Delayed return of bowel function after general surgery in South Australia.

Introduction: Reference ranges for determining pathological versus normal postoperative return of bowel function are not well characterised for general surgery patients. This study aimed to characterise time to first postoperative passage of stool after general surgery; determine associations between clinical factors and delayed time to first postoperative stool; and evaluate the association between delay to first postoperative stool and prolonged length of hospital stay.

Methods: This study included consecutive admissions at two tertiary hospitals across a two-year period whom underwent a range of general surgery operations.

Society of American Gastrointestinal and Endoscopic Surgeons guidelines development: Clinical Practice Guideline Update Standard Operating Procedure.

Introduction: The SAGES Guidelines Committee creates evidence-based clinical practice guidelines (CPGs). Updates which incorporate new evidence into the guidelines are necessary to maintain relevance for clinical use. A description of our standard operating procedure for this process is described here, which contributes to SAGES' commitment to producing high-quality clinical recommendations.

Perioperative aspirin and coronary artery bypass graft surgery: An updated meta-analysis of randomized controlled trials.

Background: The decision to continue aspirin before elective coronary artery bypass graft surgery remains contentious because of competing thrombotic and bleeding risks. We performed a contemporary systematic review and meta-analysis to compare outcomes between patients undergoing coronary artery bypass grafting who stopped and continued aspirin before surgery.

Methods: PubMed, MEDLINE, and CENTRAL databases were searched from inception to 4 October 2023 for randomized controlled trials comparing patients undergoing coronary artery bypass grafting who continued preoperative aspirin with those who discontinued before surgery.

Direct oral anticoagulant assay utilization and associated bleeding events: a multi-center cohort study.

Background: There is a lack of evidence regarding direct oral anticoagulant (DOAC) assay plasma concentrations and their association with bleeding events or transfusion requirements. This multicenter study aimed to characterize the use and plasma levels of DOAC assays of anticoagulated patients who present to emergency with a bleeding event and their association with bleeding severity.

Methods: A multicenter retrospective cohort study of consecutive emergency bleeding presentations with a DOAC assay over a five-year period was conducted.

Impact of COVID-19 pandemic on HTAsiaLink network members.

Objectives: This study investigates the impact of coronavirus disease 2019 (COVID-19) pandemic on HTAsiaLink members at the organizational level and provides recommendations for mitigating similar challenges in the future.

Methods: A survey was disseminated among HTAsiaLink members to assess the COVID-19 impact in three areas: (i) inputs, (ii) process, and (iii) outputs of the Health Technology Assessment organizations' (HTAOs) research operations and HTA process in general.

Results: Survey results showed that most HTAOs hired more staff and secured similar or higher funding levels during COVID-19.

IMRA/SRS Delphi consensus on international standards for common core components of robotic surgical training design.

Robotic surgery has expanded internationally at pace. There are multiple local robotic training pathways but there is inconsistency in standardisation of core common components for curricula internationally. A framework is required to define key objectives that can be implemented across robotic training ecosystems.

To be or not to be on: aspirin and coronary artery bypass graft surgery.

Aspirin's role in secondary prevention for patients with known coronary artery disease (CAD) is well established, validated by numerous landmark trials over the past several decades. However, its perioperative use in coronary artery bypass graft (CABG) surgery remains contentious due to the delicate balance between the risks of thrombosis and bleeding. While continuation of aspirin in patients undergoing CABG following acute coronary syndrome is widely supported due to the high risk of re-infarction, the evidence is less definitive for elective CABG procedures.

Accuracy of surgical death information: comparison of data held by Victorian Audit of Surgical Mortality and Victorian Agency for Health Information.

Background: The Victorian Audit of Surgical Mortality (VASM) investigates all surgically related deaths in Victoria. The Victorian Admitted Episodes Database (VAED) is an administrative dataset maintained by the Health Department's Victorian Agency of Health Information (VAHI). We have reviewed clinical records to assess the correlation between deaths reported to the databases.

Consensus statement: support for supervisors of surgical training in Australia and Aotearoa New Zealand.

The Supervisor Support Consensus Statement has been developed after consultation with supervisors of surgical training for the Royal Australasian College of Surgeons (RACS) programmes in Australia and Aotearoa New Zealand and other key stakeholders. Six key areas have been recognized with specific recommendations crafted to improve the support and recognition of Supervisors: 1. Clarity of role, 2.

Improving Breast Cancer Outcomes for Indigenous Women in Australia.

In Australia, the incidence rate of breast cancer is lower in Indigenous* women than non-Indigenous women; however, the mortality rate is higher, with Indigenous women 1.2 times more likely to die from the disease. This paper provides practical and achievable solutions to improve health outcomes for Indigenous women with breast cancer in Australia.

Lack of Consensus on the Definition of Aseptic Loosening in Total Ankle Replacement: A Narrative Systematic Review.

Aseptic loosening is one of the most common modes of failure of total ankle replacement (TAR). However, a precise definition of aseptic loosening is still lacking. This systematic review aimed to identify the variations of applied definitions and offer insights into the lack of consensus.

Achieving equity: patient demographics and outcomes after surgical and non-surgical procedures in South Australia, 2022.

Background: Although modern Australian healthcare systems provide patient-centred care, the ability to predict and prevent suboptimal post-procedural outcomes based on patient demographics at admission may improve health equity. This study aimed to identify patient demographic characteristics that might predict disparities in mortality, readmission, and discharge outcomes after either an operative or non-operative procedural hospital admission.

Methods: This retrospective cohort study included all surgical and non-surgical procedural admissions at three of the four major metropolitan public hospitals in South Australia in 2022.

Medical versus surgical causes of death following colorectal resection: a Queensland Audit of Surgical Mortality (QASM) study.

Background: The causes of death following colorectal resection remain poorly explored. Few studies have addressed whether early post-operative mortality is predominantly caused by a patient's medical co-morbidities, or from factors pertaining to the presenting surgical disease process itself. This study analyses data from the Queensland audit of surgical mortality (QASM) to report the causes of in-hospital death following colorectal resection, identifies whether these were due to either medical or surgical factors, and determines the patient characteristics associated with a medical cause of death.

Association between direct oral anticoagulant concentrations and clinical outcomes: A systematic review and meta-analysis.

Introduction: Current guidelines suggest preoperative direct oral anticoagulant levels of < 30-50 ng/ml. However, there is limited evidence to guide this expert consensus. Reviewing assay titres and clinical outcomes may be able to inform perioperative care of the anticoagulated patient.

Medical ethics of long-duration spaceflight.

With the advent of novel and emerging technologies, long duration spaceflight will become more common; along with it, an increase in its inherent health risks. However, health-related ethical issues arising during long-duration spaceflight remain poorly characterized, uncertain and unpredictable. Medical ethics is defined as a set of moral principles, beliefs and values that guides choices about medical care.

The United Airways Clinic: roadmap of a patient-centred multidisciplinary approach to the complex airways patient: the Sydney model.

Severe asthma is a subset of difficult-to-treat asthma which requires a systematic and multidimensional approach including the need to manage multiple comorbidities that mimic asthma. Multidisciplinary care is becoming the standard for the assessment of such patients. Multidisciplinary team (MDT) clinics are virtually nonexistent in the private space.

Death after endoscopic prostate surgery in Australia and New Zealand: a review of clinical management issues.

Background: Endoscopic prostate surgery is an established treatment for male lower urinary tract symptoms (LUTS) and is recognized to have low mortality rates. We aimed to describe factors that may have contributed to death following endoscopic prostate surgery using data from the Australia and New Zealand Audits of Surgical Mortality (ANZASM).

Methods: All urological related deaths reported to ANZASM from January 1 2012 to December 31 2019 were reviewed.

Observations from Australia's National Surgical Mortality Audit.

Background: Australia is the only country with a national surgical mortality audit. Every Australian surgical mortality is independently and externally reviewed by another surgeon. Extensive educational feedback to surgeons and hospitals is provided through individual patient reviews, state and national symposia and reports, and the distribution of deidentified informative cases.

Opioid prescribing, pain, and hospital stay of general surgery patients with oxycodone allergies in South Australia.

Background: The frequency of oxycodone adverse reactions, subsequent opioid prescription, effect on pain and patient care in general surgery patients are not well known. This study aimed to determine prevalence of documented oxycodone allergy and intolerances (independent variables) in a general surgical cohort, and association with prescribing other analgesics (particularly opioids), subjective pain scores, and length of hospital stay (dependent variables).

Methods: This retrospective cohort study included general surgery patients from two South Australian hospitals between April 2020 and March 2022.

Surgery's Rosetta Stone: Natural language processing to predict discharge and readmission after general surgery.

Background: This study aimed to examine the accuracy with which multiple natural language processing artificial intelligence models could predict discharge and readmissions after general surgery.

Methods: Natural language processing models were derived and validated to predict discharge within the next 48 hours and 7 days and readmission within 30 days (based on daily ward round notes and discharge summaries, respectively) for general surgery inpatients at 2 South Australian hospitals. Natural language processing models included logistic regression, artificial neural networks, and Bidirectional Encoder Representations from Transformers.

Sociocultural and Demographic Factors Predict Readmissions for General Surgery Patients.

Introduction: Readmission is a poor outcome for both patients and healthcare systems. The association of certain sociocultural and demographic characteristics with likelihood of readmission is uncertain in general surgical patients.

Method: A multi-centre retrospective cohort study of consecutive unique individuals who survived to discharge during general surgical admissions was conducted.