Hong Kong Medical Journal最新文献

Introduction: This study evaluated utilisation trends and early outcomes of robotic arm-assisted primary total hip arthroplasty (rTHA) compared with conventional THA (cTHA) in Hong Kong.

Methods: This retrospective cohort study included all patients who underwent primary THA in public hospitals under the Hong Kong West Cluster (HKWC) from 2019 to 2024. Data were retrieved from the Hospital Authority's electronic databases. The primary outcome was the percentage utilisation of rTHA relative to cTHA. Secondary outcomes included operating time (skin-to-skin), length of stay (LOS), 30- and 90-day reoperation rates, and 30- and 90-day emergency department attendance. Differences in these outcomes between rTHA and cTHA were examined.

Results: In total, there were 311 and 242 cases of rTHA and cTHA, respectively. Robotic utilisation increased from 32.0% in 2019 to 62.2% in 2024. Regarding patient outcomes, rTHA increased operating time by 14.59 minutes (142.02 ± 53.88 vs 127.43 ± 53.34; P=0.002). There was no significant difference in median LOS between the two groups. Robotic surgery was also associated with a lower 30-day reoperation rate (0.32% vs 2.07%; P=0.049). One reoperation due to dislocation was performed in the rTHA group. In the cTHA group, one dislocation, two periprosthetic fractures, and two infections required revision surgery.

Conclusion: Given the increasing use of rTHA in the HKWC, the present findings suggest that rTHA is associated with a lower 30-day reoperation rate. As the first local study on early outcomes of rTHA, these results may serve as reference data for other centres.

Introduction: This study aimed to develop and validate a clinical prediction model to assist radiologists in optimising the diagnostic classification of the Chinese Thyroid Imaging Reporting and Data System (C-TIRADS).

Methods: A total of 1659 patients from two hospitals were included in this study. The derivation cohort comprised 909 patients for model development and internal validation, while 750 patients formed the external validation cohort. A binary logistic regression model was constructed. Model performance in the derivation set was evaluated using receiver operating characteristic (ROC) curves and visualised with a nomogram. In the external validation set, ROC and calibration curves were used to assess discrimination and calibration.

Results: The original C-TIRADS category, abnormal cervical lymph node sonographic findings, and changes in thyroid nodule size emerged as significant predictors of C-TIRADS optimisation. The optimised nomogram demonstrated an area under the ROC curve (AUC) of 0.730 (95% confidence interval=0.697-0.762), with a sensitivity of 63.2%, specificity of 74.9%, and overall accuracy of 67.7% for predicting optimisation. Using probability thresholds of ≥60% to recommend an upgrade and <30% to recommend a downgrade, the calibration curve showed good agreement, and decision curve analysis demonstrated a favourable net clinical benefit. External validation confirmed excellent discrimination (AUC=0.865; 95% confidence interval=0.839-0.891).

Conclusion: An optimised C-TIRADS model that integrates imaging features of thyroid nodules with clinical risk factors may aid radiologists in improving the diagnostic efficiency and clinical utility of the TIRADS classification.

Introduction: The role of episiotomy in preventing obstetric anal sphincter injury (OASIS) remains controversial. Liberal use of episiotomy has been reduced locally. This study aimed to review the incidence of OASIS in our unit over the past decade given the reduced episiotomy rate.

Methods: A retrospective study was conducted in a single tertiary obstetrics and gynaecology unit. All singleton vaginal deliveries, including normal and instrumental deliveries, between 2012 and 2021 were included. Data were retrieved from the hospital electronic delivery database between July 2022 and June 2023. The degree of OASIS was assessed using the Abdul Sultan classification.

Results: In total, 43 732 deliveries were included. The episiotomy rate decreased from 62.8% in 2012 to 44.7% in 2021 (P<0.001), while the OASIS rate increased from 0.3% to 1.4% over the same period (P<0.001). Among nulliparous women, the OASIS rate was significantly lower with episiotomy in both normal vaginal deliveries (0.6% vs 1.7%; P<0.001) and instrumental deliveries with episiotomy than without (1.7% vs 42.9%; P<0.001). Among multiparous women, the OASIS rate was significantly lower in normal vaginal delivery without episiotomy than with (0.3% vs 0.5%; P=0.026), but significantly lower in instrumental deliveries with episiotomy than without (0.5% vs 23.5% P<0.001). Overall, episiotomy was a protective factor for OASIS (odds ratio=0.273, 95% confidence interval= 0.208-0.358; P<0.001).

Conclusion: Episiotomy was protective against OASIS among nulliparous women with singleton normal vaginal delivery and instrumental delivery in an Asian population. It also conferred protection among multiparous women undergoing instrumental delivery but not in those having normal vaginal delivery.

Introduction: There are insufficient population-based epidemiological data on various pleural diseases in Hong Kong. We aimed to validate ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) codes for pleural diseases and relevant procedures prior to conducting epidemiological analyses using local electronic health records.

Methods: Hospitalisation episodes coded as 'pneumothorax', 'pleural effusion', and trauma-related pleural events, as well as procedures beginning with ICD-9-CM codes 33 and 34 between 2013 and 2022, were retrieved from the Hospital Authority. Paediatric patients and uninterrupted hospitalisation episodes were excluded. The cohort was filtered to include those hospitalised at Prince of Wales Hospital (PWH). Up to 50 hospitalisation episodes were randomly selected for manual validation. Positive predictive values (PPVs) with 95% confidence intervals of individual codes were calculated; successful validation was defined as a PPV ≥0.700. The primary endpoint was the PPV of individual diagnosis and procedure codes.

Results: A total of 26 757, 218 018, 1269, 185 154, and 106 450 hospitalisation episodes with non-traumatic pneumothorax, non-traumatic pleural effusion, trauma-related pleural events, procedures with code 33, and procedures with code 34, respectively, were retrieved. Within the PWH cohort, PPVs for these diagnosis and procedure codes were 0.853 (0.787-0.904), 0.928 (0.903-0.948), 0.957 (0.907-0.981), 0.932 (0.913-0.948), and 0.933 (0.916-0.948), respectively. Procedures involving indwelling pleural catheterisation and open drainage of the pleural cavity failed validation due to frequent miscoding.

Conclusion: This is the first validation study of clinical codes for pleural diseases and related procedures in Hong Kong. All diagnosis codes and most procedure codes were successfully validated.