INTRODUCTION:As the population ages, more older patients with complex comorbidities are presenting with acute surgical pathology. Frailty is strongly associated with higher complication rates, functional decline and healthcare costs. This prospective collaborative study assessed the impact of frailty on outcomes after emergency general surgery in patients aged ≥65 years to guide future service provision. METHODS:Through the Irish Surgical Research Collaborative, approval was granted for prospective snapshot audit in eight Irish hospitals. For fourteen consecutive days, all emergency general surgery admissions ≥65 years were screened for frailty using the Clinical Frailty Score. Demographics, comorbidities and inpatient course at 30 days were compared between frail and non-frail patients using SPSS. RESULTS:In 112 cal l sessions, 244 patients ≥65 years were admitted and 55.5% were frail (n = 134/241). Frail patients were significantly older (p < 0.001), with higher rates of multimorbidity (p < 0.001), polypharmacy (p < 0.001), and both physical (p < 0.001) and cognitive impairment (p < 0.001). Similar numbers of frail and non-frail patients underwent surgery under general anaesthesia, though proportionally more frail patients required ICU care post-op. Frailty was associated with significantly higher rates of all inpatient complications (p < 0.001), including nosocomial infection (p = 0.034), cardiac events (p = 0.026), delirium (p = 0.025) and death (p = 0.016). Frail patients required significantly more medical consults (p = 0.034), MDT input (p < 0.001) and increased home-care packages (p = 0.024). Frail patients had longer hospital stays (p = 0.033) and fewer discharges to home (p < 0.001). CONCLUSIONS:High levels of frailty and frailty-associated morbidity were noted amongst emergency surgical admissions. Collaborative pathways between surgeons and geriatricians may optimise outcomes in this high-risk cohort.
BACKGROUND AND PURPOSE:Although studies suggested an association between patient factors and various outcome measures in the surgical management of femoroacetabular impingement (FAI), there is a lack of consistent evidence of the influence of osteoarthritis (OA) in patients with FAI syndrome treated arthroscopically. This systematic review investigated the influence of OA on the outcome of arthroscopy for FAI. METHODS:The present systematic review followed the PRISMA statement. Web of Science, PubMed, and Embase were accessed in June 2024. All the clinical investigations comparing the outcomes of arthroscopic FAI in patients with different OA stages according to the Tönnis classification were included. MAIN FINDINGS:Data from 1421 patients were retrieved, 52% of whom (552 of 1061) were women. The mean follow-up was 53.5 ± 34.5 months. The mean age was 37.5 ± 9.3 years, and the mean BMI was 25.7 ± 2.2 kg/m2. No significant difference was evidenced in visual analogue scale (VAS), modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Score - Activities of Daily Living (HOS-ADL), and modified Hip Outcome Score - Sport-Specific Subscale (HOS-SSS), rate of reoperation (P = 0.2), but a higher rate of progression to THA was evidenced in the groups with more advanced OA stages (P < 0.001). CONCLUSIONS:The clinical outcomes of patients who underwent arthroscopic surgery for FAI with Tönnis stages 0, I, or II were similar at approximately 54 months of follow-up. However, a higher rate of progression to THA was evidenced in the groups with more advanced OA.
BACKGROUND:Diabetic foot wounds persisting after successful revascularization are challenging to heal and prone to infection. Negative-pressure wound therapy (NPWT) facilitates granulation, while silver nanoparticles offer antimicrobial benefits; their combination may improve clinical outcomes. OBJECTIVE:To compare the efficacy of NPWT with adjunctive silver nanoparticle spray versus standard NPWT alone in patients with post-revascularization diabetic foot wounds. METHODS:This single-center, randomized, double-blinded controlled trial enrolled 115 patients with diabetic foot wounds following successful surgical or endovascular revascularization. Patients were randomized 1:1 to receive either NPWT with silver nanoparticle spray (Group A) or standard NPWT (Group B). Primary outcomes were the incidence and time to complete epithelialization over six months. Secondary outcomes included skin grafting, changes in wound dimensions, and infection rates. RESULTS:A total of 100 patients (50 per group) completed the study. Complete closure was achieved in 74% of Group A versus 62% of Group B (p = 0.198). While the mean time to complete closure was similar between groups, the time to skin grafting was significantly shorter in the silver NPWT group (3.5 ± 0.3 vs. 4.1 ± 0.3 months; p = 0.001). Group A also showed significant reductions in wound area and depth at three and six months. Additionally, Group A had significantly lower systemic inflammatory markers (CRP and WBC) and a shorter mean hospital stay (5.6 ± 3.2 vs. 7.05 ± 4.0 days; p = 0.048). CONCLUSIONS:Adjunctive silver nanoparticle therapy with NPWT significantly reduced wound infection risk, accelerated wound reduction, and shortened the time to grafting and hospital stay, although it did not significantly alter ultimate closure rates. These findings support a selective, adjunctive role for silver nanoparticles in managing complex post-revascularization diabetic foot wounds.
Laparoscopic living donor nephrectomy, first carried out in 1995 by Lloyd Ratner, is now the established gold standard technique of donor nephrectomy globally and in the United Kingdom. Its minimally invasive nature with associated patient benefits, and concomitant excellent recipient outcomes underpin surgeon preference as the technique of choice in living kidney donation. There are 23 transplant centres in the United Kingdom currently offering laparoscopic donor nephrectomy. There are however variations in the laparoscopic approach amongst and within the different centres. These variations have evolved due to various centre-related factors, including local expertise, training, and the availability of specific instrumentation. This review discusses the five variations of laparoscopic donor nephrectomy currently offered in the United Kingdom. These techniques include: Totally laparoscopic donor nephrectomy (TLDN), hand-assisted laparoscopic donor nephrectomy (HALDN), Robotic-assisted donor nephrectomy (RADN), Hand assisted retroperitoneoscopic (HARP) donor nephrectomy and Laparoscopic retroperitoneal donor nephrectomy (RDN).
BACKGROUND:Metaplastic Breast Cancer (MpBC) is a rare disease entity accounting for less than 1% of all breast cancers. There is limited data focusing on this aggressive disease. The aim of this study was to evaluate the incidence of MpBC at a UK centre and describe the demographic variables, clinical characteristics and treatment. METHODS:Between 2017-2024, we have reviewed 23 patients diagnosed with histologically proven MpBC from the hospital cancer database. RESULTS:A total of 2097 patients were diagnosed with breast cancer in our centre between 2017-2024, of which 23 patients were diagnosed with MpBC. The incidence was 1.1%. The median age at diagnosis was 71 years, the median tumour size at presentation was 5.2 cm and twenty (87%) patients had a Grade III tumour, while three (13%) patients were Grade II. Seventeen (74%) patients were triple negative. Histologically, the most common component of MpBC was purely squamous cell metaplasia found in eight patients. With regards to treatment, twenty-one patients had surgery whereas three patients received neoadjuvant chemotherapy. Eight patients had axillary lymph nodal involvement. Eight patients passed away due to various causes. CONCLUSION:Our incidence of MpBC is consistent with literature. MpBC is an infrequently encountered pathology where the current protocols are still under evaluation. Most patients have early disease progression and poor prognosis in comparison to other breast cancer subtypes. Further research and randomised control trials are needed to determine a gold standard treatment for this disease.
AIMS:Distal radius fractures (DRFs) are prevalent injuries, particularly among the elderly and young active individuals. Recent studies have emphasized the timing of surgical intervention, which may influence complication rates and functional outcomes. While some reviews have found no significant differences in outcomes between early and late surgery, others have suggested benefits from early intervention. Current guidelines from the British Orthopaedic Association Audit Standards for Trauma (BOAST) recommend surgical fixation within specific timeframes, yet optimal timing remains a topic of ongoing debate. This systematic review and meta-analysis aimed to assess the impact of surgical timing on complication rates and functional outcomes in closed DRFs. METHODS:A comprehensive search was conducted across multiple electronic databases, including PubMed, EMBASE, and the Cochrane Library, to identify relevant studies. Eligible studies included randomized control trials and observational studies which compared early versus late surgical treatment. Meta-analyses were conducted on pooled data from compatible studies. RESULTS:Fourteen studies involving 2104 patients were included in this analysis. Meta-analysis revealed late surgical intervention was associated with an 8% increase in complication rates (95% CI 4% to 13%). Functional outcomes demonstrated that early surgery led to improved range of motion in flexion, pronation, and supination; however, no statistically significant differences were observed in extension. Further, Patient-Reported Outcome Measures did not exhibit significant differences between early and late surgical interventions. CONCLUSION:Early surgical intervention for DRFs is associated with lower complication rates and improved range of motion, however it does not improve patient reported outcomes.
BACKGROUND:Cauda equina syndrome (CES) is a neurological emergency with significant potential for permanent morbidity and medicolegal consequences. Timely MRI is essential, yet delays remain common. The Irish Health Service Executive (HSE) published a National Clinical Guideline for CES in June 2024. This study evaluates the impact of its introduction on referral quality and time to MRI in a tertiary, non-spinal centre. METHODS:A retrospective review of all suspected CES referrals from the emergency department to the orthopaedic department was performed over a 40-month period spanning guideline introduction (October 2022 to January 2026). Primary outcomes included triage-to-MRI and referral-to-MRI times. Secondary outcomes encompassed documentation of post-void residual volume (PVR), ASIA score, and red flag symptoms. RESULTS:124 pre-guideline and 71 post-guideline referrals were included. Mean triage-to-MRI time decreased from 20.5 to 13.0 h (36.5% reduction; p = 0.017), with standard deviation falling from 16.2 to 7.7 h, indicating greater consistency. The proportion scanned within 24 h rose from 73.9% to 89.1% (p = 0.046). Referral-to-MRI time was substantially longer for out-of-hours/weekend referrals than in-hours referrals in both periods (pre-guideline: 20.3 vs 7.2 h; post-guideline: 12.1 vs 4.3 h). ED-initiated MRI prior to orthopaedic referral increased from 1.5% to 26.1. Documentation improved across all metrics, with ASIA score recording showing the greatest improvement. CONCLUSION:Implementation of a national CES guideline significantly improved referral quality and reduced time to MRI. However, a persistent and clinically significant out-of-hours access gap highlights the need for dedicated overnight and weekend MRI pathways as a priority for future service development.
Purpose Spinal gunshot wounds (GSW) are relatively uncommon but can be both devastating and life-changing. The exact role of surgery remains unclear. This study reviews our institutional experience with spinal GSW management and examines the clinical outcome of these patients in a developing world setting. Methods A retrospective study was conducted over a 10-year period from December 2012 to December 2022 at a major trauma centre in South Africa. All patients who sustained spinal GSW were included. Results 201 patients with a spinal GSW were included (male: 89%, mean age: 31 years, median Injury Severity Score (ISS): 16). AIS classifications: E (60%), A (20%), B (8%), D (7%), and C (3%). All patients underwent a CT scan, and 65% had an MRI. In 95% there was a bony spine injury, and in 37% a spinal cord injury. 3% of all patients underwent surgical intervention. A management algorithm for spinal GSW patients is detailed in Fig. 2. Overall, 18% of patients required admission to the intensive care unit (ICU), and 23% had one or more complications. Common complications included hospital-acquired pneumonia and acute kidney injury. The overall in-hospital mortality rate was 11% (23/201). Of the 178 patients who survived to hospital discharge, 73% were discharged for ongoing spinal rehabilitation, and the remainder were discharged home. Conclusion Although spinal GSWs are morbid with devastating consequences, there is a very limited role for spinal surgery, as neurological recovery is unlikely to improve. Non-operative management may be of benefit in resource-constrained public healthcare facilities. Future research should focus on refining the indications for surgical intervention in this patient cohort.
BACKGROUND:This innovation provides significant ergonomic benefits, along with some new challenges compared to traditional laparoscopic (TLS) and open surgical methods. Therefore, this study analyzes relevant published experimental research to evaluate ergonomics associated with RAS. METHODS AND MATERIALS:A systematic search was performed utilizing the MEDLINE/PubMed, Cochrane CENTRAL, and Embase databases to identify relevant literature related to physical, cognitive, and organizational ergonomics in RAS. Subsequently, eligible articles were selected using the Rayyan tool. The quality assessment was done using the Cochrane Collaboration Risk of Bias Tool (ROB-2, version 2). Outcomes were systematically categorized and evaluated manually, and the findings were presented in a structured format, highlighting the key aspects of physical, cognitive, and organizational ergonomics. RESULTS:The analysis included 17 articles, comprising 14 RCTs, 2 clinical trials, and 1 pilot study. Among these, 9 studies evaluated physical ergonomics, 9 addressed cognitive ergonomics, and 8 focused on organizational ergonomics. The findings indicate the RAS significantly enhances physical ergonomics for surgeons by decreasing physical demands, effort, and discomfort while simultaneously improving dexterity and ease of use. Additionally, RAS reduces the ergonomic risks associated with work-related musculoskeletal disorders (MSDs) compared to TLS. CONCLUSION:RAS has superiority in physical ergonomics compared to traditional methods.
INTRODUCTION:Locally advanced, well-differentiated thyroid cancer presents a surgical challenge, particularly when tumours involve the airway or other critical structures. Neoadjuvant tyrosine kinase inhibitors (TKIs) may downsize disease and improve operability, but evidence remains limited. This study reports oncological and surgical outcomes following neoadjuvant TKI therapy in a single-centre cohort. METHODS:A retrospective cohort study was conducted of patients with locally advanced, well-differentiated thyroid cancer treated with pre-operative TKI therapy between 2016 and 2025. Clinical outcomes, surgical aims and procedures, complications, recurrence, and survival were recorded. Tumour volume reduction was assessed radiologically. RESULTS:Nine patients were included (median age 60 years; 78% female). All had T4a disease, and 3 had pulmonary metastases. Median TKI duration was 7 months. Most patients experienced grade 1-2 adverse effects; 3 developed grade 3-4 toxicity. Tumour volume reduction occurred predominantly within the first 3-6 months, with continued regression up to 18 months. Primary surgical aims were achieved in 89%, including successful conversion of unresectable disease to resectable and avoidance of laryngectomy in all 4 patients for whom it was initially indicated. After a median 44-month follow-up, 5-year recurrence-free and disease-specific survival were both 89%; one patient with metastatic disease died during follow-up and no patient developed uncontrolled central neck disease. CONCLUSION:Neoadjuvant TKI therapy facilitated surgical management and reduced the need for morbid airway surgery in selected patients with locally advanced, well-differentiated thyroid cancer. These findings support its use within multidisciplinary pathways, although prospective studies are needed to refine patient selection and treatment duration.
OBJECTIVE:This survey aims to establish current post-EVAR surveillance practice across vascular centres in the United Kingdom (UK) and report variations in practice, including adherence to the latest European Society of Vascular Surgery (ESVS) clinical practice guidelines. METHODS:Cross-sectional web-based survey disseminated to 64 aortic centres in the UK, and data collected on use of imaging modalities (with the option to select one or multiple) at set time points after standard infrarenal and complex EVAR. Modalities included computed tomographic angiography (CTA), duplex ultrasound (DUS), contrast enhanced ultrasound (CEUS), magnetic resonance angiography (MRA) and abdominal x-ray (AXR). RESULTS:Response rate was 84.4% (54/64 centres). Early imaging was CTA at 44(81.5%), DUS at 22(40.7%) and AXR at 8 (14.8%) centres for standard EVAR and CTA at 37 (94.9%), DUS at 11 (28.2%) and AXR at 6 (15.4%) centres for complex EVAR, with variability in timing. One year imaging for standard EVAR was CTA at 21 (44.7%), DUS at 30 (63.8%) and AXR at 9 (19.1%) centres, and CTA at 26 (81.3%), DUS at 11 (34.4%) and AXR at 7 (21.9%) centres for complex EVAR. The predominant choice for annual surveillance after standard EVAR was DUS at 45 (83.3%) centres followed by CTA at 10 (18.5%) centres, with the dominant choice CTA at 22 (56.4%) centres and DUS at 21 (53.8%) centres after complex EVAR. Only one centre employed an extended interval after initial imaging until 5 years after EVAR. CONCLUSIONS:This survey reveals the variation in surveillance practices after EVAR between vascular centres in the United Kingdom, with limited adherence to the ESVS clinical practice guidelines. There continues to be reliance on CTA for early post-EVAR surveillance, with ultrasound mostly used for long-term follow-up. Creation of nationally agreed consensus protocols under the stewardship of a recognized body would foster more homogeneous practice.
BACKGROUND:The growing proportion of women in medicine and shifting expectations toward shared family responsibilities contrast with traditionally inflexible surgical careers. Comparative European data on how plastic surgeons perceive the compatibility of academic careers and parenthood remain limited. METHODS:A cross-sectional online survey was distributed via European national plastic surgery societies and academic centres. Items covered demographics, working models, parental status, parental leave, childcare, institutional support, and perceived discrimination. Group differences were tested using chi-square and non-parametric methods; predictors of perceived compatibility were assessed using multivariable logistic regression. RESULTS:A total of 456 academic plastic surgeons from 18 European countries participated (median age 44 years; 54.5% female). Perceived compatibility varied, from 35.1% in Germany to 78% in the Netherlands and 70% in Scandinavia (p < 0.001). In multivariable analysis, openness in discussing family planning with superiors (OR 5.49, 95% CI 2.51-12.05; p < 0.001) and permission to work part-time (OR 2.92, 95% CI 1.40-6.02; p = 0.004) were the strongest positive predictors. Career-related impact on family planning (OR 0.39; p = 0.033) and perceived discrimination against mothers (OR 0.41; p = 0.019) reduced compatibility; actual part-time employment was not independently associated. CONCLUSIONS:Across Europe, perceived compatibility of parenthood with an academic surgical career vary widely between countries. These differences are primarily driven by structural flexibility and a supportive culture than by actual reduced working hours. Normalising parenthood should be treated as a structural prerequisite for a sustainable and diverse academic workforce in surgery.
INTRODUCTION:Children's surgery remains underfunded after COVID-19 and waiting list times have risen. Children with inguinal hernias (IH) come into this group, and there has been concern that these delays put children at higher risk of morbidity and increases the burden on resources. The aim of this study was to evaluate trends in waiting times and establish the impact on children in a large tertiary unit. METHODS:Retrospective review of all IH operations at a tertiary unit, 1st March 2022 - 31st March 2023 (Cohort 1) and 1st April 2023 - 30th April 2024 (Cohort 2). Federation of Surgical Speciality Associations guidance was used to define prioritisation status and breaches. RESULTS:414 patients were included in the study (180 Cohort 1, 234 Cohort 2). Alongside the increase in overall operations, the proportion of emergency operations in cohort 2 was significantly higher (56/234 vs 19/180, p < 0.001). There were also increases in the median waiting times for P2 patients, from 9.9 to 21.5 weeks (p = 0.0272). For P3, this increase was from 10.1 to 23.0 weeks (p = 0.0001). In total 29 patients required an emergency operation (on the waiting list) and of these 18/29 had breached their intended target. Length of stay for emergency patients was 3 days, compared to 1 day for electives. CONCLUSION:Children with IH are experiencing longer waiting times resulting in more emergency procedures and higher hospital bed days. Increased provision of elective operating lists is needed to tackle this problem and reduce the overall burden on hospital resources.
Objectives Rural surgical training attachments are an important means to improve rural-urban workforce equity. Recent evidence from the USA indicates that the educational benefits of rural surgical attachments are much broader than just developing a rural workforce pipeline. In our own context rural attachments have been offered for many years, but the quality and gains from rural training have not been studied previously. Thus, the study aim was to explore UK core surgical trainees’ experiences of a remote and rural rotation and the value they placed on this experience in terms of positioning them for their next career surgical steps. Methods This was a qualitative study using semi-structured interviews to gather the views and experiences of core surgical trainees (CSTs) who had undertaken a placement in a Scottish rural hospital. Interview questions were developed from the wider literature. Data were analysed using an inductive, thematic approach. Results Four themes were identified from interviews with 10 trainees. First, rural surgical training is a unique and valuable learning experience, ideal for early surgical training, offering useful experiences for personal and professional growth. Second, rural training is a positive and personalised experience: a community experience both within and outside the hospital. Third, rural training is an opportunity to gain a broad understanding of healthcare delivery, and the impact of context on healthcare delivery. Fourth, there was a perceived misalignment between rural surgical training and core training requirements, and a view that rural training was not for everyone. Conclusion Rural surgical attachments in Scotland are high-quality educational experiences which effectively facilitate the development of both technical and non-technical skills and deliver self-learning as well as an understanding of the wider context of surgical care delivery. These placements integrate well into many surgical careers and their uniqueness could be better recognised in the training system.
Background Optimal surgical management for differentiated thyroid cancer (DTC) remains controversial, particularly regarding initial hemithyroidectomy versus total thyroidectomy. Understanding factors predicting the need for completion thyroidectomy and residual disease in the remnant lobe is critical for risk-adapted treatment. Methods We conducted a multicentre retrospective cohort study of 387 patients undergoing surgical management of DTC between 2015 and 2024 across three tertiary centres. Demographic, clinical, cytological, and pathological data were extracted and compared by surgical extent. Among patients initially treated with hemithyroidectomy, predictors of proceeding to completion thyroidectomy were assessed. In patients undergoing completion thyroidectomy, clinicopathological factors associated with residual disease in the completion lobe were identified using both univariate and multivariate logistic regression analyses. Results Of 387 patients (median age 44 years, 78.0% female), 243 (63.0%) initially underwent hemithyroidectomy, and 143 (37.0%) underwent total thyroidectomy. Among hemithyroidectomy patients, 174 (71.3%) proceeded to completion thyroidectomy. Among completion thyroidectomy patients, residual disease was found in 63 (36.2%). Those undergoing completion thyroidectomy were more likely to have larger tumour (p < 0.001), nodal disease (0.006), extrathyroidal spread (0.003) and lymphovascular invasion (0.004). On multivariate analysis, male sex (OR 4.20, 95% CI [1.13, 15.63], p = 0.034) was independently associated with higher odds of residual disease in the completion lobe, while papillary subtype was associated with a lower odds of residual disease (OR 0.12, 95% CI [0.03, 0.50], p = 0.0045). Conclusion Larger nodule size and adverse pathological features were associated with higher rates of completion thyroidectomy. Among patients undergoing completion surgery, male sex independently predicted residual disease (OR 4.20, p = 0.034), while papillary histology was associated with a reduced risk (OR 0.12, p = 0.0045). These findings support risk-adapted surgical strategies and highlight the need for individualised decision-making and further prospective research to refine risk prediction in DTC.
INTRODUCTION:Trauma and orthopaedic (T&O) surgery involves the use of instruments that generate loud noises. However, the perceptions of T&O surgeons regarding intraoperative noise are unknown. In the United Kingdom (UK), the 2005 Control of Noise at Work Regulations governs occupational noise exposure. This study aimed to investigate how T&O surgeons perceive and respond to intraoperative noise exposure, including their receipt of noise-related safety training and their awareness of relevant occupational health regulations. METHODS:A 19-item questionnaire was distributed to T&O surgeons via social-media and email lists between 13th November 2024 and 13th February 2025. The questionnaire captured data on demographics and topic-specific issues. RESULTS:A total of 126 responses were analysed. Most respondents were male (91.27%) with a median age of 45 years (IQR 37-53). Over half (54.76%) believed the procedures they were involved in are likely to cause noise-induced hearing loss. Concern was highest among those performing hip arthroplasty (regression coefficient 20.42, 95%CI 1.99-38.85, p = 0.030). Most participants reported not taking precautions to protect their hearing (89.68%). Only 11% were aware of the 2005 Control at Work Noise Regulations, and 99% did not receive formal training on workplace noise exposure. CONCLUSION:Despite concern about intraoperative noise exposure, most surgeons lacked awareness of the 2005 Control of Noise at Work Regulations and did not receive formal workplace training nor adopt protective measures. These findings highlight the need for improved support from professional bodies and employers to address these gaps and ensure access to training and equipment to mitigate the harms from intraoperative noise exposure.
Background The Multi-Specialty Recruitment Assessment (MSRA) is a national aptitude test increasingly incorporated into selection for Core Surgical Training (CST) in the United Kingdom. Although intended to enhance objectivity and equity, its relationship with subsequent interview performance and final CST offer outcomes remains unexplored. Methods A retrospective cross-sectional study analysed anonymised data from the 2025 UK CST national selection process. Applicants who completed both the MSRA and structured interview were included. Multivariable linear and logistic regression models examined associations between applicant characteristics (including demographic factors and requests for interview adjustments) and performance across three stages: MSRA, interview, and CST offer outcome. Results are presented as adjusted regression coefficients (β) or adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Of 1154 applicants, 1045 had complete data. Female applicants scored higher on the MSRA (β = 0.13, 95% CI 0.01 to 0.25) and interview (β = 0.18, 95% CI 0.05 to 0.30) than males. Higher MSRA performance was associated with higher interview scores (β = 0.22 per 1 SD, 95% CI 0.12 to 0.32) and greater odds of receiving a CST offer (aOR = 1.42, 95% CI 1.05 to 1.94). Non-UK graduates demonstrated lower MSRA and interview scores and consequently had lower odds of receiving a CST offer. Applicants requesting interview adjustments also had lower odds of an offer. Conclusion MSRA performance was positively associated with interview and offer outcomes, supporting its role as an objective component of CST selection. Continued monitoring across recruitment cycles is required to ensure the process remains equitable, transparent, and aligned with surgical training needs.
Background Early laparoscopic cholecystectomy is recommended for acute calculous cholecystitis. Early intervention reduces recurrent biliary events, readmissions, and morbidity without increasing complication rates. Rates of index cholecystectomy in the UK is reported to be lower than international literature. The aim of this study was to assess the rate of index cholecystectomy in a district NHS Trust and identify factors contributing to management decisions. Methods In this multicentre retrospective analysis, adult patients admitted with a primary diagnosis of acute calculous cholecystitis between May 2024 and December 2024 were included. The primary outcome was the rate of index laparoscopic cholecystectomy. Secondary outcomes included total hospital length of stay, gall-stone related representation/readmissions, and complication rates. The admitting surgeon's sub-specialty and documented reasons for a delayed approach was also recorded. Results 335 patients were included in the analysis. 242 (72.2%) underwent laparoscopic cholecystectomy, with 35/242 (14.4%) performed as index procedures. Baseline patient characteristics were similar across both groups. 60% of delayed cases had undocumented reasons for this approach. Patients who underwent index cholecystectomy had fewer representations within 12 months compared with delayed cases (5.7% vs 38.6%, p < 0.001). Admitting surgeon sub-specialty (Upper gastrointestinal) was the only independent predictor of index cholecystectomy (OR 7.03, CI 2.36 – 26.4, p = 0.001). Conclusion The rate of index laparoscopic cholecystectomy within the trust was low compared with international literature. Admitting surgeon's sub-specialty was the only independent predictor of index cholecystectomy. Poor documentation regarding the rationale for the delayed approach warrants further investigation to elucidate contributors to delays in surgical management.
