The most common reason for an acute surgical assessment of the abdomen is acute appendicitis with a rate as high as 30 %There is a   lifetime risk of 8.6% and 6.7% in men and women respectively. The common age for presentation is between that of 5 and 4.4 while 28 is the median age. The objective of this study was to determine   the diagnostic accuracy   of (NLR) neutrophil-to-lymphocyte ratio to prognosticate severe/ complicated appendicitis by taking histopathology of the appendix as a gold standard. Methodology This cross-sectional validation study was conducted at the department of surgery and western vascular institute, University College Hospital Galway, Ireland retrospectively for a period of 6 months in 2016 And approximately 186 cases with appendicitis were enrolled in the study. Results The mean age of patients in this study was 29.15±9.54 years, the ratio of male to female was 1:1.7.   The sensitivity, Specificity was 97.1% and   25.2% respectively and the diagnostic accuracy of NLR was 38.7% taking histopathology as the gold standard. We observed that the sensitivity, specificity, and diagnostic accuracy of NLR   changes with the duration of symptoms in days, the sensitivity, specificity, and diagnostic accuracy of NLR was 100%, 17.0%, and 28.7%    respectively for <3days   and 92.3%, 93.75% and93.1% respectively for >3 days. Conclusion According to our study results the (NLR) neutrophil-to-lymphocyte ratio is a highly sensitive tool to predict severe/   complicated appendicitis by taking histopathology as the gold standard, but with the low value of diagnostic accuracy in terms of specificity.

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Aims To compare the trust-wide performance with the standard by the British Association of Day Surgery in the management of cholecystectomy Methods 4 months of Electronic data of patients undergoing elective laparoscopic cholecystectomy in 2020 was analyzed. Those who had emergency cholecystectomy were excluded. Results 112 of 145 total patients were female and 33 were male. The age range was 18–82 Around 65% of patients were sent home the same day. 51 Patients ended up being admitted. 33 of these were Pre-booked as inpatients' intent. 39% (13/33) had no specific reason for being booked as an inpatient. The rest Majority had medical issues quoted as the reason for booking.35% (18) of the 51 admitted patients were actually brought in as day-case lap-chole. 6 of these were admitted for perioperative surgical issues and 8 had no documented reason. The Mean length of stay was 2.56 days(0–13). Our Performance was noted to be 10% lower than the BADS standard. Conclusion Relatively more patients are being treated as inpatients than the recommended standard. About 1/4th of those who were inpatient had no specific/genuine grounds to be kept in. There is a need for improvement in pre and perioperative documentation to explain the reason for inpatient management. Development of inpatient surgery booking criteria and adherence to set criteria.

Aims To assess the usefulness of simulation sessions with social distancing in managing critical issues on a surgical ward. Methods Simulations sessions were run from September 2020 to April 2021 for the foundation doctors and medical students following standard social distancing rules and using mannequins for patients. A feedback questionnaire was sent over to the candidates after each session and the data was analyzed. Results 4 sessions were held with a total of 20 participants. The feedback response rate was 100%. On the Likert scale of 0–10, the majority (Score range 9–10) responded that they were likely to recommend these sessions. 90% were likely to change and improve their daily practice based on their responses.70% rated the sessions as excellent and all the rest as very good no negative response was received. A 100% agreement was seen among all participants on the arrangements to be well co-ordinated and organised.95% found the training staff very helpful.75% of the participants thought the allocated time was just about right while 15% thought it was slightly short. In response to an open question, the majority of participants appreciated the concept of simulation while following social distancing rules and enjoyed the session as a whole. Conclusions Overall we received positive feedback. Although the number of participants was limited in each session but positive responses from the participants imply that sessions could be easily carried out with social distancing without compromising the learning outcome. Carrying out more sessions was strongly favored by a vast majority.

Aims The aim of this study was to evaluate the feasibility, safety, and costs associated with a dedicated flexible cystoscope for the removal of ureteric stents from transplant recipients in the outpatient setting. Methods In our centre, we routinely performed post renal transplant ureteric stent removal in theatres. Recently we have switched this practice to outpatient settings. We performed retrospective analysis of prospectively collected data from two settings between Aug 2018-Dec 2021 to compare the impact on the timing of post renal transplant ureteric stent removal, associated complications, cost effectiveness and patient satisfaction. Results In total 99 ureteric stents were removed from 100 transplant recipients in theatre and 100 stents in outpatient department. 2 patients in clinic cohort did not tolerate procedure under LA. 5 patients in theatre cohort and 6 patients in clinic cohort underwent PD catheter removal in theatres along with stent removal. Earlier stent removal was achieved in clinic compared with theatre with (36 versus 55 days after transplant; p=0.001) There was no statistically significant difference in infection rates following stent removal in either groups. Outpatient stent removal proved to be very cost effective to the trust with savings of over £250 per procedure in comparison to the theatre setting. Patient satisfaction was measured by numerical rating score for pain and discomfort which showed that the patients tolerated the outpatient procedure under local anaesthesia very well,(mean score 4/10). Conclusions A dedicated outpatient ureteric stent removal service for kidney transplant recipients seems to be feasible, cost effective, and safe.