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Short Paper Session 6.2 11:30 - 13:00 Thursday, 6Th May, 2021 Presentation Type Short Paper Presentations Dimitris Damaskos, Brian Dobbins

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Short Paper Session 6.2 11:30 - 13:00 Thursday, 6Th May, 2021 Presentation Type Short Paper Presentations Dimitris Damaskos, Brian Dobbins Short Paper Session 6.2 11:30 - 13:00 Thursday, 6th May, 2021 Presentation type Short Paper Presentations Dimitris Damaskos, Brian Dobbins TP6.2.1 Does the use of Negative Pressure Wound Dressings decrease superficial Surgical Site Infections in the Emergency Laparotomy? Eleanor Smith1,2, Hannah Merriman1, Safia Haidar1, Grace Knudsen1, Victoria Kinkaid1, Sarah Burton1 1Frimley Park Hospital. 2University Hospital Lewisham Abstract AIMS: Surgical site infection (SSI) can be a significant cause of morbidity in the emergency laparotomy patient. Previous research into the role of negative pressure wound dressings to improve the rate of SSI culminated with NICE guidelines in 2019 recommending the use of negative pressure wound dressings in people who would be considered high risk for developing an SSI. Based on this guideline, we changed our policy to recommend the use of PICO dressings for all emergency laparotomies in order to decrease our rate of SSI. Our aim of this study was to assess the success of this policy change. METHODS: In this closed-loop audit we analysed data from all laparotomy patients at Frimley Park Hospital over 12 months. We retrospectively analysed the data of the pre-intervention group between January – June 2019, and prospectively audited all laparotomy patients between July – December 2019. RESULTS: We found that there was no significant decrease in the rate of superficial SSI, from a pre intervention rate of 22.2% to a post intervention 24.1%. Similarly, we found no significant decrease in the rate of wound dehiscence, which increased from 13.8% to 17.7%. In further assessment we saw no significant difference in the rates of contamination, ASA grades, or closure techniques to account for these increased rates. CONCLUSION: While other studies have demonstrated a decrease in SSIs following the use of PICO dressings, we did not show such a result, leading us to question the cost-effectiveness of negative pressure wound dressings in the emergency laparotomy patient. Please provide the name of the author who will register for the congress: eleanor Smith Please provide the email address of this author [email protected] TP6.2.2 Multi-disciplinary interventions to increase utilisation of NELA scores and critical care involvement following emergency colorectal surgery Scott Smith, Katherine Hodge, Andrew Ying, Rebecca Swan, Alexander Von Maydell, Nicholas Ventham Department of Colorectal Surgery, Western General Hospital, Edinburgh Abstract Aims This audit aimed to assess pre-operative NELA risk score documentation and subsequent specialist peri- operative critical care involvement. Methods This complete audit cycle retrospectively reviewed notes (electronic patient records, anaesthetic charts and CEPOD booking forms) of all patients undergoing emergency laparotomy between March and May 2019. The NELA score was calculated retrospectively if not documented. Following the initial audit, the following multi- disciplinary interventions were instituted: alteration of the physical CEPOD booking form to include NELA score (Surgical); a sticker added to anaesthetic charts to prompt NELA calculation (Anaesthetic), formal recording of NELA score during theatre brief (Theatre staff); and by increasing awareness of NELA via departmental education (All). The audit cycle was completed by reassessment between October and November 2020. Results The initial cycle included 34 patients, with only 2 (6%) having a NELA documented. The repeat cycle included 35 patients, with 29 (83%) having a NELA documented. Regarding post-operative critical care admissions, both cycles found that 100% of patients with a NELA of ≥5%, were admitted to either surgical HDU or ICU (n=17 in first cycle, n=17 in second cycle). For those with a high-risk NELA of ≥10% (n=11 in first cycle, n=7 in second cycle), only 2 (18%) were admitted to ICU in the first cycle vs 7 (100%) in the second cycle. Conclusions This complete audit cycle demonstrates improved NELA score calculation following institution of several multidisciplinary interventions. The improved NELA score uptake was associated with increased critical care review and admission to ITU in high-risk cases. Please provide the name of the author who will register for the congress: Scott Smith Please provide the email address of this author [email protected] TP6.2.3 Abnormal liver function tests: A helpful diagnostic test and a predictor of severity in acute appendicitis Muwaffaq Telfah, Mathew Mason, Marianne Hollyman, Hamish Noble, David Mahon, Richard Welbourn Musgrove Park Hospital, Upper GI surgery, Taunton and Somerset NHS FT, UK Abstract Aim: Acute appendicitis (AA) is the commonest surgical emergency worldwide. The diagnosis usually is clinical but imaging and bloods tests are helpful. The study aims to establish the role of abnormalities in liver function tests (LFTs) in the diagnosis and in predicting the severity of AA. Methods: Retrospective, observational study performed in district general hospital between June 2018 and June 2019. Patients with abdominal pain and appendicectomy (excluding children <16 years with isolated ALP rise) were categorized into two groups based on presence (Group-A) or absence (Group-B) of abnormal LFTs. Demographics data, diagnosis and severity of appendicitis, hospital stay and postoperative complications were analysed. Results: Two hundred and seventy nine patients were included: Group-A (n=146, mean age 37.5 years, M: F 1.3/1.0) and Group-B (n=133, mean age 29.7 years, M:F 1.0/1.8). Appendicitis occurred in 85.6% of Group-A (125/146) and in 62.4% (83/133) of Group-B with positive predictive value 85.6%. The appendix was normal in 14.4% of Group-A (21/146) and in 37.6% of Group-B (50/133) with specificity of 70%. Laparotomy was required in 6.1% in Group-A (9/146) compared to 1.5% in Group-B (2/133). Average hospital stay was 4.7 days (range: 1-21) in Group-A versus 2.7 days (range 1-14) in Group-B. Readmission rate due to a postoperative complication was 16.4% in Group-A (24/146) compared to 6% in Group-B (8/ 133). Conclusion: Deranged LFTs is an additional diagnostic tool in AA and a good predictor of its severity. This may help to decrease the negative appendicectomy rate and guide surgeon in the decision-making process. Please provide the name of the author who will register for the congress: Muwaffaq Telfah Please provide the email address of this author [email protected] TP6.2.4 Emergency colorectal resections: do colorectal surgeons achieve better outcomes than non-colorectal surgeons? Diana Wu1,2, Isabel Gartner2, Nikola Henderson1,2 1Ninewells Hospital, Dundee. 2University of Dundee Abstract Aim: Patients requiring emergency colorectal surgery in Tayside are managed by general surgeons who may or may not have subspecialist training in colorectal surgery. We investigated whether surgeon subspecialisation influences outcomes after emergency colorectal resections. Methods: All patients undergoing emergency colorectal resections between 01/01/14 and 31/10/20 were included. Demographic, clinical, operative and outcome data were collected from hospital electronic records. Outcomes were compared for patients treated by colorectal versus non-colorectal surgeons. The primary outcome was 30-day post-operative mortality. Adjusted mortality was calculated using logistic regression. Secondary outcomes included rates of laparoscopic surgery, stomas, complications, readmissions and length of hospital stay. Categorical data were compared by chi-squared tests and non-parametric data by Wilcoxon tests. Results: Of the 177 operations performed, 104 (58.8%) were performed by colorectal surgeons. Overall 30 day mortality was 5.1%, which was significantly lower for colorectal versus non-colorectal surgeons (1.0% vs 11.0%, p=0.003), this remained significant after multivariate adjustment (Odds ratio 0.10, 95% confidence interval 0.01-0.86, p=0.036). The proportion of laparoscopic cases was significantly higher for colorectal compared with non-colorectal surgeons (54.8% vs 4.1%, p<0.0001). There were no significant differences in stoma rates (76.0% vs 63.0%, p=0.063), further procedures (5.8% vs 8.2%, p=0.523), anastomotic leaks (1.9% vs 4.1%, p=0.387), readmission within 30 days (12.5% vs 13.7%, p=0.815) or median length of hospital stay (16 vs 18 days, p=0.375). Conclusion: Mortality rates at 30 days after emergency colorectal surgery are significantly lower for patients treated by subspecialist colorectal surgeons. This provides a strong argument for a subspecialist on-call rota. Please provide the name of the author who will register for the congress: Diana Wu Please provide the email address of this author [email protected] TP6.2.5 Post-operative recovery following emergency laparoscopic cholecystectomy: a need to redefine the consent for emergency cholecystectomy James Lucocq, Ganesh Radhakishnan, John Scollay, Pradeep Patil Ninewells Hospital Abstract Aims Understanding the risks of emergency LC is necessary before patients can make an informed decision regarding operative management. Our primary aim was to provide a comprehensive analysis of the post- operative course of these patients. Methods Emergency LC performed for all biliary pathology across three surgical units between January 2015 and January 2020 were included. We followed each patient up for 100 days postoperatively and data was collected retrospectively. Data collected included demographic data, operative data, post-operative recovery, imaging, additional interventions and re-admissions. Results A total of 605 patients were identified (median age, 53 years (range 13-92); M:F, 1:2.7). 36.9% of patients had a complicated postoperative period, either suffering a significant complication, requiring prolonged post- operative stay (>3 days), further imaging, additional interventions or re-admission. The rate of complication was 13.5% (including retained stones 3.5%; collections 3.8%; bile leaks 3.3%). The rate of prolonged post- operative stay was 25.1%. 16.2% required postoperative imaging and 6.1% required post-operative intervention.12.9% were re-admitted for assessment related to the LC.
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