduction of 8.61% (15.1% v 13.8%, p=0.691).

Although the reduction in UTI incidence did not reach statistical significance, the clinical relevance is important. Further strategies, such as optimizing hydration and thorough cleaning of the urethral meatus, should be considered alongside early catheter removal to achieve a greater reduction in UTI rates in this patient group.

Regular junior doctor rotation contributes to poor staff retention and workplace stress as one learns the unique practices, protocols, and knowledge of each department. Inadequate IT infrastructure and digitalisation of guidance documents has compounded the issue, one of particular concern to a major trauma unit given the heavily protocolised and time-sensitive nature of care delivery.

This quality improvement project (QIP) aimed to improve senior house officer (SHO) induction and experience by enhancing access to IT resources via a smartphone app.

Cycle one evaluated use of the induction booklet and impact of existing IT infrastructure on seven SHOs who rotated in August 2023. Change was enacted by developing a smartphone app, the effect of which assessed via survey of thirteen SHOs who used the app following the December 2023 and April 2024 rotations.

Cycle one identified limited use of the induction booklet in day-to-day practice with 85.7% of SHOs experiencing delays and 71.4% stress when using existing IT infrastructure. All SHOs frequently used the app to access induction materials with eleven reporting reduced time (84.6%) and twelve reduced stress (92.3%) when accessing guidance documents via the app. Twelve SHOs (92.3%) would recommend using the app to new members of the department.

A smartphone app is a free, easy to use tool that improved SHO induction and experience within the trauma department, the benefits of which may include better staff retention and interest in speciality training. Further study will examine the app’s contribution towards compliance with best practice standards and tariffs.

This audit, conducted at El Mabara Health Insurance Hospital in Assuit, Egypt, aimed to evaluate the effect of pre-operative glycaemic control (HbA1c) on surgical outcomes in diabetic patients undergoing elective surgery. Elevated HbA1c levels (>69 mmol/mol) are associated with increased risks of infections, delayed wound healing, and longer recovery times. The objective was to assess whether improving pre-operative HbA1c levels could reduce surgical complications.

The audit included 150 diabetic patients aged 32-62 years, excluding those with cancer, emergency surgeries, or intra-operative complications. In the first cycle, data from 100 patients were retrospectively analysed to evaluate the relationship between HbA1c levels and surgical outcomes. Based on these findings, targeted interventions were implemented. The second cycle involved 50 patients who received focused pre-operative glycaemic management aimed at lowering HbA1c levels.

In the first cycle, 62% of patients had HbA1c levels above 69 mmol/mol, resulting in an infection rate of 38%, poor wound healing in 40%, and an average hospital stay of 3 days. After the interventions in the second cycle, 85% of patients achieved HbA1c levels below 69 mmol/mol, leading to a significant reduction in infections (5%), improved wound healing in 90% of patients, and shorter hospital stays averaging 1 day.

The audit demonstrates that effective pre-operative HbA1c management can significantly improve surgical outcomes NICE NG45 (2016). This underscores the need for structured glycaemic control protocols, including patient education and early interventions, to reduce complications and enhance recovery in diabetic patients undergoing elective surgery.

It was identified that the emergency surgical ward rounds documentation lacked structure and consistency; hence, this audit aims to improve documentation on general surgical ward rounds by introducing a ward round template. The template structure is being adapted from the ‘Surgical Assessment for Emergencies Ward Round Tool ’-SAFE introduced by the RCSEd, with modifications based on local requirements. Clear documentation of critical clinical information will make a patient’s stay in the hospital safer and ensure timely and safe discharges. Ward Rounds are fundamental to multidisciplinary team assessment, planning patient care and coordinating management decisions.

A retrospective review of case note entries from surgical WRs was conducted between 01/04/2024 and 14/04/2024. A total of 60 random ward round entries were reviewed. Recommended standards of WR documentation were obtained from the SAFE Tool. The overall documentation of 14 parameters was checked. The ward round entries from the weekends have been excluded from the Audit.

The only consistently documented Parameter is the name of the consultant-97%. Parameters such as VTE Prophylaxis-5%, Examination findings-18%, NBM/Nutrition-20%, the patient's current clinical status-30%, and NEWS/Observations-35% were very suboptimally documented. Management plans and discharge planning were not efficiently detailed-<30%.

A modifiable Documentation template was created to improve and standardise the General Surgery Ward round documentation. Using a Ward round Template would ensure a complete assessment and bring consistency in documentation, thus reducing interpersonal variation. A re-audit is recommended to check compliance in the future. Accurate documentation is crucial for continuity of patient care and overall patient safety.

CT KUB (Kidneys, Ureters, and Bladder) is a commonly used imaging technique for diagnosing urolithiasis, carrying a radiation dose of up to 10mSv. This audit aims to assess compliance with the Royal College of Radiologists’ (RCR) guideline, which recommends a maximum over-scanning margin of 10% above the upper border of the higher kidney to reduce radiation exposure.

A retrospective audit was conducted on 100 randomly selected CT KUB scans performed at Sligo University Hospital over a 10-month period (March 2023 to January 2024). The scans were reviewed using the National Integrated Medical Imaging System (NIMIS), and the distance between the upper border of the higher kidney and the upper scan limit was measured to assess compliance with the 10% rule.

Of the 100 scans reviewed, 60% were performed on males and 40% on females, with a mean patient age of 49.1 years. Compliance with the RCR’s 10% over-scanning guideline was found in 45% of cases, with 2% demonstrating no over-scanning at all. However, 55% of scans exceeded the recommended margin, including 5% that exceeded 20% over-scanning.

The audit revealed a 45% compliance rate with the recommended scanning limits, indicating a need for local radiological protocols to standardize CT KUB practices and minimize unnecessary radiation exposure. Further research is necessary to establish more comprehensive guidelines and improve patient safety.

Re-assessing adherence in CT KUB imaging guidelines following local Intervention to minimise the radiation dose to patients.

We undertook a retrospective analysis of 105 non-contrast CT KUB for patients with suspected renal/ureteric colic and compared it to our previous cohort from 2022. PACS images were individually reviewed to assess the cranial level at which scan commences & level at which kidneys start. Radiation doses were monitored in milliGrey (mGy) (standardized measure of radiation dose output of a CT scanner). We compared our findings to the initial cycle from 2022.

A total of 105 non-contrast CT KUB scans were included in this round of which 23 (22%) commenced above T10 & 79 (75%) commenced from superior border of T10-T12 &. A further 3% started below T12. This was significantly different (χ2 =18.7, p<0.01) to the first-round where the proportion of scans was for different levels was 49% (above T10), 50% (T10-12) and 1% (below T12). As previously, individuals scanned at lower levels received less radiation at 8.32mGy, 6.24mGy, and 4.66mGy respectively.

Our results show a significant improvement in adherence to accepted practice and reduction of radiation doses compared to the first round. Only 22% of scans commenced above the recommended level (T10) which would have exposed individuals to higher amounts of radiation. Our intervention resulted in a 162mGy (19%) reduction of total radiation dose for the cohort. The results demonstrate that local practices were modified which resulted in improved patient safety without negatively impacting the information yielded from the scans.

Major trauma centres are busy, and patients are physiologically stressed. Repeated venepuncture wastes patient’s blood and staff’s time. This study evaluates prevalence and reason for G&S rejection and shown improvement following intervention.

Prospective audit of consecutive trauma admissions from 26.01.24-21.05.24 and 21.05.24-31.08.24. Demographic data, number of samples collected, acceptance status and reasons for rejection were analysed. Leading reasons for rejection identified in first collection period were used to develop educational posters, which were displayed around the Trauma and Orthopaedic wards from 01.07.24. Subsequent collection continued until 31.08.2024 to assess impact of the intervention.

The rejection rate peaked in March at 13% and again in June at 10.5% with rates decreased to 6% in July and 5% in August. Notably, 73% of G&S rejections occurred during night shifts (20:00-08:00). Incomplete request forms were the most common reason for rejection. This was significantly reduced by our intervention and insufficient sample volume identified as the next most predominant cause, accounting for 25% of rejections, and incomplete and unclear request forms closely following.

This study highlights the effectiveness of targeted interventions in reducing unnecessary repeated venepuncture of trauma patients. However, higher rejection rates during night shifts and the shifts in common rejection reasons emphasise the need for ongoing improvements in sample collection practices and shift- specific strategies to further decrease rejection rates and enhance patient safety.

To evaluate the effectiveness of 3D digital breast tomosynthesis (DBT) in detecting margin status during segmental mastectomy (SM) compared to the standard of care (SOC) extensive processing method at an academic institution.

This ongoing prospective study, scheduled from March 2024 to March 2025, aims to enrol patients undergoing SM. Preliminary results from the initial cohort of 60 patients (March to July 2024) are presented. SM specimens underwent intraoperative assessment using both DBT and SOC, with results collected prospectively. Surgeons used the findings to guide additional tissue excision, completed surveys regarding margin excision and result turnaround times. A negative margin was defined as no tumour at ink for invasive carcinoma and 2mm for DCIS.

The initial cohort included 61 SMs from 60 patients. SOC identified all 13 positive margins (sensitivity 100%, specificity 16%, positive predictive value [PPV] 14%, negative predictive value [NPV] 100%), accurately identified 30 margins, but also flagged 79 unnecessary margins. DBT missed 2 of 13 positive margins (sensitivity 82% (p>0.05), specificity 41% (p<0.05), PPV 18%, NPV 93%), accurately identified 39 margins, and flagged only 40 unnecessary margins. Average intraoperative margin assessment times were 5 minutes for DBT and 33 minutes for SOC.

These preliminary findings from the first four months of a year-long study, suggest that DBT may offer comparable accuracy to the institutional labour-intensive, time-consuming SOC for intraoperative margin assessment. DBT shows potential as a more efficient alternative, with fewer unnecessary margin identifications. Further data from the ongoing study will be crucial to confirm these initial results.

Drug errors are amongst the leading causes of avoidable harm to hospital inpatients. As such, the administration of drugs should be regarded as a high-risk procedure. Prescribing errors occur in 1-15% of medications written for hospital inpatients (NICE, 2017). The aim of this audit was to assess the accuracy of medications prescribed in a general surgical ward within a district general hospital in Northern Ireland.

Data was collected from a cohort of 75 patients admitted between 13/12/21 to 03/01/2022. Data collected assessed the accuracy of prescribing with focus on four main criteria. This included: accuracy of prescribing patient details; allergy completion; VTE risk assessment and regular medications. Following liaison with the local Pharmacy team; an educational session for all junior doctors was delivered on the week commencing 03/01/2022. Further data was then collected from 87 patients who were admitted between 11/01/22 to 30/01/22.

From the December 2021 cohort; 80% of prescriptions met all 4 criteria, 17.3% met 3 out of 4 criteria and 5.7% met 2 out of the 4 criteria. In comparison, from the January 2022 cohort; 98.8% met all 4 criteria, 10.3% met 3 out of 4 criteria and 0% met only 2 out of 4 criteria.

Overall, improvements in prescribing were seen in all criteria; ultimately leading to improved patient safety. Following the recent introduction of e-prescribing in Northern Ireland in 2024; further studies investigating its effectiveness in reducing prescribing errors would be of interest to ensure current guidelines are adhered to.

Androgen Deprivation Therapy (ADT) is an effective treatment for metastatic prostate cancer; however, it significantly impacts bone mineral density (BMD), increasing the risk of osteoporotic complications. This study aimed to evaluate the application of risk stratification tools to assess and manage osteoporotic risk in patients starting long-term ADT.

We conducted a single-centre retrospective review of 140 patients newly diagnosed with metastatic prostate cancer between December 2023 and March 2024. Patient data included prostate cancer grade/stage, non-metastatic fracture risk factors (FRAX score), DEXA scan usage, and bone protection treatment.

Patients were categorized into two groups: Group 1 (<80 years, n=125) and Group 2 (≥80 years, n=15). Overall, 55 patients (35.7%) were offered a DEXA scan, with only 1 of 15 (6.67%) patients aged ≥80 years receiving this offer. Notably, none of the patients had their FRAX score assessed, or bone protective measures initiated. Relevant risk factors included a history of fractures (11.3%), smoking (7%), alcohol consumption (4%), and glucocorticoid use (2%). Calcium and vitamin D supplementation were recorded in 83% and 50% of patients, respectively.

Despite guideline recommendations, the results highlight suboptimal bone health assessments and management for patients undergoing ADT.

To mitigate fracture risks, we recommend implementing protocols, including early BMD assessment and targeted interventions. Collaborative efforts with the Oncology CNS team to streamline bone protective measures within the multidisciplinary treatment pathway are essential. Improved adherence to guidelines will enhance patient outcomes and reduce osteoporotic complications in this vulnerable population. Use of FRAX score calculators in MDT meeting.

Surgical Site Infection (SSI) pose a significant health and economic burden to healthcare services within the United Kingdom. GIRFT and PHE have strongly recommended local auditing, protocols, and systems to identify, reduce and manage SSI across surgical specialities.

A newly designed electronic SSI database was used to retrospectively screen and capture adult patients who underwent an emergency or elective general surgical procedure between January 2022 and March 2024. Records were automatically screened for biochemical changes suggestive of infection or keywords documented during ward round entries. Patients who met the criteria were highlighted as ‘probable infections. Subsequently, a manual retrospective review of patient records was carried out to assess cases of actual infection. SSI was identified as described by the Centre for Disease Control (CDC).

According to the database, 699 patients were identified, of which 21.8% were probable infections (153/699). Of those with a probable infection, 13% had a true infection documented (20/153). The median length of stay of those with a true infection was 15 days (6 – 170). 60% of infected cases were emergency surgeries (12/20) and 40% were open (8/20). 7.1% had documented cases of wound dehiscence (11/153), and 56% had clear documentation of a wound assessment post-operatively (86/153).

Our intervention relied on creating an electronic SSI bundle to standardise documentation and capture the true rate of infected cases in general surgical patients. Heterogeneity and inaccuracy in wound assessment and documentation calls for robust, standardised methods to accurately capture SSI rates.

In late 2023 no defined pathway existed within the Queen Elizabeth University Hospital in Glasgow for the outpatient investigation of clinically stable, ambulant patients with suspected ureteric colic, resulting in admissions under General Surgery. We sought to improve flow within the emergency department and surgical admissions unit by introducing an outpatient pathway.

In order to identify the scale of the problem of avoidable bed occupancy we conducted a local audit of admissions under General Surgery for patients in whom the primary diagnosis was ureteric colic. Patients who were systemically well, ambulant and without significant pain were identified from the clinical records. We then calculated the interval between assessment by ED and diagnostic scan. Current guidelines from the British Association of Urological Surgeons outline a timeframe of 14 hours between presentation and diagnostic scan.

11 patients who would have been appropriate for next-day CT KUB were identified between 1/10/23 and 31/10/23. A total of 241 inpatient bed hours were identified for patients who were suitable for urgent outpatient investigation, at a combined cost of £24,000.

In response to these potentially avoidable admissions, we introduced a pathway whereby clinically stable, ambulant patients presenting after 8PM could return to the surgical ambulatory care unit at 8AM the following morning for diagnostic imaging. Two slots were made available every day. Written guidance regarding the pathway as well as a standard operating procedure were made available in the ED. The potential annual savings from the pathway for the trust are in excess of £250,000.

Emergency laparotomies are associated with significant morbidity and mortality. We assessed our Institutes’ provision of care for patients presenting with an acute abdomen but managed conservatively (non-operatively).

A retrospective cohort study was conducted in accordance with STROBE guidelines and measured against the NELA ‘No-Lap’ criteria. Patients admitted over a 1-year period (April 2023-April 2024) with acute intra-abdominal pathology necessitating surgical intervention but were managed conservatively (no surgical, radiological, or endoscopic intervention) were included. Patient demographics, radiology findings, and outcomes were extracted into Microsoft Excel for statistical analysis.

25 patients with a mean age of 82±9.7 years were included and 44% (n=11) were male. The LOS was 5±5.8 days. Bowel perforation was reported in 56% (n=14) and ischaemia in 44% (n=11). There was a 96% mortality (n=24).

Standards of care were compared against seven criteria. Risk assessment was performed and documented in 36% (n=9), and frailty assessment in 48% (n=12). 52% (n=13) had a CT scan reported within 1 hour of being performed and findings communicated to a surgical registrar or above. 88% (n=22) had a documented discussion regarding an advance care plan. 40% (n=10) had an end-of-life care plan in place or palliative input during admission.

A ‘No-Lap’ pathway supplementing the existing ‘Em-Lap’ protocol is being designed to standardise care for patients managed non-operatively. This cohort of patients should be managed in a coordinated way, using a multidisciplinary approach, to ensure their care is not compromised at any point during their inpatient stay.

Resected foreskins are sent off for histological examination based on level of clinical suspicion of each individual case, in the absence of local guidelines.

Are we sending off too many for histology?.

1. Histological analysis of the prepuces of children and adolescents undergoing circumcision for medical reasons shows signs of BXO in 35%- 53%.

2. Histopathological examination of resected foreskin is warranted when level of clinical suspicion for BXO is high as this is associated with 20% risk of meatal stenosis.

1. Study group(n) = 70.

2. Foreskins sent for histology = 42/70 (60%) {28/42 came back as BXO}.

3. Preop Impression -> BXO = 24 (24/42=57%), Phimosis = 30, Balanitis = 3, Paraphimosis = 3, Ca = 1 (which came back as BXO).

4. Pre op impression concordance with post-op histology = 18/42 (42%).

5. Patients called in for follow-up = 6.

6. Number of patients called for second review in view of ongoing treatment - 00.

1. The main indication for which patients were followed up was to assess surgical recovery instead of need of long-term treatment. (Justified as we want to avoid meatal stenosis).

2. Sending foreskins for histology post circumcision did not change management plan. (Especially 57% cases with a preop impression of BXO, which exceeds EUA numbers of 35-53%).

3. Therefore, we recommend ONLY sending the foreskin for histology if there is a high level of clinical suspicion of BXO or Carcinoma is suspected.

It is routine for patients who have had a robotic assisted prostatectomy (RALP) or a nephroureterectomy for a urological cancer, to go home with a catheter and have it removed within 14 days in a TWOC (trial without catheter) clinic. A missed appointment can result in a patient developing a catheter associated infection (CAI) from the presence of a prolonged catheter.

To reduce the percentage of patients with unrequested TWOC appointments by 50% by 1st June 2020 for postoperative RALP and nephroureterectomy patients at this particular District General Hospital. Additionally, to reduce the number of patients with CAIs to zero.

Patients who had undergone a RALP or nephroureterectomy were identified retrospectively in a 3-month period. Outcomes were then compared after the implantation of a ‘TWOC champion’ or weekly designated doctor to ensure appointments were requested prior to discharge. Data was collected for a further 3 months after intervention. Patients that developed CAIs were identified from the morbidity mortality meeting spreadsheet.

Between December 2019 and February 2020, of 29 patients, 5 patients were identified as having a missed TWOC appointment. 1 patient was found to have developed a CAI. From March to May 2020, 15 patients had undergone a RALP or nephroureterectomy. 2 patients were found to have missed TWOC appointments. There were zero patients identified with a subsequent CAI.

There is evidence to suggest that a TWOC champion might be an effective intervention in increasing patient safety and reducing morbidity.

Discharge from a healthcare facility is a critical moment in a patient's care, necessitating a clear understanding of their diagnosis, medications, potential side effects, and post-discharge instructions. According to NICE guidelines, it is crucial to provide patients and, if applicable, their families with comprehensive information about diagnoses, treatments, and medications when transitioning from hospital to home. This proposal outlines a quality improvement program to enhance patient knowledge during discharge.

We conducted a quality improvement project involving patients discharged after emergency and elective surgical admissions. We assessed five key parameters: diagnosis, medical regimen, warning signs, emergency contact information, and follow-up plan. Initial data was collected, analysed, and reviewed in clinical governance meetings. Following this, we conducted teaching sessions to doctors and nurses, as well as put up posters in the surgical wards to ensure all patients received complete information prior to discharge. Data was then prospectively collected to complete the audit cycle.

The study included 60 patients. For the first cycle, 90% were aware of their diagnosis, 66% knew their medical regimen, 63% understood warning signs, 76% had emergency contact information, and 76% knew the follow-up plan. After implementation, 100% knew their diagnosis, 90% knew their medical regimen and warning signs, 80% had emergency contact details, and 83% understood the follow-up plan.

This quality improvement project significantly enhanced patient knowledge during discharge. This improvement facilitates a safe discharge, thus reducing hospital readmissions, unplanned GP visits, and overall healthcare costs.

The CQUIN 2023/24 has recommended prompt intravenous to oral antibiotic switch (IVOS) once patients meet criteria to reduce length of hospital stays. The aims of this audit are to assess the IVOS compliance of our unit with the National Antimicrobial IVOS Decision Aid in intra-abdominal infections and the compliance of the use of correct antibiotics according to local policy. The IVOS Decision Aid considers safe enteral route, clinical signs and symptoms, and infection markers for IVOS.

Prospective data of patients that presented with intra-abdominal infections to the Emergency General Surgical over 4 weeks was collected. Patients were excluded if they had infections that required special consideration.

Of the 30 patients included, male-to-female ratio was 2:3 and median age was 52 years. The most common diagnoses were appendicitis (9/30). cholecystitis (8/30) and diverticulitis +/- localised perforation (9/30). Correct IV antibiotics were prescribed in 90% of the patients and 67% had correct oral stepdown. Compliance with the IVOS criteria was 53.3% (16/30). Median duration of antibiotic was 6 (1-18) days. 50% (13/26) and 76.5% (13/26) of patients had blood tests performed at 48-hour and 72-hour respectively.

There was a high rate of correct IV antibiotics prescribed for patients with suspected intra-abdominal infections on admission, however, the compliance with the IVOS criteria was low (53.3%). Duration of antibiotics and intervals of blood tests taken were variable. Future efforts need to focus on antibiotic stewardship and IVOS education.

Operating Room (OR) efficiency is critical for improving surgical throughput, patient outcomes, and hospital resource utilisation. Delays and inefficiencies in OR processes, including prolonged turnover times and frequent first-case delays, have been widely reported.

The audit aims to assess OR efficiency by evaluating turnover times, first-case start times, OR utilisation rates, and case cancellation rates, and to implement evidence-based improvements to meet established standards.

A prospective audit at University Hospital from December 2022 to February 2023 evaluated OR efficiency metrics: turnover time, first case start time, OR utilization rate, and case cancellation rate. Interventions based on evidence-based guidelines were implemented over 2 months, including standardised turnover protocols, preoperative readiness checks, and data-driven OR scheduling. A re-audit was conducted from June to December 2023 to assess improvements.

The initial audit revealed that turnover time averaged 40 minutes (target: 25-30 minutes1), first case on-time start was 60% (target: 90% 2) OR utilization was 70% (target: 75-85%3), and case cancellation rate was 7% (target: <5%4). The re-audit showed significant improvements: turnover time reduced to 28 minutes, first case on-time start increased to 87%, OR utilization improved to 80%, and case cancellations dropped to 4.5%.

The audit and subsequent implementation of standardised protocols, preoperative readiness assessments, and optimised scheduling resulted in significant improvements in OR efficiency. By adopting a continuous quality improvement approach, the institution successfully met or approached key benchmarks, improving both operational performance and patient care outcomes.

Over 60,000 laparoscopic cholecystectomies (LCs) are performed annually in the UK, with approximately 350 conducted at Southend University Hospital (SUH). The "Getting It Right First Time" (GIRFT) initiative, in collaboration with the Royal College of Surgeons, have developed guidelines for documenting LCs to improve clinical communication and facilitate reviews during patient complaints. This audit aimed to assess and improve adherence to these guidelines at SUH.

LC operation notes from a 4-week period at SUH were audited against GIRFT documentation guidelines. A standardised, typed operation note template was then circulated amongst the surgical team. A second audit was then conducted to assess improvements in compliance to GIRFT guidance.

Post-intervention, inclusion of GIRFT recommended pre-procedural details improved from 51% to 74% and inclusion of required operative details increased from 56% to 64%. Documentation of operative findings specified by GIRFT rose from 75% to 85%, and compliance with guidance regarding documentation of post-operative plans improved from 38% to 51%. The new operation note template was used 52% of the time, and these notes included 94% of required pre-procedure details, 92% of recommended procedural details and 69% of the recommended details required in the post-operative plan. 100% included all required operative findings.

The introduction of the operation note template has enhanced LC documentation, improving communication between doctors. This supports better-informed post-operative care and patient safety. Further work is required to increase utilisation of the template and compliance with GIRFT guidelines, including teaching sessions and further distribution of the operation note template to other hospitals.

Timely decision-to-incision intervals (DTI) are vital in emergency surgeries across obstetrics, urology, and orthopaedics. Delays can lead to increased morbidity and mortality. Standard DTI benchmarks include 30 minutes for category 1 emergency Caesarean sections (Royal College of Obstetricians and Gynecologists, RCOG), 60 minutes for urological emergencies (American Urological Association, AUA), and 6 hours for open fractures (British Orthopaedic Association, BOA).

To reduce DTI in these specialties, ensuring compliance with established clinical standards.

A 6-month retrospective audit conducted at university hospital between July 2022 and Jan 2023 of 143 emergency cases (67 in O&G, 34 in urology, 42 in orthopaedics) revealed DTI compliance rates of 71%, 64%, and 73%, respectively. Changes were implemented over 3 months, focusing on enhancing OR availability, staff training, and emergency protocols. A prospective re-audit was conducted over a period of 7 months post-implementation on 158 cases from May till December 2023.

Post-intervention, DTI compliance improved to 93% in O&G, 87% in urology, and 96% in orthopaedics, with a significant reduction in mean DTI across all departments.

After implementing these changes, decision-to-incision intervals in all departments have shown a marked improvement. The multidisciplinary approach, coupled with better resource management and education, has successfully reduced delays. Further audits should be conducted to ensure sustained compliance.

Barrett's oesophagus (BE) is a well-recognized precursor to oesophageal adenocarcinoma. Early and accurate diagnosis is essential for appropriate surveillance and intervention to prevent progression to cancer. However, variation in the diagnostic process can lead to missed or delayed diagnoses. This audit aims to assess current adherence to the British Society of Gastroenterology (BSG) guidelines on the diagnosis of BE in endoscopic practice and identify areas for improvement.

A retrospective review of endoscopic reports and histopathology results was conducted for patients diagnosed with Barrett's oesophagus in ABUHB over a 9-month period.

Data was collected on patient demographics, endoscopic findings (e.g., segment length, biopsy protocols), and histological confirmation of intestinal metaplasia. Adherence to BSG guidelines, including the Seattle protocol for biopsy sampling, was assessed. Areas of deviation from the guidelines were identified and categorized.

Of the [196] patients included in the audit, [88%] had endoscopic reports that described Barrett’s lesion according to Prague’s classification, and [53.5%] had complete sufficient photo documentation. Histological confirmation of intestinal metaplasia was obtained in [55.6%] of cases. Several areas of non-compliance with the guidelines were identified, particularly in biopsy sampling techniques and documentation of endoscopic findings.

This quality improvement audit underscores the importance of adhering to BSG guidelines for the endoscopic diagnosis of Barrett's oesophagus. A targeted intervention plan, including educational posters and teaching sessions, will be implemented to enhance compliance and improve diagnostic consistency.

To assess the time taken to report mastectomy specimens against the standard 5–10-day reporting timeframe and propose improvements in hospital processes. This audit seeks to highlight the critical role timely reporting plays in supporting clinicians in making informed treatment decisions and optimizing patient management.

A retrospective audit was performed on 50 consecutive mastectomy patients between 1st December 2022 and 21st October 2023. The time from specimen collection to reporting was recorded using the WebIce system. The Pathology Handbook recommends 7 working days for urgent cases and 10 working days for routine cases as ideal reporting timelines. This is the second audit cycle, with the first cycle showing that only 20% of cases met the standard reporting time.

In this second cycle, 20 out of 50 patients (40%) received their reports within the 10-day target, showing an improvement from the 20% compliance in the first cycle. However, 30 patients (60%) experienced delays, with their reports taking longer than 10 days. Despite this progress, the audit’s goal of 100% compliance was not met, indicating the need for further improvements.

Although some progress was achieved, the audit's target remains unmet. This has led to discussions with the pathology team, resulting in recommendations such as optimizing workflows, increasing staffing, prioritizing urgent cases, and improving communication between pathology and surgical teams. Timely reporting remains essential for risk stratification and tailored treatment, ultimately leading to better patient care and outcomes.

Surgery is the most energy-intensive health-care practice contributing to climate change. Nail bed injuries (NBIs) are amongst the most frequently encountered type of hand injury seen in hospital emergency rooms, however, there remains a lack of its environmental impact. This study assesses the carbon footprint of NBI treatment and proposes alternatives to minimise it.

This retrospective study, conducted at the Royal Free Hospital, analysed patients that underwent NBI treatment from August 2022 to August 2023. The carbon footprint was calculated for pre-, intra- and post-operative phases using process mapping. Emissions were quantified based on patient travel, X-ray procedures, clinic room energy consumption, consumables used, waste disposal, and product transportation. A survey was shared with members of the hand trauma clinic to clarify common practices and potential variability among professionals.

Out of 1,569 patients, 449 met the inclusion criteria. Overall pathway emissions equal to 1,045.05 kg CO2e annually, or 2.33 kg CO2e per patient. The pre-operative phase contributed the most to emissions (67.2%), primarily from X-ray procedures and patient travel. Hazardous infectious waste accounted for most intra-operative emissions. Survey results revealed that several items in disposable surgical packs were unused, suggesting potential for waste reduction. Reducing products in surgical packs could save 13.44 kg CO2e for included patients or 46.95 kg CO2e annually.

By promoting same-day imaging, optimising surgical packs, and enhancing surgeon education on sustainability, healthcare institutions can reduce carbon emissions, aligning with the NHS's net-zero goals. Small, targeted changes in common procedures can achieve significant environmental and economic benefits.

By general consensus amongst oncologists, adjuvant therapy should commence within three months for suitable oesophago-gastric (OG) cancer resection patients. A regional retrospective audit was conducted due to a suspicion of delays in adjuvant therapy delivery following OG cancer resection (GIST (gastrointestinal stromal tumour) and SCC (squamous cell carcinoma) excluded). The aims were to conduct an audit on the timeline and commencement of adjuvant therapy following OG cancer resection and to assess for differences between hospitals within the region.

Data was collected on patients that underwent OG cancer resection (excluding GISTs and SSCs) between February 2023 and February 2024 and follow-up was six months post-operatively.

50 patients (45 males and 5 females) were included with a median age of 69 (43-86) years. On average, patients started adjuvant therapy 92 days after surgery, with the post-operative multi-disciplinary team meeting (MDT) occurring 30 days after surgery, 1st oncology appointment 35 days after MDT, and adjuvant therapy 27 days after the 1st oncology appointment. 57% (17) of 30 patients commenced adjuvant therapy within three months of their operation. One district general hospital (DGH) had 86% (6) patients start adjuvant therapy within three months whilst the tertiary hospital had 56% (9) and another DGH had 29% (2).

The majority of suitable OG cancer patients commenced adjuvant therapy within three months, and, on average, this took 92 days. The biggest contributor to the period of time was waiting for an oncology clinic appointment and there were notable differences between hospitals.

In a strained surgical workforce where expectations cannot be met due to workload or time restraints, communication breakdown between the surgical team and patients’ fuels distrust, which sets the stage for legal proceedings in an unfavourable event. Surgical patients are vulnerable to acute deterioration, with a risk of the loss of capacity. Hence, family involvement is important where necessary. This project aims to improve patient and family satisfaction with perioperative communication and clear documentation of family discussions.

We interviewed 25 post-operative patients and their relatives regarding perceived deficiencies in perioperative communication. They rated their overall satisfaction on an ordinal scale of 1 to 5. A score of 4 or 5 is satisfactory. Electronic patient records were reviewed for documentation of conversations occurring. Interventions include establishing a standardised three-point framework for concise updates, guidance posters and departmental teachings on documentation for the continuity of care.

This retrospective analysis revealed a mean satisfaction score of 2.6 to 3.9. Main themes of patient dissatisfaction identified are surgical team members having little time for interaction, showing less regard for their views, and uncertainty with ongoing plans. Pre- and post-intervention demonstrated a 16 to 64 percent satisfaction with perioperative communication, respectively; and an improvement of documentation from 8 to 48 percent.

Our interventions demonstrated a notable improvement in peri-operative communication between the surgical team and patients, and discussion documentation. Going forward, we will include a communication in surgery departmental teaching session for the incoming juniors and a third cycle of re-auditing.

In early 2023, there was some negative formal and informal feedback from Foundation Year doctors (FYs) about certain aspects of their experiences across surgical specialities at a tertiary hospital. The aim was to identify the areas of training in most need of improvement and via Interventions, improve the experience of FYs in Surgery and the positivity of feedback. In turn, this would attract future colleagues to the surgical specialities, enhance the quality of the surgical FY, and develop enthusiasm for the surgical experience.

Two surveys were conducted on FYs in Surgery towards the end of their rotations between November-December 2023 (cycle 1) and July-August 2024 (cycle 2). The interventions included: dedicated theatre time on the rota, voluntary extra-curricular FY surgical teaching sessions, and improvements to the induction process (access to the induction session online, recording of the induction session, and access to the induction presentation after the session as a reference tool).

Cycle 1 surveyed 10/29 (34%) FYs and cycle 2 surveyed 14/29 (48%) FYs in surgery.

Between cycles, positive responses to the following increased:.

• Induction – 60% in cycle 1, 71% in cycle 2.

• Learning opportunities – 40% in cycle 1, 79% in cycle 2.

• Opportunities to attend theatres and clinic – 10% in cycle 1, 64% in cycle 2.

There was an improvement in the perception of FYs of their experience in the surgical department. The main areas of need were more theatre and clinic time and learning opportunities in Surgery. Interventions can significantly improve the FY training experience.

To evaluate the value of ultrasound as a diagnostic tool in the investigation of suspected paediatric appendicitis, and to review the negative appendicectomy rate in a DGH.

All paediatric patients Jan-Dec 23 that underwent diagnostic laparoscopy + appendicectomy were divided into whether they had ultrasound during their investigation. Imaging reports were categorised as either positive, negative, or inconclusive for appendicitis. Furthermore, results were compared against histopathology findings to either corroborate or disprove ultrasound findings.

Furthermore, histopathology findings were used to calculate negative appendicectomy rate.

A separate metric – Negative procedure rate (NPR) was created and calculated during this project to remove cases from NAR where no signs of appendicitis were seen at histopathology, but the diagnostic laparoscopy was justified due to identification +/- correction of alternative pathology.

44 children went to theatre without any imaging – NAR 13.7%. 62 children had ultrasound – Sensitivity 55.3%, specificity 91.7%, Positive predictive value 91.3% negative predictive value of 56.4%. Alternative diagnoses found in 9 cases intraoperatively.

NAR 28.3%, NPR 19.8%. Statistically significant difference between male and female children’s rates of NAR/NPR.

NAR 15.5%, NPR 13.8%.

NAR 43.8%, NPR 27.1%.

Ultrasound has value in the workup of suspected paediatric appendicitis. However, low sensitivity and negative predictive value highlight its limitations. It would be sensible to first target the extremely high NAR/NPR in the female paediatric population initially to improve the overall NAR/NPR.

Key recommendations are to create a protocol that incorporates usage of a validated scoring system and consider MRI in borderline cases.

This audit assesses the adherence to NICE and GIRFT guidelines for acute ureteric stone management at East Surrey Hospital, aiming to identify areas for clinical improvement.

A retrospective review was conducted on 89 adult patients admitted with ureteric stones between August 1, 2023, and November 30, 2023. Exclusions were patients with incomplete data, those who self-discharged, had alternative diagnoses, prior interventions, or complicated stones.

99% (88/89) of patients had a CT scan within 24 hours. 71% received NSAIDs, with an average administration time of 4.853 hours. 65% were managed conservatively; 22 of these later required urgent intervention. 35% (31/89) received treatment within 48 hours: 1 patient had ESWL, 6 underwent ureteroscopy (URS), and 24 received ureteric stents. stented patients, 9 had no sepsis, 1 developed complication, 22 had elective URS for stent removal, and 2 were lost to follow-up. Serum calcium was checked in 47%. 18% received dietary advice.

While timely imaging was largely achieved, deficiencies were noted in pain management, metabolic assessment, and patient education. Unnecessary stent insertions and lack of follow-up were concerns. Recommendations include developing a day-case pathway for ureteroscopy/ESWL to reduce inpatient burden and complications, re-educating staff on guidelines, and ensuring proper follow-up care. A re-audit in three months is suggested to measure improvements.

• Develop a day-case pathway for primary ureteroscopy/ESWL.

• Enhance education on NSAID use, metabolic assessment, and dietary advice.

• Ensure consistent follow-up for patients with stents and those needing dietary guidance.

As thoracic surgery becomes more complex; procedure specific consent forms are essential. These forms must clearly explain risks versus benefits in language accessible to all. Tailored consent forms are crucial for informed consent, trust, and transparency between patients and healthcare professionals. The project aimed to create procedure-specific consent forms and patient information leaflets (PILs) to standardise explanations and ensure patients receive these materials in advance. Thus, allowing time for informed consent as per the Royal College of Surgeons (RCS) guidelines.

A departmental audit identified that consent forms were not routinely provided during pre-assessment and lacked procedure-specific details, leading to inconsistent patient education. Addressing this, new standardised forms with pre-filled information were developed. The supervising consultant and registrar agreed on the content, reflecting current statistics, surgical techniques, and health guidelines. The medical student then translated this into accessible language. The forms were approved for use after departmental review.

The introduction of pre-filled forms and PILs standardise patient education, providing procedure-specific information. However, challenges remain, particularly for patients with language barriers, visual impairments, and intellectual disabilities. Research indicates that eConsenting software can address these issues by offering various formats to facilitate informed consent. This software has been successfully implemented in several trusts, prompting the department to consider its adoption to ensure all patients can effectively provide informed consent.

Creation of procedure-specific consent forms is a critical step towards improving patient care and ensuring ethical and legal standards are met in the thoracic department, in accordance with RCS guidelines.

This closed-loop audit aimed to assess the reduction in the length of hospital stay following anterior cruciate ligament (ACL) surgery and to ensure alignment with the "Getting It Right First Time" (GIRFT) guidelines, which advocates for ACL surgery as a day case procedure.

The audit was conducted in two cycles. Initially, data on hospital stay rates after ACL surgery were collected and analysed from 1st August 2021 to 31st May 2022, revealing a 30% hospital admission rate. Interventions were then implemented to encourage day-case surgeries, including enhanced patient and nursing staff education, postoperative protocols like routine VTE Prophylaxis, improving the quality of physiotherapy input and streamlined discharge planning. A second audit cycle was conducted to assess the impact of these changes from 1st March 2024 to 30th August 2024.

The second cycle of the audit demonstrated a significant reduction in hospital stays after ACL surgery, with the rate of overnight admission decreasing from 30% to 4.34%. This outcome aligns closely with the GIRFT guidelines, which stress on day-case management for ACL surgeries to optimize resource use and improve patient outcomes.

The closed-loop audit successfully reduced the length of hospital stay following ACL surgery, thereby optimising hospital resources and also improving patient satisfaction. This demonstrates the effectiveness of targeted interventions and protocol adjustments in improving healthcare efficiency and patient care post-ACL surgery.

The use of tranexamic acid (TXA) in acute lower gastrointestinal bleeding (LGIB) is not supported by recent large-scale multi-centre randomised trial evidence (HALT-IT trial) or national guidelines. We completed a closed-loop audit investigating TXA use for patients admitted with LGIB.

A retrospective chart review was conducted. All patients admitted under General Surgery with LGIB were included. Outcomes investigated were length of inpatient stay (LOS), mortality during admission, incidence of venous thromboembolism (VTE) and readmission with LGIB. Fisher’s exact test was used to identify statistical significance.

The first cycle identified 47 patients (mean age 73.8 years) from June to November 2023. Of those, 36 (76.6%) received TXA. LOS was 5.54 days in the TXA group and 5.36 days in the group that did not receive TXA. There were no significant differences in re-admission rates (p=0.56). The results of the first cycle were presented at a departmental meeting on 14 June 2024.

The second cycle identified 20 patients (mean age 73.6 years), from June to November 2024. Of those, 8 (40%) received TXA, a statistically significant reduction compared to the first cycle (p=0.056). The length of stay was 5.25 days for both groups. No significant differences were seen in re-admission rates (p=0.15). No mortality or thromboembolic events were identified in either the first or second cycle.

TXA did not affect LOS, re-admission rate or mortality. The reduction in TXA use is in line with national guidelines. Future work will involve creating trust-wide guidance on LGIB management.

To determine the frequency of gynaecological history taking in female surgical patients of reproductive age presenting to general surgery with right-sided abdominal pain.

This multicentre mixed prospective cohort study collected data from female patients aged 18-35 presenting with right iliac fossa or right lower quadrant pain across two different two-week periods. It was then re-audited after a focused gynaecology history-taking teaching session. Statistical analysis was performed using R 4.4.0, with comparisons based on clinician’s gender and seniority analysed via Chi-squared tests.

Data was collected from 99 eligible patients across four centres, with 59.6% having gynaecological history documented, 56.6% last menstrual period, 31.1% sexual health history, and 53.5% pregnancy status. Documentation of gynaecological history was significantly better by female clinicians (p = 0.043), but no significant differences were found based on the gender or seniority of the clinician for other history details. Post-intervention, documentation did not significantly improve (last menstrual period 62.5%, pregnancy status 50%, sexual history 25%).

Our study identified significant gaps in the documentation of gynaecological histories among general surgical patients, with sexual health history being the most poorly recorded aspect even after intervention. Female clinicians documented gynaecological histories more effectively than male counterparts, though seniority did not significantly impact documentation quality. The inadequate documentation of crucial information, such as pregnancy status, poses serious risks to female patients of childbearing age. To address these gaps, we recommend further targeted educational interventions for surgical staff and using electronic health record tools to enhance documentation practices.

Venous thromboembolism (VTE) is a major cause of morbidity and mortality following lung cancer resections. The European Society of Thoracic Surgeons (ESTS) provides guidance on preventing cancer-associated VTEs in thoracic surgery, recommending extended prophylaxis (low-molecular-weight heparin and anti-embolism stockings) for 28-35 days post-operatively for all patients undergoing pneumonectomy/extended resections and for those at moderate/high risk undergoing lobectomy or segmentectomy, as determined by the Caprini score.

A retrospective review was conducted of patients who underwent lung cancer resections in March 2024. We risk-stratified them using the Caprini score and assessed whether they were provided with extended VTE prophylaxis where appropriate. Additionally, we surveyed other national centres to compare practices.

37 patients underwent thoracic surgery at our centre, with 19 being lung cancer resections. All had a Caprini score indicating moderate or high risk (minimum 5, median 7), this was likely underscored due to missing data (e.g., anti-cardiolipin antibodies). According to guidance, all 19 should have been discharged with 28-35 days of VTE-prophylaxis, but only two were risk-assessed with the Caprini score and both were subsequently discharged with LMWH alone and for an inadequate duration. Our survey had 11 responses from 7 centres. Seven of the respondents were aware of the ESTS guidance and routinely offered extended VTE prophylaxis (LMWH and TED stockings for 28 days).

ESTS guidance advises extended VTE prophylaxis for moderate/high-risk patients post-lung cancer resections (as assessed by the Caprini score). While most surveyed centres follow this, our practice does not consistently align.

To assess and evaluate the adherence of fluid prescription practices for surgical patients to the British Consensus GIFTASUP guidelines. Specifically, the audit aims to ensure optimal fluid management by examining Fluid Resuscitation and Fluid Maintenance The ultimate goal is to identify any gaps in practice, improve fluid management, optimize patient outcomes, and reduce the risk of complications such as electrolyte imbalances, hypovolemia, and acute kidney injury.

The fluid resuscitation audit included 59 surgical patients while maintenance audit involved 53 patients, either awaiting surgery, post-operative, or requiring diagnostic scans. Both audits were designed to compare actual fluid prescription practices against GIFTASUP guidelines.

In the fluid resuscitation audit (59 patients), 64% were prescribed intravenous fluids, but 57% were not optimally resuscitated according to GIFTASUP guidelines. Specifically, only 41% of patients received balanced salt solutions (Hartmann’s or Plasmalyte), with 34% of those receiving suboptimal fluid types (e.g., normal saline). Additionally, 10% of patients presented with acute kidney injury, and fluid resuscitation was inconsistent across this group. In fluid maintenance audit (53 patients), 74% were prescribed maintenance fluids, but only 36% adhered to GIFTASUP recommendations. Most patients did not meet their daily potassium (72%) and free fluid (53%) requirements. Only 26% received all necessary maintenance fluids and electrolytes.

The audits highlight several deficiencies in fluid resuscitation and maintenance prescriptions for surgical patients. An educational session will be organized for junior doctors (F1/F2/SHOs) to reinforce best practices in fluid management. Re-audits will be conducted to assess the effectiveness of these interventions.

Managing postoperative pain following thoracic surgery is crucial for optimising respiratory function, reducing length of stay, and minimising the risk of chronic pain syndromes and persistent opioid use. A multimodal approach is typically employed, including paravertebral blocks, patient-controlled analgesia, and non-opioid analgesics. NSAIDs are often overlooked, possibly due to concerns regarding contraindications or ineffectiveness. However, both ERAS and NICE guidelines recommend the routine use of oral ibuprofen for postoperative pain management.

We conducted a closed-loop audit composed of two cycles. Prescribing records of all thoracic surgery patients over a two-week period were reviewed. Patients with NSAID contraindications (e.g., allergy, TALC procedure, history of GI bleeding/peptic ulceration, eGFR <30/AKI, severe heart failure, pregnancy, NSAID-sensitive asthma) were excluded. Posters highlighting the described guidance and prescribing considerations were placed in the doctor's office, and prescribing was reassessed over a further two-week period. A second cycle was completed - where informational leaflets were distributed to the team, followed by review of patient prescriptions over a final two-week period.

Initially, 60% of eligible patients received an NSAID. After the first intervention, this increased to 83%. Following the second intervention, 66% received an NSAID. The second cycle may have been impacted by the seasonal changeover of junior doctors.

NSAIDs are under-prescribed postoperatively in thoracic surgery patients. We increased prescribing rates for eligible patients using posters and leaflets, with sustained change demonstrated over two cycles.

This quality improvement audit assesses the compliance of the paediatric surgery department at Cambridge University Hospitals with the national KPI of sending 95% of discharge summaries to GPs within 24 hours of discharge. It also aims to identify barriers to meeting this target and implement strategies to improve compliance.

A two-cycle audit was conducted. The population included all patients admitted under paediatric surgery between June and August (n = 64), excluding outpatient clinics and signed letters. The audit followed these steps:.

1. Identify delayed cases through monthly governance meetings.

2. Perform root cause analysis and identify common themes.

3. Implement targeted solutions based on findings.

4. Monitor compliance post-intervention and reassess through follow-up audits.

In the first cycle, 43 cases were analysed, revealing that 65% had completed summaries but lacked final sign-off, and 54% of the patients were on the short-stay ward. The department’s compliance was 80%, well below the 95% target. An inverse correlation between length of stay and missed summaries was observed, with day admissions most likely to miss the deadline. Several interventions were implemented, including improved communication, system training, task delegation, and discharge summary tracking.

The audit identified significant gaps in meeting the 24-hour discharge summary target. Post-intervention monitoring is ongoing, with further results pending to assess the strategies' effectiveness. Sustained improvement is expected through continued tracking. The second cycle will be presented at the conference.

Effective handover is essential for ensuring safety and continuity of patient care. The Royal College of Surgeons (RCS) provides guidelines outlining the minimum information required for safe handover. SurgiBase is a Microsoft Access-based digital platform, that was introduced to standardise recording of handovers. Furthermore, it is password protected and has replaced the previous use of Microsoft Word. This closed loop audit aimed to compare handovers documented using Microsoft Word (cycle 1) and SurgiBase (cycle 2) against RCS guidelines.

Two audit cycles were conducted with the standard set at 100% compliance with RCS guidelines for both. Essential handover criteria included patient name, age/date of birth, date of admission, location, responsible consultant, diagnosis, and significant investigation results. The presence of a management plan was also assessed.

A total of 243 patient handovers were screened across both cycles (cycle 1 n=108, cycle 2 n=135). In Cycle 1, none of the handovers met the standard, and date of admission was most commonly omitted (88% of handovers). In Cycle 2, 32% of handovers were compliant with the standard and improvement was seen across criteria. The biggest improvements post intervention were date of admission (+37%) and patient age (+22%).

The introduction of SurgiBase improved handover safety in line with RCS guidelines and offers enhanced information governance through its secure, password-protected system. While improvements were observed, further efforts are needed to increase compliance. Future recommendations include targeted education for clinical staff on handover practices, awareness of guidelines and regular audits to ensure continued improvement.

Fascia iliaca blocks (FIB) should be readily available in emergency departments as part of the pain management strategy for patients with fractured neck of femurs. FIBs should be administered by the A&E team, and if trained personnel are unavailable or there are time constraints, the anaesthetic team should provide the block. However, this is not always feasible as anaesthetists are often occupied in theatre, which can result in patients not receiving timely nerve blocks.

This cross-sectional study audited all adult inpatients admitted to the hospital for neck of femur fracture fixation under the Orthopaedic department from A&E. The study included 42 adult patients admitted to University Hospital Lewisham between December 2023 and February 2024. Data were recorded using a worksheet and analysed with basic statistical methods.

Out of the 42 patients, 12 either did not receive a block or lacked appropriate documentation. Fascia iliaca blocks were administered by A&E in 58.5% (24) of cases, while 9.8% (4) were provided by the anaesthetic team. Notably, 29.3% (12) of patients had no documentation regarding the block, and 2.4% (1) refused the intervention. Additionally, 38.1% of patients received the block within 4 hours of diagnosis in A&E, with the remainder receiving it after 4 hours.

Early administration of fascia iliaca blocks is crucial, particularly for elderly patients with cognitive impairment or delirium. This audit emphasizes the importance of adhering to the policy of providing blocks in A&E or ensuring early intervention by the anaesthetic team.

Minors with soft tissue injuries typically do not require referral to a trauma clinic from A&E. If symptoms persist beyond six weeks, the patient's general practitioner (GP) can make an appropriate referral. Ideally, A&E clinicians should be able to make this determination, but in some cases, they may be uncertain of the diagnosis or mistakenly identify the injury as an avulsion fracture, leading to unnecessary referrals to the fracture clinic.

This cross-sectional study audited adult patients seen in A&E and subsequently referred to the Orthopaedic fracture clinic between March 2024 and May 2024 at University Hospital Lewisham. Data were recorded on a worksheet and analysed using basic statistical methods.

Of the 120 patients referred, 15 (12.5%) were diagnosed with ankle sprains based on clinical letters from the trauma clinic. Referrals were made for various reasons: 26.7% due to diagnostic uncertainty in A&E, 26.7% for suspected avulsion fractures, 20% for misdiagnosed ankle fractures, and 26.7% for ankle sprains. Most patients were between 20 and 40 years old and were seen within 1-2 weeks of their initial A&E presentation.

All patients were provided with walking boots in A&E, and radiographs confirmed that none had bony injuries. As a result, 100% of the patients were discharged after their first clinic visit. This underscores the importance of adequate staff training to prevent overloading the fracture clinic.

Carpal tunnel syndrome (CTS) and vitamin D deficiency are distinct conditions that can both contribute to chronic neuropathy. As a result, patients are often referred for Nerve Conduction Studies (NCS) without a comprehensive evaluation, including blood tests to rule out potential biochemical deficiencies.

This cross-sectional study audited adult patients who presented to the Orthopaedic Fracture Clinic with symptoms of tingling and numbness in the wrist(s) between March 2024 and June 2024 at University Hospital Lewisham. Data were extracted from the electronic medical record system (Cerner) and analysed using basic statistical methods.

A total of 43 patients were included in the study, with 5 (11.6%) excluded due to incomplete documentation or alternative anatomical pathologies. Nerve conduction studies confirmed nerve involvement in 21 (48.8%) patients with median nerve involvement, 2 (4.7%) with ulnar nerve involvement, 1 (2.3%) with both median and ulnar nerve involvement, and 14 (32.6%) with normal NCS results. Vitamin D levels were deficient in 10 (23.3%) patients, normal in 10 (23.3%), and not tested in 18 (41.9%). Calcium levels were within the normal range in 29 (67.4%) patients, with 9 (20.9%) not tested. Among patients with normal NCS results, 3 (7.0%) had low vitamin D, and 6 (14.0%) had an incomplete biochemical workup.

This study highlights the importance of conducting a thorough biochemical evaluation, including vitamin D and calcium levels, before performing Nerve Conduction Studies. Ensuring a complete biochemical profile can help reduce the need for unnecessary and costly NCS referrals.

To evaluate the adherence to British Society for Surgery of the Hand (BSSH) national and local trust guidelines for venous thromboembolism (VTE) prophylaxis on anti-embolism stockings (AES) and pharmacological prophylaxis (PP) prescription accuracy and reassessments over three audit cycles, and to reduce inappropriate prescriptions.

Prospective data from patients admitted under the hands team were reviewed, excluding polytrauma cases. Patients were risk-assessed as per the BSSH guidelines to evaluate prescription indication and adherence.

Three audit cycles (C1, C2, C3) had 42 patients each admitted under hands. The intervention was education using BSSH and local trust posters and frequent email circulations.

Overall, inappropriate AES prescriptions were 38.10% (C1) reducing to 30.90% (C2) and 9.52% (C3). Inappropriate PP prescriptions were 26.20% (C1) reducing to 23.80% (C2) and 9.52% (C3).

11.9% (C1) had AES unnecessarily prescribed which increased to 14.28% (C2) and reduced to 7.14% (C3). 23.8% (C1) had PP unnecessarily prescribed which reduced to 21.40% (C2) and 4% (C3).

All PP prescriptions were appropriate for weight and renal function. Delay of 2 or more days in patients with PP prescription decreased from 14.3% (C1) to 9.52% (C2) to 4.75% (C3). VTE reassessment rates improved from 4.80% (C1) to 11.90% (C2) to 14.28% (C3) although remain low.

The educational interventions significantly improved prescription practices by C3. Overall, both AES and PP inappropriate prescriptions declined markedly by C3. VTE reassessment rates improved but remained low, indicating a need for continued focus. The results highlight that consistent education can enhance prescription practices, thereby patient care.

Distal radius fractures are common injuries, and the optimal management—whether through closed reduction and internal fixation (CRIF) with K-wires or open reduction and internal fixation (ORIF) with a volar locking plate - remains a topic of discussion. This study aimed to compare the functional outcomes of these two treatment approaches.

A cross-sectional study was conducted to audit adult patients who underwent operative management for distal radius fractures at University Hospital Lewisham and Queen Elizabeth Hospital between January 2023 and July 2023. Data were collected using a standardised worksheet and analysed using basic statistical methods.

A total of 62 patients underwent surgical fixation of distal radius fractures, with 44 (70.99%) treated using ORIF and 18 (29.03%) using manipulation under anaesthesia (MUA) with K-wires. At University Hospital Lewisham, 4 (22.22%) patients underwent K-wires and 20 (45.45%) underwent ORIF. At Queen Elizabeth Hospital, 14 (77.78%) patients were treated with K-wires and 24 (54.55%) with ORIF. The average number of postoperative X-rays was 2.29 in the ORIF group and 2.88 in the K-wire group. Clinic visits averaged 3.36 for ORIF patients and 3.72 for those treated with K-wires. Stiffness was reported in 11.36% of ORIF cases and 22.22% of K-wire cases, based on clinic notes from surgeons or physiotherapists.

Patients who underwent ORIF for distal radius fractures demonstrated better functional outcomes compared to those treated with K-wires. Additionally, the ORIF group required fewer postoperative imaging studies and clinic visits, suggesting greater efficiency and improved recovery.

Small bowel obstruction (SBO) is a common presentation during surgical on-call which is caused by either mechanical blockage such as adhesions, stricture, hernia, and cancer or by a functional disorder which is known as pseudo-obstruction. Commonly, patients presented with SBO were found to have adhesions likely due to a history of bowel surgeries. Most cases can be managed conservatively in the early stages were administrating a contrast medium (dye) provides a diagnostic role and can play a therapeutic role in SBO.

To assess outcomes using Gastromiro vs standard management in SBO.

A retrospective observational cohort study involving 94 patients presented with SBO at Milton Keynes Hospital in the UK between January and December 2019. Patients were treated conservatively using Gastromiro or without contrast depending on the clinical decision on presentation. Clinical and radiological assessment over the next 72 hours of dye administration. Data were collected from hospital records including admission and pre & post-operative follow-up notes.

A total of 92 patients (42 Gastromiro group vs 50 non-contrast group) were included in the final analysis. The Gastromiro group showed better outcomes compared to the non-contrast group in terms of improving symptoms and average hospital stay: 78.6% vs 70% and 4.85 vs 9.94 days, however the non-contrast group had a higher rate of turning into laparotomy surgery at 30 % vs 21.4% in the gastromiro.

Our study showed that patients with SBO who were offered Gatromiro at our unit seemed to result in better outcomes related to symptom alleviation and less hospital stay.

Day-case surgery is essential for improving patient outcomes and maximizing healthcare efficiency. The British Association of Day Surgery (BADS) recommends day case rates of 85-95% for specific procedures to optimize resource allocation and reduce patient hospital stays. An initial audit found a day case rate of 83%, slightly below target. This second cycle aims to reassess performance in general surgery and urology, identifying factors that prevent full alignment with BADS standards.

A total of 208 elective general surgery and urology admissions from August 2023 were reviewed. Following exclusions of non-BADS cases and duplicates, 181 patients remained in the analysis. Day case rates for each procedure were benchmarked against BADS recommendations, and the results from this second cycle were compared to those of the first cycle (June 2021 – May 2022) to assess progress and areas for improvement.

In this cycle, 69% (125/181) of patients were discharged as day cases, with 31% (56/181) requiring overnight stays (ONS). While laparoscopic cholecystectomy met BADS targets (77% vs. 75%), umbilical hernia repair (64% vs. 90%) and prostate laser resection (33% vs. 80%) fell short. The primary reasons for ONS were post-operative symptoms (23%) and nurse concerns (21%), underscoring the need for better symptom management and clearer discharge protocols.

Although improvements were observed in certain procedures, overall day case rates remain below BADS recommendations. Addressing post-operative care and empowering nursing staff with clearer discharge criteria are key to reducing ONS. Continued audits will be vital in further optimizing day-case surgery outcomes and procedural efficiency.

The study was conducted to critically analyse the clinical presentation, management strategies and outcomes of patients presenting with diverticular disease to measure compliance with the WSES guidelines. The primary objective was to refine the diagnostic accuracy, focusing on antibiotics protocol and importance of interventional radiology vs surgery.

A comprehensive retrospective study from January 2024 to May 2024 including 65 patients presenting with diverticular disease at a UK District General Hospital. Parameters studied were patient demographics, grades of disease, multidisciplinary involvement (radiology, microbiology, surgery), timing and type of interventional modalities for disease control and treatment outcomes.

We studied the cohort in the age range of 32 - 93 years. 45% of the patients were known to have diverticular disease previously, while 55% had first presentation. 88% patients received antibiotics started in first 6 hours out of which 59% were uncomplicated disease. CT scan was done in 88% on admission. Only 6% of the complicated disease patients received microbiology opinion for antibiotics due to severity of disease, while only 9% of the patients with abscess sought IR opinion. 3% received critical care in first 6 hours indicating multidisciplinary collaboration. 3% underwent emergency Hartman's resection and 32% had a follow-up with colonoscopy. Average length of stay was 5 days.

Our study emphasizes the need for the judicious use of antibiotics/ admission criteria in uncomplicated diverticulitis patients with strict adherence to guidelines to standardize the variability in patient care and enhance treatment outcomes with shortening the length of stay.

Enhanced Recovery After Surgery (ERAS) protocols can reduce complications and hospital stays, promoting safer recoveries. Opioid-sparing, multimodal analgesia is a key aspect of postoperative care. This audit compares the effectiveness of non-regional block (standard care) options with rectus sheath catheters (RSC) in improving outcomes within an ERAS framework.

A retrospective audit was conducted at Southport District General Hospital (SDGH) comparing standard care analgesia (n=30 from September 2022) to RSC use (n=52 from October 2022). Thirty patients admitted to postoperative critical care following intra-abdominal surgery (n=9 types) were reviewed. Prescription charts and multidisciplinary team notes were analysed to assess analgesia use, antiemetic requirements, and complication rates.

All patients required analgesia, with 63% needing ≥10mg OxyContin and 40% requiring patient-controlled analgesia (PCA). The mean duration of analgesia use was 6.5 days for simple analgesics and 4.7 days for opiates, compared to 4 days with RSC. Complications with standard care included pain (47%), decreased thoracic expansion (40%), and poor cough (53%). In contrast, only 10% of RSC patients experienced complications, with 50% reporting zero pain. Antiemetic use was required in 53% of cases, with 23% needing a combination. PONV scores were not recorded for standard care, but 92% of RSC patients had a score of 0.

RSC use within an ERAS protocol shows clear benefits in reducing opioid use, complications, and enhancing recovery. This study supports the adoption of multimodal, opioid-sparing strategies to improve postoperative outcomes after intra-abdominal surgery.

Epistaxis affects approximately 60% of the population, with 6% requiring further medical intervention. First-line management typically involves first-aid measures, followed by further interventions if necessary. Ineffective management of epistaxis can result in complications such as hypovolemia, aspiration, and, in severe cases, death. Early implementation of first aid measures is therefore crucial at the point of presentation. This project aims to improve the management of epistaxis in general practice (GP) and emergency departments (ED).

A prospective audit was conducted from March to June 2024. Patients referred to the Ear, Nose, and Throat (ENT) acute outpatient clinic, for epistaxis, completed a pre-appointment questionnaire/quiz. The questionnaire/quiz collected demographic data, details of the initial consultation with the referring clinician, including whether first aid information was provided, and assessed patients' knowledge of these first aid measures.

Among the 34 patients surveyed, 21 (62%) received either verbal or written information on managing epistaxis, with only 7 patients (20%) receiving both. Despite this, 58% of patients experienced further episodes of epistaxis before their ENT clinic visit. Only 2 patients (6%) answered all quiz questions correctly, and 44% knew where to seek help if the epistaxis persisted.

Patients with epistaxis are frequently not provided with adequate first aid information. Even when information is given, retention is suboptimal. Written information may improve patient understanding and adherence to management protocols. We recommend that GP and ED clinicians routinely provide both verbal and written information to patients, followed by a re-audit to assess the effectiveness of these interventions.

This audit aims to evaluate the increasing demand for urology services at Newham University Hospital and its effect on outpatient capacity. With patient numbers nearing the hospital's limit, the audit seeks to identify the causes behind this rise and recommend preventive measures to avoid future breaches. The objectives are threefold: ensure that the patient review process remains uninterrupted to prevent delays in urology care, uncover factors contributing to patients approaching breach, and develop strategies to mitigate future capacity challenges, enhancing referral efficiency and maintaining quality care.

A special clinic was set up on 21 October 2023 to prevent delays in urology care, targeting 65 patients. The clinic ran six sessions (three in the morning and three in the afternoon) with one consultant and two specialist registrars. Ultimately, 72 patients were seen, exceeding the original goal to better manage the patient backlog.

Of the 72 patients, 15 (21%) were not new to urology, having already been seen, discharged, recently referred, or having missed appointments. Five (7%) were inappropriate referrals, such as those meant for uro-gynaecology or with incorrect referral reasons. Additionally, two patients were already scheduled for surgery, and one was awaiting a flexible cystoscopy since September 2023.

The high patient volume, inappropriate referrals, and repeat patients contributed to delays in urology services. Solutions include refining referral processes, investigating missed appointments, and reviewing past periods for insights. Setting up general urology clinics prioritizing LUTS and introducing new pathways for Peno-scrotal and emergency stone cases could further enhance service efficiency.

Current standard practice for diagnosing prostate cancer is using MRI (PI-RADS), Prostate Specific Antigen- Density (PSA-D) and trans-perineal biopsies. Combination of PSA-D and MRI helps guide biopsy decisions whilst avoiding redundant testing. A risk data table of csPSC related to PI-RADs score and PSA-D categories was generated from 3006 biopsy-naive men. According to EAU guidelines, this is the gold standard.

Our aim was to compare our local trust practice of performing prostate biopsies for PIRADs 2/3 lesions for csPSC to the EAU risk-adapted data table.

Between January 2019 and May 2024, data was collected of 461 patients who underwent trans-perineal biopsies with MRI PIRADs 2/3 lesions for csPSC.

Of 461 patients, 107/324 of PI-RADS 3 lesions were positive for csPSC. 38/137 were PI-RADs 2 lesions and had csPSC. At thresholds of PSA-D of <0.1 and >0.2, our results showed 19.3% and 58.8% with csPSC respectively. In comparison meta-analysis thresholds, 4% (PSA-D <0.1) and 29% (PSA-D >0.2) had csPSC. For PI-RADs 2 lesions, PSA-D thresholds of <0.1 and >0.2, 18.5% and 44.7% had csPSC respectively and for meta-analysis thresholds it was 3% and 18% respectively.

We concluded MRI PI-RADs 2/3 lesions patients’ had higher percentages diagnosed with csPSC on biopsy than EAU standards. This could be due to radiological under-assessment of PI-RADs 2/3. Experienced radiologists are reporting MRI prostate, there can be inter-variability reading. However, we should not rely on guidelines completely, important to take a holistic approach including clinical assessment, radiological and biochemical assessments of the patient.

To investigate the management of appendicitis in children and young people in Milton Keynes University Hospital.

Data for patients aged between 3 – 16 years who had appendicectomy between July 2022 and the end of December 2022 was reviewed. We used the following criteria to investigate these patients: age, date of admission, date and time of procedure, diagnosis at histology, imaging, clinical risk score used, antibiotics, operation findings, and post operative pain score.

All patients had laparoscopic approach. All patients had their operation within 24 hours. Low rate of negative histopathology 2.9% per our audited data. In the current MKUH paediatric surgery pathway, no guidance specific for pain management and pain score was not always used as there is a paediatric pain care plan on eCare – not used for patients. Urinary ββ-HCG was not done in all females aged 11 and above and girls under 11 years if menses had commenced per the GIRFT recommendation.

No scoring was used formally. Referral to Oxford Hospital via discussion as a consultant-to-consultant referral. No formal transfer pathway carried out. No formal joint care with paediatric team for children > 5 years.

Update current surgical pathway for pediatric patients per the GIRFT guide – specify acute abdominal pain in children pathway and discuss with other relevant teams, include as part of the induction process. Use current Micro Guide advice for antibiotic use and update it per the GIRFT advice according to (Appendicitis definitions) to avoid the heterogenous use of antibiotics when it comes to route and duration.

Routine post-operative drugs after Thoracic surgery include analgesics, laxatives, anti-emetics, nebulisers, VTE prophylaxis and gastric protection. Currently, after each procedure, the surgeon involved has to prescribe each drug individually which often leads to missing prescription of some routine drugs. An audit conducted in the department last year concluded that most commonly missed drugs were some of the analgesics (20-30%), nebulisers (48%), and even VTE prophylaxis (4%).

To demonstrate the need for an electronic care plan bundle to ensure 100% prescription frequency of routine post-operative drugs on day 0 in patients undergoing Thoracic surgery.

Prospective prescription chart review of patients undergoing thoracic surgery was conducted on post-operative day 0 in two cycles of 2 weeks duration each. Patients undergoing day care procedures and bronchoscopy were excluded. At the end of the 1st cycle, awareness and education of doctors was conducted using posters on current guidelines.

Prescription frequency of VTE prophylaxis, paracetamol and anti-emetics was satisfactory. Knowledge and awareness significantly improved prescription of oramorph/oxycodone, nebulisers and laxatives (p<0.05) but no improvement in prescription of ibuprofen and gastric protection.

This study demonstrates that though education and awareness are important for bringing in changes, it remains a people-dependent system. A process-dependent system backed by technology is needed which offers support to surgeons in prescribing routine post-operative drugs. Therefore, a care plan has been developed with the help of pharmacists, which aims to consolidate all the routine drugs into one prescription bundle in the Trust’s electronic healthcare record system.

Despite the widespread adoption of electronic health records (EHRs), challenges persist in their effective use within the Urology Department at University Hospitals of Leicester NHS Trust. This audit aimed to evaluate the effectiveness of our EHR system in supporting efficient handover and patient care for surgeons in training.

A retrospective audit of 45 patients compared paper and electronic records for data completeness, timeliness, and accuracy. Data was collected between June and July 2024, including presenting complaint, diagnosis, past medical history, and management plan.

Significant discrepancies were found between paper and electronic records, particularly in terms of completeness and timeliness of documentation. For example, 40% of inpatient diagnoses were documented in electronic records compared to paper records. Only 20% of management plans were documented, yet none of them had been updated for at least 48 hours prior to data collection—furthermore, most of the electronic records were found to be documented by other healthcare professionals than doctors.

The current EHR system falls short in supporting efficient urology handover for surgeons, posing risks to patient safety and the quality of surgical education. To address these issues, we propose implementing.

• Automated alerts: To prompt clinicians for missing information.

• Enhanced training: For urology doctors on EHR use and best practices.

By implementing these strategies, we can improve patient safety, enhance the quality of surgical education, and optimise the use of our EHR system in the urology department.

To evaluate the completeness and accuracy of histology documentation in general surgery outpatient clinic letters and Cerner pathology records and identify areas for improvement.

A retrospective audit of 104 surgical cases was conducted, analysing histology documentation in general surgery clinic notes and Cerner pathology results. Key metrics included operation type, procedure distribution, documentation rates, and result correlation.

We observed a total of 104 surgical cases, with 31.73% (33 cases) categorized as emergency procedures and 68.27% (71 cases) as elective; 61.54% (64 cases) of the patients were female, while 38.46% (40 cases) were male. Regarding the types of procedures performed, laparoscopic cholecystectomy accounted for the highest proportion, representing 45.19% of the cases. Laparoscopic appendectomy constituted 16.35%, followed by lipoma excision (9.62%) and cyst excision (7.69%), with other procedures making up the remaining 21.15%.

About 96.4% of histology results were available on Cerner. Yet, clinic documentation discussed 89% of histology. 6.4% of patients had their histology results on Cerner but never documented, discussed, or potentially checked. All histopathology were benign. However, such findings are not relevant as histopathology samples are not united.

While current histology documentation demonstrates good compliance, there's room for improvement in ensuring complete documentation across all systems. The 6.4% documentation gap presents an opportunity for targeted interventions. The high rate of benign results supports the accuracy of current diagnostic practices. Regular audits and reconciliation processes are recommended to maintain consistency between recording systems.

Appropriate fluid prescription is essential when managing acutely unwell surgical patients. The indication for intravenous (IV) fluids includes infection, diarrhoea and/or vomiting, bleeding, etc. The variety of these indications calls for better understanding of IV fluid therapy. This study aims to evaluate fluid therapy commenced by the general surgical team for acutely unwell surgical patients.

A retrospective study of 2 cycles. Each cycle involved a 2-week snapshot of intravenous fluids prescribed to acutely unwell general surgical patients. Appropriateness of these prescription was assessed using patient age, weight, hydration status, observations, and blood results prior to fluid prescription. Fluid type, volume and rate were also recorded.

The first cycle included 73 patients. Most IV fluid prescription were treating diarrhoea and vomiting (53%). Hartmann’s solution was the most prescribed fluid (88%). There were 24 prescription errors noted, after which a teaching session on fluid management was given to surgical doctors and posters on fluid types & constituents were circulated around surgical offices. After 4 weeks the second cycle showed significant improvement (58%) with 10 prescription errors in 80 IV fluid prescriptions.

Following the implementation of the teaching session and posters there was an improvement in management of electrolyte derangements and prescribing the appropriate fluid rate. Therefore, these changes will be delivered to every new cohort of rotating surgical juniors.

To assess local practice, adherence to guidelines and the effect of the implemented change. The standard of practice is Chest X ray performed within 72 hours, documented Well’s score, D dimer recorded if Well’s score is low, and 15.4% to 37.4% of CTPA positive detection rate.

We underwent a retrospective analysis of 209 CTPA results and requests that were undergone in June 2024, each were individually assessed against the criteria.

A total of 209 CTPA were included where 185 (89%) CXR were performed within 72 hours prior to request. Two-Level Wells score was calculated for 202 (97%) of requests. 41 (19.6%) of the CTPA scans requested had Wells score below 4. Of these 41, 34 (82.9%) had D-dimer recorded. Of the total 209 CTPAs, 26 (12.4%) were positive for PE diagnosis.

Our results have shown that there is a noticeable improvement in the local practice in the documentation of Two-level Wells score from 25% to 97% as well as an improvement in chest x-rays performed in the 72 hours prior to CTPA from 75% to 89%. There was however a slight drop in adherence of documentation of D-Dimer when Wells score is below 4 from 100% to 82.9% and in positive PE diagnosis from 18% to 12.4%.

Continue to provide teaching sessions on the importance of adherence to the standard of practice and roll out similar audit methods with other imaging modalities aiming at creating robust protocols in vetting scans to safeguard patients against unnecessary and inappropriate scans.

Diabetic foot ulcers, which have a negative impact on patient well-being and place a burden on the NHS, are a prevalent complication in diabetic patients. The aim of this pathway is to facilitate and improve decision-making by Emergency Physicians in our Hospital regarding the care of these patients.

A set of relevant questions and enquiries were selected to be asked and requested by emergency physicians to obtain as much information as possible about both the previous medical patients’ history and their current clinical status. They were reviewed and designed following the Infectious Disease Society of America guidelines for diabetic foot infection.

Considering each patient's risk factors, results of blood and imaging tests, decision criteria were selected for hospital admission and safe discharge with follow-up in the community: (podiatrist, district nurse, general practitioner, or vascular outpatient care). Reasons for referral to a tertiary centre were also established according to patient severity and the availability and limitations of our Hospital Vascular Surgery Team.

Although there are well known guidelines for the management of this disease, in the hectic Emergency Department environment, it is necessary to have a clear and concise pathway to follow. This will lead to greater efficiency in our Trust by reducing the number of patient complications and readmissions.

This project aimed to audit and improve compliance with local antibiotic guidelines for managing surgically treated hand fractures, both open and closed. The audit sought to identify deviations from guidelines and implement changes to improve adherence.

This retrospective closed-loop audit was conducted in two cycles: March 2023 (first audit) and May 2024 (re-audit). Patient records of surgically managed hand fractures were reviewed. After the initial audit, specific antibiotic guidelines for plastic surgery were developed with input from infectious disease and pharmacy teams. The new guidelines were disseminated to the surgical team.

The initial audit found 0% compliance with antibiotic guidelines for both open fractures and closed fractures requiring fixation. Compliance for closed fractures not requiring fixation was 66.7%. After the intervention, the re-audit showed improvements: 71% compliance for open fractures, 89% for closed fractures requiring fixation, and 100% for closed fractures not requiring fixation. Compliance with antibiotic duration was 42% in open fractures and 100% in closed fractures.

The re-audit demonstrated notable improvements in antibiotic prescribing practices following targeted interventions. However, continued focus is needed to improve the duration of antibiotic therapy for open fractures. Ongoing education and regular re-audits are critical to maintaining high levels of compliance and ensuring better patient outcomes.

Bladder cancer is a prevalent urologic malignancy, particularly in developed countries. Transurethral resection of bladder tumour (TURBT) is the standard procedure for both diagnosis and treatment, offering high diagnostic accuracy and low complication rates. This audit aimed to assess the quality of care and identify areas for improvement in managing bladder tumour patients at a single urology facility.

We conducted a retrospective review of medical records for all patients who underwent TURBT at our facility between September 2022 and March 2023. Data collected included patient demographics, tumour characteristics, hospital stay, and complications. Histopathological analysis classified tumours based on the 2016 WHO classification of urothelial tumours. The study focused on tumour stage, grade distribution, and postoperative outcomes.

A total of 38 patients underwent TURBT. Of these, 14 (36.8%) had benign tumours, while 24 (63.2%) had malignant tumours. Among the malignant tumours, 50% were low-grade PTa, and 8.3% were high-grade PTa. Additional cases included high-grade PT1 (20.8%), low-grade PT1 (4.2%), high-grade PT2a (12.5%), and high-grade PT4a (4.2%). The mean patient age was 74.39 years, with an average hospital stay of 2.15 days. No major complications, such as bladder perforations or thromboembolic events, were recorded.

The audit shows that low-grade PTa tumours are common and have a favourable prognosis with resection and monitoring. The care provided in our unit is of high quality, with low complication rates and short hospital stays. Regular audits can help ensure continued improvement in patient outcomes.

This audit aims to assess how well prostate cancer patients feel supported throughout their treatment journey, from diagnosis to aftercare.

Patients treated between October 2023 and April 2024 were interviewed retrospectively. Each patient completed a questionnaire evaluating different aspects of the support provided during their treatment.

100 patients were interviewed retrospectively. A doctor was present in the initial consultation during delivery of diagnosis 97% of the time, a Clinical Nurse Specialist (CNS) 30% of the time, and a Macmillan representative 16% of the time. 91% of patients were given contact details for first point of contact and 93% were given information leaflets. The mean score of level of support reported by patients was 8.34 out of 10. Only 23% were offered an electronic holistic needs assessment (eHNA). Of those who used it, patients scored it 8.53 out of 10 for helpfulness. 51% of patients received further support from Croydon University Hospital following referral to another trust. 29% of patients received support for side effects of medications. Only 23% were offered a referral to a Cancer Psychologist, and nearly half (11 patients) declined the offer.

While patients reported high satisfaction with the support received, areas for improvement include increased provision of eHNAs and psychological referrals. Steps will be taken to address these gaps, with a follow-up audit planned to monitor progress.

In England, 1 out of 7 adults have a literacy level equivalent to a reading age of 9-11 years. Outpatient clinic letters serve as a vital medium for disseminating essential information. While outpatient letters have conventionally been addressed to general practitioners, in 2018, the Academy of Medical Royal Colleges (AMRC) recommended writing letters directly to patients in keeping with Good Medical Practice. This audit aims to evaluate this practice in a tertiary Plastic Surgery Department. Secondary aims include the assessment of the readability index of letters, and inclusion of surgical details relevant to the consent process where applicable.

A retrospective audit of outpatient letters was conducted between June 17 and 27, 2024. Data was collected from the EPR (Electronic Patient Record) system and analysed using the Flesch Reading Ease score in Microsoft Word to assess letter readability.

Seventy-one outpatient letters were analysed, with 93% addressed directly to patients. The average Flesch Reading Ease score was 58.33, indicating "fairly easy" readability. For patients undergoing surgery, 77% of letters included details about the procedure and potential complications.

The majority of outpatient letters were directed to patients, aligning with AMRC guidance. While readability was generally good, around 10% were found to be associated with a lower readability score and serves as areas for improvement. Providing information of surgical procedures, as part of outpatient letter or as patient information leaflets can enhance the consent process. This audit highlights adherence to best practices, readability, and consent process in patient-centred communication.

To improve the antibiotic management of patients with epididymo-orchitis (EO) at a local NHS general hospital.

Across 3 months the management of 19 patients diagnosed with EO by urology at a local NHS general hospital was analysed. Using local trust guidelines four main outcomes were identified for improvement. This was followed by two Plan-Do-Study-Act (PDSA) cycles. In PDSA 1, baseline measurements of these outcomes alongside suggestions for improvement were displayed on a poster which was distributed amongst the urology department. In PDSA 2, interactive teaching sessions were delivered to both the urology and accident and emergency (A&E) departments.

At baseline the results of the four identified outcomes were as follows: 32% did not have a sexual health history taken, 32% did not have urine microscopy, culture, and sensitivity (MCS) sent, 47% were not treated with antibiotics as per local guidelines and 16% were continued on antibiotics which the urine MCS did not show sensitivity to. With implementation of PDSA 1 the results were 31%, 56%, 44% and 13% respectively. An improvement was seen with implementation of PDSA 2 as the results were 20%, 20%, 25% and 0% respectively.

This quality improvement project demonstrated a significant improvement in compliance with local guidelines for the management of EO. This result was largely seen with the implementation of interactive teaching sessions in PDSA 2. Clinically, this should translate into both a reduction in morbidity of EO and risk of complications such as abscess formation developing.

Surgical Site Infections (SSIs) are a major cause of morbidity and increased healthcare costs among surgical patients. SSI rates globally range from 2% to 10%, depending on surgery type. This audit is the first in Sana’a, Yemen to evaluate compliance with infection prevention protocols and aims to assess SSI incidence while exploring associations with compliance across preoperative, intraoperative, and postoperative phases.

We conducted a prospective audit of 75 surgical procedures over two weeks (25 August to 7 September 2024) in two public hospitals in Sana'a, Yemen. We analysed patient demographics, comorbidities (including diabetes), SSI rates, and compliance with infection prevention protocols. A p-value <0.05 was considered statistically significant. Chi-square tests and Cramér’s V were used to assess associations between SSI occurrence and compliance.

The SSI incidence rate was 36%, significantly higher than the international average of 2%-10%. Compliance rates were 75.7% preoperatively, 44.8% intraoperatively, and 58.3% postoperatively, with an overall compliance rate of 59.6%. Significant associations were found between SSI occurrence and compliance: intraoperative (p = 0.006, Cramér's V = 0.593), preoperative (p = 0.01, Cramér's V = 0.537), and postoperative (p = 0.003, Cramér's V = 0.462), with the strongest association in the intraoperative phase. Diabetes was also associated with higher SSI rates (p = 0.02, Cramér's V = 0.266).

This audit highlights a high SSI incidence and its association with compliance, particularly during intraoperative phase. Enhancing compliance, implementing targeted interventions, and addressing infection prevention gaps could significantly lower SSI rates and impact patient outcomes in Yemeni hospitals.

Epistaxis is the most common ENT presentation in A&E. Ambulatory management is more convenient for patients and less resource intensive but is not yet established in this department. This audit evaluates the management of patients admitted with epistaxis, focusing on treatment methods and identifying candidates for ambulation.

A retrospective audit from 1/4/24 to 5/8/24 included 46 patients out of 77 initially coded for epistaxis. Exclusions were based on pre-defined criteria. Data collected included demographics, admission length, and management types. Factors such as frailty, haemoglobin levels, anticoagulation status, and proximity to the hospital were assessed to determine ambulation suitability.

The average age was 55, ranging from 0 to 97 years. Hypertension was present in 48% of cases and 1/3 were anticoagulated. Conservative management resolved epistaxis in 16/46 patients, whilst nasal packing was used in 24/46 (Rapid Rhinos [16] and Nasopores [5]). Only 5 patients required operative interventions i.e., SPA ligation and diathermy cautery. ENT managed 74% of cases, and 46% had admissions >24 hours. Most patients (76%), when documented, had full mobility and family support, 74% lived within 10 miles of the hospital, and 88% had stable Hb levels. 7 patients were identified as potential ambulation candidates.

In this study, 37% of patients admitted for >24 hours with epistaxis met the criteria for ambulation. With the overwhelming burden on the NHS and continual bed pressures, this audit paves the way for the implementation of a safe and cost-effective ambulatory pathway, which will be re-audited in due course.

Surgeons are expected to keep clear, detailed, and accurate medical records, including operation notes. These notes inform the surgical team about intraoperative events and ensure safe postoperative care. Despite the Royal College of Surgeons of England (RCS Eng) Good Surgical Practice guidelines, operation notes are often suboptimal. While the digitalisation of operation notes in NHS Wales in recent years has improved structure and legibility, the quality of reporting remains dependent on individual surgeons. This audit aimed to assess compliance and quality of digitalised operation notes in a tertiary teaching hospital in Wales.

All emergency general surgery procedures between August 12 and August 25, 2024, were retrospectively audited. Data was collected on a standardised proforma in Microsoft Excel based on 22 parameters derived from the RCS England guidelines.

48 operation records were included. High compliance (100%) was found in key fields: date and time, surgeon's name, anaesthetist’s name, operative findings, detailed postoperative instructions, and signature. Low compliance was observed in estimated blood loss (4.2%), elective/emergency classification (12.5%), identification of prosthesis (13.3%), and problems/complications (33.3%). Notably, venous thromboembolism prophylaxis was omitted in 54.3%, and antibiotic prophylaxis in 40.4%.

While certain parameters showed exemplary compliance, key deficiencies were identified. Our audit is consistent with the literature in showing that digitalisation has improved the structure and compliance of operation notes. This highlights the role of healthcare innovation in enhancing patient safety. We plan to collaborate with the IT department to integrate the required fields, where deficiencies were found, in the existing operation note template.

To assess compliance with new Best Practice Tariff (BPT) Criteria of admission delirium assessment using 4AT screening tool in neck of femur (NOF) fracture patients to achieve the BPT price and increase the Trust's funding.

First cycle was done in April 2024, in which clerking booklets of all NOF patients more than 65 years old were assessed retrospectively for 4AT score completion. A second cycle of assessment was conducted from 1st June to the first week of July. Our project focused on two key parameters (1)whether a 4AT assessment was conducted pre-operatively and (2) who did the assessment.

4AT scores of 62%(23) out of 37 patients assessed during the 1st cycle were completed during admission clerking, while 16%(6) were completed by the Ortho Geriatrician (OG) team preoperatively, and 22%(8) were missed. After 1st cycle, we designed and placed stickers inn clerking booklets, accompanied by further education and awareness-raising efforts. Our results demonstrated significant improvement in the 2nd cycle, with 90%(43) of patients had 4AT assessment at admission, 4%(2) assessed by the OG team, and only 6%(3) missed among 48 patients.

We raised the level of admission 4AT assessment by 16%, which resulted in getting the BPT price in more patients (£1335 per patient, £100,000 per annum in total if fully complied with). As a change, we suggested the department to add 4AT assessment in clerking booklets, and to conduct regular education and reminder during induction to both junior and middle grade doctors.

Microvascular breast free flaps are essential in post-mastectomy reconstructive surgery. Complications range from minor issues like wound dehiscence to more serious events such as total flap failure, both of which can significantly impact patient outcomes. This audit seeks to standardise perioperative documentation, which is expected to improve outcomes for microvascular breast free flaps.

A single-centre, closed-loop audit was conducted to analyse microvascular breast free flap cases. Thorough documentation is essential for adhering to standards of good medical practice and ensuring good outcomes. Therefore, an operative note proforma and a checklist, based on the ABS/BAPRAS 2021 Guidelines, were created to cover key perioperative data points, including patient characteristics, operative details, and postoperative outcomes. These were distributed to the surgical team, and their effectiveness in improving documentation was assessed in a follow-up audit after implementation.

Following the introduction of the operative note proforma and checklist, significant improvements were observed in the documentation of critical variables. These included clearer records of flap ischemic time, postoperative venous thromboembolism (VTE) prophylaxis, the number of perforators, and intraoperative anastomosis revision, amongst others.

Introducing an operative note proforma and structured checklist significantly improved the completeness and accuracy of perioperative documentation in microvascular breast free flap surgery. This standardisation not only facilitates better understanding of adverse outcomes but also serves as an educational tool for junior trainees, helping them appreciate the critical perioperative factors that influence flap success.

Bariatric surgery has been found to have significant effects on diabetes mellitus in patients living with obesity undergoing bariatric surgery.

This study aims to establish the long-term effects of bariatric surgery on diabetes mellitus remission in patients living with obesity.

A retrospective cohort study including all patients who had type two diabetes mellitus who underwent bariatric surgery by one of the bariatric surgery consultants at Darlington Memorial Hospital during the period between November 2012 and March 2014. Data was collected from the hospital’s electronic records, GP records and the National Bariatric Surgery Registry.

A total of 35 patients had type 2 diabetes mellitus, median age was 48 years old (range: 25-46 years), 28 patients (80%) were females. Median HBA1C was 69 preoperatively vs. 61 postoperatively. After 10 years follow up, 8 patients (23%) remained in remission while 26 (74%) patients reported reduced doses of their diabetic medications. One patient was found to have type one diabetes post-operatively. There was no significant difference in diabetes remission between patients underwent laparoscopic sleeve gastrectomy vs. laparoscopic Roux-Y gastric Bypass (p. 0.22).

Bariatric surgery can lead to sustained and significant improvements in diabetes, with many patients experiencing complete remission ten years after surgery.

Renal and ureteric stones are common urological emergencies requiring timely intervention. The management of symptomatic ureteric stones depends on various factors, including clinical presentation, stone location, patient preference, and available resources. Current guidelines from BAUS guideline and GIRFT program recommend clearing obstructing ureteric stones during the initial intervention, either via shockwave lithotripsy or primary ureteroscopy. This audit assesses our compliance to recommended standards in treating acute symptomatic ureteric stones at a district hospital and offers recommendations.

Retrospective clinical audit conducted at Birmingham Heartlands Hospital, reviewing all emergency surgeries for symptomatic unilateral ureteric stones performed between January and June 2024. Demographic and operative data were retrieved from electronic clinical records. Patients with bilateral ureteric stones or those who underwent ureteroscopy for non-stone-related reasons were excluded.

Eighty-five patients had emergency surgeries during the study period, with 69.4% (n=59) being male. The mean age was 56.7years, and the average stone size was 7.4mm. Sepsis was noted preoperatively in 29.4% of patients. Stones were located proximally in 31.8% of patients, mid-ureter in 11.8%, and distally in 56.4%. Lithoclast was used to fragment larger stones before basketing while basket retrieval was used for smaller stones. All patients had successful stent insertions, but ureteroscopy was attempted in only 28 patients with successful stone clearance in 22.

The audit highlights the underutilization of primary ureteroscopy in managing acute symptomatic ureteric stones. Improving access to flexible ureteroscopes, laser technology, and enhancing surgeon training could increase the success rate of stone clearance and align local practices with national guidelines.

Acute scrotal pain, characterized by sudden onset of pain, swelling, or tenderness in the scrotum, requires urgent evaluation due to potential testicular torsion- a surgical emergency. Other causes include epididymo-orchitis and torsion of testicular appendage. Accurate diagnosis by specialists is critical for timely intervention. We evaluated the management of this presentation in our hospital.

We retrospectively collected data of patients presenting with first episode acute scrotal pain at Birmingham Heartlands Hospital between May and June 2024 excluding post-surgical cases. Variables assessed included demographics, diagnosis, investigations, review times and management.

Ninety-seven patients were included with an average age of 34.6 years. Epididymo-orchitis was the most common diagnosis, affecting 69% (n=67). Seventeen patients underwent scrotal exploration for suspected torsion with two positive explorations: one 540-degree torsion with successful salvage, and one nonviable testes which required unilateral orchidectomy after 37-hour history of pain. Patients with epididymo-orchitis were successfully treated with antibiotics as per protocol, but only three of 33 STI-related cases were referred to genitourinary clinic. All patients had urine dipstick and routine blood tests at presentation, and 90% of those with suspected of epididymo-orchitis had outpatient ultrasounds. The average time to registrar review was 1.7 hours. Average time from presentation to scrotal exploration was 1.6 hours in those with suspected torsion. No incidence of missed torsion.

The audit revealed good performance regarding timely review and patients’ treatment. However, there needs to be improvement in fully assessing STI related cases. Overall, management of these cases were efficient and contributed to positive patient outcomes.

The Chest X Ray (CXR) is a common initial investigation for any patient that has been admitted into hospital with reports of almost 7 million CXRs being performed yearly in England alone. It is therefore paramount that quality is maintained. National guidelines indicate that posterior-anterior (PA) projection radiographs provide safer and more optimal diagnostic results when compared to their anterior-posterior counterparts (AP). On first cycle data collection, it was revealed that 84% of chest radiographs were performed as AP in our centre and only 16% as PA, compared to the 75% PA standard as set out by the Royal College of Radiologists (RCR).

MDT meetings were held, and information posters were placed on the wards. Data was then re-collected using the local radiological imaging software (PACS). This was then organized in Excel, documenting important radiograph quality information covering aspects of RIPE (Rotation, Inspiration, Projection, Exposure). Further categorization of data was made on age and adequacy. Portable (bed-bound) and paediatric chest x-rays were excluded.

The number of PA projection CXRs had increased from 16% in the first cycle to 54%, with a significant increase in overall image adequacy based on RIPE (50% to 81.3%).

Although still below acceptable standards, there has been a marked improvement in the proportion of PA CXRs (58% from 16%). The number of AP X rays had effectively halved (84% to 42%) and the proportion of inadequate CXRs in AP brought down to 8% (from 32.1%).

At our major trauma centre in the Northwest, a subset of patients is seen in Tuesday upper limb clinic, accessing same-day ultrasound for diagnosis of soft tissue injury, and a second subset seen on other days, who do not receive same day ultrasound. Our aim was to assess the difference in treatment trajectory between cohorts.

We conducted a retrospective analysis of outpatient upper limb clinics between January to October 2023. Groups were separated into those with access to same day ultrasound (TUE), and those without access to same day ultrasound (ROW).

Analysis included date of initial visit, date of ultrasound and diagnosis, date of follow-up and decision to surgery, date of surgical procedure, procedure complexity and complications.

44 patients (33 male, 11 females) with a mean age of 58.6 were included. Pathologies included - rotator cuff pathology (26), subacromial bursitis (5), subacromial impingement (1), acromioclavicular osteoarthritis (1), elbow Plica (1), sternal head pectoralis major rupture (1), bicep tendon ruptures (9).

Median time to ultrasound in the TUE vs ROW cohorts was 0 vs 60 days (range 7 - 128) respectively.

Median time to decision to surgery in the TUE vs ROW cohorts was 0 vs 70 days (7 - 341 days) respectively.

Delays to diagnosis and surgery exist on non-Tuesday clinics. There is a significant impact to quality of life, economic implications for patients (multiple clinic visits, loss of work / function). Further analysis including costing potential patient losses vs staffing full-time ultrasound service for clinics should be conducted.

Day-case surgery has been proven to be safe for various breast surgical procedures. However, there is a lack of substantial data regarding its application in immediate breast reconstruction. We aim to present our experience with day-case management specifically focusing on immediate breast reconstructive surgery using implants.

Data was collected retrospectively on 109 patients who underwent day-case skin-sparing or nipple-sparing mastectomy and immediate breast reconstruction using implants between June 2020 to 2023. Clinicopathological data, including postoperative complications, re-admission rates, and re-operations. The data were compared to established national standards for reference and analysis.

109 patients undergoing immediate mastectomy with reconstruction, 56 were discharged the same day, 53 within two days. Day-case and non-day-case groups showed no significant differences in age, BMI, smoking status, mastectomy approach, or mesh type. However, ASA status and bilateral case status differed significantly. Postoperative complications occurred in 35.7% of day-case and 26.4% of non-day case patients, with no statistically significant difference. Immediate complications were observed in 3.6% in day-case (skin and nipple necrosis) and in 1.9% in non-day case (hematoma), with no significant difference. Delayed complications were seen in 32.14% of day-case and 24.5% of non-day case patients, with no significant difference.

Our study demonstrated a very high success rate for day-case surgery in immediate implant-based breast reconstruction. Amid challenging times, ensuring reconstructive options in holistic breast oncology care remains crucial. Our data indicate the safety and efficacy of day-case mastectomy with immediate pre-pectoral reconstruction, emphasizing multidisciplinary approaches, patient education, and accessible follow-up support.

Surgical ward round notes are essential clinical and medicolegal records. In 2014, the Patient Safety Board of The Royal College of Surgeons of Edinburgh’s ‘SHINE’ report emphasized the role of ward round documentation in reducing errors and promoting patient safety, introducing the ‘SHINE checklist’ of key domains surgical notes should cover. Our EPR system, ‘Epic’ allows templates, ‘SmartPhrases,’ to be coded and auto populated with live data. We aimed to establish if implementing a shared SmartPhrase could improve adherence of surgical ward round notes to the SHINE checklist.

We performed a closed-loop audit on adherence of ward round documentation to SHINE checklist domains. Data were retrospectively collected from the notes of 50 patients on inclusion of these domains’ pre-intervention. The SmartPhrase was implemented, and notes of 50 patients were audited post-intervention. Additionally, the surgical team was surveyed on perceived effects on ward round quality and efficiency.

Introduction of the SmartPhrase improved ward round documentation across all domains; documentation of WR lead (84% pre-intervention vs 100% post-intervention), patient summary data (34% vs 94%), blood investigations (50% vs 90%), observations (48% vs 92%), fluid balance (84% vs 100%), examination findings (84% vs 100%), and provision of contact details (56% vs 90%) [p<0.05 for all comparisons]. Moreover, 100% of the surgical team (n=9) reported the SmartPhrase was useful, improved accessibility of blood results and observations, and efficiency of the ward round.

Our audit demonstrates that technology-enhanced ward round templates can improve the quality of surgical ward round documentation and are positively received by users.

International guidelines differentiate treatment recommendations between Gleason 6 prostate cancer (ISUP grade group 1) and Gleason 7 and above. It is therefore imperative that histological grading is accurate and at present are based on trans-perineal prostate biopsies. For various reasons including high PSAs and patient choice, some patients with Gleason 6 prostate cancer do undergo radical treatment.

As a result, our aim was to compare final prostatectomy histology with the pre-surgical biopsy for concordance.

Retrospective review of 100 consecutive patients with Gleason score 6 on trans-perineal prostate biopsies undergoing robotic radical prostatectomy were compared to their prostatectomy histology from 2021 to 2024 at a single centre.

Concordant histology of Gleason 6 on biopsy and prostatectomy was found in 36% (36/100). Of the 64 patients with upgraded histology, 4% (4/100) showed a Gleason 4+3 histological pattern and 2% (2/100) patients showed a Gleason 4+4 histological pattern. The remainder 58% (58/100) were upgraded to Gleason 3+4 prostate cancer.

This audit shows that approximately two thirds of patients Gleason score was upgraded on prostatectomy histology. This highlights the difficulty in the decision-making process regarding Gleason 6 score prostate cancers. Patients should be counselled about the risk of missing a higher-grade cancer if remaining on active surveillance.

The ABS guidelines on breast surgery operation notes include essential information to be documented relating to patient and operation factors to reduce inter-surgeon variability in operation note documentation. We aimed to audit compliance of breast surgery operation notes with the Association of Breast Surgery (ABS) guidelines for required documentation.

Data was retrospectively collected on all breast surgery patients operated on in an 8-week period from 01/03/2024 to 30/04/2024 in West Middlesex Hospital. Inclusion of the 24 domains of the ABS guidelines for operation notes was audited. The intervention was a breast operation note template made available on the electronic record system and results presented at a departmental meeting. The second cycle is being undertaken in September 2024.

39 breast surgery operations were conducted in this 8-week period. All operations had consultant in charge of care, operation title, laterality, procedure, closure technique and post-operative follow up instructions completed. 9 operations were bilateral, of those only 2 operation notes (22%) included which surgeon operated on each side. The grade of the assistant was not included in any notes and the grade of the anaesthetist only included in 2 of the 39 notes. Venous thromboprophylaxis was only included for 9 (23%) and skin marking in 11 (28%) operations. 22 operation notes (56%) included method of localisation and indication for operation.

There is large variability amongst information included in operation notes for breast surgery, particularly in bilateral cases. A standardised operation note template may aid improved compliance with ABS guidelines for documentation.

Acute colonic pseudo-obstruction is a functional distention of the colon without mechanical obstruction. The Association of Coloproctology of Great Britain and Ireland (ACPGBI) recommends initial conservative management for 48–72 hours, followed by neostigmine or endoscopic decompression if necessary. This audit aimed to evaluate how pseudo-obstruction was managed at University Hospitals Birmingham and to assess compliance with ACPGBI guidelines.

A retrospective analysis of patients admitted with CT-proven pseudo-obstruction between May 2023 and December 2023 was conducted. Out of 76 patients, 32 were included, while the rest were excluded due to mechanical obstruction. Patient demographics, management strategies, and outcomes were analysed.

The mean age of the cohort was 69.5 ± 18.3 years, with a mean BMI of 27.4 ± 6.3. Co-morbidities included diabetes (68.75%) and hypertension (44%). On Day 1, conservative management was initiated in 91% of patients, while 9% underwent sigmoidoscopy. By Day 2, 43% continued with conservative management, and pseudo-obstruction had resolved in 65% of patients. However, 11 patients still experienced obstruction beyond Day 3, with only one undergoing sigmoidoscopic decompression. No pharmacologic intervention with neostigmine was used, and conservative treatment was continued in most cases, despite persistent symptoms in some patients.

The audit revealed that ACPGBI guidelines were not consistently followed, particularly regarding escalation to pharmacologic or endoscopic interventions. These findings will be discussed in the audit meeting to establish protocols for timely intervention and management of pseudo-obstruction.

To evaluate and improve the reliability of orthopaedic patient follow up after acute admission in a tertiary trauma centre.

Patient data was collected retrospectively from all orthopaedic trauma admissions in March 2022. The ‘Gold Standard’ criteria for optimal follow up were established pre-intervention. ‘Gold Standard’ is achieved if all the following are fulfilled: 1. correct date of follow up, 2. correct location of follow up, 3. correct type of clinic (i.e., generic, upper limb, spinal etc.) as specified on hospital discharge letter or post-operative note. Interventions were implemented in November 2022 which consisted of an orthopaedic follow up proforma, reminder posters displayed in theatres and orthopaedic wards and two oral presentations at local orthopaedic audit meetings. Data recollected from all orthopaedic trauma admissions in March 2023 post-intervention.

252 and 208 admissions were analysed in March 2022 and 2023 respectively. Only 38.1% of orthopaedic follow ups met the ‘Gold Standard’ in March 2022. This improved to 50.9% in March 2023. There was an overall reduction of follow ups with incorrect date, location, and type of clinic. Patients lost to follow up also decreased from 8.9% to 4.2%. Of note, 33.3% of appointments at upper limb fracture clinics in March 2022 were incorrect follow ups. This decreased to 20.0% post-interventions.

Interventions implemented in this study proved effective in enhancing the accuracy of orthopaedic follow-up. However, a notable gap persists in follow up accuracy, indicating the need for further improvement.

We aimed to improve the attendance of lunch and learn sessions meant for foundation year doctors and registrars in the surgical department. we have seen reduced attendance of general surgery teaching and the sessions were less engaging. Attendance was found to be less than 20% in sessions. We aimed to increase by at least 50-60%.

Questionnaire form and feedback forms.

20% Attended the teaching.

90% believed the registrars should be present during the teaching.

70% believed that clinical work is keeping them busy.

95% Wanted the food to be provided by the department.

Suggestions from Questionnaire: Introduction of Practical Skills and registrar designated to oversee the teaching.

We concluded that by introducing practical skills such as gowning, scrubbing, and basic suturing methods, we have seen increased attendance from 20% to 80%.

Designating a registrar to oversee the teaching sessions. We have found sessions were more engaging and more learning opportunities were available during the session.

By giving constant reminders on WhatsApp groups and through emails, we have concluded that people are less likely to miss the session.

Teaching is made bleep-free forward juniors for 1 hour except the on-call. We have asked the rota managers to designate the rota for 1 hour of teaching and surgical wards should be aware of 1 hour teaching session.

An audit was conducted to calculate the rate of abandonment of Whipple´s procedures for head of pancreas mass at Kings College Hospital NHS trust. To identify the patients that could have avoided unnecessary laparotomies, the NCCN recommendations for staging laparoscopy was used as the set standard to compare the results.

Data was collected retrospectively from January 2020 to April 2024. The exclusion criteria were those patients who ended up having other pancreatic resections instead. Patient electronic records and PACS for imaging were used to collect data.

A total of 417 cases underwent laparotomy from January 2020 to April 2024. In 55 cases the surgical resection was abandoned due to intraoperative findings, representing 13%. The causes of abandonment were liver metastasis in 40%, peritoneal spread in 20%, local progression (31%) and pancreatitis (9%). More than 50% of patients met the criteria for staging laparoscopy as per NCCN guidelines.

Staging laparoscopy is a minimally invasive procedure used to detect for radiographically occult metastatic disease avoiding unnecessary laparotomy. Liver MRI can be indicated for patients with high risk for liver metastases prior to open surgery. Most studies show a combination of multiphase, thin slice CT and laparoscopy reduces the rate of unrespectability to 10-20% at laparotomy compared to the 30-50% rate historically reported for exploration for pancreatic cancer.

Faecal Immunochemical Test (FIT) has become a common tool aiding in colorectal cancer referrals. FIT detects haemoglobin degradation products rather than fresh blood and remains indicated in cases of rectal bleeding, with studies identifying sensitivity of 96.6% and specificity of 76.6% in this population.

We reviewed FIT test usage in primary care over two months, focusing on patient presentations, FIT test indications, outcomes, and subsequent referrals. We identified interpretation doubts among primary care clinicians in use of FIT testing in patients with rectal bleeding. In response, an educational session was delivered for primary care clinicians, and an infographic was distributed to aid clinical decision making.

A total of 53 patients underwent FIT testing. The most common indications were changes in bowel habits (18/53) and iron deficiency anaemia (12/53). Rectal bleeding was present in 6 of the 53 patients. Eight FIT tests yielded positive results. One of these patients had a prior positive FIT in the context of rectal bleeding, they were scheduled for a follow-up FIT after the bleeding subsided but missed the follow-up appointment. The test was repeated one year later, with a second positive result, and a colonoscopy identified colorectal cancer.

Inaccurate interpretation can lead to delays in secondary care referral and cancer identification. The main factors we identified were implementation of new testing modality (faecal occult blood testing to FIT), change in referral guidelines, without appropriate training to colleagues in primary care. Therefore, teaching and memory aid was circulated among primary care clinicians.

Testicular torsion is a medical emergency that requires timely intervention to prevent testicular loss. While colour Doppler ultrasonography is the diagnostic standard, its availability can delay treatment. The Testicular Workup for Ischemia and Suspected Torsion (TWIST) score, developed by Barbosa et al., provides a clinical tool for diagnosing testicular torsion based on five clinical variables. This study assesses the use of the TWIST score in emergency situations and the accuracy of its documentation in clinical practice.

A retrospective analysis was conducted at UHMBT from November 2020 to May 2023. The medical records of 24 patients with confirmed testicular torsion were reviewed. Documentation of the five TWIST score parameters (testicular swelling, hard testicle, absent cremasteric reflex, nausea/vomiting, high-riding testis) was evaluated. The accuracy of the TWIST score, based on proper documentation, was also assessed.

The TWIST score was not documented in any of the 24 cases reviewed. Full documentation of all parameters occurred in only 25% of cases. Testicular swelling was the most commonly documented parameter (92%), while absence of the cremasteric reflex was the least recorded (33%). Retrospective TWIST scoring placed 53% of patients in the intermediate risk category, 33% in high risk, and 12.5% in low risk. Proper documentation could have resulted in a positive predictive value of 87%.

The TWIST score is underutilised in emergency settings at UHMBT, with incomplete documentation contributing to diagnostic delays. Improved awareness and documentation could enhance diagnostic accuracy and reduce unnecessary imaging.

The UK Resuscitation Council recommends a team meeting at the beginning of shifts to introduce team members, allocate roles, and to identify patients at high risk of deteriorating. This quality improvement project aimed to identify staff experience during cardiac arrest and medical emergency team (MET) calls, with intent to introduce "Resuscitation Huddles" during handover.

A pre-intervention survey was conducted targeting clinical staff involved in cardiac arrest/MET calls to evaluate current practices. This data was used to design a "Resuscitation Huddle Handover Sheet", a standardised proforma for use during huddles. A preliminary post-intervention survey was distributed, and results analysed.

A total of 56 respondents participated across pre- and post-intervention surveys, representing various specialities and clinical grades. Pre-intervention data revealed gaps in team introductions which occurred only in one-third of shifts, and role allocation which was absent in two-thirds of cases. Approximately, 97% reported that emergency team performance was safe only some or none of the time. Preliminary post-intervention data demonstrated an increase in team introductions, role allocation and awareness of roles. Notably, 63% of respondents reported improved safety and effectiveness during emergency calls.

Resuscitation Huddles with a standardised proforma offers a structured approach to team introductions and role allocation. In addition, it has been shown to improve staff experience during emergency calls particularly in relation to patient safety. Preliminary post-intervention data has led to the integration of Resuscitation Huddles into the Hospital Out-of-Hours policy. Post-intervention data collection is continuing with the goal of developing safer practice during emergency calls.

Gallstone disease affects approximately 15% of adults, with a subset experiencing complications such as cholecystitis, cholangitis, pancreatitis, and jaundice. The management of gallstone disease varies between conservative and surgical interventions. NICE guidelines recommend laparoscopic cholecystectomy within one week for acute cholecystitis to prevent recurrence and complications. This study assesses whether NICE standards for gallstone disease management are met.

This retrospective study reviewed all emergency cholecystectomy cases at a district general hospital from March 2021 to January 2023. Elective cases and those from other hospitals within the trust were excluded. Data were collected from the hospital’s electronic record system with support from the audit team. The primary outcome was the proportion of patients who received cholecystectomy within one week of admission as per NICE guidelines.

A total of 83 emergency cholecystectomy cases were reviewed. Among these, only 49 cases (59%) underwent surgical management, while 34 cases (41%) were managed conservatively. Of the surgically managed cases, the majority did not meet the one-week surgery target. The main reasons for conservative management included patient improvement (79%), awaiting further investigations (12%), and asymptomatic presentations (6%).

The NICE standards for managing gallstone disease were not consistently met with a significant proportion of patients experiencing delays in surgery. Participating in national quality improvement initiatives such as Chole-QuIC could help improve adherence to guidelines and reduce variation in patient outcomes. Further data collection and process improvements are necessary to optimise care for gallstone disease patients.

Effective management of renal colic relies on adherence to established guidelines to ensure optimal patient outcomes. This audit aimed to evaluate and enhance the renal colic referral pathway within our healthcare setting.

We audited imaging, analgesia, metabolic workup, and treatment practices for stone disease in two cycles. We implemented interventions, including educational sessions for A&E and urology teams on appropriate referral pathways, imaging protocols, and analgesia management. Additionally, a urology crash course to improve handling of emergencies such as obstructive uropathy and urosepsis. Infrastructure enhancements included upgrading to a laser-friendly emergency theatre, increasing the number of laser-trained staff, and promoting utilization of ESWL service. A second audit cycle was then performed to assess the impact of these interventions.

The second audit cycle demonstrated substantial improvements:.

1. Adequate analgesia administration increased from 45% to 87%.

2. Provision of definitive treatment rose from 25% to 55%.

3. Completion of metabolic workup on presentation improved from 30% to 65%.

The two-cycle clinical audit successfully identified and addressed key areas for improvement in the renal colic referral pathway. Ongoing efforts and additional initiatives are expected to further enhance compliance, moving closer to complete adherence and improved patient outcomes in stone disease management.

This audit assessed the quality of departmental induction for junior doctors in the Breast Surgery department during the July-October turnover period. The goal was to evaluate doctors' comfort in managing patients’ post-induction and improve the process by introducing a tailored induction booklet.

The audit was conducted in two cycles. The first cycle evaluated baseline competencies and satisfaction using a digital questionnaire. Feedback led to the development of an induction booklet, created with input from junior doctors and a multidisciplinary team (MDT). The second cycle, after booklet implementation, reassessed the induction process using the same questionnaire.

In the first cycle, 7 doctors participated. On average only 18.57% received information on managing a variety of common breast conditions, and 24.30% had received information on administrative matters. After the induction booklet was introduced this increased to an average positive response of 76.70% and 64.60%. The confidence levels did not significantly vary between the two cycles; however, the booklet was designed to act as a reference tool which would support doctors through the transition period.

The structured induction booklet improved the quality of the departmental induction and information flow, addressing competency gaps and enhancing junior doctors' preparedness. Further refinement and ongoing use of the booklet are recommended to sustain these improvements.

To improve diagnosis, treatment, and follow-up of bladder cancer.

Over 5 months, 50 consecutive patients with first presentation non muscle invasive bladder carcinoma (non-MIBC) were identified, and charts reviewed retrospectively. Data was collected on smoking cessation support, use of intravesical Mitomycin C at time of first TURBT, obtainment of detrusor muscle during TURBT, specified level of detail in pathology reports, record of prognostic markers and risk classification in MDT notes, management of non-MIBC and cystoscopic follow-up. All outcomes were compared to standards in NICE guidance on bladder cancer.

13% of patients were offered smoking cessation advice. 13% of patients with suspected cancer were offered Mitomycin C at time of first TURBT. 80% had detrusor muscle obtained during TURBT. In MDT notes, 33% had cancer risk category, 4% had predicted risk of recurrence and 6% had predicted risk of progression recorded. 94% of pathology reports had specified detail. 90% of low-risk groups and 100% of high-risk groups had appropriate cystoscopic follow-up.

The most successful outcomes included follow-up of bladder cancer and specified detail in pathology reports. Several areas for improvement along with interventions were identified. Interventions include creation of a standard smoking advice template, protocolising bladder MDT outcomes, mandatory use of electronic operation notes and delivering the capability to administer Mitomycin C at our elective surgery unit. Extending this audit at a regional level may identify other units with significant need for improvement. Following above interventions, a re-audit is necessary to measure change and ensure continued improvement.

In the UK, patients with symptoms suggestive of gastric cancer are referred under the 2-week wait pathway. Endoscopy (OGD) and staging CT scans are the gold standard for diagnosis, but some patients cannot tolerate OGD. In such cases, barium swallow may be used as an alternative. This audit evaluates whether barium swallow adds diagnostic value following a normal staging CT in patients unable to undergo OGD.

A retrospective analysis of 107 patients investigated for upper GI cancer was performed between June 2023 and August 2024. Of these, 94 were referred under the 2-week wait pathway, and 13 for cancer progression. Patients who had both a barium swallow and staging CT were included. Sensitivity and specificity analyses were conducted.

Of 97 patients with normal or non-malignant CT findings, 96 had concordant barium swallow results. One patient had a discrepancy, with barium swallow showing an indeterminate indentation later diagnosed as mild gastritis via OGD. Of 10 patients with malignant CT findings, 2 had malignancy confirmed on barium swallow. The sensitivity and specificity of barium swallow to detect upper GI malignancy were 20% (95% confidence interval [CI]: 25.2 – 55.6%) and 99% (95% CI: 94.4 – 99.9%), respectively.

This audit suggests that barium swallow provides limited additional value following a normal CT in suspected gastric cancer cases and should not be used as a substitute for OGD. In many cases, CT scans alone may suffice for diagnosis. Further research is needed to evaluate the impact of omitting barium swallow on patient outcomes.

BESS recommends follow-up cross-sectional imaging following glenohumeral dislocation in patients between the ages 40-60 years. Imaging is either via ultrasound or MRI. The aims of this study were to calculate the incidence of rotator cuff tears within a population from a period between August 2021 to May 2024, and then calculate the percentage of patients that received conservative or surgical management. This analysis would enable us to discuss the recommendations from BESS.

Sample data was retrieved from business intelligence services at Imperial College Healthcare Trust. Patient case details were used to identify those with further imaging via US/MRI via Cerner and PACS. This would enable us to calculate the incidence of rotator cuff tears on imaging and identify if they proceeded with conservative or surgical management.

167 patients were identified within the 40-60y age cohort that presented to our unit with dislocations. The mean age was 50.6 years (SD 7.9). 136 (81.4%) patients had radiographic evidence of dislocation with 66 (48.5%) patients undergoing either MRI and/or US. Incidence of rotator cuff tears was 45.5% (30 patients). None of the patients with diagnosed tears proceeded to surgical management.

The incidence of rotator cuff tears is higher in patients following dislocation, which is consistent with previous literature on the topic. With the lack of patients in this age cohort progressing to surgery, debate can be had on the cost-effectiveness of recommendations from BESS and the necessity that these patients require further imaging if it isn’t altering management.

To improve compliance with recording NELA mortality risk scores on consent forms ensuring risk communication and informed decision making with the patients.

The study sample was patients who required an emergency laparotomy from 15/08/2024 to 14/09/2024 in our hospital. Data was sourced from the NELA database of laparotomy cases, with consent forms accessed via Mediviewer or patient folders. The first cycle included a sample size of 25 patients, and prospective data collection was performed by a separate author to minimize bias. Collected data were subsequently organized and analysed using Microsoft Excel.

Guidelines NCEPOD Knowing the Risk 2017, GPAS 5.524. An assessment of mortality risk should be made explicit to the patient and recorded clearly on the consent form and in the medical record. Target: >/- 85% (Green) Compliance.

Out of 25 patients, the percentage of mortality documented on the consent form indicated a compliance rate of 27%. No associations were found with the type of surgery, indication, or patient demographics.

Our trust's practice results are below 55%, classified as 'Red' according to NELA standards. The focus of improvement lies in education and emphasizing the importance of informed decision making for patients and their families. Our action plan involves presenting results at Clinical Governance, disseminating guidelines, promoting best practices through peer education and awareness posters, and conducting a re-audit to assess progress.

Fascia-iliaca block (FIB) is regional anaesthetic used in A&E for hip fractures. NICE recommend FIBs for hip fractures if PO/IV paracetamol/opiates provide insufficient relief. RCEM state FIBs should be administered promptly in A&E by trained personnel.

The aim of was to assess the percentage of hip fracture patients receiving FIB in Southport A&E and to find ways to increase the compliance with the intervention. These patients should have documented FIBs with a standard of ≥90% patients.

This QI project was an analysis of two 6-week periods 08/08/2022-20/09/2022 and 10/4/23-25/5/23 for hip fracture patients at Southport DGH. Data was collected from the National Hip Fracture Database. Inpatient/A&E notes and drug charts were analysed for FIB documentation. Interventions were instrumented between the two cycles including reminder posters in A&E, additions to A&E NOF admission proformas, and A&E doctor education.

The first cycle identified 46 patients, 28.2% had documented FIBs on admission (13 given, 33 not given). The second cycle identified 38 patients, 50% had documented FIBs on admission (19 given, 19 not given). There was a statistically significant increase in the patients receiving FIBs on admission following interventions (p<0.05).

The QI project demonstrates too few patients continue to receive FIBs with hip fractures despite intervention. However, there was a statistically significant increase in patients receiving FIBs post intervention in this study, showing awareness and education of the use of FIBs for hip fracture patients increases compliance with guidelines as per previous studies.

Ureteric stenting is a common urological procedure. Forgotten ureteric stents can lead to significant morbidity and mortality, including infection, encrustation, and renal damage. Therefore, it is essential to have a reliable, safe, and effective system to monitor and track stents. Currently, there is no national stent register within the NHS. The British Association of Urological Surgeons (BAUS) recommends establishing an effective register combining automation with human oversight.

An automated ureteric stent register was developed using Microsoft 365 Lists, integrated with SharePoint and Power Automate. A dedicated departmental SharePoint page and shared email address were created. The “Stent Register” was set up on SharePoint and is easily accessible and populated via a Microsoft Form, with stent actions (insertion, removal, and outcome) recorded. Automated email reminders, triggered by Power Automate, notify consultants and secretaries when stents approach removal dates. A calculated column, "Days remaining," allows real-time tracking of stent removal deadlines.

The Microsoft 365 stent register improved oversight of ureteric stents. The automated email reminder system ensured timely communication and intervention, significantly reducing forgotten stents. User feedback demonstrated high satisfaction with the system’s ease of use and efficiency, with a noticeable improvement in stent management practices.

The automated “Stent Register” using Microsoft 365 Lists is a free and efficient solution for tracking ureteric stents. It is easy to access and includes automated and visual reminders, enhancing patient safety by reducing forgotten stents. Broader implementation and adoption across departments or Trusts may be beneficial.

Reducing surgical site infections (SSI) is crucial for enhancing patient satisfaction and cutting hospital costs. Current guidelines for living donor nephrectomies recommend prophylactic Flucloxacillin or Teicoplanin at induction, however this only provides gram-positive antimicrobial cover. We aimed to determine whether SSI rates were reduced with broader spectrum antibiotic cover compared to the current regime.

Consecutive adult patients (≥18 years old) undergoing a hand-assisted donor nephrectomy between January 2022 and September 2023 were included. SSI were defined by the Centers for Disease Control and Prevention criteria, with complications graded using the Clavien-Dindo classification system. Outcomes were measured up to 30-days postoperatively. Anaesthetic charts and electronic patient records were used to collect antibiotic and patient variables. Multivariable models were used to account for case mix.

A total of 81 patients were included. Overall, 55 (67.9%) received gram-positive prophylactic coverage only, whilst 26 (32.1%) received prophylaxis also covering gram-negative organisms. 30-day SSI rates were significantly elevated in patients receiving gram-positive prophylaxis cover (25.5% vs 0%, p=0.012). Three patients (5.45%) receiving Flucloxacillin experienced Clavien-Dindo grade 3 complications, compared to none with gram-negative cover. This equated to a 21.61% absolute risk reduction (ARR) if gram-negative prophylaxis cover was used. This difference persisted after accounting for variation in age, gender, operative lateralisation, BMI, and surgeon.

Our findings support the use of antibiotic prophylaxis which includes gram-negative cover (e.g., Co-amoxiclav) for patients undergoing donor nephrectomy. This change should significantly reduce postoperative SSI morbidity in a very healthy patient population.

To assess adherence to the Trust’s rib fracture guidelines.

A retrospective analysis of 6 months' data (November 2023 to April 2024) included 38 patients with new-onset rib fractures. These patients were categorised into three groups using the STUMBL score: Low, Medium, and High risk. The score considered factors such as age, anticoagulant use, pain, SpO2 at admission, number of ribs fractured, and chronic lung disease. We reviewed their hospital course, including the timing of nerve block administration and early referral to the critical care outreach (iMobile) team for high-risk patients.

Of the 38 patients, over 55% (21) were over 70 years old. Four were in the low-risk group, five were medium-risk, and 29 were high-risk. Among high-risk patients, 31% (9/29) were not referred to the iMobile team on time. Only 9 out of 27 patients with an indication for a nerve block received it within 24 hours. Of the 17 patients who did receive nerve blocks, 11 were managed in a specific ward where trained staff for managing peripheral nerve catheters were available, while 6 were managed in other wards.

Adhering to rib fracture guidelines is crucial to preventing life-threatening complications. Prioritising peripheral nerve block administration within 24-48 hours is essential to reduce morbidity and hospital stay. Standardised training across wards would ensure consistent care and prevent overburdening specific units. These findings from our first audit cycle aim to raise awareness and drive improvement.

To evaluate the outcomes and safety profile of precision point transperineal prostate biopsy (TPPB) performed under local anaesthesia (LA) and whether there is a need for routine antibiotic prophylaxis at East Lancashire Hospitals NHS Trust over two audit cycles.

A retrospective audit was conducted on 300 patients who underwent TPPB between June 2022 and May 2023. Data were collected on patient demographics, biopsy outcomes, pain scores, satisfaction levels, use of pre-biopsy antibiotics, and complications. The first audit cycle included 100 patients, while the second cycle included 200 patients. Changes implemented after the first cycle included the cessation of routine pre-biopsy antibiotics and the introduction of pain and satisfaction assessments.

The cancer detection rate remained consistent at 80% in the second cycle. MRI-targeted biopsies showed a 70% consistency with histology findings. Most patients (93%) tolerated the procedure well under LA, with high satisfaction scores (mean CSQ-8 score: 31-32). The implementation of no routine antibiotics did not significantly increase infection rates. Only one symptomatic urinary tract infection (UTI) with a positive urine culture was reported in the second cycle, demonstrating a low infection rate despite the absence of routine prophylaxis. No cases of post-biopsy sepsis were noted.

Precision point TPPB under LA is a well-tolerated and effective procedure with a high cancer detection rate. The cessation of routine antibiotic prophylaxis is safe and appropriate in low-risk patients. Patient satisfaction remains high, and complications are minimal, supporting the continued use and potential expansion of the TPPB service in outpatient settings.

Paediatric appendicitis management is a critical aspect of surgical care, particularly in minimizing the negative appendicectomy rate, which ideally should be around 15% as per NICE guidelines. The introduction of a structured workflow aimed to enhance diagnostic accuracy and reduce unnecessary surgeries while adhering to clinical standards.

A closed-loop prospective audit was conducted from August 2020 to August 2024 at our institution. The audit focused on implementing and evaluating a comprehensive workflow for managing paediatric appendicitis, emphasizing non-operative management where feasible, and improving pre-operative diagnostic accuracy. Data were collected on diagnostic approaches, surgical outcomes, and adherence to the new pathway, with periodic feedback cycles to refine the process.

The introduction of the workflow resulted in a significant reduction in the negative appendicectomy rate from 18% to 10% over the audit period. Additionally, there was a marked increase in the use of imaging and clinical scoring systems, leading to more accurate diagnoses and a higher rate of successful non-operative management in selected cases. The overall patient outcomes improved, with fewer complications and a reduction in hospital stay duration.

The implementation of a structured paediatric appendicitis workflow has successfully reduced the negative appendicectomy rate and improved adherence to clinical guidelines. This workflow is now a part of routine practice, leading to better patient outcomes and more efficient use of healthcare resources in the management of paediatric appendicitis.

Procedure-specific consent forms (PSCFs) are an alternative to generic consent forms. The former includes pre-printed information on procedure risks/benefits, the latter require this information to be added by hand. PSCFs may therefore have an advantage in ensuring inclusion of all important information pertaining to a procedure, so that patients can provide fully informed consent.

Audit of generic handwritten laparoscopic cholecystectomy (LC) consent forms for operations performed in a tertiary centre April to May 2024. Documented risks of procedure were audited against national standard of NHS website and EIDO Healthcare listed risks of laparoscopic cholecystectomy. Additionally, consent regarding blood transfusion was audited as per GIRFT best practice guidelines.

There was poor compliance against all standards measured. The only complications mentioned in 100% of consent forms were ‘Bleeding’ and ‘Bile leak’. 0% included all 8 NHS website complications of LC. 0% included all EIDO complications of LC. 25% included patient wishes regarding blood transfusion.

There is inadequate information regarding risks of LC being documented on generic handwritten consent forms locally. This presents a risk of patients not providing fully informed consent and leaves the trust vulnerable to litigation in the event of a procedure-related complication. To address this, we are piloting the use of a PSCF for LC. This is the first use of PSCF in our trust directorate and is being rolled out following approval of form contents by the key stakeholders. We will elaborate on this process and the challenges for those wishing to introduce PSCFs locally.

This project was created in order to improve management of acute palliative surgical patients. Our goal is to educate staff on the early recognition and management of acutely dying surgical patients to enable optimal symptom control and psychosocial support.

We performed both a staff survey and closed loop audit on patients who had died on the surgical ward derived from M&M data. Outcomes were measured against NICE guidelines.

A total of 60 patients were included. Prior to interventions aspects of care were performed well such as DNACPR, anticipatory medications and family discussions. However, despite a majority of patient’s having a Treatment Escalation Plan completed a majority had no information within goals (70%) and interventions (80%) sections leading to confusion out of hours. Early drug rationalisation was not carried out in 40% of patients leading to inappropriate prescriptions. Hydration status was only assessed in on third of patients. Psychosocial support was offered to 50% of patients. Of the patients that did not receive a syringe driver, 45% should have had a syringe driver according to symptoms. Of those that received a syringe driver a quarter of these patients had a syringe driver for less than 4 hours. After interventions these areas improved.

This study shows a need for regular teaching on recognition and management of dying patients. Continued top down and bottom-up approach working with senior palliative and surgical teams to support junior staff results in increased staff confidence and improved outcomes for patients and families.

The aim of this audit was to evaluate the preoperative mid-stream urine samples (MSU) taken for elective endourology procedures and assess postoperative morbidity and mortality. Research suggests postoperative urosepsis to be a life-threatening complication and hence identifying if preop infection can reduce morbidity and mortality.

A retrospective audit identified patients that underwent elective endourology procedures during the month of February 2024. We recorded whether or not they had a preoperative urine dip and MSU. If the MSU was positive; were appropriate antibiotics given. Finally, re-admissions postoperatively with infection and subsequent morbidity or mortality was noted.

We identified 161 patients. 94 (58%) had MSU’s sent preoperatively. 2 patients had a urine dipstick done on the day of the procedure. From the preoperative cultures, 74 patients had a negative culture and 23 had a positive culture. E. Coli was the most common organism (9) then coliform species (5), Enterococcus (4), Yeasts (2) and mixed growth (1). Postoperatively 8 patients were re-admitted with infection and morbidity and 1 patient had a mortality. 6 of these were upper tract cases and 3 were lower tract. Out of the 9, 4 did not have a MSU sent preoperatively.

MSU and urine dip should be considered for endourology cases in order to mitigate risk of postoperative sepsis and mortality. By re-auditing this data and introducing a change to perform preoperative MSU’s in all patients, we hope to reduce the rate of postoperative complications.

This audit aims to evaluate the hospital’s adherence to established standards for faster diagnostic pathways and timely treatment initiation for prostate cancer, aiming to identify gaps and improve care quality.

A retrospective study was conducted on prostate cancer patients referred in January 2024. Key time intervals assessed included the duration from GP referral to clinic appointment, time for MRI imaging, time from clinic to precision-point biopsy, and time from biopsy to multidisciplinary team (MDT) discussion for treatment initiation. Shortcomings identified were addressed through targeted interventions, with a comparative analysis conducted after six months to assess improvements.

In January 2024, the average time from GP referral to clinic appointment was 25 days, which improved to 22 days by July 2024. The time from clinic appointment to biopsy decreased from an average of 28 days to 23 days. The time from biopsy to MDT discussion remained stable at 18 days but showed a narrower range. The proportion of cases experiencing a 62-day breach dropped significantly from 53% in January to 23.8% in July 2024.

The audit reveals substantial improvements in the prostate cancer diagnostic and treatment pathways. Interventions successfully reduced the average time from GP referral to clinic appointment and from clinic to biopsy. Although the time from biopsy to MDT discussion remained unchanged in average terms, the range became more consistent. The significant reduction in 62-day breaches highlights enhanced adherence to timely diagnosis and treatment standards, indicating the effectiveness of the implemented interventions in optimizing patient care pathways.

It is crucial that patients have access to reliable information. This has traditionally been through patient information leaflets (PILs) given during clinic appointments. This project addresses how modern technology can enhance delivery of information and patient engagement.

In the ENT outpatient setting of the Royal United Hospital across January 2024, pre-existing PILs were first evaluated via patient questionnaires. These findings were used to drive several changes: renovation of PILs, motivating clinician signposting and introducing QR codes linking to PILs in waiting rooms to modernise delivery of information. Patient feedback was utilised to drive each subsequent cycle.

Pre-intervention, zero of the surveyed patients had received PILs in prior appointments and of these only 30% utilised online resources, despite 69% thought QR codes would be useful. Post-intervention, 100% of the patient group received PILs during appointments, of which 64% rated the QR codes as an extremely useful mode of information.

The results successfully show that patients prefer having a digital source of information compared to traditional hardcopy alone. So far, we have identified a modern way to engage the patient group and implement an innovative patient-endorsed way of accessing information. There is scope for alternative multimedia, such as video or audio links, which we will pilot in future cycles. Innovations such as these can be deployed across other surgical specialties.

Fractures of the distal radius are common and result from both high and low energy trauma. Delays in distal radius fixation and upper limb injuries due to limited theatre time and other cases often occur. These patients come in lower priority for day case surgery ultimately may result in more pain, less functional activity, and longer recovery periods.

Identify the number of days from the day of decision regarding surgery to the actual day the patient had surgery and compare with the BOAST guideline i.e. If surgical intervention is undertaken, this should be performed within 72 hours of injury for intraarticular fractures and within one week for extra-articular fractures.

The study analysed total cases, number of cases in different theatres, upper limb and general trauma cases, time to surgery, and proportion of patients meeting recommended targets for surgery.

Data collection is done through theatre management software by searching ‘radius’, 'distal radius’, ‘forearm’ and ‘wrist’ ORIF and looking at scans of the patients.

This audit indicates that there has been improvement to 59.61% from 35% for intra-articular fractures and 74.04% from 70% for extraarticular fracture.

Possible reason is due to having a dedicated Upper Limb theatre list twice a week.

Although the Audit showed improvement in percentage those who meet the BOAST Guidelines, the rate for intra articular fracture is still far behind extra articular (possible reason may be due to requirement of specialist upper limb surgeons, delay for CT Scans and shorter time.).

To determine the extent of inadequate urine flow rate studies performed in urology outpatient clinic and aim to improve this.

Data was collected on patients presenting to outpatient urology clinics between March and May 2024 in a single tertiary hospital, who had a flow rate study and post-void residual (PVR) urine volume documented. Data was collected on patient demographics, total voided volume, maximum flow rate (Qmax) and PVR. Flow rate study was determined to be adequate if the total voided volume was between 150ml and 500ml, as per BAUS guidelines.

Total number of patients included was 59. Majority of patients were male (88%) and ages ranged between 20 years and 86 years. More than half the patients (33 patients, 56%) had an inadequate flow study. Inadequacy was due to insufficient total voided volume in 31 patients and due to over filled bladders in 2 patients.

An insufficiently filled bladder is the main factor resulting in an inadequate flow study. This is a significant drain on resources especially when further clinic appointments are scheduled for a repeat flow study. An improvement in outcomes can be made by patient information and education. Following these audit results, a patient information leaflet has been created, derived from BAUS website information leaflet on Uroflowmetry, and this has been posted out to patients along with their clinic appointment letter. Following intervention, a re-audit will be carried out to assess for improvement in the number of adequate flow studies.

The General Surgery (GS) Department at our district general hospital welcomes new Foundation Year 1 doctors (FY1s) every four months. A formal induction is held on the first day, with an induction booklet circulated prior to the start date. The existing booklet was outdated.

This project aimed to review, update, and improve the induction booklet, and audit the experience of FY1s. Feedback from the previous induction and guidance from the British Medical Association (BMA) were used to revise the booklet as well as benchmarking our booklet against that of similar departments.

A questionnaire collected quantitative and qualitative data on FY1s' experiences across two cohorts of junior doctors who started their rotations accordingly. Primary outcomes included satisfaction with induction and confidence at the start of the rotation, measured before and after the updated booklet's implementation.

Satisfaction with the induction process went from 51% to 88.6% (37.6% increase). Self-reported confidence at the start of the placement increased from 54.4% to 82.8% (28.4% increase) after introducing the new booklet. Overall, doctors in the second cohort felt more competent in clinical skills at the end of their rotation.

Feedback from both cohorts highlights the importance of regularly updating induction materials and establishing mechanisms for collecting anonymous feedback to enhance departmental processes.

This study aimed to evaluate the knowledge of surgical nurses regarding the Enhanced Recovery After Surgery (ERAS) protocol for elective colorectal surgery. It also assessed the impact of educational interventions on improving their understanding of ERAS principles to enhance patient outcomes, reduce complications, and accelerate recovery.

This study assessed the knowledge of surgical nurses working in colorectal clinics, wards, and recovery units in two district general hospitals. The first phase included 40 nurses, while the second phase involved 21 nurses. An educational initiative consisting of several teaching sessions was conducted between the two phases. A modified version of the Ongun et al. questionnaire was used to evaluate nurses’ understanding of key ERAS principles.

Prior to the teaching sessions, knowledge of key ERAS components was limited. For instance, only 45% of nurses understood the need to stop alcohol intake four weeks before surgery, which improved to 95.2% post-teaching. Early mobilisation awareness rose from 55% to 90.5%. Knowledge of thromboembolism prophylaxis grew from 70% to 90.5%, multimodal pain relief from 75% to 100%, and early postoperative feeding from 70% to 95.2%. However, it was noted that further development is needed in areas such as the routine use of bowel preparation, which saw only a modest improvement from 7.5% to 42.9%.

The study revealed significant improvements in surgical nurses' knowledge following the educational intervention. Despite these gains, certain aspects still require development, highlighting the need for ongoing education to ensure successful ERAS implementation.

Diabetic foot ulcers (DFUs) are a serious complication in diabetic patients, leading to infection, gangrene, and amputations. Hyperbaric Oxygen Therapy (HBOT) has been proposed as an adjuvant treatment to enhance wound healing. However, the NHS currently limits its use due to insufficient evidence supporting its routine application in clinical practice. This audit aims to evaluate the effectiveness of HBOT as an adjuvant therapy for DFUs and its role in preventing major below or above-knee amputations.

A retrospective study was conducted on 10 patients with Wagner grade 2-3 DFUs treated with HBOT at a District General Hospital between 2018 and 2019. Patients underwent five sessions of HBOT a week, each lasting approximately 75 minutes. Ulcer size, healing progress, and need for major amputation or revascularisation were assessed using patient records at six months post-HBOT.

Of the 10 patients, 50% (n=5) had a successful outcome, defined as complete healing with no further revascularisation required. 30% (n=3) had partial outcomes, defined as a moderate reduction in ulcer size, requiring revascularisation therapy post-treatment. 10% (n=1) had failed outcomes, defined as ulcer progression requiring urgent amputation. One patient discontinued treatment due to claustrophobia.

HBOT shows potential in promoting ulcer healing and reducing the risk of major amputations in patients with chronic DFUs. However, given the study’s limited sample size, additional large-scale, randomised controlled trials are needed to further assess HBOT’s effectiveness and to establish standardised treatment protocols.

The Francis Report recommended introducing a responsible consultant, with a headboard showing this by the patient. It is frequently reported that patients are unaware of their responsible consultant. We set out to audit awareness of a responsible consultant at a tertiary referral centre.

Inpatients from March–August ’24 in UGI, HPB and colorectal surgery were included, with eligibility generated from ward round lists. Being unable to answer questions was an exclusion criterion. This audit was registered locally. After cycle 1, data presentation occurred, a change was initiated, then cycle 2 was conducted. The set standard is that 100% patients are aware of their responsible consultant.

Overall, 107 patients were included. There were insignificant demographic differences between cycles. Between cycles 1 and 2, patient awareness of responsible consultant improved from 56.5% to 71.1% (p=0.089) and headboards showing named consultant improved from 43.5% to 53.3% (p=0.234). On stratifying by specialty, headboard improvement was significant for UGI patients (p<0.001).

During cycle 1, poor adherence existed. Results were presented to FY1 doctors and surgical departments, with juniors given whiteboard pens, aiding writing headboards. Cycle 2 results improved from cycle 1. It should be noted, electronic noting was introduced between cycles. Further cycles should aim for continued improvement.

Treatment escalation plans (TEPs) and Do Not Resuscitate (DNR) orders provide crucial guidance on how to manage patients appropriately if their condition deteriorates. There is national guidance provided by BMA and resus council in combination highlighting this. The Human Rights Act 1998 provides the legal basis in England. It is a medical decision and patients should always be informed.

This project focuses on identifying the presence of these forms in surgical patient’s records, and whether we can improve this.

Records were obtained from patient records on a single inpatient ward, obtaining date of admission and whether a TEP or DNR was in place.

The Plan-Do-Study-Act cycle approach was taken, with a snapshot initial audit, followed by an educational tool for all junior doctors in the department. Posters were sent to clinicians and displayed on acute wards.

During the first cycle, data was collected on 30 patients. Where 13.3% had TEP forms in place. Post-intervention, this increased to 36.8%. DNR forms were filled in for 4/30 patients’ pre-intervention and 1/19 post-intervention.

This conveys that many clinicians are not aware a TEP form should be filled in if the patient is for full escalation. Although this project identifies the improvement of filling in TEP forms, it additionally highlights limitations such as small sample size and its snapshot audit approach. To draw conclusions regarding appropriate DNR decisions, a more in-depth approach is required. To improve on this work, further educational opportunities such as presentation at departmental level can take place.

This study evaluates patient satisfaction in a urology day case unit performing flexible cystoscopies at a tertiary hospital, aiming to identify factors influencing satisfaction and areas for improvement.

A prospective analysis was conducted on flexible cystoscopy procedures at Royal Derby Hospital from October 2023 to June 2024. Patient feedback was collected using a structured questionnaire, assessing key elements of the consent process, patient understanding, and overall satisfaction.

Out of 89 patients surveyed, 95% received written or verbal confirmation about the procedure. 79% were directed to additional information sources, and 98% underwent detailed consent with 82% retaining a copy of the consent form. Results and management plans were discussed with 99% of patients, and 85% received a discharge plan with proper safety netting advice. 91% of patients found the information provided easy to understand, 89% felt the timing and explanation of written information were appropriate, and 83% believed it aided their decision making. Additionally, 84% understood the discharge plan without difficulty.

Overall satisfaction with the flexible cystoscopy procedure is high among patients. Nevertheless, there are areas for potential improvement, particularly in enhancing the accessibility and timing of information provided. These findings offer valuable insights for refining patient communication and consent processes in urological care settings.

It is a legal requirement to notify the DVLA about relevant medical conditions. DVLA guidelines state “you can be fined up to £1000 if you do not tell DVLA about a medical condition that affects your driving”. A significant head injury is classed as one of these conditions. As healthcare professionals we are obliged to inform patients that they need to contact DVLA and not doing so is a safety issue with the potential to cause harm.

A retrospective audit looked at surgical patients admitted with a significant head injury over a two-month period, and whether head injury and driving advice was documented in the notes and on discharge letters. A re-audit was carried out following intervention to improve outcomes. Intervention included a head injury advice leaflet for patients and documentation in the notes and discharge letters.

We found that zero patients had head injury and driving advice given and documented on their discharge letters. Following the introduction of a head injury advice leaflet, a further audit cycle over a two-month period was carried out, which showed that driving advice documentation to the GP improved by 70%. This was a significant improvement.

In order to sustain change and guide further improvement, educational sessions, and the introduction of a discharge head injury sticker for the notes has been proposed, as a means of ensuring clarity on advice given, prompt inclusion of this on the discharge letter and to aide communication with GPs on discharge.

Compare compliance with that of 1st cycle and with British Association of Day Surgery standards 2019.

BADS Guidelines for Day Case Surgery 2019 Definition of day case surgery: planned procedure; intended management of day surgery; patient admitted, operated upon, and discharged on same calendar day.

Site: Pennine Acute Trust; Duration: 6 months – April to September 2022; Number of patients: 172; Inclusion criteria: patients who underwent elective laparoscopic cholecystectomy, booked to have a day case surgery done; Exclusion criteria: patients who underwent elective laparoscopic cholecystectomy, booked for inpatient stay (not as day case) or underwent emergency cholecystectomy.

139/163 (85.3%) did have day case surgery; 24/163 (14.7%) booked for day case surgery but had inpatient stay; Trust’s day case cholecystectomy rate of 85.3% is well above the national standard compliance (75%) and has improved since previous audit cycle (65%); 8/24 (33.4%) patients did not have a documented reason for inpatient stay.

Better compliance with BADS standards and on tract with NHS 2020 5-year plan; shorter hospital stay (max LOS down to 7 from 13 days); better documentation (although 33% still did not have documented reason for inpatient stay).

To continue comprehensive assessment of patient pre-operatively in clinic and during admission. Better documentation in clinic letters when patient is booked for surgery as a day case /inpatient surgery stating the underlying reasons. Better case note documentation of inpatient stay reason and post operative instructions.

Preoperative fasting is a standard procedure before surgery that aims to prevent pulmonary aspiration. However, the consequences of excessive preoperative fasting include dehydration, reduced patient comfort, increased postoperative insulin resistance, and increased catabolic response to surgery.

The study retrospectively collected data over 4.5 months from 100 general surgery patients of the CEPOD list under general anaesthesia. Exclusion criteria consisted of under local anaesthesia, elective cases, existing GI upset e.g., nausea/vomiting and procedures involving major gastrointestinal operations.

The mean age was 44.48 ± 11.12 and 79.2% of the patients were male. Procedures included I&D of superficial and pilonidal abscess, EUA and perineal abscess drainage, hernia repair, flexible sigmoidoscopy, hot gallbladder, and haemorrhoidectomy and their percentage were 45%, 36%, 11%, 1%, 7%, 1% respectively. The mean fasting time for liquid and solid was 10.61 hours and 15.28 hours respectively. The percentage of excessive fasting from liquid (>2 hrs) and solid (>6 hrs) were 95% and 97% respectively. The main reasons for this high rate were a single theatre shared by all emergency cases, keeping patients fasting from midnight or 2 am routinely and lack of discussion of probable timing during morning CEPOD meetings.

It is believed that this current study will enhance the awareness of nurses and other healthcare professionals involved in the patient's surgical process, who hold crucial roles and duties within the healthcare team and foster a critical and inventive perspective on current practices.

To assess how safely medicines that are dependent on anthropomorphic measurements are prescribed.

This prospective snapshot audit collected data from all patients who were admitted under the General Surgery on call team at the Royal United Hospital, Bath. Electronic prescriptions for paracetamol, gentamicin and dalteparin on PowerChart were assessed to see if they were prescribed safely, factoring in patient weight.

Data was collected from 87 eligible patients: in terms of weight adjusted prescriptions, 98.6% of paracetamol prescriptions were safe, 93.8% for gentamicin, 92.6% for dalteparin. 93.1% had a VTE risk assessment completed, 58.6% had formal Malnutrition Universal Screening Tool (MUST) documented and 27.6% had just weight recorded on the system. Only 12.6% did not have a weight recorded on the system in any form and 33.3% had MUST re-documented 1 week later.

Length of hospital stay is a risk factor for malnutrition and subsequent low body weight. The British Association for Parental and Enteral Nutrition suggest using MUST (recording height and current weight) on admission and rechecking one week after admission. It is clear that digitalisation of prescribing is an effective safety net and minimises clinical error. This is evident from the data sets that had electronic prompts (e.g., gentamicin prescribing requiring you to input a weight) were well adhered to, whereas datasets without electronic prompts (e.g., re-checking MUST after 1 week admission) were more poorly documented.

The Modified Glasgow Score (MGS) is crucial in assessing the severity of acute pancreatitis (AP) within 48 hours, as advised by the Royal College of Surgeons. The audit aimed to determine whether the MGS is being documented at admission and 48 hours post-admission and to assess the use of the hospital AP proforma, which includes MGS calculation. Accurate scoring and documentation can assist in clinical decisions regarding discharge or escalation to higher care.

A retrospective audit was conducted in two cycles, analysing 54 patients diagnosed with AP. Cycle 1 included 34 patients, and Cycle 2 involved 20 patients. Data were collected from patient notes, focusing on whether MGS was documented on admission and at 48 hours, and whether the Trust’s AP proforma was completed. Compliance with these standards was compared between the two cycles.

In Cycle 1, 21% of patients (7/34) had MGS documented on admission, and 12% (4/34) at 48 hours. Only 5% (2/34) had the proforma completed. Cycle 2 showed improvement, with 70% (14/20) of patients having MGS documented on admission and 55% (11/20) at 48 hours. The proforma completion rate increased to 90% (18/20).

The audit demonstrated a significant improvement in MGS documentation and proforma usage between Cycle 1 and Cycle 2. The increased use of the MGS can allow for earlier detection of severe cases and prompt escalation as necessary thus reducing adverse clinical outcomes. Further recommendations include ongoing staff education, ensuring proforma availability, and conducting a third audit cycle to sustain improvements.

Small bowel obstruction (SBO) is a common surgical emergency with wide inconsistency in management as evidenced by the National Audit on Small Bowel Obstruction (NASBO). We sought to assess our management in the light of the NASBO recommendations.

A prospective cohort study in a UK district general hospital of patients admitted with SBO from December 2023 to March 2024. Outcomes included demographics, laboratory parameters and pathway milestones. Data were retrieved through an electronic database and analysed using descriptive statistical software in Excel.

Forty patients with a median age of 75 years were included. Mechanical causes were found in 38 (95%) with adhesions leading the list with 21 (55%). CT was done in everyone while X-ray was in 75% of them. Non-operative management was successful in 24 (60%) patients while surgery was fruitful in 16 (40%). Water soluble oral contrast challenge (WSOC) was successful in 15 out of the 20 patients who received it. Nutrition team input was sought out in 19 (∼50%) patients, among them 12 (30%) required nutritional support.

Of note fifteen (37.5%) patients had a recurrent SBO with 12 (80%) of them operated in an emergency setting.

Non-operative management with WSOC has reported a success rate of 75%. This is encouraging- as is the utilization of nutritional assessment and input.

Recurrent SBO is associated with an increased need for surgical intervention. Patients with index SBO may need closer follow-up arrangements and attention should be on identifying interventions to prevent recurrent SBO.

57% undergoing emergency laparotomy are ≥65 years. Evidence suggests geriatrician-led comprehensive geriatric assessment (CGA) may improve post-operative outcomes, but only 8% at Royal Albert Edward Infirmary (RAEI) received one between 2019-2020 (national average 27%).

The referral system from General Surgery to Ageing and Complex Medicine (ACM) (email to secretaries) had no guidelines or National Emergency Laparotomy Audit (NELA) pathway. A standardised referral proforma was created with clear guidelines and NELA pathway aiming to reduce inappropriate referrals, increase NELA referrals and CGA assessments.

We presented the challenges, importance of CGA and proforma at both departmental meetings, facilitating stakeholder engagement. Key influencing individuals were selected as implementation champions.

Data was collected from secretaries’ emails and Health Information System (HIS).

The proforma was successfully implemented (100% compliance). Post-intervention March-June 2024 (n=25) outcomes were compared with pre-intervention September 2023-January 2024 (n=21).

4% (n=1/25) were inappropriate referrals (62% pre-intervention). Six NELA patients were referred (0 pre-intervention). 5/6 were reviewed by geriatricians (CGA), 100% of these were successfully discharged. The one patient not reviewed was re-admitted post-discharge with medical issues.

80% (n=20/25) of referrals underwent geriatrician review (86% pre-intervention). 70% (n=14/20) of reviews were CGA’s (61% pre-interventions). 6/20 were planned for elderly-care bed transfer, achieved in 0% (50% pre-intervention). Total transfer wait was 54 days, costing ∼£21,600 (106 days pre-intervention, ∼£42,400).

Interventions increased NELA referrals and hence CGA reviews leading to successful discharges. The number of CGAs conducted and total transfer wait also improved. Remaining issues relate to elderly-care bed transfer.

This retrospective audit evaluates adherence to the updated NICE guidelines for paediatric grommet insertion in patients with Otitis Media with Effusion (OME). Compliance with these guidelines is essential to ensure optimal outcomes, such as improved hearing and reduced developmental delays.

We reviewed the medical records of 30 patients under 12 years who underwent grommet insertion at two district general hospitals between December 1, 2023, and March 31, 2024. Data collected included demographics, procedure dates, clinic assessments, hearing tests (initial and follow-up), clinical indications, and hearing aid offers. Compliance metrics were assessed, including the duration between first and second hearing assessments, the interval between clinic assessment and theatre booking, and the proportion of patients with significant hearing loss offered hearing aids.

Only 13.3% of patients received a second hearing assessment within the recommended 3-month interval. Delays were noted in 46.7% of cases, and 13.3% did not receive a second assessment. Hearing aids were offered to 53% of patients with significant hearing loss. Same-day theatre bookings occurred in 63.3% of cases, driven by clinical urgency or parental preference, while 23.3% experienced delays due to ongoing investigations or attempts at conservative management.

The audit highlights significant inconsistencies in adhering to NICE guidelines, particularly in follow-up hearing assessments and the offering of hearing aids. Improvements in scheduling, documentation, and communication are needed to ensure timely and appropriate care. Addressing these gaps will improve outcomes for children with OME and enhance compliance with national standards.

15% of the UK adult population have gallstones and present regularly as acute surgical admissions. We know that laparoscopic cholecystectomy is the gold standard management in those with symptomatic gallstone disease. There is still a debate whether patients should undergo definitive management at presentation, or it should be delayed until inflammation has subsided. NICE recommends that patients with acute cholecystitis should be offered cholecystectomy within 1 week of presentation while those with gallstone pancreatitis should receive therapeutic ERCP within 72 hours followed by cholecystectomy within the same hospital admission, or within 2 weeks. This audit was performed to see if patients presenting to Wrexham Maelor Hospital with acute cholecystitis are offered laparoscopic cholecystectomy as per NICE guidelines.

A retrospective audit under a particular consultant with a heavy elective workload over a 5-month period from Jan 2024 to May 2024 was performed. Data collected from the Welsh Clinical Portal (WCP) was collated into Microsoft Excel.

The average waiting time for a patient to undergo a laparoscopic cholecystectomy is 112 weeks based on the data obtained from a laparoscopic cholecystectomy list for all 7 general surgical consultants. As a result, we have also seen a trend of patients being readmitted with sequelae of gallstones such as biliary sepsis and gallstone pancreatitis.

As above, the results were presented at the local audit meeting and stickers were placed on every admission with cholecystitis for tracking. Extra elective lists were also arranged to reduce the waiting time for cholecystectomy.

The GMC requires organizations to provide trainees with effective induction to prepare them for each placement. We have created a virtual video tour of our Burns and Plastic Surgery department to provide new trainees with a comprehensive overview of the department, helping them familiarize themselves with key facilities before they begin their placement.

Our current cohort of trainees were asked to review the video and complete an online google survey to access their views on the usefulness of our virtual tour video compared to the traditional induction they had received.

All trainees had received both trust and departmental face-to-face induction on their first day. They were shown around the department by senior trainees. All respondents felt that viewing the video prior to starting their placements would have been useful in getting to know the department. Those new to our trust felt that knowing what their working environment would look like prior to starting would have allayed some of their anxieties.

Using technology to develop resources, such as virtual tour videos, will enhance the induction experience allowing trainees to have a sense of belonging, make them feel welcomed and reduce stress and anxiety associated with their new roles. By repeating the survey with incoming trainees, we can reassess the effectiveness of this approach and its impact on trainee satisfaction and preparedness.

Appendicectomy is one of the commonly performed operations in the NHS. A prolonged length of stay (LOS) following the procedure not only places a strain on hospital resources but also negatively affects patient outcomes. This project aimed to tackle these issues by reducing LOS through the implementation of a standardized care pathway.

Baseline data from June 2022-May 2023 revealed 142 cases of acute appendicitis (out of 169 total), with 32% of patients staying more than 2 days. The median LOS was 5 days, despite 92% being treated laparoscopically. Key factors contributing to prolonged stays included excessive imaging, prolonged intravenous (IV) antibiotic use, and surgical drains. A standardized care-pathway was developed with the primary goal of reducing LOS. Key interventions included reducing the use of CT scans, limiting the duration of IV antibiotics, and avoiding the use of surgical drains. This pathway was presented to stakeholders, implemented in clinical areas, and supported by the Surgical Same Day Emergency Care (SSDEC).

Post-intervention data (January-March 2024) showed significant improvement, with 40% of patients discharged within 2 days compared to an average of 22% pre-intervention. Further analysis is currently ongoing.

By addressing key drivers of prolonged LOS, this project is successfully standardising care, and improving patient outcomes. The new pathway, supported by SSDEC and virtual ward services, significantly increased early discharges. Continued refinement of the pathway is expected to further reduce LOS variability, benefitting the NHS by optimising resource use and enhancing patientcare through faster recovery and reduced hospital-acquired risks.

Evelina's high-output Day Surgery Centre and Quaternary Surgical Centre status uniquely position it as a hub for surgical training. This study aimed to evaluate the training opportunities and efficiency of case setups in the new Day Surgery Unit (DSU) compared to main theatres, addressing training needs amid surgical backlogs.

Survey was conducted among consultants (N=16) and trainees (N=27) across Paediatric Urology, Plastics, ENT, and Anaesthetics. Data were collected at the initiation of DSU and after pathway establishment, focusing on training experiences (Likert scale 1-5) and list efficiency. Responses from DSU (N=17) and main theatres (N=10) were analysed.

• Training Setup: DSU trainees reported higher satisfaction scores for training opportunities, with median of 5 and average of 4.46/5, compared to average of 4.2/5 in main theatres. Among trainers, 80% in DSU felt the setup was optimal for training, with 41.67% very positive about the opportunities provided(vs 25% in main).

• Patient Flow: DSU demonstrated enhanced efficiency, with lists starting at average of 08:43 and finishing at 15:52, versus 08:36 and 17:04 in main theatres. DSU allowed higher case turnover, averaging 4.3 cases per list(vs 2.27 main theatres).

• Training Progression: 76.9% of trainees in the DSU reported efficient skill progression, versus 55.6% in main theatres, particularly benefiting junior trainees.

Evelina DSU offers a highly effective training environment with streamlined pathways, efficient list setups, and a supportive theatre team. The setup results in fewer interruptions, higher satisfaction, and more streamlined skill progression for trainees. Implementing similar strategies in main theatres could further enhance training experiences.

The COVID-19 pandemic, medical staffing shortages, and NHS strikes have led to delays in appointments and elective surgeries, increasing pressure to perform procedures promptly. Project 3.0 was developed to perform triple the typical number of surgeries using one theatre and one surgical team.

A dedicated high-volume list was created to treat 24 patients requiring low-complexity endoscopic urological procedures. Most patients were from 2-week-wait (2ww) lists, though non-cancer cases were also included. We conducted a retrospective analysis of patients who underwent surgery on the high-volume urology list. Data such as demographics, procedure types, intervention times, theatre transfer times, and complications were recorded in Excel.

From November 2022 to December 2023, six high-volume theatre lists were conducted, treating 131 patients (average age: 45-80) who underwent rigid cystoscopy, bladder biopsy, or TURBT. Each list averaged 21.8 patients, with an average procedure time of 23.3 minutes and operating time of 9.4 minutes. Postoperative complications were low, with a 3% rate of minor complications (Clavien-Dindo grade 1). The “on the day” cancellation rate was 3.05%, significantly below national averages.

High-volume lists can be effectively implemented without compromising patient safety, provided there is thorough preparation and strong teamwork. These lists reduce overall patient wait times, free up elective theatre slots, and prevent breaches in the 2ww pathway timelines.

The British Society of Gastroenterology recommends stratification of lower GI bleed admissions as either “stable” or “unstable” by calculating the Shock Index (SI). This allows for identification of severe cases and discharge for lower risk patients. This audit aimed to measure adherence to BSG guidelines by investigating the proportion of patients who had a SI calculated.

Data collection was carried out over 1 month for each cycle. 45 patients were included in the audit – 28 in the first cycle and 17 in the second. The number of patients who had a Shock Index calculated and recorded in the clinical notes was noted. Between the first and second cycles, the study intervention involved information sheets displayed within the department to highlight the calculation of SI and reminders to clinical staff to ensure that scores were calculated.

During the first cycle, 5 out of 18 (18%) of patients had a SI calculated. 2 were classified as “unstable” and 3 as “stable”. Of the 3 stable bleeds, 2 patients had an Oakland score calculated. After implementation of the intervention (second cycle), 71% (12 out of 17) patients had a SI calculated, with 2 “unstable” and 10 “stable”. Of the stable bleeds, 90% (9/10) had an Oakland score calculated.

An increase in calculation of the Shock Index for LGI bleed patients was demonstrated after implementation of the intervention between the audit cycles. Use of SI in concordance with BSG guidelines aids in early recognition and prompt treatment of severe cases and potential early discharges.

To assess patient waiting times at the Emergency Department (ED) and Plastic Surgery Unit (PSU) at a tertiary referral centre to maximise efficiency.

Prospective data collection was conducted at a Level 1 major trauma centre from 12 February 2024 to 23 February 2024. Data included all patients referred to the on-call plastic surgery team, along with total waiting times.

A total of 23 referrals were received by the ED, with 14 deemed appropriate for review at the PSU. Importantly, no patients reviewed at the PSU were inappropriately transferred from the ED. The average waiting time for patients reviewed at the ED was 263.33 minutes, ranging from 146 to 449 minutes. In contrast, the average waiting time at the PSU was 69.5 minutes, with a range of 0 to 73 minutes. Additionally, when patients were assessed at the ED, the on-call team spent an average of 30 minutes locating and applying dressings, which were managed by nursing staff at the PSU for transferred patients.

Transferring stable patients to the PSU for review led to significantly shorter waiting times compared to those reviewed at the ED. Delays at the ED were caused by challenges in locating equipment, limited space, and the on-call team’s involvement in tasks such as dressing application, which were efficiently managed by the PSU. Optimising the transfer process to the PSU can enhance efficiency, with well-equipped and staffed units ensuring faster patient reviews and reduced waiting times, improving overall service delivery and patient care.

The management of gallbladder polyps remain contentious. There are guidelines which are based on recommendations developed between European Society of Gastrointestinal and Abdominal Radiology (ESGAR), European Association for Endoscopic Surgery and other Interventional Techniques (EAES), International Society of Digestive Surgery–European Federation (EFISDS) and European Society of Gastrointestinal Endoscopy (ESGE). This quality improvement project aimed at comparing the current clinical practice of management of gall-bladder polyps at a London NHS Healthcare Trust to the current guidelines.

Data was collected retrospectively on patients with gallbladder polyps from January 2016 to October 2023. Data were retrieved using the Trust’s electronic systems. The data included patient demographics, diagnosis, results of imaging and histology. Management was then compared against the ESGAR/EAES/EFISDS/ESGE guidelines.

The study identified 223 patients with gallbladder polyps. It revealed that 5% of the patients (n=11) had polyp of size>10mm, while 95% of the patients (n=212) had polyp of size<10 mm. 32% of the patients with polyps<10 mm was symptomatic (n=68).

Amongst the 11 patients who had polyp> 10 mm, 72% of the patients (n= 8) underwent cholecystectomy. Amongst the symptomatic patients with polyp size<10 mm, only 13% of the patients underwent cholecystectomy.

There were 22 patients with polyp size 6-9mm and risk factors for malignancy, of which only 22% (n=5) underwent surgery.

The results show that there is significant scope for improvement in the compliance of two guidelines for management of gallbladder polyp.

Standardized local guidelines as well as further teaching were recommended to improve current practice.

Non-deanery surgical trainees, particularly those new to the NHS, can often find navigating their way around the Intercollegiate Surgical Curriculum Programme (ISCP) portfolio difficult. Our aim was to develop a way to improve understanding and engagement with ISCP.

A series of voice over PowerPoint presentations were created and added onto our SharePoint system. These PowerPoints explain how to use ISCP, how to complete a work based assessment and the requirements for core surgical training in year one and two. An additional video has been created for tips for ISCP, this includes ideas such as creating a weekly target of assessments to add to the ISCP portfolio. The PowerPoints are five-minute presentations, which provide trainees with a snapshot that they can watch at any time. A link to the SharePoint folder will be emailed to all new surgical trainees joining the trust.

A survey was undertaken prior to creating these PowerPoint presentations. The majority of trainees felt overwhelmed and confused as to where to start when it came to using the ISCP portfolio. Our PowerPoint teaching presentations, in conjunction with appropriate mentoring has improved early engagement with ISCP.

We have created a useful adjunct for new surgical trainees to help improve their engagement with ISCP. Going forward, we hope to convert our voice-over PowerPoint presentations into a short video series.

The audit aimed to assess how different methods of managing the lower ureter during nephroureterectomy impacted clinical outcomes, including oncological control, overall survival, and recurrence rates. It also sought to evaluate the complication rates and morbidity associated with each method and compare these findings with the national data.

The study reviewed all patients that underwent a nephroureterectomy from 1 January 2018 to 6 March 2023 at East Lancashire Hospitals NHS Trust (ELHT), involving 94 patients: 67 laparoscopic, 25 robotic, and 2 open surgeries. Data sources included operation notes, histology reports, MDT outcomes, and discharge summaries. Outcomes were tracked up to 1 July 2023, with a median follow-up period of 23.2 months.

The audit found no significant difference in overall or disease-specific survival between different techniques for lower-end management. Robotic surgery showed a significant reduction in complication rates compared to other methods. Recurrence rates were consistent with national data, but distal tumours had a poorer prognosis, aligning with national findings.

Robotic nephroureterectomy offered reduced complication rates, while overall survival rates aligned with national data. The technique for managing the lower end of the ureter did not significantly affect survival outcomes.

To review the compliance with the completion of the organ donor checklist form on receiving an organ. The form should be signed by the receiving ward nurse and countersigned by either a registrar or consultant. This audit also aimed to review the compliance of completion of ABO crossmatch safety check at the time of timeout before starting the operation, in order to never prevent events.

Only DCD and DBD were included. Data from the first cycle was collected from February to March 2024 (N = 33) and the results were presented at the local departmental meeting. Data for the second cycle was collected from April to June 2024 (N = 39).

There was a 100% compliance with ABO safety checklist completion in the second cycle compared to 90.9% in the first cycle. There was also an increase of 8.4% in the checklist being completed and signed at the time of timeout without delays.

Overall, there was a significant increase in compliance. Some of the recommendations moving forward would be to continue effective staff training around the importance of completing the ABO crossmatch safety check at the time of timeout and for all members of the theatre staff to be included, i.e., nurses, surgeons, and anaesthetists.

This study aimed to assess the impact of implementing the Enhanced Recovery After Surgery (ERAS) ward round template on adherence to ERAS protocols and patient outcomes following elective laparoscopic colorectal resections.

A twelve-week re-audit was conducted, involving 19 patients who underwent various laparoscopic colorectal procedures. Data were collected on recovery indicators, including length of hospital stay, early mobilization, restarting oral intake, PCA (Patient-Controlled Analgesia) cessation, and urinary catheter removal (TWOC). These results were compared to an initial audit to evaluate improvements in adherence to the ERAS protocol after adopting the ERAS ward round template.

The ERAS template was used in 35% of post-operative ward rounds, up from 2.8% in the first audit. The length of hospital stay was significantly reduced, with 63% of patients discharged within 5 days, compared to 25% in the first audit. Early mobilization on Post-Operative Day 1 was achieved in 70% of patients, an improvement from 50%. Oral intake was restarted on the day of surgery or Post-Operative Day 1 in 79% of cases, up from 66%. PCA was stopped by Post-Operative Day 2 in 65% of cases, and 84% of patients had TWOC on or before Post-Operative Day 2, compared to 33% in the initial audit.

The implementation of the ERAS template led to improved adherence to recovery protocols and better patient outcomes, including earlier mobilization, reduced reliance on PCA, earlier catheter removal, and shorter hospital stays. Further efforts should focus on increasing the use of the template and training junior doctors on ERAS protocols.

We aimed to verify implant selection in a busy DGH setting against NICE guidance; additional benefits included cost-effectiveness and sustainability implications.

A retrospective review of all patients receiving a DHS (Dynamic Hip Screw) or IM (Intra-Medullary) Nail between April and October 2022 was planned.

Two independent researchers were calibrated by experienced senior Orthopaedic authors. Data was collected using a pre-specified form, including implant used, fracture pattern and classification. Discrepancies were adjudicated by a third senior author.

Basic data description in the form of percentages was planned, with the ideal NICE compliance target set at 95%. Further re-audit following intervention was also planned.

initially 86 patients received a DHS or Nail were identified over a three-month period with 63% (56) receiving a DHS. 16 received a Nail when NICE indicated DHS, of these two were confirmed to have received the incorrect treatment, the remaining 14 showed a comminuted pattern. Increased regular education, including education posters in the trauma meeting room and focused time during departmental teaching, was utilised and disseminated throughout the Trust's orthopaedic team. Increased awareness through the audit meeting to the wider consultant team was also performed. Following the intervention and re-audit, over six weeks with 25 patients included, the compliance rate increased to 100%.

The literature has shown no benefit of IM Nail over DHS when both implants can be used. The correct selection of implant compared to pattern and classification of fracture is vital to ensure increased sustainability and economy.

The GMC requires organizations to provide trainees with effective induction to prepare them for each placement. We have created a virtual video tour of our burns and plastic surgery department to provide new trainees with a comprehensive overview of the department, helping them familiarize themselves with key facilities before they begin their placement.

To streamline the induction process for new trainees within our burns and plastic surgery department.

Our current cohort of trainees was asked to review the video and complete an online Google survey to gauge their views on the usefulness of our virtual tour video compared to the traditional induction they had received.

All trainees had received both trust and departmental face-to-face induction on their first day. They were shown around the department by senior trainees. All respondents felt that viewing the video prior to starting their placements would have been useful in getting to know the department. Those new to our trust felt that knowing what their working environment would look like prior to starting would have allayed some of their anxieties.

Using technology to develop resources, such as virtual tour videos, will enhance the induction experience allowing trainees to have a sense of belonging, make them feel welcomed and reduce stress and anxiety associated with their new roles. By repeating the survey with incoming trainees, we can reassess the effectiveness of this approach and its impact on trainee satisfaction and preparedness.

Inappropriate intravenous fluid prescribing in peri-operative nil-by-mouth (NBM) patients increase the risk of electrolyte, metabolic imbalances, and starvation ketosis. Surgical patients often have conditions that cause vomiting and diarrhoea which subsequently leads to electrolytes losses such as potassium and chloride. This vulnerable cohort requires specific attention to sufficient fluid administration. NICE guidelines provide recommendations for maintenance IV fluid prescribing for 'nil by mouth" patients to provide adequate sustenance.

Clinical Audit at a District General Hospital. Our sample size was 26 patients. Our inclusion criteria included NBM for ≥24hr. Patients with diabetes or pre-existing electrolyte disturbances were excluded. Data was collected retrospectively from May 2024 to July 2024.

26 patients were included. Out of 26 patients only 6 patients' prescriptions were meeting the water requirement, and only 5 were meeting the daily sodium and chloride requirements. Only 2 patients prescriptions met the daily potassium requirements and 3 patients met glucose requirements.

Most NBM patients in the department were prescribed either Hartmann's solutions or 0.9%. Sodium Chloride for maintenance fluids. No additional potassium or glucose content was prescribed in the majority of cases audited. There was a deficit in patients' intake of all parameters measured, particularly of potassium (88%) and glucose (92%).

Discharge summaries are essential for communication between hospital teams, GPs, and multidisciplinary teams. This is particularly important for vascular patients, who require detailed information about procedures, management plans, surveillance scans, and microbiology-recommended antibiotic regimens, such as those for diabetic foot infections. This closed-loop audit aimed to evaluate and improve the quality of discharge summaries in a vascular unit, based on standards set by our trust and NICE guidelines, focusing on accuracy and completeness.

A retrospective audit was performed assessing discharge summaries for vascular inpatients admitted in March 2024 at a single institution. Seven key components were evaluated: discharge summary issuance, admission reason, relevant investigations, summary of interventions, post-operative status, discharge medications, and future management instructions. An intervention, consisting of a multidisciplinary educational exercise and the creation of a discharge summary template, was introduced. The second audit cycle reviewed patients admitted in July 2024.

A total of 141 patients were included across the two audit cycles. The majority of discharge summaries are completed by FY1s. 97.1% (n=69) of patients had discharge summaries issued, but only 27.5% (n=19) contained all key components accurately. The most frequently omitted element was investigation reports. After the intervention, the second cycle showed significant improvement, with 69 of 70 patients (98.6%) having their summaries issued, and 80% containing all required components.

Our intervention led to marked improvements in the quality and completeness of discharge summaries in our vascular unit. This simple, replicable intervention can help sustain improvements, especially with regular resident doctors' rotations.

Prostate specific membrane antigen positron emission tomography (PSMA PET) uses a radioactive substance that targets PSMA protein which detects prostate cancer. In this audit, specifically, patients who had undergone robot-assisted radical prostatectomy had a recurrence of PSA rise followed by PSMA PET scans, which showed results were considered.

Data of PSMA PET scan over 13 months were collected which had dates ranging from 01/06/2023 to 01/07/2024 from a university hospital in England. From the 13 months of data, the patients that underwent RARP prior were included in the audit. Also, data of their initial PSA and date, RARP date, recurrent PSA rise date, PSMA PET results and follow up MDT plans were collected.

After filtering the positive and negative/equivocal data the following results were found. Number of patients post RARP who had scans were 79 and 83.5% of patients that is 66 of them were found to have metastatic deposits or there were reports of prostate uptake recurrence on scan. Average PSA triggering the scan was 8.7ng/mL (Range: 0.1- 406). Patient who did not have any findings were 16.5% that is 13 people with average PSA triggering scan = 0.44ng/mL (Range: 0.1 - 0.8).

The data collected showed overall positive findings for repeat PSMA PET scans after rise in PSA test in patients after robot-assisted radical prostatectomy. The audit indicated positive data for urologists to consider PSMA PET scans with recurrent rise in PSA after RARP.

Good Surgical Practice (1.3) requires surgeons to maintain accurate, comprehensive, legible, and contemporaneous patient records. These records ensure effective postoperative communication, long-term continuity of care, and serve as medico-legal evidence.

To audit emergency general surgery (EGS) operation notes for adherence to the Royal College of Surgeons of England (RCS England) Good Surgical Practice (2014) guidelines.

A retrospective review of EGS cases from 14th-23rd June 2024. Findings were presented at a departmental meeting, followed by the introduction of an aid memoire based on RCS England guidelines. The notes were re-audited from 7th-21st August.

Compliance improved in some areas after introducing the aid memoire, but gaps remain. Additional factors like the scrub nurse name and NCEPOD score were suggested for inclusion.

Further refinements are needed, particularly in areas lacking dedicated PICS fields.

Tonsillitis was the second most common presentation in otorhinolaryngology (ENT) in 2017, and tonsillectomy was the 5th most common procedure. National standards aim for 90% of patients waiting <15 months for a first outpatient department (OPD) appointment and procedure waiting times <12 weeks. Traditionally, patients referred with recurrent tonsillitis were added to the routine OPD waiting list. The Direct Adult Tonsillectomy Pathway (DATP) is a quality improvement project aimed at shortening this waiting time. A questionnaire is sent to the patient to assess if they meet tonsillectomy criteria. Suitable patients receive an information and consent package. If they consent, they are placed on the surgical waitlist.

A retrospective audit of the waiting times for patients added to the DATP measured against national guidelines and previous published tonsillectomy waiting list initiatives. Data collected included: demographics, date referral received, date questionnaire sent, date of virtual OPD appointment, date consent form received, date of surgery.

362 patients fitted the DATP inclusion criteria between April 2021 to September 2022. Timeframes: referral to questionnaire 384 days (n=353, range 6 to 1395 days), questionnaire to OPD: 141 days (n=240, 6 to 248 days), OPD to surgery: 728 days (n= 129. 14 to 1652 days), referral to surgery: 810 days (n=129, 119 to 1121 days).

The DATP can decrease waiting times for tonsillectomy to meet national standards. Good administrative support can further reduce referral to questionnaire time and access to theatre and beds can reduce OPD to surgery timeframes in line with national guidelines.

In line with national guidelines all patients with nasal injury should be reviewed at the Emergency ENT clinic within 7-10 days. Audit aimed to assess compliance with current guidance and investigate if number of missed appointments could be reduced by introduction of Opt-in system on nasal trauma management.

Retrospective audit of nasal injury patients over 4-month period referred to Emergency ENT Clinic. Patient’s records were reviewed for: time from presentation to ENT review, requirement for nasal fracture reduction and number of appointments missed.

Further 4 months period was reaudited prospectively after introduction of Opt-in system of nasal trauma management. Patient with nasal fractures were provided with Nasal Fracture Advice leaflet at presentation and instructed to book an ENT Emergency Clinic appointment if they had symptoms including nasal deformity, swelling of the septum or nasal blockage at day 5 after injury.

Cycle 1:78% of patients who sustained nasal injury were seen in Emergency clinic within 7-10 days. 27% of patients referred did not attend their appointment. This consisted of 33% of all ENT Emergency Clinic appointment missed.

Cycle 2: 68% of patients who opted-in were seen in Emergency ENT Clinic within 7-10 days. Number of missed appointments due to nasal fracture was reduced by 33%.

Multiple factors could be contributing to missed appointments, with no requirement for intervention and significant travel time in rural regions being the key ones. Number of appointments missed can be reduced through introduction of Opt-in system of nasal trauma management especially in rural hospitals.

Liver transplantation (LT) is the most effective treatment for end-stage liver disease. Night-time transplantations are often scheduled to minimize cold ischemia time (CIT), but they may pose challenges due to potential fatigue and circadian rhythm disruptions among surgical teams. This study aims to investigate the effect of transplant timing on the outcomes of liver transplant patients.

A preliminary retrospective analysis was conducted on liver transplants performed between January and May 2018. Surgeries were categorized into daytime (8:00 am–8:00 pm) and night-time (8:00 pm–8.00 am) groups. Outcomes examined included operative time, early mortality, complications (wound, vascular, biliary, and other) occurring within 30 days post-surgery, CIT, re-transplantation, length of ITU stay and length of hospital stay.

The night-time group, the mean recipient age was 50.17 years (SD 10.86). Surgery duration averaged 5.67 hours (SD1.57) with a mean CIT of 8.08 hours (SD 2.41). The average hospital stay was 14 days, with 1-year and 3-year survival rates of 100% and 95.68%. Acute rejection occurred in 8.7% of patients. The daytime group, the mean recipient age was 51.83 years (SD 10.86). Surgery duration averaged 5.05 hours (SD 1.20) with a mean CIT of 7.31 hours (SD 1.97). Hospital stays averaged 12.88 days, with 1-year and 3-year survival rates of 97.2% and 91.67%. Acute rejection occurred in 13.9% of patients.

The preliminary results suggest slight differences in outcomes between the two groups, but a larger cohort of patients’ needs to be analysed to determine statistical significance.

X-ray booking inefficiencies often lead to delays in fracture clinics. A closed-loop quality improvement project (QIP) was implemented at a major London teaching hospital to improve clinic workflows and reduce patient waiting time. Administrative staff screened the clinic list for potential X-ray requirements to reduce doctors’ workload burden and patients were now booked one day before the clinic.

A retrospective audit design was conducted, including 646 and 589 patients attending fracture clinics between November and December 2023. Data was extracted from the Cerner electronic health records system and the Picture Archiving and Communication System (PACS). Patients with missing or erroneous data were excluded, yielding a final sample of 489 and 473 for analysis in the two cycles.

The mean waiting time post-intervention decreased by 10.61 minutes (95% CI: 4.92–16.30), P < 0.005. Patients who were missed in X-ray screening and were sent for X-rays after clinical review experienced significantly longer waiting times, with an increased total mean waiting time of 51.51 minutes (95% CI: 37.53 to 65.09). P < 0.005. The number of patients who were missed in X-ray screening was 8% pre- and post-intervention, showing no change in outcome with administrative note screening.

Interventions led to large improvements in reducing patient waiting time, though X-ray-related delays persisted. Delegating clinic preparation to administrative staff, with a doctor conducting secondary screening, did not lead to an increase in missed X-rays. Further research should formally evaluate the delegation of X-ray note screening in the fracture clinic to administrative staff.

NOF fractures impose a significant burden on elderly patients and healthcare systems. The BPT guidelines mandate geriatric assessment within 72 hours and coordinated care. Gaps in the adherence to the guidelines of perioperative care were identified. Effective handover between orthopaedic and ortho-geriatric teams is crucial to ensure the best care.

This Quality Improvement Project aims to enhance the management of neck of femur (NOF) fractures by optimizing the handover process between orthopaedic and ortho-geriatric teams, thereby improving adherence to Best Practice Tariff (BPT) and perioperative care management guidelines.

This project involved retrospectively evaluating peri-operative care for NOF fracture patients. A pilot handover protocol was developed to address identified gaps, aiming to improve adherence to effective patient management protocols.

An audit of 18 patients revealed the adherence to cognitive function assessment using the AT4 tool to be 77.8%, VTE prophylaxis was 88.9%, and antibiotic use was 83.3%. However, only 27.8% had a diabetic control plan, and 38.9% had wound reviews. Chi-square tests indicated no significant relationship between fracture side and VTE adherence but noted variability in wound review adherence by age.

Despite having a NOF Care Bundle, our study highlighted suboptimal adherence to NOF care. A pilot handover protocol was introduced to address the lack of adherence using the handover as a checkpoint, with the change results to be studied over the next two weeks. Results will be presented at the conference to assess the impact on patient management and guideline adherence.

Cauda equina syndrome (CES) poses significant morbidity risks if misdiagnosed, with an incidence of 1–3 in 100,000. Emergency Department (ED) referrals for CES constitute a substantial portion of referrals to the orthopaedic service. This audit aimed to assess the appropriateness of suspected CES referrals, ED compliance with the referral process, and post-MRI referral adherence to Trust pathway protocols.

Retrospective 3-month audit of CES referrals to Trauma & Orthopaedics (T&O) were analysed. Data on patient demographics, clinical presentations, referral pathways, MRI findings, and management outcomes were collected.

During the study period, a total of 45 patients were referred through the CES pathway. 71% of referrals presented with atraumatic lower back pain with leg pain and/or neurological features, 16% presented with a history of traumatic back pain. While ED adherence to referral protocols was satisfactory, MRI findings varied, with only 2% suspecting or confirming CES. However, 92.7% of patients received appropriate follow-up management as per local protocol.

This audit provides valuable insights into local CES referral pathways and management practices, emphasising the importance of protocol adherence and continuous quality improvement initiatives to optimise patient outcomes. Findings underscored the need for pathway refinement, particularly in identifying and triaging trauma-related back pain through enhanced pathways.

The management of mild head injuries that require just observation under NICE guidelines in elderly patients has a great impact on the workload of the general surgical unit. At least one million patients present in hospitals in the United Kingdom each year with head injuries, representing 10% of all patients attending A and E. About 90% of these patients have mild head injuries, with the remainder having moderate to severe head injuries. Approximately 20% require admission for observation but 5% are transferred to specialized neurosurgical care. This study was conducted to examine the workload pattern and financial implications on the acute surgical unit for elderly patients.

Data was collected retrospectively for mild traumatic brain injury for a one-year period. Information recorded was divided into those greater and less than 75 years of age. For those greater than 75 years, the information recorded further included the mechanism of injury, associated injuries, the length of stay, comorbidities, polypharmacy and anticoagulation. The data was collected from the healthcare analytics of the hospital.

54 % of patients were greater than 75 years of age. Of these, 36% had associated injuries, whereas 75% had polypharmacy. 98% of the patients had comorbidities. The percentage of patients who had a stay greater than 48 hours was 58%.

In the absence of specialist rehabilitation pathways and a dedicated head injury team, it was found that the prolonged hospital stay was due to severe and long-term disability in elderly patients who continued to occupy acute surgical beds.

New Patient Fracture Clinics (NPFC) at King’s Mill Hospital are frequently overbooked. This project aimed to evaluate the number of same-day discharges, identify referral patterns, and implement strategies to reduce inappropriate referrals, thereby alleviating appointment burden. As per BOAST guidelines, referrals should be for acute injuries needing specialist orthopaedic management.

We conducted two audit cycles, collecting data on NPFC patients over one-week periods (4-8/09/2023 and six months later, 4-8/03/2024), with a target of <5% inappropriate referrals. Post-first cycle, we introduced educational materials for Emergency Department (ED) staff, and a virtual fracture clinic (VFC) to review cases before face-to-face (F2F) appointments.

In the first cycle (185 patients), 28% did not have a fracture (6% had no injury), 11% needed no management, 31% saw no change in ED management, and 52% had no follow-up appointment. In the second cycle (150 patients), 37% did not have a fracture (3% had no injury), 3% needed no management, and 40% had no change in ED management. From VFC, 22% were not given a follow-up appointment, while 35% were not given one from F2F clinic.

The educational strategies implemented improved ED staff’s orthopaedic knowledge, as indicated by a reduction in the number of unnecessary referrals. Several patients could also be discharged same day from VFC, supporting its introduction as a way of streamlining care. However, some factors still exceeded the <5% target, indicating the need for ongoing monitoring and targeted interventions to optimise clinic efficiency.

Effective record-keeping is crucial in healthcare. This study aimed to assess and improve the quality of surgical records in the University Surgical Unit (USU) of the National Hospital of Sri Lanka (NHSL).

This prospective, quantitative, descriptive study included a sample of 92 patient records in two cycles. Records were scored using the STAR system, consisting of 50 components across six domains. Interventions were implemented between cycles. Pre- and post-audit scores comparison was made between the cycles.

A significant increase in total score from a mean of 67.60 ±8.13 in first cycle to 78.04 ±7.25 second cycle was seen. All domains showed enhancement, with Subsequent Entries exhibiting the greatest increase (34.8%) and Anesthetic Records the least (3.31%). Discharge Summary domain achieved a near-perfect score of 94.44±56.14, though the diagnosis was documented in only 50% of records. Despite a 25.89% improvement, the Consent domain remained the lowest scoring ().

Paired sample t-test results demonstrated statistically significant increase in total score between first and second cycles (t=-5.535, p<0.001); Initial Clerking (t = -2.889, p = .006); Subsequent Entries (t= -7.509, p < .001); Operative Record (t = -3.102, p = .003); and Discharge Summary (t = -3.361, p = .002).

This study highlights the effectiveness of targeted interventions, including the use of templates and education, in improving the quality of surgical records. By implementing these recommendations, USU of NHSL can continue to enhance its surgical record documentation, ultimately improving patient care and safety.

UK is unique in performing most abscesses under GA. No national guidelines on how long a patient with an abscess can wait. Some trust guidelines recommend same day operation. Most papers recommendation that the operation can be safety postponed. 2019 Day-Case procedure guidelines state abscesses are suitable for day-case surgery. However, patients get very frustrated waiting all day in hospital in pain with uncertain timings.

Retrospective audit carried out in patients presented with Abscess to SAU between January 2024 – May 2024. Patients presented were identified using online theatre booking list for Incision & drainage and then synthesised using the following criteria. Data collected were time of Presentation to SAU, time for theatre booking, waiting time between booking & Operation and also time of discharge.

Out of a total of 181 patients, >90% were offered ambulatory care. Time from presentation to booking time was an average of 4hrs. Waiting time was 24hrs. In hospital waiting hours on average was 11 hours. 34 patients (18%) waited >20 hrs and longest wait: 64 hrs in hospital.

Mean waiting time of 11 hours in hospital which was collected from Mostly Surgical Assessment Unit. Average costings are for a standard bed < £345/day. Since the hospital is a high-volume unit, the real cost is very high.

Biliary pathology accounts for 30-40% of ambulatory surgical admissions. Despite the current NICE guidance that recommends laparoscopic cholecystectomy (LC) within seven days of diagnosis of acute cholecystitis, patients are frequently offered surgery by chance than by design.

To audit our protocol of performing emergency cholecystectomies in the General surgery department to check compliance with the NICE guidelines and improve our practice based on NICE guidelines and the CholeQuIC-ER Learning Report (2022).

This closed-loop audit was conducted at a tertiary care hospital in India. Study sample included patients presenting with acute cholecystitis to the Surgical Admissions Unit from June 2022 to September 2022 in the first cycle and from December 2022 to March 2023 in the second cycle. Parameters recorded included demographics, clinical data, treatment provided and date of surgery. A fast-track pathway was implemented based on Tokyo guidelines and current NICE guidance.

In the first cycle, data obtained from 52 patients showed that 25 patients(48%) underwent LC within 7 days. Of the remaining 27 patients, 10 patients had re-admissions within 30 days. Following implementation of change, in the second cycle, from 56 patients, 40 patients (71%)underwent LC within 7days with the mean time to surgery reducing from 13 days to 8 days.

Early cholecystectomy is a recommended treatment for acute gallstone disease, and our experience shows that creation of a pathway streamlines patients to an appropriate level of priority. Implementing structured protocols based on NICE guidelines significantly reduces delays in surgery and lowers the risk of re-admissions.

The National Joint Registry (NJR) is utilised across the UK to assimilate and present data of patients undergoing joint arthroplasty on a large-scale. Despite strict guidelines encouraging its use, across several trusts, this is not adhered to, resulting in incomplete data collection.

As such, this audit analyses the collection of data for the NJR, aiming to identify areas for improvement moving forwards.

This hospital’s Trauma and Orthopaedics department was flagged for particularly low data completion. A database of cases relevant to the NJR was created between May 2022–Dec 2023 (n=76) and the completion of the forms assessed. Incomplete forms were further analysed, determining which fields were left incomplete. This in-depth analysis identified three key neglected fields. These included body mass index, American Society of Anaesthesiologists (ASA) grade and thromboprophylaxis.

Results and Conclusions: Data Collection via the NJR is of paramount importance to enable identification of trends and complications, informing future practice. This project was presented at a local audit meeting to increase awareness of the importance of this data collection, its importance, and impact. Additionally, barriers to data collection were discussed with the registrars and important learning occurred from this. Simple measures such as ongoing surgeon education will be implemented during registrar induction at the trust, aiming to improve adherence. Next steps include undertaking a quality improvement project to assess if implementation of these interventions on a wider scale may facilitate greater adherence.

Bleeding from the nose (epistaxis) is an acute emergency, that commonly presents in the emergency department. Immediate management by the clinicians involved plays a vital role in timely resolution.

Survey audit of the clinician’s knowledge was conducted in a district general hospital, concerning epistaxis, it’s pathophysiology, causes, immediate and further management. The questionnaire was based on NICE and RCEM guidelines. Google survey was used to collect the responses.

31 clinicians participated. 83.9% responded confidently in managing epistaxis. Majority of the respondents were junior doctors (Clinical Fellow, Foundation doctors). 90% correctly identified Kesselbach plexus as the common source of bleed. Nasal Oxygen Therapy was correctly recognized as a cause by only 58%. 5 out of 31 selected the wrong acute management, and only a third chose the correct First Aid action. There was clear confusion involving cautery, 20-70% opting for not clearing clots, using vasodilators and cauterising both sides of the septum. Nasal packing, 63% were aware of inflating the cuff correctly, 70% said to insert the tamponade parallel to the septal floor. While 80.6% recognized endoscopic assessment and electrocautery as secondary care, only 40-60% recognized other possible secondary care. Finally, advice given to the patient, 93.5% selected the right advice, while 20-60% opted for the incorrect advice. Feedback provided showed clear demand for workshop, teachings, hands on practice, training, patient advice leaflet, well stocked and accessible resources.

In conclusion, the audit showed that though the clinicians feel confident in managing epistaxis, closer observation unravelled there is much room for improvement.

Patients with femoral fractures may require postoperative X-rays to assess the position of the metal components, and the presence of any peri-prosthetic fractures or dislocations. Post-op X-rays should ideally be performed and reviewed on day 1 of the index operation. X-rays not performed on day 1 are more likely to be missed and less likely to receive a formal review.

To improve the number of post-operative X-rays that have been reviewed with formal documentation outlining the review findings.

A list of patients with femoral fractures admitted to the orthopaedic ward in a hospital in South-East England was acquired. Out of 128 patients, post-operative X-ray documentation was reviewed for 113 patients between 1 December 2023 – 29 February 2024. The post-intervention data was collected between 1 April 2024 – 30 June 2024.

There were initially 32% of post-operative X-rays with formal documentation. To address this, we used the hospital’s electronic patient record system (EPR) to create a rolling list of patients with outstanding post-operative X-ray reviews. A poster outlining this was displayed on the orthopaedic ward and the results of the 1st cycle were presented at the monthly clinical governance meeting. These interventions resulted in a 43% increase in the number of formally documented post-operative X-rays.

Use of the hospital’s EPR was an effective method in improving the number of formally documented post-operative X-rays.

Accurate and comprehensive health record management is essential for delivering effective patient care and ensuring continuity among healthcare professionals. Standardised case notes structures have been recommended, with best practice guidelines covering legibility, patient identification, diagnosis, treatment, nursing records, diagnostic tests, note organisation, and confidentiality. Recommendations from the Royal College of Surgeons (RCS), Medical Defence Union (MDU), and General Medical Council (GMC) support these standards. This audit aimed to compare the quality of paper-based notes with electronic notes following the implementation of a structured proforma on the ENCOMPASS system.

A retrospective review of 20 handwritten case notes was conducted using the Surgical Tool for Auditing Records (STAR). After the introduction of ENCOMPASS, which included a proforma based on the standardised case note structure, the same case notes were re-evaluated to assess improvements.

Significant improvements were observed across all aspects of medical notetaking, including patient details, referral source, legibility, headings, date, time, investigations, treatment plans, and signatures.

The introduction of ENCOMPASS, along with digital ward round and clerking proformas, led to marked improvements in medical notetaking. These improvements aligned the notes with the guidelines and recommendations from the RCS, GMC, and MDU, ultimately enhancing patient care and safety.

Percutaneous nephrostomy (PN) is associated with significant morbidity, impacting quality of life. Therefore, PN in malignant ureteric obstruction (MUO) should be targeted at those patients who are suitable for further oncological treatment. As the ‘gatekeepers’ to percutaneous nephrostomy, urologists and interventional radiologists often less familiar with prognosis of non-urological malignancies, depend on the referring specialists for prognosis insights. This study evaluates the outcomes of nephrostomy insertion for non-urological malignancy at our institution.

Retrospective audit of patients who received PNs between 2021 and August 2024. 211 entries were identified. We excluded re-insertions, urological malignancies (47), benign urological conditions (32) and ureteric injuries (2).

Among the 54 patients, 32 were for Gynaecological malignancies, 15 for GI malignancies and 7 for other types of malignancies.

31 patients had single nephrostomy insertion (57.4%) and 23 had bilateral nephrostomies (42.6%). 19 were done in elective settings (35.2%) and 35 (64.8%) as emergency.

Median performance status was 2. Renal function improved in most cases (average 25 ml/min).

Post-PN, 30 patients (55.5%) received chemotherapy, while others did not pursue further oncological treatment.

51.9% of patients died within 6 months of their nephrostomy insertion (n=28). Average survival of this group was 9.5 weeks post-procedure.

A significant proportion of patients do not have further oncological treatment after PN insertion for non-urological malignancy. It is imperative that PN is targeted to those patients that are suitable for further treatments. In those patients who are unsuitable for further treatment, it is obligatory to counsel patients regarding the morbidity of PN.

Sentinel lymph node biopsy (SLNB) status provides the most accurate method of regional staging, the most important prognostic factor in melanoma. Modern SLNB involves technetium-99 lymphoscintigraphy combined with local administration of blue dye. Indocyanine green (ICG) has emerged as an alternative method for SLN localisation.

The aim was to analyse patients who had undergone an SLNB for cutaneous melanoma with the combination of radioisotope lymphoscintigraphy and ICG. This was a retrospective review, between February 2022 and May 2023, identifying patients with cutaneous melanoma who underwent SLNB guided by both of these techniques.

Patients with cutaneous melanoma requiring SLNB between February 2022 and May 2023 were identified. SLNB identification used a combination of lymphoscintigraphy and ICG. Outcomes including anatomical location, melanoma subtype, AJCC stage, pT stage, lymphoscintigraphy reading and ICG identification were analysed.

27 patients were identified during the study period. Affected areas included head and neck (33%), trunk (33%), upper limb (15%) and lower limb (19%). Average Breslow thickness was 2.8mm. A total of 43 nodes were sampled. 40/43 (93%) nodes were identified using both techniques. 2/43 nodes could only be identified with lymphoscintigraphy and 1/43 nodes could be identified with ICG only. 2 patients did not have any identifiable nodes via either lymphoscintigraphy or ICG, therefore no nodal tissue could be sent.

ICG viable alternative to blue dye with no allergic reaction; effective in head and neck cases; low failure rate.

We aimed to evaluate our practice of assessment of patient’s post-peripheral angioplasty in a District General Hospital, with a focus to raise awareness, improve compliance and develop internal guidelines for optimal care extrapolated from Vascular Society of Great Britain and Ireland.

Data of patients undergoing angioplasty was analysed retrospectively for parameters including 1. Review (same day, senior involvement), 2. Assessment (hemodynamic, wound examination, peripheral perfusion, doppler) and 3. Follow up (anti-coagulation, surveillance scan, clinic appointment).

A multidisciplinary protocol was developed to facilitate assessment which was well publicised among the surgical/vascular teams. We then assessed the implementation and efficacy of the pathway prospectively.

Prior to protocol implementation, 30 angioplasties were performed. Only 37% of the patients were assessed the same day and 55% were ultimately reviewed by seniors. Anti-coagulation was commenced for 37%, follow up scans were booked for 40% and clinic appointments were arranged for 60%. Less than 20% had documented observations, wound examination, and peripheral perfusion. Doppler examination was not performed.

Post-protocol, 20 interventions were performed. All patients were reviewed by vascular team seniors the same day. All of them had anti-coagulation commenced, follow up scans and clinic appointments booked. There was overall improvement in all documented parameters including 80% haemodynamic, 100% wound examination and peripheral perfusion. Only 20% had Doppler assessment because it was mostly not indicated.

Clearly defined post-procedure management protocol helped streamline management and increased compliance in assessment of patients in accordance with guidelines which highlights the necessity of these protocols to be well embedded.

Robotic-assisted surgery (RAS) offers improved visualisation and dexterity compared to laparoscopy. As a result, RAS is considered an attractive option for performing rectopexy, particularly in the confines of the lower pelvis. The aim of this study was to explore the benefits of RAS in rectopexy by analysing the experience of an international group of expert surgeons.

A three-round Delphi process was performed. Combined qualitative, Likert-scale and binary responses were utilised in round 1&2, with binary responses seeking overall consensus in round 2&3. Particular areas that were studied included: clinical aspects of patient selection, technical aspects of using RAS, ergonomic factors, training, and the ‘learning curve’. Consensus was defined as agreement >80% among experienced RAS rectopexy surgeons.

Twenty participants were expert surgeons with a mean operative experience of 153 total rectopexies and 60 robotic rectopexies. All participants agreed that patient-reported functional outcomes and improved quality-of-life were the most important outcomes following rectopexy. Participants agreed the most significant benefits offered by RAS for rectopexy were improved precision due to better visualisation, improved dexterity and improved overall accuracy e.g., for suture placement. 90% agreed that the superior ergonomics of RAS rectopexy improved their performance on several steps of the operation, in particular: mesh fixation and rectovaginal dissection. Consensus on the learning curve for RAS abdominal rectopexy was not agreed upon: 45% reported the learning curve as 11-20 cases and 55% as 21-30 cases.

International experienced RAS abdominal rectopexy surgeons report RAS positively improves performance of rectopexy in terms of technical skills, improved dexterity and visualisation and ergonomics.

Assess whether the myrecovery system can equitably improve outcomes for those undergoing hip/knee arthroplasty.

Data from the myrecovery system for two Trusts was downloaded for the pilot phase (1/4/22 to 18/8/23). This was combined with HES data from each Trust.

There were 434 knee and 788 hip arthroplasty patients recorded on the myrecovery system. Of those invited 63% registered with the associated mobile app. There was no difference with respect to age, sex or social deprivation between app and non-app users. App registered patients had a reduced length of stay (hips 3.6d vs 4.1d; knees 3.7d vs 4.7d). For fully engaged patients, where education class attendance was avoided, this reduced further (hips 2.4d; knees 3.1d). For fully engaged patients 28-day ED attendance was 0% (non app users’ hip 3.4%; knee 5.2%) and readmission rate was 0% (non app users hip 1.9% and knee 1.4%). A higher pre-operative step count was associated a shorter length of stay (0-2999 steps 4.0d vs >9000 steps 2.0d).

Engaged myrecovery app users have better outcomes than nonusers. App use is not determined by demographic background.

Minimally invasive neurosurgery (MINS) has revolutionized the management of neurological disorders by reducing surgical trauma and enhancing recovery. The integration of robotic systems into MINS represents a significant advancement, offering improved precision, control, and outcomes. This study aims to explore the current applications, benefits, and challenges of robotic technology in MINS.

A comprehensive review of recent literature and clinical studies was conducted to assess the impact of robotic systems on minimally invasive neurosurgical procedures. Key areas of focus included technological advancements, clinical applications, patient outcomes, and training requirements.

Robotic systems have demonstrated substantial improvements in surgical precision and visualization. In endoscopic neurosurgery, robotic assistance enables more accurate navigation and manipulation within the confined cranial and spinal spaces. Applications in spinal surgery have shown enhanced alignment and reduced complications. Patient outcomes have improved with reduced recovery times, lower risk of complications, and minimized surgical trauma. Robotic simulators have become vital in training, providing surgeons with essential skills for effective robotic system use. However, despite the benefits, the high cost of robotic systems, the learning curve for surgeons, and current technological limitations remain a significant challenge. Addressing these issues is crucial for broader adoption and effective integration into clinical practice.

The integration of robotics into minimally invasive neurosurgery has advanced the field by improving precision, reducing recovery times, and enhancing patient outcomes. Ongoing research and development are essential to address existing challenges and further optimize robotic systems for future applications in neurosurgery.

Preoperative planning and templating is an important step, prior to performing a total knee arthroplasty (TKR). Preoperative templating is predominantly performed using plain film radiographs. As plain film radiographs are a two-dimensional representation of a three-dimensional object, they are subject to magnification errors. To correct for magnification errors, during planning, surgeons either utilise scalers or estimate the magnification factor. We compared the accuracy of preoperative planning with and without scalers.

Implant (Tibia and femur) size selection planning of TKR by digital templating was documented in 11 cases with a scaler and 17 without scalers. The data was analysed and compared with the size of the final component selected during surgery.

The tibial component, measured within ± 1 size, was accurate in 52.9% of cases in the no-scaler group and 100% of cases in the scaler group (P= 0.007).

The femoral component, measured within ± 1 size, was accurate in 70.6% of cases in the no-scaler group and 100% of cases in the scaler group (P=0.047).

Preoperative planning, in TKR, for size estimation of the tibial component is of little clinical value using plain film radiographs without scalers.

This video presentation demonstrates the technique and results of robotic segmental splenic flexure tumour resection with intracorporeal anastomosis and indocyanine green (ICG) injection, with key steps including patient positioning, port placement, mobilization of the splenic flexure, ICG injection to prevent extensive resection, resecting the tumour and intracorporeal anastomosis.

The procedure was performed using a da Vinci robot on a 76-year-old patient. ICG injection was administered in 2 phases. Firstly, inject locally to assess lymphatic drainage and secondly to check for effective perfusion through the anastomosis.

There were no intraoperative complications, and no conversion to open surgery was necessary. Postoperative recovery was uneventful, and she was discharged home on the 4th postoperative day. Pathological examination confirmed adenocarcinoma, complete tumour resection (R0) with clear margins. Follow-up after 12 months did not reveal any complications.

Robotic segmental resection of splenic flexure tumours with ICG injection is an effective and safe technique. It poses a challenge to the surgeon due to its advanced presentation and dual lymphatic drainage of the area. This minimally invasive approach provides precise tumour resection with favourable recovery and promising oncologic outcomes.

Robotic surgery offers several advantages to the African setting, including shorter hospital stays, faster return to work, and increased overall productivity. However, its adoption has been limited by several factors. This review aims to present the barriers to implementation, and recommendations for integrating robotic surgery into the African healthcare system.

A narrative review was conducted using PubMed, Google Scholar, WoS, and AJOL. Search terms included "robotic surgery," names of African countries, "implementation," "barriers," and "recommendations.".

Implementation is primarily limited to settings in Egypt and South Africa, where the da Vinci has been used for urological, general surgical, cardiothoracic, and gynaecological procedures. Barriers faced by other countries include limited healthcare budgets, initial costs of robotic systems, patients’ inability to afford robotic procedures, out-of-pocket healthcare financing, inadequate power supply, poor healthcare leadership, limited internet connectivity, and insufficient surgeon training facilities. Public-private partnerships, loans and subsidies, introduction of cheaper robotic systems, and local manufacturing of robotic equipment will serve as cost-effective innovations. It is also important to improve healthcare financing and strengthen healthcare leadership across Africa. To address the lack of surgeon training facilities, virtual reality, remote assistance for surgeon training, and the establishment of fellowships to provide early exposure to robotic-assisted surgery should be explored. AI-integrated robotic surgery can also enhance precision and safety and provide tailored training tools for local surgeons.

Similar barriers to the adoption of surgical robotics are faced across Africa. By implementing the provided recommendations, robotic surgery can still be widely adopted in African settings, despite the delay.

Transoral Robotic Surgery (TORS) has revolutionised the management of oropharyngeal squamous cell carcinoma (OPSCC), with the propensity to de-escalate toxic adjuvant therapy. However, this innovative procedure is not without complication. This systematic review and cohort study aims to evaluate the use of haemostatic adjuncts during TORS to reduce the risk of post-operative haemorrhage.

A retrospective cohort study examined the use of haemostatic adjuncts for patients undergoing TORS procedures between October 2023 and August 2024. All adults (>18 years) undergoing TORS for benign or malignant disease were included in this study. Baseline demographic data was collected, and patients were followed up for 30 days post-operatively. The primary outcome measure was the incidence of primary or secondary postoperative haemorrhage. Secondary outcomes including length of stay and readmission rates. A systematic review was conducted to situate our results within the context of the medical literature.

Haemostatic adjuncts were used during all 18 TORS procedures: Tisseel (44.4%, n=8), Floseal (33.3%, n=6) and Purabond (22.2%, n=4). Only one case of post-operative haemorrhage was identified (n =1, 5.6%) which was managed conservatively. Purabond was used in this case. The mean length of stay was 3.7 days.

Acknowledging the small sample size, this study suggests favourable rates of post-operative haemorrhage following the use of haemostatic adjuncts in TORS, in keeping with frequently reported rates in the literature which range between 2 and 9% [1]. This provides a robust platform for further in-depth research into the use of these adjuncts in the context of TORS.

Minimally invasive surgery (MIS) has been associated with reduced blood loss, decreased postoperative pain, decreased morbidity, earlier bowel transit, shorter hospital stays, lower risk of incisional hernias and fewer adhesions. Despite becoming more popular in elective surgery, robotic emergency surgery is still not broadly used, nevertheless, there is lack of evidence and guidelines featuring the utilisation of robotics in the emergency setting. In our case report, we present the application of the robotic platform for an emergency robotic-assisted Hartman’s procedure (rHP).

A 63-year-old male, presented with complex perforated diverticulitis, serial CTs showing progressively enlarging multiloculated complex pelvic collection (6.7cm) deemed unamenable for radio-guided drainage. Emergency rHP was performed.

rHP (using da Vinci Intuitive System® Xi system) was successfully performed with minimal blood loss, operative time was 5 hrs, rectosigmoid perforation was found with large pelvic abscess, minimal spillage and good specimen quality was achieved. Patient had uneventful postoperative recovery and was discharged home once stoma competent, six days after.

rHP can be safely performed. Robotic instruments have multiple degrees of freedom for movement, leading to flexibility like or even better than a surgeon’s hands, enlarged three-dimensional vision, and the three operating arms are all controlled by the surgeon. These technical advantages make dissection more accurate and convenient especially in pelvic cavity or narrow spaces with less risk of conversion to open and more precise dissection compared to laparoscopic approach.

Post-operative C-reactive protein (CRP) is a predictive biomarker of post-operative complications. Despite the widespread implementation and uptake of robotic-assisted surgery (RAS), the CRP profiles between laparoscopic surgery and RAS has not been directly investigated.

A retrospective single-centre service evaluation of patients undergoing either laparoscopic surgery or RAS for colorectal cancer between November 2021–February 2024. The colorectal MDT at this Scottish tertiary hospital assigned patients to the 4 laparoscopic or 3 robotic-trained (Intuitive) surgeons. Electronic patient records provided patient demographic data (age, gender, ASA and frailty scores, BMI) and CRP levels and outcome data. The statistical software R performed linear regression and ROC analyses.

195 patients were assigned laparoscopic surgery and 202 patients to RAS. ASA and frailty scores were evenly distributed between both groups, but the RAS group had more morbidly obese patients. CRP profiles differed between the groups: CRP peaked on day 3 in laparoscopic surgery but day 2 in RAS. In univariate analysis, post-operative CRP was independently predictive of length of stay > 5 days: day 1 & 3 predictive CRP values in the laparoscopic group were 85.5 (p<0.0001) and 124 (p<0.016) respectively, while day 2 & 3 predictive CRP values for the RAS group were 141.5 (p<0.001) and 153 (p<0.009) respectively.

Knowledge of the differing CRP profiles between the two minimally invasive approaches for colorectal cancer surgery can augment post-operative care delivery. It is unclear why this difference occurs. Further research is required to investigate and understand this phenomenon.

As the first UK-based robotic platform to achieve commercial availability, the CMR Versius® surgical robot offers potential advantages over laparoscopic and open procedures. This study evaluates the implementation of the Versius® system in Wales, focusing on resource utilisation, intraoperative efficiency, and postoperative outcomes.

This study evaluates robotic surgeries performed using the Versius® system between 22/06/2022 and 03/05/2024 across three surgical specialties: Lower GI, Upper GI, and Gynaecology. Retrospective, multicentred data was collected across three hospitals in Wales.

A total of 373 robotic operations were performed across three hospitals. Gynaecology accounted for the highest proportion of robotic procedures (46.1%, n=172), followed by Lower GI (42.4%, n=158) and Upper GI (11.5%, n=43). The average duration of robotic surgery across all specialties was 3.53 hours, with 45.6% of the operative time utilising the Versius® system. Conversion to open surgery occurred in 3.22% of cases (n=12), nondue to device-related complications, but rather patient anatomy and challenges obtaining optimal visualisation. The overall complication-free rate was 70.5% (n=263), with no perioperative mortality.

The Versius® system has facilitated a transition from open and laparoscopic techniques to a more refined, minimally invasive approach, marking a significant advancement in surgical practice within Wales. This evaluation demonstrates the reliability, safety, and efficiency of the CMR Versius® surgical robot, supporting its broader implementation across Wales.

In the last two decades, robotic technology has fundamentally transformed the field of colorectal surgery by providing surgeons with unprecedented levels of precision and control. This review aims to critically evaluate leading robotic platforms, comparing their perioperative, postoperative, and oncological outcomes, providing insights into the future of robotic-assisted colorectal surgery.

A comprehensive literature search of various databases was conducted, and articles published as of August 2024 were included.

Three leading robotic platforms for colorectal surgery were identified: DaVinci, Versius, and Senhance surgical systems. Each system features a unique design, resulting in varying clinical outcomes. Da Vinci-assisted surgeries reported longer operating times (123-341.1 minutes) and a lower conversion rate (0-3.8%) compared to Versius (5-131.7 minutes, 0-6.25% conversion rate). Recurrence rates are lower with Versius (0-5%) versus Da Vinci (0-9.6%). The Senhance systems have been recently introduced to the market; therefore, their use in colorectal surgery has not been thoroughly studied. Data available in the literature reported median operative time ranged from 240-283 min, 5-50mil blood loss, and 0-26.1% conversion rate to laparoscopic surgery for the enhanced system. These leading robots reported comparable oncological outcomes to laparoscopic surgery.

Robotic surgery significantly improves patient outcomes, including shorter postoperative recovery times and effective cancer resection margins. However, challenges faced with these platforms include longer intraoperative times and costs. Nevertheless, with the evolution towards managing more complex rectal cancer cases and more challenging dissection planes, the need for robotic platforms will only grow.

There is limited evidence in the literature to support the American Society for Gastrointestinal Endoscopy recommendations for the use of prophylactic antibiotics before endoscopic retrograde cholangiopancreatography (ERCP) in patient with obstructive jaundice. We studied the effect of this approach on post-ERCP outcomes in a nationwide cohort of patients with primary sclerosing cholangitis.

Using 2010-2021 nationwide inpatient sample data and relevant ICD-10 codes, we analysed adult hospitalizations for patients with obstructive jaundice who underwent ERCP with and without preventive antibiotics.

We analysed 42 972 hospitalizations for obstructive jaundice involving ERCP, with 12 891 patients (30%) receiving antibiotics before ERCP and 30 081 (70%) serving as controls. The mean age of the cohort was 64.2 years (SD, 6.3), predominantly comprising males (58.5%) and White Americans (65.3%), most had a moderate comorbidity burden (69.5%). Following prophylactic antibiotic administration, 687 cases of post-ERCP sepsis (compared with 816 in controls), 971 cases of acute cholangitis (vs. 2 009 in controls), and 408 cases of acute pancreatitis (compared with 3 459 controls). After adjusting for patient- and hospital-level covariates, antibiotic prophylaxis did not significantly reduce the likelihood of post-ERCP sepsis (adjusted Odds Ratio [aOR]: 0.85; 95% CI: 0.77-1.09; P=0.07), or acute cholangitis (aOR: 0.87; 95% CI: 0.98-1.45; P=0.08). However, it was associated with a lower risk of acute post-ERCP pancreatitis (aOR: 0.61; 95% CI: 0.57-0.66; P<0.001).

The use of antibiotic prophylaxis did not improve the odds of infectious post-ERCP complications, except acute pancreatitis, in patients with obstructive jaundice.

A meta-analysis of published comparative literature between laser and radiotherapy in the management of early glottic cancer, with regards to long-term functional outcomes and quality of life.

A systematic search was conducted across PubMed, Scopus, and Cochrane Library from inception until April 2024. The search utilised the following keywords “Glotti*”, “Laryn*”, “Surgery”, “Laser”, “Radiotherapy”, “Radiation”, “Cancer”, “Carcinoma”, “Voice”, and “Quality”. Articles considered were primary studies directly comparing the two treatment modalities in a population of T1 and T2 glottic cancer. Outcomes of interest were measures of laryngeal function, swallowing, and quality of life following treatment.

A total of 5,402 articles were identified, and 22 studies with 1,517 patients met the inclusion criteria. All studies retrieved were non-randomized cohort studies. There was no significant difference between TLM and RT in GRBAS (P < 0.001), VHI-30 scores (P< 0.001), or fundamental frequency (P <0.001). The TLM group had significantly better performance with regards to jitter (P < 0.001) and shimmer (P < 0.001). The risk of bias was assessed to be serious.

The findings suggest that long-term PROMs are fairly similar between TLM and RT in treatment of early glottic carcinoma, with non-significant favouring of TLM, while acoustic analysis shows better outcomes with TLM. However, the available evidence remains scarce, of high heterogeneity, and at significant risk of bias. A direct comparison between TLM and RT through large randomised controlled trials is needed to provide more substantial evidence of equivalence or superiority in treatment of early glottic cancer.

There is much variation in the literature on the methodology approach used to measure bone nodules in vitro, which has led to debate surrounding the differences between osteoblast-created nodules and native bone. This systematic review aimed to compare the techniques, conditions and characterisation methods used in primary research articles to report the formation of bone nodules.

A systematic review of the Web of Science database was conducted. Two separate Web of Science Core collection searches of all published primary research articles in the English language was performed which yielded a total of 38,477 results. Screening yielded 200 of the most cited primary articles, duplicates and full text articles not meeting inclusion criteria were discarded resulting in 88 papers being included into the study.

There is variance among many primary research articles using nodule characterisation techniques. The most common methodologies used stain for calcium (Alizarin Red) and phosphate (Von Kossa). Of the 88 included articles in this study, 50 articles performed an Alizarin Red staining experiment and 25 carried out a Von Kossa experiment with 52 studies carrying out 2 or more characterisation methods.

Staining techniques alone are unable to distinguish between dystrophic and spontaneous calcification. Thus, a combination of biochemical, material and morphological quantification techniques are needed to understand the type of mineral formation that is present and its association with collagen fibres. This formal characterisation procedure will create better models for bone disease and development, coupled with a more measurable outcome of possible treatment success.

Bladder cancer is the most common urological malignancy. Radical cystectomy is one of the standard treatment options. The conventional open technique is widely available, while the robotic technique has been adopted in recent decades. This study compares these methods of cystectomies using operative time, length of hospital stays, estimated blood loss and oncological outcomes.

The study was conducted according to the Cochrane standards where applicable using the EMBASE strategy. A total of 144 articles was collected, 31 articles were excluded during reviews of titles, the 106 articles excluded after reading the , and finally 5 articles is included for this paper; 5 of those articles used to run the meta-analysis for this systematized review.

Pooling of the data from all the participating studies(2)(3,4)(5)(6) showed shorter operative time in the open arms (WMD: 45.38, 95% CI:34.31 to 56.45; P = 0.00001), while less blood loss recorded on the robotic side (WMD: 325.25, 95% CI:389.41 to 261.08; P = 0.00001). No significant difference found regarding hospital stay (WMD: -0.03, 95% CI: -1.49 to 1.42; P = 0.96). The risk of 90 days complication showed no significant difference (OR: 0.79, 95% CI:0.53 to 1.18; P = 0.25). The residual risk also showed no major difference (odds ratio: 1.11, 95% CI:0.74 to 1.68; P = 0.61).

Although, more RCTs are needed to draw solid evidence, no significant differences were found between the two techniques. Future RCTs should consider surgeon robotic experiences and the theatre robotic setup.

This scoping review aimed assess the efficacy of fertility preservation techniques in patients with central nervous system (CNS) cancers and to evaluate their associated outcomes, including success rates and complications.

A literature search was conducted across PubMed, Embase, Medline, Cochrane Library, and Google Scholar by two independent reviewers. Studies were included if they provided data on fertility preservation strategies in neuro-oncology patients. Studies were excluded if they were non-English articles, editorials, animal studies, and guidelines. A meta-analysis was performed using a Random effects model to synthesize results.

This review identified sixteen studies involving 237 participants (78.8% female). Of these, 110 participants (46.4%) underwent fertility preservation procedures. The success rate for completing these procedures was 100%. The average number of oocytes retrieved was 17.8, with 78% successfully cryopreserved. Five patients (6.0%) successfully achieved pregnancies and delivered nine healthy term infants using cryopreserved sperm, embryos, or oocytes. Additionally, six patients conceived either naturally or through intrauterine insemination, resulting in seven healthy term infants.

Fertility preservation techniques could offer a viable option for neuro-oncology patients seeking to achieve successful pregnancies and deliver healthy term infants after cancer treatment. Nonetheless, further research is needed to address the associated risks, long-term pregnancy outcomes, and cost-effectiveness of these interventions.

The transversus abdominis plane (TAP) block is a regional abdominal anaesthetic technique frequently used within non-cosmetic abdominal surgery. Its use in cosmetic abdominoplasty procedures is less frequently documented. The literature is devoid of a meta-analysis to quantitatively amalgamate the results of individual reports analysing the efficacy of TAP block compared to alternative analgesic methods in abdominoplasty surgery.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were referred to conduct this systematic review and meta-analysis. All observational and randomised controlled trials (RCTs) comparing the postoperative outcomes of patients who underwent abdominoplasties with TAP blocks versus no TAP blocks were included in this study. The time taken to first analgesia and the amount of analgesia used were the primary outcome measures. The secondary outcome measures include severity of pain, time to mobilisation, and length of stay.

The time taken to the first analgesic was significantly lower in the TAP cohort (p <0.05). In addition, there was a lower incidence of postoperative nausea/vomiting (OR 0.18, 95%CI 0.04 - 0.90, p=0.04). Mean total opioid use and operative time were comparable between the TAP and no TAP groups. A qualitative review of the visual analogue scale for pain amongst the included studies showed that it was lower in the TAP group.

The authors report the first meta-analysis of the literature showing the efficacy of the TAP block in abdominoplasties. Further high-quality trials are recommended to further the current evidence base.

Adhesions form between tissue surfaces due to inflammation and trauma to tissue. Adhesions are a common postoperative complication of abdominopelvic surgery, often leading to chronic pain, adhesive small bowel obstruction (ASBO), and increased healthcare costs. Anti-adhesive agents such as Seprafilm and 4DryField PH are employed to mitigate these risks, but direct comparisons between these barriers are lacking, creating a need to evaluate their relative efficacy. This systematic review aims to compare the efficacy of 4DryField PH and Seprafilm in preventing postoperative adhesion formation and associated complications such as ASBO in patients undergoing abdominopelvic surgery.

A search of PubMed, Scopus, Cochrane Library, Embase, and trial registries identified 7 studies, including RCTs and cohort studies. Inclusion criteria were studies involving patients aged 18 and above who underwent abdominopelvic surgery and received either 4DryField PH or Seprafilm. Studies that included patients with extensive pre-existing abdominal conditions and malignancies were excluded. Data was extracted on adhesion incidence, severity, extent, chronic pain, and ASBO.

4DryField PH significantly reduced adhesion incidence and ASBO compared to Seprafilm, showing a 71.3% reduction in adhesion incidence and a 2.5% ASBO rate. It also led to greater reductions in adhesion severity and chronic pain.

4DryField PH demonstrates superior efficacy over Seprafilm in preventing postoperative adhesions, reducing chronic pain, and lowering ASBO incidence in abdominopelvic surgeries. These findings suggest that 4DryField PH has the potential to become the preferred anti-adhesive agent in clinical practice, particularly in high-risk surgical procedures. Further studies should confirm these findings and evaluate long-term cost-effectiveness.

Telemedicine is the use of information technologies in remote healthcare. Although widespread, there are discussions about the impacts of this type of medical care. Thus, this review aims to elucidate the use of telemedicine in Brazil based on systematic reviews from the last decade.

The research was conducted in NCBI/PubMed, based on the terms “(telemedicine[Title/]) AND (brazil[Title/])”. Seven records were initially found, with three excluded after screening, all of them were evaluated by two independent reviewers, based on their respective titles in primer selection and then on their s in a second stage.

The four selected articles demonstrate positive evidence of the use of telemedicine, which shows promise in increasing adherence to healthcare, as well as in cost-effectiveness by demonstrating that artificial intelligence has the potential to assist more accurate, efficient, and faster diagnoses than the traditional. This technique has become prominent since the coronavirus pandemic, becoming an alternative to conventional treatments in a chaotic scenario. However, research has also highlighted barriers to the development of quality telemedicine, considering the structure required for an evidence-based information policy and familiarizing healthcare professionals with this technology.

Thus, telemedicine has proven to be a promising practice in Brazil, with clear examples of uses and effectiveness. However, we cannot ignore the need for further studies, organization, and investments in infrastructure, for a healthcare policy that is not just effective but also universal, equitable, and integral.

Coronary artery disease is a prevalent condition that increases the risk of recurrent ischemic events. Coronary artery bypass graft surgery is an effective treatment for ischemic heart disease. Long-term outcomes are affected by atherosclerosis progression in native and grafted arteries. Statins have been shown to reduce atherosclerosis progression and improve cardiovascular outcomes.

A systematic review and meta-analysis were conducted to assess the effects of statins on patients with CABG. Five databases were searched until January 11, 2024, following PRISMA guidelines. Randomized controlled trials (RCTs) comparing statin use to placebo were included. The primary outcomes were MI and death from Cardiovascular System (CVS) complications, and the secondary outcomes were Stroke or TIA and secondary CABG.

Four RCTs involving 2402 patients were included. Patients in the statin group had significantly lower CVS events compared to the placebo group (OR: 0.61, 95% CI [0.39, 0.95], p = 0.03). Statins also significantly reduced MI events compared to the placebo group (OR: 0.57, 95% CI [0.39, 0.84], p = 0.005).

Our Meta-analysis showed that statins produce significant effects in reducing the rate of death from cardiovascular complications, myocardial infarction, and overall mortality. However, they didn’t reduce the rate of secondary CABG stroke or TIA. We suggest that future studies should try to further establish a relationship regarding the doses and agents that produce significantly lower rates of secondary CABG stroke and TIA.

THA operations have increased globally because of the increasing prevalence of hip osteoarthritis, which relieves pain and restore function in patients with severe hip arthritis and other debilitating hip conditions. THA proves effective; however, is associated with perioperative blood loss and is costly. Tranexamic acid (TXA) reduces blood loss, however its impact on hidden blood loss (HBL) is uncertain. TXA may be enhanced by haemostatic carbazochrome-sodium-sulfonate (CSS). In this meta-analysis, CSS and TXA are tested for safety and blood loss reduction in THA patients.

A systematic review and meta-analysis followed PRISMA and Cochrane Handbook guidelines. Randomised controlled studies comparing CSS+TXA vs TXA alone in primary THA patients were eligible. Total, hidden, and intraoperative blood loss, haemoglobin reduction, inflammatory markers, VAS level, hospitalisation, transfusion rates, and complications were examined.

Three studies had 450 people. The meta-analysis showed that the CSS+TXA group had significantly lower TBL (MD = -270.23 ml; P<0.001) and HBL (MD = -269.09 ml; P<0.001) than the TXA+Placebo. No significant IBL difference (MD = -82 ml; P=0.61). The CSS+TXA group had lower transfusion rates (RR = 0.10; P=0.006). Mean haemoglobin decrease, hospitalization, and operation time were not significantly different. CSS+TXA significantly reduced postoperative VAS pain and inflammation. No increase in thromboembolic events or other complications was observed.

CSS and TXA minimise THA perioperative blood loss, pain, and inflammation. Further research is needed to confirm these findings in bigger, diverse populations and identify dosing and long-term complications.

Peptic ulcer disease, characterised by defects in the gastric or duodenal mucosa, frequently leads to complications including perforation. The Graham repair using omental patch is the gold standard surgical intervention, but the falciform ligament patch repair serves as an alternative when the omentum is inadequate. This systematic review and meta-analysis aim to compare the efficacy and safety of omentopexy and falciformopexy in patients with perforated peptic ulcers.

Following PRISMA guidelines, a comprehensive search across four databases (Web of Science, PubMed, Scopus, and Cochrane Library) was conducted up to July 5th, 2024. Eligible studies included adult patients undergoing surgical repair for perforated peptic ulcer disease comparing omentopexy with falciformopexy. Data extraction and quality assessment were performed by two independent reviewers. Meta-analyses were conducted using Review Manager (RevMan) software.

Out of 58 identified articles, three retrospective cohort studies comprising 1089 patients met the inclusion criteria. Omentopexy was performed in 960 patients and falciformopexy in 129 patients. Baseline characteristics were comparable. Falciformopexy showed a shorter duration of surgery and hospital stay but had a significantly higher risk of leakage and post-operative ileus. No significant difference in mortality and other complications was found. Heterogeneity was noted in some outcomes, necessitating further research.

Both omentopexy and falciformopexy are viable for managing perforated peptic ulcers with comparable safety and efficacy. Further high-quality, prospective studies are necessary to clarify the relative benefits of each method.

The COVID-19 pandemic and junior doctor strikes have significantly impacted medical education, leading to reduced clinical exposure for students. Extended reality (XR) including virtual reality (VR), augmented reality (AR) and mixed reality (MR), offer immersive and interactive learning experiences that can potentially enhance case-based learning (CBL) and bridge the gap between theoretical knowledge and practical application. Despite the growing interest in XR within medical education, its specific use in CBL has not been systematically reviewed.

A systematic literature search was conducted across 3 databases, yielding 806 studies. Studies were included if they were published in English, involved undergraduate medical students, utilised XR for CBL. The methodological quality was assessed using the Modified Medical Education Research Study Quality Instrument. The findings were synthesised using the Braune and Clarke (2006) thematic analysis framework.

Eight studies met the inclusion criteria: VR (n=3), AR (n=3) and MR (n=2). Four main themes emerged: (1) learner engagement, (2) realism, (3) learning outcomes, and (4) implementation factors. XR enhanced engagement, provided realistic experiences. leading to improved knowledge acquisition (n=7), skill development (n=4), and retention. However, technical challenges were barriers to implementation. The certainty of the outcomes is limited by the small number and heterogeneity of studies.

XR technologies have the potential to enhance CBL in undergraduate medical education by promoting engagement and positive learning outcomes. However, careful consideration of implementation factors is necessary to ensure the successful integration of XR in medical curricula. This review provides important recommendations for future research.

This study aimed to evaluate the impact of the location, size, and type of radiological calibration markers on the accuracy of templating in total hip arthroplasty (THA) using 2D and 3D templating tools.

A systematic review and meta-analysis were conducted following PRISMA guidelines. Electronic databases (Ovid, PubMed, Web Science) were searched for studies from 1980 to July 2024 reporting on the accuracy of hip templating tools. The primary outcome was the acetabular and femoral accuracy in predicting implant size. Studies were assessed for risk of bias using Cochrane’s ROB-2 tool and the MINORS criteria. Statistical analysis was performed using Revman 5.4 with odds ratios (OR) for accuracy, and heterogeneity was evaluated using I².

The review included 8 studies with 659 templated hips. Digital templating was significantly more accurate for acetabular components (OR 2.12, 95% CI 1.36–3.30, p=0.0009) and overall implant size prediction (OR 2.53, 95% CI 1.44–4.33, p=0.0007). In a subgroup analysis, 3D templating tools outperformed 2D tools in both acetabular and femoral accuracy (OR 2.48, 95% CI 1.66–3.72, p<0.0001). Significant heterogeneity (I² = 62%) was found in some analyses.

Digital and 3D templating tools offer higher accuracy for implant size prediction in THA compared to analogue and 2D methods. These findings suggest potential clinical benefits, such as reducing implant loosening and improving patient outcomes. However, further research into cost-effectiveness and the implications of increased radiation exposure with 3D methods is required.

Custom triflange acetabular components (CTAC) is a promising contemporary modality for managing significant acetabular defects where revision total hip arthroplasty (rTHA) is necessary. This meta-analysis aims to provide a comprehensive evaluation of the clinical performance of CTAC in revision THA for large acetabular defects.

The studies for this meta-analysis were sourced from PubMed, Embase, Web of Science, Cochrane Library, and Emcare. PRISMA guidelines were followed in selecting studies, data extraction, and analysis.

25 retrospective case studies were included in this meta-analysis. Improvements in Harris Hip Scores (mean 70.53), implant survivorship (mean 45.75), and revision rates (mean 4.53) are moderately high. However, these findings are limited by high heterogeneity. The current findings and literature, consider CTAC a superior treatment option compared to other alternatives.

CTAC in rTHA offers a potentially effective approach to managing severe acetabular deficiencies, but there is still a need for standardized methodologies and further large-scale research.

This study aims to systematically compare the clinical and functional outcomes of Medial Pivot (MP) and Post Stabilised (PS) knee implants in patients undergoing total knee arthroplasty (TKA).

The strategy for this systematic review concerned an intensive literature search using databases consisting of PubMed, CINAHL, Embase, and the Cochrane Library, adhering to PRISMA suggestions. A total of ten studies were included in this SRMA.

This analysis encompassed a total of ten studies. Meta-analysis was conducted for different variables such as WOMAC score, KSS score, OKS score, and range of motion. The results showed that both methods were well tolerated in the patients and no significant difference was observed between the outcomes of both groups. Range of Motion in the studies was calculated using 5 different studies. Data was extracted and a forest plot was made. The total effect was found to be 0.15 (-0.05, 0.35).

We conclude that, although the Medial Pivot (MP) prosthesis exhibits some advantages in knee kinematics and patient satisfaction, there is no statistically significant overall clinical superiority when compared to the Post Stabilized (PS) knee implants in total knee arthroplasty (TKA). This is based on a systematic review and meta-analysis. When it comes to reducing pain, enhancing range of motion, attaining radiographic alignment, and handling complications, both MP and PS prostheses are equally effective. This gives medical professionals practical choices that can be tailored to the specific surgical preferences and needs of each patient.

The use of mesh in emergency repair of complicated groin hernias has been a subject of discussion for decades. While it is now generally accepted that mesh could safely be used in incarcerated (irreducible) and obstructed hernias (without strangulation), with wound infection rates comparable to suture repairs, the use of mesh in strangulated hernias involving bowel resection is still controversial.

The aim of this study is to analyse the safety of mesh in strangulated hernias with ischaemic bowel at the time of surgery.

A literature search was carried out using relevant key words. The study was conducted in accordance with PRISMA 2020 framework, and data analysis done using the Review Manager version 5.4 meta-analysis software.

Seven studies comprising 1,159 patients who had emergency surgery for strangulated groin hernias were analysed. A pooled random effect meta-analysis did not show any significant difference in the surgical site infection rate (OR = 0.88, 95% CI = 0.39 – 1.96, p = 0.75), seroma formation (OR = 3.39; 95% CI = 0.70 – 16.43; p = 0.13), and hernia recurrence (OR = 0.33; CI = 0.05 – 2.22; p = 0.26) between the two groups.

The long-held concern that mesh could not be safely used in strangulated groin hernias has not been validated by the results obtained from this systematic review and meta-analysis. However, more randomised controlled trials in this clinical area would need to be carried out to further validate the results of this study.

Nailbed injuries are common especially in children and pose significant health and financial burdens due to the complex fingertip anatomy. Managing these injuries is challenging. This review focuses on the epidemiology, injury patterns, treatment strategies, and outcomes of nailbed injuries.

An advanced literature search on PubMed and Cochrane using keywords which yielded 31 papers. Of these, 24 were excluded for not meeting inclusion criteria, such as studies on toe injuries, amputations, burns, or non-fingertip hand injuries.

Five retrospective and two prospective studies were reviewed, encompassing a total of 1,080 patients, the majority of whom were children. Five papers only included patients who had an intervention therefore accurate conclusion on the outcome for intervention against conservative management could not be drawn. From the papers analysed, conservative management is more common in paediatric patients than in the mixed-age group study, which includes patients aged 1 to 66 years. Nail replacement is higher in children (65.2% vs. 18.3%). Data on infection rates for the nail replacement group is insufficient. Specialist care shows high surgical intervention (96.3%) and antibiotic use (92.5%), but infection rates are not specified. Patients managed by the Emergency Department who had a procedure had 17.6% infection rate for those not prescribed antibiotics.

Surgical management is the primary approach for upper extremity nailbed injuries, while conservative treatment is less common. Infection rates and nail replacement require careful risk-benefit analysis. Future research should aim to optimise treatment protocols, reduce complications, and clarify antibiotic use to improve outcomes.

Women are recognized to carry higher periprocedural mortality risk for ascending aortic aneurysm (AscAA) surgery. We conducted a meta-analysis to study sex differences in presentation and outcomes for women undergoing AscAA surgery.

A PRISMA compliant literature search and data extraction was conducted using PubMed, EMBASE, SCOPUS, and Cochrane. Observational cohort or retrospective registries were included that compared a defined number of male and female adults undergoing surgery for AscAA. Data analysis was conducted in compliance with Cochrane methods.

A total of 6 unique studies met inclusion criteria from which 6011 patients were included, with a distribution of 4096 males (68%) and 1915 females (32%). Males were significantly younger at the time of surgery, mean difference (MD): -4.25, 95%CI [-6.94, -1.55], P= 0.0002). Female patients had significantly larger Indexed/Normalized AscAA diameter (MD: -3.21 95%CI [-4.58, -1.84], P < 0.00001 and more frequently underwent total-arch replacement (RR: 0.49, 95%CI [0.25, 0.98], P= 0.04). Male patients had significantly lower 30-day mortality, (RR: 0.66, 95% Cl [0.47, 0.93], P= 0.02).).

Women present with less comorbidities, older ages and face greater 30-day mortality. Future research should focus on delineating longer term outcomes and optimizing risk surveillance strategies for patients that may benefit from preemptive aortic repair.

Patient-Reported Outcome Measures (PROMs) are essential for understanding patients' views on their health and treatment efficacy. The Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) is frequently used to assess upper limb conditions alongside other PROMs, such as the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Michigan Hand Outcomes Questionnaire (MHQ). This review evaluates the reliability, validity, and responsiveness of QuickDASH compared to other upper limb PROMs.

A systematic review was conducted including seven prospective cohort studies and one retrospective study, with a total of 1,561 participants. Studies were selected based on their use of QuickDASH alongside other PROMs in patients with upper limb conditions. The psychometric properties of QuickDASH, including reliability, validity, and responsiveness, were analyzed in comparison with other PROMs.

The QuickDASH demonstrated strong psychometric properties across a variety of clinical contexts. Its reliability and validity were confirmed through high correlation with other upper limb PROMs. The tool's brevity and ease of use were recognized as key advantages, facilitating its implementation in both clinical practice and research.

The QuickDASH is a reliable, valid, and responsive PROM for upper limb disorders, offering a concise and accessible alternative to longer measures. However, PROM selection should be tailored to specific clinical contexts to ensure accurate assessment. Further validation of QuickDASH and similar tools is recommended to support their use in diverse healthcare settings.

Laser lipolysis (LL) for arm fat reduction has gained popularity compared to traditional liposuction. This study aims to quantify changes in arm circumference via LL and compare outcomes between treatments with and without suction.

A PRISMA-compliant search was conducted from inception until May 2024, and meta-analysis was performed using Stata. Mean differences (MD) in arm circumference were pooled using the DerSimonian and Laird random effects model.

Out of 135 screened studies, 7 were included in the analysis. The pooled arm circumference reduction (n=199) was 2.95 cm (p<0.001, 95% CI 1.50-4.41). Subgroup analysis revealed that the reduction with suction was 3.39 cm (p=0.078, 95% CI -0.38, 7.16), and without suction, it was 2.04 cm (p=0.022, 95% CI 0.30-3.78). Overall, both clinicians and patients reported high satisfaction levels with the treatment, although satisfaction was notably lower among patients with more advanced conditions. Reported complications were mild and transient, including instances of ecchymosis and prolonged oedema.

While the current evidence is limited by small sample size, the safety profile of laser lipolysis is favourable and the outcomes are promising. Further studies are needed to validate these findings.

The outcomes of skin graft and flap reconstruction can be compromised by colour mismatch between the transferred tissue and the recipient site, potentially causing patient distress. This systematic review aims to comprehensively summarise the factors influencing colour match, the assessment techniques, and innovations in this field.

We conducted a systematic search of Medline and Embase from their inception to 24 May 2024 to identify studies addressing colour match in skin grafts or flaps. We performed a narrative analysis focusing on three domains: assessment methods, influencing factors, and innovative approaches.

From 649 screened articles, thirteen studies met the inclusion criteria. These included two studies focused on skin grafts, eight on flaps, and three on both. Most studies were centred on head and neck reconstructions, with some addressing breast and extremity reconstructions. The L*a*b* system was predominantly used to assess colour match. Significant variation in colour match was observed across different ethnicities and Fitzpatrick skin types. The anatomical location of the donor site was highlighted as an important factor, although the findings were inconclusive. Innovations aimed at improving colour match included epidermal over-grafting, skin-grafted flaps, and non-cultured autologous epidermal cells (NCAECs); however, the evidence remained limited due to small sample sizes.

The reviewed studies predominantly focused on head and neck reconstructions, indicating a need for further research in other anatomical areas. Future studies should explore colour match variations more extensively and validate innovative techniques in larger, more diverse populations.

Innovation in surgery has exponentially improved over the last three decades. However, safety and efficacy assessment through lengthy randomised controlled trials can require significant resources. In-silico modelling may provide a solution, utilising computational simulations to develop and improve medical devices. To date, its potential in testing surgical devices is underexplored. This systematic review aimed to evaluate the current use of in-silico modelling for devices utilised in thoracic and abdominal surgery.

PubMed databases from January 2019 to August 2024 were searched. Inclusion criteria were defined as studies using mathematical/computational models to investigate invasive devices implanted or utilised in thoracic and abdominal surgery.

The search strategy yielded 2968 studies, with 42 included in the final analysis. Core themes identified included proof of concept (n=19), device improvement (n=22), and in-silico clinical trials (ISCTs) with simulated human patients (n=1). Specialities included: general surgery (n=4); hepato-pancreato-biliary (n=2); vascular (n=5); paediatric (n=9); and cardiothoracic (n=22). Most studies were at IDEAL stage 0 (pre-clinical) and 19 studies validated in-silico results with in-vitro/in-vivo data.

In-silico modelling has the potential to replace components of pre-clinical in-vitro and in-vivo testing of surgical devices. Applications include modelling rare diseases and patient demographics, generating efficacy data for novel devices in the pre-clinical stage, and developing/repurposing existing devices to reduce known complications. A core outcome set and unified credibility framework will help standardise methodologies and reporting of results, minimising inter-study heterogeneity. Global collaboration and appropriate regulation will help bring in-silico modelling to the forefront of surgical device research.

Osteoarthritis (OA), especially knee OA, is a major cause of disability and pain worldwide. Traditional treatments often fail to provide lasting relief, and many patients are unsuitable for or reluctant to undergo invasive surgeries like total knee arthroplasty. Recently, minimally invasive techniques such as genicular artery embolization (GAE) have shown promise as alternatives. This study reviews the safety and efficacy of GAE for knee OA-related pain.

After registering the protocol with the PROSPERO database, a search was conducted from inception until July 31, 2023, in PubMed, Cochrane Central Register of Controlled Trials, and ScienceDirect databases to gather studies evaluating GAE's safety and efficacy in knee OA. Data encompassing study characteristics, success parameters, and complications were collected and synthesized.

In total, 23 studies encompassing 657 patients were included. While technical success rates were reported at 100% in most studies, one study indicated an 84.2% success rate and two studies did not provide any information. Clinical success rates varied from 30% to 100% across three months to three years of follow-up. The most frequent post-GAE sequelae included skin discoloration without an ulcer (15.6%, n = 98) and transient post-procedural knee pain (10.2%, n = 64).

The findings from 23 studies underscore GAE's promise in addressing refractory knee OA; however, there is a need for further methodologically robust comparative studies conducted with standardization of outcome reporting and assessment.

This review synthesizes current evidence on optimizing patient outcomes in laparoscopic emergency cholecystectomies, focusing on the impact of surgical timing, surgeon expertise, and advanced laparoscopic techniques and equipment.

A systematic literature review was conducted, covering studies published from 2000 to 2023 in databases including PubMed, Cochrane Library, and Scopus. The review included studies on adult patients undergoing laparoscopic emergency surgeries for acute cholecystitis, specifically examining the effects of timing, surgeon expertise, and advanced equipment on postoperative outcomes.

The analysis revealed that performing laparoscopic cholecystectomy within the first 24 to 72 hours of symptom onset significantly reduces postoperative complications, including bile duct injuries, and lowers the rate of conversion to open surgery. Surgeon expertise emerged as a crucial factor, with experienced surgeons achieving better outcomes, such as lower complication rates and shorter operative times. Additionally, the use of advanced laparoscopic equipment, like robotic-assisted systems and enhanced imaging technologies, was associated with improved surgical precision and reduced intraoperative complications.

Early surgical intervention, coupled with the involvement of experienced surgeons and the use of advanced laparoscopic techniques, is essential for optimizing patient outcomes in emergency cholecystectomy. These findings highlight the need for adopting evidence-based practices in clinical settings to improve recovery rates and reduce surgical risks. Future research should focus on expanding the use of advanced technologies and refining surgical timing to further enhance outcomes in emergency situations.

Eye-tracking technology has been used in a variety of arenas of research but has become a trendy technique to use in surgical research. The aim of this study was to evaluate its use in the process of surgical education.

A systematic search of available literature was conducted during August 2024. Paper was accessed via PubMed, Ovid and Embase were searched using keywords such as "eye-tracking", "Surgery" OR "Surgical", Training, Trainee, Trainer. Studies were excluded if they were not available in English, were for animal studies or focused on other aspects of surgical practice than education.

There is some evidence to suggest that there are differences in the patterns of eye movements for surgeons at different stages of training and competency acquisition. This is inferred to mean that it could be used to assess attainment of these competencies and progress made.

Various metrics were used to evaluate the eye-tracking data gained which lacked standardisation across available literature as were the metrics to evaluate surgical skill.

There is little focus on the trainers including their cognitive load as evaluated by eye tracking.

Eye-tracking technology is a relatively novel tool in surgical research but there is some non-standardised evidence to suggest it can be used in evaluation of surgical trainees.

More research is required in this area to understand if eye-tracking technology can be used to understand changes in the cognitive load of trainers as the trainee’s progress in developing surgical skill and gain greater trust in their abilities.

Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). ACS can be precipitated by surgery. This review studies the clinical profiles of ACS following abdominal surgeries to identify risk factors and the impact of interventions.

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed in Medline, Embase, Cochrane, and Web of Science. The search terms related to “sickle cell disease”, “acute chest syndrome”, and “abdominal surgery”. Two researchers assessed studies for eligibility. Data was reported as a thematic qualitative synthesis.

Twenty-four articles were included. ACS occurs in 4% to 23% of SCD patients following abdominal surgeries. Conflicting views exist on the link between age and ACS. Sex is not associated with ACS. Most studies found no association between SCD severity and ACS. Two studies found no association between comorbidities and ACS rates while one study linked pulmonary comorbidities to postoperative ACS. ACS is associated with postoperative desaturation, leukocytosis, sterile blood and sputum cultures and pulmonary infiltrates. Conservative and risk-based transfusions reduce ACS rates. There is no consensus on whether using an open or laparoscopic approach affects the rates of ACS.

Conflicting views exist on the correlations between age and comorbidities with ACS. Postoperative pain has been suggested as an early indicator of ACS. Individualised risk-based transfusions confer benefits. Future studies should address the impact of intraoperative complications on postoperative ACS rates and interventions such as prophylactic cholecystectomies, prophylactic postoperative CPAP, and minimally invasive laparoscopy.

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Source: https://tomesphere.com/paper/PMC11847618