ORCID Profile
0000-0002-1104-133X
Current Organisations
Hunter New England Local Health District
,
University of Newcastle Australia
,
Calvary Mater Newcastle
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Publisher: Wiley
Date: 21-06-2021
DOI: 10.1111/ANS.17020
Abstract: Prior studies of telehealth report high levels of patient satisfaction, but within carefully selected clinical scenarios. The COVID‐19 pandemic led to telehealth replacing face‐to‐face care for many surgical consultations across a variety of situations. More evidence is needed regarding patient perceptions of telehealth in surgery, in particular, exploring barriers and facilitators associated with its sustained implementation beyond the pandemic. Survey invitations were emailed to a convenience s le of surgical patients by their surgeon following a telehealth consultation during the COVID‐19 pandemic. Surgeons were recruited from a s le ( n = 683) who completed a survey on telehealth (distributed via email to all Australian Fellows of the Royal Australasian College of Surgeons). Mixed methods analysis was performed of the patient survey data. A total of 1166 consultations were captured: 50% routine reviews, 17% initial appointments and 20% post‐operative reviews. Video‐link was used in 49% of consultations. The majority of patients (94%), were satisfied with the quality of their surgical telehealth consultation and 75% felt it delivered the same level of care as face‐to‐face encounters. Telehealth was convenient to use (96%) and led to cost savings for 60% of patients. When asked about future appointment preferences after the pandemic, 41% indicated they would prefer telehealth (24% video‐link and 17% telephone) over face‐to‐face appointments. There was a perception by patients that telehealth consultation fees should be less than face‐to‐face consultation fees. Patient satisfaction with surgical telehealth consultations is high. Barriers to more widespread implementation include financial, clinical appropriateness, technical and confidentiality concerns.
Publisher: Wiley
Date: 26-02-2021
DOI: 10.1111/ANS.16693
Publisher: Wiley
Date: 30-09-2020
DOI: 10.1111/ANS.16330
Publisher: BMJ
Date: 07-2004
DOI: 10.1136/EBM.9.4.112
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-12-2022
DOI: 10.1097/DCR.0000000000002171
Abstract: There is much debate surrounding the ideal antiseptic skin preparation agent to reduce postoperative surgical site infection. International guidelines suggest that chlorhexidine- and alcohol-containing compounds have superior efficacy. However, there are minimal clinical trials specifically looking at skin preparation agents for colorectal surgery. The aim of this study was to compare the efficacy of chlorhexidine in alcohol versus povidone-iodine in alcohol versus povidone-iodine in aqueous solution for the prevention of surgical site infection in colorectal surgery. This is a prospective, 3-armed, randomized controlled trial. This study was conducted at the 800-bed John Hunter Hospital and Newcastle Private Hospital, with all subspecialty services in New South Wales, Australia. All eligible, consenting adults undergoing colorectal surgery between July 2015 and December 2018 were included. Patients were andomized to receive preincision skin preparation with one of the following: chlorhexidine in 70% alcohol, povidone-iodine in 70% alcohol, or povidone-iodine in aqueous solution. The primary measure was surgical site infection within 30 days. A total of 482 patients were randomized to chlorhexidine in alcohol, povidone-iodine in alcohol, or aqueous povidone-iodine. The overall surgical site infection rate was 22% (107/482). There was no difference in rates of surgical site infection: 20.6% (29/141), 22.8% (44/193), and 23.0% (34/148), respectively ( p = 0.5267). There was no difference in complication rates: 54.6% (77/141), 46.1% (89/193), and 49.3% (73/148), respectively ( p = 0.1762). The median length of stay was 6 days in all 3 groups. This is a subset analysis of a larger clinical trial for all forms of incisional surgery (the NewSKIN Prep trial), and noninferiority cannot be assessed. Changes in government regulations resulted in a change from 0.5% chlorhexidine in 70% ethanol to 2% chlorhexidine in 70% ethanol during the trial. This large, prospective, randomized clinical trial appears to indicate that there is no difference in surgical site infection, complications, or length of stay among the 3 commonest forms of skin preparation in colorectal surgery. See Video Abstract at links.lww.com/DCR/B875. New Zealand Clinical Trials registry: ACTRN12615000021572 Agentes antisépticos para la preparación de la piel para prevenir la infección del sitio quirúrgico en la cirugía colorrectal: un ensayo clínico aleatorizado de tres grupos Existe un gran debate en torno al agente de preparación de la piel antiséptico ideal para reducir la infección posoperatoria del sitio quirúrgico. Las pautas internacionales sugieren que los compuestos que contienen clorhexidina y alcohol tienen una eficacia. Sin embargo, existen ensayos clínicos mínimos que analizan específicamente los agentes de preparación de la piel para la cirugía colorrectal. Comparar la eficacia de la clorhexidina en alcohol versus povidona yodada en alcohol versus povidona yodada en solución acuosa para la prevención de la infección del sitio quirúrgico en cirugía colorrectal. Este es un ensayo controlado aleatorio prospectivo de tres brazos. Este estudio se realizó en el Hospital John Hunter de 800 camas y el Hospital Privado de Newcastle con todos los servicios de subespecialidad en Nueva Gales del Sur, Australia. Se incluyeron todos los adultos elegibles que dieron su consentimiento para someterse a una cirugía colorrectal entre julio de 2015 y diciembre de 2018. Aleatorizados para recibir una preparación para la piel previa a la incisión con uno de: clorhexidina en alcohol al 70%, povidona yodada en alcohol al 70% o povidona yodada en solución acuosa. La medida principal fue la infección del sitio quirúrgico dentro de los 30 días. Un total de 482 pacientes fueron aleatorizados para recibir clorhexidina en alcohol, povidona yodada en alcohol o povidona yodada acuosa. La tasa global de infección del sitio quirúrgico fue del 22% (107/482). No hubo diferencias en las tasas de infección del sitio quirúrgico 20,6% (29/141), 22,8% (44/193) y 23,0% (34/148) respectivamente p = 0,5267. No hubo diferencia en las tasas de complicaciones 54,6% (77/141), 46,1% (89/193) y 49,3% (73/148) respectivamente p = 0,1762. La duración media de la estancia hospitalaria fue de 6,0 días en los tres grupos. Este es un análisis de subconjunto de un ensayo clínico más grande para todas las formas de cirugía incisional (el ensayo NewSKIN Prep) y no se puede evaluar la no inferioridad. Los cambios en las regulaciones gubernamentales dieron como resultado un cambio de clorhexidina al 0,5% en etanol al 70% a clorhexidina al 2% en etanol al 70% durante la prueba. Este gran ensayo clínico prospectivo y aleatorizado parece indicar que no hay diferencia en la infección del sitio quirúrgico, las complicaciones o la duración de la estancia entre las 3 formas más comunes de preparación de la piel en la cirugía colorrectal. Consulte Video Resumen en links.lww.com/DCR/B875. (Traducción—Dr. Gonzalo Hagerman ) Este ensayo se registró de forma prospectiva en el registro de ensayos clínicos de Australia Nueva Zelanda el 15/01/2015: ACTRN12615000021572
Publisher: Wiley
Date: 12-05-2020
DOI: 10.1111/ANS.15882
Publisher: Elsevier BV
Date: 04-2020
Publisher: Mary Ann Liebert Inc
Date: 24-03-2023
DOI: 10.1089/SUR.2023.012
Publisher: Springer Science and Business Media LLC
Date: 11-09-2020
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-2013
Abstract: To investigate the effectiveness of a centralized, nurse-delivered telephone-based service to improve care coordination and patient-reported outcomes after surgery for colorectal cancer. Patients with a newly diagnosed colorectal cancer were randomly assigned to the CONNECT intervention or usual care. Intervention-group patients received standardized calls from the centrally based nurse 3 and 10 days and 1, 3, and 6 months after discharge from hospital. Unmet supportive care needs, experience of care coordination, unplanned readmissions, emergency department presentations, distress, and quality of life (QOL) were assessed by questionnaire at 1, 3, and 6 months. Of 775 patients treated at 23 public and private hospitals in Australia, 387 were randomly assigned to the intervention group and 369 to the control group. There were no significant differences between groups in unmet supportive care needs, but these were consistently low in both groups at both follow-up time points. There were no differences between the groups in emergency department presentations (10.8% v 13.8% P = .2) or unplanned hospital readmissions (8.6% v 10.5% P = .4) at 1 month. By 6 months, 25.6% of intervention-group patients had reported an unplanned readmission compared with 27.9% of controls (P = .5). There were no significant differences in experience of care coordination, distress, or QOL between groups at any follow-up time point. This trial failed to demonstrate substantial benefit of a centralized system to provide standardized, telephone follow-up for postoperative patients with colorectal cancer. Future interventions could investigate a more tailored approach.
Publisher: Wiley
Date: 17-03-2017
DOI: 10.1111/ANS.13937
Abstract: Anastomotic leakage is a feared complication following colorectal surgery. Early prediction results in improved clinical outcome, but accurate predictive factors remain elusive. Many biomarkers have been studied with respect to diagnosis of anastomotic leakage but the concept of trajectory testing, using biomarkers, has not been assessed with regards to early diagnosis of anastomotic leak. C-reactive protein (CRP), procalcitonin (PCT), white cell count (WCC) and gamma-glutamyl transferase were assessed for predictive utility in diagnosing anastomotic leakage with emphasis on identifying an association with change in their levels or trajectory. Levels were collected preoperatively and daily for the first 5 post-operative days on patients undergoing elective colorectal surgery, involving an anastomosis. Anastomotic leakage was defined clinically by operative or radiological intervention. Comparison was made between biomarkers and clinical anastomotic leakage, using receiver operator characteristic curves for logistic models, based on trajectory of the four biomarkers. A total of 197 consecutive patients were analysed. Eleven patients developed clinical anastomotic leakage. An association of biomarker trajectory with anastomotic leakage was observed for WCC, PCT and CRP, but not for gamma-glutamyl transferase. CRP was the superior biomarker based on trajectory, with area under the receiver operator curve of 0.961. This study identifies change in CRP, WCC and PCT as potential markers of anastomotic leakage following colorectal surgery and in particular highlights CRP trajectory as extremely accurate in diagnosing anastomotic leakage requiring intervention. External validation should be sought before incorporating this into routine clinical practice, given the numbers in this study.
Publisher: Oxford University Press (OUP)
Date: 20-01-2011
DOI: 10.1002/BJS.7440
Publisher: MDPI AG
Date: 18-11-2022
Abstract: Background: Active patient participation in preparation and recovery from colorectal cancer surgery can be facilitated by timely information and care and may improve patient wellbeing and reduce hospitalizations Methods: We aimed to identify gaps in perioperative information and care by asking colorectal cancer surgical patients to retrospectively report on their perceptions of care via a cross-sectional survey Results: Overall, 179 (64% consent rate) patients completed one of two 64-item surveys exploring their views of ‘optimal care’ or their experiences of ‘actual care’. In total, 41 (64%) aspects of care were endorsed as optimal. Of these, almost three-quarters (73%) were received by most patients (80% or more). Gaps in care were identified from discrepancies in the endorsement of optimal versus actual survey items. Of the 41 items identified as representing ‘optimal care’, 11 items were received by fewer than 80% of patients, including the provision of information about the impact of surgical wait-times on cancer cure (69%) pre-habilitation behaviors to improve health (75%) the type of questions to ask the health care team (74%) impact of pain medications on bowel movements (73%) how to obtain medical supplies for self-care at home (67%) dietary or exercise advice after discharge (25–31%) and emotional advice after discharge (44%). Conclusions: These gaps represent patient-centered priorities and targets for supportive interventions.
Publisher: Wiley
Date: 10-2008
DOI: 10.1111/J.1445-2197.2008.04682.X
Abstract: Splenectomy is associated with a lifelong increase in the risk of sepsis. The aim of this study was to determine the level of knowledge of patients who have undergone splenectomy within an Australian area health service. Adults undergoing a splenectomy between 1994 and 2004 within the Hunter Area Health Service were invited to participate in the study. Consenting participants were contacted by telephone and a standardized questionnaire completed. More than 50% of participants displayed a good active knowledge of the risk of infection post-splenectomy and an understanding of the role of vaccinations in reducing the risk of infection. Few participants (11.3%) had standby antibiotics readily available. Knowledge of travel precautions and risk of sepsis following animal bites was poor. Although most participants displayed a good knowledge of infection risk post-splenectomy, deficiencies in knowledge were identified. We propose the development of a splenectomy protocol and patient briefing to improve patient education.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2018
DOI: 10.1097/DCR.0000000000000943
Abstract: Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking. The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage. This was a prospective, double-blind, placebo-controlled, randomized clinical trial. The study was conducted at a tertiary referral university hospital in Australia. Consecutive patients aged years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265). A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo. The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates. There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo p = 0.661), mean transfusion volume (1.27 vs 1.93 units p = 0.355), intervention rates (7/49 vs 13/47 p = 0.134), length of hospital stay (4.67 vs 4.74 d p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use. A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes. Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at links.lww.com/DCR/A453.
Publisher: Elsevier BV
Date: 2019
DOI: 10.2139/SSRN.3456869
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2016
DOI: 10.1097/DCR.0000000000000666
Abstract: Nonsteroidal anti-inflammatory drugs are commonly used analgesics in colorectal surgery. Controversy exists regarding the potential association between these drugs and anastomotic dehiscence. This study aimed to determine whether postoperative nonsteroidal anti-inflammatory drug use is associated with intestinal anastomotic dehiscence. PubMed, EMBASE, CENTRAL, and references of included articles were searched without date or language restriction. Randomized controlled trials and observational studies that compared postoperative nonsteroidal anti-inflammatory drug use with nonuse and reported on intestinal anastomotic dehiscence were selected. The use of postoperative nonsteroidal anti-inflammatory drugs relative to placebo or nonuse was investigated. Risk ratios and adjusted or unadjusted odds ratios for anastomotic dehiscence were pooled across randomized controlled trials and observational studies using DerSimonian and Laird random-effects models. Among 4395 citations identified, 6 randomized controlled trials (n = 473 patients) and 11 observational studies (n 20,184 patients) were included. Pooled analyses revealed that nonsteroidal anti-inflammatory drug use was nonsignificantly associated with anastomotic dehiscence in randomized controlled trials (risk ratio, 1.96 95% CI, 0.74–5.16 I 2 = 0%) and significantly associated with anastomotic dehiscence in observational studies (OR, 1.46 95% CI, 1.14–1.86 I 2 = 54%). In stratified analyses of observational study data, the pooled OR for anastomotic dehiscence was statistically significant for studies of nonselective nonsteroidal anti-inflammatory drug use (6 studies 4900 patients OR, 2.09 95% CI, 1.65–2.64 I 2 = 0%), but was not statistically significant for studies of cyclooxygenase-2 selective nonsteroidal anti-inflammatory drug use (3 studies patients OR, 1.34 95% CI, 0.78–2.31 I 2 = 0%). Studies varied by patient selection criteria, drug exposures, and definitions of anastomotic dehiscence. Analyses of randomized controlled trials and cyclooxygenase-2 selective nonsteroidal anti-inflammatory drugs were potentially underpowered. Pooled observational data suggest an association between postoperative nonsteroidal anti-inflammatory drug use and intestinal anastomotic dehiscence. Caution may be warranted in using these medications in patients at risk for this complication.
Publisher: SAGE Publications
Date: 03-04-2023
DOI: 10.1177/26320843231167496
Abstract: Background: High response rates for patient surveys are required in medical literature to ensure non-response bias is minimised. It is often difficult to achieve a satisfactory response rate as patient engagement in surveys is decreasing. A major barrier to phone surveys is getting patients to answer calls from unknown numbers. Purpose: To design a methodology which boosts response rates for telephone-based patient surveys. Research Design: We prospectively analysed the effectiveness of our methodology for increasing patient participation using caller ID and text messanging. Study S le: Two waves totalling 1313 patients were contacted for participation in a patient survey for a descriptive quantitative and qualitative cohort study using our developed methadology. Data Analysis: We analysed the timepoints at which successful contact was made when using caller ID and text messanging. Results: We achieved a call answer rate of 85.4%, which was a 70.8% increase when compared to a similar patient cohort contacted via blocked caller ID (i.e. with privacy settings). Conclusion: We have developed a simple, inexpensive methodology which, when tested outside the Australian setting and for other projects, shows promise for increasing patient survey response rate.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2018
DOI: 10.1097/MLR.0000000000000860
Abstract: An association between weekend health care delivery and poor outcomes has become known as the “weekend effect.” Evidence for such an association among surgery patients has not previously been synthesized. To systematically review associations between weekend surgical care and postoperative mortality. We searched PubMed, EMBASE, and references of relevant articles for studies that compared postoperative mortality either (1) according to the day of the week of surgery for elective operations, or (2) according to weekend versus weekday admission for urgent/emergent operations. Odds ratios (ORs) and corresponding 95% confidence intervals (CIs) for postoperative mortality (≤90 d or inpatient mortality) were pooled using random-effects models. Among 4027 citations identified, 10 elective surgery studies and 19 urgent/emergent surgery studies with a total of ,685,970 and ,424,316 patients, respectively, met the inclusion criteria. Pooled odds of mortality following elective surgery rose in a graded manner as the day of the week of surgery approached the weekend [Monday OR=1 (reference) Tuesday OR=1.04 (95% CI=0.97–1.11) Wednesday OR=1.08 (95% CI=0.98–1.19) Thursday OR=1.12 (95% CI=1.03–1.22) Friday OR=1.24 (95% CI=1.10–1.38)]. Mortality was also higher among patients who underwent urgent/emergent surgery after admission on the weekend relative to admission on weekdays (OR=1.27 95% CI=1.08–1.49). Postoperative mortality rises as the day of the week of elective surgery approaches the weekend, and is higher after admission for urgent/emergent surgery on the weekend compared with weekdays. Future research should focus on clarifying underlying causes of this association and potentially mitigating its impact.
Publisher: Mary Ann Liebert Inc
Date: 10-2021
DOI: 10.1089/SUR.2020.432
Publisher: Wiley
Date: 16-08-2021
DOI: 10.1111/ANS.17156
Publisher: Wiley
Date: 14-06-2022
DOI: 10.1111/ANS.17831
Abstract: Preoperative skin antiseptics are used prior to surgery to reduce the risk of surgical site infection (SSI). There is debate as to which is the most effective. The aim of this network meta‐analysis (NMA) is to compare the effectiveness of different skin preparations at reducing SSIs in patients undergoing incisional surgery. The study protocol was published in PROSPERO (CRD4202181599) a priori with predefined search terms and inclusion/exclusion criteria. The skin preparations for comparison were: chlorhexidine/alcohol (CHA), chlorhexidine/water (CHW), poviodine/alcohol (PVIA), poviodine/water (PVIW). The records identified were screened by two authors independently by title, abstract and in full text. The revised tool for risk‐of bias (ROB2) assessment was used. Twenty‐nine RCTs involving 15 796 patients were included in the NMA. A significant but small increase in the odds of infection was seen in the PVIW group compared to the CHA group (OR 1.34, 95%CrI 1.09–1.64), but other comparisons were not statistically significantly different. Ranking the treatment arms showed there was a 64% probability that CHA is the most effective and a 62.7% probability that PVIW is the least effective treatment. Chlorhexidine/alcohol (CHA) was found to be the most effective for prevention of superficial and deep SSI while PVIW was the least. There was no differences seen between CHA and PVIA, or CHW and PVIW. The superiority of CHA is likely due to the effect of the alcohol in the base. Hence the choice between CHA and PVIA should be based on health and cost considerations.
Publisher: Oxford University Press (OUP)
Date: 23-06-2010
DOI: 10.1002/BJS.7151
Abstract: Ileostomy closure is an operation with an underappreciated morbidity, including surgical-site infection, small bowel obstruction and anastomotic leakage. Surgical-site infections, in particular, are a frequent occurrence following closure of contaminated wounds. This randomized controlled trial compared a purse-string closure technique with conventional linear closure. Sixty-one patients were randomized to conventional or purse-string closure of ileostomy wounds. The primary endpoint was the incidence of surgical-site infection, including infections requiring hospital or community treatment. Purse-string closure resulted in fewer surgical-site infections than conventional closure: two of 30 versus 12 of 31 respectively (P = 0·005). The purse-string method results in a clinically relevant reduction in surgical-site infections after ileostomy closure. Registration number: ACTRN12609000021279 (Australian New Zealand Clinical Trials Registry: www.anzctr.org.au/).
Publisher: Oxford University Press (OUP)
Date: 05-2021
DOI: 10.1093/BJS/ZNAB050
Publisher: Springer Science and Business Media LLC
Date: 23-03-2013
DOI: 10.1007/S10151-013-1000-4
Abstract: We sought to compare two synthetic injectable bulking agents, with known efficacy (PTQ™: a silicone biomaterial and Durasphere(®): pyrolytic carbon-coated beads), in the form of a randomised clinical trial. Circumferential injection of either agent was performed under local anesthesia and sedation as a day-case procedure. The primary outcome measure was the Wexner incontinence scale. Secondary measures were the short-form 36 (SF-36) quality of life assessment and manometry (maximum resting and squeeze pressures). Follow-up was at 6 weeks, 6 and 12 months. Thirty-five patients were randomised, 17 to PTQ(®) and 18 to Durasphere(®). Early closure of the trial occurred, due to the removal of the agent PTQ(®), from the Australian Pharmaceutical Benefits scheme. Wexner incontinence scores were significantly better than baseline, in both groups, at 6 weeks and 6 months (P < 0.05), although the improvements were not significant at 12 months. There was no significant improvement for either agent, from baseline, in mean SF-36 scores at any follow-up sessions. There was no significant difference between the two bulking agents, with regard to both Wexner and SF-36 scores, at any of the follow-up sessions. Complications occurred in one patient in the PTQ group (perianal abscess) and did not occur in any of the patients in the Durasphere group. This trial appears to show that both synthetic agents PTQ(®) and Durasphere(®) are effective and safe, although long-term improvement is limited. In this trial, there appears to be no difference in efficacy between the two agents, over a 12-month follow-up period.
Publisher: Wiley
Date: 06-03-2020
DOI: 10.1111/ANS.15024
Publisher: Wiley
Date: 05-07-2017
DOI: 10.1111/ANS.14097
Publisher: Elsevier BV
Date: 10-2010
Publisher: Wiley
Date: 02-07-2019
DOI: 10.1111/CODI.14720
Abstract: Postoperative pain remains a major factor in recovery from colorectal resection. There is increasing interest in opioid-sparing analgesia, and intraperitoneal local anaesthetic (IPLA) has recently been shown to be useful in minor laparoscopic and open colorectal procedures. The aim of this study was to evaluate the impact of IPLA on functional recovery following major laparoscopic surgery. In this controlled trial, mobility, as measured by the De Morton Mobility Index (DEMMI), was used as a surrogate for postoperative functional recovery. Patients undergoing laparoscopic colorectal resection were randomized either to continuous ropivacaine (0.2% at 4-6 ml/h) or to saline (0.9%) which were administered via intraperitoneal catheter for 3 days postoperatively. Results were analysed in a double-blind manner. DEMMIs were assessed on postoperative days 1, 2, 3, 7 and 30, and data on pain, opioid consumption, gut and respiratory function, length of stay (LOS) and complications were recorded. Ninety-six patients were recruited. There was no difference in primary outcome (i.e., functional recovery) between IPLA and placebo groups. Opioid consumption and LOS were similar between groups, and no differences were found for any secondary outcome measure. There were no adverse events related to ropivacaine. Infusional intraperitoneal local anaesthetic appears to be safe but does not improve functional recovery or analgesic consumption following elective laparoscopic colorectal surgery, in the setting of an established enhanced recovery programme.
Publisher: Elsevier BV
Date: 2021
Publisher: Wiley
Date: 06-04-2023
DOI: 10.1111/ANS.18455
Abstract: Surgical Site Infection (SSI) of the abdominal incision is a dreaded complication following colorectal surgery. Identifying the intraoperative surgical site microbes may provide clarity in the pathogenesis of SSIs. Genomic sequencing has revolutionized the ability to identify microbes from clinical s les. Utilization of 16S rRNA licon sequencing to characterize the intraoperative surgical site may provide the critical information required to predict and prevent infection in colorectal surgery. This is a pilot, prospective observational study of 50 patients undergoing elective colorectal resection. At completion of surgery, prior to skin closure, swabs were taken from the subcutaneous tissue of the abdominal incision to investigate the microbial profile. Dual swabs were taken to compare standard culture technique and 16S rRNA sequencing to establish if a microbial profile was associated with postoperative SSI. 8/50 patients developed an SSI, which was more likely in those undergoing open surgery (5/15 33.3% versus 3/35, 8.6% P = 0.029). 16S rRNA licon sequencing was more sensitive in microbial detection compared to traditional culture. Both culture and 16S rRNA demonstrated contamination of the surgical site, predominantly with anaerobes. Culture was not statistically predictive of infection. 16S rRNA licon sequencing was not statistically predictive of infection, however, it demonstrated patients with an SSI had an increased bio ersity (not significant) and a greater relative abundance (not significant) of pathogens such as Bacteroidacaea and Enterobacteriaceae within the intraoperative site. 16S rRNA licon sequencing has demonstrated a potential difference in the intraoperative microbial profile of those that develop an infection. These findings require validation through powered experiments to determine the overall clinical significance.
Publisher: Wiley
Date: 02-05-2018
DOI: 10.1111/ANS.13916
Abstract: The presence of an indwelling urinary catheter (IDUC) is routine following colorectal resections. In Enhanced Recovery After Surgery programmes, excessive intravenous fluids (IVFs) are avoided. This study sought to determine whether the routine absence of an IDUC following colorectal surgery improved post-operative outcomes and minimized fluid prescription. A retrospective comparative cohort study was performed on patients undergoing colorectal resection at a tertiary referral teaching hospital, over a 7-year period. A policy of no routine IDUC was introduced over the last 3 years. Patients were ided into cohorts based on the presence or absence of an IDUC on leaving the operating theatre. The outcomes assessed were IVF prescription, length of stay, mortality and morbidity. Of the 213 resections over the time period, 131 met the inclusion criteria (87 IDUC and 44 no IDUC). There was no difference between groups with respect to baseline demographics. Fluid administration was less in the group without routine IDUC (total fluid 6.16 L versus 10.89 L P < 0.0001, fluid in the first 24 h 3.82 L versus 5.3 L P < 0.0001 and fluid in the first 48 h 5.15 L versus 7.23 L P < 0.0001). Length of stay was less in the 'no IDUC' group (5.9 days versus 10.1 days P = 0.0009). There was no difference in morbidity and mortality. A policy of no IDUC following colectomy was associated with a reduction in IVF administration and length of stay. A randomized controlled trial is recommended in order to more accurately determine the degree of causal relationship.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2010
Publisher: Wiley
Date: 14-03-2014
Abstract: The incidence of postoperative ileus (POI) after gynaecological surgery is 10-15% Chewing gum following general surgery improves outcomes, including early flatus, early bowel sounds, and shortening of hospitalisation periods. There is currently no guideline that supports the use of chewing gum after caesarean sections. To systematically analyse the published randomised controlled trials regarding the effectiveness of chewing gum in preventing POI in women undergoing caesarean sections. Systematic search of medical databases up to March 2013. Randomised controlled trials that reported the role of chewing gum in preventing POI in women undergoing caesarean sections. Two authors independently identified the relevant studies for inclusion, extracted outcome-related data, and analysed it systematically using REVMAN(®). The combined outcome was expressed as an odds ratio and standardised mean difference. Seven randomised controlled trials involving 1462 women (728 in the chewing gum group, 734 controls) were systematically analysed. There was significant heterogeneity (χ(2) = 29.02, df = 7 P < 0.0001 I(2) = 76%) among the included trials. Among women undergoing caesarean sections, chewing gum reduced the risk of POI (odds ratio 0.36 95% confidence interval 0.19-0.69 z = 3.08 P < 0.002) but did not affect duration of hospitalisation (P = 0.32). Chewing gum for 30-60 minutes at least three times a day appears to be effective in reducing the incidence and consequences of POI following caesarean sections.
Publisher: Cureus, Inc.
Date: 14-05-2018
DOI: 10.7759/CUREUS.2625
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.JSS.2019.12.022
Abstract: Anastomotic leak rates have not improved over several decades despite improvements in surgical techniques and patient care. The gut microbiome has been implicated in the development of leaks. The exact mechanisms by which tissue oxygenation affects gut microbial composition and anastomotic healing physiology are unclear. Also, commonly used carbon dioxide (CO A literature search was performed in MEDLINE, EMBASE, and COCHRANE to identify studies investigating the effects of hyperoxia, hypoxia, and hypercapnia on anastomotic healing and gut microbiota published between 1998 and 2018. Two reviewers screened the articles for eligibility and quality. Fifty-three articles underwent full text review, and a narrative synthesis was undertaken. Hyperoxia is associated with better anastomotic healing, increased gastrointestinal oxygen tension, and may reduce gut anaerobes. Hypoxia is associated with poor healing and increased gut anaerobes. However, it is unclear if hypoxia is the most important predictor of anastomotic leaks. Low pressure CO Tissue oxygenation influences gut anastomotic healing, but little evidence exists to demonstrate the influence on the gut microbiome in the context of healing. Further studies are needed to determine if anastomotic microbiome changes with altered tissue oxygenation and if this affects healing and leak rates. If confirmed, altering tissue oxygenation through hyperoxia or hypercapnia could be feasible means of altering the microbiome such that anastomotic leak rates reduce.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 23-12-2021
Publisher: Wiley
Date: 07-2018
DOI: 10.1111/ANS.14766
Publisher: Oxford University Press (OUP)
Date: 13-03-2021
DOI: 10.1093/BJS/ZNAB064
Publisher: BMJ
Date: 07-2023
DOI: 10.1136/BMJOPEN-2022-070159
Abstract: The Australian population presenting with surgical pathology is becoming older, frailer and more comorbid. Shared decision-making is rapidly becoming the gold standard of care for patients considering high-risk surgery to ensure that appropriate, value-based healthcare decisions are made. Positive benefits around patient perception of decision-making in the immediacy of the decision are described in the literature. However, short-term and long-term holistic patient-centred outcomes and cost implications for the health service require further examination to better understand the full impact of shared decision-making in this population. We propose a novel multidisciplinary shared decision-making model of care in the perioperative period for patients considering high-risk surgery in the fields of general, vascular and head and neck surgery. We assess it in a two arm prospective randomised controlled trial. Patients are randomised to either ‘standard’ perioperative care, or to a multidisciplinary (surgeon, anaesthetist and end-of-life care nurse practitioner or social worker) shared decision-making consultation. The primary outcome is decisional conflict prior to any surgical procedure occurring. Secondary outcomes include the patient’s treatment choice, how decisional conflict changes longitudinally over the subsequent year, patient-centred outcomes including life impact and quality of life metrics, as well as morbidity and mortality. Additionally, we will report on healthcare resource use including subsequent admissions or representations to a healthcare facility up to 1 year. This study has been approved by the Hunter New England Human Research Ethics Committee (2019/ETH13349). Study findings will be presented at local and national conferences and within scientific research journals. ACTRN12619001543178.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2014
Publisher: Wiley
Date: 20-01-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2015
Publisher: OAE Publishing Inc.
Date: 2020
DOI: 10.20517/2574-1225.2020.87
Abstract: Aim: This systemic review aims to determine if intracorporeal anastomosis (IA) adds value to patient outcomes without compromising operative and oncological safety when compared to extracorporeal anastomosis (EA) in laparoscopic colectomies. This is the first systematic review with meta-analysis to evaluate the outcomes in a combined fashion including both laparoscopic right and left colectomies. Methods: A systematic review of Medline, EMBASE, Cochrane Library, and PubMed was performed on studies analysing direct comparison between IA and EA. The primary outcome was anastomotic leakage. Quality assessment was carried out using a modified Institute of Health Economics appraisal tool. Meta-analysis was performed using a random-effects model. Results: A total of 24 papers with 2,674 patients were included in the analysis. No significant difference was found in anastomotic leakage (OR = 0.84 95%CI: 0.54-1.31 P = 0.44) and short-term mortality (OR = 0.56 95%CI: 0.20-1.58 P = 0.27) between the IA and EA cohorts. The IA cohort was associated with faster return of bowel function [MD = -0.53 days 95%CI: -0.67-(-0.39) P 0.00001] and lower incidence of surgical site infection (OR = 0.52 95%CI: 0.31-0.85 P = 0.009). The number of lymph nodes harvested was higher in IA (MD = 1.05 95%CI: 0.19-1.91 P = 0.02 I2 = 83%) with considerable heterogeneity. Conclusion: Intracorporeal anastomosis can be considered a safe alternative technique in laparoscopic colectomies, with potential benefits in patient outcomes. A lack of randomised studies and heterogeneity need to be addressed by additional high-quality trials.
Publisher: Elsevier BV
Date: 07-2022
Publisher: Wiley
Date: 19-10-2022
DOI: 10.1111/ANS.18101
Abstract: The benefits of mechanical prophylaxis for the prevention of venous thromboembolism (VTE) in abdominal and pelvic surgery are uncertain, with different guidelines stating that graduated compression stockings (GCS) and intermittent pneumatic compression devices (IPCDs) can be used either alone or in combination. To review the efficacy of IPCDs in preventing VTE following abdominal and pelvic surgery. A systematic review was conducted, identifying relevant literature reporting clinical trials conducted in abdominopelvic surgery, comparing the effect of IPCDs alone or in combination with no prophylaxis, GCS and chemical prophylaxis. The review identified studies reported from 1966 to 2022 in Medline, Embase, PubMed and Cochrane databases for randomized controlled trials. Thirteen RCTs involving 1914 participants were identified. IPCDs were superior to placebo (OR VTE 0.39 95% CI 0.20-0.76) but not superior to other forms of prophylaxis (OR 0.83 95% CI 0.30-2.27) or to GCS alone (OR 0.9 95% CI 0.24-3.36). The addition of IPCDs to GCS compared with GCS alone was beneficial (OR 0.45 95% CI 0.23-0.91) as was the addition of IPCDs to standard perioperative chemoprophylaxis (OR 0.25 95% CI 0.09-0.74). The overall quality and reliability of trials were low, with high risk of bias. IPCDs are more effective than placebo in reducing VTE rates but are not more effective than other forms of thrombo-prophylaxis (chemical or mechanical) following abdominal and pelvic surgery. There is poor quality evidence to suggest that they might have a role as additional prophylaxis when combined with GCS and chemical prophylaxis.
Publisher: Wiley
Date: 27-02-2023
DOI: 10.1111/ANS.18342
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
DOI: 10.1007/S10350-008-9365-6
Abstract: Laparoscopic rectopexy to treat full-thickness rectal prolapse has proven short-term benefits, but there is little long-term follow-up and functional outcome data available. Patients who had abdominal surgery for prolapse during a ten-year period were identified and interviewed to ascertain details of prolapse recurrence, constipation, incontinence, cosmesis, and satisfaction. Additional details on recurrences that required surgery and mortality were obtained from chart review and the State Death Registry. Of 321 prolapse operations, laparoscopic rectopexy was performed in 126 patients, open rectopexy in 46, and resection rectopexy in 21 patients. At a median follow-up of five years after laparoscopic rectopexy, there were five (4 percent) confirmed full-thickness recurrences that required surgery. Actuarial recurrence rates of laparoscopic rectopexy were 6.9 percent at five years (95 percent confidence interval, 0.1-13.8 percent) and 10.8 percent at ten years (95 percent confidence interval, 0.9-20.1 percent). Seven patients underwent rubber band ligation for mucosal prolapse and seven required other surgical procedures. There was one recurrence after open rectopexy (2.4 percent) and one after resection rectopexy (4.7 percent), and there was no significant difference between groups. Overall constipation scores were not increased after laparoscopic rectopexy, with no significant difference to open rectopexy or resection rectopexy. This study has demonstrated that laparoscopic rectopexy has reliable long-term results for treating rectal prolapse, including low recurrence rates and no overall change in functional outcomes.
Publisher: Springer Science and Business Media LLC
Date: 06-09-2012
DOI: 10.1007/S10151-012-0845-2
Abstract: Wound infusions with local anaesthesia have been used with varying success following laparotomy for colonic resections. This trial sought to determine the efficacy of ropivacaine wound infusion following laparoscopic colonic surgery. Forty-eight consecutive patients undergoing elective laparoscopic colorectal resection were randomized to receive either a local anaesthetic wound infusion (ropivacaine 0.5%) or normal saline for a period of 72 h. The primary endpoint was postoperative pain as assessed by analgesic consumption, while secondary endpoints assessed were visual analogue pain scores, respiratory function, gastrointestinal function, length of stay and postoperative complications. There was no difference in mean postoperative analgesic consumption between the two groups over 72 h (143 mEq morphine control vs 94 mEq intervention p = 0.108). Likewise, there was no difference in daily postoperative analgesic consumption or visual analogue pain scores between the two groups. Patients in the ropivacaine group experienced less reduction in their postoperative forced expiratory volume at 1 s on day 1 (mean difference FEV1 0.4 l p = 0.015). There was no difference between the two groups with respect to return of gut function and postoperative complications. In this study, local anaesthetic wound infusion with ropivacaine following elective laparoscopic colorectal surgery improves early respiratory function, but does not appear to provide an improvement in postoperative analgesia or other clinically relevant postoperative outcomes.
Publisher: BMJ
Date: 03-2023
DOI: 10.1136/BMJOPEN-2022-067150
Abstract: Surgery is the most common treatment for colorectal cancer (CRC) and can cause relative long average length of stay (LOS) and high risks of unplanned readmissions and complications. Enhanced Recovery After Surgery (ERAS) pathways can reduce the LOS and postsurgical complications. Digital health interventions provide a flexible and low-cost way of supporting patients to achieve this. This protocol describes a trial aiming to evaluate the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention in decreasing the hospital LOS in patients undergoing CRC surgery. The two-arm randomised controlled trial will assess the effectiveness and cost-effectiveness of the RecoverEsupport digital health intervention compared with usual care (control) in patients with CRC. The intervention consists of a website and a series of automatic prompts and alerts to support patients to adhere to the patient-led ERAS recommendations. The primary trial outcome is the length of hospital stay. Secondary outcomes include days alive and out of hospital emergency department presentations quality of life patient knowledge and behaviours related to the ERAS recommendations health service utilisation and intervention acceptability and use. The trial has been approved by the Hunter New England Research Ethics Committee (2019/ETH00869) and the University of Newcastle Ethics Committee (H-2015-0364). Trial findings will be disseminated via peer-reviewed publications and conference presentations. If the intervention is effective, the research team will facilitate its adoption within the Local Health District for widespread adaptation and implementation. ACTRN12621001533886.
Publisher: Wiley
Date: 03-04-2022
DOI: 10.1111/ANS.17658
Abstract: Sarcopenia has been shown to have significant adverse health outcomes in a range of patient populations. Particularly, sarcopenic patients having cancer surgery are a unique group who demonstrate poorer post‐operative outcomes. Currently, the gold standard in diagnosing sarcopenia is through the use of computed tomography. However, the widespread use of imaging to diagnose patients with sarcopenia is neither cost‐effective nor practical. Identifying a serum biomarker or a simple mobility scoring system as an alternative diagnostic tool may aid in identifying more patients at risk of sarcopenia. C1q, a novel biomarker, has previously been shown to correlate with sarcopenia. Similarly, we sought to explore whether mobility scores may provide a useful surrogate marker for sarcopenia. This was a prospective cohort study of patients who presented for colorectal cancer surgery between the dates of 6/10/2016 and 4/10/2017 at John Hunter Hospital. Computed tomography was utilized to calculate the psoas area at the L3 spinal level. Pre‐operative blood s les were obtained for C1q analysis and de Morton Mobility Index (DEMMI) was also performed. A total of 51 patients were included in the study. The median age of the patients were 69 years old. We did not demonstrate a correlation between serum C1q and DEMMI scores with psoas area. Our findings suggest that neither C1q nor DEMMI scores are correlated with psoas area in a colorectal cancer population.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2014
Publisher: Wiley
Date: 19-12-2017
DOI: 10.1111/ANS.14317
Abstract: Adequate post-operative analgesia is essential for recovery following abdominal surgery. Abdominal wall nerve blocks have been shown to be beneficial in this respect following surgery. The purpose of this trial was to examine the efficacy of infusional versus intermittent bolus delivery of abdominal wall blocks in patients undergoing abdominal resectional gastrointestinal surgery. A prospective randomized clinical trial, involving 120 patients undergoing gastrointestinal surgery, was undertaken across three hospitals. Insertion of abdominal wall catheters was performed and patients were randomized to receive ropivacaine 0.2% by either continuous infusion or regular intermittent bolus. The primary outcome was respiratory function, as measured by spirometry on post-operative days 1-3 and 30. Secondary outcomes were pain, mobility, return of gut function, length of hospital stay, complication rates and patient satisfaction with analgesia. All 120 patients were followed up to trial completion. Patients were well matched with regards to demographics. There was no difference between groups with regards to the primary outcome of post-operative respiratory function. The bolus group had improved mobility scores on post-operative day 1 (P = 0.025). There were no complications associated with blockade, and no other differences were identified between assessed outcomes. Continuous infusion and intermittent bolus are both safe ways of delivering abdominal wall nerve blockade, with equivalent analgesic outcomes. Bolus delivery appears to provide superior early mobility in comparison with continuous infusion.
Publisher: Springer Science and Business Media LLC
Date: 09-07-2011
DOI: 10.1007/S10151-011-0711-7
Abstract: Aim of the study was to assess adequacy of Colorectal Surgical Society of Australia and New Zealand (CSSANZ) endorectal ultrasound (ERUS) training and whether a subsequent learning curve exists. A prospective audit of ERUS for staging rectal cancer by a single surgeon from commencement of consultant practice was performed. Data were recorded in a prospectively maintained database. The audit commenced on completion of CSSANZ training. T- and N-stage were assessed clinically, then by ERUS prior to treatment and finally by histology over 8 years. The results were compared over three time periods: the first a single year, then two three-year periods. Two hundred and seventy-two patients were examined. Two hundred and thirty-three were assessable for T-stage (13 no tumour excision, 26 long course pre-operative radiotherapy) and 142 for N-stage (74 endoanal excision, 17 proximal mesorectum un-assessable). Overall accuracy was 82% for T-stage and 73% for N-stage. Accuracy for T- and N-staging did not change significantly over the three time periods (T: 82.1, 82.3, 81.6%, P = 0.14 N: 83.3, 67.9, 74.2%, P = 0.31). The utility of ERUS was demonstrated by clinical assessment not being possible in 32% of cases and where the two modalities disagreed was correct 82% of the time. Endorectal ultrasound rectal cancer staging is accurate for T-stage. Competency in ERUS can be achieved in the CSSANZ fellowship and accuracy does not improve with further experience. An ERUS accreditation scheme should be established for future trainees.
Publisher: Springer Science and Business Media LLC
Date: 24-06-2015
DOI: 10.1007/S00384-015-2286-7
Abstract: Adequate postoperative analgesia is essential for recovery following colorectal surgery. Transversus abdominis plane (TAP) blocks have been found to be beneficial in improving pain following a variety of abdominal operations. The objective of this study was to determine if TAP blocks are useful in improving postoperative recovery following laparoscopic colorectal surgery. A prospective double-blind randomized clinical trial, involving 226 consecutive patients having laparoscopic colorectal surgery, was performed by a university colorectal surgical department. Patients were randomized to either TAP blockade using ultrasound guidance, or control, with the primary outcome being postoperative pain, as measured by analgesic consumption. Secondary outcomes assessed were pain visual analogue score (VAS), respiratory function, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction. A total of 142 patients were followed up to trial completion (74 controls, 68 interventions). Patients were well matched with regard to demographics. No complications occurred as a result of the intervention of TAP blockade. There was no difference between groups with regards to analgesic consumption (161 mEq morphine control vs 175 mEq morphine TAP p = 0.596). There was no difference between the two groups with regards to the secondary outcomes of daily VAS, respiratory outcome, time to return of gut function, length of hospital stay, postoperative complications, and patient satisfaction. We conclude that TAP blockade appears to be a safe intervention but confers no specific advantage following laparoscopic colorectal surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 17-03-2023
DOI: 10.1097/DCR.0000000000002774
Abstract: Rubber band ligation of hemorrhoids causes less pain than excisional hemorrhoidectomy, but many patients still experience significant postprocedure discomfort. This study aimed to determine whether topical lidocaine, with or without diltiazem, is more effective than placebo for analgesia after hemorrhoid banding. This is a prospective, randomized, double-blinded, placebo-controlled trial. Patients were randomly assigned to 2% lidocaine, 2% lidocaine with 2% diltiazem, or a placebo ointment. This study was performed at 2 university public teaching hospitals and 2 private hospitals in Australia. Consecutive patients aged ≥18 years undergoing hemorrhoid banding were selected. Topical ointments were applied postprocedure 3× daily for 5 days. Visual analog pain score, opiate analgesia usage, and patient satisfaction were the main outcome measures. Of 159 eligible patients, 99 were randomly assigned (33 in each group). Pain scores were reduced at 1 hour for the lidocaine (OR 4.15 [1.12–15.41] p = 0.03) and lidocaine/diltiazem groups (OR 3.85 [1.05–14.11] p = 0.04) compared with placebo. Patients in the lidocaine/diltiazem group had improved satisfaction (OR 3.82 [1.28–11.44] p = 0.02) and were more likely to recommend the procedure to others (OR 9.33 [1.07–81.72] p = 0.04). Patients in the lidocaine/diltiazem group required approximately 45% less total and in-hospital analgesia compared with the placebo. There was no difference in complications between any of the groups. A cost/benefit analysis was not performed. Analgesic efficacy appeared to be short term and the procedures were performed only in the hospital/nonambulatory setting. Topical lidocaine reduced short-term analgesia use, whereas combination lidocaine/diltiazem was associated with both improved analgesia and patient satisfaction after hemorrhoid banding. ANTECEDENTES: La ligadura de hemorroides con banda elástica causa menos dolor que la hemorroidectomía escisional, pero muchos pacientes siguen experimentando molestias significativas tras el procedimiento. OBJETIVO: Este estudio tiene como objetivo determinar si la lidocaína tópica, con o sin diltiazem, es más eficaz que el placebo para la analgesia tras la ligadura hemorroidal. DISEÑO: Este es un ensayo prospectivo, aleatorizado, doble ciego, controlado con placebo. Los pacientes fueron aleatorizados para recibir lidocaína al 2 %, lidocaína al 2 % con diltiazem al 2 % o ungüento de placebo. AJUSTES: Este estudio se realizó en dos hospitales públicos con docencia universitaria y dos hospitales privados en Australia. PACIENTES: Se seleccionaron pacientes consecutivos de ≥18 años sometidos a ligadura para hemorroides. INTERVENCIONES: Se aplicaron ungüentos tópicos tras el procedimiento tres veces al día durante 5 días. PRINCIPALES MEDIDAS DE RESULTADO: La puntuación analógica visual del dolor, el uso de analgésicos opiáceos y la satisfacción del paciente fueron las principales medidas de resultado. RESULTADOS: De 159 pacientes elegibles, 99 fueron aleatorizados (33 en cada grupo). Las puntuaciones de dolor se redujeron a la hora para los grupos de lidocaína (OR 4,15 (1,12-15,41) p = 0,03) y lidocaína/diltiazem (OR 3,85 (1,05-14,11), p = 0,04) en comparación con el placebo. Los pacientes del grupo de lidocaína/diltiazem mejoraron su satisfacción (OR 3,82 (1,28-11,44), p = 0,02) y eran más propensos de recomendar el procedimiento a otros (OR 9,33 (1,07-81,72), p = 0,04). Los pacientes del grupo de lidocaína/diltiazem requirieron aproximadamente un 45 % menos de analgesia total e intrahospitalaria en comparación con el grupo de placebo. No hubo diferencia en las complicaciones entre ninguno de los grupos. LIMITACIONES: No se realizó un análisis de costo/beneficio. La eficacia analgésica pareció ser a corto plazo y los procedimientos solo se realizaron en el hospital/entorno no ambulatorio. CONCLUSIÓN: La lidocaína tópica mejora la analgesia a corto plazo, mientras que la combinación de lidocaína/diltiazem se asocia tanto con una mejor analgesia como con la satisfacción del paciente tras la colocación de bandas para hemorroides. (Traducción—Dr Osvaldo Gauto )
Publisher: Wiley
Date: 22-05-2018
DOI: 10.1111/ANS.14555
Abstract: Post-operative length of stay (LOS) is an increasingly important clinical indicator in general surgery. Despite this, no tool has been validated to predict LOS or readiness for discharge in general surgical patients. The de Morton Mobility Index (DEMMI) is a functional mobility assessment tool that has been validated in rehabilitation patient populations. In this prospective cohort study, we aimed to identify if trends in DEMMI scores were associated with discharge within 1 week and overall LOS in general surgical patients. A total of 161 patients who underwent elective gastrointestinal resections were included. DEMMI scores were performed preoperatively, on days 1, 2, 3 and 30 post-operative. Statistical analysis was performed to identify any association between DEMMI scores and discharge within 1 week and LOS. Functional recovery (measured by achieving 80% of baseline DEMMI score by post-operative day 1) was significantly associated with discharge within 1 week. Presence of a stoma was associated with longer LOS. The area under the receiver operating characteristic curve using functional recovery on post-operative day 1 as a predictor of discharge within 1 week is 0.772. The DEMMI score is a fast, easy and useful tool to, on post-operative day 1, predict discharge within 1 week. The utility of this is to act as an anticipatory trigger for more proactive and efficient discharge planning in the early post-operative period, and there is potential to use the DEMMI as a comparator in clinical trials to assess functional recovery.
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.BJA.2018.07.002
Abstract: Cancellation of planned surgery impacts substantially on patients and health systems. This study describes the incidence and reasons for cancellation of inpatient surgery in the UK NHS. We conducted a prospective observational cohort study over 7 consecutive days in March 2017 in 245 NHS hospitals. Occurrences and reasons for previous surgical cancellations were recorded. Using multilevel logistic regression, we identified patient- and hospital-level factors associated with cancellation due to inadequate bed capacity. We analysed data from 14 936 patients undergoing planned surgery. A total of 1499 patients (10.0%) reported previous cancellation for the same procedure contemporaneous hospital census data indicated that 13.9% patients attending inpatient operations were cancelled on the day of surgery. Non-clinical reasons, predominantly inadequate bed capacity, accounted for a large proportion of previous cancellations. Independent risk factors for cancellation due to inadequate bed capacity included requirement for postoperative critical care [odds ratio (OR)=2.92 95% confidence interval (CI), 2.12-4.02 P<0.001] and the presence of an emergency department in the treating hospital (OR=4.18 95% CI, 2.22-7.89 P<0.001). Patients undergoing cancer surgery (OR=0.32 95% CI, 0.22-0.46 P<0.001), obstetric procedures (OR=0.17 95% CI, 0.08-0.32 P<0.001), and expedited surgery (OR=0.39 95% CI, 0.27-0.56 P<0.001) were less likely to be cancelled. A significant proportion of patients presenting for surgery have experienced a previous cancellation for the same procedure. Cancer surgery is relatively protected, but bed capacity, including postoperative critical care requirements, are significant risk factors for previous cancellations.
Publisher: Wiley
Date: 05-02-2023
DOI: 10.1111/CODI.16472
Abstract: Cystic fibrosis (CF) is a hereditary, life‐limiting, multi‐system condition that results in chronic respiratory infections, pancreatic insufficiency and intestinal inflammation. Evidence indicates that CF patients develop colorectal cancer (CRC) earlier and more often than the general population. Intestinal dysbiosis resulting from genetics and CF treatment is a contributing factor. This systematic review aims to evaluate the literature to compare the microbiome of adult CF patients to non‐CF patients and to assess if these changes correspond with known CRC microbiome alterations. A systematic review across five databases was performed according to PRISMA guidelines. Studies focusing on adult CF patients using next generation sequencing and with appropriate non‐CF controls were included. Two reviewers independently screened results and assessed study quality using the Newcastle–Ottawa scale. The search generated 2757 results. 118 studies were retained after reviewing the title/abstract and full article review found five studies met the inclusion criteria. All studies consistently showed reduced microbial ersity in CF patients and unique clustering between CF and control cohorts. Thirty‐four genera and 27 species were differently expressed between CF and controls. The CF cohort had a reduced number of short‐chain fatty acid (SCFA) producing bacteria and a higher abundance of bacteria associated with CRC compared to controls. There was substantial heterogeneity across all the studies with regard to methodologies and reporting. However, all studies consistently found CF patients had reduced microbial ersity, fewer SCFA producing bacteria and increased CRC‐associated bacteria. Further prospective studies employing consistent multi‐omics approaches are needed to improve our understanding of the CF gut microbiome and its involvement in early onset CRC. This is the first systematic review to assess adult CF colorectal microbiome changes. This study shows CF patients have reduced SCFA producing bacteria and increased CRC‐associated bacteria compared to non‐CF patients and may help to explain the increased risk of CRC in the CF cohort.
Publisher: Springer Science and Business Media LLC
Date: 04-07-2014
Publisher: Oxford University Press (OUP)
Date: 16-07-2020
DOI: 10.1002/BJS.11812
Abstract: Anastomotic leak is a common complication after colorectal surgery, associated with increased morbidity and mortality, and poorer long-term survival after oncological resections. Early diagnosis improves short-term outcomes, and may translate into reduced cancer recurrence. Multiple studies have attempted to identify biomarkers to enable earlier diagnosis of anastomotic leak. One study demonstrated that the trajectory of C-reactive protein (CRP) levels was highly predictive of anastomotic leak requiring intervention, with an area under the curve of 0·961. The aim of the present study was to validate this finding externally. This was a prospective international multicentre observational study of adults undergoing elective colorectal resection with an anastomosis. CRP levels were measured before operation and for 5 days afterwards, or until day of discharge if earlier than this. The primary outcome was anastomotic leak requiring operative or radiological intervention. Between March 2017 and July 2018, 933 patients were recruited from 20 hospitals across Australia, New Zealand, England and Scotland. Some 833 patients had complete CRP data and were included in the primary analysis, of whom 41 (4·9 per cent) developed an anastomotic leak. A change in CRP level exceeding 50 mg/l between any two postoperative days had a sensitivity of 0·85 for detecting a leak, and a high negative predictive value of 0·99 for ruling it out. A change in CRP concentration of more than 50 mg/l between either days 3 and 4 or days 4 and 5 after surgery had a high specificity of 0·96–0·97, with positive likelihood ratios of 4·99–6·44 for a leak requiring intervention. This study confirmed the value of CRP trajectory in accurately ruling out an anastomotic leak after colorectal resection.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-10-2021
Publisher: Springer Science and Business Media LLC
Date: 11-03-2022
DOI: 10.1007/S00423-022-02488-7
Abstract: Whilst Enhanced Recovery after Surgery (ERAS) has been widely accepted in the international colorectal surgery community, there remains significant variations in ERAS programme implementations, compliance rates and best practice recommendations in international guidelines. A questionnaire was distributed to colorectal surgeons from Australia and New Zealand after ethics approval. It evaluated specialist attitudes towards the effectiveness of specific ERAS interventions in improving short term outcomes after colorectal surgery. The data were analysed using a rating scale and graded response model in item response theory (IRT) on Stata MP, version 15 (StataCorp LP, College Station, TX). Of 300 colorectal surgeons, 95 (31.7%) participated in the survey. Of eighteen ERAS interventions, this study identified eight strategies as most effective in improving ERAS programmes alongside early oral feeding and mobilisation. These included pre-operative iron infusion for anaemic patients (IRT score = 7.82 [95% CI : 6.01–9.16]), minimally invasive surgery (IRT score = 7.77 [95% CI : 5.96–9.07]), early in-dwelling catheter removal (IRT score = 7.69 [95% CI : 5.83–9.01]), pre-operative smoking cessation (IRT score = 7.68 [95% CI : 5.49–9.18]), pre-operative counselling (IRT score = 7.44 [95% CI : 5.58–8.88]), avoiding drains in colon surgery (IRT score = 7.37 [95% CI : 5.17–8.95]), avoiding nasogastric tubes (IRT score = 7.29 [95% CI : 5.32–8.8]) and early drain removal in rectal surgery (IRT score = 5.64 [95% CI : 3.49–7.66]). This survey has demonstrated the current attitudes of colorectal surgeons from Australia and New Zealand regarding ERAS interventions. Eight of the interventions assessed in this study including pre-operative iron infusion for anaemic patients, minimally invasive surgery, early in-dwelling catheter removal, pre-operative smoking cessation, pre-operative counselling, avoidance of drains in colon surgery, avoiding nasogastric tubes and early drain removal in rectal surgery should be considered an important part of colorectal ERAS programmes.
Publisher: Wiley
Date: 2018
DOI: 10.1111/ANS.14270
Start Date: 2021
End Date: 2021
Funder: Hunter Medical Research Institute
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End Date: 2021
Funder: Hunter Medical Research Institute
View Funded ActivityStart Date: 2019
End Date: 2019
Funder: NSW Ministry of Health
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Cancer Institute NSW
View Funded ActivityStart Date: 2019
End Date: 2022
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2020
End Date: 2021
Funder: NSW Regional Health Partners
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Hunter Medical Research Institute
View Funded ActivityStart Date: 2019
End Date: 2020
Funder: Hunter New England Local Health District
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