Surgery

Peyton P, Smith N, Kini R, Reduction of chronic post-surgical pain with ketamine - ROCKet Trial.
Locations: Wollongong Hospital.
External Partners: The University of Melbourne.

This trial examines the effect of perioperative intravenous ketamine on the incidence and severity of chronic post-surgical pain.

Smith N, McNamara P, Climbing a flight of stairs: Patient self-report compared to objective measurements.
Locations: Wollongong Hospital.

This project aims to identify whether patient self reported ability to climb a flight of stairs (FOS) correlates with objective measures, and whether self-reported or objective measures correlate with NIRS measures of leg muscle oxygen saturation. Patients from an anaesthetic pre-admission clinic will be asked to self report their ability to climb a FOS before having a NIRS device (non invasive way to measure muscle oxygen saturation) attached to their leg, and then climbing a flight of stairs. Additional parameters will be measured including Borg scale, heart rate and duration of exercise.

Still A, Selak T, Putnis S, Brinton J, Australia and New Zealand Emergency Laparotomy Audit Quality Improvement.
Locations: Wollongong Hospital.

Approximately 15,000 patients need emergency laparotomies in Australia each year. International studies show that the standard of care provided varies significantly from hospital to hospital, as does the patient outcome. This project is an initiative to provide real-time data on the management of emergency laparotomies in Australia and New Zealand, to empower clinicians and hospitals to improve the quality of care provided to the vulnerable and sizeable cohort of patients who undergo this procedures.

Ashford B, Hewitt L, Impressions of a career in surgery. Reflections from retired surgeons. An observational study.
Locations: Illawarra Shoalhaven Local Health District.

Retired surgeons who are Australian or New Zealand will be asked to participate in an anonymous survey. The aim of this study is to categorise and describe the impressions/reflections from retired surgeons regarding their career in surgery. The results of this study will provide valuable insights into the training and education of junior surgeons.

Ashford B, Clark J, Wykes J, Yabe T, Hewitt L, Periosteum and PEEK. The potential viability of its use in head and neck surgery.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: University of Wollongong, University of Sydney, Chris O'Brien Lifehouse.

The use of a periosteal flap with Polyetheretherketone (PEEK) in the setting of maxillofacial reconstruction is expected to reduce donor site morbidity significantly compared to the traditional vascularised bone graft such as fibula and scapula flap. However, this is currently untested. Our study aims to assess the viability to use the periosteum from the scalp, scapula, humerus, femur, sternum, tibia, and pelvis to wrap a PEEK prosthesis. We will assess a minimally morbid surgical approach to obtain suitable pedicled periosteal flaps on cadaveric specimens. This study will then enable a recommendation regarding further investigation into the use of PEEK covered periosteum as a customized bone fragment for use in Head and Neck Surgery.

Ashford B, Clark J, Wykes J, Yabe T, Seth I, Hewitt L, Vastus lateralis free flap for head and neck reconstructive surgery. An assessment of post-surgical donor site morbidity. Retrospective and concurrent study.
Locations: Wollongong Hospital.
External Partners: Chris O'Brien Lifehouse.

Studies have found that a section of vastus lateralis myofascial free flap (VLMFF) can be removed and is feasible to treat various disorders of the head and neck. No studies have demonstrated the prevalence of patients receiving VLMFF surgery and lower limb morbidity in receiving from this type of surgery. Identifying potential complications may assist in the prevention of various conditions e.g. patellofemoral pain syndrome, obesity, assisting in future early prevention and intervention. Identifying the number and types of patients receiving this surgery may assist in quantifying the impact of VLMFF use and patient health outcomes. Our aim is to determine the prevalence of patients receiving a VLMFF to reconstruct the head and neck in the Illawarra Shoalhaven Local Health District and to determine the association between patients who have had surgery and donor site morbidity (knee pain, decreased overall function and decreased lower limb strength/length/sensation).

Beck M, Ashford B, Napaki SM, Appendicitis in the COVID-19 Pandemic.
Locations: Wollongong Hospital.

During the COVID-19 pandemic we noticed a reduction in the number of patients presenting to Wollongong Hospital for the assessment of suspected appendicitis. Recent research seems to confirm a drop in the number of cases of appendicitis during the pandemic, but the reasons for this change and the health outcomes of these patients remain unclear. To our knowledge, no previous Australian study has been carried out to examine the association between COVID-19 and appendicitis. If we know why the number of cases of appendicitis have changed, and the characteristics of these cases, we can better prepare for treating our patients during the pandemic.

Craig S, Yabe TE, Ashford B, Davis KJ, Stretch C, Bathe O, Validation of a novel prognostic gene assay for papillary thyroid cancer to improve appropriateness of care.
Locations: Wollongong Hospital, Shoalhaven District Memorial Hospital.
External Partners: University of Calgary.

Thyroid cancer is the 8th most common cancer by prevalence, and the incidence has been increasing by more than 6% per year since 1992. In 2021, there is projected to be over 1,600 new cases in New South Wales. Papillary thyroid cancer (PTC) is the most common thyroid cancer. PTC usually has a favorable prognosis with high cure rates. However, approximately 10-15% of PTC’s display a more aggressive behavior and are often resistant to conventional adjuvant therapies such as radioactive iodine. Although the current clinical systems have been validated in clinical studies, the proportion of variance explained is sub-optimal and accounts for only a small proportion of the uncertainty in PTC prognosis.   We have developed a novel algorithm that has identified 44 genes that most highly impact PTC prognosis. From these results, we have designed a practical clinical assay to help guide treatment decisions.

Mordaunt D, Craig SJ, Davis KJ, Yu P, Thilakarathne N, Song T, Ashford B, Health pathway discovery, conformance and enhancement: appendicitis as an archetype.
Locations: Illawarra Shoalhaven Local Health District.
External Partners: University of Wollongong

This study will apply process mining (which uses machine learning) to clinical data from appendicectomies performed between 01 July 2010 and 30 June 2020 for patients presenting to ISLHD hospitals. This will produce appendectomy pathway models that represent an unbiased view of patient movements through the diagnostic and treatment process. Analysis of the discovered pathways will enable identification of the major areas of clinical variability, such as reasons for longer than usual treatment times to be explored, as well as reasons for deviations from standard treatment pathways, and will assist with identifying sources of unwarranted clinical variability. Results obtained will be able to be translated into a basis for data-driven, consensus-based clinical pathways thereby reducing unwarranted clinical variability and improving health outcomes for these patients.

Richardson A, Putnis S, Watson E, Ramsay A, Patel B, Jones M, Sutherland A, American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP).
Locations: Wollongong Hospital, Shoalhaven District Memorial Hospital.
External Partners: Coffs Harbour Health Campus, Queensland Children's Hospital, Coffs Harbour Hospital.

ACS NSQIP is a hospital based surgical quality improvement program that allows facilities to collect data on a variety of variables on all patients undergoing major procedures that meet program criteria. Data is collected in the pre-operative, intra-operative and post-operative phase up to 30 days post surgery and entered into the NSQIP database. Monitoring of surgical outcomes will highlight areas for improvement and change in service provision.

Wykes J, Clark J, Subramanian N, Charters E, Leung L, Tongue Reconstruction with Innervated Vastus Lateralis and Antero-Lateral Thigh Free Flap.
Locations: Wollongong Hospital.
External Partners: Chris O'Brien Lifehouse.

This is a study to determine tongue function (speech and swallowing) after removal for cancer and reconstruction using thigh muscle and reestablishing its nerve supply.

McLoughlin J, Hewitt L, Cherukuri R, Attewell L, Complications post elective neurosurgery. A local health district analysis.
Locations: Wollongong Hospital.

Outcomes from this study could potentially identify which patient type/surgery type is more at risk of getting a certain complication. This would mean that appropriately placed screening tools can be put into current practice in an attempt to either prevent the complication from occurring or put in place a strategy designed to mitigate the risk. 

Jaeger M, Ecroyd H, Identifying biomarkers of idiopathic normal pressure hydrocephalus in cerebrospinal fluid and brain tissue.
Locations: Wollongong Hospital.
External Partners: University of Wollongong, Illawarra Health and Medical Research Institute.

Idiopathic normal pressure hydrocephalus (iNPH) is part of the large group of neurodegenerative diseases affecting mainly the elderly population. Treatment of iNPH is surgical (insertion of a CSF Shunt). In clinical routine the correct diagnosis of iNPH and differentiation from other diseases, such as Alzheimer's dementia, is the key challenge and patients might undergo unnecessary operations or being unjustly withheld from effective treatment. The goal of this study is to investigate and search for biomarkers from cerebrospinal fluid and brain tissue of patients undergoing CSF Shunt insertion that might help to correctly diagnose iNPH, better understand disease mechanisms and help differentiate form other neurodegenerative disorders.

McNamara W, Dares M, The Orthopaedic Response to COVID-19: The Australian Experience.
Locations: Wollongong Hospital.

This observational descriptive study is designed to determine the key changes made in day to day functioning of orthopaedic departments in Australia that have been implemented in response to COVID-19. Currently, there is no guidelines for orthopaedic trauma services. It is expected that this study will identify key strategies used to promote social distancing, reduce hospital flow and ensure quality trauma services are continued. These findings would be used as a benchmark for international orthopaedic institutions and for similar situations in the future.

McNamara W, Dares M, The effect of COVID-19 on orthopaedic trauma in a tertiary institution.
Locations: Wollongong Hospital.

Since March 2020 our orthopaedic department has anecdotally noticed an increase in trauma volume and a change in trauma patterns. The study is a retrospective analysis designed to very if this anecdotal evidence is true. Outcomes of this study are important because they firstly identify high risk behaviours that can be broadcast to the community to avoid or prevent, it may direct governmental regulation formation to help prevent unnecessary traumas and it would demonstrate the essential role of orthopaedic trauma management in the setting of a pandemic that would attract funding and justify regular trauma lists.