ANZ journal of surgery
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ANZ journal of surgery · Oct 2019
Clinical TrialDevelopment and implementation of an enhanced recovery after surgery protocol for renal transplantation.
Successful implementation of enhanced recovery after surgery (ERAS) in kidney transplantation requires multidisciplinary consultation, education and attention to protocol. This study discusses the process implementation pathway of the ERAS protocol and its outcome. ⋯ An ERAS protocol for renal transplant patients is feasible. Our data show that successful implementation of ERAS in kidney transplantation is possible and results in significant cost savings due to shorter length of stay.
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ANZ journal of surgery · Oct 2019
Opioid prescribing improvement in orthopaedic specialty unit in a tertiary hospital: a retrospective audit of hospital discharge data pre- and post-intervention for better opioid prescribing practice.
This study aimed to investigate the effects of an intervention focusing on better opioid prescription practice in a tertiary metropolitan hospital orthopaedic unit. ⋯ Raised awareness across the organization and education for staff more than halved the post-operative opioid prescription levels. This highlights the capacity for change in hospitals and the ability to work towards safer prescribing of post-operative opioid therapy.
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ANZ journal of surgery · Oct 2019
Does the form of venous thromboembolism prophylaxis following primary total knee arthroplasty alter the rate of early reoperation or revision surgery?
Currently there is significant variation in the management of venous thromboembolism prophylaxis following total knee arthroplasty (TKA). Excessive wound ooze and bleeding is thought to increase a patient's risk of haematoma formation and possible infection. We evaluated the rate of unexpected reoperation in the perioperative period in patients who received aspirin, rivaroxaban or enoxaparin following primary TKA. ⋯ There was a higher rate of reoperation in patients treated with aspirin following TKA when compared to enoxaparin and rivaroxaban in the perioperative period. While there is extensive data on the safety and efficacy of these medications following joint arthroplasty, improved reporting of surgically relevant outcomes are needed to assist both the surgeon and patient in clinical decision-making.
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ANZ journal of surgery · Oct 2019
Comparative StudyDifferent clinical risk scores for prediction of early mortality after liver resection for hepatocellular carcinoma: which is the best?
Prediction of early mortality after hepatectomies for hepatocellular carcinoma is essential to identify high-risk patients and to decrease the operative mortality rate. Several post-operative clinical risk scores were developed recently to predict mortality post-hepatectomy; however, which one is the best remains undefined. Therefore, the aim of this study was to evaluate the performance of the different post-operative clinical risk scores in predicting early mortality after hepatectomies. ⋯ Post-operative clinical risk scores, especially MELD, were capable of predicting early mortality after liver resection and should be used to identify high-risk patients and provide them with more intensive medical care.