Search

Background: Australia's unique national surgical mortality audit has had a long-term focus on the avoidance of futile surgery. The 30-day mortality rate after emergency laparotomy in Australia is lower than in other countries. Early death (within 72 h) after emergency laparotomy may reflect futile surgery. This paper considers whether Australia's national mortality audit is the reason for its lower mortality rate after emergency laparotomy. Methods: Data were extracted from the Australia and New Zealand Emergency Laparotomy Audit--Quality Improvement (ANZELA-QI) from 2018 to 2022. The time elapsed from emergency laparotomy to death was determined for each patient. The cumulative daily mortality rate was calculated for the first 30 days and expressed as a proportion of all emergency laparotomies, and 30-day and inhospital mortality. Mortality data were compared with those in the only three similar overseas studies. The mortality rate after emergency laparotomy for patients who required but did not undergo surgery was calculated for each hospital. The proportion of patients with high-risk characteristics was compared with that in the National Emergency Laparotomy Audit (NELA). Results: Compared with overseas studies, there was a lower early (within 72 h) mortality rate in ANZELA-QI. Although the lower mortality rate in ANZELA-QI persisted to 30 days, there was a relative increase after 14 days that likely reflected known poor compliance with care standards. Australian patients had fewer high-risk characteristics than those in NELA. Conclusion: The present findings support the hypothesis that the lower mortality rate after emergency laparotomy in Australia is likely a consequence of its national mortality audit and the avoidance of futile surgery. [ABSTRACT FROM AUTHOR]

Background: Transanal total mesorectal excision (taTME) aims to overcome some of the technical challenges faced when operating on mid and low rectal cancers. Specimen quality has been confirmed previously, but recent concerns have been raised about oncological safety. This multicentre prospective study aimed to evaluate the safety of taTME among early adopters in Australia and New Zealand. Methods: Data from all consecutive patients who had taTME for rectal cancer from July 2014 to February 2020 at six tertiary referral centres in Australasia were recorded and analysed. Results: A total of 308 patients of median age of 64 years underwent taTME. Some 75.6 per cent of patients were men, and the median BMI was 26.8 kg/m². The median distance of tumour from anal verge was 7 cm. Neoadjuvant chemoradiotherapy was administered to 57.8 per cent of patients. The anastomotic leak rate was 8.1 per cent and there was no mortality within 30 days of surgery. Pathological examination found a complete mesorectum in 295 patients (95.8 per cent), a near-complete mesorectum in seven patients (2.3 per cent), and an incomplete mesorectum in six patients (1.9 per cent). The circumferential resection margin and distal resection margin was involved in nine patients (2.9 per cent), and two patients (0.6 per cent) respectively. Over a median follow-up of 22 months, the local recurrence rate was 1.9 per cent and median time to local recurrence was 30.5 months. Conclusion: This study showed that, with appropriate training and supervision, skilled minimally invasive rectal cancer surgeons can perform taTME with similar pathological and oncological results to open and laparoscopic surgery. !! [ABSTRACT FROM AUTHOR]

Background: Death after surgery is infrequent but can be devastating for the surgeon. Surgeons may experience intense emotional reactions after a patient's death, reflecting on their part in the death and the patient's loss of life. Excessive rumination or feelings of regret may have lasting negative consequences, but these reactions may also facilitate learning for future decision‐making. This qualitative study analysed surgeons' reflections on what might have been done differently before a patient's death and explored non‐technical (cognitive and interpersonal) aspects of care as potential targets for improvement. Methods: In Australia's Queensland Audit of Surgical Mortality, surgeons reflect on factors surrounding the death of patients in their care and respond to the open‐ended question: in retrospect, would you have done anything differently? Framework analysis was applied to surgeons' responses to identify themes relating to non‐technical aspects of care. Results: Responses from 1214 surgeons were analysed. Two main themes were identified. Dilemmas and difficult decisions confirmed the uncertainty, complexity and situational pressures that often precede a surgical death; regret and empathy for patients featured in some responses. In the second main theme, communication matters, surgeons cited better communication, with patients, families, colleagues and at handover, as a source of reflective change to improve decision‐making and reduce regret. Conclusion: Surgical decision‐making involves uncertainty, and regret may occur after a patient's death. Enhancing the quality of communication with patients and peers in comprehensive assessment of the surgical patient may mitigate postdecision regret among surgeons. [ABSTRACT FROM AUTHOR]

The article presents a study which analyzes the age-related postoperative morbidity in the prospective randomized controlled trial in New Zealand and Australia that compares laparoscopic and open colonic surgery. It states that the records of 298 elderly patients who have undergone open surgery for colonic cancer and 294 who had laparoscopic surgery were examined. Results suggest that patients who are 70 years old and above should have rigorous preoperative investigation.

The article evaluates several randomized controlled trials in Australia on the effectiveness of biofeedback in adults with pelvic floor dysfunction (PFD). Meta-analysis of the studies comparing biofeedback and other treatments suggested that biofeedback resulted in a sixfold increase in the odds of treatment success.

Summary Background ‘Idiopathic’ pancreatitis may be diagnosed when gallstones are excluded by transabdominal ultrasonography and less common causes are not implicated by history or other investigations. Transabdominal ultrasonography may not, however, detect small stones responsible for acute pancreatitis. The aim of this study was to determine if endoscopic ultrasonography (EUS) is able to identify undetected gallstones in cases of ‘idiopathic’ pancreatitis. Methods Consecutive patients presenting with ‘idiopathic’ pancreatitis were assessed using EUS for the presence of gallstones or other potential causes of the attack. A control group was also imaged. Results Forty-four patients with ‘idiopathic’ pancreatitis were assessed. Ten had suffered earlier attacks of pancreatitis before this study. EUS revealed proven pathology in 18 patients. Unconfirmed pathology was evident in 14. No abnormality was seen in only nine patients. EUS failed in one patient and there were two possible false-positive results. Conclusion EUS is able to identify significant pathology in patients in whom a diagnosis of ‘idiopathic’ pancreatitis has been made following standard investigations. Patients with untreated gallstones are at risk of recurrent attacks. Idiopathic pancreatitis should not be diagnosed unless EUS has been performed. [ABSTRACT FROM AUTHOR]

Replies to comments on an article regarding the use of low-pressure pneumoperitoneum for reduction of shoulder-tip pain following laparoscopy, published in a 2000 issue of the 'British Journal of Surgery,' vol. 87. Etiology of shoulder-tip pain; Treatment of shoulder-tip pain.

In 1970 the Government of the State of Victoria became the first in the 'western' world to introduce legislation for compulsory wearing of seat belts. Within 14 months the other Australian states followed. Seat belt wearing rates increased to attain 90 per cent in 1977. This paper presents an evaluation of changes during the period 1955--77 in the incidence of road crash fatalities and injuries for vehicle occupants in Victoria and the rest of Australia. The introduction of the legislation in Victoria and subsequently in the other Australian states coincided with significant and marked decreases in driver and passenger fatality and injury rates (numbers per 10 000 registered vehicles). The decreases were enough to reduce the total numbers of vehicle occupant fatalities and injuries for all post-legislation years in Victoria. The improvements have been maintained throughout the entire post-legislation period. The legislation did not apply to child passengers of less than 8 years of age and the frequency of seat belt or harness wearing among them remained low. These children did not share in the overall improvement for passengers. The Australian experience supports the view that legislation for compulsory wearing of seat belts is the single most effective method available for the protection of vehicle occupants in road crashes.

All abdominal aortic aneurysms presenting to hospitals and coroners in Western Australia over an 11-year period (January 1971 to December 1981) have been reviewed. A total of 1237 abdominal aortic aneurysms were found. After age and sex standardization it was apparent that the prevalence of diagnosis of abdominal aortic aneurysms had increased from 74.8 per 100 000 to 117.2 per 100 000 for men over 55 years of age (increase of 56.7 per cent) and from 17.5 per 100 000 to 33.9 per 100 000 for women over 55 years of age (increase of 93.7 per cent) during this period. One hundred and twenty-three patients were identified by coroner's autopsy after sudden death from ruptured abdominal aortic aneurysms in whom there had been no previous diagnosis of abdominal aortic aneurysm. Between 1971 to 1981, 478 patients underwent surgery; 225 had elective resection of their aneurysm with a 4.0 per cent fatality rate, and 253 had emergency operations with a 31.2 per cent fatality rate. Seasonal variations contributing to the date of emergency presentation or death from rupture of abdominal aortic aneurysms indicated a possible influence of colder weather upon rupture. It is hoped that the information provided in this paper will be of use to surgeons and physicians involved in health care planning for similar populations.