Rapid Sequence

Effectiveness of emergency surgery for five common acute conditions

There is very limited evidence about the relative effectiveness of emergency surgery vs. non-emergency surgery strategies for patients with common acute conditions. This lack of evidence means that there is likely to be considerable practice variation in the NHS in England.

The ESORT study, which was published last night, aimed to compare the effectiveness of emergency surgery or not for five acute abdominal conditions.

Joining us this morning we have three authors of this excellent new paper, Professors Moonsinghe, Hinchliffe and Grieve.

Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update

This new guideline provides an update to the previously published consensus statement on SARS-CoV-2 infection, COVID-19 and timing of elective surgery to assist policymakers, administrative staff, clinicians and patients. It focuses on the omicron variant, which is now strongly dominant in many countries. However, the principles may also be of relevance to future variants.

To set the paper in its context, Rose Kearsley speaks with authors Scarlett McNally, Tim Cook and Kariem El-Boghdadly. Five thousand watched the broadcast, catch up with the audio recording here!

‘Dear Doctor’: a randomised controlled trial of a text message intervention to reduce burnout in trainee anaesthetists

Joining us today we have the authors of a new paper reporting the effect of a text message intervention on burnout in trainee anaesthetists.

First we have Emily Larson who is a Senior Advisor at The Behavioural Insights Team. Emily has worked on reducing burnout and increasing wellbeing with physicians, educators and children. We also have Dr Alix Brazier who is also a Senior Advisor at The Behavioural Insights Team and currently leads BIT’s work applying behavioural insights to improve healthcare. Alix is also a PhD student at Imperial College, London, who also supported this research.

Finally, we have Dr Yihan Xu who is a research advisor at The Behavioural Insights Team and she designs and runs rapid online or field trials to inform and improve the delivery of government services in public health and education, for clients like the Department of Health and Social Care, the NHS, the Education Endowment Foundation, and the Ministry of Defence.

Recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic

There were more applications for higher specialty training posts in anaesthesia in the UK starting in August 2021 than in previous years, with approximately two-thirds being unsuccessful.

This new national survey is all about recruitment to higher specialty training in anaesthesia in the UK during the COVID-19 pandemic. Joining Dr C Hughes was Dr C Holt, Dr J Subramaniam, Dr N Durrant and Dr S Edwardson. Their results suggest that junior anaesthetic doctors in the UK negatively perceived postgraduate training structures and changes to the postgraduate curriculum and experienced difficulties in securing higher training. This is a ‘must listen’ for all trainees and all those involved with training. Enjoy!

Peri‐operative and critical care management of the brain ‐ current evidence

What better way to see in any new year than with a brand-new Anaesthesia Special Supplement! This year, it is all about the peri-operative and critical care management of the brain, which has been guest edited by Dr Jugdeep Dhesi and Professor Alana Flexman. Joining us also were journal Editors Professor Iain Moppett and Dr Matt Wiles. Topics include:

• Chronic SDH
• Peri-operative neurocognitive disorders
• COVID-19-associated delirium
• Mode of anaesthesia for mechanical thrombectomy
• Status epilepticus
• Cerebral oximetry 

30 minutes of high quality CPD for all. Enjoy!

Why does oesophageal intubation still go unrecognised?

A recent coroner’s report in the UK concluded that a healthy patient died as a result of unrecognised oesophageal intubation. This did not seem to be the result of misinterpretation of a flat end-tidal carbon dioxide trace, but an apparent omission to check the capnograph after intubation and to perform clinical checks of tracheal tube position.

This podcast accompanies a new editorial from Pandit, Young and Davies which highlights the main lessons that can be learned from this tragic event.

Joining Professor Pandit we are delighted to have with us Professors Laura Duggan and Andrew Smith. The tread from Tanya Selak to accompany the podcast can also be found here.

Consensus statement on measures to promote equitable authorship in research publications from international research partnerships

Parachute (or ‘helicopter’) research is the practice of conducting primary research within a host country and subsequently publishing findings with inadequate recognition of local researchers, staff and/or supporting infrastructure.

The aim is that these recommendations will be broadly applicable within academic publishing; of use to international researchers at the point of study or partnership conceptualisation; and increase awareness of this issue among the general readership of academic journals.

Joining our Associate Editor Sheila Myatra was Seye Abimbola, Refiloe Masekela, Angela Obasi and Ben Morton who are authors of the paper.

Safety of day-case paediatric tonsillectomy in England: an analysis of administrative data for the Getting It Right First Time programme

In the UK, the Getting It Right First Time (GIRFT) programme was established by the Department of Health and Social Care as an initiative to investigate variation in healthcare delivery and patient outcomes between hospital Trusts in England. Variation between Trusts is unwarranted unless justified by patient case-mix, patient preference, equivocal evidence of effectiveness of a particular patient management approach or intractable resource constraints.

This new paper used the Hospital Episodes Statistics (HES) database to investigate variation in the rates Trusts discharged children the same day after tonsillectomy and associations with adverse postoperative outcomes. They found evidence that outcomes for day-case and overnight stay tonsillectomy are similar and conclude the majority of specialist and non-specialist Trusts should increase day-case surgery rates.

Joining the authors today was our chair Tanya Selak who is an Associate Editor as well as Ruth Tyrrell from GIRFT.

SARS-CoV-2 infection and venous thromboembolism after surgery

Robust evidence is needed to enable clinicians and policymakers to minimise VTE risk in patients with SARS-CoV-2 infection. Ideally, such evidence would stratify the risk of VTE against both the duration of time between infection and surgery and presence or absence of symptoms. This study aimed to determine the VTE rate in patients with SARS-CoV-2 infection, stratified by current or prior infection.

The authors found that SARS-CoV-2 infection was independently associated with an increased incidence of postoperative VTE in patients with peri-operative and recent SARS-CoV-2 infection. In patients with pre-operative SARS-CoV-2, ongoing symptoms were associated with an increased rate of postoperative VTE, irrespective of how long before surgery the diagnosis was made.

For this live podcast, Anaesthesia Editor Ed Mariano was joined by Elizabeth Li, Joana Simoes and Francesco Pata from the authorship group. They discuss the main findings, strengths, limitations, clinical applications and much more! Enjoy!

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery

This international prospective cohort study analysed data on > 96k patients from > 1500 hospitals in > 100 countries. They found that the overall postoperative pulmonary complication rate for all patients was 2.0%, which alone is useful to know. Perhaps more strikingly, and following adjustment for various measured confounders, patients who isolated had a 20% increased risk of postoperative pulmonary complications. The risk climbed to 31% more in those isolating ≥ 8 days, which is still shorter than current periods recommended in England for certain patient groups.

The question is, can these new data be used to update guidelines and clinical practice, resulting in at once improved safety, outcomes, efficiency and patient experience?

Joining us today we have Joana Simoes, Elizabeth Li and Aneel Bhangu from the authorship group.