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Kelly ML, Stuart M, Zouki J, Long B, Sabat N, Clark CR, Donaldson E, Colbran RE. General surgeon performed emergency craniotomies in regional Queensland hospitals: a 20-year state-wide study on patient outcomes. ANZ J Surg 2024; 94:585-590. [PMID: 38553955 DOI: 10.1111/ans.18911] [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: 10/27/2023] [Revised: 02/07/2024] [Accepted: 02/07/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Traumatic brain injuries account for up to 50% of trauma related deaths and if surgical intervention is indicated, consensus suggests a maximum of 4 hours to surgical decompression. The occurrence and outcomes of craniotomies performed by non-neurosurgeons in regional Queensland hospitals have never been reported previously in the literature. METHODS A retrospective review was performed at all regional Queensland hospitals without an on-site neurosurgical service from January 2001 to December 2022 to identify patients undergoing emergency craniotomy. Data recorded included basic demographics, history of anti-coagulant use, mechanism of injury, type of haemorrhage, Glasgow Coma Score and Glasgow Outcome Scale (GOS) on discharge. Radiological parameters measured included midline shift and maximal coronal depth of haematoma. The primary aim of this study was to assess the clinical and radiological outcomes of patients who underwent a craniotomy performed by general surgeons. RESULTS Over the past 20 years there have been 23 emergency decompressive procedures (one excluded) performed in regional Queensland. Preoperative imaging demonstrated 9 extradural haematomas and 13 subdural haematomas. Six of 17 transferred cases required reoperation after transfer to a neurosurgical centre. Survival was observed in 9 of 22 cases, with 'good' functional outcome (GOS ≥3) observed in 7 cases. In no cases were rurally performed burr holes effective. DISCUSSION Qualitatively, a larger craniotomy may be associated with better clinical and radiological outcomes. Although rare occurrences, our results demonstrate that general surgeon performed craniotomies are frequently efficacious in producing radiological and/or clinical improvement and should be considered as a potentially lifesaving procedure.
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Affiliation(s)
- Madeleine Louise Kelly
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Michael Stuart
- Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Jason Zouki
- Department of General Surgery, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Brittany Long
- Department of General Surgery, Cairns Hospital, Cairns, Queensland, Australia
| | - Nestor Sabat
- Department of General Surgery, Mackay Hospital, Mackay, Queensland, Australia
| | - Claudia Rose Clark
- Department of General Surgery, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Eric Donaldson
- Department of General Surgery, Toowoomba Hospital, Toowoomba, Queensland, Australia
| | - Rachel Emily Colbran
- Department of General Surgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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Sabat N, McSweeney W, Konno T, Gilberd MA, Molloy C, Pretorius C. Advanced skills for general surgeons and carving out a niche: Endoscopic retrograde cholangiopancreatography in regional Australia. ANZ J Surg 2023; 93:1768-1772. [PMID: 37150893 DOI: 10.1111/ans.18506] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/06/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND The provision of high-quality healthcare in rural Australian hospitals has necessitated general surgeons to take up the challenge and expand their expertise to advanced endoscopy techniques including endoscopic retrograde cholangiopancreatography (ERCP). This study examines the utility of ERCP in a regional setting especially in decreasing patient transfers and associated costs while achieving exceptional safety by measuring key indicators of safety and efficacy. METHODS A single-centre retrospective cross-sectional cohort review in a rural Queensland hospital of patients who underwent ERCP (emergent and elective) from January 2019 until July 2022. Standardized international ERCP performance indicators were collected and compared to benchmark literature values including the rate of cannulation, stone extraction, successful stent placement, and post-ERCP pancreatitis. RESULTS The majority of the ERCP performance indicator benchmarks were met. 100% of patients had an appropriate indication for the procedure and consent. 98.95% successful CBD cannulation with only 14.14% requiring multiple attempts. 92.22% successful stone retrieval with 100% stent placement, well above guideline targets. The post-procedural complication rate was 6.81% (2.09% pancreatitis; 1.05% pancreatitis; 1.05% duodenal perforation). Antibiotic prophylaxis adherence was identified to require improvement (12.57%). CONCLUSION High-quality ERCP procedures can be performed in a regional hospital by general surgeons in a safe and cost-effective manner, significantly decreasing the costs associated with patient transfer. This study reflects strong evidence for consistently achieving international ERCP performance benchmarks and the provision of high-quality healthcare by a regional hospital and provides a strong argument for increasing access to ERCP in rural and remote hospitals.
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Affiliation(s)
- Nestor Sabat
- Department of General Surgery, Mackay Base Hospital, West Mackay, Queensland, Australia
| | - William McSweeney
- Department of General Surgery, Mackay Base Hospital, West Mackay, Queensland, Australia
| | - Takuma Konno
- James Cook University, Townsville, Queensland, Australia
| | | | - Charles Molloy
- Department of General Surgery, Mackay Base Hospital, West Mackay, Queensland, Australia
| | - Casper Pretorius
- Department of General Surgery, Mackay Base Hospital, West Mackay, Queensland, Australia
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Sabat N, McSweeney W, Konno T, Gilberd MA, Molloy C, Pretorius C. Upper GI bleeding in rural Australia: general surgery still alive and well! ANZ J Surg 2023. [PMID: 37043717 DOI: 10.1111/ans.18454] [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: 02/21/2023] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The complex and critically unwell upper gastrointestinal bleeding (UGIB) patient is a common emergency presentation in Australia. Managed medically and endoscopically by rural general surgeons in rural and remote Australian hospitals which lack a gastroenterology service, this can be ameliorated by clear evidence-based guidelines. METHODS A single-centre retrospective review of adult patients who underwent emergency gastroscopy for UGIB at the Mackay Base Hospital, January 2019 to January 2022. Detailed patient data from the assessment, resuscitation, time to endoscopy, endoscopic intervention, and outcomes were compared against key international gastroenterology society safety and quality standards for UGIB. RESULTS Two hundred patients had a comprehensive initial assessment and resuscitation with PRBC (39%), anticoagulation reversal (18%), pantoprazole infusion (81%), tranexamic acid (10.50%) and octreotide (16.50%). Risk scores were calculated retrospectively as none were documented. Time-to-endoscopy targets were achieved in over 70% of variceal or non-variceal UGIB patients. Bleeding was found in 59.50% of patients but 63% of patients did not require a manoeuvre to stop the bleeding. Post-operative complications were scarce. CONCLUSION This study reflects on the need for a local multidisciplinary protocol to help expedite the current high-quality healthcare delivered by rural general surgeons in managing patients with UGIB. Implementing risk assessment scores would shorten the time to endoscopy in the initial assessment Guidelines would optimize resuscitation ensuring appropriate replacement, medication administration, anticoagulation reversal, and preventing unnecessary therapy. Despite these nuisances, the time to endoscopy, endoscopic intervention, and patient outcomes were largely in line with international quality assurance and safety targets.
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Affiliation(s)
- Nestor Sabat
- Department of General Surgery, Mackay Base Hospital, Mackay, Queensland, Australia
| | - William McSweeney
- Department of General Surgery, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Takuma Konno
- James Cook University, Townsville, Queensland, Australia
| | | | - Charles Molloy
- Department of General Surgery, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Casper Pretorius
- Department of General Surgery, Mackay Base Hospital, Mackay, Queensland, Australia
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Sabat N, Schulze B. Newly diagnosed cirrhosis secondary to gastrointestinal bleed due to portal hypertensive colopathy. J Surg Case Rep 2023; 2023:rjad114. [PMID: 36896166 PMCID: PMC9991571 DOI: 10.1093/jscr/rjad114] [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: 01/11/2023] [Accepted: 02/10/2023] [Indexed: 03/09/2023] Open
Abstract
Portal hypertensive colopathy (PHC) is a colonic phenomenon commonly causing chronic gastrointestinal bleeding or less commonly a life-threatening acute colonic hemorrhage. An otherwise well, 58-year-old female presents general surgeons a diagnostic dilemma for symptomatic anemia. An interesting case where the rare and elusive PHC was diagnosed on colonoscopy, which led to the diagnosis of liver cirrhosis without evidence of oesophageal varices. Although PHC is most common in patients with cirrhosis, it is likely still underdiagnosed, given the current stepwise treatment approach of these cirrhotic patients often leads to treatment of the PHC alongside PHG without establishing a diagnosis. Instead, this case presents a generalised approach to patients with underlying portal and sinusoidal hypertension due to a variety of causes, and the endoscopic and radiological findings, which lead to their successful diagnosis and medical management of the gastrointestinal bleeding.
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Affiliation(s)
- Nestor Sabat
- Department of General Surgery, Mackay Base Hospital, Mackay, Australia
| | - Bettina Schulze
- Department of General Surgery, Mackay Base Hospital, Mackay, Australia
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Sabat N, Dissanayake M. Siamese twin polyps: exploring the nature and management of the exceptionally rare bilobed colonic polyps. ANZ J Surg 2023; 93:714-715. [PMID: 35852962 DOI: 10.1111/ans.17909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/28/2022] [Accepted: 06/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Nestor Sabat
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia
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Colbran R, Nicol A, Mangan S, Sabat N, Pretorius F. Outcomes of the overweight and obese major trauma patient in the rural setting. Injury 2023; 54:1369-1373. [PMID: 36669945 DOI: 10.1016/j.injury.2023.01.021] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 12/17/2022] [Accepted: 01/02/2023] [Indexed: 01/07/2023]
Abstract
PURPOSE Overweight and obese patients are more prevalent in rural and remote areas and are of major public health concern in Australia. We aimed to evaluate the mortality and morbidity of overweight and obese trauma patients in the rural Australian context. METHOD This was a retrospective cohort study on 207 major trauma patients (injury severity score [ISS] > 12) treated at the Mackay Base Hospital between 2018 and 2021. Data was extracted from the Mackay Base Hospital trauma database and hospital records. Outcomes were compared between body mass index (BMI) groups. RESULTS There were 164 males (79%) and 43 females (21%). The average BMI was 27.09 (standard deviation 5.46). 7 patients (3%) were in the underweight category (BMI < 18.5 kg/m2), 70 (34%) were of normal weight (BMI 18.5-24.9 kg/m2), 79 (38%) were overweight (BMI 25-29.9 kg/m2), and 51 (25%) were obese (BMI > 30 kg/m2). The majority of trauma was blunt (n = 203, 98%). Compared to patients with normal BMI, obese patients were significantly more likely to require intubation, intensive care unit (ICU) admission, and have a longer ICU stay. There were no significant differences in requirement for surgery, duration of surgery, hospital length of stay, ventilator time, or mortality (P > 0.05). However, subgroup analysis of the obese patient group showed an increased rate of complications (sepsis, acute kidney injury, fluid overload and pneumonia), longer ventilation times, hospital and ICU length of stay with increasing BMI in these patients. CONCLUSION The majority of trauma presentations in our regional community are in overweight or obese patients. Overweight and obese patients are more likely to require intubation and have a longer intensive care unit admission than normal weight counterparts. Amongst obese patients, those with BMI > 40 (obesity class 3) are at significantly increased risk of complications.
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Affiliation(s)
- Rachel Colbran
- Mackay Base Hospital, Mackay, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia.
| | - Alice Nicol
- Mackay Base Hospital, Mackay, Queensland, Australia
| | | | - Nestor Sabat
- Mackay Base Hospital, Mackay, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Francois Pretorius
- Mackay Base Hospital, Mackay, Queensland, Australia; James Cook University, Townsville, Australia
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Sabat N, Westcott A, Pretorius CF. A two-decade diagnostic dilemma of a post-cholecystectomy syndrome presenting with a remnant cystic stump stone causing Mirizzi syndrome. ANZ J Surg 2022; 92:3347-3349. [PMID: 35348262 DOI: 10.1111/ans.17652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 03/03/2022] [Indexed: 12/31/2022]
Affiliation(s)
- Nestor Sabat
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Adrian Westcott
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia
| | - Casper F Pretorius
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, James Cook University, Townsville, Queensland, Australia
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Ng J, Sabat N, Pretorius CF. Oesophagitis dissecans superficialis: role of oesophageal biopsies in early diagnosis. ANZ J Surg 2021; 91:2849-2851. [PMID: 33830608 DOI: 10.1111/ans.16855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/07/2021] [Accepted: 03/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jessica Ng
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,School of Medicine, Griffith University Queensland, Gold Coast, Queensland, Australia
| | - Nestor Sabat
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,Department of Health, School of Medicine, James Cook University, Townsville, Queensland, Australia
| | - Casper F Pretorius
- Surgical Division, Mackay Base Hospital, Mackay, Queensland, Australia.,Department of Health, School of Medicine, James Cook University, Townsville, Queensland, Australia
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Larin M, Gallo D, Tamblyn L, Yang J, Liao H, Sabat N, Brown GW, McPherson JP. Fanconi anemia signaling and Mus81 cooperate to safeguard development and crosslink repair. Nucleic Acids Res 2014; 42:9807-20. [PMID: 25056314 PMCID: PMC4150781 DOI: 10.1093/nar/gku676] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Individuals with Fanconi anemia (FA) are susceptible to bone marrow failure, congenital abnormalities, cancer predisposition and exhibit defective DNA crosslink repair. The relationship of this repair defect to disease traits remains unclear, given that crosslink sensitivity is recapitulated in FA mouse models without most of the other disease-related features. Mice deficient in Mus81 are also defective in crosslink repair, yet MUS81 mutations have not been linked to FA. Using mice deficient in both Mus81 and the FA pathway protein FancC, we show both proteins cooperate in parallel pathways, as concomitant loss of FancC and Mus81 triggered cell-type-specific proliferation arrest, apoptosis and DNA damage accumulation in utero. Mice deficient in both FancC and Mus81 that survived to birth exhibited growth defects and an increased incidence of congenital abnormalities. This cooperativity of FancC and Mus81 in developmental outcome was also mirrored in response to crosslink damage and chromosomal integrity. Thus, our findings reveal that both pathways safeguard against DNA damage from exceeding a critical threshold that triggers proliferation arrest and apoptosis, leading to compromised in utero development.
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Affiliation(s)
- Meghan Larin
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - David Gallo
- Department of Biochemistry, Terrence Donnelly Center for Cellular and Biomolecular Research, University of Toronto, Toronto, M5S 3E1, Canada
| | - Laura Tamblyn
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Jay Yang
- Department of Biochemistry, Terrence Donnelly Center for Cellular and Biomolecular Research, University of Toronto, Toronto, M5S 3E1, Canada
| | - Hudson Liao
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Nestor Sabat
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
| | - Grant W Brown
- Department of Biochemistry, Terrence Donnelly Center for Cellular and Biomolecular Research, University of Toronto, Toronto, M5S 3E1, Canada
| | - J Peter McPherson
- Department of Pharmacology and Toxicology, University of Toronto, Toronto, M5S 1A8, Canada
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