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Fitzpatrick SE, Foley K, Crittenden T, Watson D, Dean NR. Australian women's experiences of post-partum rectus diastasis: A qualitative study. Womens Health (Lond) 2024; 20:17455057241233123. [PMID: 38577913 PMCID: PMC10998484 DOI: 10.1177/17455057241233123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/23/2023] [Accepted: 01/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Post-partum rectus diastasis, or the separation of the abdominal muscles after pregnancy, occurs in conjunction with physical symptoms and impaired quality of life. In Australia, health funding for surgery to treat diastasis was ceased in 2016, but reinstated in mid-2022, providing a unique context from which women's experiences of this condition can be analysed. OBJECTIVES The objective is to examine the experiences of Australian women with post-partum rectus diastasis. DESIGN This is an interview-style study with qualitative content analysis. METHODS Women diagnosed with rectus diastasis were recruited to complete a baseline questionnaire (n = 45). Twenty-three responded to invitation for one-on-one interview via Zoom® between November 2021 and May 2022. Interviews were recorded, transcribed, and analysed using qualitative content analysis to identify key themes. RESULTS Eighteen women had undergone caesarean section and eight had twins. Thirteen had private health insurance. Women were most often diagnosed by a physiotherapist (n = 10). Key themes identified included changed physical appearance and function; issues with self-esteem and intimacy; barriers to treatment; lack of recognition as a medical condition; and overall frustration. The impact of rectus diastasis extended beyond physical and psychological symptoms to affect women's social functioning, child rearing, and return to work. There was a complex interaction between healthcare providers' knowledge of rectus the removal of funding for surgical treatment, and limitations of conservative therapy, with women's lived experiences and symptoms. The lack of an established medical definition also influenced the experiences of these women and their engagement with treatment. CONCLUSION This study contextualizes women's experience of post-partum rectus diastasis with respect to the unique landscape of Australia's healthcare economy and provides evidence of women's absorption of health policy surrounding this condition. Our qualitative analysis provides critical knowledge for future quantitative studies, the results of which in combination could advance the definition of rectus diastasis and inform healthcare policy surrounding treatment.
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Affiliation(s)
- Siobhan Elizabeth Fitzpatrick
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Kristen Foley
- Centre for Public Health, Equity and Human Flourishing, Torrens University, Adelaide, SA, Australia
| | - Tamara Crittenden
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - David Watson
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Nicola R Dean
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, SA, Australia
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Zhou MA, Deek R, Crittenden T, Dean NR. A five-year retrospective cohort study of carpal tunnel surgery complications in an Australian population. ANZ J Surg 2022; 92:3283-3287. [PMID: 36203391 DOI: 10.1111/ans.18088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/14/2022] [Accepted: 09/19/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carpal tunnel syndrome is a common compressive neuropathy. There is a lack of comprehensive studies evaluating carpal tunnel release (CTR) complications in Australia. This study aimed to evaluate complication rates associated with open and endoscopic CTR in an Australian population, and to identify associated risk factors. METHODS Retrospective cohort study of 1287 CTR from 2015 to 2020. Methods of release were endoscopic, open and surgery concomitant with synovectomy or other. Outcomes included wound infection, dehiscence, nerve injury, complex regional pain syndrome, incomplete release, and re-operation. Statistical analysis included Chi-squared test, Fisher's exact test, Odds ratio and logistic regression. RESULTS There were 71 total complications (5.5%), including 35 Clavien-Dindo IIIb complications. There was no difference in complication rates for endoscopic (3.3%) versus open (8.3%) CTR (P = 0.18). The overall rate of complications was higher in CTR with concomitant surgery (8.5%) compared to CTR alone (5.2%), though this was not statistically significant (P = 0.058). There was no association between rates of complications and immune suppression (p = 0.55), rheumatoid disease (P = 0.61), or smoking status (P = 0.72). Diabetes mellitus was associated with an increased risk of Clavien-Dindo IIIb complications (P = 0.028, OR 2.15, 95% CI 1.07-4.32). There was no association between surgical experience and complication rate (P = 0.55). CONCLUSION Open and endoscopic CTR surgeries have similar rates of complications. Diabetes is associated with higher rates of Clavien-Dindo IIIb complications. Identification of high-risk patients allows for the application of risk-mitigation strategies in the perioperative setting.
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Affiliation(s)
- Mengqi Adele Zhou
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Roland Deek
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Tamara Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Deek RP, Lee IOK, van Essen P, Crittenden T, Dean NR. Predicted versus actual complications in Australian women undergoing post-mastectomy breast reconstruction: a retrospective cohort study using the BRA Score tool. J Plast Reconstr Aesthet Surg 2021; 74:3324-3334. [PMID: 34253489 DOI: 10.1016/j.bjps.2021.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION The Breast Reconstruction Risk Assessment (BRA) Score tool is a risk calculator developed to predict the risk of complications in individual patients undergoing breast reconstruction. It was developed in a North American population exclusively undergoing immediate breast reconstruction. This study sought to assess the predictions of the BRA Score tool against the measured outcomes of surgery for an Australian public hospital population, including both immediate and delayed reconstructions. METHOD This was a retrospective cohort study of data from women at a single Australian public teaching hospital unit. Data from the Flinders Breast Reconstruction Database was retrieved and compared to BRA Scores calculated for each patient. Receiver operating curve area under the curve analysis was performed as well as Brier scores to compare predicted versus observed complications. RESULTS BRA Score predictions were reasonable or good (C-statistic >0.7, Brier score <0.09) for the complications of overall surgical complications, surgical site infection (SSI) and seroma at 30 days, and similarly accurate for prediction of the same complications for implant reconstructions at 12 months. There were similar findings between delayed and immediate reconstructions. CONCLUSION The BRA Score risk calculator is valid to detect some risks in both patients undergoing immediate and delayed breast reconstruction in an Australian public hospital setting. SSI is the best predicted complication and is well-predicted across both autologous and prosthetic reconstruction types.
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Affiliation(s)
- Roland P Deek
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Imogen O K Lee
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Phillipa van Essen
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia.
| | - Tamara Crittenden
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Nicola R Dean
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia; Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
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Stefani K, Baxter C, Crittenden T, Dean NR. Normative data for the Nasal Obstruction Symptom Evaluation Scale in the general Australian population. ANZ J Surg 2020; 90:2304-2309. [PMID: 32419225 DOI: 10.1111/ans.15990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Recent changes to the Australian Medicare Benefits Scheme have introduced the NOSE Score as a criteria threshold for funding rhinoplasty. On review of the literature, however, there is minimal normative Nasal Obstruction Symptom Evaluation (NOSE) score data to provide context for these changes. METHODS Participants were recruited according to the general Australian population distribution of age (18-65 years), gender and geographical locations using the market research company Pureprofile. The data included demographic details, risk factors for nasal obstruction such as smoking, obstructive sleep apnoea, use of continuous positive airway pressure, history of nasal trauma, operations to the nose and a history of cleft lip/palate and each participant completed the NOSE Scale. Analysis of data included descriptive statistics, independent t-tests and one-way analysis of variances to assess differences in NOSE scores between risk factors. RESULTS The NOSE score was completed by 247 males and 255 females with a mean age of 41(±13.39) years. The cohort had a mean NOSE score of 16 (±18.89) with a range from 0 to 95. A total of 48 respondents had a NOSE score greater than the Medicare threshold of >45. Cleft lip/palate, obstructive sleep apnoea and continuous positive airway pressure use were shown to have a statistically significant impact on NOSE score while other variables including body mass index, gender, smoking, location and other surgery to the nose were not shown to significantly impact results. CONCLUSIONS This study found that 9.6% of the general Australian population would have a NOSE score >45 and qualify for the Medicare Benefits Scheme rhinoplasty benefit.
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Affiliation(s)
- Kristian Stefani
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Claire Baxter
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Tamara Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Adelaide, South Australia, Australia.,Discipline of Surgery, College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
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Abstract
OBJECTIVES To assess the health burden of breast hypertrophy and the comparative effectiveness of breast reduction surgery in improving health-related quality of life. DESIGN Prospective cohort study. SETTING A major public tertiary care hospital in Australia. PARTICIPANTS Women with symptomatic breast hypertrophy who underwent breast reduction surgery were followed for 12 months. A comparison control cohort comprised women with breast hypertrophy who did not undergo surgery. INTERVENTIONS Bilateral breast reduction surgery for women in the surgical cohort. MAIN OUTCOME MEASURES The primary outcome measure was health-related quality of life measured preoperatively and at 3, 6 and 12 months postoperatively using the Short Form-36 (SF-36) questionnaire. Secondary outcome measures included post-surgical complications. RESULTS 209 patients in the surgical cohort completed questionnaires before and after surgery. 124 patients in the control hypertrophy cohort completed baseline and 12-month follow-up questionnaires. At baseline, both groups had significantly lower scores compared with population norms across all scales (p<0.001). In the surgical cohort significant improvements were seen across all eight SF-36 scales (p<0.001) following surgery. Within 3 months of surgery scores were equivalent to those of the normal population and this improvement was sustained at 12 months. SF-36 physical and mental component scores both significantly improved following surgery, with a mean change of 10.2 and 9.2 points, respectively (p<0.001). In contrast, SF-36 scores for breast hypertrophy controls remained at baseline across 12 months. The improvement in quality of life was independent of breast resection weight and body mass index. CONCLUSION Breast reduction significantly improved quality of life in women with breast hypertrophy. This increase was most pronounced within 3 months of surgery and sustained at 12-month follow-up. This improvement in quality of life is comparable to other widely accepted surgical procedures. Furthermore, women benefit from surgery regardless of factors including body mass index and resection weight.
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Affiliation(s)
- Tamara Crittenden
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David I Watson
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Philip A Griffin
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Nicola R Dean
- Department of Plastic and Reconstructive Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Discipline of Surgery, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
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Crittenden T, Veitch DE, Henneberg M, Burford K, Van Essen P, Deut K, Zeitouneh K, Lomax E, Griffin PA, Dean NR. Measuring breast volume in hypertrophy: laser scanning or water displacement? Australas J Plast Surg 2018. [DOI: 10.34239/ajops.v1i2.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: The accurate determination of intact breast volume facilitates preoperative planning for women with breast hypertrophy and, in some jurisdictions, is essential in order to justify breast reduction surgery. Not all practitioners have access to magnetic resonance imaging (MRI) or three dimensional (3D) laser scanning facilities, so the purpose of this study was to determine whether water displacement of the intact breast is an effective substitute method of measurement in women with breast hypertrophy.
Methods: A prospective cohort study of breast hypertrophy patients was undertaken. The volume of a total of 322 breasts were determined using water displacement and 3D laser scanning; 194 preoperatively and 128 at 12 months following breast reduction surgery. Pearson correlations, linear regression and Bland-Altman analyses were used to compare the methods of breast volume assessment.
Results: The mean breast volume according to 3D laser scan was 1440 millilitres (SD = 588 millilitres) and for water displacement was 1419 millilitres (SD = 811 millilitres). There was a strong linear association between breast volumes as measured using water displacement and 3D laser scanning using a Pearson correlation (r = 0.89, p < 0.001). However, using the Bland-Altman analysis, the two methods were found not to be in agreement, with water displacement values consistently larger than 3D scan values.
Conclusions: Despite the strong linear association, water displacement is not an accurate enough tool to be used as a substitute for 3D laser scanning, and therefore not an optimal method of breast volume measurement in women with breast hypertrophy.
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