Hidden work in hepatopancreaticobiliary surgery: the contemporary demands of non-operative patient management

Koea, Jonathan; Srinivasa, Sanket; Leung, Universe; Pimm, M.; Rodgers, Michael

doi:10.1016/j.hpb.2021.02.010

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…At a service level in New Zealand, provision of complex UGI and HPB surgical procedures must also take account of the fact that all New Zealand subspecialty trained surgeons must participate in rostered duties to provide acute surgical care (e.g., trauma and acute abdominal conditions), provide surgical care for patients with benign conditions (e.g., abdominal hernias and gallstone related disease) consistent with nationally mandated health targets, 10 and must also provide inpatient and outpatient care to non‐operable surgical conditions—for example, patients with metastatic gastrointestinal cancers 11 . Consequently, the challenge for surgical service providers is to meet these existing obligations but ensure that the population has access to complex surgical procedures, when required, that achieve outcomes commensurate with global centers of excellence, but in the context of a globally procedural low‐volume environment.…”

Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume‐outcome relationship with accessibility in a surgically low volume country

Koea,

Chao,

Srinivasa

et al. 2024

World j. surg.

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IntroductionNew Zealand has a population of only 5.5 million meaning that for many surgical procedures the country qualifies as a “low‐volume center.” However, the health system is well developed and required to provide complex surgical procedures that benchmark internationally against comparable countries. This investigation was undertaken to review regional variation and volumes of complex resection and palliative upper gastrointestinal (UGI) surgical procedures within New Zealand.MethodsData pertaining to patients undergoing complex resectional UGI procedures (esophagectomy, gastrectomy, pancreatectomy, and hepatectomies) and palliative UGI procedures (esophageal stenting, enteroenterostomy, biliary enteric anastomosis, and liver ablation) in a New Zealand hospital between January 1, 2000 and December 31, 2019 were obtained from the National Minimum Dataset.ResultsNew Zealand is a low‐volume center for UGI surgery (229 hepatectomies, 250 gastrectomies, 126 pancreatectomies, and 74 esophagectomies annually). Over 80% of patients undergoing hepatic resection/ablation, gastrectomy, esophagectomy, and pancreatectomy are treated in one of the six national cancer centers (Auckland, Waikato, Mid‐Central, Capital Coast, Canterbury, or Southern). There is evidence of the decreasing frequency of these procedures in small centers with increasing frequency in large centers suggesting that some regionalization is occurring. Palliative procedures were more widely performed. Indigenous Māori were less likely to be treated in a nationally designated cancer center than non‐Māori.ConclusionsThe challenge for New Zealand and similarly sized countries is to develop and implement a system that optimizes the skills and pathways that come from a frequent performance of complex surgery while maintaining system resilience and ensuring equitable access for all patients.

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Section: Introductionmentioning

confidence: 99%

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume‐outcome relationship with accessibility in a surgically low volume country

Koea,

Chao,

Srinivasa

et al. 2024

World j. surg.

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Innovative Leadership in the Digital Age: A Preliminary Research on Digital Leadership in Contemporary Management

Saputra,

Roostika

2024

Technical and Vocational Education and Training: Issues, Concerns and Prospects

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Best supportive care in advanced pancreas cancer: a systematic review to define a patient‐care bundle

Law,

Windsor,

Connor

et al. 2024

ANZ Journal of Surgery

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BackgroundThe majority of patients with pancreatic adenocarcinoma (PDAC) have advanced disease at presentation, preventing treatment with curative intent. Management of these patients is often provided by surgical teams for whom there are a lack of widely accepted strategies for care. The aim of this study was to conduct a systematic review to identify key issues in patients with advanced PDAC and integrate the evidence to form a care bundle checklist for use in surgical clinics.MethodsA systematic review of the literature was performed regarding best supportive care for advanced PDAC according to the PRISMA guidelines. Interventions pertaining to supportive care were included whilst preventative and curative treatments were excluded. A narrative review was planned.ResultsForty‐four studies were assessed and four themes were developed: (i) Pain is an undertreated symptom, requiring escalating analgesics and sometimes invasive modalities. (ii) Health‐related quality of life necessitates optimisation by involving family, carers and multi‐disciplinary teams. (iii) Malnutrition and weight loss can be mitigated with early assessment, replacement therapies and resistance exercise. (iv) Biliary and duodenal obstruction can often be relieved by endoscopic/radiological interventions with surgery rarely required.ConclusionThis is the first systematic review to evaluate the different types of interventions utilized during best supportive care in patients with advanced PDAC. It provides a comprehensive care bundle for surgeons that informs management of the common issues experienced by patients within a multidisciplinary environment.

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Hidden work in hepatopancreaticobiliary surgery: the contemporary demands of non-operative patient management

Cited by 3 publications

References 9 publications

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume‐outcome relationship with accessibility in a surgically low volume country

Upper gastrointestinal and hepatopancreaticobiliary surgery in New Zealand: Balancing the volume‐outcome relationship with accessibility in a surgically low volume country

Innovative Leadership in the Digital Age: A Preliminary Research on Digital Leadership in Contemporary Management

Best supportive care in advanced pancreas cancer: a systematic review to define a patient‐care bundle

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