Jones, H.

Kumar, N.

Shinkwin, M.

Williams, E.

Woodward, A.

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Regional referral pattern to wales' tertiary hepatobilary unit 

Abstracts / International Journal of Surgery 23 (2015) S15eS134 S65T. Burke 1,*, C. Fenelon 1, D. Dalton 2, H. Mohan 1, K. Schmidt 1. 1Wexford
General Hospital, Ireland; 2 St Vincent's University Hospital, Ireland
Aim: Laparoscopic cholecystectomy is the gold standard treatment
for symptomatic gallstone disease. The internet provides a vast infor-
mation source that patients can access. It is imperative that the infor-
mation relating to the procedure be accurate, relevant and
understandable.
Methods: We identiﬁed 125 websites from searching “laparoscopic cho-
lecystectomy” in the 5 most popular internet search engines. The websites
were examined for readability by measuring the Flesch Reading Ease
Score, the Flesch-Kincaid Grade Level, and the Gunning-Fog Index. The
quality of the websites was measured by the DISCERN instrument, the
Journal of the American Medical Association (JAMA) benchmark criteria,
and Health on the Net Foundation (HON) certiﬁcation.
Results: Overall, the quality was poor with the average DISCERN score
being only 32.72(0-80). The mean reading grade level was 9 (recom-
mended level-6). HON certiﬁcation did correspond to signiﬁcantly worse
readability scores. Those that satisﬁed more of the JAMA benchmark
criteria had signiﬁcantly better DISCERN scores (P<.001)
Conclusion: Information relating to the laparoscopic cholecystectomy
procedure is of a low standard and is in many cases written at too high a
level for the general population. We, as surgeons have a responsibility to
recommend accurate patient centred websites and thus ensure patients
receive reliable information regarding their condition and treatment
options.
0799: SIGNIFICANCE OF POST PANCREATICODUODENECTOMY DRAIN
AMYLASE IN PREDICTING CLINICALLY HIGH GRADE PANCREATIC
FISTULA AND ASSOCIATED LENGTH OF HOSPITAL STAY
M. Pizanias*, M. Papamichail, E. Prassas, P. Middleton, Z. Hayat, A.
Prachalias. Kings College Hospital, UK
Aim: To derive a cut off value of the drain ﬂuid amylase (DFA) to predict
high grade pancreatic ﬁstula (CSPF) according to the International Study
Group of Pancreatic Surgery guidelines and to evaluate its associationwith
the length of hospital stay.
Methods: Retrospective analysis of 115 patients who underwent pan-
creaticoduodenectomy between 04/2013 and 05/2014. Variables: DFA on
postoperative day 3 - 5, hospital stay and complications.
Results: DFA median values: grade A ﬁstula (PFA) 409.5 (n¼4), grade B
ﬁstula (PFB) 367 (n¼15), grade C ﬁstula (PFC) 24660 (n¼3). The DFA me-
dian for CSPF was 381.5 and for the group with PFA and without pancreatic
ﬁstula (NPF) was 22.5 (p<0.0001). Patients with CSPF had a more
complicated post-operative period (p<0.05) and prolonged hospital stay
(p<0.001). A DFA value of 109 had a sensitivity of 72.2% and speciﬁcity of
89.4% (p<0.05) in predicting CSPF and the area under the ROC curve was
calculated as 0.859.
Conclusion: This study demonstrates the potential utility of the DFA value
in predicting the risk of CSPF and its association with prolonged hospital
stay.
0837: REGIONAL REFERRAL PATTERN TO WALES' TERTIARY
HEPATOBILARY UNIT
E. Williams, H. Jones, A. Woodward, N. Kumar, M. Shinkwin*. University
Hospital of Wales, UK
Aim: Colorectal cancer is the second most common malignancy in the UK.
The development of colorectal metastases is ominous, 80% having liver
involvement, 0.1% of the UK’s population will develop colorectal metas-
tases (CRLM) annually. All CRLM patients should have access to a tertiary
hepatobiliary (HPB) unit. We studied CRLM referral patterns from each
Healthboard (HB) in Wales to the HPB unit.
Methods: A retrospective analysis of patients with CRLM over a 27-month
period was undertaken, accessing the Cancer Network Information Cymru
(CANISC) database detailing all referrals and outcomes.
Results: The HPB unit received 1063 referrals over a 27-month period from
6 different HBs. There were 605 referrals (0.136% local population) from
within the C&VUHB, 78 (0.013% local population) from ABMUHB, 193(0.032% local population) from ABUHB, 79 from CTUHB (0.021% local
population), 91 from HDUHB (0.024% local population) and 10 from PHB
(0.008% local population).
Conclusion: A varied number of referrals from different HBs are received
by HPB unit. As little as 0.008% of the population in some areas are being
referred. Over 50% of referrals are from the same HB as the specialist liver
unit. It is questionable whether all patients are having access to potentially
curative liver resection.
0854: FEASIBILITY OF SKYPE APPOINTMENTS FOR FOLLOW-UP WITH
POST LIVER CANCER RESECTION PATIENTS
K. Kaur 1,*, J. Ritchie 2, I. Wijetunga 2, R. Prasad 2, A. Hakeem 3. 1University of
Leeds Medical School, UK; 2 St James’s University Hospital, UK;
3Addenbrooke's Hospital, UK
Aim: Leeds Hepatobiliary unit performs over 200 malignant liver re-
sections yearly for patients from awide geographical area. Patients require
10 years follow-up post-operatively. This study aimed to explore feasibility
of Skype for post-operative follow-up.
Methods: Cancer resection follow-up patients attending outpatient clinics
were surveyed to explore opinions of Skype for follow-up. The concept was
discussed at the hospital Cancer Patient and Public Involvement group.
Skype reliability was tested on Trust computers by piloting calls with staff
off site. Patient recruitment to a feasibility study has started. Cost data was
analysed to determine cost-effectiveness of Skype.
Results: Ten patients completed the clinic questionnaire. 40% had Skype
access, however 60% were keen to participate. Enthusiasm for the study
came from clinic patients and the Cancer PPI Group. Skype was found to be
reliable with minimal technical interference. Cost analysis suggests Skype
clinics will generate revenue and run at 1.6% of outpatient clinic costs. Nine
of 32 eligible patients (28%) have been recruited to date. Preliminary data
will be presented.
Conclusion: We have identiﬁed patient-directed interest in telemedicine
follow-up. Skype clinics are reliable and cost-efﬁcient, necessitating only a
fraction of outpatient clinics costs. Patients' participation is reduced by
technology.
0873: PRE-OPERATIVE CROSS-MATCHING IN ELECTIVE HEPATIC
RESECTION AT A TERTIARY CENTRE
M. Kostalas*, E. Burford, R. Kumar, N. Karanjia, T. Worthington, A.
Riga. Royal Surrey County Hospital, UK
Aim: Hepatic resection is major surgery and can be associated with sig-
niﬁcant intra-operative blood loss necessitating intra-operative trans-
fusion. Historically as many as 10 units of blood have been cross-matched
given the extent of intra-operative blood loss. With advances in surgical
technique such large volume blood loss is a thing of the past. Our aim was
to identify the number of cross-matched units per hepatic resection and
the utilisation of these.
Methods: Retrospective review of all hepatic resections being undertaken
over a one-year period. Data extracted from institution database. Details of
units of blood cross-matched, intra-operative blood loss and units of blood
transfused were collected.
Results: Over 12 months 134 patients underwent hepatic resection.
The median blood loss was 400mls (0mls - 9000mls) per operation. The
median number of units of blood cross-matched per procedure was 4
(2 e 8 units). The median number of units transfused was 0 (0 e 9
units).
Conclusion: Few patients required transfusion in our series. Despite a
signiﬁcant reduction in units of blood cross-matched compared to his-
torical practice this data suggests that patients undergoing hepatic
resection are still being over cross-matched. Over cross-matching will have
signiﬁcant ﬁnancial implications on trusts and as such our practice should
change.
0876: ACUTE GALLBLADDER DISEASE ADMISSIONS AUDIT: WOULD THE
PROVISION OF A DEDICATED CHOLECYSTECTOMY OPERATING LIST
IMPROVE PATIENT CARE?


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Regional referral pattern to wales' tertiary hepatobilary unit

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