Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Criteria of day surgery discharge post elective laparoscopic cholecystectomy among adult patients

Background: Laparoscopic cholecystectomy is a minimally invasive and the most performed procedure for gallbladder resection. Despite published studies demonstrating the safety of early discharge of patients after lap-cholecystectomy, many have not accepted this approach. The present study aims to identify adult patients who are discharged late or require re-admission after laparoscopic cholecystectomy in King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia, due to the lack of information regarding a patient&amp;apos;s discharge time or re-admittance. Methods: A cross-sectional study, questionnaire-based chart review was conducted at KAMC in Saudi Arabia, Riyadh, targeting 347 patients, chosen through simple random sampling, that underwent laparoscopic cholecystectomies from January 2016 to December 2020. The p-value &amp;lt; 0.05 was considered significant for all the tests applied. The postoperative length of stay predictors was measured using linear regression modelling. Results: Among the study subjects, females accounted up to 76.4%, the largest population (27%) were aged between 51 – 65 years, and the least (23%) were aged between 41 – 50 years. Further 82.2% were not diabetic, and the remaining (35%) had increased HbA1c. The majority had BMI &amp;lt; 30 (39.7%). Discharge 1-day post-cholecystectomy reported 70.7% and 97.1% were never re-admitted. Diabetes was the only factor to increase re-admission risk (p-value: 0.029). Conclusion: None of the factors was significantly associated with hospital length of stay post-op, and having diabetes was the only factor to show a significantly higher risk of re-admission.</jats:p

Bioavailability of oral fluconazole in critically ill abdominal trauma patients with and without abdominal wall closure: a randomized crossover clinical trial

Patients with non-apposed fascial edges, known as laparostomy patients, have traditionally been given intravenous medications, because enteral absorption of medications was thought to be unpredictable. We hypothesized that critically ill patients with "open abdomens" would have bioavailability similar to that of matched patients with closed fascial edges. Fluconazole, a commonly prescribed anti-fungal with good bioavailability was used as a marker of absorption. Postoperative abdominal trauma patients were enrolled in a case-control (laparostomy versus closed abdomen) crossover design study to receive either an oral or parenteral fluconazole (400 mg loading dose followed by 200 mg QD) for one week. After a washout period, the alternate route of administration was used for the second week. Blood levels were collected at the end of each week of therapy. Rectal swab stool specimens were cultured for fungi on days 0, 7, and 15. Sixteen patients were studied. The mean injury severity score was 23 (range 9-41). The bioavailability of enteral fluconazole was 51% +/- 30% in the open abdomen and 63% +/- 19% (p = 0.347) in the closed abdomen patients. There was great variation in the bioavailability between the individual patients, with a range of 30%-100% in both groups. Three patients developed rectal colonization with Candida krusei. The bioavailability of enterally dosed fluconazole was highly variable in both the open and closed abdomen patients. Intravenous administration of pharmaceuticals may provide more reliable serum levels in the first 2 weeks after trauma-related laparotomy