Rate Of Surgical Intervention Research Articles

BS SO12 - Long-term impacts of emergency presentations following bariatric health tourism on patients and health services: A UK perspective

Abstract Background Bariatric surgery is an effective treatment for obesity. Whilst short-term complication rates are low, little is known about the longer-term impacts on patients and health services. Even less is known about the true impact of the increasing trend of Health Tourism (HT) in this field. This study aimed to explore this topic further to quantify the impact of HT on UK healthcare services and to subsequently inform future service planning. Method This was a retrospective study of consecutive emergency inpatient episodes related to bariatric surgery (presenting to ED or transferred from other hospitals) at a regional bariatric centre. The study included patients between January 2018- April 2023. Data on index procedure (type, time to presentation, location), complications (and associated management), and subsequent readmissions, diagnostic investigations, and interventions (surgical, radiological, endoscopic) following first discharge from our centre was collected. Results 308 patients (489 episodes) were included (188 patients had surgery in the UK, 77 HT, 43 unknown origin). Gastric band (50%) and gastric sleeve (39%) were the commonest causes for admission in UK and HT patients, respectively. 86 surgical interventions post discharge were required. An average of 2.0 diagnostic investigations were undertaken following discharge per patient (UK 2.3 vs HT 1.9). Following discharge, similar average rates of further readmissions (UK 0.6 v HT 0.6), surgical (UK 0.3 v HT 0.4), radiological (UK 0.2 v HT 0.2) and endoscopic interventions (UK 0.6 v HT 0.6) were seen between cohorts. Conclusion Patients presenting with emergencies following bariatric surgery require significant ongoing investigation and management following discharge from hospital. This ongoing burden is often overlooked in health services research. In our study, this demand was significantly increased by bariatric health tourism. This highlights the critical need to recognise this additional burden, improve service planning to accommodate increased service demand, and address underlying factors contributing to health tourism.

Management of persistent exudative retinal detachment: exploring etiology and surgical outcomes.

This report aims to present the causes, clinical features, and surgical outcomes of persistent exudative retinal detachment (ERD) in a single tertiary referral center experience. We retrospectively analyzed 48 patients who underwent vitreoretinal intervention for persistent ERD between 2017 and 2024. The study assessed patient demographics, underlying causes of ERD, the success rate of surgical interventions, and postoperative visual outcomes. Of the 2040 eyes with retinal detachment treated at our center, 48 (2.35%) were diagnosed with ERD. Coats disease was the most frequent underlying cause, identified in 18 (37.5%) of ERD cases. Choroidal hemangioma (n = 6, 12.5%) and nanophthalmos (n = 5, 10.4%) were the next most common etiologies. The study population comprised 48 patients (30 males and 18 females) with a mean age of 37.48 years (range, 4-88 years). The mean best-corrected visual acuity remained stable from baseline to follow-up. The recurrence rate following primary surgery was 29.2%. Patients underwent a mean of 1.75 ± 1.00 surgeries. Globe preservation was achieved in 44 eyes (91.7%), while phthisis bulbi developed in 4 eyes (8.3%). Vitreoretinal surgery may be considered as a salvage procedure in cases where persistent ERD threatens the posterior pole. In our study, Coats' disease, choroidal hemangioma, and nanophthalmos were identified as the most common etiologies associated with persistent ERD. Surgical intervention has the potential to preserve vision, but the high recurrence rate necessitates a cautious approach and the possibility of multiple surgeries.

Diagnosis and treatment of magnetic foreign bodies in the gastrointestinal tract: the experience of four centers

BACKGROUND: Magnetic foreign bodies in the gastrointestinal tract is a relatively rare problem in urgent pediatric surgery. Meanwhile, among cases with foreign bodies, they are the most difficult both in terms of timely diagnostics and timely treatment. There are no generally accepted therapeutic and diagnostic standards, and traditional algorithms of patient management are focused on the dynamic observation and are not correct. More so, algorithms described in the foreign literature contradict each other. The rate of surgical interventions and the risk of complications are high. Surgical tactics has many "white spots". All these issues remain open for discussion. AIM: To analyze the experience of four medical centers in the diagnostics and treatment of patients with magnetic foreign bodies in the gastrointestinal tract. METHODS: A retrospective analysis of diagnostic and treatment techniques applied in patients with magnetic foreign bodies in their gastrointestinal tract from four pediatric surgical hospitals in 2010–2023 was made. In the study there were patients with neodymium magnetic balls from the constructor (38 patients, 50%), neodymium magnets of other shapes and for other purposes (30 patients, 39.5%), ferrite magnets (6 patients, 7.9%), unknown types of magnets (2 patients, 2.6%). RESULTS: Patients’ average age was (4±3.65) years. The fact of foreign body swallowing was revealed in anamnesis of 46 (60.5%) patients. Mental illnesses were diagnosed in 4 children — 5.3%, which is higher than the average incidence in pediatric population. Clinical symptoms were registered in 4 (11.8%) children with a single magnet foreign body and in 33 (78.6%) children with multiple ones. The basic diagnostic technique was an overview radiography of the abdominal cavity (70 cases, 92%), which allowed to identify both a foreign body and complications (signs of intestinal obstruction, free gas in the abdominal cavity). Esophagogastroduodenoscopy was performed in 50 cases (65.8%), out of which one foreign body was detected in 34 (68%) cases, and in 28 patients, foreign bodies were removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among curative techniques, open surgeries prevailed — 32 cases (42%). Laparoscopy was used in few cases. CONCLUSION: The timely diagnostics of magnetic foreign bodies in gastrointestinal tract often depends on anamnesis findings, and if there is no such, diagnostics most often is delayed and is made only intraoperatively. Among the diagnostic techniques, it is difficult to identify a universal one that can be recommended as the "gold standard"; however, the most widely used and well-informative is abdominal X-ray and esophagogastroduodenoscopy. As to surgical tactics, the role of laparoscopic interventions is relatively low. Most often, endoscopy or "open" surgery are performed.

Long-term treatment outcomes of complicated acute diverticulitis in immunocompromised patients

PurposeThe main aim of this study was to determine the short- and long-term outcomes of the non-operative management of acute left-sided complicated diverticulitis (ALCD) in severely immunocompromised patients (IMS group) and compare them with immunocompetent patients (IC group). The secondary aim was to assess the necessity of an elective surgery following a successful prior non-operative management in the IMS group after a non-operative management of the first episode of ALCD.MethodsPatients presented with their first episode of ALCD between 2012 and 2018 were retrospectively reviewed. Only severely immunosuppressed patients were considered for the analysis, including the following: long-term oral or intravenous steroid intake, current malignancy undergoing chemotherapy, chronic kidney disease on hemodialysis, or solid organ transplant with immunosuppressive medication. For each group, demographic data, severity of the episode, management decisions (conservative or operative), and short- and long-term outcomes were recorded and compared. A sub-analysis of patients with ALCD associating and abscess (modified Hinchey classification Ib/II) was performed.ResultsA total of 290 patients were included in the study: 50 among the IMS and 240 among the IC group. The rate of emergent surgery was higher in the IMS group (50.0% vs. 22.5%, p < 0.001) and was associated with increased morbidity (72.4% vs. 50.0%, p = 0.041) and mortality (24.1% vs. 4.3%, p = 0.003). The duration of the hospital stay was significantly longer in the IMS group (15 vs. 8 days, p < 0.001). The final stoma rate was significantly higher in the IMS group (82.1% vs. 22.9, p < 0.001), with a median follow-up of 51.4 months. A total of 141 patients presented ALCD with an abscess; 25 in the IMS and 116 in the IC group. There was a higher rate of surgical intervention among the IMS group as the initial treatment approach (24.0% vs. 5.2%, p = 0.002), even though the conservative treatment had a similar rate of success (81.3% vs. 92.0%, p = 0.178). The recurrence rate following a non-operative approach was similar (IMS: 31.2% vs. 35.4% in the IC group, p = 0.169). Furthermore, 81.2% of non-operatively managed IMS patients (13 out of 16) did not require a surgical intervention at the end of the follow-up, with similar findings in the IC group (78/96, 81.2%, p = 0.148).ConclusionMedical treatment of immunosuppressed patients during their first ALCD episode associated with an abscess is feasible, with a high success rate and results comparable with the IC group. Moreover, taking into account the readmission rates, the need for emergent surgery of the recurrence, and the perioperative mortality and morbidity in the IMS group, conservative management with no differed scheduled surgery seems to be a safe option in this subgroup of patients.

Ascending aortic length predicts adverse outcomes in type a intramural hematoma.

Ascending aortic length has recently been recognized as a novel predictor of adverse events in aortic diseases, but its prognostic value in type A intramural haematoma is unknown. We aimed to evaluate the association between ascending aortic length and outcomes in patients with type A intramural haematoma initially managed medically. We retrospectively analyzed patients with acute type A intramural haematoma. Ascending aortic length was measured by computed tomography. The primary outcome was aortic progression, defined as aortic intervention or aortic-related death. A total of 98 patients were enrolled. During a median follow-up of 2.6 years, aortic progression occurred in 27 patients (27.6%), ie, 9 events per 100 patient-years). Patients with ascending aortic length ≥11 cm had significantly higher rates of aortic progression (54.2% [20.9 events per 100 patient-years] vs 18.9% [6.1 events per 100 patient-years], p = 0.001), surgical intervention (45.8% vs 12.2%, p = 0.001), and presence of ulcer-like projection (25.0% vs 2.7%, p = 0.002) compared to those with ascending aortic length <11 cm. Kaplan-Meier analysis demonstrated lower progression-free survival in the ascending aortic length ≥11 cm group (p = 0.0021). Ascending aortic length had a sensitivity of 61.9% and specificity of 77.8% for predicting aortic progression, with an area under the curve of 0.756 (95% confidence interval: 0.649-0.862). Ascending aortic elongation may identify a high-risk subgroup of acute type A intramural haematoma patients initially managed medically who could potentially benefit from early surgery. Ascending aortic length should be considered in the risk stratification and management of these patients.

The impact of a multidisciplinary team approach on the management of patients diagnosed with complex colorectal polyps.

Large nonpedunculated colorectal polyps (LNPCPs) have a greater than average risk of malignancy, incomplete resection/recurrence and complications associated with treatment. Appropriate management of these lesions is crucial to prevent cancer and reduce harm. The British Society of Gastroenterologists (BSG) and the Association of Coloproctologists of Great Britain and Ireland (ACPGBI) published guidelines for the management of LNPCPs in 2015. The aim of this work was to evaluate the case mix and outcomes from a single centre's multidisciplinary approach to managing such lesions against the key performance indicators (KPIs) set within these national guidelines. Cohort study from a single centre over a 2-year period, January 2020 to December 2022. After exclusions, a total of 229 cases were discussed. Most complex polyps were treated endoscopically, with conservative management recommended in 22 cases where patients had significant comorbidities and were unlikely to benefit from therapy. The overall surgical intervention rate (including transanal endoscopic microsurgery/per anal excision) was 14%. Of the cases treated endoscopically, there was residual polyp detected in 3.9% at 12-months' follow-up. Complications were rare. There was a single case of perforation following endoscopic submucosal dissection and no significant postprocedure bleeds. There were no perforations following endoscopic mucosal resection, although postpolypectomy bleeding requiring admission occurred in 4%. Sixty-eight per cent of patients were treated within 56 days of multidisciplinary team (MDT) discussion, despite the timeframe being within a period of huge disruption due to the global COVID pandemic. KPI standards published by the BSG were therefore met. MDT management of complex polyps (LNPCPs) is effective and meets the standards set by national guidance. Patient outcomes following treatment for complex polypectomy are improved when the most appropriate procedure is performed by the most appropriate operator. Discussion at a complex polyp MDT can facilitate this approach.

Evaluating the Impact of Age and G8 Assessment on Definitive Treatment Strategies in Elderly Patients with Local Advanced Esophageal Carcinoma

Introduction: While chemoradiotherapy (CRT) is commonly employed as a curative approach for esophageal cancer, administering standard CRT to elderly patients often presents challenges in practical settings. The objective of this study was to compare treatment tolerance and survival outcomes between younger and elderly patients (aged ≥65 years) diagnosed with locally advanced esophageal cancer receiving curative-intent treatment. Additionally, it aimed to assess the impact of the Geriatric-8 Health Status Screening Tool (G8 score) on treatment decisions in elderly patients. Methods: Ninety-seven patients treated with neoadjuvant or definitive CRT for locally advanced esophageal cancer were retrospectively evaluated at two centers from 2013 to 2023. We divided the patients by age (<65 and ≥65 years) and assessed their demographic, clinical, and treatment data, including pre- and post-treatment G8 scores. Radiotherapy (RT) was administered at a median dose of 50.4 Gy (45–66 Gy). Planned concurrent chemotherapy was completed in 73 (75.3%) of the patients. Results: In the comparative study of 97 esophageal cancer patients, 48 geriatric (aged ≥65 years) and 49 younger individuals were followed up for a median of 20 and 21 months, respectively. No significant statistical differences were noted between the groups concerning baseline and treatment characteristics. Surgical intervention rates were comparable, with 22.9% of geriatric and 36.7% of young patients undergoing surgery (p = 0.184). There were no significant differences in pathological complete response, local recurrence, distant metastasis, progression, or death rates. The median progression-free survival (PFS) for geriatric and younger patients was 31 months (95% CI, 13.6–48.4) and 19 months (95% CI, 0–39.4), respectively (p = 0.832). The median overall survival (OS) was 38 months (95% CI, 23.8–52.2) in geriatric patients, while it was not reached in younger patients (p = 0.745). There was no significant difference between the two groups. The pretreatment and post-treatment G8 values of the geriatric patients were 9.25 (6–13.5) and 9.5 (6–14), respectively. Patients with increased G8 scores were found to have significantly higher PFS (median 85 months vs. 11 months, p = 0.001) and OS (median 85 months vs. 14 months, p = 0.001) compared to those with unchanged or decreased G8 scores. Conclusion: Age alone should not be the determining factor in the treatment decision of elderly patients diagnosed with locally advanced esophageal cancer. Moreover, CRT could be safely performed even in patients with low G8 scores, and although the G8 score may not directly influence treatment decision, its enhancement during the treatment process holds significant prognostic value.

Temporal changes in characteristics, incidence, and mortality in patients undergoing surgical intervention for mitral stenosis

To examine temporal changes in patient characteristics, the incidence rate of surgical intervention, and the three-year mortality rate for patients undergoing surgical intervention for mitral valve stenosis (MS) from 2001 to 2021 in Denmark. Utilizing Danish nationwide registries, we identified all adult patients undergoing first-time surgical intervention for MS (2001–2021). Temporal changes in the incidence rate of surgical intervention across calendar periods were investigated (2001–2005, 2006–2010, 2011–2015, and 2016–2021). Using Kaplan-Meier estimates, we computed temporal changes in three-year all-cause mortality across calendar periods. With multivariable Cox regression analysis, we assessed the adjusted rates of mortality. We included 256 patients (median age 60.3 years, 31.3% males). A stepwise decrease in the burden of chronic heart failure was identified (2001–2005: 54%, and 2016–2021: 20%, p-value < 0.001 for trend), while the burden of atrial fibrillation seemed stable (2001–2005: 51%, and 2016–2021: 46%, p-value = 0.27 for trend). The proportion of patients with rheumatic MS was 64% in 2001–2005 and 33% in 2016–2021, p-value < 0.001 for trend. 28 patients (10.9%) had mitral valve surgery prior to the first-time surgical intervention for MS. A stepwise decrease in the incidence rate of surgical intervention was observed: 3.3 cases per million person-years in 2001–2005 and 2.2 in 2016–2021. The incidence of patients diagnosed with first-time MS remained stable over calendar periods (2001–2005: 54.5 incidences per million person-years, and 2016–2021: 41.9, p-value = 0.46 for trend). The in-hospital mortality was 8.6% and the three-year mortality after surgical discharge was 9.0%, and we found no difference over calendar periods in either crude estimates or adjusted analysis. From nationwide data across three decades, we identified that the incidence of surgical interventiondecreased significantly within the past 20 years, while all-cause mortality remained stable. The burden of heart failure decreased, while the burden of atrial fibrillation remained stable over the study period.

The Advancement of Appendicitis in Children in the Pre-Pandemic and the Pandemic Year.

Background: The COVID-19 pandemic affected the health of millions of people, both directly through infection and indirectly through delayed diagnosis and treatment of non-COVID-19 illnesses. The aim of this study was to check the impact of the COVID-19 pandemic on the diagnosis and treatment of appendicitis in children. Methods: The study was carried out at the Department of Paediatric Surgery of the Marciniak Hospital (Wrocław, Poland) and covered two periods, the pre-pandemic one (P1, 01/03/2019-29/02/2020) and the pandemic one (P2, 01/03/2020-28/02/2021). Results: The number of admissions of patients with suspected appendicitis and observation-only patients decreased during the pandemic (400/289 and 226/160, respectively). Although the number of operated children was similar during both analyzed periods (P1: 174, P2: 160), the rate of surgical interventions was significantly higher during P2 (55.4%) than during P1 (43.5%) (χ2 test: p = 0.00272). The values of the variables quantifying disease progression and severity of inflammation, selected inflammation-related parameters detected by laboratory blood tests, latencies from the onset of symptoms to the admission and from the admission to the operation, and total duration of hospitalization did not differ significantly between the pre-pandemic and pandemic periods. Conclusions: These results show that the COVID-19 pandemic led to more rigorous and careful triage of pediatric patients suspected of acute appendicitis that did not have a negative impact on patient outcomes.

COMPARATIVE CHARACTERISTICS OF THE INFORMATIVENESS OF THE LAL TEST AND PROCALCITONIN IN THE DIAGNOSIS OF INFECTIOUS COMPLICATIONS IN ACUTE ALCOHOLIC PANCREATITIS

Acute pancreatitis (AP) is an inflammatory condition of the pancreas, characterized by acute, intense abdominal pain. AP accounts for 20-30% of hospitalizations due to abdominal symptoms. The incidence of AP is increasing globally by 2-5% annually, ranging from 3.4 to 73.4 cases per 100,000 people. A critical concern in AAP is the potential development of infectious complications, which may require surgical intervention and increase mortality rates. Effective management and monitoring of these complications are essential. Research Justification. The diagnosis of AAP in clinical practice commonly relies on serum levels of α-amylase, lipase, C-reactive protein, and leukocyte counts. However, these markers have limitations and do not fully reflect the level of intoxication. The accuracy of C-reactive protein as a marker is not well established and is used mainly as a prognostic indicator. Serum α-amylase levels tend to decrease sharply after the fifth day of illness, regardless of the patient's condition. Lipase levels in diabetic patients can exceed reference values even without pathology, necessitating adjustments for AAP diagnosis. These criteria are most effective during the enzymatic phase of AAP (days 1-5). To predict the course of AAP and assess the adequacy of therapy, as well as to determine the need for surgical intervention, serum procalcitonin levels are commonly used. However, some studies question the diagnostic accuracy of procalcitonin, particularly regarding its correlation with organ failure, infectious complications, and patient mortality. Materials and Methods: This study involved 55 AAP patients, 51 men (92.7%) and 4 women (7.3%), with an average age of 49.49±9.87 years. Patients were categorized based on the severity of their condition: moderate (39 patients, 70.9%) and severe (16 patients, 29.1%). The control group consisted of 10 healthy individuals (9 men, 90.0%; 1 woman, 10.0%; average age 45.22±7.55 years). AAP was classified according to the Atlanta classification of acute pancreatitis. The study included patients with moderate to severe AAP who were hospitalized within 48 hours of symptom onset. All patients received treatment according to clinical guidelines, including intensive fluid therapy with Ringer's lactate. The Limulus Amebocyte Lysate (LAL) test and procalcitonin levels were measured on days 5, 8, 11, and 14 of hospitalization. For suspected infected necrosis, patients underwent contrast-enhanced computed tomography (CT) on day 14, with fine-needle aspiration biopsy or surgical intervention if necessary. Results. On day 5, LAL test values in the moderate and severe AAP groups were within reference ranges, and procalcitonin levels did not exceed 0.5 ng/ml. By day 14, a significant increase in LAL test values was noted in both groups, with a corresponding rise in procalcitonin levels. The ROC analysis for LAL test values on day 14 in the moderate AAP group showed an area under the curve (AUC) of 0.966, with 92.86% sensitivity and 96% specificity. For procalcitonin, the AUC was 0.723, with 71.43% sensitivity and 92% specificity. Conclusion. The LAL test is a sensitive and specific marker for detecting endotoxemia and monitoring the progression of AAP, particularly in predicting the development of infectious complications. The study demonstrates that LAL test values significantly correlate with the severity of AAP and may provide better diagnostic accuracy than procalcitonin, especially in the later stages of the disease.

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta-analysis.

Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random-effects model. Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] -9.85years and 95% confidence intervals [CI] -9.99 to -9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14-1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97-3.13), length of stay (WMD 1.15days and 95% CI -0.32-2.62), and mortality (OR 1.04 and 95% CI 0.95-1.14) regardless of background. Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation.

Differences in Cervical Spine Fractures in Patients Younger or Older Than 65 Years of Age: Implications for the Canadian C-Spine Rule.

There has been a distinction made in the 2001 Canadian C-Spine Rule regarding patients 65 and older and younger than 65 years of age as far as indications for cervical spine CT scanning. We sought to determine if there are differences in the symptoms, mechanisms of injury, fracture locations, and types that are still relevant in 2024. The institutional review board approved this retrospective study of cervical spine CT emergency department results from 2 hospitals in our health system after reviewing 5 years of data in patients experiencing trauma. In addition to the primary variable of age (younger than 65 years and 65 years and older), we looked at injury mechanism, fracture types, sites, symptoms, and operative or medical treatments. Because the demographics of our home site is different from most towns in the United States, we provide race/ethnicity data. Of 21,986 cervical spine CTs, 190/9455 (2.0%) participants 65 years of age and older and 199/12,531 (1.6%) participants younger than 65 years of age had fractures (total, 389/21,986, 1.8%). There were more cases of falls from standing (106, 55.8%) and falls from a height (46, 4.2%) in those 65 years and older and this mechanism was associated with a higher risk of C1 and C2 fractures (52, 27.4%; and 78, 41.1%, respectively). Among the C1 fractures, anterior and posterior arch fractures predominated (37, 19.5%). For C2 fractures, types 2 and 3 odontoid fractures (39, 20.5%; and 12, 6.3%) were more common in the older cohort. Motor vehicle collisions were more common in the younger cohort (89, 44.7%), and they were associated with more C5-C7 fractures (47, 23.6%; 60, 30.2%; and 66, 33.2%, respectively) including the facets (49, 24.6%), spinous processes (31, 15.6%), and transverse processes (52, 26.1%). Overall, the rates of instability, surgical intervention, and asymptomatic fractures were similar in the 2 age groups. Cervical spine fractures appear in about 1.8% of the CT scans performed in a busy emergency department environment. Fractures in the elderly occur more commonly due to falls, are located at C1 and C2, and may involve ligamentous injuries. Younger patients incur trauma more commonly due to motor vehicle collisions, and they are more likely to affect the posterior elements, especially C5-C7. The differences in trends for fractures in the 65 years of age and older and younger than 65 years of age groups have persisted since the Canadian C-Spine Rule 1996-1998 data were collected.

An Observational Study on the Treatment Outcomes of Adenotonsillar Hypertrophy in Children

Background: Adenotonsillar hypertrophy, marked by abnormal enlargement of the adenoids and tonsils, is common in children and can cause various health issues. For severe cases, surgical intervention, mainly adenotonsillectomy, is often recommended and has proven effective in improving airway obstruction, sleep quality, and overall health outcomes. This study aimed to assess the treatment Outcomes of adenotonsillar hypertrophy in children. Methods: This prospective observational study was conducted in the Department of Head &amp; Neck Surgery (ENT), Dhaka National Medical Institute Hospital, Dhaka, Bangladesh from January 2023 to June 2023. A total of 57 children with primary symptoms of mouth breathing, snoring, and sleep disturbances were purposively enrolled as study subjects. For data analysis, MS Office tools were applied. Results: Most participants (61.4%) were aged 2-5 years and female (60%). All participants (100%) reported symptoms of nasal blockage, snoring, and mouth breathing. A majority (61.4%) had grade 2 tonsillar hypertrophy. After 3 months of medical treatment, 57.9% experienced complete relief of nasal symptoms, including sleep apnea, 24.6% showed moderate improvement, and 17.5% saw no improvement. Conclusion: Intranasal steroids, combined with oral amoxicillin e-clavulanic acid and montelukast, reduce adenotonsillar hypertrophy symptoms and lower surgical intervention rates. This approach targets inflammation and infection, potentially improving patients' quality of life. More studies are needed to establish guidelines and optimize treatment.

10 Years of Antenatal Hydronephrosis Experience: Comparing Two Different Guidelines

Abstract Background Antenatal hydronephrosis refers to the dilation of the renal pelvis and/or calyces in the developing fetus. The challenge lies in distinguishing between cases that warrant long-term follow-up or surgical intervention and those with transient hydronephrosis that require minimal invasive investigations. Materials and Methods Our study aimed to assess and contrast the efficacy of the 2015 Congenital Anomalies of Kidney and Urinary Tract Guideline from the Turkish Society of Pediatric Nephrology with the Tepecik Antenatal Hydronephrosis Guideline, which was previously employed in our hospital. We conducted a comparative analysis of demographic data, outcome conditions, additional imaging requirements and quantities, radiation exposures, and rates of surgical interventions between two groups. Results Group 2 had a significantly higher detection rate of Vesicoureteral Reflux via voiding cystourethrogram at 38.5% compared to Group 1's 13.4% (p&lt;0.01). The incidence of abnormal findings with dimercaptosuccinic acid was similar between Group 1 (28.5%) and Group 2 (26.4%) (p&gt;0.01), but Group 2 had a higher rate of obstruction diagnosis at 68.8% versus Group 1's 29.4% (p&lt;0.01). Group 1 had greater median radiation exposure (500 mrem vs. 200 mrem, p&lt;0.01), and a higher proportion of patients underwent surgery (34.2% vs. 21.9%, p&lt;0.01). Conclusion This study showed that the new guideline required fewer tests, was less invasive, and exposed patients to less radiation than the old guideline.

Trends in orbital cellulitis severity and management: 2016 through 2022

ABSTRACT Purpose To characterize trends in orbital cellulitis (OC) severity and management from 2016 through 2022, including assessment of effects from the COVID-19 pandemic. Methods A retrospective chart review was conducted at a tertiary care center using an electronic medical record search of OC from January 1 2016 to January 1 2023. Radiography was used to categorize patients into three cohorts – OC without abscess, OC with subperiosteal abscess (SPA), and OC with orbital abscess (OA). Infection cohort and age group [pediatric (<9 years old), adolescent (9–18 years), adult (>18 years)] were compared across years. Subgroup analysis was performed in the SPA cohort. Comparisons were made between the time periods prior to and after the start of the COVID-19 pandemic. Results From 2016–2022, there were 247 (67.3%) cases of OC, 103 (28.1%) SPA, and 17 (4.6%) OA. The year 2022 incurred higher rates of SPA and OA (p = 0.035), pediatric infections (p = 0.008), and co-morbid sinusitis (p = 0.005) compared to all preceding years. Rates were similar from 2016 through 2021. Within the SPA cohort, rates of surgical intervention and outcomes were similar across all years. Rate of abscess formation was significantly higher during the COVID-19 pandemic compared to the pre-pandemic era (p = 0.033). Conclusion The severity of OC leading up to the COVID-19 pandemic appeared steady. After pandemic onset, a delayed increase in abscess formation, predominantly affecting pediatric patients and correlating with a greater rate of sinusitis, was observed in 2022.

EP431 - It's all in the NEWS: Can Early Warning Scores help identify severe post-operative complications in Medical Tourism patients?

Abstract Introduction Complications following surgical procedures abroad are regularly reported in news media. Often stories indicate delayed presentation to local medical services, possibly due to lack of good safety netting advice. Within the NHS, National Early Warning Score (NEWS) is used to identify those at risk of deterioration. This study aimed to determine if NEWS were associated with severity of post-operative complications. Methods A retrospective study was performed between January 2022-December 2023 at a DGH close to Gatwick Airport. The study included all emergency patients with complications following operations performed outside of UK. Data collected via electronic patient records included demographics, treatment and length of stay (LOS). Outcomes were analysed in two subgroups: NEWS 0 &amp; NEWS ≥1. Results A total of 36 patients (mean age 40 years) were included in the study. NEWS at presentation ranged from 0-10. 25 (70%) patients had NEWS ≥1. In 100%, tachycardia (HR &amp;gt;90) was the abnormal parameter. NEWS ≥1 group demonstrated greater severity of complications (32% Clavien-Dindo Classification &amp;gt;3a vs 9%), increased rate of surgical intervention (36% vs 9%) and increased mean LOS (5.73 days vs 2.36 days). Relative Risk for severe complication was 3.96 in the NEWS ≥1 group. Conclusion Post-operative complications after surgery abroad are a significant risk to patients and a burden for local NHS services. Early presentation may lead to reduction in complex intervention and LOS. Promoting NEWS to patients going abroad for surgery may lead to improved outcomes. Advising patients to monitor their pulse after surgery is a simple message for health promotion.

ThP7.1 - The effect of socioeconomic status on outcomes in major trauma: a systematic review and meta-analysis

Abstract Background Major trauma poses a significant public health concern, with survivors often suffering long-term disability. There is growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma in recent years. Anecdotal evidence suggests that social deprivation leads to more violent and debilitating injuries. There remains, however, a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation. Methods A comprehensive search of MEDLINE, EMBASE, and Cochrane databases was performed to identify eligible studies from 1947 to March 2024. The primary outcome is to establish the proportion of patients with the highest socioeconomic deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random effects model. Results Fourteen studies reporting on 878,872 major trauma patients were included. A substantial proportion of major trauma incidents occurred in the most deprived group at 28%. There were more male patients in the most deprived compared to the least deprived group (OR 1.36, 95% CI 1.14-1.63, I2=99%). There were no differences in surgical intervention (OR 1.74, 95% CI 0.97-3.13, I2=0%) and length of stay (WMD 1.15 days, 95% CI -0.32-2.62, I2=82%) regardless of background. Interestingly, mortality was higher in the most deprived group (OR 2.02, 95% CI 1.14-3.57, I2=80%). Conclusion Major trauma is more prevalent in deprived areas. Although rates of surgery and length of stay did not differ, mortality is higher in the most deprived group. The planning of public health interventions should target areas of higher deprivation.

Clinical Outcomes of Diabetes Mellitus on Moderately Severe Acute Pancreatitis and Severe Acute Pancreatitis.

To analyze the influence of diabetes mellitus on the clinical outcomes of moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP). This retrospective study included patients diagnosed with MSAP and SAP at Shanxi Bethune Hospital from January 1, 2017, to December 31, 2021. Clinical data were collected, including patient demographics, 24-hour laboratory indicators, and inflammation indices. Propensity score matching (PSM) was used to compare outcomes before and after matching. Patients were randomized into training and validation sets (7:3) to develop and validate a clinical prediction model for infected pancreatic necrosis (IPN). Among 421 patients, 79had diabetes at admission. Before PSM, diabetic patients had higher incidences of peripancreatic fluid (71% vs 47%, p<0.001) and IPN (48% vs 10%, p<0.001), higher surgical intervention rates (24% vs 12%, p=0.008), and significant differences in abdominocentesis (22% vs 11%, p=0.014). After PSM, 174 patients were matched, and the diabetes group still showed higher incidences of peripancreatic fluid (69% vs 47%, p=0.008), IPN (48% vs 11%, p<0.001), and surgical intervention rates (27% vs 13%, p=0.037). Diabetes, modified CT severity index (MCTSI), serum calcium, and HDL-c were identified as independent risk factors for IPN. The prediction model demonstrated good predictive value. In MSAP and SAP patients, diabetes mellitus can exert an influence on their clinical outcome and is an independent risk factor for IPN. The alignment diagram and web calculator constructed on the basis of diabetes mellitus, modified CT severity index (MCTSI), serum calcium and high-density lipoprotein cholesterol (HDL-c) have good predictive value and clinical guidance for the occurrence of IPN in MSAP and SAP.

Endovascular treatment of chronic subdural hematoma in a dual-trained neurosurgical unit: Results and proposal of a randomized controlled trial protocol

IntroductionChronic subdural hematoma (cSDH) is a prevalent neurosurgical condition with an increasing incidence due to the rising life expectancy and the widespread use of anticoagulant and antiplatelet therapies. Insights into the inflammatory origins of cSDH led to the exploration of Middle Meningeal Artery (MMA) embolization as a therapeutic strategy. In recent years the endovascular treatment of MMA has gained momentum. Herein we present the initial experience of a dual trained neurovascular unit implementing this therapeutic technique. MethodsThis single-center, prospective pilot study aimed to evaluate the feasibility, safety, and efficacy of MMA embolization in the treatment of cSDH. Following ethical approval and informed consent, demographic, clinical, and radiological data were collected. Patients requiring emergent surgical treatment were excluded. The study focused on assessing clinical outcomes, including the Modified Rankin Score (mRS) and volumetric analysis of cSDH, before and after embolization. ResultsFifteen patients underwent MMA embolization, with a predominance of males (80%) and a mean age of 72.4 years. The most common presenting symptom was headache (53.3%). The average hospital stay was 3.9 days. Various embolization techniques were employed, with DMSO-EVOH being the most frequent. All procedures were successfully conducted without complications. Although not statistically significant, trends suggested better outcomes in patients with homogeneous cSDH on the CT scan, displaying the cotton wool sign on angiography and treated with EVOH-DMSO. ConclusionMMA embolization for cSDH demonstrates promise as a safe and effective treatment, potentially reducing the need for surgical intervention and recurrence rates. This study lays the groundwork for a larger, randomized controlled trial which protocol is herein presented.

Middle fossa arachnoid cyst fenestration for ruptured cysts associated with subdural collections: paediatric neurosurgery tertiary unit experience.

Arachnoid cysts are commonly encountered benign cystic structures and often come to attention as incidental findings following cranial imaging. Surgical intervention rates vary in different studies; however, rupture of cyst and subdural collection with mass effect are some of the indications for surgical intervention. In this study, we aimed to evaluate our operated cohort of middle fossa arachnoid cysts to determine the rate of traumatic subdural collection in this cohort and further assess outcomes. A retrospective review of all consecutive operated middle cranial fossa arachnoid cysts was carried out for the period 2010 to 2024. Demographics including age, sex, Galassi type, surgical technique for fenestration, preceding history of trauma, presence of papilloedema, and complications following surgery were extracted. Indication for surgery included papilloedema and headaches or increasing head circumference or rupture and subdural collections. Arachnoid cysts managed with CSF diversion as primary surgery were excluded. Over the study period, 21 fenestrations of the arachnoid cysts were carried out in 19 patients with mean age of 7years and M:F ratio of 2.2:1 (laterality: 9 right-sided and 10 left-sided). These included seven Galassi 2 and twelve Galassi 3 arachnoid cysts. At presentation, 10 had papilloedema, 5 with no papilloedema, and 4 with no available ophthalmological assessment. Fenestration of cyst included 12 microscopic, 6 endoscopic, and 3 combined approaches. Of the operated cohort, 8 were due to rupture of arachnoid cyst and subdural collections causing mass effect. Of 8 cases of ruptured arachnoid cyst with subdural collections, 75% had clear history of preceding head injury in the context of accidental or sports-related injuries. Two patients required redo-fenestration (10.5%), 1 patient required temporary lumbar drain (5.2%), and 2 patients required cysto-peritoneal shunts (10.5%). Rupture of arachnoid cysts and subdural collections although rare can be associated with head injury in majority of cases. All operated cases belonged to grade 2 and 3 Galassi.