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Background Multiparametric magnetic resonance imaging (mpMRI) of the prostate appears to improve prostate cancer detection, but studies comparing mpMRI to histopathology at the time of radical prostatectomy (RP) are lacking. This retrospective study determined the accuracy of mpMRI predicting Gleason score and index lesion location at the time of RP, the current gold standard for diagnosis. Methods Between April 2013 and April 2016, a database of all men aged more than 40 years who underwent RP after positive transrectal ultrasound biopsy by an experienced urological surgeon was collated at a single regional centre. This was cross-referenced with a database of all men who had mpMRIs performed at a single centre and reported according to Prostate Imaging Reporting and Data System (PI-RADS version 1) during this period to generate a sample size of 64 men. A Spearman's rho test was utilized to calculate correlation. Results Median age of patients was 64 years, the median prostate-specific antigen at RP was 6.22 ng/mL. mpMRI was positive (≥PI-RADS 3) in 85.9% of patients who underwent RP. More than 92% of participants had Gleason ≥7 disease. A positive relationship between mpMRI prostate PI-RADS score and RP cancer volume was demonstrated. An anatomical location correlation calculated in octants was found to be 89.1% accurate. Conclusion mpMRI accurately detects prostate cancer location and severity when compared with gold standard histopathology at the time of RP. It thus has an important role in planning for future prostate biopsy and cancer treatment.

BACKGROUND Obesity prevalence is increasing in Australia, particularly in non-metropolitan areas. The effect of obesity on acute surgical outcomes is not known. We aimed to record waist circumference (WC) (surrogate for obesity) amongst acute surgical unit (ASU) patients in a New South Wales regional hospital, and compare outcome measures (length of stay (LOS), unplanned return to theatre, readmission rates, intensive care unit (ICU) admission and mortality). METHODS Retrospective cohort study of 4 months of consecutive ASU admissions, excluding age

Multiparametric magnetic resonance imaging (mpMRI) of the prostate appears to improve prostate cancer detection, but studies comparing mpMRI to histopathology at the time of radical prostatectomy (RP) are lacking. This retrospective study determined the accuracy of mpMRI predicting Gleason score and index lesion location at the time of RP, the current gold standard for diagnosis.Between April 2013 and April 2016, a database of all men aged more than 40 years who underwent RP after positive transrectal ultrasound biopsy by an experienced urological surgeon was collated at a single regional centre. This was cross-referenced with a database of all men who had mpMRIs performed at a single centre and reported according to Prostate Imaging Reporting and Data System (PI-RADS version 1) during this period to generate a sample size of 64 men. A Spearman's rho test was utilized to calculate correlation.Median age of patients was 64 years, the median prostate-specific antigen at RP was 6.22 ng/mL. mpMRI was positive (≥PI-RADS 3) in 85.9% of patients who underwent RP. More than 92% of participants had Gleason ≥7 disease. A positive relationship between mpMRI prostate PI-RADS score and RP cancer volume was demonstrated. An anatomical location correlation calculated in octants was found to be 89.1% accurate.mpMRI accurately detects prostate cancer location and severity when compared with gold standard histopathology at the time of RP. It thus has an important role in planning for future prostate biopsy and cancer treatment.

Background Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in orthopaedic surgery. While specific guidelines exist for hip and knee arthroplasty, there is wide variation in VTE prophylaxis in complex spinal surgery. This study sought to determine the incidence of VTE, and risk factors associated with VTE, in patients undergoing elective instrumented posterior lumbar spinal fusion. Methods In a single-centre case series study, 107 consecutive patients undergoing elective lumbar spinal fusion were evaluated for VTE by lower limb duplex ultrasonography and/or clinical observation, and where indicated, computed tomography pulmonary angiogram. The Caprini model for thrombosis risk factor assessment was retrospectively applied to grade levels of VTE risk, which were compared with overall VTE incidence. Results All patients were operated on a spinal frame and received mechanical prophylaxis (thromboembolic deterrent stockings and sequential calf-compression devices). Thirty-seven per cent also received chemoprophylaxis with low-molecular-weight heparin (LMWH). There was no significant relationship between LMWH use and protection from VTE. Risk scores ≥3 (high/highest risk categories) were observed in 96.2% of patients. Four (3.7%) patients encountered a VTE complication (all with no chemoprophylaxis), either deep vein thrombosis (1.9%) or pulmonary embolism (1.9%). No patients sustained an epidural haematoma. Conclusion Although patients undergoing elective instrumental posterior lumbar spinal fusion are at high risk of developing VTE, the actual incidence of VTE in these patients is low. Our data support the use of mechanical prophylaxis with thromboembolic deterrent stockings and sequential calf-compression devices to prevent VTE in these patients.

Obesity prevalence is increasing in Australia, particularly in non-metropolitan areas. The effect of obesity on acute surgical outcomes is not known. We aimed to record waist circumference (WC) (surrogate for obesity) amongst acute surgical unit (ASU) patients in a New South Wales regional hospital, and compare outcome measures (length of stay (LOS), unplanned return to theatre, readmission rates, intensive care unit (ICU) admission and mortality).Retrospective cohort study of 4 months of consecutive ASU admissions, excluding age16, pregnancy, out-of-area transfer and incomplete data. Patients were classified according to World Health Organization WC definitions as high-risk or non-high-risk (increased-risk and no-risk).Of 695 admissions, 512 met the inclusion criteria (47.1% female, average age 52.8 years (SD 22.3)), with 85.1% (P 0.001) of females and 69.4% (P = 0.166) of males having an increased- or high-risk WC. This compares to rates amongst inner regional populations of 71.0% (female) and 66.4% (male). LOS was longer for high-risk patients (5.0 days versus 3.7 days, P = 0.002). However, the mean age of high-risk patients was greater (56.6 years versus 46.9 years, P = 0.001) and LOS was longer for those aged ≥60 (P 0.001). After controlling for age, high-risk WC was not associated with any outcome measure, except amongst ICU admissions, where high-risk patients stayed longer (15.5 days versus 6.8 days, P 0.001).Increased- and high-risk WC was overrepresented amongst female ASU patients. High-risk WC was associated with a significantly greater LOS in patients admitted to ICU. High-risk WC was not associated with other outcomes independent of age. WC is useful for quantifying obesity in the inpatient setting.

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in orthopaedic surgery. While specific guidelines exist for hip and knee arthroplasty, there is wide variation in VTE prophylaxis in complex spinal surgery. This study sought to determine the incidence of VTE, and risk factors associated with VTE, in patients undergoing elective instrumented posterior lumbar spinal fusion.In a single-centre case series study, 107 consecutive patients undergoing elective lumbar spinal fusion were evaluated for VTE by lower limb duplex ultrasonography and/or clinical observation, and where indicated, computed tomography pulmonary angiogram. The Caprini model for thrombosis risk factor assessment was retrospectively applied to grade levels of VTE risk, which were compared with overall VTE incidence.All patients were operated on a spinal frame and received mechanical prophylaxis (thromboembolic deterrent stockings and sequential calf-compression devices). Thirty-seven per cent also received chemoprophylaxis with low-molecular-weight heparin (LMWH). There was no significant relationship between LMWH use and protection from VTE. Risk scores ≥3 (high/highest risk categories) were observed in 96.2% of patients. Four (3.7%) patients encountered a VTE complication (all with no chemoprophylaxis), either deep vein thrombosis (1.9%) or pulmonary embolism (1.9%). No patients sustained an epidural haematoma.Although patients undergoing elective instrumental posterior lumbar spinal fusion are at high risk of developing VTE, the actual incidence of VTE in these patients is low. Our data support the use of mechanical prophylaxis with thromboembolic deterrent stockings and sequential calf-compression devices to prevent VTE in these patients.