ANZ Journal of Surgery最新文献

{"title":"Significant Reduction in Length of Stay Through the Introduction of an Outpatient Management Protocol for Uncomplicated Left-Sided Diverticulitis.","authors":"Joshua M Balhorn, Dilshan K Udayasiri, Ian P Hayes, Jacob J McCormick, David J Read, Raaj Chandra, Timothy J Chittleborough","doi":"10.1111/ans.70346","DOIUrl":"https://doi.org/10.1111/ans.70346","url":null,"abstract":"<p><strong>Purpose: </strong>Acute diverticulitis is a common presentation to hospital emergency departments (ED) and a significant burden on healthcare resources worldwide. Multiple studies have shown that outpatient management of uncomplicated diverticulitis is safe, yet many patients are still treated in the hospital. We instituted a protocol for the outpatient treatment at our institution, focusing on safety and healthcare costs.</p><p><strong>Methodology: </strong>From February 2021, the new outpatient management of uncomplicated left-sided diverticulitis protocol was implemented; all patients that presented through the ED with a computed tomography diagnosis of uncomplicated left-sided diverticulitis were managed as an outpatient with oral antibiotics unless they met exclusion criteria (insulin-dependent diabetes, immunosuppression, active malignancy, pregnancy, or inflammatory bowel disease). This was compared to a historical comparison immediately prior. The primary outcome of interest was length of stay (LOS) in hours.</p><p><strong>Results: </strong>There were 106 patients in each group. The LOS in the outpatient group was 29.7 h less than in the inpatient group (95% CI 21.9-37.5; p < 0.001). Patients with co-morbidities stayed significantly longer, with ASA 3 and 4 more than 17 h (53 h vs. 35 h, p < 0.001), and a high CCI (score ≥ 5) more than 32 h (67 h vs. 35 h, p < 0.001). The odds of readmission were not significantly different between the outpatient and inpatient cohorts (OR 1.49, 95% CI 0.54-4.07, p = 0.438).</p><p><strong>Conclusion: </strong>Outpatient management for uncomplicated left-sided diverticulitis results in a significant reduction of LOS and does not result in an increase in readmissions.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145231378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Same-Day Discharge for Paediatric Uncomplicated Appendicitis in Australia.","authors":"Kyla A Clasie, Stephanie G Ng, Susan Adams, Jonathan Karpelowsky, Rawaan James, Jessica L Iemma, Amy C Cowie, Alexandra Hann, Keeley Hickey, Casey J Haubus, Laura A Constable, Donald Hannah, Blessy John-Denny, Katie R Prettyman, Katherine Donaldson, Karen Butler, Ariella Xerri, Jamilie Antoun, Grahame H H Smith, Andrew J A Holland","doi":"10.1111/ans.70334","DOIUrl":"https://doi.org/10.1111/ans.70334","url":null,"abstract":"<p><strong>Background: </strong>Acute appendicitis is the most common paediatric emergency presentation requiring timely surgical intervention. The Sydney Children's Hospital Network (SCHN) noted in their National Surgical Quality Improvement Program-Pediatrics (NSQIP-P) data that their appendicectomy postoperative length of stay (LOS) was longer than that of other hospitals.</p><p><strong>Study design: </strong>NSQIP-P reports are calculated from case reviews with a 30-day post-operative follow-up. From 2020 to 2022, the post-operative LOS for uncomplicated appendicectomy at SCHN was a median of 24 h (n = 714). A quality improvement project was initiated using Clinical Redesign Methodology. The project team developed an Uncomplicated Appendicectomy Guideline to standardize care. The Guideline also included a criteria-led discharge that could be applied after 6 h of post-operative recovery. Comprehensive information was provided for parents/carers on discharge.</p><p><strong>Results: </strong>In 2024, the median postoperative LOS was reduced from 24 to 16 h (n = 185). This represents a statistically significant reduction in post-operative length of stay of 33% (p < 0.001). There were no statistically significant increase in post-operative readmissions (p = 0.95) or in NSQIP-P morbidity rates, although there was an increase in post-operative Emergency Department presentations noted, from a median of 7-10 annual presentations (p < 0.05, n = 444). There was positive feedback from parents/carers with the earlier discharge (n = 16). Parents/carers who received the discharge information sheet reported that they were better informed about their child's care. Staff in focus groups highlighted a greater autonomy in post-operative care (n = 24).</p><p><strong>Conclusion: </strong>Paediatric patients with uncomplicated appendicitis can be safely discharged from 6 h post-operatively with comprehensive discharge information.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparation of Medical Students for Surgery Residency Training: Key Considerations and Major Advances.","authors":"Ajit K Sachdeva","doi":"10.1111/ans.70336","DOIUrl":"https://doi.org/10.1111/ans.70336","url":null,"abstract":"<p><p>This article is based on the Hamilton Russell Memorial Lecture delivered by the author at the Royal Australasian College of Surgeons Annual Scientific Congress, Sydney, May 4, 2025. The article addresses the important transition from medical school to surgery residency training that is receiving great attention within current efforts to transform surgical education. It addresses a broad range of issues in five sections that are aligned with the Hamilton Russell Memorial Lecture. These sections are background information; underlying conceptual frameworks; educational strategies and programs aimed specifically at medical students; the transition from medical school to surgery residency training; and efforts of a national professional organization.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triad Syndrome Presenting With Chronic Urinary Retention and Urosepsis.","authors":"Jordan Santucci, Peter Stapleton, Joe Ibrahim, Niranjan Sathianathen","doi":"10.1111/ans.70340","DOIUrl":"https://doi.org/10.1111/ans.70340","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testicular Torsion on Computed Tomography: \"Whirling\" of the Spermatic Cord.","authors":"Eric Ron Starra, Kieran James Hart","doi":"10.1111/ans.70341","DOIUrl":"https://doi.org/10.1111/ans.70341","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Epidemiology of Paediatric Motorcycle Injuries in Australia-A Scoping Review.","authors":"Mike Anscombe, Michael Zhang, Debbie Booth, Madeleine Hinwood, Keith Landale, Zsolt J Balogh","doi":"10.1111/ans.70339","DOIUrl":"https://doi.org/10.1111/ans.70339","url":null,"abstract":"<p><strong>Background: </strong>Motorcycle riding, in competition or for recreation, is popular globally. The burden of motorcycle injury in Australian children is perceived as significant and increasing. Despite this, there is a paucity of research on the topic. The objective of this scoping review was to summarise the existing literature concerning the epidemiology of paediatric motorcycle injuries in Australia, including identifying trends in incidence and injury characteristics and knowledge gaps.</p><p><strong>Methods: </strong>A systematic search of seven databases was performed in August 2023. Two reviewers independently screened citations for inclusion. A narrative approach (i.e., content analysis of reported results) was used for synthesising and charting the data. The review was reported according to the PRISMA guidelines for scoping reviews.</p><p><strong>Results: </strong>The search returned 230 citations. In total, 10 mostly retrospective studies involving 16 083 children were included. Data showed variation in the reporting of injury incidence, with no reports in the last 5 years. Adolescent males were injured most frequently, although there was a wide range of injured ages, including children as young as two. Musculoskeletal injuries were the most common injury type.</p><p><strong>Conclusions: </strong>Major gaps in current knowledge relate to population-based incidence and the identification and measurement of injury risk factors and the success of interventions. Further research on motorcycle injuries in children is warranted, particularly around injury prevention and advocacy strategies relevant to the Australian environment.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211414","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fistulotomy Versus Fistulectomy for Simple Fistula-In-Ano: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Girish Bochiya","doi":"10.1111/ans.70343","DOIUrl":"https://doi.org/10.1111/ans.70343","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Pilot Study of Porcine Acellular Bladder Matrix Filling in the Treatment of Anal Fistulas: A Single-Center Cohort Study.","authors":"Xiang Ma, Weisong Xue, Zuolin Zhou, Qiong He, Feng Yang, Ningchao Du, Jun Sun, Huiwen Ning, NiNi Liu, Ying Luo, Jian Cai","doi":"10.1111/ans.70342","DOIUrl":"https://doi.org/10.1111/ans.70342","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to preliminarily assess the effectiveness of a novel biomaterial, porcine acellular bladder matrix (PABM), in filling fistula tracts.</p><p><strong>Summary of background data: </strong>Anal fistula plugs (AFPs) made from biomaterials are designed to fill fistulas, promote tissue healing, and prevent anal sphincter damage caused by conventional surgeries.</p><p><strong>Methods: </strong>This single-center cross-sectional study evaluated PABM-AFP treatment for anal fistulas between May 2023 and May 2024. Twenty-eight patients diagnosed with anal fistulas underwent PABM-AFP filling, with follow-up conducted for 6-12 months postoperatively.</p><p><strong>Results: </strong>The overall success rate was 89.3%, with an efficacy rate of 90.6% for all treated fistulas. Of the three patients who experienced treatment failure, two recovered after receiving thread-ligating treatment, and the remaining patient who had Crohn's disease experienced partial healing. The mean healing time was 5 weeks, and the average follow-up duration was 7 months. No adverse complications were reported.</p><p><strong>Conclusions: </strong>PABM-AFP is a promising, safe, and effective treatment option for anal fistulas. This study provides valuable preliminary data to support the clinical use of PABM-AFP.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Closing the Loop: Building Data Systems That Inform and Improve Clinical Practice.","authors":"Magdalena Sejka, Christobel Saunders, Anita Skandarajah","doi":"10.1111/ans.70331","DOIUrl":"https://doi.org/10.1111/ans.70331","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Pregnant Surgeon: Welcoming the Advanced Ergonomics of Robotic Surgery.","authors":"Ashley Jenkin, Kim-Chi Phan-Thien, Carina Chow","doi":"10.1111/ans.70338","DOIUrl":"https://doi.org/10.1111/ans.70338","url":null,"abstract":"<p><p>The detrimental effect of poor operative ergonomics in surgery cannot be underestimated. It's associated with negative outcomes such as increased burn-out, fatigue, clinically relevant pain, and early retirement. Pregnancy creates additional challenges for female surgeons to prevent injury while adjusting to anthropometric changes that are difficult to accommodate for using open and laparoscopic surgical techniques. The robotic platform has been associated with improved ergonomic capabilities while maintaining dexterity and access. Robotic surgery will likely chaperone in a new era of possibility for female surgeons in particular of career longevity, reduced leave requirements, and improved comfort while operating pre- and post-partum.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145224800","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}