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Background: Unplanned return to theatre (URTT) is associated with longer hospital stay and higher mortality rates, placing extra burden on hospital resources. There is a lack of literature analysing causes of URTT in a rural general surgery department. This knowledge may be important to help identify patients at risk of URTT. This study aims to identify causes of URTT in rural general surgical patients. Methods: This is a retrospective multicenter cohort involving four rural South Australian (SA) hospitals: Mount Gambier (MGH), Whyalla (WH), Port Augusta (PAH), and Port Lincoln (PLH). All general surgical inpatients admitted from February 2014 to March 2020 were analysed to identify all‐cause of URTT. Results: Of the 44 191 surgical procedures performed, there were 67 (0.15%) URTT. The most common surgical subspecialty cases that resulted in URTT were Colorectal (47.1%), General surgery (33.2%) Plastics (9.8%), and Hepatopancreatico‐biliary (3.9%). The three commonest operations during URTT were washouts 22 (32.8%), interventions for haemostasis 11 (16.4%) and bowel resections 9 (13.4%). Sixteen (24%) of URTT followed emergency surgery. When comparing between elective and emergency admissions needing URTT, there were no statistical difference in age, gender, speciality type, types of surgery performed, and median number of days until URTT. Conclusion: Rates of URTT are low in South Australian rural hospitals when compared to our overseas counterpart. A wide range of surgery is being performed in rural centres, further supporting the need for rural surgical trainees to have a tailored curriculum encompassing subspecialities and being competent in managing any potential complications. [ABSTRACT FROM AUTHOR]

Background: There is a shortage of surgeons caring for the 33% of Australians residing in rural and regional areas. In order to help appreciate what rural general surgery entails and optimize training for aspiring rural surgeons, the aim of this study was to analyse the general surgical departments' procedural caseload and casemix in four rural South Australian hospitals. Methods: This is a retrospective multi‐centre study involving four rural surgical centres in South Australia (Mt Gambier, Whyalla, Port Augusta, and Port Lincoln). Surgical procedures performed from 2014–2020 were extracted from departmental audits. To identify trends of surgical procedure over time, the data was divided into three time periods (Period 1: February 2014–December 2015, Period 2: January 2016–December 2017, Period 3: January 2018–March 2020). Results: A total of 44 191 surgical procedures were performed, 70.2% being day procedures. 54% were endoscopic procedures, 46% were operative procedures. 60.6% of the operative procedures were general surgery procedures. 28.5% were general surgery‐based subspecialty (colorectal, hepato‐pancreato‐biliary, upper gastrointestinal, and breast). 10.9% were non‐general surgery‐based subspecialty (urology, plastics, vascular, orthopaedics, head and neck, and obstetrics and gynaecology). There were no statistically significant fluctuations in procedure caseload in all aspects (endoscopic and operative procedures) over the three time periods. Conclusion: The majority of a rural Australian general surgeon's procedures are endoscopic. Operative procedures are mainly general surgery based. It may be beneficial to equip aspiring rural general surgeons to manage basic non‐general surgery procedures (urological, vascular, and orthopaedic). [ABSTRACT FROM AUTHOR]

Background: There are limited opportunities for surgeons to engage in active learning programs once they achieve Fellowship, especially for non‐technical skills such as communication. This study aims to address this gap by evaluating a peer‐based coaching program in non‐technical skill using video‐recorded patient consultations from a routine outpatient clinic. Methods: Standard outpatient consultations between consultant surgeons and patients were video recorded. The surgeon viewed the videos with a peer‐coach (senior surgeon) who helped identify areas of strength and areas for improvement. To test the effect of the coaching session, outpatient consultations were recorded roughly 1 month later. Pre and post‐coaching videos were assessed using the Maastricht History‐Taking and Advice Scoring – Global Rating List (MAAS), a common tool for evaluating non‐technical skills in clinicians. Results: A total of 12 surgeons consented to participate. Coaching significantly improved MAAS scores (mean difference = −0.61; 95% CI (−0.88, −0.33); P < 0.0001). Surgeons were generally positive about the experience. All found the method of learning suitable, and most thought the process improved their skills. Most thought that coaching would improve patient outcomes and the majority thought they would participate in ongoing coaching as part of their employment. Conclusion: This supports the concept of surgical coaching as an effective tool to improve communication skills and the quality of surgical consultation. The next step is to expand beyond a voluntary cohort and link surgical coaching to improved patient outcomes. We sought to understand if a peer‐based coaching program can better the non‐technical skills of surgeons in the outpatient clinic environment. This interventional pilot study assessed 12 surgeons and was conducted at The Queen Elizabeth Hospital (TQEH) in Adelaide, Australia. Our results support the concept that a video‐based peer‐coaching program can act as an effective tool to improve the communication skills of consultant surgeons and improve the quality of surgical consultation. [ABSTRACT FROM AUTHOR]

Background: Rural general surgery is faced with a shortage of resident surgeons in many parts of Australia. Although it is accepted that an undergraduate rural exposure favourably influences graduates to undertake rural practice, it is not known whether postgraduate terms exert a similar effect. Method: Advanced general surgical trainees in 2000 were rotated for 1-month terms to Whyalla, a major provincial centre in South Australia. The trainees were asked to complete a questionnaire before and after the rotation. Results: A total of nine trainees completed a rural term in Whyalla. Eight questionnaires were returned prior to the rotation and seven following the time in Whyalla. The overall experience, and the teaching standards and pathology experienced were rated highly but the term had little effect in changing trainee’s attitudes towards eventual practice location. Conclusion: Postgraduate surgical terms in South Australia are a relatively new phenomenon compared to other states in Australia. Without a foundation in rural surgery at an undergraduate level, surgical terms for trainees, despite being of high quality, might not be very successful in influencing graduates to practise surgery in rural locations. [ABSTRACT FROM AUTHOR]

Background: The majority of patients with liver trauma can be managed conservatively. However, the unstable patient requires emergency laparotomy to control bleeding. Controversy exists regarding the primary surgical management of these injuries. This is of particular relevance for the isolated rural general surgeon. Methods: The literature was reviewed by searching MEDLINE databases from 1966 to the present time. The majority of the evidence presented is level 3, with interpretations and recommendations based on the experience of the senior authors. Results: In the majority of patients, conservative management remains the mainstay of treatment. However, haemodynamic ­instability requires urgent laparotomy. Perihepatic packing should be used to arrest bleeding. Primary anatomical resection is rarely indicated, especially in non-specialist centres. Conclusion: In the remote rural setting, severe liver trauma remains a daunting condition for the general surgeon to manage. Primary surgical treatment should be perihepatic packing, stabilization and urgent transfer; there is no place for primary anatomical resection outside specialist units. [ABSTRACT FROM AUTHOR]