Intentional physical self-injury in Auckland: patterns, associations and clinical implications in a single-centre cross-sectional study.

INTRODUCTION: Intentional physical self-injury (IPSI) is a pressing health challenge and there is little awareness of injury patterns, management and outcomes. This study examines IPSI's epidemiological and clinical aspects in one major Auckland hospital, highlighting demography, injury patterns and implications for clinical practice and prevention. METHODS: Using Auckland City Hospital Trauma Registry data, a retrospective, descriptive study was conducted covering adult patients admitted from January 2015 to December 2019. It assessed demographic characteristics, injury patterns and outcomes, using Mann-Whitney U tests, Fisher's exact tests and Chi-squared tests. RESULTS: Among 137 IPSI admissions, 92 (67%) required surgery, and 24% experienced post-operative complications. Major trauma was identified in 39 (28.5%) admissions. Discharge destinations varied, with only 64 (47%) patients returning home unassisted. Injury severity did not significantly vary across sex, age or injury event location. Major injuries often resulted from falls (19 of 39) and minor injuries from lacerations/stabs (73 of 98). CONCLUSIONS: IPSI represents a significant challenge to Auckland health services, with a notable burden of care. The study highlights the need for targeted interventions to reduce the incidence of IPSI and improve outcomes. It underscores the importance of multidisciplinary approaches to care, integrating surgical, mental health and rehabilitative services.

Quality performance indicators for hepato-pancreatico-biliary procedures: a systematic review.

BACKGROUND: This systematic review was undertaken to define and summarize existing, proposed quality performance indicators (QPI) for hepato-pancreatico-biliary (HPB) procedures. METHODS: A systematic literature review identified studies reporting on quality indicators for cholecystectomy, hepatectomy, pancreatectomy and complex biliary surgical procedures. The databases searched were MEDLINE, EMBASE, PubMed, and SCOPUS, with all literature available until the search date of 1 May 2020 included. The reference lists of all included papers, as well as related review articles, were manually searched to identify further relevant studies. RESULTS: Forty-five publications report quality indicators for pancreatectomy (n = 22), hepatectomy (n = 7), HPB resections in general (n = 12), and cholecystectomy (n = 6). No publications proposed QPI for complex biliary surgery. The 45 papers used national audit (n = 18), consensus methodology (n = 5), state-wide audit (n = 3), unit audit (n = 9), review methodology (n = 9), and survey methodology (n = 1). Sixty-one QPI were reported for pancreatectomy, 22 reported for hepatectomy, and 14 reported for HPB resections in general, in domains of infrastructure, provider, and documentation. Fourteen infrastructure and provider-based QPI were reported for cholecystectomy. CONCLUSIONS: There are few internationally agreed QPI for HPB procedures that allow global comparison of provider performance and that set aspirational goals for patient care and experience.