This study aimed to audit middle-ear surgical procedures, provide a record of Australian experiences and allow comparisons with other published audits.A retrospective continuous series audit was conducted on 274 patients who underwent tympanoplasty, mastoidectomy and stapedotomy surgery at Westmead Hospital, Sydney. All consecutive surgical procedures, performed by multiple operators at various stages of training but under the care of a single surgeon, were included.Graft uptake was 86.9 per cent in tympanoplasty. Well healed cavities were seen in 72 per cent of mastoidectomies. Although 42 per cent of the patients had one or more co-morbidities, this did not influence the outcome. Hearing improvement was dramatic in stapedotomy and minimally changed in mastoidectomy. Post-operative complications were minimal.All forms of middle-ear surgery were effective in achieving their surgical goals. Aural discharge and inflammatory diseases were well controlled with tympanoplasty and mastoid surgery.
Major lower-limb orthopedic surgery recipients are at increased risk of venous thromboembolism (VTE). The optimal strategy for preventing VTE is a topic of ongoing debate. The use of aspirin has been implicated in reducing VTE events and is potentially advantageous compared to other agents in respect to cost, access, route of administration and reduced adverse effects such as bleeding.A systematic search for Level I evidence (systematic reviews and meta-analyses of randomised-controlled trials) was performed in April 2019 to evaluate the use of aspirin for primary and secondary VTE prophylaxis compared to alternative chemical and mechanical strategies. This search encompassed three electronic databases (Pubmed, Embase and the Cochrane Database of Systematic Reviews). All references of included studies were screened for additional studies. Data was compiled and compared to the recommendations and guidelines published by major institutions. Included studies were appraised with the aid of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.In total, 21 studies were included. Interventions and outcomes identified were heterogeneous across studies. Most statistical tests applied found no difference between aspirin and other interventions in regards to deep vein thrombosis, pulmonary embolism, bleeding and mortality outcomes.Aspirin may be a viable alternative to established thromboprophylactic regimes for primary prevention of VTE, however in the setting of secondary prevention it is generally less efficacious. Future studies should have clearly identified and comparable outcome measures, with direct comparisons and assessment of intervention combination, dosing and treatment duration.
Uncontrolled donation after circulatory death (uDCD) is a potential additional source of donor kidneys. This study reviewed uDCD kidney transplant outcomes to determine if these are comparable to controlled donation after circulatory death (cDCD).
**Corresponding author mailto:[email protected] Background: The COVID-19 pandemic disrupted health services, including BreastScreen. This study examined BreastScreen data from 2018 to 2021 to evaluate the pandemic's effect on screening. This will inform service planning and recruitment strategies for the pandemic recovery. Methods: Data were collected for BreastScreen Western Sydney episodes between January 2018 and December 2021 including sociodemographic characteristics of clients and tumour characteristics of malignancies. Descriptive statistical analysis was performed using SPSS, to compare these characteristics in 'Pre-COVID' years (2018 and 2019) to 'COVID-affected' years (2019 and 2020). Analysis also compared data between individual years in addition to comparison by COVID grouping. Results: There were 172,977 screening episodes and 1,124 cancer diagnoses (in-situ n=216, 19.2%) during the study period. COVID-affected years demonstrated an 18.8% reduction in screening episodes (77,510 vs 95,467, p<0.001) and 16.3% reduction in malignancies (512 vs 612) compared to pre-COVID years. BreastScreen recall rate was lower during COVID-19 (4.2% vs 4.8% p<0.001). The cancer detection rate remained similar (52.3 and 52.7 per 10,000 screens). Younger women were less likely to attend BreastScreen during the COVID-affected years and there were fewer first screening rounds. There was no significant difference in the median invasive tumour size or proportion of high-grade lesions detected by BreastScreen services during the pandemic. There was no significant difference in BreastScreen attendance by clients from non-English speaking backgrounds during the pandemic (p=0.08). Conclusion: There was a reduction in the number of screens and cancers during the COVID-affected years. However, there was no difference in the characteristics of tumours or the cancer detection rate, and the recall rate was lower during the COVID-affected years. This suggests that the 'missing' (undiagnosed) cancers from the COVID-affected years should also be similar to pre-COVID. Younger women and those attending for their first screen should be targeted for catch-up screening.
The American College of Surgeons Oncology Group Z0011 Trial demonstrated that early breast cancer patients with positive axillary sentinel lymph nodes treated with breast-conserving surgery and breast radiotherapy had no additional oncologic benefit of proceeding to an axillary lymph node dissection (ALND). The extent to which practice has changed in Australia remains unclear. The aim of this study was to investigate the effect of the Z0011 trial on the management of positive axillary sentinel nodes at an Australian institutional level. We reviewed all breast cancer cases treated at the Sydney Adventist Hospital over a 10-year period from 1 January 2008 to 31 December 2017. Patients who fulfilled the Z0011 trial criteria were selected. These patients were divided into two groups according to the year of surgery, before and after 1 January 2011 when the Z0011 study was published. Clinicopathologic data and axillary surgical management were compared. Of the 237 patients fulfilling the Z0011 trial criteria, there were 73 patients before and 158 patients after 1 January 2011. In the earlier group the rate of proceeding to an ALND following a positive sentinel node was 78.1% compared to 43.7% in the latter group (P < 0.0001). There was a significant decline in the rate of ALND over this 10-year period (r = −0.79, P = 0.006). The Z0011 trial has influenced the surgical management of the axilla leading to a significant reduction in the rate of an ALND in patients fulfilling the Z0011 trial criteria at our institution.
Abstract Objective To describe the practice of endotracheal intubation in the ED of a tertiary hospital in A ustralia, with particular emphasis on the indication, staff seniority, technique, number of attempts required and the rate of complications. Methods A prospective observational study. Results Two hundred and ninety‐five intubations occurred in 18 months. Trauma was the indication for intubation in 30.5% (95% CI 25.3–36.0) and medical conditions in 69.5% (95% CI 64.0–74.5). Emergency physicians were team leaders in 69.5% (95% CI 64.0–74.5), whereas ED registrars or senior R esident M edical O fficers made the first attempt at intubation in 88.1% (95% CI 83.9–91.3). Difficult laryngoscopy occurred in 24.0% (95% CI 19.5–29.3) of first attempts, whereas first pass success occurred in 83.4% (95% CI 78.7–87.2). A difficult intubation occurred in 3.4% (95% CI 1.9–6.1) and all patients were intubated orally in five or less attempts. A bougie was used in 30.9% (95% CI 25.8–36.5) of first attempts, whereas a stylet in 37.5% (95% CI 32.1–43.3). Complications occurred in 29.0% (95% CI 23.5–34.1) of the patients, with desaturation the commonest in 15.7% (95% CI 11.9–20.5). Cardiac arrest occurred in 2.2% (95% CI 0.9–4.4) after intubation. No surgical airways were undertaken. Conclusion Although the majority of results are comparable with overseas data, the rates of difficult laryngoscopy and desaturation are higher than previously reported. We feel that this data has highlighted the need for practice improvement within our department and we would encourage all those who undertake emergent airway management to audit their own practice of this high‐risk procedure.
Background: Simultaneous pancreas-kidney transplantation (SPK) remains the gold standard treatment for patients with type I diabetes mellitus and end-stage renal failure. Enteric drainage is utilised to handle exocrine secretions from the graft, with enteric leaks being the most challenging of complications. There remains a lack of published research regarding risk factors for enteric leaks. Methods: As such we undertook a retrospective cohort study of SPK transplants performed at Westmead Hospital over twenty years (between 1998-2017, n=425) to identify the occurrence of enteric leaks as well as donor, recipient and transplantation procedure risk factors. Descriptive statistics were generated using SPSS version 22.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). The student’s t-test and/or Mann-Whitney U test was used to detect significance. All tests were two tailed and any statistically significant difference was considered at the P <0.05 level. Results: Of the 425 patients, 16 (3.5%) experienced an enteric leak. Of these, 12 (80%) had significant vascular disease, defined as coronary artery disease, cerebrovascular disease, retinopathy, peripheral neuropathy or peripheral vascular disease requiring surgical intervention. The risk of an enteric leak increased in recipients with significant vascular disease. Conclusion: The rates at Westmead Hospital were lower than those published in the literature. We demonstrated that the presence of significant vascular disease predisposed recipients to enteric leak. These findings highlight the importance of careful donor and recipient selection to optimise patient outcomes.
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