Abstract Aim To assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. Method All bladder, kidney, UTUC and prostate cancer patients from the COVIDSurg-Cancer Study who underwent elective potentially curative cancer surgery during the COVID-19 pandemic until July 2020 were included. Univariable and multivariable regression was performed to assess the association of patient factors with mortality, respiratory complications, and operative complications. Results A total of 1,902 patients from 36 countries were included. A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed; of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4–81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41–144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 (4.4%) major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73–20.3, p<0.001) or aged 80 or above were more likely to experience major complications. Conclusions Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.
目的评估新冠肺炎大流行期间泌尿外科肿瘤手术患者术后30天的预后。方法纳入2019冠状病毒病-癌症研究中所有在2019冠状病毒病大流行期间至2020年7月接受选择性可能治愈的癌症手术的膀胱癌、肾癌、UTUC和前列腺癌患者。采用单变量和多变量回归来评估患者因素与死亡率、呼吸系统并发症和手术并发症的关系。结果共纳入来自36个国家的1902例患者。共有42/1902例(0.2%)患者在住院期间被诊断为COVID-19。死亡21例(0.1%);其中8人(38.1%)被诊断为COVID-19。并发COVID-19感染的患者更有可能死亡(OR 31.7, 95% CI 12.4-81.42, p<0.001)，年龄超过80岁，ASA分级为3+，ECOG分级为1+。30天内出现呼吸系统并发症(急性呼吸窘迫综合征或肺炎)40例(0.2%)。合并COVID-19感染的年龄(OR 40.6, 95%CI 11.41-144.45, p<0.001)、70岁以上、社区高危地区或修正后心脏危险指数为1+的患者更容易出现呼吸系统并发症。主要并发症84例(4.4%)(Clavien-Dindo评分≥3)。合并COVID-19感染(OR 7.45, 95% CI 2.73-20.3, p<0.001)或80岁及以上的患者更容易出现重大并发症。我们的数据可以为卫生服务机构在大流行期间安全地选择手术患者提供信息。同时感染COVID-19的患者有更高的死亡和呼吸道并发症风险，如果可能，不应接受手术。
{"title":"458 Urological Cancers During COVID-19: Analyses of Short-Term Outcomes from the COVIDSurg-Cancer Study","authors":"V. Chan","doi":"10.1093/bjs/znac268.052","DOIUrl":"https://doi.org/10.1093/bjs/znac268.052","url":null,"abstract":"Abstract Aim To assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. Method All bladder, kidney, UTUC and prostate cancer patients from the COVIDSurg-Cancer Study who underwent elective potentially curative cancer surgery during the COVID-19 pandemic until July 2020 were included. Univariable and multivariable regression was performed to assess the association of patient factors with mortality, respiratory complications, and operative complications. Results A total of 1,902 patients from 36 countries were included. A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed; of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4–81.42, p<0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41–144.45, p<0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 (4.4%) major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73–20.3, p<0.001) or aged 80 or above were more likely to experience major complications. Conclusions Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83402767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim Reliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results. Method A retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining). Results A total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones <10mm had a SFR of 67%, compared to 58% for stone >10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks. Conclusion Our overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.
{"title":"571 Evaluating the Effectiveness of Extracorporeal Shockwave Lithotripsy (ESWL) for Ureteric Stones During COVID-19 Pandemic - A Single Centre Experience","authors":"M. Farah, I. Rizvi, R. Fernandes, A. Patel","doi":"10.1093/bjs/znac269.084","DOIUrl":"https://doi.org/10.1093/bjs/znac269.084","url":null,"abstract":"Abstract Aim Reliance on ESWL for treating ureteric stone has increased during the COVID-19 pandemic. We examined the outcomes for ureteric stones treated with our on-site lithotripter to assess the success rate and determine the variables that could affect the outcome results. Method A retrospective review using electronic records and images of patients who underwent ESWL for ureteric stones (January to December 2020). Univariate and multivariate analysis used to determine stone-free rate predictors (Stone Free rate/SFR: No residual stones on post-ESWL imagining). Results A total of 36 patients underwent ESWL for ureteric stones. Mean age was 58 years (21–90), and mean stone size was 8 mm (5–20). Stones were located in the proximal (67%) or lower ureter (33%). Overall SFR was 64% (67% proximal, 33% distal). 64% of patients required only one session to be stone free, with 60% stone free after two sessions. Stones <10mm had a SFR of 67%, compared to 58% for stone >10 mm. The only statistically significant predictor was stone size (longest dimension, p=0.04). No statistical significance with stone location (P=0.09), skin-to-stone distance (SSD) (P=0.7), stone density (P=0.3) or stone volume (P=0.3). In treatment failure, time to definitive ureteroscopy was 4 weeks. Conclusion Our overall SFR was slightly lower than expected but comparable to available literature. This data highlights the importance of patient selection for ESWL and would be useful in counselling about local success rate. More than half of the patients required only one session for stone clearance and stone size was the only significant predictor for successful ESWL.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91213166","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim The COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training. Method A cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1st to 31st August 2019 and mid-pandemic, March 1st to 31st August 2020. Results Of the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity. Conclusions Our study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.
{"title":"386 A Comparison of Academic Output of Welsh Plastic Surgery Trainees Pre- and Mid-COVID-19 Pandemic","authors":"C. Mcgregor, C. Sin-Hidge, N. Wilson-Jones","doi":"10.1093/bjs/znac269.397","DOIUrl":"https://doi.org/10.1093/bjs/znac269.397","url":null,"abstract":"Abstract Aim The COVID-19 pandemic has affected doctors worldwide, with 1.5 million surgeries being postponed or cancelled in England and Wales during 2020. Surgeons in competitive specialties requiring active research portfolios may have used this time to strengthen their academic work. This cross-sectional study provides insight into the academic output of Welsh plastic surgery trainees during the COVID-19 pandemic, which could be used to highlight contributing factors to benefit future training. Method A cross-sectional study was distributed to all Welsh burns and plastic surgery trainees from specialty trainee levels 3–8. Data was obtained comparing publications achieved, abstracts submitted, and projects undertaken pre-pandemic, March 1st to 31st August 2019 and mid-pandemic, March 1st to 31st August 2020. Results Of the 12 Welsh plastic surgery trainees, 75% participated in this survey, with representation from all years of training. Mid-pandemic, an average of 3 publications were achieved per trainee when compared with 1.4 pre-pandemic. 78% submitted abstracts during both periods, increasing from 1.5 to 2.44 mid-pandemic. Although the average number of projects undertaken pre- and mid-pandemic was 3.2 and 3.1 respectively, the number of trainees undertaking projects increased by 22% to 100%. Most commonly, this was attributed to an increase in capacity. Conclusions Our study demonstrated that overall, academic output increased significantly during the COVID-19 pandemic. Unsurprisingly, this sudden decrease in surgical activity led to trainees in this highly competitive specialty employing their time towards research. Further studies investigating the factors enabling trainees to increase their academic productivity would be beneficial as routine surgical activity resumes.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"109 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87510241","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Introduction Patients with COVID-19 infection peri-operatively can suffer with significant cardiovascular and pulmonary complications, increasing mortality. Clinicians should discuss these risks with their patients as per the Royal College of Surgeons of England guidance (2020), so that patients can make informed decisions. Method Our aim was to identify whether the complications associated with COVID-19 in the peri-operative period was documented on the consent forms of both emergency and elective general surgical patients. To encourage clinicians to consent their patients, we devised a colourful poster, the ‘COVID-19 Consent Poster (CCP)’ which was placed next to the consent form on wards, outpatient clinics and the emergency department. Results A total of 49 procedures took place in the two-week period, of which 67% (n= 34) of patients were consented for the COVID-19 risk, and 33% (n= 15) were not. Following implementation of the CCP, data was recollected to identify whether practice had changed. During this time frame, 26 procedures took place out of which 50% (n=13) were not consented for the risks of COVID-19 complications. Conclusions Following implementation of the CCP, we saw initial rise in the number of consents, but this soon declined. We believe, this might be due to the rates of COVID-19 decreasing in the hospital and the community during the data collection period. Despite these figures, the importance of informed consent around peri-operative complications of COVID-19 remains with more of the population still getting infected with new variants emerging each year.
{"title":"650 “Promoting Adequate Consenting for the Risks of Peri-Operative COVID-19 Complications in Patients Undergoing Surgery During the Pandemic”","authors":"E. Mazumdar, T. Valenzuela","doi":"10.1093/bjs/znac269.086","DOIUrl":"https://doi.org/10.1093/bjs/znac269.086","url":null,"abstract":"Abstract Introduction Patients with COVID-19 infection peri-operatively can suffer with significant cardiovascular and pulmonary complications, increasing mortality. Clinicians should discuss these risks with their patients as per the Royal College of Surgeons of England guidance (2020), so that patients can make informed decisions. Method Our aim was to identify whether the complications associated with COVID-19 in the peri-operative period was documented on the consent forms of both emergency and elective general surgical patients. To encourage clinicians to consent their patients, we devised a colourful poster, the ‘COVID-19 Consent Poster (CCP)’ which was placed next to the consent form on wards, outpatient clinics and the emergency department. Results A total of 49 procedures took place in the two-week period, of which 67% (n= 34) of patients were consented for the COVID-19 risk, and 33% (n= 15) were not. Following implementation of the CCP, data was recollected to identify whether practice had changed. During this time frame, 26 procedures took place out of which 50% (n=13) were not consented for the risks of COVID-19 complications. Conclusions Following implementation of the CCP, we saw initial rise in the number of consents, but this soon declined. We believe, this might be due to the rates of COVID-19 decreasing in the hospital and the community during the data collection period. Despite these figures, the importance of informed consent around peri-operative complications of COVID-19 remains with more of the population still getting infected with new variants emerging each year.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"110 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79248987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim In this region, the Sentinel Lymph Node Biopsy (SLNB) Service was established in 2018 and suspended in 2020, due to the COVID-19 pandemic. Service has resumed under interim criteria, accounting for COVID-19 constraints. Patients not fulfilling these criteria (SLNB for tumour stage pT3a or greater) had wide local excision (WLE) alone. This audit aims to examine quality of Service delivery to date, plan full-Service resumption, and generate a cohort for ongoing outcomes research. Method A prospectively collected database captured patients with tumour stage pT1b or higher. Data were analysed for demographics, tumour characteristics and outcome of Service referral, and compared to predetermined performance indicators. Results Data were collected on 410 patients, from December 2018 to April 2021; 94.4% had complete datasets. Of the remaining 5.6%, none underwent SLNB. The mean age was 62 (range 12–96). 187 patients were male; 220 were female. The most frequent tumour location in males was the trunk (36.0%), differing from females (41.8% lower limb). The most common tumour stage was pT2a, occurring in 34.7% (27.9% males, 40.7% females). 141 eligible patients were investigated with SLNB (18.4% positive, 75.9% negative, 5.7% failed). 7.9% were unsuitable for SLNB and 4.5% declined. The remaining 168 patients did not fulfil interim criteria for SLNB and underwent WLE. Conclusions This audit assesses Service quality and will be used to facilitate full-Service provision. Interim criteria reflect a higher rate of positive SLNB. Ongoing research investigates the rate of false negative SLNB and impact of the COVID-19 pandemic on rates of recurrent/disseminated disease.
{"title":"612 Sentinel Lymph Node Biopsy for Patients with Cutaneous Malignant Melanoma. an Audit of the First 30 Months of a New Regional Service","authors":"B. French, J. Bond, M. Tohill, SE McAllister","doi":"10.1093/bjs/znac269.309","DOIUrl":"https://doi.org/10.1093/bjs/znac269.309","url":null,"abstract":"Abstract Aim In this region, the Sentinel Lymph Node Biopsy (SLNB) Service was established in 2018 and suspended in 2020, due to the COVID-19 pandemic. Service has resumed under interim criteria, accounting for COVID-19 constraints. Patients not fulfilling these criteria (SLNB for tumour stage pT3a or greater) had wide local excision (WLE) alone. This audit aims to examine quality of Service delivery to date, plan full-Service resumption, and generate a cohort for ongoing outcomes research. Method A prospectively collected database captured patients with tumour stage pT1b or higher. Data were analysed for demographics, tumour characteristics and outcome of Service referral, and compared to predetermined performance indicators. Results Data were collected on 410 patients, from December 2018 to April 2021; 94.4% had complete datasets. Of the remaining 5.6%, none underwent SLNB. The mean age was 62 (range 12–96). 187 patients were male; 220 were female. The most frequent tumour location in males was the trunk (36.0%), differing from females (41.8% lower limb). The most common tumour stage was pT2a, occurring in 34.7% (27.9% males, 40.7% females). 141 eligible patients were investigated with SLNB (18.4% positive, 75.9% negative, 5.7% failed). 7.9% were unsuitable for SLNB and 4.5% declined. The remaining 168 patients did not fulfil interim criteria for SLNB and underwent WLE. Conclusions This audit assesses Service quality and will be used to facilitate full-Service provision. Interim criteria reflect a higher rate of positive SLNB. Ongoing research investigates the rate of false negative SLNB and impact of the COVID-19 pandemic on rates of recurrent/disseminated disease.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76336587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim The aim of surgical training is to ensure trainees acquire competencies to perform as a Day 1 Consultant. The last decade has seen the introduction of European Working Time Directive, NELA guidelines and the revised Junior Doctor Contract. All of these, as well as the COVID 19 pandemic, have caused concerns regarding training. Our aim was to examine any changes to night-time on call activity during this time. Method We retrospectively analysed prospectively collected data from 2011, 2018, and 2021, in a busy District General Hospital. The data collection period was 31 days, looking at night-time (8pm to 8am) operative experience, supervision, and non-operative activity. A regression analysis was conducted to compare outcomes. A qualitative survey was used to assess attitudes and confidence. Results On average, trainees spent 11% of their time operating independently, 2% operating supervised, 11% attending trauma-calls and 73% clerking/non-educational activities. There was a significant difference between the hours spent on operative versus non-operative activity (P 0.00046) with no differences over the years. Junior trainees did not feel confident operating at night and only 33% of all trainees found night-time training effective. Conclusions Nightshifts comprise a substantial proportion of potential training opportunities and managing the unselected emergency take is one of the Capabilities in Practice. Effective solutions must be implemented to help improve night-time surgical experience and confidence in order for this time to be effective for training of both operative and non-operative competency attainment.
{"title":"363 A Comparative Analysis of Night-Time General Surgical Training","authors":"R. Aseem, N. Khan, G. Bowbrick","doi":"10.1093/bjs/znac269.396","DOIUrl":"https://doi.org/10.1093/bjs/znac269.396","url":null,"abstract":"Abstract Aim The aim of surgical training is to ensure trainees acquire competencies to perform as a Day 1 Consultant. The last decade has seen the introduction of European Working Time Directive, NELA guidelines and the revised Junior Doctor Contract. All of these, as well as the COVID 19 pandemic, have caused concerns regarding training. Our aim was to examine any changes to night-time on call activity during this time. Method We retrospectively analysed prospectively collected data from 2011, 2018, and 2021, in a busy District General Hospital. The data collection period was 31 days, looking at night-time (8pm to 8am) operative experience, supervision, and non-operative activity. A regression analysis was conducted to compare outcomes. A qualitative survey was used to assess attitudes and confidence. Results On average, trainees spent 11% of their time operating independently, 2% operating supervised, 11% attending trauma-calls and 73% clerking/non-educational activities. There was a significant difference between the hours spent on operative versus non-operative activity (P 0.00046) with no differences over the years. Junior trainees did not feel confident operating at night and only 33% of all trainees found night-time training effective. Conclusions Nightshifts comprise a substantial proportion of potential training opportunities and managing the unselected emergency take is one of the Capabilities in Practice. Effective solutions must be implemented to help improve night-time surgical experience and confidence in order for this time to be effective for training of both operative and non-operative competency attainment.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73642789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Q. Mak, J. Madden, Z. Ahmed, F. Kum, J. Makanjuola, O. Cakir
Abstract Aim Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or Rigid Cystoscopy + Bladder Biopsy (BB) during pre-operative assessment (PoA). Each G&S costs £7.54 and 2 samples are required. The aim of this audit was to determine whether G&S is clinically required for these two procedures. Method This two-cycle audit reviewed the PoA components of patients undergoing TURBT or BB over a 6month period prior to the COVID-19 pandemic (July-Dec2019), in which PoA were face-to-face, and a subsequent re-audit during telephone PoA (July-Dec2020), where it was deemed unnecessary to have a G&S. Results 1st Cycle: 64 patients were included, 32.8%(21/64) had a preoperative G&S. 98.4%(63/64) had Hb measured. Mean Hb was 131.56 (79 – 165) g/l. 25%(16/64) were on anti-coagulants, of which 50%(8/16) were continued. No patients required a peri or post-operative blood transfusion. 2nd Cycle: 48 patients were included and 6.25%(3/48) had a G&S within the 1 month preceding their operation. 70.8%(34/48) had their Hb measured, with mean Hb being 135.18 (86 – 168) g/l. 22.9%(11/48) were on anticoagulants, of which 36%(4/11) were continued. There were no complications requiring a blood transfusion. Conclusions We found no requirement of blood transfusions following TURBT or BB, therefore routine G&S is not clinically indicated for this series. This reflects departmental savings of £964 over 6months (based on 64 cases). In addition, a relationship between continuing anti-coagulation or a low Hb and post-operative transfusion was not observed.
{"title":"541 Pre-Operative Assessment of Patients Undergoing Elective TURBT or Rigid Cystoscopy + Bladder Biopsy: Is a Group & Save Clinically Required?","authors":"Q. Mak, J. Madden, Z. Ahmed, F. Kum, J. Makanjuola, O. Cakir","doi":"10.1093/bjs/znac269.349","DOIUrl":"https://doi.org/10.1093/bjs/znac269.349","url":null,"abstract":"Abstract Aim Group & Save (G&S) is conducted prior to Transurethral Resection of Bladder Tumour (TURBT) or Rigid Cystoscopy + Bladder Biopsy (BB) during pre-operative assessment (PoA). Each G&S costs £7.54 and 2 samples are required. The aim of this audit was to determine whether G&S is clinically required for these two procedures. Method This two-cycle audit reviewed the PoA components of patients undergoing TURBT or BB over a 6month period prior to the COVID-19 pandemic (July-Dec2019), in which PoA were face-to-face, and a subsequent re-audit during telephone PoA (July-Dec2020), where it was deemed unnecessary to have a G&S. Results 1st Cycle: 64 patients were included, 32.8%(21/64) had a preoperative G&S. 98.4%(63/64) had Hb measured. Mean Hb was 131.56 (79 – 165) g/l. 25%(16/64) were on anti-coagulants, of which 50%(8/16) were continued. No patients required a peri or post-operative blood transfusion. 2nd Cycle: 48 patients were included and 6.25%(3/48) had a G&S within the 1 month preceding their operation. 70.8%(34/48) had their Hb measured, with mean Hb being 135.18 (86 – 168) g/l. 22.9%(11/48) were on anticoagulants, of which 36%(4/11) were continued. There were no complications requiring a blood transfusion. Conclusions We found no requirement of blood transfusions following TURBT or BB, therefore routine G&S is not clinically indicated for this series. This reflects departmental savings of £964 over 6months (based on 64 cases). In addition, a relationship between continuing anti-coagulation or a low Hb and post-operative transfusion was not observed.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82128337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim 1. A retrospective analysis of NMIBC follow-up using flexible cystoscopy during COVID-19. 2. Charlson Co-Morbidity Index (CCI) as a method of improving follow up. Method Online patient records were reviewed for 153 patients who attended Ayr University Hospital between 01/02/2020 and 01/05/ 2020 for check cystoscopy. We recorded the patients risk category and the number of months lapsed since their previous scope. Follow up schedules were compared with current NICE guidelines. CCI for each patient was calculated. Results The majority of the patients sampled had follow up adherent to NICE guidelines. Deviations were secondary to ‘allocation to an incorrect follow up schedule’, ‘late follow up’ and ‘non-compliance’. Incorrect allocation was due to both human error and clinical judgement. Clinical judgement included frail patients thought not to benefit from their current intensive schedule and patients with areas of suspicion warranting an earlier check. CCI scores ranged from 2–11. 25% of had a Charlson score of >6 - this predicts a 0% 10-year survival. Conclusions We hypothesise that patients with a CCI > 6 should be considered for less intensive follow up. Their co-morbid status makes them likely unsuitable for intervention if reoccurrence was identified.We are pleased with our current adherence to NICE guidelines. We recognise areas for improvement and have raised these at local meetings. We hope that the CCI can be used to ensure we practice realistic medicine and act in the best of the patient when deciding to follow up.
{"title":"176 A Retrospective Analysis of Non-Muscle Invasive Bladder Cancer (NMIBC) Follow-Up Using Flexible Cystoscopy and the Role of the Charlson Co-Morbidity Index (CCI) in Improving Follow Up","authors":"S. Dickson, J. Jones, R. Clark","doi":"10.1093/bjs/znac269.495","DOIUrl":"https://doi.org/10.1093/bjs/znac269.495","url":null,"abstract":"Abstract Aim 1. A retrospective analysis of NMIBC follow-up using flexible cystoscopy during COVID-19. 2. Charlson Co-Morbidity Index (CCI) as a method of improving follow up. Method Online patient records were reviewed for 153 patients who attended Ayr University Hospital between 01/02/2020 and 01/05/ 2020 for check cystoscopy. We recorded the patients risk category and the number of months lapsed since their previous scope. Follow up schedules were compared with current NICE guidelines. CCI for each patient was calculated. Results The majority of the patients sampled had follow up adherent to NICE guidelines. Deviations were secondary to ‘allocation to an incorrect follow up schedule’, ‘late follow up’ and ‘non-compliance’. Incorrect allocation was due to both human error and clinical judgement. Clinical judgement included frail patients thought not to benefit from their current intensive schedule and patients with areas of suspicion warranting an earlier check. CCI scores ranged from 2–11. 25% of had a Charlson score of >6 - this predicts a 0% 10-year survival. Conclusions We hypothesise that patients with a CCI > 6 should be considered for less intensive follow up. Their co-morbid status makes them likely unsuitable for intervention if reoccurrence was identified.We are pleased with our current adherence to NICE guidelines. We recognise areas for improvement and have raised these at local meetings. We hope that the CCI can be used to ensure we practice realistic medicine and act in the best of the patient when deciding to follow up.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"121 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74310321","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Aim Since the COVID-19 pandemic facemasks have become compulsory in UK hospitals impacting on the visual and vocal (93%) aspects of communication. This QIP looks at the difference a clear mask made to patients. Method ClearmaskTM was used in place of a surgical mask and patients were asked to rate the difference on a likert scale. 100 patients were seen at two appointments, once with a Clearmask and another with a surgical mask. Dragon voice recognition software was used as a control. Results 95% of patients rated communication better with the clearmask, Patients felt more engaged and were more likely to engage with the clinician. The effect was amplified when English was not the first language. Conclusions Clear facemasks improved communication and allow patients to become more engaged in consults and are more likely to allow information to be divulged to a clinician.
{"title":"972 Communication During the Pandemic","authors":"J. Herron, I. Radotra, A. Kay","doi":"10.1093/bjs/znac269.252","DOIUrl":"https://doi.org/10.1093/bjs/znac269.252","url":null,"abstract":"Abstract Aim Since the COVID-19 pandemic facemasks have become compulsory in UK hospitals impacting on the visual and vocal (93%) aspects of communication. This QIP looks at the difference a clear mask made to patients. Method ClearmaskTM was used in place of a surgical mask and patients were asked to rate the difference on a likert scale. 100 patients were seen at two appointments, once with a Clearmask and another with a surgical mask. Dragon voice recognition software was used as a control. Results 95% of patients rated communication better with the clearmask, Patients felt more engaged and were more likely to engage with the clinician. The effect was amplified when English was not the first language. Conclusions Clear facemasks improved communication and allow patients to become more engaged in consults and are more likely to allow information to be divulged to a clinician.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80869788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Paluch, H. Tariq, O. Small, E. Ratford, S. Sokolowski, AA Kassam, M. Hubble, J. Howell, J. Charity, S. Gowda, M. Panteli, M. Wilson
Abstract Aim COVID-19 has led to unprecedented waiting times for elective surgery. Optimising patient pathways is paramount in tackling the backlog. Length of hospital stay (LOS) is an accepted surrogate for successful elective surgery. The aims of our study were: 1) report on changes in LOS after restarting our elective THA service; 2) identify barriers to early discharge, 3) investigate effectiveness of implemented changes. Method A retrospective review of consecutive patients undergoing elective THA, comparing three groups: 1) enhanced care pathway (n=96; 09/2019–12/2019); 2) COVID group (n=56; 03/2021–04/2021); 3) intervention group (n=96; 05/2021–08/2021). Results LOS in the enhanced care pathway group was 2.6 ±2.1 days. During initial resumption of elective operating (COVID group) the LOS was 4.8 ±4.5 days (statistically significant increase; p=0.011). Factors affecting LOS included reduced physiotherapy provision; lack of pre-operative occupational therapy review; loss of educational classes and worse pre-operative functional status. To address these our department employed three new physiotherapists, introduced training for nursing staff and created a post-operative proforma. The LOS subsequently reduced to 3.7 ±4.6days (p=0.166). Subgroup analysis of the intervention group showed age <75 (p<0.001) and ASA1–2 (p=0.036) were associated with reduced LOS (2.1±1.5 days). Other variables analysed did not significantly affect LOS. Conclusions COVID-19 has had a significant effect on LOS, which is still not reversed. For effective resumption of THA services, pre-pandemic enhanced care pathways should be reinstated. With current restrictions preventing face-to-face classes, online educational sessions could be offered. Those younger than 75 years and ASA1–2 are most likely to be discharged without delay.
{"title":"608 Optimising Return to Elective Total Hip Arthroplasty (THA) Following the COVID-19 Pandemic: Lessons Learned and Future Directions","authors":"A. Paluch, H. Tariq, O. Small, E. Ratford, S. Sokolowski, AA Kassam, M. Hubble, J. Howell, J. Charity, S. Gowda, M. Panteli, M. Wilson","doi":"10.1093/bjs/znac269.085","DOIUrl":"https://doi.org/10.1093/bjs/znac269.085","url":null,"abstract":"Abstract Aim COVID-19 has led to unprecedented waiting times for elective surgery. Optimising patient pathways is paramount in tackling the backlog. Length of hospital stay (LOS) is an accepted surrogate for successful elective surgery. The aims of our study were: 1) report on changes in LOS after restarting our elective THA service; 2) identify barriers to early discharge, 3) investigate effectiveness of implemented changes. Method A retrospective review of consecutive patients undergoing elective THA, comparing three groups: 1) enhanced care pathway (n=96; 09/2019–12/2019); 2) COVID group (n=56; 03/2021–04/2021); 3) intervention group (n=96; 05/2021–08/2021). Results LOS in the enhanced care pathway group was 2.6 ±2.1 days. During initial resumption of elective operating (COVID group) the LOS was 4.8 ±4.5 days (statistically significant increase; p=0.011). Factors affecting LOS included reduced physiotherapy provision; lack of pre-operative occupational therapy review; loss of educational classes and worse pre-operative functional status. To address these our department employed three new physiotherapists, introduced training for nursing staff and created a post-operative proforma. The LOS subsequently reduced to 3.7 ±4.6days (p=0.166). Subgroup analysis of the intervention group showed age <75 (p<0.001) and ASA1–2 (p=0.036) were associated with reduced LOS (2.1±1.5 days). Other variables analysed did not significantly affect LOS. Conclusions COVID-19 has had a significant effect on LOS, which is still not reversed. For effective resumption of THA services, pre-pandemic enhanced care pathways should be reinstated. With current restrictions preventing face-to-face classes, online educational sessions could be offered. Those younger than 75 years and ASA1–2 are most likely to be discharged without delay.","PeriodicalId":76612,"journal":{"name":"The British journal of oral surgery","volume":"160 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72795730","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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