Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study

Young, Nathalie; Hulme, Rebecka Ahl; Forssten, Maximilian Peter; Kaplan, Lewis J.; Walsh, T. N.; Cao, Yang; Mohseni, Shahin; Bass, Gary Alan

doi:10.1007/s00068-022-02142-3

Eur J Trauma Emerg Surg

2023

DOI: 10.1007/s00068-022-02142-3

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Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study

Nathalie Young

Rebecka Ahl Hulme

Maximilian Peter Forssten

et al.

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Cited by 5 publications

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“…They also catalog their experience in applying this approach to achieve two specific goals: (1) identifying knowledge gaps regarding the optimal treatment for appendicitis as a hypothesis-generating launchpad for future interventional RCTs, and (2) describing the gap between evidence-based practice guidelines [6] and "real world" selective application as a lens through which to assess the variability in surgical outcomes. Tackling some of the controversies in current care of the patient with acute appendicitis, the ESTES SnapAppy collaborative explores technical aspects of surgical management (including the use of staplers and energy devices at key portions of the operation), operating surgeon experience, mentorship and graded trainee autonomy, and contemporary surgical outcomes following appendectomy across Europe, North America and the Middle East, particularly in the context of an evolving COVID pandemic [7][8][9][10].…”

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confidence: 99%

Focus on identifying and closing knowledge gaps in acute appendicitis

Kurihara

Tilsed

2023

Eur J Trauma Emerg Surg

Self Cite

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confidence: 99%

Focus on identifying and closing knowledge gaps in acute appendicitis

Kurihara

Tilsed

2023

Eur J Trauma Emerg Surg

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Identifying and addressing mentorship gaps in European trauma and emergency surgical training. Results from the Young European Society of Trauma and Emergency Surgery (yESTES) mentorship survey

Cioffi,

Benuzzi,

Herbolzheimer

et al. 2024

Eur J Trauma Emerg Surg

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Purpose European training pathways for surgeons dedicated to treating severely injured and critically ill surgical patients lack a standardized approach and are significantly influenced by diverse organizational and cultural backgrounds. This variation extends into the realm of mentorship, a vital component for the holistic development of surgeons beyond mere technical proficiency. Currently, a comprehensive understanding of the mentorship landscape within the European trauma care (visceral or skeletal) and emergency general surgery (EGS) communities is lacking. This study aims to identify within the current mentorship environment prevalent practices, discern existing gaps, and propose structured interventions to enhance mentorship quality and accessibility led by the European Society for Trauma and Emergency Surgery (ESTES). Methods Utilizing a structured survey conceived and promoted by the Young section of the European Society of Trauma and Emergency Surgery (yESTES), we collected and analyzed responses from 123 ESTES members (both surgeons in practice and in training) across 20 European countries. The survey focused on mentorship experiences, challenges faced by early-career and female surgeons, the integration of non-technical skills (NTS) in mentorship, and the perceived role of surgical societies in facilitating mentorship. Results Findings highlighted a substantial mentorship experience gap, with 74% of respondents engaging in mostly informal mentorship, predominantly centered on surgical training. Notably, mentorship among early-career surgeons and trainees was less reported, uncovering a significant early-career gap. Female surgeons, representing a minority within respondents, reported a disproportionately poorer access to mentorship. Moreover, while respondents recognized the importance of NTS, these were inadequately addressed in current mentorship practices. The current mentorship input of surgical societies, like ESTES, is viewed as insufficient, with a call for structured programs and initiatives such as traveling fellowships and remote mentoring. Conclusions Our survey underscores critical gaps in the current mentorship landscape for trauma and EGS in Europe, particularly for early-career and female surgeons. A clear need exists for more formalized, inclusive mentorship programs that adequately cover both technical and non-technical skills. ESTES could play a pivotal role in addressing these gaps through structured interventions, fostering a more supportive, inclusive, and well-rounded surgical community.

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Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient

Cimino,

Biloslavo,

Kurihara

et al. 2024

Eur J Trauma Emerg Surg

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Background Appendicitis is the most frequent global abdominal surgical emergency. An ageing population, who often exhibit atypical symptoms and delayed presentations, challenge conventional diagnostic and treatment paradigms. Objectives This study aims to delineate disparities in presentation, management, and outcomes between elderly patients and younger adults suffering from acute appendicitis. Methods This subgroup analysis forms part of ESTES SnapAppy, a time-bound multi-center prospective, observational cohort study. It includes patients aged 15 years and above who underwent laparoscopic appendectomy during a defined 90-day observational period across multiple centers. Statistical comparisons were performed using appropriate tests with significance set at p < 0.05. Results The study cohort comprised 521 elderly patients (≥65 years) and 4,092 younger adults (18–64 years). Elderly patients presented later (mean duration of symptoms: 7.88 vs. 3.56 days; p < 0.001) and frequently required computed tomography (CT) scans for diagnosis (86.1% vs. 54.0%; p < 0.001). The incidence of complicated appendicitis was higher in the elderly (46.7% vs. 20.7%; p < 0.001). Delays in surgical intervention were notable in the elderly (85.0% operated within 24 h vs. 88.7%; p = 0.018), with longer operative times (71.1 vs. 60.3 min; p < 0.001). Postoperative complications were significantly higher in the elderly (27.9% vs. 12.9%; p < 0.001), including severe complications (6.9% vs. 2.4%; p < 0.001) and prolonged hospital stays (7.9 vs. 3.6 days; p < 0.001). Conclusions Our findings highlight significant differences in the clinical course and outcomes of acute appendicitis in the elderly compared to younger patients, suggesting a need for age-adapted diagnostic pathways and treatment strategies to improve outcomes in this vulnerable population.

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Graded operative autonomy in emergency appendectomy mirrors case-complexity: surgical training insights from the SnapAppy prospective observational study

Cited by 5 publications

References 37 publications

Focus on identifying and closing knowledge gaps in acute appendicitis

Focus on identifying and closing knowledge gaps in acute appendicitis

Identifying and addressing mentorship gaps in European trauma and emergency surgical training. Results from the Young European Society of Trauma and Emergency Surgery (yESTES) mentorship survey

Practice patterns and clinical outcomes in acute appendicitis differ in the elderly patient

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