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Waldram R, Ho GC, Premakumar Y, Gabor C, Richards C, Kumar A, Colemeadow J, Kunduzi B, Clark K, Oddy J, Sran K, Barnett N. 668 Introduction of a Pre-Operative Assessment Clinic for Elective Procedures in a Renal Replacement Therapy Unit - Analysis of Effect on Cancellation of Procedures. Br J Surg 2022. [DOI: 10.1093/bjs/znac269.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Aim
In September 2020, our Renal and Transplant unit introduced a new formalised protocol for Pre-Operative Assessment Clinics (POACs), led by SHO-grade junior doctors. This study aims to investigate the efficacy of the new protocol.
Method
All elective operations including dialysis access procedures, transplant urology, parathyroidectomies and hernia repairs conducted by a single renal replacement therapy unit were examined over an 18-month period prior to POAC implementation, then a 12-month period following implementation. Living donor transplants and nephrectomies were excluded.
On-the day (OTD) cancellation causes were analysed and categorised into:
Results
Total cases performed:
Pre-implementation = 921, post-implementation = 415.
OTD cancellations:
Pre-implementation - total of 211/921 (22.9%). 90 (9.8%) were due to predictable patient factors, 54 (5.9%) for unpredictable patient factors and 67 (7.2%) for hospital factors.
Post-implementation - total of 58/415 (11.6%). 32 (7.7%) for unpredictable patient factors and 12 (2.9%) for hospital factors. Four (1%) were cancelled for predictable patient factors, two due to patients presenting with hypertension.
Conclusions
Patients with renal failure have multiple co-morbidities. Optimising pre-operative care is crucial to ensure they receive timely treatment. This audit has demonstrated that a redesigned POAC led to a reduction of OTD cancellation rates from 22.9% to 11.6%, with a marked reduction in predictable causes for cancellations. Further improvements and re-audit are planned.
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Affiliation(s)
- R Waldram
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - GC Ho
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - Y Premakumar
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - C Gabor
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - C Richards
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - A Kumar
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - J Colemeadow
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - B Kunduzi
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - K Clark
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - J Oddy
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - K Sran
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
| | - N Barnett
- Guy's and St Thomas’ NHS Foundation Trust , London , United Kingdom
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Papadakis G, Dost S, Kunduzi B, Olsburgh J, Brown C, Mamode N, Karydis N. High-grade blunt traumatic rupture of kidney transplant: is conservative management an option? Ann R Coll Surg Engl 2021; 104:e113-e115. [PMID: 34825827 DOI: 10.1308/rcsann.2021.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Road traffic accidents are the most common cause of blunt native kidney injuries. Transplanted kidneys are more exposed to such injuries due to the common positioning in the iliac fossa compared with the relatively protected position of the native kidneys. The small number of cases identified in the literature describe grade II and III transplant kidney injuries that were treated surgically. In our case a grade IV injury was managed conservatively giving the necessary time to appropriately plan the future renal replacement therapy options for the patient.
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Affiliation(s)
- G Papadakis
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - S Dost
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - B Kunduzi
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - J Olsburgh
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - C Brown
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - N Mamode
- Guy's and St Thomas' NHS Foundation Trust, UK
| | - N Karydis
- Guy's and St Thomas' NHS Foundation Trust, UK
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Sha M, Kunduzi B, Froghi S. P-25 A review of circulating exosomal biomarkers in the diagnosis of pancreatic cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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