Background: The results of personal audit have not been tested against a hospital‐based audit previously and the results of two such audits of colorectal resection in the State of Victoria have provided this opportunity. In addition, data reflecting the results of colorectal resection across a range of hospitals and surgeons in the Victorian community have been obtained.
Methods: A total of 535 patients undergoing a colorectal resection, with an anastomosis performed, were studied in two serially conducted prospective audits arranged by the Standards Sub‐committee of the Victorian State Committee. One study was public hospital‐based and the second was based on voluntary reporting by individual surgeons.
Results: Similar results were obtained in each study, demonstrating the accuracy of individual reporting. The combined results (wound infection rate 12.3%. anastomotic leak rate 3.7% and mortality 4.5%) are compared to previously published data.
Conclusions: In the State of Victoria the results of audit by individual surgeons performing colorectal resection were similar to the hospital‐based audit. The results obtained compare favourably with previously published data.
There is a changing scene with perforated peptic ulcer. The older age of presentation, the increased association with non-steroidal anti-inflammatory drugs, associated increased debility, and resulting higher mortality in the elderly, are causing a rethink in management protocols. Whereas years ago most discussion was on whether urgent definitive surgery was the most effective therapy, nowadays there is a tendency to less invasive measures. A ‘deliberative’ approach, wherein not all patients require surgery, is detailed, and there may be an increasing role for laparoscopic perforation-sealing techniques in the remainder. Anti-secretory and anti-helicobacter drugs have an important role in post-operative care following lesser procedures than definitive surgery.
Background: An ageing population will increase the need for resources to treat patients with a fractured neck of femur (DRG 210/211). Provision of these resources will be helped by a better understanding of current practices. Methods: A prospective study of outcome at discharge for 100 consecutive patients with DRG 210/211 was conducted at five Victorian metropolitan teaching hospitals to assess length of stay and the reasons for any variations. Results: The major influences on timing of discharge were: delayed availability of rehabilitation beds; the timing of referral and assessment by the Geriatric Assessment Team; delay in surgery more than 24 h after admission; and development of postoperative complications.
Conclusion:The efficient management of patients with DRG 210/211 requires a strong protocol of treatment and referral strategies with adequate resources.
Background: This study sequentially compares the results of 148 transperitoneal inguinal hernioplasties in 129 patients with 3 13 totally extraperitoneal hernioplasties in 254 patients. Methods: Patients were entered into the study prospectively and reviewed postoperatively at I day, 1 week, 5 weeks and 1 year. Results: There was no difference in length of hospital stay, postoperative analgesia requirements or the rate of early or late operative complications. The operating time was shorter and the retum to normal activities was earlier for the totally extraperitoneal group. There were no intraperitoneal complications following the totally extraperitoneal operation.
Conclusions:The extraperitoneal technique is favoured over the transperitoneal technique for laparoscopic inguinal hernioplasty.
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