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Mollah T, Gillespie C, Cocco A, Taylor L, Chong L, Hii MW. Defining Physiological Ketosis Following Very-Low-Calorie Diets. J Surg Res 2023; 290:197-202. [PMID: 37271067 DOI: 10.1016/j.jss.2023.05.001] [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: 01/29/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Very low-calorie diets (VLCDs) are used preoperatively in bariatric-metabolic surgery; however, this can lead to physiological ketosis. Euglycemic ketoacidosis is an increasingly recognized complication in diabetic patients on sodium-glucose-cotransporter-2 inhibitors (SGLT2i) undergoing surgery and requires assessment of ketones for diagnosis and monitoring. VLCD induced ketosis may confound monitoring in this group. We aimed to evaluate the influence of VLCD, compared to standard fasting, on perioperative ketone levels and acid-base balance. MATERIALS AND METHODS Twenty-seven patients were prospectively recruited to the intervention group and 26 to the control group from two tertiary referral centres in Melbourne, Australia. Intervention group patients were severely obese (body mass index) (BMI) (≥35), undergoing bariatric-metabolic surgery, and prescribed 2 wk of VLCD preoperatively. Control group patients underwent general surgical procedures and prescribed standard procedural fasting only. Patients were excluded if diabetic or prescribed SGLT2i. Ketone and acid-base measurements were taken at regular intervals. Univariate and multivariate regression was utilised with significance defined as P < 0.005. CLINICALTRIALS gov ID: NCT05442918. RESULTS Patients on VLCD, compared to standard fasting, had an increased median preoperative (0.60 versus 0.21 mmol/L), immediate postoperative (0.99 versus 0.34 mmol/L) and day 1 postoperative (0.69 versus 0.21 mmol/L) ketone level (P < 0.001). Preoperative acid-base balance was normal in both groups, however VLCD patients were found to have a metabolic acidosis immediately postoperatively (pH 7.29 versus pH 7.35) (P = 0.019). Acid-base balance had normalized in VLCD patients on postoperative day 1. CONCLUSIONS Preoperative VLCD resulted in increased pre- and postoperative ketone levels with immediate postoperative values consistent with metabolic ketoacidosis. This should be considered particularly when monitoring diabetic patients prescribed SGLT2i.
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Affiliation(s)
- Taha Mollah
- Department of Upper GI and Hepatobiliary Surgery, St. Vincent's Hospital, Melbourne, Australia.
| | - Carla Gillespie
- Department of Upper GI and Hepatobiliary Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Anthony Cocco
- Department of Upper GI and Hepatobiliary Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Lillian Taylor
- Department of Upper GI and Hepatobiliary Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Lynn Chong
- Department of Upper GI and Hepatobiliary Surgery, St. Vincent's Hospital, Melbourne, Australia; The Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
| | - Michael W Hii
- Department of Upper GI and Hepatobiliary Surgery, St. Vincent's Hospital, Melbourne, Australia; The Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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Mollah T, Brennan J. Australian trends in the treatment of pelvic organ prolapse in the non-mesh era. ANZ J Surg 2023; 93:469-475. [PMID: 36629143 DOI: 10.1111/ans.18268] [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: 06/03/2022] [Revised: 10/11/2022] [Accepted: 12/31/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND To assess the contemporary trends in the types and incidence of pelvic organ prolapse (POP) surgery in Australia after the removal of transvaginal mesh from the Australian market. METHODS This was a retrospective Australian cohort study utilizing three large Governmental databases covering all private and public POP procedures in Australia. All females ≥25 years old undergoing POP procedures between 2005 and 2021 were included. RESULTS From 2005-2006 to 2020-2021 there have been a total of 408 881 POP procedures in Australia. The total number of procedures peaked in 2005-2006 at 537.8 procedures per 100 000 age-standardized female population, decreasing by an average of 3.5% per year to 329.0 procedures per 100 000 in 2018-2019, an overall 38.8% decrease (P < 0.001). A sudden growth in private operative procedures was noted between 2019-2020 and 2020-2021, from 218.2 to 268.6 procedures per 100 000 population, a 23.1% increase (P < 0.001). Laparoscopic and abdominal POP repair has seen a 115.8% increase from 13.7 procedures to 29.6 per 100 000 between 2005-2006 and 2020-2021. Over the last 15 years, the most common age group to undergo a procedure has changed from the 55 to 64 years demographic to a later decade of 65 to 74 years. CONCLUSION Over the last 15 years, the total number of POP procedures performed has significantly decreased. There has however been a recent rise in interventions seen in the private sector and the utilization of laparoscopic or abdominal POP repair has increased, which has implications for procedural credentialing to ensure patient safety.
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Affiliation(s)
- Taha Mollah
- Department of Surgery, St. Vincent's Hospital, Melbourne, Victoria, Australia
- Department of Surgery, Swan Hill Hospital, Swan Hill, Victoria, Australia
| | - Janelle Brennan
- Department of Urology, Bendigo Health, Bendigo, Victoria, Australia
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Mollah T, Christie H, Chia M, Modak P, Joshi K, Soni T, Qin KR. Gallbladder-associated hospital admission and cholecystectomy rates across Australia and Aotearoa New Zealand (2004-2019): Are we over-intervening? Ann Hepatobiliary Pancreat Surg 2022; 26:339-346. [PMID: 35383131 PMCID: PMC9721247 DOI: 10.14701/ahbps.22-007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/11/2022] [Accepted: 03/17/2022] [Indexed: 02/06/2023] Open
Abstract
Backgrounds/Aims To investigate if the increase in the number of cholecystectomies is proportional to symptomatic gallbladder-associated hospital admissions in Australia and Aotearoa New Zealand (NZ). Methods National healthcare registries were used to obtain data on all episodes of cholecystectomies and hospital admissions for patients ≥ 15 years from public and private hospitals. Results Between 2004 and 2019, in Australia, there have been 1,074,747 hospital admissions and 779,917 cholecystectomies, 715,462 (91.7%) of which were laparoscopic, and 163,084 admissions and 98,294 cholecystectomies in NZ. The 15-54 years age group saw an increase in operative rates, +4.0% in Australia and +6.6% in NZ, and admissions, +3.7% and +5.8%, respectively. Hospital admissions decreased by -9.8% in Australia but the proportion of patients undergoing intervention increased by 10.8% (from 67.1% to 75.0% of hospital admissions). Procedural rates increased by +7.3% in NZ with no change in the intervention rate. Conclusions In Australia, there has been a decline in symptomatic gallbladder-associated hospital admissions and a rise in intervention rate. Admissions and interventions have increased proportionally in NZ. There are higher rates of cholecystectomy and admission amongst younger demographics, compared to historical cohorts. Future research should focus on identifying risk factors for increased disease and operative rates amongst younger populations.
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Affiliation(s)
- Taha Mollah
- Department of Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia,Department of Surgery, Swan Hill Hospital, Swan Hill, VIC, Australia,Corresponding author: Taha Mollah, MBBS Department of Surgery, St. Vincent’s Hospital Melbourne, 41 Victoria Parade, Fitzroy, 3065, VIC, Australia Tel: +61-3-9231-2311, Fax: +61-3-9231-3399, E-mail: ORCID: https://orcid.org/0000-0003-3338-9633
| | - Harry Christie
- Department of Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Marc Chia
- Department of Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia
| | - Prasenjit Modak
- Department of Surgery, Swan Hill Hospital, Swan Hill, VIC, Australia
| | - Kaushik Joshi
- Department of Surgery, Swan Hill Hospital, Swan Hill, VIC, Australia
| | - Trived Soni
- Department of Surgery, St. Vincent’s Hospital Melbourne, Melbourne, VIC, Australia,Department of Surgery, Swan Hill Hospital, Swan Hill, VIC, Australia
| | - Kirby R. Qin
- Department of Surgery, Austin Health, Melbourne, VIC, Australia
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Mollah T, Lee D, Giles E. Impact of a new young adult inflammatory bowel disease transition clinic on patient satisfaction and clinical outcomes. J Paediatr Child Health 2022; 58:1053-1059. [PMID: 35170119 DOI: 10.1111/jpc.15907] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/11/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 01/09/2023]
Abstract
AIM The transition from paediatric to adult care for patients with inflammatory bowel disease (IBD) is associated with an increased risk of treatment non-adherence, hospitalizations and emergency department (ED) use. We established a new young adult IBD clinic (YAC) in Melbourne to capture this at-risk population. We aimed to assess patient satisfaction as well as clinical outcomes. METHODS All patients who attended the YAC between its inception in November 2016 and November 2018 were recruited to our YAC group, 61 patients in total. A control group was selected from the pre-existing adult clinic (AC) at our service, 34 patients in total. IBD-related ED (IBD-ED) visits were collected for all patients. We compared IBD-ED visits in the 2 years before and after attending the clinic for the first time. Patient satisfaction was assessed using the IBD-Patient Satisfaction Questionnaire. RESULTS There was an overall decrease in IBD-ED visits between the pre-clinic and post-clinic periods in both the YAC (42.9% reduction) and AC (69.2% reduction) (P < 0.001). Patient satisfaction was high amongst both services with YAC patients indicating higher satisfaction with communication (P = 0.015). CONCLUSION There was a reduction in IBD-ED visits in both the YAC and the AC, high patient satisfaction, and statistically higher satisfaction with communication in the YAC. We speculate the importance of a YAC is to capture those patients in the peri-transitional period at risk of being lost to follow-up or not previously referred for specialist care.
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Affiliation(s)
- Taha Mollah
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Dongju Lee
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
| | - Edward Giles
- Monash Medical Centre, Monash Health, Melbourne, Victoria, Australia
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Mollah T, Chia M, Wang LC, Modak P, Qin KR. Epidemiological trends of gallbladder cancer in Australia between 1982 to 2018: A population-based study utilizing the Australian Cancer Database. Ann Hepatobiliary Pancreat Surg 2022; 26:263-269. [PMID: 35193994 PMCID: PMC9428426 DOI: 10.14701/ahbps.21-169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/17/2022] [Accepted: 01/17/2022] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims Gallbladder cancer (GBC) is a rare neoplasm. The epidemiology of GBC has not been updated in Australia for over five decades. Methods Data of all Australian patients diagnosed with GBC at any age from 1982 to 2018 were identified from the Australian Cancer Database. Age-standardized rates were calculated and joinpoint analysis was performed to ascertain the trends of incidence and mortality of GBC. Results Between 1982 and 2018, there were 22,745 cases of GBC and 11,054 GBC-related deaths in Australia. There were three distinct periods showing changed incidence. Period 1 (1982–1995) was stable. Period 2 (1996–2006) showed reduced incidence in females (3.6 to 2.8/100,000; p < 0.01) and all Australians (3.7 to 2.8/100,000, p < 0.01). Period 3 (2006–2017) demonstrated significantly increased incidence in all groups (males: 2.7 to 4.0/100,000, p < 0.01; females: 2.8 to 3.5/100,000, p < 0.01; all Australians: 2.8 to 3.7/100,000, p < 0.01). Incidence between females and males had declined from 1.10 : 1 in 1982 to 0.87 : 1 in 2017. There was a 71% reduction in mortality (3.1 to 0.9/100,000; p < 0.01). Median age at diagnosis increased from 69.7 to 74.3 years for females and from 67.2 to 73.3 years for males. Increasing incidence in the 6th to 8th decade of life in males, compared to previous years, was noted. Conclusions Incidence, mortality, sex, and age of GBC have significantly changed in Australia since 1982. Rising incidence of GBC in Australia warrants further investigation.
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Affiliation(s)
- Taha Mollah
- Department of General Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Surgery, Swan Hill Hospital, Swan Hill, Australia
| | - Marc Chia
- Department of General Surgery, St. Vincent's Hospital Melbourne, Melbourne, Australia
| | - Luke C Wang
- Department of Surgery, Austin Health, Melbourne, Australia
| | - Prasenjit Modak
- Department of Surgery, Swan Hill Hospital, Swan Hill, Australia
| | - Kirby R Qin
- Department of Surgery, Austin Health, Melbourne, Australia.,Department of Paediatrics, Monash University, Melbourne, Australia
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Qin KR, Paynter JA, Wang LC, Mollah T, Qu LG. Early childhood circumcision in Australia: Trends over 20 years and interrupted time series analysis. ANZ J Surg 2021; 91:1491-1496. [PMID: 33982410 DOI: 10.1111/ans.16927] [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: 02/21/2021] [Accepted: 04/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Male circumcision is one of the most common surgical procedures performed in the Australian private sector. This study examines the trends in childhood circumcision throughout the early 21st century. METHODS Circumcisions performed between 2000 and 2019 amongst preschool-aged Australian boys (0-4 years) were obtained from the Medicare Benefits Schedule. Quarterly data for Victoria and South Australia were divided into three phases separated by (i) state-wide bans of non-therapeutic circumcision in the public sector (2007) and (ii) a disfavouring of non-therapeutic circumcisions by the Royal Australasian College of Physicians (2010). Interrupted time series analyses determined differences between pre-ban (2000-2007), post-ban (2007-2010) and reversal (2010-2019) phases. RESULTS Altogether, 478 717 circumcisions were performed on preschool-aged boys. Incidence progressed from 2675 per 100 000 preschoolers in 2000 to 3140 in 2008 to 1875 in 2019. In Victoria, the baseline (Q1-2000) rate of circumcision was 294.9 per 100 000. This rose by +1.3 (1.1 to 4.1, p < 0.001) per quarter pre-ban and +6.6 (3.0 to 10.3, p = 0.001) post-ban before decreasing by -13.1 (-16.4 to -9.8, p < 0.001) in the reversal phase. In South Australia, the initial rate was 745.2 per 100 000 and increased by +1.4 (0.0 to 2.8, p = 0.045) per quarter pre-ban, +7.6 (0.5 to 14.7, p = 0.035) post-ban and retracted by -20.8 (-27.9 to -13.7, p < 0.001) during the reversal phase. CONCLUSION The incidence of childhood circumcisions in Australia observed a significant rise and fall throughout the early 21st century. Medical and surgical authorities may have played an important role in the gradual reduction of procedures over the last decade.
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Affiliation(s)
- Kirby R Qin
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia.,Department of Paediatrics, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | | | - Luke C Wang
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Taha Mollah
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia
| | - Liang G Qu
- Department of Surgery, Austin Health, Heidelberg, Victoria, Australia.,Department of Urology, Austin Health, Heidelberg, Victoria, Australia
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Garcia SC, Toolis M, Ubels M, Mollah T, Paul E, Pandey A, Thia B, Wong T, Tiruvoipati R. Comparison of clinical characteristics and outcomes between alcohol-induced and gallstone-induced acute pancreatitis: An Australian retrospective observational study. SAGE Open Med 2021; 9:20503121211030837. [PMID: 34290866 PMCID: PMC8274077 DOI: 10.1177/20503121211030837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 06/18/2021] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the characteristics and outcomes of patients presenting to hospital with alcohol-induced and gallstone-induced acute pancreatitis. METHODS Retrospective study of all patients with alcohol-induced or gallstone-induced pancreatitis during the period 1 June 2012 to 31 May 2016. The primary outcome measure was hospital mortality. Secondary outcome measures included hospital length of stay, requirements for intensive care unit admission, intensive care unit mortality, mechanical ventilation, renal replacement therapy, requirement of inotropes and total parenteral nutrition. RESULTS A total of 642 consecutive patients (49% alcohol; 51% gallstone) were included. No statistically significant differences were found between alcohol-induced and gallstone-induced acute pancreatitis with respect to hospital mortality, requirement for intensive care unit admission, intensive care unit mortality and requirement for mechanical ventilation, renal replacement therapy, inotropes or total parenteral nutrition. There was significant difference in hospital length of stay (3.07 versus 4.84; p < 0.0001). On multivariable regression analysis, Bedside Index of Severity in Acute Pancreatitis score (estimate: 0.393; standard error: 0.058; p < 0.0001) and admission haematocrit (estimate: 0.025; standard error: 0.008; p = 0.002) were found to be independently associated with prolonged hospital length of stay. CONCLUSION Hospital mortality did not differ between patients with alcohol-induced and gallstone-induced acute pancreatitis. The duration of hospital stay was longer with gallstone-induced pancreatitis. Bedside Index of Severity in Acute Pancreatitis score and admission haematocrit were independently associated with hospital length of stay.
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Affiliation(s)
| | - Michael Toolis
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Max Ubels
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Taha Mollah
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Eldho Paul
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- ANZIC-RC, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ashish Pandey
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Brandon Thia
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Tricia Wong
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
| | - Ravindranath Tiruvoipati
- Department of Intensive Care Medicine, Frankston Hospital, Frankston, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- ANZIC-RC, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Ravindranath Tiruvoipati, Department of Intensive Care Medicine, Frankston Hospital, 2 Hastings Road, Frankston, VIC 3199, Australia.
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