ANZ Journal of Surgery最新文献

{"title":"Operative caseload of general surgeons working in a rural hospital in Central Australia.","authors":"Harleen Kaur, Aisha Abdulmoeed Arayne, Steven Paredes, Antonio Barbaro, Yara Elgindy, Steven Tran, Jayantha Senaratne","doi":"10.1111/ans.19323","DOIUrl":"https://doi.org/10.1111/ans.19323","url":null,"abstract":"<p><strong>Background: </strong>There is limited published data on the caseload of general surgeons in Central Australia. The region has a significant Indigenous population, who often face higher rates of chronic diseases and require more frequent surgical interventions compared to non-Indigenous individuals. This study aims to outline the workload of surgeons at Alice Springs Hospital to determine the necessary skill set and surgical education for future surgeons.</p><p><strong>Methods: </strong>A retrospective review of all general surgery operative cases performed in Central Australia, Alice Springs Hospital was conducted between January 2012 and December 2021. The RACS Morbidity Audit and Logbook Tool was used to classify surgical procedures along with Medicare Benefits Schedule item numbers. Tables were created to present the annual and specialty-specific data on the types and volumes of procedures.</p><p><strong>Results: </strong>From January 2012 to December 2021, 35 318 cases were performed, with 92.5% being general surgery, 3% plastics and reconstructive surgery and 2.8% vascular procedures. Indigenous patients received a higher proportion of procedures (50-60%) compared to non-Indigenous patients (30-50%). Common procedures included incision and drainage of abscesses and debridement of wounds, while trends across specialties showed a decline in ENT and plastic surgeries, stable thoracic and vascular cases, and increased numbers of urology operations.</p><p><strong>Conclusion: </strong>General surgeons in rural centres must possess a wide range of skills and be capable of performing a variety of procedures. Trainees should be encouraged to consider practicing in rural areas, and those interested should account for the specific needs of the communities they plan to serve.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783952","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":"Mass-forming intrahepatic cholangiocarcinoma: treatment outcomes after curative-intent resection in an Australian tertiary referral hospital.","authors":"Sander R W J Martens, Nazim Bhimani, Cameron Gofton, Kai M Brown, Philip R de Reuver, Thomas J Hugh","doi":"10.1111/ans.19326","DOIUrl":"https://doi.org/10.1111/ans.19326","url":null,"abstract":"<p><strong>Background: </strong>Mass-forming intrahepatic cholangiocarcinoma (MF-ICC) is the second most common primary liver cancer and liver resection offers the best chance of possible cure. This study aimed to assess treatment outcomes and prognostic factors for long-term survival in patients who underwent curative-intent liver resection.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on prospectively collected data from patients with MF-ICC managed at the Royal North Shore/North Shore Private Hospital from January 1998 to October 2023. Baseline, peri-operative and long-term outcomes have been analysed, including an overall survival (OS) and disease-free survival (DFS) analysis.</p><p><strong>Results: </strong>During the 25-year study period, 47 patients underwent curative-intent liver resection for primary MF-ICC at a median age of 70 years. The median OS was 36 months, with a 5-year OS of 33%. Multiple liver tumours (HR = 2.84; 95% CI = 1.24-6.48; P = 0.013) and a positive resection margin (HR = 2.46; 95% CI = 1.10-5.52; P = 0.029) were identified as independent predictors of poor long-term OS. Recurrence occurred in 62% of patients after a median DFS of 16 months, with poor tumour differentiation (HR = 3.93; 95% CI = 1.62-9.54; P = 0.002) and elevated tumour markers (HR = 3.47; 95% CI = 1.53-7.87; P = 0.003) as independent predictors of poor DFS.</p><p><strong>Conclusion: </strong>Liver resection can offer a significant chance for prolonged survival in a highly selected population of patients with MF-ICC. However, the surgical challenges inherent in treating this rare disease are evident, emphasizing the need for a multimodal approach and continued exploration of additional therapies to enhance personalized treatment strategies.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783948","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":"How to do a hip disarticulation.","authors":"Yewon David Kim, Rowan Gillies, Varun Harish","doi":"10.1111/ans.19330","DOIUrl":"https://doi.org/10.1111/ans.19330","url":null,"abstract":"<p><p>Hip disarticulation is a salvage procedure for several hip and pelvic pathologies including recalcitrant pressure sores and pelvic soft tissue and bone neoplasms. This 'How I do it' article provides a detailed technique for hip disarticulation utilizing an anteromedial thigh myocutaneous flap.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783897","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":"Percutaneous versus surgical catheter insertion for peritoneal dialysis: a systematic review and meta-analysis of randomized controlled trials.","authors":"Juanita N Chui, Paul Kim, Tess E Cooper, Tahmid Zaman, Ahmer Hameed, Melanie Wyld, Henry Pleass, Animesh Singla","doi":"10.1111/ans.19315","DOIUrl":"https://doi.org/10.1111/ans.19315","url":null,"abstract":"<p><strong>Introduction: </strong>Peritoneal dialysis (PD) is used as a kidney replacement therapy for patients with kidney failure. Institutional practices vary considerably, and the optimal technique for insertion of PD catheters is unknown. This study compared the efficacy and safety of surgical versus percutaneous approaches to PD catheter insertion for patients with end-stage kidney disease.</p><p><strong>Methods: </strong>Electronic databases (MEDLINE, Embase, CENTRAL) were systematically searched and analysed for relevant randomized controlled trials (RCTs). Eligible RCTs for inclusion were those that compared surgical versus percutaneous approaches to catheter insertion for patients undergoing PD dialysis. Outcomes of interest were patient- and catheter-related complications. In this study risk of bias was assessed using the Cochrane Risk of Bias Tool for RCTs. The certainty of the evidence was evaluated using the Grading of Recommendations Assessment and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Four studies (397 participants) were included. With regards to surgical approaches, only one study evaluated laparoscopic insertion; all other studies reported on open surgical techniques. Percutaneous insertion techniques varied significantly between the studies. No difference in patient mortality was found (RR = 0.82, 95% CI = 0.43-1.57, I² = 0%). Percutaneous techniques were associated with lower rates of early peritonitis (RR = 0.34, 95% CI = 0.12-0.91, I² = 0%) and long-term catheter failure (RR = 0.69, 95% CI = 0.47-1.00, I² = 0%) than surgical approaches. Percutaneous catheter insertion was also associated with reduced late peri-catheter leak rates (RR = 0.35, 95% CI = 0.12-0.98, I² = 0%) and peri-procedural complications (RR = 0.25, 95% CI = 0.07-0.90, I² = 0%). The overall risk of bias was moderate, and certainty of evidence was low or very low.</p><p><strong>Conclusions: </strong>Whilst percutaneous PD insertion techniques may have lower early and late complications compared to surgical technique, there was a lack of high-quality evidence comparing outcomes between contemporary percutaneous and surgical PD catheter insertion techniques. Future RCTs are required to compare the safety and efficacy of modern percutaneous with laparoscopic techniques.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783963","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":"Preservation of pancreatic tail in traumatic pancreatic neck injury.","authors":"Alex Boue, Krishna Kotecha, Tannia Koh, Siobhan C McKay, Anubhav Mittal, Jaswinder S Samra","doi":"10.1111/ans.19325","DOIUrl":"https://doi.org/10.1111/ans.19325","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783977","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":"Impact of gastroenterologist-supported endoscopy training for surgical trainees in a regional hospital.","authors":"Ernest Cheng, Jasmine Mui, Amer Matar, Zachary Bunjo, John Wenman, Wilson Petrushnko","doi":"10.1111/ans.19328","DOIUrl":"https://doi.org/10.1111/ans.19328","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783915","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":"Indocyanine green to localize subpleural pulmonary relapse of hepatoblastoma during thoracoscopy.","authors":"Hemal Kodikara","doi":"10.1111/ans.19338","DOIUrl":"https://doi.org/10.1111/ans.19338","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783823","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":"Clinical and cost-effectiveness of earlier discharge from acute hospital after total joint arthroplasty.","authors":"Siddharth Rele, Chris Schilling, Cade Shadbolt, Tim Spelman, Nicholas F Taylor, Michelle M Dowsey, Peter Fm Choong","doi":"10.1111/ans.19322","DOIUrl":"https://doi.org/10.1111/ans.19322","url":null,"abstract":"<p><strong>Background: </strong>Reducing length of stay has been proposed as a key component of policies that aim to meet demand and minimize costs associated with total joint arthroplasty. However, few studies explore shifting of healthcare utilization when length of stay is shortened.</p><p><strong>Methods: </strong>This retrospective cohort study examined patients undergoing primary, total hip and knee arthroplasty for osteoarthritis to simulate a policy-level institutional reduction in acute hospital stay by 1 day. Costs, quality of life, and rates of complications, readmission and discharge to inpatient rehabilitation were compared in patients with a three- and four-day length of acute stay. Balance was achieved using overlap-propensity weighting.</p><p><strong>Results: </strong>In total, 2023 patients were included. Earlier discharge from acute hospital was not associated with a change in odds of 90-day complications (OR: 0.85 [95% CI, 0.58 to 1.27]; P = 0.447), readmissions (OR: 1.11 [95% CI, 0.67 to 1.82]; P = 0.691), and emergency department presentations (OR: 1.07 [95% CI, 0.66 to 1.73]; P = 0.774). Earlier discharge from acute hospital was associated with an increase in odds of discharge to inpatient rehabilitation (OR: 2.16 [95% CI, 1.45 to 3.20]; P < 0.001). No significant differences in costs and quality adjusted life years were observed at one-year. Cost savings during index admission were shifted onto increased costs associated with inpatient rehabilitation.</p><p><strong>Conclusion: </strong>Earlier discharge was not associated with changes in 90-day complications, readmission, or ED presentations. However, an increase in utilization of inpatient rehabilitation was observed, offsetting early cost savings. Patients who were discharged from acute care on day three had no difference in costs compared to those discharged on day four.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783631","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":"Inguinal herniation of the bladder: primum non-nocere.","authors":"Suvraraj Das, Gaurav Aggarwal, Sumit Sharma","doi":"10.1111/ans.19346","DOIUrl":"https://doi.org/10.1111/ans.19346","url":null,"abstract":"","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783851","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":"Clinicians' views on implementing enhanced recovery after surgery: a descriptive qualitative study.","authors":"Georgia Tobiano, Rhea Liang, Wendy Chaboyer, Josephine Lovegrove, Keith Addy, Brigid M Gillespie","doi":"10.1111/ans.19342","DOIUrl":"https://doi.org/10.1111/ans.19342","url":null,"abstract":"<p><strong>Background: </strong>Enhanced recovery after surgery (ERAS) protocols have existed for the past three decades; these protocols may improve patient outcomes and healthcare costs. Yet, ERAS is difficult to implement, and there has been limited focus on processes used to promote ERAS use. Thus, the aim of this study was to identify and describe the barriers and enablers to implementing ERAS.</p><p><strong>Methods: </strong>In this qualitative descriptive sub-study, semi-structured interviews, guided by the Theoretical Domains Framework, were conducted with surgeons, anaesthetists, and nurses. Interviews were analyzed using inductive and deductive content analysis.</p><p><strong>Results: </strong>Three categories were found, which mapped to 12 domains in the Theoretical Domains Framework. Category 1 'realizing the value of ERAS, despite varying levels of exposure and motivation' showed clinicians' different views and knowledge towards ERAS, with a general belief that ERAS was evidence-based. Category 2, 'building momentum for ERAS implementation' outlined strategies to encourage clinicians to practice ERAS. The final category 'providing resources for ERAS' illustrated the tools and up-front costs needed for ERAS implementation.</p><p><strong>Conclusion: </strong>Motivational strategies are required to inspire individual clinicians to adopt ERAS. Additionally, resources are needed for ERAS to guide practice and support implementation (i.e., staffing and time), underscoring the need for hospital leadership support.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142783889","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}