Search

The RETAINER Collaborative Group reports the impact of COVID-19 on international elective inguinal hernia practice.

Aims In response to the COVID-19 pandemic and the cancellation of elective surgery, the Independent sector (IS) has been utilised to provide COVID-light sites. On average operative log book numbers have been reduced by 50% due to a reduction in operative exposure. The Four Educational Bodies continue to support training within the independent sector. This study aimed to qualitatively assess access and barriers to UK surgical training in the Independent Sector. Methods A snap-shot online survey was distributed to ASIT members of all training specialities and grades between 21/10/2020-11/11/2020 . Data measures included participant demographics, frequency of access, participation in training opportunities including outpatient clinic, theatre lists and endoscopy and any barriers encountered. A mixture of Likert scale and short answer questions were utilised. Results 249 complete responses representing all grades and specialities were included in the final analysis (34.29% CST and 56.3% HST). 35.7% of trainees reported access to the IS. 22.9% had access to at least one operating list whilst 70.3% had none. Access to outpatient clinics and endoscopy was negligible. 75% of trainees ‘strongly agreed’ that when access was achievable, it was beneficial to their training. Multiple barriers were identified including Human Resource requirements and local service provision. Conclusions Within the sample, access to the IS has been poor. There is wide variation in barriers to access across the 4 nations and IS providers. Trainees and Trainers should maximise training opportunities in the IS. Where barriers exist, they should be reported to local Training Programme Directors.

Aims COVID-19 has caused difficulties in providing efficient surgical care. We aimed to audit cholecystectomy provision for gallstone pancreatitis from January 2019 to June 2020. We audited time from admission with gallstone pancreatitis to cholecystectomy in pre-COVID and COVID cohorts in order to assess the effect of the first wave of the pandemic on service provision. Methods Patients with confirmed gallstone pancreatitis plus their age and gender were included using information software Cerner. We analysed length of stay, time to surgery and number of patients planned for surgery. We also looked at readmissions whilst awaiting surgery. Patients with previous cholecystectomies or deemed not fit for surgery were excluded. Results 68 patients were included; 42 admitted from Jan 2019 to Feb 2020 (non-COVID group) and 26 from March 2020 to June 2020 (COVID 19 group). Average length of stay was 11.8 days for non-COVID group and 8.8 days for COVID group. Average time to surgery for non-COVID group was 47.4 days. 25 patients underwent surgery. Average time to surgery was 56.7 days and 9 patients received surgery, in the COVID group. In this group, 3 patients had index admission surgery compared to 15 in the non-COVID group. Conclusions Albeit small, our data set shows a longer wait to surgery in the COVID group with fewer operations performed at index admission, compared to the non-COVID group. Future surgical services will require careful planning to ensure that urgent cholecystectomies continue to be performed in acute gallstone pancreatitis.

Aim COVID-19 is an ongoing global pandemic that poses potential increase in the risk of post-operative complications. Early guidelines placed an embargo on minimal access surgery, aiming to minimise risk to patients and the surgical team through aerolisation of the virus. We aimed to assess the practice of minimal access surgery during the peak of the pandemic and associated surgical outcomes. Method An email link to an online questionnaire was distributed to a variety of surgical specialties via the Royal College of Surgeons COVID group and ALSGBI members. Data collection was carried out over a 4-month period. Data assessed included screening methods, case volume, surgical approach and patient outcomes. Results A total of 118 responses from a variety of surgical specialties were collected over 59 units, ranging in grade from Consultant to SHO/Core Trainee. The volume of minimal access procedures decreased during the pandemic from 94.9% of units to 39.0% (P Conclusions Whilst the risk of COVID-19 infection was not completely abolished perioperatively throughout the pandemic, it appears to be minimised by use of adequate screening with designated clean areas. It would therefore support guidelines advocating continued use of minimal access surgery during peaks of COVID-19 if prudent peri-operative measures are taken.

Introduction Never events represent a huge cost burden to the NHS due to litigation. One such event occurred at a high-volume orthopaedic unit involving the wrong implant being inserted into a patient. An extensive investigation was undertaken which highlighted a combination of human error in the implant checking process and implant storage system. As a result, local guidance was developed to ensure a ‘prosthetic pause’ was performed prior to implant opening. Method An audit of implant checking practices was performed. The first cycle involved 14 cases observed over two weeks and the second involved 16 cases over five weeks. The checks were deemed compliant if the operating surgeon read aloud the implant details to the team, the scrub nurse did the same and both happened prior to implants being opened. Results The initial audit had 8 of 14 cases complying with local guidance. Following the addition of laminated copies of the guidance to all theatres, the guidance being re-distributed to staff and targeted education of the scrub team this improved to 13 of 16 cases. Conclusions Targeted interventions and the introduction of a ‘prosthetic pause’ resulted in an improvement in compliance with implant checks and reduces the risk of further never events.