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Journal of the American College of... Dec 2020The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication was to report the impact of the pandemic on surgical training and...
BACKGROUND
The COVID-19 pandemic disrupted the delivery of surgical services. The purpose of this communication was to report the impact of the pandemic on surgical training and learner well-being and to document adaptations made by surgery departments.
STUDY DESIGN
A 37-item survey was distributed to educational leaders in general surgery and other surgical specialty training programs. It included both closed- and open-ended questions and the self-reported stages of GME during the COVID-19 pandemic, as defined by the ACGME. Statistical associations for items with stage were assessed using categorical analysis.
RESULTS
The response rate was 21% (472 of 2,196). US stage distribution (n = 447) was as follows: stage 1, 22%; stage 2, 48%; and stage 3, 30%. Impact on clinical education significantly increased by stage, with severe reductions in nonemergency operations (73% and 86% vs 98%) and emergency operations (8% and 16% vs 34%). Variable effects were reported on minimal expected case numbers across all stages. Reductions were reported in outpatient experience (83%), in-hospital experience (70%), and outside rotations (57%). Increases in ICU rotations were reported with advancing stage (7% and 13% vs 37%). Severity of impact on didactic education increased with stage (14% and 30% vs 46%). Virtual conferences were adopted by 97% across all stages. Severity of impact on learner well-being increased by stage-physical safety (6% and 9% vs 31%), physical health (0% and 7% vs 17%), and emotional health (11% and 24% vs 42%). Regardless of stage, most but not all made adaptations to support trainees' well-being.
CONCLUSIONS
The pandemic adversely impacted surgical training and the well-being of learners across all surgical specialties proportional to increasing ACGME stage. There is a need to develop education disaster plans to support technical competency and learner well-being. Careful assessment for program advancement will also be necessary. The experience during this pandemic shows that virtual learning and telemedicine will have a considerable impact on the future of surgical education.
Topics: COVID-19; Cross-Sectional Studies; Education, Medical, Graduate; General Surgery; Health Status; Humans; Learning; Pandemics; Specialties, Surgical; Students; Surveys and Questionnaires; United States
PubMed: 32931914
DOI: 10.1016/j.jamcollsurg.2020.08.766 -
The Journal of Physiology Feb 2003Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the... (Review)
Review
Fetal surgery was born of clinical necessity. Observations by pediatric surgeons and neonatologists of neonates that were born with irreversible organ damage led to the conclusion that one possible approach to prevent this alteration of developmental physiology, was fetal surgical intervention. This led to experimental validation of the pathophysiology of specific fetal defects in animal models and to the development of techniques for their prenatal surgical correction. The demonstration in animal models that the correction of an anatomical defect could reverse the associated pathophysiology led to the first systematic application of fetal surgery at the University of California, San Francisco, in the early 1980s. Since that time, fetal surgery has been applied in only a few centres and has remained relatively limited in scope. Nevertheless, there has been a dramatic improvement in our ability to diagnose, select and safely operate on an expanding number of fetal anomalies. The purpose of this article is to briefly summarize the present status of fetal surgery and to speculate about what may be in store for the future. Inherent in such an effort is a definition of what constitutes fetal surgery. In this discussion I will take considerable latitude with the definition of what constitutes fetal surgery in the future, as it is my belief that technological progress in a number of areas will result in dramatic changes in the practice and perception of fetal surgery.
Topics: Female; Fetal Diseases; Fetus; General Surgery; Humans; Pregnancy; Randomized Controlled Trials as Topic
PubMed: 12562950
DOI: 10.1113/jphysiol.2002.022327 -
Scandinavian Journal of Surgery : SJS :... 2022Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain...
BACKGROUND AND OBJECTIVE
Surgical drains are widely utilized in hepatopancreaticobiliary surgery to prevent intra-abdominal collections and identify postoperative complications. Surgical drain monitoring ranges from simple-output measurements to specific analysis for constituents such as amylase. This systematic review aimed to determine whether surgical drain monitoring can detect postoperative complications and impact on patient outcomes.
METHODS
A systematic review was performed, and the following databases searched between 02/03/20 and 26/04/20: MEDLINE, EMBASE, The Cochrane Library, and Clinicaltrials.gov. All studies describing surgical drain monitoring of output and content in adult patients undergoing hepatopancreaticobiliary surgery were considered. Other invasive methods of intra-abdominal sampling were excluded.
RESULTS
The search returned 403 articles. Following abstract review, 390 were excluded and 13 articles were included for full review. The studies were classified according to speciality and featured 11 pancreatic surgery and 2 hepatobiliary surgery studies with a total sample of 3262 patients. Postoperative monitoring of drain amylase detected pancreatic fistula formation and drain bilirubin testing facilitated bile leak detection. Both methods enabled early drain removal. Improved patient outcomes were observed through decreased incidence of postoperative complications (pancreatic fistulas, intra-abdominal infections, and surgical-site infections), length of stay, and mortality rate. Isolated monitoring of drain output did not confer any clinical benefits.
CONCLUSIONS
Surgical drain monitoring has advantages in the postoperative care for selected patients undergoing hepatopancreaticobiliary surgery. Enhanced surgical drain monitoring involving the testing of drain amylase and bilirubin improves the detection of complications in the immediate postoperative period.
Topics: Amylases; Bilirubin; Device Removal; Digestive System Surgical Procedures; Drainage; Humans; Pancreatic Fistula; Postoperative Complications
PubMed: 34749548
DOI: 10.1177/14574969211030118 -
Journal of Infection and Public Health 2015Existing evidence suggests that communication failures are common in the operating room, and that they lead to increased complications, including infections. Use of a... (Review)
Review
Existing evidence suggests that communication failures are common in the operating room, and that they lead to increased complications, including infections. Use of a surgical safety checklist may prevent communication failures and reduce complications. Initial data from the World Health Organization Surgical Safety Checklist (WHO SSC) demonstrated significant reductions in both morbidity and mortality with checklist implementation. A growing body of literature points out that while the physical act of "checking the box" may not necessarily prevent all adverse events, the checklist is a scaffold on which attitudes toward teamwork and communication can be encouraged and improved. Recent evidence reinforces the fact the compliance with the checklist is critical for the effects on patient safety to be realized.
Topics: Checklist; Communication; Humans; Intraoperative Complications; Postoperative Complications; Surgical Procedures, Operative
PubMed: 25731674
DOI: 10.1016/j.jiph.2015.01.001 -
Journal of Medicine and Life 2008Damage-control surgery is an example of a paradigm shift. The term is borrowed from naval teminology and means gaining the initial control of a damaged ship. Because of... (Review)
Review
Damage-control surgery is an example of a paradigm shift. The term is borrowed from naval teminology and means gaining the initial control of a damaged ship. Because of the lethal triad the polytrauma patient is at a grave risk. The classical concept of surgically solving all the patient's injuries in the first moment was even theoretically incorrect as a multiple injured patient is a critical patient with depleted reserves. As such, complex procedures were doomed from this point of view. The concept of damage-control surgery emerged in 1992. The core idea was that as minimal as possible had to be done in these critical patients in the first phase, meaning temporary control of a hemorrhage and simple measures for stopping contamination. After 24-48 hours in the ICU, in which time the physiological disturbances were corrected, a further intervention is perfomed for definitively treating the injuries. Further refinements consider five stages and not three in damage-control surgery. The bright side of the concept is an up to 70% survivability rate but with a higher risk of complications, mostly due to the policy of temporary closing the abdomen and sepsis.
Topics: Abdominal Injuries; Bacterial Infections; Hemorrhage; Humans; Intensive Care Units; Multiple Trauma; Patient Care Team; Surgical Procedures, Operative; Survival Analysis; Thoracic Injuries; Trauma Severity Indices; Wounds and Injuries
PubMed: 20108501
DOI: No ID Found -
World Journal of Gastroenterology Apr 2019Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (., choledocholithotomy) or diversion (., choledochojejunostomy). Because... (Review)
Review
Surgeries for benign diseases of the extrahepatic bile duct (EHBD) are classified as lithotomy (., choledocholithotomy) or diversion (., choledochojejunostomy). Because of technical challenges, laparoscopic approaches for these surgeries have not gained worldwide popularity. The right upper quadrant of the abdomen is advantageous for laparoscopic procedures, and laparoscopic choledochojejunostomy is safe and feasible. Herein, we summarize tips and pitfalls in the actual procedures of choledocholithotomy. Laparoscopic choledocholithotomy with primary closure of the transductal incision and transcystic C-tube drainage has excellent clinical outcomes; however, emergent biliary drainage without endoscopic sphincterotomy and preoperative removal of anesthetic risk factors are required. Elastic suture should never be ligated directly on the cystic duct. Interrupted suture placement is the first choice for hemostasis near the EHBD. To prevent progressive laceration of the EHBD, full-layer interrupted sutures are placed at the upper and lower edges of the transductal incision. Cholangioscopy has only two-way operation; using dedicated forceps to atraumatically grasp the cholangioscope is important for smart maneuvering. The duration of intraoperative stone clearance accounts for most of the operative time. Moreover, dedicated forceps are an important instrument for atraumatic grasping of the cholangioscope. Damage to the cholangioscope requires expensive repair. Laparoscopic approach for choledocholithotomy involves technical difficulties. I hope this document with the visual explanation and literature review will be informative for skillful surgeons.
Topics: Cholangiography; Choledocholithiasis; Choledochostomy; Common Bile Duct; Humans; Laparoscopy; Postoperative Complications; Practice Guidelines as Topic; Suture Techniques; Treatment Outcome
PubMed: 30983814
DOI: 10.3748/wjg.v25.i13.1531 -
BMJ Quality & Safety Jul 2014Postoperative adverse events occur all too commonly and contribute greatly to our large and increasing healthcare costs. Surgeons, as well as hospitals, need to know... (Review)
Review
Postoperative adverse events occur all too commonly and contribute greatly to our large and increasing healthcare costs. Surgeons, as well as hospitals, need to know their own outcomes in order to recognise areas that need improvement before they can work towards reducing complications. In the USA, the American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) collects clinical data that provide benchmarks for providers and hospitals. This review summarises the history of ACS NSQIP and its components, and describes the evidence that feeding outcomes back to providers, along with real-time comparisons with other hospital rates, leads to quality improvement, better patient outcomes, cost savings and overall improved patient safety. The potential harms and limitations of the program are discussed.
Topics: Benchmarking; General Surgery; Humans; Outcome Assessment, Health Care; Patient Safety; Postoperative Complications; Quality Improvement; Quality Indicators, Health Care; Societies, Medical; United States
PubMed: 24748371
DOI: 10.1136/bmjqs-2013-002223 -
Cleveland Clinic Journal of Medicine Mar 2006Hospital strategies to prevent VTE are important to reduce acute morbidity and mortality as well as the long-term consequences caused by venous stasis syndrome. Patients... (Review)
Review
Hospital strategies to prevent VTE are important to reduce acute morbidity and mortality as well as the long-term consequences caused by venous stasis syndrome. Patients at low risk (eg, those who are ambulatory or undergoing a same-day procedure) or who are at high risk for bleeding (including those with severe renal impairment) are candidates for nonpharmacologic strategies for thromboembolic prophylaxis. Mechanical devices are effective if used appropriately, but compliance is a challenge. Patients who require a hospital stay of more than a day or two should receive a medication-based strategy, preferably using LMWH or fondaparinux. Patients undergoing hip replacement should receive extended prophylaxis with LMWH.
Topics: Humans; Postoperative Complications; Practice Guidelines as Topic; Surgical Procedures, Operative; Treatment Outcome; Venous Thrombosis
PubMed: 16570556
DOI: 10.3949/ccjm.73.suppl_1.s88 -
Minerva Anestesiologica Jun 2006Preoperative preparation of paediatric patients and their environment in order to prevent anxiety is an important issue in paediatric anaesthesia. Anxiety in paediatric... (Review)
Review
Preoperative preparation of paediatric patients and their environment in order to prevent anxiety is an important issue in paediatric anaesthesia. Anxiety in paediatric patients may lead to immediate negative postoperative responses. When a child undergoes surgery, information about the child's anaesthesia must be provided to parents who are responsible for making informed choices about healthcare on their child's behalf. A combination of written, pictorial, and verbal information would improve the process of informed consent. The issue of parental presence during induction of anaesthesia has been a controversial topic for many years. Potential benefits from parental presence at induction include reducing or avoiding the fear and anxiety that might occur in both the child and its parents, reducing the need for preoperative sedatives, and improving the child's compliance even if other studies showed no effects on the anxiety and satisfaction level. The presence of other figures such as clowns in the operating room, together with one of the child's parents, is an effective intervention for managing child and parent anxiety during the preoperative period.
Topics: Anesthesia; Anxiety; Child; Disclosure; Humans; Parents; Surgical Procedures, Operative
PubMed: 16682916
DOI: No ID Found -
Critical Care (London, England) 2009A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to... (Review)
Review
A small group of patients account for the majority of peri-operative morbidity and mortality. These 'high-risk' patients have a poor outcome due to their inability to meet the oxygen transport demands imposed on them by the nature of the surgical response during the peri-operative period. It has been shown that by targeting specific haemodynamic and oxygen transport goals at any point during the peri-operative period, the outcomes of these patients can be improved. This goal directed therapy includes the use of fluid loading and inotropes, in order to optimize the preload, contractility and afterload of the heart whilst maintaining an adequate coronary perfusion pressure. Despite the benefits seen, it remains a challenge to implement this management due to difficulties in identifying these patients, scepticism and lack of critical care resources.
Topics: General Surgery; Goals; Hemodynamics; Humans; Oxygen Consumption; Perioperative Care; Postoperative Complications
PubMed: 19863764
DOI: 10.1186/cc8039