Elective Cases Research Articles

Minimally Invasive Video-Assisted Surgery for Concomitant Ascending Aorta and Aortic Valve Replacement via Right Infra-Axillary Thoracotomy.

This study aims to assess the safety, efficacy, and esthetic outcomes of an innovative 4 cm right infra-axillary incision approach for concomitant ascending aorta and aortic valve replacement (AAR and AVR), with a specific focus on achieving optimal surgical outcomes while ensuring minimal visible scarring. We retrospectively examined all elective cases of concomitant AAR and AVR surgery performed at our institution from July 2021 to June 2023. Exclusions encompassed emergency surgery, acute type A aortic dissection, active aortic valve endocarditis, redo cardiac surgery, the necessity for concurrent mitral valve replacement, or left ventricular assist device implantation. We collected and analyzed perioperative data for the patients. The study comprised 24 consecutive patients. Cardiopulmonary bypass time and aortic cross-clamp time averaged 215.0 (interquartile range [IQR], 38.0) and 158.0 (IQR, 37.0) min, respectively. No instances of reoperation due to postoperative bleeding or need for permanent pacemaker implantation were recorded. Initial 24-h postoperative drainage volume averaged 186.9 ± 76.9 mL. Average follow-up duration was 21.7 ± 6.2 months (range, 5 to 30 months). Throughout short-term follow-up, no occurrences of valve dysfunction, paravalvular leak, cardiovascular events necessitating readmission, or mortality were observed. The right infra-axillary incision approach effectively yields secure, successful, and cosmetically pleasing outcomes for concomitant AAR and AVR. Further research and comparisons are warranted to validate these findings.

The effect of COVID-19 lockdown on admission rates in Maternity Hospital.

The COVID-19 pandemic had adverse health outcomes on individuals and communities. In this cross-sectional study we evaluated the admission rates in a tertiary-level hospital during the first wave of the pandemic (March 22, 2020 to August 31, 2020). We compared the indications for admission during the first wave of the pandemic to a control period prior to the lockdown (November 9, 2019 to March 22, 2020). Most hospital admissions during the curfew period were obstetric emergencies (46.88%), which were significantly higher than the control group (38.19%) p ≤ 0.0001. Among the obstetric emergencies, cases in active labor (65.63%) were dominant. Significant rises in car deliveries (2.46%, p ≤ 0.0001) and admissions during the second stage of labor (6.43%, p ≤ 0.001) were noted. There was also an increased rate of admissions for early pregnancy complications, induction of labor, elective obstetric cases, and medical obstetric cases. This study demonstrates that lockdown precautions implemented had a significant impact on the rate of admissions to Maternity Hospital. The data obtained may be a used to aid in designing robust policies for future pandemics to avoid adverse health outcomes.

Analysis Of Political Communication Ahead Of The 2024 Presidential Election Case Studies On Political Campaigns, Political Propaganda, Public Opinion, Marketing, Political Advertising, And Political Negotiation

The 2024 presidential election is an important moment in the political life of a country. This study aims to analyze the role of various aspects of political communsication in the presidential election, including political campaigns, political propaganda, public opinion, political marketing and advertising, and political negotiations. The research methodology uses a holistic approach with quantitative and qualitative data collection through online surveys, interviews, and media content analysis. Key findings highlight the significance of social media in shaping public opinion and the political communication strategies used by candidates. Practical implications of these findings include recommendations for more effective political campaign strategies and the development of more transparent communication policies.

Increased access to pediatric specialist healthcare using eConsult: A retrospective observational cohort and case–control study

ABSTRACT Objectives Primary care practitioners (PCPs) report that using the Champlain BASE™ eConsult service (eConsult) averts one-third of face-to-face (FTF) specialist referrals, however, there are concerns about duplication of services and adverse patient outcomes. Following an eConsult, we evaluated patient healthcare utilization and associated treatment costs. Methods Retrospective cohort study (2014 to 2018) of patients (<18 years old) for whom an eConsult visit averted a FTF specialist referral. Patients were linked to provincial health administrative databases and hospital electronic medical records for healthcare use for the same diagnosis and specialty for the 18 months following the eConsult. Concurrently, a retrospective case–control study compared utilization and costs between an eConsult versus a matched FTF visit for the same diagnosis. We also assessed PCP satisfaction. Results In follow-up, <5% of the study cohort of eConsult patients (n = 242) later accessed the healthcare system for the identical diagnosis and specialty type. FTF visits generate more frequent outpatient visits (12.6 times more [95% CI: 2.28 to 69.66, P = 0.002]) and higher costs compared to eConsult visits. There were no hospital admissions or deaths in patients with eConsult. PCPs (98%) described eConsult as an excellent service. Conclusions Using eConsult is associated with <5% of patients subsequently having a FTF visit for the same reason. Matched FTF visits generated more healthcare utilization and higher costs compared with eConsult. eConsult in pediatrics is safe and can minimize FTF specialist visits in elective cases and increase capacity, towards a more efficient and cost-effective healthcare system.

Retrospective cost analysis of robotic and laparoscopic anti-reflux surgery and paraesophageal hernia repair.

Increased adoption of robotics in foregut surgery evokes questions regarding efficacy, safety, and cost. To many, cost remains a barrier to adoption of a robotic approach. The authors' aim to determine the difference in cost of a robotic (R-) vs laparoscopic (L-) approach for paraesophageal hernia repair (PEHR). Patients 18years and older who underwent PEHR between July 2016 and June 2021 at a university health network were included. Variables of interest included 30 day outcomes, 1 year recurrence rates, and several cost variables including hospital length of stay, operating room (OR) time, chargeable supplies and implants, non-chargeable supplies, and indirect cost. Cost data were stratified by type and the presence of fundoplication, as well as the elective versus urgent nature of the procedures. Statistical analysis consisted of parametric and non-parametric analyses, with p < 0.05 denoting statistical significance. 405 patients were included in the study (n = 188 for R-, n = 217 for L-). Significant differences were observed in the type of anti-reflux procedure performed (p < 0.001), use of mesh (R- 70.2% vs. L- 59.0%, p = 0.019), and whether a Collis gastroplasty was performed (R- 4.3% vs. L- 10.2%, p = 0.023). No differences in 30-day readmission or reoperation rates, Clavien-Dindo complication rates, or 1-year hernia recurrence rates were observed. For elective cases, regardless of the type of anti-reflux procedure performed, a robotic approach was associated with a significantly greater cost (p < 0.002). Comparing all procedures, a statistically significant increase in cost was seen with a robotic approach (R- $29,706.88 vs. L- $23,457.07, p < 0.001). Complication rates and surgical outcomes between the two approaches were similar; however, cost is significantly increased when a robotic approach is utilized. Future studies are needed to delineate which drivers of cost are modifiable with the robot.

Investigating colostomy-related morbidity in children following stoma formation and closure in a tertiary hospital, Abha, Saudi Arabia: a retrospective cohort study 2024

BackgroundOverall, stoma-related morbidity affects a reported 20–38% of pediatric patients. However, determining the true incidence of major stoma-related morbidity is challenging due to limited cohort sizes in existing studies. Thus, the aim of this study was to investigate colostomy related morbidity among children both after stoma formation and stoma closure.MethodologyThis is a retrospective cohort hospital-based study, conducted in an Abha maternity and children hospital, between August 1, 2018, and August 1, 2023, among 126 pediatric patients (aged 0–12 years) who underwent colostomy formation and subsequent closure during the study period. Data were collected from medical records. Data was analyzed using Statistical Package for Social Sciences (SPSS) v.26.ResultsThis study included a total of 126 children who underwent colostomy. (N = 37, 29.4%) of cases included in this study were emergency cases, while (N = 89, 70.6%) were elective. A variety of antibiotics were used for surgical prophylaxis, metronidazole (77%) and cefuroxime (62.7%) were the most prevalent. Oral feeding was started after 5–6 days in more than one third of cases (39.7%). Wound infection (N = 15, 11.9%) was the most reported post-operative complication, followed with bowel obstruction (N = 6, 4.8%). Emergency cases had a longer duration of hospital stay than elective cases; this difference was statistically significant (P = .04).ConclusionsMajority of patients reported no stoma related complications, while among those who reported complications, wound infection was the most reported complication, followed by bowel obstruction.

An Appraisal of Anaesthesia Practices for Obstetric and Gynaecologic Surgeries in a Tertiary Health Center in Zaria, North Western Nigeria

Abstract Background: Anaesthesia is a critical aspect of every surgical procedure. Various options exist depending on the type of procedure, nature and the clinical state of the patient. This study reviewed the anaesthesia practices for Obstetric and Gynaecologic surgeries at Ahmadu Bello University Teaching Hospital, Zaria. Materials and Methods: It was a retrospective cross-sectional descriptive study conducted at Ahmadu Bello University Teaching Hospital, Zaria. Obstetric and Gynaecologic surgeries performed from 1 November 2022 to 31 October 2023 were included in the study. Relevant data for the study were obtained from the anaesthesia register in the theatre. The data were analysed with SPSS 20. Results: The mean age ± SD of patients who had surgery was 32.1 ± 9.1 years. A total of 547 cases were reviewed, of which 273 (49.9%) were elective cases and 274 (51.1%) were emergency cases. Out of these, 254 (46.4%) were obstetric emergencies, 20 (3.7%) were gynaecologic emergencies, 149 (27.2%) were elective gynaecologic cases, and 124 (22.7%) were elective obstetric cases. The majority of the cases, 407 (74.4%), were American Society of Anaesthesiologists II. Spinal anaesthesia was the commonest type of anaesthesia used in obstetric surgeries 336 (91.8%), while general anaesthesia was the commonest type of anaesthesia used in gynaecologic surgeries 89 (79.5%). Senior registrars gave anaesthesia in 457 (83.5%) cases. Heavy Bupivacaine (0.5%) was the commonest agent used for spinal anaesthesia in 327(89.3%) cases, while plain bupivacaine (0.5%) was the least agent used in 39(10.7%). Propofol was the most common agent used for the induction of general anaesthesia in 72 (64.3%) cases, while ketamine was the least used agent in 40 (35.7%). Anaesthesia complications were recorded in only 24 (4.4%) of cases. The complications were recorded in 13 (54.2%) procedures done under neuraxial anaesthesia and 11 (45.8%) cases done under general anaesthesia. Cardiovascular instability was the most common complication recorded in 10 (41.7%) cases. Conclusion: Spinal anaesthesia was the most common technique of anaesthesia in Obstetric surgeries, while general anaesthesia was the most common in Gynaecologic surgeries during the period under review. Complications of anaesthesia were uncommon.

Trends and Outcomes of Aortic Root Enlargement During Bioprosthetic Aortic Valve Replacement

BackgroundAortic root enlargement (ARE) during aortic valve replacement (AVR) mitigates prosthesis-patient mismatch, but its use has been low. Transcatheter aortic valve-in-valve (VIV) as a treatment for failing bioprosthetic valves is limited by small surgical valves, renewing interest in ARE during the index AVR. This study demonstrates trends and outcomes of ARE after commercial approval of VIV in 2015. MethodsThis retrospective cohort study analyzed 2182 patients undergoing nonemergent AVR between August 2007 and December 2022. Endocarditis, aortic dissection, and concomitant root replacement or ventricular assist device placement were excluded. Trends in ARE use, valve size, and types were compared. Outcome measures included 30-day mortality and gradients and were compared between patients with and without ARE. ResultsOverall, 74 patients (3.4%) underwent ARE, 14 (1.0%) before 2015 and 60 (7.6%, P < .0001) after 2015. Use of smaller valves (19-21 mm) decreased from 372 (26.8%) before 2015 to 85 (10.7%, P < .0001) after 2015. ARE group was younger than the AVR-alone group (64 vs 68 years, P = .001) but had similar predicted risk of mortality (median, 1.7%). Both groups had comparable postoperative mean gradients (ARE: 11 vs AVR-alone: 10 mm Hg, P = .42). ARE had higher 30-day mortality (5 [7%] vs 48 [2%], P = .014); however, no difference was found in elective patients (2 of 65 [3%] vs 39 of 1898 [2%], P = .57). ConclusionsARE use has increased since commercial approval of VIV. The addition of ARE to AVR did not affect early safety in elective cases, and postoperative gradients were similar to those in patients not requiring ARE. Further studies are required to determine long-term outcomes after ARE, including VIV candidacy.

Compliance of enhanced recovery after surgery (ERAS) protocol in emergency and elective colorectal cancer surgery with a perspective from a developing country.

To evaluate compliance with enhanced recovery after surgery protocol of patients undergoing colorectal carcinoma surgery, and to compare its effect on outcomes. The retrospective study was conducted at the Maroof International Hospital, Islamabad, Pakistan, and comprised data from July 15, 2016, to March 20, 2022, of patients of either gender undergoing elective or emergency colorectal carcinoma surgery. Data included age, gender, tumour site, type of surgery, surgical approach, compliance with each of the 25 components of the enhanced recovery after surgery protocol, length of hospital stay, surgery duration, 30-day readmission rate and perioperative mortality. Data was analysed using SPSS 23. Of the 96 patients with mean age 50.03±14.86 years (range: 20-79 years), 65(67.7%) were males, 70(72.91%) were aged at least 40 years, and 75(78.12%) underwent elective surgery. Most common tumour site was rectum and sigmoid 49(51%). Laparoscopic surgery was performed in 17(17.7%) patients. No compliance was seen with carbohydrate loading of patients or limiting use of opioids in standard anaesthesia protocol. No nutritional supplementation was started from postoperative day 1. Mean compliance with all the protocol components was 74.9%±37.652 for both elective and emergency cases. Mean duration of surgery was 192.50±75.33 minutes, while mean length of hospital stay was 5.52±1.57 days. Re-admission within 30 days was needed in 2(2.1%) cases. There was no perioperative mortality. Better compliance with enhanced recovery after surgery protocol resulted in better perioperative outcomes.

COMPARATIVE STUDY OF CLOPIDOGREL VS PRASUGREL IN PATIENTS UNDERGOING ELECTIVE PERCUTANEOUS CORONARY INTERVENTION (PCI)

Antiplatelet therapy is a cornerstone in managing patients undergoing percutaneous coronary intervention (PCI) to prevent thrombotic complications. Prasugrel and clopidogrel are two commonly used agents, but their comparative efficacy and safety remain a subject of ongoing research, particularly in elective PCI cases. Objective: This study aimed to compare the safety and efficacy of prasugrel and clopidogrel in patients undergoing elective PCI, focusing on clinical outcomes such as minor and major bleeding, stent thrombosis, and mortality. Methods: This retrospective cohort study was conducted at a tertiary care hospital in Pakistan between January and July 2024. A total of 200 patients undergoing elective PCI were included in the study. Patients received either clopidogrel (300 mg or 600 mg) or prasugrel (60 mg) as part of their antiplatelet therapy. Clinical outcomes were assessed, including minor and major bleeding, thrombosis, and death. Statistical analyses were performed using Pearson correlations, chi-square tests, and regression analysis. SPSS software (version 25.0) was used for data analysis, with statistical significance set at p &lt; 0.05. Results: Of the 200 patients, 48.5% were male, and 51.5% were female, with the majority aged between 61 and 70. Prasugrel (60 mg) was the most commonly used loading dose (35.5%). Minor bleeding events were significantly higher in the prasugrel group compared to the clopidogrel group (p = 0.05). However, no significant differences were observed in major bleeding, stent thrombosis, or mortality between the two groups. A positive correlation between minor bleeding and stent thrombosis was noted (p = 0.048), while regression analysis confirmed that prasugrel did not significantly increase the risk of major bleeding or death. Conclusion: Prasugrel was associated with a higher incidence of minor bleeding compared to clopidogrel, but both agents exhibited comparable safety profiles in terms of major bleeding, thrombosis, and mortality in patients undergoing elective PCI. The findings suggest that prasugrel can be considered a safe and effective alternative to clopidogrel in elective PCI, with careful patient selection to minimize bleeding risks.

Case Report: Emergency endovascular management of a ruptured giant abdominal aortic aneurysm with severely angulated and conical shaped neck using novel multiple stiff wire technique

Background Ruptured abdominal aortic aneurysm (rAAA) is commonly fatal, with an overall mortality rate of nearly 90%, and the risk of subsequent rupture remains high, especially in large aneurysm diameters or progressive disease. Unfavorable neck anatomy in EVAR is linked to early graft failure and long-term complications. Recently, a novel multiple stiff wire (MSW) technique has been developed to overcome the challenges of hostile neck anatomy without introducing additional devices and procedural complexity. It has also been feasible in a series of elective cases. In this case, we report the first-ever utilization of the MSW technique in an emergency case of an acute contained rAAA with a conical-shaped, severely angulated neck who underwent Endovascular Aortic Repair (EVAR). Case presentation A 61-year-old man came with intermittent sharp stomach pain radiating to his back since three weeks ago. Physical examination showed elevated blood pressure and anemic conjunctiva. Laboratory examinations showed anemia, leukocytosis, elevated D-dimer level, high creatinine level, and low eGFR. CT-Scan Angiography (CTA) revealed severely hostile anatomy, a conical-shaped abdominal aorta aneurysm with a length of 13.2 cm and a maximum diameter of 9.3 cm with angulation of 90.1°. The patient was diagnosed with Ruptured AAA with a conical-shaped, severely angulated neck. Endovascular Aortic Repair (EVAR) management with MSW technique was planned for him. After four days, The patient was discharged in a clinically stable condition with optimal medical treatment and education. Conclusion The endovascular approach could be performed in emergency settings and has been proven to reduce length of stay, mortality, and morbidity rates. In this case, the endovascular approach with the MSW technique showed promising results for the patient.

Determinants of Neurological Outcome Following Elective and Emergency Open Thoracoabdominal Aortic Aneurysm Repair-A Retrospective Multi-Center Study.

Background/Objectives: This study aimed to evaluate and establish the incidence of all types of neurological complications at our high-volume reference center for open TAAA repair in the Netherlands and Germany. Additionally, we sought to identify predictors for various neurological complications. Methods: This retrospective study was conducted in accordance with the STROBE guidelines, with the aim of reporting neurological outcomes for all patients who underwent open thoracoabdominal aortic aneurysm repair at two centers (Maastricht-Aachen) from 2000 to 2023, and to examine the association between these outcomes and pre- and perioperative parameters. The primary endpoints of the study were all-cause mortality, spinal cord ischemia (SCI), stroke, intracerebral bleeding (ICB), critical illness polyneuropathy/myopathy (CIP/CIM), and recurrent laryngeal nerve paralysis. Results: A total of 577 patients were operated on for open TAAA repair in two centers. The total in-hospital mortality rate was 20.6%, while the elective cases in-hospital mortality rate was 14.6%. In all, 28.2% of patients experienced neurological complications. The spinal cord ischemia rate was 7.5%, intracerebral bleeding 3.6%, stroke 5.9%, critical illness polyneuropathy 3.5%, and laryngeal nerve paresis 5.7%. Crawford extent II was significantly associated with increased neurological complications (OR 2.05, 95% CI 1.39-3.03, p = 0.003), while Crawford extent III and IV were significantly associated with fewer postoperative neurological complications (OR 0.61 (0.38-0.98) p = 0.04) (OR 0.52 (0.30-0.92) p = 0.02). Preoperative ASA score > 3 (OR 1.76, 95% CI 1.16-2.67, p = 0.007), COPD (OR 1.82, 95% CI 1.19-2.78, p = 0.006), massive intraoperative transfusion (OR 1.48, 95% CI 1.01-2.17, p = 0.04), and reinterventions during hospital stay (OR 1.98, 95% CI 1.36-2.89, p < 0.001) and surgery time (p =< 0.001) were significantly associated with neurological complications. Patients with neurological complications had higher rates of other postoperative morbidities. Conclusions: Neurological complications after open TAAA repair remain a significant concern, with identified risk factors associated with increased morbidity, mortality, and resource utilization. Identifying at-risk patients could potentially lead to a reduction in neurological complications.

Financial implications of sarcopenia in colorectal cancer surgery: a cost analysis in an Australian public hospital.

Sarcopenia has a detrimental impact on patient outcomes following colorectal surgery, increasing financial strain on the healthcare system. Given the absence of specific Australian data, this study aimed to measure the cost of sarcopenia in the context of colorectal surgery in an Australian public hospital. A retrospective cost analysis, following CHEERS guidelines, was conducted on major elective colorectal cancer surgical cases at the Royal Adelaide Hospital between 2018 and 2022. The cross-sectional psoas area was measured through computed tomography (CT) imaging at the level of the third lumbar vertebrae, and sarcopenia was determined using gender-specific thresholds. Hospital billing data was used to gather costings (AU$). Out of 271 patients, 57 (21.0%) comprised the sarcopenic group (SG). SG patients were older (74 vs. 69 years, P < 0.001), had a higher American Society of Anaesthesiologists (>II, 71.9% vs. 53.7%, P = 0.014) and a lower median body mass index (24.8 vs. 28.7 kg/m2, P < 0.001). The SG exhibited a greater likelihood of complications (84.2 vs. 68.7%, P = 0.020) and prolonged hospital stay by 1 day (median 7 vs. 6 days, P = 0.027). Despite an increased mean total cost of hospital admission, no statistically significant difference was found (AU$37 712 vs. $34 845, P = 0.296). Multivariate analysis revealed hypoalbuminemia, prolonged operative time, postoperative ileus, return to theatre, Clavien-Dindo grade ≥3 complications, and prolonged stay increased overall cost (P < 0.05). Sarcopenia was not associated with a significantly increased cost of colorectal surgery in our institution. Future studies examining the cost-effectiveness of prehabilitation programmes targeting sarcopenia should be considered.

EP624 - Clavien Dindo system in general surgical patients at a district hospital in NHS

Abstract Aims To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings. Methods Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT. Results 26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 % 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %) 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study. Conclusion Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.

FP1.6 - Prospective analysis of outcomes of colorectal resections in the over 75 age group. A single centre study

Abstract Objectives Cancer is a disease of ageing. Additionally, the population of the UK is getting older. Therefore, colorectal operations in the elderly population is becoming more frequent. Herein we analyse the outcomes of patients over 75 who have had elective or emergency colorectal surgery in a single Scottish Healthboard. Methods A prospective review was conducted of 408 patients aged 75 years and over who underwent elective or emergency colorectal surgery in our region between 2018 and 2023 was performed. Patient characteristics, operative intervention, short- and long-term post operative outcomes were noted. Results Of 408 Colorectal surgery patients, 303 were elective and 105 were emergency cases. Of these cases, 40.6% (n = 123) of elective cases and 28.6% (n = 30) of emergency patients did not experience any complications. Of these patients, 8.6% of emergency patients went from being independent to requiring full care. Emergency patients (n = 34, 32.4%) demonstrated a higher mortality rate at one year than elective cases (n = 59, 19.5%). Conclusion Colorectal Surgery in patients aged 75 years and older are associated with poor post operative outcomes, functional decline, and increased mortality. Whilst these findings are intuitive, the scale of functional decline is important to discuss with future patients when counselling future patients for such procedures.

EP625 - Perioperative complications in general surgical patients at a district hospital in NHS

Abstract Aims To try and use the Clavien-Dindo system of grading of surgical complications to General Surgical patients at NMGH. To understand the predictors of grades of surgical complications. Propose the use of the CD system in regular mortality and morbidity meetings. Methods Retrospective cohort study. Total patients studied were 104. List of all elective and emergency general surgical patients at NMGH from 1st Feb to 2nd March 2023 collected from HIVE. Data collected included MRN, age, sex, BMI, ASA category, surgical time, blood loss, type of surgery, complication and CD grade. CD grade was calculated from the patient notes. Statistical analysis was performed on StatsDirect3 from MFT. Results 26.9 % (n = 28) of the patients developed CD grades complications overall. Mild complications (grade 1 and 2) were 18.2 %. Serious complications (grade 3 and 4) were 7.7 %. CD 5 was 0.96 %. 51 % of emergency cases develop complications (Mild 29%, serious 20%, death 2 %). 11 % of elective cases develop mild complications and no serious complications. Age and ASA grade have no statistically significant relationship in the present study. Higher BMI is associated with lower grades of complications in this study. Conclusion Female patients in an emergency setting with a blood loss of greater than 100 ml and a surgical time of 150 minutes or greater developing grade 2 complications. Emergency cases carry 4.6 times more complication rates than elective cases. Blood loss of 50 ml or greater would give rise to CD 1 or greater. Surgical time of lesser than 125 minutes gives CD 1. Surgical time 125 to 200 minutes gives CD 2.

FP8.9 - Surgical Synergy: Rethinking waste for a greener tomorrow in General Surgery

Abstract Aims Every year in the UK, the NHS sends approximately 156,000 tonnes of clinical waste for processing via high temperature incineration or other treatments, and then to landfill sites. Majority of the waste produced by hospitals comes from the operating theatres (OTs). In this study, we aim to assess the current implementation of waste management strategies at an NHS district general hospital (DGH) in general surgery. We have investigated a variety of cases and have surveyed the volume of waste produced. Methods We observed elective and emergency general surgery cases across 2 weeks. For each case, we weighed the waste produced- both recyclable and non-recyclable (clinical). Results This study included four umbilical hernia repairs, two right hemicolectomies, one examination of rectum under anaesthesia with seton insertion and three laparoscopic cholecystectomies. Across the operations, the average total waste produced was 5.9kg. The average clinical waste and recyclable waste was 4.7kg and 1.2kg, respectively. Additionally, a significant proportion of non-infectious recyclable waste was incorrectly placed into the clinical waste bin. Conclusion On average 5.9kg of waste is produced after a general surgery operation. Most of this waste is clinical and not recycled. However, the clinical waste can be cut down by appropriate waste segregation, thus reducing the impact on the environment as well as reducing the cost of incineration.

EP298 - Assessing the use of a rapid and standardised online operation note for laparoscopic cholecystectomy

Abstract Aims Laparoscopic cholecystectomy is one of the most common operations performed in the UK, with approximately 65,000 procedures performed per year. The operation note is of utmost importance as is documents the procedural steps, highlights peri-operative complications, details post-operative instructions and may act as medico-legal evidence if necessary. At our centre, operation notes are written using a blank online document and we aimed to make the process of writing these documents following laparoscopic cholecystectomy easier and more efficient. Methods We produced a computer based, standardised operation note for laparoscopic cholecystectomy. The document consisted of spaces for key clinical information such as the staff members involved with the operation, whether the procedure was done as an elective or emergency case and the patient’s ASA score. The document also outlined the key operative steps that could be ticked off using yes/no answers, a section for white space answers for additional details and pre-written post operative instructions that could be added to. Results This standardised operation note was well received by colleagues and facilitates rapid and thorough documentation. It ensures all steps are documented and so reduces the risk of omissions. Furthermore, it ensures legibility should it need to be referred to in the future, ensuring medico-legal compliance. Conclusions This operation note is medico-legally more rigorous, ensures legibility and is easier to use for auditing purposes. Producing the document was also an excellent trainee opportunity as it encouraged consideration of the important operative steps and outlining them in a step wise format.

SP8.3 - Institutional initial experience and outcomes for the first 100 robotic upper gastrointestinal cases: A single tertiary centre results

Abstract Background Robotic surgery is a widespread technique with potential benefits including shorter admissions, fewer complications as well as better surgeon ergonomics and precision. Evidence suggests that robotic surgery has a rapid learning curve, with number of cases linked to operative time. In this study, we report our preliminary results after initiation of upper gastrointestinal robotic assisted surgery. Methods This retrospective study included all robotic elective upper gastrointestinal cases, performed by two surgeons using Da Vinci XI from August 2022 to May 2023. Cholecystectomy and anti-reflux surgeries were performed. Demographics, console timing, number of cases per list and post-operative complications (Clavien-Dindo Scale) were analysed. Results 100 Robotic UGI cases were analysed consisting of 86 cholecystectomies and 14 anti-reflux surgeries. Females represented the majority of cases (68%). Mean age was 53.0 years (18-78) while mean ASA and BMI were 2 and 30.3 kg/m^2 respectively. Cholecystectomies required 43.0 minutes while anti-reflux surgeries required 119.3 minutes on average. The mean length of stay was 0.90 days for cholecystectomies, and 1.46 days for anti-reflux surgery. There were two readmissions post cholecystectomy for pneumonia and liver bed collection. Only one patient developed a Clavien-Dindo grade &amp;gt;3 complication for port site hernia repair post cholecystectomy. Average console time fell with increasing case number, creating a tangible impact on efficiency as surgeons increased the number of cases per list from three to four. Conclusion Our initial experience has shown favorable outcomes of robotic surgery. There was a noticeable rapid learning curve, encountering only one major post-operative complication. This high effectiveness should stimulate the swift introduction of robotic surgery to other hospitals.

SP3.1 - Could shorter length of stay and oncological non inferiority justify a radical paradigm shift towards RAS to be the gold standard for all rectal cancer resections

Abstract Aim Robotic-assisted surgery (RAS) has proven to be an effective alternative to open (OP) and laparoscopic-assisted (LAP) rectal cancer resections. We aim to evaluate pathological and peri-operative outcomes of patients in a single centre undergoing rectal cancer resections using all three surgical techniques to evaluate whether RAS should be the gold-standard. Methods We retrospectively identified all elective rectal cancer resection cases since 2019 at our centre offering OP, LAP, and RAS services. We audited length-of-stay (LoS), complications, readmission rates, margin clearance status, and lymph node yield. Results Since 2019, there were 28 OP, 77 LAP, and 35 RAS resections performed. The median LoS for OP resections was 11 days, for LAP was 8 days (p=0.02) and was lowest for RAS resections (3 days, p=0.005). Readmission rates were highest for OP resections (21.4%) and were identical for LAP and RAS resections (14.2% each). Complications (OP 25%, LAP 34%, RAS 37%; p&amp;gt;0.05) were categorized using Clavien-Dindo (CD) classification with LAP having highest proportions of CD-IV (7.7%) and CD-V (7.7%), whereas RAS and OP resections had no severe complications (CD-IVa/IVb/V). Conclusion Our analysis shows significantly superior outcomes for shorter LoS and clear non-inferiority of RAS in all other aspects as compared to conventional approaches. Efforts must be bolstered to introduce RAS for rectal cancer resections in the long run considering the need for increasing training opportunities and improved resources to allow for a stable transition to RAS led services, rather than a radical conversion. Further studies are warranted to substantiate our observation.