ANZ Journal of Surgery最新文献

Background: Fluorodeoxyglucose positron emission tomography (^18FFDG PET) aids in assessing adrenal lesions, but variability in reporting and wide diagnostic standardised uptake value maximum (SUVmax) ranges hinder routine use. This study aimed to identify the utility of FDG_PET in guiding malignancy risk stratification and define diagnostic thresholds for FDG-avid adrenal lesions.

Methods: A multi-centre retrospective cohort study of adrenalectomies (2006-2024) was conducted. Of 1136 adrenalectomies, 138 had pre-operative FDG-PET. Clinicopathological and imaging data were reviewed. Imaging parameters, including unenhanced Hounsfield units (HU), SUVmax, SUVmean and total lesion glycolysis (TLG), were independently and blindly re-reported.

Results: One hundred and four cases were included (53.8% male, median age 65, median lesion size 40 mm). Malignancy was confirmed in 65.4%. Mean SUVmax was 10.6 for malignant versus 4.7 for benign lesions (p < 0.001). An optimal SUVmax cut-off of 5.63 yielded 75% sensitivity and a 19.4% false-positive rate. In the sub-analysis excluding histologically confirmed RCC lesions, sensitivity increased to 82.5% at a SUVmax of 11.7. Multivariate analysis identified SUVmax ≥ 5.63 (OR 6.0, CI [1.1-33.7], p = 0.004) as independently predictive of malignancy. Additional predictors included ROC HU ≥ 37 (OR 9.3, CI [1.8-47.2], p = 0.001), current practice HU ≥ 20 (OR 22.8, CI [1.3-41.0], p = 0.003), and > 1 avid lesion (OR 5.4, CI [1.1-25.2], p = 0.003).

Conclusion: FDG-PET is a useful diagnostic adjunct in undifferentiated adrenal lesions, with defined thresholds (SUVmax ≥ 5.63 and HU ≥ 20) guiding malignancy risk stratification. FDG-PET should be considered in large, suspicious lesions or those with a history of malignancy.

Background: Patients undergoing cancer treatment incur significant out-of-pocket costs attributed to both medical and non-medical expenditure. We quantified out-of-pocket costs for patients receiving surgical treatment for oesophageal cancer and their financial toxicity.

Methods: Patients who had undergone oesophagectomy for cancer completed an out-of-pocket questionnaire which determined medical costs (e.g., gap payments and medications), non-medical costs (e.g., travel, accommodation, wage loss) and carer costs (travel and wage loss). Financial toxicity was assessed using the validated Comprehensive Score for Financial Toxicity (COST) questionnaire. Out-of-pocket costs and financial toxicity were summarised using medians with bootstrapped 95% confidence intervals (CIs) (1000 resamples). Between-group comparisons were assessed with Wilcoxon rank-sum and Kruskal-Wallis tests and associations with income percentiles using Spearman's correlation.

Results: Seventy individuals completed the survey (43.3% response rate). The majority were male (85.7%), aged 60-79 (76.5%) and 0-5 years post-cancer diagnosis (55.7%). Median out-of-pocket expenditure was $1352 and was mainly attributed to wage loss (64.7%), followed by carer cost (23.7%). Out-of-pocket costs were higher for younger age groups (40-59 years) compared to those aged 60-79 years (p = 0.003). There was no statistically significant difference in out-of-pocket costs between public versus privately insured patients. Median out-of-pocket costs trended higher for rural ($1696) versus urban located patients ($1235), but this was not statistically significantly different (p = 0.140). The median financial toxicity score was 23.5 (95% CI: 21.0-27.5), indicating moderate financial toxicity. Financial toxicity did not differ significantly by age, gender, country of birth, education or location. A lower income percentile was associated with greater financial toxicity (ρ = -0.30, p = 0.012).

Conclusion: Patients facing oesophagectomy for cancer incur many out-of-pocket costs, mostly due to wage loss from time spent away from work for both patients and carers. Younger patients and those with lower income face proportionately greater financial burdens, highlighting a need for targeted support to reduce financial stress.

Background: There are various surgical approaches for total hip replacement (THR), such as the Direct Lateral (Hardinge), anterior, and supra-acetabular (SuperPath) approach. The aim of this study was to compare the post-operative clinical, functional and quality of life outcomes of the SuperPath and Direct Lateral approach in hip osteoarthritis patients undergoing THR.

Methods: A retrospective analysis was performed of a single-surgeon consecutive cohort of THR's. Data was obtained from the St. Vincent's Melbourne Arthroplasty Outcomes (SMART) Registry, for all THR's between 01-01-2012 and 31-12-2019. Primary outcomes were the patient-reported WOMAC and VR12, measured at pre-op, 12- and 24-month timepoints. Groups were compared using a mixed-model analysis adjusted for potential confounders. Secondary outcomes were length of stay, surgery duration, complications, readmissions, and reoperations.

Results: 384 patients were analysed (259 Direct Lateral; 125 SuperPath). Total WOMAC Scores were significantly better for the SuperPath group (mean diff: 7.1, 95% CI 0.76-13.54, p = 0.02). VR12 Total Scores were significantly higher for SuperPath patients (mean diff: 3.9, 95% CI 0.53-7.35, p = 0.02). For secondary outcomes, the SuperPath approach had a shorter operation time than the Direct Lateral approach (81.9 min vs. 85.8 min, mean difference 3.8, 95% CI: 0.14-7.50, p = 0.04).

Conclusion: Although the SuperPath approach led to slightly better pain, function and quality of life outcomes than the Direct Lateral approach, the difference was below the minimal clinically important difference (MCID) although statistically significant. There were no differences in other clinical outcomes except for shorter surgery duration, presumably since there were more cemented procedures in the Direct Lateral group.

Objective: Retrograde cricopharyngeal dysfunction (RCPD) is characterised by an inability to burp. Typical first-line management involves injection of Botulinum A toxin (BonT-A) into the cricopharyngeus. We present our series of 109 RCPD patients.

Methods: A retrospective chart review was conducted between January 2018 and November 2024. Demographics and clinical data were extracted. From late 2021 onwards, we also started collecting scores from a 7-point Likert questionnaire based on the six cardinal symptoms of RCPD (RCPD-Q in short).

Results: A109 patients were identified. Sixty-two (56.9%) were female. Mean age was 30.0 (range: 14-72). The majority (91.7%) were of Caucasian ethnicity. Eighty patients completed the RCPD-Q at their initial consultation, with a mean score of 27.6/36 (range: 13-36). Seventy-four patients underwent initial treatment. At first follow-up within 4 weeks, 53 patients (71.6%) had complete resolution, 11 (14.9%) had partial resolution and seven (9.5%) had no change in symptoms. In the 30 patients who completed follow-up at > 3 months after treatment, 17 patients (56.7%) reported complete resolution, three patients (10%) reported partial resolution and 10 patients (33.3%) reported no resolution or reversion to baseline symptoms.

Conclusion: Younger age, treatment under general anaesthesia, and higher doses of BonT-A were associated with higher rates of success.

Level of evidence: Level 3.

Background: Written communication has changed dramatically in the computer era. Email use has exploded in the last three decades, from the inter-individual level through to mass dissemination. In the workplace, it has become the default mode of communication despite very limited critical appraisal. Specifically in the healthcare setting, its utility as a communication strategy for broadcasting information has barely been examined. The aim of this study was to quantify the use of all-staff emails (ASE) across a public hospital and its umbrella Hospital and Health Service (HHS).

Method: An audit of one year's ASE was performed to determine the number, word count and readability using validated metrics. The median was used as a reference text. Seventy five randomly selected volunteers from the five occupation groups in the health service were timed whilst reading the reference text to enable an estimate of time and financial cost.

Results: Five hundred and six ASE were identified, with a median length of 622 words (95% CI 570 to 694). The median Flesch-Kincaid (FK) Grade score was 8.9 (95% CI 8.8 to 9.1). The calculated predicted salary costs if all staff read all ASE in 1 year were AU$6 116 386.47 (range AU$3 441 365.32 to AU$13 424 704.98) at the hospital level and AU$14 555 209.62 (range AU$8 258 984.03 to AU$31 778 109.75) at the HHS level.

Conclusions: A modest reduction in annual ASE burden could result in considerable savings for hospitals and hospital health services, which could be reinvested into patient care, procedures and staff wellbeing. Further research would improve the limited understanding of the impacts of ASE and build an evidence base for how to optimise their use.

Objective: To assess the outcomes of a dual-surgeon approach to inflatable penile prosthesis (IPP) surgery, where two non-fellowship-trained urologists partnered to perform these procedures following intensive proctoring by an international expert.

Patients and methods: A retrospective analysis of patients who underwent 'dual-surgeon' IPP surgery over a 10-year period between August 2008 and July 2018 was performed. Data on patient demographics, peri-operative parameters, complications (Clavien-Dindo system), rate of prosthesis failure, and the necessity of revision surgery were extracted, analysed and compared to published outcomes from high volume institutions.

Results: A total of 175 patients underwent IPP surgery over a 10-year period. The mean age was 64 years (IQR 59-70), the mean operative time was 65.7 min (range 32-157 min), and the mean length of stay in hospital was 1.6 nights (range 1-6 nights). The majority of patients (90.9%) received a Coloplast Titan Implant. The overall complication rate was 22.2% (38/175). Notably, there were no complications > Clavein-dindo grade III. Six patients (3.4%) required revision surgery for mechanical failure.

Conclusions: Dual surgeons performing IPP after intensive training from visiting international experts can achieve comparable outcomes to high volume local and international centres. This strategy of dual-surgeon collaboration should be considered in low volume implanters with no prior fellowship training in prosthetic urology.

Background: Cosmetic tourism has become increasingly popular, with patients seeking lower cost cosmetic surgery overseas. However, complications often necessitate management in local public hospitals upon their return, placing a burden on healthcare systems. This study examines the demographics, complications, interventions and resource utilisation of patients presenting to an Australian hospital with complications from overseas cosmetic surgery.

Methods: This study retrospectively reviewed patients who presented to Westmead Hospital, NSW, during two time periods-01/07/2022 to 01/01/2023 and 01/05/2024 to 30/12/2024-with complications following cosmetic surgery performed overseas. Hospital records were analysed to extract data on patient demographics, comorbidities, presenting complications, interventions, diagnostic tests and resource utilisation. Descriptive statistics were used to summarise the findings, and patterns in clinical management were evaluated.

Results: Twenty-four patients met the inclusion criteria, with a mean age of 38.4 ± 12.5 years; 87.5% were female. Comorbidities included smoking (50%), mental health conditions such as anxiety, depression, or self-harm (20.8%) and hypothyroidism (12.5%). Abdominoplasty (54.2%), breast augmentation (20.8%) and liposuction (25%) were the most frequently performed procedures. The mean Charlson Comorbidity Index was 0.2 ± 0.4, and the mean LACE Index was 5.9 ± 1.5. Complications included wound dehiscence (45.8%), infection (41.7%) and seroma (20.8%). The median time from surgery to presentation was 3.8 weeks, with a mean hospital stay of 3.3 ± 2.9 days. Interventions included oral antibiotics (83.3%), IV antibiotics (58.3%), drainage or aspiration (33.3%) and surgery (54.2%).

Conclusion: Overseas cosmetic surgery is associated with high complication rates and significant utilisation of public hospital resources. These findings highlight the impact of cosmetic tourism on the Australian healthcare system.