2026

Root causes of surgical never-events: a systematic review (2026)

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Type of publication:

Systematic Review

Author(s):

Parmar, Dilen; *Patel, Neil; Kenneth-Ogah, Catherine; Yazdouni, Sadat; Desai, Chaitya; Raveshia, Dimit; Patel, Ravi.

Citation:

Patient Safety in Surgery [Electronic Resource]. 2026 Jan 08.

Abstract:

Background
Never-events represent serious and preventable patient safety incidents within surgical practice, despite increasing national and international efforts to reduce them. Persistent concerns regarding wrong site surgery, retained surgical items, and incorrect implants highlight the need to understand contributory human factors and system-level weaknesses.

Methods
A systematic search of PubMed/Medline, Google Scholar, and the Cochrane Library was conducted. Evidence published between 2014 and 2024 was screened according to predefined eligibility criteria to identify contemporary data relating to surgical never-events. Studies were assessed using standardised selection methods and relevant findings were extracted and synthesised.

Results
Thirty-seven studies met inclusion criteria. Across international literature, recurring contributory factors included communication breakdowns, reduced situational awareness, fatigue, inadequate staffing, inconsistent team composition, and increasing surgical caseloads. Despite advances in safety practices, these factors continued to contribute to adverse surgical outcomes.

Conclusion
Never-events remain a persistent challenge in surgical care. Strengthening safety management systems, improving awareness of human factors, and prioritising non-technical skills training may help reduce the risk of these events. Ongoing evaluation of interventions and further UK-based research are required to support improvement in patient safety outcomes.

Data availability
All data generated or analysed in this study are derived from published articles and are included within this manuscript and its supplementary materials.

DOI: 10.1186/s13037-025-00474-8

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Safety and efficacy of IL-23 inhibitors in patients with moderate to severe ulcerative colitis: a systematic review and meta-analysis of randomized controlled trials (2026)

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Type of publication:

Systematic Review

Author(s):

Amin, Hamza Muhammad; Hasan, Sundas; Abukhater, Reem; Lilley, Rachel; Atique, Arif; Shoaib, Maheen Sattar; Albustanji, Qutaiba; Sadique, Humza; *Khalid, Saad Muhammad; Hasan, Ali; Majeed, Salman; Shahzad, Muhammad Aamir; Shahzad, Maryam; Ahmed, Mushood; Ahmed, Raheel; Gardezi, Syed Anjum.

Citation:

International Journal of Colorectal Disease. 41(1) (no pagination), 2026. Article Number: 1. Date of Publication: 01 Dec 2026.

Abstract:

BACKGROUND AND OBJECTIVE: Targeting the interleukin-23 (IL-23) pathway is an emerging therapeutic strategy for moderate to severe ulcerative colitis (UC). This systematic review and meta-analysis evaluated the efficacy and safety of IL-23 inhibitors for induction and maintenance therapy in UC.

METHODS: A systematic search of PubMed, Cochrane, and Google Scholar was conducted up to May 2025 to identify randomized controlled trials (RCTs) of IL-23 inhibitors (mirikizumab, risankizumab, guselkumab) in UC. Data were analyzed using Review Manager (RevMan 5.4) with a random-effects model.

RESULTS: Seven RCTs (four induction, three maintenance) including 4203 patients were analyzed. IL-23 inhibitors significantly increased clinical remission during both induction (RR 1.52) and maintenance (RR 1.62). Rates of histo-endoscopic healing were also higher with IL-23 blockade in both induction (RR 2.53) and maintenance (RR 1.81). Importantly, IL-23 inhibitors were associated with a reduced risk of serious adverse events during induction (RR 0.39), with no significant difference observed during maintenance (RR 0.68). Other outcomes, including clinical response and corticosteroid-free remission, also consistently favored IL-23 blockade.

CONCLUSION: IL-23 inhibitors provide significant improvements in clinical remission and mucosal healing, with a favorable safety profile, particularly during induction therapy in moderate to severe UC.

DOI: 10.1007/s00384-025-05014-5

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Evaluation of inpatient physiotherapy groups on functional ability, self-reported psychological scales, and length of stay (LOS) in acute stroke patients: A service review of current provision at the Princess Royal Hospital (2026)

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Type of publication:

Service evaluation report

Author(s):

*Emily Farla

Citation:

Shrewsbury and Telford Hospital NHS Trust, January 2026

Abstract:

Purpose: The Shrewsbury and Telford NHS trust’s acute stroke rehabilitation therapy
team set up weekly circuit class therapy (CCT) groups in 2024, running alongside
individual therapy (IT) to improve stroke rehabilitation. Physiotherapists, occupational
therapists, speech and language therapists and therapy support workers delivered
both methods of rehabilitation. The service aimed to provide quality therapy to
improve motor and psychological outcomes in the acute stroke population, supported
by results reported in current literature. Anecdotal evidence was obtained from
attendees that suggested CCT to be a positive addition and so a formal review was
indicated. This service review aimed to answer; does attending additional inpatient
CCT groups up to three times per week in addition to standard therapy for inpatient
stroke patients at the Princess Royal Hospital (PRH), influence motor function,
psychological wellbeing scores and impact hospital length of stay (LOS)?
Methods: The service evaluation reviewed notes retrospectively between the months
of May and July 2025. All consenting adult patients diagnosed with a stroke in the
last 30 days and admitted on to the Stroke and Rehabilitation wards at PRH who
were receiving active treatment and referred to therapy were included. The review
aimed to collect 30-50 sets of data. Notes were screened to collect inpatient
demographics; including gender, age, height, weight, diagnosis, number of groups
attended, length of stay, and discharge destination and outcome measures; Modified
Rivermead Mobility Index, Distress Thermometer, and Stroke Recovery Perception
from baseline and discharge time points. Data was inputted into Excel and SPSS to
complete descriptive and inferential analysis. Patient identifiable data was removed
to ensure anonymity throughout analysis.
Results: 38/50 stroke inpatients admitted to the stroke rehabilitation ward were found
to have complete sets of data (n=38). Of the 38 inpatients nine received IT and 19
attended IT with additional CCT groups. Significant motor improvements were seen
in both the IT and additional CCT groups. Significant increases in psychological
outcomes and self-perceived improvement scores were seen in the additional CCT
group compared to the IT group. There appeared to be no relationship between CCT
attendance and LOS.
Conclusions: This service evaluation has shown additional CCT groups delivered
alongside IT on the stroke rehabilitation unit at the PRH is a significantly better
service in terms of patient perceived improvement and psychological outcomes with
an equivalent benefit to IT for motor outcomes. Though no impact of group
attendance on LOS was seen, it may be due to the external factors delaying
discharge. The findings from this service review support continuing provision of the
CCT service and has provided data for comparison with future service reviews.
Further research is needed to understand the relationship between CCT attendance
and becoming therapy fit for discharge and the impact of inpatient total treatment
time by adding CCT to IT for achievement of stroke therapy guidance.

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Factors associated with conversion from day-case to in-patient elective laparoscopic cholecystectomy surgery across England: an observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

*Olagunju, Naomi; *Cheetham, Mark; Savage, Katrein; Briggs, Tim W R; Gray, William K.

Citation:

Surgical Endoscopy. 40(3):2199-2209, 2026 Mar.

Abstract:

PURPOSE: Elective laparoscopic cholecystectomy is increasingly being conducted as a day-case procedure. However, some patients planned for day-case surgery stay in hospital for at least one night. The aim of this study was to identify factors associated with conversion from planned day-case to in-patient management for elective laparoscopic cholecystectomy.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics dataset for England. All patients aged >= 17 years undergoing a planned elective day-case laparoscopic cholecystectomy between 1st April 2017 and 31st March 2024 were identified. The exposure of interest was discharge on the day of admission (day-case) or requiring overnight stay. For reporting, providers were aggregated to an Integrated Care Board (ICB) level.

RESULTS: A total of 286,754 elective LCs planned as day-case were identified over the seven-year study period. Of these, 74,957 (26.1%) stayed in hospital for at least one night and were classed as day-case to in-patient stay conversions. In multilevel, multivariable modelling, conversion to in-patient stay was associated with great age (odds ratio (OR) 2.54 for 17-29 vs >= 70 years, p < 0.001), male sex (OR = 1.11, p < 0.001), deprivation (OR 1.14, first vs fifth quintile, p < 0.001), open surgery (46.93, p < 0.001), and low annual surgeon volume (OR 1.73, < 10 vs >= 80 LCs per year, p < 0.001). Comorbidities and post-procedural complications were also strongly associated with conversion. Across the 42 ICBs in England, model-adjusted conversion rates varied from 14.5% to 39.0%, 18 (42.9%) ICBs had conversion rates above the 99.8% control limit.

CONCLUSIONS: Conversion from day-case to in-patient stay was associated with increasing age, male sex, deprivation, open surgery, low surgeon volume, comorbidity and post-procedural complication. Our findings will help surgical team identify patients suitable for day-case laparoscopic cholecystectomy.

DOI: 10.1007/s00464-025-12480-z

Systemic Arterial Air Embolism Following Computed Tomography (CT)-Guided Percutaneous Lung Biopsy: Case Series and review of underlying risk factors, treatment and preventive strategies (2026)

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Type of publication:

Journal article

Author(s):

*Adamu, Maimuna; *Skillicorn, Chris; *Stone, Timothy; Moudgil, Harmesh; *Abayaratne, Chulangani.

Citation:

Clinical Medicine. 2026 Mar;26(2):100530

Abstract:

BACKGROUND: Systemic arterial air embolism is an uncommon but potentially fatal complication of CT-guided transthoracic lung biopsy. Although rare, it carries significant morbidity due to cerebral and coronary ischemia.

CASE PRESENTATION: We report two cases of systemic arterial air embolism occurring during CT-guided percutaneous lung biopsies. Both patients developed acute neurological deficits immediately following the procedure, attributed to cerebral air embolism. Imaging confirmed the presence of intracranial air in subarachnoid spaces. Neurological symptoms improved with supportive management, including oxygen administration and positioning. Histopathology in both cases revealed pulmonary adenocarcinoma.

CONCLUSION: These cases highlight the importance of prompt recognition and appropriate management of systemic air embolism. Risk mitigation strategies include careful patient positioning, minimization of intrapulmonary pressure gradients, and maintenance of needle occlusion. Although rare, this complication must be anticipated by interventionalists and managed promptly to avoid permanent neurological damage.

DOI:

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NHS blood and transplant donor echocardiography standard to improve organ utilisation in heart transplantation (2026)

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Type of publication:

Journal article

Author(s):

Akhtar W; Peck M; *Miller A; Billyard T; Goedvolk C; Ryan M; Soliman Aboumarie H; Gil FR; Berman M; Rubino A

Citation:

The Journal of the Intensive Care Society. 27(2):237-240, 2026 May.

Abstract:

Focused echocardiography plays a vital role in assessing donor hearts and improving donor utilisation in the United Kingdom. A NHS Blood & Transplant working group was established and, through a review of the current evidence and modified Delphi approach, developed guidance for a minimum dataset for image acquisition in donor heart assessment. This is in intended as a pragmatic optional supplementation to current focused echocardiography protocols. We present a donor echocardiography proforma with accompanying educational materials for use in the United Kingdom.

DOI: 10.1177/17511437251394267

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Survey of the current experience of colonoscopy training for colorectal surgical trainees in the UK (2026)

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Type of publication:

Journal article

Author(s):

Siggens K.; Williams S.; Yiu A.; El Sayed C.; Fletcher J.; Mills S.; Yeadon K.; Reza L.; Rabie M.; Drami I.; Green S.; Tamanna R.; Couderq D.; Javanmard-Emamghissi H.; Argyriou O.; Okocha M.; Khasawneh F.; Kat-Zsummercorn A.; Shakir T.; Anya L.; Bramwell C.; Haji A.; Johnston R.; Joshi H.; Oliphant R.; Piramanayagam B.

Citation:

Frontline Gastroenterology. 17(4) (pp 306-311), 2026. Date of Publication: 01 Jul 2026.

Abstract:

Introduction: The primary aim was to understand the current experience of colonoscopy training among general surgical trainees with a subspeciality interest in colorectal surgery. Method(s): An electronic survey was developed and disseminated by members of the Dukes' Club (colorectal trainees network) and Association of Coloproctologists of Great Britain and Ireland colonoscopy subcommittee between February and April 2024 to assess key themes identified through formal and informal feedback from colorectal trainees of endoscopy training experience. Result(s): The survey was completed by 196 participants. This included 13.3% from core trainee (CT) 2-speciality trainee (ST) 4, 28.6% from ST5-ST6, 36.5% from ST7-ST8, 13.3% from post-certificate for completion of training fellows, senior clinical fellows and speciality and specialist (SAS) doctors and 8.7% from early years consultants. The median number of colonoscopies performed by respondents was 121.6 (range 0-8000). Only 33.7% (66/196) reported having one dedicated training list per week, and 56.6% (111/196) were not allocated to any regular training list. The barriers to training were service provision (71.9%), lack of dedicated training lists (69.9%) and access to training lists due to other trainees or healthcare professionals (42.3%). Only 25% of respondents had experience of immersion training, but they consistently reported high numbers of colonoscopy during these periods, with 40% achieving more than 30 colonoscopies. Conclusion(s): There is an urgent need to improve access to colonoscopy training. Regular endoscopy training lists and funding of academies and immersion training centrally are likely to greatly improve the experience of colonoscopy training. Senior colorectal trainees should be prioritised to avoid delay in the completion of training.

DOI: 10.1136/flgastro-2025-103106

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The changing landscape of traumatic brain injuries at a district general hospital in a trauma network (2026)

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Type of publication:

Journal article

Author(s):

Abualsaud, Suhaib; Elmahdi, Ahmed; *Youssef, Mohamed; Jayakumar, Nithish; Lahart, Ian; Ashwood, Neil.

Citation:

British Journal of Neurosurgery. 40(2):351-356, 2026 Apr.

Abstract:

BACKGROUND: Major trauma networks were introduced in 2012 onwards with a major trauma centre (MTC) linked to district general hospitals (DGH). Most traumatic brain injuries (TBI) are managed in DGHs, without on-site neurosurgical services. It is unclear whether the characteristics of TBIs at DGHs have differed since the network was introduced. We compare outcomes of TBI patients pre- (2008-2012) and post-MTC (2013-2021) network implementation.

METHODS: We conducted a retrospective analysis of TBI patients admitted to a 500-bedded DGH, before and after the introduction of a trauma network. We compared the characteristics of patients, including age, mechanism of injury, imaging findings, and length of stay. All statistical analyses were carried out in SPSS v29 (IBM).

RESULTS: Overall, 876 patients (males = 56.1%; median age 67 years) were included. Mean yearly cases pre-MTC was 76 compared to 55 in the post-MTC period. Mean age was significantly higher, and patients had more co-morbidities, in the post-MTC period (p < 0.001). Mean GCS at presentation was not significantly different between the pre- and post-MTC periods (13.7 vs 13.8, respectively). Referrals to the regional neurosurgical centre were significantly higher in the post-MTC period. The overall mortality rate was 33.7%. Increasing age (OR = 1.072), higher comorbidities (OR = 1.243) and intracerebral haematoma (OR = 6.269) were associated with a higher risk of death. The post-MTC period was associated with a lower risk of death (OR = 0.501).

CONCLUSIONS: Fewer patients with less severe mechanisms of injury, and a more elderly population are now being managed at our DGH in the post-MTC period. Mortality was similar to published literature but the introduction of the trauma system was associated with lower risk of death. Although fewer TBIs help to optimise service delivery by maintaining orthopaedic bed capacity, the reduced exposure to these patients may lead to lowered expertise in managing these complex cases.

DOI: 10.1080/02688697.2025.2468951