ANZ Journal of Surgery最新文献

Background: COVID-19 affected access to healthcare. Victoria, Australia was heavily affected. Hospitals deferred non-urgent operations and preserved health resources to manage people with COVID-19. Elective orthopaedic surgery was directly impacted. This study investigated changes to orthopaedic procedures and the elective surgery waitlist during the COVID-19 at a large regional health service in Victoria.

Methods: Data were acquired from University Hospital Geelong, a publicly funded regional health service in Victoria, Australia. Orthopaedic surgeries and waitlist numbers were collated for financial years ending (FYE) 2020-2023. Procedures were displayed as total, planned and unplanned (i.e., trauma).

Results: From FYE 2020 to 2023 there was 8244 orthopaedic surgery cases with 8850 procedures. Planned joint replacements of knee, hip and shoulder decreased collectively by 19% in FYE 2022 and increased by 66% in FYE 2023. Waiting lists rose from 247 in FYE 2020 and peaked at 786 in FYE 2022, before falling to 390 in FYE 2023. The number of fractured neck of femur procedures were consistent each year (average 152/year), while ankle and wrist fractures declined by 55% and 43% during FYE 2022 and increased in FYE 2023 by 106% and 159% respectively.

Conclusion: Changes to planned orthopaedic procedures and waitlists in a regional centre were evident throughout the pandemic. These results can help to inform strategies to optimize the provision of orthopaedic surgery during future major disruptive events.

Introduction: Radical cystectomy and urinary diversion is required for both primary muscle-invasive bladder cancer and in the setting of pelvic exenteration for advanced malignancy of pelvic organs. Acute and chronic complications following radical cystectomy can be a significant cause of morbidity. We compared the rates of urological complications following these two procedures at our tertiary referral centre.

Methods: Patients who underwent radical cystectomy and urinary diversion either alone or as part of pelvic exenteration between June 2017 and April 2024 at our hospital were included. Short and long-term post-operative urological complications were collected, and data for patients who underwent PE were collected prospectively as part of a larger database.

Results: One hundred eleven patients underwent cystectomy: 44 as part of pelvic exenteration (PE), 67 cystectomy alone. Post-operative urological complications occurred in 45% of patients undergoing PE and 42% undergoing cystectomy alone (P = 0.703). Urosepsis was the most frequent complication in both cohorts, occurring in 27% and 24% of patients who underwent PE and cystectomy alone respectively. Return to theatre was required in 9% of PE patients and 7% of non-PE patients. ASA status was predictive of complication development in the non-PE cohort, no factors analysed were predictive in the PE cohort.

Conclusions: In this cohort, the rate of urological complications and return to the theatre following radical cystectomy and urinary diversion were comparable among those undergoing PE and cystectomy alone. No individual factor was identified that was predictive of post-operative complications.

Background: Specific image defined risk factors (IDRF) immediately prior to surgery may be more relevant to paediatric oncology surgeons than pre-neoadjuvant IDRFs at diagnosis. The aim of this study was to determine IDRF subtypes that independently predict postoperative complications.

Methods: We searched the New Zealand Children's Cancer Registry for all cases of neuroblastoma treated at a single paediatric oncology centre between January 2007 and February 2021 and determined the IDRF status on pre-operative imaging at diagnosis and after neoadjuvant therapy. Surgical complications (Clavien-Dindo grade) were correlated with total number of IDRFs (pre- and post-chemotherapy) and three subsets: vascular encasement (VE), invasive (I), and extensive (E).

Results: Of 101 patients, 73 underwent surgical resection, and 32 (44%) had a surgical complication. Of the 54 IDRF-positive tumours, all were treated by neoadjuvant therapy and in 17, all IDRFs resolved. Complications correlated with the number of post-neoadjuvant therapy VE-IDRFs at OR 1.2 (95% CI 1.0-1.4, P = 0.02) and extensive IDRFs at OR 1.7 (95% CI 1.1-1.9, P = 0.02). Pre-neoadjuvant IDRF status was not independently associated with complications when controlling for post-neoadjuvant IDRF status. The total number of VE-IDRF reduced from 181 pre-neoadjuvant therapy to 86 post, with tumour encasing the aorta and/or vena cava being the most common.

Conclusions: The vascular encasement and extensive subtypes of IDRF may be more useful prognostic indicators of surgical complications than the total number of IDRFs. This may have implications for reporting IDRF status on preoperative imaging and surgical planning but needs validation in larger cohort studies.

Objective: To evaluate the predictive value of day zero post-operative parathyroid hormone (PTH) levels in determining cure for primary hyperparathyroidism (pHPT) following parathyroidectomy.

Methods: This multicentre, retrospective diagnostic accuracy study utilized data from a single surgeon. Patients who underwent parathyroidectomy for pHPT were included, with exclusions for secondary or tertiary causes and incomplete follow-up. Day zero post-operative PTH levels were the key predictor variable, while cure at 6 months, defined by normocalcaemia, was the outcome. Diagnostic parameters including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated for an optimal PTH cut-off determined using a receiver operating characteristic (ROC) curve and Youden's index.

Results: Out of 291 patients included, 278 (95.5%) were cured at 6 months. An optimal PTH cut-off of <3 pmol/L was identified, correlating with a true positive rate of 81.3% and a false positive rate of 0%. Patients with day zero PTH <3 pmol/L (77.7% of the cohort) were all cured at six months. The PTH <3 pmol/L cut-off demonstrated a sensitivity of 81.3%, specificity of 100%, PPV of 100%, NPV of 20%, and an accuracy of 82.1%.

Conclusion: Day zero post-operative PTH level < 3 pmol/L is a reliable predictor of cure for pHPT following parathyroidectomy. A PTH level of <3 pmol/L is an effective cut-off to identify patients who will be cured, potentially reducing the need for prolonged biochemical monitoring.