The effect of surgical experience on the amount of radiation exposure from fluoroscopy during dynamic hip screw fixation

Quah, Conal; Mehta, Rajnikant; Shivji, Faiz; Hassan, S; Chandrasenan, Jeevan; Moran, Chris; Forward, D. P.

doi:10.1308/rcsann.2016.0282

Cited by 17 publications

(16 citation statements)

References 15 publications

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“…conducted their study in the UK, and thus their grading was based on the traditional UK specialization tiers of consultants, senior registrars and junior registrars. 30 Quah, 31 Madan, 7 Bahari 20 and Giannoudis, 26 followed as similar tier system.…”

Section: Grading Of Surgeon Experiencementioning

confidence: 95%

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Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review

Malik¹,

Hussain²,

Lakdawala³

et al. 2019

Orthop Rev (Pavia)

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With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience levels and their effect on the primary outcomes. A total of eighteen studies were included in the review. The studies were a mix of prospective and retrospective studies with low to moderate quality as evaluated by the MINORs criteria. Studies were variable in defining surgeon experience levels and in the type of operations being performed. Majority of the studies showed that inexperienced surgeons/trainees had a higher total fluoroscopy time and a higher mean radiation exposure as compared to experienced surgeons. We conclude that higher surgeon experience significantly reduces usage of fluoroscopy and the consequent radiation exposure in orthopedic procedures. Introduction of strict radiation guidelines involving limited usage of fluoroscopy and supervision of trainees may be beneficial in controlling radiation exposure in the future.

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Section: Grading Of Surgeon Experiencementioning

confidence: 95%

“…With the exception of four studies, 24,27,31,34 all remaining studies reported Total Fluoroscopy time(TFT)/Screening time. Majority of the studies found a longer TFT when surgeries were being performed by a junior inexperienced resident/trainee.…”

Section: Total Fluoroscopy Time/screening Timementioning

confidence: 99%

Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review

Malik¹,

Hussain²,

Lakdawala³

et al. 2019

Orthop Rev (Pavia)

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“…On the contrary, Quah et al [ 14 ] found that the registrar cohort as a whole (ST3-ST8), cumulatively used a higher dosage of ionising radiation compared to the consultant cohort for an extended series of 1203 patients. It is notable that this study again compared two extremes of surgical expertise.…”

Section: Discussionmentioning

confidence: 99%

Intraoperative Fluoroscopic Radiation Exposure During Hip Fracture Fixation: A Study Combining Surgical Experience and Fracture Complexity

Bruce¹,

De²,

Golmohamad³

et al. 2021

Cureus

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Aim Hip fracture fixation surgeries are one of the most common surgeries that every trauma unit does regularly. Surgical training and expertise to fix these fractures properly are quite crucial for every orthopaedic surgeon. Therefore, orthopaedic training programmes all over the world consider significant focus on this and teach trainee surgeons expectantly to manage these fractures independently. Surgical fixation of hip fractures often requires fluoroscopy assistance in the operating theatre with associated hazards from ionising radiation. Moreover, hip fractures can be sometimes quite complex and may require relatively more fluoroscopy usage even with the higher grade of the operating surgeons. Therefore, training need for hip fracture fixation surgery is imperative and there is also a need for intraoperative radiation safety. This study has tried to find a balance between intraoperative fluoroscopic radiation exposure, surgical training requirement, and hip fracture complexity. Methodology This single centre study has collected retrospective peri-operative data over a period of two years including hip fractures that required fluoroscopy-guided surgical fixation. Femoral head fractures, subtrochanteric fractures, diaphyseal fractures, and trochanteric fractures with associated pelvic fractures were excluded from the study. We collected data on demographic parameters, fracture complexity and grading (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA] Classification), intraoperative ionising radiation exposure (centi-Gray/cm 2 ), and grade of the operating surgeon in order to find any relation between these factors. Results Total 268 patients were included in the study with a mean age of 81.8 years (SD 9.3) comprising of 83 (31%) male patients and 185 (69%) female patients. The study population was further stratified into three groups depending upon the operating grade of the surgeon: ‘Junior Trainee’ (five years of experience; 148 cases [55%]); and ‘Consultant’ (fully trained to practice independently; 43 cases [16%]). There was no statistically significant difference among these three sub-groups with regards to the age (p = 0.79), gender (p = 0.73), body mass index (p = 0.46), and fracture pattern (p = 0.96) of the patients. However, consultants tend to operate more on the higher American Society of Anesthesiologists (ASA) grade patients (p = 0.049) with more comorbidities. There was statistically significant higher fluoroscopic radiation exposure while junior trainee surgeons (p = 0.005) were operating and during the higher complex grade of hip fracture (p = <0.001) fixation. Conclusion In conclusion, the quantity of intra-operative radiation dose utilised in the surgical fixation of hip fractures is significantly associated with the grade and level of training of the operating surgeon and fracture complexity ...

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“…Al parecer, existe controversia respecto a la dosis necesaria para el desarrollo de cataratas, pero si se consideraba que existía un efecto determinista a partir de 5 a 8 Gy, actualmente se ha bajado el nivel a 0,5 Gy. Finalmente, e importante para aquellos que nos dedicamos a la docencia, la cantidad de radiación que recibimos es inversamente proporcional a la experiencia quirúrgica y a la complejidad de la cirugía a tratar (7) . Este es un motivo más para enfrentar al residente de forma progresiva a problemas cada vez más complejos.…”

Section: Las Radiaciones Ionizantesunclassified

La salud del equipo quirúrgico en cirugía ortopédica y traumatología

Fernández-Valencia¹,

Roiz²,

Roiz³

et al. 2017

REACA

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RESUMEN Un equipo quirúrgico incluye a diferentes profesionales tales como cirujanos, anestesistas, instrumentistas, enfermería circulante o técnicos de radiodiagnóstico. Este equipo multidisciplinar, descrito en su funcionamiento óptimo como una "máquina bien engrasada", tiene como objetivo realizar las cirugías maximizando la seguridad del paciente y su satisfacción, y aumentando la calidad de los resultados. De esta forma, también se reducen de forma indirecta los costes en relación con las estancias hospitalarias y las complicaciones. En el desempeño de su trabajo, el equipo se enfrenta a diferentes factores de riesgo que pueden mermar su bienestar como grupo o bien la salud física o psíquica de cada uno de los miembros. En el presente artículo revisamos los principales factores que pueden poner en riesgo la salud del equipo quirúrgico en la especialidad de Cirugía Ortopédica y Traumatología, y cómo evitarlos o bien cómo minimizar su impacto.

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The effect of surgical experience on the amount of radiation exposure from fluoroscopy during dynamic hip screw fixation

Cited by 17 publications

References 15 publications

Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review

Does surgeon experience influence the amount of radiation exposure during orthopedic procedures? A systematic review

Intraoperative Fluoroscopic Radiation Exposure During Hip Fracture Fixation: A Study Combining Surgical Experience and Fracture Complexity

La salud del equipo quirúrgico en cirugía ortopédica y traumatología

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