Spontaneous rupture of spleen in a patient with COVID-19 disease: case report and review of the literature

Abstract Coronavirus disease 2019 (COVID-19) has been associated with multisystemic complications and thrombotic events including pulmonary embolism and deep venous thrombosis. Splenic rupture has been recently reported as a complication in patients with COVID-19, however, the number of cases is limited and the mechanism is still not clearly understood. We present a case of spontaneous splenic rupture secondary to COVID-19 disease.</jats:p

Effect of adherence to prophylaxis on the incidence of venous thromboembolism (VTE) following colorectal cancer surgery: A retrospective record review

Background/objective: Colorectal surgery is the third most common surgery associated with postoperative venous thromboembolism (VTE). While preoperative VTE prophylaxis reduces VTE risk, local studies on the effects of adherence are lacking. This study aimed to assess the effect of adherence to perioperative VTE prophylaxis on VTE incidence in patients undergoing colorectal cancer surgery. Methods: This retrospective record review included all colorectal cancer surgery patients in our center between 2013 and 2020. Any patients who had a VTE at the time of admission, had metastasis at the time of surgery, or underwent resection for other organs other than the colon and rectum in the same operation setting were excluded. Results: Total of 388 patients were included; the mean age was 58.27 ± 13.59, and 55.9 % were males. The overall rate of VTE following surgery was 5.4 %. Patients with interruptions in their VTE prophylaxis regimen showed higher VTE rates than those without interruption. However, this did not reach statistical significance (OR = 4.002, 95 %CI = 0.527–33.535, p = 0.176). Furthermore, patients with VTE prophylaxis medication switches had a significantly higher rate of VTE than those without switches (OR = 5.007, 95 %CI = 1.946–12.881, p = 0.001). In addition, positive urine cultures during 30 days of surgery increased the risk of VTE significantly (OR = 2.863, 95 %CI = 1.093–7.504, p = 0.032). Those with VTE also had higher 30-day mortality rates (p = 0.008). Conclusion: This study highlights the impact of VTE prophylaxis adherence on postoperative VTE rates. Further research, including a larger sample, should investigate reasons for prophylaxis switches to reduce interruptions, potentially decreasing morbidity and mortality

Surgical confidence when operating among residents in surgery – a cross-sectional study (SCAR study)

Abstract Background Self-confidence, is one of the critical variables influencing surgical resident’s abilities, and lack of confidence maybe a reason for not entering medical practice immediately. Measuring the level of confidence of senior surgical residents (SSRs) is a crucial step in assessing preparedness to practice. In this study, we aim to measure their confidence level and the factors that might contribute to it. Methods Cross-sectional survey conducted at King Abdulaziz University Hospital on SSRs in Saudi Arabia (SA). We approached 142 SSRs, 127 responded. Statistical analysis was performed using RStudio v 3.6.2. Descriptive statistics were performed using counts and percentages for categorical variables and using mean ± standard deviation for continuous variables. Multivariate linear regression (t-statistics) was used to assess the factors associated with confidence in performing essential procedures, while the association between demographics and residency-related factor with the number of completed cases was tested using Chi-square. The level of significance was determined as 0.05. Results Response rate was 89.4%. Among surveyed residents, 66% had completed < 750 cases as a primary surgeon. More than 90% of SSRs were confident in performing appendectomy, open inguinal hernia repair, laparoscopic cholecystectomy, and trauma laparotomy, while 88% were confident in being on-call in level-I trauma center. No difference was noted in confidence level in relation to the number of performed cases. Residents from the Ministry of Health accounted for 56.3% of the study population and showed a higher confidence level compared to others. 94% of SSRs plan to pursue fellowship training program. Conclusion The study showed that the confidence of SSRs in performing common general surgery procedures was as expected. However, it’s important to recognize that confidence doesn’t necessarily reflect competence. Considering the majority of SSRs planned to pursue fellowship training programs, it may be time to consider changing the structure of surgical training in SA to a modular format to allow earlier and more intensive exposure