‘The Impact of SIGN guidelines on Carotid Endarterectomy in South-East Scotland’

Abstracts / International Journal of Surgery 9 (2011) 363–369 367s / International Journal of Surgery 9 (2011) 363–369 367 1. Einhorn TA. Enhancement of Fracture Healing. Journal of Bone and Joint Surgery-American Volume 1995 Jun;77A(6):940-56. 2. Djouad F, Plence P, Bony C, Tropel P, Apparailly F, Sany J, et al. Immunosuppressive effect of MSC's favors tumor growth in allogeneic animals. Blood 2003 Nov 15; 102(10):3837-44. CONTEMPORARY OUTCOMES OF URGENT CABG FOLLOWING NSTEMI; URGENT CABG CONSISTENTLY OUT PERFORMS GRACE PREDICTED SURVIVAL J.D. Evans, S. Dudani, E. Senanayake, N.J. Howell, D. Pagano. University of Birmingham, UK Introduction: The GRACE registry has shown that in-hospital risk of death following non-ST-segment elevationmyocardial infarction (NSTEMI) is 5%, with a 11% mortality by 6 months. In GRACE, whilst 31% of patients received PCI, only 7% received coronary artery bypass grafting (CABG). To help identify patients at the highest risk following ACS the GRACE score was developed. This identified a highest tertile of patients who had an inhospital death rate of 6.7% and a six-month death rate of 14%. The data on the results of urgent CABG following NSTEMI are difficult to interpret as these often mix patients who have had STEMI and NSTEMI and include urgent surgery for failed revascularisation. Methods: 332 consecutive patients who had undergone CABG following NSTEMI from 2005 to 2009 were identified. The GRACE score was retrospectively calculated from hospital notes at the time of admission, and late survival data obtained from a prospectively maintained database. Results: There were 6 deaths following surgery (1.8%). Survival at 6 months was significantly higher than predicted by the GRACE score in all groups. In patients with a predicted GRACE mortality of 0-10% the 6 month mortality was 0.7%, with a predicted mortality of 10-20% the mortality was 2.6%, and in patients with a predicted mortality of >20% the mortality was 0. In patients with a EuroSCORE of <8, 5 year survival was 95%. Conclusion: In hospital CABG performed 48 hours after NSTEMI is associated with a low mortality risk and significant improvements in the GRACE predicted survival. ‘THE IMPACT OF SIGN GUIDELINES ON CAROTID ENDARTERECTOMY IN SOUTH-EAST SCOTLAND’ K.A. Gaba , Z. Raza . 1 University of Edinburgh; 2 Royal Infirmary of Edinburgh Background: Several studies have demonstrated a beneficial effect in patients undergoing carotid endarterectomy (CEA) within two weeks of suffering a focal neurological deficit. However, there is a large variation between units in the UK to provide CEA within the specified time. Aim: This study aimed to evaluate whether the Edinburgh Vascular Unit (EVU) has improved delays from neurological symptoms to surgery, in accordance with Scottish Intercollegiate Guidelines Network (SIGN) guidelines published in December 2008, which advocate the need for CEA to be performed within two weeks of a neurological event. Patients and Methods: Retrospective data related to CEA procedures carried out at the EVU between March 2007 and June 2010 (n1⁄4255) was analysed. The medianwas calculated for days from neurological symptoms to CEA, subdivided according to the four referring hospitals and whether the data was pre(n1⁄4128) or post-publication of guidelines (n1⁄4127). Results: Median delay from symptoms to surgery decreased in all four hospitals. Decrease in days from symptoms to surgery (p1⁄40.037) was statistically significant in one hospital. The percentage of patients undergoing CEA within two weeks after symptoms increased from 25% preguidelines to 40.2% post-publication of guidelines. The percentage undergoing CEA within four weeks after symptoms increased from 57% to 74.1% over the same period. Conclusion: There has been a significant improvement in CEA service provision since the implementation of SIGN guidelines. Further resource allocation is required to meet the two week target of CEA from symptoms in all patients. DOES AN ENHANCED RECOVERY PROGRAMME AFFECT READMISSION RATES FOLLOWING COLORECTAL RESECTION? N.R. Hope BSc Med Sci , Ms. A.J. MKinley , Dr. L. Feldman . University of Aberdeen; 2 Consultant colorectal surgeon, Aberdeen Royal Infirmary; 3 Attending general surgeon, Montreal General Hospital Background: Enhanced recovery after surgery (ERAS) is a clinical pathway for surgical patients designed to reduce hospital stay. Currently, this pathway is beginning to show that specific tailoring of treatment before, during and after surgery can achieve this goal. Patient safety following early discharge is of paramount importance. This study aims to compare 30 day readmission rates of those patients enrolled in an ERAS pathway versus those undergoing standard clinical care. Methods: Ethical approval was granted by the MUHC. The hospital database and patient charts of 151 consecutive patients at Montreal General Hospital who underwent colorectal resection between 1st June 2008 and the 30th June 2009 were reviewed. Results: 58 patients reviewed were in the ERAS pathway whilst 93 were reviewed in the standard care pathway. 30 day readmission rate was 10.3% and 9.7% respectively (p1⁄40.98). Mean hospital stay was 7.21 (95% CI: 5.50, 8.92) days in the ERAS group and 10.55 (95% CI: 8.58, 12.52) days (p1⁄40.02). There were no statistically significant differences in patient ASA morbidity between the two groups (p1⁄40.64). Conclusions: These results support current literature that enrolment in an ERAS pathway reduces hospital stay. Importantly, there is no increased rate of readmission if discharged home earlier from hospital. These data support the use of an ERAS pathway in routine clinical use. AN AUDIT TO EVALUATE THE EFFECTIVENESS OF DERMATOSCOPY Debbie Hunt , Mr. Christopher Duff , Mr. Stewart Watson . University of Birmingham, UK; University Hospital South Manchester, UK Background: Melanoma is an important cause of morbidity and mortality. The incidence has risen to 1 in 87, and is increasing by 7% each year. Early recognition and excision remain the most successful method of increasing patient survival. However, cure rates remain poor due to early metastasis. The standard method of diagnosis is the naked eye with accuracy ranging from 65-80%. There is therefore a need for an additional diagnostic tool to ensure no malignant melanomas are missed and reduce the number of unnecessary biopsies. Purpose: This study looks at the efficacy of the dermatoscope in increasing the sensitivity and specificity of diagnosis for melanomas. The sensitivity reflects the melanomas missed and the specificity reflects the unnecessary biopsies. Method: 89 pigmented lesions from patients presenting to clinic, within an eleven-week period, were photographed with both a standard digital camera and a dermatoscope-camera. 16 health care professionals – consultants and SpRs in plastic surgery, general surgeons, and specialist nurses were asked, from each of the photographs, which lesions were malignant. Results: The overall sensitivity of the dermatoscope was 68%, compared with 47% for the naked eye alone an increase of 21%. This is statistically significant. The overall specificity of the dermatoscope was 58% compared with 55% for the naked eye an increase of only 3%. Conclusion: The dermatoscope is an effective tool in diagnosis. It significantly increases sensitivity of diagnosis, therefore reducing the number of melanomas missed. The dermatoscope, however, did not significantly increase the specificity. One argument is that the number of negative biopsies is acceptable in order to catch as many melanomas as possible. In addition, the low sensitivity would be reduced in practice when practitioners would be more cautious with real patients, and have a lower threshold for biopsy.

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