Surgery

From operating room to leadership room: a systematic review of simulation-based interventions for leadership development in general surgery (2026)

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Type of publication:

Journal article

Author(s):

Gulnaz, Nadia; Soomro, Faiza Hashim; Nazir, Izza; *Ansar, Mehwish; Arshad, Rabia.

Citation:

BMC Medical Education. 26(1), 2026 May 27.

Abstract:

OBJECTIVE: To evaluate the effect of simulation-based leadership training on behavioral and safety-related outcomes in surgical and clinical environments. Leadership and non-technical skills (NTS) are critical for safe surgical practice. Simulation-based education can be helpful in the improvement of these skills. While simulation-based education is widely used to improve technical skills, its influence on leadership, teamwork, and patient safety outcomes is reported inconsistently.

METHODS: Following the PRISMA guidelines, studies evaluating leadership or NTS using simulation within surgical or perioperative contexts were included. Study characteristics, simulation format, assessment frameworks, leadership outcomes, and patient safety indicators were extracted. Risk of bias was evaluated using ROBINS-I and RoB-2, and visualised through the robvis platform.

RESULTS: Twelve studies with 430 participants met inclusion criteria. Sample sizes ranged from 14-69; most involving multidisciplinary teams of 2-6 members. High-fidelity modalities were used in approximately 70% of studies, while others incorporated wet-lab, video-based, or in-situ simulations. Leadership performance improved, with reported gains of 2-4 points on behavioral scales. Communication and teamwork scores increased by approximately 2-3 points, and Non-Technical Skills for Surgeons (NOTSS) domain means typically ranged from 2.8-3.5 on 4-point scales. Technical performance differences between senior and junior trainees averaged 30-40%. Checklist-supported teams missed only 6% of critical actions.

CONCLUSIONS: Simulation-based training was consistently associated with improvements in leadership, communication, teamwork, and safety-related performance across surgical and multidisciplinary settings. Although results were positive, heterogeneity in design and measurement shows the need for further high-quality, standardised research.

DOI: 10.1186/s12909-026-09486-z

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An overview of cell salvage in orthopaedic hip and knee arthroplasty surgery (2026)

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Type of publication:

Journal article

Author(s):

*Patel, Ravi; Golding, Steven; Nandra, Rajpal; Banerjee, Robin.

Citation:

Journal of Perioperative Practice. 36(4):186-191, 2026 Apr.

Abstract:

Blood management is a critical aspect of patient care during surgical procedures. In the United Kingdom, there is a growing recognition of the need to integrate intraoperative cell salvage into blood management protocols, especially for invasive surgeries where significant blood loss is anticipated. While donated blood (allogeneic blood) is traditionally used in such cases, it carries risks and potential complications. Consequently, intraoperative cell salvage presents itself as an appealing alternative, particularly in hip and knee arthroplasty procedures. Intraoperative cell salvage involves the collection and reinfusion of a patient's own blood (autologous blood) lost during surgery. Studies have consistently shown that autologous blood collected via intraoperative cell salvage has fewer complications and greater benefits compared to donated blood. However, despite these advantages, the widespread adoption of intraoperative cell salvage in UK hospitals remains limited, primarily due to associated costs. While the integration of intraoperative cell salvage into blood management services may incur initial expenses, research suggests that it could ultimately prove to be cost-effective. This is because improved patient outcomes associated with intraoperative cell salvage may lead to reduced postoperative complications and shorter hospital stays. Thus, there is a growing imperative to overcome financial barriers and promote the implementation of intraopertive cell salvage as a standard practice in perioperative care across UK health care settings. The purpose of this scoping literature review is to consolidate the available information on the current use of intraoperative cell salvage and to identify intraoperative cell salvage techniques and devices described for use in an arthroplasty setting.

DOI: 10.1177/17504589241293406

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Ileostomy creation for rectal cancer in England: An observational study of variation, and correlates 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:

Colorectal Disease. 28(9):e70622, 2026 Sep.

Abstract:

AIMS: The decision to create an ileostomy following anterior resection is a clinical one based on the judgement of the surgical team. However, there are few data to support decision-making. This study aimed to explore variation in, and factors associated with, ileostomy creation rates following surgery for rectal cancer in England.

METHODS: This exploratory, retrospective analysis used observational data from England's Hospital Episode Statistics (HES) dataset. All patients aged >=17 years undergoing an elective anterior resection with ileostomy creation from 1 April 2016 to 31 March 2024 were included. The primary outcome of interest was ileostomy creation at the time of index surgery.

RESULTS: In total, 17,540 anterior resections for rectal cancer were included, and 5,954 patients (33.9%) had a diverting ileostomy. Rates of ileostomy creation declined over time, from 38.6% in 2016/17 to 29.7% in 2023/24, while the number of anterior resections remained relatively stable, other than during the COVID-19 pandemic. There was substantial variation in ileostomy creation rates across hospital trusts from 5.8% to 62.5%. Greater odds of ileostomy creation were associated with younger age, male sex, mild/moderate frailty, living in a less deprived area, Asian ethnicity, higher surgeon and trust volume and earlier time periods.

CONCLUSIONS: Rates of ileostomy creation are falling, but there is huge variation in creation rates across providers and patient groups. Standardised guides on when to create an ileostomy may help reduce the extent of this variation.

DOI: 10.1111/codi.70622

Optimising Performance Through Sleep: An Evidence-Based Review (2026)

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Type of publication:

Journal article

Author(s):

*Bastock, Daniel; Amarnani, Raj.

Citation:

Cureus. 18(7):e111990, 2026 Jul.

Abstract:

Sleep is increasingly being recognised as an important factor influencing athletic performance, recovery and overall health. This narrative review aims to discuss the factors that can affect sleep in athletes and how sleep can affect performance. Traditionally, athlete well-being has focused on training and nutrition; however, new evidence and initiatives now highlight sleep as an important element of performance. This review examines current evidence on sleep duration, sleep quality and sleep disturbances in athletic populations, with a particular focus on the effects related to competition. Athletes often report shorter sleep durations than non-athletes, despite experiencing less sleep fragmentation and quicker sleep onset. One study found that on nights before a competition day, athletes went to bed earlier (22:56 hr +/- 49.2 min), woke up later (8:12 hr +/- 58.6 min) and slept for longer (7:57 hr +/- 60.9 min). A significant number of athletes face poor sleep quality, difficulty falling asleep, and excessive daytime sleepiness. Sleep disruptions are also common around competitions, with post-competition nights showing reductions in total sleep time and sleep quality compared to pre-competition nights. Factors contributing to this include late competition times, heightened physiological and psychological arousal, increased caffeine intake, travel demands and use of technology. Overall, these findings demonstrate that inadequate and disturbed sleep is widespread among athletes, especially during competition periods, which may impact recovery, cognitive function and emotional stability.

DOI: 10.1002/wjs.70558

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Thirty-Day Mortality and Morbidity Outcomes in Abdominal Wall Necrotizing Soft Tissue Infections: The STANMORE Study (2026)

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Type of publication:

Journal article

Author(s):

Balasubaramaniam, Vignesh; Mun Wong, Geoffrey Yuet; Martinino, Alessandro; Sarodaya, Varun; Abulazayem, Mohamed; Wazir, Ishaan; Scarano Pereira, Juan Pablo; Marques, Claudia Neves; Said, Amira; Wadhawan, Himanshu; Graham, Yitka; *Jain, Rajesh Kumar; *Riera, Manel; Mahdi, Ahmed Salah; Ammar, Ahmed Siddique; Mohamed, Aboelazaiem; Alfarwan, Ahmad; Sanli, Ahmet Necati; Aymar, Akilimali; Alkaseek, Akram; Khamees, Almu'atasim; Ouyahia, Amel; Kosti, Angeliki; Dawle, Anjali; Maqbool, Baila; Abdelhadi, Bassem; Parmar, Chetan; Colak, Elif; Erginoz, Ergin; Verras, Georgios-Ioannis; Abd El Hady, Haithm G; Hamdan, Hasan K H; Bakeer, Hibad Bileid; Alhadad, Hoda Salem; Elzayat, Ibrahim; Gerogiannis, Ioannis; Demma, Jonathan Abraham; Al-Shami, Khayry; Shalabi, Laila; Frountzas, Maximos; Manoj, Matthew Antony; Tokocin, Merve; Campanelli, Michela; Omar, Mohammad A; Farag Karamelghani, Mohammed Akasha; Rais, Mounira; Abu Jayyab, Mustafa Ahmad; Allahverdiyeva, Nigar; Gentileschi, Paolo; Abizade, Rashad; Huseynov, Sahib; Das, Aashna; Uludag, Server Sezgin; Cyclewala, Shabnam S; Meric, Serhat; Omarov, Taryel; Bakewell, Zoe Rachael; Singhal, Rishi; Mahawar, Kamal.

Citation:

World Journal of Surgery. 2026 Sep 10.

Abstract:

BACKGROUND: Necrotizing soft tissue infection is a rapidly progressive soft tissue infection with a high mortality rate. Limited contemporary data exist on abdominal wall necrotizing soft tissue infections. This study aimed to assess 30-day mortality and morbidity and identify associated clinical factors.

METHODS: This was a prospective, multinational, multicenter audit of adult patients (>= 18 years) with abdominal wall necrotizing soft tissue infection presenting between January 1 and June 30, 2022. Data on demographics, comorbidities, clinical features, treatment, and outcomes were collected. Univariate and multivariate regression analysis were performed to identify independent risk factors for morbidity and mortality.

RESULTS: A total of 331 patients were included from 63 centers in 27 countries. Thirty-day morbidity and mortality occurred in 200 patients (60.4%), with 47 deaths (14.2%). A LRINEC score >= 6 was observed in 134 out of 263 (51.0%) of cases. Common presenting signs were skin changes in 287 out of 327 cases (87.8%), pain out of proportion to clinical findings in 236 out of 311 cases (75.9%), and gas in soft tissue on imaging 210 out of 329 cases (63.8%). The median time to first antibiotics was 2 hours (Range 0-240 hours). The median time to surgery was 6 hours (Range 1-384 hours). In the mortality group, 29 out of 47 (61.7%) had diabetes, 33 out of 47 (70.2%) had hypertension, and 25 out of 47 (53.2%) had obesity. Bowel resection (38.3%, 18 out of 47), stoma formation (44.7%, 21 out of 47) and ICU admission (89.4%, 42 out of 47) were more common in the mortality group (p < 0.05, OR 7.47). On multivariable analysis, polymicrobial infection (OR 1.73 CI 1.01-2.95) and bowel resection (OR 3.10 CI 1.22-7.88) were independently associated with morbidity, while increasing age (OR 1.04 CI 1.01-1.07), elevated creatinine (OR1 CI 1.00-1.01), bowel resection (OR 7.47 CI 2.99-18.62), and longer time to antibiotics (OR 1.02, CI 1.00-1.04) were independently associated with mortality (p < 0.05).

CONCLUSION: Abdominal wall necrotizing soft tissue infection is associated with high early morbidity and mortality. Delays in recognition and treatment remain critical contributors. Risk stratification may assist early identification and management.

DOI: 10.1002/wjs.70558

Interventions to Reduce Surgical Site Infection in Transmetatarsal Forefoot Amputations: A Feasibility Survey (2026)

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Type of publication:

Journal article

Author(s):

*Alawattegama, Lakna Harindi; Al-Saadi, Nina; Bosanquet, David; Chetter, Ian; Fabre, Ismay; Garnham, Andrew; Gwilym, Brenig; Hitchman, Louise; Long, Judith; Magill, Laura; Worrallo, Katie; Pinkney, Thomas; Popplewell, Matthew; Wall, Michael.

Citation:

International Wound Journal. 23(4):e70846, 2026 Apr.

Abstract:

Surgical site infection (SSI) following transmetatarsal amputation (TMA) is common and associated with significant morbidity. However, there is limited evidence to guide perioperative strategies for SSI prevention in this population. A prospective, cross-sectional survey was conducted among vascular specialists. The questionnaire assessed current practice in SSI prevention for TMA, perceptions of evidence gaps, and willingness to participate in future research. Responses were analysed descriptively. Eighty-four valid responses were analysed, with 64.3% from consultant vascular surgeons and 84.5% from UK centres. Most respondents (84.5%) considered SSI after TMA to be a significant issue. The majority preferred primary closure in clean wounds (78.6%) and commonly used short-course antibiotics and interrupted sutures. Over 70% agreed no clear best practice exists, and 65.5% felt high-quality randomised trials are needed. Ninety-three percent expressed willingness to engage in future studies. Equipoise existed regarding interventions including antibiotic duration, wound adjuncts, and closure techniques. Opinion varied regarding whether TMA and major lower limb amputation should be pooled when undertaking research into SSI prevention. Current practice in SSI prevention for TMA is highly variable. This survey demonstrates broad support for rigorous trials to establish effective strategies and highlights the feasibility of future research in this area.

DOI: 10.1111/iwj.70846

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Breast Screening in Newport (2026)

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Type of publication:

Service improvement case study

Author(s):

*Breast Imaging Department

Citation:

SaTH Improvement Hub, March 2026

SMART Aim:

To maintain uninterrupted access to breast screening for residents in Newport between November 2025-March 2026 as evidenced by productivity figures to support early detection of breast cancer.

Link to PDF poster

Elective Hub High Flow Theatre List: Combined Robotic & Non-Robotic Double HIT List (2026)

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Type of publication:

Service improvement case study

Author(s):

*Saurav Chakravartty, *Adam Farquharson, *Rebekah Tudor

Citation:

SaTH Improvement Hub, June 2026

SMART Aim:

To improve elective performance by increasing cases per list and achieving >85% theatre utilisation on 23 June 2026.

Link to PDF poster

Variation, temporal trends and factors associated with ileostomy reversal after anterior resection surgery for rectal cancer in England: An observational study using administrative data (2026)

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Type of publication:

Journal article

Author(s):

*Olagunju N; *Cheetham M; Savage K; Briggs TWR; Gray WK

Citation:

Colorectal Disease. 28(3):e70427, 2026 Mar.

Abstract:

AIMS: The presence of a temporary ileostomy following anterior resection for rectal cancer substantially impacts the quality of life of patients and long-term functional outcomes. Timely reversal of the ileostomy can help to minimise negative impacts. Using an administrative dataset for England, this study aimed to explore temporal trends in ileostomy reversal rates, variation in reversal rates across trusts and factors associated with delayed reversal.

METHODS: This was an exploratory retrospective analysis of observational data from the Hospital Episode Statistics (HES) dataset for England. All patients aged >=17 years undergoing a planned anterior resection for rectal cancer with ileostomy creation between April 1, 2016, and March 31, 2023, were identified. The primary outcome of interest was ileostomy reversal within 18 months.

RESULTS: Data were available for 5,275 ileostomy creations during the study period. Ileostomy was reversed within 18 months in 3,338 (63.5%) patients. Frailty, socio-economic deprivation, open surgery and anastomotic leak were associated with failure to reverse ileostomy within 18 months. There was a steady decrease in rates of ileostomy reversal within 18 months over the course of the study period.

CONCLUSIONS: This study highlights a need to review current ileostomy closure pathways across England, provide equitable access to timely reversal and improve the shared decision-making process between clinicians and patients undergoing surgery for rectal cancer.

DOI: 10.1111/codi.70427

National multi-specialty robotic surgery training curriculum and implementation for UK surgical residents: a delphi consensus (2026)

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Type of publication:

Journal article

Author(s):

Francis N; Shakir T; McLarty E; Haddad F; *Farquharson A; Garnham A; Siddiq S; Bannon A; Collins J; Yassin N

Citation:

Journal of Robotic Surgery. 20(1), 2026 Aug 29.

Abstract:

Robotic-assisted surgery is now established across multiple surgical specialties in the United Kingdom, yet training for surgical residents remains variable, resource-dependent, and insufficiently standardised at national level. This study sought multispecialty expert consensus on the essential components of a national robotic surgery training curriculum for UK surgical residents. A four-round modified Delphi study was conducted between September and December 2025 under the RaDaR network of the Royal College of Surgeons of England. Round 1 used open-ended questionnaires with independent dual-coder thematic analysis; Round 2 was a hybrid face-to-face and online meeting with live anonymous electronic voting; Rounds 3 and 4 were online questionnaires addressing statements not yet reaching the pre-defined consensus threshold of 70% agreement or greater. The panel comprised consultant surgeons, surgical trainees, curriculum and training authorities, and industry representatives with deliberately bounded, non-clinical input. 25 participants completed the final round. Of 26 statements, 22 (84%) reached consensus. A three-tier framework of device, basic skills, and procedural training was endorsed, with device training introduced during Phase 1 (76%) and basic skills and procedural training introduced after Phase 1 (96% and 88% respectively). Competency assessment integrated within the Annual Review of Competence Progression was supported (84%), alongside multi-source funding; trainee self-funding was not endorsed. This consensus offers a pragmatic foundation for standardising robotic surgery training for UK residents, contingent on coordinated investment in platform access, simulation infrastructure, and faculty development.

DOI: 10.1007/s11701-026-03864-x

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