General Surgery Research Articles

Stab Wounds of the Abdomen: Epidemiological, Clinical, Therapeutic and Evolutionary Aspects in the General Surgery Department of the N'zérékoré Regional Hospital (Guinea)

Aim: To determine the place of abdominal wounds among abdominal traumas and to describe their clinical, therapeutic and evolutionary aspects. Patients and Methods: This was a retrospective descriptive study based on analysis of the records of patients seen for abdominal stab wounds in the general surgery department of the N'Zérékoré regional hospital during the period from January 2011 to December 31, 2020. Epidemiological, clinical, therapeutic and evolutionary parameters were studied. Results: Out of a total of 745 cases of abdominal trauma, we found 89 cases of abdominal stab wounds, a frequency of 12.49%. The average age was 36, with a clear male predominance (78%). Pupils/students were the most represented (32.58%), and criminal assault was the most common circumstance (70.79%). Operative treatment was the most common (74%), and the small intestine was the organ most affected (34.84%); the after-effects were simple in 89.39% of patients, and we recorded 4 deaths (6.06%). Conclusion: Stab wounds of the abdomen are a real public health problem in Africa, especially in low-resource countries such as ours. Surgery is still indicated for severe injuries or complications.

A STUDY ON THE DIFFERENT CLINICAL PRESENTATION PATTERNS OF BLUNT THORACIC TRAUMA AND ASSOCIATED MORBIDITY FOLLOWING ROAD TRAFFIC ACCIDENT IN A TERTIARY CARE CENTRE

Introduction:Chest trauma is a significant cause of morbidity and mortality following road traffic accidents (RTA). Given the significant potential for complications including respiratory failure and shock, blunt chest trauma following RTA remains a priority in trauma care and so this study aims to look into the clinical pattern of presentation of patients following chest trauma with/without associated injuries to other parts of body i.e. head/abdomen/extremities along with morbidity and mortality associated with it. Aims and objectives of the study : 1. To study the various clinical patterns of presentation of RTA patients with blunt chest trauma. 2. To study the disease burden and death rate of individuals with blunt chest trauma. Methodology: The study has been conducted in the Department of General Surgery, Silchar Medical College and Hospital from March 2024 to August 2024 after taking appropriate consent from 53 patients diagnosed with chest trauma following RTA with/without associated extra- thoracic injuries. Their data was analyzed and results published. Result and Analysis: Mean age in my study was 38.90 ± 6.57 years with male preponderance. Most patients had 3 rib fractures with pulmonary contusion being most common complication. Most common associated extra-thoracic trauma is abdominal injuries (24.5%) with mean ISS of 13.25 ± 7.73. most patients were managed conservatively with adequate pain control. Surgical intervention carried out were either tube thoracostomy (92.3%) or needle thoracostomy (7.2%). Most common secondary complication following blunt chest trauma is pneumonia (18.84%) while ARDS complication arose in 9.43% of the patients. Mortality rate was 5.6% and the most common cause that let to the demise was ARDS. Conclusion: To conclude, blunt thoracic injury is a major health problem as it carries significant mortality and morbidity more so, in case of RTA and association of other extra-thoracic injuries also play a pivotal role in the process of recovery of the patient. Presence of lung contusion, pneumothorax, hemothorax are to be dealt adequately with proper analgesia. Even though most cases of chest trauma can be dealt conservatively need for emergency surgical intervention needs to be assessed promptly. One must look for number of rib fractures as they may reflect the disease burden of the patient. Pneumonia and ARDS are a major mortality factor following chest trauma and its complications.

Association of Postoperative Outcomes with the Pre-op Categorization Based on the American Society of Anesthesia Class in Emergency General Surgery Patients

Association of Postoperative Outcomes with the Pre-op Categorization Based on the American Society of Anesthesia Class in Emergency General Surgery Patients

Management of Gynecological and Obstetrical Peritonitis in the General Surgery Department of the Hospital National Ignace Deen Conakry University Hospital (Guinea)

Aim: Was to highlight the methods of management of gynecological and obstetric peritonitis. Patients and Methods: This was a retrospective and descrıptive study analyzing the records of patients operated on for peritonitis of gynecological or obstetric origin in the general surgery department of the Ignace Deen National Hospital, CHU of Conakry during the period from January 2020 to December 2022. The parameters studied were epidemiological, sociodemographic, clinical and therapeutic. Results: Gynaecological and obstetric peritonitis accounted for 15.6% (n= 58) of all peritonitis. The mean age of the patients was 27.9 years, with extremes of 17 and 46 years. The majority of patients were married, with multiple gestations, and the average consultation time was 13.4 days. The etiology most frequently encountered was uterine perforation (34%), and the surgical procedure most frequently performed was drainage (all patients) and uterine suture (63.4%). We recorded 3 cases of death (5.2%). Conclusion: Gynecological and obstetric peritonitis are both medical and surgical emergencies, mainly affecting sexually active young women, with considerable mortality.

EFFECTIVENESS OF TOTAL LEUKOCYTE COUNT (TLC) AND C-REACTIVE PROTEIN (CRP) IN THE DIAGNOSIS OF ACUTE APPENDICITIS

Acute appendicitis is a typical surgical emergency. Diagnosing it can be challenging due to variable symptoms. Total leukocyte count (TLC) and C-reactive protein (CRP) are commonly used to assess inflammation and guide treatment. This study evaluates the diagnostic accuracy of TLC and CRP in acute appendicitis to determine appropriate management. Objective: This study aimed to assess the diagnostic accuracy of TLC and CRP in predicting acute appendicitis and their role in determining the proper management approach, either conservative or surgical. Methods: This prospective observational cohort study was conducted in the Department of General Surgery at Dow University of Health Sciences (DUHS), Ojha Campus, from July 2023 to March 2024. A total of 87 adult patients with clinical signs of appendicitis and an Alvarado score of greater than 4 were enrolled. Data was analyzed using SPSS version 22. Variables included socio-demographic characteristics, clinical presentations, and levels of TLC and CRP. Both conservative and surgical management approaches were analysed, with laparoscopic appendectomy being the most common procedure. Results: Among the 87 patients, most were male. TLC and CRP levels were similar across genders, with notable variations in socio-demographic characteristics. CRP levels were more frequently elevated in patients managed conservatively compared to those managed surgically. Both TLC and CRP were elevated in 43 patients (49.4%), highlighting the value of using both markers together. Surgical intervention, primarily laparoscopic appendectomy, was the preferred treatment, with suppurative inflammation being the most common histopathological finding. Conclusion: The combination of TLC and CRP significantly improves the diagnostic accuracy for acute appendicitis. TLC correlates more strongly with the need for surgical intervention, whereas CRP did not show a significant association with management type. Both markers are useful in assessing the duration of the complaint, but they are not substitutes for clinical judgment. Further research is warranted to refine their diagnostic utility and evaluate their impact on surgical care availability in resource-limited settings.

Determination of the effect of the pre-surgery COVID-19 fear level and hygiene behaviours of the patients on the personal protective clinical measures developed after the surgery: Across-sectional study.

This study aims to examine patients' preoperative COVID-19 fear levels, hygiene behaviours, postoperative personal protective clinical measures, and their correlations with each other. This research is a cross-sectional type of study. The study sample consisted of 131 patients hospitalized in the general surgery inpatient ward of a hospital in Turkey. The sample was determined by G-Power analysis. The data were collected in two stages in a research hospital between 1 April 2021 and 1 March 2022. Sociodemographic and Clinical Information Form, COVID-19 Fear Scale, COVID-19 Hygiene Scale were used before surgery; COVID-19 personal protective clinical measures questionnaire was used after surgery. Descriptive statistics, independent t-test, ANOVA test, Wilcoxon test and Spearman correlation analysis were used to evaluate the data. It was determined that preoperative COVID-19 fear levels, hygiene behaviours, and the personal protective clinical measures developed after the surgery were above moderate. A statistically significant and positive correlation was found between the COVID-19 Fear Scale and the preoperative COVID-19 Hygiene Scale and postoperative COVID-19 personal protective clinical prevention questionnaire total score and sub-dimension score averages. Patients' COVID-19 fears, preoperative and postoperative hygiene behaviours are statistically significantly associated with each other at a low level; postoperative clinical precautions and preoperative hygiene behaviours are statistically significantly associated with each other at a high level. The results of this study show that patients are terrified of COVID-19 while they are hospitalized due to surgical intervention during the pandemic process, and they increase their hygiene measures. It is thought that the results of the study will guide the regulation of clinical measures, patient education, and nursing care to be developed for patients during pandemic periods. No patient or public contribution.

First reported human use of wireless laparoscopic system: is it ready for prime time?

ObjectiveDuring the advent of laparoscopy, surgeons directly explored the abdominal cavity with a telescope-like device through a small incision. Since then, numerous technological advances have transformed minimally invasive surgery (MIS). Yet, in our wireless world, various devices crowd the surgical field, with long wires and light sources posing fall and fire risks. The primary objective of this study was to analyze the first reported human use of a novel wireless laparoscopy system or WLS (ArthroFree™, Lazurite®, Cleveland, Ohio).MethodsThe utility and convenience of the WLS was assessed via two avenues: (1) by analyzing surgical outcomes from first human use and (2) by surveying healthcare professionals regarding its quality and utility.ResultsEighteen patients (mean age 44.2, 83.3% female, mean BMI 33.4) underwent operations with the WLS. Operations included gynecologic and general surgical procedures. There were no intraoperative or postoperative complications, and no conversions to traditional laparoscopy or laparotomy. Mean operating time was 71.94 ± 20.41 min, and estimated blood loss was minimal. Survey results revealed varied individual experiences. Strengths included adequate illumination, improved ergonomics, and simplicity of setup and ease of operation. One respondent criticized the image resolution. Feedback indicated an overall positive impact, and 67% of respondents supported inclusion of the device at their facility. Moreover, its deployment in resource-limited settings abroad has demonstrated its efficacy in global surgery, indicating its potential in various healthcare environments.ConclusionsThis is the first reported human use of a novel WLS. Clinical results supported efficiency and safety of the technology. The successful deployment of the WLS in diverse surgical environments, including resource-limited settings, highlights its potential as a universally adaptable tool in global surgery. This report represents a strong first step toward a wireless operating room with the promise of redefining surgical standards as well as bridging gaps in surgical care worldwide.Graphical abstract

MCQs in-training examination scores of the surgical residency program in Thailand: the relationship between medical school vs public health-based training institutions

BackgroundThis study aims at investigating and evaluating the categorical knowledge of residency using an internet-based examination.MethodsAll in-training examinees from 32 Thailand’s general surgery residency training institutions participating in the online examination. One hundred fifty Multiple Choice questions (MCQs) were selected for this examination from a pool of previous MCQs used for board certification examinations. Baseline chracteristic of the examinee including residency year, training institution (medical schools and public health-based training institutions), regional-based area of the institution, overall test score, scoring by subcategory, total time to complete the examination, and the length of accredited as a training centre time were collected and analysed.ResultsTotal 613 examinees. The mean total score of 1st and 3rd year residency of a public health hospital institution differed from those with medical school-based training. On average, the scores in 4 out of 10 categories of residency from medical school training institutions were higher. However, residency from institutions with over 7 years of experience tended to score higher in the Liver, Biliary and Pancreas category.ConclusionsThe average scores of MCQs exams which reflect the medical knowledge for general surgical residency training at medical schools do not significantly differ from those of individuals undergoing public health training. Additionally, the mean scores of MCQs exams did not differ between high-experience training institutions and recent accredited training centers.

Impact of marmara-yegen cuttıng gastrojejunostomy on delayed gastrıc emptyıng after pancreatoduodenectomy: ınıtıal results.

Delayed gastric emptying (DGE) is one of the most common reasons for morbidity after pancreatoduodenectomy. The technical characteristics of anastomosis that could be affected by surgeon may offer a relevant chance to improve postoperative DGE rates. We investigated the effect of a technical modification of gastrojejunostomy after the classical pancreaticoduodenectomy on DGE. A total of 161 patients underwent classical pancreaticoduodenectomy (with 20-40 percent antrectomy) due to pancreatic adenocarcinoma at the Department of General Surgery, Marmara University, School of Medicine Hospital, from February 2019 to May 2023, and those who met the inclusion criteria were enrolled. One hundred twenty patients had undergone classical end-to-side gastrojejunostomy (Classical GJ group), and 41 had undergone Marmara-Yegen cutting side-to-side gastrojejunostomy (M-Yc group). DGE was defined according to the International Working Group on Pancreatic Surgery, and postoperative DGE rates of both groups were compared. In addition, multivariate analysis was performed to identify possible independent predictive factors for DGE. The total incidence of DGE was 31% in the Classical GJ group and 17% in the (M-Yc group). Although there was no significant difference between the groups regarding DGE and DGE grades (p = 0.1), DGE was distinctly lower in the M-Yc GJ group. In multi-variant analysis, Clavien-Dindo grade 3a and above postoperative complication was determined as independent predictors for DGE. We tried to explain the mechanism of DGE in terms of anatomical configuration. The incidence and severity of DGE decreased in patients who underwent M-Yc GJ.

Priority areas for outcomes improvement among older adults undergoing inpatient general surgery inclusive of geriatric-pertinent complications.

Comprehensive studies on priority areas for improving geriatric surgery outcomes, inclusive of geriatric-pertinent data, are limited. The ACS NSQIP geriatric database (2014-2018) was used to abstract older adults (≥65years) undergoing inpatient general surgery procedures. Thirty-day complication, functional decline, and mortality rates were analyzed, with a focus on two geriatric-pertinent complications: delirium and new/worsening pressure ulcers. There were 9062 patients; 41.9% were ≥75years. Mean age was 73.9years. The majority of patients were female (54.0%), White (77.7%), and had independent functional status before surgery (94.0%). Overall 30-day complication, functional decline, and mortality rates were 33.6%, 34.5%, and 3.5%, respectively; failure to the rescue rate was 9.7%. Including geriatric-pertinent complications increased the overall complication rate by 20.4%. Delirium emerged as the leading complication (11.9%), followed by bleeding (11.1%), and wound-related complications (10.1%); these three accounted for 53.7% of complications. Delirium and pressure ulcers were associated with a >50% rate of postoperative functional decline (52.0% and 71.4%, respectively); pressure ulcers were also notable for a 25.5% failure to the rescue rate. Both were also among complications most likely to occur following the 3 most common procedures (colorectal surgery, pancreatic resections, and exploratory laparotomy), which overall accounted for approximately 79.6% of complications, 73.4% of patients experiencing functional decline, and 82.3% of mortality. Delirium is the leading complication among older adults undergoing inpatient surgery. Overall, a small number of complications and procedure groups account for most surgical morbidity and mortality among older adults and thus constitute priority areas for outcomes improvement.

Understanding the Scope of Acute Care Vascular Surgery at a Tertiary Academic Medical System

The restructuring of nonelective general surgery and nationwide implementation of the acute care surgery paradigm has improved patient outcomes and healthcare resource utilization. Although vascular surgery maintains one of the highest acuity rates among surgical specialties, the acute care vascular surgery (ACVS) practice model has not been widely accepted. In the present study, we investigate the scope and burden of ACVS at a tertiary academic medical system. All vascular surgical procedures performed at three hospitals comprising a large tertiary academic medical system were retrospectively queried through electronic medical records. Data were collected on procedure, acuity, timing of intervention, primary service, admission type, and total costs and charges. Patients were stratified by acuity of surgical intervention, with ACVS being defined as urgent or emergent operation. A total of 12,689 vascular surgeries were performed from 2018 to 2022. ACVS procedures comprised 22.1% of this total (n=2,803; 12.5% urgent, 9.6% emergent), with an annual burden ranging from 19.1% to 28.3%. Vascular surgeons served as primary surgeon in 91.3% of ACVS and cosurgeon in 8.7%. Fourteen separate surgical specialties requested acute vascular assistance, with the most frequently consulting specialties, including trauma or acute care surgery (ACS) (n=109, 3.9%) and cardiac surgery (n=74, 2.6%). ACVS cases were more frequently performed during after-hours (30.7% vs 11.6%) and on weekends (27.1% vs 2.0%) compared with elective vascular procedures (P<0.0001 each). The majority of ACVS cases originated from inpatient (n=2,353, 85.0%) and emergency department (n=379, 13.5%) consultations. Overall, ACVS generated $37.5 million in charges, accounting for 14% of total procedure-related charges over the study period. ACVS comprises a substantial portion of modern vascular practice and is associated with significant human and healthcare resource expenditure. These data support the development of practice models dedicated to acute vascular surgical care.

Predicting long-term mortality of patients with postoperative acute kidney injury following noncardiac general anesthesia surgery using machine learning.

This study addresses the gap in knowledge regarding the long-term mortality implications of postoperative acute kidney injury (PO-AKI) utilizing advanced machine learning techniques to predict outcomes more accurately than traditional statistical models. A retrospective cohort study was conducted using data from seven institutions between March 2009 and December 2019. Machine learning models were developed to predict all-cause mortality of PO-AKI patients using 23 preoperative variables and one postoperative variable. Model performance was compared to a traditional statistical approach with Cox regression analysis. The concordance index was used as a predictive performance metric to compare prediction capabilities among different models. Among 199,403 patients, 2,105 developed PO-AKI. During a median follow-up of 144 months (interquartile range, 99.61-170.71 months), 472 in-hospital deaths occurred. Subjects with PO-AKI had a significantly lower survival rate than those without PO-AKI (p < 0.001). For predicting mortality, the XGBoost with an accelerated failure time model had the highest concordance index (0.7521), followed by random survival forest (0.7371), multivariable Cox regression model (0.7318), survival support vector machine (0.7304), and gradient boosting (0.7277). XGBoost with an accelerated failure time model was developed in this study to predict long-term mortality associated with PO-AKI. Its performance was superior to conventional models. The application of machine learning techniques may offer a promising approach to predict mortality following PO-AKI more accurately, providing a basis for developing targeted interventions and clinical guidelines to improve patient outcomes.

Effect of Flaxseed on Pain Relief and Quality of Life in Patients With Mastalgia: A Single Arm Interventional Study.

Mastalgia, a common complaint among women, denotes breast discomfort that can manifest as cyclical or non-cyclical. Reassurance, mechanical support and various non-pharmacological treatments, like flaxseeds, have been seen to have a good effect in treating mastalgia. Thus, the aim of this study was to investigates the efficacy of flaxseed in alleviating pain associated with mastalgia and its impact on the overall health-related quality of life among female patients. Conducted at a tertiary care center in Northern India over 18 months, it employed a single-arm interventional design. The participants included females aged 18 years and older presenting with breast pain at the Department of General Surgery. The intervention involved daily consumption of 30 g of milled flaxseed for each participant, administered over a period of six months. Pain severity was assessed using the visual analogue scale (VAS) before supplementation and at follow-up intervals up to six months. Concurrently, the Short Form-12 (SF-12) items Health Survey measured health-related quality of life, encompassing both physical and mental health domains. Statistical analysis employed parametric (paired t-test) and non-parametric tests (chi-square, McNemar) where appropriate, with statistical significance set at p<0.05. Two hundred women with mastalgia were included with a significant reduction in mean VAS scores from 6.03±0.83 at baseline to 2.19±0.66 at six months post-intervention (p = 0.0001). This reduction in pain intensity demonstrated a positive correlation with duration of flaxseed supplementation, notably declining after the initial three months. The mean difference in physical and mental SF-12 score at first visit and at 6 months after intervention was significant (p = 0.0001). This study underscores the potential of flaxseed as a therapeutic option for managing mastalgia and enhancing health-related quality of life among affected individuals.

Comparative efficacy of autologous platelet rich plasma and conventional dressing in the management of chronic ulcers

Background: Chronic ulcers pose a major global healthcare challenge. The use of platelet-rich plasma (PRP) for treating these wounds has garnered interest because of its potential healing benefits. Objective were to determine the effect of autologous PRP therapy on the percentage of surface area reduction/healing in chronic ulcers. Methods: This randomized controlled trial was conducted at the department of general surgery of M.M. institute of medical sciences and research (M.M.I.M.S.R.) Mullana, Ambala from May 1, 2023, to April 30, 2024. Patients aged 18-80 years of either gender with chronic ulcers were enrolled. Patients were randomly allocated to the PRP group and control group. PRP group was administered autologous PRP once in two weeks for 6 weeks after debridement, while for the control group conventional saline dressings were done after debridement. Final assessment was done at 8 weeks. Results: Of the 60 patients, the mean age was 53.90±11.23 years. There were 49 (82%) males and 11 (18%) females. At 8 weeks, the PRP group achieved 83.78% (SD=2.99) reduction in surface area of ulcers, whereas the control group had a 57.78% (SD=1.32) reduction in surface area of ulcers, with a p=0.0000 indicating a significant difference. The small sample size and 56-day follow-up period are insufficient to assess long-term treatment effects. Conclusions: A better outcome of PRP was observed compared to conventional dressing in patients with chronic non-healing ulcers.

Perioperative Hypothermia in Surgical Patients: A Retrospective Cohort Analysis at a Busy District General Hospital.

Introduction Perioperative hypothermia is a common yet underreported complication of surgery. It results from various factors, including cold operating theaters, anesthetic effects, environmental exposure, exposed tissues, and the administration of cold intravenous or irrigation fluids. This study aims to determine the incidence of perioperative hypothermia in a district National Health Service hospital to assess the feasibility of a randomized controlled trial (RCT) for interventions to prevent hypothermia. Methods This retrospective study included the data of 200 elective surgical patients at North Manchester General Hospital from June 1, 2022, to August 1, 2022. Inclusion criteria were elective general surgery, urology, breast, and gynecology patients aged 18 to 60 years. Exclusion criteria included emergency cases and patients younger than 18 or older than 60. Temperature measurement data were collected from the anesthesia records of the patients at six phases: preoperative, pre-induction, intraoperative, post-procedure, recovery room, and post-recovery. Data collection included specialty, surgery duration, and the use of intraoperative fluid warmers. Statistical analysis was performed using StatsDirect software (StatsDirect Ltd, Wirral, UK). Results Among the 200 patients, the overall incidence of hypothermia was 4% preoperatively, 5% pre-induction, 12% intraoperatively, 11% postoperatively, 8% in recovery, and 6% post-recovery. Intraoperative hypothermia incidence was significant, given that active warming was applied to patients with preoperative hypothermia. Regression analysis showed no correlation between intraoperative temperature and the use of intraoperative fluid warmers. Pre-induction temperature was the most statistically significant predictor of intraoperative hypothermia. Conclusions This study highlights the need for active interventions to recognize and prevent perioperative hypothermia in elective surgical patients. Active pre-warming of patients, regardless of surgery type and duration, is feasible and potentially beneficial. Future research should include an RCT comparing active and passive warming strategies to evaluate their effectiveness in improving perioperative outcomes.

Bariatric and general surgical procedures in obese patients with a history of venous thromboembolism and concurrent anticoagulation therapy

Bariatric and general surgical procedures in obese patients with a history of venous thromboembolism and concurrent anticoagulation therapy

The cost of virtual interviews; more than just the money

PurposeThe COVID-19 pandemic resulted in travel restrictions to limit virus transmission, altering the residency interview process across the country. While the transition to virtual interviews has the potential benefit of convenience and cost savings, concerns remain about the impact on applicants’ ability to distinguish programs. We sought to understand individual applicant motivations when presented with the opportunity to interview in-person or virtually and the associated costs.MethodsAn anonymous, voluntary, mixed-methods survey was distributed to all US allopathic medical school general surgery applicants who applied to our program in the 2023 cycle. The primary outcome was identifying factors that impacted the decision to interview either in-person or virtually. Secondary outcomes included costs associated with the entire interview process, including travel for away rotations, in-person interviews, and program second looks.Results155 (21.3%) applicants completed the survey. The average number of interviews completed was 14.2 ± 6.25. Females completed more interviews than males (14.9, 12.6, p = 0.047). Respondents accepted a mean of 89% of virtual interviews offered. 73% of applicants selected to complete at least one interview in-person. Top reasons for electing in-person interviews were to gain a stronger impression of the program (64%), make a greater impression of the program (50%), and strength of interest in the program (64%). Top factors for choosing virtual interviews were decreased costs (64%), less travel time (53%), and the ability to complete more interviews (53%). 58% of applicants planned to visit at least one program in-person post-interview. The mean total cost of interviews was $122 for virtual and $358 for in-person. Travel for a “second look” visit cost $279. 53% of respondents completed an away rotation, spending an average of $1688 per away rotation.ConclusionWhen presented with the option, applicants chose to interview in-person because of a mutual feeling of portraying and receiving a stronger impression. Candidates chose virtual due to cost reduction and the ability to complete more interviews. The financial savings of virtual interviews should be examined in the context of increased applications, increased interviews, post-interview travel or "second look" experiences, and costs associated with away rotations. Future work is needed to elucidate the role of in-person contact or away rotations on the likelihood of an applicant to interview and match in a largely virtual interview era.

Reliability of a workplace-based assessment for the United States general surgical trainees’ intraoperative performance using multivariate generalizability theory: a psychometric study

The System for Improving and Measuring Procedure Learning (SIMPL), a smartphone-based operative assessment application, was developed to assess the intraoperative performance of surgical residents. This study aims to examine the reliability of the SIMPL assessment and determine the optimal number of procedures for a reliable assessment. In this retrospective observational study, we analyzed data collected between 2015 and 2023 from 4,616 residents across 94 General Surgery Residency programs in the United States that utilized the SIMPL smartphone application. We employed multivariate generalizability theory and initially conducted generalizability studies to estimate the variance components associated with procedures. We then performed decision studies to estimate the reliability coefficient and the minimum number of procedures required for a reproducible assessment. We estimated that the reliability of the assessment of surgical trainees' intraoperative autonomy and performance using SIMPL exceeded 0.70. Additionally, the optimal number of procedures required for a reproducible assessment was 10, 17, 15, and 17 for postgraduate year (PGY) 2, PGY 3, PGY 4, and PGY 5, respectively. Notably, the study highlighted that the assessment of residents in their senior years necessitated a larger number of procedures compared to those in their junior years. The study demonstrated that the SIMPL assessment is reliably effective for evaluating the intraoperative performance of surgical trainees. Adjusting the number of procedures based on the trainees' training stage enhances the assessment process's accuracy and effectiveness.

A Lifelong Commitment: The Story of Dr. Kisu Song and His Impact on Korean Healthcare.

Dr. Kisu Song, an allopathic medical doctor specializing in general surgery, significantly impacted South Korean medicine and healthcare through his lifelong dedication to serving rural communities. Born on December 25, 1939, during the Japanese colonial period, Dr. Song witnessed the tumultuous transformation of Korea from a colonized nation to a divided one. His early life was marked by the Japanese colonial period and the Korean War and its aftermath, which influenced his decision to pursue medicine over law, a choice guided by the pressing needs of his community and his father's legacy. This biography explores Dr. Song's journey from a young student in a war-torn country to a pioneering rural physician in South Korea. His contributions, particularly in underserved areas, exemplify his profound commitment to healthcare and community service.

A Pattern and Incidence Study of Complications after Emergency Laparotomy

Background and Objectives: The study of emergency laparotomies are being carried out prospectively at the Department of General Surgery at a tertiary care facility affiliated with the Parul Institute of Medical Science and Research (Parul Sevasharam Hospital). Methods: A tertiary care teaching hospital’s Department of General Surgery conducted a prospective study involving 100 emergency laparotomy cases from July 2020 to May 2021. Every patient underwent surgery using a midline vertical incision. The main aim of the study is to identify various complications occurring following emergency laparotomies and various factors influencing them. All patients followed up at least for a period of 6 months after surgery. Results: 60 patients developed one or more complications postoperatively, 19 (31.7%) patients had abdominal complications; 34 (56.7%) had wound complications; 12 (20%) had chest complications and 4 (6.7%) had limb complications Conclusion: Even with the availability of safe anaesthetic, broad range of antibiotics, and advanced experimental or investigational devices, the risk of complications and mortality from emergency laparotomies remains significant. Chest problems were associated with a higher postoperative mortality rate than wound, limb, or abdomen complications.