Publications by authors named "Andrew D Maccormick"
Background: To determine if the positive outcomes from clinical trials regarding the safety and efficacy of metabolic bariatric surgery are reproducible at a national level.
Methods: A longitudinal registry-based observation study with data collected from all persons undergoing metabolic bariatric surgery in Australia from 28 February 2012-31 December 2021 including data from 122,567 index patients who underwent 134,625 completed bariatric procedures.
Main Outcomes And Measures: Defined adverse outcomes at 90-days (unplanned readmission, intensive care admission and re-operation; death), annual change in weight (percent total body weight loss (TBWL)), diabetes treatment and need for re-operation.
Background: The National Emergency Laparotomy Audit (NELA) risk prediction tool has demonstrated superiority in predicting 30-day mortality after emergency laparotomy (EL). The aim of our study was to evaluate the accuracy of NELA in calculating long-term (5 year) mortality and determine factors predicting long-term risk of death after EL.
Methods: This retrospective cohort study included consecutive patients who underwent EL for any indication other than trauma between May 2012 and June 2017 at a large tertiary and academic teaching center.
Introduction: Emergency laparotomy (EL) is a high-risk operation which is increasingly performed on an aging patient population. Objective frailty assessment using a validated index has the potential to improve preoperative risk stratification. This study aimed to assess the correlation between frailty and long-term mortality and morbidity outcomes for older EL patients.
View Article and Find Full Text PDFBackground: Emergency laparotomy has high morbidity and mortality rates. Frailty assessment remains underutilized in this setting, in part due to time constraints and feasibility. The Clinical Frailty Scale has been identified as the most appropriate tool for frailty assessment in emergency laparotomy patients and is recommended for all older patients undergoing emergency laparotomy.
View Article and Find Full Text PDFBackground: Patient-reported outcomes are an important emerging metric increasingly utilised in clinical, research and registry settings. These outcomes, while vital, are underutilised and require refinement for the specific patient population of those undergoing bariatric surgery. This study aimed to investigate and compare how pre-surgical patients, post-surgical patients, and healthcare practitioners evaluate patient-reported outcomes of bariatric surgery to identify outcomes that are considered most important.
View Article and Find Full Text PDFArticle Synopsis
- The study investigated micronutrient deficiencies in preoperative bariatric surgery patients, focusing on ethnic differences among 573 individuals.
- The most prevalent deficiency was vitamin D (30.85%), particularly high in Asians (60%), with significant variations among other ethnic groups, including Pacifica and Māori.
- Iron deficiency was also notable (21.1%), with Asians again showing the highest rates, highlighting the need for potential preoperative supplementation for these at-risk populations.
Background: An increasing number of older patients are undergoing emergency laparotomy (EL). Frailty is thought to contribute to adverse outcomes in this group. The best method to assess frailty and impacts on long-term mortality and other important functional outcomes for older EL patients have not been fully explored.
View Article and Find Full Text PDFBackground: The Ninth Perioperative Mortality Review Committee (POMRC) report found the likelihood of death was over three times higher in Māori youth compared to non-Māori (age: 15-18 years) in the 30-days following major trauma. The aim of our study is to investigate variations in care provided to Māori youth presenting to Te Whatu Ora Counties Manukau (TWO-CM) with major trauma, to inform policies and improve care.
Methods: This was a retrospective, observational study of 15-18-year-olds admitted to Middlemore Hospital from January 2018 to December 2021 following major trauma (Injury Severity Score (ISS) >12 or with (ISS) <12 who died).
Background: Venous thromboembolism (VTE) is a major complication of trauma. Currently, there are few studies summarising the evidence for prophylaxis in trauma settings. This review provides evidence for the use of VTE prophylactic interventions in trauma patients to produce evidence-based guidelines.
View Article and Find Full Text PDFBackground: The National Bariatric Prioritization Tool (NBPT), developed in Aotearoa New Zealand (AoNZ), has not been validated using real patient data. The aim was to determine the predictive validity of the NBPT on health outcomes.
Methods: An observational study was undertaken of consecutive patients undergoing elective bariatric surgery at Middlemore Hospital using the NBPT from December 2014 to December 2016.
Article Synopsis
- Sarcopenia, characterized by the loss of muscle strength and mass, significantly increases the risk of complications and death after elective abdominal surgery, according to a systematic review and meta-analysis of 20 studies involving over 5,400 patients.
- The updated definition of sarcopenia by the European Working Group on Sarcopenia emphasizes muscle strength alongside mass, and findings showed that sarcopenic patients had higher rates of in-hospital and short-term mortality.
- The study concludes that recognizing sarcopenia as an independent risk factor can help in predicting postoperative outcomes and improving patient management strategies.
Article Synopsis
- * The tool's development involved a structured consensus process among healthcare experts and tested its validity with established clinical judgments.
- * Four primary criteria were identified to assess patient needs, with "impact on life" being the most significant, while the next phase will test the tool's effectiveness using actual patient data.
Background: 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.
Methods: A cohort study was conducted across five hospitals, comparing the outcomes of weekend and weekday acute EL.
Article Synopsis
- - The study aimed to determine the expected average length of stay (ALOS) in hospitals for primary and conversion bariatric surgery in Australia and examine factors affecting it, such as patient and surgeon characteristics.
- - Results showed that uncomplicated primary bariatric surgery had an ALOS of 2.30 days, while conversion procedures had an ALOS of 2.71 days, with complications significantly increasing the stay duration.
- - Factors like older age, diabetes, living in rural areas, and the volume of cases handled by both the surgeon and hospital were found to significantly extend ALOS after bariatric surgery.
Purpose: This study aims to determine if the hospital efficiency, safety and health outcomes are equal in patients who receive bariatric surgery in government-funded hospitals (GFH) versus privately funded hospitals (PFH).
Materials And Methods: This is a retrospective observational study of prospectively maintained data from the Australia and New Zealand Bariatric Surgery Registry of 14,862 procedures (2134 GFH and 12,728 PFH) from 33 hospitals (8 GFH and 25 PFH) performed in Victoria, Australia, between January 1st, 2015, and December 31st, 2020. Outcome measures included the difference in efficacy (weight loss, diabetes remission), safety (defined adverse event and complications) and efficiency (hospital length of stay) between the two health systems.
Background: Tube thoracostomy (TT) in trauma is lifesaving. A previous audit at Counties Manukau District Health Board (CMDHB), New Zealand, showed a 22% complication rate for trauma TT. Subsequently CMDHB introduced a procedural guideline to reduce complications.
View Article and Find Full Text PDFBackground: Despite considerable advancements in Upper Gastrointestinal Cancer (UGIC) care in Australia and Aotearoa New Zealand (AAoNZ), the absolute number of deaths remains high. Clinical Quality and Safety Registries (CQRs) enable benchmarking and performance appraisal, however an AAoNZ CQR does not exist. To create this, we first aim to identify all national and international UGIC CQRs and amalgamate their data fields and definitions through a systematic review.
View Article and Find Full Text PDFPurpose: Patient-reported measures are an important emerging metric in outcome monitoring; however, they remain ill-defined and underutilized in bariatric clinical practice. This study aimed to determine the characteristics of patient-reported measures employed in bariatric practices across Australia and Aotearoa New Zealand, including barriers to their implementation and to what extent clinicians are receptive to their use.
Methods: An online survey was distributed to all bariatric surgeons actively contributing to the Australian and Aotearoa New Zealand Bariatric Surgery Registry (n = 176).
Article Synopsis
- The Red Blanket Protocol (RBP) is a communication strategy designed to improve the speed and safety of surgical interventions for patients who are unstable due to emergencies.
- A study at Middlemore Hospital compared outcomes of patients before and after RBP implementation, focusing on time to surgery, blood product usage, and survival rates.
- Results showed that the median time from the emergency department to surgery decreased significantly with RBP, but survival rates and clinical outcomes were similar between the two groups, indicating a need for further research.
Background: Sarcopenia refers to the progressive age and pathology-associated loss of skeletal muscle, which has been shown to independently predict mortality in patients undergoing major elective surgery. Emergency laparotomy is commonly performed for a range of procedures and is associated with high rates of mortality. However, the prognostic utility of sarcopenia after emergency laparotomy remains unknown.
View Article and Find Full Text PDFBackground: A systematic review was undertaken to identify existing quality performance indicators (QPI) for the surgical treatment of gastric adenocarcinoma (GA) with the aim of defining a set of QPIs that can be used to assist in the accreditation of institutions for training, allow cross jurisdiction comparison of treatment and outcomes, as well as provide a basis to develop quality improvement programs. These QPI's capture key components of patient care that are fundamental to overall outcome.
Methods: A systematic literature review was conducted searching MEDLINE, PubMed, EMBASE, and SCOPUS with all literature available until the date of 1 August 2021 included.