Aim Under the Australian Medicare Scheme, Australian residents are covered for many hospital-related costs. Patients with private insurance presenting with appendicitis can elect to be admitted as a private patient. Despite the stereotypes, little is known on whether the patients’ health cover actually affect clinical outcomes. This study aims to compare the differences in patient outcomes between public and private patients after undergoing operative management for appendicitis. Methods A multi-centre prospectively collected health service database of all appendicectomies performed over a 16-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon, complications and mortality rates were analysed. Results Of the total of 652 patients who underwent an appendicectomy, 203 patients were private, 444 patients were public, and 5 were overseas patients. During the post-operative period, public patients had higher rates of representation to the Emergency Department (ED) for post-operative symptoms (public 12.8% vs private 4.4%, p 0.0007, two-tailed chi square test). In comparison, the rate of post-operative complications with Clavien-Dindo (CD) score ≥ 2 is similar in both groups (p = 0.18, public 4.5% vs private 2%). There were no mortalities recorded for both groups. Conclusion Public patients have higher representation rates to the emergency department after an appendicectomy however post-operative outcomes are similar in both groups in our health system. The difference in complication rates were not significant with both groups recording low complication rates of under 5%.
Aims Electronic communication amongst surgical team members improves the team's ability to care for patients. Security and privacy of patient data are significant concerns. Recent controversy involving private data collection with WhatsApp has led to many users changing to other forms of messaging apps to protect user privacy. The aim of this study is the analyse the efficiency and effectiveness of the Signal messaging app in a research setting in Australia. Methods Members of our research group comprising three junior doctors and a supervising consultant surgeon used the Signal app as our main method of communication to discuss matters relating to our various research projects. No patient details were discussed in the messaging app. Results A total of 234 personal and 148 group messages were sent during the study period in a group and personal message setting. Most messages including picture files sent were received within one minute by the recipient. We did encounter a 24 hour period where Signal encountered some technical difficulties and some messages did not go through. Conclusion Signal messaging app is a good alternative to WhatsApp messaging app with better user privacy protection. With more user uptake on Signal app, it has the potential to be used for clinical care as Signal also provides end-to-end encryption to protect patient privacy.
Aim Surgical cover at night differ according to hospitals and are often performed by junior registrars. This can be challenging as a certain amount of independence is required in decision making. Abdominal pain remains one of the most common surgical presentations in the Emergency Department. This study analyses the type of abdominal pain presentations that were reviewed overnight in a regional Australian hospital. Method All patient presentations requiring surgical review from 9.00pm to 7.00am over a period of 4 months are prospectively collected and analysed. Patient details collected comprised of gender, date of review, blood tests, imaging results, histopathology, and intra-operative findings. Results Of the 114 patients who presented with abdominal pain, the majority of them were undifferentiated abdominal pain (n = 20, 17.1%). This is then followed by appendicitis (n = 17, 14.5%), diverticulitis (n = 13, 11.1%), pancreatitis (n = 8, 6.8%) and cholecystitis (n = 6, 5.1%). Among the others, a total of 8 presentations required urgent surgical review which resulted in three emergency surgeries being performed overnight, a laparotomy for closed loop small bowel obstruction, a Hartmann's procedure and a laparoscopic appendicectomy on a septic patient. Conclusion Common presentations for abdominal pain overnight include undifferentiated abdominal pain, appendicitis, diverticulitis, cholecystitis and pancreatitis. Hence education for night surgical registrars should be focused on management of these common conditions and also on surgical emergencies such as closed loop bowel obstructions, septic patients and perforated viscus to ensure optimal patient outcome without the need for close supervision.
Urachal cancer is a rare non-urothelial malignancy that involves the urachus, often occurring at the junction of the urachal ligament and the bladder dome. It accounts for less than 1% of all bladder tumours. Cancer during pregnancy is rare, with the incidence of all cancers in pregnancy estimated to be 25-27 per 100 000 pregnancies. Urachal cancer in pregnancy is an even rarer phenomenon, with only a handful of case reports published to date. After a systematic review, only five cases have been reported in the English literature. We aim to review the cases presented in the literature and to examine the outcomes of the management of urachal cancer in pregnancy to date.
Aim Most hospitals mandate afterhours operations to permit only cases that are life or limb-threatening. This is in the interests of promoting patient safety and reducing surgical errors. The incidence and caseload of night-time operations has not been well defined in Australia. This study aims to investigate the characteristics emergency operations involving consultant general surgeons between 10pm to 7am in regional and rural hospitals. Methods A multicentre, prospectively collected health service database of all emergency general surgery operations performed over a 12-month period was reviewed. In particular, patient demographics, type of operation, primary surgeon and time of operation were analysed. Results There were a total of 2059 emergency operations performed with 1344 cases performed in the regional hospital and 715 performed in the rural hospital within the area health network. Consultant surgeons were involved in 62 cases at night beyond 10.00pm, of which majority were laparotomies (n = 26/62, 42%), appendicectomies (n = 21/62, 34%), and hernia repair ((n = 4/62, 6.5%). In comparison, surgeons in the rural hospital performed seven emergency cases at night comprising of 6 laparotomies and one abscess drainage. Conclusion Larger hospitals have higher volumes of emergency cases, which increases the likelihood of afterhours operating. The rural hospital does not have other subspecialty cover competing for emergency operating time. This allows most emergency cases to be performed in the evening. In order to promote safe working hours and improved patient safety, theatre availability and staffing could be increased in the evening to diminish necessity for midnight to morning consultant operations.
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