ANZ Journal of Surgery最新文献

Background: Enhanced recovery after surgery (ERAS) pathways are increasingly utilised in autologous breast reconstruction (ABR) to improve patient outcomes. This Australian study evaluates the impact of our centre's newly standardised electronic ERAS pathway from 2023 to 2024 compared to a transitional ERAS cohort from 2017 to 2018.

Methods: A perioperative ERAS protocol was implemented for patients undergoing DIEP flap reconstruction for therapeutic or prophylactic mastectomies. Key components included comprehensive patient education, standardised perioperative surgical proformas, goal-directed fluid resuscitation, mitigation of opioid use, early mobilisation, and diet reintroduction. Outcomes from the 2023-2024 cohort were compared with the 2017-2018 cohort. The primary endpoint was length of stay (LoS), from admission to discharge. Secondary endpoints included daily and total oral morphine-equivalent daily dosage (oMEDD, mg), incidence and duration of patient-controlled analgesia (PCA, hours), Days 1-4 pain scores and rates of major and minor complications alongside standardised Clavien-Dindo classifications.

Results: A total of 102 patients were analysed (transitional ERAS, n = 48; standardised ERAS, n = 54). LoS for the whole cohort of unilateral and bilateral patients decreased from 5.8 days (5.0-6.6) to 4.5 days (4.1-5.0), p = 0.007. Total oMEDD reduced from 155.0 mg (134.3-175.5) to 111.6 mg (85.0-138.2), p = 0.011. PCA incidence remained unchanged at 16.7%, but duration decreased from 31.8 h (19.9-43.8) to 14.2 h (11.7-16.7), p = 0.010. These trends were consistent across subgroup analysis. No significant difference in major complication rate was observed. Minor complications showed a marginal decline.

Conclusion: Our standardised ERAS pathway for DIEP flap reconstruction significantly reduced LoS and PCA duration without increasing major or minor complication rates. These findings underscore the value of multidisciplinary perioperative collaboration and establish a framework for best practices in ABR within the Australian healthcare context.

Objectives: To understand the adoption of reusable surgical and anaesthetic devices across public hospital operating suites and recovery areas in Victoria.

Methods: Snapshot audit of procurement data of common medical devices utilised in operating theatres that are available as either reusable or single-use devices. A list of 49 common medical devices was created, and the usage data were obtained through surveys conducted by remote interviews of procurement or theatre staff between August 2024 and January 2025. Descriptive statistics were used to summarise data. Nine public health networks (i.e., 14 hospitals) were surveyed, comprising 121 operating theatres and 21 endoscopy/procedure rooms.

Results: Eight out of nine (89%) metropolitan public health services in Victoria use mostly single-use surgical and anaesthetic devices in the operating theatre. Of the 49 surgical and anaesthetic devices surveyed, 46/49 (94%) had a reusable alternative available at a minimum of one of the nine health services surveyed. Five of 16 (31%) anaesthetic devices, 15/27 (56%) surgical devices, and 2/7 (29%) recovery room devices had a reusable alternative available. The average hospital adoption of surveyed reusable devices across all sites was 22/49 (45%).

Conclusions: Most (8/9) public health services in Melbourne surveyed utilise mostly single-use devices in perioperative settings. This audit provides a snapshot where reusable alternatives are available to influence future procurement. As the Victorian healthcare system rapidly transitions to renewable energy sources of electricity, there are considerable procurement opportunities to reduce scope three greenhouse gas emissions from healthcare.

Introduction: Understanding the microbial changes within the surgical site may enhance our understanding of the origin and subsequent role of microbes in the causation of incisional surgical site infections (SSIs). In this study we used 16S rRNA sequencing to establish the dynamic microbiota of the surgical site in patients undergoing bowel resection.

Methods: The surgical site of patients undergoing bowel resection was sampled at four different time points: on initial incision of the surgical site prior to peritoneal breach; on completion of the operation following fascial closure; from the lumen of the resected segment of bowel; and from the superficial skin of the surgical site in the follow-up period. DNA was extracted and used for 16S rRNA amplicon gene sequencing to establish the dynamic microbiota changes that occur within the surgical site.

Results: A total of 250 samples were collected from 50 patients. The native subcutaneous abdominal plane is a low biodiversity Gram positive aerobic community, which following resection of the bowel, reflects a high biodiversity obligate anaerobic community, suggestive of contamination from the GI lumen. The follow-up sampling shows resilience of skin commensals, depletion of the most abundant luminal microbes with emergence of Enterobacteriaceae and Staphylococaceae. These two families thrive to colonise the follow up wound in all patients, highlighting potential pathways of infection in colorectal surgery.

Conclusions: Whilst this study does not demonstrate causality, it does add to the body of literature in deciphering the poorly understood pathogenesis of SSIs in colorectal patients. This study should be used as a platform to perform further multiomics-based investigations to try and underpin the exact mechanisms behind SSIs in this form of surgery, thus allowing us to improve preventative strategies in the future.