The Benefits of Colorectal Surgery Surveys in Australia and New Zealand.

PURPOSE: Pertaining to the Colorectal Surgery Society of Australia and New Zealand (CSSANZ) Executive and Research Support Committee, this study aimed to assess the usefulness and outcomes of surveys sent out by the society to its members. METHODS: From 2009 to 2017, CSSANZ members received 38 surveys, most of which were distributed from within the society, and a few of which originated from other affiliated groups. Surveys were categorised by type, topics, times required for completion, delivery method, response rates, and advancement to publication. RESULTS: Of 38 surveys, 20 (53%) were published and 18 remain unpublished. Four surveys were distributed annually on average, with 2.2 published annually on average, with a mean impact factor of 2.41 ± 1.55. Mean time to publication was 31 ± 17 months. Surveys contributed to 13 publications (34%). The most common survey topics were rectal cancer decisionmaking, in 6 publications (16%), preoperative assessment of colorectal patients, in 5 publications (13%), and anal physiology: continence and defaecation, in 4 publications (11%). Publication of surveys was not related to the number of surveys distributed per year, the number of questions per survey, or the time required by respondents to complete the surveys. CONCLUSION: Most of the CSSANZ-distributed surveys resulted in publications, and one third of the surveys contributed to higher degrees obtained by investigators. These surveys aid research into areas that are otherwise difficult to assess, often indicating areas for future research.

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The Relationship of Obesity, Nutritional Status and Muscle Wasting in Patients Assessed for Liver Transplantation.

INTRODUCTION: Obesity co-exists with malnutrition and muscle atrophy in patients with cirrhosis. Muscle wasting is a feature of sarcopenia, a known determinant of patient outcomes. This is the first description of a relationship between obesity, subjective global assessment (SGA) of nutritional status and muscle wasting in patients with cirrhosis. METHODS: The relationship between body mass index (BMI with obesity defined as ≥ 30 kg/m2), nutritional status (assessed by liver-specific subjective global assessment-SGA) and muscle wasting (assessed by corrected total cross-sectional psoas muscle area-cTPA) was analysed in patients with cirrhosis considered for liver transplantation between 1 January 2012 and 31 December 2014. RESULTS: There were 205 patients, of whom 70% were males. The mean age was 52 ± 0.7 years and the Model for End-Stage Liver Disease (MELD) score was 16.8 ± 0.5. Overall, 31% of patients were obese and 56% of well-nourished (SGA A) individuals were obese. Muscle wasting was identified in 86% of all patients, irrespective of their nutritional status (A, B, C). All obese males classified as well-nourished (SGA A) were sarcopenic and 62% of obese females classified as SGA A were sarcopenic. Muscle wasting was worse in obese individuals (cTPA 230.9 mm2/m2 ± 12.9, p < 0.0001) and more likely to be associated with hepatic encephalopathy (p = 0.03). Univariate and multivariate analysis demonstrated testosterone deficiency was significantly associated with muscle wasting (p = 0.007) but not obesity (p = 0.8). CONCLUSION: Obesity combined with muscle wasting is common in patients with cirrhosis. Muscle wasting is common in well-nourished (SGA A) obese patients. Consequently, all patients assessed for liver transplantation should undergo additional screening for malnutrition and muscle wasting irrespective of BMI.