ANZ journal of surgery
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ANZ journal of surgery · Dec 2018
Too frail for surgery? A frailty index in major colorectal surgery.
Frailty is defined as increased vulnerability from accumulating morbidities in multiple organ systems. Evidence suggests frailty indices predict surgical outcomes in elderly patients. We assessed the validity of a frailty index in predicting post-operative outcomes in major colorectal surgery. ⋯ These data demonstrate that frail patients who developed complications, died within 30 days and required admission to ICU had significantly higher P-Possum CR scores. However, the P-Possum CR score is a superior predictor of post-operative outcomes than frailty index alone.
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ANZ journal of surgery · Nov 2018
Meta AnalysisRole of the ultrasonographic 'whirlpool sign' in intestinal volvulus: a systematic review and meta-analysis.
Intestinal volvulus is a potentially life-threatening condition that occurs when loops of bowel twist around its supporting mesentery and associated vasculature. Clinicians often rely on various radiological investigations for prompt diagnosis to avoid complications such as bowel infarction. This review assesses the clinical reliability of the ultrasonographic whirlpool sign (WS) in the diagnosis of intestinal volvulus. ⋯ Though the pooled sensitivity was less than ideal (87.42%), this review and meta-analysis nevertheless supports the reliability of the ultrasonographic WS as an acceptable indicator of intestinal volvulus.
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ANZ journal of surgery · Nov 2018
Opioid prescribing in orthopaedic and neurosurgical specialties in a tertiary hospital: a retrospective audit of hospital discharge data.
To understand patterns of opioid prescribing on discharge in the orthopaedic and neurosurgical wards of a tertiary metropolitan hospital. ⋯ Orthopaedic and neurosurgical units had high opioid prescribing rates on discharge from hospital. This highlights the need for clear communication of the intended medication management plan post-discharge in order to minimize inappropriate and ongoing use of opioids post-surgery.
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ANZ journal of surgery · Oct 2018
ReviewEuthanasia and surgeons: an overview of the Victorian Voluntary Assisted Dying Act 2017 and its relevance to surgical practice in Australia.
Surgeons play a significant role in the treatment of patients with many types of cancer, including the management of advanced and recurrent disease after long periods of apparent remission. The recently introduced Victorian Voluntary Assisted Dying (VAD) Act represents a shift in paradigm in Australian medical practice. To be eligible for VAD, the new legislation requires patient assessment by a physician with at least 5 years post-fellowship experience and relevant expertise in the patient's condition. ⋯ It is foreseeable that other states and territories in Australia will follow suit with similar legislation. It is imperative that surgeons receiving referrals to assess patients seeking access to VAD are familiar with the legislation and assessment process. This article summarizes the current regulation of VAD in Australia, including the patient application and assessment process, briefly reviews world-wide assisted dying practices and discusses the relevance to surgeons practicing in Australia.