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

{"title":"Healthcare & the Environment","authors":"David G Healy","doi":"10.1016/j.surge.2024.07.003","DOIUrl":"10.1016/j.surge.2024.07.003","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Page 199"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141635179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Expiry dates in surgical equipment: What are the options?","authors":"","doi":"10.1016/j.surge.2024.03.003","DOIUrl":"10.1016/j.surge.2024.03.003","url":null,"abstract":"<div><h3>Introduction</h3><p>Hospitals and the healthcare system contribute significantly to global warming, due to the energy use, water use and waste produce going directly to landfill. The operating theatre environment contributes to 70% of all hospital waste, and a proportion of this is due to unused surgical supplies, such as those stocked but never used as they go past their use-by date.</p></div><div><h3>Aim</h3><p>To evaluate how use-by dates are identified and assigned to surgical equipment, and if there are opportunities to re-use, or re-sterilise this equipment in order to reduce waste from the operating theatre environment.</p></div><div><h3>Results</h3><p>Use-by dates are assigned to ensure sterility and longevity of the device, and are assigned based on risk analysis, retrospective and prospective assessment. Incineration is the mainstay of disposal of unused medical devices, but there are alternative options such as re-processing in specific circumstances.</p></div><div><h3>Conclusion</h3><p>A large volume of hospital waste is due to operating theatres, and there is movement towards developing more sustainable methods of dealing with expired surgical equipment. This is however in the early stages, with further research required to confirm if these methods will be safe for patients, and beneficial to the environment.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 212-214"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X24000301/pdfft?md5=e6761fd9a7ffeb4f0559bc42da68e92a&pid=1-s2.0-S1479666X24000301-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140787850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bone cement in total hip arthroplasty – Is it really green?","authors":"","doi":"10.1016/j.surge.2024.04.010","DOIUrl":"10.1016/j.surge.2024.04.010","url":null,"abstract":"<div><h3>Background</h3><p>Total hip replacement (THR)is typically cemented, cementless or hybrid depending on patient factors and surgeon preference. To date no studies have evaluated waste generated with each of these procedures in relation to implant choice, and particularly waste related to consumables. We aimed to quantify the volume; type and ability to recycle this waste and suggest potential strategies for reducing the overall waste related to consumables in THR.</p></div><div><h3>Method</h3><p>This was a prospective review of all waste related to consumables in THR. The waste was weighed using a Salter 1066 BKDR15 scale, accurate to the nearest 1 ​g. The primary outcome was the amount of waste generated per case depending on implant choice (cemented vs. uncemented). Secondary outcomes included: proportion of clinical waste and proportion of recyclable waste.</p></div><div><h3>Results</h3><p>Cemented THR generated a total of 1.89 ​kg of waste compared to 775 ​g for an uncemented THR. Cemented THR generated significantly more sterile (hazardous) waste than uncemented THR both as overall volume and as a proportion 763 ​g (40%) vs 76 ​g (10%). Significantly more of the waste related to uncemented THR was amenable to being recycled through conventional waste streams with simple changes in theatre 672 ​g (86%) compared to 989 ​g (52%) with cemented THR. Between 20 and 30% of waste packaging for both types of surgery compromised information booklets.</p></div><div><h3>Conclusion</h3><p>Cemented hip replacement generates significantly more waste from consumables than uncemented and a greater amount of this waste is hazardous requiring intensive processing. For both implants a significant proportion of waste can be recycled with simple process changes in theatre. Industry partners have a responsibility to minimise unnecessary packaging and work with surgeons to improve sustainability.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 227-232"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic gases and the environment: Is it time for a rethink?","authors":"","doi":"10.1016/j.surge.2024.04.014","DOIUrl":"10.1016/j.surge.2024.04.014","url":null,"abstract":"<div><h3>Background</h3><p><span>General anaesthesia<span> is in common use for patients undergoing surgical procedures, with the option of both inhalational and intravenous anaesthetic techniques. </span></span>Anaesthetic gases are often excluded from discussions on sustainable healthcare delivery, despite being a significant contributor to the overall environmental impact of healthcare services.</p></div><div><h3>Methods</h3><p>A literature review was carried out on previously published papers on the impact anaesthetic gases have on our environment and at ways to reduce their impact in current anaesthetic practice. The aim was to write a narrative review detailing the areas of concern as well as the current clinical situation in the European setting.</p></div><div><h3>Summary/conclusions</h3><p>The two classes of inhaled anaesthetic<span><span><span> agent most frequently used are nitrous oxide<span> and volatile agents (most commonly </span></span>sevoflurane, </span>isoflurane and desflurane). Both are recognised greenhouse gases that contribute to climate change.</span></p><p><span><span><span>Minor modifications in the use of anaesthetic gases can have a significant environmental impact. These modifications include avoiding nitrous oxide whenever possible, avoiding </span>desflurane<span> (and using sevoflurane<span> instead), using low flow anaesthesia during maintenance, swapping volatile-based anaesthesia for a </span></span></span>TIVA technique when clinically appropriate and considering the use of central neuraxial or </span>regional anaesthesia in place of general anaesthesia when possible.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 200-202"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077217","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An assessment of sustainable transport infrastructure in a national healthcare system","authors":"","doi":"10.1016/j.surge.2023.10.008","DOIUrl":"10.1016/j.surge.2023.10.008","url":null,"abstract":"<div><h3>Introduction</h3><p>Healthcare contributes significantly to carbon dioxide emissions, which can be reduced by promoting sustainable mobility amongst staff commuting. This study aims to investigate the national sustainable transport infrastructure for staff of healthcare facilities and utilise this data to develop a novel scoring and ranking system.</p></div><div><h3>Methods</h3><p>This was an empirical retrospective observational study. Data was collected on all 47 hospitals sustainable transport infrastructure. A working group calculated the weighted scores for each sustainable transport data point. These scores were used to calculate the Total and Active Sustainability Scores for each hospital, allowing a ranking to be formed.</p></div><div><h3>Results</h3><p>7 of 47 (15 %) hospitals had EV charging on campus. 17 of 47 (36 %) hospitals had secure bike parking. 2 of 47 (4 %) hospitals had a “bike hub”. 18 of 47 (38 %) hospitals had a bike lane. 13 of 22 (59 %) city hospitals had bike sharing facilities. 42 of 47 (89 %) hospitals had one public transport route. City hospitals ranked higher in both Total &amp; Active Sustainability Scores.</p></div><div><h3>Discussion</h3><p>This study explored a new concept of measuring sustainable transport infrastructure. Frameworks examining sustainability are available, however, none allowed for ranking of hospitals. This study highlights the lack of both research in this field and sustainable transport infrastructure in hospitals.</p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 203-208"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1479666X23001208/pdfft?md5=f82cf4f24424ca805a422dda6c3cedcb&pid=1-s2.0-S1479666X23001208-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71488025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Environmentally sustainable kidney care through transplantation: Current status and future challenges","authors":"","doi":"10.1016/j.surge.2024.01.001","DOIUrl":"10.1016/j.surge.2024.01.001","url":null,"abstract":"<div><p><span><span>The environmental impact of healthcare is an issue currently examined with increased scrutiny and on a global scale with multiple stakeholders seeking to identify the appropriate interventions to reduce it. Interestingly, a significant portion of healthcare's environmental impact stems from intensive modalities of treatment for chronic disease. There is no better example than End-Stage Renal Disease (ESRD), where dialysis or transplantation are the modalities of treatment offered to the vast majority of these patients. Kidney transplantation<span> (KTx) offers a longer life expectancy and improved quality of life<span> in comparison to dialysis. Cost-effectiveness analyses have proven its financial superiority, as well. PubMed and EMBASE literature search using keywords “kidney transplantation”, “carbon footprint”, “sustainability” showed that there is no published work in the field of environmental sustainability in kidney transplantation. Relevant literature was identified for surgical services and applied to transplantation. Assuming its environmental superiority to dialysis, maximising KTx rate would be an important action towards “green” renal care services. That could be achieved through living organ donation, systematic use of machine perfusion for extended criteria deceased donors and individualised immune </span></span></span>risk stratification techniques. All these measures aim towards implementing enhanced recovery protocols and two vital steps can be taken towards assessing their value. The first step is a detailed audit of the environmental impact of these novel techniques and secondly their impact in reducing the length of hospital stay and its subsequent environmental impact. Another key element is delivering appropriate post-operative care, substituting </span>allograft<span> biopsy with non-invasive techniques and reducing physical outpatient follow-up, using telemedicine. The gap in quantifying KTx services environmental impact needs to be addressed urgently, with development of strategies within the multidisciplinary transplant team. Introducing novel technologies can lead to donor pool expansion and improved organ utilisation rates, transforming transplant services in “green” hubs.</span></p></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 4","pages":"Pages 233-235"},"PeriodicalIF":2.3,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139670100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrospective case series of vertebral artery injuries associated with cervical spine trauma","authors":"Leah Morris ,&nbsp;Anna Lawless ,&nbsp;Jake M. McDonnell ,&nbsp;Kielan V. Wilson ,&nbsp;Harry Marland ,&nbsp;Stacey Darwish ,&nbsp;Joseph S. Butler","doi":"10.1016/j.surge.2024.07.007","DOIUrl":"10.1016/j.surge.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Vertebral artery injuries (VAI) can occur due to cervical spine trauma. VAI can prove a serious complication and potentially compromise vascular supply to the posterior aspect of the brain. Currently, there is a paucity of evidence with regards to incidence, management, and outcomes for these patients. The purpose of this study is to investigate and elucidate the incidence of VAI associated with cervical trauma at a national tertiary referral centre for spinal pathology, their respective management, and associated outcomes.</div></div><div><h3>Methods</h3><div>A retrospective review was conducted from 2012 to 2021 to identify patients with VAI secondary to cervical spine trauma. Demographic, clinical, and radiological data was collected to identify common traits in injury characteristics and management.</div></div><div><h3>Results</h3><div>1013 spine patients presented to our institution across the 10-year period. 739/1013 (72.9 %) were trauma patients. 42/739 (5.7 %) were imaged for suspected VAI secondary to trauma. There were 14/739 (1.9 %) confirmed VAI. All patients had CT-angiography for diagnosis. Four of the confirmed VAI patients (28.6 %) had additional MR-angiography imaging. Right-side was the most common side of VAI injury (7/14; 50 %), followed by left (5/14; 35.7 %) and bilateral (2/14; 14.3 %) injuries. 8/14 (57.1 %) patients were prescribed anti-thrombotic therapy. Acute mortality within 3-months was noted to be 2/14 (14.3 %) and occurred at 49 days and 57 days respectively.</div></div><div><h3>Conclusion</h3><div>VAI associated with cervical spine injury is rare in occurrence. However, it can be associated with high morbidity and mortality. As such, a multi-disciplinary approach to care is integral to ensuring good outcomes in these patients.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages 358-363"},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of disability on recruitment to higher surgical specialty training: A retrospective cohort study","authors":"Ricky Ellis ,&nbsp;Yasin Al-Tawarah ,&nbsp;Peter A. Brennan ,&nbsp;Amanda J. Lee ,&nbsp;John Hines ,&nbsp;Duncan SG. Scrimgeour ,&nbsp;Jennifer Cleland","doi":"10.1016/j.surge.2024.07.006","DOIUrl":"10.1016/j.surge.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><div>UK examining bodies are required to eliminate discrimination against people with protected characteristics. To achieve this in surgery, differential attainment (DA) in assessments used as gatekeepers to career progression must be ruled out. This study investigated the impact of disability status on the likelihood of success at national selection for Higher Surgical Training (HST).</div></div><div><h3>Methods</h3><div>A retrospective cohort study of all UK graduates in the UKMED database (<span><span>https://www.ukmed.ac.uk</span><svg><path></path></svg></span>) who underwent selection for HST (ST3) from 2012 to 2019 (<em>n</em> = 2875). Univariate analysis identified differences in success rates at first-application. Logistic regression models identified whether disability was a predictor of success after adjusting for sociodemographic factors and prior MRCS performance.</div></div><div><h3>Results</h3><div>There was no significant difference in success rates between candidates with and without disabilities (all p &gt; 0.05) for any surgical specialty. Disability status was not a statistically significant predictor of success. Female candidates were 25 % more likely to be successful (OR 1.25 [95%CI 1.05 to 1.49]) and Non-White candidates were 20 % less likely to be successful (OR 0.80 [95%CI 0.68 to 0.96]). Candidates who passed MRCS Part A and Part B at the first attempt were 49 % (OR 1.49 [95%CI 1.25 to 1.77]) and 90 % (OR 1.90 [95%CI 1.58 to 2.28]) more likely to be successful.</div></div><div><h3>Conclusion</h3><div>No significant difference was found in the likelihood of being successful at HST selection for any surgical specialty between applicants with and without disabilities, regardless of type of disability. DA was identified between other sociodemographic groups which requires further exploration.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages 344-351"},"PeriodicalIF":2.3,"publicationDate":"2024-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141861387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovative use of TXA and protamine-infused hydrogels to reduce postoperative bleeding in breast surgery for heparin-anticoagulated patients","authors":"Michael James ,&nbsp;Viren S. Sehgal","doi":"10.1016/j.surge.2024.07.002","DOIUrl":"10.1016/j.surge.2024.07.002","url":null,"abstract":"","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 5","pages":"Page e189"},"PeriodicalIF":2.3,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141753211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The place of splenectomy in the therapeutic management of patients with infective endocarditis and splenic abscess: A single center experience and a literature review","authors":"Corina-Elena Minciuna ,&nbsp;Beatrice Tivadar ,&nbsp;Vlad Costin Ilie ,&nbsp;Ruxandra Daniela Fota ,&nbsp;Alina Teodora Timisescu ,&nbsp;Vlad Anton Iliescu ,&nbsp;Ioan Mircea Coman ,&nbsp;Gabriela Droc ,&nbsp;Andrei George Iosifescu ,&nbsp;Catalin Vasilescu","doi":"10.1016/j.surge.2024.06.008","DOIUrl":"10.1016/j.surge.2024.06.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Infective endocarditis(IE) has a low incidence, but it remains a serious disease with high mortality rates. Only 5 % of these patients will develop a splenic abscess<span><span>, and the number of patients that have IE and a splenic abscess requiring surgery is low. The current guidelines recommend that splenectomy should be performed prior to valve replacement, but there is no strong evidence to support this statement and no evidence to clearly endorse the order in which the surgical interventions should be performed. The objective of this review and case series is to establish the proper treatment strategy, to assess the adequate order of the surgical interventions and to clarify the role of </span>percutaneous drainage in the management of these patients.</span></div></div><div><h3>Material and Methods</h3><div>All patients with infective endocarditis and splenic abscess who underwent surgery in our institution, between January 2008 and December 2020 were included in this study, excluding patients which had cardiac device related endocarditis. Literature review on the matter included a number of 30 studies which were selected from the PubMed database.</div></div><div><h3>Results</h3><div>Assessing the literature and case series no reinfection was reported for simultaneously performing splenectomy(S) and valvular surgery(VS) nor for VS followed by S.</div></div><div><h3>Conclusion</h3><div>Percutaneous drainage of the splenic abscesses is a feasible solution as definitive therapy in high-risk patients or as bridge therapy. Additional studies are needed, even though they are difficult to conduct, therefore a national/international infectious endocarditis register may be of use to clarify these challenges.</div></div>","PeriodicalId":49463,"journal":{"name":"Surgeon-Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland","volume":"22 6","pages":"Pages e202-e207"},"PeriodicalIF":2.3,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141724888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}