Damien Mosquera

EVALUATION OF SURGICAL PERFORMANCE USING V‐POSSUM RISK‐ADJUSTED MORTALITY RATES

Vascular‐Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (V‐POSSUM) is a risk‐adjusted scoring system for predicting 30‐day mortality in patients undergoing vascular surgery. It can assess surgical performance by comparing predicted deaths with observed deaths. The aim of this analysis was to assess trends in surgical performance over time using risk‐adjusted 30‐day mortality as the primary outcome. Major vascular surgery procedures (n = 454) were prospectively scored for V‐POSSUM between 1995 and 2006. Procedures were divided into 11 consecutive time bands. Observed and predicted deaths were compared using the logistic regression equation derived for V‐POSSUM. The observed death rates decreased over time, as did the predicted number of deaths calculated from the V‐POSSUM scores. The overall predicted mortality rate was 17.2% and the rate varied with the 12‐month period, with a high of 23.9% and a low of 9.2%. The downward trend in the predicted rate shows that the patient risk factors have changed over time and that the risk of dying has declined by almost 50% (from 21.6 to 11.1%). There was a trend towards improved surgical performance over time, with a drop in the observed to predicted ratios of deaths. Observed and predicted deaths changed over the study periods. There was a trend towards improved performance compared with the risk‐adjusted predicted mortality. V‐POSSUM is a useful tool in the longitudinal assessment of performance in major vascular surgery.

Skin grafts: a rural general surgical perspective.

Background:  Skin grafts are a common method of closing skin defects. The literature comparing methods of graft application and subsequent outcomes is poor, but reports indicate a graft failure rate between 2 and 30%. The aim of this study was to audit our current skin graft practice.

Why Taranaki women choose to have a mastectomy when suitable for breast conservation treatment

Background:  Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate may reflect the requirement for Taranaki women to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT.

The Incidence and Risk Factors for Lower Limb Skin Graft Failure

Lower limb skin grafts are thought to have higher failure rates than skin grafts in other sites of the body. Currently, there is a paucity of literature on specific factors associated with lower limb skin graft failure. We present a series of 70 lower limb skin grafts in 50 patients with outcomes at 6 weeks. One-third of lower limb skin grafts went on to fail with increased BMI, peripheral vascular disease, and immunosuppressant medication use identified as significant risk factors.

Risk-adjusted general surgical audit in octogenarians.

Background:  Surgical admissions in patients more than the age of 80 years are increasing. Age‐related comorbidities place this group at particular risk of complications and death. The aim of this study was to specifically document our current outcomes in patients more than 80 years old admitted to a surgical unit, in particular, to assess the risk‐adjusted scoring tool used to predict outcomes in this patient population for operative and non‐operative patients.

PAEDIATRIC SURGERY CARRIED OUT BY GENERAL SURGEONS: A RURAL NEW ZEALAND EXPERIENCE

Background:  There are increasing moves towards centralization in paediatric surgery. With only four paediatric tertiary centres in New Zealand, many general surgeons still routinely carry out paediatric surgery. We present an audit of paediatric surgical patients admitted to our general surgical unit.

Prospective audit of colorectal resections in a peripheral public hospital.

Background:  Colorectal disease requiring surgery is common in New Zealand where there is no established national colorectal screening programme. We established an audit to review our current practice in colorectal surgery.

Time delays in presentation and treatment of acute scrotal pain in a provincial hospital

Acute scrotal pain is a urological emergency due to the possibility of testicular torsion and subsequent testicular loss if correction is not carried out in a timely manner.

GS23P PAEDIATRIC SURGERY PERFORMED BY GENERAL SURGEONS IN A PROVINCIAL NEW ZEALAND (NZ) HOSPITAL

Purpose  To perform an audit of paediatric surgical patients in a provincial general surgical unit.

BS09 WHY WOMEN IN TARANAKI CHOOSE MASTECTOMY OVER BREAST CONSERVATION

Purpose  Breast conservation treatment (BCT) rate is recognized as a marker of surgical practice. An historically low BCT rate in Taranaki, may reflect the requirement for Taranaki women, to travel for adjuvant radiotherapy. The aim of this study was to determine the reasons Taranaki women with breast cancer choose mastectomy or BCT.