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Low mortality rate after emergency laparotomy in Australia a reflection of national surgical mortality audit influencing futile surgery

Data were extracted from the Australian and New Zealand Emergency Laparotomy Audit (ANZELA) from 2018 to 2022. Compared with overseas studies, there was a lower early (within 72 hours) mortality rate in ANZELA. The lower mortality rate persisted to 30 days, but there was a relative increase after 14 days that likely reflected known poor compliance with care standards. Australian patients had fewer high-risk characteristics than those in the National Emergency Laparotomy Audit. The present findings support the hypothesis that thelower mortality rate after emergency laparotomy in Australia is likely a consequence of its national mortality audit and the avoidance of futile surgery.

Pule LM, Kopunic H, Aitken RA, on behalf of the Australian and New Zealand Emergency Laparotomy Audit (ANZELA). Br J Surg 2023; 110(10): 1367–1373

Surgical team dynamics in a reflective team meeting to improve care quality

An adapted weekly M&M meeting was developed where the surgical team reflected on all recently discharged patients and planned procedures. A qualitative study was undertaken using semi-structured interviews from team members involved in vascular surgical care. The overarching finding was that the reflective team meeting worked to promote a shared mental model (SMM) among team members, improving quality of care. Specifically, it facilitated the availability of ‘reliable clinical data’, contributing to ‘a common understanding of the quality standard for good care’, ‘awareness of risks and opportunities’, and shaping ‘shared professional values’.

Verhagen MV, de Vos MS, van Schaik J et al. Br J Surg 2023; 110(10); 1271–1275

Multispecialty Geriatric Surgery Pathway (GSP) reduces in-patient
cost for frail patients

Patients aged over 65 who underwent an in-patient elective surgical procedure included in the American College of Surgeons National Quality Improvement Program registry from July 2016 through to December 2017 were compared with patients from February 2018 to December 2019 who were cared for on our GSP. The cost of healthcare services during hospitalisation was significantly lower in the cohort on our GSP, with cost savings more evident in our frail geriatric patients needing surgery. This study shows that high-value care can be achieved with the implementation of a GSP.

Ehrlich A, Owodunni, O, Mostales J et al. Ann Surg 2023; 278(4):
e726–e732

Assessing ChatGPT’s ability to pass the FRCS Orthopaedic Part A exam

This study evaluated the ability of ChatGPT4 to pass the Orthopaedic FRCS Orth Part A exam using a series of 240 questions. In section 1 of the exam ChatGPT4 scored 50% and in section 2 ChatGPT4 scored 85%. On average it took only six seconds to generate a response. The average score of 67.5% was below the pass mark of around 70%. Factors currently contributing to this outcome include the lack of critical abilities, limited clinical expertise, and inadequate background knowledge and training of ChatGPT4.

Saad A, Iyengar KP, Kurisunkal V, Botchu R. The Surgeon 2023; 21(5): 263–266

Evaluating YouTube as a source of education for patients undergoing surgery

This systematic review evaluated YouTube as a source of patient education relating to surgical procedures. There were 56 studies examined, 6,797 videos with 547 hours of content and 1.39 billion views. The 49 studies that evaluated the educational quality of the video and 34/49 studies (69%) concluded that the overall quality of educational content was poor. Authors recommend a peer-reviewed and standardised approach to online education with video content to better support patients.

Javidan A, Nelms M, Li A et al. Ann Surg 2023; 278(4): e712–e718

Referral criteria and assessment
for bariatric surgery: summary
of updated NICE guidance

Updated NICE guidance has removed the recommendation for people to have attempted all non-surgical interventions or to be under management of a tier 3 service to be assessed for bariatric surgery. It is still recommended that nutritional, surgical and psychological MDT assessments are undertaken as part of a specialist weight management service.

 Gildea A, Shukla S, Parretti H, Kha O. BMJ 2023; 382: 1880