Local Audit Research Articles

HPB SO46 - Risk Stratification for Acute Pancreatitis: A Retrospective Comparative Analysis between Glasgow-Imrie and BISAP Scoring Systems within a District General Hospital

Abstract Background Risk stratification for acute pancreatitis (AP) is an important tool in clinical decision making. The BISAP score has been validated to be a comparable risk prognostication tool to current models[1, 2]. Current trust practice is the Glasgow-Imrie score, which involves more invasive and non-routine investigations, resulting in an increased cost and labour burden. Additionally, a previous local audit demonstrated poor compliance with only 55% of admissions having a documented score, limiting utility and prognostication. By demonstrating non-inferiority, we aim to implement BISAP as the standard of practice with earlier severity assessment, improved patient experience and minimising unnecessary investigations. Method A retrospective analysis of 153 admissions with acute pancreatitis admitted to a single-site district general hospital over a 12-month period was performed, reviewing electronic patient records for documentation, observations and investigations. Both Glasgow-Imrie and BISAP scores were calculated within 48 and 24 hours of admission retrospectively and respectively. Descriptive statistics was used to summarise data and compare trends between both scores and the severity of acute pancreatitis, ICU admissions and mortality. Logistic regression was utilised to model the relationship between both systems and binary outcomes with area under the curve (AUC) and non-inferiority tests derived to determine efficacy. Results The cohort had a mean age of 57 ± 18.53 (52:48 male:female) with an average LOS of 7.25 ± 10.12 days. 6.54% had severe AP, 3.92% required ICU admisison and 3.26% mortality rate. The AUC value for both models was 0.868 in predicting severity (p<0.001) with Glasgow-Imrie performing better in predicting ICU admission (AUC 0.954 > 0.855, p<0.01) and BISAP outperforming Glasgow-Imrie in predicting mortality (AUC 0.903 > 0.867, p<0.01). Bootstrapping resampling demonstrated no significant difference between models in predicting severity (δAUC 0.0007, 95%CI -0.01181, 0.1167), ICU admission (δAUC 0.1010, 95%CI -0.0113, 0.2140) and mortality (δAUC -0.0366, 95%CI -0.0788, 0.0045). Conclusion Both the Glasgow-Imrie and BISAP scoring systems are accurate in predicting the severity of pancreatitis, ICU admission and mortality. The BISAP score is similar in prognostic accuracy to the Glasgow-Imrie score and is advantageous in being simpler to obtain in clinical practice with a higher rate of completeness. We recommend the BISAP score as a non-inferior, pragmatic risk stratification tool in acute pancreatitis.

Can Catering to Local Area Needs Through CSR Reduce Firm Risk?

ABSTRACTThis paper examines the effect of corporate social responsibility (CSR) spending to cater to the local area's needs (the area of business operations) in reducing the firm's risk in the mandatory CSR setting. Using a sample of 1677 Indian firms spanning the financial year 2009–2022, we present several interesting results. First, we demonstrate that the risk of the firms eligible under mandatory CSR law is higher than those not qualifying. Second, we find that the risk of firms that focus their CSR on the local area's needs is lower. In an additional analysis, we demonstrate that firms with higher spending on the local area experience lower contingent liability, legal expenses, and audit fees. We illustrate that focusing on the local area's needs in CSR efforts retains signaling value under a mandatory CSR regime.

Common auditor, knowledge transfer and audit quality: international evidence

PurposeUsing an international sample of firms affiliated with a business group, this paper aims to investigate the audit quality of common auditors, i.e. auditors shared by multiple firms affiliated with the same business group.Design/methodology/approachThis paper utilizes a large sample of group-affiliated firms from 35 regions. Following the frameworks of DeFond and Zhang (2014) and Fung et al. (2017), this paper measures audit quality using the absolute value of abnormal accruals and modified audit opinions. Ordinary least squares (OLS) regression is used to address the research question.FindingsThe findings demonstrate that audit quality improves for firms that share the same auditor with other group members. Importantly, cross-country analyses reveal that this relationship is stronger when auditors operate in countries with stricter local auditor inspection programs and an overall opaque information environment. Additionally, the impact of common auditors on audit quality is more pronounced for group affiliates that have a more opaque firm-level information environment and are monitored by heightened institutional ownership.Practical implicationsWhile affiliates are more likely to select the same audit firms as common auditors, the evidence regarding the effects of common auditors is mixed. The results of this study provide further insights into auditor choices for group-affiliated firms and offer a potential avenue for better protecting shareholders' interests.Originality/valueThe results of this study add to the ongoing debates regarding the costs and benefits of common auditor choice for group affiliates. To the best of the authors’ knowledge, this study is the first to demonstrate that the effects of common auditors may vary in different external environments.

Comparative outcomes of selective laser trabeculoplasty delivered by optometrists compared with ophthalmologists: a UK-based multicentre observational study

BackgroundSelective laser trabeculoplasty (SLT), a National Institute for Care and Health Excellence recommended first-line treatment for open-angle glaucoma and ocular hypertension, is increasingly delivered by optometrists. This retrospective multicentre observational...

지방자치단체의 감사제도와 자치권 보장

Currently, local governments operate various types of auditing systems. Audits by the National Assembly, the Board of Audit and Inspection, external audits by the central government, internal audits by local assemblies and internal audit bodies, and so on. In the case of foreign countries, since the autonomy of Korea is guaranteed, the internal audit system is well developed rather than the local or federal government. However, in Korea, rather than assuring the autonomy of the local autonomous entities, auditing at the central level is taking place, and self--audits by local assemblies and internal audit bodies are often carried out at the formal level. Local governments operate these types of auditing systems, but there are still many problems with the auditing system of local governments. Especially, there are many kinds of auditing system and there is insufficient division of the scope of auditing, and audits are conducted to make duplicate audits or unnecessary affairs. Self-audit There is also a lack of independence and expertise, so insufficient effectiveness of auditing and lack of support from self-audit bodies limits the ability to influence However, in order to guarantee the autonomy of the local autonomous entities of the local autonomous entities, Korea will examine the ways of improving the external audits and strengthening the self - audit, and discuss the audit system to guarantee the autonomy of the local autonomous entities.

Measuring the impact of automated dispensing cabinets implementation on data and inventory management of human normal immunoglobulin in an acute teaching hospital: A pre- and post- intervention study

BackgroundHuman Normal Immunoglobulin (HNIg) is a complex plasma-derived blood product used to treat a variety of medical conditions. Global supply problems have increased focus on HNIg stewardship, including mandatory recording of HNIg usage on the National Immunoglobulin Database (NIgD). Local departmental audits identified significant inconsistencies in data uploaded to NIgD. Inventory management issues caused a number of stock losses in the last financial year. A paper-based HNIg batch number recording system was replaced with the use of Automated Dispensing Cabinets (ADCs), which generated an electronic batch number report, with matching fields required for electronic upload to NIgD. AimTo measure the impact of ADC implementation on the accuracy of data uploaded to NIgD, HNIg stock control and staff time associated with processes of HNIg data and inventory management. MethodThree months of pre- and post-implementation HNIg dispensing data was compared to the data uploaded to the NIgD for discrepancies. Inventory reports were used to identify unexplained stock adjustments. Time and motion methods were used to quantify staff time associated with HNIg activities. ResultsPre-implementation: 20.7 % (3762.5 g/18,217 g) of HNIg by volume (23.7 % of dispensing episodes; 66/279) were inaccurately uploaded or absent on the NIgD and three stock adjustments were made (loss of >£15 k). Post-implementation: 12 % (2325 g/19,347 g) of HNIg by volume (10.8 % of dispensing episodes; 31/286) were inaccurately uploaded or absent on the NIgD and zero stock adjustments were observed; Mean time for dispensing per HNIg prescription reduced from 17 min to 8 min; Time spent uploading data to NIgD per month reduced from 5 h to 1.75 h. Discussion/ConclusionThe use of ADCs improved accuracy of NIgD data upload. Following implementation direct observations have cited unregistered or finished patient episodes, dispensing procedural compliance, and user familiarity with the system as common reasons for incomplete data uploads to NIgD. The new ADC process had consequences of forcing dispensing procedure compliance to improve uploads, whilst reducing dispensing times. It led to improved stock control and removed upload burden from dispensers. ADC stock discrepancy alerts allowed staff to proactively resolve discrepancies in real time. Time taken for additional processes to support management of stocks in ADCs, including monthly stock cycle counts, were important considerations for implementation. The key advantage of using ADC batch number reports is the ability to upload as a single monthly batch without having to manually access individual patient records on the NIgD. It facilitates early identification of failed upload attempts and supports resolution of stock discrepancies.

FP7.7 - Evaluation of small bowel obstruction management: A local audit in comparison to NASBO guidelines

Abstract Aims The National Audit of Small Bowel Obstruction (NASBO) report provides recommendations for optimising the management of small bowel obstruction (SBO). We aimed to audit our management and compare our outcomes with the NASBO report. Methods Retrospective case reviews were conducted for 115 patients admitted with SBO from July-December 2022, evaluating adherence to NASBO guidelines and assessing outcomes. Results The average age was 76 (21-94) years old; 53% male and 47% female. Adhesions (41.7%), hernias (30.4%), malignancy (13%) and inflammatory bowel disease (6.1%) were predominant causes. Treatment included conservative management in 67% of cases, surgery in 27% (of which, 6.1% had a trial of conservative management initially) and palliative care in 6.1%. A summary of the management and outcomes below.Table 1:Summary of managementCT scan on admissionAverage time to CTSurgery performedAverage time to surgeryNutritional screening assessmentLocal audit98.3%9 hours27%2.4 days100%NASBO80%2.2 days48%1 day90%Table 2:Summary of outcomesUnable to eat normally for ≥5 daysAverage length of stay30-day mortality30-day readmissionLocal audit12%7 days14%18%NASBO49%10.7 days8%13% Conclusion We are performing CT scans in a timely manner and screening for malnutrition. Despite a shorter length of stay compared to NASBO, our audit has identified opportunities to improve hospital readmission, suggesting that we may be discharging patients prematurely. We have introduced a SBO checklist to ensure NASBO recommendations are adhered to and to improve our 30-day outcomes.

SP5.5 - Is Cardio Pulmonary Exercise Testing a Predictor of Success in Colorectal Resections? An Evaluation of Two Years Practice in a University Hospital Colorectal Unit

Abstract Aims Cardio pulmonary exercise testing (CPET) has a well establish evidence basis in risk stratification of post operative morbidity. Frail and comorbid patients are at higher risk of complications. These patients may also have impaired aerobic fitness. Changes in UK population demographics mean that colorectal resections are now widely performed in patients with extensive comorbidity and poor aerobic fitness. In this group of patients, return to normal function at home is a key measure of operative success. The aim of this study was to investigate whether CPET performance can predict "days alive at home at 30 days after surgery" (DAH30) in patients undergoing colorectal resection. Methods Approval for evaluation granted by local audit team. All Colorectal resection conducted between January 2020 and January 2022 were analysed. Patients who did not undergo CPET were excluded. Electronic records and notes were screened to establish whether readmission, complications (Clavien-Dindo >1) or mortality occurred in the 30 days post operatively. Data was captured in a database and analysed in JASP. Results Only preliminary results are available at time of writing. Full results will be available at time of presentation. We collected data on a total of 454 patients. 85% underwent CPET testing with median age of 69 years. Risk of major complication was twice as high in the poor CPET group (RR 1.97). Those in good CPET group were twice as likely to be home at 30 days (RR 1.93). Conclusions Preliminary results suggest cardiopulmonary exercise test is an effective means of predicting DAH30.

WP2.13 - Local Audit based on MAGIC study to improve abscess management at Royal Devon University Healthcare Trust

Abstract Aim To assess efficacy of current management approaches of subcutaneous abscess at the Royal Devon University Healthcare Trust (RD&E). Methods Our audit is based on the MAGIC (Management of Acute surGIcal absCesses) national audit which involved anonymous retrospective analysis of patient records at the RD&E during September – December 2022. We collected data on patient demographics, clinical characteristics and their management. Furthermore, we conducted a literature review to compare our results to the recommended practice. Results 31 patients records were analysed whereby 22 underwent surgical intervention (general anesthetic 17, local anesthetic 5) whereby the most common incision type was transverse (n=7). Nine patients were diabetic, two were immunosuppressed, 29 had hidradenitis suppurativa, while 19 had a past medical history of abscesses (n=31). The most common abscess type was pilonidal sinus (n=10). Eighteen patients received antibiotics prior to hospital admission, 12 of whom underwent surgery. Furthermore, 19 patients received antibiotics upon admission to hospital (n=31). Of the surgically treated cohort, 19 underwent packing and six were discharged with antibiotics. Conclusion Most subcutaneous abscess are approached surgically. However, postoperative care varies widely, with prolonged packing and frequent use of antibiotic postoperatively. Literature reviews have suggested no benefit of postoperative packing and specified certain circumstances of antibiotic use. Furthermore, clear communication with primary care providers detailing clear postoperative instructions is vital for patient safety and cost effectiveness.

A local audit evaluating bone health in patients with functional hypothalamic amenorrhoea secondary to an eating disorder and a review of the application of hormone therapy in this clinical setting.

It is widely known that estrogen has a fundamental role to play in skeletal homeostasis. In the most reductionist sense, the action of estrogen can be surmised as anti-resorptive. Estrogen prevents the break-down of bone. It therefore follows that estrogen deficiency states, such as the menopause and functional hypothalamic amenorrhoea (FHA), are often characterised by increased bone remodelling and disrupted skeletal homeostasis. FHA is the cessation of menstruation secondary to abnormal signalling between the hypothalamus and pituitary gland due to deficient pulsatile secretion of Gonadotrophin Releasing Hormone (GnRH). Functional hypothalamic amenorrhoea is frequently a consequence of women suffering with eating disorders. The development of FHA secondary to eating disorders is an evolutionary adaptive response to chronic metabolic energy deficiency. Fundamentally, preservation of life is biologically prioritised over dispensable physiological process such as reproduction. Consequently, the hypothalamic-pituitary-ovarian (HPO) axis fails, which disrupts menstrual function and ovulation, culminating in a state of estrogen deficiency. One of the most important and long-lasting deleterious consequences of FHA is disrupted skeletal homeostasis and bone loss. Estrogen replacement, most commonly in the form of combined hormone replacement therapy (HRT) or the combined oral contraceptive pill (COCP), is advised for women with an early menopause to prevent bone loss. Arguably, estrogen replacement should also be utilised in the context of FHA. However, the optimum estrogen regime for women with FHA remains under-researched and so management is not evidence-based.

How Does Artificial Intelligence Shape Audit Firms?

Does artificial intelligence (AI) displace auditors? We exploit the staggered hiring of AI employees at audit office locations across the United States as a proxy for the use of AI at local audit offices. The main findings are as follows. First, relative to audit offices that do not yet hire AI employees, those that do hire AI employees have a 4.3% increase in the number of auditor jobs, particularly among junior and midlevel auditors. Second, using AI is associated with an increased demand for soft skills (e.g., cognitive skills) in auditor jobs. Third, audit offices that use AI have more accurate going concern and internal control opinions. Semistructured interviews of 11 seasoned audit partners confirm that investment in AI is centralized at the national level, but the decision to deploy it often resides at the local audit office level. Notably, none of the partners believe that AI has replaced or will replace human auditors. Overall, our study—comprising both empirical and qualitative data—suggests that using AI does not replace auditors, but rather changes the skills required for these jobs and improves audit quality. This paper was accepted by Suraj Srinivasan, accounting. Funding: K. K. F. Law’s research is supported by the Start-Up Grant from Nanyang Technological University and the Ministry of Education (MOE), Singapore, under its Academic Research Fund Tier 1 [Grant RG128/20]. M. Shen’s research is supported by the Start-Up Grant from the National University of Singapore [Grant A-0003914-00-00] and the MOE under its Academic Research Fund Tier 1 [Grant A-8000098-00-00]. Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2022.04040 .

Is Auditors’ Migration Status Associated with their Performance?

We investigate whether audit quality is associated with auditors’ migration status at the time of their entry to the job market after obtaining their academic degrees. Moving from less (more) to more (less) economically developed regions is termed as upward (downward) migration. Using a large sample of auditors in China, we find that upwards (downwards) migrating auditors tend to deliver higher quality (lower quality) audits than nonmigrating auditors. The association between migration status and audit quality varies predictably with auditor and client characteristics. Upwards migrating auditors are more successful in their career development than local auditors, and investors and clients appear to understand the varying audit quality provided by migrating auditors. Overall, our results are consistent with the hypothesis that employers underestimate (overestimate) the ability of upwards (downwards) migrating graduates in the recruitment process.

The role of auditing culture in sustainable mining practices: A review of Ghana’s mining sector

The study looks at Ghana’s mining industry’s audit culture and green mining practices about their social responsibility to the communities where their mines are located. Results: According to this study, the economic motivations of mines and green mining are inversely related. Even large mining companies incur significant costs associated with their green mining initiatives because they require a different budget each year, which has an impact on their ability to maximize wealth. Conversely, mines with strong green mining initiatives enjoy positive public perception, and vice versa. Ghanaian mines do not have pre- or during-mining strategies; instead, they only have post-social and post-environmental methods. The best method for evaluating mines’ environmental performance in the community in which they operate is, according to this study, social auditing. This is primarily influenced by the mine’s audit culture, but it is also influenced by the auditor’s compliance with audit processes, audit guidelines, and, ultimately, the audit firm’s experience. The analysis confirms that Ghana’s mine environmental performance is appallingly low since local audit firms are not used in favor of foreign auditors who lack experience or empathy for the problems encountered by these mining communities. Last but not least, corporate social responsibility (CSR) is connected to Ghana’s development of green mining, either directly or indirectly. Whether the mine adopts a technocrat, absolutist, or relativist perspective on mining will determine this. The study discovered that, in contrast to the later approach, the first two views generate work in a mechanistic manner with little to no consideration for CSR.

470 Survival Stratification After Proximal Femoral Fracture Surgery Using the Modified Glasgow Prognostic Score

Abstract Aim Proximal femoral fracture (PFF) after blunt trauma is common and significantly associated with mortality. A simple scoring system based on systemic inflammation, the modified Glasgow Prognostic Score (mGPS), has been shown to stratify survival in patients with malignant disease and we wished to assess its usefulness in the trauma cohort. Method Patient demographics, albumin, C-reactive protein (CRP), and survival data were retrospectively obtained from a previous local hip fracture audit of 278 adult (>18 years) patients whose PFFs were repaired between October 2012 and April 2014 at the Queen Elizabeth University Hospital, Glasgow. Follow-up was for 18 months allowing the generation of survival curves and univariate analysis using Kaplan-Meier and Log Rank analyses. Multivariate survival analysis and hazard ratios were calculated using Cox Regression. Results The median survival was 26.5 months with a 41.4% 1-year mortality. On univariate analysis, one year mortality was associated with advanced age (>80 years, p<0.0001), American Society of Anaesthesiology (ASA) score(p<0.0001), CRP (>10mg/L, p=0.027), Albumin (<35g/L, p=0.007), type of surgery (p=0.005) and mGPS (p=0.016). On multivariate analysis advanced age (p<0.001), male gender (p=0.016), ASA score (p<0.001) and mGPS (p=0.027) retained significance as predictive factors for 1-year mortality. A higher mGPS was associated with a shorter median survival (37.4, 27.6 and 24.0 months for mGPS 0, 1 and 2 respectively (p=0.048)). Conclusions This study demonstrated a statistically significant survival association with advanced age, ASA score, male gender and mGPS. This is the first study looking at mGPS as a predictive factor for one year mortality following PFF.

777 Local Audit Based on MAGIC Study to Improve Abscess Management at Royal Devon University Healthcare Trust

777 Local Audit Based on MAGIC Study to Improve Abscess Management at Royal Devon University Healthcare Trust

A novel colorectal cancer test combining microsatellite instability and BRAF/RAS analysis: Clinical validation and impact on Lynch syndrome screening

BackgroundLynch syndrome (LS) is under-diagnosed. UK National Institute for Health and Care Excellence guidelines recommend multistep molecular testing of all colorectal cancers (CRCs) to screen for LS. However, the complexity of the pathway has resulted in limited improvement in diagnosis.MethodsOne-step multiplex PCR was used to generate sequencing-ready amplicons from 14 microsatellite instability (MSI) markers and 22 BRAF, KRAS, and NRAS mutation hotspots. MSI and BRAF/RAS variants were detected using amplicon-sequencing and automated analysis. The assay was clinically validated and deployed into service in northern England, followed by regional and local audits to assess its impact.ResultsMSI analysis achieved 99.1% sensitivity and 99.2% specificity and was reproducible (r = 0.995). Mutation hotspot analysis had 100% sensitivity, 99.9% specificity, and was reproducible (r = 0.998). Assay-use in service in 2022–2023 increased CRC testing (97.2% (2466/2536) versus 28.6% (601/2104)), halved turnaround times, and identified more CRC patients at-risk of LS (5.5% (139/2536) versus 2.9% (61/2104)) compared to 2019–2020 when a multi-test pathway was used.ConclusionA novel amplicon-sequencing assay of CRCs, including all biomarkers for LS screening and anti-EGFR therapy, achieved >95% testing rate. Adoption of this low cost, scalable, and fully automatable test will complement on-going, national initiatives to improve LS screening.

Local Government Internal Audit Quality: Input Factors, Individual Level (Study on Inspectorate Auditors in North Sulawesi Province)

Local Government Internal Audit Quality: Input Factors, Individual Level (Study on Inspectorate Auditors in North Sulawesi Province)

Investigating ISA adaptation in a developing country context: the selective influence of Big Four affiliates

ABSTRACT This paper examines how the national process of adapting the International Standards on Auditing (ISAs) unfolds in developing countries, focusing on the case of Egypt. The study relies on data gathered from 33 semi-structured interviews with government officials and senior auditors alongside documentary evidence. Our findings show how legacy state institutions that were involved in the national standard-setting committee have largely fallen short of their aspirations to align local auditing standards with the expectations set out in the ISAs. The lack of a coherent approach to developing state policy objectives, resources, and public consultation, together with technical demands and translation difficulties, hampered the process. Such weaknesses provided an opportunity for the local Big Four affiliates to become deeply involved. The firms’ strategic manoeuvres were driven not only by a material desire to protect their market position/status but also by a commitment to a perceived national duty to support government attempts at national standard-setting. Importantly, our findings reveal the selectivity of such interventions and the differential impact of ISA adaptation on the diverse constituency of audit firms. Theoretically, we propose the institutional void perspective to conceptualise the intervention of private actors as well as to articulate the elements of a void in an audit regulatory process. While Big Four firms typically seek to position themselves in such processes, we argue that international reforms and policies should focus on fostering a more inclusive, accountable, and deliberative system that promotes the presence of diverse, independent and representative local audit actors.

Abstract PO1-23-04: The IBRAnet localisation study; a UK National multi-centre cohort study comparing the safety and effectiveness of guidewire, RFID, and magnetic seed- guided localisation for impalpable breast lesions

Abstract Background Wire-guided localisations (WGL) of breast cancers have been the gold-standard for pre-operative localisation of non-palpable breast cancers for many years but have significant limitations. Newer localisation techniques have been introduced including Radio Frequency ID tags (RFID) and magnetic seeds which aim to overcome these limitations. The UK iBRA-net group have designed a multi-centre platform study aiming to compare the safety and effectiveness of wire, RFID, magnetic seeds, and radar-based localisation. A second aim was the qualitative assessment of shared learning as users gained experience. Methods A UK national multi-centre prospective observational platform study was designed to compare a control arm of WGL for women undergoing breast conserving surgery with two interventional arms of RFID tags and magnetic seeds. Patient data were collected between August 2018 and July 2022 in UK centres. The primary outcome was accurate excision of the index lesion at the time of surgery. Secondary outcomes were defined as; resection margins, breast reoperation rate (planned and unplanned), complications, cancellation rate on day of surgery, and duration of the surgery. To account for lesion size in the assessment of excision weight, we used size as a denominator over two dimensions, reporting this as weight/size2, in g/mm2. Data was collected prospectively on a secure REDcap database following approval from local audit departments. To calculate the sample size a power calculation was employed, with n=950 patients per group the upper limit of the observed one-sided 95% confidence interval for the difference between identification rates (intervention vs WGL) is expected to be less than 0.9% with 80% power, assuming the two methods both have an expected identification rate of 99.4%. Simple summary statistics were calculated for each outcome and data were tested for distribution and differences between groups using unpaired t-tests, Mann-Whitney U tests, and Chi squared tests as appropriate. Analyses were conducted using Stata® IC version 14 (StataCorp, College Station, Texas, USA). Results Data were accrued from 3484 patients in 55 units. This included 1293 patients having WGL, 1188 RFID tags, and 1003 magnetic seeds. RFID had a lower rate of identification of the index lesion compared to magnetic seed and wire (97.9% vs. 99.8% vs. 99.1% respectively). When comparing the reasons behind failure of the primary outcome, the majority were not thought to be related to the modality of localisation. Data from 1560 patients with unifocal, unilateral breast lesions were included in subgroup analysis, excluding those having neo-adjuvant chemotherapy and those having therapeutic mammoplasty. Positive margins were lower in RFID excisions compared to wire (11.2% vs. 15% respectively, p< 0.05), whereas magnetic seed were equivalent (11.2 % vs 13.3%, P=0.22). Routine cavity shaves were performed in 64.5% of WGL vs 48.3% of RFID vs 64.3% of magnetic guided excisions. There was no difference in specimen weight/size2 (0.138 WGL vs. 0.131 RFID vs. 0.15 magnetic seed). Re-excision (for positive or close margins) was equivalent across the three groups (13.2% of wire vs 15% of RFID vs 12.3% of magnetic seed guided excisions, p=0.3). There have been four shared learning educational events focussing on three key themes relating to preoperative, intraoperative, and postoperative learning outcomes in addition to 130 database shared learning entries. This may aid other surgeons as they adopt these techniques. Conclusions All three localisation devices demonstrate high levels of localisation accuracy. There was a higher rate of device dislodgement in the RFID group, which was also identified in the shared learning events. However, re-excision rates were equivalent across the three groups. This study has demonstrated a robust platform for the comparative evaluation of new localisation technologies and of sharing learning and experience. Citation Format: Rachel Foster, James Harvey, Rajiv Dave, Anthony Maxwell, Senthurun Mylvaganam, Matthew Gardiner, Sue Down, Nicola Barnes, Mihir Chandarana, Shelley Potter, Yazan Masannat, Chris Holcombe, Tahir Masudi, Amtul Carmichael, Robert Milligan, Jenna Morgan. The IBRAnet localisation study; a UK National multi-centre cohort study comparing the safety and effectiveness of guidewire, RFID, and magnetic seed- guided localisation for impalpable breast lesions [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-23-04.

THE USE OF CELL SAVER IN PROSTHETIC JOINT INFECTION SURGERY: IS IT REALLY CONTRAINDICATED?

The benefits of cell salvage autotransfusion are well reported. There is a common non-evidenced belief amongst revision arthroplasty surgeons that auto-transfusion is potentially contraindicated in infected revisions.The aim is to study the immediate and delayed outcomes of using cell saver on patients undergoing PJI surgery.Prospective cohort service evaluation registered with the local audit department. 20 PJI cases in 18 patients where cell saver was used over a period of 4 years. Intraoperative fluid and tissue samples were taken for culture. Blood culture from salvaged blood pre and post leucodepletion filter were sent for microbiological analysis. Data on type of surgery, blood loss, further allogenic transfusion and SIRS response was collected. Success of infection clearance was assessed using 2019 MSIS ORT. Five patients receiving autologous blood in non-infection cases were used as controls.Mean age for the PJI group was 67.7 years, 67% female. 11 patients (67%) had 1st stage surgery and 5 (25%) underwent 2nd stage whereas 4 patients had single stage surgery. The mean calculated blood loss was 1398 mls (range 400–3000mls). 6 Patients required further allogenic transfusion. 16 patients received blood via a leuco-depletion filter. The same organism grown from tissues was identified in post-filter blood in 8/17 patients (47%).2/20 have grown a different organism in post-filtered blood, _P.Acne._2 patients developed SIRS upon auto-transfusion, however one was thought to be secondary to cementing. The control group had 443 mls mean amount of blood loss and 1 patient developed a SIRS response.14/20 (70%) patients had successful clearance of infection (tier 1) 2 patients died prior to undergoing 2nd stage.Using cell saver did not impact main outcome of infection clearance in PJI surgery. We would advocate its routine usage whilst avoiding direct collection of heavily contaminated blood.