General Surgery

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Research outputs from the General Surgery department at the RD&E.


Recent Submissions

Now showing 1 - 5 of 46
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    130 Paediatric Hand Fractures Requiring Surgery – the Results of a Bespoke Hand Surgery Service
    (Wiley, 2022-02-28) Donnachie, D.; Yim, G.; Watts, A.
    To evaluate the management of The Royal Devon and Exeter Hospital (RD&E) bespoke hand surgery service on paediatric closed hand fractures. In particular, an assessment against The British Society for Surgery of the Hand (BSSH) closed fracture standards on treatment timelines and national guidance compliance.A retrospective review of all paediatric patients requiring plastic surgery seen at the RD&E plastics trauma clinic from 1st Nov 2020 to 28th Feb 2021 was performed. This was compared to two previous audit cycles completed during winter 2019 and summer 2020. Health informatics was collated via our IT department and thoroughly reviewed using departmental notes. Exclusion criteria included: all non-fracture injuries, patients > 18 years old and open fractures.In winter 2020–21 all patients were referred the same day of injury and 92% were seen by a Plastic Surgeon within 24 hours of injury. This was an improvement from the mean time from referral to clinic of 5 days in winter 2019 and 1.33 days in summer 2020 respectively. 85% of cases are now operated within 48 hours of review and 92% of cases were operated within 72 hours of the decision to operate where conservative management had failed.The introduction of a ‘rapid-access’ musculoskeletal unit with early senior review and a dedicated theatre has created ‘gold-standard’ compliance with national standards for the operative management of closed paediatric fractures. We should continue to focus on improving and increasing capacity of this service as it has likely improved both the patient journey and outcomes.
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    157 Diagnostic Test Accuracy of Artificial Intelligence Models Used in Cross-Sectional Radiological Imaging of Surgical Pathology in the Abdominopelvic Cavity: A Systematic Review
    (Wiley, 2022-02-28) Fowler, G.E.; Blencowe, N.S.; Hardacre, C.; Callaway, M.P.; Smart, N.J.; Macefield, R.C.
    Medical imaging is important for diagnostic, prognostic, and management decisions. It is reliant on an increasingly limited number of interpreters. A developing interest has explored how artificial intelligence (AI) research in medical imaging can support clinicians and provide greater efficiency in clinical care. Reviews exist for thoracic and endoscopic imaging, but one is lacking for the abdominopelvic cavity. This could benefit several specialities which use this modality of imaging to guide their clinical decision making. This systematic review examines and critically appraises the application of AI models to identify surgical pathology from cross-sectional radiological images of the abdominopelvic cavity, to identify current limitations and inform future research.Systematic database searches (Medline, EMBASE, Cochrane Central Register of Controlled Trials) to identify relevant studies were performed, adhering to the PRISMA-DTA guidelines. Study characteristics and outcomes assessing diagnostic performance were extracted. A narrative synthesis was performed in accordance with the Synthesis Without Meta-analysis guidelines.10 retrospective studies were included, comprising 3,096 and 1,432 patients for AI training and test sets, respectively. There was diversity in the speciality, intention of the AI applications and the reporting, which was unstandardised. Diagnostic performance of models varied (range: 70–95% sensitivity, 73.7%-98% specificity). Only one study used a comparator, in which AI (AUC=0.920) outperformed both senior and junior radiologists (AUC=0.791 and 0.780, respectively).AI application in this field is diverse and adherence to new and developing reporting guidelines is warranted. With finite healthcare resources and funding, future endeavours may benefit from prioritising clinical need, rather than scientific inquiry.
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    266 Improving Management of Women Presenting with Groin Hernias at Royal Devon and Exeter Hospital (RD&E)
    (Wiley, 2022-02-28) Chillarge, G.
    Determine the percentage of women with groin hernia undergoing laparoscopic repair at RD&E hospital and if it was offered during clinic visit.The lifetime risk of groin hernia in women is 3–5.8%. The incidence of missed femoral hernia at re-operation after open repair in women is 41%. The HerniaSurge group has recommended laparoscopic repair of all groin hernias in women as it offers opportunity to identify all types of groin hernias and reduces post-operative pain and recurrence.All female patients undergoing groin hernia surgery at RD&E hospital from 1 Feb 2018–31 Jan 2020 were identified. Patients undergoing surgery after this period were not included as the surgical practice was changing due to COVID-19 pandemic. Electronic patient records including clinic letters, operative notes, radiology reports and follow up letters were reviewed.117 female patients undergoing groin hernia repair were identified. During clinic visit, rationale for laparoscopic surgery was documented only in 29/117 while discussion regarding material risks of surgery was documented in 51/117. Only 41/117 (35%) patients underwent laparoscopic hernia repair.The current practice at RD&E requires improvements in terms of documentation of material risks associated with groin hernia repair and offering laparoscopic repair for women with groin hernias. For the next cycle, we aim to present at the local audit meeting and then collect further data to evaluate improvements in practice. We also aim to create a standardised electronic clinic letter and operative note format to bring uniformity of care.
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    218 Compliance With the British Society for Surgery of the Hand (BSSH) Guidelines on the Management of Open Hand Fractures Audit
    (Wiley, 2022-02-28) John, H.; Nagrath, N.
    British Society of Surgery of the Hand (BSSH) have defined standards for managing open hand fractures. We intended to ascertain our and referring peripheral units’ adherence with BSSH’s standards of care in managing open hand fractures and determine the associated morbidity.We performed a 6-month prospective audit reviewing clinical records of patients referred to our department with open hand fractures, to determine whether: antibiotic prophylaxis had been started, and discontinued at definitive closure; wound washout and closure had been performed within 24 hours of injury; patients had continued rehabilitation with hand therapists.25 patients sustained open hand fractures in this period. All patients, except 1 who declined, received antibiotic prophylaxis. 19 (76%) had a wound washout and closure within 24 hours of injury.Antibiotic prophylaxis was discontinued at time of definitive closure in theatre in 3 (12%) patients. The remaining 21 patients continued antibiotic prophylaxis beyond 72 hours. 3 (12%) patients developed a wound infection, 2 (6%) of these requiring debridement and irrigation in theatre. Both patients had proximal interphalangeal joint fracture dislocations who underwent a wound debridement within 24 hours of injury, 1 of which was secondary to an animal bite. 22 (88%) patients attended their hand therapy appointment.The incidence of deep infection requiring subsequent operative debridement remains low in open hand fractures, despite the substandard adherence to BSSH’s recommendations.Educating colleagues will improve the adherence to guidance. The BSSH hand injury triage app fulfils this purpose. We intend to raise awareness and encourage its use.
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    A Systematic Review of the Outcomes of Microsurgical Toe Transfer for Metacarpal and Metacarpal-Like Hand Deformity
    (World Scientific Publishing, 2022-02-01) Nagrath, N.; Duggan, E.; Thurley, N.; Rodrigues, J. N.
    Background: Thumb and multiple finger amputations may result in a metacarpal and a metacarpal-like hand deformity. Toe-to-hand transfer is a recognised treatment strategy for this deformity but has risks and is resource intensive. The aim of this study is to conduct a systematic review of the outcomes of toe-to-hand transfer for traumatic metacarpal and metacarpal-like hand deformity in adult patients. Methods: Multi-database searching with index and free text terms, duplicate standardised screening and extraction, and quality assessment was performed. The inclusion and exclusion criteria were prespecified. We included any randomised controlled trials, cohort studies, case-control studies, as well as interrupted time series, before and after intervention studies. Results: Screening of 548 articles yielded 20 studies eligible that included 19 retrospective observational studies and one before and after intervention study. A total of 171 patients underwent 274 toe transfers for metacarpal and metacarpal-like hand deformity. No study compared toe-transfer to a control group or to a prosthesis. The before and after intervention study demonstrated significant improvement in activities of daily living, work, aesthetics and satisfaction. Additionally, no significant donor site morbidity occurred in the heterogenous sample. Outcomes from remaining studies at risk of bias suggest that those with a lesser severity of injury and at least two toe transfers score higher in functional tests and scoring systems. Conclusions: There is limited confidence in the effectiveness of toe transfer for metacarpal and metacarpal-like hand deformity. The available evidence indicates that toe transfer(s) may restore acceptable function permitting activities of daily living, return to original or sedentary occupation and affords satisfaction. Level of Evidence: Level III (Therapeutic).