Postprocedural Research Articles

Abstract 12177: Quantitative Flow Ratio is a Great Predictor of Microvascular Obstruction in ST-Segment Elevation Myocardial Infarction After Percutaneous Coronary Intervention

Backgrounds: Compare the predictive effects of ST-segment resolution (STR) and quantitative flow ratio (QFR) in the detection of MVO in STEMI patients after PCI. Research Questions: To investigate the efficacy of STR/QFR in the evaluation of MVO detected by CMR in STEMI after PCI. Methods: A prospective cohort study enrolled 208 consecutive patients with STEMI. The degree of STR post procedure and predischarge after reperfusion was calculated. QFR were measured according to the angiography, CMR was performed within median time 5 days after revascularization to determine MVO. Clinical factors were enrolled to predict the incidence of MVO. Results: The MVO/LV mass is 1.42±2.28 in 126 patients with MVO according to CMR, and the area under ROC curves (AUC) identified QFR is the best predictor (AUC: 0.784, P <0.001). Factors including QFR, STR, TIMI flow, CK-MB, cTnI, WBC, and HsCRP showed good predictive effects for the incidence of MVO ( P <0.05). Except for peak cTnI, QFR (%) was the best predictor (AUC: 0.784, P <0.001) ( Figure 1 ). A nomogram for predicting MVO was done (c-index: 0.894) ( Figure 2 ). A significant correlation was observed between STR and various parameters ( P <0.05), except for the correlation between predischarge STR and MVO/LV mass at 6 months. Predischarge STR has the best correlation with infarct size after the 6-month follow-up ( r =-0.509, P <0.001) ( Figure 3 ). Regression analysis indicated that postoperative STR (β=-0.248, P =0.007) was a significant predictor of MVO/LV mass ( Figure 3 ). Figure 4 further analyzed heart function from in-hospital CMR between different postoperative STR levels, and from 6 months CMR between predischarge STR subgroups. Higher STR predicted less cardiac injury and more ideal index of cardiac remodeling. Conclusions: In STEMI patients after PPCI, QFR demonstrated better predictive effect of the incidence of MVO than STR. Predischarge STR is closely related to infarct size and ejection fraction after 6-month follow-up.

Abstract 16357: Reducing Repeat Transthoracic Echocardiograms in the Inpatient Setting

Background: Transthoracic echocardiogram (TTE) is a common cardiovascular imaging test for hospitalized patients. Repeat TTE testing, defined as a TTE done within one year of a prior TTE, contribute to high resource utilization without clear impact on changes in management. Hypothesis: An interruptive electronic medical record (EMR) alert deployed for repeat TTEs will decrease TTE overordering and will help elucidate reasons behind TTE ordering practices. Methods: We created an interruptive EMR alert for five hospitals within the Johns Hopkins Health System (JHHS). The alert was triggered when an inpatient TTE was ordered for non-ICU/non-cardiology service patients with a completed TTE within the prior 90 days. The alert displayed most recent TTE results and prompted the clinician to continue with the order or not. If order continuation was selected a free text clinician reason was required. Outcomes were length of stay (LOS) and reduction in repeat TTE orders. Focus groups were held with internal medicine residents to understand practice behaviors, given this was a leading cohort that continued with orders. Results: From July 2021- July 2022 the alert triggered 4,976 times, of these 32% of orders were discontinued while 68% were continued. There was no significant reduction in repeat TTE order attempts per month. More orders were continued at academic hospitals compared to the community setting (71% vs 63%, p=<0.01). Medicine and non-medicine departments continued the order at similar rates (69% and 67%, p=0.12). Patients who had a repeat TTE had a longer average LOS compared to those who did not (14 vs 11 days, p=0.08). Twenty internal medicine residents were interviewed for focus groups. Top reasons for order continuation were a change in clinical status (n=8), worsening of chronic conditions (n=5), and post procedure monitoring (n=3). Majority (70%) requested more education within the alert to guide indications for repeat TTE ordering. Conclusion: EMR alerts can reduce repeat TTEs without increasing LOS, however knowledge gaps persist for ordering providers. Iterative changes to our health system EMR alert with a focus on best practice guideline incorporation and education may better mitigate overordering, and thus acute care utilization, in the future.

Nonsteroidal Anti-inflammatory Medications in Cranial Neurosurgery: Balancing Opioid-Sparing Analgesia with Bleeding Risk

Post-craniotomy pain is a common problem frequently encountered by neurosurgeons. This is typically managed with opioids; however, opioids have been shown to increase intracranial pressure by way of hypercapnia and straining from the associated constipation. Additionally, opioids can confound and mask the neurologic examination of post-craniotomy patients as well as be the nidus for a potential opioid addiction. Thus, alternative solutions for opioids have been a major topic of investigation within the neurosurgical community. Non-steroidal anti-inflammatory drugs (NSAIDs), present as a potential solution due to their non-addictive and analgesic properties, but utilization of NSAIDs in neurosurgical patients has been controversial given that NSAIDs alter platelet function. Whether the degree to which NSAIDs alter platelet function and bleeding time to clinically relevant manner has remained controversial; although, there have been several well-designed studies concluding that the utilization of NSAIDs in post-craniotomy patients does not increase the risk of postoperative bleeding. Herein, we review the pharmacology, efficacy, and safety of NSAIDs with a particular emphasis on NSAID use for post intracranial neurosurgical procedure pain management.

Role of gastric peroral endoscopic myotomy (GPOEM) in chronic gastroparesis management after pancreas transplantation.

Gastroparesis is a common complaint among patients with diabetes. Symptoms tend to improve following successful pancreas transplantation (PTx), but persist despite euglycemia in a subset of patients. We aimed to assess the benefit of gastric peroral endoscopic myotomy (G-POEM) in persistent gastroparesis following PTx. This was a single center retrospective review of all patients who underwent G-POEM for persistent gastroparesis following PTx. Patient demographics, pre and post procedure perception of symptom severity according to the patient assessment of upper gastrointestinal symptoms severity index (PAGI-SYM), gastroparesis cardinal symptom index (GCSI) score, and 36-item short form survey (SF36) score along with gastric emptying scintigraphy (GES) were analyzed. Seven PTx recipients underwent G-POEM for persistent gastroparesis symptoms. The majority were female. All reported nausea/vomiting, abdominal pain, bloating, and post prandial fullness prior to G-POEM. The post procedure survey scores improved in all patients although this was not significant. The improvement in gastric emptying on GES was statistically significant. G-POEM is a relatively new treatment option for gastroparesis. While it requires specialized proceduralist and training, we have documented improvement in the management of symptoms. With increasing experience, we anticipate more significant benefit in post PTx patients with persistent symptoms of gastroparesis undergoing G-POEM.

Abstract 246: Effect of platelet count on outcome in ischemic stroke patients with LVO undergoing MT;a meta‐analysis

Introduction Large randomized clinical trials have established the superiority of Mechanical Thrombectomy (MT) for the treatment of Large Vessel occlusion (LVO) in patients with Acute Ischemic stroke (AIS) in terms of revascularization rates and clinical outcomes as compared to IV‐tPA alone.(1, 2, 3) However, Data regarding outcomes of mechanical thrombectomy in patients with low platelets is limited and shows conflicting results. (4, 5, 6, 7, 8) Methods This meta‐analysis was performed according to the preferred reporting items for systematic review and meta‐analysis (PRISMA) guidelines.(9) We defined thrombocytopenia as platelet count < 150,000 /μL. We further classified these patients into two groups: 1) Mild thrombocytopenia (Platelet count 100,000 – 149,000 /μL) and 2) Moderate to severe thrombocytopenia (Platelet count <100,000 /μL). The favourable outcome was 90‐day functional independence, designated as an Modified Rankin Score (MRS) ≤ 2 at 90 days. Unfavorable outcomes were 1) Symptomatic Intracranial hemorrhage (sICH) and 2) Mortality at 90 days. Results All studies were determined to be of good/high quality (Newcastle Ottawa scale).(10) Compared to patients with normal platelets, Patients with low platelets (< 150,000 /μL) had a statistically significant worse outcome (mRS >2 )at 90 days (RR 0.80 [95% CI: 0.69 ‐ 0.94] p = 0.006). However, on analysis based on different platelet cutoff values, the difference in mRS score was not statistically significant in patients with Mild low platelets (100,000 – 149,000 /μL) (RR 0.84 [95% CI: 0.70 ‐ 1.00] p = 0.05) and moderate/severely low platelets (< 100,000 /μL) (RR 0.71 [95% CI: 0.48 ‐ 1.06] p = 0.09) when compared to patients with normal platelets. Similarly, Mortality was significantly increased in patients in the low platelet group (RR 1.95 [95% CI: 1.62 ‐ 2.36] p < 0.00001). Mortality was also significantly increased in the mild low platelet subgroup (RR 1.88 [ 95% CI: 1.34 ‐ 2.63] p = 0.0002) and moderate/severe low platelet subgroup (RR 2.07 [95% CI: 1.46 ‐ 2.92] p < 0.0001) when compared to patients with normal platelets. Furthermore, sICH events were significantly increased in patients in the low platelet group (RR 2.47 [95% CI: 1.51 ‐ 4.05] p = 0.0003). Similarly, on analysis based on different platelet cutoff values, sICH was also significantly increased in the mild low platelet subgroup (RR 2.34 [ 95% CI: 1.24 ‐ 4.40] p = 0.008) and moderate/severe low platelet subgroup (RR 4.13 [95% CI: 2.00 ‐ 8.50] p = 0.0001). Conclusion Our meta‐analysis revealed that compared to individuals with normal platelet count, those with platelet count (< 150,000 /μL) had worse functional outcomes (MRS ≤ 2) , higher mortality rates, and a greater incidence of sICH. However, on analysis based on different platelet cutoffs, difference in MRS score was insignificant while the mortality rates and sICH incidence remained significantly higher. This may be attributed to smaller number of studies in the “cut‐off” groups leading to decreased power. Nevertheless, our findings suggest that MT for LVO in patients with low platelets leads to worse outcomes, however these risk were not significant in group with mild thrombocytopenia. Hence, Clinicians should carefully monitor for these risks while performing procedure or post procedure care.

A STUDY INTO THE DIAGNOSTIC YIELD OF FIBER-OPTIC BRONCHOSCOPY AT RURAL MEDICAL COLLEGE IN THE POST COVID ERA

Introduction: Thefiber-optic bronchoscopy (FOB) has become an integral and essential part of respiratory medicine as diagnostic, therapeutic and interventional modality due to advancement that has occurred during last five decades. FOB facilitates direct visualization of centrally located lung pathology and the biopsies can also be procured from lung parenchyma. The diagnostic yield is variable and depends upon available resources and skill. Material and Method: 241 cases of FOB that were performed in post Covid-19 era were evaluated for diagnostic yieldat RD Gardi Medical College hospital, Ujjain, India. Results: 230 cases of FOB done for the diagnosis were considered for study after exclusion of 11 casesin which FOB was performed for therapeutic or other reason. The male predominance was found with > 80% in the patients belonging to age group of 41 yrs and above. The diagnostic yield remained at 82.6% including the inflammatory malignancy, bacterial TB and fungal infection which were 36.3%, 33.7%, 17.9, 7.4% and 3.2 % respectively. Discussion: The clinical, radiologic, and pathologic investigations are prerequisite and determine the indication to perform endoscopy for further evaluation and it helps in selecting procedure during FOB. The gross abnormalities are not always seen but TBLB, TBNA and inflammatory cytology of BAL definitely helpful in diagnostic yield. The minor complications during and post procedure are not uncommon. Occasionally the anatomical variations and anomalies of the airways can also be detected during FOB. Conclusion: The FOB enables to procure tissue and secretions from the airways and also facilitates evaluation of lung parenchyma for diagnosis of underlying pathology. The advancement in multifunctional utility of FOB, supported with basic knowledge of guidelines, with expertise and skill is required for better outcomes.

Sequential, ultrasound-guided, minimally invasive pit-picking procedure with Nd:YAG laser epilation treatment for pilonidal disease.

<b><br>Aim:</b> The aim of this retrospective study was to evaluate our treatment for pilonidal disease in adolescent patients, which uses ultrasonography, minimally invasive pit-picking, and Nd:YAG laser therapy.</br> <b><br>Material and methods:</b> We included 52 of 147 patients treated between June 2017 and December 2020. The patients underwent pit-picking procedures and 6-10 Nd:YAG treatments. The remnants of the cysts were removed by laser therapy, which provided easy epilation. Each patient underwent multiple ultrasound examinations during the therapy to uncover any potential newly formed asymptomatic sinuses. When such issues were identified, the pit-picking procedure was repeated on those sinuses.</br> <b><br>Results:</b> A total of 52 patients were included in this study with a 1-year follow-up following the procedure. There were 49 symptom-free patients (96%). One patient underwent surgery in another hospital because of a recurrence and 1 had a pilonidal disease relapse (4%). In the follow-up period, asymptomatic cysts were found in 2 other patients by ultrasound examination. They were all treated with a pit-picking procedure in the outpatient department with good results.</br> <b><br>Conclusions:</b> Combining sequentially repeated pit-picking procedures and Nd:YAG laser therapy is an effective treatment method for adolescent pilonidal disease. Simultaneous Nd:YAG laser therapy enables efficacious epilation of the intergluteal cleft. Repeatable ultrasonography examinations allow for early diagnosis of possible pilonidal sinus relapse.</br&gt.

Superior semicircular canal dehiscence and subsequent closure induces reversible impaired decision-making.

Vestibular loss and dysfunction has been associated with cognitive deficits, decreased spatial navigation, spatial memory, visuospatial ability, attention, executive function, and processing speed among others. Superior semicircular canal dehiscence (SSCD) is a vestibular-cochlear disorder in humans in which a pathological third mobile window of the otic capsule creates changes to the flow of sound pressure energy through the perilymph/endolymph. The primary symptoms include sound-induced dizziness/vertigo, inner ear conductive hearing loss, autophony, headaches, and visual problems; however, individuals also experience measurable deficits in basic decision-making, short-term memory, concentration, spatial cognition, and depression. These suggest central mechanisms of impairment are associated with vestibular disorders; therefore, we directly tested this hypothesis using both an auditory and visual decision-making task of varying difficulty levels in our model of SSCD. Adult Mongolian gerbils (n = 33) were trained on one of four versions of a Go-NoGo stimulus presentation rate discrimination task that included standard ("easy") or more difficult ("hard") auditory and visual stimuli. After 10 days of training, preoperative ABR and c+VEMP testing was followed by a surgical fenestration of the left superior semicircular canal. Animals with persistent circling or head tilt were excluded to minimize effects from acute vestibular injury. Testing recommenced at postoperative day 5 and continued through postoperative day 15 at which point final ABR and c+VEMP testing was carried out. Behavioral data (d-primes) were compared between preoperative performance (training day 8-10) and postoperative days 6-8 and 13-15. Behavioral performance was measured during the peak of SSCD induced ABR and c + VEMP impairment and the return towards baseline as the dehiscence began to resurface by osteoneogenesis. There were significant differences in behavioral performance (d-prime) and its behavioral components (Hits, Misses, False Alarms, and Correct Rejections). These changes were highly correlated with persistent deficits in c + VEMPs at the end of training (postoperative day 15). The controls demonstrated additional learning post procedure that was absent in the SSCD group. These results suggest that aberrant asymmetric vestibular output results in decision-making impairments in these discrimination tasks and could be associated with the other cognitive impairments resulting from vestibular dysfunction.

Hypercarbia and high-flow nasal oxygen use during anaesthesia - risking a failure to thrive?

Prevention of arterial oxygen desaturation during anaesthesia with high-flow nasal oxygen (HFNO) has gained greater acceptance for a widening range of procedures. However, during HFNO use there remains the potential for development of significant anaesthesia-associated apnoea or hypoventilation and the possibility of hypercarbia, with harmful cardiovascular or neurological sequelae. The aim of this study was to determine whether any HFNO-related hypercarbia adverse incidents had been reported on webAIRS, an online database of adverse anaesthesia-related incidents. Two relevant reports were identified of complications due to marked hypercarbia during HFNO use to maintain oxygenation. In both reports, HFNO and total intravenous anaesthesia were used during endoscopic procedures through the upper airway. In both, the extent of hypoventilation went undetected during HFNO use. An ensuing cardiac arrest was reported in one report, ascribed to acute hypercarbia-induced exacerbation of the patient's pre-existing pulmonary hypertension. In the other report, hypercarbia led to a prolonged duration of decreased level of consciousness post procedure, requiring ventilatory support. During the search, an additional 11 reports of postoperative hypercarbia-associated sedation were identified, unrelated to HFNO. In these additional reports an extended duration of severe acute hypercarbia led to sedation or loss of consciousness, consistent with the known effects of hypercarbia on consciousness. These 13 reports highlight the potential dangers of unrecognised and untreated hypercarbia, even if adequate oxygenation is maintained.

A - 99 Older Adult Male with Idiopathic Normal Pressure Hydrocephalus (iNPH): Neuropsychological Case Study.

Idiopathic normal pressure hydrocephalous (iNPH) is a potentially reversible syndrome characterized by ventriculomegaly. Parkinsonism is an often-overlooked clinical feature of iNPH. Mostile et al. (2022) argued that the diagnostic iNPH "triad" should be reconsidered as a "tetrad" including parkinsonism. This case will discuss iNPH presenting with parkinsonism. Patient is an 81-year-old male with a history of iNPH with Hakim's triad. His medical history includes hyperlipidemia, hypertension, deep vein thrombosis, benign prostatic hyperplasia, total knee replacement, and chronic depression. Presenting concerns were continued cognitive and gait impairments. Patient was referred from his physiatrist for evaluation of his cognitive functioning and assistance with discharge planning in an acute inpatient rehabilitation hospital. Patient was neuropsychologically evaluated to clarify the etiology of his cognitive presentation. Patient's cognitive profile was impaired in areas of attention, executive functioning, processing speed, visuoperception, and displayed a subcortical memory profile. Patient had intact functioning in areas of oral reading, naming, and working memory. Motor examination was evident for apraxia, task-specific tremor, and micrographia. This case report provides additive findings for common presentation of iNPH including parkinsonism presenting with comorbid psychiatric and medical confounders, highlighting the need for further research on neuropsychological profile of iNPH post shunt procedure. It also accentuates the need to accept parkinsonism as one of the common presentations of iNPH. Akinesia has been reported in nearly 70% of iNPH cases (Krauss et al, 1997), with bradykinesia and postural instability being the main parkinsonian features. Asymmetry and resting tremor were seen to be uncommon (Molde et al., 2017).

Lumbar Transforaminal Epidural Platelet Rich Plasma Injections: The Novel Modality for the Treatment of Low Back Pain

Background: Low back is a common health problem, it causes significant morbidity that limits the economic productivity, the use of platelet rich plasma has been shown to be effective in cosmetic surgical procedures and help accelerate wound healing in trauma and joint injuries. Platelet rich plasma injections use each individual patient’s own healing system to improve musculoskeletal problems. We therefore investigated the use of lumbar transforaminal epidural platelet rich plasma injections for the treatment of low back pain patients. Methods: We evaluated a pain numerical rating scale for a total of 210 patients with low back pain at the level of L3-4-5, immediately prior to the procedure, the patients completed the pain numerical rating scale score were 0 no pain and 10 the worst pain, a successful categorical outcome were defined as reduction in pain by at least 50%, we also evaluated an assessment of immediate post procedure numerical rating scale at 2 weeks and we measure the successful outcomes at 2 months. Results: Immediate NRS response was weakly associated with 2-month outcomes, Patients that responded at 2 weeks were more likely to be responders at 2 months than those who were non-responders at 2 weeks. Conclusion: Immediate post-TFE PRP pain relief does not strongly predict longer term effectiveness in pain relief or functional recovery. Response in pain relief or functional recovery at 2 weeks is more strongly associated with 2-month outcomes.

Upgrading MSW pyrolysis oil through distillation and hydrotreatment for automobile engine applications: A short review

The demand for fossil fuel in today’s world is increasing at a higher pace with rapid population growth and industrial development. The reserve for petroleum-based fossil fuels is finite which necessitates the search for alternative fuels. Pyrolysis oil obtained from Municipal Solid Waste (MSW) has drawn the attention of many researchers because of their high heating value and similar fuel properties with commercial automobile fuel and has potential to substitute commercial diesel fuel. Nevertheless, the crude oil obtained from pyrolysis of MSW has some shortcomings such as higher viscosity and density, lower flash point and cetane index, unpleasant odor, and higher sulfur content, preventing its useability as a drop in fuel for automobiles at present. In this short review, distillation and hydrotreatment post treatment procedures, amongst many others, are discussed for improving the properties of pyrolysis crude oil. Focus has been given on waste plastic and waste automobile tire pyrolysis oils as they constitute a significant amount of MSW currently. This review reported that noticeable improvement of the properties (cetane number, flash point, viscosity, and sulphur contents) of crude pyrolysis oil (PPO or TPO) can be achieved through distillation and/or hydrotreatment, which are comparable to the properties of standard diesel.

Nigam’s standardization of manual anal dilatation (Lord’s procedure)

Background: Standardisation of manual anal dilatation. It was a quality improvement study. Patients were admitted in various hospitals of Gurgaon, Haryana, India. Methods: Two hundred thirty-six patients of fissure in ano were treated by manual anal dilatation (Lord’s procedure) as per Nigam’s standardization between January 2010 and January 2022. Informed consent was obtained from each patient. All patients were evaluated for post procedure for complications. Two hundred thirty-six patients of fissure in ano were treated by manual anal dilatation (Lord’s procedure). Results: No patient developed faecal incontinence. Pain subsided immediately in all patients. No patient had non healing of anal fissure. Two patients had mild gas incontinence which resolved after 3-4 days. None of the patients required lateral sphincterotomy or fissurectomy. Most of the patients healed completely within three weeks. Conclusions: If manual anal dilatation is performed slowly, gently with controlled force for four minutes, as per Nigam’s standardisation then results are very good. This study includes patients of acute and chronic fissure in ano. The study excludes cases of anal cancer, stage III and IV haemorrhoids and inflammatory bowel disease.

Randomised control trial of epidural platelet rich plasma versus epidural steroids for low back pain

Background: Lower back pain (LBP) is a prevalent medical condition that frequently results in work-related disability and is one of the leading causes of missed workdays. Low back pain (LBP) struck 619 million people worldwide in 2020, and by 2050, it's predicted that there will be 843 million instances worldwide. 70 to 85% of people are predicted to suffer from LBP at some point of time in their lives. 90% of these people will experience multiple episodes, and an intervertebral disc prolapse accounts for a significant portion. Medications and lifestyle adjustments may be used as the first line of treatment. However, if the symptoms do not improve, minimally invasive procedures such as epidural steroid injection and epidural platelet-rich plasma injection may relieve the pain and lessen disability. We therefore aim to conduct a study to analyse the patient’s functional status and satisfaction after epidural platelet-rich plasma infiltration. Methods: Eligible patients with low back pain will be divided into two groups(Group A and Group B). Patients in group A will receive epidural steroid whereas Group B will receive epidural Platelet rich plasma. These patients will be monitored where visual analogue scale will be used to assess relief of pain before and after the procedure, Straight leg raising test will be used to understand the improvement of the patient clinically during examination pre and post procedure. Oswestry disability index will be used to compare the outcome in patient's day to day activities before and after the intervention. Patients will be evaluated with these methods pre-procedure and 1 hour after and later follow up evaluation will be done after 3 weeks and 3 months. The follow-up scores will be taken post one hour, three weeks and three months of the treatment. Protocol version: v1 dated 04/07/23 CTRI registration: REF/2023/06/068736 (12/06/2023)

Endovascular ultrasound renal denervation to lower blood pressure in young hypertensive women planning pregnancy: study protocol for a multicentre randomised, blinded and sham controlled proof of concept study

IntroductionA major issue confronting clinicians treating hypertension in pregnancy is the limited number of pharmacological options. Endovascular catheter-based renal denervation (RDN) is a new method to lower blood pressure (BP)...

Transperineal vs. transrectal prostate biopsies under local anesthesia: A prospective cohort study on patient tolerability and complication rates.

An increasing number of urologists is switching from transrectal (TR) to transperineal (TP) biopsy procedures for the diagnosis of prostate cancer. Local anesthesia (LA) might be advantageous in terms of patient management, risks and costs. We aimed to evaluate the tolerability and complication rates of TP prostate biopsy performed under LA. This is a monocentric, prospective, comparative, observational cohort study. Between July 2020 and July 2021 we included 128 consecutive patients (TR, n = 61; TP, n = 67), with a suspicion of prostate cancer. Transrectal vs. transperineal prostate biopsies were both performed under LA. To evaluate the tolerability we administered a validated visual analog pain score (VAS) during the different steps of the biopsy procedure as well as at 12-, 24- and 48-hours post procedure. The International Prostate Symptom Score (IPSS) questionnaire was administered before the procedure and at the same time intervals. The presence of hematuria, hematospermia, rectal blood loss, acute retention and febrile urinary tract infection (UTI) were also monitored. There were no significant differences in pain or IPSS between groups, except for a significantly higher pain score during the LA of the prostate in the TP group. In general, complication rates were similar, only the prevalence of hematuria at 24 hours was significantly higher in the TP group, as was rectal blood loss at 12 hours postprocedure in the TR group. In conclusion, our study showed that transperineal prostate biopsy under local anesthesia could be performed with similar pain scores and complication rates, compared to the transrectal procedure.

962 Are We Right to Continue to Omit Antibiotic Prophylaxis in Trans-Perineal Prostate Biopsies? A Clinical Audit in a Single NHS Trust

Abstract Introduction Transperineal Prostate Biopsies (TPPB) offer lower rates of infection-related complications than Transrectal Prostate Biopsies (TRPB), with post-procedural sepsis rates reported between 0.5% and 3%. The intuitive evolution from TRPB to TPPB has, however, involved the use of routine antibiotic prophylaxis, but studies have shown that there may be no difference in infection rates post procedure in patients with and without antibiotics. Aim This audit aimed to assess infection-related complications in patients undergoing TPPB without antibiotic prophylaxis in a single NHS Trust, following the Trust decision to discontinue antibiotic use. Method Retrospective analysis of 200 patients that had been biopsied between April 2022 and October 2022 was performed. 28-day post procedure hospitalisation and sepsis rates were assessed, in addition to 28-day GP presentations, antibiotic prescriptions and relevant co-morbidities. Results The cohort had a mean age of 70.1 years. The most common co-morbidities included Hypertension and Type 2 Diabetes Mellitus. 1 patient presented to hospital with sepsis within 28 days, representing a post-procedure infection rate of 0.5%. This patient received IV antibiotics in hospital and was discharged after 3 days. No patients presented to their GP within 28 days post procedure or were prescribed antibiotics in the community. Conclusions Given the low post procedure infection rates, we believe the evidence provided in this audit further supports and justifies the discontinuation of routine prophylactic antibiotics in patients undergoing TPPB. We believe this to be relevant in a world where antibiotic stewardship is becoming an ever more important issue.

618 Flexible Cystoscopy: The Differences in Patient Recall of Post Procedural Complications When Using Verbal Consent as Opposed to Written Consent

Abstract Aim To analyse the efficacy of taking verbal consent for flexible cystoscopy as opposed to taking written consent and whether it affected patient recall of complications related to the procedure. Method Flexible cystoscopy has 3 main complications that we mention to the patients – Dysuria, Haematuria and Infection. The 3-month long study from September to November 2022 involved 40 patients who underwent flexible cystoscopy in Aberdeen Royal Infirmary. 20 patients had verbal consent prior to the procedure and the other 20 had a written and signed consent form. We then asked these patients post procedure, if they recollected the 3 important complications mentioned earlier. Results 65% of the patients who gave verbal consent and 75% of those who gave written consent recalled that dysuria could be expected post procedure. Also, 55% of the patients who had a written and signed consent recalled haematuria as a complication as compared to 40% of the patients who had verbal consent. 40% of the patients who had a written and signed consent recollected that they might have a urinary tract infection post procedure. This was 55% in the group that gave verbal consent Conclusions Informed consent is an important in any clinical intervention. It safeguards patient autonomy, is a legal requirement and is a central feature of the covenant relationship between the healthcare professional and the patient. Putting pen to paper increases patient recall and makes written consent the gold standard for flexible cystoscopy.

090 Transarterial Haemorrhoidal Dearterialization Versus Open Haemorrhoidectomy for Symptomatic Haemorrhoids- a Meta-Analysis of Randomized Controlled Trials

Abstract Although effective, open haemorrhoidectomy (OH) is associated with significant postoperative pain. Novel non-excisional techniques such as transarterial haemorrhoidal dearterialization (THD) are increasingly advocated due to a lower incidence of pain and complications. We aimed to compare short and long-term outcomes of THD and OH in the present meta-analysis. A PRISMA-compliant systematic review and meta-analysis was performed including randomised controlled trials (RCTs) from inception until June 2022. The primary objective was recurrence, whilst secondary objectives included complication rates, mean length of stay (LOS), operative time and time to return to baseline. Random-effects models were used to calculate pooled effect size estimates. A p-value < 0.05 was considered statistically significant. 6 RCTs encompassing 474 patients were captured. There were 129 (54%) males in the THD group and 142 (59%) in the OH group. On random effects analysis, OH had a lower recurrence rate (OR = 2.76, p = 0.04) whereas THD was associated with a quicker return to baseline (MD = -14.05 days, p < 0.0001). There were no differences in bleeding (OR = 0.58,p = 0.09), urinary retention (OR = 1.01, p = 0.99), incontinence (OR = 0.49, p = 0.41), anal stenosis (OR = 0.14, p = 0.19), number of patients with chronic pain (OR = 1.30, p = 0.40), operating time (MD = 11.79 mins, p = 0.20) or LOS (MD = -0.23 days, p = 0.22). THD is a safe technique that affords a quicker return to baseline post procedure but is associated with a higher recurrence rate compared to OH.

827 Greenlight Laser Prostatectomy: A Safe and Effective Day Case Option for Bladder Outlet Obstruction in the Elderly Population

Abstract Aim Greenlight-laser prostatectomy (GLLP) is becoming a popular treatment option for bladder outlet obstruction. In this retrospective study, we aim to explore the patient selection, perioperative morbidity, and functional outcomes of GLLP. Method Patients who underwent GLLP at a UK tertiary centre between June 2018 and November 2021 were included in this study. Retrospective data covering patient demographics, perioperative parameters and postoperative outcomes were collected using the electronic records systems. Results 305 patients were included in this study with a median age of 74 (range 30-90) years. The most common indication (62.6%) for the procedure was patient’s wish to be free from long-term catheters (LTC) or intermittent catheterisation (ISC), followed by failed medical therapy for LUTS (36.4%). 84.6% of patients had an ASA ≥2, and 32.1% took anticoagulant or antiplatelet therapy. Inpatient stays were minimal, with the majority (68.2%) of patients were performed as day case, and 21.3% of patients discharged on the next day. The 3-month readmission rate was 10.8%, with the most common causes being haematuria and urinary-tract infection. The successful TWOC rate at follow up was 91.2%. Amongst the 19 patients who failed TWOC, 14 had LTC prior to the procedure and 4 had been performing ISC. Conclusions Our study shows that GLLP is a safe and effective day case treatment, and that with appropriate anaesthetic input it can be suitable for elderly and comorbid patients. Patients requiring LTC or ISC pre-operatively should be counselled carefully about the risk of not being catheter-free post procedure.