ORCID Profile
0000-0001-8672-6379
Current Organisation
The University of Auckland
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2014
Publisher: Elsevier BV
Date: 05-2011
DOI: 10.1016/J.JSS.2010.12.043
Abstract: At the present, no fully validated instrument is available for the assessment of general postoperative recovery. Such an instrument would form a useful patient-centered outcome measure in studies evaluating surgical and perioperative interventions. The aim of our study is to develop and validate a summary score based on the Identity Consequence Fatigue Scale (ICFS), for the specific purpose of reliably measuring functional patient recovery following surgery. Patients who underwent elective open or laparoscopic colonic resection between June 2006 and June 2009 were included. The 31 item ICFS was administered at baseline and postoperative d 3, 7, 30, and 60. Item reduction was applied based on defined parameters, to derive a single summary score capable of predicting >90% of the variance present in the original ICFS and maximizing sensitivity to changes over time. The final score was then validated against published criteria as set out by Terwee et al. [2]. Data from 150 patients were included in the analysis. Application of the item reduction process retained 13 items. These items form the Surgical Recovery Scale (SRS). The SRS was able to predict 94% (89.4%-98.1%) of the ICFS subscale variances, and was successfully validated against seven out of eight published validation criteria. The new SRS is a simple and sensitive tool for the assessment of functional recovery following major surgery. Seven of the eight Terwee et al. validation criteria have been addressed, making this the most broadly validated measure of surgical recovery available.
Publisher: Wiley
Date: 07-2023
DOI: 10.1111/ANS.18595
Abstract: The ‘weekend effect’ is the term given to the observed discrepancy regarding patient care and outcomes on weekends compared to weekdays. This study aimed to determine whether the weekend effect exists within Aotearoa New Zealand (AoNZ) for patients undergoing emergency laparotomy (EL), given recent advances in management of EL patients. A cohort study was conducted across five hospitals, comparing the outcomes of weekend and weekday acute EL. A propensity‐score matched analysis was used to remove potential confounding patient characteristics. Of the 487 patients included, 132 received EL over the weekend. There was no statistically significant difference between patients undergoing EL over the weekend compared to weekdays. Mortality rates were comparable between the weekday and weekend cohorts ( P = 0.464). These results suggest that modern perioperative care practice in New Zealand obviates the ‘weekend’ effect.
Publisher: Springer Science and Business Media LLC
Date: 13-10-2011
Publisher: Springer Science and Business Media LLC
Date: 31-12-2008
DOI: 10.1245/S10434-008-0265-8
Abstract: The most important prognostic factor in colonic cancer is the presence or absence of regional lymph nodes metastases. The aim of this study was to evaluate the relationship between 5-year mortality in the New Zealand population, and the number of nodes examined in Stage II and III colon cancers. New Zealand Cancer Registry data were retrieved for patients with colonic cancer from January 1995 to July 2003. Patients with incomplete entries, Stage I tumors, and distant metastases were excluded from analysis. Univariate and Cox regression models were used with 5-year mortality as the primary endpoint. The study identified 4309 patients. Younger age, female gender, Pacific Island descent, and right-sided tumors were associated with significantly higher lymph node retrieval. Cox regression analysis showed that the number of nodes examined was a significant predictor of 5-year mortality when age, sex, ethnicity, and site were controlled for. Five-year survival consistently improved between nodal strata until the 16-node mark, above which survival advantage was minimal. For Stage III cancers, a higher lymph node ratio was associated with a significant increase in mortality. Increased rates of nodal examination are associated with a significantly lower 5-year mortality for Stage II and III colonic cancer, but this survival advantage appears to be minimal after the 16-node mark. The lymph node ratio has been validated as a powerful predictor of survival in Stage III cancer. Our results support the current practice of harvesting and examining as many nodes as possible during attempted curative resection.
Publisher: Springer Science and Business Media LLC
Date: 19-01-2012
DOI: 10.1007/S00464-011-2101-7
Abstract: Fatigue is one of the main complaints after surgery and may last longer than physical symptoms. It prevents return to normal function and activity. Relaxation interventions, performed prior to abdominal surgery, have been shown to reduce pain, wound erythema, and systemic cortisol levels. However, there is a lack of data on the impact of this intervention on patient well-being, functional recovery, activities of daily living, and fatigue after discharge from hospital. The study was a randomised single-blinded trial. Patients who were to undergo elective laparoscopic cholecystectomy for any indication between April 2008 and May 2010 were screened for inclusion. Those in the intervention group attended a standardised 45 min relaxation session with a health psychologist and were given relaxation exercise CDs to take home. The control group did not have the intervention. Patients were followed for 30 days. Fatigue was measured using the identity-consequence fatigue scale. Seventy-five patients were randomised. Fifteen patients were excluded after randomization for various reasons hence, 60 patients were followed up and analysed. Both groups had similar fatigue at baseline. There was improved fatigue and consequence of fatigue on postoperative day 30 in the intervention group. There was no difference in fatigue at any other time point postoperatively. This was the first interventional study targeting fatigue after laparoscopic cholecystectomy by using a brief psychological relaxation intervention. It has shown a reduction of fatigue and impact of fatigue at 30 days postoperatively in the intervention group.
Publisher: Wiley
Date: 15-04-2010
DOI: 10.1007/S00534-010-0271-7
Abstract: With the advent of minimally invasive gallbladder surgery, and now with natural orifice techniques emerging, visceral nociception has been neglected as a cause of postoperative pain. A systematic review and metaanalysis was carried out to investigate the use of intraperitoneal local anesthetic (IPLA) in order to assess its role in laparoscopic cholecystectomy (LC). The aim of this systematic review was to appraise the clinical effects of this modality. Comprehensive searches were conducted independently without language restriction. Studies were identified from the following databases from inception to September 2009: Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Cochrane Library, Medline, PubMed, Excerpta Medica Database (EMBASE), and Cumulative Index to Nursing and Allied Health Literature (CINHAL). Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software. Thirty randomized controlled trials were identified for review. The clinical heterogeneity of IPLA use was high. However, there appeared to be reduced pain, opioid use, and need for rescue analgesia, and reduced postoperative cortisol and glucose responses. There is evidence in favor of IPLA in LC. Further trials of this modality in LC are not needed as these are unlikely to reduce clinical heterogeneity. IPLA should be trialled as future minimally invasive surgical techniques approach.
Publisher: Wiley
Date: 06-2017
DOI: 10.1111/ANS.13975
Publisher: Oxford University Press (OUP)
Date: 11-07-2008
DOI: 10.1002/BJS.6304
Abstract: Studies on the use of warmed and humidified insufflation (WHI) in laparoscopic abdominal procedures to reduce pain have been inconclusive owing to small s le sizes. An electronic database search identified all randomized controlled trials (RCTs) on adults undergoing elective laparoscopic abdominal surgery under general anaesthesia in which the exposure group had WHI and the control group had standard cold and dry carbon dioxide. The outcome measure was pain by visual analogue score or morphine usage. Seven RCTs were included. Patients in the WHI group experienced a significant reduction in pain score at 6 h (P = 0·006), 1 day (P = 0·010) and 3 days (P & 0·001) after operation, and in morphine usage on day 2 (P = 0·040). WHI reduces pain after laparoscopy.
Publisher: Springer Science and Business Media LLC
Date: 04-09-2010
DOI: 10.1007/S11695-010-0267-Z
Abstract: This is the largest single-centre series of single-stage laparoscopic sleeve gastrectomy (LSG) reporting on perioperative outcomes, weight loss, comorbidity resolution including urological outcomes and results in the super obese. Review of prospectively collected data for patients who underwent LSG from March 2007-August 2009. There were 253 patients with a mean age of 44 years (SD, 9) and a mean preoperative body mass index (BMI) of 50 kg/m(2) (SD, 7). There were 17 (7%) major complications and no deaths. The mean follow-up was 9 months. One hundred and seventy-one patients with a mean follow-up of 12 months had a mean postoperative weight loss of 41 kg (SD, 16) and mean excess BMI (meBMI) loss of 59% (SD, 22). One hundred fourteen patients were super obese (BMI, >50 kg/m(2)). The mean weight loss was 45 kg (SD, 18), and the meBMI lost was 49% (SD, 21). Super-obese patients experienced more complications (p = 0.02) and lost less eBMI (49% vs. 61% p 40 kg/m(2)) postoperatively. Hypertension and diabetes improved or resolved in 73 (79%) and 73 (90%) patients, respectively. Stress urinary incontinence was reported preoperatively in 60 (32%) females, and complete resolution or improvement was reported in 54 (90%) patients. LSG provides satisfactory weight loss and resolution of comorbidities in the short- and medium-term with inferior, though acceptable, results in the super obese.
Publisher: Oxford University Press (OUP)
Date: 21-10-2009
DOI: 10.1002/BJS.6744
Abstract: Recent data have suggested a relationship between postoperative fatigue and the peritoneal cytokine response after surgery. The aim of this study was to test the hypothesis that preoperative administration of glucocorticoids before surgery would decrease fatigue and enhance recovery, by reducing the peritoneal production of cytokines. In a double-blind randomized controlled study, patients undergoing elective, open colonic resection were administered 8 mg dexamethasone or normal saline. Patients were treated within an enhanced recovery after surgery programme. Primary outcomes were cytokine levels in peritoneal drain fluid and fatigue as measured by the Identity–Consequence Fatigue Scale (ICFS). Baseline parameters were similar for 29 patients in the dexamethasone group and 31 in the placebo group. Patients who received dexamethasone had lower ICFS scores on days 3 and 7. Dexamethasone was associated with significantly lower peritoneal fluid interleukin (IL) 6 and IL-13 concentrations on day 1, and these correlated with changes in the ICFS score. There was no significant increase in adverse events in the dexamethasone group. Preoperative administration of dexamethasone resulted in a significant reduction in early postoperative fatigue, associated with an attenuated early peritoneal cytokine response. Peritoneal production of cytokines may therefore be important in postoperative recovery. Registration number: ACTRN12607000066482 (www.anzctr.org.au/).
Publisher: Elsevier BV
Date: 03-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2010
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.JSS.2010.02.008
Abstract: Enhanced Recovery after Surgery (ERAS) programs have gained popularity with potential to accelerate recovery and reduce morbidity after colectomy. We were interested in comparing recovery after open right colectomy within an ERAS program compared with laparoscopic right colectomy in a standard care perioperative environment. Between October 2005 and June 2009, prospective data were collected on consecutive patients undergoing elective open right colectomy within an established ERAS setting (OpERAS). Similarly, between March 2008 and June 2009, data were collected on consecutive patients undergoing laparoscopic right hemicolectomy with conventional care (LapCon). Exclusion criteria for both groups were: ASA >or= 4, formation of a stoma, and dementia or mental illness rendering the patient unable to comply with instructions. Perioperative variables were collected. The surgical recovery score (SRS) was used as a validated means to measure convalescence on d 1, 3, 7, 30, and 60 postoperatively. There were 74 patients in the OpERAS and 39 patients in the LapCon groups. At baseline, there were no significant demographic differences except that more patients had malignancy in OpERAS group. Mean operating time was longer in the LapCon group. Median day stay was 4 (3-28) in OpERAS and 5 (2-18) in LapCon (P = 0.032). There was no statistical difference in the incidence of complications or the severity of complications. There were no significant differences in SRS after surgery at any time point. When perioperative care is optimized, recovery after elective open right hemicolectomy is comparable with laparoscopic resection. Studies looking at the combination of laparoscopy and ERAS are warranted.
Publisher: IWA Publishing
Date: 10-2023
Publisher: Springer Science and Business Media LLC
Date: 04-11-2015
Publisher: Wiley
Date: 17-11-2010
DOI: 10.1111/J.1445-2197.2010.05573.X
Abstract: The use of intraperitoneal local anaesthetic (IPLA) can be used to modulate visceral nociception after abdominal surgery however, this technique is not routinely used in open abdominal surgery. The aim of this systematic review was to appraise the clinical effects of IPLA in open abdominal surgery for metachronous outcomes including pain, metabolic response to surgery and gastrointestinal function. A comprehensive search was conducted independently without language restriction. Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager Version 5.0 software. Post-operative clinical and metabolic outcomes of randomized controlled trials comparing IPLA versus no IPLA or placebo solution were used for meta-analysis. Twelve trials were identified including eight randomized trials in gastrointestinal and gynaecological surgery. Post-operative pain was reduced but not opioid use. There was blunting of postoperative hyperglycaemia. There was no difference in post-operative cortisol response. Return of bowel function appeared to be quickened, although meta-analysis was not possible. The use of IPLA is safe and appears to have clinical benefits. However this technique has not been studied in optimized perioperative settings. Trials are needed to evaluate this method of visceral blockade further after major abdominal surgery.
Publisher: Wiley
Date: 21-08-2008
DOI: 10.1111/J.1445-2197.2008.04647.X
Abstract: Early laparoscopic cholecystectomy has been shown to be the treatment of choice for acute presentations of gallstone disease. However, currently this practice is not common in many centres. The aim of the study was to evaluate surgical management of patients presenting with acute symptomatic gallstone disease to Middlemore Hospital in 2005. A retrospective case review of acute presentations of symptomatic gallstone disease was carried out between 1 January and 31 December 2005. Four hundred and two patients were included in the final analysis. Forty-six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 25 declined surgery. Therefore, 305 patients (76%) were eligible for surgery at index admission (IA). Two hundred and four (67%) received surgery during IA with a median time to surgery of 3 days. From the 198th patient who did not have acute surgery at IA, 112 had delayed surgery. When comparing those with surgery at IA with those who did not receive surgery at IA, median length of stay for IA was significantly longer in acute surgical group (5 vs 3 P = 0.05) however, there was no significant difference in duration of total hospital stay (6 vs 6 P > 0.05). For those who had acute surgery the conversion rate was 3% (six) compared with 7% (seven) in delayed surgery group (P = 0.09). Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and effective.
Publisher: Springer Science and Business Media LLC
Date: 08-12-2009
DOI: 10.1007/S11695-009-0038-X
Abstract: Laparoscopic sleeve gastrectomy is increasingly being used as a stand-alone procedure in bariatric surgery, with medium-term follow-up data now emerging. We present our early experience in patients with a mean body mass index (BMI) in the super-obese range. Review of prospectively collected data for the first 100 patients who underwent laparoscopic sleeve gastrectomy at Counties Manukau District Health Board between March 2007 and July 2008. One hundred patients were identified, with a mean age of 43 years (range, 20-60 years). Maori and Pacific Islanders made up 31% of the patient subset. Patients had a mean BMI of 50.3 kg/m(2) (range, 34.5-72.8 kg/m(2)). Forty-five patients were super-obese. The median hospital stay was 2 days (range, 1-7 days). Mean follow-up was 12.0 months (range, 0.9-23.3 months). Mean excess weight loss was 62.9% (range, 7.2-129.0%). Twenty-five percent of patients were diabetic and 45% of patients were hypertensive pre-operatively. Diabetics and hypertension resolved or improved in 72% and 60% of patients, respectively. There was a major complication rate of 7%, including three staple-line leaks (one requiring laparotomy), two staple-line bleeds (one requiring laparotomy) and one infected haematoma. There were no deaths. In this public hospital setting, laparoscopic sleeve gastrectomy has achieved satisfactory weight loss results with an acceptable complication rate in the medium-term.
Publisher: Routledge
Date: 17-12-2014
Publisher: Springer Science and Business Media LLC
Date: 14-10-2009
Publisher: Wiley
Date: 04-2009
DOI: 10.1111/J.1445-2197.2009.04854.X
Abstract: The incidence of acute fascial wound dehiscence (AFWD) after major abdominal operations is as high as 3%. AFWD is associated with mortality rates of 15-20%. Male gender, advanced age and numerous systemic factors including malignancy hypoproteinemia and steroid use have been associated with increased risk. The aim of the present study was to investigate the association between smoking prevalence and AFWD. Middlemore Hospital records were retrieved from the 1997-2006 period for patients who had undergone midline abdominal surgery and developed AFWD. A return to the operating theatre for closure of the fascial dehiscence was required for study group inclusion. Each patient in the study group was matched to two control patients who had been admitted in the same year for surgery and who had a similar initial surgical intervention. Conditional logistic regression was used to calculate odds ratios with 95% confidence intervals, representing the risk of developing fascial wound dehiscence in smokers compared with the non-smoking group. There were 52 patients (32 male, 20 female) and 104 controls (64 male, 40 female). Median age for both groups was 63 years. A history of heavy tobacco use (> or =20 pack-years) was more prevalent in those who had AFWD (46%) compared with the control group (16% P = 0.0002 odds ratio 3.7). Smoking is associated with an increased incidence of acute fascial wound dehiscence following laparotomy. It is not known whether smoking is a causal or a surrogate factor.
Publisher: Elsevier BV
Date: 02-2010
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2009
DOI: 10.1016/J.IJSU.2008.11.004
Abstract: Multimodal care or Enhanced Recovery after Surgery (ERAS) protocols are gaining popularity in order to modify surgical stress responses after colonic resection. However, these protocols are not straightforward to implement as peri-operative care is varied. We aimed to identify areas that may need attention in order to successfully change practice. The literature was reviewed for current practice, methods and issues in implementing ERAS. Based on this and our own experience we discuss several important areas that need particular attention in developing and sustaining an ERAS program. International surveys have shown that current peri-operative care in colorectal resection is not evidence based. Important aspects of the ERAS philosophy including patient counselling, teamwork and attitude change are identified and discussed. Implementing evidence-based peri-operative care into practice is challenging. Barriers to multimodal recovery pathways should be addressed.
Publisher: Wiley
Date: 2008
DOI: 10.1111/J.1445-2197.2007.04350.X
Abstract: Enhanced recovery after surgery (ERAS) care pathways are becoming increasingly common in colonic surgery. ERAS is a combination of in idual strategies that have been shown to be effective in improving care. In this article, we review the evidence surrounding core components of enhanced recovery care pathways for patients undergoing open colonic surgery. We will also identify new elements that should be considered as part of ERAS strategy.
Publisher: Wiley
Date: 03-2014
DOI: 10.1111/ANS.12432
Publisher: Elsevier BV
Date: 02-2011
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2010
Publisher: Wiley
Date: 08-2005
DOI: 10.1111/J.1445-2197.2005.03491.X
Abstract: Several previous studies have shown that Gastrografin can be utilized to triage patients with adhesive small bowel obstruction (ASBO) to an operative or a non-operative course. Previous studies assessing the therapeutic effect of Gastrografin have been confounded by post-administration radiology alerting the physician to the treatment group of the patient. Therefore the aim of the present paper was to test the hypothesis that Gastrografin hastens the non-operative resolution of (ASBO). Patients, diagnosed with ASBO on clinical and radiological grounds, were randomized to receive Gastrografin or placebo in a double-blinded fashion. Patients did not undergo further radiological investigation. If the patient required subsequent radiological intervention or surgical intervention they were excluded from the study. End-points were passage of time to resolution of ASBO (flatus and bowel motion), length of hospital stay and complications. Forty-five patients with ASBO were randomized to receive either Gastrografin or placebo. Two patients were excluded due to protocol violations. Four patients in each group required surgery. Eighteen of the remaining patients received Gastrografin and 17 received placebo. Patients who received Gastrografin had complete resolution of their ASBO significantly earlier than placebo patients (12 vs 21 h, P = 0.009) and this translated into a median of a 1-day saving in time in hospital (3 vs 4 days, P = 0.03). Gastrografin accelerates resolution of ASBO by a specific therapeutic effect.
Publisher: Elsevier BV
Date: 2012
Publisher: Wiley
Date: 05-2020
DOI: 10.1111/ANS.15582
Publisher: Informa UK Limited
Date: 16-03-2015
DOI: 10.1586/17474124.2015.1026328
Abstract: Familial colorectal cancer syndromes pose a complex challenge to the treating clinician. Once a syndrome is recognized, genetic testing is often required to confirm the clinical suspicion. Management from that point is usually based on disease-specific guideline recommendations targeting risk reduction for the patient and their relatives through surgery, surveillance and chemoprophylaxis. The aim of this paper is to provide an up-to-date summary of the most common familial syndromes and their medical and surgical management, with specific emphasis on evidence-based interventions that improve patient outcome, and to present the information in a manner that is easily readable and clinically relevant to the treating clinician.
Publisher: BMJ
Date: 2023
DOI: 10.1136/BMJOPEN-2022-062687
Abstract: To develop consensus statements regarding the regional-level or district-level distribution of surgical services in low and middle-income countries (LMICs) and prioritisation of service scale-up. This work was conducted using a modified Delphi consensus process. Initial statements were developed by the International Standards and Guidelines for Quality Safe Surgery and Anesthesia Working Group of the Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) and the International Society of Surgery based on previously published literature and clinical expertise. The Guidance on Conducting and REporting DElphi Studies framework was applied. The Working Group convened in Suva, Fiji for a meeting hosted by the Ministry of Health and Medical Services to develop the initial statements. Local experts were invited to participate. The modified Delphi process was conducted through an electronically administered anonymised survey. Expert LMIC surgeons were nominated for participation in the modified Delphi process based on criteria developed by the Working Group. The consensus panel voted on statements regarding the organisation of surgical services, principles for scale-up and prioritisation of scale-up. Statements reached consensus if there was ≥80% agreement among participants. Fifty-three nominated experts from 27 LMICs voted on 27 statements in two rounds. Ultimately, 26 statements reached consensus and comprise the current recommendations. The statements covered three major themes: which surgical services should be decentralised or regionalised how the implementation of these services should be prioritised and principles to guide LMIC governments and international visiting teams in scaling up safe, accessible and affordable surgical care. These recommendations represent the first step towards the development of international guidelines for the scaling up of surgical services in LMICs. They constitute the best available basis for policymaking, planning and allocation of resources for strengthening surgical systems.
Publisher: Oxford University Press (OUP)
Date: 09-07-2009
DOI: 10.1002/BJS.6651
Abstract: There have been several reports of ischaemic complications after routine laparoscopy. The aim of this review was to investigate the relationship between this oxidative stress and pneumoperitoneum. Medline, Medline in-process, The Cochrane Library, PubMed and EMBASE were searched for papers on oxidative stress and pneumoperitoneum, from 1947 to March 2008 with no language restriction or restriction on trial design. Papers that did not investigate pneumoperitoneum as a causative factor, or did not report outcome measures related to oxidative stress, were excluded. A total of 73 relevant papers were identified: 36 animal studies, 21 human clinical trials, nine case reports, five review articles and two comments. Pneumoperitoneum causes a reduction in splanchnic blood flow, resulting in biochemical evidence of oxidative stress in a pressure- and time-dependent manner. There is evidence that the use of carbon dioxide for insufflation is contributory. Several measures proposed to minimize the oxidative stress have shown promise in animal studies, but few have been evaluated in the clinical setting. There is an increasing body of evidence, mainly from animal studies, that pneumoperitoneum decreases splanchnic perfusion with resulting oxidative stress. It is now appropriate to investigate the clinical significance of pneumoperitoneum-associated oxidative stress.
Publisher: Springer Science and Business Media LLC
Date: 03-02-2009
DOI: 10.1007/S00268-008-9906-0
Abstract: Postoperative fatigue (POF) significantly impacts well-being after major surgery. However, this topic has received little emphasis. We conducted a comprehensive search on major databases with a focus on studies relevant to assessment and etiology of POF. POF has been measured by a number of different and inadequate instruments. It has a complicated etiology, with a number of biological and psychological factors implicated. However, the etiology of this condition has not been fully explained. The role of local inflammation in the development of POF requires further research. Multimodal interventions should be conducted with a focus on addressing various factors that contribute to the development and progression of POF.
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.INJURY.2008.07.032
Abstract: Early assessment of injury severity is important in trauma. Trauma scores are calculated after the fact and are useful for audit and research, but not in the emergency clinical setting. Glucose metabolism is altered in trauma, and we hypothesised that alterations in glucose and lactate levels would be an early predictor of mortality. Review of trauma registry data identified 1197 patients between May 2000 and September 2006 who had a trauma-team call out. Data collected included trauma scores, venous glucose (gluc), and arterial lactate (lact) on arrival. The predictive value of these variables was compared by ROC curves. The mortality rate for patients with gluc >11.0mmol/L was 13.4% compared to 1.8% in those with gluc <or=11.0mmol/L (p 2.0mmol/L died, versus 2.7% with lact <or=2.0mmol/L, (p0.0003, specificity 56.8% and sensitivity 81.0%). Glucose was the better biochemical predictor of mortality compared to lactate (ROC area 0.845 and 0.716, respectively). The TRISS (trauma and injury severity score) was a very accurate predictor (ROC 0.963), whereas the ISS (injury severity score) significantly less so (ROC 0.854). There was a significant correlation between gluc, ISS, and TRISS (p 0.01), as well as lactate and ISS (p 0.01). Glucose and lactate can predict mortality in severe trauma. The predictive value of glucose is comparable to that of ISS, and can be more easily employed in the clinical setting.
Publisher: Informa UK Limited
Date: 14-03-2011
DOI: 10.3109/13645706.2011.556647
Abstract: Pneumoperitoneum is reported to induce oxidative stress due to the desiccative effect of cold, dry gas insufflation. The aim of this study is to compare the effect of warmed, humidified insufflation to standard gas, by measuring oxidative stress markers in a physiologically relevant animal model. Twenty male Wistar rats (330?650 g) were alternately assigned to the Warm Humidified group (WH, n = 10) and Control group (n = 10). All rats underwent pneumoperitoneum at 5 mmHg and a controlled flow rate for 110 min. The WH group received warmed (37?C) and humidified (98% Relative Humidity (RH)) gas and the control group received standard gas at room temperature (19?C) and 0% RH. At the end of pneumoperitoneum, s les of liver, kidney, pancreas, jejunum, and lung were excised. Levels of plasma and tissue malondialdehyde (MDA) and protein carbonyls (PC) were measured. Organ light microscopy was performed. There were no differences between groups for MDA or PC concentrations in plasma, liver, kidney, jejunum, or lung tissue. There were no differences in histological score between groups. Warming and humidification of pneumoperitoneum insufflation gas have no effect on measures of oxidative stress compared to non-warmed, non-humidified controls.
Publisher: Springer Science and Business Media LLC
Date: 21-08-2009
DOI: 10.1007/S00384-008-0540-Y
Abstract: Mortality from cancer recurrence in Dukes B patients is approximately 25-30%. Outcome in Dukes B patients improves in direct relation to the number of lymph nodes examined. Examining fewer lymph nodes risks understaging and also such patients are less likely to receive chemotherapy. The aim of this study was to assess the impact of the number of lymph nodes examined on recurrence and mortality in Dukes B colon cancers. A retrospective database was constructed of 328 consecutive patients who underwent resection for Dukes B colorectal cancer between January 1993 and December 2001 at Middlemore Hospital. Patients with incomplete data, previous colorectal cancer, or perioperative deaths were excluded as were cases of rectal cancer. Data for the remaining 216 patients was subjected to multivariate and logistic regression analysis with 'patient death' or 'cancer recurrence' (CRec5) within 5 years as endpoints. A graph was constructed depicting CRec5 as broken down by lymph node strata. Receiver operator characteristic (ROC) curves were constructed for mortality and CRec5. The mean number of lymph nodes examined was 16.0 (median 14 range 2-48). The mean number of lymph nodes examined in those who died within 5 years was 12.8 vs. 17.5 in those who remained alive (p = 0.0027). The mean number of lymph nodes examined in those with evidence of recurrence within 5 years was 11.8 vs. 17.1 in those without recurrence (p = 0.0007). Analysis at various lymph node strata showed a sharp and statistically significant drop in the recurrence rate after the 16th node mark. The ROC curve for CRec5 showed that examination of 12 lymph nodes provided maximum sensitivity (0.60) and specificity (0.64). Examination of more than 16 lymph nodes is associated with a significant reduction in cancer recurrence. This supports the current clinical practice of harvesting and analysing as many nodes as possible during surgical resection and pathological analysis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2011
Publisher: Wiley
Date: 07-03-2019
DOI: 10.1111/ANS.15051
Abstract: Practice visits are a peer review activity where one or more healthcare providers visit the practice of another in the same field. The purpose of this exercise is for visitors to observe and review a host's practice in a non-punitive manner and provide them with constructive feedback as required ultimately to improve practice quality and patient care. A rapid review of three biomedical databases was conducted to identify relevant literature published up until 9 April 2018. There were no limits placed on publication date or publication type. Two authors were responsible for study selection and data extraction using a priori inclusion criteria and extraction templates. Study details and key findings were reported narratively and in tables. A total of nine publications, reporting outcomes for eight study groups, were identified as eligible for inclusion in this rapid review. Of these eight, six were observational studies, one was a longitudinal study and one was a randomized controlled trial. Practice visits were considered useful in identifying areas of improvement in professional practice however, the rate at which these improvements were elicited varied greatly between the included studies. Overall, both hosts and visitors gained insight from the practice visit process and in general their experiences were positive. Based on the evidence provided by the included studies, recommendations for an effective practice visit can be made. Importantly, the poor quality and age of the literature from which these recommendations are based should be considered.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2009
Publisher: Wiley
Date: 07-12-2007
DOI: 10.1111/J.1365-2044.2007.05233.X
Abstract: The use of intra-operative Doppler oesophageal probes provides continuous monitoring of cardiac output. This enables optimisation of intravascular volume and tissue perfusion in major abdominal surgery, which is thought to reduce postoperative complications and shorten hospital stay. Medline and EMBASE were searched using the standard methodology of the Cochrane collaboration for trials that compared oesophageal Doppler monitoring with conventional clinical parameters for fluid replacement in patients undergoing major elective abdominal surgery. Data from randomised controlled trials were entered and analysed in Meta-view in Rev-Man 4.2 (Nordic, Denmark). We included five studies that recruited 420 patients undergoing major abdominal surgery who were randomly allocated to receive either intravenous fluid treatment guided by monitoring ventricular filling using oesophageal Doppler monitor or fluid administration according to conventional parameters. Pooled analysis showed a reduced hospital stay in the intervention group. Overall, there were fewer complications and ICU admissions, and less requirement for inotropes in the intervention group. Return of normal gastro-intestinal function was also significantly faster in the intervention group. Oesophageal Doppler use for monitoring and optimisation of flow-related haemodynamic variables improves short-term outcome in patients undergoing major abdominal surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2008
DOI: 10.1007/S10350-008-9386-1
Abstract: Fast-track (enhanced recovery) care pathways for colonic surgery are becoming increasingly popular however, there have been concerns regarding protocol compliance, high readmission rates, and also the true impact on morbidity rates with these protocols. This study was conducted to assess the impact of a fast-track program for colonic surgery on hospital stay, complications, and readmission rates. From December 2005 to March 2007, consecutive patients undergoing colonic surgery were prospectively studied. The comparison group consisted of a comorbidity-matched group of patients who had undergone similar surgery before establishment of the fast-track program. Fifty patients were included in each group. Groups were comparable at baseline. The fast-track group received significantly smaller amounts of intraoperative and postoperative intravenous fluids, were fed earlier, mobilized earlier, passed flatus earlier, and were discharged earlier than the comparison group (4 vs. 6.5 days, P < 0.001). The numbers of patients with urinary infections (2 vs. 12, P = 0.008), ileus (5 vs. 18, P = 0.005), and cardiopulmonary complications (11 vs. 21, P = 0.032) were significantly lower in the fast-track group. There was no difference in the rate of readmission. Fast-track is a safe and effective approach for reducing hospital stay and morbidity following major colonic surgery.
Publisher: Informa UK Limited
Date: 13-02-2010
DOI: 10.3109/13645701003644475
Abstract: In laparoscopic surgery CO2 is commonly insufflated at room temperature, with a relative humidity approaching 0%. There has been an increase in utilization of devices to warm and humidify the insufflated gas to avoid potential detrimental effects caused by desiccation. Available data on the performance of these devices are limited. We aimed to conduct independent testing of the Fisher & Paykel MR860 Laparoscopic Humidification System at variable flow rates. A 2.5l insulated chamber was constructed and a digital thermo-hygrometer placed inside it. The humidifier water vessel was weighed and exactly 30.0g of water poured in. 50.0L of CO2 was insufflated into the chamber via the humidifier at 2.0L/min, 4.0l/min, 6.0l/min, 8.0l/min, and 10l/min using a laparoscopic insufflator. Measurements of temperature and humidity in the chamber were taken at 30 second intervals. After 50.0l of gas was insufflated the water left in the humidifier was weighed, and this was used to calculate the mean absolute humidity of the insufflated gas by the gravimetric method. At every flow rate, > 98.0% relative humidity was achieved in the chamber after less than 30 seconds of insufflation. Using the gravimetric estimate, the humidifier was able to saturate 50.0l of CO2 to close to saturation humidity at every flow rate tested. The Fisher & Paykel MR860 Laparoscopic Humidification System effectively humidifies insufflated CO2 at a range of flow rates commonly used in the surgical setting.
Publisher: Wiley
Date: 19-10-2023
DOI: 10.1111/ANS.18740
Publisher: Elsevier BV
Date: 10-2010
DOI: 10.1016/J.JSS.2010.04.054
Abstract: Laparotomy is commonly performed as an emergency operation. It is often performed on elderly patients with high risks of mortality and morbidity. Currently, there is no accurate scoring system to predict mortality and morbidity, preoperatively, in these circumstances. This study was conducted to develop a scoring system that can accurately predict the risk of in-hospital mortality and complications for these patients in the emergency department prior to surgery. Middlemore Hospital data were searched for patients who underwent emergency laparotomy for an acute abdominal condition between January 1997 and December 2006. Data collected included age, gender, presenting diagnosis, indications for surgery, acute physiologic parameters, and also data on associated comorbidities. We categorized patients for the risk of morbidity and 30-d mortality. The risk categorization was based on preoperative existing comorbidities and acute disturbances of physiologic parameters. Regression analysis was used to correlate between acute laboratory parameters, patients age and gender, clinical premorbid conditions, and surgical procedures with the risk of mortality and rates of complications. Emergency laparotomy was performed on 1712 patients. The median age was 58 and there were 896 male patients. Patients with one or two minor comorbidities had comparable mortality and complication rate to those with no comorbidities. There was high correlation between factors that denoted the onset of multiple organ failure with in-hospital mortality and complication rates. This allowed us to ide patients into four prognostic groups with increasing mortality and morbidity. Mortality and morbidity after emergency laparotomy are closely related to the presence or absence of acute physiologic impairment and the presence or absence of chronic organ system failure. The Simple Prognostic Index (SPI) is a simple scoring system for prediction of mortality and morbidity prior to emergency laparotomy.
Publisher: Wiley
Date: 23-12-2010
DOI: 10.1111/J.1445-2197.2010.05595.X
Abstract: The prognostic significance of lymph node evaluation is not well described for rectal cancer due to a lack of reproducibility in nodal counts and variable use of adjuvant and neoadjuvant therapy. The aim of this study was to examine the role of quantitative lymph node evaluation as an independent marker of prognosis in stage III rectal cancer. New Zealand Cancer Registry data were retrieved for consecutive patients with rectal cancer from January 1995 to July 2003. Cases with node-negative tumours, distant metastases, death within 30 days of surgery and incomplete data fields were excluded. Three nodal stratification systems were investigated - Total Number of Nodes examined (TNN), Absolute number of Positive Nodes (APN) and Lymph Node Ratio (LNR). Univariate and Cox regression analyses were performed with 5-year all-cause mortality as the primary end point. The study identified 895 stage III rectal cancer cases. The mean APN and LNR were significantly higher in patients who died within 5 years. An increasing APN or LNR was associated with a significant increase in 5-year mortality. The APN and LNR were also powerful predictors of 5-year mortality after correcting for other factors using Cox regression. The TNN was of no prognostic significance. Both the APN and LNR are highly effective at independently predicting and stratifying 5-year mortality in stage III rectal cancer. The significant predictive value of the LNR is likely to be a reflection of the APN rather than one functioning in autonomy, given that the TNN was of no prognostic significance.
Publisher: Elsevier BV
Date: 11-2012
DOI: 10.1016/J.JSS.2010.10.009
Abstract: There is a sequential, high concentration cytokine response after major abdominal surgery. The magnitude of this response has been directly linked to postoperative metabolic derangement, ileus, adhesions, and oncological outcomes. We aimed to compare the local and systemic cytokine response in laparoscopic and open colonic surgery and relate this to postoperative recovery parameters. Using a prospectively collected patient database, we compared a Study Group (n = 50) of patients undergoing elective laparoscopic colonic resection with a Control Group (n = 25) of patients undergoing equivalent open colonic surgery within an ERAS program. Patients were matched for age, gender, BMI, ASA, Cr Possum, side of resection, diagnosis, and histologic stage. Plasma and peritoneal fluid concentrations of IL-6, IL-8, IL-10, and TNFα were measured at 20-24 h after surgery. The Surgical Recovery Score was determined pre-operatively and at 3, 7, 30, and 60 d postoperatively. All data were prospectively collected, and a priori definitions were used for discharge parameters, complications, and complication severity. Peritoneal fluid IL-6 concentration was lower after laparoscopic surgery. There were no significant differences in the other cytokines measured, or in any postoperative recovery outcomes. Significant correlations were found between cytokine levels and discharge criteria achievement, day stay, postoperative complications, and the Surgical Recovery Score. With the exception of a lower peritoneal IL-6 level, the systemic and peritoneal cytokine response at 20-24 h is similar after laparoscopic versus open colonic resection within an ERAS program, with corresponding equivalent rates of postoperative recovery.
Publisher: Springer Science and Business Media LLC
Date: 29-01-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2011
DOI: 10.1097/SLA.0B013E318204A8B4
Abstract: Laparoscopic colorectal resection is equivalent to open resection in a number of important areas. However, recent data have raised concern that intraoperative complications may be increased.We conducted a meta-analysis comparing intraoperative complication rates of laparoscopic and equivalent open colorectal resection. Cochrane Central Register of Controlled Trials, MEDLINE, and Embase databases were searched, as were relevant scientific meeting abstracts and reference lists of included articles. Randomized controlled trials (RCTs) evaluating laparoscopic versus open surgery for any colorectal indication were included. Exclusion criteria were: trials assessing hand-assisted resection, and trials that excluded conversions to open surgery. There were no restrictions on language. Data were entered on an intention-to-treat basis in prospectively designed tables with complications categorized per event as: total complications, haemorrhage, bowel injury, and solid organ injury. Corresponding authors were contacted if information was missing. The Cochrane Collaboration tool was used for assessing risk of bias, the PETO odds ratio method was used for meta-analysis. Complete intraoperative complication data were obtained for 10 out of 30 included RCTs. Four thousand and fifty-five patients were analyzed 2159 in the Laparoscopic Group and 1896 in the Open Group. There was a higher total intraoperative complication rate (OR 1.37, P = 0.010) and a higher rate of bowel injury in the Laparoscopic Group (OR 1.88, P = 0.020). There was no difference in the rate of intraoperative haemorrhage or solid organ injury. Laparoscopic colorectal resection is associated with a significantly higher intraoperative complication rate than equivalent open surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2011
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.BBI.2011.06.014
Abstract: Psychological stress has been shown to impair wound healing, but experimental research in surgical patients is lacking. This study investigated whether a brief psychological intervention could reduce stress and improve wound healing in surgical patients. This randomised controlled trial was conducted at a surgical centre. Inclusion criteria were English-speaking patients over 18 years booked to undergo elective laparoscopic cholecystectomy exclusion criteria were cancellation of surgery, medical complications, and refusal of consent. Seventy five patients were randomised and 15 patients were excluded 60 patients completed the study (15 male, 45 female). Participants were randomised to receive standard care or standard care plus a 45-min psychological intervention that included relaxation and guided imagery with take-home relaxation CDs for listening to for 3 days before and 7 days after surgery. In both groups ePTFE tubes were inserted during surgery and removed at 7 days after surgery and analysed for hydroxyproline as a measure of collagen deposition and wound healing. Change in perceived stress from before surgery to 7-day follow-up was assessed using questionnaires. Intervention group patients showed a reduction in perceived stress compared with the control group, controlling for age. Patients in the intervention group had higher hydroxyproline deposition in the wound than did control group patients (difference in means 0.35, 95% CI 0.66-0.03 t(43)=2.23, p=0.03). Changes in perceived stress were not associated with hydroxyproline deposition. A brief relaxation intervention prior to surgery can reduce stress and improve the wound healing response in surgical patients. The intervention may have particular clinical application for those at risk of poor healing following surgery.
Publisher: Wiley
Date: 21-09-2018
DOI: 10.1111/ANS.14838
Abstract: Excisional haemorrhoidectomy has traditionally been performed on an inpatient basis due to concerns over post-operative pain and urinary retention. Day case procedures are increasingly common. This study aims to investigate readmission rates following day case compared with inpatient haemorrhoidectomy. A retrospective cohort review of all haemorrhoidectomies performed at Counties Manukau District Health Board, Auckland from January 2012 to December 2017 was queried from the hospital database. Readmission rates, reason for readmission, time to represent and length of stay within 30 days were recorded. Continuous data were analysed using Mann-Whitney U and Student's t-tests. Categorical data were analysed using the Fisher's exact and chi-squared tests. A total of 485 cases of excisional haemorrhoidectomy were performed, with 62 (12.8%) readmissions within 30 days. There were 170 patients who were treated as day cases with 19 (11.2%) readmissions 315 patients stayed one night or longer with 43 (13.7%) readmissions (P = 0.97). The demographics of both groups were similar. Pain and bleeding were the most common reasons for readmission in both groups. There were no significant differences between rates of readmission, length of stay following readmission and time to readmission between day case and inpatient groups. Day case surgery should be considered as an alternative to inpatient surgery for excisional haemorrhoidectomy and can be achieved without increase in hospital readmissions.
Publisher: Elsevier BV
Date: 07-2010
DOI: 10.1016/J.JSS.2010.02.028
Abstract: Adhesive small bowel obstruction (ASBO) causes considerable morbidity and may require surgical intervention. The role of statins in adhesion prevention is of increasing interest, though no investigation of its impact on ASBO and operative rates has been conducted. This study investigates the impact of statin use on operative rates in ASBO. A retrospective review of all patients with ASBO within our institution from January 1997 to December 2007 was conducted. Demographic data, potential confounders, and treatment received (conservative/operative) were recorded. Statistical significance was determined using the two-tailed Fisher's exact test for categorical data and the Mann-Whitney U test for continuous data. Univariate and logistic regression were conducted to control for potential known confounders. There were 419 cases of ASBO with 253 (60.4%) females. The median age of diagnosis was 62 (15-93) years and the median ASA score was 2 (1-4). Forty-nine (11.7%) patients required operative management, the median day-stay was three (1-154) d and 151 (36%) patients were taking statins. On univariate analysis, statin use was associated with decreased operative rates (P = 0.02). The relative risk was 0.46 with an absolute risk reduction of 7.9% (95% CI: 2.1%-13.7%). The number needed to treat was 13 (NNT = 13 95% CI: 7.3-46.8). Statin use was associated with decreased operative rates using a logistic regression model (P = 0.04). Statin use is independently associated with decreased operative rates in ASBO.
Publisher: Wiley
Date: 31-08-2009
DOI: 10.1111/J.1445-2197.2009.05012.X
Abstract: Burnout is the state of prolonged physical, emotional and psychological exhaustion characteristic of in iduals working in human service occupations. This study examines the prevalence of burnout among Younger Fellows of the Royal Australasian College of Surgeons and its relationship to demographic variables. In March 2008, a survey was sent via email to 1287 Younger Fellows. This included demographic questions, a measure of burnout (Copenhagen Burnout Inventory), and an estimate of social desirability (Marlowe-Crowne Social Desirability Scale - Form C). Females exhibited higher levels of personal burnout (P < 0.001) and work-related burnout (P < 0.025), but no significant difference in patient-related burnout. Younger Fellows in hospitals with less than 50 beds reported significantly higher patient-related burnout levels (mean burnout 37.0 versus 22.1 in the rest, P = 0.004). An equal work ision between public and private practice resulted in higher work-related burnout than concentration of work in one sector (P < 0.05). Younger Fellows working more than 60 hours per week reported significantly higher personal burnout than those who worked less than this (P < 0.05). There was no significant correlation between age, country of practice, surgical specialty and any of the burnout subscales. Female surgeons, surgeons that work in smaller hospitals, those that work more than 60 h per week, and those with practice ision between the private and public sectors, are at a particularly high risk of burnout. Further enquiry into potentially remediable causes for the increased burnout in these groups is indicated.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2016
DOI: 10.1097/DCR.0000000000000598
Abstract: Accumulating evidence suggests that peritoneal cytokine concentrations may predict anastomotic leak after colorectal surgery, but previous studies have been underpowered. We aimed to test this hypothesis by using a larger prospectively collected data set. This study is an analysis of prospectively collected data. This study was conducted at 3 public hospitals in Auckland, New Zealand. Patients undergoing colorectal surgery recruited as part of 3 previous randomized controlled trials were included. Data on peritoneal and plasma levels of interleukin-6, interleukin-8, interleukin-10, and tumor necrosis factor-α on day 1 after colorectal surgery were reanalyzed to evaluate their predictive value for clinically important anastomotic leak. Area under receiver operating characteristic curve analysis was performed. A total of 206 patients with complete cytokine data were included. The overall anastomotic leak rate was 8.3%. Concentration levels of peritoneal interleukin-6 and interleukin-10 on day 1 after colorectal surgery were predictive of anastomotic leak (area under receiver operating characteristic curve, 0.72 and 0.74 p = 0.006 and 0.004). Plasma cytokine levels of interleukin-6 were higher on day 1 after colorectal surgery in patients who had an anastomotic leak, but this was a poor predictor of anastomotic leak. Levels of other peritoneal and plasma cytokines were not predictive. The study was not powered a priori for anastomotic leak prediction. Although the current data do suggest that peritoneal levels of interleukin-6 and interleukin-10 are predictive of leak, the discriminative value in clinical practice remains unclear. Peritoneal levels of interleukin-6 and interleukin-10 on day 1 after colorectal surgery can predict clinically important anastomotic leak.
Publisher: Wiley
Date: 03-2010
Publisher: Springer Science and Business Media LLC
Date: 30-07-2007
Publisher: Elsevier BV
Date: 11-2010
DOI: 10.1016/J.JSS.2010.05.046
Abstract: The local and systemic humoral response after colorectal surgery is thought to affect postoperative recovery. It is commonly claimed that laparoscopic surgery elicits a diminished inflammatory response than equivalent open surgery. Despite these claims, the evidence is conflicting. Therefore, we aimed to systematically review the results from randomized controlled clinical trials comparing the humoral response associated with laparoscopic versus open colorectal surgery. A high-sensitivity search was conducted independently by two of the authors with no language restriction. Studies were identified from the Cochrane Central Register of Controlled Trials (CENTRAL/CCTR), Cochrane Library, Medline (January 1966 to January 2009), PubMed (1950 to January 2009), and Embase (1947 to January 2009). Relevant meeting abstracts and reference lists were manually searched. Data analysis was performed using Review Manager ver. 5.0. Thirteen randomized controlled trials were included. Meta-analysis demonstrated a significantly higher serum IL-6 on d 1 after open colorectal resection for neoplasia (n = 97) compared with laparoscopic resection (n = 76, P = 0.0008) without significant heterogeneity. Data for plasma IL-6 were heterogeneous, with no apparent difference between groups. No other significant differences were identified, and there were not enough data on local peritoneal humoral factors to allow meta-analysis. Open colorectal resection for neoplasia is associated with higher postoperative serum levels of IL-6 on d 1 than equivalent laparoscopic surgery. The aetiology and clinical significance of this finding is uncertain, and further studies are required to elucidate any differences in the local humoral response which may be more clinically relevant in surgery for this indication.
Publisher: Wiley
Date: 27-01-2011
DOI: 10.1111/J.1445-2197.2010.05642.X
Abstract: Background: Sleep deprivation and disturbances in circadian rhythms generally lead to poor performance, but is there a link in surgery? This review aimed to determine whether fatigue has an impact on surgeon performance or surgical outcomes. Methods: Studies were identified by searching EMBASE, CINAHL, PubMed, The Cochrane Library, Current Contents and clinical trials databases. Inclusion of relevant studies was by application of a predetermined protocol and independent assessment by two reviewers. Each included study was critically appraised for its study quality according to the methods used for Cochrane Reviews. Data from included studies were extracted by one researcher using standardized data extraction tables developed a priori and checked by a second researcher. Results: From 823 potentially relevant studies, a total of 16 studies were included in this review: two randomized controlled trials, five non‐randomized comparative studies and nine case series. Of five studies that directly measure clinical performance, three studies reported no significant difference as a result of sleep deprivation, while two studies found increases in complications or errors. Eleven studies assessed psychomotor skill performance using a variety of simulation‐based methods when a participant was rested and/or fatigued. Two randomized controlled trials reported no significant differences, while the nine remaining studies reported mixed results. Surgical residents with less surgical training/experience appeared to be more affected than more senior residents. Conclusion: There is little evidence, as yet, to inform the issue of the effect of fatigue on surgical performance.
Publisher: Elsevier BV
Date: 03-2011
DOI: 10.1016/J.SURG.2010.10.020
Abstract: An abdominal operation combines a somatic abdominal wall wound with a second autonomic wound to the peritoneal cavity and viscera and little attention has been paid the autonomic eritoneal wound that communicates directly to the brain by the vagus nerve. Moreover, vagal input originating from the peritoneum modulates and regulates postoperative recovery. Consequently, blockade of the afferent neural and inflammatory input from this autonomic eritoneal wound will reduce postoperative neurohormonal stress and enhance patient recovery from an abdominal operation.
Publisher: Wiley
Date: 16-08-2006
DOI: 10.1111/J.1445-2197.2006.03875.X
Abstract: Physiologic and operative severity score for the enumeration of mortality and morbidity (POSSUM), 'Portsmouth'-physiologic and operative severity score for the enumeration of mortality and morbidity (P-POSSUM) and 'Colorectal'-physiologic and operative severity score for the enumeration of mortality and morbidity (Cr-POSSUM) are three related scoring systems, which uses in idual patient parameters to predict postoperative mortality. POSSUM overpredicts mortality in low-risk patients and underpredicts mortality in elderly and emergency patients. P-POSSUM was developed to compensate for these weaknesses. Cr-POSSUM was developed specifically for colorectal surgery. We aim to establish which of these scoring systems would be most useful in an Australasian context. Data were collected for 308 patients and predicted mortality risk values were generated using each of the three systems. The Mann-Whitney U-test was then carried out on the scores for each system. Receiver-operator characteristic curves were designed to determine the relative accuracy of each approach at discriminating between death and survival. All three POSSUM scoring systems showed a statistically significant ability to predict postoperative mortality. Additionally, in each system there was a significant difference in the raw physiologic and operative severity scores between survivors and those who died. A risk-stratification model was applied to each set of data, showing a correlation between an increase in risk and an increase in mortality rate. Finally, the receiver-operator characteristic curves generated showed that in this study group POSSUM, P-POSSUM and Cr-POSSUM were all satisfactory predictive tools although the latter tended to be relatively less accurate. Physiologic and operative severity score for the enumeration of mortality and morbidity, P-POSSUM and Cr-POSSUM are all reliable predictors of postoperative mortality in the Australasian context although there was a trend towards POSSUM and P-POSSUM being better predictors than Cr-POSSUM. However, Cr-POSSUM requires fewer in idual patient parameters to be calculated and is thus easier to generate. An ideal preoperative scoring system remains to be developed for predicting mortality in patients undergoing colorectal surgery.
Publisher: CMA Impact Inc.
Date: 04-2011
DOI: 10.1503/CJS.024009
Publisher: Elsevier BV
Date: 06-2009
DOI: 10.1016/J.JSS.2008.06.023
Abstract: Enhanced Recovery After Surgery (ERAS) programs have demonstrated significant reduction in hospital stay for patients undergoing colonic surgery however, their impact on long-term outcomes, such as postoperative fatigue (POF), has not been fully established. To assess the impact of an ERAS program on POF and recovery following elective open colonic surgery. In a prospective study, 26 consecutive patients undergoing open colonic surgery under a conventional care plan were compared with 26 consecutive patients in an ERAS program. Demographic and clinical characteristics were comparable at baseline. The median duration of total hospital stay (4 versus 7 d, P < 0.001), rates of urinary tract infections (P = 0.028) and ileus (P = 0.042) were significantly smaller in the ERAS group. Postoperatively, POF significantly increased in both groups. However, peak POF score was significantly lower in the ERAS group (P = 0.001). In the first 30 d after surgery, Fatigue Consequence scores were also significantly smaller in the ERAS group. Overall, the total fatigue experience (P = 0.035) and the total fatigue impact (P = 0.005) were significantly smaller in the ERAS group. The impact of ERAS programs may extend beyond the commonly reported short-term outcomes, and ERAS may accelerate overall recovery and return to normal function.
Publisher: American Medical Association (AMA)
Date: 03-2016
Publisher: Springer Science and Business Media LLC
Date: 05-01-2010
DOI: 10.1007/S00268-009-0382-Y
Abstract: The peritoneum is a bilayer serous membrane that lines the abdominal cavity. We present a review of peritoneal structure and physiology, with a focus on the peritoneal inflammatory response to surgical injury and its clinical implications. We conducted a nonsystematic clinical review. A search of the Ovid MEDLINE database from 1950 through January 2009 was performed using the following search terms: peritoneum, adhesions, cytokine, inflammation, and surgery. The peritoneum is a metabolically active organ, responding to insult through a complex array of immunologic and inflammatory cascades. This response increases with the duration and extent of injury and is central to the concept of surgical stress, manifesting via a combination of systemic effects, and local neural pathways via the neuro-immuno-humoral axis. There may be a decreased systemic inflammatory response after minimally invasive surgery however, it is unclear whether this is due to a reduced local peritoneal reaction. Interventions that d en the peritoneal response and/or block the neuro-immuno-humoral pathway should be further investigated as possible avenues of enhancing recovery after surgery, and reducing postoperative complications.
No related grants have been discovered for Andrew Hill.