Sustainable surgical practices: a comprehensive approach to reducing environmental impact

The authors present an overview of the environmental impact of surgical procedures and highlight potential strategies to reduce the associated greenhouse gas emissions. They discuss procurement, waste management and energy consumption, with examples of successful interventions. The authors emphasise the importance of adopting the Green Theatre Checklist as a tool for clinicians to implement sustainable surgical practices.

McNamee C, Rakovac A, Cawley DT, et al. Surgeon 2024; 22(5): b253. https://doi.org/10.1016/j.surge.2023.08.007

Increasing opportunities for breast-conserving therapy in multiple ipsilateral breast cancer (MIBC): Dutch nationwide study 

Data from 114,433 patients (83%) with unifocal breast cancer and 23,932 patients (17%) with MIBC from the Netherlands Cancer Registration were analysed. Breast-conserving surgery (BCS) rates increased in MIBC from 29% in 2011 to 41% in 2021. The five-year OS estimate for MIBC treated with BCS was 93%. The pathological complete response in MIBC patients treated with neoadjuvant chemotherapy followed by mastectomy was 23%. The authors conclude that there are opportunities for more BCS in MIBC.

Heeling E, Volders JH, Roos WK, et al. Br J Surg 2024; 111(9) znae229. https://doi.org/10.1093/bjs/znae229

Nurse understaffing associated with adverse outcomes for surgical admissions 

This longitudinal study used data on 213,910 surgical admissions to examine the impact of exposure to low staffing on patient outcomes. Increased exposure to understaffing of registered nurses was associated with a longer hospital stay and increased risk of deep vein thrombosis, pneumonia and pressure ulcers. This was also true for understaffing of nurse assistants, but effect sizes tended to be smaller. There were similarly increased hazards of death for nurse understaffing. The authors conclude that understaffing is associated with a range of adverse events.

Meredith P, Turner L, Saville C, Griffiths P. Br J Surg 2024; 11(9): znae215. https://doi.org/10.1093/bjs/znae215

Standard or extended lymphadenectomy for muscle invasive bladder cancer

This trial randomised 592 patients with localised muscle-invasive bladder cancer to undergo bilateral standard lymphadenectomy or extended lymphaden-ectomy. Overall survival at five years was 59% in the extended lymphadenectomy group and 63% in the standard lymphadenectomy group. Adverse events (54% vs. 44%) and death within 90 days after surgery (7% vs. 2%) were higher in the extended lymphadenectomy group. The authors concluded that extended lymphadenectomy did not result in improved survival and was associated with higher perioperative morbidity and mortality. 

Lerner SP, Tangen C, Svatek RS, et al. for the SWOG S1011 Trial Investigators. N Engl J Med 2024; 391: 1206–16. https://doi.org/10.1056/nejmoa2401497

The cost of cosmetic surgery tourism complications to the NHS: a retrospective analysis

This database review identified 81 patients during a five-year period presenting to Canniesburn Plastic Surgery Unit with complications from cosmetic surgery tourism undertaken outside the UK. Of these, 75% had undergone surgery in Turkey. The most common problems were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9,327.90 per patient. The authors recommend a national consensus on the
extent of NHS management and urgent international collaboration with policymakers to address this issue. 

Roberts JL, Eckersley M, Davies KJ, et al. Surgeon 2024; 22(5): b281. https://doi.org/10.1016/j.surge.2024.04.012

Upper gastrointestinal training in the UK and Ireland: a Roux Group study

This questionnaire of 241 surgeons sought views on current upper gastrointestinal (UGI) training in the UK and Ireland. Operative requirements were considered achievable (87.6%) but inadequate for day-one consultant practice (74.7%). Most deemed there was a role for on-the-job operative training following consultant appointment. The numbers of index UGI operations suggested were comparable with current curriculum requirements. Post-CCT fellowships were not considered essential but most (73.6%) saw their advantage. Areas for improvement include flexibility in geographical working
and increasing provisions for high-quality endoscopy training.

Robinson DBT, Zakeri R, Brown LR, et al. on behalf of Roux Group. Ann. R. Coll. Surg. Engl 2024; 106(7): 610–19. https://doi.org/10.1308/rcsann.2023.0104