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The article discusses the use of oral antibiotics (OAB) and mechanical bowel preparation (MBP) in elective colorectal resections to reduce the risk of surgical site infections (SSI) and anastomotic leaks (AL). While there is increasing evidence supporting the use of OAB with MBP, the uptake of this protocol in Australia and New Zealand remains relatively low. International guidelines vary in their recommendations, with some recommending against the use of MBP. However, recent studies have shown that OAB with MBP can significantly reduce the risk of SSI and AL. The article highlights the need for a large-scale randomized control trial in the Australasian population to further investigate the efficacy of OAB and MBP. [Extracted from the article]

Background: Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in relation to their risk of bleeding and venous thromboembolism. Methods: Retrospective review of all elective major general surgeries performed between 1 January 2018 and 30 June 2019 across seven Victorian hospitals was conducted. Results: A total of 5912 patients who underwent 6628 procedures were reviewed. Significant heterogeneity was found in the use of chemoprophylaxis, timing of its initiation, type of anticoagulant administered and application of extended chemoprophylaxis. These variations were observed within the same procedure, and between different surgeries and subspecialties. Contrastingly, there was minimal heterogeneity with the use of mechanical thromboprophylaxis. Oesophago‐gastric, liver and colorectal cancer resections had the highest thromboembolic risk. Breast, oesophago‐gastric, liver, pancreas and colon cancer resections had the highest bleeding risk. Conclusion: Perioperative chemoprophylaxis across general surgery is highly variable. This study has highlighted key areas of variance. Our findings also enable surgeons to compare their practices, and provide baseline data to inform future efforts towards optimizing thromboprophylaxis for general surgical patients. [ABSTRACT FROM AUTHOR]

Background: Cholecystectomy is commonly performed in general surgery. Despite guidelines recommending chemical thromboprophylaxis in the perioperative period, the most appropriate time for its initiation is unknown. Here, we investigated whether timing of chemoprophylaxis affected venous thromboembolism (VTE) and bleeding rates post‐cholecystectomy. Methods: Retrospective review of all elective cholecystectomies performed between 1 January 2018 and 30 June 2019, across seven Victorian hospitals. Clinical VTE was defined as imaging‐proven symptomatic disease within 30 days of surgery. Major bleeding was defined as the need for blood transfusion, surgical intervention or >20 g/L fall in haemoglobin from baseline. Results: A total of 1744 cases were reviewed. Chemoprophylaxis was given early (pre‐ or intra‐operatively), post‐operatively or not given in 847 (48.6%), 573 (32.9%) and 324 (18.6%) patients, respectively. This varied significantly between surgeons, fellows, trainees and institutions. Clinical VTE occurred in 5 (0.3%) patients and was not associated with chemoprophylaxis timing. Bleeding occurred in 42 (2.4%) patients. Of this, half were major events, requiring surgical control in 5 (11.9%) patients and blood transfusion in 9 (21.4%) patients. Bleeding also extended length of stay (mean (SD), 3.1 (4.0) versus 1.4 (2.2) days, P < 0.001). One bleeding‐related mortality was recorded. Importantly, when compared with post‐operative (risk ratio 1.46, 95% confidence interval 1.21–1.62) and no (RR 1.23, 95% CI 1.03–1.35) chemoprophylaxis, early usage significantly increased bleeding risk and independently predicted its occurrence. Conclusions: Perioperative chemoprophylaxis is variable among patients undergoing elective cholecystectomy. The rate of clinical VTE post‐cholecystectomy is low. Early chemoprophylaxis increases bleeding risk without an appreciable additional protection from VTE. [ABSTRACT FROM AUTHOR]

General surgical patients who undergo major operations are at risk (0.3-40%) of venous thromboembolism (VTE).1 This incurs significant morbidity and healthcare costs. Therefore, the Royal Australasian College of Surgeons and healthcare agencies recommend routine thromboprophylaxis in the absence of clear contraindications.2,3 However, the optimal time to initiate chemoprophylaxis in the perioperative period remains unclear, resulting in variable practices. Moreover, 50% of respondents from network B administer chemoprophylaxis post-operatively, while only 16% do so from network A. Of those who initiate chemoprophylaxis post-operatively, 12%, 69% 16% and 3% apply it immediately after skin closure, 6 h post-operation, 20.00 hours on the same day and 08.00 hours the following day, respectively. [Extracted from the article]