ORCID Profile
0000-0002-9269-9001
Current Organisation
Royal Australasian College of Surgeons
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Publisher: Wiley
Date: 12-03-2023
DOI: 10.1111/ANS.18363
Abstract: This study aims to identify the objective findings of haemoglobin (Hb) drift in patients that had a Whipple's procedure in the last 10 years, their transfusion status intraoperatively and post‐operatively, the potential factors affecting Hb drift, and the outcomes following Hb drift. A retrospective study was conducted at Northern Health, Melbourne. All adult patients who were admitted for a Whipple's procedure from 2010 to 2020 were included and information collected retrospectively for demographics, pre‐operative, operative and post‐operative details. A total of 103 patients were identified. The median Hb drift calculated from a Hb level at the end of operation was 27.0 g/L (IQR 18.0–34.0), and 21.4% of patients received a packed red blood cell (PRBC) transfusion during the post‐operative period. Patients received a large amount of intraoperative fluid with a median of 4500 mL (IQR 3400‐5600). Hb drift was statistically associated with intraoperative and post‐operative fluid infusion leading to concurrent issues with electrolyte imbalance and diuresis. Hb drift is a phenomenon that does happen in major operations such as a Whipple's procedure, likely secondary to fluid over‐resuscitation. Considering the risk of fluid overload and blood transfusion, Hb drift in the setting of fluid over‐resuscitation needs to be kept in mind prior to blood transfusion to avoid unnecessary complications and wasting of other precious resources.
Publisher: Springer Science and Business Media LLC
Date: 22-08-2019
DOI: 10.1007/S00268-019-05138-0
Abstract: The original article can be found online.
Publisher: Wiley
Date: 13-10-2020
DOI: 10.1111/ANS.16387
Publisher: Wiley
Date: 08-04-2020
DOI: 10.1111/ANS.15875
Publisher: Springer Science and Business Media LLC
Date: 05-08-2019
DOI: 10.1007/S00268-019-05104-W
Abstract: The Tokyo Guidelines 2018 (TG18) were developed to aid diagnosis and treatment for acute cholecystitis. The benefits of being treated in an acute general surgical unit (AGSU) include earlier diagnosis and treatment. This study aims to define the usefulness of TG18 before and after the introduction of AGSU. Patients who underwent cholecystectomy at Northern Health were audited retrospectively and assessed for TG18 diagnostic criteria and outcomes between 1 February 2012 and 1 February 2014 (one-year pre- and post-AGSU). Five hundred and eighty-seven patients underwent emergency cholecystectomy with 203 (34.6%) patients having a suspected diagnosis, and 234 (39.9%) patients with a definitive diagnosis of acute cholecystitis using TG18 diagnostic criteria. After the introduction of AGSU, time from imaging to operation improved from 2.5 to 1.7 days (p = 0.012). There were more operations occurring during in-hours following AGSU implementation (75.8% vs. 62.7%, p 26.6 mg/L had a higher likelihood of Clavien-Dindo complication grade 3 or 4 (OR 3.86, 95%CI 1.18-12.63, p = 0.027) compared with TG18 definitive diagnosis criteria (OR 1.50, 95%CI 0.46-4.91, p = 0.501). Surprisingly, there was a trend towards higher complications and readmissions for patients operated within 24 h, although this trend was not significant. Patients with suspected acute cholecystitis should be stratified clinically and with CRP in an AGSU with TG18 adding little value in a busy metropolitan unit.
Publisher: Springer Science and Business Media LLC
Date: 08-01-2020
DOI: 10.1007/S10029-019-02115-3
Abstract: There is debate regarding the use of drain tubes in incisional hernia repair. This has become topical in Australia, with a court judge suggesting that drain tubes are mandatory. There continues to be a lack of evidence to support generalised decision-making regarding the use of drain tubes. The general surgeon membership of General Surgeons Australia (GSA) were surveyed regarding incisional hernia repair, their use of drains, and the decision-making behind their use. A total of 196 surgeons' survey responses were analysed. Most surgeons perform less than 20 incisional hernia repairs per year (78%), prefer an open approach (78%), and preferably perform a pre-peritoneal (sub-lay) repair (53%). There was a variety of approaches to leaving a drain, with the most common answer being "sometimes" (31.28%) and an equal number of surgeons claiming to always or never leaving a drain (11.79% each). There was also no consensus in the duration the drain should stay in, with most surgeons averaging less than 5 days. Interestingly, there was a range of views on the effects of drain tubes, with some surgeons believing drains decreased infections and more believing they increased infections. Most surgeons felt seromas were decreased, but there was increased post-operative pain. The majority of surgeons agreed there was no evidence to support their beliefs. Placement of drain tubes is not universally practiced by the general surgeons who participated in the survey. The lack of evidence is reflected by a varied approach to incisional hernia repair and the use of drain tubes.
No related grants have been discovered for Yuchen Luo.