Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland最新文献

Background: Older adults have high rates of morbidity and mortality following traumatic spinal cord injuries (SCI) but are also at increased risk of intraoperative and postoperative complications compared to younger counterparts. This study aims to identify the optimal time to surgical intervention in elderly patients presenting with traumatic SCI.

Methods: A retrospective review was carried out at our centre from 2016 to 2020 to identify geriatric patients (≥65 years old) presenting with a traumatic SCI, managed surgically. Cohorts were categorised and compared for outcomes based on their time from injury to surgery. The different time intervals assessed include: 24 h and 72 h.

Results: 72 patients were identified. 13/72 (18.1 %) underwent surgery within 24 h of their injury and 32/72 (44.4 %) underwent surgery within 72 h of their injury. Overall, the results favoured delayed surgical intervention for both time intervals in terms of high dependency unit (HDU) requirement (p = 0.004 and p = 0.048), intensive care unit (ICU) requirement (p = 0.001 and p = 0.015) and intraoperative complications (p = 0.043 and p = 0.02). Of the patients with preoperative American Spinal Injury Association (ASIA) Impairment Scale (AIS) A grade, those who underwent surgical decompression after 72 h had greater neurological improvement (p = 0.019) and a smaller proportion of HDU (p = 0.006) and ICU (p = 0.047) requirement.

Conclusion: To the authors' knowledge, this is the first study to compare surgical outcomes in geriatric patients with traumatic spinal cord injury (SCI) based on injury-to-surgery time intervals. The findings are hypothesis-generating and suggest a potential benefit to delayed surgical intervention in a subset of these patients. Further prospective research is needed to better define optimal timing and management strategies in this complex and vulnerable population.

Background & aims: Sleeve gastrectomy is a widely performed bariatric surgery, yet its outcomes can vary significantly depending on environmental factors such as high altitude. High altitude, characterized by hypobaric hypoxia, may affect oxygen delivery, recovery, and metabolic processes post-surgery. This study aims to evaluate high altitude as a prognostic factor in sleeve gastrectomy outcomes, focusing on complication rates, weight loss, and recovery duration.

Results: The meta-analysis revealed a significantly higher postoperative complication rate for the high-altitude group, with a relative risk (RR) of 1.45 (95 % CI: 1.35-1.55, p < 0.05) [9, 14]. To address heterogeneity in altitude definitions [6, 9], we performed a sensitivity analysis excluding the study with the highest altitude cutoff (≥2500 m). The results remained consistent (RR: 1.42, 95 % CI: 1.32-1.53) [14, 19], confirming the robustness of our primary finding.

Conclusions: High altitude is a critical factor influencing sleeve gastrectomy outcomes, leading to increased complications and prolonged recovery. Preoperative assessments and postoperative care must address altitude-specific challenges, including enhanced oxygenation strategies, to optimize patient recovery and surgical success. These findings emphasize the need for tailored clinical approaches to improve outcomes for bariatric surgery patients in high-altitude environments.

Background: Given changing demographics in surgery, this study aimed to assess the representation and diversity of speaker pool in the last decade of Conjoint Scientific Congresses by analysing the participating speakers, both the invited speakers and presenting trainees, in terms of their gender, affiliations and origin.

Methods: This study retrospectively reviewed online program leaflets to collect information on the gender, origin, presentation role, invitation status, and affiliation of speakers. Information on invited speakers were evaluated from 2013 to 2022, and for presenting trainees, from 2015 to 2023, due to data availability.

Results: This study identified 1817 speakers, including invited speakers (2013-2023) and 791 trainees (2015-2023). The percentage of female invited speakers increased significantly from 7.7 % in 2013 to 27.5 % in 2023 (p < 0.05; 95 % CI [0.46, 0.95]). The mean percentage of female trainees was 37.4 % (range 28.7 %-48.7 %), and there was no significant change in this percentage over the years (p = 0.44; 95 % CI). Local speakers increased significantly from 69.2 % in 2013 to 83.8 % in 2022 (p < 0.05; 95 % CI [0.91, 0.99]), associated with a greater involvement from the public sector, from 57.8 % in 2013 to 92.3 % in 2023 (p < 0.05; 95 % CI [0.64, 0.96]).

Conclusion: Over the years, female invited speakers increased, and female trainee participation remained similar, suggesting better representation of surgical community. There was an increasing participation of local speakers, particularly in the public sector, which may lead to potentially less diversity in the speaker pool.

Introduction: Surgical care is an essential, resource-intensive component of healthcare. It contributes a significant carbon footprint and waste production. As part of Ireland's commitment to achieving net-zero emissions by 2050, surgical services have emerged as a critical focus area for sustainability reforms.

Aims: This review explores national policies, research contributions, and the leadership role of institutions in driving sustainable practices.

Discussion: Ireland has made significant strides in incorporating sustainability into its healthcare system, particularly within surgical care. National initiatives and efforts led by institutions are commendable steps toward reducing the environmental footprint of healthcare. The integration of sustainability into education and research is assessed, along with challenges and barriers to systemic change. Significant gaps remain in terms of implementing Ireland's sustainability policies effectively across all hospitals. Issues include the disparity in resources between urban and rural hospitals and patient engagement practices.

Recommendations: Four key findings are recommended. Stronger national policies on sustainability audits and practices are essential. An increased focus on sustainability in research is required. An emphasis on training and teaching sustainable surgical practices is needed. Improving patient education will aid in the goal of increasing surgical sustainability in Ireland.

Conclusions: Ireland continues to focus on enhancing policy frameworks, expanding research, building capacity across the healthcare workforce, and engaging the public in sustainable healthcare practices. Several challenges persist that hinder the scaling and broad implementation of these initiatives. Evidence from global studies supports actionable recommendations for Ireland's future sustainability agenda.

Introduction: Mentorship is perceived to influence the nuanced decisions of medical students on the precipice of their chosen career path. No previous study has evaluated whether formalised mentorship ab initio impacts medical students attitudes towards a career in surgery.

Methods: A crossover, randomised controlled trial (RCT) was performed. Medical students were randomised to: (1) lack of exposure to a mentor (control/crossover arm) and assessment using a questionnaire, and (2) exposure to a mentor (intervention arm) and assessment. The control/crossover arm were then exposed to a mentor and underwent re-assessment and comparison with their initial results.

Results: Overall, 43 students were enrolled with no significant difference observed in student age, gender, or nationality (all P > 0.050). In the intervention arm, students were less likely to feel a lack of mentorship in surgery (P = 0.021) or be discouraged by the 'unknowns' of surgical training (P = 0.001). Furthermore, mentorship provided them with significant clarity regarding training (P = 0.032) and made the recommendation for mentorship more likely (P < 0.001). Following crossover, students felt significantly more interested in a surgical career (P = 0.001). Students also felt less concerned regarding competition (P = 0.032), the 'unknowns' (P = 0.007), workload (P = 0.006), and lack of direction (P = 0.016) within surgical training, while also reporting less concern regarding a lack of mentorship (P = 0.010) and less insecurity about their ability to succeed in surgery (P = 0.003). Lastly, crossover provided students with clarity regarding training (P = 0.033), while making mentor recommendation more likely (P = 0.001).

Conclusion: Formalised mentorship has a positive impact upon medical students' attitudes through structured support towards a career in surgery. Medical education institutions should consider the inclusion of formalised mentorship programmes in their curricula.

Introduction: Breast-cancer-related-lymphoedema (BCRL) remains problematic clinically. A recent meta-analysis showed a pooled incidence of 21.9 %. Greater lymph node dissection increases BCRL incidence with a pooled average of 5.9 % for sentinel lymph node biopsy (SLNB) versus 23.6 % for axillary lymph node dissection (ALND). The primary aim was to assess the BCRL incidence in symptomatic breast cancer patients undergoing axillary surgery.

Methods: A prospective, single centre study was carried out whereby included patients had limb volumes assessed pre-operatively and at 1 and 2 years post-operatively between January 2016 and July 2019. Assessment involved two standardised methods; arm circumference measurement and water displacement.

Results: 147 patients, mean age 56.4 years (±sd 14.0, range 28-86) were included. 97/147(66 %) of patients underwent SLNB, with 50/147(34 %) undergoing ALND. 70/97(72.2 %) of the SLNB group had a wide local excision versus 24/50(48.0 %) in the ALND group (p = 0.004). Mean lymph nodes excised was 8.0(±sd 7.4, range 1-30) for all patients, 3.3(±sd 2.2, range 1-11) for SLNB and 17.1(±sd 5.1, range 9-30) for ALND (p < 0.001). Overall incidence of BCRL was 6.1 %(9/147) using arm circumference measurement and 15.7 %(23/147) with water displacement at 2 year follow-up. BCRL incidence determined using arm circumference measurement was found to be 4.3 % (4/94), 33.3 % (1/33), 11.5 % (3/26) and 4.2 % (1/24) for SLNB alone, SLNB + RLNR, ALND alone and ALND + RLNR respectively. Using water displacement, BCRL incidence in the SLNB alone, SLNB + RLNR, ALND alone and ALND + RLNR groups was 10.6 % (10/94), 33.3 % (1/3), 15.4 % (4/26), and 33.3 % (8/24) respectively.

Conclusion: This study gives a real world perspective on the diagnosis, incidence and subsequent management of BCRL whilst showing that the incidence of BCRL is low at our institution by international standards.