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Aim: Prolonged postoperative ileus (PPOI) is common and is associated with a significant healthcare burden. Previous studies have attempted to predict PPOI clinically using risk prediction algorithms. The aim of this work was to systematically review and compare risk prediction algorithms for PPOI following colorectal surgery. Method: A systematic literature search was conducted using MEDLINE, Embase, Web of Science and CINAHL Plus. Studies that developed and/or validated a risk prediction algorithm for PPOI in adults following colorectal surgery were included. Data were collected on study design, population and operative characteristics, the definition of PPOI used and risk prediction algorithm design and performance. Quality appraisal was assessed using the PROBAST tool. Results: Eleven studies with 87 549 participants were included in our review. Most were retrospective, single‐centre analyses (6/11, 55%) and rates of PPOI varied from 10% to 28%. The most commonly used variables were sex (8/11, 73%), age (6/11, 55%) and surgical approach (5/11, 45%). Area under the curve ranged from 0.68–0.78, and only three models were validated. However, there was significant variation in the definition of PPOI used. No study reported sensitivity, specificity or positive/negative predictive values. Conclusion: Currently available risk prediction algorithms for PPOI appear to discriminate moderately well, although there is a lack of validation data. Future studies should aim to use a standardized definition of PPOI, comprehensively report model performance and validate their findings using internal and external methodologies. [ABSTRACT FROM AUTHOR]

Gastrointestinal dysfunction (GDF) is one of the primary causes of morbidity and mortality in critically ill patients. Intensive care interventions, such as intravenous fluids and enteral feeding, can exacerbate GDF. There exists a paucity of high-quality literature on the interaction between these two modalities (intravenous fluids and enteral feeding) as a combined therapy on its impact on GDF.

Aim: The watch‐and‐wait approach is increasingly being used in the management of rectal cancer as many patients achieve a clinical complete response after neoadjuvant treatment This national, multicentre, retrospective cohort study aims to understand the use of the watch‐and‐wait approach in the management of rectal cancer in Aotearoa New Zealand and its associated outcomes. Method: This retrospective cohort study will include patients aged 18 years and over with biopsy proven rectal adenocarcinoma diagnosed between January 2015 and December 2022 who have a clinical complete response following neoadjuvant treatment (including short‐course radiotherapy, long‐course chemoradiotherapy or total neoadjuvant treatment) and have been managed with a watch‐and‐wait approach. Data will be collected from centres that manage rectal cancer in Aotearoa New Zealand with the eligible population being identified using data linkage with the National Cancer Registry. Conclusion: This multicentre, national cohort study will investigate the use of the watch‐and‐wait strategy for rectal cancer in Aotearoa New Zealand. Through novel data linkage approaches, these data and methods will lay the foundation for a future prospective registry and outcome‐tracking initiative. [ABSTRACT FROM AUTHOR]

Aim: Faecal incontinence is common and of multifactorial aetiologies, yet current diagnostic tools are unable to assess nerve and sphincter function objectively. We developed an anorectal high‐density electromyography (HD‐EMG) probe to evaluate motor‐evoked potentials induced via trans‐sacral magnetic stimulation (TSMS). Method: Anorectal probes with an 8 × 8 array of electrodes spaced 1 cm apart were developed for recording HD‐EMG of the external anal sphincter. These HD‐EMG probes were used to map MEP amplitudes and latencies evoked via TSMS delivered through the Magstim Rapid2 (MagStim Company). Patients undergoing pelvic floor investigations were recruited for this IDEAL Stage 2a pilot study. Results: Eight participants (median age 49 years; five female) were recruited. Methodological viability, safety and diagnostic workflow were established. The test was well tolerated with median discomfort scores ≤2.5/10, median pain scores ≤1/10 and no adverse events. Higher Faecal Incontinence Severity Index scores correlated with longer MEP latencies (r = 0.58, p < 0.001) and lower MEP amplitudes (r = −0.32, p = 0.046), as did St. Mark's Incontinence Scores with both MEP latencies (r = 0.49, p = 0.001) and MEP amplitudes (r = −0.47, p = 0.002). Conclusion: This HD‐EMG probe in conjunction with TSMS presents a novel diagnostic tool for anorectal function assessment. Spatiotemporal assessment of magnetically stimulated MEPs correlated well with symptoms and offers a feasible, safe and patient‐tolerable method of evaluating pudendal nerve and external anal sphincter function. Further clinical development and evaluation of these techniques is justified. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is the most common reason children undergo acute general surgery but international, population‐level disparities exist. This is hypothesised to be caused by preoperative delay and differential access to surgical care. The impact of prehospital factors on paediatric appendicitis severity in New Zealand is unknown. Methods: A prospective, multicentre cohort study with nested parental questionnaire was conducted by a national trainee‐led collaborative group. Across 14 participating hospitals, 264 patients aged ≤16 years admitted between January and June 2020 with suspected appendicitis were screened. The primary outcome was the effect of prehospital factors on the American Association for the Surgery of Trauma (AAST) anatomical severity grade. Results: Overall, 182 children had confirmed appendicitis with a median age of 11.6. The rate of complicated appendicitis rate was 38.5% but was significantly higher in rural (44.1%) and Māori children (54.8%). Complicated appendicitis was associated with increased prehospital delay (47.8 h versus 20.1 h; P < 0.001), but not in‐hospital delay (11.3 h versus 13.3 h; P = 0.96). Multivariate analysis revealed increased anatomical severity in rural (OR 4.33, 95% CI 1.78–7.25; P < 0.001), and Māori children (OR 2.39, 95% CI 1.24–5.75; P = 0.019), as well as in families relying on external travel sources or reporting unfamiliarity with appendicitis symptomology. Conclusion: Prehospital delay and differential access to prehospital determinants of health are associated with increased severity of paediatric appendicitis. This manifested as increased severity of appendicitis in rural and Māori children. Understanding the pre‐hospital factors that influence the timing of presentation can better inform health‐system improvements. [ABSTRACT FROM AUTHOR]