2021 |
Peters L, Zhao J, Makanyengo S, Pockney P, 'Delayed Splenic Artery Pseudoaneurysm After Laparoscopic Sleeve Gastrectomy.', Obes Surg, 31 872-874 (2021)
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2021 |
Knight SR, Shaw CA, Pius R, Drake TM, Norman L, Ademuyiwa AO, et al., 'Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries', The Lancet, 397 387-397 (2021)
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license Background: 80% of individuals with cancer will require a surgica... [more]
© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70¿8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39¿8·80) and upper-middle-income countries (2·06, 1·11¿3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26¿11·59) and upper-middle-income countries (3·89, 2·08¿7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit.
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2021 |
Glasbey JC, Nepogodiev D, Simoes JFF, Omar O, Li E, Venn ML, et al., 'Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.', J Clin Oncol, 39 66-78 (2021)
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2020 |
Whitcher S, Magnusson M, Gani J, Oldmeadow C, Pockney PG, 'Comparison of colonic neoplasia detection rates in patients screened inside and outside the National Bowel Cancer Screening Program', Medical Journal of Australia, 212 275-276 (2020) [C1]
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2020 |
Stephensen BD, Reid F, Shaikh S, Carroll R, Smith SR, Pockney P, 'C-reactive protein trajectory to predict colorectal anastomotic leak: PREDICT Study', British Journal of Surgery, 107 1832-1837 (2020)
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2020 |
Zhao J, Peters L, Gelzinnis S, Carroll R, Nolan J, Di Sano S, et al., 'Post-discharge opioid prescribing after laparoscopic appendicectomy and cholecystectomy', ANZ Journal of Surgery, 90 1014-1018 (2020)
© 2020 Royal Australasian College of Surgeons Background: Opioid over-prescription following surgery is a significant public health issue in most developed countries. Multiple stu... [more]
© 2020 Royal Australasian College of Surgeons Background: Opioid over-prescription following surgery is a significant public health issue in most developed countries. Multiple studies have been conducted in the USA demonstrating and investigating the issue; however, there is a lack of literature addressing this topic in the Australian setting. The aim of this study is to review prescribing practices at an Australian tertiary referral hospital on discharge in patients having undergone laparoscopic cholecystectomy (LC) or laparoscopic appendicetomy (LA). Additionally, to identify potential factors which influence medical officer prescribing practices. Methods: A retrospective observational study on opioid prescribing practice on all patients who underwent LC or LA over a 12-month period at an Australian tertiary referral hospital. Results: A total of 435 patients (223 LC, 214 LA) were prescribed a mean opioid dose on discharge of 25 oral morphine milli-equivalents (range 0¿180 morphine milli-equivalents). Less opioids were prescribed following elective procedures (42% versus 10%, P < 0.001). There is a downward trend of opioid prescribing on discharge as the Junior Medical Officer clinical year progresses (P < 0.001). Conclusions: This study demonstrates a lower rate of opiate prescription on discharge for LC and LA in an Australian setting when compared to the US data. There is a wide diversity of prescribing demonstrated. This indicates the need for better training of opioid prescribers to reduce over-prescribing.
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2020 |
Glasbey JC, Nepogodiev D, Omar O, Simoes JFF, Ademuyiwa A, Fiore M, et al., 'Delaying surgery for patients with a previous SARS-CoV-2 infection', British Journal of Surgery, 107 e601-e602 (2020)
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2020 |
Fenton M, Gani J, Pockney P, 'Adverse Events After Inpatient Colonoscopy in Octogenarians: Patient Selection Key for Colonoscopies', JOURNAL OF CLINICAL GASTROENTEROLOGY, 54 484-484 (2020)
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2020 |
Chapman SJ, Blanco-Colino R, Pérez-Ajates S, Bautista OA, Hodson J, Blanco-Colino R, et al., 'Safety of hospital discharge before return of bowel function after elective colorectal surgery', British Journal of Surgery, (2020)
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative comp... [more]
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien¿Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4¿7) and 7 (6¿8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients.
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2020 |
Vavilov S, Smith G, Starkey M, Pockney P, Deshpande AV, 'Parental decision regret in childhood hypospadias surgery: A systematic review', Journal of Paediatrics and Child Health, 56 1514-1520 (2020)
© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) We conducted a systematic review of the literature to establish the prevalence of and p... [more]
© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians) We conducted a systematic review of the literature to establish the prevalence of and predictive factors for parental decision regret in hypospadias surgery. A search strategy without language restrictions was developed with expert help, and two reviewers undertook independent study selection. Five studies were included in this review (four for quantitative analysis) with a total of 783 participants. The mean overall prevalence of parental decision regret was 65.2% (moderate to severe ¿ 20.3%). Although significant predictors of regret were identified (post-operative complications, small size glans, meatal location, decision conflict between parents, parental educational level and others), they had unexplained discordance between studies. Parental decision regret after proximal hypospadias surgery and refusing surgery was inadequately reported. In conclusion, even though the prevalence of parental decision regret after consenting for the hypospadias repair appears to be high, risk factors associated with it were discordant suggesting imprecision in estimates due to unknown confounders.
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2020 |
Chapman SJ, Clerc D, Blanco-Colino R, Otto A, Nepogodiev D, Pagano G, et al., 'Safety and efficacy of non-steroidal anti-inflammatory drugs to reduce ileus after colorectal surgery', British Journal of Surgery, 107 e161-e169 (2020)
© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and ... [more]
© 2019 BJS Society Ltd Published by John Wiley & Sons Ltd Background: Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non-steroidal anti-inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods: A prospective multicentre cohort study was delivered by an international, student- and trainee-led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre-specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results: A total of 4164 patients were included, with a median age of 68 (i.q.r. 57¿75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1¿3, of whom 1061 (92·0 per cent) received non-selective cyclo-oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion: NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.
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2020 |
Eliezer DD, Holmes M, Sullivan G, Gani J, Pockney P, Gould T, et al., 'High-Risk Emergency Laparotomy in Australia: Comparing NELA, P-POSSUM, and ACS-NSQIP Calculators', Journal of Surgical Research, 246 300-304 (2020) [C1]
© 2019 Background: The National Emergency Laparotomy Audit (NELA) highlights the importance of identifying high-risk patients due to the potential for significant morbidity and mo... [more]
© 2019 Background: The National Emergency Laparotomy Audit (NELA) highlights the importance of identifying high-risk patients due to the potential for significant morbidity and mortality. The NELA risk prediction calculator (NRPC) was developed from data in England and Wales and is one of several calculators available. We seek to determine the utility of NRPC in the Australian population and compare it with Portsmouth Physiological and Operative Severity Score for the enumeration of mortality and Morbidity (P-POSSUM) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculators. Methods: A retrospective review of all emergency laparotomies undertaken at four Australian centers was performed between January 2016 and December 2017. Data extracted from patient records were used to calculate NRPC, ACS-NSQIP, and P-POSSUM scores for 30-day mortality risk. The sensitivity of NRPC was assessed using the NELA high-risk cohort score of =10% and this was compared with the other two calculators. Results: There were 562 (M = 261, mean age = 66 [±17] y) patient charts reviewed in the study period. 59 patients died within 30 d (10.5%). NRPC was able to identify 52 (sensitivity = 88.1%) of these as being within the high-risk group. Using the NELA high-risk cutoff, NRPC identified 52 deaths of 205 (25.4%) high-risk patients, P-POSSUM identified 46 of 245 (18.8%), and ACS-NSQIP identified 46 of 201 (22.9%). Using the McNemar test, no significant difference was noted between NRPC and P-POSSUM (P = 0.07) or NRPC and ACS-NSQIP (P = 0.18). Conclusions: In the Australian context, the NRPC is a highly sensitive and useful tool for predicting 30-day mortality in high-risk emergency laparotomy patients and is comparable with P-POSSUM and ACS-NSQIP calculators.
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2020 |
Gani J, Pockney P, 'Comparison of colonic neoplasia detection rates in patients screened inside and outside the National Bowel Cancer Screening Program', MJA, (2020)
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2020 |
Glasbey JC, Bibi S, Pata F, Ozkan BB, Van Straten S, Hodson J, et al., 'Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study', Colorectal Disease, 22 2288-2297 (2020)
© 2020 The Association of Coloproctology of Great Britain and Ireland Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastr... [more]
© 2020 The Association of Coloproctology of Great Britain and Ireland Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30¿days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56¿1.87, P¿=¿0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30¿days of surgery compared with reactive insertion.
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2020 |
Carroll GM, Burns GL, Petit JA, Walker MM, Mathe A, Smith SR, et al., 'Does postoperative inflammation or sepsis generate neutrophil extracellular traps that influence colorectal cancer progression? A systematic review', Surgery Open Science, 2 57-69 (2020) [C1]
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2020 |
Watson DI, Tan L, Richards T, Muralidharan V, Pockney P, 'Trainee-led collaboratives, clinical trials and new opportunities in the COVID-19 era.', ANZ J Surg, 90 2175-2176 (2020)
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2020 |
Nepogodiev D, Omar OM, Glasbey JC, Li E, Simoes JFF, Abbott TEF, Ademuyiwa AO, 'Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans', British Journal of Surgery, 107 1440-1449 (2020)
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total ... [more]
© 2020 BJS Society Ltd Published by John Wiley & Sons Ltd Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian ß-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.
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2020 |
Peters LE, Zhao J, Martin J, Smith SR, Pockney P, 'Comment on "Opioids After Surgery in the United States Versus the Rest of the World: The International Patterns of Opioid Prescribing (iPOP) Multicenter Study".', Ann Surg, Publish Ahead of Print (2020)
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2020 |
Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JFF, et al., 'Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study', The Lancet, 396 27-38 (2020)
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2019 |
Clarke L, Pockney P, Gillies D, Foster R, Gani J, 'Direct access colonoscopy service for bowel cancer screening produces a positive financial benefit for patients and local health districts', Internal Medicine Journal, 49 729-733 (2019) [C1]
© 2018 Royal Australasian College of Physicians Background: A direct access colonoscopy service (DACS) for the National Bowel Cancer Screening Program has become standard of care ... [more]
© 2018 Royal Australasian College of Physicians Background: A direct access colonoscopy service (DACS) for the National Bowel Cancer Screening Program has become standard of care in Newcastle public hospitals because of the effect it has on time to colonoscopy. Cost-effectiveness has not been studied to date. Aim: The aim of this retrospective study was to analyse the cost-effectiveness of a DACS. Methods: Data were collected for patients referred to DACS between January 2014 and June 2016, and patients who were treated on the normal service pathway in 2013 prior to the introduction of the process. A cost-benefit analysis from the patient¿s and local health district¿s perspective was undertaken. Results: Introduction of the DACS produces a direct financial gain to patients in the form of reduced direct costs. It produces an indirect financial gain in terms of increased productivity if the patient is in work, and of increased leisure time if not in work. The DACS is modest income generating for the local health district, an evaluation which is sensitive to internal policies for distribution of government funding within a district. The DACS increases the availability of outpatient consultations to other patients, which is not a quantifiable economic benefit, but is likely to be an overall health benefit. Conclusion: The introduction of DACS in the public system in Australia is of financial benefit to patients and to the local health service provider. It is likely to produce health benefits to non-screening patients, by means of freeing consultations to be used for other indications.
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2019 |
Clarke L, Pockney P, Gillies D, Foster R, Gani J, 'Time to colonoscopy for patients accessing the direct access colonoscopy service compared to the normal service in Newcastle, Australia', Internal Medicine Journal, 49 1132-1137 (2019) [C1]
© 2018 Royal Australasian College of Physicians Background: The 2017 National Bowel Cancer Screening Program report records a median time from positive faecal occult blood test to... [more]
© 2018 Royal Australasian College of Physicians Background: The 2017 National Bowel Cancer Screening Program report records a median time from positive faecal occult blood test to colonoscopy of 53 days. There is some intrinsic delay in accessing specialist medical opinion prior to colonoscopy. Aim: To examine the effect of the introduction of a Direct Access Colonoscopy Service (DACS). Methods: Using prospectively maintained databases, patients undergoing normal service (NS) colonoscopy and those referred to DACS were compared. The primary outcome measure was the time from general practitioner (GP) referral to colonoscopy. Secondary outcome measures included the proportion of patients who met the current recommended 30 days from GP referral to colonoscopy, and the proportion of patients who waited longer than 90 days. Results: There were 289 patients in the NS group, and 601 patients who progressed on the DACS pathway. The demographics of both groups were comparable. DACS patients had a median waiting time of 49 days, significantly shorter than NS patients whose median wait was 79 days (P < 0.0001). Approximately 15.1% patients in the DACS group had their colonoscopy within 30 days from GP referral, significantly better than in the NS group (4.5%, P < 0.001). In the NS group, 41.2% patients waited longer than 90 days from GP referral to colonoscopy, compared with 16.3% in the DACS group (P < 0.001). Conclusion: DACS reduces waiting times to colonoscopy and is associated with an increased proportion of patients undergoing colonoscopy in a timely manner.
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2019 |
March B, Leigh L, Brussius-Coelho M, Holmes M, Pockney P, Gani J, 'Can CRP velocity in right iliac fossa pain identify patients for intervention? A prospective observational cohort study', Surgeon, 17 284-290 (2019) [C1]
© 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland Introduction: Previous studies have shown single CRP meas... [more]
© 2018 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland Introduction: Previous studies have shown single CRP measurements at time of presentation to have limited predictive benefit for appendicitis. Our objective was to determine the diagnostic utility of serial CRP measurements (to determine CRP velocity [CRPv]) in patients with right iliac fossa (RIF) pain. Methods: A single-centre prospective observational study was conducted on adult patients admitted with RIF pain. CRP was measured on admission, at midnight, and the following morning. Appendicitis was diagnosed on histopathology, or diagnostic imaging in non-operatively managed patients. Therapeutic interventions included all appropriate operative procedures and effective non-operative treatment with antibiotics. Logistic regression was used to generate predictors of therapeutic intervention, and then used to create a new risk score incorporating CRPv. Results: 98 of 112 (87.5%) participants had complete CRP data. 58 patients met the criteria for appendicitis (59.2%). Most patients presented with intermediate Modified Alvarado Scores (MAS) 5¿6 (40.8%) or Appendicitis Inflammatory Response Scores (AIRS) 5¿8 (49%). Our risk score had an AUROC of 0.88 (95% CI 0.81¿0.96) in predicting therapeutic intervention. This score was superior to MAS, AIRS, and single admission biomarker measurements. Patients with an increasing CRPv had 14 times the odds (OR 14.07, 95% CI 0.63¿315.2) of complicated appendicitis, and no cases of complicated appendicitis were observed in patients with a flat CRPv. Conclusions: CRP velocity is superior to single CRP at predicting intervention. Our v-Score shows promise as a decision making-aide by predicting the need for surgical intervention in RIF pain. A flat CRPv identifies a group of patients with a very low risk of complicated appendicitis.
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2019 |
Petit J, Carroll G, Gould T, Pockney P, Dun M, Scott RJ, 'Cell-free DNA as a Diagnostic Blood-Based Biomarker for Colorectal Cancer: A Systematic Review', Journal of Surgical Research, 236 184-197 (2019) [C1]
© 2018 Elsevier Inc. Background: Circulating tumour DNA (ctDNA) has emerged as an excellent candidate for the future of liquid biopsies for many cancers. There has been growing in... [more]
© 2018 Elsevier Inc. Background: Circulating tumour DNA (ctDNA) has emerged as an excellent candidate for the future of liquid biopsies for many cancers. There has been growing interest in blood-based liquid biopsy because of the potential of ctDNA to produce a noninvasive test that can be used for: the diagnosis of colorectal cancer, monitoring therapy response, and providing information on overall prognosis. The aim of this review was to collate and explore the current evidence regarding ctDNA as a screening tool for colorectal cancer (CRC). Methods: A systematic review of published articles in English over the past 20 y was performed using Medline, Embase, and Cochrane databases on May 23, 2017. After a full-text review, a total of 69 studies were included. Two assessment tools were used to review and compare the methodological quality of these studies. Results: Among the 69 studies included, 17 studies reviewed total cfDNA, whereas six studies looked at the DNA integrity index and 15 focused on ctDNA. There were a total of 40 studies that reviewed methylated cfDNA with 19 of these focussing specifically on SEPT9. Conclusions: The results of this review indicate that methylated epigenetic ctDNA markers are perhaps the most promising candidates for a blood-based CRC-screening modality using cell-free (cf) DNA. Methylated cfDNA appears to be less specific for CRC compared to ctDNA; however, they have demonstrated good sensitivity for early-stage CRC. Further research is required to determine which methylated cfDNA markers are the most accurate when applied to large cohorts of patients. In addition, reliable comparison of results across multiple studies would benefit from standardization of methodology for DNA extraction and PCR techniques in the future.
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2018 |
Smith SR, Murray D, Pockney PG, Bendinelli C, Draganic BD, Carroll R, 'Tranexamic Acid for Lower GI Hemorrhage: A Randomized Placebo-Controlled Clinical Trial', Diseases of the Colon and Rectum, 61 99-106 (2018) [C1]
© 2017 The American Society of Colon and Rectal Surgeons, Inc. BACKGROUND: Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolyti... [more]
© 2017 The American Society of Colon and Rectal Surgeons, Inc. BACKGROUND: Lower GI hemorrhage is a common source of morbidity and mortality. Tranexamic acid is an antifibrinolytic that has been shown to reduce blood loss in a variety of clinical conditions. Information regarding the use of tranexamic acid in treating lower GI hemorrhage is lacking. OBJECTIVE: The aim of this trial was to determine the clinical efficacy of tranexamic acid when used for lower GI hemorrhage. DESIGN: This was a prospective, double-blind, placebo-controlled, randomized clinical trial. SETTINGS: The study was conducted at a tertiary referral university hospital in Australia. PATIENTS: Consecutive patients aged >18 years with lower GI hemorrhage requiring hospital admission from November 2011 to January 2014 were screened for trial eligibility (N = 265). INTERVENTIONS: A total of 100 patients were recruited after exclusions and were randomly assigned 1:1 to either tranexamic acid or placebo. MAIN OUTCOME MEASURES: The primary outcome was blood loss as determined by reduction in hemoglobin levels. The secondary outcomes were transfusion rates, transfusion volume, intervention rates for bleeding, length of hospital stay, readmission, and complication rates. RESULTS: There was no difference between groups with respect to hemoglobin drop (11 g/L of tranexamic acid vs 13 g/L of placebo; p = 0.9445). There was no difference with respect to transfusion rates (14/49 tranexamic acid vs 16/47 placebo; p = 0.661), mean transfusion volume (1.27 vs 1.93 units; p = 0.355), intervention rates (7/49 vs 13/47; p = 0.134), length of hospital stay (4.67 vs 4.74 d; p = 0.934), readmission, or complication rates. No complications occurred as a direct result of tranexamic acid use. LIMITATIONS: A larger multicenter trial may be required to determine whether there are more subtle advantages with tranexamic acid use in some of the secondary outcomes. CONCLUSIONS: Tranexamic acid does not appear to decrease blood loss or improve clinical outcomes in patients presenting with lower GI hemorrhage in the context of this trial. see Video Abstract at http://links.lww.com/DCR/A453.
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2018 |
Almazi JG, Pockney P, Gedye C, Smith ND, Hondermarck H, Verrills NM, Dun MD, 'Cell-Free DNA Blood Collection Tubes Are Appropriate for Clinical Proteomics: A Demonstration in Colorectal Cancer.', Proteomics. Clinical applications, 12 e1700121 (2018) [C1]
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2018 |
Smith SR, Pockney P, Holmes R, Doig F, Attia J, Holliday E, et al., 'Biomarkers and anastomotic leakage in colorectal surgery: C-reactive protein trajectory is the gold standard.', ANZ journal of surgery, 88 440-444 (2018) [C1]
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2018 |
Holmes R, Smith SR, Carroll R, Holz P, Mehrotra R, Pockney P, 'Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks.', ANZ journal of surgery, 88 786-791 (2018) [C1]
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2018 |
Smith SR, Holmes R, Pockney P, Holz P, Carroll R, Mehrotra R, 'Response to Re: Randomized clinical trial to assess the ideal mode of delivery for local anaesthetic abdominal wall blocks', ANZ JOURNAL OF SURGERY, 88 805-806 (2018)
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2018 |
Holmes M, Connor T, Oldmeadow C, Pockney PG, Scott RJ, Talseth-Palmer BA, 'CD36-a plausible modifier of disease phenotype in familial adenomatous polyposis', HEREDITARY CANCER IN CLINICAL PRACTICE, 16 (2018) [C1]
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2017 |
Penna M, Hompes R, Arnold S, Wynn G, Austin R, Warusavitarne J, et al., 'Transanal Total Mesorectal Excision: International Registry Results of the First 720 Cases', Annals of Surgery, 266 111-117 (2017) [C1]
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Objective: This study aims to report short-term clinical and oncological outcomes from the international transana... [more]
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Objective: This study aims to report short-term clinical and oncological outcomes from the international transanal Total Mesorectal Excision (taTME) registry for benign and malignant rectal pathology. Background: TaTME is the latest minimally invasive transanal technique pioneered to facilitate difficult pelvic dissections. Outcomes have been published from small cohorts, but larger series can further assess the safety and efficacy of taTME in the wider surgical population. Methods: Data were analyzed from 66 registered units in 23 countries. The primary endpoint was "good-quality TME surgery." Secondary endpoints were short-term adverse events. Univariate and multivariate regression analyses were used to identify independent predictors of poor specimen outcome. Results: A total of 720 consecutively registered cases were analyzed comprising 634 patients with rectal cancer and 86 with benign pathology. Approximately, 67% were males with mean BMI 26.5 kg/m 2. Abdominal or perineal conversion was 6.3% and 2.8%, respectively. Intact TME specimens were achieved in 85%, with minor defects in 11% and major defects in 4%. R1 resection rate was 2.7%. Postoperative mortality and morbidity were 0.5% and 32.6% respectively. Risk factors for poor specimen outcome (suboptimal TME specimen, perforation, and/or R1 resection) on multivariate analysis were positive CRM on staging MRI, low rectal tumor <2 cm from anorectal junction, and laparoscopic transabdominal posterior dissection to <4 cm from anal verge. Conclusions: TaTME appears to be an oncologically safe and effective technique for distal mesorectal dissection with acceptable short-term patient outcomes and good specimen quality. Ongoing structured training and the upcoming randomized controlled trials are needed to assess the technique further.
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2017 |
Schmiegel W, Scott RJ, Dooley S, Lewis W, Meldrum CJ, Pockney P, et al., 'Blood-based detection of RAS mutations to guide anti-EGFR therapy in colorectal cancer patients: concordance of results from circulating tumor DNA and tissue-based RAS testing', MOLECULAR ONCOLOGY, 11 208-219 (2017) [C1]
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2017 |
Zala A, Bollipo SJ, Pockney P, Foster R, 'Endoscopic Removal of a Large Kitchen Knife', GASTROINTESTINAL ENDOSCOPY, 85 AB126-AB126 (2017)
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2017 |
'Abstract Journal General Surgery', ANZ Journal of Surgery, 87 41-60 (2017)
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2015 |
Smith S, Pockney P, Attia J, 'Corrigendum: A Meta-analysis on the Effect of Sham Feeding Following Colectomy: Should Gum Chewing Be Included in Enhanced Recovery After Surgery Protocols?', Diseases of the colon and rectum, 58 e416 (2015) [O1]
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2015 |
Smith SR, Draganic B, Pockney P, Holz P, Holmes R, Mcmanus B, Carroll R, 'Transversus abdominis plane blockade in laparoscopic colorectal surgery: a double-blind randomized clinical trial', INTERNATIONAL JOURNAL OF COLORECTAL DISEASE, 30 1237-1245 (2015) [C1]
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2015 |
'Abstract Journal for General Surgery', ANZ Journal of Surgery, 85 43-59 (2015)
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2015 |
'Abstract Journal for Pain Medicine (RACS)', ANZ Journal of Surgery, 85 93-94 (2015)
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2014 |
Ho YM, Smith SR, Pockney P, Lim P, Attia J, 'A Meta-analysis on the Effect of Sham Feeding Following Colectomy: Should Gum Chewing Be Included in Enhanced Recovery After Surgery Protocols?', DISEASES OF THE COLON & RECTUM, 57 115-126 (2014) [C1]
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2014 |
'Colorectal Surgery Program Abstracts', ANZ Journal of Surgery, 84 30-52 (2014)
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2014 |
'The Six Best Abstracts', Colorectal Disease, 16 1-2 (2014)
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2010 |
Reid K, Pockney PG, Pollitt T, Draganic B, Smith SR, 'Randomized clinical trial of short-term outcomes following purse-string versus conventional closure of ileostomy wounds', British Journal of Surgery, 97 1511-1517 (2010) [C1]
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2010 |
Reid K, Pockney P, Draganic B, Smith S, 'Barrier wound protection decreases surgical site infection in open elective colorectal surgery: A randomized clinical trial', Diseases of the Colon & Rectum, 53 1374-1380 (2010) [C1]
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2009 |
Pockney PG, Primrose J, George S, Jayatilleke N, Leppard B, Smith H, et al., 'Recognition of skin malignancy by general practitioners: Observational study using data from a population-based randomised controlled trial', British Journal of Cancer, 100 24-27 (2009) [C1]
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2008 |
George S, Pockney PG, Primrose J, Smith H, Little P, Kinley H, et al., 'A prospective randomised comparison of minor surgery in primary and secondary care. The MISTIC trial', Health Technology Assessment, 12 1-30 (2008) [C1]
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2008 |
George S, Pockney P, Primrose J, Smith H, Little P, Kinley H, et al., 'A prospective randomised comparison of minor surgery in primary and secondary care. The MiSTIC trial', HEALTH TECHNOLOGY ASSESSMENT, 12 III-+ (2008)
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2004 |
Pockney P, George S, Primrose J, Smith H, Kinley H, Little P, et al., 'Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by general practitioners: observational study', JOURNAL OF PUBLIC HEALTH, 26 264-267 (2004)
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2002 |
Smith GB, Nolan J, King A, Pockney P, Nielsen M, Coombes M, et al., 'Medical emergency teams and cardiac arrests in hospital [3] (multiple letters)', British Medical Journal, 324 1215-1216 (2002)
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2002 |
King A, Pockney P, Nielsen M, Coombes M, Bailey I, Clancy M, 'Medical emergency teams and cardiac arrests in hospital. Bottom up approach works too.', BMJ (Clinical research ed.), 324 (2002)
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2002 |
Smith GB, Nolan J, 'Medical emergency teams and cardiac arrests in hospital - Results may have been due to education of ward staff', BRITISH MEDICAL JOURNAL, 324 1215-1215 (2002)
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1998 |
Clancy MJ, Pockney PG, 'Fitness to drive', JOURNAL OF ACCIDENT & EMERGENCY MEDICINE, 15 366-366 (1998) |
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