IntroductionPercutaneous cholecystostomy is a recognised treatment modality for acute cholecystitis. Traditionally, its use was reserved for patients deemed unfit for surgery. However, the coronavirus disease 2019 (COVID-19) pandemic had a detrimental effect on both elective and emergency surgery. The utilisation of cholecystostomy thus increased. Unanswered questions remain over timing with respect to interval cholecystectomy. We evaluated our local practice over the preceding three years. MethodsA retrospective analysis was performed of all patients who had a percutaneous cholecystostomy inserted over a three-year period (1 January 2018-1 January 2021). The primary outcome was time to cholecystectomy. Secondary outcomes were cholecystostomy-related complications, 30-day mortality, cholecystectomy-related complications and length of postoperative hospital stay. ResultsA total of 31 patients were identified during the period. Thirteen (42%) patients went on to have a laparoscopic cholecystectomy. The median time interval from cholecystostomy to cholecystectomy was 97 days (interquartile range [IQR]: 81-140, minimum: 47 and maximum: 791). One case was complicated by small bowel perforation; this occurred after an interval of 106 days. The median length of postoperative stay was one day (IQR: 1-1, minimum: 0 and maximum: 4). Cholecystostomy-related complications were observed in four (13%) patients, whereby three became displaced and one developed blockage. Thirty-day mortality following cholecystostomy insertion was zero. ConclusionsPercutaneous cholecystostomy is a safe and effective intervention for the management of acute cholecystitis. Interval cholecystectomy should be carefully considered; it may be safer to perform prior to 90 days.

Objective Elective surgery came to a standstill during the first wave of COVID-19. The safe resumption of elective surgery with COVID-19 prevalent in the community remains a significant challenge. The aim of this study was to look into the outcomes of elective general surgery in a dedicated ‘Green Zone (GZ)’ during the second wave of COVID-19 in the United Kingdom. Method A ‘Green Zone’ pathway, meant to provide a COVID-free environment, was created. A retrospective review of prospectively collected data was done on consecutive patients who underwent an elective general surgical procedure at a single NHS trust over a six-month period (September 1, 2020, to February 28, 2021). The primary outcome was 30-day COVID-19 mortality. Secondary outcomes included 30-day non-COVID-19 mortality, readmissions, and complications. Results The study included 331 patients with a median age of 55 years (interquartile range, IQR, 41-67); 169 (51%) were females. The majority of the patients were American Society of Anaesthesiologists grade 2 (ASA 2; n=177, 53%) followed by ASA 3 (n=76, 23%). Forty-seven patients (14%) had been shielding earlier in the year. Most of the cases were day cases (n=224, 67%). There was no 30-day COVID-19 or non-COVID-19 mortality. One patient developed COVID-19 three weeks after the index operation. Thirty-day readmission and complication rate were 4% (n=14) and 6% (n=21). Most of the complications were Clavien-Dindo grade 2 (n=10, 3%) followed by an equal number of grades 1 and 3b (n=5, 1.5%). Conclusion This study has shown that a dedicated ‘Green Zone’ elective operating pathway is safe and feasible provided a balanced risk assessment approach is adopted.

Introduction The COVID-19 pandemic had a deleterious effect not only upon medical and surgical training, but also upon inspiring the medics and surgeons of the future. Prior to applying for a career in medicine, students often take part in work experience. This observership provides in insight into what a medical career entails. Nationwide lockdowns and hospital visiting restrictions rendered it impossible to gain this understanding. We designed a novel virtual work experience (VWE) aimed at mitigating this loss. Methods A timetable was created to simulate a chronological progression throughout a medical career. A range of speciality talks were given by junior and senior doctors. Students were invited to sign up after contacting local schools, dissemination on social media and word of mouth. The one day event was free and hosted using online video conferencing software. Pre and post course questionnaires assessed confidence with regards to a career in medicine. Results There were 434 student registrations which spanned internationally to 9 countries. 140 post course responses were obtained. 131 students (94%) responded that the event was a good alternative to face to face (F2F) experience. Confidence levels of above 3 (on a 5 point Likert scale) improved from 54% to 99% regarding medical school applications and the interview process. 96% of students were interested in pursuing a career in medicine after the event. Conclusions This VWE event aimed to combat the loss of F2F experience. Student reported outcomes were extremely favourable. This may form the foundation of a hybrid work experience in the future.

Aim Indications for blood tests are often poorly considered. Appropriate blood requests reduce trauma for patients, improve laboratory workflow and reduce costs. We therefore created a novel protocol for bloods requested in the post-operative period for patients undergoing elective colorectal cancer resections. We performed two audit cycle loops to assess protocol adherence and evaluate financial savings. Method The protocol was agreed locally by consultant consensus, presented locally in February 2021, and displayed on surgical wards in May 2021. Bloods requested were reviewed retrospectively for patients undergoing elective colonic resection with an uncomplicated post-operative course. Data was collected prior to the local meeting between September-November 2020 (audit 1, cycle 1), after the meeting between March-April 2021 (audit 2, cycle 1), then after distribution of the protocol to wards between July-August 2021 (cycle 2). Results The locally agreed protocol was post-op day 1,5,7 FBC, U&E, CRP; day 3 FBC, U&E, CRP, LFT; day 2,4,6 no bloods. In audit 1 (cycle 1) 100% protocol adherence would have saved £15.96 per patient (n = 20). In audit 2 (cycle 1) the protocol was followed on 21.4% of days with further savings of £14.21 per patient (n = 23) had there been 100% adherence. In cycle 2, there was 40.74% protocol adherence with £6.62 further potential savings per patient (n = 15). Conclusions Following the post-elective colorectal resection bloods protocol may save our hospital £1700 per annum. Protocol adherence improved when displayed on surgical wards. With these exciting results, we are working with Medway EPR to create an order set containing this protocol.

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