Global Level of Harm experienced by Bariatric Surgeons for Bariatrics surgical interventions: An exploration of predictors

Background: COVID-19 pandemic has taken the world by surprise with the depth and breadth of its effect on all walks of life, bariatric surgery being no exception. With the scientific literature hitherto unable to comment and ascertain the influence of the COVID-19 pandemic on bariatric surgery and the level of harm experienced by bariatric surgeons, we- TUGS 'Level of Harm' collaborative group- attempted to gauge the effect of the said pandemic on bariatrics surgery specifically vis a vis the level of harm experienced by bariatric surgeons due to the pandemic. Method(s): A virtual questionnaire- developed on both: Google forms and Survey Monkey- was circulated via TUGS social media platforms to reach bariatric consultant surgeons, fellows and residents practising throughout the world in a bid to explore the influence of the COVID-19 pandemic on their surgical practice including but not limited to the annual surgical volume including re-do surgeries volume and postoperative complications. Moreover, they were also requested to categorise their respective level of harm vis a vis bariatric surgical interventions they undertake. After de-identification of the data, SPSS (V.26) was adopted to undergo statistical analysis. After exploring the dataset by descriptive analyses, the Chi-square test was applied to pursue the association of categorical variables with the reported level of harm. A double-sided p-value of less than 0.05 was considered statistically significant. Result(s): 16.8% of the respondents (21/125) indicated no harm vis a vis bariatrics surgery work whereas a comparative 18.4% of the respondents (23/125) reported moderate harm with significant worsening of symptoms. None of those who indicated less than 10% increase in surgery waitlisted patients being subjected to endoscopic interventions (0/14) reported Moderate Harm for bariatrics surgery work with significant worsening of symptoms whereas 1 in every 3 of those who indicated between 10% to 25% increase in surgery waitlisted patients being subjected to endoscopic interventions (5/15) reported such level of harm for bariatrics surgery work. (p < 0.001) Upon exhaustive sub-group analysis, it was uncovered that 33.6% of bariatrics surgical professionals perceived no harm (no evidence of change in clinical condition) during gastric band or related surgery work with only 4% perceiving Moderate Harm (significant worsening of symptoms/ comorbidities control/ minor increase in medications) for such surgical interventions. All of those who reported No harm for gastric band or related surgical work reported that Single anastomosis duodeno-ileal bypass (SADI-S) accounts for 10% of their practice whereas none of those who indicated that SADI-S accounts for more than 10% of their practice reported No harm for such surgical work. (p = 0.019) Conclusion(s): The global snapshot illustrates a trend of low harm vis a vis bariatrics surgery work in surgical professionals practising in the private sector with a lesser number of patients developing COVID-19 postoperatively and no postoperative COVID-19 related mortality. The patient being subjected to endoscopic intervention portends a higher level of harm for bariatrics surgical work- strict adherence to criteria and safety protocols being a logical inference. For gastric band and related surgery work, preoperative COVID-19 testing appears to be influenced by confounders in its effect on the surgeon's level of harm for the said interventions warranting further exploration. SADI-S, at a cut-off of 10%, exhibits strong interaction with the surgeon's level of harm for gastric band insertion and relation surgery work. Women surgical professionals came out to exhibit equivalent mental resilience and technical prowess at par with their male colleagues when it came to bariatrics surgical intervention.

Impelling Factors for Contracting COVID-19 among Surgical Professionals during the Pandemic: A Multinational Cohort Study

Background: Medical workers, including surgical professionals working in COVID-19 treating hospitals, were under enormous stress during The pandemic. This global study investigated factors endowing COVID amongst surgical professionals and students. Method(s): This global cross-sectional survey was made live on The 18th of February, 2021, and closed for analysis on The 13th of March, 2021. It was freely shared on social and scientific media platforms. It was also sent via email groups and circulated through a personal network of authors. Chi-square test for independence, binary logistic regression analysis was carried on determining predictors of surgical professionals contracting COVID-19. Result(s): This survey captured The response of 520 respondents from 66 countries. 92.29% (503/545) were working in ahospital receiving patients with COVID-19. More than one-fourth (25.5%) caught COVID-19, which was more frequent in participants working in public sector hospitals (P=0.001). 75.7% of those who did not contract COVID (283/376) were vaccinated (P<0.001). Surgical professionals undergoing practice in The private sector (OR: 0.33;95% CI: 0.14-0.77;p=0.011) and getting two doses of vaccines (OR: 0.55;95% CI: 0.32-0.95;p=0.031) had decreased odds of contracting COVID-19. only 6.9% of those who reported not contracting COVID-19 (26/376) were calculated to have The highest Level of Harm score (LH4) (P<0.001). Conclusion(s): High prevalence of respondents caught COVID-19, which was more frequent in participants working in public sector hospitals. Self-isolation or shield, getting two doses of vaccines decreases The odds of contracting COVID-19. Those who reported contracting COVID-19 were calculated to have The highest Level of Harm score.

Global Level of Harm Upper Gastrointestinal (GLEOHUG) – a multinational gastric cancer cross- sectional appraisal

Background Gastric cancer (GC) is the 5th most common malignancy and remains one of the major causes of worldwide cancer-related deaths. COVID-19 pandemic has had a significant impact on the provision of cancer care. This study aims to overview the global standpoint of gastric cancer patients (GCP) during the first year of the pandemic. Methods The Upper Gastrointestinal Surgeons (TUGS), within its Global Level of Harm Project, designed an online cross-sectional survey to assess how gastric cancer patient’s management changed during the first year of the pandemic. The questionnaire included 33 questions about expertise, kind of health system, hospital organization and screening policies, personal protective equipment (PPE), change in patient’s characteristics, preoperative, operative and postoperative management of GCP. Results There were 209 participants from 178 centres & 50 countries). Results showed: most hospitals (88,18%) had restricted areas for COVID-19 patients;53.58% of surgeons were redeployed;most frequent COVID-19 screening method was PCR (78,82%) & chest CT-scan (25,62%), and 55.98% lack full PPE. Preoperative management: 43.16% noted reduction in multidisciplinary teams (MDT) meetings;28,42% increase in cT2 or higher GCP;34,74% increase in metastatic (M1) GCP;26,84% increase in patients receiving definitive palliative treatment;23,68% note increase in frail patients;50% increase in waiting list time;and 41,58% faced problems in the provision of oncological treatment. Operative management: 54,50% decrease in elective gastrectomies;29,10% increase in urgent/semi-urgent gastrectomies;37,04% decrease in the number of minimally-invasive gastrectomies (MIG);& 18,52% increase in the number of palliative surgeries. Postoperative management: 16,48% increase in the overall complication rate (OCR);12,64% increase in the number of Clavien-Dindo 3 or higher complications;8,13% increase in the leak rate;increase in pulmonary infections (26,79%) and bowel obstruction (2,39%);44,51% note postoperative COVID-19;15,38% increase in 30-days mortality;23,08% mortality due to COVID-19 infection;17,58% increase in the need for adjuvant treatment. Most patients were postoperatively assessed either through a face-to-face consultation or a hybrid approach. Conclusions COVID-19 pandemic has affected gastric cancer management by decreased frequency of MDT’s, higher clinical-stage migration and fuelled frailty. The pandemic increased waiting list time, the number of urgent and palliative surgeries, OCR, Clavie-Dindo 3 or higher complications, leak rate, and pulmonary infections. There was a noticeable high rate of postoperative COVID-19 infection and associated mortality. Further multicentric studies are warranted to affirm these findings.

Leveraging Automated Machine Learning to provide NAFLD screening diagnosis: Proposed machine learning models

Background and Objective: Non-alcoholic fatty liver disease (NAFLD) is reported to be the only hepatic ailment increasing in its prevalence concurrently with both;obesity & Type 2 Diabetes Mellitus. Abdominal ultrasonography is done for NAFLD screening diagnosis which has a high monetary cost associated with it. • In the wake of a massive strain on global health resources due to COVID-19 pandemic, NAFLD is bound to be neglected and shelved. Machine learning is explored, here, to propose screening-diagnostic tools for NAFLD that can be easily deployed without the requirement of substantial resources and can provide instantaneous screening-diagnosis predictive results. Methods: The study takes in data from Huang BX et al. : 4053 subjects, 2436 men and 1617 women between 20 and 88 years of age, after excluding those patients that had a history of co-morbid conditions as well as those with a lack of hepatic ultrasonography data. The Graif’s criteria was adopted to diagnose Fatty liver disease on ultrasonography. Mljar, the current state-of-the-art automated ML zero-code machine learning web platform, was adopted with a ‘homogenous’ approach for the development of the models vis-à-vis the preprocessing & tuning protocols as well as system specifications so as to keep the model development bias to a minimum. The discriminative ability of the models were the primary outcome variables. The ‘Area under the receiver operating curve’ (AUROC) analysis was adopted to measure that ability. Results: All 8 of the algorithms, trained in accordance with the aforementioned Homogenous Development Framework, came out to have good discriminating ability to designate the dichotomous variable of interest. Random Forest came out to have the highest discriminating ability with a computation time of minutes 9 seconds. Out of the proposed models, K-Nearest Neighbor had the least AUC but a considerably less computation time of only 6 seconds. Conclusion: Our proposed models are the very first effort, to the best of our knowledge, to leverage the current state-of-the-art for autoML to develop machine learning models that are trained to have a good discriminating ability to predict NAFLD using only anthropometric measures. The proposed models neither require costly analysis so that variables, such as ultrasonographic signals, may be fed into them for training nor do they require considerably high computation time & resources to be deployed. A study comparing the presented models’ predicted diagnosis with an abdominal ultrasound diagnosis for NAFLD, the predictions subsequently assessed against hepatic biopsy, is proposed to be in order to explore the presented models’ potential to replace abdominal ultrasound as a cost-effective screening diagnostic modality for NAFLD. Keywords: Non-alcoholic fatty liver disease, Machine learning, prediction, abdominal ultrasonography, Diabetes mellitus Abbreviations: NAFLD: Non-alcoholic fatty liver disease;autoML: Automated machine learning Funding and Conflicts of Interest None