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Audit of Superficial Temporal Artery Biopsies (TAB) for Suspected Giant Cell Arteritis (GCA)
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Abstracts / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127
between VTE and postoperative complications, length of stay, mortality and costs in Head and Neck Cancer (HNCA) surgery. The medical records of 50 patients that underwent major HNCA surgery over a 12 months period were reviewed and the data collected on patient demographics, risk of VTE at pre-assessment, risk of bleeding, type of VTE prophylaxis, timing of VTE prophylaxis, and complications. Seventy two percent of patients were assessed for VTE at pre-assessment and 58% within 24 hrs of admission. Ninety three percent were given Thrombo-embolic deterrant stockings and 58% were prescribed pharmacological VTE prophylaxis 6-12 hrs after surgery. Ten percent of patients developed complications.We also present on the type and timing of chemical VTE prophylaxis and the cost incurred and financial loss due to lack of compliance to VTE assessment. We propose recommendations to improve VTE assessment and prophylaxis in HNCA patients. http://dx.doi.org/10.1016/j.bjoms.2014.07.115 P14 Audit of Superficial Temporal Artery Biopsies (TAB) for Suspected Giant Cell Arteritis (GCA) Catherine Lawson ∗ , Vyomesh Bhatt Southend University Hospital Background: GCA is the most common vasculitis of adults in the western world, between 7 and 29/100,000 in population aged over 50 in Europe. Objectives: The aim of this audit was to identify the number of TAB performed and by whom, time taken between presentation and biopsy, quality of biopsy, usefulness of Duplex Ultrasonograpy, and quality of patient information provided. These criteria were measured against BSR and BHPR Guidelines for the management of GCA. Materials and Methods: Data was collected for all TAB performed in Southend Hospital across all departments between February 2012-February 2013. 42 patients were identified, and information was collected from hospital notes. A patient telephone questionnaire was also carried out for 35/42 patients regarding post-op experience. Results: TAB were performed by; opthalmology: 31%, OMFS: 57%, general and vascular surgeons: 12%. As a whole biopsy specimens were too short (6.78 mm) compared to the recommended guidelines of between <1-2 cm, and in 12% of cases an artery was not even biopsied. The telephone questionnaire revealed that OMFS had the highest satisfaction rate (96%) with the information they received about TAB, however feedback suggested patients were not well informed about their follow-up. Conclusions: OMFS performed 57% of all TAB (1 year) in the recommended time period. Improvements are required n the quality of TAB specimen, and in patients information - a
leaflet is to be provided to all TAB patients. This audit is part of a larger on-going study into the treatment for GCA and review of the guidelines. http://dx.doi.org/10.1016/j.bjoms.2014.07.116 P15 A single-centre retrospective audit of blood ordering for oral and maxillofacial surgery patients undergoing free flap reconstruction Sophie A. Ledger ∗ , Valmiki Sharma, Chi-Hwa Chan Luton and Dunstable University Hospital NHS Foundation Trust Aims: To assess blood utilisation and compliance with the maximum surgical blood ordering schedule (MSBOS) in head and neck oncology patients undergoing microvascular free tissue transfer. Patients and Methods: Data retrospectively collected over a two-year period from consecutive head and neck surgical oncology patients undergoing free flap reconstruction at a single university teaching hospital, a hub for 4 spoke units, was used to determine compliance and calculate both the cross-match to transfusion (C:T) ratio and transfusion index (TI). Results: A total of 87 units were cross-matched and 34 units transfused in 14 patients, resulting in an overall C:T ratio of 2.6:1 and TI of 1.1. Compliance with the MSBOS was higher in non-osseous microvascular free flaps than osseous, but the C:T ratio was lower for osseous microvascular free flaps than non-osseous. Conclusions: Recommendations have been made to modify the terminology used in the MSBOS, and to update units pre-operatively cross-matched for osseous microvascular free flaps to reflect current practice. http://dx.doi.org/10.1016/j.bjoms.2014.07.117 P16 Audit of temporal artery biopsy specimen length Arathi Papineni McIntosh ∗ , Mark Thompson Addenbrooke’s Hospital Introduction: Adequate specimen length for temporal artery biopsy (TAB) is critical as the focal nature of giant cell arteritis (GCA) may generate skip lesions. The British Society for Rheumatology and British Health Professionals in Rheumatology guidelines for the management of GCA advise specimen length should be no less than 10 mm. Once harvested and fixed specimen lengths are often greatly reduced. Ypsilantis et al. (2011) found a post-fixation length above 7 mm had a significantly higher rate of positive results and advised to aim for a pre-fixation specimen length of at least 10 mm to raise the diagnostic accuracy of TAB. In this audit a
Abstracts / British Journal of Oral and Maxillofacial Surgery 52 (2014) e75–e127
between VTE and postoperative complications, length of stay, mortality and costs in Head and Neck Cancer (HNCA) surgery. The medical records of 50 patients that underwent major HNCA surgery over a 12 months period were reviewed and the data collected on patient demographics, risk of VTE at pre-assessment, risk of bleeding, type of VTE prophylaxis, timing of VTE prophylaxis, and complications. Seventy two percent of patients were assessed for VTE at pre-assessment and 58% within 24 hrs of admission. Ninety three percent were given Thrombo-embolic deterrant stockings and 58% were prescribed pharmacological VTE prophylaxis 6-12 hrs after surgery. Ten percent of patients developed complications.We also present on the type and timing of chemical VTE prophylaxis and the cost incurred and financial loss due to lack of compliance to VTE assessment. We propose recommendations to improve VTE assessment and prophylaxis in HNCA patients. http://dx.doi.org/10.1016/j.bjoms.2014.07.115 P14 Audit of Superficial Temporal Artery Biopsies (TAB) for Suspected Giant Cell Arteritis (GCA) Catherine Lawson ∗ , Vyomesh Bhatt Southend University Hospital Background: GCA is the most common vasculitis of adults in the western world, between 7 and 29/100,000 in population aged over 50 in Europe. Objectives: The aim of this audit was to identify the number of TAB performed and by whom, time taken between presentation and biopsy, quality of biopsy, usefulness of Duplex Ultrasonograpy, and quality of patient information provided. These criteria were measured against BSR and BHPR Guidelines for the management of GCA. Materials and Methods: Data was collected for all TAB performed in Southend Hospital across all departments between February 2012-February 2013. 42 patients were identified, and information was collected from hospital notes. A patient telephone questionnaire was also carried out for 35/42 patients regarding post-op experience. Results: TAB were performed by; opthalmology: 31%, OMFS: 57%, general and vascular surgeons: 12%. As a whole biopsy specimens were too short (6.78 mm) compared to the recommended guidelines of between <1-2 cm, and in 12% of cases an artery was not even biopsied. The telephone questionnaire revealed that OMFS had the highest satisfaction rate (96%) with the information they received about TAB, however feedback suggested patients were not well informed about their follow-up. Conclusions: OMFS performed 57% of all TAB (1 year) in the recommended time period. Improvements are required n the quality of TAB specimen, and in patients information - a
leaflet is to be provided to all TAB patients. This audit is part of a larger on-going study into the treatment for GCA and review of the guidelines. http://dx.doi.org/10.1016/j.bjoms.2014.07.116 P15 A single-centre retrospective audit of blood ordering for oral and maxillofacial surgery patients undergoing free flap reconstruction Sophie A. Ledger ∗ , Valmiki Sharma, Chi-Hwa Chan Luton and Dunstable University Hospital NHS Foundation Trust Aims: To assess blood utilisation and compliance with the maximum surgical blood ordering schedule (MSBOS) in head and neck oncology patients undergoing microvascular free tissue transfer. Patients and Methods: Data retrospectively collected over a two-year period from consecutive head and neck surgical oncology patients undergoing free flap reconstruction at a single university teaching hospital, a hub for 4 spoke units, was used to determine compliance and calculate both the cross-match to transfusion (C:T) ratio and transfusion index (TI). Results: A total of 87 units were cross-matched and 34 units transfused in 14 patients, resulting in an overall C:T ratio of 2.6:1 and TI of 1.1. Compliance with the MSBOS was higher in non-osseous microvascular free flaps than osseous, but the C:T ratio was lower for osseous microvascular free flaps than non-osseous. Conclusions: Recommendations have been made to modify the terminology used in the MSBOS, and to update units pre-operatively cross-matched for osseous microvascular free flaps to reflect current practice. http://dx.doi.org/10.1016/j.bjoms.2014.07.117 P16 Audit of temporal artery biopsy specimen length Arathi Papineni McIntosh ∗ , Mark Thompson Addenbrooke’s Hospital Introduction: Adequate specimen length for temporal artery biopsy (TAB) is critical as the focal nature of giant cell arteritis (GCA) may generate skip lesions. The British Society for Rheumatology and British Health Professionals in Rheumatology guidelines for the management of GCA advise specimen length should be no less than 10 mm. Once harvested and fixed specimen lengths are often greatly reduced. Ypsilantis et al. (2011) found a post-fixation length above 7 mm had a significantly higher rate of positive results and advised to aim for a pre-fixation specimen length of at least 10 mm to raise the diagnostic accuracy of TAB. In this audit a