Routine ward admission for patients undergoing elective craniotomies with selective ICU admission appears safe; however, approximately 2% of patients may require a direct postoperative unplanned ICU admission. Patients with anticipated long operation times, extensive blood loss, and high anesthetic risks should be selected for postoperative ICU admission, but further study is needed to determine the preoperative factors that can aid in identifying and caring for these groups of patients.

Background. Despite advances in surgical repair of hiatus hernias, there remains a high radiological recurrence rate. We performed a novel technique incorporating bilateral oesophageal fixation and evaluated outcomes, principally symptom improvement and hernia recurrence. Methods. A retrospective study was performed on a prospective database of patients undergoing hiatus hernia repair with bilateral oesophageal fixation. Retrospective and prospective quality of life (QOL), PPI usage, and patient satisfaction data were obtained. Hernia recurrence was assessed by either barium swallow or gastroscopy. Results. 87 patients were identified in the database with a minimum of 3 months followup. There were significant improvements in QOL scores including GERD HRQL (29.13 to 4.38, P < 0.01), Visick (3 to 1), and RSI (17.45 to 5, P < 0.01). PPI usage decreased from a median of daily to none, and there was high patient satisfaction (94%). 57 patients were assessed for recurrence with either gastroscopy or barium swallow, and one patient had evidence of recurrence on barium swallow at 45 months postoperatively. There was an 8% complication rate and no mortality or oesophageal perforation. Conclusions. This study demonstrates that our technique is both safe and effective in symptom control, and our recurrence investigations demonstrate at least short term durability.

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Background/Objectives: An involved or close resection margin in the setting of cutaneous SCC (cSCC) is associated with the risk of developing recurrence. The scalp poses unique anatomical challenges when obtaining adequate resection margins and further treatment may be required. We aimed to investigate the risk of recurrence in patients with scalp cSCCs and the role of adjuvant radiotherapy. Methods: Eligible patients with cSCC of the scalp treated with curative intent at Westmead hospital, Sydney, were identified and patient, tumor and treatment factors analyzed. Patients were categorized based on margin status and analyzed in terms of treatment delivered, local recurrence and survival. Results: In total, 114 patients with a median age of 70 years with the majority (81%) male, were identified with a median follow up of 5.6 years. Following surgery, 52 patients (46%) had clear margins, 62 (54%) had close (≤2mm) or involved margins, with a significant difference in the 5-year disease specific mortality of 20% and 35%, respectively (p=0.05). Twenty-eight patients (25%) underwent surgery and adjuvant radiotherapy, most with a close/involved margin. There was no significant difference in the risk of developing local recurrence between the group of patients in whom a clear margin was obtained and the group in whom the margin was close/involved (p=0.23). Conclusion: Margin status had a significant impact on disease specific mortality, but was not associated with the risk of developing local recurrence. The addition of adjuvant radiotherapy in select high-risk patients may improve outcome although this was not demonstrated in our study.