Consultant Surgeon Research Articles

Utilising a modified accelerated Delphi process to develop a national multidisciplinary consensus on peri-operative optimisation of patients with obesity undergoing non-bariatric surgery

BackgroundIn the last three decades, the worldwide prevalence of obesity has increased by threefold. Using a modified Delphi consensus technique, the Irish Surgical Research Collaborative (ISRC) aimed to formulate consensus guidelines on the peri-operative optimisation of patients with obesity undergoing non-bariatric surgery. MethodsSubgroups within the ISRC were established to formulate consensus statements using a nominal group technique (NGT) to address the three domains of pre-operative, intra-operative and post-operative care. Three Delphi rounds were circulated nationally to multidisciplinary members of the peri-operative team via electronic survey. Consensus was considered achieved for any statement with >80 % agreement. Data was analysed using Microsoft Excel (Microsoft Corp, Redmond, WA). ResultsFollowing three Delphi rounds, a total of 94 statements centred around optimising peri-operative care for patients with obesity undergoing non-bariatric surgery reached consensus. Pre-operatively, access to prehabilitation, use of pre-operative risk stratification tools and strategies to reduce obesity-related co-morbidities were all deemed important along with nomination of a hospital obesity lead. Intra-operatively, the prioritised domains were involvement of consultant anaesthetist and surgeon for safe and considered patient positioning, utilisation of minimally invasive surgical techniques, adherence to venous thromboembolism prophylaxis and surgical site infection prevention strategies as well as adoption of multimodal analgesia. Appropriate analgesia prescription, nutritional support, enhanced recovery after surgery and the role of physiotherapy were all deemed essential elements of post-operative care. ConclusionAs a multidisciplinary peri-operative group, through Delphi consensus, we report agreed perioperative standards to optimise the perioperative care of patients with obesity undergoing non-bariatric surgery. This consensus can be utilised to standardise clinical practice and identify areas for quality improvement.

WP3.15 - National Emergency Laparotomy (NELA) deaths within 90 days: A cohort study

Abstract Aims NELA is committed to enhancing quality of care of patients undergoing emergency laparotomy. NELA care pathways include: initial clinical assessment, resuscitation, prompt diagnosis, early surgery, peri-operative care. NELA emphasizes the importance of identifying high risk patients, who are associated with significant morbidity & mortality. Aim of study is to review the NELA 90-day deaths. Methods Cohort study of NELA deaths within 90 days, from Jan'2014 to Jan'2024 at single centre. Descriptive demography, outcomes were evaluated. NELA survivors beyond 90 days were controls. Results 90 Day (n = 113) Others (n = 751) Mann Whitney U (p value) Age(yrs) 74.3 66.6 < 0.0001 Sex(M:F) 58 : 55 334 : 417 NS ASA 3 2 < 0.0001 BMI(kg/m2) 25.1 25.7 NS Lap(n) 16 218 Ns Open(n) 97 533 < 0.01 Op time(mins) 120.2 119.1 NS LOS(days) 17 12 NS ITU/HDU 70 318 < 0.001 ITU stay(day) 3 2 < 0.05 Lactate(mmol/L) 3.0 1.9 0.0002 WCC(x109/L) 13.2 12.3 NS CRP(mg/L) 93.6 68.8 < 0.0001 Physiological score 28.2 21.6 < 0.0001 Operative severity score 20.0 16.4 < 0.0001 Pre possum score 29.4 11.9 < 0.0001 PP mortality score 23.4 6.1 < 0.0001 PP morbidity score 82.9 63.5 < 0.0001 Survival Rate (%) 1styear 81.4 5thyear 63.0 10thyear 50.7 Conclusion 90-day NELA mortality rate is 13.1 %. NELA deaths occurred in older, frail, multi-comorbid & higher ASA status Patient survival appears to plateau out beyond 90-days (natural deaths). NELA risk scores were greater amongst the 90-day deaths. NELA risk scores can identify high risk patients, where early collaborative senior assessment by consultant surgeons, anaesthetist and intensivists may identify and allocate appropriate surgical & critical care intervention.

WP7.15 - Surgical dogma… Why change?

Abstract Aims Surgical dogma still persists today despite up-to-date evidence. Implementation of evidence into clinical practice takes on average 17 years. Acute appendicitis is typically managed with surgery, despite evidence recommending a non-operative, antibiotic-only strategy as an appropriate first line treatment in uncomplicated cases. This study investigates barriers to, and facilitators of, changing practice with regards to management of acute appendicitis. Methods Surgeons involved in emergency general surgery in U.K. hospitals were invited to participate in online/telephone semi-structured interviews. Thematic analysis based on the theoretical domains framework was used to develop belief statements. Results 16 interviews were conducted to achieve data saturation. 8 consultant surgeons, 8 surgical trainees from secondary and tertiary centres participated. Numerous barriers and facilitators were identified. There is a lack of awareness of current research with variable interpretation of evidence and its practical applications. There were concerns regarding loss of training opportunities in a “benchmark” procedure; failure of treatment and subsequent complications; missed malignancy and cost implications. Surgeons identified a reluctance to change from long standing practice and recognised their communication may skew patients’ decision making. Decision making practice varied from paternalistic to shared/supported. Surgeons believe they undertake a fully informed consent process, despite some not offering non-operative management as an alternative treatment. Conclusions Numerous barriers and facilitators exist to implementing change and are often based on surgeons’ personal experiences rather than evidence. The identified factors will be used to develop an implementation strategy to drive evidence-based practice and may be transferable to other surgical conditions.

FP8.8 - LumenEye XI rigid digital rectoscope in the assessment of anorectal symptoms: a sustainable substitute for outpatient flexible sigmoidoscopy?

Abstract Aims To evaluate the acceptability, safety and diagnostic yield of the LumenEye XI in the assessment of anorectal symptoms. Methods Consecutive patients with anorectal symptoms, referred to the colorectal unit by their general practitioner, had a full clinical assessment followed by endoscopic examination using the LumenEye XI by a consultant colorectal surgeon. Results 59 consecutive patients,16 being male, were examined. The median age was 59 years (range 27-90). The main reported presenting complaints were rectal bleeding (n = 18, 21.4%), proctalgia (n = 10, 15.5 %), faecal incontinence (n=12, 14.3%), obstructive defaecation (n=7, 8.3%), anorectal swelling (n = 7, 8.3%), and mucous discharge (n = 2, 2.4%). The main findings were haemorrhoids (n= 18, 22.5%), rectal prolapse and rectocoele (n=14, 17.5%), and inflammatory conditions (proctitis, anal fistula, pouchitis) (n=4, 5%). One patient was diagnosed with rectal cancer. 19 patients (23.75%) had normal findings. 13 patients (22%) were referred for further investigations. Out of the 18 patients with rectal bleeding, 16 had a definitive diagnosis made with LumenEye. The diagnoses in patients with rectal bleeding were haemorrhoids (n=15, 53.6%), inflammation (n=4, 14.3%), prolapse (n=2, 7.1%), and ulceration (n=1, 3.6%). No cause could be identified in 2 of these patients. The rectosigmoid junction was visualised in all patients who had an intact rectum (57 out of 59 patients). All patients tolerated the procedure well, with no complications. Conclusions LumenEye XI is safe and well accepted by patients with good diagnostic accuracy. It therefore offers a potential solution to helping to relieve the endoscopy burden and enable cost savings by reducing the number of outpatient flexible sigmoidoscopies.

SP8.6 - Exploring Barriers of Entry for Women Pursuing Surgery: Impact of a Conference on the Confidence, Understanding, and Preparedness of Attendees

Abstract In the UK, women are underrepresented in surgery. Women make up only 16% of consultant surgeons and 34% of surgical registrars in the UK, whilst 59% of medical students are female. This project aims to explore the impact of conferences on perceived barriers and attitudes of female medical students aspiring to become surgeons. A survey was administered to 130 attendees, yielding 95 eligible responses, at a national student-led conference held at UCL encompassing speaker events, workshops, and speed mentoring. Pre- and post- questionnaires were provided. This included an open ended question on personal barriers, and a 5-Point Likert Scale to assess opinions on barriers of entry, confidence in surgical skills, preparedness for a surgical career, and understanding of challenges faced by women in surgery. Wilcoxon Signed-Ranks Test was used to assess statistical significance. The study included participants aged 18-30 from 23 universities and NHS trusts, representing 7 ethnic groups and 12 medical professions, with medical students comprising 87% of the cohort. Following the conference, 14 barriers of entry were analysed and there was a notable average increase in measured outcomes: confidence in surgical skills by 175%; preparedness by 192%; and understanding of the challenges faced by 177%. Overall, an average increase of 181% across reported metrics. Overall, the study data has demonstrated the effectiveness of the UCL Women in Surgery conference in empowering students pursuing surgical careers. Specialised conferences offer safe spaces for networking, mentorship, and field insights, while also mitigating financial barriers through low registration costs. Representation matters, and supporting aspiring surgeons by addressing barriers of entry for women is crucial.

Comparison of Mean Postoperative Hemoglobin Concentrations in Patients Undergoing Total Knee Arthroplasty With Intravenous Versus Intraarticular Administration of Tranexamic Acid.

Total knee arthroplasty (TKA) may result in significant blood loss, but it is an effective and affordable treatment for severe osteoarthritis in the knees. While intravenous (IV) tranexamic acid(TXA) is a commonly used technique, intraarticular (IA) TXA has just recently started to gain traction in joint replacement procedures. The purpose of this research was to examine the mean postoperative hemoglobin concentration in order to assess the effectiveness of TXAadministered IVvs IAafter TKA. To assess the effectiveness of intraarticular TXA against intravenous administration. The six-month randomized controlled experiment was started from October 5, 2022, to April 4, 2023, at "the Orthopedics Department of Sir Ganga Ram Hospital in Lahore". The experiment included 60 patients undergoing TKA, ranging in age from 30 to 70. All members of the surgical team, including the supervisor (a consultant surgeon), assistants, and researchers, were present throughout the surgery. A high, thigh tourniquet was employed in every case, and a medial parapatellar technique was performed as well. Before the tourniquet was inflated, individuals in the intravenous group received 1 g of TXA intravenously 15-30 minutes beforehand. In the IA group, the "patient received an injection of 2 g of TXA in a 20 mL solution"straight into the joint after the prosthesis was implanted and secured. Data were analyzed using SPSS (version 26), with numerical data (age, BMI, surgical length, and hemoglobin levels) presented as mean ± SD and categorical factors (gender, American Society of Anesthesiologists (ASA) class, anatomical side) shown as frequency and percentage. The mean postoperative hemoglobin levels were compared between groups using an independent sample t-test, with data stratified by various factors and p ≤ 0.05 considered significant. There were 60 patients in this study, ranging in age from 30 to 70. The mean±SD age was 48.73±10.35 years. Patients' mean BMI was 25.51±4.48 kg/m², with representation across underweight, normal, overweight, and obese categories. The procedure took 173.10±32.61 minutes. The overall postoperative hemoglobin concentration was significantly higher in the IA TXA group (12.12±1.32 g/dL) compared to the IV TXA group (11.11±1.10 g/dL), with a p-value of 0.02. Additionally, when stratified by age, the IA TXA group consistently demonstrated higher postoperative hemoglobin levels across all age brackets, with significant differences observed in the 51-60 years (p = 0.001) and 61-70 years (p = 0.011) groups. Gender-based comparisons showed that IA TXA was associated with higher postoperative hemoglobin levels for both males (p < 0.05) and females (p < 0.05) compared to IV TXA. This study demonstrates that IAadministration of TXAis more effective in maintaining higher postoperative hemoglobin concentrations compared to IVTXA in patients undergoing TKA. The IA TXA group consistently achieved significantly higher hemoglobin levels across various age groups and both genders, indicating superior efficacy in reducing blood loss associated with TKA. These findings suggest that IA TXA could be a preferable alternative to IV TXA for enhancing postoperative hemoglobin recovery and potentially improving patient outcomes in knee arthroplasty procedures.

Have changes in colorectal surgery training impacted on mortality in cancer patients? A retrospective cohort study of 51,562 procedures.

The aim of this study was to explore whether there were any differences in consultant colorectal surgeon training and adjusted 90-day postoperative colorectal cancer mortality rates (AMR). We undertook a retrospective analysis of outcomes data published on the Association of Coloproctology of Great Britain and Ireland (ACPGBI) website. A total of 51,562 procedures for patients in England diagnosed with large bowel cancer between 2010 and 2015, registered under 551 consultants were included. Consultants were split into two cohorts. The first group were the pre-Calman Trained Consultants (pre-CTr), who completed their training before 1998. The second group-the post-Calman Trained Consultants (post-CTr)-included those who received their Certificate of Completion of Training (CCT) under the Calman Training Principles (CTC, 1998-2007) and the Modernising Medical Careers Curriculum (MMC, 2008 and onwards). The outcome measure was an AMR. The pre-CTr cohort (n=84) consisted of 3.6% female colorectal consultants (n=3/84), whereas the post-CTr cohort (n=467) consisted of 14.3% female colorectal consultants (n=67/467) (p=0.006). In this cross-sectional analysis over 5 years, the average pre-CTr undertook a greater number of colorectal resections than their post-CTr peers: median procedures (interquartile range, IQR): 104 (59) vs 89 (57) respectively, p=0.008. The median AMR was significantly greater among pre-CTrs compared with post-CTrs, median AMR (IQR): 2.7% (2.0) vs 2.1% (2.9), p=0.022. These data indicate that the implementation of the MMC and Calman training principles for colorectal training is associated with a statistically lower AMR compared with other historical training periods. This merits further exploration.

Upper gastrointestinal training in the UK and Ireland: a Roux Group Study.

Surgical training programmes in the United Kingdom and Ireland (UK&I) are in a state of flux. This study aims to report the contemporary opinions of trainee and consultant surgeons on the current upper gastrointestinal (UGI) training model in the UK&I. A questionnaire was developed and distributed via national UGI societies. Questions pertained to demographics, current training evaluation, perceived requirements and availability. A total of 241 responses were received with representation from all UK&I postgraduate training regions. The biggest discrepancies between rotation demand and national availability related to advanced/therapeutic endoscopy and robotic surgery, with 91.7% of respondents stating they would welcome greater geographical flexibility in training. The median suggested academic targets were 3-5 publications (trainee vs consultant <3 vs 3-5, p<0.001); <3 presentations (<3 vs 3-5, p=0.002); and 3-5 audits/quality improvement projects (<3 vs 3-5, p<0.001). Current operative requirements were considered achievable (87.6%) but inadequate for day one consultant practice (74.7%). Reassuringly, 76.3% deemed there was role for on-the-job operative training following consultant appointment. Proficiency in diagnostic endoscopy was considered a minimum requirement for Certificate of Completion of Training (CCT) yet the majority regarded therapeutic endoscopy competency as non-essential. The median numbers of index UGI operations suggested were comparable with the current curriculum requirements. Post-CCT fellowships were not considered necessary; however, the majority (73.6%) recognised their advantage. Current CCT requirements are largely consistent with the opinions of the UGI community. Areas for improvement include flexibility in geographical working and increasing national provisions for high-quality endoscopy training.

Efficacy of Platelet-Rich Plasma Versus Steroids In Patients of Tennis Elbow

Objective: To compare the efficacy of Platelet Rich Plasma versus Steroids among patients managed for Tennis elbow at our Orthopaedic unit. Study Design: Quasi-experimental study. Place and Duration of Study: Orthopaedic Department, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2021 to Jul 2022. Methodology: Patients with Tennis Elbow diagnosed by a consultant orthopaedic surgeon were included in the study. They were randomly allocated treatment with platelet-rich plasma and steroid injections. The team assessed them after three months of treatment using the Disabilities of Arm, Shoulder, and Hand score. Different factors, including mode of treatment, were associated with significant improvement in these patients at the end of three months. Results: Out of 250 patients with tennis elbow included in the final analysis, 193(77.2%) were male, and 57(22.3%) were female. Patients were divided into two groups for comparison, and Group-1 had significant improvement, while Group-2 had no improvement. Out of the total, 117(46.8%) patients received platelet-rich plasma, while 133(53.2%) patients were managed with corticosteroids. The presence of comorbid illnesses and the use of platelet-rich plasma was statistically significantly found in a group with significant improvement in Disabilities of Arm, Shoulder, and Hand score (p-value&lt;0.05) as compared to a group of patients without significant improvement. Conclusion: Most patients had significant improvement in symptoms at the end of three months. In our study, patients who were managed with platelet-rich plasma and had no comorbid illness had more chances of significant improvement at the end of three months.

Use of a remote assessment pathway for diagnosis of carpal tunnel syndrome.

We undertook a retrospective cohort study of a remote carpal tunnel syndrome assessment pathway created in response to limitations caused by the COVID-19 pandemic. Between July 2020 and September 2021, 702 patients referred from primary care (general practice) were assessed in a nurse-led telephone clinic using the carpal tunnel questionnaire of Kamath and Stothard (2003). Depending on their questionnaire score, patients were referred either for nerve conduction studies or a consultant hand surgeon review for diagnosis and treatment planning. Questionnaire scores of 3 and above accurately predicted a likely diagnosis of carpal tunnel syndrome in 83% of patients, and a diagnosis was unlikely in 90% of those with a score below 3. The pathway resulted in an estimated cost savings of £24,436 (€28,862, US$30,945) in comparison with the pre-pandemic service. However, some limitations in the pathway may have impacted effective patient management and we suggest possible improvements.Level of evidence: III.

Artificial intelligence for optimum tissue excision with indocyanine green fluorescence angiography for flap reconstructions: Proof of concept

BackgroundIndocyanine green fluorescence angiography (ICGFA) is gaining popularity as an intraoperative tool to assess flap perfusion. However, it needs interpretation and there is concern regarding a potential for over-debridement with its use. Here we describe an artificial intelligence (AI) method that indicates the extent of flap trimming required. MethodsOperative ICGFA recordings from ten consenting patients undergoing flap reconstruction without subsequent partial/total necrosis as part of an approved prospective study (NCT 04220242, Institutional Review Board Ref:1/378/2092), provided the training-testing datasets. Drawing from prior similar experience with ICGFA intestinal perfusion signal analysis, five fluorescence intensity and time-related features were analysed (MATLAB R2024a) from stabilised ICGFA imagery. Machine learning model training (with ten-fold cross-validation application) was grounded on the actual trimming by a consultant plastic surgeon (S.P.) experienced in ICGFA. MATLAB classification learner app was used to identify the most important feature and generate partial dependence plots for interpretability during training. Testing involved post-hoc application to unseen videos blinded to surgeon ICGFA interpretation. ResultsTraining:testing datasets comprised 7:3 ICGFA videos with 28 and 3 sampled lines respectively. Validation and testing accuracy were 99.9 % and 99.3 % respectively. Maximum fluorescence intensity identified as the most important predictive curve feature. Partial dependence plotting revealed a threshold of 22.1 grayscale units and regions with maximum intensity less then threshold being more likely to be predicted as “excise”. ConclusionThe AI method proved discriminative regarding indicating whether to retain or excise peripheral flap portions. Additional prospective patients and expert references are needed to validate generalisability.

RSTN COVID-19 Hand Recovery: Two years on, where are we now?

Hand surgery services were required to rapidly adapt to the coronavirus disease 2019 (COVID-19). Two years following the initial wave, hand surgery units continue to adapt and recover from the pandemic. The aim of the RSTN COVID-19 Hand Recovery survey was to evaluate what adaptions made to hand surgery services during COVID-19 have been maintained in the COVID recovery phase. A survey was distributed to hand surgery units, across the UK and Ireland. The survey was completed by consultant hand surgeons across 39 hospitals. Most practices returned to pre-pandemic standards. The main changes that endured were the increase in consultant-led triaging for referrals and utilisation of video conferencing platforms for teaching and meetings. Changes made during the pandemic, such as increased use of WALANT, out of theatre operating and use of telemedicine were not sustained during the recovery period. The COVID-19 pandemic allowed the opportunity for hand surgery services to adapt their services. Several changes that were implemented have since been proven to be more efficient and equally effective for patients. However, these changes have not been sustained and the barriers preventing permanent implementation should be scrutinised. We call on hand surgery units to evaluate their current practice to ensure that patients are provided a streamlined and sustainable service.

Incidence of postoperative complications is underestimated if outcome data are recorded by interns and first year residents in a low volume hospital setting

The aim of this study is to evaluate the accuracy of outcome reporting after elective visceral surgery in a low volume district hospital. Outcome measurement as well as transparent reporting of surgical complications becomes more and more important. In the future, financial and personal resources may be distributed due to reported quality and thus, it is in the main interest of healthcare providers that outcome data are accurately collected. Between 10/2020 and 09/2021 postoperative complications during the hospitalisation were recorded using the Clavien–Dindo classification (CDC) and comprehensive complication index by residents of a surgical department in a district hospital. After one year of prospective data collection, data were retrospectively analyzed and re-evaluated for accuracy by senior consultant surgeons. In 575 patients undergoing elective general or visceral surgery interns and residents reported an overall rate of patients with complications of 7.3% (n = 42) during the hospitalization phase, whereas a rate of 18.3% (n = 105) was revealed after retrospective analysis by senior consultant surgeons. Thus, residents failed to report patients with postoperative complications in 60% of cases (63/105). In the 42 cases, in which complications were initially reported, the grading of complications was correct only in 33.3% of cases (n = 14). Complication grades that were most missed were CDC grade I and II. Quality of outcome measurement in a district hospital is poor if done by unexperienced residents and significantly underestimates the true complication rate. Outcome measurement must be done or supervised by experienced surgeons to ensure correct and reliable outcome data.

807 Reliability of Simulation-Based Assessment of Surgical Technical Skills

Abstract Aim To examine the reliability of surgical trainees’ assessment data from a structured simulation training and assessment programme. Method The General Surgical Skills Programme is a simulation-based surgical training programme integrated within the clinical training pathway for surgical trainees across London. It is tailored to each trainee’s level of training and subspecialty. The ‘Junior’ pathway involves nine training sessions and one assessment session performing three procedures (Inguinal hernia [IH], laparoscopic cholecystectomy [LC] and small bowel anastomoses [SBA]). Within the scope of the Programme, skills assessment data collection was initiated in 2012. Data collected includes demographics and training data (grade/subspecialty/case numbers). Each procedure is assessed by two consultant surgeons using two procedure specific assessment tools, a visual analogue scale (VAS) and competency assessment tool (CAT). Reliability analyses were performed using SPSS for ‘Junior’ data over a four-year period. Results In total, 355 surgical trainees (Male = 199, Female = 154, Missing = 2) were assessed from 2014 to 2017 (2014 n=105; 2015 n=92; 2016 n=89; 2017 n=69). Both assessment tools showed satisfactory inter-item reliability (IH-CAT α=.794-.903, LC-CAT α=.837–910, IH-VAS α=.851-.991, LC-VAS α=.831-.986, SBA-VAS α=.778-.984). Inter-rater reliability, ICC (1,2), was good to poor across all tools. (IH-CAT .345-.510, IH-VAS .243-.600, LC-CAT .271-.766, LC-VAS .157-.678, SBA-VAS .225-.278). Conclusions The assessment tools used within the Programme both demonstrate satisfactory inter-item reliability. Inter-rater reliability is variable, highlighting a potential utility for assessor training within the Programme.

45 Skin Preparation in Arthroscopic Surgery – Are There Environmental Savings to Be Made?

Abstract Background The environmental impact of surgery is concern that has been raised in recent years. Operating theatres have been found to create up to 230kg of waste per day. There is a need to reduce surgical waste whilst maintaining patient safety. This study assessed the waste and CO2 production associated with two accepted skin preparation techniques. Method Groups consisted of two consultant surgeons, both performing 5 arthroscopic procedures. Surgical skin preparation was performed with disposable ChloraPrep™ sticks or bottled Hydrex 0.5% solution with red dye. Annual waste and CO2 production was assessed via modelling. Results The disposable group generated a total of 876g of net waste compared to 1727g in the solution group. Waste per surgical case was 134.6g (SD 14.97) in the disposable group compared to 328.8g (SD 86.09) in the solution group. The disposable group produced significantly less waste than the solution group (P &amp;lt;0.0069). In 2022, a total of 514 arthroscopies were performed at our institution (134 shoulder, 380 knee). Modelling using the research group data provided estimated annual waste in both groups; 225.132kg in the ChloraPrep™ stick group compared to 443.839kg in the Hydrex 0.5% solution group, with Kg CO2 production of 241.79-701.57 Kg and 476.68-1383.13 Kg in each group respectively. Conclusions This study demonstrates that choice of skin preparation in arthroscopy can significantly reduce waste and CO2 production, without a significant increase in cost.

Factors influencing patient decision-making to undergo shoulder arthroplasty.

Shoulder arthroplasty is effective in the management of end-stage glenohumeral joint arthritis. However, it is major surgery and patients must balance multiple factors when considering the procedure. An understanding of patients' decision-making processes may facilitate greater support of those considering shoulder arthroplasty and inform the outcomes of future research. Participants were recruited from waiting lists of three consultant upper limb surgeons across two NHS hospitals. Semi-structured interviews were conducted with 12 participants who were awaiting elective shoulder arthroplasty. Transcribed interviews were analyzed using a grounded theory approach. Systematic coding was performed; initial codes were categorized and further developed into summary narratives through a process of discussion and refinement. Data collection and analyses continued until thematic saturation was reached. Two overall categories emerged: the motivations to consider surgery, and the information participants used to inform their decision-making. Motivations were, broadly, the relief of pain and the opportunity to get on with life and regain independence. When participants' symptoms and restrictions prevented them enjoying life to a sufficient extent, this provided the motivation to proceed with surgery. Younger participants tended to focus on maintaining employment and recreational activities, and older patients were eager to make the most of their remaining lifetime. Participants gathered information from a range of sources and were keen to optimize their recovery where possible. An important factor for participants was whether they trusted their surgeon and were prepared to delegate responsibility for elements of their care. Relief of pain and the opportunity to get on with life were the primary reasons to undergo shoulder arthroplasty. Participants highlighted the importance of the patient-surgeon relationship and the need for accurate information in an accessible format which is relevant to people of different ages and functional demands.

1145 The Role of Emotional Intelligence in Surgical Leadership: A Qualitative Study

Abstract Aim Effective leadership is crucial in the NHS, enhancing patient safety and care quality. Surgical leaders play a vital role, addressing patient needs and managing teams (RCSEng, 2014). Emotional intelligence (EQ) is a key leadership skill, encompassing 12 competencies. However, EQ and leadership are often overlooked in medical training. This study investigates the significance of EQ in surgical leadership and aims to identify optimal methods for EQ development in surgery. Method The study employed semi-structured interviews (SSIs) with consultant and trainee surgeons, aiming to elucidate the influence of EQ on workplace behaviours in surgery. Ethical approval was obtained from the University of Nottingham Ethics Committee. Purposive sampling was used to select potential study participants with the aim of providing the most credible information to the study. Results Thematic analysis of transcribed interviews identified three overarching themes (Patients, Clinical Organisation, Surgeons) and related sub-themes. Results from 10 SSIs revealed that EQ positively affects job satisfaction, interpersonal relationships, teamwork, and mitigates burnout among surgeons. In the context of surgical leadership, EQ emerged as a catalyst for positive organisational culture change. Conclusions In conclusion, EQ is a crucial skill for surgical leaders, impacting various facets of their professional life. The study's findings contribute to the ongoing debate on the significance of EQ in surgery and advocate for evidence-based EQ training programmes in professional development. This research provides valuable insights for shaping effective leadership and training initiatives in the field of surgery.

247 Prophylactic Use of 3D Intraperitoneal Mesh in the Prevention of Parastomal Hernia in Permanent Colostomies After Rectal Cancer Resection

Abstract Background Parastomal hernia (PSH) is the most common complication of stomas associated with significant morbidity. Prophylactic mesh in preventing PSH is less well studied, and evidence is conflicting. We compare PSH rates in patients in whom 3D intraperitoneal mesh was and was not used prophylactically in a cohort of rectal cancer patients undergoing elective curative resection. Method Retrospective data from the Somerset Database and Electronic Patient Record were collected on patients under a single consultant surgeon between May 2016 and December 2021. Follow up was for a minimum of 2 years (excluding deaths). Appropriate statistical tests of difference significance were performed for proportions of categorical data, and time to hernia occurrence in patients with and without Dynamesh IPST placement. (Fisher’s Exact test; Kaplan Meier) Results From 397 colorectal cancer patients under the care of a single surgeon, 223 had elective surgery with curative intent, of which 63 (28%) underwent total mesorectal excision (TME) (30 TME &amp; ileostomy, 12 TME Hartmann and 21 APER) - 90% laparoscopic. 16 patients had prophylactic mesh used. Demographics and co-morbidities between groups were similar. PSH incidence was 1 (6%) (radiological) vs.7 (41%) (clinical) in the mesh vs. non-mesh group; P=0.039. Post operative complications and pain scores differed only slightly. Time to hernia development did not differ between groups. Conclusions Use of prophylactic mesh during permanent stoma formation in our practice appears safe, and effective in preventing PSH. Further studies may answer the question “Should 3D collared mesh be routinely placed during the formation of permanent stomas to prevent parastomal hernia?”

948 Learning Curve for Single Surgeon Approach of Laparoscopic Peritoneal Dialysis Catheter Insertion Using Freehand Robotic Assistant

Abstract Introduction A single surgeon approach to laparoscopic peritoneal dialysis catheter insertion can offer improved efficiency to surgical lists as well as freeing up surgeons to complete other operations or ward jobs. Simple, low risk laparoscopic procedures which can be completed quickly with the aid of a robotic assistant can help hospitals improve efficiency of surgical departments. This study aims to assess the learning curve of a single surgeon approach using the Freehand robotic assistant in peritoneal dialysis catheter insertion. Method Seventy-two cases were analysed over a period of three years from 2020-2023, operations involving the Freehand robotic assistant were performed by a single consultant surgeon. The duration of the procedure was one of the main factors evaluated for assessing learning curve. Other factors considered were re-do procedures and post-operative complications. Results Total mean operating time was 30.23 minutes. The peak point of the CUSUM chart for operating time was found at case 30, from this point onward trend began to decrease. From the 72 cases 6 had post-operative complications due to peritonitis and 2 had to be re-done due to inadequate positioning. Conclusions CUSUM chart indicated proficiency was gained at operation 30. There were minimal replacements necessary and only 6 cases that had post-operative complications all within the first 25 operations. This implies a short learning curve with great potential for improving efficiency with the use of the Freehand robot in simple laparoscopic procedures such as peritoneal dialysis catheter insertion.

An interview with Miss Samantha Tross

Miss Samantha Tross discusses her career, being the first Black woman to become a consultant orthopaedic surgeon in the UK and what advice she would give to future trainees.