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Background: While fatigue is an inevitable aspect of performing surgical procedures, lack of consensus remains on its effect on surgical performance. The aim of this systematic review was to assess the effect of non-muscular fatigue on surgical outcome. Methods: MEDLINE and Embase were searched up to 17 January 2023. Studies on students, learning, duty-hour restrictions, muscle fatigue, non-surgical or subjective outcome, the weekend effect, or time of admission were excluded. Studies were categorized based on real-life or simulated surgery. The Cochrane risk-of-bias tool was used to assess RCTs and the Newcastle–Ottawa scale was used to assess cohort studies. Due to heterogeneity among studies, data pooling was not feasible and study findings were synthesized narratively. Results: From the 7251 studies identified, 134 studies (including 1 684 073 cases) were selected for analysis (110 real-life studies and 24 simulator studies). Of the simulator studies, 46% (11 studies) reported a deterioration in surgical outcome when fatigue was present, using direct measures of fatigue. In contrast, only 35.5% (39 studies) of real-life studies showed a deterioration, observed in only 12.5% of all outcome measures, specifically involving aggregated surgical outcomes. Conclusion: Almost half of simulator studies, along with one-third of real-life studies, consistently report negative effects of fatigue, highlighting a significant concern. The discrepancy between simulator/real-life studies may be explained by heightened motivation and effort investment in real-life studies. Currently, published fatigue and outcome measures, especially in real-life studies, are insufficient to fully define the impact of fatigue on surgical outcomes due to the absence of direct fatigue measures and crude, post-hoc outcome measures. The aim of this systematic review was to assess the effect of non-muscular fatigue on surgical outcome. While most simulator studies that reported an effect of fatigue reported a negative effect, in real-life studies, a large range of findings was found, with inconclusive supporting evidence. While this discrepancy could be explained by heightened motivation and effort investment in real-life studies, the current evidence on fatigue and surgical performance is worrisome; current fatigue and outcome measures used, especially in real-life studies, are insufficient, stemming from the absence of direct fatigue measures and crude, post-hoc outcome measures. Lay Summary: At some point, surgeons become tired, just like anyone else. While in other jobs, people start to perform worse as they get tired, it is not known whether this is also true for surgeons. It is important to know this because patients may be worse off if their surgeon is tired. The aim of this study was to find out if being tired affects how surgeons do their work. Medical databases were searched through for studies on tired surgeons and the impact of fatigue on their work. Some studies looked at tired surgeons during real surgery and other studies looked at tired surgeons during sessions on surgery simulators. More than 7000 studies were examined and 134 of them were selected. They included over 1.6 million surgeries. Among these studies, 110 investigated real surgeries and 24 looked at simulated surgical sessions. Interestingly, almost half of the studies looking at simulated surgeries found that being tired had a negative effect on the simulated surgery. However, in real surgeries, this happened in only one-third of studies. The difference between real surgery and simulator surgery could be because in real surgeries surgeons always try to do their best, even when fatigued, because they are dealing with real patients. Another reason could be that the tools used to check whether surgeons are tired or whether the surgery went well are not very good. To help both surgeons and patients, there is a need to find better ways to determine if surgeons are truly tired and to make sure the tests are better. [ABSTRACT FROM AUTHOR]

Background: Comparisons of peri-operative complications associated with paediatric (≤16 years) and adult anaesthesia are poorly available, especially in which cardiac surgery, organ transplantation and neurosurgery are involved.Objective: The aim of this study was to evaluate the nature and incidence of peri-operative complications that might be due to anaesthesia and to identify independent risk factors for complications in children and adults, including those undergoing cardiac surgery, organ transplantation and neurosurgery.Design: Retrospective cohort study.Setting: The study was performed at the University Medical Centre Groningen in the 4 years between 1 January 2010 and the 31 December 2013.Main Outcome Measures: Complications and their severity were graded according to the standard complication score (20 items) of the Dutch Society of Anaesthesia. Univariate and multivariate regression analysis was used to identify independent risk factors for the reported complications.Results: A total of 81 267 anaesthetic cases were included. In the paediatric cohort, there were 410 (2.9%) complications and 1675 (2.5%) in the adults. In both cohorts age, American Society of Anaesthesiologists classification and emergency treatment were independent risk factors for complications. With respect to age, infants less than 1 year were at the highest risk, whereas in the adult cohort, increased age was related to a greater number of complications. The incidences of the specific complications were different between both cohorts. Upper airway obstruction was more frequently observed in paediatric patients (26%), whereas in the adults, complications with the highest incidence concerned conversion of regional-to-general anaesthesia (25%) and hypotension (17%).Conclusion: Risk factors for all peri-operative complications were similar for paediatric and adult anaesthesia. However, the incidence of specific complications differed between both age categories. [ABSTRACT FROM AUTHOR]

Background: Early delivery of calories is important in critically ill patients, and the administration of parenteral nutrition (PN) is sometimes required to achieve this goal. However, PN can induce acute hyperglycemia, which is associated with adverse outcome. We hypothesized that initiation of PN using a rapid "step-up" approach, coupled with a computerized insulin-dosing protocol, would result in a desirable caloric intake within 24 hours without causing hyperglycemia., Methods: In our surgical intensive care unit (ICU), glucose is regulated by a nurse-centered computerized glucose regulation program. When adequate enteral feeding was not possible, PN was initiated according to a simple step-up rule at an infusion rate of 10 mL/h (approximately 10 kcal/h) and subsequently increased by steps of 10 mL/h every 4 hours, provided glucose was <10 mmol/L, until the target caloric intake (1 kcal/kg/h) was reached. All glucose levels and insulin doses were collected during the step-up period and for 24 hours after achieving target feeding., Results: In all 23 consecutive patients requiring PN, mean intake was 1 kcal/kg/h within 24 hours. Of the 280 glucose samples during the 48-hour study period, mean ± standard deviation glucose level was 7.4 ± 1.4 mmol/L. Only 4.5% of glucose measurements during the step-up period were transiently ≥10 mmol/L. After initiating PN, the insulin requirement rose from 1.1 ± 1.5 units/h to 2.9 ± 2.5 units/h (P < .001)., Conclusions: This proof of concept study shows that rapid initiation of PN using a step-up approach coupled with computerized glucose control resulted in adequate caloric intake within 24 hours while maintaining adequate glycemic control.