ANZ Journal of Surgery

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Table of Contents for ANZ Journal of Surgery. List of articles from both the latest and EarlyView issues.
Updated: 9 hours 17 min ago

Don't Forget Trauma Patient: Lessons from a Major Trauma and Major COVID Centre

April 21, 2021 - 16:21
ANZ Journal of Surgery, Accepted Article.

Patient, surgical and hospital factors associated with the presence of a consultant surgeon during hip fracture surgery. Do we know the answer?

April 20, 2021 - 17:05

The study reports on patient, surgical and hospital factors associated with the presence of a consultant surgeon during hip fracture surgery. It describes variation in the presence of a consultant surgeon influenced by the complexity of hip fracture surgery and hospital volume. Potentially, operating times for patients with specific surgical characteristics could be allocated within surgical teams.


Abstract Background

Provision of quality care can help to reduce adverse health outcomes following hip fracture. While surgical management by either a consultant or junior surgeon has shown inconclusive differences in patient outcomes, consultant presence is often recommended, yet little is known about the factors that influence whether a consultant surgeon is present during hip fracture surgery. The aim of this study is to examine patient, surgical and hospital factors associated with having a consultant surgeon present during hip fracture surgery.

Methods

An examination of hip fracture surgeries of adults aged ≥ 50 years admitted to hospitals in Australia and New Zealand between 1 January 2015 and 31 December 2018 using data from the Australia and New Zealand Hip Fracture Registry was conducted. Multivariable logistic regression was used to examine factors associated with the presence of a consultant surgeon during hip fracture surgery.

Results

There were 29 530 hip fracture surgeries 58.1% had a consultant surgeon present (range 8.5–100% by hospital). Patients were more likely to have a consultant surgeon present during surgery if they had private health insurance, were operated on after hours, required total hip replacements or were operated on in hospitals that conducted ≤150 surgeries per year.

Conclusion

There is variation in the presence of consultant surgeons within Australia and New Zealand during hip fracture surgery, potentially associated with the complexity of surgery and hospital factors. However, further research is needed to determine the optimum level of supervision required based on patient factors and surgical complexity.

Comparison of ethanol concentrations after drinking in patients who underwent total gastrectomy versus healthy controls

April 20, 2021 - 16:59

We conducted a clinical trial to investigate the trend in alcohol absorption in actual patients who underwent total gastrectomy. The peak concentration of ethanol in patients was higher than that of healthy controls. To avoid acute alcoholic intoxication, these patients need to drink smaller amounts of alcohol, and also drink such portions more slowly than healthy people.


Abstract Background

The safety of drinking in patients who have undergone total gastrectomy for gastric cancer has not been established. We conducted a clinical trial to investigate the trend in alcohol absorption in actual patients.

Methods

Patients who received total gastrectomy with lymph‐node dissection and Roux‐en‐Y reconstruction six or more months ago were enrolled. Participants drank 1 unit (20 g) of ethanol within 1 h starting at least 1 h after a meal. The blood alcohol concentration (BAC) was then estimated by a measurement of the breath alcohol concentration. The peak and trend in the BAC in patients was compared with that in healthy volunteers who were matched with patients for the alcohol‐sensitive genotype.

Results

Ten patients and 10 healthy people were enrolled in the BAC evaluation. The peak BAC (%) was 0.158 in patients after total gastrectomy versus 0.110 in control (P < 0.001). The mean half‐life of BAC was 58.0 min in the patient group and 94.0 min in the control group, although the mean time to complete drinking was significantly longer in the patient group than in the control group at 40.8 versus 21.9 min (P = 0.009).

Conclusion

Drinking alcohol is likely to carry a risk of increasing the BAC in patients who have undergone total gastrectomy.

Smartphone‐controlled patch electro‐acupuncture versus conventional pain relief during colonoscopy: a randomized controlled trial

April 20, 2021 - 16:58

The use of an acupuncture device was known to reduce pain and discomfort during the gastrointestinal procedure. We study the use of mobile phone electroacupuncture on reducing the pain and discomfort during colonoscopy. This device has more versatility and portability. Its use is safe and convenient. Its use may reduce the usage of sedatives and opiates during colonoscopy procedure. Sedative‐free colonoscopy may be more frequently adapted to with the advent of such device.


Abstract Background

Smartphone‐controlled patch electro‐acupuncture (SCEA) is a novel device which gives the same analgesic effect as with conventional acupuncture. There are no published articles in the English literature on the use of this device as a primary mode of pain relief during colonoscopy. Primary aims of this study were to investigate the efficacy of SCEA as a substitute for pain relief during colonoscopy.

Methods

Thirty‐seven patients were randomized to receive SCEA (n = 19) or placebo (n = 18) during colonoscopy. Additional rescue sedation was administered to patients if they had pain or discomfort during the procedure. Visual analogue scale was used to quantify the intensity of pain from the beginning to end of the procedure. Other variables analysed were the amount of sedation used, duration from start to caecal intubation, length of time for completion of colonoscopy and recovery time to home discharge.

Results

Patients who received SCEA had a lower median pain score of 4.6 (interquartile range 5.7) compared to the placebo group of 6.0 (interquartile range 3.2). Statistical analysis comparing the groups revealed a non‐significant P‐value of 0.12, although more than 90% of the patients indicated willingness for SCEA as the primary analgesia if they were to repeat the procedure. Throughout the study, there were no adverse complications that occurred during the use of SCEA.

Conclusions

Even though this study did not demonstrate, a significance in pain reduction, SCEA remains a safe modality which, more than 90% of patients favoured as a substitute for pain relief during colonoscopy.

Gossypiboma: when it is what we think it cannot be

April 20, 2021 - 02:04
ANZ Journal of Surgery, EarlyView.

Small bowel hamartomatous polyp causing recurrent intussusception

April 20, 2021 - 01:50
ANZ Journal of Surgery, EarlyView.

Long‐term outcomes of pulmonary metastasectomy: a multicentre analysis

April 19, 2021 - 14:17

Many extrapulmonary neoplasms metastasize to lung. Pulmonary metastasectomy is safe and is associated with survival of greater than 50% at 5 years in select patients.


Abstract Background

Many extrapulmonary neoplasms metastasize to the lungs. We conducted a retrospective review of all patients who underwent pulmonary metastasectomy for oligometastatic disease at two centres in order to determine long‐term outcomes.

Methods

The study institutions' thoracic surgery databases were searched for all patients who underwent pulmonary metastasectomy from 2000 to 2017.

Results

There were a total of 476 patients who underwent pulmonary metastasectomy. Mean age at time of surgery was 57.2 ± 15.9 years. Mean number of pulmonary lesions was 1.9 ± 1.6. Mean disease‐free interval (DFI) was 3.6 ± 4.3 years. The most common primary neoplasms were colorectal cancer (CRC) in 35.1% (167/476), sarcoma in 23.9% (114/476), melanoma in 16.2% (77/478), renal cell carcinoma (RCC) in 7.3% (35/476) and germ cell tumour (GCT) in 4.4% (21/476). Hospital mortality was 0.4% (2/476). Mean follow‐up time was 3.8 ± 2.9 years. Survival was 88.9% (95% confidence interval 85.77–91.5) at 1 year and 49.6% (95% confidence interval 44.4–54.6) at 5 years. On multivariate Cox‐regression analysis GCT (P = 0.004), CRC (P = 0.03), DFI of 36+ months (P = 0.007), R0 resection (P = 0.002) and non‐anatomical, sub‐lobar (wedge) resection (P = 0.002) were protective against mortality.

Conclusion

Pulmonary metastasectomy is associated with survival of 50% at 5‐year follow‐up. DFI of over 36 months, R0 resections, lesions resectable by wedge resection rather than anatomic resection and GCT and CRC primary cancers were associated with improved survival.

Outcomes of diverting loop ileostomy reversal in the elderly: a case–control study

April 19, 2021 - 14:15

Advanced age is not a risk factor for increased morbidity after diverting loop ileostomy (DLI) closure. Though relatively a simple and short procedure, DLI closure is associated with substantial overall complications rates and non‐negligible severe complications rate. This should be taken into account when deciding to construct the ileostomy and prior to its closure. Efforts should be made to minimize the time interval between DLI creation and reversal of the ileostomy.


Abstract Background

Although diverting loop ileostomy (DLI) reversal is considered to be a relatively simple procedure, it is not immune from major morbidity. We aimed to compare outcomes of DLI reversal between elderly and non‐elderly patients.

Methods

Retrospective review of all patients who underwent DLI reversal at a single tertiary medical centre between 2010 and 2020. The elderly group consisted of patients 70 or older compared to a control group of those younger than 70 years.

Results

During the study period, 307 patients underwent DLI reversal. Of these, 76 patients were in the elderly group (mean age 75.6) and 231 in the control group (mean age 55.3). The groups were comparable in terms of mean time interval between the creation of the ileostomy and reversal (242 versus 255 days, respectively, P = 0.5), choice between stapled and hand‐sewn anastomoses (97.4% stapled anastomosis versus 93.1%, P = 0.086), median post‐operative length of stay (5 days in both, P = 0.086), rates of post‐operative complications (26.3% versus 26.8%, P = 0.99), severe complications (5.3% versus 6.9%, P = 0.81) and 30‐day readmission rates (13.2% versus 10.8%, P = 0.58). Multivariate analysis found the time interval between the creation of the stoma and its reversal to be the only significant risk factor for major post‐operative morbidity. Age was not found to be correlated with post‐operative morbidity.

Conclusion

The outcomes of loop ileostomy reversal in elderly patients are similar to non‐elderly patients. Efforts should be made to decrease the time interval between the creation of the stoma and its reversal as this is a significant risk factor for major post‐operative morbidity.

Evaluation of palliative treatments in unresectable pancreatic cancer

April 19, 2021 - 14:14

This study presents comprehensive data on patients with locally advanced and metastatic pancreatic ductal adenocarcinoma in real‐life practice in local Australian setting. A large proportion of patients received adequate palliative care at the institution with appropriate level of aggressiveness of end‐of‐life care. Further prospective studies are necessary for examining the management and impacts of pancreatic insufficiency in this group.


Abstract Background

Pancreatic ductal adenocarcinoma (PDAC) presents as unresectable disease in 80% of patients. Limited Australian data exists regarding management and outcome of palliative management for PDAC. This study aims to: (i) identify patients with PDAC being managed with palliative intent; (ii) assess the type of palliative management being used.

Methods

A prospectively maintained pancreatic database at Western Health (2015–2017) was used to identify patient demographics; stage and multidisciplinary decision regarding resectability and operative interventions; palliative care; use of chemotherapy, radiotherapy and; management of exocrine and endocrine insufficiency. Data on chemotherapy use, number of hospital admissions, emergency department attendances and intensive care unit admissions 30 days prior to death were recorded.

Results

One‐hundred and eleven patients had diagnosis of PDAC, 15% with locally advanced and 45% with metastatic PDAC. Among the locally advanced and metastatic PDAC, 48% received biliary stent insertions, 93% had palliative care referral, 45% received palliative chemotherapy and 10% received radiotherapy. Dietitian referral occurred in 79% and 36% were prescribed with a pancreatic enzyme replacement therapy. Diabetes mellitus was present in 52% of which 31% was new onset. Within 30 days prior to death, 11% patients received palliative chemotherapy, 32% were hospitalized and 11% visited an emergency department more than once. Sixty‐five percent died in hospital.

Conclusion

A high proportion of patients diagnosed with locally advanced and metastatic PDAC received palliative care referrals and appropriate level of end‐of‐life care. Further prospective studies are necessary, examining the management and impacts of pancreatic insufficiency in this group.

Impact of ultrasound on inguinal hernia repair rates in Australia: a population‐based analysis

April 19, 2021 - 14:13

The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR rates; however, they may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.


Abstract Background

Inguinal hernias are a common pathology that often requires surgical management. The use of groin ultrasound (GU) to investigate inguinal hernias is a growing area of concern as an inefficient use of healthcare resources. Our aim was to assess changes in the rates of GU and the impact on surgical practice.

Methods

Medicare Item Reports and the Australian Institute of Health and Welfare Database were used to estimate annual GU and inguinal hernia repair (IHR) rates per 100 000 population for the period 2000/2001–2017/2018. Pearson's correlation coefficients and linear regression analyses were performed to assess associations between these variables.

Results

Over the 18‐year period, GU rates increased 13‐fold from 88 to 1174 per 100 000 population. Overall, total IHR rates decreased from 217 to 192 per 100 000. Overall, unilateral IHR rates have decreased (182–146 per 100 000), bilateral IHRs have increased (35–46 per 100 000), laparoscopic IHR has increased (30–86 per 100 000) and open surgery has declined (187–106 per 100 000). The increase in GU rates were strongly associated with the decrease in unilateral (r = −0.936, P = <0.001) and increase in bilateral IHR rates (r = 0.924, P = <0.001).

Conclusion

The use of GU has increased substantially, potentially representing an unnecessary cost to the healthcare system. Rising GU rates are not associated with an increase in IHR, however, may contribute to the increasing rates of bilateral IHRs. This study supports the opinion that more extensive clinical and health policy initiatives are needed in Australia to address this health issue.

How is surgery included in the Strategic Health Plans of the Pacific, Papua New Guinea and Timor‐Leste?

April 19, 2021 - 14:12

Papua New Guinea, Pacific Island nations and Timor‐Leste represent a range of island countries with populations ranging from a few thousand to 8 million. They perform on average about 25% of the Lancet Commission of Global Surgery's target 5000 per 100 000 population and their health workforce have significant deficits of trained surgeons and anaesthetists. This study was conducted to determine how the current national health plans of these nations have included surgery and anaesthesia.


Abstract Background

Papua New Guinea, Pacific Island nations, and Timor‐Leste represent a range of island nations with populations ranging from a few thousand to 8 million. They perform on average about 25% of the Lancet Commission of Global Surgery's target 5000 per 100 000 population and their health workforce have significant deficits of trained surgeons and anaesthetists. This study was conducted to determine how the current national health plans of these nations have included surgery and anaesthesia.

Methods

The most recent (as of December 2018) published national health plans of 10 Pacific Island nations (Cook Islands, Fiji, Nauru, Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu), Papua New Guinea and Timor‐Leste were reviewed for content and process, searching for key words and identifying themes related to surgery and anaesthesia.

Results

There were 12 national health plans with a combined total of 478 pages. There was limited surgical and/or anaesthesia input within the planning process. Injuries, blindness, cancer and non‐communicable diseases were included themes, but the potential role of surgical care in addressing these conditions was not well documented. The need for better information and registries was noted by several nations but possible surgical care delivery or outcome metrics were not included.

Conclusion

There is limited mention of surgical and anaesthesia care planning within current health plans in the Pacific, PNG and TL. There is a need for greater surgical and anaesthesia engagement in future plans with performance measured against World Health Organization core surgical indicators.

Experience of treating biliary atresia with laparoscopic‐modified Kasai and laparoscopic conventional Kasai: a cohort study

April 19, 2021 - 14:12

Laparoscopic Kasai procedures for biliary atresia; complete mobilization of the left and right portal veins; improve the outcome of biliary atresia treated by laparoscopic Kasai.


Abstract Background

Complete mobilization of the left and right portal veins had been seldom utilized in the laparoscopic Kasai procedures. The purpose of this study was to evaluate the feasibility and efficacy of the key technique in detail.

Methods

A total of 82 patients with type III biliary atresia were operated by laparoscopic Kasai at our hospital during January 2012 to October 2019. Forty‐two patients underwent modified laparoscopic Kasai (group 1), and 40 patients of control group underwent general laparoscopic Kasai (group 2). The clinical data between the two groups were compared.

Results

The early clearance of jaundice was significantly higher for group 1 (88.1%) versus group 2 (68.4%) (P < 0.05), the incidence of repeated cholangitis was significantly lower in group 1 (11.9%) versus group 2 (31.6%) (P < 0.05). The native liver survival rate was (85.7%) in group1 versus in group 2 (65.8%) (P < 0.05). In addition, there were no significant differences regarding the resumption oral intake and the post‐operative hospital stay in the two groups.

Conclusion

The key technique of the complete mobilization of the left and right portal veins would improve the outcome of biliary atresia treated by laparoscopic Kasai.

Serum carcinoembryonic antigen pre‐operative level in colorectal cancer: revisiting risk stratification

April 19, 2021 - 14:10

The present paper is a retrospective cohort analysis that we conducted to verify the prognostic role of pre‐operative serum carcinoembryonic antigen (CEA) level in predicting overall survival and risk of metastatic development in colorectal cancer patients. Although already evaluated by several studies, there is still lack of consensus in literature on the optimal cut‐off values which may allow for risk stratification and individualized treatments. Our results show that a pre‐operative CEA level >4.5 ng/mL correlated with a higher risk of developing distant recurrence in stage I, II and III colorectal cancer. Moreover, a pre‐operative CEA level >10 ng/mL was found to be significantly predictive of all‐cause mortality and poor disease‐free survival in patients with stage III and IV colorectal cancer undergoing potentially curative surgery.


Abstract Background

Biomarkers may play a role as predictive and prognostic factors in colorectal cancer patients. The aims of the study were to verify the prognostic role of pre‐operative serum carcinoembryonic antigen (CEA) level in predicting overall survival and risk of recurrence in a cohort of colorectal cancer patients and to evaluate optimal cut‐off values.

Methods

A retrospective cohort analysis was performed on colorectal cancer patients undergoing elective curative surgery between 2004 and 2019 at an Italian Academic Hospital. Main outcomes were overall survival, disease‐free survival at 3‐years and risk of local, loco‐regional and distant recurrence during follow‐up. A receiver operating characteristic (ROC) curve analysis was plotted using CEA pre‐operative values and follow‐up data in order to estimate the optimal cut‐off values.

Results

A total of 559 patients were considered. The mean CEA value was 12.1 ± 54.1 ng/mL, and the median 29.3 (0–4995) ng/mL. The ROC curve analysis identified 12.5 ng/mL as the best CEA cut‐off value to predict the risk of metastatic development after surgery in stage I–III colorectal cancer patients, and 10 ng/mL as the best CEA cut‐off value to predict overall survival and disease‐free survival in stage III–IV patients. These data suggest a stratification of colorectal cancer patients in three classes of risk: a low risk class (CEA <10 ng/mL), a moderate risk class (CEA 10–12.5 ng/mL) and a high risk class (CEA >12.5 ng/mL).

Conclusion

In conclusion, pre‐operative serum CEA measurements could integrate information to enhance patient risk stratification and tailored therapy.

Operating at your limits: sport, surgery and performance under pressure

April 17, 2021 - 00:49
ANZ Journal of Surgery, EarlyView.

Quality of life preferences in colorectal cancer patients aged 80 and over

April 14, 2021 - 14:09

Surgeons underestimate many domains of quality of life in colorectal cancer patients. Nevertheless, these patients' expectations from surgery are largely met. Quality of life is very subjective and this should be considered when decision‐making.


Abstract Background

Management of patients with colorectal cancer (CRC) is about not only survival, but also quality of life (QoL). What patients want is important but is not well researched or understood for elderly patients where it is very relevant. This study aimed to measure and compare what patients with CRC aged 80 and over and surgeons consider important in terms of survivorship after surgery for CRC.

Methods

Patients aged 80 and over who were having surgery for CRC were recruited and interviewed using closed and open questions about their expectations of surgery and various QoL dimensions. These were assessed preoperatively and 3 months post‐operatively. Surgeons ranked the same QoL dimensions of patients by questionnaire.

Results

Nineteen patients (median age 87.5, range 80–95, eight males and 11 females) were recruited. Patients rated items relating to health, mobility and independence (n = 23) as top three items most often followed by people outside self (n = 13). Surgeons underestimated importance in 17 domains with the biggest discrepancy being in ‘avoiding a stoma’ (4.11 versus 2.3, P < 0.01).

Conclusion

With patients over 80 years having surgery for CRC, there is a lack of concordance between what surgeons think is important and what patients think is important. Despite this, CRC patients aged 80 and older are almost always satisfied with the outcome of surgery. Surgeons should ensure that they understand patients' expectations and that they are aligned with likely outcomes of surgery.

He Wānanga Whakarite: preparing Māori for surgical selection interviews

April 14, 2021 - 14:03

‘He Wananga Whakarite: Preparing Māori for Surgical Selection Interviews’ is a kaupapa Māori initiative that illustrates an active measure that can be taken to support Junior Māori Doctors with surgical training selection as they attempt to effect change and work towards achieving Māori aspirational equity in health and the surgical workforce.


Abstract Background

Māori are significantly under‐represented in the surgical workforce in Aotearoa New Zealand. There needs to be more effort and initiative action to address this lack of diversity in order to ultimately achieve proportionality so that more Māori surgeons are available to help treat and care for their communities.

Methods

An independent kaupapa Māori wānanga (course) initiative, using a ‘by Māori, for Māori’ approach, and adhering to tīkanga Māori (Māori lore and protocols) was developed to support and prepare Māori Non‐Training Surgical Registrars for the Royal Australasian College of Surgeons Surgical Education and Training (SET) interviews. This paper reviews the inception of the wānanga, its content, and shares experiences had by attendees.

Results

Those who attended this wānanga agreed unanimously that this initiative dramatically improved their preparation for SET interviews. In 2020, the wānanga produced a significant success rate amongst attendees with 80% of wānanga attendees selected for SET training positions.

Conclusion

This kaupapa Māori initiative illustrates a successful active measure that can be taken to support Māori doctors seeking selection in surgical training programmes. The initiative seeks to address inequity in the surgical workforce in Aotearoa New Zealand.

Anaemia and its impact on colorectal cancer patients: how can we better optimize surgical outcomes?

April 14, 2021 - 14:02

Normocytic is a more common finding in CRC patients than microcytic anaemia. Patients with anaemia are rarely tested for iron deficiency. Anaemic patients are more likely to have both medical and surgical postoperative complications as well as a longer LOS. Routine testing and active anaemia management may help reduce these complications.


Abstract Background

Anaemia is a common manifestation of colorectal cancer (CRC). However, appropriate workup prior to surgery and the effect of anaemia on outcomes have not been well defined. This study aimed to describe preoperative anaemia incidence, investigations performed, treatment and associated complications in a CRC surgical population at a single large tertiary institution in Australia.

Methods

Patients who received surgery with curative intent for CRC between 2012 and 2017 were identified from a prospectively maintained database. Demographic and clinical outcome data were analysed.

Results

In total, 754 patients with CRC were included. Anaemia was found in 350 (46.4%) patients, of which 124 (35.4%) were microcytic, 20 (5.7%) were macrocytic and 206 (58.9%) were normocytic. Older patients were more likely to have anaemia (mean age 70.28 years, standard deviation (SD) 12.98 versus 64.74 years, SD 11.74). Only 89 patients (25.4%) were tested for iron deficiency, and of these, 76 (85.4%) were found to be iron deficient and 42 (47.7%) had low ferritin. Preoperative anaemia was associated with a higher incidence of postoperative complications (adjusted odds ratio (OR) 1.46, 95%, CI 1.04–2.05; P = 0.03) and a longer length of stay (LOS; average 1.8 days; 95% CI 0.3–3.3 days).

Conclusion

A significant proportion of CRC patients had anaemia and the majority were normocytic. Only a small number of anaemic patients were tested for iron deficiency. Preoperative anaemia had an adverse effect on LOS and postoperative complications. The evaluation of anaemic patients is essential in CRC patients undergoing surgery.

Variation in Human Research Ethics Committee and governance processes throughout Australia: a need for a uniform approach

April 14, 2021 - 14:02

Ethics processes are varied across Australia with considerable repetition. A centralized, harmonized application process would enhance collaborative research.


Abstract Background

In Australia, ethics committees across different states vary in application, requirement and process for the ethical review and approval for clinical research. This may lead to confusion and delays in the enablement of multicentre research projects. This study explores the effect of differing processes for Ethics and Governance in the establishment of the CovidSurg‐Cancer study during the global COVID‐19 pandemic.

Methods

An anonymous, structured web‐based questionnaire was designed using the Research Electronic Data Capture application (REDCap) platform to capture consultant surgeons, fellows, and trainees experience in the ethics application process. ‘CovidSurg‐Cancer’ was an international multicentre collaborative study to assess the impact of COVID‐19 on the outcomes of patients undergoing cancer surgery. The ethics process to set up this observational study was used as to explore the differing processes applied across Australia.

Results

The CovidSurg‐Cancer study was successfully set up in 14 hospitals. Four hospitals approved the study directly as an audit. Of the remaining sites, 10 ethics applications underwent Human Research Ethics Committee review following which two (14%) were subsequently approved as an audit activity and eight hospitals (57%) were given formal ethical approval with waiver of consent. Ethics application acceptance from another Australian Human Research Ethics Committee was provided with six applications; however, only three were reciprocated without the requirement for further agreements. A third of (30%) respondents suggested that the details of the application pathway, process and documentation were unclear.

Conclusion

Ethics processes are varied across Australia with considerable repetition. A centralized, harmonized application process would enhance collaborative research.