Pediatric Urachal Anomalies: Monocentric Experience and Mini-Review of Literature

Background: Surgery is the current mainstay for the treatment of urachal anomalies (UA). Recent literature data support the theory of a spontaneous resolution within the first year of life. The aim of this study, comprising solely surgically treated children, was to identify age specific patterns regarding symptoms and outcomes that may support the non-surgical treatment of UA. Methods: Retrospective review on the clinico-laboratory characteristics of 52 children aged < 17 years undergoing resection of symptomatic UA at our pediatric surgical unit during 2006–2017. Data was dichotomized into age > 1 (n = 17) versus < 1 year (n = 35), and complicated (pre-/post-surgical abscess formation or peritonitis, n = 10) versus non-complicated course (n = 42). Results: Children aged < 1 year comprised majority (67%) of cohort and had lower complication rates (p = 0.062). Complicated course at surgery exclusively occurred in patients aged > 1 year (p = 0.003). Additionally, complicated group was older (p = 0.018), displayed leukocytosis (p < 0.001) and higher frequencies regarding presence of abdominal pain (p = 0.008) and abdominal mass (p = 0.034) on admission. Regression analysis identified present abdominal pain (OR (95% CI), 11.121 (1.152–107.337); p = 0.037) and leukocytosis (1.435 (1.070–1.925); p = 0.016) being associated with complicated course. Conclusions: This study provides evidence that symptomatic disease course follows an age-dependent complication pattern with lower complication rates at age < 1 year. Larger, studies have to clarify, if waiting for spontaneous urachal obliteration during the first year of life comprises a reasonable alternative to surgery.

Comparison of different scales for the evaluation of anxiety and compliance with anesthetic induction in children undergoing scheduled major outpatient surgery

Introduction Anxiety in children triggered by a scheduled surgical intervention is a major issue due to its frequency and consequences. Preoperative anxiety is associated with increased patient fear and agitation on anesthetic induction. The aim of this study is to compare three preoperative anxiety scales for children undergoing elective outpatient surgery, and to correlate each of these tools with the degree of patient compliance on induction, as assessed by the Induction Compliance Checklist (ICC). Methods An observational prospective study was performed on a cohort of children with ages between 2 and 16 years old, scheduled for outpatient surgery. Anxiety was assessed upon arrival to the hospital (M0), during transfer to the surgical unit (M1), and in the operating room during anesthetic induction (M2). Anxiety in the parents (measured with the State-Trait Anxiety Inventory, STAI) and in the children (measured with the Spence Anxiety Scale-Pediatric, SCAS-P, the State-Trait Anxiety Inventory Children, STAIC, and Modified Yale Preoperative Anxiety Scale, m-YPAS) was assessed. Compliance with anesthetic induction was assessed with ICC. Results The study included 76 patients (72.4% male, median age 7.9 years). Anxiety scores (m-YPAS) increased as the moment of surgery approached, being greater at the entrance to the surgical unit (M0 = 26.1 ± 9.5; M1 = 31.8 ± 18.1; M2 = 33.5 ± 21.1). A strong correlation was found between ICC scale and m-YPAS at M1 (0.738) and M2 timepoints (0.794), but not with the rest of scales at M0. Conclusions Standard anxiety assessment scales do not predict the quality of anesthetic induction. m-YPAS scale can detect increasing anxiety in children as they approach the surgical procedure and this correlates strongly with a worse anesthetic induction, defined by higher score on ICC scale.

O-BN05 The management of pancreatitis and complications that require intervention in a Benign Specialist Surgical Unit

Background Acute pancreatitis or inflammation of the pancreas is a common surgical pathology that presents with a spectrum of severity. The condition itself ranges from a mild/moderate self-limiting pathology to one associated with a systemic inflammatory response that can lead to organ dysfunction and death. We aim to investigate the aetiology/management and outcomes of patients presenting with pancreatitis in a benign specialist surgical unit with dedicated upper GI surgical care. Methods A retrospective analysis of all patients presenting and falling under surgical care with biochemical/radiological pancreatitis was conducted, using hospital archiving systems, reviewing operative notes and follow up events was conducted over an 8-year period. Results Within our benign specialist centre, 1393 patients were treated over an 8-year period. 73% of patients presenting with acute pancreatitis were male, whereas only 37% were female. The age range of patients presenting was 12 to 100 years, with the median age being 44 years. Within our population, 36.8% of acute pancreatitis was caused by gallstones, and 29.6% caused by alcohol and 33.6% other causes. 81% of patients seen had mild/moderate self-resolving pancreatitis requiring only fluids and analgesia. 19% had complicated pancreatitis requiring complex medical/surgical treatment.4.8% patients developed pancreatic necrosis, and 3.7% developed pancreatic pseudocysts. 8 patients required necrosectomy, 19 patients required cystogastrostomy and 1 patient required distal pancreatectomy with no 90-day mortality. Conclusions Our specialist unit with the support of gastroenterology, nutrition team, radiology and ITU have managed a large cohort of pancreatitic patients, the small number patients who require a surgical intervention have had good outcomes.

An Experience of Superficial Parotidectomy in Tertiary Care Teaching Hospitals

Background: Superficial parotidectomy is associated with a decreased incidence of transient facial nerve paralysis compared with that of total parotidectomy. Aim: To analyze the clinical presentation, histopathology and complications following superficial parotidectomy performed for benign parotid tumors. Methods: Two center study data was collected from the Surgical Unit I, Department of Surgery AIMC/Jinnah Hospital Lahore (1st January 2012 to October 2018) and Surgical Unit II, Department of Surgery, Sir Ganga Ram Hospital Lahore (November 2018 to 31st December 2020). All patients who underwent superficial Parotidectomy surgery for benign parotid tumors, from 1st January 2012 to 31st December 2020 were assessed for intra-operative and post-operative complications. Demographic data, intraoperative details, and postoperative outcomes of all patients who underwent superficial parotidectomy were collected. Patients with benign parotid tumors on FNAC were included while patients with malignant cells on histopathology were excluded. Results: A total of 50 patients having benign parotid tumors on FNAC underwent superficial parotidectomy during this study period. There were 35 female patients (70%) and 15 male (30%), with female to male ratio of 2.3:1. The age range was 23-70 years with mean age of patients 35.6 years (5.65±SD). In 48% cases the tumor was on left side of face and in 52% cases it was on right side. Amongst 50 cases, on postoperative histopathology, 2 patients had malignant change. Key words: Superficial parotidectomy, pleomorphic adenoma, facial nerve paralysis.

29. Impact of Antimicrobial Stewardship Intervention on Unrestricted Meropenem Use Upon Transitions of Care

Background Broad-spectrum antimicrobials, like carbapenems, are often initiated empirically and can be continued for long periods of time, which may increase rates of multi-drug resistant organisms. Antimicrobial stewardship programs (ASP) have been shown to decrease the duration of antimicrobial therapy. Since July 2017 at UTMB Health, meropenem use has been restricted to infectious diseases and intensive care unit (ICU) providers. This study evaluated the impact of an electronic medical record (EMR)-based ASP intervention on meropenem days of therapy (DOT) in patients transitioning from the ICU to the general floors. Methods Patients aged at least 18 years with an active medication order for meropenem upon transition from an ICU to a medical/surgical unit were included. Once transitioned, the active meropenem order appeared in the “review” column of the pharmacists’ queue. Pharmacists contacted the primary team, requested infectious diseases or ASP approval to continue therapy, and documented communication in the chart. Data for the pre- and post-intervention groups was collected retrospectively for the months of November 2017 to April 2018 and March 2020 to August 2020. The primary outcome of the study was meropenem DOT after transition from the ICU to the medical/surgical unit. Secondary outcomes of the study included meropenem total DOT, total number of meropenem doses after transfer to the medical unit, 30-day all-cause mortality, and 30-day readmission. Results A total of 163 patients were evaluated in both the pre-intervention (n = 87) and post-intervention groups (n = 76). Median meropenem DOT after transition of care (3 days vs. 2 days, P = 0.0004) and number of meropenem doses after transition (6 doses vs. 4 doses, P = 0.014) were significantly lower after TOC intervention implementation. However, total meropenem DOTs were not different at 5 days in both groups. Recommendations for de-escalation or discontinuation were accepted 60% of the time among providers. Conclusion An EMR-based ASP intervention did decrease meropenem DOT after patients were transitioned from the ICU to the medical/surgical floors. Results of the meropenem EMR-based ASP intervention may be used to expand to other broad-spectrum antimicrobials/antifungals in patients transitioning levels of care. Disclosures All Authors: No reported disclosures

Ultrasound guided tube drainage of perinephric abscess: Experience of 70 cases.

Objective: To determine the efficacy of ultrasound guided tube drainage of Perinephric abscess. Study Design: Observational study. Setting: Surgical Unit-II and Urology Ward Ghulam Muhammad Mahar Medical College Teaching Hospital Sukkur & Mustafia Hospital Sukkur. Period: February 2016 to January 2020. Material & Methods: 70 cases with Perinephric abscess underwent ultrasound guided tube drainage. Diagnosis was established by history, clinical examination, investigations like ultrasound & CT scan. Patients with emphysematous kidney & chronic sinus formation and with small abscess were excluded from the study. Patients were followed up for 4 weeks for complete regression of abscess cavity on ultrasound. Results: Out of 70 Patients 61.4% were male and 35% were female. 58.5% of the patients had right sided Perinephric abscess. Majority of the patients(42.8%) belonged to age group 41-50 years. 31.4% of the patients were diabetic. Clinically 95.7% of the patients reported with fever and 88.5% with flank pain. Ultrasound guided tube drainage was successful in 65(92.8%) while in 5(7.1%) patients it failed and open drainage was performed. Conclusion: Ultrasound guided tube drainage is an effective way to treat Perinephric abscess with very few minor complications as compared to open drainage.

TP10.2.13Outcome of Acute appendicitis management during COVID-19 pandemic in a tertiary hospital

Aim Coronavirus (COVID) has influenced the management of acute appendicitis. The Royal Colleges of Surgeons recommend best practice depending on local circumstances. The aim of this project is to assess the 30-day outcome of patients managed operatively and conservatively for acute appendicitis during the first wave of the pandemic in the UK. Method Patient data were collected prospectively at the end of March 2020, when Covid-19 became prevalent in the UK and lockdown started. Data was collected for patients admitted to the acute surgical unit for the admission dates of 20/03/2020 to 15/05/2020. At 30 days after admission, a search was done on the electronic clinical portal to check if the patient was readmitted for operation. The inclusion criteria are any patients above 16-year-old admitted through acute surgical unit with a clinical diagnosis of acute appendicitis or computed tomography scan findings of proven acute appendicitis. Result A total of 34 patients (median age, 33; range, 17-74) were identified from March 2020 to May 2020. All patients have covid-19 status as negative and were given intravenous antibiotics at point of admission. All patients received a course of seven-day of antibiotic. 17 patients underwent operation and 17 patients were managed conservatively. Only one patient who was treated conservatively for acute appendicitis, was re-admitted within 30 days of admission date. Discussion The readmission rate of patients treated conservatively for acute appendicitis after 30 days were low during the first wave of the pandemic.

EP.FRI.362 Improving Prescribing and Minimising Delay in Administration of Potassium Replacement Therapies: Surgical Audit on Management of Hypokalaemia in Emergency Surgical Unit at a District General Hospital in UK

Aims Surgical patients are prone to hypokalaemia due to gastrointestinal losses1. Hypokalaemia prolongs ileus2 and thus prompt management is essential. No current guideline on hypokalaemia focuses on surgical patients. We aimed to identify the prevalence of hypokalaemia in emergency surgical patients as well as measure timeliness and appropriateness of replacement. Methods We retrospectively reviewed adult emergency surgical admissions exceeding 48 hours between 05/05/2020 and 15/07/2020. A sub-group analysis assessed the timing of intravenous replacement and duration taken to normalise potassium (3.5 mmol/L). We used another NHS trust’s guideline3 as standard for appropriate potassium replacement. Results Of 110 surgical admissions, 26 cases were hypokalaemic. Of these, 15 had initially normal potassium level. Three cases were likely iatrogenic secondary to inappropriate fluid prescribing. Mean potassium in the hypokalaemic group was 3.2 mmol/L (80.8% mild vs. 19.2% moderate). Mean length of stay was 11.3 days for hypokalaemia versus 6.54 days in normokalaemic cases. Mean duration of hypokalaemia was 2.13±1.45 days. Potassium replacement was prescribed correctly in only 50% of cases (23% not prescribed; 25% insufficient; 2% incorrect) and of these correct prescriptions, 46% were not actually administered. When intravenous replacement was given, there was a mean 3.55-hour delay between lab result and administration. Conclusion The majority of hypokalaemic cases developed during admission. Only 27% of these patients had correct potassium replacement in terms of both prescription and administration. Consequently, we have created a local guideline for hypokalaemia in surgical patients to standardise both prevention and management.