Burnout within UK surgical specialties: a systematic review.

INTRODUCTION: Burnout is of growing concern within the surgical workforce, having been shown to result in reduced job satisfaction, decreased patient satisfaction and higher rates of medical errors. Determining the extent of burnout and identifying its risk factors within UK surgical practice is essential to ensure appropriate interventions can be implemented to improve mental wellbeing. MATERIALS: A systematic search of PubMed, Medline, Embase, PsychINFO and Cochrane databases was performed, following PRISMA guidelines. Studies published between January 2000 and October 2019 that reported prevalence data or risk factors on burnout for surgeons working within the UK and/or the Republic of Ireland were included. FINDINGS: Ten papers met the inclusion criteria. The overall prevalence of burnout amongst surgeons in the UK was 32.0% (IQR 28.9-41.0%), with surgical trainees having the highest prevalence (59.0%) of burnout documented for any subgroup. The most common risk factors identified for burnout were younger surgeon age and lower clinical grade. Being married or living with a partner was found to be protective. CONCLUSIONS: Burnout is highly prevalent in UK surgical specialties, mostly amongst surgical trainees. Targeted pre-emptive interventions based upon relevant risk factors for burnout should be prioritised, at both individual and institutional levels.

Increased use of laparoscopy in acute right iliac fossa pain - is it good for patients?

AIM: The use of laparoscopy, with or without appendicectomy, is becoming more common in the management of acute right iliac fossa (RIF) pain, but little is known of the 'unintended' consequences of this change. This study aimed to evaluate the impact of increased use of laparoscopy on the number and type of patients treated surgically and on the rate of negative appendicectomy. METHOD: A prospective audit was carried out of admissions to a teaching hospital over two, 3-month periods during 2007 and 2008. The management, investigations and outcome of patients presenting with RIF pain were studied. RESULTS: Admissions were stable over the two time-periods. There was a significant increase in the number of laparoscopic operations performed, from 22.5% (14/62) in 2007 to 85.7% (72/84) in 2008 (P < 0.0001), and the percentage of patients undergoing surgery rose from 55.4% (n = 62) in 2007 to 71.2% (n = 84) in 2008 (P < 0.01). In 2008, female patients were more likely to have surgery, an increase from 37.1% to 66.2% (P < 0.001), and were more likely to have a laparoscopic procedure, an increase from 50% to 98% (P < 0.0001). The rate of histologically confirmed appendicitis did not increase significantly (50/122 vs 57/118; P = 0.25), but the number of patients with a normal appendix either left in situ because it was macroscopically normal or found to be histologically normal following excision, increased significantly, from 9.01% in 2007 to 21.2% in 2008 (P < 0.01). The diagnostic value of pelvic ultrasound decreased from 75.6% of examinations in 2007 to 54.5% in 2008 (P = 0.039). CONCLUSION: An increase in laparoscopic procedures has resulted in more operations in women, an associated higher negative appendicectomy rate and decreased usefulness of pelvic ultrasound. Increased use of laparoscopy needs to be balanced against the diagnostic benefits of 'negative' laparoscopy.

Factors influencing incident reporting in surgical care.

OBJECTIVES: To evaluate the process of incident reporting in a surgical setting. In particular: the influence of event outcome on reporting behaviour; staff perception of surgical complications as reportable events. DESIGN: Anonymous web-based questionnaire survey. SETTING: General Surgical Department in a UK teaching hospital. POPULATION: Of 203 eligible staff, 55 (76.4%) doctors and 82 (62.6%) nurses participated. MAIN OUTCOME MEASURES: Knowledge and use of local reporting system; propensity to report incidents which vary by outcome (harm, no harm, harm prevented); propensity to report surgical complications; practical and psychological barriers to reporting. RESULTS: Nurses were significantly more likely to know of the local reporting system and to have recently completed a report than doctors. The level of harm (F(1.8,246) = 254.2, p<0.001), incident type (F(1.9,258) = 64.4, p<0.001) and profession (F(1,135) = 20.7, p<0.001) all significantly affected the likelihood of reporting. Staff were most likely to report an incident when harm occurred. Doctors were significantly less likely to report surgical complications than other types of incident (15% vs 53%, z = 4.633, p<0.001). Fear was a significantly less important barrier to reporting than other reasons (z = -3.49, p<0.0002). CONCLUSION: An incident is more likely to be reported if harm results. Surgical complications are not generally perceived to be "reportable incidents," but they are addressed in Mortality and Morbidity meetings (M&M). Integrating M&M and incident reporting data will result in more comprehensive healthcare safety systems.