Featured Articles in Feb 2022

Ronald K. Tompkins, 1934–2021

 

Author list: O. Joe Hines & Jonathan R. Hiatt

Abstract:  NA
Free Link:  https://rdcu.be/cEubf

 


Work Characteristics of Acute Care Surgeons at a Swiss Tertiary Care Hospital: A Prospective One-Month Snapshot Study

 

 

Author list:   Claudine Di Pietro Martinelli, Tobias Haltmeier, Joël L. Lavanchy, Stéphanie F. Perrodin, Daniel Candinas & Beat Schnüriger

 

Abstract:  

Background

Multiple acute care surgery (ACS) working models have been implemented. To optimize resources and on-call rosters, knowledge about work characteristics is required. Therefore, this study aimed to investigate the daily work characteristics of ACS surgeons at a Swiss tertiary care hospital.

Methods

Single-center prospective snapshot study. In February 2020, ACS fellows prospectively recorded their work characteristics, case volume and surgical case mix for 20 day shifts and 16 night shifts. Work characteristics were categorized in 11 different activities and documented in intervals of 30 min. Descriptive statistics were applied.

Results

A total of 432.5 working hours (h) were documented and characterized. The three main activities ‘surgery,’ ‘patient consultations’ and ‘administrative work’ ranged from 30.8 to 35.9% of the documented working time. A total of 46 surgical interventions were performed. In total, during day shifts, there were 16 elective and 15 emergency interventions, during night shifts 15 emergency interventions. For surgery, two peaks between 10:00 a.m.–02:00 p.m. and 08:00 p.m.–11:00 p.m. were observed. A total of 225 patient were consulted, with a first peak between 08:00 a.m. and 11:00 a.m. and a second, wider peak between 02:00 p.m. and 02:00 a.m.

Conclusion

The three main activities ‘surgery,’ ‘patient consultations’ and ‘administrative work’ were comparable with approximately one third of the working time each. There was a bimodal temporal distribution for both surgery and patient consultations. These results may help to improve hospital resources and on-call rosters of ACS services.


Free Link: https://rdcu.be/cEubs

 


Long-Term Impact of a Low-Cost Paediatric Intussusception Air Enema Reduction Simulation-Based Education Programme in a Low-Middle Income Country

 

Author list: R. M. Nataraja, Yin Mar Oo, D. Ljuhar, M. Pacilli, Nyo Nyo Win, S. Stevens, Aye Aye & D. Nestel

Abstract:

Introduction

Intussusception is one of the commonest causes of bowel obstruction in infants. Most infants in Low- and Middle-Income Countries (LMICs) undergo an invasive operative intervention. Supported by simulation-based education (SBE), the Air Enema (AE) non-operative technique was introduced in 2016 in Myanmar. This study assesses the long-term outcomes.

Methods

Mixed methods study design over 4 years including clinical outcomes and surgeon’s attitudes towards the AE technique and SBE. Prospectively collected clinical outcomes and semi-structured interview with reflexive thematic analysis (RTA). Primary outcome measure was a long-term shift to non-operative intervention. Secondary outcomes: Length of Stay (LoS), recurrence rates, intestinal resection rates, compared to the operative group. The data was analysed according to intention to treat. Quantitative data analysis with Mann–Whitney U test, Fisher’s exact test, Student’s T-Test or Wilcoxon Signed-Rank Test utilised. A p-value of 

Results

A total of 311 infants with intussusception were included. A sustained shift to AE was revealed with high success rates (86.1–91.2%). AE had a reduced LoS (4 vs. 7 days p ≤ 0.0001), Duration of Symptoms (DoS) was lower with AE (1.9/7 vs. 2.5/7, p = 0.002). Low recurrence rates (0–5.8%) and intestinal resection rates stabilised at 30.5–31.8% vs.15.3% pre-intervention. Four RTA themes were identified: Expanding conceptions of healthcare professional education and training; realising far reaching advantages; promoting critical analysis and reflective practice of clinicians; and adapting clinical practice to local context. RTA revealed an overall positive paradigm shift in attitudes and application of SBE.

Conclusions

A sustained change in clinical outcomes and appreciation of the value of SBE was demonstrated following the intervention.


Free Link: https://rdcu.be/cEub6

 


Intraoperative Mapping Angiograms of the Parathyroid Glands Using Indocyanine Green During Thyroid Surgery

 

Author list: Fares Benmiloud, Guillaume Penaranda, Laurent Chiche & Stanislas Rebaudet

Abstract:

Background

During thyroid surgery, preservation of parathyroid gland (PG) feeding vessels is often impossible. The aim of the Fluogreen study was to determine the feasibility of using indocyanine green (ICG)-based intraoperative mapping angiograms of the PG (iMAP) to improve vascular preservation.

Study design

This prospective study enrolled all patients undergoing thyroid lobectomy or total thyroidectomy at the Hôpital Européen Marseille between September and December 2018. After exploring the thyroid lobe by autofluorescence to locate the PGs, ICG solution was injected intravenously to locate the PG feeding vessels and guide dissection. A second ICG injection was administered at the end of the lobectomy to assess perfusion of the PGs. The primary outcome was the quality of the angiogram, scaled as iMAP 0 (not informative), iMAP 1 (general vascular pattern visible but no clear vascular pedicle flowing into the PG), or iMAP 2 (clear vascular pedicle flowing into the PG). The secondary outcome was the PG perfusion score at the end of surgery, scaled from ICG 0 (no perfusion) to ICG 2 (intense uptake).

Results

A total of 47 adult patients were analyzed, including 34 total thyroidectomies and 13 lobectomies. ICG angiography assessed 76 PGs, which were scored as iMAP 2 in 24 cases (31.6%), iMAP 1 in 46 (60.5%) and iMAP 0 in six (7.9%). At the end of dissection, the ICG perfusion score was significantly better for the PGs with informative angiography (iMAP 1 or 2), than for the PGs with uninformative angiography (iMAP 0), or the PGs not evaluated by vascular angiography (p < 0.05).

Conclusion

iMAP is feasible and provides direct vascular information in one-third of the cases. Further improvements to this technology are necessary, and the influence of this technique on patient outcomes during thyroidectomy will need to be further evaluated.


Free Link: https://rdcu.be/cEueZ

 

 


Inspirational Women in Surgery

Ms. Sindiswa Ntloko, Vascular Surgery, KwaZulu-Natal, South Africa

 

Author list: Timothy Hardcastle

Abstract:  NA
Free Link: https://rdcu.be/cEue9

 

Dr. Nadine R. Caron, Canada

Author list: Janice L. Pasieka

Abstract:  NA
Free Link: https://rdcu.be/cEufd

 

Karen Deveney, MD, FACS: A Pioneer Surgeon

Author list: Richard J. Mullins

Abstract:  NA
Free Link:
https://rdcu.be/cEufe

 


We Asked the Experts: Use of Gendered Titles by Surgeons – A Boon or a Bane?

 

Author list:  Akaninyene Eseme Ubom, Adekunle Adeyemo & AbdulHafiz Oladapo Adesunkanmi

Abstract:
Free Link: https://rdcu.be/cEufp

 


Systematic Reviews and Meta-Analyses: Emergency Neurosurgery Performed by General Surgeons: A Systematic Review

 

Author list: Joseph N. Hewitt, Christopher D. Ovenden, John M. Glynatsis, Ahad Sabab, Aashray K. Gupta, Joshua G. Kovoor, Adam J. Wells & Guy J. Maddern

Abstract:

Background

In under-resourced settings, general surgeons may be called upon to perform emergency operations within other specialties. Accordingly, we aimed to characterise patient outcomes after emergency neurosurgery performed by a general surgeon or general surgery trainee.

 

Methods

PubMed, Embase and the Cochrane Library were searched to 30 May 2021 for observational studies reporting outcomes after emergency neurosurgery performed by a general surgeon. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, mortality rates and complications were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42021258097.

Results

From 632 records, 14 retrospective observational studies were included, covering a total sample of 1,988 operations. Four studies were from Australia, and the remaining 10 were, respectively, from 10 other countries. Most common operations performed were decompressive surgery with burr holes or craniectomy for head trauma and insertion of intracranial pressure monitors. Rural hospitals were the most common settings. Mortality rates for procedures performed by general surgeons at latest follow-up were heterogenous, ranging from 5% for evacuation of chronic subdural haematoma in Kenya to 81% in head injured patients in a Hong Kong study.

Conclusions

This is the first systematic review that synthesises the literature to characterise patient outcomes after neurosurgical operations performed by a general surgeon. Findings from this study may benefit global surgery performed in rural, remote, military or humanitarian settings.

Free Link: https://rdcu.be/cEufJ

 


Interventions for the Prevention of Retained Surgical Items: A Systematic Review

 

 

Author list: Rattima Sirihorachai, Kate M. Saylor & Milisa Manojlovich

Abstract:

Background

Retained surgical items (RSI) are preventable error events. Interest in reducing RSI is increasing globally because of increasing demand for safe surgery. While research of interventions to prevent RSI have been reported, no rigorous analysis of the type and effectiveness of interventions exists. This systematic review examines (1) what types of intervention have been implemented to prevent RSI; and (2) what is the effectiveness of those interventions.

Methods

We performed a systematic review of PubMed, Embase, CINAHL, Cochrane Library, Scopus, ClinicalTrials.gov, Mednar, and OpenGrey databases. Two reviewers independently screened a total of 1,792 titles and abstracts, and reviewed 87 full-text articles, resulting in 17 articles in the final analysis. Study characteristics included qualitative and quantitative studies that examined the effectiveness of RSI prevention interventions for adult patients who undergo open surgery. The primary outcome was RSI and related error events.

Results

Four studies and 13 quality improvement projects described RSI interventions categorized into four groups: (1) technology-based, (2) communication-based, (3) practice- or guideline-based, (4) interventions that fell into more than one category. Following guidance in the Quality Improvement minimum quality criteria set, the quality of all studies ranged from poor to fair. Heterogeneity in the interventions used and variable study quality limit our confidence in the interventions’ ability to reduce RSI.

Conclusion

Since technology-based interventions may not be financially feasible in low and middle-income countries (LMIC), in those settings interventions that target the social system may be more appropriate. Rigorous methods to investigate local contexts and build knowledge are needed so that interventions to prevent RSI have a greater likelihood of success.

Free Link: https://rdcu.be/cEufQ

 


 

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