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

Mitral Para-valvular leakage following usage of non-pledgeted compared to Teflon-pledgeted sutures

Background: Despite a wide variety of mitral prosthesis suturing, pledgeted annular sutures are preferred to lower the incidence of para-valvular leakage (PVL). However, there is limited evidence in the literature on the effect of non-plegeted sutures on such serious complication. Objective: The purpose of this study was to determine the safety and practicality of employing non-pledgeted sutures for Mitral valve replacement (MVR), especially regarding postoperative PVL. Patients and methods: Data on 100 patients with MVR were gathered from Cairo University Hospitals. Cases were split into two groups: group 1 underwent surgery using non-pledgeted horizontal sutures where in group 2 we used Teflon-pledgeted sutures. Preoperative, operative, and postoperative factors including follow-up echocardiographic examination one year following discharge, were compared between the two groups. Results: Both groups had similar preoperative characteristics, with group 1 including 49 patients compared to 51 patients in group 2. Data showed significantly shorter cross clamping (AXC) time in group 1 (p value < 0.05), intraoperative TEE has never observed para-prosthetic leakage in both groups, there was no significant difference regarding both mean ICU and hospital stay

Management of post intubation tracheal stenosis

Background: Postintubation tracheal stenosis (PITS) is caused by a number of etiologies demanding mechanical ventilation and application of endotracheal or tracheostomy tubes which in turn conflict regional ischemic necrosis of the airway at various levels, presenting the characteristic signs and symptoms of airway obstruction. The incidences of PITS have been decreased with the recognition of the causes, and modification of endotracheal tubes and methods of management. Patients and Methods: Fifty four patients were identified between June 2017 and June 2019. Those patients were treated for tracheal stenosis which developed after prolonged endotracheal intubation. The study was done in Cardiothoracic Surgery departments at Kasr-Alainy Hospital (Cairo University). Patients were managed by rigid bronchoscopic dilatation, airway devices (as Montgomery t-tube or metallic stent) and/or primary tracheal resection and end to end anastomosis. Results: Out of the 54 patients: Three (5.5%) were planned for tracheostomy from the start. Fifty-one (94.4%) were subjected to rigid bronchoscopic examination & dilatation. Three patients (5.5%) were fully improved after bronchoscopic dilatation. The rest of the patients (48) were directed to the next stage in our management, either staged management or resection anastomosis.&nbsp