Burnout within UK surgical specialties: a systematic review.

INTRODUCTION: Burnout is of growing concern within the surgical workforce, having been shown to result in reduced job satisfaction, decreased patient satisfaction and higher rates of medical errors. Determining the extent of burnout and identifying its risk factors within UK surgical practice is essential to ensure appropriate interventions can be implemented to improve mental wellbeing. MATERIALS: A systematic search of PubMed, Medline, Embase, PsychINFO and Cochrane databases was performed, following PRISMA guidelines. Studies published between January 2000 and October 2019 that reported prevalence data or risk factors on burnout for surgeons working within the UK and/or the Republic of Ireland were included. FINDINGS: Ten papers met the inclusion criteria. The overall prevalence of burnout amongst surgeons in the UK was 32.0% (IQR 28.9-41.0%), with surgical trainees having the highest prevalence (59.0%) of burnout documented for any subgroup. The most common risk factors identified for burnout were younger surgeon age and lower clinical grade. Being married or living with a partner was found to be protective. CONCLUSIONS: Burnout is highly prevalent in UK surgical specialties, mostly amongst surgical trainees. Targeted pre-emptive interventions based upon relevant risk factors for burnout should be prioritised, at both individual and institutional levels.

Systematic review and meta-analysis of the relationship between hospital volume and outcome for lower limb arterial surgery.

BACKGROUND: : The aim was to investigate whether a relationship existed between case volume and outcome for lower limb vascular surgical procedures. METHODS: : PubMed, Embase, the Cochrane Library and Google Scholar were searched for all articles on population-based studies on the volume-outcome relationship for lower limb vascular surgery at hospital level. Outcomes were mortality and subsequent amputation after lower limb vascular surgery. The data were subjected to meta-analysis by outcome. RESULTS: : Some 452 093 patients from ten studies were included in the systematic review and five studies were included in meta-analyses. Seven of these articles found a significant positive hospital-volume outcome relationship. The pooled effect estimate for mortality was odds ratio (OR) 0.81 (95 per cent confidence interval 0.71 to 0.91) and that for amputation was OR 0.88 (0.79 to 0.98), with better results being found after surgery at higher-volume hospitals. Significant heterogeneity was seen in the data. CONCLUSION: : Higher-volume hospitals were associated with reduced amputation and mortality rates after lower limb vascular surgery. These data were not as conclusive as those for other vascular surgical procedures owing to significant heterogeneity.