Reshma Bharamgoudar and Aniket Sonsale are final year medical students at the University of Birmingham, with a keen interest in improving healthcare deliveryrnand optimising organisational performance. James Hodson is an experienced statistician at University Hospitals Birmingham (UHB) with previous experience inrnthe CholeS dataset as well as expertise in producing various scoring tools. Mr Griffiths is a Consultant Upper GI Surgeon at UHB with a passion for research andrnimproving care quality. He has published extensively in this field and is a widely respected surgeon.
Background: The ability to consistently predict operative duration can revolutionise patient care and staff satisfaction whilstrnoptimising theatre efficiency and utilisation, thus reducing costs. With laparoscopic cholecystectomies being one of the mostrncommonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcarernorganisations.rnMethods: Data collected on patients undergoing cholecystectomy in acute UK and Irish hospitals between 03/2014 andrn05/2014 formed the CholeS dataset, which was used as the basis for duration prediction. Data were evaluated to assess the effectrnof age, gender, BMI, ASA and results of any pre-operative imaging on operative duration. A binary logistic regression modelrnwas produced, with a forwards stepwise approach used to select variables for inclusion. The resulting model was converted torna risk score and its predictive accuracy was assessed using ROC curves. The model also applied to a second cohort of patientsrnfor external validation.rnResults: After exclusions, data were available for 7,227 surgeries in the derivation (CholeS) cohort. The risk score was thenrnapplied to a cohort of N=2,405 patients from a tertiary centre for external validation. This cohort had a similar operativernduration to the derivations cohort, with a median of 66 minutes (IQR: 52-85), and 20% (N=481) of operations taking >90rnminutes. The score as a whole had a similar degree of predictive accuracy to that observed in the derivation cohort. ASA wasrna significant predictor of duration and all other factors but gender (p=0.480) and planned intra-op cholangiogram (p=0.306)rnwere found to be significantly predictive of operative duration.rnConclusion: Through validating the score using a large and comparable cohort, this tool has shown to have the potential tornenable organisations to better organise theatre lists and deliver greater efficiencies in care.
Sujen Jayakody is a current surgical registrar at Westmead Hospital. He was the Mary Jo Reeve Endocrine Surgery Fellow at Royal North Shore Hospital, Australiarnin 2016 where he has developed his research interests in Endocrine Surgery.
The incidence of thyroid cancer has been increasing globally over the last few decades. A significant part of this rise is duernto the increase in detection of papillary thyroid carcinoma. Whilst improved diagnostic techniques are thought to bernthe main reason for this rise, the overall picture however is more complex. Concurrent to rising incidence, survival rates arernimproving and mortality rates have remained the same. Research reports geographical variation and multi-factorial causes forrnthe epidemiological trends. However there is minimal data on incidence rates in Australia and the effect of tumour size onrnincident trends. This study presents unique data on thyroid cancer over a 20-year period at a NSW tertiary institution - thernUniversity of Sydney Endocrine Surgical Unit. Our aim is to add to current research knowledge by reviewing our data andrnexamining thyroid cancer incidence and survival outcomes in relation to tumour size. Univariate analyses were performed tornexplore the effects of age, sex, tumour size, vascular invasion and lymph node metastasis. Kaplan-Meir survival curves werernproduced to examine survival rates and multivariate Cox regression was performed to identify independent prognostic factors.rnWe found that 49% of new papillary thyroid cancers were due to papillary micro carcinomas, however there was a significantrnincrease in papillary carcinomas greater than 20mm. Overall survival rates were lower than anticipated however mortalityrnrates were presumed to have fallen. We also found that genetic status in medullary thyroid carcinoma directly affected overallrnsurvival. Further research in thyroid cancer incidence should focus on mortality rates and TNM staging. The reasons for therntrue rise in incidence rates should also be studied. Advances in genetic testing are important in identifying at risk individualsrnfor medullary thyroid cancer.