ANZ Journal of Surgery

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Syndicate content
Wiley Online Library : ANZ Journal of Surgery
Updated: 9 hours 12 min ago

Medicine in small doses

April 3, 2017 - 16:24

Precision medicine?

April 3, 2017 - 16:24

25, 50 & 75 years ago

April 3, 2017 - 16:24

Comparison of cost of care for tethered versus non-tethered ureteric stents in the management of uncomplicated upper urinary tract stones

March 31, 2017 - 10:50
Background

Many surgeons use a stent after ureteroscopic lithotripsy (URSL). For short-term stenting purposes, a surgeon has the choice of either a tethered or a non-tethered stent. Stents may be associated with complications that entail an additional cost to their use. There is a paucity of data on the direct healthcare cost of using stent type after either primary or secondary URSL.

Methods

We retrospectively reviewed medical records for patients who underwent URSL for uncomplicated urolithiasis between January 2013 and December 2013 at two tertiary referral hospitals. Costs data was sourced from the costing department with complete data available for 134 patients. The overall medical care cost was estimated by computing the cost of surgery, stent-related emergency department presentations, re-admissions and stent removal.

Results

A total of 113 patients had tethered stents and 21 had non-tethered stents, with similar age and gender composition between the two groups and complications rates. The mean cost of URSL and stent placement was A$3071.7 ± A$906.8 versus A$3423.8 ± A$808.4 (P = 0.049), mean cost of managing complications was A$309.4 ± A$1744.8 versus A$31.3 ± A$98.9 (P = 0.096), mean cost of out-patient clinic stent removal was A$222.5 ± A$60 versus A$1013.6 ± A$75.4 (P < 0.001) for endoscopic stent removal, overall mean cost of care was A$3603.6 ± A$1896.7 versus A$4468.1 ± A$820.8 (P = 0.042) for tethered and non-tethered stents, respectively.

Conclusion

It is cheaper to use a tethered ureteric stent compared with non-tethered stents for short-term stenting after uncomplicated URSL, with a mean cost saving of A$864.5.

Cohort study on emergency general surgery patients and an observation unit

March 31, 2017 - 10:50
Background

Medium-sized, non-trauma hospitals experience many of the same difficulties as tertiary centres do when it comes to managing emergency general surgery patients. However, acute surgical units are not a financially viable option in these hospitals. To improve the care of emergency general surgery patients at one such hospital, a Rapid Assessment Medical Surgical (RAMS) unit was developed to decrease the time to review and increase the efficiency in caring for these patients.

Methods

To assess the unit's effect, a prospective analysis was completed of the patients who came through the RAMS unit over a 6-month period and compared with a retrospective analysis of patients presenting in the same 6-month period the year prior to the unit's instigation.

Results

The RAMS unit was effective in providing an avenue for faster review by the surgical team. This resulted in patients leaving the emergency department faster, decreased the number of patients that breached emergency department time-targets and increased the number of patients discharged after a period of observation or basic treatments.

Conclusion

General surgery patients were managed more efficiently with the RAMS unit in place. However, a full cost analysis is required to determine if such units are cost-effective.

Acute cholangitis: current concepts

March 24, 2017 - 15:00
Background

Acute cholangitis, also known as ascending cholangitis, is a life-threatening systemic condition that results from a biliary tree infection and obstruction. Severe acute cholangitis was reported to have a mortality rate between 11 and 27% in the 1990s. This article is a literature review about acute cholangitis. Its aim is to review the latest literature about acute cholangitis and to discuss its pathogenesis, clinical presentation, diagnosis, prognosis, risk factors and treatment.

Methods

Ovid Medline and PubMed database searches were performed for articles about acute cholangitis published in English from 1877 to 2016. The keyword search headings included ‘acute’, ‘ascending’ and ‘cholangitis’, and a combination of these were used. Only articles with full-text descriptions were chosen for this literature review.

Results

Common causes of biliary tree obstruction include choledocholithiasis, benign and malignant biliary strictures. According to the Tokyo Guidelines, clinical presentation, laboratory blood results and diagnostic imaging are important in the diagnosis of acute cholangitis. Treatments consist of intravenous fluids and antibiotics followed by biliary decompression and drainage. Available drainage options include endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, endoscopic ultrasound and open surgical drainage.

Conclusion

It is important to diagnose acute cholangitis as early as possible to initiate appropriate treatments to reduce mortality and morbidity.

Management of colorectal trauma: a review

March 21, 2017 - 09:19

Traumatic colorectal injuries are common during times of military conflict, and major improvements in their care have arisen in such periods. Since World War II, many classification systems for colorectal trauma have been proposed, including (i) Flint Grading System; (ii) Penetrating Abdominal Trauma Index; (iii) Colonic/Rectal Injury Scale; and (iv) destructive/non-destructive colonic injuries. The primary goal of these classifications was to aid surgical management and, more particularly, to determine whether a primary repair or faecal diversion should be performed. Primary repair is now the preferred surgical option. Patients who have been identified as having destructive injuries have been found to have higher anastomotic leak rates after a primary repair. Damage control principles need to be adhered to in surgical decision-making. In this review, we discuss the mechanisms of injury, classifications, clinical presentation and current recommendations for the management of colorectal trauma.