ANZ Journal of Surgery最新文献

Purposes: The use of the textbook outcome (TO) as a multidimensional measurement method allows for an accurate assessment of the ideal hospitalization process for surgical patients. This study aims to construct a nomogram for predicting non-TO in patients undergoing hepatectomy for hepatocellular carcinoma (HCC) based on Lasso-Logistic regression.

Methods: A retrospective study was conducted to analyze preoperative clinical data from HCC patients who underwent hepatectomy at The University of Hong Kong-Shenzhen Hospital between 2013 and 2021. Lasso regression was employed to identify risk factors and develop a novel nomogram. The performance of the nomogram in terms of discrimination, calibration, and clinical utility was evaluated through internal validation.

Results: Compared to the TO group, the non-TO group exhibited a higher proportion of male patients, fewer patients in the 0/A stage, a greater tumor burden score (TBS), fewer patients with an AFP level of ≤ 400 μg/L, a higher incidence of tumors located in segments 7/8, and a greater number of patients undergoing major hepatectomy. The variables selected through Lasso regression included sex, Charlson comorbidity index, history of abdominal surgery, BCLC staging, TBS, AFP level, tumor location in segments 7/8, and extent of resection. These factors were incorporated into a logistic model to establish the nomogram. The ROC curve demonstrated an area under the curve of 0.755, which was significantly superior to using TBS or BCLC staging alone. The Hosmer-Lemeshow test indicated that the model exhibited good fit (p = 0.582).

Conclusion: This study presents a clinically applicable nomogram that reliably predicts non-TO prior to hepatectomy for HCC. With its favorable performance, the model facilitates informed patient consent and supports strategic resource allocation, ultimately contributing to enhanced healthcare quality and efficiency.

Background: Extravasation is the leakage of intravenous drugs, chemicals, or fluids into the extravascular compartment and is common in paediatric patients. These injuries can cause ulceration with tissue loss. This study investigates whether a washout procedure can reduce the incidence of partial- or full-thickness skin loss following extravasation.

Methods: All extravasation injuries referred to the Plastic and Maxillofacial Department at the Royal Children's Hospital, Melbourne, from June 2018 to June 2023 were prospectively identified and reviewed. Data collected included patient demographics, extravasated fluid potency, injury grade, anatomical site, washout timing, and outcomes at 24 and 48 h. Logistic regression was used to identify predictors of skin loss.

Results: A total of 216 extravasation injuries were analysed; 61.1% were male, and 41.7% were under 1 year old. Washout was performed in 50.5% of cases, and 16.7% developed skin loss. Multivariate analysis identified lower limb site (OR = 7.46; p = 0.008), grade 3 injury (OR = 193.10; p < 0.001), and grade 4 injury (OR = 441.30; p < 0.001) as strong predictors of skin loss. Absence of washout significantly increased the risk (OR = 7.51; p = 0.018), particularly in grade 3 and 4 injuries (OR = 15.48; p = 0.003). Fluid potency and age were not independent predictors after adjusting for confounders.

Conclusion: Washout is effective for reducing skin loss in paediatric extravasation injuries, particularly in grades 3 and 4. Lower limb cannulation carries a significantly higher risk of skin loss. Injury grade should guide urgent washout intervention.

Background: Major bile duct injury (BDI) is a severe complication of biliary surgery, associated with high morbidity, mortality, and long-term sequelae. This study aimed to identify predictors of outcomes after surgical repair of major BDI in a North African hepatopancreatobiliary center.

Materials and methods: We retrospectively analyzed 147 patients who underwent repair of Strasberg type E BDI at a single HPB department in Oran, Algeria (2014-2024). Outcomes included morbidity, 90-day mortality, and long-term complications (Terblanche grade > 1). Logistic regression identified independent predictors.

Results: Mean age was 49.1 years, 67.3% were female, and 62.6% sustained injury during laparoscopic cholecystectomy; vascular injury occurred in 17.7%. Hepaticojejunostomy was performed in 95.9%, mostly after delayed referral (> 6 weeks in 91.2%). Morbidity occurred in 35.4%, bile leakage in 16.3%, and 90-day mortality in 4.1%. At a median follow-up of 69 months, 95.8% achieved Terblanche grade 1 outcomes. Independent predictors were laparoscopic index surgery for morbidity (OR = 5.41, 95% CI 1.08-27.09; p = 0.040); age (OR = 1.10, 95% CI 1.01-1.19; p = 0.028), vascular injury (OR = 16.45, 95% CI 2.13-127.20; p = 0.007), and bilirubin ≥ 15 mg/dL (OR = 19.74, 95% CI 1.74-224.53; p = 0.016) for mortality. Immediate repair predicted unfavorable long-term outcomes (OR = 10.44, 95% CI 1.60-68.34; p = 0.014).

Conclusion: Hepaticojejunostomy providing durable reconstruction. However, laparoscopic causative surgery, advanced age, vascular injury, and severe hyperbilirubinemia predicted adverse early outcomes, while immediate repair increased the risk of late stricture.

Backgrounds: Enhanced recovery after surgery (ERAS) has revolutionised perioperative care in colorectal surgery with reduced length of stay (LOS), reduced complications and superior patient outcomes. Despite this, colorectal ERAS is still not the standard of care across Australia. A growing body of evidence shows that ERAS is associated with significant cost benefits; however, currently, there is a lack of Australian data. The aim of this study is to retrospectively compare the healthcare system costs for elective colorectal resections utilising ERAS compared with conventional perioperative management.

Methods: A single-centre, retrospective cohort study compared the total cost of an elective colorectal resection to the public healthcare system when utilising the 25 principles of ERAS versus conventional care (CC). The estimated cost of each elective resection was manually calculated, including preadmission, operation, postoperative and readmission costs between the years 2010 and 2022 with the introduction of ERAS at the start of 2015. Cost data were also cross-examined with patient outcomes to assess how variations in patient care impact costs.

Results: A total of 642 patients were included: 237 (36.9%) received conventional perioperative management, and 405 (63.1%) underwent ERAS. The use of ERAS resulted in a median cost reduction of 2010 AUD per patient (20,719 vs. 22,729 AUD, p = 0.008). Overtime, ERAS was associated with a downward cost trend each year as the program matured. This reduction in median cost was also demonstrated in a subgroup analysis of uncomplicated admissions (-961 AUD, p = 0.087) and in the presence of Grades I-II complications (-2049 AUD, p = 0.504); however, neither was statistically significant. The cost benefits of ERAS were not present in the presence of Grades III-V complications or when a patient was readmitted within 30 days. ERAS was associated with a reduced median LOS (5 vs. 6 days, p < 0.001) and a reduction in the overall complication rate (26.42% vs. 37.55%, p = 0.003), which was most appreciable in the reduced rates of Grades I-II complications (22.96% vs. 29.96%).

Conclusion: Colorectal ERAS resulted in a statistically significant reduction in the cost per patient for elective resections at an Australian public hospital. The reported cost benefits stem from the associated reduction in LOS and an improved overall complication rate, particularly in the rates of Grades I and II complications. Additionally, there was a downtrend in median cost each year as the ERAS program matured at this institution, with the potential for further benefit in future years.

Background: TRUS Biopsy (TRUS Bx) can be poorly tolerated under local anaesthetic. Virtual Reality (VR) has been shown to reduce pain and anxiety levels as an adjunct to standard analgesia in a range of settings. This includes paediatric procedures, burn wound debridement and gynaecological procedures. However, its effect in TRUS Bx remains unclear. The aim of this study was to determine if intra-procedure VR improved patient pain and satisfaction during TRUS Bx.

Method: A single-centre, parallel-group randomised controlled trial was conducted at Dunedin Hospital. Two hundred and fifty patients presenting for first TRUS Bx were randomised to either conventional TRUS or VR-assisted TRUS over 36 months. The intervention group wore a VR headset with distraction video software, with the control group having standard care. The primary outcome measured patients' pain scores using a visual analogue scale.

Results: Patients reported similar pain when distracted with VR (mean difference [MD] -2.6, 95% CI -8.5 to 3.2). Similarly, there was no evidence of a difference in 'time thinking about pain' (MD 0.9, 95% CI -7.2 to 9.0) or 'worst pain' (pain intensity) (MD -2.4, 95% CI -8.6 to 3.8). Both groups were equally satisfied with the procedure and would happily accept having the procedure again if needed. VR was not associated with any side effects.

Conclusion: VR technology did not improve patients' pain and overall satisfaction with TRUS Bx. The inherent vulnerability and invasive nature of the procedure may impact the effectiveness of this distraction technique and prevent its analgesic effects proven in non-urological studies.

Subcutaneous abscesses are among the most common soft-tissue infections encountered in acute surgical and emergency practice. While incision and drainage (I&D) remains the cornerstone of treatment, the best post-I&D strategy remains debated. Key questions include whether adjunct antibiotics improve cure rates or prevent recurrence, whether packing the cavity provides any advantage, and whether modern alternatives such as primary closure, drains, or irrigation offer superior outcomes. These issues are particularly relevant to perianal abscesses, where the risk of developing a fistula-in-ano is substantial, and to general cutaneous abscesses, where pain, delayed healing, and recurrence are frequent concerns. Recent randomized trials and contemporary guidelines have begun to clarify these controversies, helping clinicians move beyond traditional dogma toward evidence-based, patient-centered care. Landmark evidence now shows that, for uncomplicated cutaneous abscesses, adding a short course of MRSA-active antibiotics to I&D improves short-term cure and reduces new lesions. For perianal abscesses, the goal shifts to preventing fistula-in-ano: here the trials conflict, pooled estimates hint at a modest benefit from antibiotics, and clinical judgment still matters. Perhaps the clearest evidence-based shift is against routine packing, as it offers no outcome advantage and clearly increases pain. Large randomized data support abandoning it in favor of simple dressings or selective drains. Modern, patient-centered management now emphasizes thorough drainage, selective antibiotics, and avoidance of routine packing; use simple dressings or short-term drains when needed, and arrange reliable follow-up. That combination reduces pain and resource use without sacrificing safety.