A SURGICAL AUDIT OF GENERAL SURGERY CASES IN A TERTIARY CARE HOSPITAL AND THE IMPACT OF COVID-19 ON THE SAME

BACKGROUND: After the COVID-19 pandemic was declared on March 11, 2020 by the World Health Organization (WHO), routine clinical and surgical practices were affected, including General Surgery services. We aimed to compare how our General Surgery department was affected during this time period of Covid, we have included various parameters, we have also statistically shown how the elective and emergency services were before the Covid outbreak and during the COVID-19 pandemic in our institution. MATERIAL AND METHODS: We retro spectively compared General Surgery practices, including elective, emergency and septic surgeries in a surgical unit of Sir JJ Group of Hospitals over a span of 3 years (April 2018 - March 2021), including the era before and during Covid. RESULTS: The frequency of all the surgeries performed during the pandemic was lower as compared to previous two years before the pandemic in our study, also there was a signicant drop in the number of laparoscopic surgeries. CONCLUSION: The General Surgery practices in our institution have been drastically affected by the COVID-19 pandemic. This setback needs a denite strategy to be formulated to decrease the morbidity and mortality from the neglected elective surgical cases, the real risk-benet ratio must be met before operating such cases.

EP.FRI.362 Improving Prescribing and Minimising Delay in Administration of Potassium Replacement Therapies: Surgical Audit on Management of Hypokalaemia in Emergency Surgical Unit at a District General Hospital in UK

Aims Surgical patients are prone to hypokalaemia due to gastrointestinal losses1. Hypokalaemia prolongs ileus2 and thus prompt management is essential. No current guideline on hypokalaemia focuses on surgical patients. We aimed to identify the prevalence of hypokalaemia in emergency surgical patients as well as measure timeliness and appropriateness of replacement. Methods We retrospectively reviewed adult emergency surgical admissions exceeding 48 hours between 05/05/2020 and 15/07/2020. A sub-group analysis assessed the timing of intravenous replacement and duration taken to normalise potassium (3.5 mmol/L). We used another NHS trust’s guideline3 as standard for appropriate potassium replacement. Results Of 110 surgical admissions, 26 cases were hypokalaemic. Of these, 15 had initially normal potassium level. Three cases were likely iatrogenic secondary to inappropriate fluid prescribing. Mean potassium in the hypokalaemic group was 3.2 mmol/L (80.8% mild vs. 19.2% moderate). Mean length of stay was 11.3 days for hypokalaemia versus 6.54 days in normokalaemic cases. Mean duration of hypokalaemia was 2.13±1.45 days. Potassium replacement was prescribed correctly in only 50% of cases (23% not prescribed; 25% insufficient; 2% incorrect) and of these correct prescriptions, 46% were not actually administered. When intravenous replacement was given, there was a mean 3.55-hour delay between lab result and administration. Conclusion The majority of hypokalaemic cases developed during admission. Only 27% of these patients had correct potassium replacement in terms of both prescription and administration. Consequently, we have created a local guideline for hypokalaemia in surgical patients to standardise both prevention and management.

425 The Impact Of COVID-19 On Hernia Surgery in The Lothian Region Of Scotland

Aim The COVID-19 pandemic resulted in a lockdown in South East Scotland on the 23 March 2020. This had an impact on the volume of benign elective surgery able to be undertaken. The degree to which this reduced hernia surgery was unknown. The aim of this study was to review the hernia surgery workload in the Lothian region of Scotland and assess the impact of COVID-19 on hernia surgery. Method The Lothian Surgical Audit database was used to identify all elective and emergency hernia operations over a six-month period from 23 March 2020, and for the same time period in 2019. Data was collected on age, gender, location of the hernia, type of hernia repair and whether elective or emergency operation. Results The number of hernia repairs reduced dramatically between 2019 and 2020 (570 versus 149). The majority of this can be explained by a reduction in elective operating (488 versus 87). There was, however, also a reduction in the numbers of hernias repaired as an emergency over the same study periods (82 to 62). Lockdown in 2020 had the biggest effect on elective incisional hernia repair (74 versus 2). Conclusions The COVID-19 pandemic has reduced both the number of elective and emergency hernia operations in 2020 compared to 2019. While the reduction in elective surgery has not resulted in an associated increase in emergency surgery over the study period, it is possible that if continuing reduced availability to elective hernia surgery continues in Lothian, the emergency hernia workload may increase.

Speech Outcomes Following Orticochea Pharyngoplasty in Patients With History of Cleft Palate and Noncleft Velopharyngeal Dysfunction

Objective: To report speech outcomes following Orticochea pharyngoplasty in 43 patients with cleft palate and noncleft velopharyngeal dysfunction. Design: A retrospective surgical audit of patients undergoing Orticochea pharyngoplasty between 2004 and 2012, with speech as a primary outcome measure. Setting: Patients known to a regional UK cleft center. Methods: Forty-three patients underwent Orticochea pharyngoplasty by a single surgeon in a UK regional cleft center. Twenty-one patients had undergone a prior procedure for velopharyngeal dysfunction. Pre- and postoperative speech samples were assessed blindly using the Cleft Audit Protocol for Speech-Augmented by a specialist cleft speech and language therapist, external to the team. Speech samples were rated on the following parameters: hypernasality, hyponasality, audible nasal emission, nasal, turbulence, and passive cleft speech characteristics. Statistical differences in pre- and postoperative speech scores were tested using the Wilcoxon matched-pairs signed-ranks test. Inter- and intrareliability scores were calculated using weighted Cohen κ. Results: Whole group: A statistically significant difference in pre- and postoperative scores for hypernasality ( P < .001), hyponasality ( P < .05), nasal emission ( P < .01), and passive cleft speech characteristics ( P < .01) were reported. Patients with cleft diagnoses: A statistically significant difference in scores for hypernasality ( P < .001), nasal emission ( P < .01), and passive cleft speech characteristics ( P < .01) were reported for this group of patients. Patients with noncleft diagnoses: The only parameter to demonstrate a statistically significant difference was hypernasality ( P < .01) in this group. Conclusions: Orticochea pharyngoplasty is a successful surgical procedure in treating velopharyngeal dysfunction in both the cleft and noncleft populations.

Utilization of the iOS Shortcuts App to Generate a Surgical Logbook Tool: Feasibility Study

Background Surgical audit is an essential aspect of modern reflective surgical practice and is key to improving surgical outcomes. The surgical logbook is an important method of data collection for both personal and unit audits; however, current electronic data collection tools, especially mobile apps, lack the minimum recommended data fields. Objective This feasibility study details the creation of a free, effective surgical logbook tool with the iOS Shortcuts app and investigates the time investment required to maintain a surgical logbook with this tool. In addition, we investigate the potential utility of the Shortcuts app in creating medical data collection tools. Methods Using the iOS Shortcuts app, we created a shortcut “Operation Note,” which collects surgical logbook data by using the minimum and extended audit data sets recommended by the Royal Australasian College of Surgeons. We practically assessed the feasibility of the tool, assessing the time requirement for entry, accuracy, and completeness of the entered data. Results The shortcut collected accurate and useful data for a surgical audit. Data entry took on average 65 seconds per case for the minimum data set, and 135 seconds per case for the extended data set, with a mean difference of 68 seconds (P<.001; 95% CI 61.6-77.7). Conclusions This feasibility study demonstrates the utility of the iOS Shortcuts app in the creation of a surgical logbook and the time-consuming nature of data collection for surgical audit. Our iOS Operation Note shortcut is a free, rapid, and customizable alternative to currently available logbook apps and offers surgical trainees and consultants a method for recording surgical operations, complications, and demographic data.

Utilization of the iOS Shortcuts App to Generate a Surgical Logbook Tool: Feasibility Study (Preprint)

BACKGROUND Surgical audit is an essential aspect of modern reflective surgical practice and is key to improving surgical outcomes. The surgical logbook is an important method of data collection for both personal and unit audits; however, current electronic data collection tools, especially mobile apps, lack the minimum recommended data fields. OBJECTIVE This feasibility study details the creation of a free, effective surgical logbook tool with the iOS Shortcuts app and investigates the time investment required to maintain a surgical logbook with this tool. In addition, we investigate the potential utility of the Shortcuts app in creating medical data collection tools. METHODS Using the iOS Shortcuts app, we created a shortcut “Operation Note,” which collects surgical logbook data by using the minimum and extended audit data sets recommended by the Royal Australasian College of Surgeons. We practically assessed the feasibility of the tool, assessing the time requirement for entry, accuracy, and completeness of the entered data. RESULTS The shortcut collected accurate and useful data for a surgical audit. Data entry took on average 65 seconds per case for the minimum data set, and 135 seconds per case for the extended data set, with a mean difference of 68 seconds (<i>P</i>&lt;.001; 95% CI 61.6-77.7). CONCLUSIONS This feasibility study demonstrates the utility of the iOS Shortcuts app in the creation of a surgical logbook and the time-consuming nature of data collection for surgical audit. Our iOS Operation Note shortcut is a free, rapid, and customizable alternative to currently available logbook apps and offers surgical trainees and consultants a method for recording surgical operations, complications, and demographic data.

SURGICAL AUDIT - LAPAROSCOPIC CHOLECYSTECTOMY IN A FREE CAMP AT PRIVATE SECTOR HOSPITAL

BACKGROUND & OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy. METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated. RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study. CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.

Stakeholder’s perceived value of surgical audit data provided by the Victorian Audit of Surgical Mortality

Background: Clinical audits can vary in their effectiveness depending on how the information is provided and the relationship between those giving and receiving feedback. In the Australian state of Victoria, the Victorian Audit of Surgical Mortality (VASM) is a state-wide mortality audit that, prior to this study, did not have a bidirectional feedback mechanism in place to gauge perception of the audit held by its stakeholders. Objective: We aimed to investigate the perceived quality of the audit’s information and the effectiveness of the audit’s communication strategies from the stakeholder population. Methods: We used a mixed methods approach to provide open-ended explorations into stakeholders’ views while also providing structured tools for conducting annual reviews. The qualitative data were analysed using an inductive content analysis. Results: Between 2015 and 2017, 240 VASM stakeholders were contacted, of whom 82 (34.2%) agreed to be interviewed. The VASM’s data were perceived to be of high quality and used in a variety of ways. The audit’s communication strategies were seen to be adequate but could be more targeted to the stakeholder. There is a perception that the audit might not be relevant to hospital stakeholders that are not themselves clinicians, despite direct involvement with the audit. Conclusion: This study helps to explain the role the audit plays among its stakeholders and offers three overarching recommendations for improvement strategies: produce data sharing strategies that are relevant to rural or highly specialised surgical centres, improve communication to be targeted at stakeholders and explore methods to provide feedback to hospital management with more individualised feedback.