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Background: The selective publication of articles based on factors, such as positive outcome, statistical significance and study size is known as publication bias. If publication bias is present, any clinical decision based on a review of the published work will also be biased. Publication bias has been shown in various specialties, based on review of publication rates for abstracts presented at major scientific meetings. This study was conducted to investigate publication bias in orthopaedics. Methods: Abstracts presented at the 1998 Australian Orthopaedic Association Annual Scientific Meeting were reviewed independently by two reviewers. Details of sample size, study setting, country of origin, outcome and study type were recorded for each abstract. Publication within 5 years was ascertained by electronic searching of Medline and Embase databases and direct author contact. Logistic regression analysis was used to identify predictors of publication. Results: The overall publication rate was 31%. Publication was more likely if the study was a laboratory study, rather than a clinical study (odds ratio (OR), 3.45; 95% confidence interval (CI) 1.69–7.01, P < 0.001). Sample size, country of origin, study type, statistical significance and positive outcome were not significantly associated with publication. Conclusion: According to this study, laboratory studies were significantly more likely to be published than clinical studies. In contrast to previous studies, publication bias due to the selective publication of papers with a positive outcome or those reporting statistical significance was not found. [ABSTRACT FROM AUTHOR]

Background: Almost 20 000 people undergo an emergency laparotomy each year in New Zealand and Australia. Common indications include small and large bowel obstruction, and intestinal perforation. Considered a high‐risk procedure, emergency laparotomy is associated with significantly high morbidity and mortality. The aim of this review was to identify and compare 30‐day, 90‐day and 1‐year mortality rates following emergency laparotomy in New Zealand and Australia. Methods: A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement. Electronic searches were performed in Medline, Embase, PubMed and Scopus in April 2020. Results: Thirty‐three papers met the inclusion criteria. Studies ranged in size from 58 to 75 280 patients. Weighted mean 30‐day mortality was 8.40% (8.39–8.41). Mortality rates increased with longer postoperative follow up with 90‐day weighted mortality rate of 14.14% (14.13–14.15) and the weighted mortality rate at 1 year of 24.60% (24.56–24.66). There was significant variability in mortality rates between countries. Conclusion: There is a wide variability of 30‐day, 90‐day and 1‐year mortality rates internationally. Lowering postoperative mortality rates following emergency laparotomy through quality improvement initiatives could result in up to 120 lives in New Zealand and over 250 lives in Australia being saved each year. The continued work of the Australian and New Zealand Emergency Laparotomy Audit – Quality Improvement is crucial to improving emergency laparotomy mortality rates further in New Zealand and Australia. [ABSTRACT FROM AUTHOR]

Background: Obtaining research funding in Otolaryngology – Head and Neck Surgery (ORL‐HNS) can be challenging. In this paper, an analysis of research output in ORL‐HNS in Australia and worldwide between 2008 and 2018 was conducted and then adjusted for the number of specialist surgeons in each country. Methods: Scopus by Elsevier was used to measure research output of Ear, Nose and Throat (ENT) surgeons in Australia between 2008 and 2018. Each individual's career and 10‐year h‐index was identified and then repeated with self‐citations excluded. Total and 10‐year citations were also recorded. The top 15 countries in terms of research output in ORL‐HNS were also ranked based on the number of ENT articles published in the 10‐year period, and then adjusted by the number of actively practicing ENT surgeons per country. Results: Between 2008 and 2018, Australia published 1510 articles out of a total global output of 48 613 papers in ORL‐HNS with the top 10 authors having an h‐index placing them within the world's top 100. Whilst the USA made the greatest total contribution with 12 912 publications, when adjusted for the number of specialist ORL‐HNS clinicians in each country, Australia, Canada and India in order topped the rankings. Conclusion: Australia has established itself as a research leader in the global field of ORL‐HNS, publishing more articles per surgeon than any other country between 2008 and 2018. The Australian ORL‐HNS Academic Surgeons also rank highly on an individual basis when compared to global peers. [ABSTRACT FROM AUTHOR]

In this article, we aim to describe our modern‐day approach to total thyroidectomy, detailing the subtle refinements of our technique, as it has evolved over three decades and 21 000 cases. Since Delbridge's seminal paper in 2003, the major changes to our approach include a retrograde approach to the recurrent laryngeal nerve that allows dissection of the distal RLN from fascial bands within the ligament of Berry before medialisation of the thyroid lobe. Routine use of intraoperative nerve monitoring systems has increased our awareness of temporary neuropraxia, facilitated a reduction in the risk of bilateral RLN palsy and improved our identification and preservation of the external branch of the superior laryngeal nerve. The increasing use of advanced energy devices has been associated with a reduction in post‐operative haematoma rates. We adopt a low threshold to parathyroid auto‐transplantation, unless all glands are assessed to be clearly not at risk, and routinely supplement patients with Caltrate in the immediate post‐operative period to minimize the risk of symptomatic hypocalcaemia. Ultimately, when we reflect on the subtle refinements that have contributed to improved outcomes, the fundamental principles of exposure and dissection that have evolved over decades remain the basis of our surgical approach and must continue to do so. [ABSTRACT FROM AUTHOR]

Introduction: Total knee arthroplasty (TKA) has a success rate of 80–90%, but despite this encouraging figure a painful TKA can be a source of dismay for patients and surgeons. Computed tomography (CT) scan has been developed as a tool to collect data in the analysis of TKA component placement. Protocols used to collect such data exist in orthopaedic and radiology practice with little standardization and significant variation. The aim of this review article was to evaluate such variability by sampling a series of protocols from a range of different radiology practices within NSW, Australia in a case‐based manner and to then compare them against any literature standards. Methods: The literature was surveyed for existing CT scan protocols used in TKA assessment. These were then compared with a series of metropolitan and rural radiology firms across the public and private sectors in NSW, Australia. Results: Considerable variability exists between current protocols across NSW, Australia, which differ with proposed literature standards. Conclusion: Variabilities encountered when comparing the different scanning protocols in use for the assessment of TKA constitute a large potential source of error in the analysis of TKA component positioning. The reliance surgeons place on such analyses suggests the need for an established scanning protocol with an incorporated grading system and standardized values to allow reproducible data to help assess and predict TKA function. Computed tomography may be used in the assessment of component position for TKA. Whilst many protocols for such assessment exist, there is a lack of consensus among them regarding methodology. This paper highlights the high degree of variability among these protocols and its potential as a source of error in detailing component position. [ABSTRACT FROM AUTHOR]

Background Surgical checklists are designed to improve patient outcomes following surgery. While such checklists have been widely implemented worldwide, few studies examine surgical checklists within an Australian context. For this purpose, we have performed a literature review using data from OECD member nations to determine the effectiveness of surgical checklists in improving patient outcomes and factors that contribute to their successful implementation. Method The databases, Pubmed, Medline, EMBASE, Cochrane and CINAHL were searched using the keywords ('surgical' AND 'checklist') and ( (surgical) AND checklist) AND ( (implementation) OR (utilization) OR (usage) ). Studies were limited to those written in the English language, peer-reviewed, published between January 2000 and December 2012, and including an abstract. Results Our search yielded 2242 papers, of which 72 papers were identified for their potential relevance and selected for full text review. Of these, nine papers met the inclusion criteria and were reviewed in detail. Evidence that supports the use of surgical checklists in countries with a large number of protocols already in place is limited. Adequate checklist implementation plays a central role in checklist effectiveness, which in turn is dependent on multiple factors. Conclusion Although evidence from OECD member countries is non-conclusive, it does suggest that surgical checklists, when effectively implemented, have the potential to be effective at reducing complication and mortality rates following surgery. Within an Australian context, more studies are needed to fully establish the potential effectiveness of surgical checklists and to monitor checklist use compliance in order to ensure greater patient safety. [ABSTRACT FROM AUTHOR]

Background The acute surgical unit ( ASU) model of care is a new paradigm shift in the provision of emergency surgery. Clinical and non-clinical outcomes have been described after the introduction of the ASU model in Australia and New Zealand. This paper reviews and analyses the current published literature and methods of implementation of contemporary ASU models. Method We conducted a comprehensive database search to identify all relevant published papers pertaining to the ASU. Included papers compared ASU models to emergency surgery's traditional model of care. Relevant clinical and non-clinical end points were extracted for analysis. Results Seven papers and two abstracts published data assessing clinical and non-clinical end points within the ASU. Four out of six studies reported a reduction in hospital length of stay. Two out of three studies showed reduction in mean time to emergency department review and two out of four studies reported a reduction in time to surgery. Additionally, four out of five studies showed a reduction in after hours operating with an ASU model. Conclusion Trends in clinical outcomes are seen including reduced length of stay, time to emergency department assessment and surgery, supplemented by non-clinical outcomes including reduced after hours operating and the potential for increased training opportunities. The published data presents certain weaknesses and further information is required to appreciate the applicability of certain aspects of the ASU model to smaller centres. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has resulted in global disruptions to the delivery of healthcare. The national responses of Australia and New Zealand has resulted in unprecedented changes to the care of colorectal cancer patients, amongst others. This paper aims to determine the impact of COVID‐19 on colorectal cancer diagnosis and management in Australia and New Zealand. Methods: This is a multicentre retrospective cohort study using the prospectively maintained Binational Colorectal Cancer Audit (BCCA) registry. Data is contributed by over 200 surgeons in Australia and New Zealand. Patients receiving colorectal cancer surgery during the pandemic were compared to averages from the same period over the preceding 3 years. Results: There were fewer operations in 2020 than the historical average. During April to June, patients were younger, more likely to have operations in public hospitals and more likely to have urgent or emergency operations. By October to December, proportionally less patients had Stage I disease, proportionally more had Stage II or III disease and there was no difference in Stage IV disease. Patients were less likely to have rectal cancer, were increasingly likely to have urgent or emergency surgery and more likely to have a stoma created. Conclusion: This study shows that the response to COVID‐19 has had measurably negative effects on the diagnosis and management of colorectal cancer in two countries that have had significantly fewer COVID‐19 cases than many other countries. The long‐term effects on survival and recurrence are yet to be known, but could be significant. [ABSTRACT FROM AUTHOR]

Background: Recent research has shown that knee arthroscopy does not provide a meaningful clinical benefit for degenerative knee changes in the older population. The 2016 Australian Orthopaedic Association (AOA) Annual Scientific Meeting held a plenary session on this topic to educate surgeons about these research findings and communicate their clinical practice statement on this issue. This paper set out to find if there has been a change in clinical practice since this meeting. Methods: The analysis consisted of all knee arthroscopies performed in a single city of Far North Queensland, Australia, over an 8‐year period. The number and type of arthroscopies performed in patients <50 and ≥50 years of age was compared before and after the 2016 AOA plenary session. Results: After the 2016 AOA educational session, there was a significant reduction in the number of debridement procedures performed in patients aged 50 years or older (275 vs. 142 per year, P < 0.01) but not in patients under 50 years of age (192 vs. 135 per year, P = 0.91). The annual number of repair procedures for all ages combined, increased from 11 per year to 60 per year (P < 0.01). Conclusion: The surgeons of this city have changed their knee arthroscopy clinical practice in line with the evidence and advice from their professional body. [ABSTRACT FROM AUTHOR]

Background: Oral squamous cell carcinoma (OSCC) is a significant public health issue. Australia had 448 deaths from lip and oral cavity cancer in 2018, some of which could be prevented. Consideration of the factors contributing to mortality after OSCC resection can provide a greater insight into how deaths can be prevented. Methods: This paper used data from the Australia and New Zealand Audit of Surgical Mortality from the last 10 years from 1 January 2009 to 31 December 2018 for analysis. All surgical deaths were captured as the treating surgeons were mandated to complete a surgical case form for assessment by an independent surgeon from the same specialty. Results: This study found 25 cases of death after OSCC resection. In 44% of cases, death was related to cardiac causes and 40% was related to respiratory causes. Fourteen cases were found to have issues with management, and 25 issues were raised. In 36% of issues, it was found to be related to decision to operate. There were no obvious differences between the patients who had neck dissections and those who did not. Conclusion: The decision to operate on high‐risk patients, cardiovascular and respiratory causes were the major contributors to surgical mortality. The small number of deaths and the limitation of using existing data limited statistical analysis and conclusions. Changes could be made to the Australia and New Zealand Audit of Surgical Mortality to improve the results for analysis. [ABSTRACT FROM AUTHOR]

Background: women historically have been underrepresented in the field of academic publishing. This study aims to analyse ANZJS gender authorship trends and compare this to the proportion of women in surgery in Australia/NZ using RACS demographic data to provide parity context. Methods: This is a bibliographic gender analysis of ANZJS publications from 2002 to 2021; articles were analysed using a web-based application classifying gender from names. Results: There were 7265 articles analysed. Gender was predicted for 87% (6303/7265) first-, 89% (5847/6439) last- and 98% (323/329) editorial first-authors. There were 1269/6303 (20%) women first-authors, this increased from 14% to 27% (p = 0.001) over time. Eleven percent (654/5847) of last-authors were women, this proportion remained unchanged (p = 0.09). Eleven (3%) editorials were first-authored by women, with 3/329 (1%) as solo-author. Conclusion: Numbers of women authors remain low in ANZJS, although the percentage of women first-authors has increased over time. However, if being last-author serves as a measure of senior academic supervision, and, editorial authorship shows leadership in one’s field, women authors in these positions, in ANZJS, represent a small minority. [ABSTRACT FROM AUTHOR]

Background: The Australian Orthopaedic Association (AOA) is the peak professional body for orthopaedic surgeons in Australia and is responsible for their training and continuing medical education. The 2012 AOA strategic education review employed a gap analysis to identify issues and generate a roadmap for the enhancement of AOA's education and training activities. This paper describes the process and outcomes of this review, which led to the 'AOA 21' Education Re‐design Project, and the review's relevance to surgical education in Australia. Methods: The AOA strategic education review was undertaken by international clinician education and orthopaedic experts, and involved AOA staff, fellows and trainee members throughout Australia. This review progressed through four phases: a review of current training; a global 'best‐practice' perspective; a set of aspirational goals; and a roadmap for implementation. Results: Seven key strengths (e.g. camaraderie in training and surgical skills teaching) and 15 challenges (e.g. 'non‐technical' skills teaching, subjective methods of decision making and inadequate assessment practices) were identified in the review stage. Sixteen major recommendations for improvements incorporating current or emerging world's best education practices were targeted in an 8‐year implementation framework. Conclusion: The AOA's strategic education review serves as a roadmap for other specialty training organizations to review their programmes and implement contemporary best practices in surgical training. The AOA 21 project has positioned orthopaedic surgery as a leader in competency‐based surgical education and training in Australia. [ABSTRACT FROM AUTHOR]

Background: Intraoperative nerve monitoring (IONM) has increasingly been used in thyroid surgery by general, endocrine and head and neck surgeons. The purpose of this paper was to explore the prevalence and reasons for the usage of IONM in endocrine surgery in Australia and New Zealand. Methods: A survey was sent to general surgeons registered with the Royal Australasian College of Surgeons involved in endocrine surgery and members of the Australian and New Zealand Endocrine Surgeons. Users were divided into surgeon type, area of work, hospital type and volume of surgery. These data were analysed with univariate and multivariate logistic regression models. Results: Significant differences in IONM usage levels were observed between endocrine and general surgeons, area of work and volume of surgery performed. Endocrine surgeons are significantly more likely to use IONM than general surgeons. Surgeons who work in tertiary hospitals are more likely to use IONM as compared to those working in district hospitals. Surgeons who perform less than 100 thyroidectomies were more likely to be users of IONM. Conclusion: IONM is not routinely used in thyroid surgery in Australia and New Zealand. The main reasons for the use of IONM given in our study by routine users were to establish familiarity of equipment and medicolegal reasons. Selective users chose as the most common reasons, a documented pre‐existing unilateral nerve paresis or a hostile surgical field. Non‐users stated that there was conflicting evidence that it improves outcomes and increased costs. [ABSTRACT FROM AUTHOR]

The prospect of a terrorist attack against Australian interests is currently being debated across our society. The explosive blast attack is most favoured by terrorists. Blast injuries create unique patterns of multisystem injury with contaminated wounds and extensive devitalized tissue. Australian civilian surgeons are increasingly likely to be involved in the management of these injuries, either in response to a terrorist incident in Australia or as part of delayed management of Australian nationals injured overseas. An appreciation of the unique complexities of blast injuries is equally important to both military and civilian surgeons. This paper covers the mechanisms and pathophysiology of blast injuries and discusses issues of surgical management as they would apply to an Australian civilian setting. [ABSTRACT FROM AUTHOR]

Background: Clinical decision making is a core competency of surgical practice, involving a continuous and evolving process of data interpretation and evaluation. The aim of this article is twofold. First, to recognize patient deaths where a clinical incident arose following unsatisfactory clinical decision making, determining where in the clinical decision‐making process each failure occurred. Second, to discuss and explore individual incidents to provide lessons from which the surgical community can learn. Methods: Using the Australian and New Zealand Audit of Surgical Mortality database, all deaths from 1 January 2015 to 31 December 2015 were analysed. All deaths in which the surgeon or assessor identified an aspect of patient management that was inadequate were recognized. Clinical incidents deemed by the assessor to be an area of concern or an adverse event were individually reviewed to determine if a clinical decision‐making incident (CDMI) occurred. CDMIs were categorized into various themes depending on the nature of the incident. Results: A total of 3422 fully audited deaths occurred throughout the study period; from these cases, 226 individual CDMIs were identified. Decision to operate was the most commonly identified CDMI (n = 99, 43.8%), followed by diagnostic error (n = 49, 21.7%). The least common CDMI identified was inadequate post‐operative assessment (n = 14, 6.2%). Conclusion: This paper demonstrates thought‐provoking examples of clinical decision‐making failure implicated in patient death. Clinical decision‐making failures most commonly occur around the decision to operate with increased discussion of complex cases possibly required. Further CDMI evaluation should be considered to complement more traditional methods of surgical mortality evaluation. [ABSTRACT FROM AUTHOR]

Information about the topics discussed during the sixth biennial Cowlishaw Symposium held in Australia on October 28, 2006 is presented. Wyn Beasley of the Gordon Craig Library delivered the eighth Kenneth Russell Memorial Lecture titled "An approach to the natural." Honorary Professor Sam Mellick presented complimentary papers on the life and achievements of Dr. Nicolaas Tulp of Amsterdam in the Netherlands.

Background This paper aimed to describe the training available and the process taken to establish a robotic colorectal surgery programme in a large Australian academic private hospital. Through this we hope to guide other surgeons and hospitals planning to introduce this technology in circumstances where such guidelines do not exist. Methods The available training and credentialing pathways are described, including the da Vinci Surgery Training Pathway provided by Intuitive Surgical and hospital-based supports. A proposed 9-point training and credentialing pathway is presented, along with the activities undertaken by each surgeon. Results From December 2011 to December 2013, 48 robotic colorectal procedures were performed at the Cabrini Hospital. Operations performed were as follows: 23 anterior resections, seven abdominoperineal resections, 11 rectopexies, three proctectomies and ileal pouch-anal anastomosis and four right hemicolectomies. There have been no conversions, and no major complications. There were no robot-specific complications. Conclusion We believe that this thorough and methodical approach to introducing robotics to colorectal surgery has been safe and effective, and should be applicable to other surgeons and hospitals wishing to introduce robotic technology to colorectal surgery. [ABSTRACT FROM AUTHOR]

Background: The management of an open abdomen (OA) remains an evolving field because of its relative rarity. Many techniques to achieve temporary abdominal closure exist, but often require multiple returns to the operating theatre and usually do not address the issue of lateral fascial retraction and do not achieve primary fascial closure (PFC). The ensuing incisional hernias result in a significant surgical challenge affecting both the physical and mental health of the patient. We describe our experience with the Abdominal Re‐approximation Anchor (ABRA) device, which addresses some of these issues. Methods: The records of patients with an OA managed by a single surgeon using the ABRA device at Princess Alexandra Hospital, Queensland, Australia, between December 2014 and April 2020 were analysed retrospectively. Results: Six patients with OA were managed with the ABRA. All patients required an OA for the ramification of intraabdominal sepsis. Three patients were managed with the ABRA device electively and three in the acute setting. 100% of patients achieved PFC. Average follow‐up was 40 months with three developing incisional hernias that were subsequently repaired. Conclusion: The OA in critically ill surgical patients remains one of the most challenging problems in general surgery. The ABRA device is simple to use and has shown positive outcomes in both the acute and elective setting. Our use has resulted in 100% PFC, which demonstrates that the ABRA device is an important tool for the general surgeon in managing these complex cases. [ABSTRACT FROM AUTHOR]

Background: The Surgical Research Society of Australasia (SRS)was established in 1961. The main intent was to promote surgicalresearch, especially by young surgeons. The 50th Scientific Meetingof the SRS is due to be held in 2002. Methods: Selected information was extracted from the programmebooks for the scientific meetings of the SRS, while historical materialwas retrieved from the Records and Archives Unit of the Royal AustralasianCollege of Surgeons. Results: There have been 48 scientific meetings of the SRS between1962 and 2000 inclusive, which have included the presentation of1627 free papers. Forty-one percent of the presenters (325/784)have done so on more than one occasion. The content of the presentationsreflects the changing nature of surgical research during the lastseveral decades. Conclusions: The SRS has achieved its original intent of promotingsurgical research. [ABSTRACT FROM AUTHOR]

Surgical mentors have helped trainees develop fulfilling and academically productive careers, while supervisors are formally assigned to impart skills and oversee training. This paper reviews the comparative roles of the supervisor and mentor and how they overlap, while exploring the impact of the 'unknown' mentor. While the supervisor's role in directing the student is formally recognized, the mentee will personally select a mentor who successfully models the career and life balance to which the mentee aspires. The unknown mentor is known only to the mentee. The mentee's commitment to communicating with both mentor and supervisor is crucial to success. Better processes can be used to guide the mentor relationship. Confusion between the two roles - mentor and supervisor - is due to their complementary nature as well as an overlap in roles. Both remain essential to the growth and development of the surgical trainee. The unknown mentor could give detached advice and guidance to the student, while acting as a positive role model. [ABSTRACT FROM AUTHOR]

Background Lower back pain is a common and costly condition in Australia. This paper aims to conduct an economic evaluation of lumbar artificial intervertebral disc replacement ( AIDR) compared with lumbar fusion for the treatment of patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed conservative treatment. Methods A cost-effectiveness approach was used to compare costs and benefits of AIDR to five fusion approaches. Resource use was based on Medicare Benefits Schedule claims data and expert opinion. Effectiveness and re-operation rates were based on published randomized controlled trials. The key clinical outcomes considered were narcotic medication discontinuation, achievement of overall clinical success, achievement of Oswestry Disability Index success and quality-adjusted life-years gained. Results AIDR was estimated to be cost-saving compared with fusion overall ($1600/patient); however, anterior lumbar interbody fusion and posterolateral fusion were less costly by $2155 and $807, respectively. The incremental cost-effectiveness depends on the outcome considered and the comparator. Conclusions AIDR is potentially a cost-saving treatment for lumbar disc degeneration, although longer-term follow-up data are required to substantiate this claim. The incremental cost-effectiveness depends on the outcome considered and the comparator, and further research is required before any firm conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Mycobacterium ulcerans causes significant morbidity in various endemic locations in Australia and West Africa. The commonest presentation is as a necrotic ulcer often with surrounding subcutaneous necrosis and oedema, which can cause significant morbidity, deformity and functional impairment. Traditional treatment was wide excision and debridement with grafting or flap reconstructions further adding to morbidity and with high recurrence rates. Following publication of clinical studies where antibiotics were shown to be effective, treatment has moved towards combination management with systemic antibiotics and limited surgery involving mainly debridement of the ulcers. Identification of the 'paradoxical' immune-reconstitution syndrome has also impacted upon the extent of excision required. This paper will present the evolution in clinical management of M. ulcerans cases on the Bellarine Peninsula, Victoria, Australia. [ABSTRACT FROM AUTHOR]

The article presents a perspective on the paper about the practical guidelines for the management of hemodynamically stable patients with stab wounds to the anterior abdomen. The author highlights that the paper blends a comprehensive review of published work with clinical recommendations and a safe and simple algorithm. He also believes that the guideline should be considered the benchmark resource for clinicians in Australia and New Zealand who deal with potentially devastating injuries.

Introduction: Orthopaedic surgeons performing total hip replacements (THR) today are faced with a vast array of options. Inspired by a recent UK study, we wanted to determine the current trend in prosthesis choice, fixation and bearing surfaces used in ‘young’ Australian patients, and to compare this trend to the UK. Methods: A questionnaire identical to that used in the UK study was posted to all current members of the Australian Orthopaedic Association and returned questionnaires were directly compared to the UK results on a percentage-of-responses basis. Results: Two hundred and forty-six valid responses were received. The number of THR reported to be performed by these respondents (15 789) was equivalent to the estimated number of prostheses sold here during the same period (15 624). The UK results showed a predominant use of Charnley and Exeter femoral prostheses, an all-polyethylene acetabular component, and cement fixation of both the acetabular and femoral components for both their older and younger patients. In younger patients, Australian surgeons favoured uncemented fixation techniques for the femur (57%vs 23%), and especially the acetabulum (85%vs 32%). There was a higher percentage use of modular design (95%vs 67%) and a very high use of ceramic as a bearing surface, 49% (vs 25%) using it for the femoral head, and 21% (vs 2%) employing a ceramic-on-ceramic bearing combination. Discussion: Despite being privy to the same published papers, the THR prosthesis and fixation preferences of UK and Australian orthopaedic surgeons are markedly different. This may be because of interpretation of papers, peers, personal experience, patient assessment, budgets, institutions, theories, fashions, differences in autonomy and advertising. [ABSTRACT FROM AUTHOR]

Background: The purpose of the present paper was to examine patterns of surgical care and the likelihood of death within 5 years after a diagnosis of colorectal cancer, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance. Methods: The Western Australian Data Linkage System was used to extract all hospital morbidity, cancer and death records for people with a diagnosis of colorectal cancer from 1982 to 2001. Demographic, hospital and private health insurance information was available for all years and measures of socioeconomic and locational disadvantage from 1991. A logistic regression model estimated the probability of receiving colorectal surgery. A Cox regression model estimated the likelihood of death from any cause within 5 years of diagnosis. Results: People were more likely to undergo colorectal surgery if they were younger, had less comorbidity and were married/defacto or divorced. People with a first admission to a private hospital (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.16−1.48) or with private health insurance (OR 1.27, 95% CI: 1.14−1.42) were more likely to undergo surgery. Living in a rural or remote area made little difference, but a first admission to a rural hospital reduced the likelihood of surgery (OR 0.76, 95% CI: 0.66−0.87). Residency in lower socioeconomic areas also made no difference to the likelihood of having surgical treatment. The likelihood of death from any cause was lower in those who were younger, had less comorbidity, were elective admissions and underwent surgery. Residency in lower socioeconomic status and rural areas, admission to a rural hospital or a private hospital and possession of private health insurance had no effect on the likelihood of death. Conclusions: The present study demonstrates that socioeconomic and locational status and access to private health care had no significant effects on surgical patterns of care in people with colorectal cancer. However, despite the higher rates of surgery in the private hospitals and among those with private health insurance, their survival was no better. [ABSTRACT FROM AUTHOR]

Australia and New Zealand (ANZ) have had complete population cancer incidence registration for decades and are beginning to develop clinical data systems to collect details of staging and treatment. Sadly, this bounty of statistical data is often under utilized and occasionally abused. Many are unaware of the data and statistical services available from their local cancer registry. To promote the use of ANZ population cancer data, the following paper describes the principal statistics that are available and identifies common problems with their use. [ABSTRACT FROM AUTHOR]

Trauma registries, like disease registries, provide an important analysis tool to assess the management of patient care. Trauma registries are well established and relatively common in the USA and have been used to change legislation, promote trauma prevention and to evaluate trauma system effectiveness. In Australia, the first truly statewide trauma registry was established in Victoria in 2001 with an estimated capture of 1700 major trauma cases annually. The Victorian State Trauma Registry, managed by the Victorian State Trauma Outcomes Registry and Monitoring (VSTORM) group, was established in response to a ministerial review of trauma and emergency services undertaken in 1997 to advise the Victorian Government on a best practice model of trauma service provision that was responsive to the particular needs of critically ill trauma patients. This taskforce recommended the establishment of a new system of care for major trauma patients in Victoria and a statewide trauma registry to monitor this new system. The development of the Victorian state trauma registry has shown that there are certain issues that must be resolved for successful implementation of any system-wide registry. This paper describes the issues faced by VSTORM in developing, implementing and maintaining a statewide trauma registry. [ABSTRACT FROM AUTHOR]

The CLEAR (critical literature evaluation and research) module was developed to meet an identified need in both trainees and Fellows for the basic tools to allow them to plan research projects and evaluate research papers. This paper describes briefly the way in which the module was developed and presents results of participant evaluation of the mature product, which indicate a high level of satisfaction. [ABSTRACT FROM AUTHOR]

Background: Although Australia encounters vascular injury less frequently than countries such as the USA, the predominance of blunt trauma with associated complex injuries continues to pose problems for clinicians. The present paper reviews Royal Perth Hospital’s experience of vascular trauma epidemiology. Methods: All individuals who presented to the Royal Perth Hospital (RPH) with a vascular injury between August 1994 and January 2000 were identified from a prospective trauma database. Injuries were classified using the Abbreviated Injury Score (AIS 90 code). The five major vascular injury groups as defined by AIS 90 (neck, thorax, abdomen, upper limb and lower limb) were analysed in turn to determine which injuries were most frequent, what the common causes were, effects of alcohol and drugs, common associated injuries, investigations performed, mortality, proportion of rural vascular trauma with transfer details and lengths of hospital stay. Results: During the study period, 153 patients (1% of total trauma workload) sustained 175 vascular injuries. The commonest causes of injury for each group were stabbing (neck and lower limb), motor vehicle accident (thorax and abdomen) and work machinery (upper limb). Mortality was highest for thoracic injury (14/32; 44%) followed by abdominal injury (10/29; 34%). The ratio of blunt to penetrating vascular trauma is high and is increasing, as is the ratio of truncal to extremity vascular trauma. The most common artery–vein combination injury was to the femoral vessels. Conclusions: The injury patterns emerging from the present study will hopefully help all medical personnel to recognize the potential for vascular injury in a trauma setting. [ABSTRACT FROM AUTHOR]

Background: The surgical management of trauma within Australia and New Zealand has recently been undergoing major organizational changes. The aim of the present paper was to evaluate the attitudes and experience of Australian and New Zealand advanced surgical trainees in this changing climate and to identify problems with trauma training. Methods: A survey assessing important areas of trauma management and training was sent to all advanced surgical trainees of the Royal Australasian College of Surgeons. Results: Two hundred and seventy-two of 587 trainees responded (46%). Overall 85% of trainees believed they would be involved in trauma management in the future. The majority of trainees reported low rates of involvement and consultant supervision in trauma resuscitations. Only 32% of general surgical trainees believed that their exposure to major trauma operations was very adequate despite an average of 12.3 trauma operations per year. Seventy per cent of general surgical trainees reported a very adequate level of consultant supervision at trauma operations. In contrast 86% of orthopaedic trainees reported a very adequate exposure to trauma operations with an average of 221 orthopaedic trauma operations per year. Only 46% of orthopaedic trainees reported a very adequate level of consultant supervision at trauma operations. Conclusions: Regional rotations may need to be developed to even out trainees’ experience in trauma management. The low level of supervision in trauma resuscitations and orthopaedic surgical training requires attention. This survey warrants repeating in a prospective manner. [ABSTRACT FROM AUTHOR]

Background Topographical anatomy has been taught to medical students by cadaver-based dissection for centuries. However, there is a void in the literature assessing the long-term retention of anatomical knowledge by medical students following teaching by whole-body dissection. The purpose of this paper was to assess both the acquisition and retention of topographical anatomical knowledge gained by medical students undertaking an elective whole-body dissection course. Methods This is a retrospective review of prospectively gathered data. A total of 24 students completed the elective 8-week Anatomy by Whole Body Dissection course at the University of Sydney in 2013. Surgeons and surgical trainees acted as demonstrators and anatomical knowledge was assessed on four occasions: pre, mid, end and 8 months post-course in the form of a 20-question wet specimen tag test. Results There was strong evidence of a significant difference ( P < 0.001) in the students' pre-course scores (median = 8 out of 20, IQR = 6) compared with their end-course scores (median = 19 out of 20, IQR = 2). Similarly, there was a highly significant difference ( P < 0.001) between students' pre-course scores and the 8-month follow-up post-course test (median = 18, IQR = 3), with a median difference of 10 points. There was no significant difference ( P > 0.2) between the students' end-course assessment results and the 8 months post-course assessment indicating retention of knowledge. Conclusion Surgeon-facilitated anatomical teaching to medical students by whole-body dissection significantly improves topographical anatomical knowledge which is maintained in the long term. [ABSTRACT FROM AUTHOR]

The article offers information on the 56th Annual Surgeons' Meeting (Vic ASM) that was held on October 24-25, 2014 at the Sheraton Melbourne Hotel, Melbourne, Australia. Topics discussed include upcoming Victorian parliamentary elections, a representative group of metropolitan hospitals' surgical directors and Victorian Regional Committee (VRC) members met with key political representatives Health Minister David Davis, Shadow Minister Gavin Jennings and Greens Spokesperson Colleen Hartland.

Introduction: A comprehensive review of the surgical management of injuries sustained by deployed members of the Australian Defence Force (ADF) during Operation SLIPPER and HIGHROAD in Afghanistan has not previously been undertaken. Understanding the mechanism of injury, injury types sustained and surgical intervention undertaken should provide valuable information for future health planning and surgical capability determination. Methods: Retrospective chart review of scanned medical records of injured personnel identified through casualty register examination was undertaken. Results: There were 259 ADF personnel injured in Afghanistan between January 2002 and December 2021, of which 53 were seriously (SI), or very seriously injured (VSI). Case notes for 90 of 101 casualties including those sustaining VSI, SI and those classified as being in satisfactory condition, but likely requiring surgery and/or returned to Australia following trauma, were available for review. Most patients with VSI/SI required surgery (93%) and most were returned to Australia following injury (91%). Almost two‐thirds (64.4%) of initial surgery was undertaken at a Role 2 E medical treatment facility (MTF). Gun‐shot wound (GSW) was the commonest injuring mechanism (47%) followed by blast injury (39.6%). Orthopaedic (32.2%) and soft tissue initial wound surgery (47.1%) were the commonest surgical procedures. Discussion: Surgical management of military trauma was undertaken at multiple sites by multiple surgical teams from different nationalities delivering exceptional results and conforming to modern principles of damage control surgery. The military trauma system is distinctly different from its civilian counterpart with dispersion of assets requiring multiple episodes of casualty movement between echelons of care rather than centralization at level 1 trauma centres. Despite this, excellent results are achievable. Strengthening lines of communication and documentation would reinforce the ability of the military trauma system to continue to provide such results, and regular oversight and review of surgical caseload would align military trauma surgery with civilian standards. The benchmark set by the United States Department of Defense Trauma Registry should be replicated for Australian led combat operations and modified to facilitate interoperability to support future coalition combat operations. [ABSTRACT FROM AUTHOR]

Background: Trauma continues to place a burden on individuals, communities and health care systems around the world. To help reduce this burden and improve care, trauma registries in Australia and Aotearoa New Zealand collect standardized data on patients admitted with Injury Severity Scores greater than 12. There is currently no agreed minimum data set for trauma patients with Injury Severity Score less than 13, representing an opportunity to provide more data for quality improvement and injury prevention. Methods: A binational, expert, advisory group assessed the value of potential fields for a minimum dataset for low severity trauma. Existing trauma registries in Australia and Aotearoa New Zealand were assessed to ensure compatibility. Results: Thirty‐five data fields met criteria for inclusion in the low‐severity minimum dataset. The fields comprised a subset of the Australia New Zealand Major Trauma Registry and were included in existing low‐severity registries. Conclusion: A minimum data set for low severity has been defined for use in Australia and Aotearoa New Zealand. In addition to high severity trauma data this will provide a standard for data collection that will contribute to quality improvement and injury prevention. [ABSTRACT FROM AUTHOR]

Background: Centralization of subspeciality procedures in Australia is difficult due to a vast geographical span and in the appropriate patient group, surgery in regional centres should be considered. Our study reviews the safety of adrenalectomy performed at a low‐volume regional centre in regards to length of hospital admission, operative time, complication rate and conversion to open rate. Method: A retrospective cross‐sectional study was performed of consecutive patients undergoing laparoscopic or open adrenalectomy over a nine‐year period (2012–2021) at Dubbo Base Hospital, a regional hospital in Western New South Wales, Australia. These operations were all performed by a single Urologist. Results: Thirteen patients underwent adrenalectomy at our institution over the nine‐year period. The mean age was 51.7 years (SD10.1). There were seven women (53.8%) and six men (46.2%). Seven patients were considered low risk, four patients were medium risk and two patients were high risk as per the Charlson Comorbidity Index. All of our patients were overweight, with mean body mass index of 34.6 (SD 6.9). Mean operating time was 133.5 min (SD 36.3) and mean length of stay was 3.8 days (SD 2.2). There was one conversion to open (8.3%). Three patients (23.1%) had complications, of these complications, one was Clavien‐Dindo grade II, and one was Clavien‐Dindo grade IIIb. There were no mortalities. Conclusion: Our outcomes demonstrate that adrenalectomy in our low volume regional centre is safe with comparable outcomes of operative time, length of hospital stay and complication rate with other centres. [ABSTRACT FROM AUTHOR]

The authors comment on the research paper, "Australian and New Zealand Audit of Surgical Mortality: Concordance Between Reported and Audited Clinical Events and Delays in Management in Surgical Mortality Patients," by R.S. Raju et al. published in this journal. The paper outlines differences between independent secondary analysis and surgeon's self-assessment in the Australian and New Zealand Audit of Surgical Mortality (ANZASM) in 2009-2010.

Background: Rheumatic heart disease (RHD) in young people presents a complex management problem. In Australia a significant proportion of those affected are Aboriginal and Torres Strait Islanders. Transcatheter mitral valve‐in‐valve (TMViV) replacement has emerged as an alternative to redo surgery in high‐risk patients with degenerated mitral bioprostheses. The aim of this study is to review outcomes of TMViV replacement in young patients with RHD. Methods: A single‐centre, retrospective review of prospectively collected data on patients undergoing TMViV from December 2017 to June 2021. Primary outcome was major adverse cardiovascular events. Secondary outcome was post‐operative trans‐thoracic echocardiogram (TTE) results. Results: There were seven patients with a mean age of 33 years and predominantly female (n = 5). Pre‐operative comorbidities included diabetes (29%), chronic obstructive pulmonary disease (43%), left ventricular dysfunction (43%) and current smoking status (80%). Post‐operative median length of hospital stay was 4 days with no post‐operative renal failure, stroke, return to theatre, valve embolization or in hospital mortality. Post‐operative TTE showed either nil or trivial central mitral regurgitation, no paravalvular leak and a median gradient of 5 mmHg (IQR 4.5, 7) across the new bioprosthesis; sustained at median follow‐up of 22 months. Conclusion: Current literature of TMViV replacement is focused on an older population with concurrent comorbidities. This study provides a unique insight into TMViV replacement in a young cohort of patients with complex social and geographical factors which sometimes prohibits the use of a mechanical valve. The prevalence of RHD remains high for Aboriginal and Torres Strait Islanders, planning for future repeat valve operations should be considered from the outset. We consider TMViV as a part of a staged procedural journey for young patients with RHD. [ABSTRACT FROM AUTHOR]

Background: Analysis of multi‐institutional data and benchmarking is an accepted accreditation standard in cardiac surgery. Such a database does not exist for congenital cardiac surgery in Australia and New Zealand (ANZ). To fill this gap, the ANZ Congenital Outcomes Registry for Surgery (ANZCORS) was established in 2017. Methods: Inclusion criteria included all cardiothoracic and extracorporeal membrane oxygenation (ECMO) procedures performed at five participating centres. Data was collected by data managers, validated by the surgical team, and securely transmitted to a central repository. Results: Between 2015 and 2019, 9723 procedures were performed in 7003 patients. Cardiopulmonary bypass was utilized for 59% and 9% were ECMO procedures. Fifty‐seven percent (n = 5531) of the procedures were performed in children younger than 1 year of age. Twenty‐four percent of procedures (n = 2365) were performed in neonates (≤28 days) and 33% (n = 3166) were performed in children aged 29 days to 1 year (infants). The 30‐day mortality for cardiac cases (n = 6572) was 1.3% and there was no statistical difference between the participating centres (P = 0.491). Sixty‐nine percent of cases had no major post‐operative complications (5121/7456). For cardiopulmonary bypass procedures (n = 5774), median stay in intensive care and hospital was 2 days (IQR 1, 4) and 9 days (IQR 5, 18), respectively. Conclusion: ANZCORS has facilitated pooled data analysis for paediatric cardiac surgery across ANZ for the first time. Overall mortality was low. Non‐risk‐adjusted 30‐day mortality for individual procedures was similar in all units. The continued evaluation of surgical outcomes through ANZCORS will drive quality assessment in paediatric cardiac surgery across ANZ. [ABSTRACT FROM AUTHOR]

Background: Emergency Laparotomy (EL) is recognized as high‐risk surgery with high mortality. Established surgical risk assessment tools (NELA Risk Prediction Calculator, P‐POSSUM, ACS‐NSQIP) are accurate predictors of morbidity and mortality. However, their multicomponent complexity limits their use in practice. Sarcopenia is associated with poorer surgical outcomes. This study tests for an association between a simple measure of radiological sarcopenia and mortality in EL patients in an Australian cohort. Methods: A retrospective analysis was conducted of 500 patients admitted to four Australian hospitals who underwent EL during 2016–2017. All patients had a contemporaneous abdomino‐pelvic CT scan. Radiological sarcopenia was measured as the ratio of total psoas muscle area (PM) to L3 vertebral body cross sectional area (PM:L3). Patients were followed up to 12 months. Primary outcomes were 30‐, 90‐ and 365‐day mortality. Results: The mean 30‐day mortality predictions for NELA, P‐POSSUM and ACS‐NSQIP were 11.36%, 17.28% and 11.30% respectively. PM:L3 ratio was associated with 30‐, 90‐ and 365‐day mortality (P < 0.001) and sex (P < 0.001) and negatively correlated with age (r = −0.4612; P < 0.001). Radiological sarcopenia had a weak negative correlation with NELA (r = −0.2737; P < 0.001), P‐POSSUM (r = −0.1880; P < 0.001) and ACS‐NSQIP (r = −0.2351; P < 0.001). The latter three metrics were significantly correlated (r > 0.5696; P < 0.001). Conclusion: Radiological sarcopenia (CT‐assessed PM:L3) is a significant predictor of mortality in EL patients in Australia. The results of this study suggest that radiological sarcopenia is equivalent to established risk assessment tools. The more timely and easily accessible CT‐assessed PM:L3 metric is potentially automatable and may have significant utility in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Despite increasing specialization within general surgery, many general surgeons, particularly in rural practice, continue to treat a wide range of conditions. The aim of the present paper was to provide accurate information on three rural surgeons case-loads to illustrate the spectrum of surgery encountered and to assist in the planning of rural general surgical training. Methods: A review was conducted of a prospectively maintained database of operations performed by three rural general surgeons in different parts of Victoria, Australia over a 5-year period. Results: A large volume and wide range of procedures was performed by each surgeon, who averaged more than 500 operations per year (excluding endoscopies). Although most were within the range of procedures covered in the Royal Australasian College of Sur-geons (RACS) Fellowship in general surgery, some encroached upon other specialties such as orthopaedics, urology, paediatric surgery and obstetrics/gynaecology. Operations outside of general surgery reflected individual training and local community needs. Conclusions: The current RACS Fellowship in general surgery, augmented by training in other specialties as required, will help prepare general surgeons for rural practice. [ABSTRACT FROM AUTHOR]

Background: Social disparities in cancer survival have been demonstrated in Australia despite a universal healthcare insurance system. Colorectal cancer is common, and reasons for survival disparities related to socioeconomic status need to be investigated and addressed. The aim is to evaluate the current Australian literature concerning the impact of socioeconomic status on colorectal cancer survival and stage at presentation. Methods: A systematic search of PUBMED, EMBASE, SCOPUS and Clarivate Web of Science databases from January 2010 to March 2022 was performed. Studies investigating the impact of socioeconomic status on colorectal stage at presentation or survival in Australia were included. Data were extracted on author, year of publication, state or territory of origin, patient population, other exposure variables, outcomes and findings and adjustments made. Results: Of the 14 articles included, the patient populations examined varied in size from 207 to 100 000+ cases. Evidence that socioeconomic disadvantage was associated with poorer survival was demonstrated in eight of 12 studies. Evidence of effect on late stage at presentation was demonstrated in two of seven studies. Area‐level measures were commonly used to assess socioeconomic status, with varying indices utilized. Conclusion: There is limited evidence that socioeconomic status is associated with late‐stage at presentation. More studies provide evidence of an association between socioeconomic disadvantage and poorer survival, especially larger studies utilizing less clinically‐detailed cancer registry data. Further investigation is required to analyse why socioeconomic disadvantage may be associated with poorer survival. [ABSTRACT FROM AUTHOR]

Hernia 2018; 22: 1 - 65. 11 Hansen DL, Fonnes S, Rosenberg J. Spin is present in the majority of articles evaluating robot-assisted groin hernia repair: a systematic review. There has been a slow but steady rise in Australia over the past 20 years in the proportion of groin hernias repaired using a minimally invasive surgery (MIS) approach. [Extracted from the article]

Background: Burn injuries are a common subtype of trauma. Variation in models of care impacts clinical measures of interest, but a nation‐wide examination of these measures has not been undertaken. Using data from the Burns Registry of Australia and New Zealand (BRANZ), we explored variation between Australian adult burn services with respect to treatment and clinical measures of interest. Methods: Data for admissions July 2016 to June 2020 were extracted. Clinical measures of interest included intensive care admission, skin grafting, in‐hospital death, unplanned readmissions, and length of stay (LOS). Estimated probabilities, means, and corresponding 95% confidence intervals (CI) were calculated for each service. Results: The BRANZ recorded 8365 admissions during the study period. Variation between specialist burn services in admissions, demographics, management, and clinical measures of interest were observed. This variation remained after accounting for covariates. Specifically, the adjusted proportion (95% CI) of in‐hospital mortality ranged from 0.15% (0.10–0.21%) to 1.22% (0.9–1.5%). The adjusted mean LOS ranged from 3.8 (3.3–4.3) to 8.2 (6.7–9.7) days. Conclusions: A decade after its launch, BRANZ data displays variation between Australian specialist burn services. We suspect differences in models of care between services contributes to this variation. Ongoing research has begun to explore reasons underlying how this variation influences clinical measures of interest. Further engagement with services about models of care will enhance understanding of this variation and develop evidence‐based guidelines for burn care in Australia. [ABSTRACT FROM AUTHOR]

Background: Left‐handers make up 10%–12% of all surgeons. Surgical education and practice by nature has significant technical demands but there is a paucity of data on left‐handers and training in surgery. The surgical curriculum has no specific salutation or recognition of left‐handers and the contributions and challenges they represent. Methods: The purpose of the study was to explore, describe and understand the lived experience of left‐handed surgeons in relation to surgical education and training in Australia. Semi‐structured interviews were used to gather in‐depth information relating to the participants' experiences, viewpoints, beliefs and motivations. Results: The responses of the participants involved were categorized using the data analysis method described by Colaizzi. Seven themes were identified: left‐handed surgeons are universal adapters; left‐handed instruments are not necessary for left‐handed trainees; most left‐handed trainees have experienced discrimination or negativity due to their laterality; ambidexterity is considered an advantage; communicating one's laterality is important; a formal mentoring program is not necessary; and simulation can be a complementary tool for left‐ handed trainees. Being a left‐handed surgical trainee need not be a negative experience. Conclusion: With appropriate support and teaching, left‐handed trainees can develop into excellent surgeons. The themes from this study can be used by trainees, trainers and Colleges of surgical training to build awareness and optimize the training of future left‐handed surgeons. [ABSTRACT FROM AUTHOR]

Background: Despite advances in medical management and endoscopic therapy, gastrectomy remains an important yet high‐risk procedure for a range of benign and malignant upper gastrointestinal pathologies. No study has previously analysed Australian gastrectomy perioperative mortality rate (POMR). This retrospective, population‐based cohort study was conducted to determine the Australian national gastrectomy POMR, allowing state‐based and regional trends and outcomes to be assessed. Methods: Logistic regression models were compared using de‐identified procedural data between 1 July 2005 and 30 June 2017 from the Australian Institute of Health and Welfare. Codes relating to total and subtotal gastrectomy contained in the Australian Classification of Health Interventions were used to extract patient data. Mortality rates were risk adjusted for age and gender. Temporal trends and differences between states/territories and regions were investigated. Results: The national average POMR throughout the study period was 2.1%. For subtotal gastrectomy, the national mean POMR was 1.1%, decreasing from 2.7% (2005) to 1.3% (2017). For total gastrectomy, the national mean POMR was 2.8%, decreasing from 3.3% (2005) to 1.7% (2017). POMR significantly reduced over time without variation between states or regions. Procedure volume steadily reduced in rural centres with a concomitant increase in metropolitan centres over time. Conclusion: Pleasingly, the Australian gastrectomy POMR is favourable when compared to international cohorts. Improved outcomes were consistent between states and territories, and metropolitan and regional centres. Progressive metropolitan centralization of gastrectomy was demonstrated without evidence of improved outcomes. [ABSTRACT FROM AUTHOR]

Background: Interhospital transfers in Australia facilitate access to acute surgical services, however transfer delays can occur. The aims of this study were to examine Australian mortality audit data on acute surgical patients who were transferred after presenting with a surgical emergency, and to identify modifiable predictors of transfer delay. Methods: Surgical admissions between 1 January 2001 and 18 August 2020 were retrospectively extracted from the Australian and New Zealand Audit of Surgical Mortality database. Relevant factors and themes of interest were collated. Results were presented as odds ratios (OR) and 95% confidence intervals (CI), with statistical significance defined as P <0.05. Results: After exclusion, a final 8270 cases were analysed. Non‐modifiable predictors identified were female gender (OR 1.34, 95% CI 1.05–1.70, P = 0.0184), comorbidities (OR 1.50, 95% CI 1.40–161, P <0.0001) and major non‐trauma non‐vascular specialty (OR 1.54 to 7.77, depending on specialty, P < 0.05). Modifiable predictors were inadequate clinical assessment (OR 49.48, 95% CI 32.91–74.38, P <0.0001), poor communication (OR 6.62, 95% CI 3.70–11.85, P <0.0001) and multiple transfers (OR 6.30, OR 95% 4.31–9.21, P <0.0001). Age, lack of bed and after‐hours transfer did not predict transfer delays. Metropolitan transfers was protective against transfer delays (OR 0.64, 95% CI 0.47–0.86, P = 0.0035). Conclusion: In the view of the receiving surgeon or assessor, all transfer delays potentially contributed to patient deaths, and may have been preventable. Strategies directed at modifiable factors could minimize delays. Increased surgical services in non‐metropolitan regions could reduce need for transfer. Prospective data is required to examine if the same predictors are observed in surgical patients who survive. [ABSTRACT FROM AUTHOR]

Background: Anaphylaxis is a severe, potentially life-threatening generalized or systemic hypersensitivity reaction. Sequential reports have cited anaphylaxis as the most common cause of anaesthesia-related deaths. We undertook an audit at a quaternary centre, examining the management of perioperative anaphylaxis and quality of referrals made to our anaesthesia allergy testing service., Methods: The data of 41 patients consulted at St Vincent's Hospital Melbourne for perioperative anaphylaxis between 17th of January 2020 and 20th of January 2022 were analysed. Intervention outcomes included total intravenous fluid administered, adrenaline administration, instigation of CPR and the collection and the timing of serum tryptase samples. We also assessed referral quality, provision of institutional allergy alert and time elapsed from the anaphylaxis event to allergy testing. Contemporaneous Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) guidelines were used as the reference standard for most outcomes., Results: Our data reveals compliance of <80% with respect to intravenous fluid administration, referral quality and tryptase sampling, particularly at the 4-h timepoint., Conclusion: Surgical leadership and patient advocacy in the post-acute phase would likely facilitate requisite testing and improve the quality of counselling. We recommend institutions adopt a case-by-case review of management compliance with recommendations. Additionally, we advocate for the inclusion of a prompt to the ANZAAG referral form, that encourages the operator to update their patient's institutional allergy alert while awaiting allergy testing., (© 2023 Royal Australasian College of Surgeons.)

Background: Multiple cancer registries in Australia are used to track the incidence of cancer and the outcomes of their treatment. These registries can be broadly classed into a few types with an increasing number of registries comes a greater potential for collaboration and linkage. This article aims to critically review cancer registry types in Australia and evaluate the Australian Cancer registry landscape to identify these areas., Methods: A systematic review was performed through MEDLINE, EMBASE and Cochrane Library, updated to September 2022 using a predefined search strategy. Inclusion criteria were those that only analysed Australian and/or New Zealand based cancer registries, appraised the utility of cancer outcomes and/or incidence registries, and explored the utility of linked databases using cancer outcomes and/or incidence registries. The grey literature was searched for all operating cancer registries in Australia. Details of registry infrastructure was extracted for analysis and comparison., Results: Three thousand two hundred and sixteen articles identified from the three databases. Twelve met the inclusion criteria. Twenty-eight registries were identified using the grey literature. Strengths and weaknesses of Cancer Outcome Registries(COR) and Cancer Incidence Registries(CIR) were compared. Data linkage between registries or with other healthcare databases show great benefits in improving evidence for cancer research but are challenging to implement. Both registry types utilize differing modes of administration, influencing their accuracy and completeness., Conclusion: Outcome registries provide detailed data but their weakness lies in incomplete data coverage. Incidence registries record a large dataset which contain inaccuracies. Improving coverage of quality outcome registries, and quality assurance of data in incidence registries is required to ensure collection of accurate, meaningful data. Areas for collaboration identified included establishment of defined definitions and outcomes, data linkage between registry types or with healthcare databases, and collaboration in logistical planning to improve clinical utility of cancer registries., (© 2023 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons.)

Background: The importance of gender diversity is well recognized. Despite promising change in addressing gender disparity, there remains a significant gap in women's representation in urology. Worldwide, a lack of diversity has been observed at scientific meetings. This study analyses the trend in women's representation at the Urological Society of Australia and New Zealand Annual Scientific Meeting (USANZ ASM) over the last nine years., Method: We retrospectively collected data from eight conference programs between 2014 and 2022, evaluating the trend in the proportion of women represented in various sections. A difference of proportions test was performed to determine whether a significant change was seen from year to year., Results: A significant increase in women's representation was observed, the most significant increase was evident in the last three years, chairpersons increased from 5.9% to 44.1% (P = 0.003), international speakers from 11.7% to 39.1% (P ≤ 0.001), expert speakers from 19.1% to 42.0% (P = 0.002), and total speakers from 19.5% to 34.7% (P ≤ 0.001)., Conclusion: Our study shows that a significant increase in the representation of women at the USANZ ASM has been achieved over the last three years. Unfortunately, this increase in representation has not been mirrored in the number of women trainees and training applicants. Additionally, this increase in representation well exceeds the proportion of women who are USANZ members, and is unevenly distributed across topics. A positive change has been observed, the challenge remains in dealing with unconscious bias and balancing the fine line between inclusivity and tokenism., (© 2023 Royal Australasian College of Surgeons.)