Show notes
Andy Cumpstey is joined by Christian Macutkiewicz Consultant General, HPB and Hernia Surgeon at Manchester Royal Infirmary, Director of The Gallstone Clinic and Manchester Hernia at Spire Manchester Hospital and the incoming President of the Association of Surgeons of Great Britain and Ireland, and Dimitris Damaskos Consultant General Surgeon within the Department of Surgery at the Royal Infirmary of Edinburgh (NHS Lothian), Honorary Clinical Senior Lecturer at the University of Edinburgh.
They discuss the postoperative period as a critical part of the perioperative journey, emphasizing the importance of clear postoperative communication, reassurance even after "successful" operations, and explaining complications and expected recovery timelines.
They highlight challenges in recognizing deterioration, including reduced reliance on clinical examination skills among junior doctors and the systems-based concept of "failure to rescue," arguing that consistent ward-based recognition systems and high-volume units help detect complications earlier.
Enhanced Recovery After Surgery (ERAS) pathways are cited, including using day-3 CRP thresholds to trigger CT imaging for early detection of anastomotic leak. They note post-COVID pressures to clear surgical backlogs have increased situations where patients are operated on by surgeons who did not initially see them, potentially weakening trust and continuity when complications occur, and they discuss flattening hierarchy so trainees can do ward rounds with consultant support.
The conversation covers future technology, including AI for risk stratification and imaging interpretation, and remote continuous vital-sign monitoring, while acknowledging data governance challenges and potential deskilling. The episode closes with a discussion of robotic surgery: improved optics and precision and usefulness for more complex cases (including abdominal wall reconstruction), but with concerns about cost, rollout, training implications, and differing adoption between the UK, US, and New Zealand.
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