ANZ Journal of Surgery最新文献

{"title":"Primary Repair Versus Pyloric Exclusion in Adult Traumatic Duodenal Injury: A Systematic Review and Meta-Analysis With a Grade-Restricted Analysis of AAST Grade III Injuries.","authors":"Mateo Londoño Barrientos, Elizabeth Velásquez Ramírez, Carlos Alberto López Zapata, Shokei Matsumoto, Jun Sakuma, David Alejandro Mejía Toro, Carlos Andrés Delgado López","doi":"10.1111/ans.70965","DOIUrl":"https://doi.org/10.1111/ans.70965","url":null,"abstract":"<p><strong>Background: </strong>Whether pyloric exclusion (PE) retains any advantage over primary repair (PR) in adult traumatic duodenal injury is uncertain and confounded by indication. We restricted the comparison to the zone in which both techniques are realistically applicable.</p><p><strong>Methods: </strong>Five databases were searched through March 2026 for comparative studies of adults with AAST Grade II or higher injuries undergoing operative management. Primary outcomes were duodenal leak/fistula and in-hospital mortality; secondary outcomes were intra-abdominal abscess and hospital and ICU length of stay. Random-effects models used REML estimation with Hartung-Knapp adjustment. A prespecified analysis restricted to AAST Grade III pooled studies reporting outcomes by grade and technique.</p><p><strong>Results: </strong>Twenty-seven studies (3574 patients) were included. PR was not associated with reductions in mortality (RR 0.66, 95% CI 0.39-1.13) or duodenal leak (RR 0.35, 0.09-1.44; I² = 64.9%). PR was associated with lower intra-abdominal abscess (RR 0.39, 0.23-0.68), although pooled definitions were heterogeneous, and shorter hospital stay (mean difference -9.21 days, -12.72 to -5.69). Restricted to Grade III, the leak estimate was RR 0.97 (0.03-31.42; I² = 84.0%). No comparative Grade IV-V data were available.</p><p><strong>Conclusions: </strong>No advantage of pyloric exclusion was demonstrated for any outcome, but absence of demonstrated benefit is not evidence of absent benefit: prediction intervals were wide and grade-specific data sparse. These findings are consistent with, rather than establish, the contemporary preference for primary repair. Because no comparative data isolate Grade IV-V or combined pancreaticoduodenal injuries, the residual indication for pyloric exclusion remains undefined rather than refuted.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928620","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":"Surgical Strategy for En Bloc Iliacoinguinal Resection and Reconstruction Using Myopectineal Orifice Repair Principles for Anterior and Lateral Pelvic Tumors: A Case Series.","authors":"Song Yang, Yao Lu, Huan Peng, Shenying Luo, Jiawei Che, Darius Aw Kang Lie, Jian Zhang","doi":"10.1111/ans.70954","DOIUrl":"https://doi.org/10.1111/ans.70954","url":null,"abstract":"<p><strong>Background: </strong>Anterior and lateral pelvic tumors may extend into the iliacoinguinal region and require wide en bloc resection. When resection includes the inguinal ligament, lower abdominal wall, and-in selected cases-the external iliac vessels, reconstruction must restore a mechanically demanding abdomen-groin junction while protecting major neurovascular structures. We describe an MPO-based reconstructive strategy and report early outcomes.</p><p><strong>Methods: </strong>We retrospectively reviewed six consecutive patients who underwent en bloc iliacoinguinal resection and reconstruction between January and December 2024. Reconstruction followed preperitoneal MPO repair principles, including a mesh-based inguinal ligament substitute, peritoneal envelope (\"visceral sac\") reconstruction when required, abdominal wall reinforcement, and femoral canal/oval fossa dead-space management. Prosthetic graft reconstruction was performed when the external iliac vessels were resected.</p><p><strong>Results: </strong>All patients completed the planned procedure. Inguinal ligament substitute reconstruction was performed in 6/6 patients, peritoneal envelope reconstruction in 5/6, and external iliac vessel resection with reconstruction in 4/6. Mean operative time was (375.83 ± 129.63) min and estimated blood loss was (433 ± 245.95) mL. Mean time to first flatus was (4 ± 0.89) days and length of stay was (8.67 ± 4.37) days. Pathology confirmed R0 resection in all cases. One patient developed an oval fossa seroma that resolved with repeated aspiration; two had transient mild lower-limb edema. No limb ischemia/necrosis, enteric fistula, bowel obstruction/ileus, or early abdominal wall hernia occurred during early follow-up.</p><p><strong>Conclusions: </strong>MPO-based reconstruction after en bloc iliacoinguinal resection is feasible and appears safe in the short term. A stepwise approach that restores a groin anchor, re-establishes compartment separation, reinforces the abdominal wall, and manages femoral dead space may improve early junctional stability.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148928761","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":"Long-Term Outcomes After Elective Splenectomy for Haematological Disease: A 27-Year Single-Centre Study.","authors":"Salil Dutt Barrett, Anthony Downhill, Douglas Greer, William Stevenson, Ian Kerridge, Chris Ward, Matthew Greenwood, Naomi Mackinlay, Luke Coyle, Thomas J Hugh","doi":"10.1111/ans.70961","DOIUrl":"https://doi.org/10.1111/ans.70961","url":null,"abstract":"<p><strong>Background: </strong>Splenectomy has traditionally been used to treat a range of haematological diseases. Advances in medical therapies and minimally invasive surgery have altered its therapeutic role. This study evaluates evolving indications and outcomes of elective splenectomy in an Australian teaching hospital over a 27-year period.</p><p><strong>Methods: </strong>Adult patients undergoing elective splenectomy for haematological disease between 1999 and 2025 at a single tertiary institution were identified from medical records. Caseload, demographics, operative approach, complications and follow-up outcomes were assessed either annually or over three 9-year cohorts. Regression and Fisher's exact tests were used for trend analysis.</p><p><strong>Results: </strong>Seventy patients underwent splenectomy. The annualised caseload and cohort patient age decreased significantly over the study period (p = 0.005 and 0.020, respectively). Benign indications accounted for 54% of patients, most commonly immune thrombocytopenia, while lymphoma and myelofibrosis predominated among malignant indications. There was an upward trend for laparoscopic splenectomy over time (p = 0.051), reduced conversion rates (p = 0.189) and a decrease in operative time (p = 0.012). The overall post-operative complication rate was 21.4%, and most were minor. Ninety-day post-operative mortality was zero. The median follow-up was 9.1 years. Long-term survival was primarily influenced by underlying haematologic disease, with most long-term survivors well with normal platelet counts.</p><p><strong>Conclusion: </strong>Despite declining referrals in the era of targeted therapies, splenectomy remains a safe and effective treatment option in selected patients. Outcomes are favourable when performed laparoscopically in experienced hands, and long-term follow-up demonstrates sustained haematologic benefit in surviving patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917825","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":"Concomitant Panniculectomy During Ventral Hernia Repair: Outcomes From a High-Volume Abdominal Wall Reconstruction Unit.","authors":"Thomas G Mackay, Jai Hoff, Tahera Ahmed, Mairi McLaren, Kellee Slater","doi":"10.1111/ans.70964","DOIUrl":"https://doi.org/10.1111/ans.70964","url":null,"abstract":"<p><strong>Background: </strong>Concomitant panniculectomy during ventral hernia repair (VHR) remains controversial due to concerns about wound morbidity. Potential benefits include improved operative exposure and reduced abdominal wall strain. This study evaluated outcomes of VHR with and without panniculectomy in a specialised abdominal wall reconstruction unit.</p><p><strong>Methods: </strong>A retrospective analysis of a prospectively maintained database of consecutive adult patients undergoing VHR with or without panniculectomy was performed. The primary outcome was hernia recurrence. Secondary outcomes included surgical site occurrence (SSO), SSO requiring procedural intervention (SSOPI), mesh infection, and length of stay (LOS). Propensity-score overlap weighting adjusted for measured differences between cohorts. Time-to-recurrence was assessed using Kaplan-Meier analysis.</p><p><strong>Results: </strong>A total of 819 patients were included (VHR: n = 341; VHR + PAN: n = 478). The VHR + PAN group was younger, more often female, had higher BMI, fewer smokers, and more botulinum toxin use. Crude hernia recurrence was lower in VHR + PAN (5.6% vs. 14.7%, p < 0.001), though wound morbidity was higher (SSO: 26.4% vs. 14.1%, p < 0.001; SSOPI: 17.2% vs. 11.7%, p = 0.040). After overlap weighting, panniculectomy remained associated with lower recurrence (aOR 0.42, 95% CI 0.19-0.95; p = 0.037) and higher SSO (aOR 2.14, 95% CI 1.18-3.89; p = 0.012), but no significant difference in SSOPI (aOR 1.28, 95% CI 0.66-2.47; p = 0.461). LOS was longer in VHR + PAN (adjusted ratio 1.16, 95% CI 1.07-1.27; p < 0.001). Kaplan-Meier analysis confirmed higher recurrence-free survival in VHR + PAN (log-rank p = 0.001).</p><p><strong>Conclusion: </strong>Concomitant panniculectomy was associated with lower hernia recurrence but higher wound morbidity and longer LOS. These findings support its feasibility in selected patients, though the observational design limits causal inference.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148918392","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":"Perioperative Inspiratory Muscle Training Improves Functional Recovery in Heart Valve Replacement: A Meta-Analysis of Randomised Controlled Trials.","authors":"Cholid Tri Tjahjono, Veny Mayangsari, Muhammad Isra Rafidin Rayyan, Sabila Larasati, Fadhlan Abdur Rahman, Siti Ulfatur Rizqa, Aghnia Hasya, Alvian Ramadhitya, Lusi Padma Sulistianingsih Mata, Adelia Fairus Wafi Asfa, Pandit Bagus Tri Saputra","doi":"10.1111/ans.70938","DOIUrl":"https://doi.org/10.1111/ans.70938","url":null,"abstract":"<p><strong>Background: </strong>Heart valve replacement is associated with a high risk of respiratory dysfunction and postoperative pulmonary complications (PPCs). This meta-analysis of randomised controlled trials (RCTs) specifically aims to evaluate the effectiveness of perioperative inspiratory muscle training (IMT) in this patient population.</p><p><strong>Methods: </strong>A systematic search was conducted on ClinicalTrials.gov, PubMed, ProQuest, and Scopus until October 2025. Data were synthesised using random-effects meta-analysis, with results reported as mean difference (MD), standardised mean difference (SMD), or risk ratio (RR), along with 95% confidence intervals (CI).</p><p><strong>Results: </strong>A total of nine RCTs involving 1531 patients were included. IMT significantly improved primary outcomes: 6-min walk distance (6 MWD) (MD 49.91 m; 95% CI, 22.52-77.30), maximal inspiratory pressure (MIP) (MD 11.66 cm H₂O; 95% CI, 3.15-20.16), and reduced the incidence of PPCs (RR 0.71; 95% CI, 0.56-0.90) compared to the control group. However, for secondary outcomes, including ICU and postoperative length of stay (LOS), forced vital capacity (FVC), and forced expiratory volume in 1 s (FEV₁), no significant differences were observed. Subgroup analysis indicated greater clinical benefits of IMT in patients undergoing open surgery who received it postoperatively and integrated it into a rehabilitation bundle.</p><p><strong>Conclusions: </strong>IMT may improve 6 MWD and MIP and reduce the risk of PPCs in patients undergoing valve replacement. These findings suggest that IMT is a promising adjunct to perioperative cardiac rehabilitation (PROSPERO CRD420251172698).</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904842","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":"Spindle Cell Lesions of the Breast: A 12-Year Experience.","authors":"Shalvin Jassal, Wesley Tjang, Shaun Monagle, Michael Law, Justin James","doi":"10.1111/ans.70948","DOIUrl":"https://doi.org/10.1111/ans.70948","url":null,"abstract":"<p><strong>Introduction: </strong>Breast spindle cell lesions (BrSCL) are rare pathologies encompassing a wide range of conditions, from benign reactive processes to aggressive malignancies. Their diverse and overlapping clinical, radiological and histological features pose significant diagnostic challenges. This study examines the clinical, radiological and histological characteristics of BrSCL to improve diagnostic accuracy and inform management strategies.</p><p><strong>Methods: </strong>This retrospective, single-centre cohort study included all cases of BrSCL identified on core biopsy from 2008 to 2020, excluding fibroepithelial lesions and metaplastic cancers. It examined clinical presentations, imaging findings, formal excisional pathology and clinical outcomes.</p><p><strong>Results: </strong>Thirty cases were analysed, with 70% (n = 21) presenting due to breast symptoms and 30% (n = 9) detected through breast screening or incidentally. Eligible cases were histologically subdivided into atypical (ASCL) (n = 10) and bland (BSCL) (n = 20) spindle cell lesion groups. Following formal excision, 80% of ASCLs were malignant (sarcoma: n = 1; malignant phyllodes tumour: n = 3; metaplastic cancer: n = 4), whilst 20% (n = 2) were benign. Eleven BSCLs underwent excisional biopsy, with no malignancy found (benign: n = 10; no lesion: n = 1). Nine patients underwent radiological and clinical surveillance.</p><p><strong>Conclusion: </strong>BrSCLs are rare and diagnostically complex entities. Lesions detected on core biopsy with features of ASCL carry a high risk of malignancy and should undergo surgical excision. In contrast, BSCL from core biopsy are frequently benign and those demonstrating low-risk imaging features and benign core biopsy findings may be considered for surveillance. A multidisciplinary approach is essential for optimising outcomes in this challenging and uncommon subset of breast pathology.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904864","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":"Pulmonary Embolism-A Century of Progress.","authors":"D A Watters","doi":"10.1111/ans.70957","DOIUrl":"https://doi.org/10.1111/ans.70957","url":null,"abstract":"<p><strong>Introduction: </strong>This narrative review covers a century of progress in the diagnosis, prevention, and treatment of pulmonary embolism (PE).</p><p><strong>Diagnosis: </strong>Although the classic clinical presentation of PE was already well described, in the first half of the 20th century additional diagnostic support was limited to signs on a chest radiograph and evidence of right heart strain on ECG. From the 1960's, imaging accuracy improved through the introduction of pulmonary angiography (1963), ventilation perfusion scans (1964), CT (1978), and today's gold standard, CT Pulmonary Angiography (1990's). Echocardiographic signs of right ventricular dysfunction and pulmonary hypertension were described to help determine the physiological severity of PE.</p><p><strong>Prevention: </strong>Prophylaxis reduces the risk of venous thromboembolism (VTE) by 55%-70%. Heparin began to be used to prevent and treat PE from the 1930s, replaced by enoxaparin from 1993. In patients not suitable for anticoagulation, vena cava ligation and open clips were replaced by endovascularly-placed filters (now retrievable) from the 1970s.</p><p><strong>Treatment: </strong>Despite the first successful pulmonary embolectomy in 1924, subsequent success with massive PE was rare until embolectomy could be performed with the support of cardiopulmonary by-pass in the 1960's. Today, catheter-based thrombolysis or mechanical thrombectomy delivered by interventional radiology are the first choice for haemodynamically compromised patients. Pulmonary Embolism Response Teams (PERT) rapidly assess acute PE presentations to determine the optimal treatment based on patient risk. Enoxaparin is prescribed for lower risk cases, whilst Direct Oral Anticoagulants have largely replaced warfarin as the ambulant oral treatment of choice to prevent recurrent VTE.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904878","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":"Consent for Pudendal Nerve Block.","authors":"Meena Fatima Singh, Cameron Douglas, Alan Meagher","doi":"10.1111/ans.70959","DOIUrl":"https://doi.org/10.1111/ans.70959","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904840","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":"Cxbladder Triage in Haematuria Assessment Reduces Time From Referral to Specialist Assessment and Bladder Cancer Treatment and Improves Equity for Māori.","authors":"Daniel Eaton, Melissa Kerdemelidis, Giovanni Losco, Stephen Mark, Maira Patu, Nikki Elliot, Chris Frampton","doi":"10.1111/ans.70960","DOIUrl":"https://doi.org/10.1111/ans.70960","url":null,"abstract":"<p><strong>Background: </strong>Bladder cancer is responsible for considerable morbidity and mortality. Patients commonly present with haematuria to primary care for assessment. In Canterbury, New Zealand, the first-line investigations available to primary care were changed in 2018, from urine cytology to CxBladder Triage (CxBT) and upper urinary tract imaging. This retrospective study was performed to evaluate the impact of this change in diagnostics.</p><p><strong>Methods: </strong>A retrospective audit of routinely collected electronic data from March 2013 to December 2021 from Christchurch Hospital, New Zealand, compared the traditional primary care haematuria pathway with the CxBT haematuria pathway. The primary outcome was waiting time from primary care referral to urological specialist appointment and waiting time to first operative treatment for bladder cancer. Waiting time was further analysed for ethnicity. The secondary outcome was monthly haematuria referrals for urological specialist appointment.</p><p><strong>Results: </strong>There were 4512 haematuria referrals during the study period. Following the introduction of CxBT to the primary care haematuria pathway, waiting time from primary care referral to urological specialist review reduced by 14.8 days and time to surgery by 15.0 days. There was a greater reduction for Māori compared with that of non-Māori patients. The monthly haematuria referrals for urological specialist appointment reduced on average by 6.9 referrals per month.</p><p><strong>Conclusion: </strong>CxBT in primary care haematuria pathway reduces waiting time from primary care referral to urological specialist appointment and to first operative treatment for bladder cancer, whilst also reducing monthly referrals for urological specialist appointments and improving equity for Māori.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148904833","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":"Socioeconomic Disadvantage, Body Mass Index, Rurality and Postoperative Outcomes Following Hip and Knee Arthroplasty in a Regional Australian Cohort.","authors":"Blake Clarke, Margaret Rogers, Richard Page, Kevin Eng, Michael Bullen","doi":"10.1111/ans.70953","DOIUrl":"https://doi.org/10.1111/ans.70953","url":null,"abstract":"<p><strong>Background: </strong>Socioeconomic disadvantage, body mass index (BMI) and geographic location influence healthcare access and outcomes. This study examined associations between socioeconomic status, rurality and BMI with outcomes following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a regional public referral centre.</p><p><strong>Methods: </strong>A retrospective cohort study of all primary THA and TKA admissions between 2017 and 2024 was performed. Variables included socioeconomic indices (SEIFA), rurality (Modified Monash Model classification), age, sex and BMI. The primary outcome was unplanned 90-day readmission. Secondary outcomes were length of stay (LOS) and intensive care unit (ICU) admission. Multivariate regression was performed. LOS was analysed as a continuous variable, and BMI and socioeconomic indices were modelled continuously to assess dose-response relationships.</p><p><strong>Results: </strong>A total of 3364 admissions were analysed (1862 THA; 1502 TKA). Mean age was 66.63 years (THA) and 69.22 years (TKA). Mean BMI was 30.87 and 34.02, respectively. Increasing BMI demonstrated a dose-response association with 90-day readmission, with a stronger effect in THA (OR 1.08, p < 0.01) than TKA (OR 1.03, p = 0.05). Increasing age and BMI were independently associated with longer LOS in both cohorts (all p < 0.01). Socioeconomic disadvantage was associated with longer LOS in THA (p < 0.01) but not TKA. Higher BMI was associated with ICU admission in both cohorts (THA p = 0.01; TKA p = 0.02).</p><p><strong>Conclusion: </strong>In this regional arthroplasty cohort, obesity was associated with increased readmission and longer LOS, while socioeconomic disadvantage was associated with longer LOS. Rurality was not associated with LOS or readmission.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148890791","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}