BACKGROUND: It is unknown whether the method of application of povidone iodine solution for skin antisepsis affects its efficacy. The primary aim of this study was to compare the efficacy of spray-on aqueous povidone iod...BACKGROUND: It is unknown whether the method of application of povidone iodine solution for skin antisepsis affects its efficacy. The primary aim of this study was to compare the efficacy of spray-on aqueous povidone iodine solution in preventing surgical site infection in patients undergoing open head and neck surgery versus the standard paint-on application of the same agent. The secondary objective was to assess if the use of spray-on antiseptic solution reduced time in the operating room in complex head and neck surgery. METHODS: This was a prospective, double-blinded, noninferiority randomised controlled trial. The intervention arm received spray-on application of 10% aqueous povidone iodine solution after induction of general anaesthesia. Those in the control arm underwent standard skin preparation by painted application of the same agent. Participants were reviewed on Days 7 and 30 postoperatively to identify postoperative surgical site infection. RESULTS: Four-hundred and forty adult patients undergoing open head and neck surgery were recruited. After withdrawals, 432 participants were included, with 210 patients in the intervention arm (spray) and 222 in the control arm (paint). The overall rate of surgical site infection was 6.5%. There was no significant difference in the rate of surgical site infection between the groups receiving spray-on versus painted povidone iodine solution (5.7% and 7.2%, respectively, p = 0.66). For patients undergoing free flap surgery, the mean time in the operating room was 12.9 min less in the spray-on arm; however, this was not statistically significant (95% CI -42.7 to 68.4 min, p = 0.65). CONCLUSIONS: Spray-on skin preparation with povidone iodine solution before open head and neck surgery appears to be as effective as traditional paint-on application in preventing surgical site infection in the first 30 days following surgery.
BACKGROUND: Surgical site infections (SSIs) are common postoperative complications that delay wound healing and increase morbidity and healthcare costs. Conventional sutures lack antimicrobial properties and may act as a...BACKGROUND: Surgical site infections (SSIs) are common postoperative complications that delay wound healing and increase morbidity and healthcare costs. Conventional sutures lack antimicrobial properties and may act as a nidus for infection. Antimicrobial-coated sutures have been proposed to reduce SSI rates. This systematic review synthesizes literature comparing traditional and antimicrobial sutures regarding SSIs and wound healing to inform clinical guidelines and future research. METHODS: A systematic review was conducted according to PRISMA guidelines. PubMed, Cochrane Library, Web of Science, and VHL were searched on March 25, 2025, using terms related to antimicrobial sutures, traditional sutures, and surgical site infection. Two independent reviewers screened studies by title and abstract, followed by full-text review using predefined eligibility criteria. Included studies were original investigations in English involving live human subjects. RESULTS: Included studies primarily evaluated absorbable sutures, most commonly polyglactin 910 and polydioxanone, with antimicrobial variants incorporating triclosan or chlorhexidine. Antimicrobial sutures did not significantly reduce superficial SSI (OR 0.92, 95% CI 0.69-1.24, p = 0.59) but were associated with a 36% reduction in deep SSI (OR 0.64, 95% CI 0.44-0.93, p = 0.02). Significant reductions were observed in abdominal (OR 0.61, 95% CI 0.39-0.97, p = 0.04) and colorectal procedures (OR 0.60, 95% CI 0.45-0.80, p = 0.0004), but not in vascular or cardiothoracic surgery. In procedures demonstrating significant benefit, the incremental cost of antimicrobial sutures was lower than the estimated cost of treating SSI. CONCLUSION: Antimicrobial sutures reduce deep, but not superficial, SSIs, with most benefit in abdominal and colorectal procedures. This supports selective, risk-stratified implementation of antimicrobial sutures.
BACKGROUND: Pancreatectomy offers a potential cure for pancreatic cancer but may not be accessible to all Australians. We aimed to explore sociodemographic, healthcare and patient factors associated with undergoing pancr...BACKGROUND: Pancreatectomy offers a potential cure for pancreatic cancer but may not be accessible to all Australians. We aimed to explore sociodemographic, healthcare and patient factors associated with undergoing pancreatectomy. METHODS: This study used a nationally linked dataset from the Australian Institute of Health and Welfare, including people diagnosed with pancreatic cancer between July 2010 and December 2018 (excluding Western Australia and the Northern Territory). Pancreatectomy trends were analysed using Joinpoint regression, and associations with sociodemographic, clinical and healthcare factors were assessed using log-binomial regression, with causal mediation analysis assessing the extent to which private specialist visits mediated each association. RESULTS: Among 22 739 individuals with pancreatic cancer (mean age 72.5 years; 51% male), 15% underwent pancreatectomy. Uptake increased over time, with an average six-monthly increase of 1.36% (95% confidence interval [CI] = 0.63-2.11). After adjustment for age, sex and comorbidities, older age was strongly associated with lower pancreatectomy prevalence (80+ years vs. 60-69 years: prevalence ratio [PR] = 0.16; 95% CI = 0.14-0.19). Lower prevalence was observed in remote areas (PR = 0.59; 95% CI = 0.43-0.77) and the most disadvantaged socioeconomic group (PR = 0.75; 95% CI = 0.68-0.82). Conversely, private specialist visits (PR = 1.60; 95% CI = 1.50-1.72) and general practitioner (GP) visits were associated with higher prevalence. Private specialist visits explained 61% of the regional-metropolitan difference and 41% of the high-low GP visits difference, and counteracted the negative effect of comorbidities. CONCLUSIONS: Undergoing pancreatectomy is associated with sociodemographic, clinical and healthcare factors. Understanding the reasons is crucial to improving equity.
BACKGROUND: Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures and provides good functional outcomes in both rheumatoid arthritis (RA) and osteoarthritis (OA) patients. However, RA patients...BACKGROUND: Total hip arthroplasty (THA) is one of the most successful orthopaedic procedures and provides good functional outcomes in both rheumatoid arthritis (RA) and osteoarthritis (OA) patients. However, RA patients face higher risks of adverse post-operative outcomes. Despite recognising the unique risks of RA autoimmunity and drug therapy, there remains minimal RA-specific evidence to guide arthroplasty surgeons. METHODS: This study analysed the rate of all cause revision, and revision for infection, dislocation, periprosthetic fracture, and aseptic loosening for 3657 RA and 446 428 OA patients who underwent primary THA recorded in the Australian Orthopaedic National Joint Replacement Registry (AOANJRR). RESULTS: Key findings of this study indicate that RA is associated with a younger age at THA, an increased risk of all-cause revision (HR 1.35; 95% CI 1.16-1.56; p = 0.001), and an increased risk of revision for infection (HR 1.48; 95% CI 1.12-1.98; p = 0.006), dislocation (HR 1.87; 95% CI 1.45-2.42; p < 0.001), and early aseptic loosening (0-3 month; HR 2.81; 95% CI 1.50-5.26; p = 0.001). There was no difference in all-cause revision for cemented, cementless, or hybrid THA fixation in RA patients. CONCLUSION: This study suggests that RA continues to be associated with worse post-THA outcomes compared to OA. Further research is needed to develop strategies that improve perioperative management of inflammation and immune suppression to reduce the risk of post-operative complications in RA patients undergoing THA.
BACKGROUND: There are studies on parent, patient and child preferences regarding hospital staff attire, but no corresponding studies on staff preferences. The COVID-19 pandemic in Australia coincided with a rapid change...BACKGROUND: There are studies on parent, patient and child preferences regarding hospital staff attire, but no corresponding studies on staff preferences. The COVID-19 pandemic in Australia coincided with a rapid change to scrubs as standard staff attire on hospital wards. These are often at staff choice, whereas theatre scrubs are typically mandated and supplied by the hospital. There is therefore choice outside theatre, but no choice for theatre staff. OBJECTIVES: Survey staff preferences regarding two styles and colours of hospital-provided scrubs, along with reasons underpinning staff preferences. METHODS: Anonymous survey of all in-theatre staff in response to a recent change in scrub uniforms. Mixture of survey and free-text responses to questions. RESULTS: A total of 267 staff responded, with the majority completing the survey. There were ~20 000 words of free-text responses to analyse. There was a clear choice for dark colour, elastic waistband and trouser-style pockets over the alternative. Reasons fell into seven major categories: Comfort/fit/availability, professionalism, functionality/practicality, dignity/self-esteem, modesty/privacy, stains/sweat/dirt and safety. There was no clear preference for own scrubs vs. supplied scrubs, or for multiple options vs. everyone looking the same. Female staff particularly did not like lighter scrubs, with their risk of strikethrough menstrual bleeding. INTERPRETATION: Staff have clear reasons for scrub preferences. Poorly designed scrubs present a hazard to physical safety and well-being. Light colours show stains, sweat and blood more. Underwear can be visible through poorly designed or light-coloured scrubs. There is a pride which comes from wearing well-fitting and functional theatre attire.
BACKGROUND: Social media is frequently used by clinicians to establish their professional identity, but engagement remains dubious. A 2015 study of Australian and New Zealand urologists demonstrated widespread use of soc...BACKGROUND: Social media is frequently used by clinicians to establish their professional identity, but engagement remains dubious. A 2015 study of Australian and New Zealand urologists demonstrated widespread use of social media, though no follow-up study has been conducted. METHODS: Cross-sectional study of urologists identified on the Royal Australasian College of Surgeons 'Find a Surgeon' page or on a group practice website. A thorough search on 'Google' and individual platforms (LinkedIn, X, Facebook, Instagram, YouTube, TikTok) was performed to identify professional websites and social media accounts associated with each urologist. RESULTS: Amongst 516 urologists identified across Australia and New Zealand, most had a business website (79.0%). The mean number of social media accounts per individual was 1.72. LinkedIn (60.9%) was the most popular social media platform. Facebook (34.3%) and X (31.4%) were also commonly used by urologists. Few personal accounts on X (26.8%), Facebook (11.5%) and Instagram (21.8%) were active. Video-based platforms had the poorest uptake, with 8.3% of urologists identifiable on YouTube and 1.2% on TikTok. Academic urologists were significantly more likely to have a social media presence. There was a parabolic decline in social media use with more years since medical qualification, most notable on Facebook and X. CONCLUSION: The number of urologists with a professional website has increased substantially in the past decade, with a moderate rise in overall social media use. Most social media accounts are inactive. Unlike their international counterparts, ANZ urologists appear to have retreated to conservative digital platforms.
UNLABELLED: This paper describes the technique of performing an intrathoracic linear stapled/sutured anastomosis between the oesophagus and gastric conduit. It analyses the outcome from a single surgeon working at two co...UNLABELLED: This paper describes the technique of performing an intrathoracic linear stapled/sutured anastomosis between the oesophagus and gastric conduit. It analyses the outcome from a single surgeon working at two co-located hospitals. METHOD: A retrospective review of prospectively collected data was performed. The study includes 188 operations performed by a single surgeon (ASH) between 1998 and 2025. The mortality and morbidity for the series are analyzed and the technique used is described. RESULTS: The anastomotic leak rate for the 188 patients was found to be 3.2% with an inpatient mortality of 0.5% at 30 days and a mortality of 1.1% at 90 days. The overall stricture rate requiring dilatation was approximately 4.3%. These results from a low volume center compare favorably with international data. CONCLUSION: The linear stapled/sutured anastomotic technique is associated with a low anastomotic leak rate and mortality. The stricture rate is also low when compared to other series of oesophagectomy.
AIMS: Our study aimed to compare the peri-operative and economic outcomes of an anterior resection undertaken using robotic and laparoscopic techniques. By evaluating key factors such as surgical complications, recovery...AIMS: Our study aimed to compare the peri-operative and economic outcomes of an anterior resection undertaken using robotic and laparoscopic techniques. By evaluating key factors such as surgical complications, recovery times, hospital stays and overall procedural expenses. This research aims to enhance understanding of the potential benefits of robotic surgery, including its financial implications. METHODS: This is a retrospective study conducted on patients undergoing elective anterior resections via laparoscopy or the robotic platform (Da Vinci Xi) between January 2018 and August 2023. A single surgeon across public and private hospitals in New South Wales and Queensland, Australia, performed the surgeries. RESULTS: There were 107 patients in total: 58 underwent robotic resection, and 49 underwent laparoscopic resection. The majority of patients were male; otherwise, demographics were similar between groups, with a mean age of 65. Most patients in both groups underwent resections for benign conditions. Among the group undergoing robotic procedures, there was a reduced incidence of ileus, along with a faster recovery of bowel function and a notably shorter length of hospitalisation (4.3 days vs. 5.8 days, p = 0.0038). The average operative time was shorter for the robotic cohort (96 min) compared to the laparoscopic group (136 min, p < 0.0001). Within those patients who underwent a robotic resection, they achieved a higher average lymph node harvest (21 vs. 18). While the laparoscopic cohort had more Clavien-Dindo Grades 1 and 2 complications and statistically high rates of wound infections (p = 0.046), there was no significant disparity in 30-day mortality rates. Regarding costs, when considering differences in length of stay and total operative time, there was a saving in cost of care totalling AUS$3528.61 in favour of robotic resections. Robotic instrument expenses totalled AUS$4176.97, compared to AUS$3829.58 for laparoscopic instruments. The cost of a hospital bed stay was AUS$1464.00/day. CONCLUSION: Our findings suggest that robotic anterior resections result in shorter hospital stays, a quicker recovery and return of bowel function and a greater yield of lymph nodes. Additionally, fewer complications were observed with the robotic platform. When performed by an experienced team, robotic surgeries may also have shorter operative times than laparoscopic procedures. Robotic resection proves to be safe, efficient and cost-effective.
AIM: To determine our incidence of parastomal hernia (PSH) after end colostomy formation and to integrate clinical and novel computed tomography (CT)-derived stoma-site risk factors. METHODS: We performed a retrospective...AIM: To determine our incidence of parastomal hernia (PSH) after end colostomy formation and to integrate clinical and novel computed tomography (CT)-derived stoma-site risk factors. METHODS: We performed a retrospective study of adults undergoing operations resulting in permanent end colostomy at Dunedin Hospital, New Zealand (2009-2022), who had at least one pre- or post-operative abdominal CT scan. PSH and risk factors were identified clinically from electronic medical records or radiologically using the Moreno-Matias classification. Radiological variables included abdominal wall width, rectus muscle-to-subcutaneous fat ratio, rectus density, intraperitoneal area, aperture size and stoma location within the rectus muscle; univariable and multivariable logistic regression identified independent predictors of PSH. RESULTS: Among 217 patients, 64 (29%) were diagnosed with PSH, with approximately half symptomatic. Univariable analysis identified six risk factors: body mass index, diabetes, abdominal wall width, abdominal wall muscle-to-fat ratio, fascial defect diameter and stoma position within the rectus. In adjusted analyses, larger defect diameter (OR: 3.24 per 1 cm increase, 95% CI; 1.96-5.91), abdominal wall muscle-to-fat ratio (OR: 0.68 per 10% increase, 95% CI: 0.49-0.88) and lateral stoma position (OR: 2.79, 95% CI: 1.03-7.86) were independently associated with PSH. CONCLUSION: Combining clinical information with CT-based morphological assessment identified aperture size and abdominal wall muscle-to-fat ratio as key risk factors, and precise central transrectus stoma placement as a risk factor of interest. These findings may inform preoperative risk stratification, technical optimisation of stoma construction and selection of patients for prophylactic interventions.