ANZ journal of surgery
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ANZ journal of surgery · Nov 2016
Changes in the management of liver trauma leading to reduced mortality: 15-year experience in a major trauma centre.
Worldwide, the evolution of management of liver injury has resulted in improved outcomes. The aim of this study was to examine the trend in the management and outcomes of patients with liver injury. Primary outcomes were defined as mortality and hospital length of stay. The secondary aim was to identify independent predictors of mortality. ⋯ At this institution, an integrated trauma service has led to an evolution in the management of hepatic trauma, favouring non-operative management, damage control surgery and the use of hepatic angioembolization. We experienced a significantly improved mortality within 24 h of arrival to hospital in patients with liver trauma.
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ANZ journal of surgery · Nov 2016
Effects of an Enhanced Recovery After Surgery programme on emergency surgical patients.
Enhanced Recovery After Surgery (ERAS) programmes have been used in elective surgery since the 1990s to optimize peri-operative care, reducing post-operative complications, length of stay and overall costs. Following the local introduction of an ERAS programme for colorectal elective patients, it was suggested an increase in the use of ERAS-type principles in emergency patients may have occurred. The aims of this study were to determine whether management changes could be demonstrated and if there was a difference in outcomes. ⋯ This study demonstrates a significant change in management towards ERAS principles in emergency patients following the introduction of such a programme in elective patients. The lack of increased complications in the second period suggests the use of ERAS principles is not harmful. The wider application of ERAS principles could improve outcomes in emergency surgery and deserves further study.
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ANZ journal of surgery · Nov 2016
Observational StudyFailed validation of risk prediction model for intervention in renal colic patients after emergency department evaluation.
It has been reported that three criteria (size of calculus ≥6 mm, visual analogue scale pain score at discharge ≥2 cm and location above mid-ureter; the Papa criteria) were sensitive for predicting patients who require intervention (surgery or lithotripsy) within 28 days of index emergency department (ED) visit for ureteric colic. It was suggested that absence of these criteria identified a group for whom early follow-up may not be needed. No validation has been reported. We aimed to validate these criteria. ⋯ The Papa criteria are not sufficiently accurate to determine which patients require intervention or a subgroup who do not need specialist urological follow-up.
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ANZ journal of surgery · Nov 2016
Observational StudyImpact of workflow on the use of the Surgical Safety Checklist: a qualitative study.
Regardless of the benefits associated of the Surgical Safety Checklist, adherence across its three phases remains inconsistent. The aim of this study was to systematically identify issues around workflow that impact on surgical teams' ability to use the Surgical Safety Checklist in a large tertiary facility in Queensland, Australia. ⋯ One of the greatest systemic challenges to checklist use in surgery is workflow. Process changes in the way that surgical safety checklists are used need to incorporate the temporal demands of the workflow. Any changes made must ensure the process is reliable, is easily embedded into existing work routines and is not disruptive.
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ANZ journal of surgery · Oct 2016
Laparoscopic approach to a planned two-stage hepatectomy for bilobar colorectal liver metastases.
This report describes the technical aspects and outcomes of a laparoscopic approach in planned two-stage liver resections for patients with bilobar colorectal cancer (CRC) liver-only metastases. ⋯ Laparoscopic first-stage resection of tumours in the left liver can be safely combined with RPVL/RPVE to achieve adequate hypertrophy of the FLR, allowing subsequent right hepatectomy.