Reviewing the risk of breast cancer recurrence following breast reconstruction.

BACKGROUND: It is widely accepted that both autologous and alloplastic reconstruction are safe. A recent publication reported a significant association between textured implants and metastatic recurrence of breast cancer. This study aims to assess if the published results are reproducible in our cohort and to review the safety of breast reconstruction. METHODS: This is a retrospective cohort study of adult patients undergoing mastectomy and either alloplastic or autologous breast reconstruction at a single quaternary hospital. Outcomes include disease free survival (DFS), local and recurrence free survival (LRRFS) and BIA-ALCL. For time to event endpoints, unadjusted and multivariate adjusted hazard ratios (HRs) were estimated using Cox regression, and penalized Cox regression respectively. RESULTS: Four hundred and twenty-six patients of whom 187 underwent autologous reconstruction and 239 underwent alloplastic. There were 43 cancer recurrences (24 alloplastic and 19 autologous) and 14 local regional recurrences (8 alloplastic and 4 autologous). There were 26 deaths and no instances of BIA-ALCL. Median follow-up time was 4.7 years. No evidence of association was found between breast reconstruction method and DFS (HR 0.87 CI: 0.47-1.58). It is uncertain whether implant texture grade was associated with increased breast cancer recurrence (HR 2.17 CI: 0.65-7.52). CONCLUSION: Both autologous and alloplastic breast reconstruction have been carried out in our cohort and reconstructive modality was not associated with either reduced DFS or LRRFS. The results in this cohort show there is uncertainty between the use of textured breast implants and either local or distant breast cancer recurrence.

Clinical concern for necrotising fasciitis: a review of referrals to plastic surgery units at two tertiary centres.

OBJECTIVES: To evaluate the impact of clinical suspicion on the diagnosis of necrotising fasciitis (NF) in two inpatient plastic surgery units. METHODS: A multicentre retrospective audit of all referrals of adult patients to the inpatient plastic surgery units of two Melbourne metropolitan tertiary centres from 1 February 2018 to 31 December 2018. RESULTS: A total of 53 patients (37 male, 16 female) were referred to evaluate for NF. There were 20 patients (37.04%) who underwent operative debridement. Of those, 15 were pre-operatively suspected of having NF and there were seven confirmed cases of NF (13.21%). Laboratory risk indicator for NF (LRINEC) score ≥ 6 had a statistically significant association with a diagnosis of NF (P = 0.03) and with operative debridement (P = 0.04). The incidence of NF in the cohort where the referrer had clinical concern for NF was 13.21% (P < 0.001) and when the referrer and the plastic surgeon suspected NF was 46.67% (P < 0.001). The number of patients needed to be referred for one case of NF to be diagnosed was 7.58. CONCLUSIONS: Clinical suspicion of NF is essential for diagnosis and clinicians who suspect NF should not hesitate to refer to the appropriate surgical unit. Prompt review is required of patients in whom NF is clinically suspected as these patients have a 13.21% incidence of NF. The laboratory risk indicator for NF score is not sufficiently specific nor sensitive to exclude or to diagnose NF as a stand-alone diagnostic tool but may have a role as an adjunct.

Unplanned inter-hospital transfers following elective paediatric surgery in a private hospital.

BACKGROUND: A significant number of surgeries in children are being performed in the private setting. Our aim was to determine the rate of unplanned inter-hospital transfers (IHTs) for paediatric patients undergoing elective surgical procedures in a private hospital without a paediatric intensive care unit to a tertiary hospital, and to investigate the reasons for these transfers. METHODS: A retrospective clinical audit was performed searching hospital coded data of all patients aged 18 years or less at the date of admission, who underwent elective surgery between 1 January 2013 and 31 October 2018 at St Vincent's East Melbourne Private Hospital. RESULTS: A total of 17 366 patients were identified, of whom 23 required IHT, with an overall transfer rate of 0.13%. Adenotonsillectomy had the highest IHT rate of 0.26%; however, operative specialty had no statistical correlation with IHT (P = 0.24) with a comparable transfer rate across all specialties. Hypoxia was the most frequent reason for IHT and was the cause in 16 out of 23 transfers (69%). Nine cases (39%) were transferred due to hypoxia while awake and seven (30%) due to hypoxia only while asleep. Three patients requiring IHT were identified as having preoperative acute respiratory illness. CONCLUSION: Elective paediatric surgery undertaken at St Vincent's East Melbourne Private Hospital is safe and has a low IHT rate, with surgery involving the upper airway having a higher risk. In the paediatric population, hypoxia while awake is the most frequent cause for IHT.