This study evaluated the impact of a dedicated perioperative nursing team on operating theatre efficiency in robotic-assisted spinal surgery. A structured training programme was developed for a team of four perioperative nurses to achieve competence and autonomy in robotic system management across all phases of care. Operative data were retrospectively collected and compared between a pre-implementation phase and a post-implementation phase. A total of 130 robotic-assisted spinal procedures were analysed, including 47 performed before and 83 after team implementation. Following introduction of the specialised nursing team, mean time to surgical start decreased from 67.5 to 61.1 min, and overall operative duration was significantly reduced from 253.9 to 195.0 min. Implant execution time remained stable (30.0 min) despite a significant increase in the mean number of pedicle screws implanted per procedure from 4.9 to 6.4. Efficiency per screw improved markedly, with time per screw decreasing from 7.0 to 4.8 min. Three robotic procedures were abandoned in the pre-implementation period due to workflow-related issues, whereas no procedures were abandoned after introduction of the dedicated team. These findings demonstrate that the implementation of a specialised perioperative nursing team is associated with substantial improvements in workflow efficiency in robotic-assisted spinal surgery.

The global population rise has increased surgeries to over 300 million annually. Operations on patients with multiple comorbidities contribute to postoperative complications affecting 15%-20% of surgical patients. Traditional pre-anaesthesia check-up (PAC) relies on snapshot assessments, potentially missing dynamic health changes. This review explored the integration of wearable technology in preoperative assessment to enhance monitoring through continuous data collection. This scoping review was conducted according to PRISMA ScR guidelines. Literature search performed across PubMed, Google Scholar, Embase and Scopus. Inductive thematic analysis, following Braun and Clarke, was used to synthesise findings. Risk of bias was assessed using the Mixed Methods Appraisal Tool. A total of 17 full-text articles were included, and thematic analysis revealed: Benefits: Wearable devices enable continuous monitoring of physiological parameters and improve patient engagement. Challenges: Implementation barriers include data accuracy concerns and healthcare provider training needs. Future Directions: Advances in sensor technology may enhance personalised medicine. Most studies focused on limb-worn devices, showing correlations with functional tests. Risk of bias was low to moderate, with methodological rigour but limited sample sizes. Integrating wearable technology into PAC can improve surgical outcomes. Addressing implementation challenges is crucial for optimising perioperative care for surgical patients.

Sedation during Extracorporeal Membrane Oxygenation (ECMO) is challenging due to altered pharmacokinetics. At Manchester University NHS Foundation Trust, Wythenshawe Hospital, the Richmond Agitation-Sedation Scale is the standard tool for sedation monitoring; however, it lacks precision in assessing deep sedation. Bispectral Index (BIS) monitoring offers an objective assessment but remains underused, partly because of limited nursing training. This article presents the implementation of small-group teaching sessions (SGTS) on ECMO sedation and BIS monitoring, integrated into existing ECMO refresher training. The sessions included interactive presentations, followed by anonymous feedback collection to evaluate perceptions of the clarity, relevance, appropriateness and usefulness of the SGTS. Sixty-one staff members attended, and 44 provided feedback. All respondents indicated that their learning needs were met, and 93% reported confidence in using BIS independently. The training was highly rated for clarity, relevance and practical value. Overall, our SGTS approach improved nurses' understanding and confidence in BIS monitoring and ECMO sedation, supporting broader clinical adoption and highlighting the value of continued professional education.

Barn-integrated operating rooms represent an emerging model in surgical education, offering open-plan layouts designed to enhance efficiency and learning. Despite growing use across United Kingdom centres, limited data exist on their impact on surgical training. This primary aim of this study is to explore the perceived benefits and challenges of barn-integrated operating rooms among orthopaedic surgeons in the context of the multidisciplinary team. A prospective mixed-methods study was conducted using a pilot-tested questionnaire distributed to 93 orthopaedic theatre personnel, including consultant and trainee orthopaedic surgeons, operating department practitioners, and scrub nurses, assessing satisfaction, supervision, and educational value. Of 54 respondents (58% response rate), 81.5% preferred barn-integrated operating rooms to conventional theatres. Of the total, 78.3% of surgeons reported visiting adjacent barn-integrated operating rooms theatres for learning, and 67.4% agreed supervision was superior. Thematic analysis revealed improved accountability, communication, and support. Concerns included potential infection risk (33%), radiation exposure (33%), and noise disturbance (46%). Barn-integrated operating rooms provide a promising environment for surgical training, promoting supervision, learning frequency, and teamwork. Addressing perceived risks through structured safety protocols will be essential as adoption expands. Further multicentre research is warranted to evaluate long-term outcomes. Findings should be interpreted within the constraint that perspectives were limited predominantly to surgeons.

This study investigates the outcomes after very early chest drain removal following off-pump endoscopic coronary artery bypass grafting. A single-centre retrospective cohort study was conducted at our hospital. All patients undergoing a primary endoscopic coronary artery bypass grafting procedure between May 2021 and January 2025 were eligible. Both single- or multivessel endoscopic coronary artery bypass grafting procedures were analysed. Patients were excluded if they underwent a redo-operation, coronary unroofing procedure, or conversion to sternotomy. A total of 476 patients were included in the final analysis: 246 patients in the conventional drain removal protocol and 230 patients in the early drain removal protocol. Patients in the early drain removal group had significantly higher rates of preexisting comorbidities, preoperative antithrombotic therapy, and urgent procedures (52.6% vs. 36.2%, p < 0.001). The total drain time (5.1 vs. 22.4 h, p < 0.001) and the total drain volume (135 vs. 310 mL, p < 0.001) were both significantly lower in the early postoperative drain removal protocol. There were no significant differences between protocols in the incidence of cardiac tamponade in the first 30 postoperative days (1.3% vs. 0.4%, p = 0.569) and thoracentesis rates (8.7% vs. 5.3%, p = 0.199). Very early chest drain removal after endoscopic coronary artery bypass grafting is safe and does not increase postoperative complications for both single- and multivessel revascularisation. This approach enables early ambulation and may contribute to enhanced postoperative recovery.

Identifying risk factors for acute kidney injury (AKI) following major non-cardiac surgery is challenging due to heterogeneous findings and variable relevance across published studies. This complexity hinders the development of a standardised prognostic model. A systematic review and meta-analysis were conducted based on an extensive literature search (2002-2022) in PubMed, Scopus, Web of Science, Cochrane Central, LILACS, and Dart Europe. Studies were independently screened and selected, with extraction of relevant preoperative and intraoperative variables. Meta-analysis was performed using RevMan 5.4. Out of 533 studies, ten met inclusion criteria. Significant risk factors for postoperative AKI included diabetes mellitus (OR: 1.65, CI: 1.20-2.27), hypertension (OR: 1.86, CI: 1.36-2.54), ACE inhibitors or ARBs use (OR: 1.76, CI: 1.48-2.09), ischaemic heart disease (OR: 1.93, CI: 1.55-2.41), and male sex (OR: 1.28, CI: 1.07-1.53). Protective factors were female sex (OR: 0.72, CI: 0.54-0.96) and higher preoperative haemoglobin (MD: -0.41, CI: -0.52 to -0.30). Trends without statistical significance were noted for older age, low glomerular filtration rate, prolonged operative time, and higher serum creatinine. Comorbidities and certain pharmacological treatments significantly elevate postoperative AKI risk. These findings underscore the need for vigilant preoperative risk stratification.PROSPERO registration:CRD420251111455.

Acute kidney injury (AKI) remains a common yet under-recognised perioperative complication associated with significant morbidity and mortality. Despite technological advances in monitoring and interventions, preoperative identification of at-risk patients remains suboptimal. This project aimed to assess the need and efficacy of a renal risk-stratification tool at a large Level 1 trauma centre in Eastern Georgia, combining qualitative findings and retrospective chart review analysis to guide perioperative AKI prevention. The project involved a two-phase approach: assess the need for a risk tool by surveying stakeholders, followed by piloting the Bell et al model retrospectively on 125 randomly selected patients at the facility. Findings revealed 42% of patients were at moderate to high risk for AKI, emphasising the utility of structured renal assessments to inform clinical decisions and improve outcomes.

Robotic surgery in England is undergoing rapid expansion, with projected growth from 70,000 procedures in 2023-24 to over 500,000 annually by 2035. This shift not only affects surgical technology but redefines perioperative roles - particularly bedside assistance. Despite growing attention from national initiatives such as Getting It Right First Time, regulatory clarity remains lacking. The scope and responsibilities of bedside assistants - a role often conflated with surgical assistance - vary significantly depending on professional background and qualifications. Without clear governance, perioperative practitioners may face liability risks, and patients are left exposed to inconsistent practice. This viewpoint highlights the urgent need for perioperative bodies such as The Association for Perioperative Practice and the Perioperative Care Collaborative to lead the development of national guidance specific to bedside assistance in robotic surgery. Doing so is essential to ensure safe practice, appropriate delegation, and professional accountability in this evolving surgical landscape.