District General Hospital Research Articles

EP241 - Managing Cervical Spine fracture in a district general hospital

Abstract Introduction Cervical spinal injury affects 2–3% of trauma patients and accounts for 8.2% of all trauma-related deaths. Respiratory complications are cited as the primary cause of mortality with a 14 - >27 % rate in patients aged more than 65 years old. Aim Produce a clear set of guidelines in an aim to reduce mortality in patients > 65 years presenting with cervical spine fracture. Method Data was retrospectively collected for patients aged >65 between September 2021 and August 2022 in a district general hospital. Patients with confirmed cervical spine injury were included in the study. Data was collated and analysed using Excel. Results 36 patients presented to ED with acute cervical spine fracture. 22 (61%) were female and 14 (39%) male with an age range of 66-98 years old. 31 (84%) patients were discussed with a tertiary centre. Complications ranged from constipation, delirium, DVT/PE, chest infections (n=5, 36%) to spinal shock (n= 3, 27%). 11 (30.6%) patients presenting with a c-spine fracture died within 30 days of admission.9 (25%) patients had an outpatient appointment booked in a tertiary centre and 13 (36%) were seen locally in the fracture clinic. 14 (39%) patients did not have any follow ups planned. Conclusions To mitigate in-hospital complications and improve outcomes, shared care with orthopaedics, geriatrics, and physiotherapy is being proposed for this group of patients. It would be beneficial to compare the data from the local network and aim at publishing an up-to-date set of robust guidelines.

EP421 - The multidisciplinary management of acute pancreatitis at a district general hospital – an NCEPOD audit

Abstract Aim To assess adherence to NCEPOD Acute Pancreatitis 2016 guidelines in order to optimise the multidisciplinary care of patients presenting with acute pancreatitis. Methods A retrospective case-based audit was conducted of the last 10 admissions with acute pancreatitis. Data on demographics, investigations and management were collected and audited against the NCEPOD evidence-based recommendations. Results The average age was 54 years (33-84) and 70% were male. The cause of the acute pancreatitis was identified as gallstones in 40%, alcohol in 30% and was unknown in the remaining 30%. All patients with alcoholic pancreatitis were referred to alcohol support services. 80% of all patients had significant co-morbidities at presentation: in 63% of patients these were well-controlled; of those uncontrolled, none received onwards referrals. Nutritional assessment only occurred in 10% of patients. Conclusions Our audit showed that we successfully identified a cause of acute pancreatitis in 70% of patients and involved alcohol services in 100% of alcoholic pancreatitis cases. This demonstrates good organisational infrastructure in managing these patients. However, despite the highlighted importance in the NCEPOD report, patients were not appropriately referred to dietitians or other medical specialities. We have therefore developed a series of multi-disciplinary team teaching sessions and an admission proforma to address these areas of the report and improve compliance. A second audit loop will be conducted to demonstrate impact.

EP 632 - Management of chest trauma in a District General Hospital - Audit of current practice

Abstract This abstract was published in Volume 110, Supplement 10, December 2023 ASGBI Emergency General Surgery Symposium. 1st November 2023. Glasgow, UK, and can be accessed at https://academic.oup.com/bjs/article/110/Supplement_10/znad388.012/7455140

EP452 - Outcomes of Appendiceal Cancer Over 10 Years in a District General Hospital

Abstract Aims To evaluate outcomes of appendiceal tumour patients at a district general hospital. Methods A retrospective review was performed to detect patients (16 years or older) with positive histology findings of appendiceal cancers post appendicectomy or colectomy between January 2014 to January 2024. Data was collected from a prospectively maintained electronic patient hospital record (Meditech, Version 6, USA). Results 13 patients were diagnosed to have appendiceal tumours between January 2014 – January 2024. Median age of presentation was 53 (IQR 43).Total Patient Number13Male30.8%Female69.2%Appendiceal Tumour TypePercentage of Appendiceal Tumour PatientsCarcinoid (Neuroendocrine)76.9%Adenocarcinoma7.7%Low Grade Mucinous15.4%High Grade Mucinous0% Median length of stay was 2.5 days (IQR 2.25). Emergency presentations made up 76.9% of admissions. Appendicectomy was the primary operation for 92.3%. 75% of tumours were <1cm, with 25% of tumours >1cm. Location of tumour was predominantly involving the tip in 61.5% of cases, with body and base involvement being 23.1% and 15.4% respectively. Tertiary referral was made for 84.6% of patients. 15.4% had evidence of metastatic disease. Subsequently 15.4% of patients had hyperthermic intraperitoneal chemotherapy (HIPEC), with 7.7% having HIPEC and systemic chemotherapy and radiotherapy. Conclusions Carcinoid (neuroendocrine) was the most common type of appendiceal tumour, mostly presenting as an emergency appendicitis. It was more commonly diagnosed in females. While appendiceal cancers are very rare, outcomes remained good with 100% five-year survival, demonstrating the importance of prompt tertiary referral if further treatment is required.

ThP2.4 - Unveiling the Odds: Identifying the Axillary Recurrence rates in Invasive Breast Cancer Surgery in a district general hospital - Seventeen years of Surgical Performance decoded

Abstract Introduction Axillary recurrence should be minimised by effective staging and treatment where appropriate Minimum standard <5% axillary recurrence at 5 years Target <3% axillary recurrence at 5 years according to UK ABS guidelines. Methods All patients with primary cancer diagnosed at our institution between January 2004 and December 2020 were identified from a prospectively maintained database of operations obtained from the medical coding department. Demographics of the patients, pre-operative investigations, MDT discussion outcomes, operative details (and complications), post-operative pathology, neo-adjuvant and adjuvant therapy regimens and follow-up data were recorded. All patients were followed up to the censoring date of December 2021 which gave a median follow-up of 18 months (range, 12- 204). Axillary recurrence and treatment regimens were recorded. Primary outcome measures were overall axillary recurrence and disease-free. IBM SPSS Statistics (Version 26.0 (IBM Corporation, Armonk, NY, USA) was used for statistical analysis to determine patient and pre-operative pathological characteristics that were predictive of isolated axillary recurrence after completion of the primary treatment course. Significance was defined as P<0.05. Results There were 4024 women diagnosed with breast cancer in Midyorks trust between this period who were referred and had surgical intervention. Of these, 107 patients were identified with recurrences. 12 were found to have an isolated axillary recurrence (8 ANC 4 SLNB) Conclusion The 17-year isolated axillary recurrence rate of women treated was 0.3%. Multimodality management at the time of recurrence, including axillary surgery, radiation, and systemic therapy, significantly improved the morbidity

WP3.9 - Characteristics and outcomes of an emergency hot clinic in a district general hospital - are they still a useful resource?

Abstract Introduction Hot clinics with ambulatory imaging have become integral to service provision in emergency general surgery, reducing admissions and expediting diagnoses. However they can come under criticism over a lack of senior decision making and perceived unnecessary reviews. Aims We aimed to evaluate the service in our department, by characterising the seniority level of the decision makers and assessors in the hot clinic, and outcomes of patients seen. Methods Retrospective analysis over a 3 month period of patients seen in the hot clinic of a district general hospital was performed. Results Total number of patients seen was 128. Median time from referral to appointment was 1 day. Abdominal pain formed 70.3% original presenting complaints. Over half of patients (52.3%, n=67) had review arranged by a registrar, and 46.9% (n=60) of patients were seen by a registrar at their appointment. 7% (n=9) had their hot clinic review arranged by a consultant. 63.3% (n=81) of patients had imaging performed as part of their review, and 53.1% (n =43) of these patients had pathology identified. 13.3% (n=17) of patients seen at the clinic required admission, and 43.0% (n=55) were discharged. 21.4% (n=3) of those brought back for a further hot clinic review had been seen by a consultant, versus 64.3% (n=9) seen by a registrar. Discussion Hot clinics are a valuable resource, and in our department a senior decision maker at a registrar level is involved in majority of decision making. The admission rate is low, demonstrating that the service is effective in helping to avoid admissions. Consultant input can help avoid repeated reviews.

EP186 - Blood transfusion documentation in surgical patients - are we doing it correctly? An audit on the blood transfusion documentation in surgical patients at a district general hospital in the United Kingdom

Abstract Aim Transfusion of blood products is commonly indicated in surgical patients, especially in patients with gastro-intestinal bleeding, gastro-intestinal cancers, and trauma patients. However, the documentation regarding blood transfusion in these patients often does not meet the guidelines. The aim of this clinical audit was to improve the blood transfusion (BT) related documentation in patients of general surgery (GS) at a district general hospital (DGH) in the United Kingdom, in accordance with the national guidelines (Administration of blood components: a British Society for Haematology Guideline) and the local trust guidelines. Method For the 1st-cycle of the audit, we did retrospective study of all adult patients admitted under GS in our DGH from 1st July 2023 to 15th August 2023 (6weeks) who received BT, and their electronic records were assessed with regards to documentation regarding the following criteria: decision to transfuse, patient's consent and understanding, post-transfusion effect and discharge notes. Following this, we had a discussion with the junior doctors in the department, who do these documentation, to make them aware of the BT guidelines, and to improve adherence. The 2nd-cycle included retrospective data collection from 1st September 2023 to 15th October 2023 (6 weeks). Results BT-documentation during the 2nd-cycle showed significant improvement to adherence above 80% in most of the criteria where it needed improvement in the 1st-cycle. Conclusion This clinical audit successfully improved the BT-documentation adherence to the guidelines, showing that through simple educational methods, the documentation practices could be improved significantly. Our plans for subsequent improvement includes posters in the departmental resource room to increase the awareness, and to re-audit in December 2023.

WP7.4 - A closed loop audit assessing adherence to NELA frailty guidelines in over 75’s undergoing Emergency Laparotomy

Abstract Background and Aims The National Emergency Laparotomy Audit (NELA) 2023 recommend patients over 65 should have clinical frailty score (CFS) recorded, and, if frail or aged 80 or over, should have Care of the Elderly (COE) input. Due to the multi-morbid nature of frailty this population carry additional surgical and post-operative risk. This audit reviewed use of these recommendations at a large District General Hospital (DGH). Methods We performed a closed loop audit on all patients aged 75 and older who had an emergency laparotomy between September 2020 to December 2023. We collected data from their admissions, including CFS and if COE reviews had occurred. The data was analysed. Interventions included presentation at clinical governance, discussion with the COE consultant and a poster was developed for the surgical assessment unit. The data was again retrospectively collected to complete the audit cycle. Results A total of 94 patients were included. The initial audit found 0 patients had CFS recorded and 16% had COE review. The reaudit found significant improvement, with 92% of patients having CFS recorded and 46% having had COE review. Conclusion The second cycle audit has shown significant improvement at the DGH in recording CFS and organising COE reviews for patients over 75 having an emergency laparotomy. However, there remains scope for improvement. Suggested improvements include: a referral pathway to prompt COE reviews and the creation of the “general surgery geriatrician” similar to the ortho-geriatrician role. Organising COE reviews could improve patient outcomes and provide more holistic care.

ThP4.10 - Outcomes of Transcystic Laparoscopic Common Bile Duct Exploration at the time of Laparoscopic Cholecystectomy in patients with small common bile duct diameter

Abstract Aim Laparoscopic Cholecystectomy with Laparoscopic Common Bile Duct Exploration (LC+LCBDE) is a single stage therapeutic option for management of choledocholithiasis. There have been limited publications regarding the feasibility of transcystic LCBDE in patients with small (≤8mm) common bile ducts (CBD). This study seeks to examine the outcomes for patients with small ducts who underwent LC+LCBDE via a transcystic approach in a district general hospital over a two-year period. Methods Prospectively collected data regarding all patients who underwent LC+LCBDE over a period from January 2022 to December 2023 was retrospectively reviewed. Data concerning indication for surgery, CBD diameter, length of stay, complication rate, and readmission rate were determined from Electronic Care Records. Data were analysed using Microsoft Excel. Results 50 patients were identified. CBD diameter (as measured at pre-operative Magnetic Resonance Cholangiopancreatography [MRCP]) ranged from 3.5mm to 8mm (average 6.25mm). One patient required conversion to open surgery due to difficulties with the LC element of the operation. Median postoperative length of stay was 1 day (range 0-8 days) and readmission rate was 6%. One patient experienced a complication beyond Clavien-Dindo Grade 2, this caused by a superficial wound infection requiring washout under general anaesthetic. One patient required subsequent Endoscopic Retrograde Cholangiopancreatography (ERCP) for management of retained CBD stones. Conclusions LC+LCBDE is a safe and effective management option for patients in the setting of choledocholithiasis with small common bile duct diameter. Small CBD should not necessarily be a deterrent to consideration of LCBDE as a therapeutic option in appropriately selected patients.

WP4.6 - Reducing Unnecessary Transfusion of Blood Products – A Quality Improvement Project in a General Surgical Department in a District General Hospital

Abstract Aims To audit adherence of transfusion of blood products against NICE guideline thresholds. To reduce unnecessary blood transfusions following departmental teaching sessions and installation of posters on surgical wards. Methods We retrospectively audited all patients receiving packed red cells transfusions consecutively across two consecutive four-month periods in a general surgery department. Departmental teaching sessions were held after the first audit cycle, supplemented by installation of posters including NICE guideline thresholds on surgical wards. The medical notes for each patient were assessed for pre-transfusion haemoglobin, indication for transfusion, and whether each transfusion was prescribed according to NICE guidelines. Results A total of 112 units of packed red blood cells in 42 patients and 133 units in 43 patients were transfused, respectively, before and after intervention. 45 units (40.2%) were prescribed according to NICE guidelines on first audit, improving to 67 units (50.4%) following intervention. 23 units of blood (20.5% of total) were transfused back-to-back inappropriately on first audit, reducing to 6 units (4.51% of total) after intervention. There were 2 self-limiting transfusion-related reactions (1.79%) on first audit, both in patients transfused above guidance thresholds, and no reactions following intervention. At a raw cost of approximately £135 per unit of donated blood, savings of £1830 were made over a four-month period (£5493pa), not including nursing and administration costs Conclusions Through simple local interventions and stricter adherence to transfusion thresholds, we reduced inappropriate above-threshold blood product transfusions in our hospital. This corresponded to a reduction in unnecessary blood-transfusion reactions and significant hospital savings.

EP281 - Outcomes of the Abdominal Wall Reconstruction in a District General Hospital

Abstract Background The aim of this study was to explore the outcomes of abdominal wall reconstruction surgery by assessing postoperative complications and recurrence. Methods This is a retrospective case series. All patients who underwent abdominal wall reconstruction between 2018 and 2023 were included and followed up for complications and recurrence till January 2024. Patient demographics, operative parameters and postoperative complications were extracted in an Excel sheet, and data analysis was performed with SPSS 27 software. Results Forty-two patients were included in this study with a median age of 61.5 (34-83) and 1.2: 1 female: male gender distribution. Moreover, 41% of the included patients had a BMI > 35, and 47.6% were smokers. The type of hernia was incisional in 50% and recurrent hernia in 31%, and the defect size was > 10 centimetres in 48% of the included cohort. The type of operation was as follows: Rives-Stoppa (50%), TAR (24%), and combined procedure (26%). additionally, only 18% had their operation laparoscopically, and the position of mesh was retro-rectus in 88% of the cases. Post-operative complications were SSI (11.9%), seroma (28.6%), haematoma (7.1%), re-operation (9.5%), entero-cutaneous fistula (2.4%), and Hernia recurrence (4.7%) at a median follow-up of 42.5 months. Length of hospital stay was < 5 days in 48% of patients. Conclusion The Component separation technique is an excellent approach to repairing complex incisional hernia with excellent results (<5% recurrence rate). Abdominal reconstruction is feasible in district general hospital settings.

WP5.15 - A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital in United Kingdom

Abstract Aims Emergency surgical presentations require urgent attention by surgeons to ensure appropriate treatment, However, increased waiting time in A&E often leads to delayed diagnosis and subsequently delayed management. A direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays and subsequently improve patient outcome. Methods A retrospective observational study of Emergency General Surgery (EGS) admissions from May 2023 to December 2023 was performed. Structured DAP referral proforma was implemented for patients to be directly referred to SEAU from A&E triage. Factors taken into consideration were - initial presentation, source of referral, time of initial assessment and patient outcome. Results A total of 265 patients were channeled through DAP referrals during the study period, of which 96.6% were appropriate referrals. The main source of the referral the A&E (52.4%), while the UTC-GP and GP constituted the remaining (47.6%). The most common clinical presentations were abdominal pain (32.4%), followed by subcutaneous abscess (17.3%). The median watiting time for initial assessment by the surgical team was 60 minutes. In terms of outcomes - 15 % patients were admitted, 14.7% were discharged after intervention, 35.8 % were discharged without intervention and 28.6% were planned to return for investigations or interventions. Conclusion The DAP for EGS admissions has enabled surgical emergencies to be addressed more promptly, and thus seen to have improved patient outcome as a result of avoiding unnecessary steps and delays before being reviewed by the surgical team through A&E pathway.

WP8.10 - Ultrasound Cannulation Training Programme: Quality Improvement Project

Abstract Aim Familiarisation with ultrasound skills can be very useful. This reduces stress for patients from multiple access attempts and preserves venous access. In our District General Hospital (DGH), no teaching on ultrasound-guided venous access was available. Our aim was to create a formal training programme on ultrasound-guided venous access for junior doctors. Methods Discussions were held with the medical education team at our DGH to understand how to organise a formal teaching programme. The interest of junior doctors was gathered through informal discussion. Those interested were then asked to complete course evaluation forms. Data was gathered on experience using ultrasound, confidence (out of 5) in performing ultrasound cannulation, and usefulness of the session (out of 5). Results Of the 49 participants, only 65% (n=32) filled in the course forms. Data was only analysed from these individuals. 47% (n=15) had previous experience using an ultrasound machine. Of the 32 participants analysed, 87.5% (n=28) felt the session was very useful and the other 12.5% (n=4) found the session to be useful. 100% (n=32) felt more confident performing ultrasound-guided access after the session. The average confidence score pre vs post-session was 1.59/5 vs 3.88/5, respectively. Conclusions This programme can improve confidence in procedural skills amongst junior doctors, whilst also minimising stress for patients of multiple access attempts. Though the sample obtained was small, it is clear to see increased confidence in participants, regardless of prior experience. The results obtained will be critical in continuing this programme in our hospital and hopefully roll out to a wider audience.

WP2.16 - Hartman’s Reversal; A comparison of conventional vs minimally invasive surgical approach

Abstract Background Hartman’s procedure is a safe operation for emergency colonic resections. Hartman’s reversal, however, is a technically challenging operation with high morbidity. Hence, almost half of the patients choose to live with lifelong stoma. Hartman’s reversal can be done open or laparoscopic, with single incision laparoscopic surgery (SILS) as an emerging minimally invasive technique. We will discuss the different surgical techniques along with their results and challenges. Methods This is a single centre retrospective study done at District General Hospital. All the Hartman’s reversals done between July 2021 to July 2023 were included in the study. Demographics, primary disease, interval between primary operation and reversal, post-operative complications and hospital stay was calculated. Results A total number of 19 Hartman’s reversal operations were done between July 2021 to July 2023. Average age of the patients was 61.8 years. The pathology was cancer in 7 patients and 12 cases were benign. The average interval between Hartman’s procedure and reversal was 23.2 months. Only 3 (15.7%) patients had a co-morbid. Out of 19 Hartman’s reversals done, 11 (57.89%) were done open, 5 (26.3%) SILS, 1 (5.2%) laparoscopic, and 2 (10.5%) laparoscopic converted to open. The complication rate in open cases was 61.5% vs 33.33% in laparoscopic/SILS. Average length of stay (LOS) was 10.38 days in open vs 9.19 days in laparoscopic group. Conclusion The limitations of this study are single centre and low sample size. The length of stay is slightly better in minimally invasive group, and much better post-operative outcomes. We suggest a multicentre study can help establish more reliable results.

SP5.4 - Is Fecal Calprotectin a useful test?

Abstract Aim To identify whether there is a correlation between a positive Fecal Calprotectin level(FCP) and a diagnosis of Inflammatory Bowel Disease. Method Data was collected retrospectively from a database of all colonoscopies performed at a District General Hospital. Data was collected including patient demographics, FCP result, colonoscopy and histology report from the hospital electronic record system. Results A total of 450 patients underwent a colonoscopy for any reason with 250 male and 200 female. The average age was 63.5 years. Patients undergoing surveillance or interventional colonoscopies were excluded. 90 patients were referred for colonoscopy with a change in bowel habit and all these patients had a FCP. Out of these, 42 had a FCP greater than 99 ug/g. Only 4 had IBD confirmed on histology, 3 had non-specific bowel inflammation. Of the other 360 patients who underwent a colonoscopy for other indications, 33 had a FCP sent, with 6 being positive. Out of a total of 48 patients who had a positive FCP, 25 had a FCP result greater than 250 ug/g. however, only three of these patients had IBD confirmed on histology. Conclusion The results show no correlation between a positive FCP and a diagnosis of IBD even using a higher cut off at 250 ug/g. For most cases with altered bowel habits or rectal bleeding, a FCP should not be recommended as it will not change the need for a colonoscopy.

ThP5.12 - Safety of emergency laparoscopic cholecystectomy in the treatment of gall stone disease: A single centre observational study from a District General Hospital

Abstract Aim To evaluate the safety of emergency laparoscopic cholecystectomy in the treatment of gallstone disease. Methods This was a retrospective, single-centre observational study of 267 patients who were admitted with abdominal pain due to a gallstone related pathology during June 2021 to June 2022. The parameters studied were age, gender, duration of symptoms, previous admissions, investigations, imaging, conservative or surgical treatment, emergency surgery or elective interval surgery, utilisation of dedicated "hot gallbladder list", re-admissions, and re-operations. Results Out of the 267 patients, 163 were female and 104 were male. The median age was 61 with the age ranging from 20 to 96. The median duration of symptoms was 2 days before admission. First-time admissions were 226 and re-admissions were 41. Ultrasound, CT and MRI were done on 188, 123 and 64 patients respectively. 178 patients were diagnosed to have acute calculous cholecystitis, 51 patients had acute gallstone pancreatitis and 38 had biliary colic due to lithiasis. 172 patients were treated with surgery of which 104 were operated on during the same admission, 20 in readmission and 48 as an interval elective surgery. Of the 124 emergency operations, 37 were performed on the dedicated "hot gallbladder list" and 87 were performed on the emergency CEPOD list. 2 patients were re-operated due to post-operative complications. 95 patients were managed conservatively. Conclusions Emergency laparoscopic cholecystectomy is a safe option when performed by experienced surgeons. A dedicated "hot gall bladder list" provides a safe and effective way to reduce the disease burden.

WP7.14 - The change of a DGH emergency surgical service leads to marked improvements in timing of cholecystectomy for gallstone pancreatitis, in line with international guidance

Abstract Background International Association of Pancreatology (IAP) guidelines recommend that cholecystectomy should be performed on patients with mild biliary pancreatitis during their index admission. This retrospective study compares how a paradigm shift in the provision of emergency surgical services in one district general hospital (DGH) significantly improved ability to follow this guideline. With input from the surgical ambulatory emergency care network (SAEC), our team transformed care via an Emergency Surgery Unit (EmSU) system. This includes surgical assessment with ambulation, linked radiology slots, semi-emergency theatre lists twice weekly in addition to NCEPOD theatre and the emergency take divided in two according to sex of patient ensuring appropriate patient load for each of the surgeons of the week. Methods A retrospective study of patients with mild biliary pancreatitis for three years before (n = 107) and after (n=108) the EmSU system. Cholecystectomy on index admission was recorded, as was overall time to surgery (days). Data was analysed using GraphPad Prism Version 9.5.1. Data is expressed as Mean + SEM. Percentages underwent Arcsine transformation prior to inferential analysis. Groups of data were analysed using Students T-Tests. Results The percentage of patients operated on index admission increased 13.1-fold (4.8% to 62.9%; P < 0.01). Days to surgery saw a 10.1-fold reduction (332.5 + 41.1 to 32.9 + 6.3 days; P < 0.0001). Conclusions Adoption of our EmSU system has drastically improved care for patients with gallstone pancreatitis, now closer to best practice guidance. Further improvement is likely with increased buy-in from all members of staff.

EP369 - Abscess as unplanned returns to theatres in Emergency General Surgery

Abstract Aim Unplanned Return to Theatre (URTT) impacts patient care along with financial and legal implications on hospital resources. This can be reduced by identifying the contributing factors and measures taken to rectify them. This study was conducted at District General Hospital in England, aims to review the incidence of URTT in Emergency General Surgery and identify the preventable causes. Method A retrospective review was conducted for all Emergency General Surgical Procedures done between 1st January 2019 to 31st January 2021. The data was obtained from the Hospital data softwares Fusion and Bluespier, in addition to the paper notes. The operations were classified as index operation, followed by the number of returns and the indication for the URTT. Result A total number of 1578 emergency general surgery operations were performed during a period of 25 months (Jan 2019 to January 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. Among these, 29.4% (25) URTT were abscess. The major reason (66%) for this URRT was inadequate drainage requiring redo/debridement. The other reasons were laying open of fistula/seton placement (30%) and stoma formation (4%). Level of operating surgeon was Consultant (8%), Registrar/Core Trainee (64%) and missing data (28%). Conclusion Abscess is a frequently performed operation in Emergency General Surgery. Knowledge of anatomy with adequate incision ensuring good drainage of the abscess can prevent URTT for abscess, improving patient outcomes and cost benefits.

WP5.19 - The undifferentiated general surgical take over 10 years: admissions

Abstract Aims The aim of this study is to review the undifferentiated emergency general surgical take, with regards to admissions in July 2013 and July 2023, at a District General Hospital in order to understand the specific pressures on the department and to identify areas in which we could adapt to facilitate these demands. Methods Retrospective data regarding admission and re-admission on all patients treated by the emergency general surgical team in July 2013 and July 2023 was collected from electronic notes. If insufficient information was available, patients were excluded from analysis. Results Patient numbers increased by 50% from 2013 to 2023, from 395 to 594. Average length of stay in 2013 was 3.26 days (+/-0.2, p = 0.03), reducing to 2.58 days (+/-0.2, p = 0.03) in 2023. Number of patients admitted overnight has decreased from 74% (n=291/395) in 2013, to 54% (n=324/594) in 2023. Proportion of referrals from ED increased from 48% in 2013, to 69% in 2023. Planned reviews and patients ambulated for surgery the following day has increased from 4% of all patients seen in 2013, to 16% in 2023. Conclusions Volume of patients has increased significantly over this 10-year period. Simultaneously, duration and number of overnight admissions have decreased, alongside increasing use of ambulatory services. This reflects the aims of the Government, and the Royal College of Surgeons, with increasing investment in day-case and ambulatory services. However, without an increase in hospital bed numbers, the rising volume of patients may become difficult to manage.

FP4.11 - Patient Reported Outcome Measures (PROMs) of Altemeier’s Procedure

Abstract Rectal prolapse (RP) is a debilitating condition that can be managed using Altemeier’s procedure (AP). We aimed to evaluate patient-reported long-term outcomes following AP focusing on symptoms, post-procedure pain and overall satisfaction. Patients who underwent AP in a District General Hospital between January 2015 and December 2022 were reviewed. Patients were contacted by telephone and interviewed using a standardised questionnaire. Likert scores and a Numeric Rating Scale (NRS) were used to assess functional outcome and pain respectively. Indication for surgery, recurrence, and data on further procedures were also collected. Out of 38 patients identified, 20 who underwent AP over the study period (mean age 78 years, s.d. 7.44, Female=20) were contactable and included in our study. In combination with RP, indications for surgery included faecal incontinence, obstructive defaecation symptoms, pain and rectal bleeding. At the time of follow up, 75% of patients reported their initial symptoms to be slightly or much better, 10% reported no change and 15% reported slightly worse symptoms. Prior to AP, 45% of patients reported no pain compared to 70% post-procedure. Severe pain was reported by 30% of patients pre-Altemeier’s compared to five percent post-procedure. Recurrence of RP occurred in 40% patients. 30% of patients required a second procedure. Overall, 80% of patients were satisfied with their outcome and 90% would recommend AP to friends and family. Most patients reported better functional outcome and good overall satisfaction, despite 30% requiring a further procedure. Our study was limited by small sample size and subjectiveness of patient reporting.