ORCID Profile
0000-0002-6179-0507
Current Organisations
Royal Brisbane and Women's Hospital
,
Gold Coast University Hospital
,
Saint Andrew's War Memorial Hospital
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Publisher: Wiley
Date: 16-07-2021
DOI: 10.1111/ANS.17064
Abstract: Surgical rib fixation in the general population can decrease morbidity, including length of stay and ventilator days. Elderly rib fractures convey high rates of morbidity and mortality, and it is unclear whether this population benefits from operative management. A single‐centre, retrospective study at a Level 1 Australasian trauma centre was conducted. Registry‐identified patients aged ≥70 years, admitted to hospital with blunt trauma‐induced rib fractures, were included. Outcome measures included demographics, pre‐morbid function, acute length of stay, intensive care unit admission, injury characteristics, management and complications. A total of 920 presentations were identified, with 295 meeting the inclusion criteria. Falls accounted for majority ( n = 148/295, 50.2%), with a median Injury Severity Score of 10 (inter‐quartile range [IQR] 10–14). Severe chest trauma occurred overall in 80% ( n = 243/294) and all operative patients ( n = 15/15). Conservative management was used in 95% ( n = 280/295). Patient‐controlled analgesia was common ( n = 177/295, 60.0%) and regional techniques increased in the surgical approach ( n = 12/15, 80.0%) compared with conservative approach ( n = 71/280, 25.4%). Despite longer acute length of stay (12 days, IQR 9–15), operative management resulted in similar complications (26.7% vs. 30.4%) and no deaths. Operative intervention was significantly associated with increased number of fractures ( p 0.001), flail segment ( p = 0.001) and higher chest Abbreviated Injury Score ( p 0.001) however, it was not significantly associated with age ( p = 0.90), comorbidities (0.91) or anticoagulation ( p = 0.51). Surgical management of rib fractures in the elderly was performed without increased complications within this centre's multimodal approach. Standard indications for rib fixation may be applicable in the elderly population, whilst comorbidities, age and anticoagulation use alone may not be adequate reasons to withhold surgical rib fixation.
Publisher: Wiley
Date: 12-2019
DOI: 10.1111/ANS.15570
Publisher: Wiley
Date: 24-05-2018
DOI: 10.1111/ANS.14678
Publisher: Wiley
Date: 10-10-2018
DOI: 10.1111/ANS.14896
Publisher: Wiley
Date: 12-05-2019
DOI: 10.1111/ANS.15277
Publisher: Springer Science and Business Media LLC
Date: 25-08-2023
Publisher: Wiley
Date: 28-11-2019
DOI: 10.1111/ANS.15601
Publisher: Wiley
Date: 11-10-2017
DOI: 10.1111/ANS.14020
Abstract: The role of minimally invasive approach for pancreaticoduodenectomy has not yet been well defined in Australia. We present our early experience with laparoscopic pancreaticoduodenectomy (LPD) from Brisbane, Australia. Retrospective review in a prospectively collected database of patients undergoing LPD between 2006 and 2016 was performed. Patients who underwent a hybrid LPD (HLPD) mobilization approach and resection followed by open reconstruction and totally LPD (TLPD) approach were included in this study. Operative characteristics, perioperative outcomes, pathological and survival data were collected. Twenty-seven patients underwent LPD including 17 HLPD (63%) and 10 TLPD (37%) patients. HLPD patients were mostly converted to open for planned reconstruction or vascular resection. With increasing experience, more TLPDs were performed, including laparoscopic anastomoses. Median operating time was 462 min (504 min for TLPD). Median length of hospital stay was 10 days. Histology showed 21 invasive malignancies, two neuroendocrine tumours, two intraductal papillary mucinous neoplasms and two benign lesions. Median nodal harvest was 22. Margin negative resection was achieved in 84% of patients. Twenty-two percent of patients developed a Grade 3/4 complication, including 19% clinically significant pancreatic fistula. There was one perioperative mortality (4%) due to pancreatic fistula, post-operative haemorrhage and sepsis. LPD is a technically challenging operation with a steep learning curve. The early oncological outcomes appear satisfactory. It remains to be determined whether the minimally invasive approach to pancreaticoduodenectomy offers benefits to patients.
Publisher: Wiley
Date: 13-05-2021
DOI: 10.1111/ANS.16934
Publisher: Wiley
Date: 17-10-2019
DOI: 10.1111/ANS.15528
No related grants have been discovered for bhavik patel.