ANZ Journal of Surgery最新文献

Objectives: The objective of this study was to compare the efficacy of oral and intralesional steroid injection in the treatment of idiopathic granulomatous mastitis (IGM) cases with clinical, ultrasonography (US) and Superb microvascular imaging (SMI) findings.

Methods: A total of 53 patients with newly diagnosed IGM who applied to our outpatient clinic between September 2021 and December 2022 were included. Oral steroid therapy was administered to 26 patients, while intralesional steroid therapy was administered to 27 patients. Pretreatment and postreatment difference of the affected area was compared clinically (Unresponsive to treatment: stable or progression; Partial response: <50% reduction; Near complete response: >50% reduction; Complete response: 100% reduction) and radiologically. Grey scale US (size, skin thickness) and SMI vascular index (SMIvi) for vascularization of the pathological area were noted. Recurrence and side-effect rates at the 6 months were compared.

Results: No statistically significant difference was found in the efficacy of oral steroid and intralesional steroid treatment, both radiologically (P = 0.839) and clinically (P = 0.550). There was a considerable difference in size and SMIvi values before and after treatment (P < 0.001) in patients with an adequate response. There was no significant difference between the two treatment methods in terms of recurrence (P = 0.153) or side effects (P = 1).

Conclusion: Intralesional steroid was as effective as oral steroid treatment in IGM patients, and SMI is a reliable sonographic method that can be used to evaluate clinical findings, treatment response, and patient follow-up.

Background: The gender disparity in the field of orthopaedic surgery is globally recognized. In Australia, the percentage of female orthopaedic surgeons is currently 5.5% while the percentage of trainees is 18.9%. The Australian Orthopaedic Association's annual scientific meeting (ASM) program represents one way to visualize gender diversity within orthopaedics. This study aims to quantify the representation of women in national orthopaedic research presentations.

Methods: This is a retrospective cohort study of ASM presentations from 2021 to 2023. Presenter information was obtained from available published scientific programs. Presenter gender was classified by first name as a binary construct using a combination of biography, internet, registration, and the website Gender API (https://gender-api.com). The proportion of female versus male presenters and moderators was determined and gender trends between topics was analysed.

Results: Of 936 research presentations given across the 3 years, 15.9% were given by females. The topic areas with the highest percentage of female speakers were paediatrics (42.1%) and hand (25.0%), with the lowest percentage in shoulder and elbow (10.3%) and spine (3.8%). The proportion of female session moderators averaged 20.2%. There was no difference in number of presentations given or sessions moderated per person with regard to gender.

Conclusions: This is the first paper to investigate gender disparity in the presentation of orthopaedic research in Australia. The percentage of female participation is low, however remains in proportion with female representation within the speciality. Increasing numbers of visible female presenters will serve to improve the gender landscape within orthopaedics.

Background: The COVID-19 pandemic facilitated the rapid uptake of telehealth Australia wide. To date, no studies have analysed patient perceptions of a regional urological telehealth service before and after the pandemic. With over 10 years of experience delivering telehealth to Southwest Victoria, we aim to highlight the benefits, limitations and progress of a regional urological telehealth service.

Methods: Regional patients living within Western Victoria who participated in our 2017 survey and continued their urological telehealth consultations throughout 2021-2023 were invited to participate in our 2023 survey. Questions were both short answer and multiple choice. Seventy-eight patients met inclusion criteria, and 42 responses were returned. Data analysis utilized a mixed methods approach.

Results: Overall patient perceptions were favourable in 2017 and improved throughout the Pandemic. The greatest improvements were seen within the performance areas: overall satisfaction, technological aspects, comprehension and financial benefits. Following the pandemic, the distance patients were prepared to travel for face-to-face reviews decreased and preferences for telehealth compared to face-to-face consultations increased by almost 20%. However thematic analysis revealed loss of personalized care, technological faults, fixed beliefs and unsuitable appointments as limitations of this model of care.

Conclusion: Patients' perspectives of a regional urological telehealth service were overwhelmingly positive highlighting the vital place of urological telehealth in the delivery of equitable urological healthcare to a regional population. Overall, post COVID-19 there were improved patient perceptions of a telehealth service and its role in providing regional patients with the provision of timely, supportive and high-quality urological care.

Background: There are few realistic and accessible laparoscopic pyeloplasty training models. The aim of this study is to develop a functional training model through user-centered design that depicts the pathological features of pelvicoureteric junction obstruction (PUJO).

Methods: Realistic patient-matched anatomical models of the kidney, renal pelvis, and ureter were created based on segmentations of computed tomography (CT) scans of a paediatric patient with PUJO who underwent laparoscopic pyeloplasty. Three training model versions (polyjet, resin, and silicone) were produced, tested, and published. Training model testing was conducted by consultant surgeons (n = 14), training surgeons (n = 5), and medical students (n = 8). Face validity testing was conducted to assess realism and usefulness of training models on a 10-point Likert-type scale. Training model accessibility was assessed using equipment availability and cost to set-up and produce as proxy measures.

Results: Participants significantly preferred polyjet and silicone models over resin models for overall rating (6.9 ± 2.3, 7.9 ± 1.1, and 5.0 ± 1.8) respectively; and usefulness in trainees (7.6 ± 2.1, 8.6 ± 0.9, and 5.0 ± 3.1) respectively. While both the polyjet and silicone models were found to be realistic and useful, the silicone model is considered more accessible due to the ready availability of the manufacturing equipment and materials and around 300-fold reduction in cost compared to polyjet.

Conclusions: A surgeon-assessed realistic and useful pyeloplasty surgical training model was developed here which enables surgical practice on challenging small anatomical features. The comparatively low cost and accessibility of the silicone model can enable trainees to practice the procedure depicting the realistic pathological features in environments with limited resources.

Introduction: Upon graduation, newly qualified doctors are expected to manage complex and unwell patients, and adapt their prior learning to navigate an often-nuanced healthcare workplace environment. Surgical rotations can bring a unique set of learning curves and challenges to this already demanding transitional period. The aim of this study was to identify the training needs of medical students and early-career doctors in surgical skills, incorporating viewpoints from all stakeholder groups to provide a holistic insight into the provision of surgical education currently, and how it can be optimized to improve work preparedness.

Methods: Final-year medical students, interns and clinical educators from five clinical schools affiliated with the University of Melbourne were recruited for semi-structured interviews. Following transcription, multi-phased thematic analysis was performed to identify key themes.

Results: Thirty-seven participants were interviewed (18 students, 8 interns and 11 clinical educators). Outside of commonly utilized procedural skills, different emphases were placed on non-technical skills by students and interns, compared to clinical educators. Increased hands-on learning and structured teaching were thought to be key to increasing confidence and work preparedness.

Conclusion: This qualitative study interviewed key stakeholders to identify important skills in order to help newly qualified interns to thrive in a surgical rotation. These skills in particular included more supervised hands-on practical teaching. Future studies involving graduates from other medical schools may provide a better understanding of surgical education in the wider Australian context.

G. Ian Taylor and Rollin Daniel described the first fasciocutaneous vascularized free tissue transfer in 1973 using the groin flap. Over the last 50 years, the field of microsurgery has advanced significantly, with the advent of improved surgical instruments, discovery and description of numerous flaps, and a growing application and indications for free tissue transfer. The aim of this paper is to discuss the origins and major milestones of free tissue transfer reconstruction over the past half-century, providing insights into the evolution of surgical techniques and technological integration. The review culminates in a forward-looking perspective, contemplating future directions and innovations that will shape the ever-evolving field of free autologous tissue transplantation and reconstruction.

Background: The introduction of non-vitamin-K-antagonist oral anticoagulants (NOAC) has shifted the landscape of anticoagulation in the setting of atrial fibrillation (AF), as an alternative to warfarin. Despite extensive evidence for NOACs in non-perioperative and non-valvular AF, there remains little consensus on anticoagulation choice for patients with postoperative atrial fibrillation (POAF) after cardiac surgery.

Methods: This retrospective, observational study included 2263 patients who underwent cardiac surgery between 1 March 2016 and 13 January 2023 at a tertiary cardiac centre. Patients with pre-existing AF, valvular AF and transcatheter interventions were excluded. Short- and long-term outcomes were compared between patients who received a NOAC and those who received warfarin for POAF. A Cox regression model was constructed to identify independent predictors for time-to-mortality. Subgroup analysis was performed based on the type of surgery, including CABG-only, aortic valve replacement (AVR)-only, and combined surgery cohorts.

Results: Of the 2263 patients, 556 (24.5%) developed POAF. Of those who developed POAF, 162 were anticoagulated with warfarin and 65 were anticoagulated with a NOAC, including apixaban, rivaroxaban and dabigatran. There were three cases of permanent stroke in the warfarin group compared with no cases in the NOAC group. All-cause 30-day and one-year readmission rates were similar between groups. The use of NOAC or warfarin did not impact overall survival in the Kaplan-Meier analysis. Subgroup analysis demonstrated similar outcomes in CABG-only, AVR-only and combined surgery groups.

Conclusions: Warfarin and NOAC performed similarly in short- and long-term complications, suggesting NOAC as a plausible alternative to warfarin for anticoagulation in POAF.

Background: The general surgery prioritization tool (GSPT) was implemented in 2018 to equitably prioritize non-cancer elective general surgery waitlists. It combines patient-reported Impact On Life (IOL) scores and clinician-reported values for a total score which determines access to the waitlist. In New Zealand there are inequities in surgical access and outcomes, particularly for Māori, and this study evaluates whether the GSPT may contribute.

Method: A retrospective review of general surgery prioritization events at Capital & Coast District Health Board, New Zealand, between May 2018 and August 2022 was conducted. The patient-reported IOL score (6-36), total score (0-100), waitlist access, and time to surgery in days were recorded and analyzed for ethnic, age and gender differences.

Results: 4527 events were included. Median IOL score and total score were 20 and 68. 4231 (90.8%) met the waitlist threshold with a median time to surgery of 99 days. Higher average IOL scores were associated with being female (P = 0.005), Pacific Peoples (P = 0.007) and Other Ethnicity (P = 0.006). The average total score for Māori was 1.13 points higher than Europeans (P = 0.013). There was no evidence of associations between the odds of surgery booking and patient age, ethnicity and gender when adjusted for deprivation and procedure type.

Conclusion: This study shows that despite differences in the IOL and total scores across ethnicity, no evidence of difference was found in the odds of surgical booking based on patient ethnicity, age or gender. Amendments to weighting of IOL scores and ethnicity score adjustment could be considered to remedy this.