scholarly journals 1601 Trends in Investigation, Management and Patient Outcomes Following Emergency Presentation with Groin Hernia

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
D Clyde ◽  
L Li ◽  
R Swan ◽  
R McLean ◽  
L Brown
Keyword(s):  
Patient Outcomes ◽  
Bowel Resection ◽  
Postoperative Mortality ◽  
Ct Scanning ◽  
Operative Management ◽  
The North ◽  
Emergency Presentation ◽  
Inguinal Hernias ◽  
The Impact ◽  
Groin Hernias

Abstract Aim Groin hernias are associated with an increased morbidity and mortality following emergency presentations. This study aimed to review current practices regarding investigation and operative management of acute admissions of groin hernias in the North of England. Method Patients ≥18 years admitted as an emergency with femoral or inguinal hernias, between 2002-2016, across NHS trusts in the North of England were included. Data on demographics, investigations and operative interventions was collected. Outcomes of interest included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality. Results A total of 6165 patients were identified over 15 years: 4698 inguinal hernias and 1467 femoral hernias. 3904 (63.3%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.3% (2012-2016) (p < 0.001) and was associated with a reduced rate of surgical intervention (64.0% vs. 55.3%, p < 0.001). Bowel resection was higher amongst patients who underwent CT (16.6% vs. 6.4%, p < 0.001). Of those presenting with bowel obstruction, 11.7% required resection, 95.9% of these being small bowel. Bowel resection was associated with increased LoS (p < 0.001) and 30-day postoperative mortality (16.4% vs. 2.8%, p < 0.001). Laparoscopic repair, utilised in 177 procedures (4.5%), was associated with a shorter LoS compared to open repair (4.7 vs 5.5 days, p < 0.001) but no difference in mortality. Conclusions Emergency hernia repair, particularly cases requiring bowel resection, have high mortality rates. Pre-operative CT scanning is associated with reduced rates of operative intervention. Further research is required to assess the impact these changes have on surgical decision-making, and subsequent patient outcomes.

NELA.02Trends in management and outcomes for patients presenting acutely with inguinal hernia

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Danielle Clyde ◽  
Lucy Li ◽  
Rebecca Swan ◽  
Ross McLean ◽  
Leo Brown
Keyword(s):  
Inguinal Hernia ◽  
Current Practice ◽  
Open Repair ◽  
Bowel Resection ◽  
Postoperative Mortality ◽  
Ct Scanning ◽  
Fold Increase ◽  
The North ◽  
Management Approaches ◽  
Review Current

Abstract Aims Rates of emergency inguinal hernia presentations are increasing as ‘watch and wait’ management approaches become more popular. This study aimed to review current practice regarding clinical management of patients admitted acutely with an inguinal hernia in the North of England. Methods Patients ≥18 years admitted acutely with an inguinal hernia between 2002-2016 to North of England NHS trusts were identified. Data on demographics, investigations and operative interventions was collected. Outcomes analysed included rate of bowel resection, length of stay (LoS) and 30-day postoperative mortality. Results A total of 4698 patients presented acutely with an inguinal hernia, and 2588 patients (55.0%) underwent emergency surgery. Pre-operative CT scanning increased from 1.0% (2002-2006) to 12.1% (2012-2016) (p < 0.001). Patients who had a pre-operative CT were less likely to undergo repair than those who did not (42.2% vs. 56.0%, p < 0.001). Rates of bowel resection were higher in patients who had a CT (9.6% vs. 2.7%, p < 0.001). Of those presenting with obstructive symptoms, only 5.7% required bowel resection, 85.7% of these being small bowel. Bowel resection was associated with increased LoS (p < 0.001) and 30-day postoperative mortality (18.8% vs. 2.0%, p < 0.001). Laparoscopic repair, used in 119 procedures (4.6%), was associated with shorter mean LoS compared with open repair (3.0 vs 4.4 days, p < 0.001) but no difference in 30-day mortality (p = 0.169). Conclusions Emergency inguinal hernia repairs, requiring bowel resection, are associated with significantly increased LoS and a 9-fold increase in 30-day mortality. These findings raise important aspects to be discussed with patients during the consent process.

SP7.1.7 The impact of surgical subspecialisation on patient outcomes in those admitted with gallstone disease in the North of England: a retrospective cohort study

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Julia McGovern ◽  
John Young ◽  
Leo Brown ◽  
Ross McLean
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Patient Outcomes ◽  
Conservative Management ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Gallstone Disease ◽  
Mortality Data ◽  
The North ◽  
The Impact

Abstract The management of gallstone disease has evolved over time and includes laparoscopic and open cholecystectomy, interventional radiology, endoscopic intervention and conservative management. Subspecialisation within general surgery is commonplace, allowing development of specialist skillsets. The aim of this study is to assess the impact of consultant subspecialisation on patient outcomes in those admitted with gallstone disease. A retrospective cohort study - data was collected on patients admitted with gallstone disease in the North of England between 2002 and 2016. Subspecialisation was categorised as Upper GI or other general subspecialties. The primary outcome of interest was overall 30-day mortality; secondary outcomes included surgical approach and length of stay. A total of 62,286 patients were admitted with gallstone disease. Overall 30-day mortality was 2.1%. The UGI specialists had a higher operative rate - 21.5% vs 10.7% (<0.001) than their colleagues including performing more laparoscopic cholecystectomies– 15.6% vs 6.4% (<0.001), and on-table cholangiogram (OTC) – 3.5% vs 1.5% (p < 0.001). 22,071 patients were diagnosed with acute cholecystitis. Non-UGI Consultants preferred conservative management (76.5% vs 59.0% - p < 0.001) which did not significantly affect 30-day mortality. Data was analysed using IBM SPSS Statistics. Categorical data were compared with chi-square test, and continuous data with t-test or ANOVA. Statistical significance was defined as a p value of ≤ 0.05. UGI consultants performed significantly more “hot gallbladders” than their non-UGI counterparts. UGI consultants choose to operate laparoscopically and perform significantly more OTCs, likely reducing need for pre-operative MRCP but not significantly reducing overall 30-day mortality or length of stay.

scholarly journals SP3.2.15 Patient demographics and outcomes following emergency presentation with a groin hernia; a 15-year retrospective cohort study from the North of England

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Danielle Clyde ◽  
Lucy Li ◽  
Rebecca Swan ◽  
Ross McLean ◽  
Leo Brown
Keyword(s):  
Groin Hernia ◽  
Inpatient Mortality ◽  
Day Case ◽  
Patient Demographics ◽  
The North ◽  
Emergency Presentation ◽  
Included Patient ◽  
Male Preponderance ◽  
The Uk ◽  
Groin Hernias

Abstract Aims Over 70,000 groin hernia repairs are performed in the UK annually. While most are performed in day-case settings, emergency presentation remains common and has a high associated morbidity and mortality. This study aims to report on patient demographics and outcomes following emergency presentation with a groin hernia. Methods Data was collected for all patients >18 years admitted acutely with an inguinal or femoral hernia to NHS trusts between 2002-2016 in the North of England. This included patient demographics and operative interventions. Outcomes of interest were thirty-day inpatient mortality and length of stay (LoS). Results Overall, 6165 patients presented as an emergency with a groin hernia (76.2% inguinal) over the 15-year study period. There was a male preponderance (n = 4469, 72.5%) with a median age of 73 years (IQR: 58,82). No changes in the distribution of age or gender were noted over the study period. Comorbidity, as measured by Charlson score, increased over time (p < 0.001). Median LoS was 2 days (IQR: 1,5), increasing with age and comorbidity (both p < 0.001). Emergency surgery was performed for 3904 patients (63.3%). The thirty-day mortality rate of 3.1% rose to 3.7% in the subgroup of patients undergoing operative repair and 5.6% in those with associated bowel obstruction. Greater comorbidity and advanced age were again associated with increased mortality (both p < 0.001). Conclusions This study highlights changing patient demographics more comorbid patients presenting acutely with groin hernias. These patients must be counselled regarding their increased mortality risk as part of the shared decision-making process.

Nachhaltigkeit im Wald – vor und hinter der Welle der Globalisierung | Sustainable Forest Management – In Front and Behind the Wave of Globalization

2000 ◽  
Vol 151 (12) ◽  
pp. 502-507
Author(s):  
Christian Küchli
Keyword(s):  
Forest Management ◽  
Cultural Landscape ◽  
Sustainable Forest Management ◽  
Essential Element ◽  
Specific Situation ◽  
The South ◽  
The North ◽  
Time Space ◽  
Starting Point ◽  
The Impact

Are there any common patterns in the transition processes from traditional and more or less sustainable forest management to exploitative use, which can regularly be observed both in central Europe and in the countries of the South (e.g. India or Indonesia)? Attempts were made with a time-space-model to typify those force fields, in which traditional sustainable forest management is undermined and is then transformed into a modern type of sustainable forest management. Although it is unlikely that the history of the North will become the future of the South, the glimpse into the northern past offers a useful starting point for the understanding of the current situation in the South, which in turn could stimulate the debate on development. For instance, the patterns which stand behind the conflicts on forest use in the Himalayas are very similar to the conflicts in the Alps. In the same way, the impact of socio-economic changes on the environment – key word ‹globalisation› – is often much the same. To recognize comparable patterns can be very valuable because it can act as a stimulant for the search of political, legal and technical solutions adapted to a specific situation. For the global community the realization of the way political-economic alliances work at the head of the ‹globalisationwave›can only signify to carry on trying to find a common language and understanding at the negotiation tables. On the lee side of the destructive breaker it is necessary to conserve and care for what survived. As it was the case in Switzerland these forest islands could once become the germination points for the genesis of a cultural landscape, where close-to-nature managed forests will constitute an essential element.

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