ObjectivesTo determine the morbidity and mortality outcomes of patients presenting with a fractured neck of femur in an Australian context. Peri-operative variables related to unfavourable outcomes were identified to allow planning of intervention strategies for improving peri-operative care.MethodsWe performed a retrospective observational study of 185 consecutive adult patients admitted to an Australian metropolitan teaching hospital with fractured neck of femur between 2009 and 2010. The main outcome measures were 30-day and one-year mortality rates, major complications and factors influencing mortality. ResultsThe majority of patients were elderly, female and had multiple comorbidities. Multiple peri-operative medical complications were observed, including pre-operative hypoxia (17%), post-operative delirium (25%), anaemia requiring blood transfusion (28%), representation within 30 days of discharge (18%), congestive cardiac failure (14%), acute renal impairment (12%) and myocardial infarction (4%). Mortality rates were 8.1% at 30 days and 21.6% at one year. Factors predictive of one-year mortality were American Society of Anesthesiologists (ASA) score (odds ratio (OR) 4.2 (95% confidence interval (CI) 1.5 to 12.2)), general anaesthesia (OR 3.1 (95% CI 1.1 to 8.5)), age > 90 years (OR 4.5 (95% CI 1.5 to 13.1)) and post-operative oliguria (OR 3.6 (95% CI 1.1 to 11.7)).ConclusionsResults from an Australian metropolitan teaching hospital confirm the persistently high morbidity and mortality in patients presenting with a fractured neck of femur. Efforts should be aimed at medically optimising patients pre-operatively and correction of pre-operative hypoxia. This study provides planning data for future interventional studies.Cite this article: Bone Joint Res 2013;2:162–8.

OBJECTIVE• To validate the relationship of the R.E.N.A.L nephrometry score to histological features of renal lesions treated by surgical excision by radical nephrectomy (RN) or nephron-sparing surgery (NSS) at an Australian tertiary referral centre. PATIENTS AND METHODS• Patients undergoing surgery between 2005 and 2009 with imaging studies available were included.• The R.E.N.A.L. nephrometry score is an objective measure of factors important in determining suitability for NSS, e.g. size, exophytic nature, proximity to collecting system and polar location, and R.E.N.A.L scoring was done using the online template at www.nephrometry.com .• Pathological details were collected by retrospective chart review.• Comparisons were made using chisquared or Fisher ' s exact tests and trends analysed by linear regression. RESULTS• The rate of benign pathology decreased from 12/58 (20.7%) low-complexity lesions to 1/16 (6.2%) high-complexity lesions ( P = 0.09), renal cell carcinomas (RCCs) were stable between 45/58 (77.6%) and 13/16 (81.2%), but other malignancies increased ( P = 0.058) from 1/58 (1.7%) to 2/16 (12.5%).• Among the RCCs, high vs low R.E.N.A.L score was associated with an increasing risk of clear cell histology (84.6% vs 64.4%, P < 0.05), stage ≥ pT3 (76.9% vs 8.9%, P < 0.001) and grade 4 tumours (15.4% vs 2.2%, P < 0.05), and conversely with a lower risk of papillary histology (0% vs 24.4%, P < 0.02) and stage T1a (0% vs 84.4%, P < 0.001). CONCLUSIONS• Increasing R.E.N.A.L score is associated with histological features of tumour aggressiveness, thus reinforcing the need for RN for lesions with a high score, and conversely the safety of NSS or observation for lesions with a low score.

TP should be considered in selective cases for treatment of pancreatic neoplasm if it allows complete clearance. The procedure does not appear to be associated with significant increases in serious complications compared with PD.

Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Nephron‐sparing surgery (NSS) is increasingly recognised as a preferred form of management for the incidentally detected small renal mass (SRM). Within the context of equivalent oncological outcomes, patients treated by NSS may have a survival advantage over those treated by radical nephrectomy (RN) through a reduced risk of chronic kidney disease and its associated cardiac morbidity. Despite this, according to Medicare data from the USA, a disproportionate number of patients with SRMs continue to be treated with RN instead of NSS. Similar data from Australia are not yet available. The present study explores the evolving management of SRMs at an Australian tertiary centre over a 5‐year period. It utilises the R.E.N.A.L. Nephrometry Score to assess how lesion complexity has influenced surgical decision‐making and charts the increasing use of NSS in the management of low‐complexity renal masses at our centre. OBJECTIVE To examine recent trends in the use of nephron‐sparing surgery (NSS) at our centre. Specifically, we sought to examine the process of surgical decision‐making by applying the R.E.N.A.L. nephrometry scoring system to assess the complexity of lesions for which surgery was undertaken. PATIENTS AND METHODS We performed a retrospective review of renal masses treated by surgery from January 2005 to December 2009, including 79 RN and 70 NSS. CT images were available for analysis in 50 patients within each group. Lesions were scored on the basis of their complexity using the R.E.N.A.L. nephrometry scoring system developed by Kutikov and Uzzo. RESULTS There was no difference in age between patients undergoing RN and NSS (median age 61 vs 60 years). RN was performed for significantly larger lesions (mean [sd] 68 [9] vs 29 [2] mm, P < 0.05) of predominantly moderate and high complexity (12% low, 56% moderate, 32% high). NSS was primarily used for low‐complexity lesions, but included four (8%) moderate‐complexity lesions in the final 2 years of the study. The use of NSS increased from 28.6% of cases in 2005 to 60.0% of cases in 2009, which mirrored the increase in the proportion of operations performed for low‐complexity lesions (22.2% low‐complexity in 2005 to 70.6% in 2009, P < 0.01 for trend). CONCLUSIONS The increasing use of NSS at our institution mirrored the increasing treatment of low‐complexity renal lesions. This may reflect an increased detection and referral of such lesions, or a shift towards treatment of lesions that in the past would have been under surveillance. Practice at our centre reflects a shifting paradigm towards preferential use of NSS for the treatment of suitable renal masses.