Postoperative complications significantly impact recovery and overall health in frail and older patients undergoing hip fracture surgery. This study aims to determine the predictors associated with severe complications, as classified by the Clavien-Dindo system (grade ≥ 3). A retrospective cohort study was conducted on patients aged ≥ 65 years who underwent hip fracture surgery from January 2019 to December 2024. We assessed complication severity using the Clavien-Dindo classification, categorizing cases as minor (grade < III) or severe (grade ≥ III). Logistic regression analyses were performed to identify factors independently associated with severe complications, and a corresponding risk estimation model was developed. Among 417 analyzed patients, 22 (5.3
A recent taxonomy distinguished risky surgery, the risky surgeon, and the risk-taking surgeon, separating risk arising from the procedure from risk arising from the individual performing it. We argue that an essential dimension is missing from this taxonomy: time. Surgical risk is not a fixed property of an operation or an operator; it evolves as a surgeon accumulates experience, judgment, and technical competence. We propose that the taxonomy is better understood as a developmental trajectory than a static classification, and we distinguish two surgeons who may look identical on outcomes alone: the developmental risky surgeon, a trainee on a learning curve who recognizes limitations, seeks help, and improves with feedback, and the problematic risky surgeon, who repeats preventable errors and resists feedback. We further argue that the “risk-taking surgeon” is better understood as the risk-calibrated surgeon — an expert whose distinguishing skill is not a greater appetite for risk but a superior ability to judge which risks are worth taking. We relate this individual-level calibration to the organisational principles of high-reliability healthcare and to recent evidence on surgical never-events, unnecessary surgery, and decision support for difficult operations. We outline the practical implications of this reframing for training, supervision, assessment, and credentialing.
Abstract Background Postoperative anaesthesia visits after inpatient procedures guarantee a comprehensive assessment of the patient’s status. As the number of outpatient surgical cases in hospitals increases, more patients are recovering at home. Telemedicine may provide an efficient and effective link between anaesthesiologists and patients at home without restricting their freedom and self-determination. Methods After an initial acceptance survey, a single-arm, observational pilot study piloted an optional postoperative anaesthesia visit for patients undergoing outpatient surgery under general anaesthesia. It was implemented using videochats and patient-reported outcome measure (PROM) questionnaires. Results Of the 300 people initially surveyed in the initial acceptance survey, nearly two-thirds (62.0%) expressed interest in using videochats to contact an anaesthesiologist after discharge. One hundred patients ( n = 100) were included in the subsequent observational pilot study. The offer of an optional postoperative visit was used by 65 participants ( n = 65, 65%). Videochats were considered a reliable tool for communicating medical issues and perceived as superior to telephone calls. The use of PROM questionnaires was considered meaningful by more than 80% of participants. Sixty-two of the sixty-five participants considered the postoperative anaesthesia visit a useful and beneficial part of the treatment and recovery process. Conclusions Postoperative anaesthesia visits via videochat combined with PROM questionnaires after outpatient surgery were successfully piloted and consistently perceived positively by participants. Telemedicine-assisted postoperative anaesthesia visits may be a feasible component of patient-centred care in settings with limited resources. Trial registration German Clinical Trials Register; https://drks.de/search/en; registration number: DRKS00028755, registration date: 26th January 2023.
Abstract Background Retained surgical items are classified as never events but continue to occur, and the count meant to prevent them is often recorded as correct even when an item is retained. Computer vision could provide an independent check on what is on the instrument table, but purpose-built surgical systems are scarce. Industrial vision platforms offer a faster route, although their surgical performance is unknown. Methods In a prospective experimental study, a commercial artificial intelligence vision platform developed for industrial inspection was applied to 19 surgical instruments and 3 suture items, each presented once in 100 runs (2,200 experiments). No software redesign was required, but the classifier had been trained on this item set, making this a supervised rather than a zero-shot setting. Two outcomes were recorded: whether the platform assigned the exact item identity, and whether it registered an item as present at the packing step irrespective of type, termed count-presence detection. Because experiments are clustered within items and runs, the primary estimate is the mean per-item accuracy with cluster-adjusted intervals. Results The correct instruments were identified in 2,036 of 2,200 experiments (92.5%). The mean per-item accuracy was 92.5% (95% confidence interval 88.4 to 96.7; cluster-adjusted 87.7 to 95.6). Count-presence detection was 99.1% (98.7 to 99.4). Performance was reproducible across runs (intraclass correlation 0.02), whereas variance clustered by item (0.12). Accuracy ranged from 64% (suture needle 6-0) to 100% (six items). Errors were directional and almost always within visually near-identical sub-types. Conclusions An industrial vision platform detected item presence with high reliability and identified item type with high accuracy, however, with a residual error rate of 7.5%. The errors were predictable and confined to visually similar classes, pointing to correctable mitigations rather than a fundamental limit. These figures represent an upper bound under highly controlled conditions rather than expected intraoperative performance. Such a system is intended to support rather than replace the perioperative team. This study establishes feasibility rather than clinical benefit; a prospective intraoperative study is the necessary next step.
Moral distress, the psychological strain experienced when a clinician recognises the ethically preferable course of action but is constrained from pursuing it, and, more broadly, when the ethically preferable course of action is itself uncertain or contested, is increasingly recognised as a significant occupational hazard across healthcare. Neurosurgery, characterised by high-acuity decisions, prognostic uncertainty, and frequent end-of-life conflict, may represent a particularly high-risk specialty. We conducted a narrative review of the published literature on moral distress relevant to neurosurgical practice, drawing on the foundational conceptual literature, validated measurement instruments, two national surveys of moral distress among practicing neurosurgeons conducted in different healthcare systems, qualitative and ethics-focused literature involving neurosurgical trainees and decision-making, and closely related literature from surgery, critical care, and decompressive craniectomy decision-making. Nearly half of practicing neurosurgeons surveyed in the United States report significant moral distress within a given year, most commonly triggered by managing critically ill patients without a clear treatment plan, and most intensely triggered by family or institutional pressure to perform perceived futile surgery. A subsequent Danish national survey, using the same instrument but a different healthcare and legal context, found a substantially lower prevalence of clinically significant moral injury, indicating meaningful variation across healthcare systems. Moral distress is associated with burnout and has measurably contributed to neurosurgeons leaving or considering leaving clinical positions, and adjacent literature linking burnout to self-reported medical errors raises the plausible, though not yet directly tested, possibility that unaddressed moral distress carries downstream implications for patient safety. Decompressive craniectomy and other high-stakes, irreversible interventions in patients lacking decision-making capacity represent a recurring locus of ethical conflict. Emerging interventions, including moral distress consultation services (a distinct model descended from, but functionally different to, clinical ethics consultation), structured debriefing, peer-support rounds, and early palliative care integration, show promise but lack neurosurgery-specific evaluation. Moral distress represents an underappreciated threat to neurosurgical workforce wellbeing and, potentially, patient care quality and safety. Dedicated neurosurgery-specific research, validated measurement with full characterisation of relevant psychometric properties, and tailored mitigation strategies, including clearer delineation of when moral distress consultation versus clinical ethics consultation is indicated, are needed.
