Journal articles on the topic 'Postoperative care Australia'
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von Peltz, Claudia A., Celine Baber, and Suzi LH Nou. "Australian perspective on Fourth Consensus Guidelines for the management of postoperative nausea and vomiting." Anaesthesia and Intensive Care 49, no. 4 (July 2021): 253–56. http://dx.doi.org/10.1177/0310057x211030518.
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This is a summary document that provides an Australian perspective on the Fourth Consensus Guidelines for the management of postoperative nausea and vomiting. The Australian Society of Anaesthetists has endorsed the Fourth Consensus Guidelines for the management of postoperative nausea and vomiting and has written this document with permission from the authors and the American Society for Enhanced Recovery to provide an Australia-specific summary.
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Campbell, N. N., G. J. Reynolds, and G. Perkins. "Postoperative Analgesia in Neonates: An Australia-Wide Survey." Anaesthesia and Intensive Care 17, no. 4 (November 1989): 487–91. http://dx.doi.org/10.1177/0310057x8901700416.
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An Australia-wide survey of the use of postoperative analgesia in neonates has been conducted. A high overall use of analgesia has been recorded with 75% of respondents prescribing an opioid. The frequency of use of local or regional analgesia was disappointingly low at 8% overall. The general attitude is that analgesia is desirable but a fear of respiratory depression inhibits its use, particularly in non-ventilated neonates and after more minor surgery. It is suggested that a wider use of regional anaesthesia techniques may reduce this problem.
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MacFarlane, Patricia L., Simon Nasser, William B. Coman, Gregory Kiss, Penelope K. Harris, and A. Simon Carney. "Tonsillectomy in Australia: An audit of surgical technique and postoperative care." Otolaryngology–Head and Neck Surgery 139, no. 1 (July 2008): 109–14. http://dx.doi.org/10.1016/j.otohns.2008.03.015.
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Greaves, Danielle, Peter J. Psaltis, Amit Lampit, Daniel H. J. Davis, Ashleigh E. Smith, Alice Bourke, Michael G. Worthington, Michael J. Valenzuela, and Hannah A. D. Keage. "Computerised cognitive training to improve cognition including delirium following coronary artery bypass grafting surgery: protocol for a blinded randomised controlled trial." BMJ Open 10, no. 2 (February 2020): e034551. http://dx.doi.org/10.1136/bmjopen-2019-034551.
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IntroductionCoronary artery bypass grafting (CABG) surgery is known to improve vascular function and cardiac-related mortality rates; however, it is associated with high rates of postoperative cognitive decline and delirium. Previous attempts to prevent post-CABG cognitive decline using pharmacological and surgical approaches have been largely unsuccessful. Cognitive prehabilitation and rehabilitation are a viable yet untested option for CABG patients. We aim to investigate the effects of preoperative cognitive training on delirium incidence, and preoperative and postoperative cognitive training on cognitive decline at 4 months post-CABG.Methods and analysisThis study is a randomised, single-blinded, controlled trial investigating the use of computerised cognitive training (CCT) both pre-CABG and post-CABG (intervention group) compared with usual care (control group) in older adults undergoing CABG in Adelaide, South Australia. Those in the intervention group will complete 1–2 weeks of CCT preoperatively (45–60 min sessions, 3.5 sessions/week) and 12 weeks of CCT postoperatively (commencing 1 month following surgery, 45–60 min sessions, 3 sessions/week). All participants will undergo cognitive testing preoperatively, over their hospital stay including delirium, and postoperatively for up to 1 year. The primary delirium outcome variable will be delirium incidence (presence vs absence); the primary cognitive decline variable will be at 4 months (significant decline vs no significant decline/improvement from baseline). Logistic regression modelling will be used, with age and gender as covariates. Secondary outcomes include cognitive decline from baseline to discharge, and at 6 months and 1 year post-CABG.Ethics and disseminationEthics approval was obtained from the Central Adelaide Local Health Network Human Research Ethics Committee (South Australia, Australia) and the University of South Australia Human Ethics Committee, with original approval obtained on 13 December 2017. It is anticipated that approximately two to four publications and multiple conference presentations (national and international) will result from this research.Trial registration numberThis clinical trial is registered with the Australian New Zealand Clinical Trials Registry and relates to the pre-results stage. Registration number: ACTRN12618000799257.
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Reilly, Jennifer R., Mark A. Shulman, Annie M. Gilbert, Bismi Jomon, Robin J. Thompson, Jonathon J. Nicholson, Justin A. Burke, et al. "Towards a national perioperative clinical quality registry: The diagnostic accuracy of administrative data in identifying major postoperative complications." Anaesthesia and Intensive Care 48, no. 3 (April 28, 2020): 203–12. http://dx.doi.org/10.1177/0310057x20905606.
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Accurately measuring the incidence of major postoperative complications is essential for funding and reimbursement of healthcare providers, for internal and external benchmarking of hospital performance and for valid and reliable public reporting of outcomes. Actual or surrogate outcomes data are typically obtained by one of three methods: clinical quality registries, clinical audit, or administrative data. In 2017 a perioperative registry was developed at the Alfred Hospital and mapped to administrative and clinical data. This study investigated the statistical agreement between administrative data (International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes) and clinical audit by anaesthetists in identifying major postoperative complications. The study population included 482 high-risk surgical patients referred to the Alfred Hospital anaesthesia postoperative service over two years. Clinical audit was conducted to determine the presence of major complications and these data were compared to administrative data. The main outcome was statistical agreement between the two methods, as defined by Cohen’s kappa statistic. Substantial agreement was observed for five major complications, moderate agreement for three, fair agreement for six and poor agreement for two. Sensitivity and positive predictive value ranged from 0 to 100%. Specificity was above 90% for all complications. There was important variation in inter-rater agreement. For four of the five complications with substantial agreement between administrative data and clinical audit, sensitivity was only moderate (61.5%–75%). Using International Statistical Classification of Diseases and Related Health Problems (10th edition) Australian Modification codes to identify postoperative complications at our hospital has high specificity but is likely to underestimate the incidence compared to clinical audit. Further, retrospective clinical audit itself is not a highly reliable method of identifying complications. We believe a perioperative clinical quality registry is necessary to validly and reliably measure major postoperative complications in Australia for benchmarking of hospital performance and before public reporting of outcomes should be considered.
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Wong, Danny Jon Nian, Scott Popham, Andrew Marshall Wilson, Lisa M. Barneto, Helen A. Lindsay, Laura Farmer, David Saunders, et al. "Postoperative critical care and high-acuity care provision in the United Kingdom, Australia, and New Zealand." British Journal of Anaesthesia 122, no. 4 (April 2019): 460–69. http://dx.doi.org/10.1016/j.bja.2018.12.026.
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Stewart, P. C. H., D. B. Baines, and C. Dalton. "Paediatric Day Stay Tonsillectomy Service: Development and Audit." Anaesthesia and Intensive Care 30, no. 5 (October 2002): 641–46. http://dx.doi.org/10.1177/0310057x0203000517.
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Day stay paediatric tonsillectomy is well established in many parts of the world but not in Australia. This audit presents the protocol and results of the first one hundred and twenty-five patients managed this way at our hospital. Patients assessed as being at low risk of postoperative complications were offered the procedure as a day patient. All patients had a standardized relaxant anaesthetic technique with an intraoperative opioid and antiemetics. The patients were observed for six hours postoperatively in the Day Stay Unit and contacted the day following surgery to assess any problems. The overall incidence of postoperative vomiting was 15.6%. Two patients required overnight admission. One child was re-admitted on day four for delayed postoperative haemorrhage. Forty-four of the first forty-nine patients’ parents were contacted four to six weeks later to assess their experiences of the process. Although approximately three-quarters of the parents rated their child's pain as moderate or severe at some stage, all but one felt the analgesic regimen was good or adequate. Eighty per cent were satisfied with having the surgery as a day stay procedure.
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Ludbrook, Guy L., and Richard M. Walsh. "Impact of age on the future burden of postoperative complications in Australia." Anaesthesia and Intensive Care 47, no. 5 (September 2019): 480–81. http://dx.doi.org/10.1177/0310057x19879452.
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Schadewaldt, Verena, Sandhya Cherkil, Dilip Panikar, and Katharine J. Drummond. "Quality of life after resection of a meningioma—A cross-cultural comparison of Indian and Australian patients." PLOS ONE 17, no. 9 (September 26, 2022): e0275184. http://dx.doi.org/10.1371/journal.pone.0275184.
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Purpose To compare health-related quality of life (HRQoL) and symptom burden following meningioma resection in patients from two samples from Australia and India. This will add to the body of data on the longer-term consequences of living with a meningioma in two socio-economically and culturally different countries. Methods The European Organisation for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire (QLQ-C30), Brain Neoplasm Module (QLQ-BN20) and the Hospital Anxiety and Depression Scale (HADS) were administered to 159 Australian and 92 Indian meningioma patients over 24 months postoperative. A linear mixed model analysis identified differences between groups over time. Results Australian patients reported better physical functioning in the early months after surgery (T1: mean diff: 19.8, p<0.001; T2: mean diff: 12.5, p = 0.016) whereas Indian patients reported better global HRQoL (mean: -20.3, p<0.001) and emotional functioning (mean diff:-15.6, p = 0.020) at 12–24 months. In general, Australian patients reported more sleep and fatigue symptoms while Indian patients reported more gastro-intestinal symptoms over the 2-year follow-up. Future uncertainty and symptoms common for brain tumour patients were consistently more commonly reported by patients in Australia than in India. No differences for depression and anxiety were identified. Conclusion This is the first cross cultural study to directly compare postoperative HRQoL in meningioma patients. Some differences in HRQoL domains and symptom burden may be explained by culturally intrinsic reporting of symptoms, as well as higher care support from family members in India. Although there were differences in some HRQoL domains, clinically meaningful differences between the two samples were less common than perhaps expected. This may be due to an Indian sample with high literacy and financial resources to afford surgery and follow up care.
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Butterworth, Paul, Mark F. Gilheany, and Paul Tinley. "Postoperative infection rates in foot and ankle surgery: a clinical audit of Australian podiatric surgeons, January to December 2007." Australian Health Review 34, no. 2 (2010): 180. http://dx.doi.org/10.1071/ah08687.
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Background.Surgical site infections are one of the most common post-operative complications encountered by foot and ankle surgeons. The incidence reported in the literature varies between 0.5 and 6.5%. The results of a 12-month Australia-wide clinical audit analysing the rates of postoperative infections in association with podiatric surgery are presented. Methods.De-identified patient data was collected from nine podiatric surgeons Australia-wide. Infections were identified according to Australian Council on Health Care Standards (ACHS) definitions and data was entered no earlier than thirty days post procedure. Results.A total of 1339 patient admissions and 2387 surgical procedures were reported using the International Classification of Diseases (ICD-10) and Medicare Benefit Schedule (MBS) coding systems. The overall infection rate was 3.1% and the rate of infection resulting in hospital re-admission was 0.25%. Conclusions.The benchmark results presented in this paper suggest that infection rates associated with podiatric surgery are well within accepted industry standards as stated in recent literature. What is known about the topic?The rates of infection in foot and ankle surgery have been reported in international literature to vary between 0.5 and 6.5%. No such data has been published to date, which describes the rate of infection following podiatric surgery in Australia. What does this paper add?This paper provides benchmark data on complication rates associated with Australian podiatric surgeons. Such data also informs health and hospital managers who may be considering podiatric surgery as an option for providing foot surgery services within the public hospital system. What are the implications for practitioners?This paper challenges podiatric surgeons to consider their own practice and whether it is a reflection of best practice.
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Olesnicky, Benjamin L., Andrew Lindberg, Frank B. Marroquin-Harris, and Kerrie Ren. "A survey of current management of neuromuscular block and reversal in Australia and New Zealand." Anaesthesia and Intensive Care 49, no. 4 (July 2021): 309–15. http://dx.doi.org/10.1177/0310057x21995498.
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In recent years there has been a significant investment in education on the management of neuromuscular blockade and increased availability of sugammadex in anaesthetic practice. This survey aimed to examine contemporary practice of Australian and New Zealand anaesthetists in managing neuromuscular blockade and its reversal. A web-based, voluntary survey was distributed to a cohort of 1000 Fellows of the Australian and New Zealand College of Anaesthetists. We received 229 completed responses (survey response rate of 23%). Seventy-one percent (95% confidence interval (CI) 64% to 76%) of the survey respondents thought that 5% or fewer of the patients in their hospital display clinically significant postoperative paralysis. Only 35% (95% CI 18% to 29%) thought that quantitative neuromuscular twitch monitors should be used to monitor neuromuscular block, and the dose and time given for reversal agents was often inconsistent with published recommendations. Sugammadex was the preferred reversal agent for 78% (95% CI 72% to 83%) of survey respondents, but they indicated that cost remains a significant barrier to its widespread uptake. Despite the low response rate, this survey identified that some reported practices in Australia and New Zealand deviate from guidelines and current recommendations in the management of neuromuscular blockade. If the respondents are representative of the broader anaesthetic community, there appears be a greater preference for sugammadex over neostigmine for reversal of neuromuscular blockade.
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Rigg, J. R., K. Collins, and K. Jamrozik. "Survey: National Audit of Anaesthesia for Major Abdominal Surgery." Anaesthesia and Intensive Care 25, no. 3 (June 1997): 282–85. http://dx.doi.org/10.1177/0310057x9702500314.
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A postal survey was conducted of all hospitals in Australia known to have a department of anaesthesia and an intensive care or high dependency unit. Each hospital was asked to report the anaesthetic and postoperative analgesic techniques used for the last ten cases of four common major surgical procedures—aorto-femoral bypass, repair of an abdominal aortic aneurysm, hemicolectomy and anterior resection of the rectum. Half of 76 hospitals sent a survey form completed and returned it. Responding hospitals were larger, on average, than non-responding ones, but otherwise typical of them in terms of university affiliation and metropolitan versus rural location. For each of the four procedures studied, the proportion of cases in which epidural block was used intra- or postoperatively varied from 0% to 100%. Depending on the procedure, between 65% and 85% of hospitals used epidural block sometimes, with between 10% and 90% of patients in these hospitals being managed with this technique. There is wide variation in the use of epidural block, intra- and postoperatively, in Australia, variation that is unlikely to be explained by systematic differences between institutions in the patients seen or their suitability for one or other technique. This pattern of practice mirrors the lack of agreement about the proper place for epidural techniques evident in the recent literature. There is a widespread belief among clinicians that this is a question of great importance. Accordingly, we believe that anaesthetists and surgeons share an ethical responsibility to enter suitable patients in an appropriately designed randomized controlled trial in order to resolve this question.
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Cobcroft, M. D., and C. Forsdick. "Awareness under Anaesthesia: The Patients’ Point of View." Anaesthesia and Intensive Care 21, no. 6 (December 1993): 837–43. http://dx.doi.org/10.1177/0310057x9302100616.
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The collective experience of 187 patients who suffered awareness during general anaesthesia is presented. This has been collated from letters solicited in September 1992 by a women's magazine widely distributed throughout Australia and New Zealand. The responses cover anaesthetics given during a period from the 1950s to the present. The findings show a disturbing symptomatology ranging over almost all modalities of sensation and of postoperative psychological and psychiatric disturbances. The letters also reveal that in most cases understanding of awareness and its proper management by medical personnel was poor or totally lacking.
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Bright, Matthew R., Sandra I. Concha Blamey, Linda A. Beckmann, and Martin D. Culwick. "Iatrogenic uvular injury related to airway instrumentation: A report of 13 cases from the webAIRS database and a review of uvular necrosis following inadvertent uvular injury." Anaesthesia and Intensive Care 49, no. 2 (March 2021): 133–39. http://dx.doi.org/10.1177/0310057x20982623.
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Published reports of uvular necrosis are uncommon and it is possibly an under-reported complication of oropharyngeal manipulation. Uvular necrosis is thought to develop due to ischaemia secondary to mechanical compression of the uvula from oropharyngeal devices. Patients typically present with symptoms of a sore throat within 48 hours postoperatively. It is unclear whether there are any preventable factors, or any specific management strategies that might reduce this complication. Treatment is most commonly conservative management, including observation and simple analgesia. We present 13 cases of uvular injury that were reported to a web-based anaesthesia incident reporting system (webAIRS), a voluntary de-identified anaesthesia incident reporting system in Australia and New Zealand. While the postoperative findings varied, sore throat was the most frequent symptom. Most of the cases resolved spontaneously; the remainder with supportive treatment only. The findings suggest that patients who sustain a uvular injury can be reassured, but they should be advised to seek review early if sore throat persists or any difficulty with breathing develops.
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Hummel, Richard, Ngoc Hoang Ha, Andrew Lord, Markus I. Trochsler, Guy Maddern, and Harsh Kanhere. "Centralisation of oesophagectomy in Australia: is only caseload critical?" Australian Health Review 43, no. 1 (2019): 15. http://dx.doi.org/10.1071/ah17095.
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Objective High caseload is considered one of the most important factors for good outcomes after high-risk surgeries such as oesophagectomy. However, many Australian centres perform low volumes of oesophagectomies due to demographics. The aim of the present study was to audit outcome after oesophagectomy in an Australian low-volume centre over a period of 13 years and to discuss potential contributors to outcome other than just case volume. Methods Perioperative and long-term outcomes of all oesophagectomies over a 13-year period in a low-volume Australian tertiary care centre were analysed retrospectively. Data were compared in subgroups of patients in two separate time periods: 2000–05 (n=23) and 2006–12 (n=24). Results There were two perioperative deaths over the entire 13-year period with no postoperative mortality in the last decade. The complication and long-term survival rates for each of the two separate time periods were similar to those from high-volume centres, more so in the second half of the study period. Conclusions The data suggest that under specific conditions, oesophagectomies can be safely performed even in smaller- or low-volume centres in Australia. The policy of centralisation for these procedures in Australia needs to be carefully tailored to the needs of the population, clinical outcomes, cost-effectiveness and optimal utilisation of existing facilities rather than on caseload alone. What is known about the topic? High caseload is considered one of the most important factors for good outcomes after oesophagectomy and a driving force behind centralisation of this procedure. However, other factors may also affect outcome – such as availability of experienced surgeons, specialist nurses, interventional radiology, gastroenterology, etc. What does this paper add? With the availability of appropriate levels of expertise, infrastructure and specialist nursing staff as is the case in most Australian tertiary centres, good perioperative outcomes can be obtained despite low volumes. Case load only should not be used as a surrogate marker of quality. What are the implications for practitioners? The policy of centralisation for oesophagectomy in Australia needs to be carefully thought out on the basis of population demographics, outcomes and cost-effectiveness, with the appropriate use of existing facilities, rather than on a caseload basis alone.
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Assareh, Hassan, Jack Chen, Lixin Ou, Stephanie J. Hollis, Kenneth Hillman, and Arthas Flabouris. "Rate of venous thromboembolism among surgical patients in Australian hospitals: a multicentre retrospective cohort study." BMJ Open 4, no. 10 (October 2014): e005502. http://dx.doi.org/10.1136/bmjopen-2014-005502.
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ObjectivesDespite the burden of venous thromboembolism (VTE) among surgical patients on health systems in Australia, data on VTE incidence and its variation within Australia are lacking. We aim to explore VTE and subsequent mortality rates, trends and variations across Australian acute public hospitals.SettingA large retrospective cohort study using all elective surgical patients in 82 acute public hospitals during 2002–2009 in New South Wales, Australia.ParticipantsPatients underwent elective surgery within 2 days of admission, aged between 18 and 90 years, and who were not transferred to another acute care facility; 4 362 624 patients were included.Outcome measuresVTE incidents were identified by secondary diagnostic codes. Poisson mixed models were used to derive adjusted incidence rates and rate ratios (IRR).Results2/1000 patients developed postoperative VTE. VTE increased by 30% (IRR=1.30, CI 1.19 to 1.42) over the study period. Differences in the VTE rates, trends between hospital peer groups and between hospitals with the highest and those with the lowest rates were significant (between-hospital variation). Smaller hospitals, accommodated in two peer groups, had the lowest overall VTE rates (IRR=0.56:0.33 to 0.95; IRR=0.37:0.23 to 0.61) and exhibited a greater increase (64% and 237% vs 19%) overtime and greater between-hospital variations compared to larger hospitals (IRR=8.64:6.23 to 11.98; IRR=8.92:5.49 to 14.49 vs IRR=3.70:3.32 to 4.12). Mortality among patients with postoperative VTE was 8% and remained stable overtime. No differences in post-VTE death rates and trends were seen between hospital groups; however, larger hospitals exhibited less between-hospital variations (IRR=1.78:1.30 to 2.44) compared to small hospitals (IRR>23). Hospitals performed differently in prevention versus treatment of postoperative VTE.ConclusionsVTE incidence is increasing and there is large variation between-hospital and within-hospital peer groups suggesting a varied compliance with VTE preventative strategies and the potential for targeted interventions and quality improvement opportunities.
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Moran, Benjamin L., David A. Scott, Elizabeth Holliday, Serena Knowles, Manoj Saxena, Ian Seppelt, Naomi Hammond, and John A. Myburgh. "Pain assessment and analgesic management in patients admitted to intensive care: an Australian and New Zealand point prevalence study." Critical Care and Resuscitation 24, no. 3 (September 6, 2022): 224–32. http://dx.doi.org/10.51893/2022.3.oa1.
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OBJECTIVE: To describe pain assessment and analgesic management practices in patients in intensive care units (ICUs) in Australia and New Zealand. DESIGN, SETTING AND PARTICIPANTS: Prospective, observational, multicentre, single-day point prevalence study conducted in Australian and New Zealand ICUs. Observational data were recorded for all adult patients admitted to an ICU without a neurological, neurosurgical or postoperative cardiac diagnosis. Demographic characteristics and data on pain assessment and analgesic management for a 24-hour period were collected. MAIN OUTCOME MEASURES: Types of pain assessment tools used and frequency of their use, use of opioid analgesia, use of adjuvant analgesia, and differences in pain assessment and analgesic management between postoperative and non-operative patients. RESULTS: From the 499 patients enrolled from 45 ICUs, pain assessment was performed at least every 4 hours in 56% of patients (277/499), most commonly with a numerical rating scale. Overall, 286 patients (57%) received an opioid on the study day. Of the 181 mechanically ventilated patients, 135 (75%) received an intravenous opioid, with the predominant opioid infusion being fentanyl. The median dose of opioid infusion for ventilated patients was 140 mg oral morphine equivalents. Of the 318 non-ventilated patients, 41 (13%) received patient-controlled analgesia and 76 (24%) received an oral opioid, with the predominant opioid being oxycodone. Paracetamol was administered to 63 ventilated patients (35%) and 164 non-ventilated patients (52%), while 2% of all patients (11/499) received a non-steroidal anti-inflammatory drug. Ketamine infusion and regional analgesia were used in 15 patients (3%) and 17 patients (3%), respectively. Antineuropathic agents (predominantly gabapentinoids) were used in 53 patients (11%). CONCLUSIONS: Although a majority of ICU patients were frequently assessed for pain with a validated pain assessment tool, cumulative daily doses of opioids were high, and the use of multimodal adjuvant analgesia was low. Our data on current pain assessment and analgesic management practices may inform further research in this area.
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Paech, M. J., M. W. M. Rucklidge, S. L. Banks, L. C. Gurrin, C. E. P. Orlikowski, and T. J. G. Pavy. "The Efficacy and Cost-effectiveness of Prophylactic 5-hydroxytryptamine3 Receptor Antagonists: Tropisetron, Ondansetron and Dolasetron." Anaesthesia and Intensive Care 31, no. 1 (February 2003): 11–17. http://dx.doi.org/10.1177/0310057x0303100102.
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There are currently three 5-hydroxytryptamine 3 (5-HT 3 ) receptor antagonists available in Australia. In this randomized, double-blind, parallel group study the prophylactic antiemetic effect of a single dose of tropisetron 2 mg, ondansetron 4 mg or dolasetron 12.5 mg was compared after major gynaecological surgery. One hundred and eighteen patients (group T n=42; group O n=36; group D n=40) were evaluated for nausea, vomiting, recovery characteristics and satisfaction for 24 hours postoperatively. A cost-effectiveness analysis was performed. Rescue antiemetic, prochlorperazine 12.5 mg IM, was given if vomiting occurred more than 10 minutes after arrival in the recovery room. If prochlorperazine was ineffective one hour after administration, droperidol 1 mg IV was given. There were no significant differences between groups for the incidence of vomiting during consecutive epochs until 24 hours postoperatively or overall (57%, 75% and 72.5% for groups T, O and D respectively, P=0.18). The incidence and number of rescue antiemetic treatments for nausea or vomiting were similar. The incidence of nausea and the overall and interval nausea scores were similar except for lower “worst nausea” score in group T between 12 and 18 hours (P=0.02). Recovery times, satisfaction and cost per patient did not differ between groups. We conclude that the risk of postoperative nausea and vomiting remained high in this setting despite 5-HT 3 receptor antagonist prophylaxis and that the choice between these agents should be based on the lowest available acquisition cost.
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Ellis, Robert J., Daniel P. Edey, Sharon J. Del Vecchio, Megan McStea, Scott B. Campbell, Carmel M. Hawley, David W. Johnson, et al. "End-Stage Kidney Disease following Surgical Management of Kidney Cancer." Clinical Journal of the American Society of Nephrology 13, no. 11 (September 28, 2018): 1641–48. http://dx.doi.org/10.2215/cjn.06560518.
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Background and objectivesWe investigated the incidence of ESKD after surgical management of kidney cancer in the Australian state of Queensland, and described patterns in the initiation of kidney replacement therapy resulting from kidney cancer across Australia.Design, setting, participants, & measurementsAll newly diagnosed cases of kidney cancer in the Australian state of Queensland between January of 2009 and December of 2014 were ascertained through the Queensland Cancer Registry. There were 2739 patients included in our analysis. Patients who developed ESKD were identified using international classification of disease–10–coded hospital administrative data. Incidence rate and 3-year cumulative incidence were calculated, and multivariable Cox proportional hazards models were used to identify factors associated with ESKD. Additional descriptive analysis was undertaken of Australian population data.ResultsThe incidence rate of ESKD in all patients was 4.9 (95% confidence interval [95% CI], 3.9 to 6.2) per 1000 patient-years. The 3-year cumulative incidence was 1.7%, 1.9%, and 1.0% for all patients, and patients managed with radical or partial nephrectomy, respectively. Apart from preoperative kidney disease, exposures associated with increased ESKD risk were age≥65 years (adjusted hazard ratio [aHR], 2.0; 95% CI, 1.2 to 3.2), male sex (aHR, 2.3; 95% CI, 1.3 to 4.3), preoperative diabetes (aHR, 1.8; 95% CI, 1.0 to 3.3), American Society of Anesthesiologists classification ≥3 (aHR, 4.0; 95% CI, 2.2 to 7.4), socioeconomic disadvantage (aHR, 1.6; 95% CI, 0.9 to 2.7), and postoperative length of hospitalization ≥6 days (aHR, 2.1; 95% CI, 1.4 to 3.0). Australia-wide trends indicate that the rate of kidney replacement therapy after oncologic nephrectomy doubled between 1995 and 2015, from 0.3 to 0.6 per 100,000 per year.ConclusionsIn Queensland between 2009 and 2014, one in 53 patients managed with radical nephrectomy and one in 100 patients managed with partial nephrectomy developed ESKD within 3 years of surgery.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_09_28_CJASNPodcast_18_1_.mp3
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Bailey, Martin A., Andrew J. Toner, and Tomas B. Corcoran. "A survey of perioperative intravenous lidocaine use by anaesthetists in Australia and New Zealand." Anaesthesia and Intensive Care 48, no. 1 (January 2020): 53–58. http://dx.doi.org/10.1177/0310057x19889367.
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Perioperative intravenous lidocaine administration by anaesthetists is purported to confer a variety of benefits across a range of surgical procedures. It remains unclear whether the available evidence regarding efficacy and safety is sufficient to influence Australasian practice broadly, and whether significant barriers to uptake exist. We therefore conducted a survey of Fellows of the Australian and New Zealand College of Anaesthetists to evaluate patterns of lidocaine use, and perceptions relating to benefit and safety. Of 979 survey invitations, 295 (30.1%) responded. Of these, 51.9% of anaesthetists incorporate lidocaine administration into their practice. Amongst users, the most common indication is open abdominal or pelvic surgery (88.9%), with the principal intent of reducing acute pain and opioid use (both 92.2%). Only 51% perceive lidocaine to have a role in the prevention of chronic post-surgical pain, and less than a third administer it for operations strongly linked to this condition. Nearly all (91%) users deliver the drug by intraoperative bolus and infusion, with the majority using doses between 1.0 and 1.5 mg/kg for both the bolus and the hourly infusion rate. When parallel local anaesthetic techniques are employed, 44.4% restrict the dose, 37.3% turn the lidocaine infusion off first and 15.7% make no modifications. Most respondents terminate infusions by the end of surgery (52.3%) or in the post-anaesthesia care unit (26.8%). Few deliver postoperative infusions without electrocardiographic monitoring (5.9%). There were no reports of life-threatening events. The dichotomy in Australasian use of perioperative lidocaine revealed by this survey confirms that large multicentre trials are now required to guide practice accurately.
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McGain, Forbes, Jason R. Bishop, Laura M. Elliot-Jones, David A. Story, and Georgina LL Imberger. "A survey of the choice of general anaesthetic agents in Australia and New Zealand." Anaesthesia and Intensive Care 47, no. 3 (May 2019): 235–41. http://dx.doi.org/10.1177/0310057x19836104.
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Strategies to reduce the adverse environmental costs of anaesthesia include choice of agent and fresh gas flows. The current preferences of Australian and New Zealand anaesthetists are unknown. We conducted a survey of Australian and New Zealand anaesthetists to determine the use of volatiles, nitrous oxide and intravenous anaesthesia, lowest fresh gas flow rates, automated end-tidal volatile control, and the rationales for these choices. The survey was answered by 359/1000 (36%), although not all questions and multiple responses within single questions were answered by all respondents. Sevoflurane was preferred by 246/342 (72%, 95% confidence interval (CI) 67%–77%), followed by propofol, 54/340 (16%, 95% CI 12%–20%), desflurane 39/339 (12%, 95% CI 8%–16%) and isoflurane 3/338(1%, 95% CI 0–3%). When asked about all anaesthetics, low-risk clinical profile was the most common reason given for using sevoflurane (129/301 (43%, 95% CI 37%–49%)), reduced postoperative nausea for propofol (297/318 (93%, 95% CI 90%–96%)) and faster induction/awakening times for desflurane (46/313 (79%, 95% CI 74%–83%)). Two-thirds (226/340 (66%, 95% CI 61%–71%)) of respondents used nitrous oxide in 0–20% of general anaesthetics. Low fresh gas flow rates for sevoflurane were used by 310/333 (93%, 95% CI 90%–95%) and for 262/268 (98%, 95% CI 95%–99%) for desflurane. Automated end-tidal control was used by 196/333 (59%, 95% CI 53%–64%). The majority of respondents (>70%) preferred sevoflurane at low flows. These data allow anaesthetists to consider further whether changes are required to the choices of anaesthetic agents for environmental, financial, or any other reasons.
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Kenyon-Smith, Timothy, Eric Nguyen, Tarandeep Oberai, and Ruurd Jarsma. "Early Mobilization Post–Hip Fracture Surgery." Geriatric Orthopaedic Surgery & Rehabilitation 10 (January 1, 2019): 215145931982643. http://dx.doi.org/10.1177/2151459319826431.
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Introduction: Early mobilization after hip fracture surgery is a widely practiced component of postoperative care. However, there is little evidence to suggest that early mobilization post–hip fracture surgery is beneficial in reducing postoperative complications. This study aims to investigate the effect of early mobilization following hip fracture surgery on postoperative complications. Materials and Methods: This study retrospectively included 240 patients (female = 165, male = 75, mean age: 82.2 years) admitted to a level 1 trauma center in Adelaide, Australia, for hip fracture surgery. The effect of early mobilization on postoperative complications was assessed along with premorbid status. Subgroup analysis of patients stratified by premorbid health was subsequently analyzed to reduce confounding. Results: The odds of developing a complication were 1.9 times higher if the patient remained bedbound compared to mobilizing. Early mobilization was favorable to delayed mobilization. On average, complication-free patients mobilized earlier (mean [M] = 29 hours) compared to patients who experienced complications (M = 38 hours). In particular, rates of delirium was significantly reduced in patients who mobilized compared to remaining bedbound. However, premorbid status varied greatly. Early mobilizers had significantly better premorbid health than patients who remained bedbound. Overall subgroup analysis of patients with similar premorbid health showed mobilization was not associated with a reduction in complications. With an exception of patients with poor premorbid health, who experienced a reduction in complications following early mobilization. Discussion: In general, early mobilization was associated with the same complication rates as delayed mobilization and remaining bedbound. Patients with poor premorbid health benefited most from early mobilization with reduced complication rates. Conclusion: Postoperative delirium and premorbid health were better indicators of postoperative outcomes than time to mobilization.
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Johnston, Amy, Nicola Creighton, Jonathon Parkinson, Eng-Siew Koh, Helen Wheeler, Elizabeth Hovey, Michael Rodriguez, and David C. Currow. "Ongoing improvements in postoperative survival of glioblastoma in the temozolomide era: a population-based data linkage study." Neuro-Oncology Practice 7, no. 1 (July 6, 2019): 22–30. http://dx.doi.org/10.1093/nop/npz021.
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Abstract Background Translating outcomes achieved by clinical trials into routine care is crucial to improving outcomes of glioblastoma (GBM). This study examines the extent to which an advance in treatment for GBM has translated into meaningful, population-level survival benefits in New South Wales (NSW), Australia. Methods This retrospective cohort study used linked population-based cancer registry, admitted patient, and mortality datasets. The cohort (n = 2604) included NSW residents aged ≥18 years with a histologically confirmed GBM and a surgical resection between July 2001 and December 2012. The study outcome was all-cause survival, examined using multivariable proportional hazard models. The main study factor was period of surgery, categorized into 4 periods corresponding to different eras in temozolomide (TMZ) use. Survival was examined over time by age (≤70 and >70 years) and for a subcohort selected to approximate the seminal European Organisation for Research and Treatment of Cancer (Stupp) protocol trial cohort. TMZ use was estimated using aggregate prescription claims data. Results Median survival in 2001-2003, 2004-2006, 2007-2009, and 2010-2012 was 7.4, 9.0, 9.8, and 10.6 months, and risk-adjusted 2-year survival was 8.2%, 13.8%, 15.5%, and 18.3%, respectively. Survival improved for those aged ≤70 years and those aged >70 years. In the proxy trial subcohort, median and 2-year survival were 14.3 months and 27.3%, respectively. The volume of TMZ prescribed annually increased rapidly from 2005. Conclusions Introduction of TMZ into standard care in 2005 coincided with improvements in survival and a rapid increase in TMZ prescribing. Optimization of care has continued to improve survival of people with GBM in subsequent years.
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Sandy-Hodgetts, Kylie, Richard Parsons, Richard Norman, Mark W. Fear, Fiona M. Wood, and Scott W. White. "Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial—the CYGNUS protocol." BMJ Open 10, no. 10 (October 2020): e035727. http://dx.doi.org/10.1136/bmjopen-2019-035727.
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IntroductionCaesarean delivery is steadily becoming one of the more common surgical procedures in Australia with over 100 000 caesarean sections performed each year. Over the last 10 years in Australia, the caesarean section rate has increased from 28% in 2003 to 33% in 2013. On the international stage, the Australian caesarean delivery rates are higher than the average for the Organisation for Economic Co-operation and Development, Australia ranked as 8 out of 33 and is second to the USA. Postoperative surgical site infections (SSIs) and wound complications are the most common and costly event following a caesarean section. Globally, complication rates following a caesarean delivery vary from 4.9% to 9.8%. Complications such as infection and wound breakdown affect the postpartum mother’s health and well-being, and contribute to healthcare costs for clinical management that often spans the acute, community and primary healthcare settings. Published level one studies using advanced wound dressings in the identified ‘at-risk’ population prior to surgery for prophylactic intervention are yet to be forthcoming.Methods and analysisA parallel group randomised control trial of 448 patients will be conducted across two metropolitan hospitals in Perth, Western Australia, which provide obstetric and midwifery services. We will recruit pregnant women in the last trimester, prior to their admission into the healthcare facility for delivery of their child. We will use a computer-generated block sequence to randomise the 448 participants to either the interventional (negative pressure wound therapy (NPWT) dressing, n=224) or comparator arm (non-NPWT dressing, n=224). The primary outcome measure is the occurrence of surgical wound dehiscence (SSWD) or SSI. The Centres for Disease Control reporting definition of either superficial or deep infection at 30 days will be used as the outcome measure definition. SWD will be classified as per the World Union of Wound Healing Societies grading system (grade I–IV). We will assess recruitment rate, and adherence to intervention and follow-up. We will assess the potential effectiveness of NPWT in the prevention of postpartum surgical wound complications at three time points during the study; postoperative days 5, 14 and 30, after which the participant will be closed out of the trial. We will use statistical methods to determine efficacy, and risk stratification will be conducted to determine the SWD risk profile of the participant. Follow-up at day 30 will assess superficial and deep infection, and wound dehiscence (grade I–IV) and the core outcome data set for wound complications. This study will collect health-related quality of life (European Quality of Life 5-Dimensions 5-Level Scale), mortality and late complications such as further surgery with a cost analysis conducted. The primary analysis will be by intention-to-treat. This clinical trial protocol follows the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) and the Consolidated Standards of Reporting Trials guidelines.Ethics and disseminationEthics approval was obtained through St John of God Health Care (HREC1409), Western Australia Department of Health King Edward Memorial Hospital (HREC3111). Study findings will be published in peer-reviewed journals and presented at international conferences. We used the SPIRIT checklist when writing our study protocol.Trial registration numberAustralian and New Zealand Clinical Trials Registry (ACTRN12618002006224p).
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Pirie, Katrina, Paul S. Myles, and Bernhard Riedel. "A survey of neuraxial analgesic preferences in open and laparoscopic major abdominal surgery amongst anaesthetists in Australia and New Zealand." Anaesthesia and Intensive Care 48, no. 4 (July 2020): 314–17. http://dx.doi.org/10.1177/0310057x20937315.
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Practising anaesthetists who are Fellows of the Australian and New Zealand College of Anaesthetists were surveyed with the objective of gaining insight into current analgesic preferences, with particular regard to neuraxial techniques, when managing patients having major open and laparoscopic abdominal surgery. Major abdominal surgery is common and effective analgesia is fundamental to optimal postoperative recovery. A multitude of analgesic options exist, with epidurals recommended in recent Enhanced Recovery After Surgery protocols. We believe the place of epidurals is increasingly questioned in the setting of continuous improvement in surgical technique, with increasing laparoscopic and robotic-assisted surgery. Evidence for various techniques is mixed and benefit-risk profiles exist for all alternatives. An opioid epidemic and abuse crisis has directed attention towards opioid minimisation strategies. The survey was completed by 28% (275) of the 975 Fellows who received it, with good representation across the Australian and New Zealand College of Anaesthetists’ general membership. Respondents manage laparoscopic major abdominal surgery more frequently than open procedures, with approximately one-third of respondents each providing anaesthesia for two open laparotomies versus four to eight laparoscopic cases per month. Respondents reported a high perceived benefit of neuraxial analgesia, which was discordant with their clinical practice. Less than half of the respondents used epidural or spinal analgesia in open surgery (48% versus 49% of respondents, respectively). A minority (16%) of respondents use a neuraxial technique in major laparoscopic surgery, with a strong preference for intrathecal morphine (74%) when they choose to do so. Further investigation of the role of intrathecal analgesia is warranted given the shift towards laparoscopic major abdominal surgery, the perceived benefits of neuraxial techniques and the need for opioid-sparing analgesic strategies.
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Wood, Timothy, Mark Chatfield, Leonard Gray, Nancye Peel, Shannon Freeman, and Melinda Martin-Khan. "Examining the adaptability and validity of interRAI acute care quality indicators in a surgical context." SAGE Open Medicine 10 (January 2022): 205031212211032. http://dx.doi.org/10.1177/20503121221103221.
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Background: Currently, the use of quality indicators in the surgical setting may be challenged by diverse patient needs, clinical complexity, and health trajectories. Therefore, the objective of this study was to examine the adaptability of existing quality indicators to a surgical context and propose new time points. Methods: A multi-method approach included an environmental scan of the literature, consultation with multinational experts, and analysis of surgical patient data. Quality indicators from the nurse-administered interRAI Acute Care instrument were examined within a surgical context using secondary data from a hospital in Brisbane, Australia (N = 1006 surgical cases). Results: A lack of relevancy of existing time points can preclude meaningful quality indicator measurement. Definitions of some quality indicators were adapted to ensure relevancy for the surgical population. As well, a surgical baseline (measured preoperative and post-injury) and a 48-h postoperative time point were added to the existing measurement timeline. Conclusion: Distinct measurement timelines were created for elective and non-elective surgical patients. The use of surgery-specific time points that can be embedded into an existing Acute Care measurement framework supports consistent quality indicator reporting. This study represents the first steps towards standardized quality reporting for health information systems across different care settings.
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Young, Jane M., Phyllis N. Butow, Jennifer Walsh, Ivana Durcinoska, Timothy A. Dobbins, Laura Rodwell, James D. Harrison, et al. "Multicenter Randomized Trial of Centralized Nurse-Led Telephone-Based Care Coordination to Improve Outcomes After Surgical Resection for Colorectal Cancer: The CONNECT Intervention." Journal of Clinical Oncology 31, no. 28 (October 1, 2013): 3585–91. http://dx.doi.org/10.1200/jco.2012.48.1036.
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Purpose To investigate the effectiveness of a centralized, nurse-delivered telephone-based service to improve care coordination and patient-reported outcomes after surgery for colorectal cancer. Patients and Methods Patients with a newly diagnosed colorectal cancer were randomly assigned to the CONNECT intervention or usual care. Intervention-group patients received standardized calls from the centrally based nurse 3 and 10 days and 1, 3, and 6 months after discharge from hospital. Unmet supportive care needs, experience of care coordination, unplanned readmissions, emergency department presentations, distress, and quality of life (QOL) were assessed by questionnaire at 1, 3, and 6 months. Results Of 775 patients treated at 23 public and private hospitals in Australia, 387 were randomly assigned to the intervention group and 369 to the control group. There were no significant differences between groups in unmet supportive care needs, but these were consistently low in both groups at both follow-up time points. There were no differences between the groups in emergency department presentations (10.8% v 13.8%; P = .2) or unplanned hospital readmissions (8.6% v 10.5%; P = .4) at 1 month. By 6 months, 25.6% of intervention-group patients had reported an unplanned readmission compared with 27.9% of controls (P = .5). There were no significant differences in experience of care coordination, distress, or QOL between groups at any follow-up time point. Conclusion This trial failed to demonstrate substantial benefit of a centralized system to provide standardized, telephone follow-up for postoperative patients with colorectal cancer. Future interventions could investigate a more tailored approach.
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Rosenfeld, Hannah E., Rebecca Limb, Patrick Chan, Mark Fitzgerald, William Pierre Litherland Bradley, and Jeffrey V. Rosenfeld. "Challenges in the surgical management of spine trauma in the morbidly obese patient: a case series." Journal of Neurosurgery: Spine 19, no. 1 (July 2013): 101–9. http://dx.doi.org/10.3171/2013.4.spine12876.
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Object The treatment of morbidly obese individuals with spine trauma presents unique challenges to spine surgeons and trauma staff. This study aims to increase awareness of current limitations in the surgical management of spine trauma in morbidly obese individuals, and to illustrate practical solutions. Methods Six morbidly obese patients were treated surgically for spine trauma over a 2-year period at a single trauma center in Australia. All patients were involved in high-speed motor vehicle accidents and had multisystem injuries. All weighed in excess of 265 pounds (120 kg) with a body mass index ≥ 40 (range 47.8–67.1). Cases were selected according to the considerable challenges they presented in all aspects of their management. Results Best medical and surgical care may be compromised and outcome adversely affected in morbidly obese patients with spine trauma. The time taken to perform all aspects of care is usually extended, often by many hours. Customized orthotics may be required. Imaging quality is often compromised and patients may not fit into scanners. Surgical challenges include patient positioning, surgical access, confirmation of the anatomical level, and obtaining adequate instrument length. Postoperative nursing care, wound healing, and venous thromboembolism prophylaxis are also significant issues. Conclusions Management pathways and hospital guidelines should be developed to optimize the treatment of morbidly obese patients, but innovative solutions may be required for individual cases.
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McGuinness, Shay P., Rachael L. Parke, Kate Drummond, Tim Willcox, and Michael Bailey. "A Multicenter, Randomized, Controlled Phase IIb Trial of Avoidance of Hyperoxemia during Cardiopulmonary Bypass." Anesthesiology 125, no. 3 (September 1, 2016): 465–73. http://dx.doi.org/10.1097/aln.0000000000001226.
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Abstract Background Cardiac surgery utilizing cardiopulmonary bypass (CPB) is one of the most common forms of major surgery. Cardiac surgery–associated multiorgan dysfunction (CSA-MOD) is well recognized and includes acute kidney injury (AKI), hepatic impairment, myocardial damage, and postoperative neurologic deficit. Pathophysiology of CSA-MOD involves numerous injurious pathways linked to the use of CPB including oxidative stress and formation of reactive iron species. During cardiac surgery with CPB, arterial return blood is oxygenated to supranormal levels. This study aimed to determine whether the avoidance of arterial hyperoxemia decreased oxidative stress and reduced the severity of the multiorgan dysfunction in patients undergoing cardiac surgery utilizing CPB. Methods The study was a multicenter, open-label, parallel-group, randomized controlled study of the avoidance of arterial hyperoxemia versus usual care in patients undergoing cardiac surgery involving CPB. Primary outcome was the incidence and severity of AKI. Secondary outcomes included serum biomarkers for CSA-MOD, duration of mechanical ventilation, and length of intensive care and hospital stay. Results A total of 298 patients were randomized and analyzed at two hospitals in New Zealand and Australia. Mean Pao2 was significantly different between groups during CPB. There was no difference in the development of AKI (intervention arm 72.0% vs. usual care 66.2%; difference, −5.8% [95% CI, −16.1 to 4.7%]; P = 0.28), other markers of organ damage, or intensive care unit and hospital length of stay. Conclusions Avoiding modest hyperoxemia during CPB failed to demonstrate any difference in AKI, markers of organ damage, or length of stay.
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Davies, M. J. "Perioperative Epidural Anaesthesia and Analgesia—An Appraisal of Its Role." Anaesthesia and Intensive Care 35, no. 4 (August 2007): 593–600. http://dx.doi.org/10.1177/0310057x0703500421.
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Perioperative epidural anaesthesia and analgesia (PEA) has become controversial because of its doubtful effect on patient outcome and its serious complications. These scientific considerations have been affected by the changing medicolegal climate in Australia and has led to a reappraisal of this technique in our practice of anaesthesia. Many anaesthetists are now uncertain about indications, consent requirements, optimal management and the prevention and early detection of complications of PEA. The aim of this paper is to present a personal perspective of the place and use of PEA in current anaesthetic practise. The primary indication for PEA should be pain relief for open abdominal or thoracic surgery because there is level 1 evidence that it provides better analgesia than parenteral opioids. There is reasonable evidence that outcome is improved but the studies are conflicting. Coagulation status needs to be assessed carefully before the insertion and removal of epidural catheters. Consent issues are difficult in practice, both from the timing and the content of the information. The decrease in the use of PEA may paradoxically result in more complications as loss of expertise becomes an issue. PEA is labour intensive and therefore needs the support of an Acute Pain Service in order to use this technique safely and recognise problems early. Permanent neurological complications are the most feared complication of this technique but early recognition of these problems can improve outcome. These complications need to be balanced against the potentially serious hypoxaemia associated with parenteral opioids used for postoperative pain relief.
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Boord, Monique S., Daniel H. J. Davis, Peter J. Psaltis, Scott W. Coussens, Daniel Feuerriegel, Marta I. Garrido, Alice Bourke, and Hannah A. D. Keage. "DelIrium VULnerability in GEriatrics (DIVULGE) study: a protocol for a prospective observational study of electroencephalogram associations with incident postoperative delirium." BMJ Neurology Open 3, no. 2 (December 2021): e000199. http://dx.doi.org/10.1136/bmjno-2021-000199.
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IntroductionDelirium is a neurocognitive disorder common in older adults in acute care settings. Those who develop delirium are at an increased risk of dementia, cognitive decline and death. Electroencephalography (EEG) during delirium in older adults is characterised by slowing and reduced functional connectivity, but markers of vulnerability are poorly described. We aim to identify EEG spectral power and event-related potential (ERP) markers of incident delirium in older adults to understand neural mechanisms of delirium vulnerability. Characterising delirium vulnerability will provide substantial theoretical advances and outcomes have the potential to be translated into delirium risk assessment tools.Methods and analysisWe will record EEG in 90 participants over 65 years of age prior to elective coronary artery bypass grafting (CABG) or transcatheter aortic valve implantation (TAVI). We will record 4-minutes of resting state (eyes open and eyes closed) and a 5-minute frequency auditory oddball paradigm. Outcome measures will include frequency band power, 1/f offset and slope, and ERP amplitude measures. Participants will undergo cognitive and EEG testing before their elective procedures and daily postoperative delirium assessments. Group allocation will be done retrospectively by linking preoperative EEG data according to postoperative delirium status (presence, severity, duration and subtype).Ethics and disseminationThis study is approved by the Human Research Ethics Committee of the Royal Adelaide Hospital, Central Adelaide Local Health Network and the University of South Australia Human Ethics Committee. Findings will be disseminated through peer-reviewed journal articles and presentations at national and international conferences.Trial registration numberACTRN12618001114235 and ACTRN12618000799257.
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Truong, Anthony P., Daniel Pérez-Prieto, Joshua Byrnes, Joan C. Monllau, and Christopher J. Vertullo. "Vancomycin Soaking Is Highly Cost-Effective in Primary ACLR Infection Prevention: A Cost-Effectiveness Study." American Journal of Sports Medicine 50, no. 4 (February 18, 2022): 922–31. http://dx.doi.org/10.1177/03635465211073338.
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Background: Although presoaking grafts in vancomycin has been demonstrated to be effective in observational studies for anterior cruciate ligament reconstruction (ACLR) infection prevention, the economic benefit of the technique is uncertain. Purpose: To 1) determine the cost-effectiveness of vancomycin presoaking during primary ACLR to prevent postoperative joint infections and 2) to establish the break-even cost-effectiveness threshold of the technique and determine its cost-effectiveness across various international health care settings. Study Design: Economic and decision analysis; Level of evidence, 2. Methods: A Markov model was used to determine cost-effectiveness and the incremental cost-effectiveness ratio of additional vancomycin presoaking compared with intravenous antibiotic prophylaxis alone. A repeated search of the PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials databases, using the same criteria as a recent meta-analysis, was completed. A repeated meta-analysis of 9 cohort studies (level 3 evidence) was completed to determine the odds ratio of infection with vancomycin presoaking compared with intravenous antibiotics alone. Estimated costs of the vancomycin technique, treatment of infection, and further surgery were sourced from local hospitals and literature. Transitional probabilities for further surgery, including revision reconstruction and primary arthroplasty, were obtained from the literature. Probabilistic sensitivity analyses and a 1-way sensitivity analysis were performed to evaluate the ACLR infection rate break-even threshold for which the vancomycin technique would be no longer cost-effective. Results: The vancomycin soaking technique provides expected cost savings of $660 (USA), A$581 (Australia), and €226 (Spain) per patient. There was an improvement in the quality-adjusted life-years of 0.007 compared with intravenous antibiotic prophylaxis alone (4.297 vs 4.290). If the infection rate is below 0.014% with intravenous antibiotics alone, the vancomycin wrap would no longer be cost-effective. Conclusion: The vancomycin presoaking technique is a highly cost-effective method to prevent postoperative septic arthritis after primary ACLR.
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Reade, Michael C., Denese C. Marks, Belinda Howe, Shay McGuinness, Rachael Parke, Leanlove Navarra, Richard Charlewood, Lacey Johnson, and Zoe McQuilten. "Cryopreserved platelets compared with liquid-stored platelets for the treatment of surgical bleeding: protocol for two multicentre randomised controlled blinded non-inferiority trials (the CLIP-II and CLIPNZ-II trials)." BMJ Open 12, no. 12 (December 2022): e068933. http://dx.doi.org/10.1136/bmjopen-2022-068933.
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IntroductionCryopreservation at −80°C in dimethylsulphoxide extends platelet shelf-life from 7 days to 2 years. Only limited comparative trial data supports the safety and effectiveness of cryopreserved platelets as a treatment for surgical bleeding. Cryopreserved platelets are not currently registered for civilian use in most countries.Methods and analysisCLIP-II and CLIPNZ-II are harmonised, blinded, multicentre, randomised, controlled clinical non-inferiority trials comparing bleeding, transfusion, safety and cost outcomes associated with cryopreserved platelets versus conventional liquid platelets as treatment for bleeding in cardiac surgery. CLIP-II is planning to enrol patients in 12 tertiary hospitals in Australia; CLIPNZ-II will recruit in five tertiary hospitals in New Zealand. The trials use near-identical protocols aside from details of cryopreserved platelet preparation. Patients identified preoperatively as being at high risk of requiring a platelet transfusion receive up to three units of study platelets if their treating doctor considers platelet transfusion is indicated. The primary endpoint is blood loss through the surgical drains in the 24 hours following intensive care unit (ICU) admission after surgery. Other endpoints are blood loss at other time points, potential complications, adverse reactions, transfusion and fluid requirement, requirement for procoagulant treatments, time to commencement of postoperative anticoagulants, delay between platelet order and commencement of infusion, need for reoperation, laboratory and point-of-care clotting indices, cost, length of mechanical ventilation, ICU and hospital stay, and mortality. Transfusing 202 (CLIP-II) or 228 (CLIPNZ-II) patients with study platelets will provide 90% power to exclude the possibility of greater than 20% inferiority in the primary endpoint. If cryopreserved platelets are not inferior to liquid-stored platelets, the advantages of longer shelf-life would justify rapid change in clinical practice. Cost-effectiveness analyses will be incorporated into each study such that, should clinical non-inferiority compared with standard care be demonstrated, the hospitals in each country that would benefit most from changing to a cryopreserved platelet blood bank will be known.Ethics and disseminationCLIP-II was approved by the Austin Health Human Research Ethics Committee (HREC/54406/Austin-2019) and by the Australian Red Cross Lifeblood Ethics Committee (2019#23). CLIPNZ-II was approved by the New Zealand Southern Health and Disability Ethics Committee (21/STH/66). Eligible patients are approached for informed consent at least 1 day prior to surgery. There is no provision for consent provided by a substitute decision-maker. The results of the two trials will be submitted separately for publication in peer-reviewed journals.Trial registration numbersNCT03991481and ACTRN12621000271808.
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Erdol, Sebnem, Kwok Ho, Rhodri Saunders, Rafael Torres, and Audrey Ozols. "PD01 IPC For Prevention Of VTE: An Economic Analysis." International Journal of Technology Assessment in Health Care 34, S1 (2018): 133. http://dx.doi.org/10.1017/s026646231800291x.
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Introduction:Total hip and knee arthroplasty (THKA) patients are at risk of venous thromboembolism (VTE). Guidelines recommend 10–35 days of pharmacoprophylaxis, but this may induce bleeding resulting in increased healthcare costs. This study assessed whether using intermittent pneumatic compression (IPC) for VTE prophylaxis is associated with reduced healthcare costs compared to anticoagulants.Methods:Studies related to VTE and prophylaxis in THKA were identified by a structured search of the PubMed database. VTE incidence and cost data were Australia specific or, if not available, taken from other developed healthcare systems. A Markov model was used to estimate the incidence of deep vein thrombosis (DVT), pulmonary embolism (PE), death, post-thrombotic syndrome, as well as minor and major bleeding and heparin-induced-thrombocytopenia, to assess the budget impact of different VTE prophylaxis strategies. The time horizon was one year, low-molecular-weight-heparin (LMWH) was used as the reference intervention, and effectiveness data were obtained from meta-analyses.Results:A total of 102,459 THKA were performed in Australia in 2015. The twelve-day incidence of DVT and PE using LMWH prophylaxis were 4.48 percent and 0.25 percent, respectively, with minor and major bleeding occurred in 9.9 percent (within twelve days) and 1.9 percent (within 10 days) of the patients, respectively. The incidence of VTE was not different between LMWH and IPC after THKA. The model estimated that the total cost of post-operative care for THKA was AUD 101.7 million (USD 77 million) in 2015. A one percent-point change from LMWH to IPC prophylaxis (n=1025 patients) would reduce the total healthcare costs by AUD 317,361 (USD 240,274) per year (or AUD 310 (USD 235) per patient), primarily through reduced bleeding events (-72 minor and -3 major bleeds). Sensitivity analysis including 500 simulations demonstrated a likelihood of 100 percent for IPC to reduce both costs and bleeding events compared to LMWH. Similarly, a one percent-point change from dabigatran and rivaroxaban to IPC also resulted in total healthcare savings of AUD 320,580 (USD 242,711) and AUD 702,584 (USD 531,926) per year, respectively, with two-thirds and ninety-nine percent of the simulations favored IPC over dabigatran for bleeding and cost savings, respectively.Conclusions:Using IPC for VTE prophylaxis after THKA has the potential to substantially reduce total healthcare costs compared to anticoagulants, primarily through reduced bleeding events. IPC is suitable for all patients, but may be particularly cost-effective in the immediate postoperative period or in patients at high-risk of bleeding.
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Tan, Michelle M. C., Xingzhong Jin, Craig Taylor, Adrian K. Low, Philip Le Page, David Martin, Ang Li, David Joseph, and Nic Kormas. "Long-Term Trajectories in Weight and Health Outcomes Following Multidisciplinary Publicly Funded Bariatric Surgery in Patients with Clinically Severe Obesity (≥ 3 Associated Comorbidities): A Nine-Year Prospective Cohort Study in Australia." Journal of Clinical Medicine 11, no. 15 (July 31, 2022): 4466. http://dx.doi.org/10.3390/jcm11154466.
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Background: Real-world data on long-term (> 5 years) weight loss and obesity-related complications after newer bariatric surgical procedures are currently limited. The aim of this longitudinal study was to examine the effectiveness and sustainability of bariatric surgery in a cohort with clinically severe obesity in a multidisciplinary publicly funded service in two teaching hospitals in New South Wales, Australia. Methods: Patients were adults with complex clinically severe obesity with a BMI ≥ 35 kg/m2 and at least three significant obesity-related comorbidities, who underwent bariatric surgeries between 2009 and 2017. Detailed obesity-related health outcomes were reported from annual clinical data and assessments for up to 9 years of follow-up. Data were also linked with the national joint replacement registry. Results: A total of 65 eligible patients were included (mean, 7; range, 3–12 significant obesity-related comorbidities); 53.8% female; age 54.2 ± 11.2 years, with baseline BMI 52.2 ± 12.5 kg/m2 and weight 149.2 ± 45.5 kg. Most underwent laparoscopic sleeve gastrectomy (80.0%), followed by laparoscopic adjustable gastric banding (10.8%) and one anastomosis gastric bypass (9.2%). Substantial weight loss was maintained over 9 years of follow-up (p < 0.001 versus baseline). Significant total weight loss (%TWL ± SE) was observed (13.2 ± 2.3%) following an initial 1-year preoperative intensive lifestyle intervention, and ranged from 26.5 ± 2.3% to 33.0 ± 2.0% between 1 and 8 years following surgery. Type 2 diabetes mellitus (T2DM), osteoarthritis-related joint pain and depression/severe anxiety were the most common metabolic, mechanical and mental health comorbidities, with a baseline prevalence of 81.5%, 75.4% and 55.4%, respectively. Clinically significant composite cumulative rates of remission and improvement occurred in T2DM (50.0–82.0%) and hypertension (73.7–82.9%) across 6 years. Dependence on continuous positive airway pressure treatment in patients with sleep-disordered breathing fell significantly from 63.1% to 41.2% in 6 years. Conclusion: Bariatric surgery using an intensive multidisciplinary approach led to significant long-term weight loss and improvement in obesity-related comorbidities among the population with clinically complex obesity. These findings have important implications in clinical care for the management of the highest severity of obesity and its medical consequences. Major challenges associated with successful outcomes of bariatric surgery in highly complex patients include improving mental health in the long run and reducing postoperative opioid use. Long-term follow-up with a higher volume of patients is needed in publicly funded bariatric surgery services to better monitor patient outcomes, enhance clinical data comparison between services, and improve multidisciplinary care delivery.
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Webster, Kate E., Haydn J. Klemm, Brian M. Devitt, Timothy S. Whitehead, and Julian A. Feller. "Effect of COVID-19 Social Isolation Policies on Rehabilitation After Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 9, no. 10 (October 1, 2021): 232596712110472. http://dx.doi.org/10.1177/23259671211047216.
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Background: The coronavirus 2019 (COVID-19) pandemic has had a profound impact on health care in Australia. To contain the spread of the virus, strict physical distancing and social isolation policies were implemented from late March 2020. This presented a situation in which patients recovering from anterior cruciate ligament (ACL) reconstruction had limited access to face-to-face supervised rehabilitation and rehabilitation facilities. Purpose: To explore the impact of social distancing and isolation policies on postoperative rehabilitation in patients after ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who had ACL reconstruction from October 2019 until the end of March 2020 (6 months before the implementation of COVID-19 restrictions) completed an online self-report questionnaire containing 5 sections: utilization of health care professionals for rehabilitation, frequency of rehabilitation, patient concerns and attitude, perceived impact on recovery, and changes to employment status. We compared the responses of patients who had surgery in 2019 with those who had surgery in 2020. Statistical analysis was performed using frequency statistics and central tendency measures. Results: A total of 185 patients (97 men, 88 women) completed the survey, for a 73% response rate. Patients had a mean age of 28 years (range, 13-57 years) and had undergone surgery a mean 4.5 months prior (range, 1.5-8 months). Most patients (80%) maintained face-to-face rehabilitation, predominantly with a physical therapist, regardless of whether their surgery took place in 2019 or 2020; rehabilitation with active, supervised exercises was most common. Almost all patients were performing strengthening exercises (164/185), and most were performing range-of-motion (139/185) and aerobic (123/185) activities at their homes. Patients were minimally concerned about access to supervised rehabilitation and knee reinjury, but they were concerned about access to equipment. Because of COVID-19, 30% were working from home; 17% were on reduced hours and 8% on increased hours; 15% were on leave or unemployed; and 30% reported no change in employment status. Conclusion: Patients who had undergone ACL reconstruction just before or during the first few months of the COVID-19 pandemic were able to maintain in-person contact with their health professionals during rehabilitation, and they had a positive outlook and managed well despite the restrictions.
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Webster, Kate E., Haydn J. Klemm, Brian M. Devitt, Timothy S. Whitehead, and Julian A. Feller. "Effect of COVID-19 Social Isolation Policies on Rehabilitation After Anterior Cruciate Ligament Reconstruction." Orthopaedic Journal of Sports Medicine 9, no. 10 (October 1, 2021): 232596712110472. http://dx.doi.org/10.1177/23259671211047216.
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Background: The coronavirus 2019 (COVID-19) pandemic has had a profound impact on health care in Australia. To contain the spread of the virus, strict physical distancing and social isolation policies were implemented from late March 2020. This presented a situation in which patients recovering from anterior cruciate ligament (ACL) reconstruction had limited access to face-to-face supervised rehabilitation and rehabilitation facilities. Purpose: To explore the impact of social distancing and isolation policies on postoperative rehabilitation in patients after ACL reconstruction. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Patients who had ACL reconstruction from October 2019 until the end of March 2020 (6 months before the implementation of COVID-19 restrictions) completed an online self-report questionnaire containing 5 sections: utilization of health care professionals for rehabilitation, frequency of rehabilitation, patient concerns and attitude, perceived impact on recovery, and changes to employment status. We compared the responses of patients who had surgery in 2019 with those who had surgery in 2020. Statistical analysis was performed using frequency statistics and central tendency measures. Results: A total of 185 patients (97 men, 88 women) completed the survey, for a 73% response rate. Patients had a mean age of 28 years (range, 13-57 years) and had undergone surgery a mean 4.5 months prior (range, 1.5-8 months). Most patients (80%) maintained face-to-face rehabilitation, predominantly with a physical therapist, regardless of whether their surgery took place in 2019 or 2020; rehabilitation with active, supervised exercises was most common. Almost all patients were performing strengthening exercises (164/185), and most were performing range-of-motion (139/185) and aerobic (123/185) activities at their homes. Patients were minimally concerned about access to supervised rehabilitation and knee reinjury, but they were concerned about access to equipment. Because of COVID-19, 30% were working from home; 17% were on reduced hours and 8% on increased hours; 15% were on leave or unemployed; and 30% reported no change in employment status. Conclusion: Patients who had undergone ACL reconstruction just before or during the first few months of the COVID-19 pandemic were able to maintain in-person contact with their health professionals during rehabilitation, and they had a positive outlook and managed well despite the restrictions.
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Leong, Trevor, Mark Smithers, Michael Michael, Val Gebski, Alex Boussioutas, Danielle Miller, John Raymond Zalcberg, Rebecca Wong, and Karin Haustermans. "TOPGEAR: An international randomized phase III trial of preoperative chemoradiotherapy versus preoperative chemotherapy for resectable gastric cancer (AGITG/TROG/EORTC/NCIC CTG)." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): TPS4141. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.tps4141.
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TPS4141 Background: Optimal management of patients with resectable gastric cancer remains unknown. Since the INT0116 and MAGIC trials, there are 2 standards of care for adjuvant therapy: postoperative chemoradiotherapy (CRT) and perioperative ECF chemotherapy. The important question arising from these studies is whether CRT is superior to chemotherapy alone as adjuvant therapy. This randomized phase II/III trial will compare CRT to chemotherapy alone in the preoperative setting. Methods: Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either preoperative chemotherapy alone (ECFx3 as per MAGIC regimen) or preoperative CRT (ECFx2 followed by 45Gy of radiation with concurrent 5-FU). Following surgery, both groups will receive 3 further cycles of ECF. The trial is being conducted in two Parts; Part I (phase II component) will recruit 120 patients with the aim of demonstrating sufficient efficacy and safety of preoperative CRT, as well as trial feasibility. Part II (phase III component) will recruit a further 632 patients to provide a total of 752. The primary endpoint for Part I is pathological complete response rate, and for Part 2 it is overall survival. The trial includes formal quality of life and biological sub-studies. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of surgical technique. Current status: This study is an international, intergroup trial led by the Australasian Gastro-Intestinal Trials Group (AGITG), in collaboration with the Trans-Tasman Radiation Oncology Group (TROG), European Organisation for Research and Treatment of Cancer (EORTC) and the NCIC Clinical Trials Group. To date, 36 patients have been recruited from 20 sites in Australia and New Zealand; European and Canadian sites will commence recruitment in 2012.
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Mcbride, L. J. "Spinal Anaesthesia—Early Australian Experience." Anaesthesia and Intensive Care 33, no. 1_suppl (June 2005): 39–44. http://dx.doi.org/10.1177/0310057x0503301s06.
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Australia in 1902 was a fledgling colony in its second year of Federation with a population of around 3.7 million. European settlement had been largely confined to the coastal margins of this enormous land mass, although some bold adventurers in search of gold and farmland had struggled their way into the interior. Horsham, situated 300 km northwest of Melbourne in the state of Victoria, was founded in June 1849. By 1902 the town, with a population of around 2500, had grown to boast a hospital, two doctors, a pharmacist and a dentist. It was at the Horsham Hospital on January 7, 1902 that Dr Robert Ritchie performed Australia's first recorded spinal anaesthetic. Ritchie performed a lumbar puncture at the L3–4 level, injected 2 ml of 2% cocaine solution and waited for a total of 20 minutes before realising that the sensation the patient was feeling when he pinched him was pressure, not pain. The 78-year-old man with a gangrenous right leg, prostatic obstruction and congestive cardiac failure was laid supine, and had his right leg amputated through the thigh while being administered brandy and water. Strychnine injections were administered four hourly postoperatively. The adoption of the technique of spinal anaesthesia spread quickly in Australia despite communication difficulties at that time.
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Jastrzab, G., G. Fairbrother, and K. E. Khor. "Management of Postoperative Epidural Analgesia: A Survey of Australian Practice." Anaesthesia and Intensive Care 29, no. 3 (June 2001): 266–72. http://dx.doi.org/10.1177/0310057x0102900308.
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Ledowski, Thomas, Brendan O’Dea, Luke Meyerkort, Mary Hegarty, and Britta S. von Ungern-Sternberg. "Postoperative Residual Neuromuscular Paralysis at an Australian Tertiary Children’s Hospital." Anesthesiology Research and Practice 2015 (2015): 1–4. http://dx.doi.org/10.1155/2015/410248.
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Purpose. Residual neuromuscular blockade (RNMB) is known to be a significant but frequently overlooked complication after the use of neuromuscular blocking agents (NMBA). Aim of this prospective audit was to investigate the incidence and severity of RNMB at our Australian tertiary pediatric center.Methods. All children receiving NMBA during anesthesia were included over a 5-week period at the end of 2011 (Mondays to Fridays; 8 a.m.–6 p.m.). At the end of surgery, directly prior to tracheal extubation, the train-of-four (TOF) ratio was assessed quantitatively. Data related to patient postoperative outcome was collected in the postoperative acute care unit.Results. Data of 64 patients were analyzed. Neostigmine was given in 34 cases and sugammadex in 1 patient. The incidence of RNMB was 28.1% overall (without reversal: 19.4%; after neostigmine: 37.5%; n.s.). Severe RNMB (TOF ratio < 0.7) was found in 6.5% after both no reversal and neostigmine, respectively. Complications in the postoperative acute care unit were infrequent, with no differences between reversal and no reversal groups.Conclusions. In this audit, RNMB was frequently observed, particularly in cases where patients were reversed with neostigmine. These findings underline the well-known problems associated with the use of NMBA that are not fully reversed.
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Abdelkarim, Hussam, Natasha Ciampoli, Lara Zwakman-Hessels, Jai N. Darvall, and Rinaldo Bellomo. "Chewing gum prophylaxis for postoperative nausea and vomiting in the intensive care unit: a pilot randomised controlled trial." Critical Care and Resuscitation 22, no. 4 (December 7, 2020): 321–26. http://dx.doi.org/10.51893/2020.4.oa4.
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Objective: To test the effectiveness of chewing gum in the prophylaxis of postoperative nausea and vomiting (PONV) in patients admitted to the intensive care unit (ICU) after surgery. Design: Prospective, open label, pilot randomised controlled trial. Setting: Two metropolitan ICUs. Participants: Ninety postoperative adult patients admitted to the ICU. Intervention: Patients administered chewing gum, who chewed for at least 15 minutes every 4 hours, were compared with a control group, who were administered a 20 mL sip of water orally every 4 hours. Main outcome measures: The primary outcome was the number of patient-reported episodes of nausea in the first 24 hours after the operation. Secondary outcomes included vomiting or dry retching episodes, and duration and severity of nausea. Results: Forty-six patients were randomly allocated to chewing gum and 44 patients to water. There was no difference between groups in the number of patients with nausea (10 [22%] chewing gum v 12 [27%] control patients; P = 0.72), nausea episodes (22 episodes; [median, 0; IQR, 0–0] v 21 episodes [median, 0; IQR, 0–1] per patient in each group respectively), vomiting/retching (2 [4%] chewing gum v 6 [14%] control patients; P = 0.24), or duration/severity of nausea. Conclusion: Regular postoperative administration of chewing gum in a surgical ICU patient cohort did not reduce nausea, vomiting or retching. The prevalence of PONV is less than previously reported. Our findings can inform future studies of PONV prophylaxis in post-surgical ICU patients. Trial registration: Australian New Zealand Clinical Trial Registry No. ACTRN12617001185358.
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Moonesinghe, S. Ramani, Danny J. N. Wong, Laura Farmer, Richard Shawyer, Paul S. Myles, and Steve K. Harris. "SNAP-2 EPICCS: the second Sprint National Anaesthesia Project—EPIdemiology of Critical Care after Surgery: protocol for an international observational cohort study." BMJ Open 7, no. 9 (September 2017): e017690. http://dx.doi.org/10.1136/bmjopen-2017-017690.
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IntroductionThe admission of high-risk patients to critical care after surgery is a recommended standard of care. Nevertheless, poor compliance against this recommendation has been repeatedly demonstrated in large epidemiological studies. It is unclear whether this is due to reasons of capacity, equipoise, poor quality clinical care or because hospitals are working creatively to create capacity for augmented care on normal surgical wards. The EPIdemiology of Critical Care after Surgery study aims to address these uncertainties.Methods and analysisOne-week observational cohort study in the UK and Australasia. All patients undergoing inpatient (overnight stay) surgery will be included. All will have prospective data collection on risk factors, surgical procedure and postoperative outcomes including the primary outcome of morbidity (measured using the Postoperative Morbidity Survey on day 7 after surgery) and secondary outcomes including length of stay and mortality. Data will also be collected on critical care referral and admission, surgical cancellations and critical care occupancy. The epidemiology of patient characteristics, processes and outcomes will be described. Inferential techniques (multilevel multivariable regression, propensity score matching and instrumental variable analysis) will be used to evaluate the relationship between critical care admission and postoperative outcome.Ethics and disseminationThe study has received ethical approval from the National Research Ethics Service in the UK and equivalent in Australasia. The collection of patient identifiable data without prior consent has been approved by the Confidentiality Advisory Group (England and Wales) and the Public Privacy and Patient Benefit Panel (Scotland). In these countries, patient identifiable data will be used to link prospectively collected data with national registers of death and inpatient administrative data. The study findings will be disseminated using a multimedia approach with the support of our lay collaborators, to patients, public, policy-makers, clinical and academic audiences.
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Boyle, R. K. "Herpes Simplex Labialis after Epidural or Parenteral Morphine: A Randomized Prospective Trial in an Australian Obstetric Population." Anaesthesia and Intensive Care 23, no. 4 (August 1995): 433–37. http://dx.doi.org/10.1177/0310057x9502300403.
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A prospective randomized controlled trial was conducted in women undergoing emergency and elective caesarean section to determine whether epidural morphine predisposes to postoperative herpes simplex labialis and whether the risk is increased or decreased by previous oral herpes or pruritus. Following cannulation of the epidural space, analgesia for labour and/or caesarean section was induced in two groups of similar age, parity, preoperative status and anaesthetic. According to tables of random numbers, 386 were allocated to receive parenteral morphine and 425 to receive epidural morphine. Postoperative herpes labialis was diagnosed by laboratory culture and microscopy. Patients who received epidural morphine were 11.5 times (95% CI 2.6–49.4) more likely than the parenteral morphine group to suffer herpes labialis. A past history of oral herpes increased the risk of herpes labialis by 8.6 times (95 % CI 3.3–22.0). When the influence of past herpes infection and route of morphine were taken into account, no separate association between pruritus and herpex simplex labialis could be demonstrated.
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Lee, L., and K. Leslie. "Target Words for the Word Stem Completion Test in Australian Patients." Anaesthesia and Intensive Care 31, no. 2 (April 2003): 184–86. http://dx.doi.org/10.1177/0310057x0303100208.
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A robust test that reliably demonstrates implicit memory during general anaesthesia is required. The Word Stem Completion (WSC) test has been used as a measurement tool in a number of recent studies that have detected implicit memory during anaesthesia. However, target words used in the WSC test need to be culturally appropriate in order to maximize the sensitivity of the test. Therefore, fifty postoperative patients with English as a first language were recruited at The Royal Melbourne Hospital in order to assess the frequency of 98 target words in response to a word stem presentation. This generated a list of 32 target words that is suitable for use in studies of implicit memory during anaesthesia in Australian patients.
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Kee, W. D. Ngan. "Epidural Pethidine: Pharmacology and Clinical Experience." Anaesthesia and Intensive Care 26, no. 3 (June 1998): 247–55. http://dx.doi.org/10.1177/0310057x9802600303.
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Pethidine is an effective epidural opioid for the treatment of acute pain. Its use has been well described in Australian and New Zealand practice, particularly in the field of obstetric anaesthesia. Reported methods of delivery have included bolus injection, continuous infusion and patient-controlled epidural analgesia. Areas of application have included treatment of postoperative pain, labour pain and intraoperative pain. Because of its intermediate lipid solubility, pethidine may have advantages over many other epidural opioids. However, potential for accumulation of norpethidine limits its use to relatively short durations of treatment.
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Tan, Adeline CH, Bernadette A. Bugeja, David A. Begley, Jennifer A. Stevens, Kok-Eng Khor, and Jonathan Penm. "Postoperative use of slow-release opioids: The impact of the Australian and New Zealand College of Anaesthetists/Faculty of Pain Medicine position statement on clinical practice." Anaesthesia and Intensive Care 48, no. 6 (November 2020): 444–53. http://dx.doi.org/10.1177/0310057x20956664.
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Dose titration with immediate-release opioids is currently recommended for acute pain. The Australian and New Zealand College of Anaesthetists and the Faculty of Pain Medicine released a statement in March 2018 supporting their use in the treatment of opioid-naïve patients; however, the impact of this statement on clinical practice is currently unknown. This retrospective cohort study was conducted to compare opioid prescribing patterns before and after the release of the recommendations. Data were collected on 184 patients (2017, n = 78; 2018, n = 106) admitted to the Prince of Wales Hospital in November 2017 and 2018, which consisted of demographic data, opioid prescriptions and discharge opioid information. The main outcome is the number of prescriptions of slow-release opioids in 2017 versus 2018 after the recommendations were published. Confounding factors were accounted for using logistic and multiple regression as appropriate. There was a 29% decrease in slow-release opioid prescriptions during hospitalisation ( n = 31, 40% versus n = 12, 11%; P < 0.001) and 17% decrease at discharge ( n = 20, 26% versus n = 9, 9%; P = 0.02) post-publication. After adjusting for confounders, the odds of slow-release opioids being prescribed postoperatively and at discharge reduced by 86% and 88%, respectively (postoperative period: odds ratio 0.14, P < 0.05; discharge: odds ratio 0.12, P < 0.05). In addition, orthopaedic patients were more likely to receive slow-release opioids, consistent with existing literature. As the use of slow-release opioids has been associated with increased harm and protracted opioid use compared to immediate-release opioids, it is hoped that wider dissemination of these recommendations and a change in prescribing practice can be a step towards overcoming the opioid crisis.
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Olesnicky, Benjamin, Matthew Doane, Clare Farrell, Greg Knoblanche, and Anthony Delaney. "Prevention of Postoperative Events following Reversal with Sugammadex or Neostigmine (the P-PERSoN Trial): Pilot Data Following Early Termination of a Prospective, Blinded, Randomised Trial." Anesthesiology Research and Practice 2022 (July 8, 2022): 1–8. http://dx.doi.org/10.1155/2022/4659795.
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Background. Residual paralysis following anaesthesia is common and can lead to postoperative morbidity. While sugammadex has been shown to be effective in minimising residual paralysis, uncertainty exists as to whether its use reduces any associated morbidity. We designed this trial to determine if the use of sugammadex for the reversal of intraoperative aminosteroid neuromuscular blockade results in improvements in postoperative pulmonary complications, complications in the recovery unit, postoperative nausea and vomiting, and patient satisfaction, when compared to reversal with neostigmine. Methods. A prospective, double-blind, randomised controlled trial in adult patients admitted for surgical operations at two Australian hospitals between December 2018 and March 2019 was performed comparing the reversal of neuromuscular paralysis using sugammadex 2 mg/kg versus neostigmine 50mcg/kg. Statistical analysis of continuous data was performed using two tailed t-tests, with categorical and ordinal data being assessed by chi-squared analysis. Results. The trial was terminated due to a combination of resource constraints and the 2019 novel coronavirus disease (COVID-19) pandemic. Of 51 patients screened, 33 were eligible for participation and 30 subsequently recruited and randomised. All patients received the intended treatment allocated. Data for the primary outcome was obtained in all patients. There was no difference in the rates of postoperative pulmonary complications between the sugammadex and neostigmine groups (0% (0/19) vs 9% (1/11) RR 5.0 (95% CI 0.22–113) p = 0.37 . There was no difference in any of the secondary outcomes between the groups. Conclusions. The P-PERSoN trial showed no difference in postoperative pulmonary complications between sugammadex and neostigmine based reversal of aminosteroid neuromuscular block, but was underpowered to show any difference due to early trial termination. The randomisation and data collection was feasible. We support the need for an adequately resourced and funded randomised controlled trial to address this important clinical question.
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Lee, A., T. Gin, and T. E. Oh. "Opioid Requirements and Responses in Asians." Anaesthesia and Intensive Care 25, no. 6 (December 1997): 665–70. http://dx.doi.org/10.1177/0310057x9702500613.
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The provision of good analgesia can be influenced by ethnic differences in how pain is expressed, the attitudes of patients and health professionals towards pain management and pharmacological differences in the responses to opioids. It is difficult to generalize results so that they are applicable to any ethnic group as a whole. There is also the question of how best to categorize ethnic Asians who have been in Australasia for several generations. Much of the pharmacogenetic work has focused on the metabolism of codeine, morphine and pethidine, and there are some differences between Chinese and Caucasians. Asians may receive less analgesia because they are more likely to experience, or are less tolerant of the adverse effects of opioids. Despite this, ethnic factors are probably only a small contributor to the inter-individual variation in opioid requirements. Unlike earlier studies, recent larger studies using patient-controlled analgesia have shown similar opioid usage between Asians and Caucasians in the postoperative period. An individualized pain management program is essential for any patient, whatever his or her ethnic origin. The use of patient-controlled analgesia will minimize some of the problems that may occur because of poor communication between the patient and the healthcare staff. Nevertheless, in a multicultural society like Australia's, health professionals should be conscious of the many factors that may influence the effects of prescribed treatment to manage pain in different ethnic groups.
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Reddi, Benjamin AJ, Sonya D. Johnston, Stanley Bart, Justin CY Chan, and Mark Finnis. "Abnormal pulmonary function tests are associated with prolonged ventilation and risk of complications following elective cardiac surgery." Anaesthesia and Intensive Care 47, no. 6 (October 24, 2019): 510–15. http://dx.doi.org/10.1177/0310057x19877188.
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Elective cardiac surgery accounts for a significant proportion of perioperative resource allocation in Australasia. Preoperative pulmonary function testing (PFT) is routinely undertaken in some centres to identify patients who may require prolonged ventilation and intensive care unit (ICU) stay, although there are currently no data supporting this practice. Routine PFT places a burden on respiratory diagnostic laboratories, is inconvenient to patients and may delay surgery. We aimed to identify whether PFT parameters identify patients requiring prolonged mechanical ventilation after elective cardiac surgery. Adult patients admitted to the Royal Adelaide Hospital ICU following elective cardiac surgery between July 2013 and December 2017 were identified retrospectively from the local ICU database. Preoperative PFT and operative and postoperative outcome data were retrieved from local databases, and multivariable logistic regression was undertaken to identify which PFT variables were associated with prolonged mechanical ventilation. PFT data were available for 835/1139 (73%) elective cardiac surgical cases. The best independent predictors of prolonged mechanical ventilation were post-bronchodilator forced vital capacity (FVC) and single-breath diffusing capacity for carbon monoxide (DLCO). Patients with FVC <80% predicted and DLCO <60% predicted had an odds ratio for prolonged postoperative ventilation of 7.5 (95% confidence intervals 3.6–15.6; P < 0.001). The area under the receiver operating characteristic curve derived from this model was 0.68. Abnormal PFT results were associated with prolonged postoperative mechanical ventilation. A PFT-based prediction tool does not accurately predict individual patient outcome but identifies a cohort of patients at higher risk of requiring prolonged ventilation, potentially informing ICU resource allocation and surgical planning.