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.
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Outcomes and learning curve for robotic‐assisted radical cystectomy: an Australian experience

September 3, 2019 - 04:46

In the largest Australian series of robotic‐assisted radical cystectomy, initial short‐term experience shows technical improvements along a learning curve and favourable perioperative and survival outcomes compared to open and robotic radical cystectomy series.


Abstract Background

This study aimed to describe perioperative, oncological and learning curve outcomes for robotic‐assisted radical cystectomy (RARC) across the first 100 cases performed by an Australian high‐volume, fellowship‐trained robotic surgeon.

Methods

A retrospective cohort study was performed on a consecutive group of 100 patients who underwent RARC between 2010 and 2016 in Brisbane, Australia. Perioperative, oncological and survival data were collected. Demographic, survival and learning curve analyses were performed in MedCalc.

Results

A total of 100 patients underwent RARC over the study period. Median operative time was 389 min, with a reduction in median times from 420 to 330 min when comparing the first 50 versus the second 50 patients (P < 0.001). Median estimated blood loss was 500 mL, while urinary diversion was performed extracorporeally in 20 patients, intracorporeally in 69 patients and using a hybrid technique in 11 patients. Median length of hospital stay was 11 days. Post‐operative complications occurred in 56% of patients (Clavien–Dindo classification I–II 32%, III–V 24%). Positive operative margins were 2% and median lymph node yield was 21 nodes. Overall recurrence‐free survival was 50.3 months.

Conclusion

Initial short‐term experience with RARC shows favourable outcomes with regard to operative, perioperative and pathological indicators compared to open radical cystectomy and other RARC series.

Changing trends in surgical management of renal tumours from 2000 to 2016: a nationwide study of Medicare claims data

September 3, 2019 - 04:46
Abstract Background

Guidelines recommend nephron sparing surgery where possible for patients with T1 renal tumours. The trends of nephron sparing surgery outside the USA are limited, particularly since the introduction of robotic‐assisted partial nephrectomy (RAPN). The aim of this study was to describe contemporary surgical management patterns of renal tumours in Australia according to Medicare claims data.

Methods

Claims data according to the Medicare Benefits Schedule on surgical management of renal tumours in adult Australians between January 2000 and December 2016 was collated. Analysis of absolute number, population‐adjusted rate and renal cancer‐adjusted rate of interventions according to age and gender were performed, as well as proportion of RAPN.

Results

Between 2000 and 2016, the rate of partial nephrectomy (PN) increased while radical nephrectomy (RN) remained stable (PN: 0.87–4.16, RN: 6.52–6.70 per 100 000 population). Since 2015, PN has become more common than RN in patients aged 25 to 44 years (0.98 versus 0.95 procedures per 100 000 population). Renal cancer‐adjusted rate exhibited a trend towards increasing utilization of PN and reduced RN across all age groups. An increase in overall surgical treatment was observed (25%–41%), mainly due to increased treatment of patients older than 75 years. The proportion of RAPN was seen to rapidly increase (4.7% in 2010 to 58% in 2016).

Conclusions

Treatment utilization for renal masses has markedly changed in Australia according to Medicare claims. PN is increasingly replacing RN in younger patients, and older patients are receiving more surgical treatment. The impact of increased RAPN utilization is yet to be determined.

Incidental abdominal heterotaxy syndrome

September 3, 2019 - 04:46
ANZ Journal of Surgery, EarlyView.

Do Indigenous patients in Australia's Northern Territory present with more advanced colorectal cancer? A cohort study based on registry data

August 28, 2019 - 22:10

Previous studies have shown that Indigenous Australians in the Northern Territory have allowed survival from, and present at a later stage with colorectal cancer than non‐Indigenous Australians. This study shows that a later stage of presentation is no longer present, implying that other factors such as treatment complaint or comorbidity may be responsible for the continued survival disparity.


Background

Previous studies show that Indigenous Australians (IndA) of the Northern Territory (NT) present later and have lower survival for colorectal cancer (CRC) compared with non‐Indigenous (NI) Territorians. This study compared the odds of presenting with advanced‐stage CRC between IndA and NI adjusted for demographic, histopathological and surgical features.

Methods

A cohort study of NT Cancer Registry (NTCR) CRC cases from 2005 to 2014. All (667) persons notified to the NTCR with a new diagnosis of CRC were included, of which 504 had sufficient data for analysis. The NTCR was used for case identification and linked to available hospital clinical data. The principal exposure was IndA compared with NI and the principal outcome was odds of presenting with advanced‐stage tumour (III and IV) compared with early‐stage (I and II). Univariable and multivariable logistic regression were performed on all relevant variables.

Results

Univariable logistic regression found no difference in the odds of advanced CRC between IndA and NI (odds ratio (OR) 0.99, 95% confidence interval (CI) 0.56–1.76, P = 0.982). This effect remained insignificant adjusted for the effects of sex, tumour position, remoteness and time period (OR 0.85, 95% CI 0.47–1.55, P = 0.606) and when adjusted for tumour grade, lympho‐vascular invasion, lymph node harvest and emergency status (OR 1.39, 95% CI 0.64–3.03, P = 0.401).

Conclusions

In distinction from previous studies, there was no evidence that IndA of the NT presented with later stage CRC in 2005–2014. Other factors (incomplete treatment or comorbidity) may be responsible for the continued observed survival disparity.

Marked increase in the incidence of anterior cruciate ligament reconstructions in young females in New Zealand

August 27, 2019 - 04:15

We found a 120% increase in the incidence of anterior cruciate ligament reconstruction surgery in young females in New Zealand from 2000–2005 to 2013–2016. A higher proportion of anterior cruciate ligament reconstruction in New Zealand are now due to sport‐related causes, particularly netball, rugby and football. Injury prevention strategies should target these high‐risk groups, especially young females.


Abstract Background

Anterior cruciate ligament injuries cause significant morbidity, and may be increasing in incidence as participation in high‐risk sports increases. The aim of this study is to investigate the incidence of anterior cruciate ligament reconstruction (ACLR) surgery in New Zealand, and to analyse changes over time in demographic subgroups.

Method

Data were sourced from the Accident Compensation Corporation. Data relating to primary ACLRs performed from 2009 to 2016 were evaluated (n = 20 751). Baseline population estimates were obtained from national census data to calculate the incidence, and results were compared to previous data from 2000 to 2005 (n = 7375).

Results

The annual incidence of ACLR for 2009–2016 was 58.2 per 100 000 person‐years and was greater in males than in females (72.2 and 44.9, respectively). This represents a 58% increase when compared with the period 2000–2005 (36.9 per 100 000). The greatest increase was seen in females aged 15–19 years, with the incidence increasing by 120% in the last decade, compared with 53% in females aged 20–24 years. The percentage of injuries caused by sports changed from 65% over 2000–2005 to 76% over 2009–2016, with netball, rugby and football accounting for the highest number of injuries.

Conclusion

The incidence of ACLR procedures has increased markedly in New Zealand, and this increase was most pronounced in females aged 15–19 years. A greater proportion of procedures are now due to sport‐related injuries.

Distribution of lymph node metastasis and the extent of lymph node dissection in descending colon cancer patients

August 27, 2019 - 04:14

The optimal extent of lymph node dissection in patients with descending colon cancer is still debatable. This retrospective study evaluated lymph node metastasis of 118 descending colon cancer patients. Lymph nodes at the origin of the inferior mesenteric artery (IMA) showed no metastasis in any of the 26 patients who underwent high ligation of the IMA, and ligation of the IMA showed no prognostic benefit after propensity score matching.


Abstract Background

The optimal extent of lymph node dissection in patients with descending colon cancer is still debatable. We designed this study to evaluate the distribution of lymph node metastasis and the appropriate extent of lymph node dissection in descending colon cancer patients.

Methods

We retrospectively reviewed the medical records of 118 descending colon cancer patients without distant metastasis, who underwent curative resection between January 2004 and December 2014. The distribution of lymph node metastasis was evaluated, and prognostic factors were analysed.

Results

The median follow‐up period was 52 months (range 1–125 months). Twenty‐six (22.0%) patients underwent high ligation of the inferior mesenteric artery (IMA), whereas 92 (78.0%) patients underwent ligation of the left colic artery, saving the IMA. Lymph nodes at the origin of the IMA showed no metastasis in any of the 26 patients who underwent high ligation of the IMA. After propensity score matching, 3‐year disease‐free survival (80.4% versus 92.9%, P = 0.471) and 5‐year overall survival (81.8% versus 90.9%, P = 0.875) were not significantly different according to the type of IMA ligation.

Conclusion

In patients with descending colon cancer, there was no lymph node metastasis at the origin of the IMA, and ligation of the IMA showed no prognostic benefit.

Colo‐pleural fistula: a rare complication of bariatric surgery

August 27, 2019 - 02:19
ANZ Journal of Surgery, EarlyView.

Lymphopaenia in the diagnosis of paediatric appendicitis: a false sense of security?

August 27, 2019 - 02:19


Abstract Background

Appendicitis is a common indication for emergent surgery in children; however, it is a small proportion of presentations with abdominal pain. As viral illness is a common differential diagnosis, lymphopaenia is used by some as a predictor against appendicitis. Furthermore, neutrophil–lymphocyte ratio (NLR) has been found to predict appendicitis. We aimed to verify if lymphopaenia predicted against appendicitis in children.

Methods

Retrospective review was conducted for all patients aged 15 years and under presenting with abdominal pain to our institution in 2017, and data including age, white cell count, neutrophil and lymphocyte count, NLR, C‐reactive protein and diagnosis of appendicitis were recorded. Statistical analysis was performed using Stata©. Receiver operating characteristic curves for various tests were formed and areas under curve (AUC) compared using regression, P < 0.05 was considered significant.

Results

A total of 1263 patients were presented, of whom 546 had their blood performed and were included, 86 had appendicitis and 460 did not. Neutrophilia was the best predictor for appendicitis (AUC = 0.86), significantly higher than NLR (0.81), P < 0.05. Lymphopaenia was a poor negative predictor of appendicitis (AUC = 0.46), and while isolated lymphopaenia was more predictive (AUC = 0.23) this was inferior to the positive prediction of neutrophilia, P < 0.05.

Conclusion

The value of isolated lymphopaenia to predict against appendicitis is largely accounted for inherently normal neutrophils, independently lymphopaenia has little value. NLR, while predictive, is a weaker predictor than neutrophilia.

Laparoscopic totally extra‐peritoneal groin hernia repair with self‐gripping polyester mesh: a series of 780 repairs

August 27, 2019 - 02:19

Laparoscopic inguinal hernia repair using polyester self‐gripping mesh may reduce chronic pain by avoiding fixation. We present a large series (2011–2017) of 780 repairs using this technique with a chronic pain rate of 1.67% and four recurrences (0.51%) (follow‐up was up to 4.4 years).


Background

Laparoscopic groin hernia repair is an increasingly common procedure with benefits of reduced post‐operative pain and infection. Post‐operative chronic pain remains an ongoing concern in about 10% of patients. Parietex ProGrip™, a polyester self‐gripping mesh, has a theoretical benefit of avoiding tacks for mesh‐fixation. This case series reflects our long‐term experience of this technique.

Methods

We conducted a retrospective case series from November 2011 to December 2017. Patients were identified through an operative Medicare Benefits Schedule item number search. Clinical documentation was reviewed with length of stay, mesh infection, chronic pain, recurrence and re‐operation as primary data points.

Results

A total of 514 patients underwent 780 laparoscopic inguinal hernia repairs with self‐gripping polyester mesh during this period. There were 53 female (10.3%) and 461 male patients (89.7%). Unilateral hernia repair was performed in 248 patients (48.2%) and bilateral repair in 266 patients (51.8%). Almost all repairs (779, 99.8%) were primary hernias. There were no mesh infections. Four recurrences were noted (0.51%) and three of these subsequently underwent open redo‐hernia repairs (0.38%). Post‐operative follow‐up was up to 4.4 years.

Conclusions

Our series of laparoscopic groin hernia repair with self‐gripping mesh demonstrate this is a safe and reliable mesh and effective technique with low recurrence rates.

Sarcopenia is an independent predictor of delayed gastric emptying following pancreaticoduodenectomy: a retrospective study

August 27, 2019 - 02:18

High body mass index, clinically relevant post‐operative pancreatic fistula and sarcopenia were predictor of delayed gastric emptying (DGE) after pancreaticoduodenectomy. Sarcopenia is likely to be involved in the pathogenesis of DGE after pancreaticoduodenectomy. Improved pre‐operative sarcopenia might prevent DGE.


Background

The pathogenesis of delayed gastric emptying (DGE), a common complication of pancreaticoduodenectomy, is unclear. Loss of skeletal muscle mass (sarcopenia) is associated with post‐pancreaticoduodenectomy complications; however, few studies have investigated the relationship between sarcopenia and DGE. The aim of this study was to investigate whether post‐pancreaticoduodenectomy DGE is affected by pre‐operative skeletal muscle mass.

Methods

We retrospectively analysed the data of 112 consecutive patients who had undergone pancreaticoduodenectomy and divided them into the following two groups: no DGE (n = 100) and with DGE (n = 12). Patients were stratified by quartiles according to each element of body composition. The lowest quartile for skeletal muscle mass was defined as having sarcopenia.

Results

Ten and two patients had grades B and C DGE, respectively. According to univariate analysis, body mass index (P = 0.031), clinically relevant post‐operative pancreatic fistula (P < 0.001) and skeletal muscle mass (P = 0.002) were significantly associated with DGE. According to multivariate analysis, high body mass index (≥25 kg/cm2) (P = 0.005), post‐operative pancreatic fistula (P = 0.027) and low skeletal muscle mass (P = 0.004) were independently associated with DGE.

Conclusion

Sarcopenia is an independent predictor of DGE after pancreaticoduodenectomy.

Long‐term significance of an anastomotic leak in patients undergoing an ultra‐low anterior resection for rectal cancer

August 26, 2019 - 21:40

A study that looks at the long‐term consequences of anastomotic leaks in patients who have undergone an ultra‐low anterior resection for rectal cancer. An evaluation of morbidity and mortality in both anastomotic leaks and diverting ileostomy were undertaken. Risk factors identified include male gender and response to radiotherapy.


Background

Australia has one of the highest rates of colorectal cancer worldwide. Despite technological advances in colorectal surgery, anastomotic leaks (ALs) continue to cause significant morbidity and mortality. Ultra‐low anterior resections (ULARs) carry the highest prevalence of AL. The aim of the study is to evaluate the incidence, treatment and consequences of AL following ULAR for colorectal cancer from a single colorectal unit.

Methods

This is a retrospective evaluation of prospectively collected data on patients undergoing ULAR following rectal cancer. The main end points include the prevalence and management of AL following initial operation and the morbidity, re‐operation and mortality rates associated with AL. A stepwise logistic regression analysis and a multivariate analysis were performed to identify independent risk factors.

Results

A total of 467 patients underwent an ULAR. There were 32 (6.8%) ALs. Average follow‐up time was 79 months. There were five subclinical leaks and only one (20%) required intervention. The overall survival rate at 5 years was 80% (95% confidence interval 58–91). On univariate analysis male sex was a risk factor for AL (P = 0.03). On multivariate analysis patients who had a complete response to radiotherapy were more likely to have a leak than the patients who had no radiotherapy (grade 4, odds ratio 4.0, 95% confidence interval 1.4–10.9, P = 0.01).

Conclusion

This study has highlighted the relevance of subclinical leaks and their associated morbidity. It identified that radiotherapy a risk factor for AL, but the response to radiotherapy is an even better predictor of leakage.

Novel technique of insertion of decompression tube for Ogilvie's syndrome/colonic pseudo‐obstruction

August 26, 2019 - 21:38

Novel technique of management of colonic pseudo‐obstructing using colonoscopy guided insertion of decompression tube.


Declining incidence of pyloric stenosis in New Zealand

August 26, 2019 - 21:38
Background

Pyloric stenosis is a relatively common paediatric surgical condition, but a worldwide decline in its incidence has been observed in recent decades. The objective of this study was to identify if the incidence of pyloric stenosis in New Zealand has been declining.

Methods

A retrospective review of the four New Zealand paediatric surgical centres’ theatre databases from 2007 to 2017. Demographic data were recorded for all infants who had a pyloromyotomy and annual incidences of pyloric stenosis calculated.

Results

A total of 393 infants underwent a pyloromyotomy for pyloric stenosis during the study period. Most infants (81%) were of European ethnicity. There was a significant decline (P = 0.0001) in the national incidence of pyloric stenosis from 0.73/1000 live births (LB) in 2007 to 0.39/1000 LB in 2017. From 2007 to 2017, the incidence of male infants with pyloric stenosis declined from 1.27/1000 LB to 0.62/1000 LB. The current annual incidence of pyloric stenosis in New Zealand is 0.39/1000 LB.

Conclusions

The incidence of pyloric stenosis in New Zealand has significantly declined in the last decade and is currently the lowest reported incidence in the world involving a predominantly European cohort. A decline in male infants developing pyloric stenosis was also observed. Further study is required to investigate causes for this low incidence and declining trend.

Delayed diagnosis of anorectal malformations in neonates

August 26, 2019 - 21:38
Background

Anorectal malformations (ARM) are common congenital abnormalities of the terminal hindgut. Ideally, ARM should be diagnosed at, or shortly following, birth by careful physical examination of the perineum. Delayed diagnosis has been implicated as a risk factor for complications, including intestinal perforation. This study aimed to determine the rate of delayed diagnosis and associated intestinal perforation in ARM.

Methods

A retrospective review was performed for all ARM patients managed at The Royal Children's Hospital over a 16‐year period (2000–2015). Data collected included ARM type, timing of diagnosis and complications. Delayed diagnosis was defined as being at more than 24 h of age.

Results

A total of 243 ARM patients (male 146/243, 60%) were included. The most frequent ARM types were perineal fistula (83/243, 34%) and rectovestibular fistula (40/243, 16%). Diagnosis was delayed beyond 24 h of age in 92 of 243 (38%) patients. The ARM type most commonly delayed in diagnosis was perineal fistula (37/83, 45%). Two patients in whom diagnosis was delayed suffered an intestinal perforation.

Conclusion

Delayed diagnosis in ARM patients remains a common, and potentially fatal, occurrence. Improved assessment of newborns is required to ensure timely diagnosis of ARM, and avoidance of complications associated with delayed diagnosis.

Clinical role of frequency‐doubled double‐pulse neodymium YAG laser lithotripsy for removal of difficult biliary stones in laparoscopic common bile duct exploration

August 23, 2019 - 18:28

The optimal methods for patients with difficult biliary stones remain under debate. Laparoscopic common bile duct exploration combined with frequency‐doubled double‐pulse neodymium YAG laser lithotripsy appear to be effective and safe for the treatment of difficult biliary stones.


Background

The optimal methods for patients with difficult biliary stones remain under debate. The aim of this study was to evaluate the role of frequency‐doubled double‐pulse neodymium YAG (FREDDY) laser lithotripsy for removing difficult biliary stones during laparoscopic common bile duct exploration (LCBDE).

Methods

Between March 2013 and January 2015, 42 consecutive patients with difficult biliary stones who underwent LCBDE with FREDDY laser lithotripsy were included in this study. The clinical data of all patients were retrospectively collected and analysed.

Results

Bile ducts were completely cleared in all patients. The complications related to laser lithotripsy were not noted. A total of 38 patients (90.5%) underwent primary closure of common bile duct, and T‐tube drainage was applied to four patients (9.5%). No bile duct injury, bleeding and perforation were observed. There were no post‐operative surgery‐related deaths. Bile leakage occurred in four patients (9.5%) with primary closure procedure, and all of them were managed successfully with conservative therapy. The median follow‐up period was 42.8 months, with no evidence of bile duct stricture and stone recurrence in all patients.

Conclusions

The LCBDE combined with FREDDY laser lithotripsy appear to be effective and safe for the treatment of difficult biliary stones.

Patterns of immediate breast reconstruction in New South Wales, Australia: a population‐based study

August 16, 2019 - 22:21

This study is the most comprehensive Australian analysis of immediate breast reconstruction (IBR) utilisation patterns through a population‐based study. It revealed that wide inter‐hospital variation exists in IBR rates within NSW, which raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.


Background

The rate of immediate breast reconstruction (IBR) following mastectomy for breast cancer in Australia is low and varies between regions. To date, no previous Australian studies have examined IBR rates between all hospitals within a particular jurisdiction, despite hospitals being an important known contributor to variation in IBR rates in other countries.

Methods

We used cross‐classified random‐effects logistic regression models to examine the inter‐hospital variation in IBR rates by using data on 7961 women who underwent therapeutic mastectomy procedures in New South Wales (NSW) between January 2012 and June 2015. We derived IBR rates by patient‐, residential neighbourhood‐ and hospital‐related factors and investigated the underlying drivers for the variation in IBR.

Results

We estimated the mean IBR rate across all hospitals performing mastectomy to be 17.1% (95% Bayesian credible interval (CrI) 12.1–23.1%) and observed wide inter‐hospital variation in IBR (variance 4.337, CrI 2.634–6.889). Older women, those born in Asian countries (odds ratio (OR) 0.5, CrI 0.4–0.6), residing in neighbourhoods with lower socioeconomic status (OR 0.7, CrI 0.5–0.8 for the most disadvantaged), and who underwent surgery in public hospitals (OR 0.4, CrI 0.1–1.0) were significantly less likely to have IBR. Women residing in non‐metropolitan areas and attending non‐metropolitan hospitals were significantly less likely to undergo IBR than their metropolitan counterparts attending metropolitan hospitals.

Conclusion

Wide inter‐hospital variation raises concerns about potential inequities in access to IBR services and unmet demand in certain areas of NSW. Explaining the underlying drivers for IBR variation is the first step in identifying policy solutions to redress the issue.

Surgical aortic valve replacement in Australia, 2002–2015: temporal changes in clinical practice, patient profiles and outcomes

August 15, 2019 - 02:39

Surgical aortic valve replacement is increasing and the predominant cardiothoracic procedure in Australia. There is a greater use of bioprosthetic aortic valves, a fall in 30‐day readmission but no change in mortality between 2002 and 2015.


Background

This study describes the temporal changes in risk profiles and outcomes among patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Australia between 2002 and 2015.

Methods

Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, we identified first‐recorded SAVR for AS over 14 years. Patients’ surgical risk profiles, procedures, 30‐day and 12‐month outcomes were summarized before and after the introduction of transcatheter aortic valve implantation in Australia, in 2008. We applied multivariable regression models to investigate the changes over time on risk‐adjusted 30‐day mortality, re‐hospitalization and 12‐month mortality.

Results

We identify a total of 18 147 patients with AS who underwent SAVR; mostly men (64%) with a mean age of 72 years. The proportion of major cardiac surgeries devoted to SAVR increased from 14% in 2002 to 20% in 2015. More SAVRs were performed electively (80% in 2002 versus 86% in 2015), and the recipients were at lower surgical risk (mean multi‐risk score 3.9% in 2002 versus 3.0% in 2015). The use of bioprosthetic aortic valves increased over time (67% in 2002 to 88% in 2015). We found no significant changes in 30‐day mortality, a significant decrease in 30‐day readmission and minor fluctuations in 12‐month mortality over the study period.

Conclusion

SAVR comprises an increasingly larger proportion of all adult cardiac surgeries in Australia. There has been a greater use of bioprosthetic aortic valves, a fall in 30‐day readmission but no significant changes in mortality.

Different clinical risk scores for prediction of early mortality after liver resection for hepatocellular carcinoma: which is the best?

August 7, 2019 - 02:49
Background

Prediction of early mortality after hepatectomies for hepatocellular carcinoma is essential to identify high‐risk patients and to decrease the operative mortality rate. Several post‐operative clinical risk scores were developed recently to predict mortality post‐hepatectomy; however, which one is the best remains undefined. Therefore, the aim of this study was to evaluate the performance of the different post‐operative clinical risk scores in predicting early mortality after hepatectomies.

Methods

A total of 240 patients who underwent liver resection for hepatocellular carcinoma at our hospital between June 2011 and July 2016 were retrospectively reviewed. Post‐operative clinical risk scores including 50–50 criteria, peak bilirubin >7 mg/dL, model for end‐stage liver disease (MELD), risk assessment for early mortality and Hyder scores were evaluated for their performance in predicting early mortality after hepatic resection using the receiver operating characteristic (ROC) curve.

Results

The 90‐day mortality rate after hepatic resection was around 2.5%. The 50–50 criteria and peak bilirubin >7 mg/dL were weak predictors of early mortality with low sensitivity (area under the ROC curve: 0.65, 0.66, respectively), whereas, Hyder, risk assessment for early mortality, and post‐operative MELD were good predictors of early mortality (area under the ROC curve: 0.89, 0.91 and 0.88, respectively). Moreover, MELD score on post‐operative day 3 was an independent risk factor for 90‐day mortality with an odds ratio of 1.4 (95% confidence interval 1.06–1.81, P = 0.02).

Conclusions

Post‐operative clinical risk scores, especially MELD, were capable of predicting early mortality after liver resection and should be used to identify high‐risk patients and provide them with more intensive medical care.

Impact of a major sporting event on local orthopaedic service provision: Commonwealth Games 2018, Gold Coast, Australia

August 7, 2019 - 02:47
Background

The Gold Coast (Queensland, Australia) held the 2018 Commonwealth Games. Previous studies have focussed on the socio‐economic and employment impact of hosting a major sporting event; however, there is limited research available about the provision of medical recourses required of the host city.

Methods

Twelve weeks of data were retrospectively collected from the local health service to quantify the orthopaedic department workload for the period surrounding the 2018 Commonwealth Games. Data collected included referrals to Orthopaedic Fracture Outpatient clinic, theatre cases – emergency and category 1 (scheduled trauma) performed, and entries made into electronic medical records by the on‐call orthopaedic staff.

Results

A statistically significant increase was found for theatre cases performed during the Commonwealth Games (86 versus 71 cases per week, P = 0.033, 95% confidence interval 1.46–27.5). We found no statistically significant increase in Fracture Outpatient Clinic referrals or medical record entries between peri‐games and games periods (P = 0.149 and 0.699, respectively).

Conclusion

Based on our experience, orthopaedic departments should plan for an increase in operative intervention requirements of at least 20%, in consultation with other local services. Strategic use of pre‐existing resources and staff may be sufficient to address the increased workload during the event period.

Case report of nasopharyngeal rhabdomyosarcoma causing obstructive sleep apnoea

August 6, 2019 - 22:24
ANZ Journal of Surgery, EarlyView.