Surgeons In Australia Research Articles

Surgeons’ Views on Hypospadias Care Journey: A Qualitative Study.

BackgroundThree major parties are involved in the hypospadias treatment journey – the patient, their parents/carers, and the surgeon. There is a strong trend towards involving all three, where possible, in deriving evidence around the care pathways. Currently, there are little data available on surgeons’ perspectives of distal hypospadias care. AimThis study explored the reflections of Australian and Aotearoa New Zealand Paediatric hypospadias surgeons on the journey and experience of children born with distal hypospadias and their families, with the aim to improve this journey to achieve a better healthcare experience and satisfaction. We sought to understand a) what informs the content and process of a hypospadias surgeon’s consultation with parents/carers, b) how hypospadias surgeons negotiate surgical outcomes, parents/carers’ views and preferences, social circumstances, cultural context, and their clinical opinions and treatment recommendations, and c) how surgeons perceive the journey for families with a child born with distal hypospadias could be improved. MethodsWe conducted a qualitative descriptive study to generate rich descriptions of the lived experiences of hypospadias surgeons caring for children with distal hypospadias and their families. Data were collected using semi-structured interviews with nine paediatric hypospadias surgeons in Australia and Aotearoa New Zealand. All participants had routinely practised hypospadias surgery as a consultant for at least five years. Participants were purposively sampled to obtain a diverse representation of perspectives. Data were collected and analysed using the reflexive thematic analysis methodology. ResultsTwo overarching themes reflecting the lived experiences of paediatric hypospadias surgeons emerged: The journey is as varied as the children and their families, and The best possible journey. The first overarching theme is characterised by three themes: Journey feature, Journey process, and Journey influences, each illuminating main elements informing participants’ perspective of the treatment journey. Surgeons perceive the journey as highly individualised; they mark the start of the journey differently but put a great emphasis on the consultation and identify several essential parts of it. The second overarching theme reflects participants’ ideas on key elements of hypospadias care that could improve the treatment journey, such as better information for carers and non-surgeon healthcare providers, more communication training for surgeons in their formative years, and societal acceptance of anatomical variance. ConclusionThe journey of children and families is perceived by surgeons as variable, individualised, and affected by different influences. Those influences highlight the importance of knowing your patient/family and creating tailored, individualised, family-centred communication and care.

Barriers and Willingness to Continue Using Telehealth Services Beyond the COVID-19 Pandemic from the Perspectives of Oral and Maxillofacial Surgeons in Australia: A Mixed-Method Study.

Patient demand for oral and maxillofacial telehealth services increased during COVID-19. To explore the potential for their continued use post-COVID-19, an assessment was conducted by examining the association between the clinical and socio-demographic characteristics of consultants and the perceived facilitators and barriers influencing their future intent. Practicing oral and maxillofacial consultants were recruited through purposive and snowball sampling methods. Data were collected through surveys and key informant interviews. Chi-square tests were used to determine whether consultants' clinical and socio-demographic characteristics and perceptions were associated with a willingness to use telehealth in the future. Coded interview transcripts were analyzed thematically to identify the main themes influencing their willingness. Among the 42 respondents, 82% expressed a willingness to continue using telehealth services with the majority having at least 2 to 3 years (p = 0.028) of experience utilizing these services. The four main themes impacting consultants willingness include the accessibility of oral and maxillofacial healthcare, challenges addressing patient needs, the uncertainty of diagnostic accuracy and effectiveness as a post-operation observation tool. Most oral and maxillofacial consultants favored the routine use of telehealth services beyond COVID-19. Concern for patients' needs was a key determinant of their continued use. Co-designing strategies to eliminate barriers and unmet needs for consultants and patients may improve oral and maxillofacial telehealth uptake.

Evaluating anti-bullying training in surgery: surgeons' perceptions from Australia and Aotearoa New Zealand.

ObjectiveTo evaluate how surgeons in Australia and Aotearoa New Zealand perceive the effectiveness of the Operating with Respect (OWR) face-to-face training program in reducing workplace bullying.MethodsA cross-sectional survey examined the perceived effectiveness of the Royal College of Surgeons' (RACS) face-to-face OWR training and complementary interventions in reducing workplace bullying in surgical settings. The sample included supervisory surgeons, RACS committee members, and targeted educators. The survey instrument had 35 questions, including five related to the research question. In December 2020, the survey was distributed by RACS to all surgeons who undertook OWR training between April 2017 and December 2019. Likert scales and coded free text responses were used to explore the effectiveness of face-to-face OWR training and other interventions included in the 2015 RACS Action Plan.ResultsOf the 756 surveys sent, 252 were received. The face-to-face OWR training program was rated as moderately effective. RACS's overarching approach to anti-bullying was almost equally important, highlighting the need to consider a broader ecosystem of reform.ConclusionsThis study finds the RACS full-day anti-bullying training moderately effective in reducing bullying in surgical workplaces. However, enhancing its impact requires a sustained, multi-faceted strategy, including broader policy reforms, accountability measures, and cultural changes, to foster a long-term respectful environment in surgical settings.

Podiatric surgery: a canary in the coalmine for professional monopolies.

What is known about the topic? The health workforce and health tasks are highly contested and largely controlled by regulation. Since the introduction of medical regulation in the mid-19th century, the practice of surgery has been largely dominated by medically trained surgeons. A small group of Australian podiatrists have defied these historic boundaries by creating their own colleges of training and convincing government and regulators of their safety and efficacy in surgical practice. The Podiatry Board of Australia commissioned an independent review of the regulation and regulatory practices of podiatric surgeons in Australia. What does this paper add? This paper discusses the implications of a regulatory review of the role of podiatric surgeons for professional role boundaries. What are the implications for practitioners? Despite historic role boundaries and definitions, with appropriate training, regulation, and financing, the health workforce can be mobilised in different ways to meet population needs, overcoming a professional monopoly over roles.

Update on gender-affirming surgery

William Blake looks at advances in the provision of gender-affirming surgery and how plastic surgeons in Australia can respond to the need for better surgical care for gender-diverse people.

Estimation of risk posed by malignant polyps amongst colorectal surgeons in Australia and New Zealand.

The estimation of the risk posed by malignant polyps for residual or lymphatic disease plays a central role. This study investigated colorectal surgeons' assessment of these risks associated with malignant polyps. A cross-sectional questionnaire was electronically administered to colorectal surgeons in Australia and New Zealand in October 2022. The questionnaire contained 17 questions on demographics, when surgeons consider colorectal resection appropriate, and the risk assessment for 5 hypothetical malignant polyps. The mean risk of residual or lymphatic disease that would prompt surgeons to recommend colonic resection was 5%. However, this increased to a mean risk of 10% if the malignant polyp was located in the rectum, and the only resection option was abdominoperineal resection with end-colostomy. There was high concordance between the estimated risk of residual or lymphatic disease by colorectal surgeons and the Association of Coloproctology of Great Britain and Ireland (ACPGBI) guidelines for the 5 hypothetical malignant polyps, with the ACPGBI estimated risk lying within the 95% confidence interval for 4 of the 5 malignant polyps. Nonetheless, 96.6% of surgeons felt that an online risk calculator would improve clinical practice. Colorectal surgeons in Australia and New Zealand accurately estimated the risk posed by malignant polyps. An online risk calculator may assist in better conveying risk to patients.

What is the nature, extent and impact of bullying in surgical settings? Insights of surgeons in Australia and Aotearoa New Zealand.

A significant body of literature has examined the impact of verbal and non-verbal bullying in surgical settings, where a central focus has been on the experiences of trainee and junior members of the surgical team, women in surgery and other health professionals, such as nurses. Research on how surgeons' perceive or experience bullying is more limited. Therefore, this study aims to investigate the views of surgeons on negative and disrespectful verbal and non-verbal behaviour and bullying in surgical settings, including its impact on surgeons themselves and the surgical staff they oversee. Semi-structured interviews were undertaken with surgeons between February and November 2019. Questions explored surgeons' perceptions of interpersonal communication and behaviour in their surgical workplaces in the preceding 6-months. A narrative analysis approach was used to code, interpret, and report the interview data. Thirty-one interviews were conducted with surgeons (19 male and 12 female), from Australia (26) and Aotearoa New Zealand (5) from 10 surgical specialties. Three themes were identified with associated subthemes: bullying (five subthemes), non-verbal bullying (seven subthemes), and impact and outcomes of bullying (six subthemes). This study revealed a notable shift in the reported verbal and non-verbal bullying behaviour among surgeons, demonstrating a decrease in intensity, physicality and violence for the 6-months prior to interviews conducted in 2019, when compared with surgeons' historic experiences. Despite reported behaviour being more subtle and indirect, it nonetheless continues to have a marked impact on many surgeons as well as the staff they oversee.

Venous thromboembolic prophylaxis: current practice of surgeons in Australia and New Zealand for major abdominal surgery

BackgroundSurgical prophylaxis for venous thrombo-embolic disease (VTE) includes risk assessment, chemical prophylaxis and mechanical prophylaxis (graduated compression stockings [GCS] and/or intermittent pneumatic compression devices [IPCD]). Although there is overwhelming evidence for the need and efficacy of VTE prophylaxis in patients at risk, only about a third of those who are at risk of VTE receive appropriate prophylaxis.ObjectiveThere is debate as to the best combination of VTE prophylaxis following abdominal surgery due to lack of evidence. The aim of this survey was to understand this gap between knowledge and practice.MethodsIn 2019 and 2020, a survey was conducted to investigate the current practice of venous thromboembolism (VTE) prophylaxis for major abdominal surgery, with a focus on colorectal resections. The study received ethics approval and involved distributing an 11-item questionnaire to members of two professional surgical societies: the Colorectal Surgical Society of Australia and New Zealand (CSSANZ) and the General Surgeons Australia (GSA).ResultsFrom 214 surgeons: 100% use chemical prophylaxis, 68% do not use a risk assessment tool, 27% do not vary practice according to patient risk factors while > 90% use all three forms of VTE prophylaxis at some stage of treatment. Most surgeons do not vary practice between laparoscopic and open colectomy/major abdominal surgery and only 33% prescribe post-discharge chemical prophylaxis. 42% of surgeons surveyed had equipoise for a clinical trial on the use of IPCDs and the vast majority (> 95%) feel that IPCDs should provide at least a 2% improvement in VTE event rate in order to justify their routine use.ConclusionMost surgeons in Australia and New Zealand do not use risk assessment tools and use all three forms of prophylaxis regardless. Therfore there is a gap between practice and VTE prophylaxis for the use of mechanical prophylaxis options. Further research is required to determine whether dual modality mechanical prophylaxis is incrementally efficacious. Trial Registration- Not Applicable.

How to perform breast augmentation using a composite myofascial flap

Breast augmentation is one of the most frequently performed by specialist plastic surgeons in Australia.^1^ Refinements in operative breast augmentation techniques have continued to evolve over time. Implant migration remains a concern, especially when using smooth implants. The breast implant can either displace laterally towards the mid-axillary line or inferiorly through the inframammary fold, resulting in a loss of cleavage, upper pole fullness, ‘bottoming out’ and in some cases a mega pocket. Specifically, this technique aims to prevent telemastia, defined as an abnormally wide separation between the breasts.^2^ We propose an intraoperative technique unique to primary breast augmentation that ensures the breast implant is secured by means of a composite autologous myofascial (CMF) sling involving the pectoralis major muscle. This aims to prevent inferno-lateral displacement of the breast implant which renders a poor aesthetic result secondary to loss of ‘cleavage’ and the resultant formation of a ‘mega pocket’. The authors have integrated this technique into their practice since August 2020, with case numbers now in excess of 500. The authors use the technique to mitigate implant displacement in both breast augmentation and augmentation mastopexy cases.

ARE ORTHOPAEDIC SURGEONS READING RADIOLOGY REPORTS? A TRANS-TASMAN SURVEY

The attitudes of orthopaedic surgeons regarding radiology reporting is not well-described in the literature. We surveyed Orthopaedic Surgeons in Australia and New Zealand to assess if they routinely review formal radiology reports.An anonymized, 14 question online survey was distributed to consultant surgeons of the Australian and New Zealand Orthopaedic Associations (AOA, NZOA). Two hundred respondents completed the survey (Total number of Fellows: 283 NZOA, 1185 AOA). 18.5% of respondents always reviewed the formal Radiology report, 44.5% most of the time, 35% sometimes and 2% never. By imaging modality, MRI reports were the most frequently reviewed (92%), followed by ultrasound (74%) and nuclear medicine (63%). Only 10% of surgeons consulted formal reports for plain radiography. 55% of surgeons were still likely to disagree with the MRI report, followed by 46% for plain radiography. In cases of disagreement, only 21% of surgeons would always contact the reporting radiologist. The majority of Surgeons (85.5%) think there should be more collaboration between the disciplines, although only 50.5% had regular attendance of a Radiologist at their departmental audit.This survey reveals that the majority of orthopaedic surgeons are not routinely reading radiology reports. This points towards a need for further interdisciplinary collaboration. To our knowledge, this is the first survey directly assessing attitudes of orthopaedic surgeons towards radiology reports.

Are there differences between SIMG surgeons and locally trained surgeons in Australia and New Zealand, as rated by colleagues and themselves?

BackgroundRepresentation of specialist international medical graduates (SIMGs) in specific specialties such as surgery can be expected to grow as doctor shortages are predicted in the context of additional care provision for aging populations and limited local supply. Many national medical boards and colleges provide pathways for medical registration and fellowship of SIMGs that may include examinations and short-term training. There is currently very little understanding of how SIMGs are perceived by colleagues and whether their performance is perceived to be comparable to locally trained medical specialists. It is also not known how SIMGs perceive their own capabilities in comparison to local specialists. The aim of this study is to explore the relationships between colleague feedback and self-evaluation in the specialist area of surgery to identify possible methods for enhancing registration and follow-up training within the jurisdiction of Australia and New Zealand.MethodsFeedback from 1728 colleagues to 96 SIMG surgeons and 406 colleagues to 25 locally trained Fellow surgeons was collected, resulting in 2134 responses to 121 surgeons in total. Additionally, 98 SIMGs and 25 Fellows provided self-evaluation scores (123 in total). Questionnaire and data reliability were calculated before analysis of variance, principal component analysis and network analysis were performed to identify differences between colleague evaluations and self-evaluations by surgeon type.ResultsColleagues rated SIMGs and Fellows in the ‘very good’ to ‘excellent’ range. Fellows received a small but statistically significant higher average score than SIMGs, especially in areas dealing with medical skills and expertise. However, SIMGs received higher scores where there was motivation to demonstrate working well with colleagues. Colleagues rated SIMGs using one dimension and Fellows using three, which can be identified as clinical management skills, inter-personal communication skills and self-management skills. On self-evaluation, both SIMGs and Fellows gave themselves a significant lower average score than their colleagues, with SIMGs giving themselves a statistically significant higher score than Fellows.ConclusionsColleagues rate SIMGs and Fellows highly. The results of this study indicate that SIMGs tend to self-assess more highly, but according to colleagues do not display the same level of differentiation between clinical management, inter-personal and self-management skills. Further research is required to confirm these provisional findings and possible reasons for lack of differentiation if this exists. Depending on the outcome, possible support mechanisms can be explored that may lead to increased comparable performance with locally trained graduates of Australia and New Zealand in these three dimensions.

Current practice of trabeculectomy in a cohort of experienced glaucoma surgeons in Australia and New Zealand

Background/ObjectivesTo evaluate current routine trabeculectomy technique preferences among Australian and New Zealand Glaucoma Society surgeons regularly performing trabeculectomy surgery.Subjects/MethodsSurvey of experienced surgeons who perform trabeculectomy.ResultsForty-nine surgeons (33 male:16 female) participated in the survey. Trabeculectomy was performed as day surgery (39/47, 83.0%) under local anesthesia (44/47, 93.6%). The surgical techniques most commonly used were a corneal traction suture (44/47, 93.6%), fornix-based conjunctival flap (43/47, 91.5%) and half-thickness scleral flap (38/47, 81.0%). Mitomycin C antifibrotic agent was used in routine cases by 45/46 (97.8%) surgeons. Surgeons applied the antifibrotic agent under the Tenon layer with a pledget (36/46, 78.2%) with a concentration of 0.02% (37/46, 80.4%) for 2 (11/46, 23.9%) or 3 min (30/46, 65.2%). The Kelly (26/46, 56.5%) and the Khaw Descemet (19/46, 41.3%) punches were used to perform the sclerostomy. Most surgeons performed a peripheral iridectomy in all phakic patients (46/47, 97.9%), but less commonly in pseudophakic patients (34/47, 72.3%). Techniques for closure of the limbal conjunctival edge were quite varied with a combination of suturing including purse string (21/47, 57.4%), wing (20/47, 42.6%) and horizontal mattress sutures (33/47, 70.2%). Surgeons reviewed their routine patients four times in the first month (29/47, 61.7%) and continued the postoperative topical steroids for 3–4 months (28/47, 59.6%).ConclusionsAlthough a wide range of techniques for trabeculectomy exists among surgeons, there are consistent procedures currently in use to optimize patient outcomes. This report will assist surgeons in choosing which surgical techniques fit their best practice.

Characteristics, treatment and outcomes of 589 melanoma patients documented by 27 general practitioners on the Skin Cancer Audit Research Database.

ABSTRACTBackground and objectiveGeneral practitioners manage more melanomas than dermatologists or surgeons in Australia. Previously undescribed, the management and outcomes of melanoma patients treated by multiple Australasian general practitioners are examined.MethodsThe characteristics, management and outcomes of 589 melanoma patients, managed by 27 Australasian general practitioners and documented on the Skin Cancer Audit Research Database (SCARD), were analysed.ResultsMost patients (58.9%) were males with mean age at diagnosis of 62.7 years (range 18–96), and most melanomas were in situ or thin‐invasive. Patients aged under 40 years had fewer melanomas, but a higher proportion (the majority) were invasive, compared with older patients (P < 0.0001).Most (55.9%) melanomas were diagnosed following elliptical excision biopsy, the rate of unintended involved margins being eightfold higher for shave biopsies. Wide re‐excision was performed by the treating general practitioner for most (74.9%) melanomas, with thick melanomas preferentially referred to surgeons. The average Breslow thickness of invasive melanomas re‐excised by general practitioners was 0.67 mm compared with 1.99 mm for those referred to other specialists (P < 0.0001). Of 205 patients with invasive melanoma, 14 progressed to metastatic disease, 50% of these being associated with nodular melanoma. Nine patients progressed to melanoma‐specific death. The 5‐year survival rate for patients with invasive melanoma was 95.2% (95% CI: 91.2–98.5%).ConclusionsDiagnostic and therapeutic management of a series of melanoma patients by Australasian general practitioners were closely aligned with current guidelines and 5‐year survival with respect to invasive melanoma was at least as favourable as national population‐based metrics.

Acute postoperative pain management protocols in podiatric surgery within Australia: a Delphi study

BackgroundThere is limited evidence in the literature to describe an analgesic protocol that takes into consideration the extent of foot and ankle surgery. The aim of this study was to develop a guide for acute postoperative pain management for podiatric surgery in Australia, and to identify opportunities to improve the current list of scheduled medicines available to podiatric surgeons.MethodsA Delphi method involving 3 survey rounds was employed for this study. Twelve expert panellists in the field of podiatric surgery and anaesthesiology were invited to participate, and 10 panellists remained by the end of the study. Round 1 involved 15 open-ended questions. These answers formed the basis of the 55 statements that were developed for the following 2 survey rounds, where panellists rated the appropriateness of each statement on a 9-point Likert scale. The third survey round was an opportunity for panellists to revise their answers to each statement in light of the majority response.ResultsFor mild acute postoperative pain, non-opioid oral analgesics were recommended as an appropriate management option. For moderate and severe acute postoperative pain, both non-opioid and opioid products were found to be appropriate by the majority. It was agreed that oral opioids be reserved for breakthrough pain at all severity levels. All other statements in the Delphi study pertaining to drug hypersensitivities or allergies, stratification of pain management, opioid prescription concerns, and access to pain medications were accepted as appropriate by the majority of panellists.ConclusionThe agreed approach to acute postoperative pain management for podiatric surgeons in Australia was with a stepwise approach, utilising multimodal therapy, and reserving oral opioids for breakthrough pain. Additionally, there was consensus for podiatric surgeons in Australia to have wider access to alternative analgesics and anti-emetics that have similar or improved efficacies with better safety profiles.

Venous Thromboembolic Prophylaxis: Current Practice of Surgeons in Australia and New Zealand for Major Abdominal Surgery

Venous Thromboembolic Prophylaxis: Current Practice of Surgeons in Australia and New Zealand for Major Abdominal Surgery

Opinions about the most appropriate surgical management of diabetes-related foot infection: a cross-sectional survey

BackgroundThere is a lack of high quality evidence to guide the optimal management of diabetes-related foot infection, particularly in cases of severe diabetes-related foot infection and diabetes-related foot osteomyelitis. This study examined the opinions of surgeons about the preferred management of severe diabetes-related foot infection.MethodsVascular and orthopaedic surgeons in Australia and New Zealand were invited to complete an online survey via email. The survey included multi-choice and open-ended questions on clinical management of diabetes-related foot infection. Responses of vascular surgeons and orthopaedic surgeons were compared using non-parametric statistical tests. Open-text responses were examined using inductive content analysis.Results29 vascular and 20 orthopaedic surgeons completed the survey. One-third (28.6%) used best-practice guidelines to assist in decisions about foot infection management. Areas for guideline improvement identified included more specific advice regarding the indications for available treatments, more recommendations about non-surgical patient management and advice on how management can be varied in regions with limited health service resource. The probe-to-bone test and magnetic resonance imaging were the preferred methods of diagnosing osteomyelitis. Approximately half (51.2%) of respondents indicated piperacillin combined with tazobactam as the preferred antibiotic choice for empirical treatment of severe diabetes-related foot infection. Negative pressure wound therapy was the most common way of managing a wound following debridement. All vascular surgeons (100%) made revascularisation decisions based on the severity of ischemia while most orthopaedic surgeons (66.7%) were likely to refer to vascular surgeons to make revascularisation decisions. Vascular surgeons preferred using wound swabs while orthopaedic surgeons favoured tissue or bone biopsies to determine the choice of antibiotic. Respondents perceived a moderate variation in management decisions between specialists and supported the need for randomised controlled trials to test different management pathways.ConclusionsMost vascular and orthopaedic surgeons do not use best-practice guidelines to assist in decisions about management of diabetes-related foot infection. Vascular and orthopaedic surgeons appear to have different preferences for wound sampling to determine choice of antibiotic. There is a need for higher quality evidence to clarify best practice for managing diabetes-related foot infection.

The impact of the COVID-19 pandemic on colorectal cancer diagnosis and management: a Binational Colorectal Cancer Audit study.

The COVID-19 pandemic has resulted in global disruptions to the delivery of healthcare. The national responses of Australia and New Zealand has resulted in unprecedented changes to the care of colorectal cancer patients, amongst others. This paper aims to determine the impact of COVID-19 on colorectal cancer diagnosis and management in Australia and New Zealand. This is a multicentre retrospective cohort study using the prospectively maintained Binational Colorectal Cancer Audit (BCCA) registry. Data is contributed by over 200 surgeons in Australia and New Zealand. Patients receiving colorectal cancer surgery during the pandemic were compared to averages from the same period over the preceding 3 years. There were fewer operations in 2020 than the historical average. During April to June, patients were younger, more likely to have operations in public hospitals and more likely to have urgent or emergency operations. By October to December, proportionally less patients had Stage I disease, proportionally more had Stage II or III disease and there was no difference in Stage IV disease. Patients were less likely to have rectal cancer, were increasingly likely to have urgent or emergency surgery and more likely to have a stoma created. This study shows that the response to COVID-19 has had measurably negative effects on the diagnosis and management of colorectal cancer in two countries that have had significantly fewer COVID-19 cases than many other countries. The long-term effects on survival and recurrence are yet to be known, but could be significant.

Clinicians' perceptions around discectomy surgery for lumbar disc herniation: a survey of orthopaedic and neuro-surgeons in Australia and New Zealand.

Understanding practice-based differences in treatment of lumbar disc herniations (LDHs) is vital for reducing unwarranted variation in the delivery of spine surgical health care. Identifying factors that influence surgeons' decision-making will offer useful insights for developing the most cost-effective and safest surgical strategy as well as developing surgeon education materials for common lumbar pathologies. This study was to capture any variation in techniques used by surgeons in Australia and New Zealand (ANZ) region, and perceived complications of different surgical procedures for primary and recurrent LDH (rLDH). Web-based survey study was emailed to orthopaedic and neurosurgeons who routinely performed spinal surgery in ANZ from Decmber 20, 2018 to February 20, 2020. The response data were analyzed to assess for differences based on geography, practice setting, speciality, practice experience, practice length, and operative volume. Invitations were sent to 150 surgeons; 96 (64%) responded. Most surgeons reported microdiscectomy as their surgical technique of choice for primary LDH (73%) and the first rLDH (72%). For the second rLDH, the preferred choice for most surgeons was fusion surgery (82%). A surgeon's practice setting (academic/private/hybrid) was a statistically significant factor in what surgical procedure was chosen for the first rLDH (P = 0.014). When stratifying based on surgeon experience, there were statisfically significant differences based on the annual volume of spine surgeries performed (perceived reherniation rates following primary discectomy, P = 0.013; perceived reherniation rates following revision surgeries, P = 0.017; perceived intraoperative complications rates following revision surgeries, P = 0.016) and based on the annual volume of lumbar discectomies performed (perceived reherniation rates following revision surgeries, P = 0.022; perceived intraoperative complications rates following revision surgeries, P = 0.036; perceived durotomy rates following primary discectomy, P = 0.023). Surgeons' annual practice volume and practice setting have significant influences in the selection of surgical procedures and the perception of surgical complications when treating LDHs.

Bowel Preparation and Oral Antibiotic Agents for Selective Decontamination in Colorectal Surgery: Current Practice, Perspectives, and Trends in Australia and New Zealand, 2019-2020.

Background: There has been much debate as to the importance of mechanical bowel preparation (MBP) and oral antibiotic agents (OAB) prior to elective colorectal surgery over the past two decades. There is no consensus between international guidelines. Methods: The Australia and New Zealand Mechanical Bowel Preparation and Oral Antibiotics (ANZ-MBP-OAB) questionnaire was distributed to colorectal surgeons after institutional board approval assessing specialist attitudes toward 18 enhanced recovery after surgery (ERAS) interventions. Data were analyzed using a rating scale and graded response model in item response theory (IRT) on Stata MP, version 15 (StataCorp LP, College Station, TX). Specialist attitudes toward the effectiveness of MBP and OAB strategies in providing better short-term outcomes was ranked alongside other ERAS interventions. This was followed by specific questions examining current practice, perspectives, and trends. Results: Ninety-five of 300 (31.7%) colorectal surgeons in Australia and New Zealand participated in the survey. Statistical modeling was achieved in 13 ERAS interventions. Compared with other ERAS interventions, the use of MBP with OAB and MBP alone ranked nine of 13 and 10 of 13, respectively, in order of effectiveness in providing better short-term outcomes after colorectal surgery. Oral antibiotic agents alone was not considered effective. Mechanical bowel preparation with OAB was considered to be the best strategy in both colon (37%) and rectal surgery (48%) but current practice varied substantially from perspective. Mechanical bowel preparation alone was strongly favored in rectal surgery (81%) with only 14% using MBP with OAB. In colon surgery, only 10% used MBP with OAB, with MBP alone (45%) and no preparation (45%) being equally the most commonly used strategies. Conclusions: Among Australian and New Zealand colorectal surgeons, MBP with OAB was considered the best bowel preparation strategy. However, despite an awareness of its benefits, MBP with OAB has yet to be widely adopted into clinical practice or guidelines in Australia and New Zealand.

Management of thoracic empyema in children: a survey of the Australia and New Zealand Association of Paediatric Surgeons (ANZAPS).

To define the spectrum of management for thoracic empyema in children in Australia and New Zealand. Online survey of members of the Australian and New Zealand Association of Paediatric Surgeons (ANZAPS), limited to consultant/attending paediatric surgeons. A total of 54/80 (67.5%) members, from 16 paediatric surgical centres, responded. The majority (33/54, 61%) preferred chest drain with fibrinolytics, whilst 21/54 (39%) preferred video-assisted thoracoscopic surgery (VATS) with drain insertion. Urokinase was the most commonly used fibrinolytic (64%). There were no significant differences in management preferences between practising surgeons in Australia and New Zealand (p = 0.54), nor between consultants who had been practising a shorter (< 5years) or longer (> 20years) amount of time (p = 0.21). The practices described by the surveyed ANZAPS members were in line with the Thoracic Society of Australia and New Zealand recommendations for the management of paediatric empyema. Across Australia and New Zealand there exists significant variation surrounding the intra- and post-intervention management of thoracic empyema in children. The surveyed paediatric surgeons demonstrated a preference for fibrinolytics over the use of VATS. All management regimens were within published local guidelines.