Author(s) Puglia F.A.; Hills A.; Dawoud B.; Magennis P.; Chiu G.A. et al.
Source British Journal of Oral and Maxillofacial Surgery; Oct 2021; vol. 59 (no. 8); p. 867-874
Language English
Publication Date Oct 2021
DOI 10.1016/j.bjoms.2020.12.021
ISSN 0266-4356
Database EMBASE
Abstract
We assess the effect of coronavirus disease 2019 (COVID-19) on UK oral and maxillofacial (OMF) trauma services and patient treatment during the first wave of the pandemic. From 1 April 2020 until 31 July 2020, OMF surgery units in the UK were invited to prospectively record all patients presenting with OMF trauma. Information included clinical presentation, mechanism of injury, how it was managed, and whether or not treatment included surgery. Participants were also asked to compare the patient's care with the treatment that would normally have been given before the crisis. Twenty-nine units across the UK contributed with 2,229 entries. The most common aetiology was mechanical fall (39%). The most common injuries were soft tissue wounds (52%) and, for hard tissues, mandibular fractures (13%). Of 876 facial fractures, 79 patients' treatment differed from what would have been normal pre-COVID, and 33 had their treatment deferred. Therefore the care of 112 (14%) patients was at variance with normal practice because of COVID restrictions. The pattern of OMFS injuries changed during the first COVID-19 lockdown. For the majority, best practice and delivery of quality trauma care continued despite the on-going operational challenges, and only a small proportion of patients had changes to their treatment. The lessons learnt from the first wave, combined with adequate resources and preoperative testing of patients, should allow those facial injuries in the second wave to receive best-practice care.

• Available in full text at The British journal of oral & maxillofacial surgery

Author(s) Ali Z.; Al-Janabi A.; Warren R.B.; Matthews R.
Source Expert Review of Clinical Immunology; 2021; vol. 17 (no. 10); p. 1073-1081
Language English
Publication Date 2021
DOI 10.1080/1744666X.2021.1967748
ISSN 1744-666X
Database EMBASE
​Abstract
Introduction: Interleukin (IL)-17 is critical in the pathogenesis of psoriasis and psoriatic arthritis (PsA) with most data suggesting that IL-17A alone was the key cytokine. However, in vitro and in vivo studies have suggested dual blockade of IL-17A and IL-17 F may be more effective than IL-17 A blockade alone. Bimekizumab is the first human monoclonal antibody to exert simultaneous specific inhibition of IL-17A and IL-17 F, and has been studied in several phase II/III trials for psoriasis and PsA. Areas covered: Bimekizumab is not currently licensed for use. A literature search identified clinical trials examining the efficacy and safety of bimekizumab for psoriasis and PsA, and these were critically appraised. Expert opinion: Clinical trials of bimekizumab have been promising, demonstrating a rapid onset of response and superior efficacy compared to three currently licensed biologics: secukinumab, ustekinumab, and adalimumab. Bimekizumab maintains a high level of efficacy with maintenance dosing intervals of 8 weeks, compared with 4 weeks for currently licensed IL-17A antagonists. No unexpected adverse events have been identified, although mild-to-moderate fungal infections occur in approximately 10%. Studies over longer time periods involving additional active comparators would be valuable in further defining the role of bimekizumab amongst currently available treatments.

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Author(s) Wang R.; Gao C.; Tao L.; Kawashima H.; Ono M. et al.
Source Clinical Research in Cardiology; Oct 2021; vol. 110 (no. 10); p. 1680-1691
Language English
Publication Date Oct 2021
DOI 10.1007/s00392-021-01922-y
ISSN 1861-0684
Database EMBASE
Abstract
Aims: To investigate the impact of established cardiovascular disease (CVD) on 10-year all-cause death following coronary revascularization in patients with complex coronary artery disease (CAD). Method(s): The SYNTAXES study assessed vital status out to 10 years of patients with complex CAD enrolled in the SYNTAX trial. The relative efficacy of PCI versus CABG in terms of 10-year all-cause death was assessed according to co-existing CVD. Result(s): Established CVD status was recorded in 1771 (98.3%) patients, of whom 827 (46.7%) had established CVD. Compared to those without CVD, patients with CVD had a significantly higher risk of 10-year all-cause death (31.4% vs. 21.7%; adjusted HR: 1.40; 95% CI 1.08-1.80, p = 0.010). In patients with CVD, PCI had a non-significant numerically higher risk of 10-year all-cause death compared with CABG (35.9% vs. 27.2%; adjusted HR: 1.14; 95% CI 0.83-1.58, p = 0.412). The relative treatment effects of PCI versus CABG on 10-year all-cause death in patients with complex CAD were similar irrespective of the presence of CVD (p-interaction = 0.986). Only those patients with CVD in >= 2 territories had a higher risk of 10-year all-cause death (adjusted HR: 2.99, 95% CI 2.11-4.23, p < 0.001) compared to those without CVD. Conclusion(s): The presence of CVD involving more than one territory was associated with a significantly increased risk of 10-year all-cause death, which was non-significantly higher in complex CAD patients treated with PCI compared with CABG. Acceptable long-term outcomes were observed, suggesting that patients with established CVD should not be precluded from undergoing invasive angiography or revascularization.

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Author(s) Tan S.Z.C.P.; El Santawy H.; Abdelhaliem A.
Source Journal of Cardiac Surgery; Oct 2021; vol. 36 (no. 10); p. 3831-3833
Language English
Publication Date Oct 2021
DOI 10.1111/jocs.15828
ISSN 0886-0440
Database EMBASE
Abstract
Thoracic endovascular aortic repair (TEVAR) has quickly become the mainstay of treatment for acute aortic dissection, in particular cases of acute complicated Stanford Type B dissection (co-TBAD). Necessarily, TEVAR carries with it the risk of postoperative complications, including stroke and renal failure. As a result, the management of patients with uncomplicated type B aortic dissection (un-TBAD), which is generally accepted as being less severe, is safely managed via optimal medical therapy (OMT) alone. However, despite OMT, patients with un-TBAD are at substantial risk of severe disease progression requiring delayed intervention. The cost-benefit ratio associated with TEVAR for un-TBAD is therefore of key interest. Howard and colleagues produced a fascinating systematic review and meta-analysis investigating the clinical outcomes of TEVAR for complicated and uncomplicated TBAD. Their data suggest that there is no significant difference in in-hospital mortality or 5-year survival between TEVAR for un-TBAD and co-TBAD, although the 30-day mortality rate appeared to be higher in the co-TBAD cohort. Patients with co-TBAD appeared to also be at a higher risk of postoperative stroke and TEVAR endoleak, while un-TBAD patients were at a higher risk of postoperative renal failure. Further prospective research into these relationships is recommended to fully elucidate the comparative efficacies of TEVAR for un-TBAD and co-TBAD.

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Author(s) Mansell; Hughes, Kirsty; Heyes, Jane-Ward; Brownlee, Adrian; Charm, Clare; Blake, Daniel; Collinge, Sarah; Smith, Jason
Source Clinical Child Psychology & Psychiatry; Oct 2021; vol. 26 (no. 4); p. 1046-1052
Publication Type(s) Academic Journal
Database CINAHL
AbstractUK National Guidelines stress the importance of reducing waiting times for mental health assessments and interventions for children. They stress the importance of early help, multidisciplinary working, and collaboration with families regarding treatment plans. We piloted a new assessment model (CARM) within a CAMHS service to: reduce non-attendance rates and subsequently waiting times; increase staff and patient satisfaction; and improve the quality of assessment. All waiting list patients and new referrals over a three-month period were contacted to self-book an hour session to meet two clinicians who utilised collaborative reflection and formulation to produce a care plan (CARM). Results revealed that non-attendance rates dropped from 33% over the month prior to CARM to 7% during CARM. Satisfaction levels were high. Qualitative feedback regarding satisfaction revealed the most common themes was feeling listened to and having the opportunity to listen to staff reflections. The themes of staff satisfaction included 'feeling more supported' and 'feeling safer in their decision making'. All assessments were completed in the one appointment. A formulation-driven care plan was developed and discussed with the family. This approach has the potential to make services more effective, efficient and satisfying for both staff and families.

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Author(s) Wang R.; Onuma Y.; Serruys P.W.; van Geuns R.J.; Takahashi K. et al.
Source Clinical Research in Cardiology; Oct 2021; vol. 110 (no. 10); p. 1543-1553
Language English
Publication Date Oct 2021
DOI 10.1007/s00392-020-01802-x
ISSN 1861-0684
Database EMBASE
Abstract
Background: Coronary bypass artery grafting (CABG) has a higher procedural risk of stroke than percutaneous coronary intervention (PCI), but may offer better long-term survival. The optimal revascularization strategy for patients with prior cerebrovascular disease (CEVD) remains unclear. Methods and Results: The SYNTAXES study assessed the vital status out to 10 year of patients with three-vessel disease and/or left main coronary artery disease enrolled in the SYNTAX trial. The relative efficacy of PCI vs. CABG in terms of 10 year all-cause death was assessed according to prior CEVD. The primary endpoint was 10 year all-cause death. The status of prior CEVD was available in 1791 (99.5%) patients, of whom 253 patients had prior CEVD. Patients with prior CEVD were older and had more comorbidities (medically treated diabetes, insulin-dependent diabetes, metabolic syndrome, peripheral vascular disease, chronic obstructive pulmonary disease, impaired renal function, and congestive heart failure), compared with those without prior CEVD. Prior CEVD was an independent predictor of 10 year all-cause death (adjusted HR: 1.35; 95% CI: 1.04-1.73; p = 0.021). Patients with prior CEVD had a significantly higher risk of 10 year all-cause death (41.1 vs. 24.1%; HR: 1.92; 95% CI: 1.54-2.40; p < 0.001). The risk of 10 year all-cause death was similar between patients receiving PCI or CABG irrespective of the presence of prior CEVD (p-interaction = 0.624). Conclusion(s): Prior CEVD was associated with a significantly increased risk of 10 year all-cause death which was similar in patients treated with PCI or CABG. These results do not support preferential referral for PCI rather than CABG in patients with prior CEVD. 

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Author(s) Bashir ; Mohammed, Idhrees; Mousavizadeh, Mostafa; Rezaei, Yousef; Hosseini, Saeid
Source Journal of Cardiac Surgery; Oct 2021; vol. 36 (no. 10); p. 3994-3995
Language English
Publication Date Oct 2021
DOI 10.1111/jocs.15837
ISSN 08860440
Database CINAHL

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Author(s) Cadilhac ; Bagot, Kathleen L; Demaerschalk, Bart M; Hubert, Gordian; Schwamm, Lee et al.
Source Journal of Telemedicine & Telecare; Oct 2021; vol. 27 (no. 9); p. 582-589
Language English
Publication Date Oct 2021
DOI 10.1177/1357633X19899262
ISSN 1357633X
Database CINAHL
Abstract
Introduction: Globally, the use of telestroke programmes for acute care is expanding. Currently, a standardised set of variables for enabling reliable international comparisons of telestroke programmes does not exist. The aim of the study was to establish a consensus-based, minimum dataset for acute telestroke to enable the reliable comparison of programmes, clinical management and patient outcomes.Methods: An initial scoping review of variables was conducted, supplemented by reaching out to colleagues leading some of these programmes in different countries. An international expert panel of clinicians, researchers and managers (n = 20) from the Australasia Pacific region, USA, UK and Europe was convened. A modified-Delphi technique was used to achieve consensus via online questionnaires, teleconferences and email.Results: Overall, 533 variables were initially identified and harmonised into 159 variables for the expert panel to review. The final dataset included 110 variables covering three themes (service configuration, consultations, patient information) and 12 categories: (1) details about telestroke network/programme (n = 12), (2) details about initiating hospital (n = 10), (3) telestroke consultation (n = 17), (4) patient characteristics (n = 7), (5) presentation to hospital (n = 5), (6) general clinical care within first 24 hours (n = 10), (7) thrombolysis treatment (n = 10), (8) endovascular treatment (n = 13), (9) neurosurgery treatment (n = 8), (10) processes of care beyond 24 hours (n = 7), (11) discharge information (n = 5), (12) post-discharge and follow-up data (n = 6).Discussion: The acute telestroke minimum dataset provides a recommended set of variables to systematically evaluate acute telestroke programmes in different countries. Adoption is recommended for new and existing services.

• Available in full text at Journal of telemedicine and telecare 

Author(s) Puglia F.A.; Ubhi H.; Dawoud B.; Magennis P.; Chiu G.A.
Source British Journal of Oral and Maxillofacial Surgery; Oct 2021; vol. 59 (no. 8); p. 875-880
Language English
Publication Date Oct 2021
DOI 10.1016/j.bjoms.2020.12.017
ISSN 0266-4356
Database EMBASE
Abstract
On 25 March 2020, the Chief Dental Officer issued national guidance restricting the provision of all routine, non-urgent dental services in response to the spread of COVID-19. We analysed odontogenic cervicofacial infections (CFI) presenting to oral and maxillofacial surgery (OMFS) departments during the first wave of COVID-19 in the United Kingdom. From 1 April 2020 until 31 July 2020 a database was used to prospectively collect records for all patients with CFI who presented to oral and maxillofacial teams. Information gathered included clinical presentation, location/origin of infection, and how this was managed. The OMFS units were asked to compare the patient's care with the treatment that would usually have been given prior to the crisis. A total of 32 OMFS units recorded 1381 cases of CFI in the UK. Most of the infections were referred via the emergency department (74%). Lower first or second molars were the most common origin, contributing 40% of CFI. Collaborators reported that patients' treatments were modified as a response to COVID in 20% of cases, the most frequently cited reason being the application of COVID-19 hospital policy (85%). The impact of the first wave of COVID modified the management of a significant number of patients presenting with CFI, and there was a proactive move to avoid general anaesthetics where possible. Some patients who presented to secondary care were given no treatment, suggesting they could have been managed in primary dental care if this had been available. We recommend that OMFS units and urgent dental care centres (UDCCs) build strong communication links not only to provide the best possible patient care, but to minimise COVID exposure and the strain on emergency departments during the pandemic.

• Available in full text at The British journal of oral & maxillofacial surgery

Author(s) Kumar A.; Taggarsi M.
Source BMJ Evidence-Based Medicine; Oct 2021; vol. 26 (no. 5); p. 228-230
Language English
Publication Date Oct 2021
DOI 10.1136/bmjebm-2020-111525
ISSN 2515-446X
Database EMBASE
Abstract
Evidence-based practice forms an integral part of modern-day practice. It is so indispensable that modern healthcare cannot be imagined if evidence and its quality is ignored. However, evidence-based medicine is not as perfect as it is thought. Time and again, researchers have questioned the quality of evidence (QOE) in present era’s researches. The evidence in this regard can be found in the article published in The Lancet by the editor himself. Horton argued that much of the scientific literature, nearly 50%, might be false or untrue because of inclusion of small sample size studies, researches with statistically insignificant effects, unfitting analyses, atrocious conflicts of interest, together with an unrestricted fascination to pursue fashionable trends of dubious importance.
Camouflaged application of evidence-based medicine can be precarious to the patients and may hamper the idea of promoting healthy society.  According to National Institute for Clinical Excellence, approximately 62% of publications used to formulate the guidelines and recommendations of primary care were based on dubious researches and were judged of uncertain relevance to patients.

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Author(s) Bashir B.; Banerjee M.; Fahmy A.A.; Raza F.
Source Postgraduate Medical Journal; Oct 2021; vol. 97 (no. 1152); p. 667-671
Language English
Publication Date Oct 2021
DOI 10.1136/postgradmedj-2020-138513
ISSN 0032-5473
Database EMBASE
Abstract
The genesis of ketone bodies by organisms is a protective mechanism. This metabolic process helps organisms to survive acute metabolic derangements in times of nutrient deficiency. When prolonged, ketogenesis leads to ketoacidosis, which is a potentially life-threatening metabolic disorder due to the accumulation of keto-acids in the body. The most common cause is diabetic ketoacidosis, though starvation ketoacidosis and alcoholic ketoacidosis are not uncommon. The presentation of all ketoacidotic states is similar - being generally unwell, abdominal pain, rapid and shallow breathing, vomiting and dehydration. Non-diabetic ketoacidotic states are very commonly overlooked due to relative unawareness among the clinicians, leading to misdiagnosis and thereby inappropriate management culminating in added mortality and morbidity. We describe here six cases of alcoholic and starvation ketoacidosis, review the literature currently available and discuss the common pitfalls in managing such cases.

• Available in full text at Postgraduate medical journal from BMJ Journals - NHS

Author(s) Ahmed N.; Obeidallah R.; Subar D.
Institution(s) (Ahmed, Obeidallah, Subar) Royal Blackburn Hospital, Blackburn, United Kingdom
Source British Journal of Surgery; Oct 2021; vol. 108
Language English
Database EMBASE
AbstractAims: To ascertain the impact of ''Cost effective home-based pre-rehabilitation'' on post-operative outcomes in patients undergoing major hepatic and pancreatic oncological surgery. Method(s): In this non-randomized comparative study (2019-2021), we included 36 patients having pancreatic or hepatic malignancy. In group I, patients were signed up for home-based pre-rehabilitation program and dietary modification. Group II; included patients who did not have rehabilitation. The two groups were compared for post-operative outcomes (post-operative complications, length of ITU and hospital stay) Results: Mean age was 69.05+/-9.68 years in group I and 67.50+/-8.75 years in group II (p-value 0.61). Open approach was used in 02 (11.0%) patients in group I and in 09 (50%) patients in group II (p-value 0.01). More patients in group II needed admission in intensive care unit (ICU); 18 (100%) versus 11 (61.1%) in group II (p-value 0.0003). The group I had shorter length of hospital stay as compared to Group II (p-value 0.0001). There was no significant difference in post-operative complications between the groups. Conclusion(s): Home based pre-rehabilitation, has shown beneficial outcomes in terms of less requirement for ITU admission post operatively, shorter length of hospital stay and cost effective method of pre rehabilitation.

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Author(s) Sawhney R.; Seite E.; Fedder A.
Institution(s) (Sawhney, Seite, Fedder) East Lancashire Hospitals NHS Trust
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: The quality of junior clerking is essential to patient safety and care; it provides information vital to the management of surgical patients. This audit aimed to evaluate the completion of the General Admission Document (GAD) on the Surgical Admissions Unit to identify the impact of staff absences secondary to CoViD-19. Method(s): Admissions to the unit over a 5-day period (n=92) were evaluated against a checklist of the 26 items included on the GAD utilised by the trust, and daily handover sheets were used to identify staff absences. Mean completion was measured alongside thematic analysis of free-text remarks. Result(s): Handover sheets identified staff absences on 3 days. The overall mean completion of the GAD was 50.88% (95%CI: 46.65, 55.11, p<0.05). This was not significantly (p=0.074) impacted by staffing; mean completion was 48.47% (95%CI: 42.75, 54.20, p<0.05) on days with junior doctor absences, and 54.98% (95%CI: 49.14, 60.82, p<0.05) without. The major theme identified was deferring to the 'senior review' section of the GAD, suggesting a lack of awareness among juniors regarding the importance of a full junior clerking. Conclusion(s): Staff shortages secondary to CoViD-19 absences did not significantly impact the quality of junior clerking. However, the baseline completion of the GAD was noted to be poor regardless. Therefore, a teaching session during induction of the next cohort of doctors could be a sensible intervention to reiterate the importance of a full clerking.

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Author(s) Yang N.P.C.; Nijjar P.S.; Phyu S.; Barkeji M.; Butt M.A.J.
Institution(s) (Yang, Nijjar, Phyu, Barkeji) West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust
(Butt) Royal Blackburn Hospital
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: Nipple discharge is a presentation commonly seen at breast clinics. It is conventionally evaluated with physical examination and sonography( or mammography). The aim of this study is to investigate the diagnostic value of magnetic resonance imaging (MRI) as an additional imaging tool in the evaluation of potential malignancy in patients presented with nipple discharge. Method(s): A retrospective evaluation of 85 patients with nipple discharge who underwent breast ultrasound (USS) and MRI between 04/ 06/2008 and 25/10/2019 was conducted. Clinical notes, radiographic reports and biopsy results were reviewed. Sensitivity, specificity, positive predictive value and negative predictive value of USS and MRI were calculated. Result(s): Out of the 85 patients (all female; mean age 45.33 +/- 12.93 years old) with nipple discharge, 11 were found to have biopsy-proven malignancy (invasive ductal carcinoma/ ductal carcinoma in situ; 12.94% risk). USS failed to identify seven malignancies (27.27% sensitivity) while MRI missed three malignancies (72.72% sensitivity). USS falsely identified four malignancies from 74 patients with no malignancy (94.59% specificity) while MRI only falsely identified one case (98.65% specificity). For patients with negative USS results (U1/U2/U3) or negative MRI results (BI-RADS category 1,2 or 3), the negative predictive values of USS is 89.74% while that of MRI is 96.05%. The positive predictive values of USS and MRI are 42.86% and 88.88% respectively. Conclusion(s): Compared to USS, MRI has a higher sensitivity, specificity, positive predictive value and predictive value. It will be a valuable addition to the standard nipple discharge evaluation workup to help rule out malignancy.

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Author(s) Taib A.; Hammill C.; Abraham A.; Subar D.; Fakim B.; Garstang P.
Institution(s) (Taib, Hammill, Abraham, Subar) Blackburn Research Innovation, Development Group in General Surgery (BRIDGES), Blackburn, United Kingdom
(Taib, Hammill, Abraham, Fakim, Subar) Department of General Surgery, East Lancashire Hospitals NHS Trusts, Blackburn, United Kingdom
(Garstang) Women's and Children's Division, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, United Kingdom
Source British Journal of Surgery; Oct 2021; vol. 108
Database EMBASE
AbstractAims: Surgical Advanced Clinical Practitioners (SACP) form part of the extended surgical workforce and are drawn from allied health care backgrounds. The primary aim of this study was to determine if there is a financial benefit performing minor surgical procedures on dedicated SACP lists compared to consultant surgeon lists. Method(s): This was a retrospective cohort study including all patients who had a minor 'lumps and bumps' procedure undertaken between April 2014 and August 2019 at Anonymous Hospitals NHS Trust (AHT) under local anaesthetic by the general surgery team. Data such as lesion type, theatre staffing levels and operating time was collected. The cost of the procedure was calculated by operating time multiplied by cost of staff of per minute according to local banding. Result(s): A total of 1399 patients had a lesion excised; the majority were carried out by a doctor n=907, the rest independently by a SACP. The majority of lesions excised were lipomas and cysts. There was no difference in the median surgical time (20 minutes, IQR 14) taken to operate on each patient by SACPs and doctors. Minor procedures carried out on consultant surgeon lists cost 62.4% (21.72) more on average than those on SACP lists (56.55 vs 34.83 median respectively, p<0.001) due to excess staff for these cases. Conclusion(s): A dedicated and independent SACP 'lumps and bumps' list has shown to be a financially beneficial service. Operative times are similar to doctors. These lists free staff for consultant lists, potentially permitting more major cases.

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Author(s) Parmar K.; Badrick E.; Malcomson L.; Renehan A.; Sharma A.; Heywood N.
Institution(s) (Parmar, Badrick, Malcomson, Renehan) Manchester Cancer Research Centre, University of Manchester
(Parmar) General Surgery Training Programme, Health Education North West England
(Renehan) Christie NHS Foundation Trust
(Sharma) Manchester University NHS Foundation Trust
(Heywood) East Lancashire Hospitals Trust
Source British Journal of Surgery; Oct 2021; vol. 108
Language English
Database EMBASE
AbstractIntroduction: Guidelines suggest the laparoscopic approach may be safe and feasible in emergency general surgery. Despite this, the UK National Emergency Laparotomy Audit (NELA) rate of laparoscopic surgery remains low. Our earlier analysis of the NELA database identified factors associated with use of laparoscopy, then recommended further analysis to compare outcomes between laparoscopic and open surgery. Method(s): We obtained information from the NELA database (2013- 2017) and performed logistic regression on all first operations during the hospital admission. Outcomes were compared between open and laparoscopic approach (fully laparoscopic, laparoscopic assisted and laparoscopic converted). The primary outcome was death during hospital admission; secondary outcomes were admission to intensive care unit (ICU), length of ICU stay and return to theatre. Result(s): The cohort comprised 68,928 open (52% men, mean age 65) and 12,144 laparoscopic (51% men, mean age 58). In a model adjusted for all factors influencing primary or secondary outcomes (age, gender, p-possum, weekday versus weekend, operative time of day, malignancy, peritoneal soiling, CEPOD urgency, surgical grade and anaesthetist grade), death rates were significantly lower in the laparoscopic group (OR 0.65, 95% CI 0.59-0.71). Post-operative admission to ICU and ICU stay > 3 days were both significantly lower in the laparoscopic group (OR 0.59, 95% CI 0.56-0.62; OR 0.82, CI 0.75-0.89). There was no difference in return to theatre. Conclusion(s): Outcomes for laparoscopy in emergency general surgery appear superior to open surgery, although there may be residual unmeasured confounding factors. Further analysis will compare outcomes between pathologies.

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