Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey Mostafa Shalaby, Ahmed M. ElSheikh, Hosam Hamed, Ahmed Elsheik, Ahmad Sakr, et al. BMC Psychology, 2024 Background SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration The study was registered on clicaltrials.gov “NCT04433286” on 16/06/2020.
Understanding the long-term impact of the COVID-19 pandemic on non-muscle-invasive bladder cancer outcomes: 12-Month follow-up data from the international, prospective COVIDSurg Cancer study Cameron E. Alexander, Arjun Nathan, Alexander Light, Chuanyu Gao, Vinson Chan, et al. Bjui Compass, 2024 ObjectiveThe objective of this study was to report the 12‐month oncological outcomes for patients with non‐muscle‐invasive bladder cancer (NMIBC) within the prospective, international COVIDSurg Cancer study.Patients and methodsEligible patients were aged ≥18 years and scheduled for elective surgical management of NMIBC with curative intent (transurethral resection of bladder tumour [TURBT] or bladder biopsy) from 21 January to 14 April 2020. The primary outcome was disease recurrence within 12 months of previous elective TURBT/bladder biopsy. Secondary outcomes included disease progression within 12 months of previous elective TURBT/bladder biopsy, site‐declared delay to surgery from diagnosis as a consequence of COVID‐19 and deviation in standard care due to COVID‐19. Comparisons were made to cohorts from the pre‐pandemic era.ResultsBladder cancer accounted for 2.2% (n = 446) of patients in the COVIDSurg Cancer study, with data contributed by 27 centres across 12 countries internationally. Within this included cohort, 229 patients had NMIBC and 12‐month follow‐up data available. On application of National Institute for Health and Care Excellence (NICE) criteria, 47.2% were classified as having high‐risk disease. Overall disease recurrence and progression rates were 29.3% and 9.7% at 12 months, respectively. In purely high‐risk pre‐pandemic cohorts, the International Bladder Cancer Group (IBCG) estimates a recurrence rate of 25% at 12 months, and the European Association of Urology (EAU) NMIBC 2021 scoring model estimates a 12‐month progression rate of 3.5%. As a consequence of the COVID‐19 pandemic, 10.9% of patients had site‐declared delay to TURBT/bladder biopsy; 7.4% did not undergo intravesical therapy or had early discontinuation of this; 9.2% did not undergo early repeat resection for high‐risk disease; and 18.3% had a delay to cystoscopic follow‐up surveillance.ConclusionsThis prospective study indicates that there were widespread deviations in usual care for NMIBC during the pandemic and that 12‐month oncological outcomes appear to be impaired compared to published pre‐pandemic outcomes.
Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study Mauro Podda, Marcello Di Martino, Francesco Pata, Giuseppe Nigri, Adolfo Pisanu, et al. Updates in Surgery, 2024 The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity > 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI.
Development and external validation of the 'Global Surgical-Site Infection' (GloSSI) predictive model in adult patients undergoing gastrointestinal surgery McLean KA, Knight SR, Clark N, Ademuyiwa A, Adisa A, et al. British Journal of Surgery, 2024 Background Identification of patients at high risk of surgical-site infections may allow surgeons to minimize associated morbidity. However, there are significant concerns regarding the methodological quality and transportability of models previously developed. The aim of this study was to develop a novel score to predict 30-day surgical-site infection risk after gastrointestinal surgery across a global context and externally validate against existing models. Methods This was a secondary analysis of two prospective international cohort studies: GlobalSurg-1 (July–November 2014) and GlobalSurg-2 (January–July 2016). Consecutive adults undergoing gastrointestinal surgery were eligible. Model development was performed using GlobalSurg-2 data, with novel and previous scores externally validated using GlobalSurg-1 data. The primary outcome was 30-day surgical-site infections, with two predictive techniques explored: penalized regression (least absolute shrinkage and selection operator (‘LASSO’)) and machine learning (extreme gradient boosting (‘XGBoost’)). Final model selection was based on prognostic accuracy and clinical utility. Results There were 14 019 patients (surgical-site infections = 12.3%) for derivation and 8464 patients (surgical-site infections = 11.4%) for external validation. The LASSO model was selected due to similar discrimination to extreme gradient boosting (AUC 0.738 (95% c.i. 0.725 to 0.750) versus 0.737 (95% c.i. 0.709 to 0.765)), but greater explainability. The final score included six variables: country income, ASA grade, diabetes, and operative contamination, approach, and duration. Model performance remained good on external validation (AUC 0.730 (95% c.i. 0.715 to 0.744); calibration intercept −0.098 and slope 1.008) and demonstrated superior performance to the external validation of all previous models. Conclusion The ‘Global Surgical-Site Infection’ score allows accurate prediction of the risk of surgical-site infections with six simple variables that are routinely available at the time of surgery across global settings. This can inform the use of intraoperative and postoperative interventions to modify the risk of surgical-site infections and minimize associated harm.
Malignant transformation and tumour recurrence in sacrococcygeal teratoma: a global, retrospective cohort study Lieke J. van Heurn, Joep P.M. Derikx, Nigel Hall, Jennifer H. Aldrink, Maria M. Bailez, et al. International Journal of Surgery, 2024 Introduction: Sacrococcygeal teratoma (SCT) is a rare congenital tumour. The risk of malignancy and recurrence is not well defined. Previous studies are small and report differing conclusions about the timing of surgery and the duration of follow-up. The authors studied the risk of malignant transformation and SCT recurrence after surgery to address these gaps. Methods: This was a global retrospective cohort study. Data of consecutive SCT patients was obtained from 145 institutes in 62 countries. Malignant transformation, defined as malignancy at initial resection, malignant recurrence or death due to malignancy, and its risk factors were analysed. Results: Of the 3612 included patients, 3407 entered analysis. The risk of malignant transformation of the initial tumour was 3.3, 5.1, 10.1, and 32.9% at age 3 months, 6 months, 1 year, and 2 years, respectively. After 6 years, the censored risk of malignancy (64%) did not further increase. Recurrent SCT was diagnosed in 349 (10.2%) children with 126 (36.1%) malignant recurrences. Risk factors for recurrence were Altman type II [odds ratio (OR): 1.6, 95% confidence interval (CI): 1.2–2.2], Altman type III (OR: 1.6, 95% CI: 1.2–2.3), initial immature histology (OR: 1.9, 95% CI: 1.4–2.6), and initial malignant histology (OR: 4.0, 95% CI: 2.9–5.4). Conclusion: The risk of malignancy at initial resection in SCT increases with age reaching a plateau at 6 years of age. Recurrence after resection occurred in 10% of patients and 36% of these were malignant at that time. Altman type II or type III, and immature or malignant histology were associated with recurrence. Level of evidence: Level III.
Extrahepatic bile duct fibroma in an infant: a case report Md. Samiul Hasan, S. M. Nazmul Islam, Umama Huq, Mashud Parvez, Hasiba Mahshed Khan, et al. Annals of Pediatric Surgery, 2023 Background Extrahepatic bile duct tumor in neonates and infants is extremely rare. Fibroma in neonates and infants has been reported in different body parts but not in the bile duct. We report a 2-month-old girl with common bile duct (CBD) fibroma. Case presentation A 2-month-old girl presented with jaundice and pale stool for 15 days. Her perinatal period was uneventful. On examination, we found the girl deeply icteric and having hepatomegaly but no palpable lump. Laboratory investigations revealed direct hyperbilirubinemia with elevated liver enzymes. Ultrasonography revealed hepatomegaly with focal dilatation of the extrahepatic bile duct (2.1 × 0.5 cm). Our preliminary diagnosis was a type I choledochal cyst. Considering the clinical scenario, we planned for exploration without further imaging. On exploration, we found the liver blackish and a hard mass involving the common CBD and cystic duct. The gall bladder was filled with clear mucus. After excising the mass, the gall bladder, and CBD, we reconstructed the anatomy with Roux-N-Y hepaticojejunostomy. The postoperative period was uneventful except for minor bile leakage during the first four postoperative days, which stopped spontaneously. Histopathology revealed spindle-shaped fibrous tissue admixed with collagenous tissue, compatible with a fibroma. A liver biopsy showed the features of cirrhosis. However, liver function tests were normal 2 weeks after surgery. The baby was thriving at 6 months of follow-up, hepatomegaly was resolved, and there was no clinical or radiological sign of recurrence. Conclusions CBD fibroma is a rare cause of obstructive jaundice in neonates and infants. The earliest possible excision of the tumor and bile drainage restoration are necessary to halt the progression of liver damage.
Pediatric trauma and emergency surgery: an international cross-sectional survey among WSES members Martin Reichert, Massimo Sartelli, Ingolf H. Askevold, Jaqueline Braun, Markus A. Weigand, et al. World Journal of Emergency Surgery, 2023 Background In contrast to adults, the situation for pediatric trauma care from an international point of view and the global management of severely injured children remain rather unclear. The current study investigates structural management of pediatric trauma in centers of different trauma levels as well as experiences with pediatric trauma management around the world. Methods A web-survey had been distributed to the global mailing list of the World Society of Emergency Surgery from 10/2021–03/2022, investigating characteristics of respondents and affiliated hospitals, case-load of pediatric trauma patients, capacities and infrastructure for critical care in children, trauma team composition, clinical work-up and individual experiences with pediatric trauma management in response to patients´ age. The collaboration group was subdivided regarding sizes of affiliated hospitals to allow comparisons concerning hospital volumes. Comparable results were conducted to statistical analysis. Results A total of 133 participants from 34 countries, i.e. 5 continents responded to the survey. They were most commonly affiliated with larger hospitals (> 500 beds in 72.9%) and with level I or II trauma centers (82.0%), respectively. 74.4% of hospitals offer unrestricted pediatric medical care, but only 63.2% and 42.9% of the participants had sufficient experiences with trauma care in children ≤ 10 and ≤ 5 years of age (p = 0.0014). This situation is aggravated in participants from smaller hospitals (p < 0.01). With regard to hospital size (≤ 500 versus > 500 in-hospital beds), larger hospitals were more likely affiliated with advanced trauma centers, more elaborated pediatric intensive care infrastructure (p < 0.0001), treated children at all ages more frequently (p = 0.0938) and have higher case-loads of severely injured children < 12 years of age (p = 0.0009). Therefore, the majority of larger hospitals reserve either pediatric surgery departments or board-certified pediatric surgeons (p < 0.0001) and in-hospital trauma management is conducted more multi-disciplinarily. However, the majority of respondents does not feel prepared for treatment of severe pediatric trauma and call for special educational and practical training courses (overall: 80.2% and 64.3%, respectively). Conclusions Multi-professional management of pediatric trauma and individual experiences with severely injured children depend on volumes, level of trauma centers and infrastructure of the hospital. However, respondents from hospitals at all levels of trauma care complain about an alarming lack of knowledge on pediatric trauma management.
Clinical outcomes after Kasai portoenterostomy in biliary atresia: role of early surgery and liver surface telangiectasia in a resource-limited setting S Hasan, UF Karim, R Mahmud, N Islam, A Rahman Surgery on Children 3 (2), 38-42 , 2026 2026
Malignant transformation of sacrococcygeal teratoma versus presacral teratoma in Currarino syndrome: Results of ‘The SCT-study’ LJ Van Heurn, JPM Derikx, NJ Hall, AA AbouZeid, SCV Abib, LB Chirdan, ... Journal of Pediatric Surgery, 162848 , 2026 2026
Comparison of outcome of preformed silo with traditionally constructed silo among neonates with gastroschisis NJ Mona, S Hasan, A Rahman Surgery on Children 2 (2), 54-59 , 2025 2025
Role of intramuscular testosterone therapy for the position of meatus as well as the changes in the degree of chordee on proximal penile hypospadias in children: a non … R Mahmud, S Hasan, N Islam, A Rahman Surgery on Children 2 (1), 5-10 , 2025 2025
Effect of mucous fistula refeeding in neonates with small bowel enterostomy at a low resource center-a prospective interventional study in a Bangladeshi pediatric surgical unit U Huq, S Hasan, CM Burgos, A Rahman Surgery on Children 1 (4), 79-83 , 2024 2024
Understanding the long‐term impact of the COVID‐19 pandemic on non‐muscle‐invasive bladder cancer outcomes: 12‐Month follow‐up data from the international, prospective … CE Alexander, A Nathan, A Light, C Gao, V Chan, S Khadhouri, ... BJUI compass 5 (11), 1158-1165 , 2024 2024 Citations: 3
Safety and benefits of early urethral catheter removal after resectioning the recto urethral fistula during posterior sagittal anorectoplasty S Hasan, N Islam, R Mahmud, A Rahman Surgery on Children 1 (3), 49-51 , 2024 2024
A prognostic model for use before elective surgery to estimate the risk of postoperative pulmonary complications (GSU-Pulmonary Score): a development and validation study in … L Bravo, JFF Simões, VR Cardoso, A Adisa, ML Aguilera, A Arnaud, ... The Lancet Digital Health 6 (7), e507-e519 , 2024 2024 Citations: 9
Development and external validation of the ‘Global Surgical-Site Infection’(GloSSI) predictive model in adult patients undergoing gastrointestinal surgery British Journal of Surgery 111 (6), znae129 , 2024 2024
Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in … BM Biccard, D Smith, S Peters, A Boutall, G Wilson, E Coetzee, M Flint, ... BJA open 7, 100207 , 2023 2023
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries British Journal of Surgery 110 (7), 804-817 , 2023 2023 Citations: 31
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries A Adisa, M Bahrami-Hessari, A Bhangu, C George, D Ghosh, J Glasbey, ... British Journal of Surgery , 2023 2023 Citations: 17
Use of Telemedicine for Postdischarge Assessment of the Surgical Wound I Trout, V Adeyeye, A Ademuyiwa, A Adisa, A Bhatt, B Biccard, ... ANNALS OF SURGERY 277 (6), 1331-1347 , 2023 2023
Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries JC Glasbey, TEF Abbott, A Ademuyiwa, A Adisa, E AlAmeer, S Alshryda, ... The Lancet 400 (10363), 1607-1617 , 2022 2022 Citations: 56
Paediatric appendicitis: international study of management in the COVID-19 pandemic P Van Amstel, A El Ghazzaoui, NJ Hall, T Wester, F Morini, ... British Journal of Surgery 109 (11), 1044-1048 , 2022 2022 Citations: 12
Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic S Bandyopadhyay, N Peter, K Lakhoo, SCV Abib, H Abdelhafeez, ... BMJ Global Health 7 (10) , 2022 2022 Citations: 8
Global economic burden of unmet surgical need for appendicitis A Reuter, L Rogge, M Monahan, M Kachapila, DG Morton, J Davies, ... British journal of surgery 109 (10), 995-1003 , 2022 2022 Citations: 22
Evolving trends in the management of acute appendicitis during COVID‐19 waves: The ACIE Appy II study F Pata, M Di Martino, M Podda, S Di Saverio, B Ielpo, G Pellino, ... World journal of surgery 46 (9), 2021-2035 , 2022 2022 Citations: 12
Correction to: Two years later: Is the SARS-CoV-2 pandemic still having an impact on emergency surgery? An international cross-sectional survey among WSES members A Brillantino World Journal of Emergency Surgery , 2022 2022
Use of telemedicine for postdischarge assessment of the surgical wound: international cohort study, and systematic review with meta-analysis J Glasbey, I Trout, V Adeyeye, A Ademuyiwa, A Adisa, A Bhatt, B Biccard, ... Annals of surgery 277 (6), e1331 , 2022 2022 Citations: 12
MOST CITED SCHOLAR PUBLICATIONS
Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study MI GONZALEZ Anaesthesia , 2021 2021 Citations: 677
Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study A Bhangu, AO Ademuyiwa, ML Aguilera, P Alexander, SW Al-Saqqa, ... The Lancet Infectious Diseases 18 (5), 516-525 , 2018 2018 Citations: 613
Mortality of emergency abdominal surgery in high-, middle-and low-income countries Journal of British Surgery 103 (8), 971-988 , 2016 2016 Citations: 407
Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective … NJ Wright, AJM Leather, N Ade-Ajayi, N Sevdalis, J Davies, D Poenaru, ... The Lancet 398 (10297), 325-339 , 2021 2021 Citations: 167
Global attitudes in the management of acute appendicitis during COVID‐19 pandemic: ACIE Appy Study B Ielpo, M Podda, G Pellino, F Pata, R Caruso, G Gravante, S Di Saverio, ... British Journal of Surgery 108 (6), 717-726 , 2021 2021 Citations: 137
SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study C COVIDSurg, C GlobalSurg Anaesthesia: Peri-operative medicine, critical care and pain , 2022 2022 Citations: 133
Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries AO Ademuyiwa, AP Arnaud, TM Drake, JEF Fitzgerald, D Poenaru, ... BMJ global health 1 (4) , 2016 2016 Citations: 108
Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy Journal of British Surgery 106 (2), e103-e112 , 2019 2019 Citations: 94
Laparoscopy in management of appendicitis in high-, middle-, and low-income countries: a multicenter, prospective, cohort study Surgical endoscopy 32 (8), 3450-3466 , 2018 2018 Citations: 87
Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score British journal of surgery 108 (11), 1274-1292 , 2021 2021 Citations: 57
Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries JC Glasbey, TEF Abbott, A Ademuyiwa, A Adisa, E AlAmeer, S Alshryda, ... The Lancet 400 (10363), 1607-1617 , 2022 2022 Citations: 56
It is time to define an organizational model for the prevention and management of infections along the surgical pathway: a worldwide cross-sectional survey M Sartelli, FM Labricciosa, F Coccolini, R Coimbra, FM Abu-Zidan, ... World journal of emergency surgery 17 (1), 17 , 2022 2022 Citations: 51
Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study COVIDSurg Collaborative, GlobalSurg Collaborative, D Nepogodiev, ... Anaesthesia 76 (11), 1454-1464 , 2021 2021 Citations: 51
Neonatal surgical morbidity and mortality at a single tertiary center in a low-and middle-income country: A retrospective study of clinical outcomes MS Hasan, N Islam, AR Mitul Frontiers in Surgery 9, 817528 , 2022 2022 Citations: 37
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries British Journal of Surgery 110 (7), 804-817 , 2023 2023 Citations: 31
COVID-19-related absence among surgeons: development of an international surgical workforce prediction model BJS open 5 (2), zraa021 , 2021 2021 Citations: 31
Global variation in anastomosis and end colostomy formation following left-sided colorectal resection GlobalSurg Collaborative, ... BJS open 3 (3), 403-414 , 2019 2019 Citations: 29
Surgical site infection after gastrointestinal surgery in children: an international, multicentre, prospective cohort study TM Drake, F Pata, D Ghosh, AO Ademuyiwa, A Arnaud, A Bhangu, ... BMJ global health 5 (12) , 2020 2020 Citations: 28
Management and outcomes following surgery for gastrointestinal typhoid: an international, prospective, multicentre cohort study GlobalSurg Collaborative, TTK Anyomih, TM Drake, J Glasbey, ... World journal of surgery 42 (10), 3179-3188 , 2018 2018 Citations: 24
Global economic burden of unmet surgical need for appendicitis A Reuter, L Rogge, M Monahan, M Kachapila, DG Morton, J Davies, ... British journal of surgery 109 (10), 995-1003 , 2022 2022 Citations: 22