Emergency General Surgery Research Articles

Assessing the standard of emergency general surgical (EGS) operation notes in accordance with the Royal College of Surgeons guidelines.

Operation notes are important for care in surgical patients. The objectives of this study were to analyze the emergency general surgery (EGS) operation note documentation in accordance with the Royal College of Surgeons of England (RCSEng) guidelines and to assess the impact of creating awareness of the guidelines and effect of a new proforma. A retrospective review of 50 EGS operation notes was conducted between December 2019 and March 2020 and compared to RCSEng guidelines. Education was delivered on the importance of documentation in accordance with RCSEng guidelines. A new electronic proforma was introduced. A further 50 EGS operation notes were analysed between August 2020 and December 2020. One hundred operation notes were reviewed, and each given a score out of 19. Our interventions showed significant improvement to the average score (15.64 vs 17.96; p <0.001). Within the second cycle, there was a statistically significance difference when comparing electronic to handwritten notes (18.55 vs 17.50; p= 0.001). Implementation of the new proforma showed improvement in operation note documentation when compared to the RCSEng standard. Therefore, this study emphasizes the need for surgeons to familiarize themselves with the current guidelines.

Changes in social care after major emergency general surgery procedures

IntroductionEmergency 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. MethodsOur local data uploaded to the National Emergency Laparotomy Audit (NELA) database (2014-2022) was analysed. This national database encompasses all major emergency general surgery cases undertaken in the United Kingdom. The variables considered were patient 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<0.05. ResultsData 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<0.001). Patients who died were 11.4 years older compared to those discharged without additional support (p<0.001). ConclusionA 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.

Utility of indocyanine green fluorescent dye in emergency general surgery: a review of the contemporary literature.

For decades, indocyanine green (ICG) has been available for medical and surgical use. The indications for ICG use in surgery have expanded where guided surgery directed by fluorescence and near-infrared fluorescent imaging offers numerous advantages. Recently, surgeons have reported using ICG operative navigation in the emergency setting, with fluorescent cholangiography being the most common procedure. The utility of ICG also involves real-time perfusion assessment, such as ischemic organs and limbs. The rising use of ICG in surgery can be explained by the ICG's rapid technological evolution, accuracy, ease of use, and great potential to guide precision surgical diagnosis and management. The review aims to summarize the current literature on the uses of ICG in emergency general surgery. It provides a comprehensive and practical summary of the use of ICG, including indication, route of administration, and dosages. To simplify the application of ICG, we subdivided its use into anatomical mapping and perfusion assessment. Anatomical mapping includes the biliary tree, ureters, and bowel. Perfusion assessment includes bowel, pancreas, skin and soft tissue, and gonads. This review provides a reference to emergency general surgeons to aid in implementing ICG in the emergency setting for more enhanced and safer patient care.

Patient reported outcomes of emergency general surgery procedures

BackgroundEmergency general surgery (EGS) involves care of a patient's often previously unknown disease in the setting of an unplanned interaction with the healthcare system. This leads to challenges collecting and interpreting patient reported outcome measures (PROMs). MethodsWe performed a qualitative and mixed methods study using semi-structured interviews during the index hospitalization and at 6–12 months to capture peri-operative patient experiences. We compared interview findings to clinical characteristics. ResultsAmong 30 patients, two-thirds reported feeling no choice but to pursue emergency surgery with many reporting exclusion from decision-making. Females reported these themes more commonly. Patients with minor complications less frequently reported trust in their team and discussed communication issues and delays in care (all p ​< ​0.05). Patients with major complications more frequently reported confidence in their team and gratefulness, but also communication limitations (all p ​< ​0.05). Patients not admitted to the ICU more frequently discussed good communication and expeditious treatment. ConclusionsPROMs developed for EGS patients should consider patient outcomes and reflections that they felt excluded from decision-making. Severity of complications may also differentially impact PROMs.

Association of prior bariatric surgery with outcomes following emergency general surgery

BackgroundDespite the favorable outcomes and safety profile associated with metabolic and bariatric surgery (MBS), complications may occur postoperatively, necessitating emergency general surgery (EGS) intervention. ObjectivesTo evaluate the association of outcomes in patients with prior MBS following EGS interventions. SettingAcademic, University-affiliated; USA. MethodsAll adults undergoing nonelective EGS operations were identified using the 2016 to 2020 Nationwide Readmission Database. Patients with a history of MBS were subsequently categorized as Bariatric, with the remainder of patients as NonBariatric. The primary outcome of interest was in-hospital mortality, while perioperative complications, length of stay (LOS), hospitalization costs, non-home discharge, and 30-day readmission were secondarily assessed. Multivariable regression models were developed to evaluate the association of history of MBS with outcomes of interest. ResultsOf an estimated 632,375 hospitalizations for EGS operations, 29,112 (4.6%) had a history of MBS. Compared to Nonbariatric, Bariatric were younger, more frequently female and more commonly had severe obesity. Following risk adjustment, Bariatric had significantly lower odds of in-hospital mortality (AOR .83, 95%CI .71–.98). Compared to others, Bariatric had reduced LOS by .5 days (95%CI .4–.7) and hospitalization costs by $1600 (95%CI $900–2100). Patients with prior MBS had reduced odds of nonhome discharge (AOR .89, 95%CI .85–.93) and increased likelihood of 30-day readmissions (AOR 2.32, 95%CI 1.93–-2.79) following EGS. ConclusionsPrior MBS is associated with decreased mortality and perioperative complications as well as reduced resource utilization in select EGS procedures. Our findings suggest that patients with a history of MBS can be managed effectively by acute surgical interventions.

A lay of the land: a description of academic acute care surgery models in Canada.

Patients who require emergency general surgery (EGS) are at a substantially higher risk for perioperative morbidity and mortality than patients undergoing elective general surgery. The acute care surgery (ACS) model has been shown to improve EGS patient outcomes and cost-effectiveness. A recent systematic review has shown extensive heterogeneity in the structure of ACS models worldwide. The objective of this study was to describe the current landscape of ACS models in academic centres across Canada. We sent an online questionnaire to the 18 academic centres in Canada. The lead ACS physicians from each institution completed the questionnaire, describing the structure of their ACS models. In total, 16 institutions responded, all of which reported having ACS models, with a total of 29 ACS services described. All services had resident coverage. Of the 29, 18 (62%) had dedicated allied health care staff. The staff surgeon was free from elective duties while covering ACS in 17/29 (59%) services. More than half (15/29; 52%) of the services described protected ACS operating room time, but only 7/15 (47%) had a dedicated ACS room all 5 weekdays. Four of 29 services (14%) had no protected ACS operating room time. Only 1/16 (6%) institutions reported a mandate to conduct ACS research, while 12/16 (75%) found ACS research difficult, owing to lack of resources. We saw large variations in the structure of ACS models in academic centres in Canada. The components of ACS models that are most important to patient outcomes remain poorly defined. Future research will focus on defining the necessary cornerstones of ACS models.

1879 On a knife's edge: role of a Clinical Nurse Specialist on balancing complex treatment decisions in acute surgery

Abstract Introduction 1 in 4 older individuals having emergency general surgery live with frailty, are more likely to have a longer hospital stay, readmission rate, morbidity and mortality. This underscores the importance of individualised approaches to care through Shared Decision Making (SDM). We introduced SDM into our surgical liaison service aiming to measure effectiveness and patient outcomes. Methods Between October 2021 and September 2022, patients aged &amp;gt;70 years living with frailty admitted to the surgical unit were identified by an Older Persons Clinical Nurse Specialist (CNS). Involvement in treatment decisions was measured by using the patient and clinician SDM-Q9 questionnaire. Pre-admission as well as follow-up quality of life scores at 6 months using the EQ-5D-5L (0-100) as well as Decision Regret were obtained on subsets of patients. Results Of a total of 76 patients seen by the CNS, follow-up data were available for 61 patients, clinician and patient SM-Q9 were completed in 54 patients. Clinicians were 10% more likely to strongly or completely agree that they explained choice available, 16% more likely to feel they explained treatment options compared with patients. Patients were less likely to feel completely involved in decision making. However, they were more likely to agree they understood clinical information presented them. Low levels of decision regret were ascertained at follow up where 18 patients agreed and 32 patients strongly agreed that a right decision was made of their care. Of 15 patients who underwent emergency laparotomy, mean EQ-5D scores across all domains from improved from baseline (69 vs 78). Conclusions CNS led implementation of SDM is feasible, acceptable. Patients felt involved in their care and had lower levels of decisional regret. Encouraging and investing in an environment where health professionals take time to determine what is important to their patient can be associated with better outcomes.

Improving outcomes in emergency general surgery: Construct of a collaborative quality initiative.

Emergency general surgery conditions are common, costly, and highly morbid. The proportion of excess morbidity due to variation in health systems and processes of care is poorly understood. We constructed a collaborative quality initiative for emergency general surgery to investigate the emergency general surgery care provided and guide process improvements. We collected data at 10 hospitals from July 2019 to December 2022. Five cohorts were defined: acute appendicitis, acute gallbladder disease, small bowel obstruction, emergency laparotomy, and overall aggregate. Processes and inpatient outcomes investigated included operative versus nonoperative management, mortality, morbidity (mortality and/or complication), readmissions, and length of stay. Multivariable risk adjustment accounted for variations in demographic, comorbid, anatomic, and disease traits. Of the 19,956 emergency general surgery patients, 56.8% were female and 82.8% were White, and the mean (SD) age was 53.3 (20.8) years. After accounting for patient and disease factors, the adjusted aggregate mortality rate was 3.5% (95% confidence interval [CI], 3.2-3.7), morbidity rate was 27.6% (95% CI, 27.0-28.3), and the readmission rate was 15.1% (95% CI, 14.6-15.6). Operative management varied between hospitals from 70.9% to 96.9% for acute appendicitis and 19.8% to 79.4% for small bowel obstruction. Significant differences in outcomes between hospitals were observed with high- and low-outlier performers identified after risk adjustment in the overall cohort for mortality, morbidity, and readmissions. The use of a Gastrografin challenge in patients with a small bowel obstruction ranged from 10.7% to 61.4% of patients. In patients who underwent initial nonoperative management of acute cholecystitis, 51.5% had a cholecystostomy tube placed. The cholecystostomy tube placement rate ranged from 23.5% to 62.1% across hospitals. A multihospital emergency general surgery collaborative reveals high morbidity with substantial variability in processes and outcomes among hospitals. A targeted collaborative quality improvement effort can identify outliers in emergency general surgery care and may provide a mechanism to optimize outcomes. Therapeutic/Care Management; Level III.

Incidence of COVID-19 in general surgery emergency and complications associated in different types of management

Background COVID-19 disease causes complications that are classified according to likelihood to high such as venous thromboembolism, acute kidney injury, and postintensive care syndrome. Other complications are low in likelihood such as cytokine release syndrome, pancreatic injury, gastrointestinal complications, and pregnancy-related complications. Mortality and morbidity are really high when it is combined with surgical intervention especially under general anesthesia. Objectives To evaluate the incidence of COVID-19 in general surgery emergency and complications associated in different types of management. Patient and method This is a retrospective study from June 2020 to January 2021 including all COVID-19 positive cases admitted in general surgery department during previously mentioned period. Before September 2020, screening for COVID was based on swab for only clinically suspected COVID-positive patients. Starting from September 2020, routine swab to all admitted patients was done. All data collected about included cases in study underwent statistical analysis to get results. Results In this study, incidence of COVID-19 is 1.35%, mortality incidence is 26.4% (about 92.9% of mortality cases underwent surgery) and morbidity incidence is 30.2%. About 74% (73.6%) of positive cases improved and discharged. Management of cases is according to guidelines of management to each disease and decision of ER consultant. About 77.4% of cases are managed surgically; about 70.7% of cases operated upon underwent exploration. However, 60.4% of cases are admitted with sepsis and septic shock. Asymptomatic cases for COVID during admission are 26.4%. Conclusion Incidence of COVID-19 in acute general surgery emergency in Kasr Al-Ainy is not that high. However, cases operated upon in the era of COVID are associated with high incidence of mortality. Cases are presented to our institute late, which might be an effect of lock down.

Racial and Socioeconomic Disparities in Complex Abdominal Wall Reconstruction Referrals.

Background: Health disparities are pervasive in surgical care. Particularly racial and socioeconomic inequalities have been demonstrated in emergency general surgery outcomes, but less so in elective abdominal wall reconstruction (AWR). The goal of this study was to evaluate the disparities in referrals to a tertiary hernia center. Methods: A prospectively maintained hernia database was queried for patients who underwent open ventral hernia (OVHR) or minimally invasive surgical (MISR) repair from 2011 to 2022 with complete insurance and address information. Patients were divided by home address into in-state (IS) and out-of-state (OOS) referrals as well as by operative technique. Demographic data and outcomes were compared. Standard and inferential statistical analyses were performed. Results: Of 554 patients, most were IS (59.0%); 334 underwent OVHR, and 220 underwent MISR. IS patients were more likely to undergo MISR (OVHR: 45.6% vs. 81.5%, laparoscopic: 38.2% vs. 14.1%, robotic: 16.2% vs. 4.4%; p < 0.001) when compared to OOS referrals. Of OVHR patients, 44.6% were IS and 55.4% were OOS. Patients' average age and BMI, sex, ASA score, and insurance payer were similar between IS and OOS groups. IS patients were more often Black (White: 77.9% vs. 93.5%, Black: 16.8% vs. 4.3%; p < 0.001). IS patients had more smokers (12.1% vs. 3.2%; p = 0.001), fewer recurrent hernias (45.0% vs. 69.7%; p < 0.001), and smaller defects (155.7 ± 142.2 vs. 256.4 ± 202.9cm2; p < 0.001). Wound class, mesh type, and rate of fascial closure were similar, but IS patients underwent fewer panniculectomies (13.4% vs. 34.1%; p < 0.001), component separations (26.2% vs. 51.4%; p < 0.001), received smaller mesh (744.2 ± 495.6 vs. 975.7 ± 442.3cm2; p < 0.001), and had shorter length-of-stay (4.8 ± 2.0 vs. 7.0 ± 5.5days; p < 0.001). There was no difference in wound breakdown, seroma requiring intervention, hematoma, mesh infection, or recurrence; however, IS patients had decreased wound infections (2.0% vs. 8.6%; p = 0.009), overall wound complications (11.4% vs. 21.1%; p = 0.016), readmissions (2.7% vs. 13.0%; p = 0.001), and reoperations (3.4% vs. 11.4%; p = 0.007). Of MISR patients, 80.9% were IS and 19.1% were OOS. In contrast to OVHR, MISR IS and OOS patients had similar demographics, preoperative characteristics, intraoperative details, and postoperative outcomes. Conclusion: Although there were no differences in referred patients for MISR, this study demonstrates the racial disparities that exist among our IS and OOS complex, open AWR patients. Awareness of these disparities can help clinicians work towards equitable access to care and equal referrals to tertiary hernia centers.

Association of COVID-19 Visitor Limitations and Goals of Care Discussions in the Intensive Care Unit

IntroductionThe COVID-19 pandemic led to visitor restrictions in many hospitals. Since care in the surgical intensive care unit (SICU) often engages visitors as surrogate decision-makers, we investigated whether there was an association between COVID-19–related visitor restrictions, goals of care discussions (GOCD), and patient outcomes in SICU patients. MethodsWe conducted a retrospective review of trauma and emergency general surgery (EGS) patients admitted to a rural tertiary SICU between July 2019 and April 2021, dividing patients into those admitted during COVID-19 visitor restrictions and those admitted at other times. Using univariate and multivariate logistic regression analyses, we compared the primary outcome, incidence of GOCD, and incidence of prolonged hospital (> 14 d) and intensive care unit length of stay (LOS, > 7 d) between the two groups. ResultsOne hundred seventy nine of 368 study patients (48.6%) presented during restricted visitation. The proportion of GOCD was 38.0% and 36.5% in the restricted and nonrestricted visitation cohorts, respectively (P = 0.769). GOCD timing and outcomes were similar in both groups. The use of telecommunication increased during restricted visitation, as did the proportion of trauma patients admitted to the SICU. On multivariable logistic regression, age and patient category were independent predictors of GOCD. On outcomes analysis, visitor restriction was associated with prolonged hospital LOS for EGS patients (odds ratio 2.44, 95% confidence interval 1.01-5.91, P value 0.048). ConclusionsRestricted visitation was not associated with changes in frequency or outcome of GOCD, but was associated with prolonged hospital LOS among EGS patients who had SICU admissions. Further investigation of patient/surrogate satisfaction with virtual GOCD in the SICU setting is needed.

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. Having a weekly Radiology-General Surgery-MDM leads to better outcome in management of EGS-patients, &amp; also improves learning of surgeons &amp; junior-doctors. Methods A prospective study of weekly 1-hour Radiology-GeneralSurgery-MDMs over 10-weeks during May2023-September2023 was performed. These MDMs were led by a consultant radiologist who discussed the scans with consultant surgeons &amp; other junior-doctors. Factors taken into consideration were clinical presentation, original scan report, any missed findings not mentioned in original scan report, any changes recommended in management plan that would lead to better patient outcome. The scans were also discussed with junior-doctors to improve their knowledge of interpretation of scans. Results A total of 70 cases were discussed during the study period, 25 (35.71%) initially reported by the out-of-hours reporting system. Few had missed findings that were noted as result of Radiology-GeneralSurgery-MDM, &amp; 27(38.57%) had change in management plan. The informal feedback collected after these MDMs noted over 85% junior-doctors agreed that these MDMs had significant impact on their understanding of interpretation of radiological-scans in EGS. Conclusion Weekly Radiology-GeneralSurgery-MDMs for EGS-admissions has been seen to improve patient outcome as a result of having an expert 2nd-opinion, &amp; also recommending change in management plan in significant proportion of patients. It also had an impact on learning the clinical correlation of radiological-scans by junior-doctors who regularly attended these meetings.

Unplanned Returns to Theatres in Emergency General Surgery; What can be improved?

Abstract Introduction Unplanned return to theatre impacts physical, psychological, social and financial aspects of patients and healthcare. It is a significant adverse event, which can be avoided, nonetheless reduced. This study aims to review the incidence of unplanned return to theatre in Emergency General Surgery at a District General Hospital. Methods A retrospective review of patients undergoing Emergency General Surgery between January 2019 to January 2021 was done. Data was obtained from the hospital management information systems. The operations were classified based on primary operation, followed by indication for the return. Results A total number of 1578 patients underwent emergency general surgery operations over a period of 25 months (Jan 2019-Jan 2021). The unplanned return to theatres (URTT) were 85 (5.3%), with a 90-day mortality of 16. There were 12 (14.11%) appendicectomies, 7 (8.2%) necrotizing fasciitis, 25 (29.4%) abscess, 5 (5.8%) hernias, 16 (18.8%) large bowel, 19 (22.3%) small bowel operations and 1 (1.17%) laparoscopic cholecystectomy. The total number of appendicectomies were 302 with 3.9% (12) URTT. Similarly, 4.2% (n=583) abscesses, 22.8% (n=70) large bowel operations, 6% (n=316) small bowel operations were returned. 66% of the abscesses were returned for redo/debridement. Conclusion Unplanned returns to theatres pose a major burden to the healthcare system. There is no established data for an acceptable rate of URTT in emergency general surgery. Most of the returns in our study, are due to haemorrhage or inadequate drainage of the abscess, both of these complications could easily be prevented with meticulous surgical technique.

A review of emergency general surgery (EGS) admissions via the direct access pathway (DAP) in a district general hospital

Abstract Aims Patients presenting with emergency general surgical (EGS) conditions require urgent management - however, increased waiting time in A&amp;E often leads to delayed diagnosis and subsequently delayed management. Having a direct access pathway (DAP) to Surgical Emergency Assessment Unit (SEAU) helps minimize these delays - leading to better outcome in management of these patients. Methods A retrospective observational study of EGS admissions in May 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 188 referrals were made to SEAU, of which 46 (24.5%) were DAP referrals. The average number was 18 over weekdays and 10 over weekends - of these, 97.8% of referrals were appropriate with correctly filled out proforma, whereas 2.2% were inappropriate referrals. 33% patients were discharged, 10% were admitted, and 10% were planned to return for investigations the following day. The median waiting time for initial assessment was 1.5hours. The most common presentations were RUQ Pain, subcutaneous abscess and RLQ pain which correlated with the final diagnosis. It was also noticed that when compared with May 2022 (176patients during the same 2-week period), there was 6.8% increased referral since commencement of DAP. Conclusion The DAP for EGS admissions has been 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.

Outcomes of Emergency Surgical patients with acute pathology managed without emergency laparotomy - a single site review

Abstract Aim To establish the outcomes of Emergency General Surgery patients admitted with acute pathology that did not progress to Emergency Laparotomy Method Retrospective single site review of all Emergency General Surgery patients admitted over three calendar months. Review of patient demographics, diagnostics, diagnosis and management. Identification of and further collection of data from electronic patient records for patients that did not proceed to Emergency Laparotomy despite indicative pathology. Results A total of 619 emergency general surgical patients were admitted from 1st January to 31st March 2023. 39 (6.3%) patients had an Emergency Laparotomy. 17 (2.7%) patients did not proceed to laparotomy despite pathology that could indicate the need for emergency laparotomy. 100% of these patients has CT imaging to diagnose the pathology. Of the 17 patients without laparotomy 12 were female patients. Median age of 86 years (range 42 – 91 years). At 30 days post admission 6 patients who did not proceed to laparotomy were alive. 7 patients survived to discharge, 5 were discharged home and 2 were discharged to a Nursing Home for full nursing care requirements. Conclusion Surgeons are starting to explore the issues around futility in emergency general surgery. This snapshot retrospective review shows alignment with the very limited published literature. We recognise our numbers are extremely limited. Further data collection and analysis is needed to explore futility in emergency general surgery.

Atypical Influx: Navigating Invasive Group A Streptococcus Cases in Emergency General Surgery

Abstract Aim To highlight the rising national incidence of iGAS infections, particularly during the post emergency phase of the COVID-19 pandemic, and emphasise its significance as a differential diagnosis in acutely unwell emergency surgical patients. Methods Data was gathered retrospectively from December 2022 - August 2023. Inclusion criteria were emergency surgical patients testing positive for GAS isolated from sterile sites, or non-sterile sites in case of septic shock. Results Six cases (four females, two males), with a mean age of 55 (36-67) were identified. Four had necrotizing fasciitis, one bacterial peritonitis in the presence of a ventriculo-peritoneal shunt, and one streptococcal bacteremia. All presented in septic shock, with metabolic acidosis and multiorgan impairment. The initial diagnosis was clinical in 66% of cases. iGAS was confirmed via wound, peritoneal fluid, tissue or blood culture in five patients and via genital swab in one. 50% of cases were sensitive to clindamycin and amoxicillin. Two received IV immunoglobulins. All cases were managed according to Sepsis 6 protocols, involving multidisciplinary teams. Five patients underwent immediate surgery for debridement and washout. The mortality rate was 16.6%. Three patients were transferred to tertiary centres once stabilised (1 for neurosurgical input, and 2 for plastics grafting). Conclusion It is crucial for frontline doctors to consider iGAS as a differential when encountering critically ill surgical patients. Simultaneous systemic resuscitation, early surgical intervention, multidisciplinary care, tailored antibiotic therapy and immunoglobulins are essential to minimise morbidity and mortality.

A Global Survey of Precision Medicine in Emergency General Surgery

Abstract Background Since first sequencing the human genome, precision medicine has become a modern-day reality. However, translation to all areas of medicine has not been equal. This study aimed to provide a ‘status update’ of precision medicine in EGS to guide future priority setting. Methodology An observational study was conducted utilising two curated global on-line databases: 1. Pubmed publications from 2001 &amp; 2. Clinical trials registered on ClinicalTrials.gov. The top 10 presenting conditions in EGS, Oncology, and Acute Medicine were identified from literature review. Publications/trials in these areas were identified using associated keywords: precision, personalised, genomics, genome-wide association studies, exome studies, epigenetics, transcriptomics, proteomics, metabolomics, microbiomics, and pharmacogenomics. Duplicated publications/trials were removed prior to final analysis and only active, recruiting or completed trials were included. Temporal trends were compared and annual growth rates were calculated. Results There were 209,423 EGS publications, 1807 (0.9%) being precision-focused. Oncology had 1,137,396 publications, with 127,556 precision-focused (11.2%), and Acute Medicine had 1,647,046 publications, with 80,240 (4.9%) precision-focused. The rate of rise of annual publications since 2001 (human genome project publication) was significantly (p&amp;lt;0.05) lower for EGS (x2.9) versus oncology (x3.5) and medicine (x6.0). Only 7 precision-focused clinical trials were identified for EGS compared to 96 for Oncology and 39 for Medicine. x10 fewer precision-focused EGS publications and trials exist over 20 years, compared to covid-19 over 2 years. Conclusion Research and implementation of precision medicine in EGS remains inadequate. Increased investment and improved global implementation are warranted to address the widening gap in translation.

The importance of accuracy in consenting in Laparoscopic Appendicectomies and Cholecystectomies in Emergency General Surgery

Abstract Background Emergency General Surgery frequently necessitates expediting the consent due to clinic pressure often reducing the time for extensive and accurate consents. New recommendations from GIRFT, RCS and ASGBI advise the best practice for laparoscopic appendicectomy and cholecystectomies documentation to ensure that clinicians are adhering to safe practice with focus on consenting and informing patients accurately. Aim The aim of this study is to look at the accuracy of the documentation of consent in emergency general surgery laparoscopic appendicectomies and cholecystectomies to ensure and promote best practice. Method A retrospective analysis of 75 patients from the emergency general surgical take requiring laparoscopic appendicectomy or cholecystectomy from 08/09/23-14/9/23 in the Royal infirmary of Edinburgh, a tertiary trauma centre. The consent forms were analysed for scribed operation, legibility, abbreviations, and risks/ complications. The patients’ notes were then analysed to find out the operation carried out and any operative or immediate post operative complications. The consents forms were then compared to the post operative notes looking at the immediate operative complications to assess their accuracy. Conclusion The retrospective study demonstrated that there is scope for improvement within the consenting process to ensure the accuracy of the predicted operation and subsequent risks thus to improve true informed consent. The areas which could easily be improved on as such is the legibility, use of abbreviations and complete documentation of risks/complications the use of Procedure specific consent forms (PSCF) may be beneficial in creating standardisation.

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.

Assessment of the quality of care in acute bowel obstruction patients at a tertiary care hospital with the NCEPOD guidelines

Abstract Background Acute bowel obstruction (ABO) is a common cause of admission under the emergency general surgery services offered across the UK. The Aim of this quality improvement project (QIP) was to assess the quality of care for patients with ABO with the national and NCEPOD guidelines in a tertiary care hospital. Method Data was collected for two months in October and November 2022 from an electronic database in the trust and patient notes maintained throughout the admission. Results 35 patients were included in the QIP (19 males and 16 females). Consultant review is recommended in &amp;lt; 14 hours after admission and national statistics show a delay in 15.9% of cases, in our hospital, it was 73.33% (22/30). Pain assessment on admission, the national average is 57% but, in this hospital, it was 42.86% (15/35). Similarly, guidelines recommend assessment of MUST score, hydration status and Rockwood score at admission, which was documented in 0/35, 1/35 and 15/35 cases in our hospital. QIP was presented in the local clinical governance meeting followed by a teaching session to improve the patient care in ABO. Conclusion This QIP showed a lack of documentation in the pain score, hydration status, Rockwood score, MUST score and a delay in the consultant review for patients with ABO when compared with the guidelines of NCEPOD and national statistics. A repeat cycle of this QIP will be conducted in 6 months' time to analyse the effectiveness of the intervention on patient care outcomes.