Objective: Quality of intraoperative teamwork may have a direct impact on patient outcomes. Heart rate variability (HRV) synchrony may be useful for objective assessment of team cohesion and good teamwork. The primary aim of this study was to investigate the feasibility of using HRV synchrony in surgical teams. Secondary aims were to investigate the association of HRV synchrony with length of procedure (LOP), complications, number of intraoperative glitches and length of stay (LOS). We also investigated the correlation between HRV synchrony and team familiarity, pre- and intraoperative stress levels (STAI questionnaire), NOTECHS score and experience of team members. Methods: Ear, nose and throat (ENT) and vascular surgeons (consultant and registrar team members) were recruited into the study. Baseline demographics including level of team members’ experience were gathered before each procedure. For each procedure, continuous electrocardiogram (ECG) recording was performed and questionnaires regarding pre- and intraoperative stress levels and non-technical skills (NOTECHS) scores were collected for each team member. An independent observer documented the time of each intraoperative glitch. Statistical analysis was conducted using stepwise multiple linear regression. Results: Four HRV synchrony metrics which may be markers of efficient surgical collaboration were identified from the data: 1. number of HRV synchronies per hour of procedure, 2. number of HRV synchrony trends per hour of procedure, 3. length of HRV synchrony trends per hour of procedure, 4. area under the HRV synchrony trend curve per hour of procedure. LOP was inversely correlated with number of HRV synchrony trends per hour of procedure (p < 0.0001), area under HRV synchrony trend curve per hour of procedure (p = 0.001), length of HRV synchrony trends per hour of procedure (p = 0.002) and number of HRV synchronies per hour of procedure (p < 0.0001). LOP was positively correlated with: FS (p = 0.043; R = 0.358) and intraoperative STAI score of the whole team (p = 0.007; R = 0.493). Conclusions: HRV synchrony metrics within operating teams may be used as an objective marker to quantify surgical teamwork. We have shown that LOP is shorter when the intraoperative surgical teams’ HRV is more synchronised.

Background: Applications of Artificial Intelligence (AI) are gaining traction in healthcare, including vascular surgery. While most healthcare data is in the form of narrative text or audio recordings, natural language processing (NLP) offers the ability to extract structured information from unstructured medical records. This can be used to develop more accurate risk prediction models, and to identify patients for trials to improve recruitment. The goals of this scoping review were to determine the source of data used to develop AI-based algorithms with emphasis on natural language processing, establish their application in different areas of vascular surgery and identify a target audience of published journals. Methods: A literature search was carried out using PubMed, EMBASE, and Google Scholar database from January 1996 to March 2023. Following screening, 342 peer-reviewed articles met the eligibility criteria. Findings: Among the 342 articles meeting eligibility criteria, the majority (191) were published after 2020. NLP algorithms were described in 34 papers, while 115 and 193 papers focused on machine learning (ML) and deep learning (DL), respectively. Two-thirds (67.25%) were published in non-clinical journals. The AI-based algorithms found widest application in research related to aorta and its branches (126 articles), followed by carotid disease (85), and peripheral arterial disease (65). Image-based data were utilised in 216 articles, while 153 and 85 papers relied on medical records, and clinical parameters. The AI algorithms were used for predictive modelling (123 papers), medical image segmentation (118), and to aid identification, detection, and diagnosis (103). Only 18 publications aimed to enhance the understanding of vascular disease pathophysiology. Interpretation: Utilisation of different data sources and AI technologies depends on the purpose of the undertaken research. Despite the abundance of available of textual data, the NLP is disproportionally underutilised AI sub-domain. Funding: None.

Deep vein thrombosis (DVT) is a frequent complication in patients suffering from inflammatory bowel disease (IBD), especially in those with frequent relapses of the disease or extensive inflammatory lesions. The aetiology for the increased risk is multifactorial. Current evidence on management of acute iliofemoral DVT in IBD patients is scarce. This case series highlights two cases of active IBD, who developed acute iliofemoral DVTs and were treated with catheter-directed thrombolysis (CDT). This report demonstrates that CDT is effective in clearing the clot burden and producing significant symptomatic improvement in the absence of major complications. An individualised approach must be taken for the management of IBD patients with acute iliofemoral DVT.