Background Measurement of transepidermal water loss (TEWL) is widely used to evaluate skin barrier function.Materials and Methods This study compared two devices-the DermaLab (DL) TEWL probe and the VapoMeter (VM) - from data collected across three studies to measure TEWL in scarred and normal skin. Each site was measured three times per device, alternating devices to allow vapor clearance. Inter-device reliability was assessed from 1,617 paired locations, each averaged from the three readings. Intra-observer reliability was able to be determined from a dataset of 1,628 DL and 1,635 VM measurements.Results Data were stratified into low, medium, and high TEWL ranges based on measurement distribution and observations. Overall inter-device reliability was 'good' but varied by range: 'poor' in low, 'excellent' in medium, and 'moderate' in high TEWL ranges. In the medium range, the VM reported nearly twice the TEWL values compared to the DL, while in the high range, it read approximately 34% higher.Conclusions Both devices showed excellent intra-observer reliability overall. However, in the low TEWL range, the DL exhibited 'moderate' reliability, whereas the VM showed slightly better, 'good' reliability. Differences in chamber architecture-semiopen for the DermaLab and closed for the VM-appear to drive the observed variability in measurement reliability across TEWL ranges. Analysis of this large dataset indicates that the VM likely approaches saturation at the categorized 'high' TEWL values, constraining its accuracy, whereas the DermaLab exhibits reduced measurement stability at low TEWL levels, limiting its applicability under those conditions. Targeted methodological work is needed to refine DL performance in the lowTEWL regime and to more precisely define the upper operational limit of the VM.

Walled-off pancreatic necrosis (WOPN) is a serious sequela following acute pancreatitis with significant associated morbidity and mortality. These guidelines provide best practice recommendations for the management of this complication. A systematic review was conducted, including a literature search from 1/1/2020 to 1/24/2025, addressing four key questions regarding the management of WOPN in adults. The findings were subsequently presented to a multidisciplinary panel of surgeons, gastroenterologists, and interventional radiologists, including those from both the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the Americas Hepato-Pancreato-Biliary Association (AHPBA). The GRADE methodology was then used to develop evidence-based recommendations. All recommendations were based on very low certainty of evidence. A conditional recommendation was made for endoscopic management versus image-guided intervention. A conditional recommendation was made for image-guided intervention versus open surgery. A conditional recommendation was made for either minimally invasive surgery or image-guided intervention. A conditional recommendation was made for minimally invasive surgery versus endoscopic intervention. A conditional recommendation was made for either a pure endoscopic approach versus a step-up approach. These recommendations provide guidance for the approach to the management of WOPN according to the existing literature and expert input. The panel also highlighted evidence gaps to support future research for a stronger evidence base regarding the treatment of WOPN.

Objectives: The effect of COVID-19 lockdown periods on surgical admission patterns in the Australian healthcare system has been relatively unexplored. The impact of these lockdowns was investigated via analysis of a surgical mortality dataset. Setting: All cases that had completed the evaluation process by 4 March 2025 (patient death between 1 January 2017 and 31 December 2024, n = 28 685) were included. The ANZASM database captures deaths during surgical admissions, not all surgical admissions. Data from NSW were unavailable at the time of extraction. Cases were grouped into three cohorts, according to date of patient death: pre-COVID (2017-2019), COVID (2020-2021) and post-COVID (2022-2024). Results: Demographics were consistent across cohorts, with minor differences between pre- and post-COVID for age (p < 0.05), length of stay (p < 0.05) and ASA score (p < 0.001). Differences were observed in admission patterns (p < 0.001). There was a 3.9% decrease in private hospital admissions between pre- and post-COVID (19.1% vs. 15.2%), contrasting with a 4.3% increase in public hospital admissions (79.4% vs. 83.7%). Similarly, there was a decrease in elective procedures between pre- and post-COVID (18.5% vs. 12.9%) and an increase in 'scheduled emergency' procedures (i.e., > 24 h post-admission) (29.7% vs. 33.1%). While there was an overall decrease in postoperative complications post-COVID, there was an increase in the occurrence of anastomotic leaks. There was an increase in palliative care observed between pre- and post-COVID (2.2% vs. 4.1%; p < 0.001). Conclusion: These data indicate lasting shifts in surgical care patterns following the COVID-19 pandemic. The increase in admissions for palliative care under surgery post-COVID could indicate that disease states customarily amenable to surgical intervention had progressed due to delayed diagnosis and COVID-associated shutdowns of elective theatre activity. The increased occurrence of anastomotic leaks post-COVID may reflect skill fatigue, but other potential explanations for this observation also warrant further investigation.

TPS4262 Background: Higher abundance of specific oral, pancreatic and/or gut microbes is correlated with pancreatic cancer occurrence (e.g. Porphyromonaas gingivalis , Malassezia sp.). Furthermore, the pancreatic tumour microenvironment of long-term survivors (≥ 5 years) shows richer tumoral microbial diversity associated with more active T-cells and fewer immune-suppressing cells than short-term survivors. Preclinical animal studies have also demonstrated that faecal microbiota transplantation (FMT) from a healthy donor or a long-term survivor can significantly decrease the size of pancreatic tumours. These findings demonstrate that manipulations of the gut and/or organ microbiota holds promise as part of cancer treatment. This trial aims to evaluate whether restoring a healthier microbiota can improve symptoms, visceral pain and treatment efficacy in people with non-resectable pancreatic cancer. Methods: This study is a Phase 1 double-blind randomised placebo-controlled trial (RCT) assessing the safety and potential benefit of oral FMT in patients with non-resectable pancreatic cancer. FMT will be a co-treatment to the standard of care chemotherapy. The primary outcomes are FMT safety and toxicity and mortality at 3, 6, and 12 months after chemotherapy initiation. Secondary outcomes include: changes in visceral pain and symptoms measured by PAGI-SYM, changes from baseline in blood CA-19-9 levels and reduction in tumour size as surrogate marker of treatment efficacy, and changes in faecal microbiota as a surrogate marker of gut flora restoration and treatment efficacy at 3, 6, and 12 months after treatment initiation. Power calculations were conducted for the main secondary clinical outcome of interest (i.e. the PAGI-SYM tool) that encompasses pain and symptom monitoring using published evidence, an MCID of 0.94, for an alpha of 0.05 and 80% power a minimum of 14 participants per arm is required. The trial aims to recruit a minimum of 28 and maximum of 60participants, 14-30 per arm. Eligible patients will have advanced and unresectable adenocarcinoma of the pancreas suitable for standard chemotherapy (gemcitabine/nab-paclitaxel or FOLFIRINOX) and be treatment-naive. Patients will be randomised 1:1 to FMT or placebo. FMT and placebo capsules will be prepared by BiomeBank (Adelaide South Australia). Stool will be sourced from healthy donors and rigorously screened following criteria specified by the Australian Therapeutic Administration (TGA). FMT/placebo will be provided through two doses (dose 1: 25mg, dose 2: 50mg). Chemotherapy will commence 3 to 14 days after completion of the first FMT dose (week 0). Supportive medication includes pancrelipase (2x25,000U three times a day) to facilitate digestion during FMT treatment. The FMTPanc is open at 3 sites across South Australia and Victoria and as of January 2025 12 patients have been enrolled. Clinical trial information: ANZCTR: ACTRN12624000455561.

The Functional Lumen Imaging Probe (FLIP) measures luminal geometry and distensibility to assess esophagogastric function during endoscopy and foregut surgery. It is increasingly used in gastroesophageal reflux disease, achalasia, and gastroparesis for diagnostic and intraoperative guidance. However, the lack of standardized protocols limits consistent clinical use, prompting the need for evidence-based recommendations. A systematic review conducted from January 1, 2005, to June 24, 2025, addressed four key questions regarding FLIP use in adult and pediatric surgical patients. Findings were presented to an international, multidisciplinary panel of surgeons and gastroenterologists, including those from both the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) and the European Association of Endoscopic Surgeons (EAES). GRADE methodology was used to develop evidence-based recommendations. All recommendations were based on very low certainty of evidence. A conditional recommendation suggests FLIP may be used as a triage tool to rule out achalasia prior to anti-reflux surgery, with high-resolution manometry being performed if FLIP is positive. The panel suggests that anti-reflux surgery in adult patients may be performed with or without FLIP. Conditional recommendations suggest intraoperative FLIP during peroral endoscopic myotomy in adults and during esophagomyotomy in pediatric patients. No evidence-based recommendation could be made regarding preoperative FLIP prior to pylorus-directed therapy for gastroparesis. Current evidence evaluating FLIP in surgical practice is limited and, largely, of very low certainty, but FLIP shows potential as a complementary diagnostic and intraoperative tool in foregut disorders. These recommendations provide an initial framework for the responsible, evidence-informed use of this technology in clinical practice. Further prospective studies are essential to establish standardized protocols, define clinically meaningful thresholds, and strengthen future guideline updates in adult and pediatric populations.

BACKGROUND:Hip fracture is a common, high-risk condition over-represented in surgical mortality audits, yet the contribution of non-technical errors has not been examined. This study aimed to determine the number, characteristics and clinical context of non-technical errors associated with patient death in hip fracture mortality to identify targets for improvement. METHODS:A retrospective cohort study analysed all inpatient hip fracture mortalities reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) between 2012 and 2019. Patient mortalities flagged with an adverse event or area of concern were independently reviewed using a validated non-technical error classification tool. Outcomes included number and proportion of errors within this cohort, error type, temporal trends, clinical phase of occurrence and team responsibility. RESULTS:Of 8414 orthopaedic mortalities, 510 were flagged with an adverse event or area of concern, including 255 hip fracture patients. Non-technical errors associated with death were identified in 116/255 (45.5%) patients, with no meaningful change over time. Decision making errors were most common (47.9%), followed by situational awareness (35.2%), communication/teamwork (10.3%) and leadership errors (6.7%). Most errors occurred outside the operating theatre, with 60.6% pre-operative and 28.5% post-operative. Orthopaedics were responsible for 86% of single-team errors and contributed to all multi-team errors. Other specialties were responsible for 14% of single-team errors and contributed to multi-team errors. CONCLUSION:In this cohort non-technical errors associated with death are common. Distinct patterns by clinical phase, error type and team involvement highlight actionable targets for interventions to improve surgical safety and reduce future errors associated with death.

BACKGROUND:This study sought to assess clinician ability to correctly identify unwell surgical patients from the 'end-of-bed' to determine the validity of this commonly utilised clinical tool, and whether accurate assessment increases with experience. METHODS:This prospective observational study recruited patients at the time of surgical admission. Patients were filmed responding to three standard questions concerning their presentation. Each patient video was then viewed by five participants from various groups: surgical consultants, registrars, interns, medical students and orderlies (control group). Five 'Yes/No' questions were answered for each video, regarding how unwell patients appeared and their likely clinical trajectory. Assessor answers were compared with 'correct' answers as determined by the investigators, utilising patient clinical data. For each group, the percentage of questions answered correctly was calculated across 99 patients. The mean and standard deviation for the percentage correct was calculated as well as Cohen's Kappa Score when comparing the score for each assessor group with the 'correct' answer. RESULTS:The percentage of correctly answered questions was highest in the registrar group (82.21%), closely followed by consultants (82.04%), interns (80.47%), medical students (79.74%) and orderlies (79.44%) (p values < 0.001, except students' p value 0.0729). The order of Cohen's Kappa for correctly answered questions found consultants to have the highest agreement (0.26-fair agreement), followed by registrars (0.25-fair agreement) and lastly medical students (0.14-slight agreement) (p values < 0.001). CONCLUSION:The 'end-of-bed' assessment is a potential initial tool for assessing disease severity and clinical trajectory of surgical patients and improves with clinician experience.

BACKGROUND:Fluorescence image-guided surgery (FIGS) with indocyanine green (ICG) is a surgical adjunct that provides real-time, advanced visualization during surgery. It has been increasingly used in clinical practice for its potential to enhance intraoperative precision and safety. However, evidence to date regarding its utility remains variable. An expert panel was convened to provide evidence-based recommendations on the intraoperative use of FIGS with ICG across several surgical applications to support clinicians and patients in decision-making. METHODOLOGY:A systematic review was carried out, including a literature search up to October 2022, addressing eight key questions regarding FIGS with ICG compared to its absence in various surgical settings and service lines. The findings were subsequently presented to a panel of adult and pediatric surgeons. Subject matter experts then used the GRADE methodology to develop evidence-based recommendations. RESULTS:Recommendations in favor of using FIGS with ICG were made for detection of non-regional metastases, intraoperative identification of primary cancers, LN identification in GI cancers, and anastomosis quality in esophageal and left-sided colorectal anastomosis. Thoracic duct identification and bariatric and pediatric pull-through anastomosis did not have sufficient evidence to make a formal recommendation. Still, the expert consensus was that FIGS with ICG is a reasonable option for those surgical applications. CONCLUSION:These recommendations guide the use of FIGS with ICG in different surgical areas according to the existing literature and expert input. The panel also highlighted evidence gaps to support future research for a stronger evidence base around FIGS in adult and pediatric gastrointestinal surgery.

BACKGROUND:Surgical expert witnesses play a crucial role in providing informed and objective opinions on surgical procedures, standards of care and patient outcomes. However, clear criteria outlining the qualifications and level of expertise required to be considered an expert witness are lacking. OBJECTIVE:To provide a guideline for the essential and desired qualifications required of a surgeon to serve as an expert witness. METHODS:The PubMed database was searched to identify existing guidelines relating to the roles and qualifications of expert witnesses. Published statements from national and international surgical colleges were also reviewed. SUMMARY OF GUIDELINES:Five published specialty college guidelines provided insight into the role of expert witnesses. Existing literature comparing the qualifications of surgeons testifying for defendants and plaintiffs was also analysed to identify the recommended criteria for serving as a surgical expert witness. CONCLUSIONS:Surgical expert witnesses must meet stringent standards to provide objective and impartial expert opinions. The fundamental qualifications for surgical expert witnesses are: unconditional registration, good standing with their respective college, active participation in a CPD program and compliance with codes of conduct and ethical standards. Experts should also have at least 5-10 years of clinical experience and be in active clinical practice (or within 3 years of leaving) in the relevant specialty field. Academic involvement and high scholarly impact are desirable to further enhance credibility. These recommendations ensure expert testimonies uphold professional standards to support fair and informed legal outcomes.

BACKGROUND:Due to limited healthcare resources, there is global incentive to maximize efficacy while minimizing patient harm. Given the low rate of cancer diagnoses made via routine histopathological analysis of surgical specimens, a selective approach has been proposed as a viable alternative. This systematic review aimed to evaluate effectiveness of cancer detection and costs with a selective approach. METHODOLOGY:This study was registered with PROSPERO (CRD42022346535) and conducted according to PRISMA 2020 and MOOSE guidelines. Ovid Embase, Ovid MEDLINE and PubMed were searched from earliest result (1973) to 30 July 2022 for studies evaluating selective histopathology for surgical specimens. Screening, risk of bias assessment and data extraction were completed in duplicate. Statistical analysis used a random effects model. RESULTS:Searches identified 4194 records, with 11 studies included consisting of 26 126 patients. Eight studies analysed patients who underwent cholecystectomy while three analysed patients who underwent appendectomy, vertical laparoscopic sleeve gastrectomy and neurectomy. In total, 295 neoplasms were detected: 196 malignant, 99 benign. Overall mean proportion of malignant neoplasms is 0.01 (95% confidence interval 0.00, 0.01). Weighted mean projected cost savings were calculated in varying formats, ranging from 6891 Euros per year within one hospital, 712 748 Euros per 10 000 patients, to 875 077 Euros per year within one country. CONCLUSION:A selective approach is not associated with a significant proportion of missed cancer diagnoses, and provides considerable cost savings, particularly demonstrated for cholecystectomy samples. Further discussion is required regarding how surgeons will be protected medicolegally without the safety net of routine analysis.

Many surgical adverse events are due to errors in non-technical skills (NTS); consequently, improving NTS is a priority. However, evidence to guide NTS improvement activities is lacking. This study aimed to investigate the incidence and characteristics of non-technical errors linked to fatalities in a large, representative surgical-patient population to guide future NTS improvement. All fatality cases with known or suspected adverse events reported to the Australian and New Zealand Audit of Surgical Mortality (ANZASM) between 2012 and 2019 were retrospectively assessed using a validated tool developed by the study authors. Outcomes included the incidence of non-technical errors linked to death (overall and by NTS domain), the identification of non-technical error predictors through multivariate analysis, and change in non-technical error incidence over time using statistical process control charts. Some 30 971 cases of surgical fatality were reported between 2012 and 2019, of which 3829 met the inclusion criteria. Due to insufficient information, 134 were excluded, leaving 3695 for analysis. Non-technical errors associated with patient death were identified in 63.7%. Of these, 58.4% had Decision-Making errors, 56.4% had Situational Awareness errors, 15.2% had Communication/Teamwork errors, and 5.44% had Leadership errors. Statistically significant predictors of Communication/Teamwork, Decision-Making, and Situational Awareness errors were identified. The incidence of overall non-technical errors decreased significantly between 2012 and 2019 and periods of significant decrease in Communication/Teamwork and Leadership errors were demonstrated. No significant decrease in Decision-Making or Situational Awareness errors were demonstrated. The incidence of non-technical errors associated with surgical mortality rate is high. Future NTS improvement efforts should be targeted towards Decision-Making and Situational Awareness errors.

BACKGROUND:Moisturizing is a widely recommended and accessible approach to scar management, yet objective evidence supporting the efficacy of commonly used products remains limited. Research suggests that moisturizers may reduce hypertrophic scar activity by normalising transepidermal water loss (TEWL) and enhancing skin hydration. AIM:This study aimed to provide insights into the effect of generic moisturizers on TEWL and hydration in a scar model, helping clinicians make informed recommendations for scar treatment. METHODS:The performance of eight moisturizing products were evaluated using a tape-stripping method on normal skin to simulate the elevated TEWL conditions observed in active scars. Thirty participants were recruited based on power calculations, with TEWL and hydration measurements recorded at baseline and hourly for four hours. Untreated tape-stripped areas served as controls for each participant. RESULTS:Eucerin demonstrated the highest efficacy, significantly increasing hydration and normalising TEWL. Sorbolene ranked second, showing notable improvements in both hydration and TEWL regulation. Alhydran produced mixed results, effectively normalizing TEWL but reducing hydration. QV Lotion increased hydration but had minimal impact on TEWL. Aqueous Cream exhibited a non-significant trend toward TEWL normalisation. The silicone gel sheet provided high hydration levels but caused elevated TEWL after removal due to rapid evaporation of retained moisture. Liquid silicone (Strataderm) and BioOil performed poorly, with negligible effects on hydration and TEWL. CONCLUSION:These findings reveal significant variability in the effectiveness of common scar management products, emphasising the limited utility of liquid silicones compared to basic moisturizers. Products with balanced formulations of humectants, emollients, and occlusives showed objective evidence to indicate efficacy in managing hypertrophic scars during their active phase. This study offers evidence-based guidance for clinicians and highlights the need for further research to optimise formulations for scar management.

BACKGROUND:Patients undergoing emergency general surgery procedures have significantly greater mortality rates than those undergoing the same procedures electively. However, the exact number of potentially preventable deaths after these procedures is unclear. This study aims to examine potentially preventable and nonpreventable deaths after 7 common emergency general surgery procedures and the clinical management issues associated with potentially preventable deaths. METHODS:A retrospective analysis of surgical deaths after 7 emergency general surgery procedures-laparotomy, colectomy, adhesiolysis, cholecystectomy, peptic ulcer repair, small bowel resection, and appendectomy-was conducted on Australian and New Zealand Audit of Surgical Mortality data between 2010 and 2022. Deaths were classified into 2 groups: potentially preventable or nonpreventable. RESULTS:Within the study period, 875 deaths (18.5%) were potentially preventable, and 3,848 deaths (81.5%) were not preventable. Potentially preventable deaths had significantly greater rates of overall postoperative complications (57.0% vs 37.0%, P < .001) compared with nonpreventable deaths. The potentially preventable deaths group had also significantly greater rates of clinical management issues in the preoperative (38.6% vs 7.0%, P < .001), intraoperative (21.4% vs 3.2%, P < .001), and postoperative (20.5% vs 4.0%, P < .001) phases of care. CONCLUSION:Among the most common emergency general surgery procedures, approximately 20% of deaths are potentially preventable. For patients with potentially preventable deaths, the majority of clinical management issues occurred during the preoperative phase of care. The overall clinical management issues identified relate to 14 separate areas of patient care. Further quality improvement projects, such as enhanced recovery after surgery protocols, should address these areas of clinical management issues to improve future patient mortality rates.

BACKGROUND:Ward rounds are crucial to providing high-quality patient care in hospitals. Ward round quality is strongly linked to patient outcomes, yet ward round best practice is severely underrepresented in the literature. Accurate and thorough ward round documentation is essential to improving communication and patient outcomes. METHODS:A prospective observational cohort study was performed by reviewing 135 audio-visual recordings of surgical ward rounds over 2 years at two hospitals. Recordings were transcribed, and an external reviewer stratified discussion points as Major, Minor, or Not Significant. Discussion was compared to the ward round note to assess the accuracy of documentation based on bedside discussion. The primary endpoint was the accuracy of Major discussion in the patient case notes. Secondary objectives involved investigating variables that may have impacted accuracy (e.g., patient age, sex, length of stay in hospital, and individual clinicians). RESULTS:Nearly one third (32.4%) of important (Major) spoken information regarding plans and patient care in the ward round was omitted from the patients' written medical record. Further, 11% of patient case notes contained significant errors. Patient age (P = 0.04), the day of the week on which the ward round occurred (P = 0.05) and who the scribing intern was (P ≤ 0.001) were found to impact documentation accuracy. There was a large variation in interns documenting ability (35.5%-88.9% accuracy). CONCLUSIONS:This study highlighted that a significant portion of important discussion conducted during the ward round is not documented in the case note. These results suggest that system-wide change is needed to improve patient safety and outcomes.

BACKGROUND:Peroral Endoscopic Myotomy (POEM) is a safe treatment for esophageal achalasia with comparable safety to Heller myotomy plus fundoplication and pneumatic dilatation (PD). More data comparing POEM to Heller Myotomy plus fundoplication and pneumatic dilation are available since the previous Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline published on this topic in 2021. OBJECTIVE:This guideline provides an update to the evidence-based guideline from SAGES published in 2021. It is intended to support clinicians, surgeons, and patients in decisions about the use of POEM for the treatment of achalasia. RESULTS:The panel agreed on 3 recommendations for adults with achalasia. A conditional recommendation for the use of POEM over PD was issued. Conditional recommendations included the option of using either POEM with appropriate use of proton pump inhibitors (PPIs) or HM with fundoplication to treat achalasia. POEM was favored over HM with fundoplication for achalasia subtype III. No new literature was found for children, and the previous recommendation from 2021 should be referred to for this population. CONCLUSIONS:POEM is a safe and effective treatment for achalasia in adults. It demonstrates greater efficacy than PD, though there are specific situations where PD may be the more appropriate choice. POEM has previously been compared to Heller myotomy, but this comparison is less relevant to modern surgical practice. Shifting the paradigm, POEM plus appropriate use of PPIs should be compared to Heller plus fundoplication. This reflection of current practice allows for a conditional recommendation for either approach in the treatment of achalasia subtypes 1 and 2, and for a preference of POEM for subtype 3.

BACKGROUND:The Adelaide Score is an artificial intelligence system that integrates objective vital signs and laboratory tests to predict likelihood of hospital discharge. METHODS:A prospective implementation trial was conducted at the Lyell McEwin Hospital in South Australia. The Adelaide Score was added to existing human, artificial intelligence, and other technological infrastructure for the first 28 days of April 2024 (intervention), and outcomes were compared using parametric, non-parametric and health economic analyses, to those in the first 28 days of April 2023 (control). Artificial intelligence evaluated inpatients admitted under 18 surgical and medical teams, and patients of high likelihood of discharge were provided, on working shifts between Thursday to Sunday, to the Supportive Weekend Interprofessional Flow Team (SWIFT) comprising a senior nurse and pharmacist. RESULTS:Two thousand nine hundred and sixty-eight admissions were included across intervention and control periods. Relative to the control group, use of the Adelaide Score in the intervention group resulted in significantly shorter median length of stay (3.1 versus 2.9 days, P = 0.028) and significantly lower seven-day readmission rate (7.1 versus 5.0%, p = 0.02). The 0.2 bed-day reduction in median length of stay produced a cost saving of $735 708.60 across the 28-day period, or $9 564 211.80 across a 52-week year. There was no significant difference between intervention and control groups in median length of stay for patients discharged on weekends, in-hospital mortality, or discharge to non-home destinations. CONCLUSIONS:The prospective implementation of the Adelaide Score was associated with improved hospital and cost efficiency, alongside lower readmissions, for patients across surgical and medical services.

BACKGROUND:Acute coronary syndrome (ACS) remains one of the leading causes of death globally. Accurate and reliable mortality risk prediction of ACS patients is essential for developing targeted treatment strategies and improve prognostication. Traditional models for risk stratification such as the GRACE and TIMI risk scores offer moderate discriminative value, and do not incorporate contemporary predictors of ACS prognosis. Machine learning (ML) models have emerged as an alternate method that may offer improved risk assessment. This review compares ML models with traditional risk scores for predicting all-cause mortality in patients with ACS. METHODS:PubMed, Embase, Web of Science, Cochrane, CINAHL, Scopus, and IEEE XPlore databases were searched through October 30, 2024, as well as Google Scholar and manual screening of reference lists from included studies and the grey literature for studies comparing ML models with traditional statistical methods for event prediction of ACS patients. The primary outcome was comparative discrimination measured by C-statistics with 95% confidence intervals (CIs) in estimating risk of all-cause mortality. RESULTS:Twelve studies were included (250,510 patients). The summary C-statistic of best-performing ML models across all end points was 0.88 (95% CI 0.86-0.91), compared with 0.82 (95% CI 0.80-0.85) for traditional methods. The difference in C-statistic between ML models and traditional methods was 0.06 (P < 0.0007). Five studies undertook external validation. The PROBAST tool demonstrated high risk of bias for all studies. Common sources of bias included reporting bias and selection bias. Best-performing ML models demonstrated superior discrimination of all-cause mortality for ACS patients compared with traditional risk scores. CONCLUSIONS:Despite outperforming well established prognostic tools such as the GRACE and TIMI scores, current clinical applications of ML approaches remain uncertain, particularly in view of the need for greater model validation.

BACKGROUND:The relationship between postoperative in-hospital mortality and inflammatory markers has not been well described. This study aimed to characterize the association between specific clinical markers of inflammation and in-hospital mortality in the early postoperative period in general surgical patients. METHODS:This study included consecutive general surgery admissions at two tertiary hospitals in South Australia over a 2-year period. Collected data included patient demographics, Charlson comorbidity index, in-hospital mortality, vital signs, and laboratory tests. In particular, temperature, neutrophil count, lymphocyte count, platelet count, albumin level, and C-reactive protein (CRP) were collected for the 48 h after surgery. Multivariable logistic regression was conducted to examine the association between clinical inflammatory markers and in-hospital mortality in the first 24 h postoperatively and 24-48 h postoperatively. RESULTS:5493 patients were included, with an average age of 52.8 (SD 19.4). 2548 (46.4%) were female, and 53 (1.0%) experienced in-hospital mortality. In the first 24 h postoperatively, temperature >38°C, neutrophil count >14 × 109/L, and a lymphocyte count >5 × 109/L were significantly associated with an increased likelihood of in-hospital mortality, whereas platelets, albumin, and CRP during were not. Between 24 and 48 h postoperatively, increases in maximum neutrophil counts, lymphocyte counts, and platelet counts were significantly associated with an increased likelihood of in-hospital mortality, whereas changes in temperature, albumin, and CRP were not. CONCLUSIONS:This is the first study to characterize the inflammatory response using specific clinical laboratory markers, and their relative association with in-hospital mortality, in the first 2 days after general surgery.