Vol. 1 No. 1 (2017)

Open Access

Case Report

Article ID: 31

Extreme long survival of a patient operated with uterine leiomyosarcoma

by Zsolt Baranyai, Valéria Jósa, Attila Zaránd

General Surgery, Vol.1, No.1, 2017; 778 Views, 26 PDF Downloads

Leiomyosarcomas of the uterus are rare tumours that recur and metastasize early. Adjuvant chemotherapy or postoperative radiotherapy has not been proven effective in treating it. The most successful therapeutic approach seems to be repeated surgical resection and removal of metastases. The authors presented a case of a female who had metastases resections, both from the abdomen and thoracic cavity, for a total of 10 times following hysterectomy due to leiomyosarcoma of the uterus. The patient is still alive 23 years later following the first surgery. 

Open Access

Article

Article ID: 32

How to use administrative data for surgical outcomes in acute diverticulitis

by Michael K-Y Hong, Anita R Skandarajah, Omar D Faiz, Ian P Hayes

General Surgery, Vol.1, No.1, 2017; 889 Views, 28 PDF Downloads

The measurement of quality outcomes is crucial in surgical care. Administrative data are increasingly used but their ability to provide clinically useful information is reliant on how closely the coding can define a particular cohort.        In acute admissions for diverticular disease, it is important to differentiate between complicated and uncomplicated diverticulitis, and between diverticulitis and diverticular bleeding. We aim to develop a method to define clinically relevant cohorts of patients from an administrative database in acute diverticulitis. Codes for acute diverticulitis were found from the ICD-10-AM (Australia and New Zealand) coding system, and the accuracy was established with retrospective chart review and cross-referenced with a clinical database at a single institution. Coding of non-diverticular and missed diverticular  cases was examined to determine non-diverticular codes that could differentiate these cases. These were combined into  logic algorithms designed to differentiate between uncomplicated and complicated diverticulitis admissions derived from   an administrative database. Specific K57 diverticular codes possessed sensitivity and positive predictive values of 0.92    and 0.69 for uncomplicated diverticulitis, respectively, with 0.61 and 0.92 for complicated diverticulitis, respectively, based on 153 cases. Most of the missing cases were usually complicated diverticulitis whilst some cases coded incorrectly  as uncomplicated diverticulitis were often found as undifferentiated abdominal pain. Diagnostic codes combined into algorithms that accounted for predictable variations improved cohort definition. In conclusion, algorithms with combined codes improved definitions of clinically relevant cohorts for acute diverticulitis from an Australian or New Zealand administrative database. This method may be used to develop logic algorithms for other surgical conditions and enable widespread measurement of relevant surgical outcomes.