Limb Lengthening and Reconstruction Society orthopedic surgeons in the United States:An analysis of geographical distribution,academic,leadership,and demographic characteristics

BACKGROUND The Limb Lengthening and Reconstruction Society(LLRS)is a premier orthopedic specialty organization that promotes limb reconstruction for all ages.LLRS membership characteristics,however,are poorly reported.This study delineates orthopedic surgeon LLRS members’demographic traits,academic achievement,leadership attainment,and geographical distribution across the United States.AIM To inform aspiring orthopedic professionals,as well as to promote growth and diversity in both the LLRS organization and overarching field.METHODS This cross-sectional study examined United States LLRS members’academic,leadership,demographic,and geographical attributes.After reviewing the 2023 LLRS member directory,Google search results were matched to the listings and appended to the compiled data.Sex and ethnicity were evaluated visually utilizing retrieved images.The Hirsch index(H-index)of academic activity,residency and fellowship training,other graduate degrees,leadership positions,practice type(academic or non-academic),and spoken languages were categorized.LLRS members per state and capita determined geographic distribution.The Mann Whitney U test was applied to compare H-index between males and females,as well as to assess member differences pertaining to affiliation with academic vs non-academic practice facilities.RESULTS The study included 101 orthopedic surgeons,78(77.23%)Caucasian and 23(22.77%)non-Caucasian,79(78.22%)male and 22(21.78%)female.Surgeons with DO degrees comprised only 3.96%(4)of the cohort,while the vast majority held MDs[96.04%(97)].Mean H-index was 10.55,with male surgeons having a significantly higher score(P=0.002).Most orthopedic surgeons(88.12%,)practiced in academic centers.Of those professionals who occupied leadership positions,14%were women,while 86%were men.Additionally,19(37.25%)United States regions and the District of Columbia lacked an LLRS-member orthopedic surgeon.Total per capita rate across the United States was 0.30 LLRS orthopedic surgeons per 1 million people.CONCLUSION Over 21%of LLRS members are women,surpassing prior benchmarks noted in orthopedic faculty reporting.LLRS members’high research productivity scores imply field dedication that can refine expertise in the limb lengthening and reconstruction space.Gender disparities in leadership remain,however,necessitating greater equity efforts.A low rate of LLRS representation per capita must be addressed geographically as well,to affect improvements in regional care access.This study can serve to support aspiring orthopedic professionals,inform diversity,leadership,and field advancement strategies,and maintain the continued goal of enhanced patient care worldwide.

Hans G.Beger:one of the most renowned general and gastrointestinal surgeons in Germany

Professor Beger is one of the most renowned general and gastrointestinal surgeons in Germany.His worldwide reputation is based on his expertise in surgery of the pancreas.He belongs to the group of the 100most cited surgeons worldwide.

Recording the direct surgeon’s view with an operating microscopic view improves microscopic ophthalmic surgery training

AIM:To establish a recording system with a direct view of the surgeon to supplement video recording under an operating microscope,which lacks information on the movement and position of the surgeon’s hands,and to facilitate the reproduction of a skilled surgeon’s technique by a surgeon in training.METHODS:A small camera was attached to the operating microscope with a custom adapter.Microscopic surgeon’s view and direct surgeon’s view through this new camera were recorded in the surgical recording system.Both movies were synchronized and analyzed how do surgeons handle the instruments.RESULTS:A small camera attached to the operating microscope allowed the surgeon’s hands motion to be recorded without interfering with the surgeon’s movements.Different surgeons used different methods to manipulate the ultrasound handpiece and the irrigation/aspiration device.Even in the simple paracentesis procedure,different surgeons used different methods.Surgeons-in-training were able to identify and improve their weaknesses by watching synchronized movies of their hand motions and microscopic view.CONCLUSION:Simultaneous recording the surgical field out of the operating microscopic view by a small camera set on the microscope is comprehensive and improves surgeons-in-training understanding and learning surgeries.

Entry-Level Forward Surgical Team Training Is Associated with Increased Confidence of Primary Combat Surgeons

Background: In recent years, we have established an entry-level Forward Surgical Team (FST) training program in a Chinese military medical university for the 5th grade undergraduates, who would be deployed to different military medical services as primary combat surgeons. This study aimed to assess the role of this pre-service training in improving their confidence with combat medical skills, after several years since they received the training. Methods: We conducted a nationwide survey of 239 primary combat surgeons who have ever participated in an entry-level FST training program before deployment between June 2016 and June 2020, which was for evaluating on a 5-point Likert scale the benefits of entry-level FST training and conventional surgery training in improving their confidence with combat medical skills. The difference in scores was compared using the student t-test. Significance was considered as P Results: The total score was significantly higher for entry-level FST training than that for conventional surgery training (30.76 ± 4.33 vs. 28.95 ± 4.80, P There was no significant difference between the training for surgical skills confidence scores (18.03 ± 8.04 vs. 17.51 ± 8.30, P = 0.098), but for non-technical skills, the score of entry-level FST training was significantly higher than that of conventional surgery training (12.73 ± 5.39 vs. 11.44 ± 5.62, P The distributions of confidence scores were different under various subgroups by demographics. There were no significant differences in scores between the two training in all specific surgical skill sets except “life-saving surgery” (P = 0.011). Scores of all 4 non-technical skill sets were significantly higher for entry-level FST than those for conventional surgery training (P Conclusions: The training should be considered as an essential strategy to improve confidence in combat medical skills, especially life-saving surgery and non-technical skills, for primary combat surgeons.

Urinary tract injury during hysterectomy:Does surgeon specialty and surgical volume matter?

BACKGROUND Ureteral injury is a known complication of hysterectomies.Recent studies have attempted to correlate surgeon volume and experience with incidence of urinary tract injuries during hysterectomies.Some studies have reported that as surgeon volume increases,urinary tract injury rates decrease.To our knowledge,no studies have assessed the relationship between surgeon subspecialty and the rate of urinary tract injury rates during minimally invasive hysterectomy.AIM To determine the incidence of urinary tract injury between urogynecologists,gynecologic oncologists,and general gynecologists.METHODS The study took place from January 1,2016 to December 1,2021 at a large comm-unity hospital in Detroit,Michigan.We conducted a retrospective chart review of adult patients who underwent minimally invasive hysterectomy.After we identified eligible patients,the surgeon subspecialty was identified and the surgeon’s volume per year was calculated.Patient demographics,medical history,physician-dictated operative reports,and all hospital visits postoperatively were reviewed.RESULTS Urologic injury occurred in four patients(2%)in the general gynecologist group,in one patient(1%)in the gynecologic oncologist group,and in one patient(1%)in the urogynecologist group.When comparing high and low-volume surgeons,there was no statistically significant difference in urinary tract injury(1%vs 2%)or bowel injury(1%vs 0%).There were more complications in the low-volume group vs the high-volume group excluding urinary tract,bowel,or major vessel injury.High-volume surgeons had four(1%)patients with a complication and low-volume surgeons had 12(4%)patients with a complication(P=0.04).CONCLUSION Our study demonstrated that there was no difference in the urinary tract injury rate in general gynecologists vs subspecialists,however our study was underpowered.

Hanging up the surgical cap:Assessing the competence of aging surgeons

BACKGROUND As the average age of surgeons continues to rise,determining when a surgeon should retire is an important public safety concern.AIM To investigate strategies used to determine competency in the industrial workplace that could be transferrable in the assessment of aging surgeons and to identify existing competency assessments of practicing surgeons.METHODS We searched websites describing non-medical professions within the United States where cognitive and physical competency are necessary for public safety.The mandatory age and certification process,including cognitive and physical requirements,were reported for each profession.Methods for determining surgical competency currently in use,and those existing in the literature,were also identified.RESULTS Four non-medical professions requiring mental and physical aptitude that involve public safety and have mandatory testing and/or retirement were identified:Airline pilots,air traffic controllers,firefighters,and United States State Judges.Nine late career practitioner policies designed to evaluate the ageing physician,including surgeons,were described.Six of these policies included subjective performance testing,4 using peer assessment and 2 using dexterity testing.Six objective testing methods for evaluation of surgeon technical skill were identified in the literature.All were validated for surgical trainees.Only Objective Structured Assessment of Technical Skills(OSATS)was capable of distinguishing between surgeons of different skill level and showing a relationship between skill level and post-operative outcomes.CONCLUSION A surgeon should not be forced to hang up his/her surgical cap at a predetermined age,but should be able to practice for as long as his/her surgical skills are objectively maintained at the appropriate level of competency.The strategy of using skill-based simulations in evaluating non-medical professionals can be similarly used as part of the assessment of the ageing surgeons’surgical competency,showing who may require remediation or retirement.

Magnetic resonance imaging in rectal cancer:A surgeon's perspective

Magnetic resonance imaging(MRI)in rectal cancer was first investigated in 1999 and has become almost mandatory in planning rectal cancer treatment.MRI has a high accuracy in predicting circumferential resection margin involvement and is used to plan neoadjuvant therapy.The accuracy of MRI in assessing mesorectal lymph nodes remains moderate,as there are no reliable criteria to assess nodal involvement.MRI seems to be good in assessing peritoneal involvement in upper rectal cancer;this however has been assessed in only a few studies and needs further research.For low rectal cancers,mesorectum is thin at the level of levator ani especially in relation to prostate;so predicting circumferential resection margin involvement is not easy.However high spatial resolution coronal imaging shows levator muscles,sphincter complex and intersphincteric plane accurately.This is used to stage low rectal tumors and plan plane of surgery(standard surgery,intersphincteric resection,Extralevator abdominoperineal resection).While most centres perform MRI post chemoradiotherapy,its role in accurate staging post neoadjuvant therapy remains debatable.THe role of Diffusion weighted MRI post neoadjuvant therapy is being evaluated in research settings.

Comparison of lymph node number and prognosis in gastric cancer patients with perigastric lymph nodes retrieved by surgeons and pathologists

Objective： To compare the numbers of positive and total lymph nodes and prognosis in gastric cancer patients whose perigastric lymph node retrieval was performed by surgeons and pathologists. Methods： We conducted a retrospective analysis of clinical and follow-up data from 1,056 patients who underwent gastric cancer D2 radical lymph node resection between January 2008 and December 2010 in the Gastrointestinal Surgery Department of Yantai Yuhuangding Hospital. The follow-up ended in December 2015. Patients were divided into two groups according to the specialty of physicians who performed the postoperative perigastric lymph node retrieval： the surgeon group （475 cases） and the pathologist group （581 cases）. The numbers of positive and total perigastric lymph nodes and the 3- and 5-year survival were compared between gastric cancer patients in the two groups overall and stratified by TNM stage （AJCC 7th Edition）. Results： Overall, the numbers of positive and total lymph nodes were significantly higher in the surgeon group than in the pathologist group （6.53±4.07 vs. 4.09±3.70, P=0.021; 29.64±11.50 vs. 20.71±8.56, P〈0.001）. Further analysis showed that the total number of lymph nodes in stage Ⅰ patients （19.40±9.62 vs. 15.45±8.59, P=0.011） and the numbers of positive and total lymph nodes in stage Ⅱ（1.38±1.08 vs. 0.87±1.55, P=0.031; 25.35±10.80 vs. 16.75±8.56, P〈0.001） and stage Ⅲ patients （8.11±6.91 vs. 6.66±5.12, P=0.026; 32.34±12.55 vs. 25.45±8.31, P〈0.001） were significantly higher in the surgeon group than in the pathologist group. The survival analysis showed that the 3- and 5-year survival of stage Ⅱ and Ⅲ patients was significantly higher in the surgeon group than in the pathologist group （82.0% vs. 73.1%, 69.5% vs. 61.2%, P=0.038; 49.2% vs. 38.9%, 36.3% vs. 28.0%; P=0.045）. Conclusions： Compared with retrieval performed by pathologists, postoperative perigastrie lymph node retrieval performed by surgeons was associated with significant increase in the total lymph node number of stage Ⅰ patients, the numbers of positive and total lymph nodes of stageⅡ and Ⅲ patients, and the survival of stageⅡ and stage Ⅱ gastric cancer patients.

Is there a difference in adenoma detection rates between gastroenterologists and surgeons?

AIM To compare the adenoma detection rate(ADR) between gastroenterologists and colorectal surgeons at Box Hill Hospital, Melbourne, Australia.METHODS A total of 300 colonoscopies performed by gastroenterologists and colorectal surgeons at Box Hill Hospital were retrospectively reviewed from May 2016 to June 2017. Exclusion criteria were: Patients ≤ 50 years old, colonoscopies with failure of caecal intubation, patients who previously had colon cancer and/or a colonic resection, history of polyposis syndromes or inflammatory bowel disease, or a colonoscopy within the last 10 years. Patient demographics, indications, symptoms and procedural-related outcomes were measured.RESULTS The ADR was not significantly different between gastroenterologists and colorectal surgeons(34% vs 34.67%; P = 0.90). The adjusted odds ratio correcting for gender, age, 1^(st) degree relative with colorectal cancer, previous colonoscopy, trainee involvement and caecal or terminal ileum intubation rate was 1.19(0.69-2.05).CONCLUSION Both specialties at our institution exceed benchmark standards suggested by published Australian and American guidelines. An association between endoscopist specialty and ADR was not observed.

Gastric cancer:Where is the place for the surgeon,the oncologist and the endoscopist today?

Gastric cancer remains a major health issue and a leading cause of death worldwide.While the incidence is decreasing in western countries,there has been a shift to more proximal cancers of the diffuse type,which are usually more aggressive and associated with a worse prognosis.Radical surgery still offers the only chance of long term survival,but surgery has reached a plateau of effectiveness and more aggressive approaches like"ultraradical" lymphadenectomy have not improved prognosis.There are three options to improve the situation:Earlier detection,neoadjuvant chemotherapy and adjuvant therapy.Whilst systematic gastroscopic screening makes sense in countries with a high incidence of gastric cancer,in other regions targeted investigation of risk groups including first-degree relatives of cancer patients,patients with a chronic corpusdominant gastritis or with defined genetic abnormalities may help to detect cancer at an earlier stage.Neoadjuvant chemotherapy has meanwhile proved to significantly improve the prognosis not only in patients with a locally advanced cancer who cannot be resected for cure but but also in those who are potentially amenable to curative resection.In the largest randomised study so far reported,perioperative chemotherapy raised overall survival after 5 years from 23%to 36%.The role of adjuvant chemotherapy has been discussed for over 30 years.Meta-analyses demonstrate a small but significant effect which,however,seems to be restricted to Asian patients.In a large USstudy,adjuvant radiochemotherapy appeared to significantly improve outcomes.However,less than 50%of the study patients underwent a systematic lymphadenectomy and so the results of the therapy group were not better to those of"only resected"patients in two large European studies.Thus,the indication of adjuvant(radio-)chemotherapy in gastric cancer currently remains uncertain.Endoscopists have found a therapeutic role through endoscopic resection of early cancers,introduced mainly by Japanese authors.With the development of high resolution endoscopy,endosonography and adequate equipment,the endoscopic curative resection of T1a-tumors(restricted to the mucosal layer) has been established.

Evaluation of utility in shoulder pathology:Correlating the American Shoulder and Elbow Surgeons and Constant scores to the EuroQoL

AIM: To study whether health utility scores can be derived from shoulder-specific scores.METHODS: Authors investigated two questions:(1) do the American Shoulder and Elbow Surgeons(ASES) score and the Constant score correlate with the EuroQo L(EQ-5D), a measure of health utility?(2) can the ASES and Constant scores be obtained from a complete study sample without bias? Thirty subjects with various shoulder diagnoses completed ASES, Constant, and EQ-5D instruments. Pearson correlations were calculated to assess the associations between EQ-5D score and ASES and Constant scores.RESULTS: The correlation between EQ-5D score and ASES score was 0.60(P < 0.001); it was 0.54 for EQ-5D and Constant scores(P < 0.003). A multiple regression model containing ASES score, Constant score, age, and gender failed to adequately predict EQ-5D. Moreover, 25% of patients meeting the inclusion criteria did not complete the ASES questionnaire because they did not feel that specific questions, such as "do usual sport-list" and "throw ball overhand," applied to them.CONCLUSION: Authors' results do not support the use of the ASES and Constant scores in predicting EuroQ ol health utility values. However, the Constant score was more suitable for this patient population because all patients were able to complete it.

Prevalence and factors of work-related musculoskeletal disorders among hand surgeons

BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers,thus subjecting these surgeons to the risk of musculoskeletal(MSK)injuries during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among hand surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail.The collected data were analyzed using descriptive statistics,one-way analysis of variance,and Fisher’s exact test.P values of<0.05 were considered statistically significant.RESULTS Of the 578 respondents,60.4%reported that they had sustained a work-related MSK injury,of which the most common diagnoses were lateral elbow epicondylitis(18.7%),low back pain(17.1%)and carpal tunnel syndrome(15.6%).Among those that reported an injury,73.1%required treatment and 29.2%needed time off work as a direct result of their injury.The number of work-related injuries incurred by a surgeon increased significantly with increasing age(P<0.003),increasing years in practice(P<0.001)and higher case load(P<0.05).CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence.These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries,thus minimizing the financial and psychological burden on these surgeons and the healthcare system.

Intraoperative complication rates in cataract surgery performed by resident trainees and staff surgeons in a tertiary eyecare center in Hungary

AIM: To compare the incidence of intraoperative complications during primary phacoemulsification(phaco) surgery between resident surgeons(residents) and staff surgeons(specialists) and to objectively determine the difficulty of stages in phaco surgery. METHODS: This retrospective study included cases of phaco cataract surgery performed between January and December 2019. There were no exclusion criteria. For each patient, demographics, clinical history, case complexity, type of surgeon, and operative details were reviewed. Primary outcomes included intraoperative complication rates and the objective measure of difficulty in the steps of the surgery performed by residents and specialists.RESULTS: A total of 3272 cases were included;7.4%(n=241) of cases were performed by residents. The overall complication rate was 5.4%(n=177). The intraoperative complication rate was significantly higher(P<0.001) in residents(n=33, 13.7%) than in specialists(n=144, 4.8%). The most frequent complications were posterior capsule tear(n=85, 2.6%), anterior capsule tear(n=50, 1.53%), zonular fiber loss(n=45, 1.38%), and dropped nucleus(n=15, 0.46%). Objectively, the most difficult steps during surgery were phaco in 66(60.0%), capsulorhexis in 21(19.1%), irrigation/aspiration in 13(11.8%), hydrodissection in 9(8.2%), and intraocular lens(IOL) implantation in 1(0.9%) case. CONCLUSION: Intraoperative complication rates are higher in residents than in specialists. The order of objective difficulty in phaco surgery steps is in line with the subjective findings of other surveys, revealing that the most challenging parts of phaco surgery are phaco and capsulorhexis.

Work-related musculoskeletal injuries among upper extremity surgeons:A web-based survey

BACKGROUND Work-related injuries have gained recent attention,especially in the orthopaedic literature.As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers,these surgeons can be at increased risk of acquiring workrelated musculoskeletal(MSK)disorders during their years in practice.AIM To assess the prevalence,characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail.The collected data were analyzed using descriptive statistics,one-way analysis of variance,and Fisher's exact test.P values of<0.05 were considered statistically significant.RESULTS Of the 142 respondents,90.8% were males and the majority were younger than 55 years old(65.5%).A work-related MSK injury was reported by 89.4% of respondents,of which the most common diagnoses were low back pain(26.1%)and lateral elbow epicondylitis(18.3%).Among those that reported an injury,82.7%required treatment and 26% required time off work as a direct result of their injury.The need to undergo treatment due to the injury was associated with increased number of injuries(P<0.01).Moreover,surgeons were more likely to require time off work when they had been in practice for>21 years(P<0.05).CONCLUSION A high proportion of surgeons in our survey reported MSK injuries,with more than one quarter of surgeons reported requiring time off work due to an MSK injury.The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care.Awareness of operative ergonomics,irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.

SARS-CoV-2, surgeons and surgical masks

The exact risk association of coronavirus disease 2019(COVID-19)for surgeons is not quantified which may be affected by their risk of exposure and individual factors.The objective of this review is to quantify the risk of COVID-19 among surgeons,and explore whether facemask can minimise the risk of COVID-19 among surgeons.A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers(HCWs)especially those work in surgical specialities including surgical nurses and intensivists.Additionally,systematic reviews that assessed the effectiveness of facemask against viral respiratory infections,including COVID-19,among HCWs were identified.Data from identified articles were abstracted,synthesised and summarised.Fourteen primary studies that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask(and other personal protective equipment)were summarised.Although the risk of COVID-19 could not be quantified precisely among surgeons,about 14%of HCWs including surgeons had COVID-19,there could be variations depending on settings.Facemask was found to be somewhat protective against COVID-19,but the HCWs’compliance was highly variable ranging from zero to 100%.Echoing surgical societies’guidelines we continue to recommend facemask use among surgeons to prevent COVID-19.

A Comparative Study of the Short-Term Efficacy of Laparoscopic Radical Resection of Right-Sided Colon Cancer with Two Different Surgeon Positions and Trocar Placements

Objective: To investigate the short-term efficacy of laparoscopic radical resection of right-sided colon cancer with two different surgeon positions and trocar placements. Methods: The data of 78 patients who underwent laparoscopic radical resection of right-sided colon cancer between January 2018 and August 2019 were retrospectively analysed. The surgical method was selected by the patients. The patients were divided into two groups according to the surgeons’ positioning habits and trocar placements. The group with the lead surgeon standing between the patient’s legs had 35 patients, and the group with the lead surgeon standing at the left side of the patient had 43 patients. The operation time, intraoperative blood loss, postoperative anal gas evacuation time, postoperative urinary catheter indwelling time, postoperative hospital stay, C-reactive protein (CRP) level on the first day after surgery, and postoperative pathological data and complications were compared between the two groups. Results: All patients underwent the laparoscopic radical resection of right-sided colon cancer, none converting to laparotomy. No significant difference (P > 0.05) in intraoperative blood loss (57.6 ± 21.3 ml vs 60.2 ± 35.3 ml), postoperative anal gas evacuation time (3.5 ± 1.1 d vs 3.8 ± 1.3 d), postoperative urinary catheter indwelling time (2.6 ± 1.3 d vs 2.4 ± 1.2 d), postoperative hospital stay (7.1 ± 1.8 d vs 7.5 ± 2.1 d), or CRP level on the first day after surgery (54.7 ± 9.6 mg/L vs 53.9 ± 8.2 mg/L) was detected between the two groups. The operation time was shorter in the group with the lead surgeon standing between the patient’s legs (185.2 ± 25.6 min vs 196.2 ±19.7 min) (P < 0.05). The two groups did not differ significantly in the tumour length (4.2 ± 1.3 cm vs 3.9 ± 1.5 cm), number of dissected lymph nodes (27.5 ± 11.6 vs 25.1 ± 15.4), pathological type, or postoperative pathological tumour-node-metastasis stage (P > 0.05). No patients died or had anastomotic fistula during their postoperative hospital stay, and the incidence of postoperative complications did not differ between the two groups (22.9% (8/35) vs 23.3% (10/42);P > 0.05). Conclusion: Under the principle of radical resection, the surgeon should adopt the most suitable standing position and trocar placement according to the specific situation. If the surgeon stands between the patient’s legs, this might shorten the operation time and promote a smoother surgery.

Evaluation of current surgeon practice for patients undergoing lumbar spinal fusion surgery in the United Kingdom

AIM: To ascertain current surgeon practice in the United Kingdom National Health Service for the management of patients undergoing lumbar spinal fusion surgery. METHODS: Descriptive survey methodology utilised an online questionnaire administered through SurveyMonkey. Eligible participants were all surgeons currently carrying out lumbar spinal fusion surgery in the National Health Service. Two previous surveys and a recent systematic review informed questions. Statistical analyses included responder characteristics and pre-planned descriptive analyses. Open question data were interpreted using thematic analysis.RESULTS: The response rate was 73.8%. Most surgeons(84%) were orthopaedic surgeons. Range of surgeon experience(1-15 years), number of operations performed in the previous 12 mo(4-250), and range of information used to predict outcome was broad. There was some consistency of practice: most patients were seen preoperatively; all surgeons ensured patients are mobile within 3 d of surgery; and there was agreement for the value of post-operative physiotherapy. However, there was considerable variability of practice: variability of protocols, duration of hospital stay, use of discharge criteria, frequency and timing of outpatient follow up, use of written patient information and outcome measures. Much variability was explained through patient-centred care, for example, 62% surgeons tailored functional advice to individual patients. CONCLUSION: Current United Kingdom surgeon practice for lumbar spinal fusion is described. The surgical procedure and patient population is diverse, and it is therefore understandable that management varies. It is evident that care should be patient-centred. However with high costs and documented patient dissatisfactionit is important that further research evaluates optimal management.

Census report on Chinese urological surgeons

Objective:To grasp the general situation of Chinese urological surgeons and the status quo of their scientific research,work and training,thus providing valuable recommendations for urological talent team construction in future.Methods:The survey respondentswere the urological surgeons,who held the Certificate ofMedical Practitioner in the People’s Republic of China,whose scope of practice was confined to urological surgery.The urological surgeons involved in the project completed an online questionnaire survey.All the data were collected through the internet.Results:There were a total of 18981 urological surgeons in China in 2015,of whom 15875 from 2602 hospitals participated in this project,with a mean age of 39.64 years old.In 2015,1949631 cases of surgery were performed,including 493723 cases of open surgery,1146444 cases of endoscopic/laparoscopic surgery(robot-assisted laparoscopic surgery were excluded),6259 robot-assisted surgery and other types of urological surgery.Besides,Chinese urological surgeons published 1358 monographs as well as 14558 academic papers,and also obtained 2064 scientific funds in 2015.A total of 92122 person-time participated in academic conferences.Urological surgeons with higher educational degrees as well as higher academic titles and from Eastern China or higher-level hospitals hadmore opportunities to participate in further education and training.

Knowledge and Practices of Dentists, Oral and Maxillofacial Surgeons of Cone Beam Computed Tomography (CBCT) and the Dentascanner in a Low Income Country: Case of Togo

Background: In dental-maxillofacial imaging, 3D sectional imaging progressively replaces conventional 2D imaging in developed countries. They are based specially on Computed tomography (CT-Scan), with the Dentascan application and cone beam computed tomography (CBCT). In developing countries those technics are newly introduced. Aim: This study aimed at studying the knowledge and practices of dentist and oral and maxillofacial surgeons on sectional imaging such as Dentascan and Cone Beam Computed Tomography (CBCT). Materials and Methods: We conducted an anonymous survey among dentists and oral maxillofacial surgeons in Togo over one month. Results: The response rate was 78.79% (27/33). They were mainly male sex (sex ratio of 2.25 men for one woman). They were aged between 27 and 71 years old with an average of 49.69 years old. The majority (61.54%) had a professional experience over 20 years. The majority of respondents (65.38%) believed their level of knowledge about dental x-Ray was poor. Half of them (50%) confirmed that they had never asked for a Dentascan, and 15.38% asked from time to time for it and only two (7.69%) asked often for this test. 96.15% confirm they have no knowledge of the Dentascan. Regarding the CBCT, 84.62% didn’t ask for it because this technique did not exist in Togo before. 69.20% of respondents confessed to be interested in continuing training on sectional imaging. Conclusion: This study shows that sectional imaging is very little used by oral and dental practitioners in Togo because of the ignorance of the new techniques and the absence of the CBCT. It is therefore necessary to promote the teaching of the new technique of sectional imaging in the training syllabus of oral and dental specialists and to initiate continuing medical training.

Preoperative Laboratory Testing by Surgeons: Implication on Anaesthetic Management

Background: Request for preoperative laboratory investigations is usually done by surgeons. On some occasions, the patient may come with laboratory investigations that have been requested by the primary physician. This occurs in situations where the primary physician saw the patient first and referred to the surgeon. There is usually no indications based on history or physical examination before these laboratory request is done but rather on speculations that the “anaesthetist may require them”. This is done in order to avoid cancellation or delay of cases. The aim of this study was to find out how tests ordered in Komfo Anokye Teaching Hospital (K.A.T.H.) by the surgeons affected the decisions of the anaesthetists in the perioperative management of the patients. Methodology: This was a prospective, cross sectional study of patients undergoing elective surgery at K.A.T.H from 1st to 31st March 2014. A quantitative technique was used to effectively quantify laboratory results that were contained in a patient’s folder before an elective surgical procedure. A close and open-ended questionnaire was developed and answered by reviewing patient’s folders during the pre-anesthesia assessment. Data were analyzed using Statistical Package of Social Sciences (SSPS) version 22. Results: The average age of patients studied was 50 years. Abnormal test results did not influence the anaesthetic management in 70.5% of cases but led to either delay or cancelation of cases or requirement for transfusion of blood or blood products in 29.5% of cases. Conclusion: Preoperative laboratory tests ordered by Surgeons in KomfoAnokye Teaching Hospital do not significantly influence the anaesthetic managements of patients.