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Background: The role of routine intraoperative cholangiograms (IOCs) for prevention of bile duct injury (BDI) is contentious. There are recent reports of limited utility of IOC in preventing BDI. In Australia, IOCs are used more frequently than internationally. This study aimed to evaluate the rate of IOC use in Australia and explore potential changes in practice in light of evolving evidence for the utility of IOC. Methods: Data were collated using service item numbers in Medicare Benefits Scheme records on the Australian Government Medicare website, for services claimed between 1 January 2001 and 31 December 2019. These data were used to analyse trends in rates of IOC, cholecystectomy and BDI repair. Data were age‐standardized to account for changes in the population over time. Results: The number of IOCs claimed increased by 31.8% and cholecystectomies by 7.0% over the study period. Age‐standardized service rates per 100 000 persons increased by 5.5 and 32.6, respectively. Rates of IOC per 100 000 cholecystectomies steadily increased across the study period, while BDI repair rates remained low and erratic. Conclusion: Increasing use of IOC over the last 20 years reflects a trend towards routine rather than selective IOC; however, there is little discernible change in the number of BDIs requiring repair procedures. This suggests that routine IOC use to prevent or minimize BDI is unwarranted. Further investigation is required into the selective IOC use in high‐risk patients rather than mandatory use in all patients. [ABSTRACT FROM AUTHOR]

Background: Symptomatic para‐oesophageal hiatus (PEH) hernias are treated by surgical intervention, and are associated with older age (>50 years) and higher body mass index (>25 kg/m2). Both risk factors are increasing within the Australian population. Given these trends, this study aimed to determine if the rate of PEH repair is increasing within Australia. Methods: The study used publically available Medicare Benefits Scheme service data for operations claimed under the item number 31468 (PEH hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication) between 1 January 2001 and 31 December 2016. Directly age‐standardized rates per 100 000 population were calculated using the 2001 Australian standard population and compared using Poisson regression models. Results: Repair of PEH significantly increased (P < 0.0001) in Australia during this period, with the average number of services increasing by 14.6% per annum. Average rates of repair increased significantly (P < 0.001) with increasing age up to 75 years after which they significantly reduced (P < 0.001) in each successive age group. Western Australia had the greatest increase in annual claims and Northern Territory had the least, but the state‐specific average claim rate over the whole period was highest in Queensland and lowest in Northern Territory. Conclusion: Operations claimed under Medicare Benefits Scheme item number 31468 have significantly increased in Australia since January 2001. Reasons for this rise are likely multifactorial, and may indicate increasing PEH incidence, increased diagnosis and investigation or increased surgical capability to manage the issue laparoscopically with reduced peri‐operative morbidity. Operations claimed under MBS item number 31468 (para‐oesophageal hiatus hernia, repair of, with complete reduction of hernia, resection of sac and repair of hiatus, with or without fundoplication) have significantly increased in Australia since January 2001. Reasons for this rise are likely multifactorial, and may indicate: increasing para‐oesophageal hiatus hernia incidence; increased diagnosis and investigation; or increased surgical capability to manage the issue laparoscopically with reduced peri‐operative morbidity. [ABSTRACT FROM AUTHOR]

Objectives: The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra–Shoalhaven region of New South Wales, Australia. Methods: HbA1c values recorded between 2010 and 2012 for non-pregnant individuals aged ≥18 years were extracted from the Southern.IML Research (SIMLR) database. Individuals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0–5.99% (lowest risk), 6.0–7.49% (intermediate risk) and ≥7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results: Data from 29 064 individuals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile; odds ratio 1.74, 95% confidence interval 1.58, 1.93; P < 0.001). Conclusion: In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness. What is known about the topic?: The rapid increase in the prevalence of Type 2 diabetes (T2D), both globally and nationally within Australia, is a major concern for the community and public health agencies. Individual socioeconomic disadvantage is a known risk factor for abnormal glucose metabolism (AGM), including T2D. Although small-area-level socioeconomic disadvantage is a known correlate of AGM in Australia, less is known of the association of area-level disadvantage and glycaemic-related risk in individuals with AGM. What does this paper add?: This study demonstrates a robust association between small-area-level socioeconomic disadvantage and glycaemic-related risk in regional New South Wales. The study demonstrates that it is feasible to use geocoded, routinely collected clinical data to identify communities at increased health risk. What are the implications for practitioners?: The identification of at-risk populations is an essential step towards targeted public health policy and programs aimed at reducing the burden of AGM, its complications and the associated economic costs. Collaboration between primary care and public health in the collection and use of data described in the present study has the potential to enhance the effectiveness of both sectors. [ABSTRACT FROM AUTHOR]