ANZ Journal of Surgery最新文献

{"title":"Why Are Patients Readmitted After Surgery for Gastric Cancer? Predictors of 30-Day Readmission Following Gastrectomy: A Single-Center Retrospective Cohort Study.","authors":"Tamir Lotan, Jossy Braun, Harel Jacoby, Yehonatan Nevo, Yuri Goldes","doi":"10.1111/ans.70302","DOIUrl":"https://doi.org/10.1111/ans.70302","url":null,"abstract":"<p><strong>Objective: </strong>Gastric cancer (GC) remains a major global health concern, with gastrectomy serving as the primary curative intervention. Early hospital readmission after gastrectomy is an important quality-of-care metric; however, data on its predictors and clinical implications remain limited. This study aimed to evaluate the incidence, timing, causes, and predictors of early readmission (within 30 days) after gastrectomy for GC.</p><p><strong>Methods: </strong>We conducted a retrospective single-center cohort study of patients who underwent gastrectomy for GC between January 2012 and January 2023. Patients with non-adenocarcinoma histology or cytoreductive/bariatric indications were excluded. The primary outcome was 30-day readmission, defined as inpatient hospitalization within 30 days of discharge. Univariable and multivariable logistic regression models were used to identify predictors of readmission.</p><p><strong>Results: </strong>Of 416 patients included, 103 (24.8%) presented to the emergency department (ED) within 30 days of discharge, and 72 (17.3%) were readmitted. The most common causes of readmission were intra-abdominal infections (26.4%), gastrointestinal symptoms (20.8%), and bleeding (12.5%). Readmitted patients had a significantly higher Charlson comorbidity index (median: 6 vs. 5, p = 0.002), more postoperative complications (54.2% vs. 38.7%, p = 0.018), and higher 90-day mortality (8.3% vs. 1.2%, p = 0.003). In multivariable analysis, a higher comorbidity burden and postoperative complications showed trends toward association with readmission but did not reach statistical significance.</p><p><strong>Conclusions: </strong>Thirty-day readmission after gastrectomy was associated with comorbidity burden and postoperative complications. Although these factors did not remain statistically significant in adjusted analyses, they may inform targeted discharge planning and early follow-up. Improved perioperative care and risk-based post-discharge interventions may reduce readmissions and improve outcomes in high-risk patients.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940094","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":"BCG Intolerance in Nonmuscle Invasive Bladder Cancer-A Systematic Review.","authors":"Claris Oh, Georgia Bourlotos, Michael O'Callaghan, Luke Grundy, Matthew Hong","doi":"10.1111/ans.70281","DOIUrl":"https://doi.org/10.1111/ans.70281","url":null,"abstract":"<p><strong>Background: </strong>Most patients with localized bladder cancer are initially managed with endoscopic resection. For high-grade nonmuscle invasive bladder cancer (NMIBC), intravesical Bacillus Calmette-Guerin (BCG) therapy is the gold standard adjuvant treatment. However, 30%-40% of patients fail BCG treatment with lack of response or disease relapse. An understudied area of treatment failure is BCG intolerance, where patients drop out of treatment due to adverse effects.</p><p><strong>Objectives: </strong>To examine the incidence and underlying reasons for BCG intolerance among adult patients with NMIBC.</p><p><strong>Methods: </strong>We conducted a search on Embase, MEDLINE, and Cochrane Central Register of Controlled Trials for studies from January 1, 1974 to January 10, 2023, retrieving 3340 articles. Two authors independently conducted screening and data extraction with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria include English-language studies reporting dropout rates and reasons for discontinuation of BCG therapy in NMIBC patients.</p><p><strong>Results: </strong>BCG dropout rates reported among the 28 included studies varied widely from 0% to 52% (estimated summary proportion 12.8%, 95% CI 9%-17%). There was significant heterogeneity in study design. Subgroup analyses show a dose-dependent effect on dropout rates (3.3% vs. 20%, X² = 83.6, p = < 2.2 × 10^-16). Dropout rates vary with BCG strains: the Connaught strain had the highest at 21.1%, while the Pasteur strain had 2%. Clinical outcomes for BCG intolerance are not widely reported.</p><p><strong>Conclusions: </strong>Dropout rates due to BCG intolerance average 12.8%. As cessation of treatment could lead to an increased risk in progression or recurrence of disease, strategies to mitigate BCG intolerance would be valuable.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940122","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 Review of the Anatomy of Anal Glands Relevant to Cryptoglandular Fistulas; Are We on the Right Track?","authors":"James Church","doi":"10.1111/ans.70296","DOIUrl":"https://doi.org/10.1111/ans.70296","url":null,"abstract":"<p><strong>Purpose: </strong>Anal fistulae are relatively common, quite symptomatic, and sometimes difficult to repair. Multiple procedures are used to treat patients with anal fistulae, and healing rates vary considerably, both between different procedures and between different centers doing the same procedure. Some of this variability in approach and outcomes may be due to different understandings of anal gland anatomy and its role in anal sepsis. This is a review of the anatomy of the anal glands and their relationship to anal sepsis in the light of current techniques for repair.</p><p><strong>Methods: </strong>A search of the English language literature was performed looking for articles related to the anatomy of the anal glands. Reports that placed anatomy in the context of cryptoglandular sepsis were selected.</p><p><strong>Results: </strong>Seven articles fulfilled the criteria; in addition to the original articles that described anatomy in isolation. Anal glands number from 2 to 11 and are merocrine secretory glands that drain into an anal crypt. They are mostly submucosal and lie caudally from the crypt. A varying proportion of glands traverse the internal anal sphincter. These are surrounded by a lymphocytic infiltrate and can have dilated segments. The anatomy suggests that some people are born with sepsis-prone glands and that issues with their passage through the internal sphincter may potentiate that sepsis.</p><p><strong>Conclusion: </strong>This review suggests that the correct focus of repair should be on the infected gland itself, as it passes through the internal sphincter.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940136","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":"What Makes a Surgical Expert Witness?","authors":"Anthony Vo, Wendy Babidge, Guy J Maddern","doi":"10.1111/ans.70288","DOIUrl":"https://doi.org/10.1111/ans.70288","url":null,"abstract":"<p><strong>Background: </strong>Surgical expert witnesses play a crucial role in providing informed and objective opinions on surgical procedures, standards of care and patient outcomes. However, clear criteria outlining the qualifications and level of expertise required to be considered an expert witness are lacking.</p><p><strong>Objective: </strong>To provide a guideline for the essential and desired qualifications required of a surgeon to serve as an expert witness.</p><p><strong>Methods: </strong>The PubMed database was searched to identify existing guidelines relating to the roles and qualifications of expert witnesses. Published statements from national and international surgical colleges were also reviewed.</p><p><strong>Summary of guidelines: </strong>Five published specialty college guidelines provided insight into the role of expert witnesses. Existing literature comparing the qualifications of surgeons testifying for defendants and plaintiffs was also analysed to identify the recommended criteria for serving as a surgical expert witness.</p><p><strong>Conclusions: </strong>Surgical expert witnesses must meet stringent standards to provide objective and impartial expert opinions. The fundamental qualifications for surgical expert witnesses are: unconditional registration, good standing with their respective college, active participation in a CPD program and compliance with codes of conduct and ethical standards. Experts should also have at least 5-10 years of clinical experience and be in active clinical practice (or within 3 years of leaving) in the relevant specialty field. Academic involvement and high scholarly impact are desirable to further enhance credibility. These recommendations ensure expert testimonies uphold professional standards to support fair and informed legal outcomes.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144940087","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":"Umbilical Myiasis in an Adult With Down Syndrome.","authors":"Jun Sen Chuah, Chee Cheng Yoong","doi":"10.1111/ans.70300","DOIUrl":"10.1111/ans.70300","url":null,"abstract":"<p><p>(A) Significant umbilicus destruction, with surrounding erythema and induration. (B) Visible maggot infestation in the umbilicus.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871049","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":"Multidisciplinary Clinical Quality Indicators for Head and Neck Cancer: A Modified Delphi Study in Australia.","authors":"Rebecca L Venchiarutti, Ashleigh R Sharman, Candice Donnelly, Nectarios Andrews, Martin Batstone, Sandeep Bhuta, Ruta Gupta, Claire Jeans, Jenny Lee, Eng H Ooi, Mark Schifter, Puma Sundaresan, Swee T Tan, Denyse Whelan, Takako Eva Yabe, Meiling Zhou, Carsten E Palme, Jonathan R Clark","doi":"10.1111/ans.70297","DOIUrl":"https://doi.org/10.1111/ans.70297","url":null,"abstract":"<p><strong>Background: </strong>Monitoring delivery of cancer care is critical to improve outcomes in increasingly resource-constrained settings. The aim of this study was to develop a priority set of multidisciplinary quality indicators (QIs) for benchmarking and monitoring the quality of care for head and neck cancer (HNC) in Australia.</p><p><strong>Methods: </strong>Following a systematic literature review, a modified Delphi consensus process was undertaken with Australian health professionals and people with lived experience of HNC. Consensus was sought over three rounds. In Rounds 2 and 3, participants rated the importance of QIs on a scale of 1 (not at all important) to 7 (highly important). QIs reached consensus if they had a mean importance score ≥ 6 (out of 7) and ≥ 75% of participants rated them 6 or 7.</p><p><strong>Results: </strong>The systematic review identified 317 unique QIs, and 81 were chosen for presentation in Rounds 2 of the Delphi. In Round 2, 66 health professionals and 12 people with lived experience of HNC reached consensus on 48 QIs, with three reworded and one new QI added. Fifty-two QIs were presented in Round 3; 42 health professionals and 10 people with lived experience participated, reaching consensus on 24 QIs. Most of the QIs fell under the treatment domain, with commencement of curative treatment and documentation of surgical margins attaining the highest consensus.</p><p><strong>Conclusion: </strong>We developed a priority set of 24 clinically relevant QIs for HNC, which will be tested in a clinical quality registry to benchmark optimal management of HNC and outcomes.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854346","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":"Fragility in Focus: Gallbladder Rupture in a Patient With Vascular Ehlers-Danlos Syndrome.","authors":"Sadhbh O'Connor, Oscar Hocking, Michael Warner","doi":"10.1111/ans.70298","DOIUrl":"https://doi.org/10.1111/ans.70298","url":null,"abstract":"<p><p>Spontaneous lumenal haemorrhage in gallbladder with subsequent rupture in patient with vascular variant Ehlers-Danlos syndrome.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854345","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 Metabolic-Bariatric Surgery in Australia: Experience in a Regional Public Hospital.","authors":"Lee S Kyang, Igor Lemech, Richard Harrison, Denbigh Simond, Nicholas Williams","doi":"10.1111/ans.70289","DOIUrl":"https://doi.org/10.1111/ans.70289","url":null,"abstract":"<p><strong>Background: </strong>Access to publicly funded bariatric surgery (MBS) remains suboptimal across Australia and New Zealand. The COVID-19 pandemic placed additional stress on the public healthcare system, and as a result, overnight beds in public hospitals have become a premium commodity. Same-day discharge (SDD) MBS has been shown to enhance efficiency and reduce costs in Europe and the United States. This study aims to evaluate the safety and clinical outcomes of implementing SDD MBS in a public regional hospital in Australia.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using a prospectively maintained database of patients who underwent SDD MBS at Wagga Wagga Base Hospital between December 2018 and September 2024. Patient selection followed strict inclusion criteria and a multidisciplinary approach. Standardised perioperative protocols were applied, with virtual follow-up at 24-48 h and outpatient intravenous hydration provided if needed. Outcomes included successful SDD rates, 30-day readmissions, complications, and mortality.</p><p><strong>Results: </strong>Thirty-eight patients underwent MBS with intended SDD. Thirty-five (92.1%) were successfully discharged on the same day. Three (7.9%) patients required overnight hospitalisation. The 30-day readmission rate was 2.9% (n = 1/35), with no postoperative complications or mortality recorded. Outpatient intravenous hydration was required in 11.4% (n = 4/35) of cases. Laparoscopic sleeve gastrectomy was the most common procedure (68.4%).</p><p><strong>Conclusion: </strong>This study demonstrates that SDD MBS is a safe and effective pathway in selected patients, with low readmission and complication rates. Implementing SDD in the public sector has the potential to improve access to bariatric services, reduce healthcare costs, and optimise resource utilisation.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854348","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":"Subdural Haematoma at the Royal Darwin Hospital, Australia: A 6-Year Review of Epidemiology, Management and Outcomes.","authors":"Charlie Cho, Joseph Yoon, Claire Maree O'Bryan, Rhiannon Oakhill, Michael Redmond","doi":"10.1111/ans.70285","DOIUrl":"https://doi.org/10.1111/ans.70285","url":null,"abstract":"<p><strong>Background: </strong>Subdural haematoma (SDH) is an increasingly common neurosurgical condition, particularly in aging and at-risk populations. In the Northern Territory, the burden of neurotrauma is compounded by geographic remoteness and disparities in access to care. This study aimed to describe the incidence, management and outcomes of SDH at Royal Darwin Hospital.</p><p><strong>Methods: </strong>A retrospective cohort study was conducted of all adults (≥ 18 years) admitted to Royal Darwin Hospital with convexity SDH between June 2014 and May 2020. Clinical and radiological data were extracted from medical records. Incidence was calculated using 2016 Census data. Outcomes were assessed using the Glasgow Outcome Scale-Extended (GOSE) at discharge and 6 months.</p><p><strong>Results: </strong>A total of 247 patients were included. The incidence of SDH was 23.4 per 100 000 person-years (95% CI: 17.3-31.7), higher than national estimates. Patients travelled a mean distance of 121 km to access care, highlighting geographic barriers. Most patients (67%) presented with acute SDH, and 44% underwent surgical intervention, with burrhole drainage being the most common procedure. Functional outcomes were favourable in 65.2% at discharge and 70.5% at 6 months. Initial Glasgow Coma Scale scores strongly predicted outcomes. The 30-day mortality rate was 16.9%.</p><p><strong>Conclusion: </strong>SDH represents a significant burden on regional neurosurgical services in Northern Australia. The findings underscore the challenges of delivering timely care across vast distances and the need for improved service models to support neurotrauma care in rural and remote settings.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854349","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":"Patterns of Presentation of Prostate Cancer in Patients of Non-English-Speaking Background at an Australian Institution-A 6-Year Retrospective Study.","authors":"Brendan A Yanada, David Homewood, Vaisnavi Thirugnanasundralingam, Niranjan Sathianathen, Henry Yao, Brendan H Dias, Daniel Steiner, Jason Ooi, Cindy Ogluszko, Niall M Corcoran","doi":"10.1111/ans.70291","DOIUrl":"https://doi.org/10.1111/ans.70291","url":null,"abstract":"<p><strong>Background: </strong>Patients originating from culturally and linguistically diverse (CALD) backgrounds and lacking English proficiency often experience poorer health outcomes within Australia. This study aimed to determine whether patients of non-English speaking background (NESB) are more likely to be diagnosed with higher-grade prostate cancer on biopsy, and whether their NESB status affects treatment.</p><p><strong>Methods: </strong>A retrospective review was conducted of all patients diagnosed with prostate cancer on transperineal biopsy and followed up at Western Health in Melbourne, Australia from January 2016 to December 2022. Patients who were not followed up at our institution were excluded. Nonparametric testing and propensity score matching in a 1:1 ratio were used to evaluate differences in disease characteristics and treatments between NESB and English-speaking patients. The need for an interpreter during medical consultations was used to classify patients as non-English-speaking.</p><p><strong>Results: </strong>We identified 779 patients who were diagnosed with prostate cancer. Within this group, 136 (17.5%) were non-English-speaking and required an interpreter. The median PSA (ng/mL) and PSA density (ng/mL/cc) pre-biopsy were 9.9 (IQR: 6.7-15.0) and 0.23 (0.15-0.46) respectively, in the NESB group, and 7.4 (5.2-12.3) and 0.19 (0.12-0.31) respectively, in the English-speaking group (p < 0.001). A greater proportion of men of NESB were diagnosed with higher-grade prostate cancer on biopsy compared with their English-speaking counterparts (p < 0.001). When we controlled for pre-biopsy prostate cancer grade, there was no statistical difference in the proportion of patients managed with radical prostatectomy (p = 0.977), radiotherapy (p = 0.544), ADT (p = 0.113) or chemotherapy (p = 0.792).</p><p><strong>Conclusion: </strong>NESB men are more likely to be diagnosed with higher-grade prostate cancer on biopsy compared with their English-speaking counterparts due to delayed presentation. Language is not seen as a barrier to receiving appropriate treatment for their prostate cancer. Further studies with more granular data pertaining to cancer staging, sequence of treatments and oncological outcomes are required to ascertain the effectiveness of care delivery towards NESB patients living with prostate cancer.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2025-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144854347","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}