Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine.

Introduction:The impact of radical prostatectomy on the social well-being of survivors remains poorly understood. This meta-synthesis therefore aimed to integrate the findings of qualitative research evaluating the impact of surgery on the patient relationships with partners, family and wider societal interactions.Methods: Medline, CINAHL, PsycINFO and Embase were searched for qualitative studies evaluating social well-being dimensions. A thematic meta-synthesis was conducted to inductively construct descriptive themes and overarching analytical themes.Results: Thirty-one articles were included, with seven descriptive themes under two analytical themes generated to describe the experiences of 469 participants. 'Pathway to Conversion' encompassed three themes on the evolving social behaviour of men with both partners and family to adapt to their new normality postoperatively.'A Man on My Own' discussed four themes focussing on both intimate and wider social relations, describing the stigma, shame and embarrassment felt by patients due to changes in their perceived body image and physical function. This resulted in men feeling alone, unsupported and seeking isolation.Conclusion: Radical prostatectomy's impact on survivors' social well-being extends beyond surgery and causes a shift in their relationship dynamics with partner and family, highlighting the importance of preoperative and postoperative clinician's counselling to both patient and partner.

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Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high‐ (HICs) and low‐ and middle‐income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7‐day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally.

Background: Administration of tranexamic acid (TXA) peri-operatively is a well-recognised strategy used by orthopaedic surgeons to reduce blood loss during total knee arthroplasty (TKA). Furthermore, not using a drain has been advocated to be a safe and effective way to further reduce blood loss. The main aim of this study is to assess the effect of a combination of these two strategies on total blood loss associated with TKA. Methods: This is a retrospective study conducted on a single surgeon's data gathered over a two-year period. This study compares the blood loss in two groups of patients. The control group received no antifibrinolytic agents and a drain was inserted, while the study group received TXA and the drain was omitted. Results: A total of 109 patients were included in the analysis, with 86 patients in the study group and 23 patients in the control group. The two groups were compared in terms of pre-operative haemoglobin, American Society of Anesthesiologists (ASA) score and body mass index (BMI). The mean age of the study group was lower than that of the control group (64±8 years vs 68±9 years; p=0.03). The mean total blood loss was lower in the study group compared to the control group (mean difference 171.8 ml; 95% CI 31.2-312.2; p=0.01). Duration of hospital stay was also reduced in the study group (2.4 days vs 3.1 days; p=0.003). There was, however, no difference in the functional outcome according to the Knee injury and Osteoarthritis Outcome Score (KOOS). Conclusion: These findings are in accordance with previous studies, indicating that intra-articular administration of TXA and omission of negative pressure drainage may be associated with a reduction in blood loss following TKA. Larger, well-designed studies are required to determine the optimal TXA administration strategy.