scholarly journals P-EGS30 Audit of the management of patients presenting with gallstone pancreatitis during the COVID-19 pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Christophe Thomas ◽  
Katie Hutchinson ◽  
James Brown
Keyword(s):  
Disease Patient ◽  
Operative Management ◽  
Weekend Effect ◽  
Definitive Treatment ◽  
Gallstone Pancreatitis ◽  
Biliary Disease ◽  
Recurrent Pancreatitis ◽  
Retrospective Audit ◽  
Number Of Patients ◽  
The Uk

Abstract Background In the UK around 50% of cases of pancreatitis are caused by gallstones. BSG guidelines recommend ERCP is undertaken within 72h of onset of pain and patients should undergo definitive treatment with cholecystectomy if fit enough during the index admission or within two weeks of discharge to avoid the risk of potentially fatal recurrent pancreatitis. A national audit in 2015 showed that 34.2% of patients receive definitive treatment. During the first COVID-19 wave our surgical service was forced to modify practice including more conservative/non operative management potentially increasing the possibility of recurrent pancreatitis and thus complications. Methods We performed a retrospective audit of patients presenting to our unit with gallstone pancreatitis during the first wave of the COVID-19 pandemic from March to August 2020 (COVID) and compared this to the same period in 2019 (pre-COVID). Patients were filtered from a larger dataset of all admissions with an ICD-10 coding of any biliary disease. Patient demographics, admission details, investigations, surgical management and post-operative complications were recorded. This was then audited against the standards in the BSG guidelines for the management of pancreatitis. Results Conclusions There were significant differences in the management of the groups. Most significantly in the number of hot procedures and number of patients receiving definitive treatment, a consequence of the conservative approach during COVID. Our pre-COVID results are similar to our previous audit in 2016; 76% received definitive treatment. Those that didn’t have definitive treatment were generally due to frailty/co-morbidities. Majority of ERCP delays were due to weekend effect. Of the 40 patients who didn’t receive definitive treatment 16 have represented with biliary flares/pancreatitis in the year following the study period highlighting the importance of definitive treatment.

scholarly journals P-EGS27 Outcomes of disorders of the gallbladder, biliary tract, and pancreas during COVID pandemic

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Christophe Thomas ◽  
Freddie Dowker ◽  
Hettie O'Connor ◽  
Liam Horgan
Keyword(s):  
Conservative Management ◽  
Significant Proportion ◽  
Operative Management ◽  
Definitive Treatment ◽  
Categorical Variables ◽  
Gallstone Pancreatitis ◽  
Retrospective Audit ◽  
Increased Risk ◽  
Operative Complications ◽  
Post Operative Complications

Abstract Background Biliary disorders make up a significant proportion of the acute general surgical workload. Effective management allows definitive treatment with relief of symptoms and reduced impact to patients due to recurrent admissions and complications. During the first COVID-19 wave and lockdown there were reduced surgical presentations to hospital and patients presented later. Surgical services were forced to implement different practices including more conservative/non operative management potentially increasing the possibility of recurrent presentations and greater complications in biliary-pancreatic presentations. Methods We performed a retrospective audit of patients presenting to our unit with ICD 10 codes: K80;Cholelithiasis, K81;Cholecystitis and K85;Acute pancreatitis. We used the period of the first wave of the COVID pandemic March – August 2020(COVID) and compared this to the same period in 2019(pre-COVID). On note review those with inaccurate coding were excluded. Patient demographics, admission details, investigations, surgical management, operative details, and post-operative complications were recorded. The primary outcomes were change in operative management, representation, and post-operative complications. χ2 test was used to test for significance of categorical variables. Results Conclusions The two groups were demographically similar with equal spread of primary diagnoses however there were significant differences in outcomes. Patients presenting with cholecystitis and gallstone pancreatitis had significantly reduced rates of definitive management. The increase in adverse operative findings is likely secondary to patients presenting later and initial conservative management. The increase in complications for the COVID cohort correlates with the increase in adverse findings/operative complexity. Conservative management with the aim of reducing COVID exposure inadvertently resulted in increased risk to patients with increased presentations/admissions. Despite this risk there were no COVID cases in our cohort.

scholarly journals 1333 A Retrospective Audit Against National Standards and Guidelines of The Management and Outcomes of Acute Pancreatitis in A London District General Hospital

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
K Tytler ◽  
L Nip ◽  
C M Borg
Keyword(s):  
Acute Pancreatitis ◽  
Correct Diagnosis ◽  
District General Hospital ◽  
National Standards ◽  
British Society ◽  
Definitive Treatment ◽  
Gallstone Pancreatitis ◽  
Post Discharge ◽  
Retrospective Audit ◽  
Threatening Condition

Abstract Introduction Acute pancreatitis (AP) is a potentially life-threatening condition. The audit looks at its management and compares it versus the British Society of Gastroenterology guidelines. Method The study retrospectively assessed plans and results for patients with AP over 4 months. Targets were mortality rate below 10% (<30% for severe cases), correct diagnosis at 48h from admission, ultrasound examination of the gallbladder within 24h of diagnosis, severity stratification within 48h of diagnosis, cause established in over 80%, management involving intensive care settings for severe cases and definitive treatment of gallstone pancreatitis in less than 14 days. Results 34 patients were identified, 3(8.6%) had severe acute pancreatitis (SAP). Mortality was 2.9% overall (33.3% in SAP). AP was diagnosed within 48h of presentation in all cases with severity stratification undertaken in 91.2%. Determination of aetiology was achieved in 82.4% with the rest documented as unknown/idiopathic/requiring further investigations post-discharge. Ultrasound studies were undertaken in 58.8% of cases but, as the hospital did not offer ultrasonography on the weekend, 41.2% actually had this type of imaging performed within 24h. Within those who did not have ultrasound at 24h, 50% had had computer tomography imaging. All SAP cases were discussed with intensivists and 7.1% of gallstone pancreatitis underwent definite treatment within 2 weeks. Conclusions Current practice in the hospital mostly meets the reference standards. However, the percentage undergoing definitive treatment of gallstone pancreatitis is low. We aim to re-audit in 4 months following meetings with local surgical leads to discuss implementation of a suitable pathway.

scholarly journals An Audit of Urology Two-Week Wait Referrals in a Large Teaching Hospital in England

2009 ◽  
Vol 91 (4) ◽  
pp. 310-312 ◽  
Author(s):  
Anup Mathew ◽  
KM Desai
Keyword(s):  
Testicular Cancer ◽  
Cancer Detection ◽  
Detection Rate ◽  
Specific Antigen ◽  
Cancer Detection Rate ◽  
Department Of Health ◽  
Urological Cancers ◽  
Retrospective Audit ◽  
Number Of Patients ◽  
The Uk

INTRODUCTION Two week wait referral guidelines have been published by the UK Department of Health for suspected urological cancers. Concordance to these guidelines is variable. Our objectives were to assess the incidence of urological malignancy and the proportion of inappropriate referrals in the two-week wait pathway. PATIENTS AND METHODS Retrospective audit of all two-week wait referrals to the urology department over 6 months. Inappropriate referrals were those not satisfying the referral criteria, but referred under the two-week wait system. Detection rates were calculated for each referral criterion based on diagnosis obtained from histology, imaging reports and clinic letters. RESULTS Incidence of cancer was 90 of 400 two-week wait referrals (23%). The cancer-detection rate based on reasons for referral ranged from 50 of 122 (41%) for elevated prostate-specific antigen levels to 2 of 56 (4%) for scrotal lumps; 42 (11%) referrals were inappropriate. CONCLUSIONS The overall cancer-detection rate is acceptable. Most inappropriate referrals were for long-standing symptoms and non-specific testicular/scrotal symptoms. The testicular cancer detection rate raises questions about the two-week wait guidelines. Providing general practitioners with fast-track scrotal ultrasound and revising the guideline may reduce the disproportionately high number of patients referred with suspected testicular cancer. Other inappropriate referrals are a cause for concern as they add to the workload of the ‘urgent-referral’ pathway. Urological cancers (those involving the prostate, testis, penis, urethra, bladder, ureters and kidneys) accounted for 15.4% of all new cancers in England, 1 and 12.1% of deaths from cancer, 2 in England and Wales, in 2004. The two-week wait referral guidelines published by the UK Department of Health for suspected urological cancers 3 are summarised in Table 1 . NHS trusts and SHAs are encouraged to carry out clinical audits of suspected cancer referrals to generate further information. 4 There is wide variation among various centres and regions in the concordance of general practitioner (GP) referrals based on these guidelines, and also the rate of cancers detected based on the two-week wait system. [Table: see text] The objectives of this audit were to calculate: (i) the rate of detection of cancers among the two-week wait referrals; (ii) the rate of detection of cancers based on the reason for referral; and (iii) the proportion of inappropriate referrals.

Improving weekend review for trauma and elective orthopaedic patients in the post-operative period

2018 ◽  
Vol 23 (4) ◽  
pp. 264-268 ◽  
Author(s):  
Alexandra Khoury ◽  
Mark Jones ◽  
Christopher Buckle ◽  
Mark Williamson ◽  
Guy Slater
Keyword(s):  
Improve Patient Safety ◽  
Phase 1 ◽  
The Body ◽  
Weekend Effect ◽  
Content Type ◽  
Post Operative Period ◽  
Orthopaedic Patients ◽  
Retrospective Audit ◽  
Number Of Patients ◽  
Working Practices

Purpose Weekend surgery carries higher mortality than weekday surgery, with complications most commonly arising within the first 48 hours. There is a reduced ability to identify complications at the weekend, with early signs going undetected in the absence of thorough early patient review, particularly in the elderly with multiple co-morbidities. Weekend working practices vary amongst UK hospitals and specialties. The weekend effect has been a prominent feature in the literature over the past decade. The purpose of this paper is to identify the number of patients undergoing weekend surgery who receive a Day 1 post-operative review and improve this outcome by implementing an effective change. Design/methodology/approach It was observed that not all patients undergoing surgery on a Friday or Saturday at the authors’ District General Hospital were receiving Day 1 post-operative review by a clinician. A retrospective audit was carried out to identify percentage of patients reviewed on post-operative Day 1 at the weekend. A change in handover practice was implemented before re-audit. Findings In Phase 1, 54 per cent of patients received Day 1 post-operative reviews at the weekend against a set standard of 100 per cent. A simple change to handover practice was implemented to improve patient safety in the immediate post-operative period resulting in 96 per cent of patients reviewed on Day 1 post-operatively at re-audit. Originality/value This study confirms that simple changes in handover practices can produce effective and translatable improvements to weekend working. This further contributes to the body of literature that acknowledges the existence of a weekend effect, but aims to evolve weekend working practices to accommodate improvement within current staffing and resource availability by maximising efficiency and communication.

scholarly journals 883 Modified Framework for The Management of Acute Gallstone Disease During The COVID-19 Pandemic

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A White ◽  
J Brewer ◽  
E Efthimiou ◽  
H Khwaja ◽  
G Bonanomi
Keyword(s):  
Gallstone Disease ◽  
Operative Management ◽  
Definitive Treatment ◽  
Biliary Colic ◽  
Gallstone Pancreatitis ◽  
Early Laparoscopic Cholecystectomy ◽  
Global Pandemic ◽  
Early Adoption ◽  
Efficient Resource ◽  
Non Operative Management

Abstract Introduction On 12/03/2020 WHO declared SARS-CoV-2 a global pandemic. PHE and RCS advised non-operative management wherever possible, changing management of acute gallstone disease from early laparoscopic cholecystectomy to conservative treatment and frequent percutaneous drainage. Planning, prioritisation, and implementation of “COVID-Safe” pathways presented multi-factorial challenges throughout the NHS. Method Prospective data of patients admitted with acute gallstone pathology was collected at Chelsea & Westminster Hospital (23/03/2020-16/08/2020), and prioritised using Tokyo, FSSA and RCS Guidance. A restructured “Gallbladder-pathway” was implemented comprising trust-wide referral proforma, weekly clinical planning MDT meetings and dedicated theatre lists. Results Sixty-eight patients were prioritized as either “Urgent” (25), “Expedited” (12) or “Elective” (31); comprising gallstone pancreatitis (11), acute cholecystitis (53), obstructive jaundice (12) and biliary colic (8). 12 patients required cholecystostomies. During the “Peak” (23/3/20-02/06/2020) no cholecystectomies were performed, 10 in “Recovery” (02/06/20-06/07/20) in NCEPOD theatre, 21 in “Resolution” (06/07/20-18/08/20) since implementation of the “Gallbladder-Pathway”. Eleven patients (16%) re-presented while awaiting definitive treatment, none critically ill. The highest number of re-presentations was in “Urgent” patients (36%) and those with cholecystostomy (45%). Conclusions Early adoption of a modified “Gallbladder-pathway” during the pandemic allowed accurate case stratification, efficient resource allocation and safe care. Our model enabled prompt service recovery and a framework to navigate future disruption.

scholarly journals EPEN-24. SIOP EPENDYMOMA II: CENTRAL EPENDYMOMA MANAGEMENT ADVISORY GROUP – THE UK EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii312-iii312
Author(s):  
Donald C Macarthur ◽  
Conor Mallucci ◽  
Ian Kamaly-Asl ◽  
John Goodden ◽  
Lisa C D Storer ◽  
...  
Keyword(s):  
Survival Rates ◽  
Target Volume ◽  
Advisory Group ◽  
Subtotal Resection ◽  
Str Analysis ◽  
Oncological Treatment ◽  
Beneficial Effects ◽  
Number Of Patients ◽  
Pathological Review ◽  
The Uk

Abstract Paediatric Ependymoma is the second most common malignant brain tumour of childhood with approximately 50% of cases recurring. It has been described as a “surgical” disease since patients who have undergone a gross total surgical resection (GTR) have a better prognosis than those who have a subtotal resection (STR). Analysis of the UKCCSG/SIOP 1992 04 clinical trial has shown that only 49% of cases had a GTR, with 5-year survival rates for STR of 22–47% and GTR of 67–80%. As part of the SIOP II Ependymoma trial the UK established a panel of experts in the treatment of Ependymoma from Neuro-oncology, Neuro-radiology and Neuro-surgery. Meeting weekly, cases are discussed to provide a consensus on radiological review, ensuring central pathological review, trial stratification and whether further surgery should be advocated on any particular case. Evaluation of the first 68 UK patients has shown a GTR in 47/68 (69%) of patients and STR in 21/68 (31%) of patients. Following discussion at EMAG it was felt that 9/21 (43%) STR patients could be offered early second look surgery. Following this 2nd look surgery the number of cases with a GTR increased to 56/68 (82%). There has been a clear increase in the number of patients for whom a GTR has been achieved following discussion at EMAG and prior to them moving forwards with their oncological treatment. This can only have beneficial effects in decreasing their risk of tumour recurrence or CSF dissemination and also in reducing the target volume for radiotherapy.

888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
A Bhojwani ◽  
M Ahmed ◽  
F Mahmood ◽  
C Sellahewa ◽  
C Desai
Keyword(s):  
Risk Stratification ◽  
Gastrointestinal Bleeding ◽  
District Hospital ◽  
Hospital Setting ◽  
Lower Gastrointestinal Bleeding ◽  
Shock Index ◽  
Retrospective Audit ◽  
Ct Angiogram ◽  
Sensitive Tool ◽  
The Uk

Abstract Introduction Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting. Method Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management. Results 143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB. Conclusions OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.

scholarly journals Public Interest in Knee Pain and Knee Replacement during the SARS-CoV-2 Pandemic in Western Europe

2021 ◽  
Vol 10 (5) ◽  
pp. 1067
Author(s):  
Arne Kienzle ◽  
Lara Biedermann ◽  
Evgeniya Babeyko ◽  
Stephanie Kirschbaum ◽  
Georg Duda ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Knee Replacement ◽  
Knee Arthroplasty ◽  
Public Interest ◽  
Western Europe ◽  
Surgical Care ◽  
Number Of Patients ◽  
Primary Knee Arthroplasty ◽  
The Uk

Due to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) pandemic, a large number of elective knee replacement procedures had to be postponed in both early and late 2020 in most western countries including Germany and the UK. It is unknown how public interest and demand for total knee arthroplasties was affected. Public interest in knee pain, knee osteoarthritis and knee arthroplasty in Germany and the UK was investigated using Google Trend Analysis. In addition, we monitored for changes in patient composition in our outpatient department. As of early March in Germany and of late March in the UK, until the lockdown measures, a 50 to 60% decrease in relative search frequency was observed in all categories investigated compared to the beginning of the year. While public interest for knee pain rapidly recovered, decreased interest for knee osteoarthritis and replacement lasted until the easing of measures. Shortly prior to and during the first lockdown mean search frequency for knee replacement was significantly decreased from 39.7% and 36.6 to 26.9% in Germany and from 47.7% and 50.9 to 23.7% in the UK (Germany: p = 0.022 prior to lockdown, p < 0.001 during lockdown; UK: p < 0.0001 prior to and during lockdown). In contrast, mean search frequencies did not differ significantly from each other for any of the investigated time frames during the second half of 2020 in both countries. Similarly, during the first lockdown, the proportion of patients presenting themselves to receive primary knee arthroplasty compared to patients that had already undergone knee replacement declined markedly from 64.7% to 46.9%. In contrast, patient composition changed only marginally during the lockdown measures in late 2020 in both Germany and the UK. We observed a high level of public interest in knee arthroplasty despite the ongoing pandemic. The absence of a lasting decline in interest in primary knee arthroplasty suggests that sufficient symptom reduction cannot be achieved without surgical care for a substantial number of patients.

scholarly journals Interventional radiology versus operative management for splenic injuries: a study protocol for a systematic review and meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (8) ◽  
pp. e028172
Author(s):  
Masahiro Kashiura ◽  
Noritaka Yada ◽  
Kazuma Yamakawa
Keyword(s):  
Systematic Review ◽  
Interventional Radiology ◽  
Meta Analysis ◽  
Operative Management ◽  
Sensitivity Analyses ◽  
Definitive Treatment ◽  
Controlled Trials ◽  
Cochrane Central Register ◽  
Statistical Heterogeneity ◽  
Non Operative Management

IntroductionOver the past decades, the treatment for blunt splenic injuries has shifted from operative to non-operative management. Interventional radiology such as splenic arterial embolisation generally increases the success rate of non-operative management. However, the type of intervention, such as the first definitive treatment for haemostasis (interventional radiology or surgery) in blunt splenic injuries is unclear. Therefore, we aim to clarify whether interventional radiology improves mortality in patients with blunt splenic trauma compared with operative management by conducting a systematic review and meta-analysis.Methods and analysisWe will search the following electronic bibliographic databases to retrieve relevant articles for the literature review: Medline, Embase and the Cochrane Central Register of Controlled Trials. We will include controlled trials and observational studies published until September 2018. We will screen search results, assess the study population, extract data and assess the risk of bias. Two review authors will extract data independently, and discrepancies will be identified and resolved through a discussion with a third author where necessary. Data from eligible studies will be pooled using a random-effects meta-analysis. Statistical heterogeneity will be assessed by using the Mantel-Haenszel χ² test and the I² statistic, and any observed heterogeneity will be quantified using the I² statistic. We will conduct sensitivity analyses according to several factors relevant for the heterogeneity.Ethics and disseminationOur study does not require ethical approval as it is based on the findings of previously published articles. This systematic review will provide guidance on selecting a method for haemostasis of splenic injuries and may also identify knowledge gaps that could direct further research in the field. Results will be disseminated through publication in a peer-reviewed journal and presentations at relevant conferences.PROSPERO registration numberCRD42018108304.

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