Coad, Laura

Jones, Mark

Khorsandi, Maziar

Rammohan, Kandadai

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Abstracts / International Journal of Surgery 12 (2014) S13eS117S20identical to those with complex disease randomised to PCI in the SYNTAX
trial (80.8%). This suggests that depending on clinical situation, either
treatment can be justiﬁed.
0422: STAGED HYBRID PROCEDURE FOR THE MANAGEMENT OF EMER-
GENCY LEAKING TYPE A AORTIC DISSECTION
June 1,2, Yi-Ling Low*,1, Sanjay Asopa 2, Suresh Babu 2, Sergei Dudnikov 2,
James Kuo 2. 1 Peninsula Medical School, Plymouth, UK; 2 South-West
Cardiothoracic Centre, Plymouth, UK.
Introduction: Acute Type A aortic dissection (ATAAD) is a surgical emer-
gency with a high mortality. Procedures including a frozen elephant trunk
have been suggested to manage them surgically. We describe our experi-
ence of a leaking ATAAD, which was managed successfully with a staged
hybrid procedure (SHP) by a multidisciplinary team approach (MDT).
Methods: 78 years old manwith leaking ATAAD underwent a 1st stage sur-
gical replacement of his ascending aorta under deep hypothermic circulatory
arrest with retrograde cerebral perfusion. Re-entry tear and site of the con-
tained rupture were identiﬁed just distal to the origin of the left subclavian
artery (LSA). Thiswasnotpossible to repair throughamediansternotomy. The
Interventional Radiologist performed the 2nd stage procedure by stenting the
leaking descending thoracic aneurysm with a Thoracic Endovascular Aortic
Stent followed by Amplatz device closure of his LSA to prevent an endoleak.
Results: SHP has made it possible to manage this complex ATAAD, which
cannot be treated by conventional surgery alone. The patient made an
excellent recovery with no neurological complications.
Conclusions: A multidisciplinary staged hybrid procedure provides an
effective treatment for an acute Type A aortic dissection complicated by a
contained rupture of the descending thoracic aorta.
0485: DOES PERI-OPERATIVE ANTI-COAGULATION IN THORACIC SUR-
GERY ALTER THE RATE OF POST-OPERATIVE BLEEDING?
Joshil Lodhia*, Krishna Prasad, Ashvini Menon, Eustace Fontaine,
Piotr Krysiak, Kandadai Rammohan.Wythenshawe Hospital, Manchester, UK.
Introduction: Patients undergoing thoracic surgery have a higher risk of
developing veno-thromboembolism (VTE). There are currently no guide-
lines for the use of perioperative anticoagulation in thoracic surgery. We
performed a prospective audit assessing the use of perioperative anti-
coagulation and its impact on postoperative bleeding.
Methods: Data for thoracic procedures was collected from drug charts,
surgical database and notes. The ﬁelds included: type of surgery, VTE score,
preoperative medications, use of perioperative anticoagulation, drain
output at 6, 12 and 24 hours post procedure and reoperations.
Results: 78 patients with an average VTE score of 19 (>14 is high risk)
thoracic surgery. 34 patients (Group A) received enoxaparin on post-
operative day 0, however 44 patients (Group B) did not receive anti-
coagulation. The mean bleeding rates were 389ml and 444ml in group A
and B respectively. During our audit period no patients were reopened for
bleeding and there were no in hospital postoperative VTEs.
Conclusions: There was no trend towards increased bleeding in the group
that received anticoagulation on the day of the operation. While keeping in
mind the small sample size in this study, one could make a case for
commencing anticoagulation on the night of the operation to reduce the
incidence of postoperative VTEs.
0559: WHO SURGICAL SAFETY CHECKLIST COMPLIANCE AFTER CORO-
NARY ARTERY BYPASS GRAFTING IN A LARGE TERTIARY CARE HOSPITAL
Maziar Khorsandi*,1, Laura Coad 2, Mark Jones 1, Kandadai Rammohan 1.
1Department of Cardio-Thoracic Surgery, Wythenshawe Hospital, Manchester,
UK; 2Clinical Audit, Wythenshawe Hospital, Manchester, UK.
Introduction: The WHO surgical safety checklist can prevent 40% of
inadvertent deaths and prevent almost 29% of major complications when
correctly adhered to. Failure to complete the checklist puts patient safety at
risk and has large ﬁnancial implications for NHS trusts.
Methods: We studied WHO checklist compliance for coronary artery
bypass grafting (CABG) at the cardio-thoracic surgery department of
Wythenshawe hospital. Advancing quality North West guidelines require
100% adherence with the WHO checklist. We completed the audit cycle
and a third audit to ensure sustained improvement in practice.
Results: We assessed the WHO checklist of 70 consecutive CABG pa-
tients during the year 2013 and found 25% compliance. The loop-closure
audit of 40 consecutive patients revealed 88% compliance. A thirdprospective audit of 50 patients revealed 90% compliance with the WHO
checklist.
Conclusions: The correct completion of the WHO checklist is the re-
sponsibility of the surgeon. However, through completion of 3 audits we
observed over three-fold improvement in checklist completion when the
entire theatre team was given the responsibility in ensuring its correct
completion by surgeons. We recommend theatre team empowerment in
ensuring the correct completion of the checklist as well as regular auditing
as monitoring tool to assess checklist adherence.
0958: HOSPITAL STAYS POST CARDIAC SURGERY: WARFARIN VS DABI-
GATRAN
Amerdip Birring*, John Dark. Freeman Hospital, Newcastle, UK.
Introduction: To compare the hospital stays of patients anticoagulated
with warfarin versus dabigatran for the treatment of post-cardiac surgery
atrial ﬁbrillation (AF).
Method: All patients that developed new-onset AF following cardiac
surgery in our hospital were identiﬁed, using data from the National Adult
Cardiac Surgery Database. Patients that were not anticoagulant naïve or
required anticoagulation for multiple reasonswere excluded. The hospitals
electronic prescribing system was used to calculate time between initia-
tion of anticoagulation and discharge.
Results: 110 patients with AF post-cardiac surgery were identiﬁed. Of
these, 63 (57%) reverted to sinus rhythm within 48 hours of surgery and
therefore were not anticoagulated. 20 patients (18%) did not meet the
aforementioned criteria and were therefore excluded.
27 patients met the criteria for comparison. Of these 20 (74%) were anti-
coagulated with Warfarin, and 7 (26%) with Dabigatran. The average
hospital stay for patients' anticoagulated with Warfarin and Dabigatran
was 3.5 and 2.7 days, respectively.
Conclusions: Anticoagulation with dabigatran results in shorter hospital
stays. However, warfarin is still much more likely to be prescribed than
dabigatran. This may be because doctors are not conﬁdent in prescribing
this relatively new drug. More education is necessary in order to increase
utilization of Dabigatran.
1173: PERIOPERATIVE ASPIRIN IN THORACIC SURGERY: AN AUDIT OF
DOCUMENTATION AND USE
Simon Tallowin*, Babu Naidu. Heart of England Foundation Trust, West
Midlands, UK.
Introduction: This audit aimed to identify current peri-operative use of
aspirin in a regional thoracic surgery department and how clearly this is
communicated to patients.
Methods: Patients taking aspirin admitted for elective thoracic surgery
were identiﬁed from electronic records. Medical records and pre-operative
clinic letter(s) were assessed to determine the indication for aspirin use,
and whether a clear plan for its peri-operative use had been explained to
the patient in writing. Inconsistencies between pre-operative letters from
clinicians and pre-operative assessment clinic recommendations to the
patient were identiﬁed.
Results: 41 patients were identiﬁed over a 4-month period. Overall, 74%
of patients had no clear plan documented in pre-operative clinic letter(s).
With the exception of those on dual therapy for coronary stents (100%),
the documentation for high-risk patients was poor: Coronary stent
(single agent e 20%); Secondary prevention of CVA/TIA (10%); Secondary
prevention of MI (0%). There was also inconsistency in practice e 84% of
patients (on single therapy) had aspirin stopped pre-operatively,
including 40% of patients with coronary stents, contrary to current
guidelines.
Conclusions: This audit revealed inconsistent documentation and peri-
operative use of aspirin in the department. Further work to clarify
appropriate aspirin use and improve written communication is ongoing.
1270: OUTCOMES OF THORACIC SURGICAL INTERVENTIONS ON ECMO
PATIENTS: A 4 YEAR EXPERIENCE
Pouya Yousseﬁ*, Tom Doyle, Karen Harrison-Phipps, John Pilling,
Juliet King, Tom Routledge, Loic Lang-Lazdunski, Guy Glover,
Chris Langrish, Nicholas Ioannou, Chris Meadows, Nicholas Barrett. Guys
& St. Thomas' NHS Trust, London, UK.
Introduction: Extra-corporeal-membrane-oxygenation (ECMO) is used in
severe respiratory failure to maintain adequate gas exchange. These


WHO surgical safety checklist compliance after coronary artery bypass grafting in a large tertiary care hospital 

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WHO surgical safety checklist compliance after coronary artery bypass grafting in a large tertiary care hospital

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