INTRODUCTION:Burnout is characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. Anaesthesia providers are at particular risk of experiencing burnout, with implications for workforce well-being and patient safety. We aimed to quantify the prevalence of burnout among practising anaesthesia providers and critically appraise the methodological quality of the underlying evidence. METHODS:Databases were searched for English-language studies reporting prevalence of burnout in anaesthesia providers. Definitions of burnout, measurement tools used and prevalence estimates were narratively synthesised. RESULTS:We included 50 studies, encompassing 35,599 fully qualified anaesthesia providers (31,500 physicians and 4099 non-physicians); 43 (86%) studies used the Maslach Burnout Inventory. Overall median (IQR [range]) prevalence of burnout was 42 (21-59 [9-99])%. Burnout dichotomisation varied substantially, with 15 distinct and reproducible Maslach Burnout Inventory-based criteria identified. Re-analysis of five datasets showed prevalence estimates for the same population ranged from 3.1% to 69.9%, depending on the criteria applied. Most studies used non-random sampling and were judged to be at unclear or high-risk of bias across many domains. DISCUSSION:Prevalence estimates of burnout vary widely due to inconsistent measurement and interpretation. Standardised reporting of subscale scores and use of validated binary classification tools would improve comparability. Robust sampling strategies are needed to inform targeted interventions.
INTRODUCTION:The majority of surgical cases in the UK occur in a day-case setting. Published short-term follow-up studies after day-case surgery are lacking and patterns of recovery including pain and patient reported outcome measures, are largely unknown. METHODS:Data from the Patient-reported Outcomes, Postoperative Pain and pain relief after daY case surgery (POPPY) study, a national, prospective, observational study exploring outcomes following day-case surgery in the UK, were used to explore acute recovery over the first 7 postoperative days. Baseline data were captured on the day of surgery alongside pain severity, functional scores and quality of recovery-15 scores on postoperative days 1, 3 and 7. A poor pain outcome was defined as a pain severity score of > 4/10 and a poor functional outcome was defined as any functional impairment due to pain on days 1, 3 and 7. RESULTS:Of the 7839 patients initially recruited, 7331 responded on day 7. Pain severity scores decreased over the first postoperative week and yet pain impaired function in 1279/4854 (26.3%) patients at day 7. In the first 7 days, 1458/4348 (33.5%) of patients had a poor pain outcome. Associated variables included: treatment for anxiety or depression; baseline chronic pain; frailty; greater surgical magnitude; and type of surgery (head and neck surgery). Increasing age was associated with reduced probability of poor pain outcomes. Poor functional outcomes were associated with: surgical magnitude; type of surgery (orthopaedic surgery); chronic pain; and frailty. Opioid naivety was associated with a reduced odds ratio of both poor pain and functional outcomes. DISCUSSION:These findings suggest that by postoperative day 7, recovery from day-case surgery is incomplete for many patients. We identified characteristics associated with poor pain and functional outcomes that could be used to improve peri-operative pathways, in particular highlighting patients who may benefit from enhanced preparation and closer follow up.
INTRODUCTION:Meaningful validation of artificial intelligence for medical image interpretation requires comparison against human expert performance, yet multi-rater frameworks establishing such comparisons remain uncommon. METHODS:We developed and applied a consensus framework using nine clinicians who independently segmented the femoral nerve on 100 ultrasound images, yielding 900 annotations and a combined consensus standard established by majority voting. We then evaluated an academic deep learning model against this consensus and individual human performance. RESULTS:The artificial intelligence model achieved a median (IQR [range]) Dice coefficient of 0.72 (0.56-0.84 [0.00-0.91]) against combined consensus. Sensitivity was 0.94 (0.88-0.97 [0.33-1.00]) and precision 0.60 (0.44-0.76 [0.00-0.89]). Individual human Dice scores ranged from 0.32 to 0.73 (median 0.60). The artificial intelligence model matched median human performance and outperformed five of nine annotators (31%-125% relative improvement), with the greatest benefit for the lowest-performing practitioners. Leave-one-annotator-out analysis confirmed consensus stability (median (IQR [range]) artificial intelligence Dice 0.749 (0.745-0.752 [0.742-0.769])). Inter-rater reliability was moderate overall (Fleiss's κ 0.54, p < 0.001). DISCUSSION:The sensitivity and precision profile of the artificial intelligence model indicated reliable nerve detection with over-segmentation that remained clinically interpretable. The moderate inter-rater reliability is consistent with the inherent subjectivity of nerve delineation on ultrasound. The circularity inherent in evaluating annotators against a consensus they helped define limits direct comparison of artificial intelligence and human scores. A Dice score of 0.72 represents the upper range of human expert performance rather than moderate accuracy. The framework methodology is independent of the specific artificial intelligence system evaluated and offers a transferable approach for calibrating artificial intelligence performance in clinical imaging where no single correct interpretation exists.
INTRODUCTION:Ultrasound-guided neuraxial anaesthesia has gained increasing attention because it may improve procedural success and safety. Lower thoracic epidural anaesthesia provides effective postoperative analgesia and is used widely in patients undergoing abdominal surgery. However, studies evaluating lower thoracic epidural puncture remain limited, and whether real-time or pre-procedural ultrasound guidance provides superior technical performance remains unclear. Therefore, we aimed to compare real-time and pre-procedural ultrasound-guided techniques in achieving first-pass success in lower thoracic epidural puncture. METHODS:We enrolled patients scheduled to undergo abdominal surgery requiring thoracic epidural anaesthesia. Patients were allocated randomly to real-time or pre-procedural ultrasound groups. In both groups, a preliminary scan was performed to identify and mark the target intervertebral level before needle insertion. In patients allocated to the real-time group, continuous in-plane ultrasound guidance was maintained throughout needle advancement. The primary outcome was first-pass success rate. Secondary outcomes included procedure time; number of passes; and number of punctures. RESULTS:In total, 64 patients were included in the final analysis. Patients allocated to the pre-procedural ultrasound group had a significantly lower first-pass success rate compared with the real-time ultrasound group (15/32 (47%) vs. 26/32 (81%), p = 0.008). In addition, fewer passes and punctures were required in patients allocated to the real-time group. Procedure time did not differ significantly between groups. DISCUSSION:Real-time ultrasound guidance significantly improved first-pass success compared with pre-procedural ultrasound guidance. These findings support the use of real-time ultrasound guidance to improve procedural success and technical performance during lower thoracic epidural puncture.
INTRODUCTION:Choice of peri-operative anaesthetic technique may influence cancer recurrence, survival and mortality following curative surgery. Conflicting evidence exists on whether propofol-based anaesthesia improves outcomes over volatile anaesthesia. This systematic review and meta-analysis examined evidence from randomised trials on overall survival and recurrence in adult patients having oncological surgery. METHODS:We systematically searched relevant databases for randomised trials comparing propofol-based with volatile-based anaesthesia in adults undergoing curative cancer surgery. In addition to narrative synthesis, random-effects meta-analysis was performed with exploratory trial sequential analysis. RESULTS:Eleven studies were included, comprising 3904 and 3907 patients assigned to propofol-based or volatile-based anaesthesia, respectively. Meta-analysis found no significant effect on overall or recurrence-free survival with a hazard ratio of 1.05 (95%CI 0.94-1.17, p = 0.42) and 1.06 (95%CI 0.95-1.19, p = 0.31), respectively. There was no significant effect on mortality (relative risk 1.03, 95%CI 0.94-1.13, p = 0.48). Similar results were found for recurrence (relative risk 0.92, 95%CI 0.76-1.12, p = 0.41). There was minimal detected heterogeneity in all analyses. DISCUSSION:Propofol-based and volatile-based anaesthesia yield similar long-term oncological outcomes, with no significant differences in survival or recurrence and minimal heterogeneity, supported by high-certainty evidence. Trial sequential analysis confirms mortality findings are robust while recurrence remains inconclusive.
