scholarly journals Consensus exercise identifying priorities for research in the field of general surgery of childhood in the UK

BJS Open ◽  
2021 ◽  
Vol 5 (2) ◽  
Author(s):  
N J Hall ◽  
C M Rees ◽  
H Rhodes ◽  
A Williams ◽  
M Vipond ◽  
...  
Keyword(s):  
Clinical Research ◽  
General Surgery ◽  
Enhanced Recovery ◽  
Research Priorities ◽  
Surgical Care ◽  
Evidence Base ◽  
Emergency General Surgery ◽  
High Quality ◽  
Research Questions ◽  
Multicentre Research

Abstract Background The evidence base underlying clinical practice in children’s general surgery is poor and high-quality collaborative clinical research is required to address current treatment uncertainties. The aim of this study was, through a consensus process, to identify research priorities for clinical research in this field amongst surgeons who treat children. Methods Questions were invited in a scoping survey amongst general surgeons and specialist paediatric surgeons. These were refined by the study team and subsequently prioritized in a two-stage modified Delphi process. Results In the scoping survey, a total of 226 questions covering a broad scope of children’s elective and emergency general surgery were submitted by 76 different clinicians. These were refined to 71 research questions for prioritization. A total of 168 clinicians took part in stage one of the prioritization process, and 157 in stage two. A ‘top 10’ list of priority research questions was generated for both elective and emergency general surgery of childhood. These cover a range of conditions and concepts, including inguinal hernia, undescended testis, appendicitis, abdominal trauma and enhanced recovery pathways. Conclusion Through consensus amongst surgeons who treat children, 10 priority research questions for each of the elective and emergency fields have been identified. These should provide a basis for the development of high-quality multicentre research projects to address these questions, and ultimately improve outcomes for children requiring surgical care.

SP3.1.1Research Priorities in Emergency General Surgery

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Elizabeth Vaughan ◽  
Robert Pearson ◽  
Jared Wohlgemut ◽  
Stephen Knight ◽  
Michael Wilson
Keyword(s):  
General Surgery ◽  
Health Care Professionals ◽  
Research Agenda ◽  
Phase 1 ◽  
Research Priorities ◽  
Future Research ◽  
Emergency General Surgery ◽  
Delphi Approach ◽  
Surgical Subspecialty ◽  
Research Questions

Abstract Aims Delphi methodology can be used to achieve consensus opinion amongst experts in a particular field. This study used a modified Delphi approach to identify research priorities in emergency general surgery (EGS). The aim was to establish a research agenda using a formal consensus-based approach in an effort to identify questions relevant to EGS that have been prioritised by relevant stakeholders with an equal voice. Methods Three rounds were conducted using an electronic questionnaire and involved health care professionals, research personnel, patients and their relatives. In the first round stakeholders were invited to submit clinical research questions that they felt were priorities for future research. In rounds two and three, participants were asked to score individual questions in order of priority using a 5-point Linkert scale. Between rounds an expert panel were asked to analyse results before forwarding questions to subsequent rounds. Results Ninety-two EGS research questions were proposed in Phase 1. Following the first round of prioritisation, 47 questions progressed to the final phase. A final list of 17 research questions were identified from the final round of prioritisation. These included questions on peri-operative strategies, EGS outcomes in elderly and frail patients as well as non-technical and technical influences on EGS outcomes. Conclusion Our study provides a consensus delivered framework that should determine the research agenda for future EGS projects. It may also assist setting priorities for research funding and multi-centre collaborative strategies within the surgical subspecialty of EGS.

scholarly journals 892 Emergency General Surgical Practice at a District General Hospital during COVID-19 Pandemic: Implementing Royal College of Surgeons Guidance

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Hashmi ◽  
S Khalid ◽  
K Raja ◽  
A Zaka ◽  
J Easterbrook
Keyword(s):  
Informed Consent ◽  
Royal College ◽  
Mortality Risk ◽  
General Surgery ◽  
Surgical Care ◽  
District General Hospital ◽  
Emergency General Surgery ◽  
Surgical Practice ◽  
Full Compliance ◽  
Type Of Surgery

Abstract Introduction COVID-19 pandemic had a significant impact on surgical practice across NHS. RCS released guidance on altering surgical practise during the pandemic to deliver safe surgical care in March, 2020. We present an audit conducted at a DGH comparing practice of emergency general surgery (EGS) with RCS guidance at the peak of COVID-19 pandemic. Method Consecutive patients undergoing EGS from 1st April to 15th May,2020. Data of demographics, ASA grade, comorbidities, type of surgery, hospital stay, informed COVID-19 pneumonia consent, complications and 30-day mortality were collected. Pre- and post-operative COVID-19 status was determined. Results Forty-four (n = 44) patients, mean age 47.5 and IQR (26-69). Male (55.8%) and females (44.2%). Preoperative COVID19 status was confirmed in around 79.1% patients. All (100%) patients who underwent CT imaging preoperatively had CT chest performed. Informed consent for COVID19 pneumonia was taken in 4.7% patients. 30-day mortality risk was 7% and complications risk was 4.7%. RR of 30-day mortality in preoperative COVID19 status positive patients was RR = 0.92 (CI 0.85-1.01) and for complications was RR = 0.95 (CI 0.88-1.02). Conclusions RCS guidance on managing and altering practice in EGS during COVID-19 pandemic is reliable, implementable, and measurable in a DGH setting. Simple improvements in consent process can achieve full compliance with RCS guidelines.

scholarly journals SP3.2.4 Creating sub-specialty emergency surgical care and changing consultant working patterns improves consultant morale and stress levels

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Edward Hardy ◽  
Thomas Smart ◽  
Jacob Hatt ◽  
Jon Lund
Keyword(s):  
Length Of Stay ◽  
Perceived Stress ◽  
General Surgery ◽  
Surgical Care ◽  
Emergency General Surgery ◽  
Quality Of Patient Care ◽  
Stress Levels ◽  
General Surgeons ◽  
The Impact

Abstract Aims General surgery consultants have some of the highest rates of burnout. Ever increasing emergency general surgery (EGS) admissions playing a major role in this. A move to create split sub-speciality cover consisting of upper GI/HPB (UGI) and colorectal (CR) consultants has been suggested to improve EGS outcomes. We assessed the impact changing on-call working patterns had on perceived consultant stress levels, manageability of their workload and patient length of stay (LOS). Methods Consultant on call patterns changed from an individual consultant covering four consecutive weekdays to two consultants (one UGI/HPB, one CR) sharing four consecutive weekdays. Consultants were surveyed to assess the impact of this change on the manageability of their workload and their perceived stress levels. Admission numbers and LOS were also analysed for all EGS admissions over a 6-month period either side of the rota change. Results 89% of consultants who responded chose to work the new on call format. 78% felt it had improved the manageability of their workload, decreased perceived stress levels and improved quality of patient care. There was no change in the number of EGS admissions (862 vs 866) or EGS patient length over the time periods studied (Pre: 0D: 8%, 1 – 2D 38%, 3 – 4D 19%, >4D 34%. vs Post: 0D 8%, 1 – 2D 40%, 3 – 4D 17%, > 4D 35%). Conclusions A move to shorter and sub-specialty on call duties reduced stress and improved manageability for consultant general surgeons without adverse impact on patient’s length of stay.

scholarly journals Protocolo ERAS® en cirugía colorrectal

2021 ◽  
Vol 113 (2) ◽  
pp. 176-188
Author(s):  
William Maclean ◽  
◽  
Paul Mackenzie ◽  
Chris Limb ◽  
Timothy Rockall
Keyword(s):  
Colorectal Surgery ◽  
Stress Reduction ◽  
Multidisciplinary Approach ◽  
Physiological Stress ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Surgical Care ◽  
Evidence Based ◽  
High Quality ◽  
High Quality Research

Enhanced Recovery After Surgery (ERAS®) in colorectal surgery is a protocol that promotes quicker return to function. It follows the latest evidence-based research to promote stress reduction related to surgery. The recommended perioperative pathway is fine-tuned, dynamic and in line with the latest evidence-based research to enhance all aspects of the patient’s surgical care. We describe the four aspects for a patient undergoing colorectal surgery – pre-admission, pre-operative, intra-operative and post-operative. The running theme is to reduce overall physiological stress related to surgery and interventions overlap throughout the patient’s pathway. Using a multidisciplinary approach, adherence to ERAS® in colorectal surgery with ≥70 % compliance to the ERAS interventions has shown a risk reduction of 5-year cancer-related death by 42%. The optimum interventions are not only determined through the publication of high-quality research, but regular international collaboration enables experience and research to be shared and care standardised

scholarly journals P-O11 Surgical Ambulatory Care: Reducing surgical admissions whilst maintaining patient satisfaction. Experiences over a four year period

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Alicja Pscia ◽  
Jonathan Eley ◽  
Kathryn Forsyth ◽  
Nicola Lawrie ◽  
Yvonne Hay ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Ambulatory Care ◽  
General Surgery ◽  
Surgical Care ◽  
Bed Occupancy ◽  
Emergency General Surgery ◽  
Surgical Specialty ◽  
Ambulatory Clinic ◽  
Retrospective Audit ◽  
Surgical Ward

Abstract Background The tri-association document; The future of Emergency General Surgery (2015) has a number of key recommendations for the provision of emergency general surgical care. Key recommendations include for senior surgeons to triage referrals and to utilise a “hot clinic” model. Prior to 2016 in the authors’ hospital, all General Practitioner/community referrals were formally admitted to General Surgery. A consultant led ambulatory clinic with dedicated Advanced Nurse Practitioner support was instituted in October 2016. It offers preliminary assessment, phlebotomy and priority access to routine imaging modalities. The clinic is located in a tertiary hospital serving a population of 500,000. Methods A retrospective audit of prospectively collected referral and outcome lists for the Surgical Ambulatory clinic was conducted for the time periods of October 2016 to June 2021.  The two primary outcomes were defined as admission to the General Surgical ward and discharge to the community/non-general surgical specialty. Secondary outcomes for patient satisfaction were measured by randomly distributing over a six week period a patient satisfaction survey. The survey was designed in accordance with trust guidance, was anonymous and would cover multiple lead Consultant encounters as a cohort. Results In total, 9069 patients presented to the surgical ambulatory clinic over a period of 44 months. 2347 (26%) were admitted to the General Surgical ward whilst 6717 (74%) were discharged directly from the clinic. 71% of survey responders rated their experiences of the ambulatory clinic as “Excellent”, 19% “Very Good”, 0.5% “Good” and 0.5% “Poor.” Conclusions The introduction of an ambulatory care model has demonstrated a marked reduction in surgical admissions whilst remaining favourable to the patient populace. This has a direct impact on overall bed occupancy rates.  In the age of COVID-19, efforts must me made to reduce the the number of potential inpatient interactions to protect those most at risk. A reduced admission and bed occupancy rate will contribute to the reduction of this risk.

scholarly journals Impact of the COVID-19 pandemic lockdown on the utilization of acute surgical care in the State of Salzburg, Austria: retrospective, multicenter analysis

2021 ◽  
Author(s):  
Jaroslav Presl ◽  
Martin Varga ◽  
Christof Mittermair ◽  
Stefan Mitterwallner ◽  
Michael Weitzendorfer ◽  
...  
Keyword(s):  
General Surgery ◽  
Surgical Care ◽  
Length Of Hospital Stay ◽  
Abdominal Wall Hernia ◽  
Colon Surgery ◽  
Emergency General Surgery ◽  
Medical Centers ◽  
Time Period ◽  
Multicenter Analysis ◽  
Medical Disciplines

Summary Background Some medical disciplines have reported a strong decrease of emergencies during the coronavirus disease 2019 (COVID-19) pandemic; however, the effect of the lockdown on general surgery emergencies remains unclear. Methods This study is a retrospective, multicenter analysis of general surgery emergency operations performed during the period from 1 March to 15th 2020 lockdown and in the same time period of 2019 in three medical centers providing emergency surgical care to the area Salzburg-North, Austria. Results In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 lockdown (p = 0.005). The length of hospital stay was reduced to 3 days in 2020 compared to 4 in 2019. Appendectomy remained the most performed emergency surgery for both periods; however the number of surgeries was reduced to less than a half, with 72 cases in 2019 and 33 cases in 2020 (p = 0.118). Emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. The strongest reduction in frequencies of emergency surgeries was reported from the designated COVID center in the examined region. Conclusions Emergency general surgery is an essential service that continues to run under all circumstances. Our data show that COVID-19-related restrictions have resulted in a significant decrease in the utilization of acute surgical care.

scholarly journals A modified Delphi process to establish research priorities in hernia surgery

Hernia ◽  
2021 ◽  
Author(s):  
D. S. G. Scrimgeour ◽  
M. Allan ◽  
S. R. Knight ◽  
B. East ◽  
S. Blackwell ◽  
...  
Keyword(s):  
Phase I ◽  
Abdominal Wall ◽  
Phase Ii ◽  
Healthcare Professionals ◽  
Research Priorities ◽  
Abdominal Wall Hernia ◽  
Hernia Surgery ◽  
High Quality ◽  
Modified Delphi ◽  
Research Questions

Abstract Background Abdominal wall hernia repair is one of the most commonly performed surgical procedures worldwide, yet despite this, there remains a lack of high-quality evidence to support best management. The aim of the study was to use a modified Delphi process to determine future research priorities in this field. Methods Stakeholders were invited by email, using British Hernia Society membership details or Twitter, to submit individual research questions via an online survey. In addition, questions obtained from a patient focus group (PFG) were collated to form Phase I. Two rounds of prioritization by stakeholders (phases II and III) were then completed to determine a final list of research questions. All questions were analyzed on an anonymized basis. Results A total of 266 questions, 19 from the PFG, were submitted by 113 stakeholders in Phase I. Of these, 64 questions were taken forward for prioritization in Phase II, which was completed by 107 stakeholders. Following Phase II analysis, 97 stakeholders prioritized 36 questions in Phase III. This resulted in a final list of 14 research questions, 3 of which were from the PFG. Stakeholders included patients and healthcare professionals (consultant surgeons, trainee surgeons and other multidisciplinary members) from over 27 countries during the 3 phases. Conclusion The study has identified 14 key research priorities pertaining to abdominal wall hernia surgery. Uniquely, these priorities have been determined from participation by both healthcare professionals and patients. These priorities should now be addressed by well-designed, high-quality international collaborative research.

scholarly journals The Impact of COVID-19 pandemic Lockdown on the utilization of acute surgical care, retrospective, multicenter analysis

2020 ◽  
Author(s):  
Jaroslav Presl ◽  
Martin Varga ◽  
Christof Mittermaier ◽  
Stefan Mitterwallner ◽  
Michael Weitzendorfer ◽  
...  
Keyword(s):  
General Surgery ◽  
Average Length ◽  
Surgical Care ◽  
Length Of Hospital Stay ◽  
Abdominal Wall Hernia ◽  
Colon Surgery ◽  
Emergency General Surgery ◽  
Multicenter Analysis ◽  
Medical Disciplines ◽  
The Impact

Abstract Background: The emergency general surgery encompasses the care of critically ill patients, with a potentially high mortality if delayed. As some medical disciplines have reported a strong decrease of emergencies during the COVID-19 pandemic, remains the effect of the Lockdown on the general surgery emergencies unclear. Methods:This study is a retrospective, multicentre analysis of the general surgery emergency operations performed during the 2020 Lockdown and in the same period of 2019 in three centers covering the surgical care of the area Salzburg-North, Austria. Results: In total 165 emergency surgeries were performed in the study period of 2020 compared to 287 in Year 2019. This is a significant decrease of 122 (42.5%) emergency surgeries during the COVID-19 Lockdown (p=0.005). The average length of hospital stay in the 2019 was in median 4 days and was reduced to 3 days during the Lockdown. Appendectomy remained the most performed emergency surgery for the both periods but the operations count reduced to less than a half with 72 cases in 2019 and 33 cases in 2020 (p=0.118). Considering the ration of appendectomy vs all emergency surgeries, it represented 25 % in 2019 and 20% in 2020. The emergency colon surgery observed the strongest decrease of 75% from 17 cases in 2019 to 4 in 2020. In addition, the emergency abdominal wall hernia, cholecystectomies for acute cholecystitis, small surgeries and proctological emergencies recorded drops of 70%, 39%, 33% and 47% respectively. A strongest reduction in frequency of 6 of 13 main categories of emergency surgeries was reported from Center 1, which was the only COVID designed Center (“Hot” hospital) in the examined region.Conclusions:The emergency general surgery is an essential service that continues to run under any circumstances. Our data showed that the COVID-19 related restriction and the fear of being infected with COVID-19 in the hospital result in a significant decrease of the utilization of acute surgical care. Policies and modern alternatives are needed to ensure continued access to specialized services to prevent patients from harm.

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