bluuebunny/crossref_metadata_2025_split huggingface dataset:
GS02 **INGUINAL HERNIA REPAIR WITH UHS – A SINGLE SURGEON REVIEW
Authors: Hatch J. A. , Tan P. 
Published: April 2009

Purpose:   Inguinal hernia repair is a common operation with much focus in recent times on improving morbidity. The use of mesh repair has greatly decreased reoccurrence rates and focus turns towards improving postoperative groin pain. This review examines the use of UHS in inguinal hernia repair and relation with postoperative groin pain.Methods:   A retrospective audit of consecutive cases over one year (telephone and mailed questionnaires) was conducted. The recently validated IPQ (inguinal pain score) was used. A review of files and operative reports was also undertaken. Cases undergoing bilateral repair, or other operations simultaneously were excluded.Results:   59 patients (61%) participated in the audit, with a mean follow up of 11 months (range 5–16). 4 minor wound complications occurred. Higher pain scores appeared to correlate preoperatively with age and workers compensation status. Postoperative pain scores and limitation to functional status were low, and trended towards lower values in the UHS (ultrapro hernia system) repair group compared to the group who underwent repair with PHS (preceding week pain scores respectively –UHS repair, mean 1.22, (95%CI 1.07–1.38); PHS 1.76, (95%CI 1.11–2.43)). The average time until pain disappeared in the groin was within one month (IPQ score of 1.27). For those patients still experiencing any pain, (14 of 59; 23.7%) it occurred on average, once per week for minutes to hours and was at a level that could be ignored.Conclusion:   Inguinal hernia repair with UHS appears to be a safe procedure with minimal complications and a favourable postoperative chronic pain profile.
GS21 *ENHANCED RECOVERY PROGRAMS (EPR) – IS IT APPROPRIATE IN A TERTIARY REFERRAL CENTRE AND COMPLEX COLORECTAL SURGERY?
Authors: Cooke F. J. , Ballal M. , Entriken F. , Aitken J. R. , Hodder R. J. 
Published: April 2009

Introduction:   Enhanced Recovery Programs (EPR) have been shown to reduce mortality, morbidity and length of stay. Can similar results be produced in tertiary centres with the presence of complex colorectal cases?Method:   102 patients were prospectively analysed with a power calculation of 34 being established prior to commencement of the study. The average age was 66.6 (male: female ratio of 1:1).Data collection included demographics, operative procedure, pain scores, POSSUM scores, American Society of Anaesthiology (ASA) scores, and discharge times. All complications were documented.Results:   83 cases were open procedures and 19 laparoscopically, (3 were converted intra‐operatively). The majority were anterior resection (47, [46.1%]) and right hemicolectomies (32, [31.3%]).The average overall discharge time was 11.75 days compared to 15.11 (p < 0.001) prior to commencement of the study in 2005. Anterior resections and subtotal colectomies (14.3 and 13.7 days respectively) had significantly longer lengths of stay compared to right hemicolectomies (10.7 days) [p < 0.001].56% patients were ASA grade 3 & 4 (50% and 6% respectively). A clear correlation with increasing ASA and discharge time was demonstrated (ANOVA p = 0.0004) with significant exponential rise with ASA greater than 2. POSSUM scoring demonstrated a positive correlation with prolonged hospital stay with increasing scores having worse discharge time.Conclusion:   In the presence of complex major surgery and tertiary centre referrals an ERP is feasible producing an average saving of 3.36 days. The benefit is however less with increasing ASA and POSSUM Scores. It however still produced an average economic bed stay saving cost of $3700 per patient stay.
GS22 *THE PROVISION OF A DEDICATED ACUTE GENERAL SURGICAL UNIT IMPROVES THE MANAGEMENT OF PATIENTS WITH ACUTE GALL BLADDER DISEASE
Authors: Shackleton S. D. , O’neill C. J. , Shah K. , Wills V. L. 
Published: April 2009

Introduction:   The goal of an acute general surgical unit (AGSU) is to improve the management of all emergency surgical admissions including those with acute gall bladder disease. In May 2008, John Hunter Hospital Newcastle implemented an AGSU. Changes to service provision included an in‐house consultant (7 am to 7 pm) dedicated to acute surgery with access to an afternoon operating list most weekdays. This study compares the management of acute gall bladder disease before and after implementation of the AGSU in the setting of an unchanged policy of operative management during the index admission (where appropriate) for acute gall bladder disease.Method:   An analysis was performed of all patients admitted via the emergency department with biliary colic or cholecystitis. Demographic, clinical management data and complications were compared for the 6 months of June to November (inclusive) 2007 (pre‐AGSU) and 2008 (AGSU).Results:   In 6 months of 2007, 45 patients were admitted with acute gall bladder disease of which 35 (78%) underwent operative management. By comparison in the same 6 months of 2008, there were 70 admissions, with operative management in 61 (87%). In 2008 average length of stay was 4.24 days (5.07 days in 2007); average time from admission to surgery 34.8 hrs (54.5 hours in 2007, p < 0.05) and, 70.5% of operations occurred between 8 am and 5 pm on a weekday (60% in 2007).Conclusion:   The provision of an acute gall bladder service is improved within a dedicated acute general surgical unit. This translates to benefits to patients, staff and healthcare economics.
GS24P ACUTE COLONIC PSEUDO‐OBSTRUCTION (ACPO): SURGERY REMAINS AN IMPORTANT TREATMENT OPTION
Authors: Chow Z. Y. , Lee H. S. , Jones I. , Hastie I. , Hayes I. , Shedda S. 
Published: April 2009

Purpose:   ACPO often occurs in patients with serious comorbidities and can result in high morbidity and mortality. We aimed to evaluate the current practice of treatment of pseudo obstruction in the era of neostigmine in a single metropolitan hospital.Method:   A retrospective review of prospective hospital databases was undertaken to identify patients with radiological evidence of pseudo‐obstruction and gather demographic information. Further information was retrieved from patient files.Results:   133 patients were identified with radiological evidence of pseudo‐obstruction from June 1996 to December 2008. The median age was 68.5 (range 17–95). There were 80 (60%) males. Overall median length of stay was 37 days with a mortality rate of 9%. For conservative treatment or neostigmine (CN), endoscopic decompression (E), surgery (S) groups, the mortality rates were 9.5%, 8.6% and 6.2% respectively, p = 0.36. There were 94 patients in the CN group, 16 (12%) required surgery (S) and 23 (17%) had endoscopy (E), p = 0.36. The median time to diagnosis from admission was 10 days (CN), 0 days (E) and 7 days (S); p = 0.13. The most frequent mode of diagnosis was gastrograffin enema for CN (43), AXR for E (9) and CT abdomen for S (7). It was noted that 44 (33%) patients had unrelated surgery within the last 30 days prior to the current admission. Surgery for complications was required including 7 colectomies (44%) and 5 caecostomies (31%).Conclusion:   Surgery remains crucial as a treatment modality for pseudo‐obstruction in the era of neostigmine. The majority of operations performed at our institution for pseudo‐obstruction were colectomies, which reflects a high rate of complications in our cohort of patients.
GS26P C REACTIVE PROTEIN IMPROVES DIAGNOSTIC ACCURACY OF ACUTE APPENDICITIS IN EQUIVOCAL CASES
Authors: Thanavinthan thirumalai S. , Wijesuriya R. , Lim S. , Ong S. , Delriviere L. , Mitchell A. 
Published: April 2009

Introduction:   The aim of the study was to evaluate whether C reactive protein level (CRP) on admission could aid the diagnostic accuracy of Alvarado score in acute appendicitis.Patients and methods : 233 patients (males 115, females 118, median age 28 years, range 15–87 years) who underwent appendicectomy were evaluated.Methods:   Patients were categorized in to 3 groups retrospectively based on the Alvarado score. Group I: score 7–10 (n = 154), Group II: score 4–6 (n = 66), Group III: score < 3 (n = 13). Negative (NPV) and positive predictive values (PPV) of CRP which was performed at the time of admission was calculated.Results:   Overall, 169 of 233 (72.5%) had histopathological confirmation of acute appendicitis. In Group I it was 134 patients (87%), Group II: 35 patients (53%) and none of patients in Group III. NPV and PPV for Group I was 29.6% and 85.5%, Group II was 65% and 80% respectively.Conclusion:   The CRP level improves the predictive value of diagnosing acute appendicitis in the equivocal group of Alvarado 4–6. Patients in this group with a normal CRP should be further investigated before proceeding to appendicectomy.
GS28P DOES THE USE OF DEDICATED RANSON'S CRITERIA IMPROVE PATIENT OUTCOME?
Authors: Chakraborty J. K. , Jivan Y. , Subramanya M. S. , Smith B. , Memon B. , Memon M. A. 
Published: April 2009

Purpose:   Early identification of the disease severity in acute pancreatitis and focused management based on Ranson's criteria has shown to improved patients’ outcomes in many trials. We introduced Ranson's criteria at Ipswich Hospital in 2007 and compared the patients’ outcome using historical controls.Methodology:   A retrospective chart analysis was undertaken on patients diagnosed with acute pancreatitis at Ipswich Hospital between 2006 and 2007. Ranson's criteria and treatment protocols were introduced in January 2007 and data was collected prospectively. Data was assessed for the length of hospital stay, ICU admission, transfers to tertiary centres, morbidity and mortality.Results:   33 patients were admitted with acute pancreatitis in 2006 compared to 76 patients in 2007. Ranson's criteria were not formally assessed in any patient prior to 2007. However, 88% of patients had Ranson's criteria scored with strict adherence to the treatment protocol since 2007. 13 patients were scored as severe (greater than 3) in 2007 compared to none in 2006. 6% of patients developed pneumonia compared to 14% in 2007. Length of stay was 5.5 days in 2007 versus 4.87 days in 2006. Five ICU admissions and 4 transfers to tertiary centres occurred in 2007 compared to one transfer with no ICU admissions in 2006. There was no mortality in 2006 compared to 2% in 2007.Conclusion:   Use of Ranson's criteria enables us to tailor our treatment of acute pancreatitis. It is a clinically useful tool and strict adherence leads to quick severity stratification, improved management and better use of health care resources.
GS29P EFFECT OF IMMUNE‐ENHANCED SUPPLEMENTED FORMULAS IN PERIOPERATIVE OUTCOMES: A META‐ANALYSIS
Authors: Osland E. , Khan S. , Hossain M. B. , Memon M. A. 
Published: April 2009

Purpose:   Providing enteral supplements containing ‘immunonutrition’ has been proposed to decrease postoperative complications and duration of hospital stay for elective surgical patients. This meta‐analysis was undertaken to elucidate the potential benefit of providing immune‐enhanced nutrition in surgical patients.Methodology:   A search of Medline, Embase, Science Citation Index, PubMed and the Cochrane Database identified all RCTs comparing the use of perioperative immunonutrition with standard nutrition provision in elective adult surgical patients between 1990 and 2008. The variables analysed included mortality, total complications, infective complications, anastomotic leak and length of hospital stay.Results:   21 distinct studies were identified that met inclusion criteria involving 2135 patients (immunonutrition n = 1100; standard nutrition n = 935). The provision of immunonutrition was shown to be associated with significant reductions in the incidence of total postoperative complications (OR 0.50, 95% CI 0.37, 0.69, p < 0.0001), postoperative infective complications (OR 0.47, 95% CI 0.37, 0.60, p < 0.0001), anastomotic breakdown (OR 0.43, 95% 0.25, 0.75, p = 0.003), and the duration of hospital stay (WMD −2.95, 95% CI −4.01, −1.88, p < 0.0001) when compared to standard nutritional provision. No differences were seen between interventions with relation to mortality (OR 0.90, 95% CI 0.41, 1.97. p = 0.8).Conclusion:   Provision of immunonutrition in preference to standard nutrition was associated with clinically significant decreased length of hospital stay, reduction in the development of postoperative complications including those of infective origin and anastomotic breakdown but has no impact on mortality.
GS30P EFFECTIVENESS OF A STANDARD TEACHING PROGRAMME FOR MEDICAL STUDENTS ACROSS MULTIPLE CLINICAL TEACHING SITES
Authors: Wheeler B. R. , Yu T.‐C. , Wright M. , Hill A. G. 
Published: April 2009

Introduction:   Surgical teaching for clinical medical students is often undertaken across multiple clinical campuses. There are concerns heterogeneity of clinical experience may result in heterogeneity of learning outcome achievements. To avoid this, we have utilised standardised learning materials and tutorials across four hospital campuses.Methods:   Using a feedback questionnaire, clinical experience from assigned hospitals was collected, including a question on influence of clinical experience on future career choice. This was analysed for inter‐hospital differences. Clinical experience was also assessed by analysis of individual student portfolios. Students were administered a centralised standardised formative Objective Structured Clinical Examination (OSCE) during rotations. We analysed OSCE results from 2005 to 2008 for internal reliability and correlation with final written examination grades on a hospital‐by‐hospital basis.Results:   Analysis of student feedback results and portfolios identified inter‐hospital differences in clinical experience. Students indicated that clinical experiences had influence on decision to pursue future surgical careers. The OSCE had a good level of internal reliability (Cronbach's‐alpha 0.62–0.75). No significant inter‐hospital difference in OSCE results was found using one‐way analysis of variance. OSCE results had strong correlations with final examination grades.Conclusions:   Heterogeneity of clinical experience across different teaching settings does not translate into heterogeneity in achievement of learning outcomes when teaching materials are standardised. Consistent with previous published data, undergraduate clinical experience may influence future career choices.
GS32P IS ABDOMINAL CT IN ADDITION TO GASTRO‐INTESTINAL TRACT INVESTIGATION SUFFICIENT TO DETECT ALL SIGNIFICANT DISEASE IN PATIENTS PRESENTING WITH IRON DEFICIENCY ANAEMIA
Authors: Hernon J. M. , Fenech M. , Hall N. R. 
Published: April 2009

Introduction:   The British Society of Gastroenterology (BSG) guidelines for patients presenting with iron deficiency anaemia (IDA) suggest patients should undergoing upper and lower gastrointestinal tract examination in addition to coeliac serology. Studies suggest that in approximately 20% of patients no diagnosis is made. In these patients subsequent management and risk of underlying malignancy remains unclear. In our unit all patients initially negative following investigation undergo an abdominal CT scan. Aim To determine 1) cancer detection and overall disease detection rates for patients referred with IDA on the cancer pathway 2) Subsequent outcomes of patients with no diagnosis made after initial investigations.Methods:   Patients referred between Jan 2002 – Jan 2005 were retrospectively reviewed with respect to 1) diagnosis following initial investigations 2) addition diagnosis following abdominal CT 3) Eventual outcome 3 years following presentations.Results:   111 patients were reviewed. Following initial investigation 12 colorectal and 2 gastric cancers were identified. 63% of patients had a diagnosis following initial investigations. Three patients were diagnosed with underlying malignancy following abdominal CT. 38 patients had no diagnosis, non reattended over a 3 year period with significant pathology.Conclusion:   BSG guideline investigations with addition abdominal CT is sufficient to detect disease in patients with IDA.
GS34P LAPAROSCOPIC MANAGEMENT OF PRIMARY OMENTAL TORSION: A REGIONAL HOSPITAL EXPERIENCE
Authors: Desai D. J. , Seow H. S. , Ashraf M. , Wagner N. 
Published: April 2009

Introduction:   Infarction of the greater omentum is a rare entity representing 0.1% of the total laparotomies performed for acute abdomen.Materials and Methods:   Prospectively collected data was retrospectively analysed for the last three calendar years from Jan 2006 to Dec 2008. A total of five cases of Primary Omental torsions were identified of which four were managed laparoscopically and one was managed conservatively.Discussion:  The cause of Primary (Idiopathic) segmental infraction of the greater Omentum is unknown. The possible mechanisms are arterial micro thrombosis or venous thrombosis secondary to stretching of the Omental veins, and precipitating factors such anomalous arterial supply to the omentum, kinking of vein secondary to increase intra‐abdominal pressure and vascular congestion after large meals have been suggested. Here we present five cases, all males, ranging from ages of 23 to 55 years with a primary presenting complaint of abdominal pain. Only one of these had a previous appendectomy while two had other abdominal surgeries. The working diagnosis was that of an acute abdomen and four of these underwent laparoscopy and Omentectomy. One of them was conservatively managed. Postoperatively there was an immediate relief of pain and the recovery was uneventful with no mortality.Conclusion:   The aim of this article is to share our experience in the diagnosis and management of this rare condition successfully with minimally invasive laparoscopic surgery in our regional centre, and a brief review of the literature.
GS36P PREOPERATIVE FINE NEEDLE CYTOLOGY AND IMAGING FACILITATES THE MANAGEMENT OF SUBMANDIBULAR SALIVARY GLAND LESIONS
Authors: Taylor M. J. , Serpell J. W. , Thompson P. 
Published: April 2009

Purpose:   Lesions of the submandibular gland represent a pleomorphically diverse group making benign and malignant lesions difficult to differentiate from each other. The current series aims to identify the roles of pre‐operative cytology and imaging with subsequent histopathology in the management of these lesions.Methods:   Between 1998 and 2008 fifty‐four patients, of median age 54 years (range 25–94), were retrospectively identified. Fifty patients underwent fifty‐two surgical procedures involving the submandibular gland. The utility of imaging and cytology was analysed, and the accuracy of cytology correlated with histopathology.Results:   Pathologies of resected specimens included: sialadenitis; 17 (32%), pleomorphic adenoma; 9 (17%), calculi; 8 (15%), lymphoma; 5 (10%) squamous cell carcinoma; 2 (4%), adenoid cystic carcinoma; 1 (2%) and other; 10 (20%). Twenty‐eight patients (52%) underwent fine needle aspiration cytology/core biopsies; of these 25 proceeded to surgery. Accuracy, sensitivity, and specificity of fine needle aspiration cytology correlation with histology were 88.0%, 71.4%, and 94.4% respectively. Overall, the complication rate was 9.6%.Conclusion:   This series demonstrates histological outcomes in patients specific to the submandibular salivary gland for which there are few comparative series in the literature. The trans‐cervical surgical approach to submandibular gland pathology is a safe and effective method with minimal morbidity. Combining investigative modalities and cytology optimises the diagnosis and management of submandibular salivary gland lesions.
GS38P THE SAT‐SET COURSE #1: DEVELOPING A TOOL FOR WORKPLACE‐BASED ASSESSMENT OF SURGICAL TRAINEES
Authors: Blackham R. E. , Hamdorf J. M. 
Published: April 2009

The SAT SET course is an innovative course designed by the Royal Australasian College of Surgeons in response to a need to meet the challenges posed by the new SET training program. The course aims to teach current Fellows of the College a number of skills and evaluation methods required of surgical supervisors in assessment and performance management. Specifically, the course demonstrates effective use of the Mini‐CEX and DOPS (Direct Observation of Procedural Skills) for initial and mid‐term assessment of trainees; discusses the College's training policies and relevant legal issues such as the appeals process, as well as explaining expectations of their roles as supervisors and trainers.The course is a forerunner in Australia in active teaching of modern competency‐based assessment tools implemented across a number of disciplines and workplace environments. From its commencement in May 2007 until September 2008, 555 Fellows have participated in SAT SET courses convened in Australia and New Zealand (229 in 2007, 326 in 2008). In addition, 185 SET Supervisor Fellows have attended the course, approximately 40% of all Surgical Supervisors in Australasia.Our survey aims to test the outcomes of the SAT SET course by the cumulative feedback from Supervisors who have attended the course and follow‐up. Future iterations to improve the course, such as video demonstration of mid‐term assessment, co‐badging of SAT SET courses with hospitals and expansion of resources for facilitators will also be discussed.
GS05 SAFER SURGERY GUIDELINES – EXPERIENCE AT A TERTIARY SURGICAL CENTRE
Authors: Lam J. T. , Heriot A. G. , Lynch C. 
Published: April 2009

Introduction:   Although modern surgery is often complex, adherence to simple but critical safety steps have been shown to markedly improve patient outcomes.Aim:   To review and compare surgical practice at a tertiary surgical centre to recommendations from the WHO Safe Surgery Saves Lives Committee.Methodology:   Retrospective analysis of all prospectively recorded surgical adverse events over an 18 month period (1st Jan 2007–30th June 2008). These events were compared to the WHO recommendations.Results:   The tertiary centre practiced all but 3 of the WHO recommendations and 166 surgical adverse events and 23 process failures/near misses were identified. Rate of adverse events was better than the average reported in industrialised nations. Leading adverse events were infection and bleeding/haematoma. Seventeen percent of adverse events identified could have been modified had a ‘sign‐out’ process been followed.Conclusion:   Implementation of WHO recommendations has the potential to reduce surgical adverse events.
GS06 NUTRITIONAL STATUS OF ACUTE SURGICAL PATIENTS‐PREDICTOR OF HOSPITAL STAY
Authors: Kahokehr A. A. , Sammour T. , Wang K. , Plank L. D. , Hill A. G. 
Published: April 2009

Background:   Previous studies have shown that nutritional status affects recovery after elective surgery. The impact of nutritional status in the acute surgical setting has not been well defined.Methods:   Over a 4 week period consecutive patients admitted for >24 hours under the general surgical service at a tertiary hospital were screened on admission using the subjective global assessment (SGA) nutritional assessment tool.Results:   Of 332 eligible patients, 310 were screened. Diagnoses at discharge were: Colorectal pathology (28%), Infective (23%), Hepatopancreaticobiliary (15%), upper gastrointestinal (9%), Vascular (5%), trauma (5%), other (15%). 5% had a malignancy diagnosed during their admission. Mean age was 52 years (95% CI 18–84), mean BMI was 28.6 kg/m2 (95% CI 19.2–41.7), and 170 (55%) were female. 48% were deemed well nourished (SGA‐A), 40% had moderate/suspected malnutrition (SGA‐B) and 12% were severely malnourished (SGA‐C). Median (range) hospital stay was 3 (1–20), 5 (1–30) and 7 (2–38) days (p < 0.001 Kruskal Wallis) for SGA category A to C respectively. Cox regression revealed that SGA was an independent predictor of day stay after taking age, malignancy, sex, albumin, lymphocyte and diagnosis into consideration.Conclusion:   Nutritional status in the acute surgical setting, as measured by a simple clinical tool predicts duration of hospital stay. Admission nutrition screening may be considered in order to determine nutritional requirements of acute surgical patients.