P-O14 The predictive role of pre-operative liver function tests in outcomes following emergency appendicectomy

Background Acute appendicitis remains one of the most common diagnoses in emergency general surgery, with recent evidence from the COMMA trial confirming that appendicectomy is the cornerstone of definitive management in most patients. With a wide range of severity and of patient physiology, complications are a burden to patients and the health service. We hypothesised that liver function tests have predictive value for complications following emergency appendicectomy. Methods A multicentre retrospective observational study was carried out across 4 hospitals (2 teaching centres and 2 district general hospitals) for adult patients who underwent emergency appendectomy between August 2018 and November 2020. Patients were identified through pathology records and data was extracted from electronic case records for patient demographics, pre-operative routine laboratory results, operative details, and clinical outcomes. Peak perioperative liver function parameters were analysed using unpaired two-way T-tests, Pearson’s correlation coefficient, ANOVA and multivariate regression to determine their relationship with conversion to open surgery, superficial and deep surgical site infection (SSI), length of stay (LOS) and 30-day re-admission rates. Results Of 1131 patients included, 57.4% were male, 80.5% were laparoscopic, with 7.3% converted to open, 10.8% performed open, and 1.5% by laparotomy. Mean LOS was 3.81 (SD4.0) days, 6.3% readmission rate, with 2.3% superficial SSI and 5.0% deep SSI. ALP was higher in patients with superficial SSI (p < 0.001). Lower ALT was associated with wound dehiscence (p < 0.001). Bilirubin, AST and ALT were lower in patients with chest infections (p < 0.001). ALP correlated with increased LOS (p < 0.001). On multivariable regression, ALP was associated with superficial SSI (p < 0.001), and LOS (p < 0.001). ROC curve analysis demonstrated AUC of 0.655 for ALP and superficial SSI. Conclusions Emergency appendicectomy is completed laparoscopically in more than 80% of patients and complication rates are acceptable. Routine liver function tests were associated with important clinical outcomes including superficial SSI, wound dehiscence, chest infection, LOS and readmission rate. Patients who had superficial SSI, wound dehiscence, chest infection and readmission with 30 days had lower transaminase levels compared with those with uncomplicated recovery.

Laparoscopic Deroofing and Excision of a Large Left Renal Cyst Mimicking Chest Infection: Case Report

Background: The routine use of abdominal ultrasonography and computed tomography scan has increased the detection of asymptomatic renal cysts. Laparoscopy is usually suitable for treating large symptomatic renal cysts. Objective: To report a case of laparoscopic treatment of a man with large left renal cyst mimicking chest infection. Case presentation: A 75-year-old man, known hypertensive who had empirical treatment for chest infection without resolution of symptoms of cough and chest pain. He was on treatment for storage and voiding lower urinary tract symptoms with 10mg alfuzocin. Abdominal ultrasound and computed tomography scan confirmed a large left renal cortical cyst that measured 380mls. He subsequently had transperitoneal laparoscopic deroofing and excision of the renal cyst with operation finding of 300mls of straw coloured fluid excluding spillage. The immediate postoperative period was uneventful, and he was discharged home in a stable condition on the second day. The aspirate yielded no growth while the cytology report of cystic fluid was acute-on-chronic inflammation. Histology was reported as chronic pyelonephritis with cystic degeneration. Conclusion: Large renal cyst should be considered as differential diagnosis of unresolved chest infection and is safely treated by laparoscopic deroofing and excision.

EP.FRI.623 Outcome of Rectus Sheath Catheters for Post Operative Analgesia in Patients Undergoing Laparotomies and Elective Colorectal Resections

Aims Multimodal analgesia combining regional and local analgesia and avoiding opioids are part of most ERAS protocols aiming to achieve good pain relief. We aim to examine the effectiveness of using rectus sheath catheters (RCSs) for pain relief in patients undergoing laparotomy surgery and wither this have affected the postoperative (30-day) outcome and the need of opioids. Methods This was a retrospective study involving patients who underwent midline laparotomy surgery, including elective colorectal resections in the period between 01/07/2020 and 23/12/2020. Results A total of 71 patients were included in the study, of which 40(56.33%) had RSCs while 31(43.66%) did not. Morphine was required for 24(60%) of those with RSCs and for 18 patients (58.06%) with no RSCs. PCA was used in 5 (12.5%) of those with RSCs and in 10 (32.25%) of those without RSCs. Of patients requiring non-PCA morphine, mean total morphine doses were 6.4 in patients with RSCs and 4.89 in patients with no RSCs. Of patients with RSCs, (22.5%, 9/40) developed chest infection within 30 days (average onset at day-11) compared to (25.8%,8/31) of the other group (average onset at day-5). 20% (8/40) of the patients with RSCs had atelectasis postoperatively compared to 29.03% (9/31) of those who did not. The Average postoperative stay was 13.65 days and 21 days for those with and without RSCs, respectively. Conclusions Using RSCs did not reduce morphine usage, However, it is associated with lower incidence of chest infection and atelectasis in addition to shorter hospital stay.

Renaming COPD exacerbations: the UK respiratory nursing perspective

Background Patients with COPD experience acute worsenings, termed ‘exacerbations’. While other terms to describe these events have been proposed there is no consensus on terminology which has led to multiple terms being used across the UK. Respiratory nurses are part of a multi-disciplinary team managing COPD patients, however, the nursing perspective on the term ‘exacerbation’ is unknown. Methods An anonymised survey of 17 questions was sent to respiratory nurses through an email invitation link. The survey link was open for one month. The aim was to understand the nurse perspective on ‘exacerbation’. Alternative terms used in the UK were compared versus the term 'exacerbation’. Results Responses were received from 113 nurses. The majority (88%) were female. There was no consensus on preference or meaning for the term ‘exacerbation’ between nurses. Less than 5% of nurses thought that patients with COPD would understand the term ‘exacerbation’. In ranked order, the nurses preferred the following terms: ‘flare-up’, ‘lung attack’, ‘crisis’, ‘exacerbation’ and ‘chest infection’. The term ‘crisis’, although new, was considered to be the term that most resonated with clinical practice. Conclusion Respiratory nurses in the UK report that the term ‘exacerbation’ is not fit for purpose for patients, and alternatives should be sought.

342 Rib Fracture Scoring at The Royal Sussex County Hospital, A Major Trauma Centre

Introduction In April 2017, The Royal Sussex County Hospital introduced rib fracture scoring to help guide the management of rib fractures. Rib fracture score = (number of fractures x number of sides) + age score1 In this study, we audit our adherence to the scoring system and compare our management of chest trauma before and after its implementation. Method All admissions with rib fractures between 1/10/2016- 28/02/2017 (N = 35) and 1/10/2019- 31/01/2020 (N = 41) were recorded. Electronic and written notes were used to retrospectively record multidisciplinary care involvement, analgesics, chest infection and death. Results The pre-intervention cohort had an average age of 55.1 years and rib score of 8.8. The post intervention cohort had an average age of 67.2 years and score of 11.3. Following implementation, 45% of patients had a rib score recorded. Post-intervention, anaesthetic involvement increased by 34.5% and 15.4% more patients received a regional block. Inpatient nights fell from 11.2 to 10.1, mortality rate from 7% to 4% but the incidence of chest infection remained similar. Conclusions The implementation of a rib fracture scoring system has led to greater multidisciplinary care and higher levels of pain management. A larger study is required to assess patient outcome given the change in sample population over time.

Upper gastrointestinal series in children: what surgeons need to know

Background Upper gastrointestinal (UGI) series is the standard imaging tool for diagnosis of structural and functional abnormalities affecting the esophagus, stomach, and proximal small bowel. The aim of this study was to delineate the clinical indications for UGI series in children that are associated with the presence of significant radiological abnormalities aiming for more standardized care for those patients. Results UGI series of 118 patients was analyzed with calculation of clinical score. Vomiting was the most frequent primary complaint (63.6%), followed by dysphagia and recurrent chest infection. Forty-nine patients had positive upper GI findings (42%). The most detected abnormality was related to the stomach and duodenum (21.4%). Variable degrees of idiopathic gastroesophageal reflux were detected in 16 patients (13.6%). Patients with clinical score 2 or more had significantly more prevalence of abnormal findings (p = .001). Vomiting (especially when bilious), underweight, aspiration, and recurrent chest infection were strong predictors of abnormal findings on upper GI series (p = 0.007, 0.001, 0.009, and 0.001, respectively) and increased the diagnostic yield of upper GI series for detection of abnormalities by 3.48, 9.6, 4, and 4.12 times, respectively. Conclusion Diagnostic yield of UGI series was relatively higher in patients having two or more symptoms (clinical score 2 or more) and in children with bilious vomiting, aspiration and underweight, or repeated chest infection.