In-hospital survival after pancreatoduodenectomy is greater in high-volume hospitals versus lower-volume hospitals: a meta-analysis.

BACKGROUND: Variation in cut-off values for what is considered a high volume (HV) hospital has made assessments of volume-outcome relationships for pancreaticoduodenectomy (PD) challenging. Accordingly, we performed a systematic review and meta-analysis comparing in-hospital mortality after PD in hospitals above and below HV thresholds of various cut-off values. METHOD: PubMed/MEDLINE, Embase and Cochrane Library were searched to 4 January 2021 for studies comparing in-hospital mortality after PD in hospitals above and below defined HV thresholds. After data extraction, risk of bias was assessed using the Downs and Black checklist. A random-effects model was used for meta-analysis, including meta-regressions. Registration: PROSPERO, CRD42021224432. RESULTS: From 1855 records, 17 observational studies of moderate quality were included. Median HV cut-off was 25 PDs/year (IQR: 20-32). Overall relative risk of in-hospital mortality was 0.37 (95% CI: 0.30, 0.45), that is, 63% less in HV hospitals. All subgroup analyses found an in-hospital survival benefit in performing PDs at HV hospitals. Meta-regressions from included studies found no statistically significant associations between relative risk of in-hospital mortality and region (USA vs. non-USA; p = 0.396); or 25th percentile (p = 0.231), median (p = 0.822) or 75th percentile (p = 0.469) HV cut-off values. Significant inverse relationships were found between PD hospital volume and other outcomes. CONCLUSION: In-hospital survival was significantly greater for patients undergoing PDs at HV hospitals, regardless of HV cut-off value or region. Future research is required to investigate regions where low-volume centres have specialized PD infrastructure and the potential impact on mortality.

Clinical practice visits: a rapid review.

BACKGROUND: Practice visits are a peer review activity where one or more healthcare providers visit the practice of another in the same field. The purpose of this exercise is for visitors to observe and review a host's practice in a non-punitive manner and provide them with constructive feedback as required; ultimately to improve practice quality and patient care. METHODS: A rapid review of three biomedical databases was conducted to identify relevant literature published up until 9 April 2018. There were no limits placed on publication date or publication type. Two authors were responsible for study selection and data extraction using a priori inclusion criteria and extraction templates. Study details and key findings were reported narratively and in tables. RESULTS: A total of nine publications, reporting outcomes for eight study groups, were identified as eligible for inclusion in this rapid review. Of these eight, six were observational studies, one was a longitudinal study and one was a randomized controlled trial. Practice visits were considered useful in identifying areas of improvement in professional practice; however, the rate at which these improvements were elicited varied greatly between the included studies. Overall, both hosts and visitors gained insight from the practice visit process and in general their experiences were positive. CONCLUSIONS: Based on the evidence provided by the included studies, recommendations for an effective practice visit can be made. Importantly, the poor quality and age of the literature from which these recommendations are based should be considered.

Leaving surgical training: some of the reasons are in surgery.

In 2014, the Royal Australasian College of Surgeons identified, through internal analysis, a considerable attrition rate within its Surgical Education and Training programme. Within the attrition cohort, choosing to leave accounted for the majority. Women were significantly over-represented. It was considered important to study these 'leavers' if possible. An external group with medical education expertise were engaged to do this, a report that is now published and titled 'A study exploring the reasons for and experiences of leaving surgical training'. During this time, the Royal Australasian College of Surgeons came under serious external review, leading to the development of the Action Plan on Discrimination, Bullying and Sexual Harassment in the Practice of Surgery, known as the Building Respect, Improving Patient Safety (BRIPS) action plan. The 'Leaving Training Report', which involved nearly one-half of all voluntary 'leavers', identified three major themes that were pertinent to leaving surgical training. Of these, one was about surgery itself: the complexity, the technical, decision-making and lifestyle demands, the emotional aspects of dealing with seriously sick patients and the personal toll of all of this. This narrative literature review investigates these aspects of surgical education from the trainees' perspective.

Lumbar artificial intervertebral disc replacement: a systematic review.

BACKGROUND: Low back pain represents a significant disease burden in Australia. Lumbar artificial intervertebral disc replacement (AIDR) has emerged as an alternative surgical option to lumbar fusion for patients suffering from axial low back pain as a result of degenerative disc disease. OBJECTIVES: The aim of this review was to assess the safety and effectiveness of lumbar AIDR for patients suffering from significant axial back pain and/or radicular (nerve root) pain, secondary to disc degeneration or prolapse, who have failed non-operative treatment. METHODS: A systematic search of several electronic databases was conducted between January 2005 and April 2012 to identify relevant randomized controlled trials and non-randomized comparative studies. Inclusion of studies was established through the application of a predetermined protocol by two independent reviewers. RESULTS: Six randomized controlled trials (comprising nine studies) and one non-randomized comparative study comparing lumbar AIDR with lumbar fusion were included in this review. For the majority of adverse events reported, there were no obvious differences in incidence rates between the two treatment groups, and serious adverse events were rare in both groups. Following lumbar AIDR, effectiveness outcomes including Oswestry Disability Index scores, procedural success rates, pain scores, narcotic medication use and patient satisfaction were generally significantly better than, or equivalent to, outcomes achieved following lumbar fusion. CONCLUSIONS: In the short to medium term, the safety and effectiveness of lumbar AIDR appears to be comparable to that of lumbar fusion.