IN BRIEF The latest guidance, articles and studies

The Operating Room Black Box: understanding adherence to surgical checklists

This retrospective study looked at the use of the Operating Room Black Box (ORBB) – a data capture system for identifying intraoperative errors, events, and distractions – to track checklist compliance, engagement and quality. After a hospital policy change, the debrief scores improved significantly to 85%, P<0.001 for compliance; 88%; P<0.001 for engagement; and 71%; P<0.001 for quality. The authors concluded that the ORBB provides the unprecedented ability to assess compliance with surgical safety checklists and also engagement and quality.

Al Abbas A, Sankaranarayanan G, Polanco P et al. Ann Surg 2022; 276(6): 995–1001

Planned caesarean births have doubled in 20 years in Scotland The number of planned caesarean births in Scotland has more than doubled in the past 20 years. Public Health Scotland said there were 8,884 elective C-sections last year, up from 4,285 in 2001. The number of emergency C-sections also rose, from 7,526 to 9,359, despite the total number of births falling. Experts have attributed the rise to higher obesity rates and older mothers.

BBC Scotland News, November 2022. www.bbc.co.uk/news/ukscotland-62926167

Factors associated with postprocedure opioid prescribing and persistent opioid use among opioidnaive patients

This observational study determined factors associated with post-procedure opioid receipt and persistent opioid use among opioid-naive patients. Younger age, certain locations, in-patient procedures and musculoskeletal diagnosis were associated with increased

Higher rates of caesarean sections in Scotland may be due to higher rates of obesity and older mothers opioids. Persistent opioid use was associated with certain locations, musculoskeletal diagnosis, public insurance and a positive depression screener. Authors concluded this information should be used to inform national guidelines for opioid prescribing and post-procedure pain management.

Parikh MA, Fabiyi C, Mistry K. Ann Surg 2022; 276(6): e706–e713

Effect of oral antimicrobial prophylaxis on surgical-site infection after elective colorectal surgery

This randomised trial evaluated the addition of 1g oral ornidazole to standard intravenous prophylaxis in 926 patients undergoing elective colorectal surgery. Surgical site

Updated guideline for closure of abdominal-wall incisions from the European and American Hernia Societies

These updated guidelines are intended to help surgeons in selecting the optimal approach and location of abdominal-wall incisions. Laparoscopic surgery and non-midline incisions are preferred when safe and feasible. In laparoscopic surgery, suturing the fascial defect of trocar sites of 10mm and larger is advised, especially after infection within 30 days after surgery occurred in 13% in the oral prophylaxis group and 22% in the placebo group. The proportion of patients with deep infections was 4.8% in the oral prophylaxis group and 8% in the placebo group. Authors concluded that the addition of ornidazole (1g, p.o.) significantly reduced surgical site infections.

Futier E, Jaber M, Garot M et al on behalf of the COMBINE group. BMJ 2022; 379: e071476

Surgery or endovascular therapy for chronic limb-threatening ischemia

A randomised trial of 1830 patients with chronic limbthreatening ischemia contained two parallel-cohort trials. Patients with suitable great saphenous vein were cohort 1; those needing an alternative bypass conduit were cohort 2. In cohort 1, a major adverse limb event or death from any cause occured in 43% in the surgical group and 57.4% in the endovascular group. In cohort 2 it occured in 43% in the surgical group and 48% in the endovascular group. Authors concluded that surgical revascularisation had lower adverse events than endovascular treatment if saphenous vein was available; in the absence of saphenous vein, results were similar.

Farber A, Menard MT, Conte MS et al. N Engl J Med 2022, DOI: 10.1056/

NEJMoa2207899 single-incision laparoscopic surgery and at the umbilicus.

For closure of an elective midline laparotomy, a continuous small-bites suturing technique with a slowly absorbable suture is suggested. Prophylactic mesh augmentation after elective midline laparotomy can be considered.

Deerenberg EB, Henriksen NA, Antoniou GA et al. Br J Surg 2022; 109(12): 1239–1250