General Surgery Research Articles

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.

ThP6.13 - A closed loop clinical audit on adherence of weight-based and renal function-adjusted venous thromboprophylaxis prescribing to local guidelines in emergency general surgical patients

Abstract Aims to audit adherence of venous thromboembolism (VTE) prophylaxis according to local trust guidelines in a single-centre emergency general surgery department, adjusting doses based on weight and renal function (creatinine clearance). Following initial audit of practice, intervention to improve local practice was implemented with informative posters and teaching sessions, aiming to improve overall adherence to guidelines and limit risk of complications from incorrect dosing. Methods A two-cycle snapshot audit of VTE prophylaxis prescribing was conducted in a district general hospital emergency general surgery department against local guidelines concerning VTE prophylaxis. All current inpatients admitted under general surgery were included in the study reviewing baseline characteristics including age, weight, and creatinine clearance. Results The first cycle audited the adherence of departmental practice against guidelines in 57 inpatients. 49 (86.0%) were prescribed VTE prophylaxis in accordance with local guidelines. Of the 8 patients who did not adhere to guidelines, 5 (62.5%) had no VTE prophylaxis prescribed, while 3 (37.5%) had incorrect doses prescribed for their weight or renal function. The second cycle audited 43 inpatients. 39 (90.7%) adhered to guidelines. All re-audited patients had the correct VTE prophylaxis prescribed, although there was no VTE prophylaxis prescribed in 4 (9.3%) patients. There were no bleeding or thromboembolic complication in any patients over the course of admission in both cycles of this audit. Conclusion Adherence to local guidelines concerning VTE prophylaxis was increased following intervention. This eliminated VTE prophylaxis prescribing errors, although did not improve the amount of VTE prophylaxis prescription omissions.

EP218 - A closed-loop audit on the assessment of the documentation of frailty at admission in emergency general surgery admission at a tertiary care hospital

Abstract Background NHS frailty guidelines advise that frailty score should be documented at the first time of contact for patients aged 65+ years. The Aim of this quality improvement project (QIP) was to assess the adequate documentation of frailty at the time of first encounter by the general surgery department for patients aged 65+ years. Method Data was collected for October 2022 for the first cycle and January and February 2023 for the second cycle. Data collection was done from an electronic database in the trust and patient notes maintained throughout the admission. Results 136 patients were included in the QIP for the first cycle. 3/136 (2.2%) patients had documented frailty at the first encounter. These findings were discussed in the clinical governance meeting, followed by a teaching session for the junior doctors. A specific section was added in the documentation as a reminder for the team to document the frailty upon the first encounter. 212 patients were included in the second cycle and documentation of frailty improved to 39/212 (18.4%). Conclusion There was a lack of documentation, which improved after the intervention advised by QIP. A teaching session for new junior doctors is planned at the induction session, to strengthen the importance of frailty documentation.

WP6.9 - Essential Surgery Skills Course: A One Week Training Program to Prepare Surgeons for Humanitarian Deployment

Abstract Background Medical students, surgical trainees, and surgical faculty are increasingly interested in incorporating global surgery into their clinical practices and professional careers. However, many concerns remain about the preparation of surgeons for operating in resource-limited settings and their exposure to critical procedures such as cesarean sections, hysterectomies, or fracture reductions. In an attempt to address these concerns, academic institutions have developed advanced professional training programs for the global surgeon. Methods A six-day essential surgery skills conference was created at a large academic institution that provides trainees and surgeons with an overview of common surgical scenarios across orthopedics, urology, obstetrics, gynecology, general surgery, anesthesia and ultrasound in the form of didactics, simulations, and wet labs. Results 11 surgical trainees from four large academic institutions attended the essential surgery skills conference. Trainees attended sessions on point of care ultrasound, regional anesthesia, general anesthesia, hysterectomies, cesarean sections, post-partum hemorrhage, fracture reduction and fixation, ureteral injuries, and humanitarian deployment. A pre and post-test was administered. Improvement was noted in the trainees scores on the post-test in their knowledge of surgical subspecialty care. Trainees also reported feeling better prepared for humanitarian deployment. Conclusion Global surgery conferences can be designed to provide a networking and collaboration forum for improving access to surgical services worldwide. One-week predeparture conferences that discuss essential technical skills and relevant global surgery knowledge may better prepare surgeons to operate in resource-limited settings.

FP8.12 - Theatre time utilisation in General Surgery at a district hospital in NHS

Abstract Aim To understand the operation theatre time utilisation in the Department of General Surgery at a busy district NHS hospital. The time spent in each step of surgery and operating list at large and understand the patterns of cancellations and its’ predictors. Method Retrospective study of all elective general surgical patients from 1 Dec 2021 to 15 May 2022. Emergency cases were excluded and statistics were performed on Statsdirect3. Results Total surgeries performed were 182 with 153 true and 41 false cancellations. Mean surgical time was 84.5 minutes (mean 73min) for all general surgical cases. Lap cholecystectomies had a mean time of 92.3mins, upper GI surgeries took 178.6mins (mean) EUA and other procedures was 30.86mins, inguinal hernia 77.2mins, umbilical hernia 68.5mins. Mean anaesthesia time was 33 mins (median 31mins). Theatre time utilised was 56.45%, anaesthesia time utilised was 15.85%, surgery time utilised was 40.60% and non-clinical time was 43.55%. Mean delay in sending for first patient was 31.58mins (median 29min). Delay in calling for first patient is statistically significant (p=0.00015) for cancellation for the last patient in the list. Mean gap in between 2 consecutive cases was 35.74mins (median 22min). Conclusion Delay in sending for the patient will lead to cancellation of the last patient on the list which is proven statistically. We utilised 82.19% of the total surgery days and cancelled 17.81% days. Non clinical time comprised of 43.55%.

SP8.1 - Emergency Robotic General Surgery in the UK: Operations, Staff, and Missed Opportunities

Abstract Aims The primary aim was to determine the volume of emergency robotic general surgery performed in the UK. Secondary aims were to determine compatible operations with opportunities for training and the availability of robotic-trained staff. Methods Freedom of Information (FOI) requests were sent to 122 UK Acute Trusts, asking for data on general surgery procedures (open, laparoscopic, robotic) from January 2019 to January 2023. Data on common emergency procedures, in-patient length of stay, robotic complications, and availability of robotically trained staff was requested. Results Of the 122 Acute Trusts, 22 did not respond (82% response rate), 32 had no general surgery robotic access, 16 could not comply due to cost (under section 12 of FOI Act), and 52 provided data. Fifteen Trusts performed emergency robotic surgeries: cholecystectomy (262 cases), hernia repair (140), and appendectomy (3). 86% of these Trusts utilized the DaVinci system, while the CMR Versius system was employed by the remaining 14%. There was a median of 12.5 (range 2-40) robotic-trained staff in-hours, versus a median of 0 (range 0-4) out-of-hours. Conclusions Emergency robotic general surgery in the UK is limited by financial constraints, staff availability, and selective procedural use. Compatible emergency operations that have been performed were cholecystectomies, hernias, and appendectomies. To expand its role, there's a need for training, infrastructure investment, and further research into the cost-effectiveness and outcomes of robotic surgery in emergency cases.

EP51 - Uses of pharmaceutical and mechanical VTE prophylaxis - A clinical audit

Abstract Aim Venous thromboembolism (VTE) is a serious global health care safety concern for both patients and staff. Although it has been amply demonstrated that pharmaceutical and mechanical methods of prophylaxis against VTE are effective, their application has been uneven and insufficient. The purpose of this audit was to assess junior physicians working in general surgery, regarding their adherence to local and NICE guidelines regarding the pharmacological VTE prophylaxis practice as well as the mechanical prophylaxis Methodology Pre-intervention audit took place for two weeks. Throughout the course, it covered every adult general surgical emergency inpatient admission at conquest hospital who were deemed indicated for VTE prophylaxis. Each evening while the patients were still in the hospital, data was collected using the prescription charts, nursing and medical notes. The proforma used for data collection detailed the characteristics of VTE risk, the prophylactic medication prescribed for each patient, TED stockings and whether or not this aligned with the NICE clinical guideline (CG) 46,6.8. Post intervention took place for two weeks after teaching of junior doctors and the same as above was carried out, using the new proforma Results Pre-intervention showed that 87% of patients had the proforma filled in and 100% of patients received the appropriate dose of pharmaceutical prophylaxis. However, less than 40% of patients received the appropriate mechanical prophylaxis. Therefore, intervention was made in the form of a new proforma and teaching to junior. Post intervention data is currently being carried out Conclusion Implementation was necessary to ensure that at-risk patients receive appropriate prophylaxis.

WP7.2 - The Role of a Frailty Team to improve Perioperative Care for ELLSA Patients

Abstract Aim Frailty assessment amongst emergency laparotomy patients is essential. The 8th NELA report highlighted that only 31.8% of patients who were frail and over 65 years received geriatrician input. Within our organisation, patients who undergo emergency laparotomy are included in the Emergency Laparotomy and Laparoscopic Scottish Audit (ELLSA). The consultant geriatrician led Surgical Acute Frailty Team (SAFT) works collaboratively with the emergency general surgery team and ELLSA specialist nurse to review ELLSA patients within our hospital. Our aim was to establish outcomes of ELLSA patients reviewed by SAFT. Methods Data collected routinely via Redcap as part of our organisation’s ELLSA was reviewed. All ELLSA patients aged ≥65 years admitted between November 2022 and November 2023 were included. Data included frailty assessment, discharge destination and 30 day mortality. Results 152 patients aged ≥ 65 years underwent operative intervention as defined by ELLSA. 100% of patients had a documented Clinical Frailty Scale (CFS) score. 72 patients (47.4%) had a pre-operative frailty review. 68.4% of patients had their initial frailty assessment by a consultant geriatrician. 19.7% of patients were reviewed by frailty ANPs or clinical fellow. Only 7.9% of patients required care support on discharge. 30 day mortality was 17.1%. Conclusions Embedding a dedicated frailty team within our general surgery wards has been incredibly successful; frailty assessment is significantly above that of the 8th NELA report. The majority of ELLSA patients aged ≥65 years are discharged home independently. Collaborative working and early identification of frailty in ELLSA patients is essential to improve patient outcomes.

WP3.10 - Variability of frailty scoring during unplanned surgical admissions in older persons - why accuracy matters

Abstract Introduction The Clinical Frailty Score (CFS) is a reliable predictor of outcomes for older patients in the acute hospital setting and is used to guide management decisions. Our hospital routinely calculates the CFS for older adults on admission to the Emergency Department (ED). Patients admitted under general surgery will then be referred for a Comprehensive Geriatric Assessment (CGA) by our Perioperative Medicine for the Older Patients undergoing Surgery (POPS) team who also calculate CFS. This study aimed to compare the CFS calculated in ED and CGA for these patients. Methods We performed a single centre prospective study of emergency general surgical admissions who were reviewed as an inpatient by our POPS team between August 2022 and September 2023. CFS from ED documentation was compared to that after CGA. A two tailed, paired t test was performed to compare the CFS on admission and after CGA using GraphPad Prism version 10.0. Results A total of 293 patients were identified with a mean age of 79 years(65-102). There was a difference between the admission CFS [4.2 (3.9-4.4 95%CI)] and the CFS following POPS review [4.5 (4.3-4.7 95%CI)] which was statistically significant (p<0.0001). Univariate analysis showed that CFS was predictive of length of hospital stay. Conclusion CFS calculated in the ED can both over and underestimate the degree of frailty when compared to the CFS calculated during the CGA. As evidence suggests that CFS is predictive of outcomes in this cohort, we suggest staff are adequately trained in undertaking an accurate assessment of this score.

SP1.12 - Who should manage recurrent foreign body ingestion? A questionnaire survey

Abstract Aims Recurrent foreign body ingestion (RFBI) associated with complex mental health illness is a common presentation to the emergency department. The aim of this study was to explore senior clinician’s experience and views on decision-making, support offered and management of patients with RFBI. Methods An anonymous survey, with questions on confidence in decision-making, support levels, and opinions on admitting specialty, was distributed to consultants and registrars in emergency medicine, gastroenterology, general surgery, and psychiatry. Results 189 responses with 166 complete surveys. 99% had encountered similar patients. 42% felt comfortable with decision-making. However, 35% felt stressed and 15% would delay or even avoid decision-making. Only 36% felt they received adequate support from legal and higher management teams and 84% were not aware of a management protocol. 60% were not confident in their knowledge of sectioning. 60% did not know when it is appropriate to call the police and 56% believe there is inadequate security staff support. 74% found difficulty referring to other specialties. 49% believe patients should be admitted under psychiatry, 29% believe admission should be under gastroenterology, and 22% believe they should be under surgery. Conclusion The majority of clinicians had encountered patients with RFBI but did not feel comfortable making management decisions for them. There is a lack of support, knowledge, and protocols surrounding management. There is difficulty referring between specialties and uncertainty on appropriate admitting specialty. There is a need for further research and guidance on management of these patients to increase collaborative teamworking and improve patient outcomes.

EP244 - Improving communication and accessibility to surgical doctors with introduction of a baton bleep system

Abstract Aims Communication between allied health professionals and doctors is vital to patient care. When not effective and delayed, patient safety is at risk due to failure of critical information being shared resulting in medical errors. Within general surgery at our trust there are three surgical teams, with 25 doctors holding individual bleeps. Due to shift patterns, contacting the correct doctor for the correct team has resulted in concerns of poor accessibility. A team baton bleep system was therefore introduced to improve communication. Methods A baton bleep was introduced to each of the three surgical teams, with a doctor from each team being allocated each day. Information was sent to allied health professionals and doctors to make them aware of the new bleep, with posters places on all surgical wards. A qualitative survey was created for allied health professionals and one for doctors to assess perceived effectiveness of the new system. Results 16 members of the surgical team were surveyed, over half found the bleep system helpful with 69% agreeing that it improved communication and collaboration within the team. 12 allied health professionals were also surveyed, 67% were satisfied with the new system. The main suggestion for improvement overall was to clearly document in the ward notes the consultant and team responsible for each patient. Conclusions A baton bleep system appears to be helping enhance communication and streamline workflow within the department through improving accessibility of surgical teams which is crucial for effective patient care and timely responses to critical situations.

FP7.10 - An audit assessing the documentation of antibiotic indication and course length on an acute surgical unit

Abstract Aims Documenting antibiotic indications and course lengths on drug charts at the time of prescription is recommended in numerous publications. A closed loop audit was therefore performed to assess the documentation of this information for acute general surgery patients in a district general hospital. Methods During the first cycle, drug charts from acute general surgery patients were reviewed and the rates of documentation for antibiotic indication and course length were assessed. To improve these measures, the results from this cycle were presented to junior doctors and cards reminding doctors to complete antibiotic documentation were made and attached to drug charts when necessary. The impact of these measures was examined during a re-audit. Results 50 patients were assessed during cycle one and antibiotic indication and course length were documented in 54.0% and 42.0% of cases respectively. Data from a further 50 patients were collected following the presentation to junior doctors working in general surgery and the introduction of the reminder cards. Following these interventions, antibiotic indication and course length were documented in 74.0% and 68.0% of cases respectively. Co-amoxiclav and Tazocin were the most common agents prescribed across cycle 1 (64.0% and 14.0% respectively) and cycle 2 (60.0% and 16.0% respectively). Conclusions The documentation of antibiotic indication and course length on drug charts needed improving in this cohort. Although the presentation of the data from cycle 1 and reminder cards achieved this outcome, further improvements are required and should be assessed during future re-audits.

EP3 - Reducing general surgical inpatient falls: an allied health professionals’ perspective

Abstract Aims Understand the current view of inpatient falls on a general surgical ward from allied health professionals. Identifies ways to reduce inpatient falls in general surgery. Methods Staff from two acute surgical wards were surveyed in December 2023. Seven questions used Likert scales (1-to-5, 1=Not preventable at all/significantly reduces the risks of falls/not confident at all/unimportant 5= Entirely preventable /significantly increases the risks of falls/very confident/important). One question focused on recent fall involvement. Modal values were taken. Data was inputted using Google Docs and analysed in Microsoft Excel. Results 13 responded (5 nurses, 4 health care support workers, 4 sisters). 7/13 had been involved in a fall in the last six months. Staff felt that the current post-inpatient fall proforma slightly reduces further falls risk. Factors that staff felt significantly increases the risks of falls were reduced mobility, delirium, falls history and impaired cognition. Factors that staff felt significantly reduces the risk of falls were, identifying patients at risk of falls, measuring lying and standing blood pressure, identifying the level of supervision for patient mobilisation, therapy assessment, initiating geriatric/falls review of high-risk falls patients, medication review, education of patients on avoiding falls and early senior clinician involvement in falls. Most staff felt mostly confident (4) knowing how to reduce the risk of falls and managing falls. Conclusions Most staff are comfortable managing falls. The falls proforma needs further development incorporating areas identified in this study to help reduce inpatient falls.

EP334 - What does ERAS mean to foundation doctors?

Abstract Aims To quantify the Enhanced Recovery After Surgery (ERAS) protocol knowledge of foundation doctors on the general surgical rotation from August 2023 to December 2023. ERAS protocol has decreased recovery time, length of stay, complications, and readmission rates. [1] ERAS protocol can be categorised into 5 domains: diet, pre-operative medications including bowel preparation, post-operative medications including nutritional drinks, mobilisation, and discharge. Foundation doctors should be aware of the details within ERAS protocol. Methods Survey questions were devised alongside a senior registrar to probe foundation doctors understanding of ERAS protocol. The questions were either single best answer questions out of 5 or had multiple correct answers. Foundation doctors who worked on general surgery between 2nd August 2023 and 5th December 2023 undertook this survey, carried out from 6th December 2023 to 28th January 2024. There were 10 respondents to the survey, out of 21 foundation doctors. Results Out of 10 surveys, foundation doctors correctly answered 47% of questions, with scores ranging from 36% to 57%. On further sub analysis the lowest scoring domains were mobilisation (21%), medication (post-op) (23%), and medication (pre-op) (50%). Conclusions Foundation doctors should have more knowledge of the ERAS protocol to improve the quality of patient care. Our proposed method of improving this involves presenting study findings and the ERAS protocol to foundation doctors at the next departmental Clinical Governance meeting, alongside ERAS nurses and senior team members. We aim to re-audit to identify whether an ERAS induction makes a difference to their understanding of ERAS.

WP6.15 - A dedicated teaching programme in Colorectal Surgery: continuing education beyond medical school

Abstract Background The UK Foundation Programme (UKFP) Curriculum illustrates the need for educational progression for doctors in their first two years of work. Although UKFP recommends use of departmental teaching for this, there is limited guidance on structured and learning-objective focussed training. We designed a colorectal surgery lecture series to create a reproducible teaching programme with defined learning outcomes. Methods We developed a 6-part lecture series aimed at FY1 doctors working in General Surgery at our Teaching Hospital. Teaching was in the form of 30-minute powerpoint presentations, with 15 minutes for questions, at weekly departmental teaching meetings. Lectures were delivered by FY2 doctors and members of colorectal multidisciplinary team (Enhanced Recovery CNS, Stoma Care CNS). Each session was supervised by a Colorectal Consultant. Feedback was obtained using a 10-point Likert scale questionnaire, assessing various domains. Results FY1 trainees indicated an increase in their knowledge with each lecture. Furthermore, the domains of relevance (mean score 9.53±0.80); teaching style (mean score 9.66±0.94); and audiovisual aid (mean score 9.68±0.70) were all rated highly. Lecture duration was rated as perfect length (mean score 5.86±1.80). Conclusion We have demonstrated that weekly departmental teaching can be utilised to enhance training for FY1 doctors within a challenging surgical subspecialty. Feedback revealed high satisfaction, facilitating improvement in knowledge and thus empowerment in undertaking clinical duties. Strengthened by this positive outcome work is in progress to introduce this format of structured teaching into departmental teaching meetings in all disciplines of medicine and surgery across our Trust.

SP8.5 - Enhancing the confidence of FY1 Doctors in managing General Surgical Patients through the introduction of an online handbook– A quality improvement project

Abstract Background Emerging as a Foundation Year 1 (FY1) doctor from undergraduate training can be daunting. Furthermore, working in Colorectal Surgery can pose challenges: managing both elective and acute surgical patients with complex needs. We designed a General Surgery and Colorectal Surgery handbook to help FY1 doctors navigate training. This Quality Improvement Project aimed to assess the impact of and alleviate some of the uncertainty experienced by FY1 doctors during this transitional phase. Methods An electronic handbook was compiled with contributions from across the Multidisciplinary Team which was reviewed and approved for distribution within our Trust. An online questionnaire was distributed to assess pre-placement confidence in key domains on a 10-point Likert scale. This was sent to FY1 doctors who had previously completed a rotation within colorectal surgery without the handbook. The handbook was distributed to new cohort of FY1 doctors a week prior to the start of their rotation in Colorectal Surgery. An identical questionnaire was sent to the new cohort of FY1s within a month of their rotation and results were compared with previous cohort. Results In all surveyed areas, there was an improvement in confidence in the post-intervention group compared to that shown in the pre-intervention group. The average improvement in median score across all areas was 3.8 points. Conclusion This project demonstrated an overwhelmingly positive response to a formalised handbook by FY1 doctors in training. This intervention has helped FY1 doctors manage colorectal and general surgery patients with enhanced confidence thus paving way for safer patient care.

EP120 - A Retrospective Review of Pregnant Patients Referred to an Emergency General Surgery Service

Abstract Aims To gain insight into the journey and outcomes of pregnant patients referred to an emergency general surgery service. Methods Surgical handover lists from Jan 2021-Dec 2023 were reviewed to identify pregnant patients referred to the service. Data was collected from the electronic patient record on demographics, timeline, imaging, diagnosis, management and subsequent delivery method if pregnancy reached term. Results There were 91 referrals of pregnant women to the emergency general surgery service over the 3 year period. 80% were for abdominal pain. 64% of patients received a documented review by a general surgery consultant, and 35% received a documented review by an obstetric consultant. For those presenting with abdominal pain, 79% had imaging other than plain film, the most common being ultrasound abdomen (75%). 5% of patients had an MRI abdomen and pelvis, and 4% of patients had a CT abdomen and pelvis. Of the 21 patients treated for a confirmed abdominal surgical diagnosis who had a documented delivery, 29% required emergency c-sections. In comparison, out of 17 patients who had either non-surgical pathologies or extra-abdominal surgical pathologies, excluding pregnancy-related complications, 0 went on to have emergency c-sections. This is statistically significant (p=0.0241). Conclusion The investigation and management of an acute abdomen in pregnancy poses a number of unique challenges. Our dataset, though small, has hinted at unacceptable rates of consultant review and under-utilisation of cross-sectional imaging. Furthermore, there is the suggestion that patients with confirmed abdominal surgical pathology may be at increased risk of delivering via emergency c-section. There is a need for further research into this patient population.

A Survey of Preoperative, Perioperative, and Postoperative Management Practices for Testicular Torsion in Pediatric Patients among European Surgeons.

Management of testicular torsion varies between specialties resulting in lack of standardization. The aim of this survey was to assess pre-, peri-, and postoperative differences. An online questionnaire was distributed in 2023 to general and pediatric surgeons, pediatric urologists, and urologists by the Trainees of European Pediatric Surgery. Among 88 respondents (92% tertiary referral hospital), 38% always or usually perform sonography in case of suspected torsion respectively. In addition, 15% always attempt manual detorsion and 44% depending on the clinical presentation. Most surgeons (93%) favor a scrotal approach. Interestingly, pediatric surgeons choose a transscrotal while other specialties opt for a midline incision (p = 0.002). The majority (57%) employ a three-point fixation, while 42% opt for a two-point fixation. In case of necrotic testis, 61% puncture the testis with 52% opting for surgical removal, while 33% perform orchiectomy and 6% leave it in situ. Regarding necrotic or borderline-appearing testis, 54% take a biopsy. Furthermore, 82% perform prophylactic orchidopexy of the contralateral side during the same session. Postoperative antibiotics are always administered by 12%, while 52% do so sometimes. Most perform sonographic (58%) or clinical (57%) follow-up 3 months postoperatively. Notably, pediatric surgeons and urologists perform follow-up more frequently themselves, while general surgeons/urologists recommend follow-up by pediatricians (p = 0.002). In addition, 76% of responders affirm adhering to European Association of Urology guidelines. Unawareness of guidelines and institutional practices are reasons most commonly cited for nonadherence. Our study reveals significant disparities in the pre-, peri-, and postoperative management of testicular torsion underscoring the need for establishing standardized practices.

Prior coronary stent does not exclude major pulmonary resection regardless of antiplatelet therapy.

We assessed the safety of general thoracic surgery in patients with prior coronary stents undergoing lung resection, based on differences in perioperative antiplatelet therapy management. We retrospectively examined 150 patients with coronary artery stents who underwent pulmonary resection between July 2009 and July 2018. The impact of the antiplatelet agent on thoracic surgery safety was assessed by comparing perioperative outcomes, including major adverse cardiac and cerebrovascular events, among the discontinued antiplatelet therapy (group D), heparin bridging (group H), and continuous antiplatelet therapy (group C) groups. Groups D, H, and C included twenty-four, eighty-four, and forty-two patients, respectively. Second-generation drug-eluting stents were used in > 50% of the patients. No significant differences were found in the estimated blood loss, transfusion rate, or operative duration. Major adverse cardiac and cerebrovascular events occurred in four (2.7%) patients, which was comparable among the groups. In group H, postoperative heart failure and transient ischemic attack with stroke occurred in one patient each. Major bleeding occurred in two (4.7%) patients in group C. Pulmonary resection surgical outcomes in patients with coronary artery stents were feasible regardless of antiplatelet therapy continuation. However, discontinuing dual-antiplatelet or single-antiplatelet therapy in such patients may be reasonable because this generation of drug-eluting stents has a higher safety profile than bare-metal and first-generation drug-eluting stents.

ThP7.8 - What is the gap in operative trauma surgical skills needed for humanitarian and military deployment? A systematic narrative review of surgeons in high-income countries

Abstract Aims The incidence of armed conflict, terrorist attacks and environmental disaster is increasing and death from traumatic injury remains a leading cause of mortality globally, posing complex challenges in surgical care. Despite advancements in trauma systems development, practice in high-income countries (HICs) is characterised by low trauma volumes, evolving non-operative strategies and increasing sub-specialisation, raising concerns about surgical preparedness for managing diverse injuries. This systematic review aims to assess the operative trauma skills of surgeons in HICs mapped against core military and humanitarian procedures. Examination of the breadth of skills acquired and identification of areas where further experience is required will inform the development of more comprehensive and adaptable surgical training programs. Methods A systematic literature review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE and EMBASE. Inclusion criteria targeted general and trauma surgery consultants or trainees in HICs, analysing quantitative and qualitative data on operative workload and skills acquisition. Results Twelve studies from the USA, UK, Netherlands, Ireland, Australia, and New Zealand were included. Trainees demonstrated experience in general surgical trauma but lack exposure to critical skills in orthopaedic, vascular and obstetric and gynaecological surgery. Conclusion This review highlights a gap in the operative trauma surgical skills of surgeons in HICs and the need for re-evaluation of surgical training curricula to address the dynamic challenges posed by contemporary trauma care. Emphasising a versatile skillset and exploring avenues for enhanced exposure through didactic courses and global surgery partnerships might prove crucial for better preparing surgeons for the diverse and demanding scenarios in the field of trauma care