ORCID Profile
0000-0002-7109-8493
Current Organisation
Alfred Health
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Publisher: SAGE Publications
Date: 07-2020
Publisher: SAGE Publications
Date: 18-01-2022
DOI: 10.1177/0310057X211030284
Abstract: In Australia, 2.7 million surgical procedures are performed annually. Historically, a lack of perioperative data standardisation and infrastructure has limited pooling of routinely collected data across institutions. We surveyed Australian and New Zealand College of Anaesthetists (ANZCA) Clinical Trials Network hospitals to investigate current and potential uses of perioperative electronic medical record data for research and quality assurance. A targeted survey was sent to 131 ANZCA Clinical Trials Network–affiliated hospitals in Australia. The primary aim was to map current electronic data collection methods and data utilisation in six domains of the perioperative pathway. The survey response rate was 32%. Electronic data recording in the six domains ranged from 19% to 85%. Where electronic data exist, the ability of anaesthesiology departments to export them for analysis ranged from 27% to 100%. The proportion of departments with access to data exports that are regularly exporting the data for quality assurance or research ranged from 13% to 58%. The existence of a perioperative electronic medical record does not automatically lead to the data being used to measure and improve clinical outcomes. The first barrier is clinician access to data exports. Even when this barrier is overcome, a large gap remains between the proportion of departments able to access data exports and those using the data regularly to inform and improve clinical practice. We believe this gap can be addressed by establishing a national perioperative outcomes registry to lead high-quality multicentre registry research and quality assurance in Australia.
Publisher: Wiley
Date: 20-06-2023
DOI: 10.1111/ANS.18575
Abstract: The length of a patient's stay (LOS) in a hospital is one metric used to compare the quality of care, as a longer LOS may flag higher complication rates or less efficient processes. A meaningful comparison of LOS can only occur if the expected average length of stay (ALOS) is defined first. This study aimed to define the expected ALOS of primary and conversion bariatric surgery in Australia and to quantify the effect of patient, procedure, system, and surgeon factors on ALOS. This was a retrospective observational study of prospectively maintained data from the Bariatric Surgery Registry of 63 604 bariatric procedures performed in Australia. The primary outcome measure was the expected ALOS for primary and conversion bariatric procedures. The secondary outcome measures quantified the change in ALOS for bariatric surgery resulting from patient, procedure, hospital, and surgeon factors. Uncomplicated primary bariatric surgery had an ALOS (SD) of 2.30 (1.31) days, whereas conversion procedures had an ALOS (SD) of 2.71 (2.75) days yielding a mean difference (SEM) in ALOS of 0.41 (0.05) days, P 0.001. The occurrence of any defined adverse event extended the ALOS of primary and conversion procedures by 1.14 days (CI 95% 1.04–1.25), P 0.001 and 2.33 days (CI 95% 1.54–3.11), P 0.001, respectively. Older age, diabetes, rural home address, surgeon operating volume and hospital case volume increased the ALOS following bariatric surgery. Our findings have defined Australia's expected ALOS following bariatric surgery. Increased patient age, diabetes, rural living, procedural complications and surgeon and hospital case volume exerted a small but significant increase in ALOS. Retrospective observational study of prospectively collected data.
Publisher: Wiley
Date: 15-09-2020
DOI: 10.1111/ANS.16255
Abstract: Risk prediction tools can be used in the perioperative setting to identify high‐risk patients who may benefit from increased surveillance and monitoring in the postoperative period, to aid shared decision‐making, and to benchmark risk‐adjusted hospital performance. We evaluated perioperative risk prediction tools relevant to an Australian context. A systematic review of perioperative mortality risk prediction tools used for adults undergoing inpatient noncardiac surgery, published between 2011 and 2019 (following an earlier systematic review). We searched Medline via OVID using medical subject headings consistent with the three main areas of risk, surgery and mortality/morbidity. A similar search was conducted in Embase. Tools predicting morbidity but not mortality were excluded, as were those predicting a composite outcome that did not report predictive performance for mortality separately. Tools were also excluded if they were specifically designed for use in cardiac or other highly specialized surgery, emergency surgery, paediatrics or elderly patients. Literature search identified 2568 studies for screening, of which 19 studies identified 21 risk prediction tools for inclusion. Four tools are candidates for adapting in the Australian context, including the Surgical Mortality Probability Model (SMPM), Preoperative Score to Predict Postoperative Mortality (POSPOM), Surgical Outcome Risk Tool (SORT) and NZRISK. SORT has similar predictive performance to POSPOM, using only six variables instead of 17, contains all variables of the SMPM, and the original model developed in the UK has already been successfully adapted in New Zealand as NZRISK. Collecting the SORT and NZRISK variables in a national surgical outcomes study in Australia would present an opportunity to simultaneously investigate three of our four shortlisted models and to develop a locally valid perioperative mortality risk prediction model with high predictive performance.
Publisher: The Endocrine Society
Date: 03-2006
DOI: 10.1210/JC.2005-1862
Abstract: The identification of mutations in genes encoding peptides of succinate dehydrogenase (SDH) in pheochromocytoma araganglioma syndromes has necessitated clear elucidation of genotype-phenotype associations. Our objective was to determine genotype-phenotype associations in a cohort of patients with pheochromocytoma araganglioma syndromes and succinate dehydrogenase subunit B (SDHB) or subunit D (SDHD) mutations. The International SDH Consortium studied 116 in iduals (83 affected and 33 clinically unaffected) from 62 families with pheochromocytoma araganglioma syndromes and SDHB or SDHD mutations. Clinical data were collected between August 2003 and September 2004 from tertiary referral centers in Australia, France, New Zealand, Germany, United States, Canada, and Scotland. Data were collected on patients with pheochromocytomas and/or paragangliomas with respect to onset of disease, diagnosis, genetic testing, surgery, pathology, and disease progression. Clinical features were evaluated for evidence of genotype-phenotype associations, and penetrance was determined. SDHB mutation carriers were more likely than SDHD mutation carriers to develop extraadrenal pheochromocytomas and malignant disease, whereas SDHD mutation carriers had a greater propensity to develop head and neck paragangliomas and multiple tumors. For the index cases, there was no difference between 43 SDHB and 19 SDHD mutation carriers in the time to first diagnosis (34 vs. 28 yr, respectively P = 0.3). However, when all mutation carriers were included (n = 112), the estimated age-related penetrance was different for SDHB vs. SDHD mutation carriers (P = 0.008). For clinical follow-up, features of SDHB mutation-associated disease include a later age of onset, extraadrenal (abdominal or thoracic) tumors, and a higher rate of malignancy. In contrast, SDHD mutation carriers, in addition to head and neck paragangliomas, should be observed for multifocal tumors, infrequent malignancy, and the possibility of extraadrenal pheochromocytoma.
Publisher: SAGE Publications
Date: 09-2018
DOI: 10.1177/0310057X1804600506
Abstract: Prolonged fasting leads to a shift from carbohydrate to fat as the primary energy source, resulting in the production of ketones such as beta-hydroxybutyrate. Hyperketonaemia and ketoacidosis have been observed in young children fasting for surgery. The aim of this study was to investigate ketonaemia in adults fasted for surgery. One hundred non-diabetic adults presenting for elective or emergency surgery were assessed for the presence of hyperketonaemia (beta-hydroxybutyrate levels more than 1 mmol/l), and the relationship between beta-hydroxybutyrate, blood glucose and fasting duration was investigated. Three of 100 patients demonstrated hyperketonaemia, one of whom had ingested a ketogenic supplement the evening prior to surgery. No patient demonstrated beta-hydroxybutyrate levels suggestive of ketoacidosis (above 3 mmol/l). No relationship between fasting duration and ketone or glucose levels was observed. We found no evidence that prolonged preoperative fasting led to beta-hydroxybutyrate levels consistent with ketoacidosis.
Publisher: Wiley
Date: 2022
DOI: 10.1111/ANS.17438
Abstract: Clinical quality registries (CQRs) systematically collect data on pre-agreed markers of quality of care for a given procedure, that can be reliably and reproducibly defined and collected across multiple sites. Data is then risk adjusted, and comparisons may be used to benchmark performance. These data then inform quality improvement initiatives. CQRs require an overarching independent governance structure and surety of funding. CQRs rely upon whole of population enrolment to minimize the risk of selection bias, and often rely on the secondary use of sensitive health information, meaning that the processes for ethical review and consent to participation are different to clinical trials. Despite several local ex les of CQR improving practice in Australia and Aotearoa New Zealand, providing substantial cost-benefit to the community, there remain significant barriers to CQR implementation and functions. These include the difficulty of accurate data capture, lack of a fit for purpose ethical review system, the constraints of existing Qualified Privilege legislations and the need for protected funding. Whilst the Australian Government has released a 10-year strategy for CQR reform, and the Aotearoa New Zealand Government has included registries in the planned Health New Zealand reforms for the public sector, we believe more urgent implementation of strategies to overcome these barriers is needed if CQRs are to have the impact on quality of care our Communities deserve.
Publisher: Wiley
Date: 18-08-2022
DOI: 10.1111/ANS.17946
Abstract: We previously conducted a systematic review to identify surgical mortality risk prediction tools suitable for adapting in the Australian context and identified the Surgical Outcome Risk Tool (SORT) as an ideal model. The primary aim was to investigate the external validity of SORT for predicting in‐hospital mortality in a large Australian private health insurance dataset. A cohort study using a prospectively collected Australian private health insurance dataset containing over 2 million deidentified records. External validation was conducted by applying the predictive equation for SORT to the complete case analysis dataset. Model re‐estimation (recalibration) was performed by logistic regression. The complete case analysis dataset contained 161 277 records. In‐hospital mortality was 0.2% (308/161277). The mean estimated risk given by SORT was 0.2% and the median (IQR) was 0.01% (0.003%–0.08%). Discrimination was high (c‐statistic 0.96) and calibration was accurate over the range 0%–10%, beyond which mortality was over‐predicted but confidence intervals included or closely approached the perfect prediction line. Re‐estimation of the equation did not improve over‐prediction. Model diagnostics suggested the presence of outliers or highly influential values. The low perioperative mortality rate suggests the dataset was not representative of the overall Australian surgical population, primarily due to selection bias and classification bias. Our results suggest SORT may significantly under‐predict 30‐day mortality in this dataset. Given potential differences in perioperative mortality, private health insurance status and hospital setting should be considered as covariables when a locally validated national surgical mortality risk prediction model is developed.
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-068057
Abstract: Registry randomised clinical trials (RRCTs) have the potential to provide pragmatic answers to important clinical questions. RRCTs can be embedded into large population-based registries or smaller single site registries to provide timely answers at a reduced cost compared with traditional randomised controlled trials. RRCTs can take a number of forms in addition to the traditional in idual-level randomised trial, including parallel group trials, platform or adaptive trials, cluster randomised trials and cluster randomised stepped-wedge trials. From an implementation perspective, initially it is advantageous to embed RRCT into well-established registries as these have typically already overcome any issues with end point validation and adjudication. With advances in data linkage and data quality, RRCTs can play an important role in answering clinical questions in a pragmatic, cost-effective way.
Publisher: SAGE Publications
Date: 28-04-2020
Abstract: Accurately measuring the incidence of major postoperative complications is essential for funding and reimbursement of healthcare providers, for internal and external benchmarking of hospital performance and for valid and reliable public reporting of outcomes. Actual or surrogate outcomes data are typically obtained by one of three methods: clinical quality registries, clinical audit, or administrative data. In 2017 a perioperative registry was developed at the Alfred Hospital and mapped to administrative and clinical data. This study investigated the statistical agreement between administrative data (International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes) and clinical audit by anaesthetists in identifying major postoperative complications. The study population included 482 high-risk surgical patients referred to the Alfred Hospital anaesthesia postoperative service over two years. Clinical audit was conducted to determine the presence of major complications and these data were compared to administrative data. The main outcome was statistical agreement between the two methods, as defined by Cohen’s kappa statistic. Substantial agreement was observed for five major complications, moderate agreement for three, fair agreement for six and poor agreement for two. Sensitivity and positive predictive value ranged from 0 to 100%. Specificity was above 90% for all complications. There was important variation in inter-rater agreement. For four of the five complications with substantial agreement between administrative data and clinical audit, sensitivity was only moderate (61.5%–75%). Using International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes to identify postoperative complications at our hospital has high specificity but is likely to underestimate the incidence compared to clinical audit. Further, retrospective clinical audit itself is not a highly reliable method of identifying complications. We believe a perioperative clinical quality registry is necessary to validly and reliably measure major postoperative complications in Australia for benchmarking of hospital performance and before public reporting of outcomes should be considered.
Publisher: Elsevier BV
Date: 05-2019
Publisher: Wiley
Date: 18-07-2022
DOI: 10.5694/MJA2.51658
Abstract: To assess the relationships of patient and surgical factors and hospital costs with the number of days alive and at home during the 30 days following surgery (DAH Retrospective cohort study analysis of Medibank Private health insurance hospital claims data, Australia, 1 January 2016 - 31 December 2017. Admissions of adults (18 years or older) to hospitals for elective or emergency inpatient surgery with anaesthesia covered by private health insurance, Australia, 1 January 2016 - 31 December 2017. Associations between DAH Complete data were available for 126 788 of 181 281 eligible patients (69.9%) their median age was 62 years (IQR, 47-73 years), 72 872 were women (57%), and 115 117 had undergone elective surgery (91%). The median DAH DAH
Publisher: Springer Science and Business Media LLC
Date: 31-08-2013
No related grants have been discovered for Jennifer Reilly.