Emergency General Surgery Research Articles

Frequency and Natural History of Emergency General Surgery Conditions in Cancer Patients: A SEER-Medicare Population Analysis.

To determine if cancer patients experience variability in incidence or management of emergency general surgery (EGS) conditions compared to non-cancer patients. The true frequency, and natural history of EGS conditions among cancer patients has not been characterized. We utilized SEER-Medicare data from January 2006-December 2015 to compare patients with breast, prostate, and lung cancer to a non-cancer cohort. Patients were followed from date of cancer diagnosis, or an index date for non-cancer patients, to the development of an EGS condition, death or last follow up. We assessed the cumulative incidence of EGS conditions over time, and fit multivariable Cox proportional hazards models to evaluate the impact of time-dependent surgical intervention on mortality. We identified 322,756 patients with breast (N=82,147), lung (N=128,618), and prostate cancer (N=111,991) and 210,429 non-cancer patients.. Cancer patients had a higher incidence of an EGS condition within the first year after diagnosis (4.8% vs. 3.2%), with lung (6.8%) and breast cancer (4.0%) showing consistent rends. Cancer patients were less likely to undergo surgery for (13% vs. 14%, P=0.005), though this varied by cancer type and EGS conditions. Patients with breast (HR 1.27, 95%CI 1.17-1.39) and lung cancer (HR 3.27, 95%CI 3.07-3.48) were more likely to die within 30-days of an EGS diagnosis. Cancer patients experience a higher incidence of EGS conditions within the first year following diagnosis, but are less likely to undergo surgery. Future research is needed to explore the interplay between EGS conditions, their management, and receipt of intended oncologic therapy, and resulting outcomes.

Early placement of a non-invasive, pressure-regulated, fascial reapproximation device improves reduction of the fascial gap in open abdomens: a retrospective cohort study

BackgroundSince current fascial traction methods involve invasive procedures, they are generally employed late in the management of the open abdomen (OA). This study aimed to evaluate early versus late placement...

Perioperative risk assessment in emergency general surgery: a single-centre audit

Perioperative risk assessment in emergency general surgery: a single-centre audit

Application of Community Detection Methods to Identify Emergency General Surgery–Specific Regional Networks

There is growing interest in developing coordinated regional systems for nontraumatic surgical emergencies; however, our understanding of existing emergency general surgery (EGS) care communities is limited. To apply network analysis methods to delineate EGS care regions and compare the performance of this method with the Dartmouth Health Referral Regions (HRRs). This cross-sectional study was conducted using the 2019 California and New York state emergency department and inpatient databases. Eligible participants included all adult patients with a nonelective admission for common EGS conditions. Interhospital transfers (IHTs) were identified by transfer indicators or temporally adjacent hospitalizations at 2 different facilities. Data analysis was conducted from January to May 2024. Admission for primary EGS diagnosis. Regional EGS networks (RENs) were delineated by modularity optimization (MO), a community detection method, and compared with the plurality-based Dartmouth HRRs. Geographic boundaries were compared through visualization of patient flows and associated health care regions. Spatial accuracy of the 2 methods was compared using 6 common network analysis measures: localization index (LI), market share index (MSI), net patient flow, connectivity, compactness, and modularity. A total of 1 244 868 participants (median [IQR] age, 55 [37-70 years]; 776 725 male [62.40%]) were admitted with a primary EGS diagnosis. In New York, there were 405 493 EGS encounters with 3212 IHTs (0.79%), and 9 RENs were detected using MO compared with 10 Dartmouth HRRs. In California, there were 839 375 encounters with 10 037 IHTs (1.20%), and 14 RENs were detected compared with 24 HRRs. The greatest discrepancy between REN and HRR boundaries was in rural regions where one REN often encompassed multiple HRRs. The MO method was significantly better than HRRs in identifying care networks that accurately captured patients living within the geographic region as indicated by the LI and MSI for New York (mean [SD] LI, 0.86 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.16 [0.13] for REN vs 0.32 [0.21] for HRR) and California (mean [SD] LI, 0.83 [1.00] for REN vs 0.74 [1.00] for HRR; mean [SD] MSI, 0.19 [0.14] for REN vs 0.39 [0.43] for HRR). Nearly 27% of New York hospitals (37 of 139 hospitals [26.62%]) and 15% of California hospitals (48 of 336 hospitals [14.29%]) were reclassified into a different community with the MO method. Development of optimal health delivery systems for EGS patients will require knowledge of care patterns specific to this population. The findings of this cross-sectional study suggest that network science methods, such as MO, offer opportunities to identify empirical EGS care regions that outperform HRRs and can be applied in the development of coordinated regional systems of care.

Gastrointestinal complications requiring operative intervention after cardiovascular surgery: Predictors of in-hospital mortality

BackgroundRisk factors for in-hospital mortality related to gastrointestinal complications requiring operative intervention after cardiovascular surgery have not been previously described. MethodsAdult patients who underwent cardiovascular surgery followed by gastrointestinal surgery during the same admission between January 2010 and June 2023 were included. Multivariable logistic regression was used to identify predictors of in-hospital mortality. Kaplan-Meier survival analysis was performed to assess overall survival based on identified risk factors. ResultsGastrointestinal complications requiring operative intervention after cardiac surgery occurred in 151 patients, with an overall in-hospital mortality of 35.76% (n = 54). The most common diagnosis was bowel ischemia (50.33%). On multivariable logistic regression, the history of cirrhosis (odds ratio: 37.96, 95% confidence interval: 3.57–543.90) and the clinical condition at the time of emergency general surgery consultation, described by elevated lactate (odds ratio: 5.76, 95% confidence interval: 1.71–22.82), platelets <50 × 109/L (odds ratio: 11.34, 95% confidence interval: 1.60–162.37), ≥3 vasoactive medications (odds ratio: 4.93, 95% CI: 1.29–20.14), and the need for renal replacement therapy (odds ratio: 5.18, 95% confidence interval: 1.46–20.79) were predictive of in-hospital mortality. In-hospital mortality was low when none of the risk factors identified on multivariable analysis were present (2.38%, n = 1 of 42), but in-hospital mortality was universal among patients with 4–5 risk factors (100%, n = 8 of 8). ConclusionsGastrointestinal complications after cardiac surgery are disastrous when patient illness becomes severe. Clinicians should maintain a high index of suspicion for gastrointestinal complications to promote early involvement of general surgery. Knowledge of these risk factors could help guide discussions among the multidisciplinary care team, patients, and their families.

Association of Postoperative Outcomes with the Pre-op Categorization Based on the American Society of Anesthesia Class in Emergency General Surgery Patients

Association of Postoperative Outcomes with the Pre-op Categorization Based on the American Society of Anesthesia Class in Emergency General Surgery Patients

Outcomes of emergency general surgery admissions in patients experiencing homelessness: A matched cohort study

BackgroundHousing status impacts outcomes after elective and emergent operations but has not been well studied in the emergency general surgery population. This study investigates the impact of housing status on complications and 30-day follow-up, emergency department visits, and readmissions after emergency general surgery admission. MethodsWe conducted a retrospective matched cohort study of adult patients admitted with an emergency general surgery diagnosis at an urban, safety net hospital from 2014 to 2021. Patients were matched 1 to 2 on the basis of age, sex, Charlson Comorbidity Index, diagnosis, and operative status. The primary exposure was unhoused status. The primary outcome was in-hospital complications. Secondary outcomes included intensive care unit admission, extended length of stay, follow-up attendance, and emergency department visit or unplanned readmission within 30 days. Multivariable conditional logistic regression was used to determine the association between housing status and the outcomes of interest. ResultsThe study included 531 patients (177 unhoused, 354 housed). There were no significant differences in complications, intensive care unit admissions, or extended length of stay. Unhoused patients had lower odds of outpatient follow-up (odds ratio, 0.54; 95% confidence interval, 0.35–0.85, P = .008) and higher odds of emergency department utilization (odds ratio, 2.72; 95% confidence interval, 1.78–4.14, P < .001) and readmission (odds ratio, 1.87; 95% confidence interval, 1.09–3.19, P = .02). ConclusionCompared with housed patients, unhoused patients with emergency general surgery conditions have lower rates of outpatient follow-up and greater odds of using the emergency department and being readmitted within 30 days of discharge. This points to a need for dedicated posthospitalization care and creative methods of engaging with this population.

The Readiness Imperative: Leveraging Large Animal Resident Research to Enhance Expeditionary Surgical Skills.

The Defense Health Agency aims to ensure that military surgical residents have the expeditionary general surgical skills necessary to deploy to a combat environment and maintains the Clinical Investigation Programs (CIPs) that foster research during graduate medical education. This project evaluates the potential to achieve both aims simultaneously through a large animal Combat Casualty Care Research Program (CCCRP). Large animal experimental protocols within a single CIP's CCCRP were collected from July 1, 2017, to June 30, 2022. Operations performed were tabulated and categorized by Emergency General Surgery procedure equivalent. In addition, procedures performed by a single resident from July 1, 2020, to June 30, 2022, were separately indexed for a more granular analysis. The results are presented with total 5-year numbers listed first, followed by single resident 2-year numbers in parentheses. The residents at the CIP carried out 8676 (1,609) tabulated procedures. Major surgical procedures included 573 (154) laparotomies, 364 (129) thoracotomies, 279 (125) splenectomies, 219 (108) craniotomies, 206 (81) hepatorrhaphies, 363 (62) nephrectomies, 383 (48) bowel resections, 215 (48) spine exposures with laminectomies, and 173 (9) sternotomies. Additional procedures included 1028 (127) central venous lines, 878 (127) arterial lines, 90 (67) tube thoracostomies, 199 (37) carotid artery exposures, 394 (29) suprapubic urostomies, and placement of 278 (10) aortic occlusion catheters. At this time, the residents had 17 (10) presentations at national meetings, 8 (7) research awards, and published 20 peer-reviewed manuscripts. Additionally, the residents involved in the CCCRP gained valuable experience in critical care, including management of 110 traumatic brain injuries, 121 Intercranial Pressure catheters, 316 cases of hemorrhagic shock, and 211 massive transfusion protocols, among a variety of other vital critical care skills. This large animal CCCRP represents a unique training model that not only achieves its primary goal of fostering graduate medical education research but also bolsters Emergency General Surgery readiness for military surgical residents.

MOY 1 - The Emergency General Surgeon: what should their future operative role be, and how can an EGS post be more attractive?

Abstract Aims Determine the desired future operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI), and how to improve the attractiveness of an EGS post. Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked using a Likert scale which operations a dedicated EGS surgeon should perform and how an EGS post could be more attractive. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. Respondents stated the desired future operative role of EGS surgeons included most EGS operations, including for torso trauma. Few believed EGS surgeons should perform emergency colonic resection for cancer (49%) or inflammatory bowel disease (37%), gastric volvulus (34%), bariatric complications (26%), or Boerhaaves (28%). The vast majority agreed that EGS posts could be improved by including elective general and subspecialty operating lists, continuing professional development, minimally-invasive (laparoscopic/robotic) opportunities, rest days post-on-call, family-friendly hours, EGS ambulatory and follow-up clinics, and major trauma responsibility. Conclusions EGS surgeons should operate on the majority of EGS patients. Job plans that include elective operating, professional development, and patient follow-up may improve recruitment and retention.

WP4.19 - The Emergency General Surgeon: what is their current operative role?

Abstract Aims Determine the current operative role of dedicated Emergency General Surgery (EGS) surgeons in the United Kingdom (UK) and the Republic of Ireland (ROI). Methods A live interactive online survey, designed and endorsed by ASGBI, was completed by attendees at two ASGBI conferences in 2023. The study was conducted according to CHERRIES and exempt from REC according to HRA. Consent was obtained from study participants, who were asked which surgeons usually perform the most common EGS operations in their hospital. Results The survey was completed by 156/371 eligible participants, of which 132 responses were analysed once duplicate responses (n=16), and non-UK/ROI respondents (n=8), were excluded. Participants included consultants (34%), surgical trainees (42%), and other doctors (23%), 61% were male and 39% were female, aged between 25 and 69. The general surgeon on-call – or a dedicated EGS surgeon, where such service exists – operates on the majority of EGS pathology through an un-selected take. A surgeon with the relevant sub-specialty interest usually operates on emergency non-traumatic complex upper gastrointestinal or colorectal pathology. These include emergency colonic resections for cancer or inflammatory bowel disease, and operations for gastric volvulus, bariatric complications, and Boerhaaves. Acute cholecystectomy forms a major part of a dedicated EGS surgeon’s practice. Conclusions Dedicated EGS surgeons deliver a wide variety of operations, in addition to the peri-operative management of acute surgical patients. Future curriculum design and NHS workforce planning should reflect this service delivery pattern, should EGS become a recognised specialty interest.

SP5.1 - The importance of weekly Radiology-General Surgery Multi-Disciplinary Meetings (MDMs) in the management of Emergency General Surgery (EGS) patients

Abstract Aims Most patients in Emergency-General-Surgery (EGS) require radiological investigations as part of their management plan. However, unlike cancer services where structured multi-disciplinary-meetings (MDMs) form an integral part of patient management, MDMs are not commonly practised in EGS. Our aim is to identify if having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS patients. Methods A prospective study involving weekly 1-hour MDM focusing on Radiology and General Surgery was conducted from May to November 2023. These sessions were led by consultant radiologists where discussions amongst general surgical consultants and junior doctors took place. Factors taken into consideration were clinical presentation, original scan report, any missed findings on imaging and any changes to the initial management plan. Results A total of 85 cases were discussed during the study period, majority were initially reported by the out-of-hours radiologists. Out of those, 40 (47%) had changes to the management plan as well as missed findings that were noted as a result of Radiology-GeneralSurgery-MDM. Informal feedback gathered from junior doctors who attended revealed a significant impact in their knowledge on interpreting radiological scans in EGS. Conclusion Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions have seen to improve overall patient outcome as a result of having a second opinion and recommending change in management plan in significant proportion of patients. It also had a positive impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.

SP2.2 - A Retrospective Audit: Evaluating Changes in Negative Appendicectomy Rates from 2019 Before the Establishment of the Emergency General Surgery Service at a Tertiary Centre to 2022

Abstract Introduction and Aim Negative surgical exploration for suspected acute appendicitis remains prevalent, with a reported 20% rate in the UK Right Iliac Fossa Pain Treatment (RIFT) study. WSES guidelines endorse structured diagnostic pathways to decrease negative appendicectomy rates. To enhance acute surgery care, a dedicated Emergency General Surgery (EGS) service was established at a tertiary centre in 2020. This retrospective audit compares the negative appendicectomy rates between 2019 and 2022, therefore the main aim is to assess whether the introduction of a consultant-led EGS service influenced overall negative appendectomy rates. Methodology Appendicectomy numbers and histology results from 2019 and 2022 were analyzed. Histologically normal appendix cases were deemed negative appendicectomies, excluding unclear, other conditions, or missing reports. A retrospective review was conducted pre- and post-EGS service implementation. Results In 2019, 479 appendicectomies were audited, with a mean age of 34; 51% were female, and 20% were negative. Negative cases averaged 28 years, with 67% females. In 2022, 420 cases had a mean age of 40; 45% were female, 55% male, and negative rates reduced to 13%. Negative cases averaged 29 years, with 62% females. Conclusions Between 2019 and 2022, age groups were comparable. Negative cases in both years were more likely to be younger females compared to positive and total groups. The EGS service introduction demonstrated a notable decrease in negative appendectomy rates from 20% to 13% within two years, suggesting that consultant-led EGS services effectively reduce negative appendicectomy rates.

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.

WP5.15 - 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&amp;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&amp;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&amp;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&amp;E pathway.

WP4.5 - Changes in Social Care Post Major Emergency General Surgery Procedures

Abstract Introduction Emergency General Surgery (EGS) is a major part of the provision of healthcare and patients undergoing EGS are at elevated risk of morbidity and mortality. The aim of this study is to determine factors contributing to patients losing their independence and being discharged to residential and nursing homes having previously lived in their own residences. Methods Data from patients in the NELA database (2014-2022) was analysed, considering demographics, ASA score, admission and discharge dates, presenting pathology, operation type, and discharge destination. Comparative analyses segmented patients based on post-discharge EGS destinations. Multivariable logistic regression identified factors linked to residential/nursing home placement post-discharge. Significance was set at p&amp;lt;0.05. Results Data from all patients in the NELA database (n=1,611) was analysed. Nearly one in ten patients over the age of 70 never returned home. Patients requiring additional support were on average 8.6 years older (p=0.008). Over the age of 80 years, the need for extra social support increased substantially with each increasing year in age and those over the age of 85 years old were more than twice as likely to require extra support than 80-year-olds (p&amp;lt;0.001). Patients who died were 11.4 years older compared to those discharged without additional support (p&amp;lt;0.001). Conclusion A significant proportion of patients, particularly the elderly, do not return to their usual place of residence and require a higher level of care post-emergency surgery. These important social factors need to be considered before operating as they may have significant quality of life and economic implications.

SP2.6 - Improvements in patient discharge efficiency and safety: the impact of a dedicated Clinical Pharmacist in an Emergency General Surgery team

Abstract Introduction Efficiency in management of acute surgical admissions is related to safe clinical practice combined with good patient flow, optimising use of limited capacity. Preventable morbidity and discharge delays may significantly compromise outcomes for Emergency General Surgery (EGS) teams managing increasing numbers of admissions. Aim To investigate the effectiveness of a prescribing pharmacist employed within an EGS team in a DGH, with specific focus on patient discharge times by facilitating discharge prescription efficiency, including venous thromboembolism (VTE) prophylaxis. Methods Data was collected for two separate 1-month time periods in 2021 (Period A), before the appointment of a pharmacist and in 2023 (Period B), after pharmacist appointment. Data was analysed for (i) differences in times related to ‘to take home’ (TTH) medication prescription and (ii) prescribing of post-operative extended enoxaparin prophylaxis (EEP) following discharge. Results Mean time for prescription of TTH medications during working hours in Period A was 100 minutes (n=133, range 0-433 minutes) compared with 67 minutes (n=120, range 0-416 minutes) in Period B. Pharmacist prescribing accounted for 51.6% of TTH prescriptions with a mean prescription time of 18.6 minutes (range 0-389 minutes). During Period A, 36% of patients (n=48) who had a VTE assessment mandating EEP received this on discharge compared to 100% in Period B (n=31). Conclusions This data highlights an improvement in prescribing of TTH medications since appointment of a dedicated EGS pharmacist. The consequences of such improvements include more rapid patient flow, better patient experience and heightened patient safety by prevention of post-operative VTE through EEP.

WP5.8 - Robotic versus laparoscopic general surgery in the emergency setting: a systematic review

Abstract Introduction Robot-assisted general surgery, a cutting-edge technology in minimally-invasive procedures, is increasingly utilised in elective general surgery, demonstrating advantages over laparoscopy in select cases. While laparoscopy remains a standard approach for common acute abdominal conditions, the role of robotic surgery in emergency general surgery is unclear. This systematic review aims to compare outcomes in acute general surgery settings for robotic versus laparoscopic surgeries. Method A PRISMA compliant systematic search across MEDLINE, EMBASE, Science Citation Index Expanded, and Cochrane library was performed. The literature review focused on articles comparing perioperative outcomes of emergency general surgery managed laparoscopically versus robot-assisted. A descriptive analysis was performed and outcome measures recorded. Results Six articles, reporting on 1063 patients, compared outcomes of robotic and laparoscopic procedures. Two covered cholecystectomies, while the others addressed ileocaecal resection, subtotal colectomy, hiatal hernia and perforated gastrojejunal ulcer repair. The level of evidence was low. Laparoscopic bowel resection in inflammatory bowel disease (IBD) patients had higher complications; no significant differences were found in complications for other operations. Operative time showed no differences for cholecystectomies, but robotic approaches were longer for other procedures. Robotic cases had shorter hospital length of stay, though the associated costs were significantly higher. Conclusion Perioperative outcomes for emergency robotic surgery in selected general surgery conditions are comparable to laparoscopic surgery. However, recommending robotic surgery in the acute setting requires a well-powered large population study for stronger evidence.

ThP6.5 - Anorectal Abscess and Diabetes Mellitus: An Overlooked Association?

Abstract Aims Patients with anorectal abscesses often require treatment from Emergency General Surgery. Prior European epidemiological studies report 6% of patients with anorectal abscesses have diabetes mellitus (DM). This study primarily quantified prevalence of DM, and secondarily, adherence to the WSES-AAST anorectal emergencies guidelines, which recommend routine HbA1c and serum glucose testing. Methods A retrospective analysis identified all surgically managed patients with anorectal abscesses at an urban DGH over a two-month period from 1st December 2023. Data were collected on demographics, existing DM status, HbA1c and blood glucose testing from the electronic health record. Results The study included 17 patients, 59% male (10/17), with a mean age of 45 years (range 20-72). Among the group, 4/17 (24%) had a known DM diagnosis. Only 2/13 (15%) without a pre-existing DM diagnosis underwent DM testing. No new cases of DM were diagnosed. HbA1c and serum glucose testing were performed more commonly in patients with known DM compared to those without a prior diagnosis, but not significantly (3/4 vs 2/13, p=0.09). Conclusions The proportion of anorectal abscess patients with DM in our study is markedly higher than previously reported in the literature. Compliance with DM testing guidelines is poor, and the causes are uncertain. Routine DM screening for anorectal abscess patients could lead to earlier detection and improved outcomes. The actual incidence of newly detected DM in this patient group remains unknown due to inadequate testing, underscoring the need for further research to evaluate the real-world benefit and cost-effectiveness of following diabetes detection guidelines in these patients.

SP1.10 - Patient Perceptions of Shared Decision-Making in Emergency Surgery

Abstract Background Shared decision-making (SDM), a concept becoming increasingly more prevalent in medical practice, is now considered the ‘gold standard’ approach. Research into patient perceptions of SDM is lacking and barriers to its implementation remain, specifically in emergency general surgery. Considering procedures with high mortality risks makes research into patients understanding of SDM here a critical step for its implementation. Aim Explore what emergency surgery patients understand about SDM and their experience of it. Methods A literature review and scoping review determined the quantity and quality of research in this area enabling long-listing of known SDM concepts. This developed questions and structured discussions for the patient and public involvement (PPI) exercise. This exercise was developed following research, patient representative input and discussions with experienced researchers. Twenty-five participants, identified from the local ELLSA database, were invited with their support-person. Small-group discussions considered how surgeons make decisions, what SDM means to patients, and improving this process. Responses were transcribed, then analysed. Results Nine patients and four supporters attended the exercise. Thematic analysis identified two key themes: patient perceptions of how surgeons make decisions, and patient experiences of emergency surgical decision-making. Subtheme analysis showed participants weren’t aware of surgeons’ use of “30-day mortality” and couldn’t quantify surgical risk, feeling time pressures and out-of-control. They relied on surgeons to make their decision. Conclusions Patients who’ve undergone emergency surgery don’t understand how surgeons make emergency surgical decisions. Many reported not experiencing SDM at all. This work provides the first patient-insights into an area requiring more research – on a larger scale.

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.