There is wide variability in opioid prescriptions for common general surgery procedures. In many cases excess pills are prescribed. Using our ideal number, surgeons can adequately treat postoperative pain and markedly decrease the number of opioids prescribed.

By defining postoperative opioid requirements through patient surveys and disseminating operation-specific guidelines for opioid prescribing to surgeons, we were able to decrease the number of opioids initially prescribed by more than half. Decreased initial opioid prescriptions did not result in increased opioid refill prescriptions.

Steroid-induced hyperglycaemia (SIH) is a common adverse effect in patients both with and without diabetes. This project aimed to improve the screening and diagnosis of SIH by improving the knowledge of healthcare professionals who contribute to the management of SIH in hospitalised patients. Monitoring and diagnosis of SIH were measured in areas of high steroid use in our hospital from May 2016 to January 2017. Several interventions were implemented to improve knowledge and screening for SIH including a staff education programme for nurses, healthcare assistants and doctors. The Trust guidelines for SIH management were updated based on feedback from staff. The changes to the guideline included shortening the document from 14 to 4 pages, incorporating a flowchart summarising the management of SIH and publishing the guideline on the Trust intranet. A questionnaire based on the recommendations of the Joint British Diabetes Societies for SIH was used to assess the change in knowledge pre-intervention and post-intervention. Results showed an increase in junior doctors’ knowledge of this topic. Although there was an initial improvement in screening for SIH, this returned to near baseline by the end of the study. This study highlights that screening for SIH can be improved by increasing the knowledge of healthcare staff. However, there is a need for ongoing interventions to sustain this change.

Objectives: Provoked deep vein thrombosis (DVT) is precipitated by a specific event. In this study, the characteristics of provoked DVT in patients with a reversible risk (RR) factor were compared with patients with constant risk (CR) factors.Methods: A retrospective review of the records of all consecutive patients diagnosed with DVT between January 2013 and August 2014 was performed. Patients with provoked DVT were included in the RR group if the provoking event resolved and they did not have an ongoing risk of thrombosis. Patients in the CR group had a provoked DVT with an ongoing risk of thrombosis due to individual factors deemed as ongoing risks of thrombosis, such as cancer, on record review. Demographics, risk factors, association with pulmonary embolism and its severity, risk of recurrent venous thromboembolism (VTE), and mortality were compared between the two groups. SAS 9.3 software was used for analysis.Results: A total of 838 patients were diagnosed with DVT and 425 (50.7%) were provoked. There were 127 patients (29.9%) with RR and 298 (70.1%) with CR. RR patients were younger (60.4 6 16.3 vs 65.9 6 16.0 years; P ¼ .001). DVTs in RR patients were more likely to be provoked by surgery (70.9% vs 55.4%; P ¼ .0028), whereas DVTs in CR patients were more likely to be provoked by immobilization (21.5% vs 12.6%; P ¼ .032). CR patients were affected by cancer (48.7%) and hypercoagulable disorders (4.4%). RR patients were more likely to have calf DVTs (36.2% vs 26.2%, P ¼ .0468). There was a trend towards lower association with PE upon presentation in RR (17.3% vs 21.1%, P ¼ .072), but that did not reach statistical significance. However, RRs were more likely to be associated with a low-risk pulmonary embolism compared with CRs (54.6% vs 30.2%, P ¼ .04). After mean follow-up of 7.2 months, CR patients had higher risk of recurrent VTE (14.0% vs 6.8%, P ¼ .045) and mortality (23.5% vs 7.1%, P < .0001).Conclusions: Provoked DVT with CR affects older patients and is associated with high recurrence of VTE and mortality compared with provoked DVT with RR.Objectives: Patients presenting with delayed rupture after endovascular repair of their abdominal aortic aneurysm (EVAR) were identified, and medical records and imaging were reviewed to identify their anatomic characteristics.Methods: This was a retrospective study of all patients with abdominal aortic aneurysms presenting with delayed ruptures after EVAR from January 2002 to December 2014. Demographics, comorbidities, preoperative imaging, and perioperative and long-term outcomes were analyzed.Results: Identified were 54 among 3081 patients (1.8%) with delayed rupture after EVAR. The primary EVAR in 47 (87%) was performed in our facility and in seven (13%) in another hospital. The mean time between the initial repair and rupture was 44.2 months. Ruptures were related to an endoleak in 45 (83%) and to infection in nine (17%). Twenty-eight patients (52%) had an open repair for their delayed rupture, and 26 (48%) had secondary endovascular repair. Mean follow-up wa...

No abstract