The objectives of this study were to perform a cost‐analysis of admissions following gastrectomy for gastric carcinoma. The presence and severity of post‐operative complications is strongly associated with increasing cost. Minimizing complications, in addition to obvious clinical benefits, enables a large reduction in costs of care.

Background: Low muscle mass (LMM) has been associated with post-operative morbidity. This study aimed to examine the relationship between pre-operative LMM and major postoperative complications and survival in patients undergoing curative resection for gastric cancer. Methods: A single-centre retrospective cohort study was conducted on consecutive patients who underwent surgical resection for gastric adenocarcinoma between 2008 and 2018. Patient demographics, radiological parameters, pathological data and complications were recorded. Skeletal muscle index was calculated using OsiriX software by manually measuring the cross-sectional skeletal muscle area at the third lumbar vertebra and correcting to the patient's height. Univariate and multivariate analyses were used to identify the risk factors associated with the outcomes. Results: A total of 62 patients (36 males, mean age 68.3 ± 1.5 years) met the inclusion criteria. Twenty-six (41.9%) patients had LMM pre-operatively. Demographic data in the non-LMM and LMM groups were equally matched except for body mass index (27.6 ± 0.8 kg/m 2 versus 24.3 ± 1.1 kg/m 2 ; P = 0.012) and serum albumin (36.7 ± 0.7 g/L versus 33.8 ± 1.0 g/L; P = 0.017), which were higher in the non-LMM. LMM was associated with higher incidence of total (35.5% versus 64.5%; P = 0.006), minor (40% versus 60%; P = 0.030), major (9.1% versus 90.9%; P = 0.004) post-operative complications and decreased recurrence-free survival (hazard ratio 2.29; 95% confidence interval 1.10-4.77; P = 0.027). Conclusion: LMM is a significant independent risk factor for major post-operative complications and recurrence-free survival after gastrectomy. Pre-operative identification of LMM could be a useful tool for prognostication and may identify a group suitable for prehabilitation.

Background: Swan Hill District Health (SHDH) provides Otolaryngological services to outer regional Victoria. A preoperative checklist determines eligibility for tonsillectomy, and the role of preoperative investigations such as oximetry. Visiting specialists who provide T&A also remain on-site for 24 h post-surgery. Management of post-discharge complications is supported by SHDH's Emergency Department. Unstable patients are transferred to tertiary care hospitals. This study examines the safety outcomes associated with rural Tonsillectomy and adenotonsillectomy (T&A) and the impact of peri-operative protocols on these outcomes. Methods: This is a retrospective cohort study of all paediatric (2-18 years old) patients undergoing T&A from August 2014 to June 2020 at SHDH. Four external hospital databases which accept patient transfers from SHDH were searched for T&A-related complications. The primary outcome was complication incidence. Secondary outcomes were length of stay, and rates of hospital readmissions, return to theatre and inter-hospital transfer. Results: Two hundred and four patients were included, with median age 6 years old; 68.1% (n = 139/204) had obstructive sleep apnoea, or sleep disordered breathing, wherein 36.0% (n = 50/139) had documented evidence of normal/inconclusive oximetry. The complication rate is 6.9% (n = 14/204), with two intraoperative, five perioperative and seven post-discharge complications. All intra-and peri-operative complications were managed locally. All post-discharge complications presented to outer regional EDs. Two patients required inter-hospital transfer for monitoring of post-tonsillectomy bleeds in a specialist unit. Conclusions: Patients who pass a preoperative risk checklist can safely undergo T&A in selected rural settings which adhere to strict patient selection criteria and implement safety measures to address complications.

Neuroendocrine tumours (NETs) are rare neoplasms that present with non-specific symptoms, with an increase in incidence and prevalence mainly due to increased endoscopic diagnoses. 1,2 Endoscopically, rectal NETs (rNETs) appear as rounded, smooth, mainly <10 mm polypoid lesions of normal mucosa, which makes them challenging to distinguish from other colonic polyps. 3 A 45-year-old asymptomatic Caucasian man was referred to a rural district hospital for a routine bowel screening with a background of first-degree family history of bowel cancer. He was fit and well and did not take regular medication.The first colonoscopy was performed in October 2015, revealing a pedunculated rectal polyp 10 cm from the anal verge without central depression or ulceration (Fig. 1a). The histopathology showed an NET measuring 15 mm, limited to the mucosa and submucosa, and appears 1.0 mm from the cauterized deep resection margin, with no lymphovascular invasion and Ki-67 <1% (Fig. 1b,c). Pelvic magnetic resonance imaging suggested a T3N0 rectal carcinoma (Fig. 1d). Computed tomography of the chest, abdomen and pelvis, ¶The tumour marker CEA. All hazard ratios are from the meta-analysis of Gonzalez et al. (2013). 5 CEA, carcinoembryonic antigen; ECOG, Easter Cooperative Oncology Group; FEV 1 , forced expiratory volume in the first second.