INTRODUCTION: Optimal care pathways (OCP) were developed in Australia as a framework to define quality and timeliness targets. The 2022 National Pancreatic Cancer Roadmap highlighted a paucity of population-level data on...INTRODUCTION: Optimal care pathways (OCP) were developed in Australia as a framework to define quality and timeliness targets. The 2022 National Pancreatic Cancer Roadmap highlighted a paucity of population-level data on pancreatic cancer management in Australia, such that compliance with OCP targets is uncertain. This study used real-world data to compare pancreatic cancer care in Victoria, Australia, against OCP targets. METHODS: Data collected on pancreatic cancer patients between January 2016 and July 2025 were extracted from the PURPLE registry for five Victorian tertiary hospitals. Care processes and timeliness outcomes were compared with OCP benchmarks. RESULTS: 1878 patients were identified, with a median age of 70 years. At diagnosis, 41% had metastatic disease and 69% were ECOG performance status 0-1. Median interval from diagnosis to surgery was 20 days (OCP benchmark ≤ 28 days) with 60% of patients operated on within the timeframe, and to adjuvant therapy 55 days with 88% of patients receiving chemotherapy within the OCP benchmark of ≤ 84 days. However, just 33% received neoadjuvant chemotherapy, and 38% received palliative chemotherapy within the 28-day timeframe for commencing systemic treatment. Palliative care referral occurred in 65% of patients with advanced disease and 61% were discussed at a multidisciplinary meeting. Marked inter-site variation was evident across metrics. CONCLUSION: In Victoria, Australia, pancreatic cancer care variably met OCP targets. Real-world registry data can identify domains of care where performance is strong and highlight opportunities for process improvement and resource optimisation. Where OCP targets are rarely achieved, these findings support review of their real-world feasibility.
The American College of Surgeons' Minimum Hospital Standardization (MHS) Programme was central to its foundation and subsequent growth over the next 40 years. Its significance was second only to the election of its Fello...The American College of Surgeons' Minimum Hospital Standardization (MHS) Programme was central to its foundation and subsequent growth over the next 40 years. Its significance was second only to the election of its Fellows. The development of the MHS exactly overlapped the years preceding the foundation of the College of Australasian Surgeons in 1927 and its reputation was well known to Australasian surgeons and governments-yet it was never developed in Australasia. The current interest in Australian Clinical Quality Registries and the upcoming College's Centenary is an opportunity to reappraise a missed opportunity.
Choi JDW, Huynh N, Kuppusamy K
… +33 more, Clark D, Bryant R, Edmundson A, Radford R, Gilmore A, Farooque Y, Zhang E, Kumar N, Morgan M, Merrett N, Zeng M, Hodge B, Sutherland A, Lee JCL, Giles A, Tam D, Plecas E, Strekozov B, Gablonski C, de Robles S, Hearn J, Nolan G, Cooper M, Boyle R, Kwok K, Incoll I, Queripel C, Cao A, Pathma-Nathan N, El-Khoury T, Richardson AJ, Hitos K, Toh JWT
BACKGROUND: There is increasing evidence that the addition of preoperative antibiotics (OAB) reduces infectious complications after colorectal surgery. To understand practice patterns in Australia, Australian hospitals p...BACKGROUND: There is increasing evidence that the addition of preoperative antibiotics (OAB) reduces infectious complications after colorectal surgery. To understand practice patterns in Australia, Australian hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) collecting targeted colectomy and proctectomy data were collated. METHODS: Adult patients who had elective restorative colectomy or proctectomy between January 2015 and November 2023. RESULTS: Eight hundred thirty-nine patients were included. Mechanical bowel preparation (MBP) alone was the most common strategy for segmental colectomy (42.46%) and proctectomy (75%). The rate of MBP and oral antibiotics (OAB) remained low (11.7% to 25.3% between 2019 and 2023). This was associated with a decline in superficial SSI (11.7% to 4%) over this time. When the cohort was divided into three groups: MBP+/OAB+ (n = 143), MBP+/OAB- (n = 458) and MBP-/OAB- (n = 238), there were no statistical differences in infectious complications between the groups. However, the MBP+/OAB+ group had the lowest superficial surgical site infection (SSI) rate in the laparoscopic (5.3%) and open surgery (9.2%) subgroups. This was associated with a significant reduction in the odds ratio (OR) 0.52 (95% CI 0.27-1.01) of developing any SSI and a reduced length of stay in the open subgroup. CONCLUSIONS: Despite recommendations by several international guidelines, level 1 evidence from meta-analyses and network meta-analyses as well as a Cochrane review that MBP and OAB reduce infectious complications, there remains a low uptake of MBP and OAB in major colorectal surgery at major NSQIP hospitals in Australia, with even lower uptake in smaller non-NSQIP hospitals.
BACKGROUND: Anastomotic leakage (AL) is the most feared complication after colorectal surgery, with high morbidity and mortality. Early detection remains challenging, as clinical and radiological signs are often delayed....BACKGROUND: Anastomotic leakage (AL) is the most feared complication after colorectal surgery, with high morbidity and mortality. Early detection remains challenging, as clinical and radiological signs are often delayed. This study aimed to evaluate the diagnostic value of procalcitonin (PCT) kinetics between postoperative days (POD) 1 and 3 in predicting AL after colorectal surgery. METHODS: A prospective analytical study was conducted from January 2021 to January 2024 at the Department of General Surgery, Trauma and Burns Center, Ben Arous, Tunisia. Patients undergoing colorectal resection with immediate anastomosis were included. Serum levels of white blood cells (WBC), C-reactive protein (CRP), and PCT were measured on POD1 and POD3. The diagnostic performance of each marker and their kinetics was assessed using receiver operating characteristic (ROC) analysis. RESULTS: Among 114 included patients, 11 (9.6%) developed an AL. Significant associations were found with older age (p = 0.038), absence of bowel preparation (p = 0.048), and manual anastomosis (p = 0.013). PCT and CRP levels at POD3 were significantly higher in patients with AL (p < 0.001). The optimal PCT cutoff at POD3 was 3.53 ng/mL (AUC = 0.85; sensitivity = 81%; specificity = 80%). The ΔPCT (POD3-POD1) > 0.51 ng/mL showed the best performance (AUC = 0.94). The combined variable (CRP + PCT at POD3) achieved an AUC = 0.95 and a negative predictive value of 98.9%. CONCLUSIONS: PCT kinetics between POD1 and POD3 are a reliable early predictor of AL after colorectal surgery. Combined monitoring of PCT and CRP improves diagnostic accuracy and may optimize postoperative management.
BACKGROUND: Wide-awake local anaesthesia no tourniquet (WALANT) is increasingly used globally for hand surgery, offering clinical and operational benefits. However, its adoption in Australia remains understudied. This st...BACKGROUND: Wide-awake local anaesthesia no tourniquet (WALANT) is increasingly used globally for hand surgery, offering clinical and operational benefits. However, its adoption in Australia remains understudied. This study assessed current WALANT usage among Australian hand surgeons to identify key factors influencing its implementation. METHODS: A national cross-sectional survey of all Australian Hand Surgery Society (AHSS) active members (n = 164) was conducted in 2024. The survey examined current WALANT use, perceived benefits and drawbacks, as well as facilitators and barriers of incorporation into practice. Quantitative data were analysed using descriptive and inferential statistics and qualitative data were analysed thematically. RESULTS: Sixty-eight surgeons responded (41% response rate). Seventy percent had performed WALANT at least once, and 50% incorporated it in practice. Current WALANT use was associated with hand surgery fellowship (OR = 8.7), prior WALANT exposure during training (OR = 6.1) and practice in university/teaching hospital (OR = 3.2). Respondents highlighted avoidance of general anaesthesia, shorter recovery, improved patient satisfaction and lower costs as benefits. Conversely, workflow inefficiencies, limited outpatient infrastructure, concerns over anaesthetist scheduling and remuneration and the absence of dedicated billing codes were the dominant barriers. Non-users viewed WALANT as more complex and remained wary of adrenaline safety, whereas users perceived more benefits and reported few technical concerns. CONCLUSION: WALANT is used by a substantial proportion of Australian hand surgeons, but broader adoption is limited by systemic and institutional barriers contributing to a perception gap. Training, infrastructure, policy reform, appropriate funding mechanisms and interprofessional collaboration may support wider integration of WALANT in Australia.
BACKGROUND: Hernia imposes a growing global and national disease burden, yet public understanding remains limited. Short-video platforms such as TikTok and Bilibili have become major sources of health information in Chin...BACKGROUND: Hernia imposes a growing global and national disease burden, yet public understanding remains limited. Short-video platforms such as TikTok and Bilibili have become major sources of health information in China, but the quality and reliability of hernia-related content have not been systematically evaluated. METHODS: Hernia-related videos were retrieved from TikTok and Bilibili between November 15 and 20, 2025. After excluding irrelevant, duplicate, and promotional content, 184 videos were included. Video characteristics, uploader categories, and engagement metrics were collected. Content themes were categorized, and quality was assessed using the Global Quality Score (GQS), modified DISCERN, Patient Education Materials Assessment Tool (PEMAT-U/A), and Journal of the American Medical Association (JAMA) benchmark criteria. Group comparisons were performed using the Mann-Whitney U test, and associations were examined via Spearman correlation. RESULTS: TikTok videos showed significantly higher engagement (likes and comments, both p < 0.01) but were shorter in duration compared with Bilibili. Professional physicians produced 98% of TikTok videos, whereas non-professionals contributed 56% of Bilibili content. TikTok demonstrated higher scores in mDISCERN, PEMAT-A, and JAMA benchmarks (all p < 0.05), though overall GQS scores remained low on both platforms. Longer videos were modestly associated with higher GQS (r = 0.35) and PEMAT-U (r = 0.34). Engagement indicators did not correlate with quality metrics. CONCLUSION: Hernia-related content on TikTok and Bilibili exhibits a clear trade-off: TikTok achieves greater reach but offers limited educational depth, while Bilibili supports more comprehensive content with lower engagement.
Young E, Fenton-Lee D, Süsstrunk J
… +14 more, Ferguson J, Amprayil M, Yin Y, Assi RA, Karatassas A, Khurana S, Hensman C, Tse A, Urquhart H, Lord RVN, Wong J, Tonkin D, Trochsler M, Maddern GJ
BACKGROUND: In an effort to improve hernia care and mesh product surveillance, the Australia and New Zealand Hernia Society (ANZ Hernia) has been setting up a prototype binational learning healthcare system virtual clini...BACKGROUND: In an effort to improve hernia care and mesh product surveillance, the Australia and New Zealand Hernia Society (ANZ Hernia) has been setting up a prototype binational learning healthcare system virtual clinical quality registry (CQR) for clinical use. The aim of this study was to assess the feasibility for clinicians to enrol patients for a prototype hernia CQR in a typical clinical environment across two metropolitan centres in Australia. METHODS: All English-speaking adult patients with capacity to consent and who were being managed for abdominal wall hernias by participating clinicians at the Queen Elizabeth Hospital (Adelaide) or at St Vincent's Private Hospital (Sydney) during specified periods were eligible for inclusion. Participating clinicians were recruited and encouraged to provide feedback. The total number of eligible patients for each recruitment period was determined from clinical records. The literature was reviewed to summarise existing hernia registries. RESULTS: Over a continuous 6-month recruitment period, the conditional recruitment rate of eligible patients encountered by participating clinicians was 34.7% (25 of 74) at TQEH (07/08/2024-02/02/2025) and 48.7% (58 of 119) at SVPHS (15/08/2025-10/02/2025). In the absence of incentives and sustained funding, clinician goodwill alone was insufficient to achieve the minimal standards required by the Australian Commission on Safety and Quality in Health Care for CQRs. An in-depth analysis of the CQR was conducted. CONCLUSION: The prototype ANZ Hernia CQR would benefit from a redesign to address the structural issues identified, if meaningful system-wide quality improvement is to be delivered across Australia and New Zealand as envisioned.
BACKGROUND: Cholangiocarcinoma (CCA) is a malignancy of the bile duct epithelium. Its incidence is highest in Northeast Thailand, where it is strongly associated with Opisthorchis viverrini (OV) infection. The only curat...BACKGROUND: Cholangiocarcinoma (CCA) is a malignancy of the bile duct epithelium. Its incidence is highest in Northeast Thailand, where it is strongly associated with Opisthorchis viverrini (OV) infection. The only curative treatment for intrahepatic cholangiocarcinoma (IHCCA), the most common subtype, is surgical resection. This study aimed to investigate survival outcomes and identify factors associated with long-term survival in resectable IHCCA patients in the high-incidence of OV infection. METHODS: This retrospective cohort study included all patients who underwent curative-intent hepatic resection for pathologically confirmed IHCCA at Sakon Nakhon Hospital between January 2016 and December 2023. Survival was analysed using Kaplan-Meier method. Univariate and multivariate Cox proportional hazard regression models were used to identify prognosis factors. RESULTS: A total of 63 patients were included. The 30-day and 90-day mortality rate were 1.6% and 6.3%, respectively. The median overall survival was 28.5 months (95% CI: 13.79-43.13). The 1-year, 3-year, and 5-year survival rates were 71.1%, 43.5%, and 30.1%, respectively. In the multivariate analysis, factors significantly associated with poorer survival were advanced disease (Stages III and IV) (adjusted hazard ratios [aHR] = 3.37; 95% CI: 1.63-6.97) and lymphovascular invasion (LVI) (aHR = 2.55; 95% CI: 1.27-5.11). CONCLUSION: The median survival and 5-year survival in this study are consistent with outcomes from previous studies. Advanced disease stage and the presence of LVI are independent predictors of poor survival.
BACKGROUND: Whilst guidelines recommend routine frailty screening for elderly patients with head and neck cancer (HNC), no consensus exists on the preferred tool to predict postoperative morbidity. The aim of this study...BACKGROUND: Whilst guidelines recommend routine frailty screening for elderly patients with head and neck cancer (HNC), no consensus exists on the preferred tool to predict postoperative morbidity. The aim of this study was to assess the predictive capacity of three validated frailty screening tools for postoperative complications in patients undergoing major ablative and reconstructive head and neck surgery. METHODS: A prospective cohort of 50 patients aged ≥ 70 years undergoing major ablative and reconstructive HNC surgery was recruited from a single institution in Sydney, Australia. Patients completed three frailty assessment tools pre-operatively: the Clinical Frailty Scale (CFS), Modified Frailty Index-5 (mFI-5) and Modified Frailty Index-11 (mFI-11). Postoperative complications were recorded using the Clavien-Dindo Classification (CDC) and the Comprehensive Complication Index (CCI). Logistic regression and ROC analysis were used to assess predictive performance. RESULTS: The CFS increased the odds of severe (CDC ≥ 3) complications five-fold (OR 5.16, 95% CI 1.12, 23.69; AUC 0.70; cut-off 5). Age ≥ 86 years was also a significant predictor of severe complications (OR = 9.00, 95% CI: 1.79, 45.19, p = 0.008, AUC = 0.71), though limited by prevalence. The mFI-5 and mFI-11 demonstrated limited predictive utility for severe complications (AUC = 0.30 and 0.58, respectively). CONCLUSION: CFS provided the greatest accuracy in predicting severe complications after free-flap surgery, with high specificity and negative predictive value. Age ≥ 86 years also confers high risk. Incorporating CFS into preoperative pathways may guide surgical decision-making and perioperative interventions to improve patient outcomes.
INTRODUCTION: This cross-sectional study aims to evaluate the association between experience in musical instruments and surgical skills in medical students. METHODS: Online questionnaires were distributed to 243 final ye...INTRODUCTION: This cross-sectional study aims to evaluate the association between experience in musical instruments and surgical skills in medical students. METHODS: Online questionnaires were distributed to 243 final year students for their baseline demographic data and exposure to musical instrument training. A two-hour surgical skills training was conducted, and students were assessed for their surgical skills by two blinded assessors 4 weeks after the teaching using the objective structured assessment of technical skills (OSATS) score. RESULTS: Two hundred three final year medical students were recruited. The median age was 24 years old (range 23-34). 126 (62.3%) had experience in playing musical instruments. 101 (80.2%) students mainly played keyboard, 23 (18.3%) played strings, and 2 (1.5%) played brass/wind. The mean time for task completion was 249.3 s (SD = 45.9) in the control group (no musical experience), while the case group (with musical experience) was 223.5 s (SD = 28.8), p < 0.001. The mean OSATS score in the control group was 7.79 (SD = 0.78) while the case group was 8.28 (SD = 0.59), p < 0.001. The mean time for task completion was 223.8 s (SD = 30.8) in the keyboard group, while that in the strings group was 223.2 s (SD = 18.6), p = 0.926. The mean OSATS score was 8.3 (SD = 0.59) in the keyboard group and 8.26 in the strings group (SD = 0.54), p = 0.789. CONCLUSION: Experience with musical instruments is associated with quicker time of basic surgical tasks completion with better technique.
BACKGROUND: E-scooters have become a popular, low-cost mode of urban transport worldwide, with rideshare programmes increasing public access. However, safety concerns are growing, with many studies describing injury patt...BACKGROUND: E-scooters have become a popular, low-cost mode of urban transport worldwide, with rideshare programmes increasing public access. However, safety concerns are growing, with many studies describing injury patterns and healthcare burden. This study evaluated the impact of the suspension of rideshare e-scooters on emergency department (ED) presentations and demographic data in Perth, Western Australia. METHODS: A retrospective cohort study was conducted at the Royal Perth Hospital Emergency Department (ED). All e-scooter-related presentations were identified through triage records and reviewed via chart audit. Two 12-week observation windows were analysed. The first examined the rates of e-scooter injuries during the 12 weeks before and after 5 June 2024 to establish a baseline injury rate. The second assessed presentations during the 12 weeks before and after the suspension of rideshare e-scooters on 5 June 2025. RESULTS: Across both study windows, 272 e-scooter presentations occurred. In the 2024 window, there were a total of 128 presentations corresponding to 10.6 presentations per week. During 2025, there were 144 presentations, corresponding to 12 presentations per week. After the suspension of rideshare scooters in 2025, presentations decreased from 105 to 39 (17.5 to 6.5 presentations per day), with an incidence rate ratio of RR 2.69, 95% CI 1.86-3.89, p ≤ 0.001. CONCLUSIONS: The suspension of rideshare e-scooters was associated with a marked reduction in ED presentations. These findings suggest that local regulation can rapidly influence the e-scooter injury burden and highlight the need for ongoing surveillance to inform safe micro-mobility policy.
BACKGROUND: Early onset colorectal cancer (EoCRC), commonly defined as colorectal cancer diagnosed in people under 50 years of age, is increasing in incidence in Australia and New Zealand. The underlying cause of this re...BACKGROUND: Early onset colorectal cancer (EoCRC), commonly defined as colorectal cancer diagnosed in people under 50 years of age, is increasing in incidence in Australia and New Zealand. The underlying cause of this remains unclear, despite its growing public health importance. The objective of this scoping review was to comprehensively map and synthesise the literature for EoCRC across Australia and New Zealand, focusing on themes and data sources. METHODS: A scoping review was performed according to the PRISMA guidance. INCLUSION CRITERIA: English language, humans, publications 01/01/2000-31/05/2025, Australian and/or New Zealand patients, studies addressing EoCRC (adenocarcinoma). A systematic literature review was performed: 698 titles and abstracts were screened, 72 full texts were reviewed, with 59 studies included for final analysis. RESULTS: Studies were mostly derived from national and state-based cancer registries and thus presented results achievable by analysis of these databases: incidence, patient demographics, familial cancer syndromes and genetics, tumour characteristics, treatment, short term outcomes and survival. Direct comparison between studies was difficult due to the heterogeneity of patient groups and outcome measures. Gaps identified in the literature included lack of longitudinal risk factor analysis and detailed clinicopathological data. CONCLUSION: Australia and New Zealand benefit from the mandatory reporting of colon cancer into central registries. To further progress our understanding of EoCRC, prospectively collected and detailed clinicopathological data are required. Despite relatively small populations, the incidence of colorectal cancer in Australia and New Zealand remains among the highest in the world; insights obtained locally have potential global impact.
BACKGROUND: Small bowel obstruction (SBO) is a common long-term complication following abdominal surgery and a frequent cause of inpatient admissions. The most common cause of SBO is adhesions, followed by hernias and ma...BACKGROUND: Small bowel obstruction (SBO) is a common long-term complication following abdominal surgery and a frequent cause of inpatient admissions. The most common cause of SBO is adhesions, followed by hernias and malignancy. Non-operative management strategies include bowel rest, nasogastric decompression, and Gastrografin administration, each with their own advantages and risks. Intravenous (IV) corticosteroids (Dexamethasone) have demonstrated benefit in malignant SBO but remain unexamined in adhesive SBO. The aim of this study is to evaluate the role of Dexamethasone in adhesive SBO. METHODS: A retrospective review of all patients admitted with adhesive SBO to a tertiary Colorectal Unit between 2020 and 2024 was performed. Demographics, patient results and interventional data were collected. All patients received nasogastric decompression, and IV Dexamethasone was used based on surgeon preference. For analysis, the cohort was divided into two: those who received Dexamethasone (Dex) and those who didn't (Control). RESULTS: A total of 105 patients were included with a mean age of 63.5 years and 54% male. There was no significant difference in baseline characteristics between the two groups. In the Dex group, 92% (46/50) resolved with non-operative management, compared to 75% (41/55) in the Control group, which was statistically significant (p = 0.018). There was no difference in Gastrografin use or the length of stay between the two groups. CONCLUSION: IV Dexamethasone was safe and significantly reduced the need for surgical intervention in adhesive SBO. This is the first study which evaluates the use of IV Dexamethasone in non-malignant SBO and a randomised clinical trial is warranted.
BACKGROUND: A shift in the age profile of major trauma patients creates new challenges to trauma system design. Examining historical trends of major trauma in older people allows us to better plan for an effective trauma...BACKGROUND: A shift in the age profile of major trauma patients creates new challenges to trauma system design. Examining historical trends of major trauma in older people allows us to better plan for an effective trauma system. This study explores the clinical characteristics of older adult trauma cases presenting to a level one trauma center in Australia during the last 10 years. METHODS: This single-center retrospective observational study utilized data from the Western Australian State Trauma Registry. Patients aged 65 years and over with major trauma (ISS > 12) who presented to our center between 2014 and 2023 were included. RESULTS: 2549 patients met the inclusion criteria, with a mean age of 77 years and 63% of them were male. The number and the proportion of major trauma in older adults increased from 195 (21.1%) in 2014 to 324 (29%) in 2023. Falls from standing height were the most frequent mechanism of injury (44.1%). Injuries to head and neck were the most common serious injuries (60.4%). Significant differences were observed across age groups in injury mechanisms, interventions, discharge destination, and in-hospital mortality rates. CONCLUSION: Older trauma presentations at the State Trauma Referral Service have increased. This study highlights the changes in injury patterns, clinical outcomes, and trauma management in older adult major trauma cohort during the last 10 years. These data provide the basis for the ongoing, tailored, evolution of trauma services to cater to the patients it serves.