General surgeons' occupational musculoskeletal injuries: A systematic review.

INTRODUCTION: Surgeons are expected to work long hours in operating theatres. A high prevalence of work-related musculoskeletal (WRMSK) injuries and pain in healthcare professions exists. We aimed to study WRMSK pain and injuries in general surgeons and study their risk in different surgical techniques comprising open, laparoscopic and robotic-assisted surgery. METHODS: A systematic search was performed in compliance with The PRISMA checklist. Search was performed in PubMed and Cochrane library databases for 6 years to 2024. The search terms used were "disability and surgeon", "occupational injuries and surgeon", and "musculoskeletal pain and surgeons", in addition to MESH terms in PubMed database. Risk of bias was calculated among studies. RESULTS: The search revealed 3648 citations from which a final list of 24 citations were included after application of inclusion and exclusion criteria. The citations comprised over 1900 surgeons including consultants and surgical trainees from different subspecialities. Incorporated citations consisted of 21 cross-sectional 3 observational studies. Most common pain sites, risks and preventative measure for MSK injuries were revealed. CONCLUSION: There is high prevalence of WRMSK pain among general surgeons. Surgeons were primarily affected at physical body parts ranging from the neck, shoulders, upper back and lower back to upper extremity. Robotic-assisted surgery led to lower post-operative discomfort and decreased demanding muscle activity in upper extremities but enhanced static neck position resulting in subjective back stiffness compared with laparoscopic surgery.

Surgeons with disabilities, they do exist.

INTRODUCTION: Doctors with disability are likely to face major life crises, challenges and distressing emotions from unforeseen circumstances that threaten their physical well-being. We aimed to identify the existence of work-related pain and discomfort that may cause surgeon's disability. Surgeons who were struck with unpredictable disasters leading to disabilities were also reviewed. METHODS: We conducted a 10-year literature review. In addition, citations about surgeons' physical disabilities were complemented with commentaries about disabled surgeons from gray literature. The quantitative citations were quality assessed by MERSQI scores and evidence graded according to GRADE. For the qualitative study part, the severely traumatized surgeons were analysed by means of Cullberg's crisis phases (CCP) and analysed from Tedeschi and Calhoun's post-traumatic growth perspective (PTG). RESULTS: Altogether 3593 citations from PubMed were studied, and 10 citations met inclusion criteria with a total of 11591 participants. We included 6 surgeons subjected to highly traumatic events complicating their medical career. Our quantitative citations' mean MERSQI score was 11.73 (SD .79) and the citations' evidence value completed grade II (moderate quality: 11.26 to 12.00 scores). Work-related musculoskeletal pain and occupational injuries may lead to physical disabilities. The accidentally traumatized surgeons fought through the four CCP phases and reached successfully the PTG stage. CONCLUSIONS: The surgical workforce is at high risk of work-related musculoskeletal morbidity which can progress to chronic pain and disruption of surgeon's career. Surgeons with disabilities faced serious barriers in their career. Institutions and healthcare systems must urgently develop support strategies for surgeons with disabilities.

Surgeons' personality, characteristics and presence of meaning in life.

BACKGROUND: Surgeons work long shifts and are frequently on call. Pressure to make quick and accurate decisions along with the responsibility of performing complex procedures contribute to surgeons' high stress-levels, anxiety and altered empathy level. We aimed to study surgeons' personality and meaning in life at two different centres. METHODS: General surgeons completed 47 questions. Visual analogous scale-items with controlled internal consistency (Cronbach alpha) coefficients varying from .77 to .85 were used from the following scales: Global Measure of Perceived Stress; Hostility Questionnaire; Jefferson Scale of Physician Empathy; Meaning in Life Questionnaire-SF; Rosenberg Self-Esteem Scale; Spielberger State Anxiety Scale and Quality of Work life Scale. Multiple linear regression analyses, parametric or non-parametric tests were employed when considered adequate. RESULTS: Fifty-four participants were recruited from 3 different levels of training. Gender differences in Anxiety, Physician Empathy and presence of meaning in life (MIL-P) were revealed. Junior trainees differed from senior trainees and consultants as regards MIL-P, Anxiety, Stress and work-related factors. The surgeons' self-rated self-esteem was work-related. Surgeons' Quality of Work Life was best predicted by Physician Empathy but also their self-rated Self-Esteem contributed significantly to the prediction. Surgeons' MIL-P was significantly predicted by Physician Empathy and State Anxiety. CONCLUSION: Surgeons' current personality attributes might not apply to all of them. Female surgeons were more empathetic and felt more presence of meaning in life than male surgeons, and men were less anxious than female surgeons. Junior trainees experienced less anxiety than senior trainees but were more stressed than consultants. The most significant predictors of surgeons' personality were their experience of presence of meaning in life along with their level of empathy.

Surgeon's narcissism, hostility, stress, bullying, meaning in life and work environment: a two-centered analysis.

INTRODUCTION: Disruptive physician behaviour can affect patients' safety. If surgical trainees throughout higher education experience disruptive behaviour, impaired work-life may follow. Therefore, we aimed to study surgeons' level of narcissism (N), hostility, and stress in relation to their work environment and potential experience of bullying. We also scrutinized search for or presence of meaning in life. METHODS: General surgeons in UK National Health Service from 2 hospitals participated with 3 levels of training: junior trainees (JT), senior trainees (ST), and consultants (CONS). Participants completed 52 VAS-formed questions plus demographics. Modified questionnaires were used for assessments of 'hostility', 'narcissism', meaning in life, quality of work-life, and bullying. RESULTS: Altogether 33% of surgeons displayed narcissism and 22% could exhibit disruptive behaviour. MANOVA significant differences between low, medium, and high narcissism groups were revealed in hostility (p<.01), perceived stress (p=.001), and presence of meaning in life (p<.05). Regression analyses explained hostility both by N-scale (p=.000) and 'being bullied during training'(p=.009) but negatively by 'presence of meaning in life'(p=.004). Surgeons' perceived stress was explained both by N-scale (p=.000) followed by 'seeing others bullied during training (p=.000) and negatively by 'working extra days beyond schedule' (p=.007). The presence of meaning in life was explained mostly by good beneficial stress (p= .000) but negatively both by 'doing extra work beyond schedule' (p= .016) and hostility (p= .003). CONCLUSION: Surgeons may exhibit disruptive behaviour in a challenging situation. The narcissim-scale was the best predictor of hostility and perceived stress. Being bullied during surgical training predicted hostility. Seeing others being bullied during surgical training predicted stress. Beneficial stress is explained best by surgeons' experience of the presence of meaning in life.

Racial discrimination in surgery: A systematic review.

INTRODUCTION: Racial/ethnic discrimination indicates the stereotyped or unkind conduct of superiority towards other persons based on their race or skin color. The UK General Medical Council published a statement supporting zero-tolerance approach to racism in the workplace. We aimed to systematically review racial discrimination in surgery and answer the following questions: (1) Does racial/ethnic discrimination in surgery exist in citations from the last 5 years. (2) If yes, are ways suggested to reduce racial/ethnic discrimination in surgery? METHODS: The systematic review was performed in compliance with the PRISMA guidelines along AMSTAR 2. A 5-year literature search was carried out on PubMed for articles published from 1/1/2017 to 01/11/2022. Search terms were 'racial discrimination and surgery', 'racism OR discrimination AND surgery', 'racism OR discrimination AND surgical education'. The retrieved citations were quality assessed by MERSQI and evidence graded by GRADE. RESULTS: A total of 9116 participants responded with a mean of 1013 (SD = 2408) responses per citations reported in 9 studies from a final list of 10 included citations. Nine studies were from USA and 1 from South Africa. There was evidence of racial discrimination in the last 5 years and the results were justified on strong scientific evidence constituting the basis for evidence grade I. The second question's answer was 'yes' which was defendable on moderate scientific recommendation and thereby establishing the basis for evidence grade II. CONCLUSION: There was sufficient evidence for the presence of racial discrimination in surgical practice in the last 5 years. Ways to decrease racial discrimination in surgery exist. Healthcare and training systems must increase the awareness of these issues to eliminate the harmful effect on the individual as well as on the level of the surgical team performance. The existence of the discussed problems must be managed in more countries with diverse healthcare systems.

Post-operative antibiotics for cutaneous abscess after incision and drainage: Variations in clinical practice.

Background: Acute cutaneous abscess is a common surgical condition that mostly requires incision and drainage. Despite this, there is no standardized national or international guidance on post-operative antibiotics prescription. Traditionally, antibiotics are not indicated unless complications and/or risk factors such as immunocompromisation, diabetes or cellulitis exist. We aimed to study the local practice for post-operative antibiotics prescription for cutaneous abscesses in a UK university teaching hospital. Methods: Retrospective data collection for emergency general surgical admissions for a period of 6 months was carried out. All patients with cutaneous abscesses were included in this analysis. Scrotal, breast and limb abscesses were excluded. Patients' demographics, co-morbidities and complications, including local (cellulitis, necrosis) and systemic (e.g sepsis), were studied. Approval for access to patient data was granted by the local clinical governance department prior to the commencement of this study. Computations were performed using IBM SPSS version 26. Chi square (X 2), Pearson correlation (r), one or two samples t-test (one or two tailed) were applied. Results: A total of 148 patients were included. The mean age was 40 years (55 % males). The most common site of abscess was perianal (27.7 %), followed by pilonidal (20.3 %) and axilla (16.9 %). A total of 107 (73 %) were managed surgically with incision and drainage, and of these 92 (86 %) were managed within 24 h. Altogether, 83 (76 %) were prescribed post-operative antibiotics, while only 25 (23 %) had indications. The most used post-operative empirical antibiotics was co-amoxiclav (59 %). There was a significant relationship between 'abscess site' × 'antibiotics' [X 2 (36)=54.8, P=0.023]. A total of 103 patients' average duration of post-operative antibiotics was 7.2 (sd 2.9) days. Ten patients subject to readmission spent an average of 8.4 (sd 3.8) days on antibiotics. Conclusions: There were variations in clinical practice regarding post-operative antibiotic prescription for cutaneous abscesses. Research is required in the future in cooperation with microbiologists to develop a standardized evidence-based treatment protocol for the management of such a common surgical condition.

Abdominal hernia mesh repair in patients with inflammatory bowel disease: A systematic review.

BACKGROUND: Postoperative hernia-repair complications are frequent in patients with inflammatory bowel disease (IBD). This fact challenges surgeons' decision about hernia mesh management in these patients. Therefore, we systematically reviewed the hernia mesh repair in IBD patients with emphasis on risk factors for postoperative complications. METHOD: A systematic review was done in compliance with the PRISMA guidelines. A search was carried out on PubMed and ScienceDirect databases. English language articles published from inception to October 2021 were included in this study. MERSQI scores were applied along with evidence grades in agreement with GRADE's recommendations. The research protocol was registered with PROSPERO (CRD42021247185). RESULTS: The present systematic search resulted in 11,243 citations with a final inclusion of 10 citations. One paper reached high and 4 moderate quality. Patients with IBD exhibit about 27% recurrence after hernia repair. Risk factors for overall abdominal septic morbidity in Crohn's disease comprised enteroprosthetic fistula, mesh withdrawals, surgery duration, malnutrition biological mesh, and gastrointestinal concomitant procedure. CONCLUSION: Patients with IBD were subject, more so than controls to postoperative complications and hernia recurrence. The use of a diversity of mesh types, a variety of position techniques, and several surgical choices in the citations left room for less explicit and more implicit inferences as regards best surgical option for hernia repair in patients with IBD.

The innate aptitude's effect on the surgical task performance: a systematic review.

Surgery is known to be a craft profession requiring individuals with specific innate aptitude for manipulative skills, and visuospatial and psychomotor abilities. The present-day selection process of surgical trainees does not include aptitude testing for the psychomotor and manual manipulative skills of candidates for required abilities. We aimed to scrutinize the significance of innate aptitudes in surgical practice and impact of training on skills by systematically reviewing their significance on the surgical task performance. A systematic review was performed in compliance with PRISMA guidelines. An initial search was carried out on PubMed/Medline for English language articles published over 20 years from January 2001 to January 2021. Search strategy and terms to be used included 'aptitude for surgery', 'innate aptitude and surgical skills, 'manipulative abilities and surgery', and 'psychomotor skills and surgery'. MERSQI score was applied to assess the quality of quantitatively researched citations. The results of the present searches provided a total of 1142 studies. Twenty-one studies met the inclusion criteria out of which six citations reached high quality and rejected our three null hypothesis. Consequently, the result specified that all medical students cannot reach proficiency in skills necessary for pursuing a career in surgery; moreover, playing video games and/or musical instruments does not promote skills for surgery, and finally, there may be a valid test with predictive value for novices aspiring for a surgical career. MERSQI mean score was 11.07 (SD = 0.98; range 9.25-12.75). The significant findings indicated that medical students with low innate aptitude cannot reach skills necessary for a competent career in surgery. Training does not compensate for pictorial-skill deficiency, and a skill is needed in laparoscopy. Video-gaming and musical instrument playing did not significantly promote aptitude for microsurgery. The space-relation test has predictive value for a good laparoscopic surgical virtual-reality performance. The selection process for candidates suitable for a career in surgery requests performance in a simulated surgical environment.

Laparoscopic Surgery and the debate on its safety during COVID-19 pandemic: A systematic review of recommendations.

INTRODUCTION: The transmission of COVID-19 virus since the outbreak of viral pneumonia due to SARS-CoV-2 gave rise to protective operative measures. Aerosol generating procedures such as laparoscopic surgery are known to be associated with increased risks of viral transmission to the healthcare workers. The safety of laparoscopy during the pandemic was then debated. We aimed to systematically review the literature regarding the safe use of laparoscopy during COVID-19. METHODS: We performed a systematic search using PubMed and ScienceDirect databases from inception to 1st May, 2020. The following search terms were used: ''laparoscopic surgery and COVID-19''; ''minimally invasive surgery and COVID-19''. Search items were considered from the nature of the articles, date of publication, aims and findings in relation to use of laparoscopic surgery during COVID-19. The study protocol was registered with PROSPERO register for systematic reviews (CRD42020183432). RESULTS: Altogether, 174 relevant citations were identified and reviewed for this study, of which 22 articles were included. The analysis of the findings in relation to laparoscopic surgery during the pandemic were presented in tabular form. We completed the common recommendations for performing laparoscopy during the COVID-19 pandemic in forms of pre-, intra- and postoperative phases. CONCLUSION: There is no scientific evidence to date for the transmission of COVID-19 by laparoscopic surgery. Laparoscopy can be used with precautions because of its benefits compared to open surgery. If safe, conservative management is the primary alternative during the pandemic. We concluded that recommended precautions should be respected while performing laparoscopy during the pandemic.

The influence of music on the surgical task performance: A systematic review.

INTRODUCTION: Music is commonly played in operating theatres. Music was shown to diminish stress of the surgical team along with reducing the patient's anxiety before surgery. On the other hand, it has been revealed that music might give rise to negative effects of divided attention causing distraction in surgical routines. Therefore, we aimed to systematically review the effect of music on the surgeon's task performance. METHODS: A systematic review was performed in compliance with the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) and AMSTAR (Assessing the methodological quality of systematic reviews) guidelines. A literature search using PubMed/Medline, ScienceDirect and Google Scholar, was performed by means of the search terms: "music and operating theatre", as well as "music and surgery". The search was limited to citations in English from year 2009-2018. Search items were considered from the nature of the articles, date of publication, forum of publication, aims and main findings in relation to use of music in operating theatres. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied. Studies were included based on predetermined inclusion criteria where after the papers' quality assessments and evidence grading were completed by two independent reviewers. The protocol was registered with the PROSPERO register of systematic reviews. RESULTS: Out of 18 studies that formed the base for evidence evaluations, 6 studies were assessed as having high quality and 8 studies of moderate quality. Five studies, provided both strong and moderate scientific evidence for a positive effect of music on surgeon's task performance. In contrast, strong scientific evidence for a negative effect of music on surgeon's task performance also was revealed in 2 high-quality studies. Nevertheless, the positive effect of music on the surgical task performance was significantly higher when compared to its negative effect (p < 0.0001). CONCLUSION: Certain music elements affect the surgical task performance in a positive or negative way. The total and significant outcome of the present study was that the positive effect of music on surgeon's task performance, overrides its negative effect. Classic music when played with a low to medium volume can improve the surgical task performance by increasing both accuracy and speed. The distracting effect of music should also be put in consideration when playing a loud or high-beat type of music in the operating theatres.