Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

This 12-year audit aimed to review the number and outcomes of all cases of Necrotizing fasciitis (NF) admitted to CAIRNS BASE HOSPITAL (CBH) from 2001 to 2013. Methodology: A retrospective chart review of cases between 2000 and 2013 was carried out using a standard proforma to document patient characteristics, management and outcomes. Results: 66 patients were identified. Of these, 64% were male and the average age was 54 years. 50% of patients identified as either Aboriginal or Torres Strait islander. 74% required an intensive care admission and the overall mortality was 18%. The strongest identifiable risk factor was diabetes mellitus (DM), present in 60% of the cohort. DM was a predictor of mortality, with the data suggesting a tenfold increase in chance of death from NF (p=0.031). An isolated infection with staphylococcus had a higher mortality in comparison to polymicrobial (p=0.015) or streptococcus (p=0.041). The presence of acute renal failure was associated with a nine-fold increase in the likelihood of death (p=0.002). Smoking, race, time to surgery, precipitating cause (i.e. spontaneous, post operation, trauma etc.) and location (leg, perineum, etc.) had no statistical impact on mortality. Conclusion: Diabetes mellitus, primary staphylococcus infection and acute renal failure are strong predictors of mortality in NF. Race and time to surgery had no statistical impact in the overall mortality, which is a very relevant finding for a regional centre with a high indigenous population.

We report the case of a 24-year-old Torres Strait Islander woman who presented to a rural hospital ED with chest pain suspicious for myocardial ischaemia and was found to have an anterior ST-elevation myocardial infarction. She was thrombolysed and transferred to a tertiary centre where subsequent angiography revealed atheromatous disease of the left anterior descending coronary artery. We believe this to be one of the youngest reported cases of myocardial infarction due to atheromatous coronary artery disease, and demonstrates important learning points regarding the demographics and risk factors of indigenous patients with chest pain.

Background Postoperative acute kidney injury (AKI) is a common complication of major gastrointestinal surgery with an impact on short- and long-term survival. No validated system for risk stratification exists for this patient group. This study aimed to validate externally a prognostic model for AKI after major gastrointestinal surgery in two multicentre cohort studies. Methods The Outcomes After Kidney injury in Surgery (OAKS) prognostic model was developed to predict risk of AKI in the 7 days after surgery using six routine datapoints (age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker). Validation was performed within two independent cohorts: a prospective multicentre, international study (‘IMAGINE’) of patients undergoing elective colorectal surgery (2018); and a retrospective regional cohort study (‘Tayside’) in major abdominal surgery (2011–2015). Multivariable logistic regression was used to predict risk of AKI, with multiple imputation used to account for data missing at random. Prognostic accuracy was assessed for patients at high risk (greater than 20 per cent) of postoperative AKI. Results In the validation cohorts, 12.9 per cent of patients (661 of 5106) in IMAGINE and 14.7 per cent (106 of 719 patients) in Tayside developed 7-day postoperative AKI. Using the OAKS model, 558 patients (9.6 per cent) were classified as high risk. Less than 10 per cent of patients classified as low-risk developed AKI in either cohort (negative predictive value greater than 0.9). Upon external validation, the OAKS model retained an area under the receiver operating characteristic (AUC) curve of range 0.655–0.681 (Tayside 95 per cent c.i. 0.596 to 0.714; IMAGINE 95 per cent c.i. 0.659 to 0.703), sensitivity values range 0.323–0.352 (IMAGINE 95 per cent c.i. 0.281 to 0.368; Tayside 95 per cent c.i. 0.253 to 0.461), and specificity range 0.881–0.890 (Tayside 95 per cent c.i. 0.853 to 0.905; IMAGINE 95 per cent c.i. 0.881 to 0.899). Conclusion The OAKS prognostic model can identify patients who are not at high risk of postoperative AKI after gastrointestinal surgery with high specificity. Presented to Association of Surgeons in Training (ASiT) International Conference 2018 (Edinburgh, UK), European Society of Coloproctology (ESCP) International Conference 2018 (Nice, France), SARS (Society of Academic and Research Surgery) 2020 (Virtual, UK).

Objective: Traumatic pneumothoraces (T-PTXs) are traditionally managed with an intercostal catheter (ICC), despite little evidence for this. Success with conservative management of primary spontaneous PTX has been demonstrated, and our ED has adopted a conservative approach where safe for all PTX. Methods: We reviewed all T-PTXs at our institution over a 7-year period to assess outcomes of those conservatively managed and compare with those who received an ICC. A total of 144 cases were identified, 65 managed conservatively and 79 invasively. Each was individually reviewed and variables including demographics, aetiology, smoking/lung disease history, T-PTX size (apical interpleural distance and hemithorax percentage), length of stay, Revised Trauma Score, Injury Severity Score and delayed intervention/complications were recorded.Chi-squared, Z-score, Mann-Whitney U and t-tests were used for analysis. Results: The mean apical interpleural distance was 26.8 mm (95% confidence interval [CI] 22.1-29.7 mm) in the conservative group and 49.1 mm (95% CI 41.2-57.0 mm) in the ICC group (P < 0.05 for difference between groups). Mean T-PTX percentage 25.9% (95% CI 22.1-29.7%) in the conservative group versus 45.9% (95% CI 39.7-50.5%) in the ICC group (P < 0.05 for difference between two groups) and mean Revised Trauma Score 7.4 (conservative) versus 6.8 (invasive) (P < 0.05). No conservatively managed patient required a delayed intervention for their T-PTX, and 2 of 79 (3%) patients in the ICC group had a complication (one infection, one haemothorax). Conclusion: Our data support conservative management of selected T-PTXs and shows a need for a prospective randomised trial to further examine this intervention.