Search

Background: The frequency of oxycodone adverse reactions, subsequent opioid prescription, effect on pain and patient care in general surgery patients are not well known. This study aimed to determine prevalence of documented oxycodone allergy and intolerances (independent variables) in a general surgical cohort, and association with prescribing other analgesics (particularly opioids), subjective pain scores, and length of hospital stay (dependent variables). Methods: This retrospective cohort study included general surgery patients from two South Australian hospitals between April 2020 and March 2022. Multivariable logistic regression evaluated associations between previous oxycodone allergies and intolerances, prescription records, subjective pain scores, and length of hospital stay. Results: Of 12 846 patients, 216 (1.7%) had oxycodone allergies, and 84 (0.7%) oxycodone intolerances. The 216 oxycodone allergy patients had lower odds of receiving oxycodone (OR 0.17, P < 0.001), higher odds of tramadol (OR 3.01, P < 0.001) and tapentadol (OR 2.87, P = 0.001), but 91 (42.3%) still received oxycodone and 19 (8.8%) morphine. The 84 with oxycodone intolerance patients had lower odds of receiving oxycodone (OR 0.23, P < 0.001), higher odds of fentanyl (OR 3.6, P < 0.001) and tramadol (OR 3.35, P < 0.001), but 42 (50%) still received oxycodone. Patients with oxycodone allergies and intolerances had higher odds of elevated subjective pain (OR 1.60, P = 0.013; OR 2.36, P = 0.002, respectively) and longer length of stay (OR 1.36, P = 0.038; OR 2.24, P = 0.002, respectively) than patients without these. Conclusions: General surgery patients with oxycodone allergies and intolerances are at greater risk of worse postoperative pain and longer length of stay, compared to patients without. Many still receive oxycodone, and other opioids that could cause cross‐reactivity. [ABSTRACT FROM AUTHOR]

Background: The applicability of the vital signs prompting medical emergency response (MER) activation has not previously been examined specifically in a large general surgical cohort. This study aimed to characterize the distribution, and predictive performance, of four vital signs selected based on Australian guidelines (oxygen saturation, respiratory rate, systolic blood pressure and heart rate); with those of the MER activation criteria. Methods: A retrospective cohort study was conducted including patients admitted under general surgical services of two hospitals in South Australia over 2 years. Likelihood ratios for patients meeting MER activation criteria, or a vital sign in the most extreme 1% for general surgery inpatients (<0.5th percentile or > 99.5th percentile), were calculated to predict in‐hospital mortality. Results: 15 969 inpatient admissions were included comprising 2 254 617 total vital sign observations. The 0.5th and 99.5th centile for heart rate was 48 and 133, systolic blood pressure 85 and 184, respiratory rate 10 and 31, and oxygen saturations 89% and 100%, respectively. MER activation criteria with the highest positive likelihood ratio for in‐hospital mortality were heart rate ≤ 39 (37.65, 95% CI 27.71–49.51), respiratory rate ≥ 31 (15.79, 95% CI 12.82–19.07), and respiratory rate ≤ 7 (10.53, 95% CI 6.79–14.84). These MER activation criteria likelihood ratios were similar to those derived when applying a threshold of the most extreme 1% of vital signs. Conclusions: This study demonstrated that vital signs within Australian guidelines, and escalation to MER activation, appropriately predict in‐hospital mortality in a large cohort of patients admitted to general surgical services in South Australia. [ABSTRACT FROM AUTHOR]

Research guides evidence-based general surgery practice, advocacy, policy and resource allocation, but is seemingly lacking representation from those countries with greatest disease burden and mortality. Accordingly, we conducted a geographic study of publications in the most impactful general surgery journals worldwide. The six general surgery journals with the highest 2020 impact factors were selected. Only journals specific to general surgery were included. For all original articles over the past five years, the affiliated country and city were extracted for the first, second and last author. Number of publications were adjusted per capita, and compared to Human Development Index (HDI) using logistic regression. 8274 original articles were published in the top six ranked general surgery journals over 2016–2020, with 24,332 affiliated authors. Authors were most commonly associated with the US (27.88%), Japan (9.09%) and China (8.46%), or per capita, The Netherlands, Sweden and Singapore. There is a linear association between publishing in a top six journal and HDI of country of affiliation. Just four publications were from medium or low HDI countries over the period. Authorship in leading general surgery journals is predominantly from wealthy, Western countries. Authorship is associated with affiliation with a high HDI country, with few authors from medium or low HDI countries. There is a lack of representation in literature from Africa, Russia, and parts of Southeast Asia, and thus a lack of locally relevant evidence to guide surgical practice in these areas of high disease burden and low life expectancy. • Authorship in leading general surgery journals is largely from Western countries • Linear association between publishing in a top 6 journal and HDI • Lack of representation in literature from Africa, Russia, and parts of SE Asia • Limited locally relevant evidence in these areas of high disease burden [ABSTRACT FROM AUTHOR]

The Internet is an extensively used source of medical education by the public. In particular, YouTube is a valuable source of information which can be used to improve patient education. However, there is no quality assurance regime for YouTube videos pertaining to medical education. In this study, we aimed to evaluate the quality and accuracy of videos regarding inguinal hernia repair. Two hundred videos were searched for and viewed on YouTube from the phrases: 'inguinal hernia repair,' 'patient information for inguinal hernia repair,' and 'hernia operation.' After the application of predefined exclusion criteria, 23 videos were selected and the following data were collected: number of views, duration since video was posted, and the number of likes, dislikes, and comments. The educational quality was rated using three scoring systems: Health on the Net code, Journal of the American Medical Association, and DISCERN scoring systems. All three scoring systems have been previously used to evaluate online videos; however, they have not been formally validated. The videos were of low quality when using the Health on the Net code, Journal of the American Medical Association, and DISCERN scoring systems. There was no association between video quality as measured by any of the scoring systems and the number of views. The number of days online was independently predictive of the number of views (P = 0.044) and explained 18% of the variance in views. Likewise, there was no significant association between video quality and video length. YouTube videos on inguinal hernia repair are of low quality and accuracy. However, the potential of using YouTube to educate patients cannot be ignored. [ABSTRACT FROM AUTHOR]