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

The Vascular Interventions and Surgery in Trauma Audit (VISTA): A Prospective National Service Evaluation of Vascular Trauma in the UK

\ua9 2025 The Author(s). Objective: The frequency, operative management, and outcomes for patients with traumatic vascular injury in the UK are unknown. The Vascular Interventions and Surgery in Trauma Audit (VISTA) aimed to describe the contemporary landscape of UK vascular trauma compared with retrospective data from the National Vascular Registry (NVR). Methods: A prospective, resident led service evaluation was conducted across UK major trauma centres (MTCs) delivered by the National Trauma and Research Innovation Collaborative and the Vascular and Endovascular Research Network. The evaluation included patients with traumatic injuries to named vessels falling under the management remit of vascular surgery, identified radiologically or intra-operatively, between March and October 2022 and comparative NVR data from 2017 to 2022. Results: VISTA captured 302 patients with 339 vascular injuries from 27 MTCs. The median patient age was 41 years (interquartile range 26, 59) and 78.8% (n = 238) were men. Most injuries resulted from road traffic collisions (42.4%, n = 128). Overall, 38 patients (12.6%) were shocked on arrival at the emergency department. Two thirds of patients (65.6%, n = 198) required surgery, of whom 140 (70.7%) had an open procedure and 58 (29.3%) an endovascular intervention. Open procedures included 86 (61.4%) extremity interventions (including six [4.3%] primary amputations), four (2.9%) carotid repairs, four (2.9%) caval repairs, and two (1.5%) aortic repairs. Endovascular procedures included 23 (40%) thoracic endovascular aortic repairs, two (3%) extremity stents, and one (2%) extremity embolisation. The secondary amputation rate was 12% (10 of 86). Extrapolated annual VISTA data suggest the NVR fails to capture 58% of aortic injuries and 42% of extremity vascular injuries requiring intervention. Conclusion: UK wide registries do not accurately capture surgical volume and outcomes for vascular interventions following trauma. Granular national datasets are required to establish evidence based key performance indicators for life and limb salvage following vascular trauma to improve services, promote safety, and assure patient outcomes

The Vascular Interventions and Surgery in Trauma Audit (VISTA): A Prospective National Service Evaluation of Vascular Trauma in the UK

Objective: The frequency, operative management, and outcomes for patients with traumatic vascular injury in the UK are unknown. The Vascular Interventions and Surgery in Trauma Audit (VISTA) aimed to describe the contemporary landscape of UK vascular trauma compared with retrospective data from the National Vascular Registry (NVR). Methods: A prospective, resident led service evaluation was conducted across UK major trauma centres (MTCs) delivered by the National Trauma and Research Innovation Collaborative and the Vascular and Endovascular Research Network. The evaluation included patients with traumatic injuries to named vessels falling under the management remit of vascular surgery, identified radiologically or intra-operatively, between March and October 2022 and comparative NVR data from 2017 to 2022. Results: VISTA captured 302 patients with 339 vascular injuries from 27 MTCs. The median patient age was 41 years (interquartile range 26, 59) and 78.8% (n = 238) were men. Most injuries resulted from road traffic collisions (42.4%, n = 128). Overall, 38 patients (12.6%) were shocked on arrival at the emergency department. Two thirds of patients (65.6%, n = 198) required surgery, of whom 140 (70.7%) had an open procedure and 58 (29.3%) an endovascular intervention. Open procedures included 86 (61.4%) extremity interventions (including six [4.3%] primary amputations), four (2.9%) carotid repairs, four (2.9%) caval repairs, and two (1.5%) aortic repairs. Endovascular procedures included 23 (40%) thoracic endovascular aortic repairs, two (3%) extremity stents, and one (2%) extremity embolisation. The secondary amputation rate was 12% (10 of 86). Extrapolated annual VISTA data suggest the NVR fails to capture 58% of aortic injuries and 42% of extremity vascular injuries requiring intervention. Conclusion: UK wide registries do not accurately capture surgical volume and outcomes for vascular interventions following trauma. Granular national datasets are required to establish evidence based key performance indicators for life and limb salvage following vascular trauma to improve services, promote safety, and assure patient outcomes

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

Purpose: We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. Methods: International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. Results: 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. Conclusions: Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. Trial registration: ACTRN12620000421932 registered on 30/03/2020

Correction: Epidemiology and outcomes of early-onset AKI in COVID-19-related ARDS in comparison with non-COVID-19-related ARDS: insights from two prospective global cohort studies (Critical Care, (2023), 27, 1, (3), 10.1186/s13054-022-04294-5)

Following publication of the original article [1], the authors identified that the collaborating authors part of the collaborating author group CCCC Consortium was missing. The collaborating author group is available and included as Additional file 1 in this article

Stroke in critically ill patients with respiratory failure due to COVID-19: Disparities between low-middle and high-income countries

Purpose: We aimed to compare the incidence of stroke in low-and middle-income countries (LMICs) versus high-income countries (HICs) in critically ill patients with COVID-19 and its impact on in-hospital mortality. Methods: International observational study conducted in 43 countries. Stroke and mortality incidence rates and rate ratios (IRR) were calculated per admitted days using Poisson regression. Inverse probability weighting (IPW) was used to address the HICs vs. LMICs imbalance for confounders. Results: 23,738 patients [20,511(86.4 %) HICs vs. 3,227(13.6 %) LMICs] were included. The incidence stroke/1000 admitted-days was 35.7 (95 %CI = 28.4–44.9) LMICs and 17.6 (95 %CI = 15.8–19.7) HICs; ischemic 9.47 (95 %CI = 6.57–13.7) LMICs, 1.97 (95 %CI = 1.53, 2.55) HICs; hemorrhagic, 7.18 (95 %CI = 4.73–10.9) LMICs, and 2.52 (95 %CI = 2.00–3.16) HICs; unspecified stroke type 11.6 (95 %CI = 7.75–17.3) LMICs, 8.99 (95 %CI = 7.70–10.5) HICs. In regression with IPW, LMICs vs. HICs had IRR = 1.78 (95 %CI = 1.31–2.42, p < 0.001). Patients from LMICs were more likely to die than those from HICs [43.6% vs 29.2 %; Relative Risk (RR) = 2.59 (95 %CI = 2.29–2.93), p < 0.001)]. Patients with stroke were more likely to die than those without stroke [RR = 1.43 (95 %CI = 1.19–1.72), p < 0.001)]. Conclusions: Stroke incidence was low in HICs and LMICs although the stroke risk was higher in LMICs. Both LMIC status and stroke increased the risk of death. Improving early diagnosis of stroke and redistribution of healthcare resources should be a priority. Trial registration: ACTRN12620000421932 registered on 30/03/2020