- [Show abstract] [Hide abstract] ABSTRACT: Various models have been proposed to effectively provide acute surgical care in Australasia. Recently, General Surgeons Australia (GSA) has published a 12-point plan with guiding principles on this matter. This study describes a model of providing acute general surgical care in a high-volume institution, evaluates clinical outcomes and critically appraises the system against the GSA 12-point plan. The acute care system is qualitatively described with quantitative measures of workload. The outcomes of acute laparoscopic cholecystectomy were used as a proxy of system performance. The system was critically appraised against the GSA 12-point plan. Teams are on call once per week with each surgeon on call once per fortnight. The three key elements of acute management - collecting patients, post-acute ward round and operating - are treated as modules. The patient remains under the care of the admitting consultant but is often operated on by another team. From June 2009 to 2010, there were 7429 acute general surgical admissions (mean: 20.4 patients per day) with 2999 acute operations (mean: 8.4 operations per day). The other activities of the department were not compromised. In that time, 388 acute laparoscopic cholecystectomies were performed with a conversion rate of 1.3% and no major bile duct injury. The system is compatible with the GSA 12-point plan. This study describes an efficient and safe system for providing acute general surgical care in a high-volume setting with satisfactory clinical outcomes. It is compatible with the GSA 12-point plan.
- [Show abstract] [Hide abstract] ABSTRACT: Gastric cancer location and histopathology in Pacific people (mostly of Samoan, Tongan, Niuean, or Cook Islands origin) and Māori in New Zealand has not been specifically examined. A retrospective review of all histologically-proven new cases of gastric adenocarcinoma and gastro-oesophageal adenocarcinoma at Middlemore Hospital (Auckland, New Zealand) from June 2003-June 2009 was conducted. Demographic data, clinical presentation, diagnostic/ staging investigations and surgical outcomes were recorded. There were 133 patients of whom 79 (59%) were male. Forty-nine (37%) patients were of Pacific ethnicity and 34 (26%) were Māori. Māori (59.3 years; p=0.01) and Pacific (64.5 years; p=0.01) patients were significantly younger at diagnosis compared to European patients (77.2 years). European patients had more proximal tumours (n=18; 47%) compared to Pacific (n=5; 10%) and Māori (n=4; 12%) patients (p= 0.01). Pacific (n=25; 51%) and Māori (n=21; 62%) patients had a significantly higher percentage of diffuse-type gastric cancer compared to European (n=7; 18%) patients. There was no difference in stage of presentation between ethnic groups. Māori and Pacific patients present with gastric cancer at higher rates and at a younger age. They have a predominance of diffuse-type antral and gastric body cancers which stand in contrast to global trends in gastric cancer.
- [Show abstract] [Hide abstract] ABSTRACT: Early laparoscopic cholecystectomy has been shown to be the treatment of choice for acute presentations of gallstone disease. However, currently this practice is not common in many centres. The aim of the study was to evaluate surgical management of patients presenting with acute symptomatic gallstone disease to Middlemore Hospital in 2005. A retrospective case review of acute presentations of symptomatic gallstone disease was carried out between 1 January and 31 December 2005. Four hundred and two patients were included in the final analysis. Forty-six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 25 declined surgery. Therefore, 305 patients (76%) were eligible for surgery at index admission (IA). Two hundred and four (67%) received surgery during IA with a median time to surgery of 3 days. From the 198th patient who did not have acute surgery at IA, 112 had delayed surgery. When comparing those with surgery at IA with those who did not receive surgery at IA, median length of stay for IA was significantly longer in acute surgical group (5 vs 3 P = 0.05); however, there was no significant difference in duration of total hospital stay (6 vs 6 P > 0.05). For those who had acute surgery the conversion rate was 3% (six) compared with 7% (seven) in delayed surgery group (P = 0.09). Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and effective.
- [Show abstract] [Hide abstract] ABSTRACT: Purpose To evaluate surgical management of patients presenting with symptomatic gallstone disease to Middlemore Hospital in 2005. Method Retrospective case review of acute presentations of symptomatic gallstone disease between Jan 1st and Dec 31st 2005. Results Four hundred and two patients were included in the final analysis. Forty six of these patients were unfit for surgery, 26 were solely admitted to the emergency department without being referred to a surgical team and 22 declined surgery. Therefore 308 patients (77%) were eligible for surgery at index admission (IA). Sixty six percent (204) of these received surgery during IA with an average time to surgery of 4 days. Of the remaining 104 eligible patients who did not receive surgery during IA, 54% (56) received public surgery at a later date with an average wait of 85 days. Fourteen percent (42) never received surgery despite being eligible during IA. There was no significant difference in duration of total acute hospital stay between those with surgery at IA and those who did not receive surgery at IA. For those who had acute surgery the conversion rate was 2% (4). There were no biliary injuries or perioperative deaths and post-operative readmission rate was 4% (9). Sixty two percent (64) of the 104 eligible patients who did not receive surgery at IA were subsequently readmitted acutely within 24 months. The average wait time for US, MRCP and ERCP was 0.9, 3.1 and 3.4 days respectively. Conclusion Acute surgery remains the treatment of choice for acute biliary disease. This approach requires a committed team approach but is safe and cost effective.