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Background: Although modern Australian healthcare systems provide patient‐centred care, the ability to predict and prevent suboptimal post‐procedural outcomes based on patient demographics at admission may improve health equity. This study aimed to identify patient demographic characteristics that might predict disparities in mortality, readmission, and discharge outcomes after either an operative or non‐operative procedural hospital admission. Methods: This retrospective cohort study included all surgical and non‐surgical procedural admissions at three of the four major metropolitan public hospitals in South Australia in 2022. Multivariable logistic regression, with backwards selection, evaluated association between patient demographic characteristics and outcomes up to 90 days post‐procedurally. Results: 40 882 admissions were included. Increased likelihood of all‐cause, post‐procedure mortality in‐hospital, at 30 days, and 90 days, were significantly associated with increased age (P < 0.001), increased comorbidity burden (P < 0.001), an emergency admission (P < 0.001), and male sex (P = 0.046, P = 0.03, P < 0.001, respectively). Identification as ATSI (P < 0.001) and being born in Australia (P = 0.03, P = 0.001, respectively) were associated with an increased likelihood of 30‐day hospital readmission and decreased likelihood of discharge directly home, as was increased comorbidity burden (P < 0.001) and emergency admission (P < 0.001). Being married (P < 0.001) and male sex (P = 0.003) were predictive of an increased likelihood of discharging directly home; in contrast to increased age (P < 0.001) which was predictive of decreased likelihood of this occurring. Conclusions: This study characterized several associations between patient demographic factors present on admission and outcomes after surgical and non‐surgical procedures, that can be integrated within patient flow pathways through the Australian healthcare system to improve healthcare equity. [ABSTRACT FROM AUTHOR]

Background: Interhospital transfers of surgical patients are an independent risk factor for mortality. The Australian and New Zealand Audit of Surgical Mortality (ANZASM) aims to improve surgical care through assessment of all cases of surgical mortality. This study aimed to describe common clinical management issues that contributed to interhospital transfer patient mortality. Methods: Data for all surgical patient mortality in Australia (except New South Wales) that underwent interhospital transfer between 1 January 2010 and 31 December 2019 were extracted from ANZASM. The surgeons' reports and assessors' evaluations were examined to identify clinical management issues. Thematic analysis was performed to develop pertinent themes and subthemes. Results: Some 8679 patients were identified over the 10-year period. Of these, 2171 (25.0 per cent) had 3259 clinical management issues identified. Prominent themes were operative design (n = 466, 14.3 per cent), decision to operate (n = 425, 13.0 per cent), medical conditions (n = 344, 10.6 per cent), diagnosis (n = 326, 10 per cent), transfer (n = 293, 10.0 per cent), intraoperative issues (n = 278, 8.5 per cent), inadequate assessment (n = 238, 7.3 per cent), communication (n = 224, 6.9 per cent), delay in recognizing complications (n = 180, 5.5 per cent), coagulopathy (n = 151, 4.6 per cent), insufficient monitoring (n = 127, 3.9 per cent), infection (n = 107, 3.3 per cent), and hospital resources (n = 100, 3.1 per cent). Assessors considered 58.4 per cent of clinical management issues (n = 1903) probably or definitely preventable. Conclusion: This study identified 13 themes of potentially avoidable management issues present in surgical mortality following interhospital transfers. Quality-improvement initiatives targeting these areas may improve surgical patient outcomes. [ABSTRACT FROM AUTHOR]

The article discusses the translational benefits of space medicine for rural and remote perioperative medicine. Topics include ways high-quality perioperative medicine improves the patient experience of surgery, considerations that need to be made regarding the requirements needed to allow remote perioperative medicine to mirror the advancements in space medicine, and significance of the delivery of high-qualitative perioperative care in Australian rural and remote medicine.

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: Older Australians are major health service users and early diagnosis is key in the management of their health. Radiological services are an important component of diagnosis and disease management planning in older Australians, but their national utilisation of diagnostic services has never been investigated in Australia.Purpose: This study aims to evaluate the utilisation of major plain X-rays by Australians ≥ 65 years old.Methods: A population-based epidemiological evaluation and yearly cross-sectional analyses of X-ray examinations per 1,000 Australians aged ≥ 65 years old between 2009 and 2019 were conducted using publicly available Medicare Benefits Schedule and Australian Bureau of Statistics data sources. Age and sex specific incidence rate (IR) of plain X-rays per 1,000 Australians, adjusted incidence rate ratios (IRR) and 95% confidence intervals (CI) were estimated using a negative binomial regression model.Results: During the study period, the Australian population over 65 years old increased by 39% while the crude plain X-ray utilisation by this population increased by 63%. Most X-rays were conducted on extremities or the chest. Men used chest radiography more than women, and particularly for lungs, where the incidence increased the most in those ≥ 85 years old. There was an increase in X-rays of extremities and the hip joint between 2009-10 and 2013-14 in people ≥ 85 years old.Conclusion: The utilisation of plain X-rays of the chest, the gastro-intestinal tract and extremities was high and has increased among older Australians between 2009-10 and 2018-19. Plain X-rays remain a commonly used diagnostic tool for conditions affecting the older population. [ABSTRACT FROM AUTHOR]

The article presents a prospective study which aims to assess the quality of rural colonoscopy service at the Mount Gambier and Districts Health Service in South Australia. The hospital provides outreach endoscopy and colonoscopy service to neighboring towns. Topics include the low incidence of mortality among colorectal cancer (CRC) patients in the country due to programs like the colonoscopy service and the National Bowel Cancer Screening Program (NBCSP).

Background: In under-resourced settings, general surgeons may be called upon to perform emergency operations within other specialties. Accordingly, we aimed to characterise patient outcomes after emergency neurosurgery performed by a general surgeon or general surgery trainee. Methods: PubMed, Embase and the Cochrane Library were searched to 30 May 2021 for observational studies reporting outcomes after emergency neurosurgery performed by a general surgeon. Study screening, data extraction, and risk of bias using the Downs and Black checklist were performed in duplicate. Data on setting, operation undertaken, mortality rates and complications were extracted. Meta-analysis was planned but not possible due to heterogeneity. This study is registered with PROSPERO, CRD42021258097. Results: From 632 records, 14 retrospective observational studies were included, covering a total sample of 1,988 operations. Four studies were from Australia, and the remaining 10 were, respectively, from 10 other countries. Most common operations performed were decompressive surgery with burr holes or craniectomy for head trauma and insertion of intracranial pressure monitors. Rural hospitals were the most common settings. Mortality rates for procedures performed by general surgeons at latest follow-up were heterogenous, ranging from 5% for evacuation of chronic subdural haematoma in Kenya to 81% in head injured patients in a Hong Kong study. Conclusions: This is the first systematic review that synthesises the literature to characterise patient outcomes after neurosurgical operations performed by a general surgeon. Findings from this study may benefit global surgery performed in rural, remote, military or humanitarian settings. [ABSTRACT FROM AUTHOR]

Background: Surgical outpatient consultations are demanding for the surgeon and patients without a definite formula for success. Various factors have been identified regarding factors that influence patient satisfaction and engagement. We aimed to examine the modern-day surgical outpatient consultation and report on these factors. Methods: An observational cross-sectional study was performed by reviewing video recordings of 182 surgical consultations by 12 surgeons at The Queen Elizabeth Hospital, South Australia, Australia. Results: The mean consultation time was 12.3 min, with pre-surgical consultations being the longest. There were 107 consultations for benign conditions (58%). Proportionally, the consultant spoke most (51.9% of total consultation time), followed by the patient (19.5%) and then companion (8.2%). Forty-eight (26.4%) patients brought a companion to the clinic but monopolisation of the consultation by the companion was rare. When a companion was present, there was more mutual eye gaze between the consultant and the patient. Interruptions were present in 23.6% of consultations and were associated with a significant increase of the length of the consultation. Table positioning did not seem to affect the dynamics of the outpatient consultation. Conclusion: Companions are highly valuable for promoting patient engagement and their presence should be encouraged in surgical outpatients. Interruptions should be kept to a minimum to avoid unnecessary delays. Further studies should be conducted to investigate the effect of companions, interruptions and table positioning during a consultation on patient outcomes. [ABSTRACT FROM AUTHOR]

Background: This study systematically reviewed the literature regarding perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair, including an audit of the Royal Australasian College of Surgeons (RACS) Australian and New Zealand Audit of Surgical Mortality (ANZASM) database. Methods: A systematic review was conducted in accordance with PRISMA guidelines for the reporting of systematic reviews and meta‐analysis of observational studies. Cochrane Library, PubMed, MEDLINE and Embase database searches and data extraction were conducted from June 1979 to October 2019. Statistical analysis was undertaken utilising denominator values for elective hernia procedures derived from the Australian Institute of Health and Welfare (AIHW) data. Risk‐adjusted perioperative mortality rates for the relevant procedures were also produced, using a binary logistic regression for the risk adjustment. Results: Through systematic review of the literature, it was established that the overall reported perioperative mortality in human adults undergoing elective surgical abdominal wall hernia repair was low (0.1%–0.5%). Using ANZASM and AIHW data, the calculated risk‐adjusted mortality rate for Australian patients was found to be significantly lower (0.04%–0.06%, p < 0.001). Conclusion: The risk‐adjusted mortality rate for elective abdominal wall hernia surgery in Australia is very low and compares favourably to international cohorts. Despite low absolute numbers, the factors which were most significantly associated with increased perioperative mortality in patients undergoing elective surgical abdominal wall hernia repair were increased age, cardiorespiratory co‐morbidity and incisional hernia repair. [ABSTRACT FROM AUTHOR]

Background: Cholecystectomy is a commonly performed procedure; however, it is not without risks. It is crucial to constantly audit surgical outcomes in order to improve quality of care. The aim of this retrospective population-based cohort study is to identify preventable issues of clinical management associated with adverse occurrences in order to reduce mortality of cholecystectomy patients. Methods: Data were obtained from the Australian and New Zealand Audit of Surgical Mortality (ANZASM). It encompasses peer-reviewed first and second line assessments of management of cholecystectomy patients who died from 2005 to 2015 in Australia. Clinical Management Issues (CMIs) were identified from text in assessments and grouped into communication failures, pre-operative, intra-operative and post-operative categories. These were further classified into subthemes using thematic analysis with a data-driven approach. Results: There were 359 deaths in the study period. CMIs were present in 71 cases, with a reported total of 124 concerns or adverse events. Post-operative CMIs were the most prevalent issue [50% (62/124)], with the most common theme being delay to recognise complications (19/124). Pre-operative concerns were the second most common (n = 34). Decision to operate was questioned in 14 cases, and delay to surgery was reported in 12 cases. Conclusion: ANZASM analysis has allowed us to identify modifiable adverse occurrences. This audit shows that delay to recognise complications is the most common assessment recorded. Preventive measures should be taken to improve outcomes and reduce peri-operative mortality, with an emphasis on post-operative management and enhancing communication between members of the multidisciplinary team. [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]

The article informs that Australian Medical Services Advisory Committee recommended the listing of a Medicare Benefits Schedule (MBS) rebate for the call out fee for mobile X-ray services in aged care facilities for conditions that contribute to hospitalisation risk of older individuals. It mentions mobile radiology services utilisation by aged care residents.

Background: This study aimed to identify the most common potentially avoidable factors in urology deaths, focusing on the lessons that can be learnt. Methods: This study analysed data from a well‐established and comprehensive peer review audit of surgical deaths in Australian hospitals (excluding New South Wales) from 2009 to 2015, focusing on urology cases with identified areas for improvement in patient management. Of all audited deaths, 11% (79/719) had serious clinical management issues with a total of 109 individual clinical management issues identified. These were categorized based on perioperative stage (preoperative, intraoperative or post‐operative), followed by thematic analysis within each stage. Results: The study found preoperative issues to be the most common (n = 48), followed by post‐operative issues (n = 32) with intraoperative issues less common (n = 13). Communication issues were seen at all three stages (n = 16). Overall, the most common theme was at the preoperative stage; inadequate preoperative assessment (n = 27). More specifically, the most common preoperative assessment issues involved a failure to order necessary preoperative investigations, or to administer necessary preoperative treatment (e.g. prophylactic antibiotics). The most common communication issue was between teams and at handover, often involving failure by junior medical staff to communicate issues to the responsible surgical consultant. Conclusion: Urological surgical cases with potentially avoidable mortality constitute a small, but important subset of deaths. The analysis of these cases can inform various stakeholders to improve the quality and safety of urological surgical care. [ABSTRACT FROM AUTHOR]

Background: Appendicectomy is a safe surgical procedure with minimal risks. Low mortality rates (0.04–0.24%) have been reported from a number of countries. Appendicectomy mortality rates have not been reported in Australia in recent years. The aim of the study was to conduct an appendicectomy mortality audit, to identify clinical management issues and to calculate the mortality rate of appendicectomy in Australia. Methods: This study analysed data from a peer review of appendicectomy deaths in Australian hospitals of all states and territories, from 2006 to 2017. Additional procedural data were obtained from the Australian Institute of Health and Welfare for the calculation of mortality rates. Results: The final analysis included 82 patients of whom 62 were elderly (age >65 years) with 47 males and 35 females. Two or more comorbidities were present in 68 patients. Open operation was performed in 62 patients, with complicated appendicitis found in 50 cases. The majority of management issues were non‐surgical. Of the 16 surgical management issues identified, 11 issues occurred post‐operatively in the elderly, which were potentially preventable. The overall mortality was 0.02% with 0.01% in the young (age <65 years) and 0.20% in the elderly. Conclusion: Australia's appendicectomy mortality rate was very low and comparable to international figures. Surgical management of appendicectomy was satisfactory in general. However, post‐operative care in the elderly was found to be poor at times, with room for improvement. Further research is needed whether improvements in post‐operative care could alter the clinical course to death in the elderly. [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]

Background: To assess the adherence rate of surveillance colonoscopy booking intervals to recommended National Health and Medical Research Council guidelines at The Queen Elizabeth Hospital, Adelaide, Australia. Methods: Patients on The Queen Elizabeth Hospital colorectal unit surveillance colonoscopy waiting list were included in this audit. Patient demographics, colonoscopy findings, follow‐up plans and pathology results were analysed. Patients were categorized as normal/non‐neoplastic finding, low‐risk adenomas, high‐risk adenomas, personal history of colorectal cancer (CRC) and family history of CRC. Booked colonoscopy within 2 months of guideline recommended interval was considered correct. Results: A total of 467 patients were included (59.1% male; mean age 60 years). Two hundred and fifty‐one (53.7%) patients had an incorrect surveillance colonoscopy booking. Twenty‐seven patients with a normal/non‐neoplastic previous colonoscopy not requiring surveillance colonoscopy were incorrectly booked for a colonoscopy. For the 222 patients booked incorrectly and requiring surveillance colonoscopy, 88.7% were early and 11.3% were late. The proportions of incorrect bookings were highest in the low‐risk finding (66.1%) and history of CRC (67.6%) groups. For the 186 patients requiring a 3‐year surveillance interval, 38.7% were booked incorrectly. For the 197 patients requiring a 5‐year surveillance interval, 63.5% were booked incorrectly, of which 99.2% were early. More 5‐year surveillance interval patients were booked at 3 years (n = 79), than at the correct interval of 5 years (n = 72). Conclusion: Adherence to the National Health and Medical Research Council guidelines for surveillance colonoscopy is poor. The majority of deviations represent early follow‐up, which is most common among patients with low‐risk findings or history of CRC. There is a tendency towards 3‐year surveillance among low‐risk patients. [ABSTRACT FROM AUTHOR]

Objective: High caseload is considered one of the most important factors for good outcomes after high-risk surgeries such as oesophagectomy. However, many Australian centres perform low volumes of oesophagectomies due to demographics. The aim of the present study was to audit outcome after oesophagectomy in an Australian low-volume centre over a period of 13 years and to discuss potential contributors to outcome other than just case volume. Methods: Perioperative and long-term outcomes of all oesophagectomies over a 13-year period in a low-volume Australian tertiary care centre were analysed retrospectively. Data were compared in subgroups of patients in two separate time periods: 2000–05 (n = 23) and 2006–12 (n = 24). Results: There were two perioperative deaths over the entire 13-year period with no postoperative mortality in the last decade. The complication and long-term survival rates for each of the two separate time periods were similar to those from high-volume centres, more so in the second half of the study period. Conclusions: The data suggest that under specific conditions, oesophagectomies can be safely performed even in smaller- or low-volume centres in Australia. The policy of centralisation for these procedures in Australia needs to be carefully tailored to the needs of the population, clinical outcomes, cost-effectiveness and optimal utilisation of existing facilities rather than on caseload alone. What is known about the topic?: High caseload is considered one of the most important factors for good outcomes after oesophagectomy and a driving force behind centralisation of this procedure. However, other factors may also affect outcome – such as availability of experienced surgeons, specialist nurses, interventional radiology, gastroenterology, etc. What does this paper add?: With the availability of appropriate levels of expertise, infrastructure and specialist nursing staff as is the case in most Australian tertiary centres, good perioperative outcomes can be obtained despite low volumes. Case load only should not be used as a surrogate marker of quality. What are the implications for practitioners?: The policy of centralisation for oesophagectomy in Australia needs to be carefully thought out on the basis of population demographics, outcomes and cost-effectiveness, with the appropriate use of existing facilities, rather than on a caseload basis alone. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery is the most effective method of sustainable weight loss for the treatment of morbid obesity. Low mortality associated with these procedures has been reported internationally; however, Australian outcomes are yet to be published. Despite its efficacy, limited access to bariatric surgery exists in Australian public hospitals. This retrospective data analysis was conducted for two reasons. Firstly, to determine the perioperative mortality rate (POMR) associated with bariatric procedures in Australia, and secondly, to compare public and private hospital bariatric surgery admission demographics and outcomes.Method: A retrospective review of de-identified patient data from the National Hospital Morbidity Database, held by the Australian Institute of Health and Welfare (AIHW), was conducted using codes relating to bariatric procedures. POMR calculations were established using AIHW admission data from 1 July 2005 to 30 June 2013.Results: From 1 July 2005 to 30 June 2013, 113,929 patient admissions occurred for patients undergoing a bariatric procedure. Thirty-nine deaths occurred nationally, with an overall average POMR of 0.03%. A higher POMR was associated with public admissions and secondary procedures. A higher proportion of secondary procedures were performed in public hospitals. Primary bariatric procedure incidence increased throughout the study period while secondary bariatric procedure incidence decreased.Conclusion: This study demonstrates the Australian bariatric procedure POMR to be substantially lower than internationally reported figures. Public hospitals were shown to perform far fewer bariatric procedures at a higher POMR than private hospitals. Public hospitals performed a higher proportion of secondary revision procedures. [ABSTRACT FROM AUTHOR]

Introduction: The use of safety checklists in interventional radiology is an intervention aimed at reducing mortality and morbidity. Currently there is little known about their practical use in Australian radiology departments. The primary aim of this mixed methods study was to evaluate how safety checklists (SC) are used and completed in radiology departments within Australian hospitals, and attitudes towards their use as described by Australian radiologists.Methods: A mixed methods approach employing both quantitative and qualitative techniques was used for this study. Direct observations of checklist use during radiological procedures were performed to determine compliance. Medical records were also audited to investigate whether there was any discrepancy between practice (actual care measured by direct observation) and documentation (documented care measured by an audit of records). A focus group with Australian radiologists was conducted to determine attitudes towards the use of checklists.Results: Among the four participating radiology departments, overall observed mean completion of the components of the checklist was 38%. The checklist items most commonly observed to be addressed by the operating theatre staff as noted during observations were correct patient (80%) and procedure (60%). Findings from the direct observations conflicted with the medical record audit, where there was a higher percentage of completion (64% completion) in comparison to the 38% observed. The focus group participants spoke of barriers to the use of checklists, including the culture of radiology departments.Conclusion: This is the first study of safety checklist use in radiology within Australia. Overall completion was low across the sites included in this study. Compliance data collected from observations differed markedly from reported compliance in medical records. There remain significant barriers to the proper use of safety checklists in Australian radiology departments. [ABSTRACT FROM AUTHOR]

Introduction: A decline in surgical deaths has been observed in Australia since the introduction of the Australian and New Zealand Audit of Surgical Mortality (ANZASM). The current study was conducted to determine whether the perioperative mortality rate (POMR) has also declined. Methods: This study is a retrospective review of the POMR for surgical procedures in Australian public hospitals between July 2009 and June 2013, using data obtained from the Australian Institute of Health and Welfare. Operative procedures contained in the Australian Refined Diagnosis Related Groups were selected and the POMR was modelled using urgency of admission, age and gender as explanatory covariates. Results: The POMR in Australian public hospitals reduced by 15.4 % over the 4-year period. The emergency admissions POMR dropped from 1.40 to 1.12 %, and the elective admissions POMR from 0.09 to 0.08 %. The binary logistic regression model used to predict patient mortality showed emergency admissions to have a higher POMR than elective, being more evident at older ages. For emergency admissions, the difference in POMR between females and males increased with age, from about 55 years onwards, with females being lower. For elective surgeries, the difference between males and females was of little practical importance across ages. Conclusions: The reduction in the POMR in Australia confirms the reduction in surgical deaths reported to ANZASM. Continuing to monitor POMR will be important to ensure the safest surgery in Australia. Further investigations into case-mix will allow better risk adjustment and comparison between regions and time-periods, to facilitate continuous quality improvement. [ABSTRACT FROM AUTHOR]

The majority of analysed patients with cholangitis have hepatic fibrosis8 and the development of severe hepatic fibrosis in the presence of multiple intrahepatic stones may lead to LT, even in the setting of preserved liver function. Biliary atresia is a rare progressive inflammatory destruction of the bile ducts in the perinatal period, with complete obstruction of all or part of the extrahepatic bile ducts leading to liver fibrosis and ultimately liver failure. [Extracted from the article]

Objective Previous Australian studies have suggested poorer survival of patients with colorectal cancer in remote areas. To date no studies have assessed the geographic disparity in patients with metastatic disease. This retrospective cohort study looks at geographic differences in the surgical care and survival of patients with metastatic colorectal disease. The paper utilises data from the South Australian Clinical Registry for Metastatic Colorectal Cancer ( SACRMCC). Design, participants, interventions and main outcome measures Data on patients' socio-economic status, primary and metastatic tumour characteristics, treatment and survival was extracted from the SACRMCC database. A binomial model analysis was used to identify geographical differences in the surgical treatment of patients and a Cox proportional hazards model was used to identify any geographic differences in survival. Results The findings showed no differences in the diagnosis of liver metastases or provision of liver surgery between geographic areas, however there was a reduced likelihood of liver surgery with increasing age. The median overall survival rate, from the date of diagnosis of metastatic disease, was 20.0 months and the distribution by geographic remoteness was 19.1 months, 20.2 months, 22.0 months and 20.4 months in Major Cities, Inner Regional, Outer Regional and Remote areas respectively. This was not statistically significant. Conclusion Overall, there was no evidence of a geographical disparity in the diagnosis, surgical treatment or survival in metastatic colorectal cancer. This may be due to the shift toward centralising surgical care in South Australia. Nevertheless, there remains a need to improve the uptake of surgical care in the growing elderly population. [ABSTRACT FROM AUTHOR]

Background The Australian and New Zealand Audit of Surgical Mortality ( ANZASM) is a nationwide confidential peer review of deaths associated with surgical care. This study assesses the concordance between treating surgeons and peer reviewers in reporting clinical events and delays in management. Methods This is a retrospective cross-sectional analysis of deaths in 2009 and 2010. Cases that went through the process of submission of details by the surgeon in a structured surgical case form ( SCF), first-line assessment ( FLA) and a more detailed second-line assessment ( SLA) were included. Significant clinical events reported for these patients were categorized and analysed for concordance. Results Of the 11 303 notifications of death to the ANZASM, 6507 (57.6%) were audited and 685 (10.5%) required the entire review process. Nationally, the most significant events were post-operative complications, poor preoperative assessment and delay to surgery or diagnosis. The SCF submissions reported 338 events, as compared with 1009 and 985 events reported through FLA and SLA, respectively ( P = 0.01). Treating surgeons and assessors attributed 29-30% of events to factors outside the surgeon's control. Surgeons felt that delay to surgery or diagnosis was a significant event in 6.6% of cases, in contrast to 20% by assessors ( P = 0.01). Preoperative management could be improved in 19% of cases according to surgeons, compared with 45 and 36% according to the assessors ( P < 0.001). Conclusion There is significant discordance between treating surgeons and assessors. This suggests the need for in-depth analysis and possible refinement of the audit process. [ABSTRACT FROM AUTHOR]

Background Fatigue has been shown to have a negative impact on surgical performance. However, there is a lack of research investigating its effect on laparoscopy, particularly in Australia. This study investigated whether fatigue associated with a surgeon's usual workday led to a measurable drop off in laparoscopic surgical skills as assessed on a laparoscopic simulator. Methods A comparative study involving two cohorts was undertaken: a study group whose data were collected prospectively was compared to a historical control group. Participants were required to reach a predetermined level of proficiency in each laparoscopic task on either a FLS or LapSim simulator. The participants in the study cohort were re-tested approximately 1 month after completing 10 h of work. The participants in the historical non-fatigued group were re-tested approximately 1 month after reaching proficiency. Comparisons between cohorts were made using a 'decrease in score per day elapsed' value to account for the natural attrition in skills over time and the variability in testing times within and between the two cohorts. Results The decrease in overall score per day elapsed for fatigued participants was significantly greater than for historical non-fatigued participants, irrespective of the simulator type. Fatigue had a greater impact on certain laparoscopic skills, including peg transfer and knot tying. Participants who self-reported higher level of fatigue demonstrated significantly better skills than those who self-reported lower levels. Conclusion Overall laparoscopic skill proficiency was reduced in the fatigued participants compared to the historical non-fatigued participants, with certain laparoscopic skills more affected than others. [ABSTRACT FROM AUTHOR]

Keywords: Colorectal surgery; Rural health services; Survival analysis; Morbidity; Mortality EN Colorectal surgery Rural health services Survival analysis Morbidity Mortality 186 187 2 03/03/21 20210301 NES 210301 The incidence of colorectal cancer in Australia is among the highest in the world.1 About 29% of Australians live in rural or remote areas. Colorectal cancer surgery in rural Australia can match outcomes in metropolitan hospitals: a 14-year study The proportion of deaths at 30 days after emergency colorectal cancer surgery (three of 34 patients, 9%) was significantly greater than following elective surgery (one of 277, 0.4%; I P i = 0.002). [Extracted from the article]

Inflammatory pseudotumor-like follicular dendritic cell sarcoma of the spleen: computed tomography imaging characteristics in 5 patients. Anaplastic lymphoma kinase receptor staining (ALK) should be negative to exclude inflammatory myofibroblastic tumours which may have a similar morphology.2 GLO:HWR/01mar21:ans16216-fig-0003.jpg PHOTO (COLOR): 3 Histopathological specimen from excised Epstein-Barr virus-positive inflammatory pseudotumour-like follicular dendritic cell sarcoma lesion showing neoplastic spindled cells with a rich lymphoplasmacytic infiltrate. The biopsy findings were mostly consistent with an Epstein-Barr Virus-positive Inflammatory Pseudotumour-like Follicular Dendritic Cell Sarcoma (EBV-IPTFDC) of the liver. [Extracted from the article]

Background The incidence of colorectal cancer in Australia is among the highest worldwide. We investigate whether similar treatment results for colorectal cancer can be achieved in rural surgery as reported from metropolitan centres. Methods Retrospective analysis of prospectively collected follow-up data in a rural surgical centre in South Australia has been carried out. Results of all patients undergoing surgical treatment for colorectal cancer are analysed, and all cancer stages and interventions over a 5-year period are included. Results Five-year survival of all patients ( n = 194) treated for colorectal cancer independent of stage and cause of death was 56%, cancer-specific 5-year survival was 64%. Perioperative mortality was 1.7%. Overall survival was 96% in stage 1, 92% in stage 2, 58% in stage 3 and 0% for patients with metastatic disease at the time of diagnosis. Cancer-specific survival ranged from 100% in stage 1 to 0% for patients with metastatic disease. Conclusions Assessment of overall and cancer-specific survival of all patients undergoing surgery for colorectal cancer over a 5-year time period in a rural South Australian centre shows that good long-term results can be achieved with low perioperative mortality. These findings compare well with the results of other groups. [ABSTRACT FROM AUTHOR]

Background In this study, the Australian and New Zealand Audit of Surgical Mortality evaluated the effect of operative supervision on certain post-operative outcomes in the surgical death subset. Methods This retrospective cohort study was based upon mortality data collected in 2009 which included 1673 patients who died and had surgery within 30 days of death or during the last admission. Cases were divided into three groups: consultant not supervising (group NS), consultant supervising (group S) and consultant performing the operation (group C). A comparison was done nationally and between participating states in Australia. Certain post-operative outcomes were compared between the three groups as well as between elective and emergency operations. Results There were significant variations in the levels of operative supervision among states in Australia. Group NS ( n = 468) generally had more favourable post-operative outcomes than group S ( n = 147) and group C ( n = 1058), with post-operative complication rates of 24.8%, 37.4% and 40.9% for groups NS, S and C, respectively. The level of operative supervision in emergency operations was half that of elective operations. Nevertheless, the post-operative complications rate was significantly lower in emergency operations (30.6%) compared with elective operations (64.4%). The same trend was seen with clinical management deficiencies and unplanned return to theatre. Conclusion Operative supervision in emergency setting within Australian hospitals appears to be potentially inadequate. However, the available data suggest that unsupervised surgery did not result in worse post-operative outcomes. In appropriately selected cases, the data support surgical registrars performing surgery without consultant supervision. [ABSTRACT FROM AUTHOR]

Introduction: Clinicians often use the Van Nuys Prognostic Index (VNPI) to determine management of ductal carcinoma in situ (DCIS). The VNPI uses age, extent of DCIS, pathological grade and resection margins to stratify patients into three groups pertaining to risk of local recurrence: low-risk (where breast-conserving surgery - BCS - alone appears adequate), intermediate-risk (where BCS plus radiotherapy is recommended) and high-risk (where mastectomy may be the safest option). The purpose of this study was to determine patterns of management of DCIS in Australia and New Zealand according to the VNPI. Methods: Using the National Breast Cancer Audit for the period 2004-2009, 4578 cases of DCIS were identified where complete data were available. Patterns of management according to the VNPI were determined. The chi-squared test was used for statistical analysis. Results: In VNPI group 1, 77% of patients were treated with BCS compared with 63% in group 2 and 32% in group 3. Of patients in group 1 who underwent BCS, 58% also received adjuvant radiotherapy, compared with 80% in group 2. In group 3, 68% were treated with mastectomy, and of those who underwent BCS, 86% received radiotherapy. Overall, 23% of DCIS cases did not conform to best practice according to individual VNPI prognostic groupings. Conclusions: Significant differences in the management of DCIS according to VNPI groups were observed. The results suggest the possibility that some patients in the low-risk group were over-treated, while a proportion of patients in the intermediate- and high-risk groups were under-treated. [ABSTRACT FROM AUTHOR]

Background: Trastuzumab increases disease-free and overall survival in HER-2-positive, early breast cancer. In 2007, the National Breast and Ovarian Cancer Centre recommended that patients with HER-2 positive cancers (node positive or node negative tumours >1 cm) be offered adjuvant trastuzumab with chemotherapy. The aim of this study was to evaluate recent trends in trastuzumab therapy in Australia and New Zealand. Methods: Following data were obtained from the National Breast Cancer Audit for patients treated between 2006 and 2008: tumour size, number of cases recorded per surgeon per year, location of hospital, HER-2 receptor status, age, lymph node status, chemotherapy and trastuzumab treatment. Results: Data were available from 23 290 patients. During the study period, the percentage of breast cancers tested for HER-2 rose from 77% to 91%. Patients over 70 had fewer HER-2 tests than their younger counterparts. Fourteen percent of tumours were HER-2 positive; the proportion treated with trastuzumab in 2006, 2007 and 2008 was 50%, 66% and 74%, respectively. Significantly more node-positive patients (77%) were given trastuzumab than node-negative patients (52%). All the patients prescribed trastuzumab also received chemotherapy. Patients under 70 years, patients treated in Australia and patients treated by higher caseload surgeons were more likely to be prescribed trastuzumab than those over 70, patients in New Zealand and patients treated by lower caseload surgeons. Conclusions: Trastuzumab-prescribing trends conform to the published guidelines. However, older patients and those with HER-2 positive, node-negative tumours >1 cm may be undertreated in some cases. [ABSTRACT FROM AUTHOR]

This paper describes existing inconsistencies as well as the disparate processes and logistics required when obtaining ethics approval in Australia and New Zealand in order to initiate a multi-centre bi-national surgical trial. The endovascular aortic aneurysm repair trial is a large multi-centre trial that aims to obtain pre- and post-operative data from patients in hospitals across Australia and New Zealand. As the trial was research based, ethics applications were submitted to all hospitals where surgeons wished to be involved in the trial. Few ethics committees have embraced attempts to simplify the application process for multi-centre trials. There was limited mutual review between Human Research Ethics Committees necessitating the submission of multiple applications. Though the use of the National Ethics Application Form in ethical review is increasing, some Human Research Ethics Committees do not accept it in its entirety; many require site-specific applications or sections of the Common Application Form modules. Queensland, New South Wales and New Zealand were the easiest systems to prepare, submit and lodge ethics applications because of their understanding and accommodation of reviewing multi-centred trials. The time, expense and complexity of obtaining ethics approval for multi-centre research projects are impediments to their establishment and reduce the time available for research. Australia is working to implement a system named the Harmonisation of Multi-centre Ethical Review to ease the process of obtaining multi-centre ethics clearance. Our experience suggests there will be some teething problems with implementation and acceptance. [ABSTRACT FROM AUTHOR]

The National Breast Cancer Audit (NBCA) of the Royal Australasian College of Surgeons has collected data on early breast cancer since 1998. In this project, deaths were traced by linkage of NBCA patient identifiers (first three digits of surname and date of birth) with the National Death Index that covers all deaths in Australia. Death data were traced to 31 December 2007. Invasive cancers diagnosed in 1998-2005 were included in survival analyses to allow enough follow-up for assessment. Survivals were compared with survivals for similar stages recorded by the New South Wales (NSW) Cancer Registry and USA Surveillance Epidemiology and End Results (SEER) programme. Survivals were analysed by conventional clinical risk factors to see if expected differences presented. The 5-year survival from breast cancer of 93% for NBCA cases was the same as the SEER figure for local and regional cases combined in 1996-2004. The NBCA figure for localized cases was 97%, which was the same as for NSW. Node-positive NBCA cancers had a 5-year survival of 89%, which was slightly higher than the corresponding 86% for NSW, which may reflect exclusion from the NBCA of some cases with a poorer prognosis, including those with positive fixed nodes. As expected, lower survivals presented for older cases and those with conventional clinical risk factors. These survivals are credible both overall and by clinical risk factor. Opportunities present to use these data for survival monitoring and to investigate survival by socio-demographic characteristic, treatment protocol, case volume and provider characteristics. [ABSTRACT FROM AUTHOR]

Background: The Australia health workforce productivity Commission Research Report in 2005 identified workforce shortages. One of the recommendations is that new models of health care be established. As a result South Australia is trialling United States trained physician assistants in a pilot program. This paper summaries the review of literature of the physician assistant role and safety in the surgical setting. Methods: A literature search using Medline and Pubmed from 1966 until 2009 with key words: physician assistants, midlevel providers, surgery. The references of the results were also searched for suitable articles. The Google search engine was also used with the above keywords to search for latest developments from nontraditional sources. Results: There were over 200 suitable articles relating to the quality and safety of physician assistants. The overwhelming majority of the articles originate from the United States and these vary in quality. There were 13 published studies identified that documented physician assistants in the surgical setting. Conclusion: From the published data physician assistants have been shown to provide safe and provide high quality care in surgical units. It is important that prior to their commencement their role is defined to alleviate conflict and confusion in the team. Continued auditing should be conducted to monitor progress and impact. [ABSTRACT FROM AUTHOR]

Although treatment recommendations have been advocated for all women with early breast cancer regardless of age, it is generally accepted that different treatments are preferred based on the age of the patient. The aim of this study was to assess the pattern of breast cancer surgery after adjusting for other major prognostic factors in relation to patient age. Data on cancer characteristics and surgical procedures in 31,298 patients with early breast cancer reported to the National Breast Cancer Audit between 1999 and 2006 were used for the study. There was a close association between age and surgical treatment pattern after adjusting for other prognostic factors, including tumor size, histologic grade, number of tumors, lymph node positivity, lymphovascular invasion (LVI), and extensive intraduct component. Breast Conserving Surgery (BCS) was highest among women aged ≤40 years (OR = 1.140; 95% CI: 1.004–1.293) compared to women aged 51–70 years (reference group). BCS was lowest in women aged >70 years (OR = 0.498, 95% CI: 0.455–0.545). Significantly more women aged ≤50 years underwent more than one operation for breast conservation (20.4–24.8%) compared with women aged >50 years (11.4–17.0%). Women aged >70 years were more likely to receive no surgical treatment, 3.5% versus 1.0–1.3% in all other age groups (≤40, 41–50 51–70 years). There is an association between patient age and the type of breast cancer surgery for women in Australia and New Zealand. Women age ≤40 years are more likely to undergo BCS despite having adverse histologic features and have more than one procedure to achieve breast conservation. Older women (>70 years) more commonly undergo mastectomy and are more likely to receive no surgical treatment. [ABSTRACT FROM AUTHOR]

On the basis of their innovation and experience with reduced-size grafts in children, 20 years ago, Russell Strong and his team in Brisbane, Australia, performed the first successful living donor liver transplant in the world from a mother to her son. The mismatch between supply and demand for deceased donor organs has fueled the expansion of all forms of reduced-size grafts, including split-liver and living donor transplantation. This review outlines the story of Russell Strong, reduced-size liver transplantation techniques, and the development of living donor liver transplantation. [ABSTRACT FROM AUTHOR]

The Australian Safety and Efficacy Register of New Interventional Procedures – Surgical (ASERNIP-S) came into being 10 years ago to provide health technology assessments specifically tailored towards new surgical techniques and technologies. It was and remains the only organisation in the world to focus on this area of research. Most funding has been provided by the Australian Government Department of Health, and assessments have helped inform the introduction of new surgical techniques into Australia. ASERNIP-S is a project of the Royal Australasian College of Surgeons. The ASERNIP-S program employs a diverse range of methods including systematic reviews, technology overviews, assessments of new and emerging surgical technologies identified by horizon scanning, and audit. Support and guidance for the program is provided by Fellows of the Royal Australasian College of Surgeons. ASERNIP-S works closely with consumers to produce health technology assessments and audits, as well as consumer information to keep patients fully informed of research. Since its inception, the ASERNIP-S program has developed a strong international profile through the production of over 60 reports on evidence-based surgery, surgical technologies and audit. The work undertaken by ASERNIP-S has evolved from assessments of the safety and efficacy of procedures to include guidance on policies and surgical training programs. ASERNIP-S needs to secure funding so that it can continue to play an integral role in the improvement of quality of care both in Australia and internationally. [ABSTRACT FROM AUTHOR]

Every surgical activity poses some element of risk to the public and should include a quality control initiative. Surgical audit is one strategy used to maintain and/or improve standards in surgical care. The Royal Australasian College of Surgeons is committed to ensuring best practice in surgical care and strongly endorses the use of audits to achieve this. This review provides an overview of clinical audit and its role in surgical practice. [ABSTRACT FROM AUTHOR]

Background: Ductal carcinoma in situ (DCIS) is a significant issue in Australia and New Zealand with rising incidence because of the implementation of mammographic screening. Current information on its natural history is unable to accurately predict progression to invasive cancer. In 2003, the National Breast Cancer Centre in Australia published recommendations for DCIS. In Australia and New Zealand, the National Breast Cancer Audit collects information on DCIS cases. This article will examine these recommendations and provide information from the audit on current DCIS management. Methods: Three thousand six hundred and twenty-nine cases of DCIS were entered by 274 breast surgeons between January 1998 and December 2004. Data items in the National Breast Cancer Audit database that were covered in the National Breast Cancer Centre recommendations were reviewed. Information was available on the following: diagnostic biopsy rates for all cases and mammographically positive cases and rates of breast conserving surgery (BCS), clear margins following BCS, postoperative radiotherapy following BCS for groups at high risk of recurrence as well as axillary procedures and tamoxifen prescription. Results: Close adherence was found in diagnostic biopsy, BCS and clear margin rates. Some high-risk groups received radiotherapy, although women with ‘close’ margins did not in 33% of cases. Axillary procedures were conducted in 23% of cases and most (81%) patients were not prescribed tamoxifen. Conclusion: There was predominantly close adherence to recommendations with three possible areas of improvement: fewer axillary procedures, an appraisal of radiotherapy practice following BCS and more investigation into tamoxifen prescription practices for DCIS. [ABSTRACT FROM AUTHOR]

Background: An audit of surgical treatment of early breast cancer was introduced nationally in 1999. In August 2002, the Australian Safety and Efficacy Register of New Interventional Procedures − Surgical, under the auspices of the Royal Australasian College of Surgeons, assumed responsibility for managing this audit. This article provides an update of audit activities, now known formally as the National Breast Cancer Audit (NBCA), including a description of the new governance structure and the development of a secure online surgical audit system. Methods: Major changes have taken place in the design and governance of the NBCA during the last two years. Two committees have been established to oversee the audit. A clinical advisory committee comprises experts from a number of fields including breast surgery, oncology, government, and from peak breast cancer and consumer bodies. A technical advisory committee oversees many of the technical issues that have arisen with the development of an online data entry system. The online system of data entry was developed and launched to surgeons in May 2004. Results: There are now 28 000 cases of primary breast surgery in the audit. Around 250 surgeons are currently participating, an increase of over 50 surgeons since May 2004. Surgeons can review their data using the online system and compare their own results by generating reports which graph their own results against national aggregate data. Conclusions: There has been a significant increase in the volume of data received since the launch of the secure online system. The governing committees are working towards creating a clinical audit which will provide an improved data entry system and better reporting for all participating surgeons. The NBCA can also serve as a template on which to base other surgical audits. [ABSTRACT FROM AUTHOR]

Hypothesis: Surgical undergraduate education in a rural setting is feasible and sound in terms of educational outcomes. Design: The final-year surgical curriculum at the University of Adelaide, Adelaide, South Australia, was restructured to include the option of a rural surgical term. Setting: Five provincial center hospitals in rural South Australia. Interventions: Forty-three final-year medical students undertook rural surgical clerkships in 1998. Main Outcome Measures: End-of-year results and subjective ward assessments were compared between the group of students who completed rural surgical terms and the remainder of the student group who participated in tertiary hospital-based electives. Subjective student feedback was obtained in a survey conducted by the Clinical Education Development Unit at the University of Adelaide. Results: No significant (P = .45) differences in examination results were noted between the rural and city groups. A significant (P<.01) finding was observed in the subjective assessments, indicating that it was more difficult for the rural group to obtain an A grade compared with the city group. The rural students ranked the level of teaching and supervision highly and enjoyed the overall rural experience. Conclusion: Surgical undergraduate education is practical in a rural setting and, for educational outcome, seems to be at least as effective as city-based surgical clerkships in preparing students for final examinations. [ABSTRACT FROM AUTHOR]

The author reflects on the surgical works of the Australian and New Zealand Army Corps (ANZAC) official war artists in Australia and New Zealand. He cites explores the powerful and impressive surgical practices employed by the official war artists, who were involved in the major conflicts such as the First and Second World Wars. The author commends the effort of the official war artists including Murray Griffin, James Boswell, and Roy Hodgkinson.

We thank Professor Merrett I et al i . for their interest and observations regarding our article.[1] With regard to their concerns relating to the study period length, the analysis was intentionally lengthened to ensure adequately powered statistics and a true representation of national and state-based performance over time. The national and state-based (including New South Wales) improvement over time was extensively discussed in our previous nationwide analysis.[2] We thank Merrett I et al i . for highlighting the improvement over time and ensuring our chosen benchmark did not mask this outcome. The 90-day POMR has been validated to identify a greater number of mortality outliers when compared with 30-day POMR.[3] Despite this, 30-day analysis does hold an advantage in greater potential international comparison with 90-day outcome data limited in many healthcare systems.[4] The data set utilized in this publication prevented the inclusion of 90-day mortality; however, this would make for interesting and welcomed future comparison. [Extracted from the article]

The Australian Safety and Efficacy Register of New Interventional Procedures− Surgical (ASERNIP-S) audit of laparoscopic live-donor nephrectomy commenced in 1999 and concluded in 2003. Six centres in Australia and New Zealand contributed data for 219 donor patients regarding perioperative and postoperative outcome of surgery and short-term follow-up. These data were compared with a recent systematic review of LLDN. The Australasian experience to date compared favourably with worldwide practice, both in terms of efficacy and safety for donors (at least in the short term). The collection of audit data, as this technique was introduced into the Australasian healthcare system, has allowed the local experience with this technique to be pooled and shared, resulting in the development of Australasian practice in line with world's best practice in this area. [ABSTRACT FROM AUTHOR]

Abstract The Australian Safety and Efficacy Register of New Interventional Procedures - Surgical (ASERNIP-S) project has been established to form a register of new surgical procedures which have been assessed for their safety and efficacy. The ASERNIP-S project systematically reviews the evidence and produces recommendations on the future use of surgical procedures in clinical practice. Further data may be collected to provide information on the outcomes of procedures in use in Australia. Horizon Scanning of new and emerging techniques and technologies complements the ASERNIP-S process. This research identifies procedures that will impact on clinical practice in the near future. Dissemination of information from ASERNIP-S assessments, both locally and internationally, is important for quality improvement. The ultimate aim is for appropriate changes in practice to ensure the highest quality of Australian healthcare. [ABSTRACT FROM AUTHOR]

The author reflects on the enhancement of medical device regulation by improving the transparency and communication to the public about the assessment of a certain device. He informs that in Australia, the device regulation has undergone several reviews and evaluations before approval and even after the device has been presented in the market. The publicized defective breast implants device of Poly Implant Prothèse (PIP), which brings out the regulatory issues, is also discussed.

The authors discuss the research study that examines the implementation of the Health Practitioner Regulation National Law Act in Australia. They mention that the law is a uniform legal framework for the registration and regulation of health practitioners. The authors also outline the controversial aspect of the legislation that requires mandatory reporting for 10 types of health professionals, putting emphasis on the impact of politics on the protection and evidence-based medical policy.

The article discusses a court case regarding negligence in the disclosure of medical risks in Australia. It notes that legal outcomes which seem nonsensical to practicing clinicians can result from the conflict between legal ideals of medical malpractice litigation and surgical realities. It mentions that a sample is not required for reasonable foreseeability in surgery.

The authors reflect on the laparoscopic surgical training courses offered by schools in Australia, based on the review of Simulated Surgical Skills Program (SSSP). It discusses the results of the review which show that the courses were concentrated on areas with designated surgical skills centers, adding that they use various teaching methods which were allegedly similar with other countries. The authors also mention the approach of standardization which provides local graduates with competency.