bluuebunny/crossref_metadata_2025_split huggingface dataset:
271 Surgical Trainees’ Burnout During Covid-19 Pandemic
Authors: Egbe A , Abuelgasim M , El Boghdady M 
Published: August 2023

Abstract

Introduction
The impact of the COVID-19 pandemic has been particularly significant for surgical trainees. We aimed to systematically review the prevalence of burnout in surgical trainees during the pandemic, to compare rates of burnout between different specialities, and to identify factors that may modify the risk of burnout.

Method
A systematic review was performed in compliance with the PRISMA guidelines to identify articles related to the keywords “surgeons’ burnout and Covid-19’’ and “surgical trainees burnout and Covid-19”. A search was performed on PubMed/Medline and ScienceDirect for articles published from January 2020 to August 2022.

Results
A total of 19 articles met the inclusion criteria, 3866 surgical trainees included across all the studies. The overall prevalence of burnout in surgical trainees during the pandemic was between 9.0%-95.2% across the globe. Burnout rates were higher in general surgery (33.1%-95.2%) than in urology (17.6%-55%), neurosurgery (16.2 %-44.1%), and orthopaedic surgery(9% - 44.1%). Otorhinolaryngology trainees had the lowest burnout rate (10.9%). Factors associated with an increased risk of burnout included female gender, being a more junior trainee, and increased working hours.

Conclusions
There has been a high level of burnout amongst surgical trainees across the globe during the pandemic. In light of the devastating effect of COVID-19 on surgical training, and the serious consequences of surgeons’ burnout both for the individual, and for patients, targeted interventions for the prevention and treatment of burnout in surgical trainees are urgently needed and must be prioritised by healthcare institutions and training programmes.
852 The Impact of Surgical Training on Clinical Outcomes After Oesophagectomy: A Systematic Review and Meta Analysis
Authors: Gysling S , Peck D , Elso A , Codreanu S , Rushton F , Caruana E 
Published: August 2023

Abstract

Aim
Surgical training, including in technical skills through theatre exposure, is integral to healthcare delivery and sustainability. We sought to investigate the impact of intraoperative trainee involvement during oesophageal resection on perioperative outcomes.

Method
A protocol was registered at PROSPERO (CRD42022330705). Seven databases were searched up to May 2022. Studies providing direct comparison between consultant- and trainee-performed oesophagectomies in adult patients were included.
The co-primary outcomes were length of hospital stay and 30-day survival.
Data was analysed in Stata SE v17. Log odds ratios (log OR) were calculated for dichotomous outcomes, whilst continuous variables were summarised as mean differences (MD). A random-effects model was employed. Heterogeneity was assessed using I2. Bias was assessed using ROBINS-I.

Results
804 studies were screened, with 9 papers considered in the final quantitative synthesis. 3183 (72% male) patients, including 762 (24%) trainee-led cases, were included. There was a high risk of bias across included papers.
Hospital stay was significantly shorter in the trainee group (MD -1.83 days: 95% CI [-2.88, -0.78], p&lt;0.01). There was no difference in 30-day survival (p = 0.23), in-hospital survival (p = 0.92), anastomotic leak (p = 0.80), operative time (p = 0.63) or completeness of resection (p = 0.76) between groups.

Conclusions
Trainee involvement in oesophageal resections does not appear to have a detrimental impact on patient safety and outcomes. High-quality studies, with consistent outcome reporting and larger populations are needed to further inform this area of interest.
1091 Trends in Exception Reporting (ER): Medicine vs Surgery
Authors: Richardson T , Naqvi M 
Published: August 2023

Abstract

Aim
ER was introduced with the new junior doctor contract in 2016. This was a mechanism to ensure compensation for all work performed and to uphold all educational opportunities. Literature regarding ER is limited and focuses on barriers to reporting. The aim of this study was to assess how ER practices have changed over 5 years and to highlight differences between grade and speciality.

Method
A retrospective cohort study was carried out. 5 years of reports from 1/1/2017 to 31/12/2021 were downloaded from Medic Online, Allocate Software. Quantitative and qualitative data were analysed in Microsoft Excel.

Results
125 doctors submitted 549 reports. The number of reports submitted per year have decreased over time whilst the number of doctors submitting at least one report has increased. The number of male doctors submitting reports has not changed in contrast to female doctors which has increased with a correlation of 0.76. Overall, there is no difference in number of reports submitted by sex (p = 0.1). F1s are more likely to report than any other grade (p&lt;0.001) and are most likely to report for hours worked rather than educational opportunity lost. ER in medicine has remained constant whilst it has declined within surgery.

Conclusions
Numbers of reports are declining but more doctors, especially females, are prepared to report. This suggests working conditions are improving and suggested barriers to ER are being broken down. Hospital specialties should learn from each other’s ER data to improve patient care as well as working conditions and educational opportunities for junior doctors.
1113 How Healthy Are Core Surgical Trainees in the East of England Deanery?
Authors: Ramjeeawon A , Edwards C 
Published: August 2023

Abstract

Aim
To understand whether core surgical trainees (CSTs) adhere to nationally issued guidance on health behaviours (government, NHS) and whether poor health behaviours are related to the demands of being a CST.

Method
An anonymised electronic questionnaire addressing five health behaviour domains (exercise, diet, smoking, alcohol, and sleep) and stress was distributed to all CSTs within one UK deanery.

Results
29 (29%) CSTs responded. 17% exercised ≥4 times per week, 31% exercised ≥150 minutes per week. 7% stated they smoked, of those 50% stated that their smoking increased during CST. 0% reported drinking ≥14 units of alcohol per week. 34% stated they slept ≥7 hours each night, 93% stated they sleep less since becoming a CST. 24% stated they ate ≥5 portions of fruit/vegetables each day, 59% stated they ate a balanced diet, and 17% stated they drank ≥7 cups of fluid per day. 31% of responders stated they drank ≥150ml of sugary drinks and ≥3 cups of caffeinated drinks per day. 52% of CSTs experienced symptoms of stress ≥3-4 times per week. 90% of CSTs felt more stressed than prior to becoming a CST. The demands of being a CST was the most frequently attributed reason to poor health behaviours across all domains.

Conclusions
CSTs in this region generally have poor health behaviours with regards to sleep, diet and exercise, but not alcohol and smoking. Health promoting behaviours should be encouraged amongst CSTs to promote long-term quality of life, career longevity and improved mental health.
782 Tranexamic Acid Administration for Blood Loss in High-Tibial Osteotomy (HTO): A Systematic Review and Meta-Analysis
Authors: Dadah H , O'Donnell C 
Published: August 2023

Abstract

Aim
To evaluate clinical outcomes after tranexamic acid (TXA) administration with the aim of reducing blood loss during and after high-tibial osteotomy (HTO) with available clinical evidence.

Method
Systematic search methodology of PUBMED, EMBASE and CINAHL databases was conducted in July 2022. The search workflow was undertaken in adherence to PRISMA guidelines. Inclusion criteria: 1) randomised control trials, cohort or case-control studies. 2) Studies reporting outcomes after TXA administration, of any route, before or after HTO, compared to: placebo, control, different doses or routes. 3) Studies reporting blood loss, including haemoglobin drop, estimated blood loss, transfusion requirement and complications. Excluded: case reports, reviews, abstracts, non-HTO studies, non-human studies and duplicates.

Results
Eleven studies were identified comparing 974 patients. Nine studies had placebo comparison and two used single dose TXA vs multiple doses. All studies reported on post-operative haemoglobin, nine on blood loss. In the 6 TXA vs placebo studies reporting on total blood loss, the TXA group had a pooled, estimated standardised mean difference (SMD) in blood loss of -2.37 [95% CI -3.67, -1.07, P = 0.0004]. For haemoglobin drop, on post-operative days 1, 2, and 5 SMDs were: POD1: -0.97 [95% CI -1.19, -0.75 P&lt;0.00001], POD2: -0.74 [95% CI -1.03, -0.46, P&lt;0.00001], POD5: -0.87 [-1.10, -0.64, P&lt;0.00001].

Conclusions
The data demonstrates that TXA administration in HTO significantly reduces blood loss and haemoglobin decrease; results of particular relevance given supply shortages of NHS blood resources. Furthermore, this can greatly improve recovery, complications, and post-operative stay.
304 Does Vitamin D Deficiency Lead to Poorer Health Outcomes After (Total) Knee Arthroplasty? a Systematic Review and Meta-Analysis
Authors: Vivek K , Kamal R , Perera E , Gupte C 
Published: August 2023

Abstract

Aim
Vitamin D deficiency is a predictor of poorer musculoskeletal disease outcomes and affects approximately 1-in-4 people. Prior literature has assessed the effects of vitamin D deficiency in joint arthroplasties. This updated systematic review and meta-analysis aims to evaluate and collate evidence available on vitamin D supplementation in total knee arthroplasty (TKA).

Method
A targeted terms search related to vitamin D and TKA outcomes was conducted (data inception until 01/09/2021). PubMed, Cochrane Central Register of Controlled Trials, Clinicaltrials.gov, American Academy of Orthopaedic Surgeons and British Orthopaedic Association databases were used. Analyses consisted of forest plots with I2 heterogeneity statistics, pooled effects with 95% confidence intervals (CI) and, p-values. A p &lt; 0.05 was considered statistically significant.

Results
10 studies fitted inclusion criteria for narrative description and 3 for meta-analysis. 6 studies showed improved outcomes in revision surgery risk, joint infection incidence and postoperative function. Additionally, there were poorer outcomes in postoperative stiffness, prosthesis explanation and postoperative vascular events. Meta-analysis of the length of hospital stays (LOS) demonstrated a significant decrease in LOS between vitamin D sufficiency versus deficiency (standard mean difference = -0.54, 95% CI [-0.69, -0.38], p&lt;0.00001) favouring vitamin D sufficiency.

Conclusions
Vitamin D supplementation demonstrated a statistically significant benefit for TKA patients regarding LOS. Most studies found positive effects of vitamin D supplementation improving patients’ health, reducing hospital resource use, and decreasing the burden on surgeons. Further research with standardised assessment scores is required to definitively prove the vitamin D screening and supplementation benefits in TKA.
506 Video-Assisted Thoracoscopic Surgery in Traumatic Rib Fractures in Comparison with Conventional Surgery: Systematic Review and Meta-Analysis
Authors: Ravikumar N , Ali Azamathullah Khan H F , Karnati S A , Jacob P A 
Published: August 2023

Abstract

Aim
This review aims to analyse the efficacy and safety of Video-assisted thoracoscopic surgery (VATS) in the management of traumatic rib fractures.

Method
A systematic review was performed in accordance with the PRISMA guidelines identifying literature regarding the use of VATS in rib fractures. The primary efficacy outcome included change in pain score. Safety outcomes included mortality, infection, and readmission. Meta-analysis was performed using the RevMan and R software.

Results
11 studies were included, with a total of 866,044 patients, of which 1,510 underwent VATS and 12,555 underwent conventional surgery. Participants included were predominantly male (77.46%), and the mean age was 53.22 ± 10.61 years. Overall, a considerable decrease of 2.60 (95% CI [1.38 – 3.83]) points was noted in the pain score within the VATS group which was higher when compared to conventional surgery (SMD = -1.62, 95% CI [-2.25, -0.99], p&lt;0.01). Similarly, the rates of surgical site infections (OR = 0.21, 95% CI [0.06 – 0.68], p&lt;0.01) and pneumonia (OR = 0.15, 95% [0.03 – 0.84], p = 0.03) were lower in the VATS group. The rates of mortality within 30 days were only 2.09% (95% CI [1.43% - 3.04%]), and readmission rates were 3.48% (95% CI [0.65% - 16.59%]) in the VATS group.

Conclusions
The results of the study suggest that there is a significant improvement in the Quality-of-Life in terms of change in pain score and reduced rates of infection, that make VATS a suitable alternative to conventional surgery in the management of traumatic rib injuries. However, further studies exploring the long-term effects are warranted.
914 A Scoping Review of Studies Relating to Digital Healthcare Utilisation in Obese Patients Presenting with End Stage Hip and Knee Arthritis
Authors: Akhtar M A , Hanif H , Blacklock C 
Published: August 2023

Abstract

Aim
Digital health technologies provide high-reach, low cost, readily accessible and scalable interventions for large patient populations that address time and resource constraints. Weight loss may reduce the risk of symptomatic lower limb osteoarthritis and may lead to the resolution of symptoms. Musculoskeletal-focused digital apps are increasingly being used for physical therapy and rehabilitation. The scoping review will yield evidence from a breadth of healthcare services about how obese patients with musculoskeletal problems can benefit from digital advances in health care delivery.

Method
Search engines MEDLINE and CINAHL were used. We initially identified 109 papers from 2000 onwards. An inclusion criterion was added for terms relating to ‘osteoarthritis’, ‘obesity’, ‘weight/exercise interventions’ and ‘digital technology’ which yielded 11 studies, 6 of which were identified as being more specific to our scoping reviews’ aim.

Results
Several papers study the role of tele-rehabilitation by using online digital platforms. Several commercially available devices have been studied in activity monitoring, the most common being the Fitbit. Mobile-phone apps have been studied to monitor activity. The review also identified recent trial protocols studying weight loss before total joint arthroplasty using a remote dietitian and mobile app along with positive psychology and healthy living skills to slow the progression of symptoms.

Conclusions
This review indicated that research on digital care is limited but that comprehensive digital care programmes can significantly improve functional outcomes in obese patients with end-stage arthritis and identified the motives for weight loss, strategies utilized during past weight loss attempts, and preferences for future weight loss programmes.
919 The Effect of the Covid-19 Pandemic on BMI in Patients Awaiting Total Knee Replacement
Authors: Akhtar M A , Thomson J , Blacklock C , Ballantyne A 
Published: August 2023

Abstract

Aim
Obesity increases the risk of postoperative complications following Total Knee Replacement (TKR). The Covid-19 pandemic has increased waiting times for TKR in the United Kingdom. It is therefore important to understand whether these prolonged waiting times are impacting patient Body Mass Index (BMI) at the time of surgery. The aim of our study was to assess for changes in BMI whilst awaiting TKR.

Method
Prospective data was collected for 54 patients who attended the pre-assessment-clinic (PAC) from January - March of 2022, before undergoing TKR. This included demographics, waiting times for surgery, and BMI on referral to Orthopaedics versus BMI at PAC.

Results
Of the 54 patients studied, 29 were female and 25 were male with a mean age of 69 years (SD 8.07). 42 patients waited ≥ 3 months for surgery, 29 waited ≥ 6 months and 2 waited ≥ 12 months. Mean waiting time was 191.5 days (SD 114.23).
33 of the 54 patients (61%) were obese (BMI ≥ 30) when listed for surgery, with a mean BMI of 31.7 (SD 4.59). Between listing for surgery and PAC review, 72% saw an increase in BMI, 24% saw a decrease and 4% saw no change. Mean BMI at PAC was 33.2 (SD 4.97) with a mean change in BMI of +1.5 since listing (SD 2.51).

Conclusions
In this study, 72% of patients gained weight while awaiting surgery and surgical waiting times were considerably higher than pre-pandemic targets (&lt;3 months). This increase in BMI may result in increased risk of complications and patients should be counselled about it.
507 A Powerful Proforma: Improving Regional Urology Patient’s Information Sharing Between NHS Trusts
Authors: Prayle M , Thompson A 
Published: August 2023

Abstract

Aim
Two Urology Departments work symbiotically to provide service provision across their local region by hosing ‘hot weekends’. On alternating weekends, all urological patients attending the ‘parent A&E’ are transferred to the ‘sister hospital’ for treatment. This QIP aimed to improve the data sharing of these transferred patients post discharge to ensure efficient patient follow-up at the ‘parent hospital’.

Method
Cycle 1 reviewed the current quality of information sharing utilising freestyle emails versus a newly created proforma to prompt doctors to share key urological specific data (Cycle 2). The content, quality, and evidence of information shared was compared. The cycles reviewed 17 and 15 patients respectively over 16 weekends.

Results
There was no documentation of emails sent during cycle 1 within the patient’s notes compared to cycle 2 where 100% of patients had a proforma within an 'electronic drive' in addition to 94% within patient’s notes; a 194% improvement. 48% more patients had a 'diagnosis' documented on the proformas. 56% of emails contained relevant blood results compared to 90% within the proformas and 83% of the emails contained radiological imaging results versus 100% on the proformas (40% vs. 75% contained the original report respectively). The proforma improved ‘suggested follow-ups’ by 32% and overall, the parent site consultants voted ‘very satisfied’ with the proforma compared to emails.

Conclusions
The development of a proforma created sustainable positive change for urological follow-ups on a regional level by helping doctors easily share standardised data and follow-up requests.
953 Outcomes of Partial Nephrectomy for pT3a Renal Cell Cancer Over 20 Years at a Single Centre
Authors: Gorgoraptis S , Cui H , Ramsamy G , Leiblich A , Cranston D , Browning L , Verrill C , Sullivan M 
Published: August 2023

Abstract

Aim
There is limited information on outcomes of pT3a RCC treated with PN. Retrospective studies of cT1/2 upstaged to pT3a treated with RN vs PN show contradictory results.

Method
Retrospective analysis of all pT3a renal tumours removed by either RN or PN between 2000-2020 at a single centre performed by 6 surgeons with a median follow up period of 4 years.

Results
186 cases of pT3a RCC were treated with RN and 78 with PN. There was CT suspicion of T3a disease in 1 PN and 6 RN cases. The mean tumour size in PN vs RN was 4.5cm vs. 8cm. Preoperative and postoperative eGFR were similar between RN and PN groups with a smaller drop in eGFR from preop to post op in the PN vs RN group (16 vs 20ml/min) The number of patients who went on to have renal replacement therapy for end stage renal failure was 6 in the RN group and 2 in the PN group. At median 4 years follow up, 86% of PN patient were alive vs 93% who had RN. Of the patients who had died 5.6% were due to renal cancer in the PN group vs 8.6% in the RN group. The rate of any recurrence or spread of renal cancer detected at follow up was 21% in the PN group and 38% in the RN group.

Conclusions
This case series suggests PN for pT3a tumours is a reasonable option for patients who have strong indications for nephron sparing surgery.
959 Is It Necessary to Repeatedly Check Haemoglobin Following Robotic Assisted Radical Prostatectomy (RARP)?
Authors: Msellati A , O'Connor C , Collins P , Hegazy M , O'Beirne E , Galvin D , Hegarty N , Connolly S , Nason G , O'Malley K 
Published: August 2023

Abstract

Aim
The primary aim of this study was to examine the necessity for routine post-operative haemoglobin (Hb) checks for patients undergoing RARP.

Method
Between April 2019 and March 2022, 155 patients underwent RARP. Demographic and clinical variables were collated including blood loss, pre-operative and post-operative Hb checks, need for transfusion and length of stay (LOS).
Paired samples t-tests were undertaken to compare mean pre-operative and post-operative Hb results.

Results
The mean age of patient was 62 years (range 45-79). The mean blood loss was 281.2mls (range 50-1000). There was a statistically significant drop between pre-operative and day 1 post-operative Hb (p&lt;0.001) (15.07 to 12.97) (mean drop of 2.2g/dl). There was not a statistically significant drop between day 1 and day 2 post-operative bloods (p = 0.547) (mean 0.13g/dl). No patient required a blood transfusion. The mean LOS was 2.4 days (range 1-16).

Conclusions
Blood loss at RARP is low and unlikely of clinical significance. Following a Hb check on post-operative day one, further routine bloods are unnecessary in the absence of a clinical concern.
1063 Prioritising Primary Ureteroscopy: Getting It Right First Time in Patients with Obstructing Urolithiasis by Using a New Treatment Pathway
Authors: Kasmani Z , Donati-Bourne J , Dhanasekaran A K , Malik S , Jamal A , Doody J , Boniecki K 
Published: August 2023

Abstract

Aim
Obstructing urolithiasis should be cleared on first attempt, minimising the need for multiple treatments and associated morbidity. Achieving this primary ureteroscopy (P-URS) standard is paramount in the post-pandemic era, where elective waiting lists cannot afford to accommodate ‘stent and wait’ patients. This project aims to evaluate the efficiency of our modified stone treatment pathway which focusses on P-URS.

Method
We conducted 3 audit cycles in the years 2018, 2020 and 2022 including all patients listed for emergency stone surgery. Extracted data included age, sex, stone number, location and size, and presence of sepsis. Between 2018 and 2022, all Urologists were encouraged to follow a modified stone treatment pathway with an emphasis on P-URS.

Results
P-URS and attempted URS increased from 7.4% to 62.7%. The average waiting time for subsequent treatment in those who did not have primary/attempted URS was 135 days (23- 412) in 2020 and 95 days (23 -152) in 2022. Sepsis as justification for not attempting P-URS accounted for 19% of cases in 2018 and 21% in 2022. Stent insertion led to subsequent URS in &gt; 95% of cases, ESWL was rarely used. Spontaneous stone after stenting occurred in only 3% of patients. There was no significant difference in WCC, CRP, age, sex or stone distribution between the cycles. No P-URS patients re-presented with complications.

Conclusions
Limited spontaneous stone passage means P-URS is necessary. Furthermore, it is safe and reduces long waiting times for almost certain subsequent surgery, benefiting both patients and the NHS.