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AUJERO, Loida O.

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Study examines surgeons' stress related to surgery and


night duty
November 15, 2010

A small study of Japanese surgeons suggests that duration of surgery and


the amount of blood loss are associated with increased stress scores, and
that night duty is associated with reduced stress arousal scores, according
to a report posted online today that will be published in the March print
issue of Archives of Surgery.

Young physicians are decreasingly likely to choose surgery as a specialty, according


to background information in the article. About 80 percent fewer chose the
profession in 2000 compared with the 1980s. "One of the reasons is the unfavorable
working conditions experienced by surgeons, which has led to a decrease in the
number of surgeons and, in turn, has caused even greater increases in the
surgeons' workload and risk of errors," the authors write. "It has therefore become a
vicious circle."

The effect of surgical stress on patients has been widely studied, whereas the stress
on surgeons due to surgery and night duty has not. Koji Yamaguchi, M.D., Ph.D., and
colleagues at University of Occupational and Environmental Health, Kitakyushu,
Japan, studied 66 surgeons at one university hospital and 15 community and public
hospitals. Both before and after day shifts, operations and night duty shifts,
participants completed questionnaires assessing stress and workload and provided
urine samples, which were analyzed for levels of a compound (biopyrin) that
indicates the body is under stress.

Questionnaires revealed that the surgeons experienced stress following surgery,


which increased with the duration of surgery and the amount of surgical blood loss.
"There were no significant associations between surgical stress and number of
operations per day, number of operations as a surgeon, number of operations as an
assistant or laparoscopic or conventional surgery," the authors write.

The average operating time was 210 minutes. Urine analysis showed that biopyrin
levels were significantly higher after an operation that was 210 minutes or longer
compared with 209 minutes or shorter, and also that these levels increased after an
operation in which 200 grams or more of blood was lost.

Surgeons who had night duty got less sleep. Based on urine biopyrin levels,
surgeons experienced more stress the morning after night duty. They also
demonstrated lower stress arousal scores when they finished the day shift following
night duty than they were when finishing a day shift not preceded by night duty.

"The problem of chronic sleep deprivation and overwork of surgical residents has
become an important issue in the world, including Japan. A combination of poor-
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quality daytime sleep and increased sleep pressure during the night may result in
lowered levels of alertness and an increased risk of errors in people on night duty,
such as medical personnel," the authors write. "The present study demonstrated
the stress of night duty on surgeons subjectively and objectively. Surgeons' working
conditions, including night duty, should be improved to enhance the quality of life
for surgeons, resulting in fewer errors in operations and medical treatments and
better medical services for patients."

http://www.physorg.com/news/2010-11-surgeons-stress-surgery-night-duty.html

Surgical instruments left in children rarely fatal, but


dangerous
November 15, 2010

Surgical items, such as sponges and small instruments, left in the bodies
of children who undergo surgery are quite uncommon and rarely fatal but
decidedly dangerous and expensive mistakes, according to a Johns
Hopkins Children's Center study to be published in the November issue of
JAMA-Archives of Surgery.

Such errors added eight days, on average, to a young patient's hospital stay and
nearly $36,000 in extra hospital charges, both stemming from complications and
the need for follow-up surgery to retrieve the forgotten objects.

Analyzing more than 1.9 million records over 17 years detailing surgeries performed
on children nationwide, the researchers identified 413 cases of items left behind, or
0.02 percent -- an uncommon but costly and preventable error that can cause
complications and require expensive repeat surgeries, the investigators say.

The retrospective study examined patient records after the fact and did not directly
analyze factors such as operating room conditions and surgical routines that
increased the chance of leaving items inside a patient. Yet the researchers noted
that teenage patients undergoing surgeries for gynecological problems had the
greatest risk
-- four times higher than other patients -- based on how frequently they ended up
being wheeled out of the OR with a surgical item left inside them. The finding
suggests that some operations may be inherently riskier than others.

"It's important to find out what mistakes we make as surgeons, but it is infinitely
more important to know why we're making them and how we can prevent them,"
says principal investigator Fizan Abdullah, M.D., Ph.D., a pediatric surgeon at Johns
Hopkins.

The study did find a difference in death rates between patients with and without
surgical items left in them after surgery, 1.7 percent compared with 0.7 percent,
but the discrepancy was so small it could have been the result of pure chance, the
investigators say.
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Most instances of forgotten items involved gastrointestinal surgeries


-- 22 percent of the 413 episodes occurred during such procedures -- followed by
cardio-thoracic surgeries (16 percent) and orthopedic surgeries (13 percent).

http://www.physorg.com/news/2010-11-surgical-instruments-left-children-
rarely.html

Gastric bypass surgery increases risk of kidney stones


March 10, 2010

March 11, 2010 - Patients who undergo gastric bypass surgery experience
changes in their urine composition that increase their risk of developing
kidney stones, research from UT Southwestern Medical Center
investigators suggests.

A new study, published in the March issue of The Journal of Urology, found that
some of these urinary changes place weight-loss surgery patients at higher risk for
developing kidney stones than obese patients who do not undergo the procedure.

For the study, researchers collected urine samples from 38 study participants.
There were 16 women and three men in each of two groups. One group had
undergone Roux-en-Y gastric bypass (RYGB) surgery; the second group contained
normal obese individuals. RYGB, which is one of the most commonly performed
weight-loss procedures, involves the creation of a small gastric pouch and allows
food to bypass part of the small intestine.

The researchers found that the excretion of a material called oxalate in urine was
significantly greater in the participants who had the surgical procedure than those
who did not (47 percent, compared with 10.5 percent, respectively). In addition, the
amount of a chemical called citrate in the urine was low in many gastric bypass
patients in comparison to the obese nonsurgical group (32 percent to 5 percent).

Oxalate is found in the majority of kidney stones, while citrate inhibits stone
formation.

"Almost half of the patients who had undergone gastric bypass and did not have a
history of kidney stones showed high urine oxalate and low urine citrate - factors
that lead to kidney-stone formation," said Dr. Naim Maalouf, assistant professor of
internal medicine in the Charles and Jane Pak Center for Mineral Metabolism and
Clinical Research and the study's lead author.

The cause for stone formation after bariatric surgery is not entirely clear, but the
study reinforces the message that weight-loss surgery patients and their physicians
should be alert to the heightened risk, Dr. Maalouf said.
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"These findings illustrate that the majority of patients are at risk for kidney-stone
formation after RYGB," Dr. Maalouf said. "This complication may not be well-
recognized in part because it tends to occur months to years after the bypass
surgery."

http://www.physorg.com/news187464321.html

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