Patterns of infection following transrectal ultrasound-guided biopsy of the prostate in a regional New South Wales Centre.

OBJECTIVE: To determine the rates, severity and patterns of resistance in patients presenting with post-transrectal ultrasound infection in a regional centre in New South Wales, Australia. DESIGN: A single-centre retrospective review from August 2013 until August 2017. SETTING: Murrumbidgee Local Health District, New South Wales. PARTICIPANTS: All patients who underwent transrectal ultrasonography biopsy of the prostate in the public health system. MAIN OUTCOME MEASURES: Rate of infection and sepsis following biopsy of the prostate requiring readmission to hospital within 30 days from the procedure. RESULTS: A total of 317 men underwent transrectal ultrasound-guided biopsy of the prostate over the study period. Nineteen (6%) patients presented with clinical signs of post-transrectal ultrasound infection, of which 18 (5.7%) required readmission for intravenous antibiotics. Median time to readmission was 2 days (0-7), and the average length of hospital stay was 5 days (1-15). Three (0.3%) patients required admission to intensive care for inotropic support. Thirteen patients (68%) had positive blood cultures, and all were positive for Escherichia coli. Four of these patients (21%) had extended spectrum beta-lactamase producing isolates resistant to their preoperative antibiotics. CONCLUSION: Prostate cancer is common in the elderly community with worse outcomes in regional settings. Infective complications from transrectal ultrasound biopsy were 6% in this regional setting with high rates of multi-resistant organisms. Awareness of this is important for rural health practitioners who are likely to be exposed to this patient population.

Improving operating theatre efficiency: an intervention to significantly reduce changeover time.

BACKGROUND: Operating theatre inefficiency and changeover delays are not only a significant source of wasted resources, but also a familiar source of frustration to patients and health-care providers. This study aimed to prove that the surgical registrar through active involvement in patient changeover can significantly improve operating room efficiency and minimize delays. METHODS: A two-phase prospective cohort study was undertaken, conducted over the course of 4 weeks at a single institution. The only inclusion criteria comprised patients to undertake endoscopic urological day surgery cases and require general anaesthesia. There were no exclusions. In the first phase (observational, with no intervention), changeover times between cases were documented. The second phase followed a structured intervention, involving the surgical registrar being actively involved in the patient's operative journey. Outcome measures were qualitative measures of operative efficiency. Statistical analysis was undertaken. RESULTS: There were 42 patients included in this study, with 21 patients in each of its arms. A 48% (P-value < 0.01) reduction in overall case changeover times was demonstrated with the utilization of a structured intervention from 27.7 min (95% confidence interval (CI) 22.8-32.7%) to 15.7 min (95% CI 13.2-18.2%). The intervention results were statistically significant (P-value < 0.05) for all markers of efficiency except for the waiting time in the anaesthetic holding bay (P-value 0.13). CONCLUSION: The surgical registrar can improve operating room efficiency by using a structured intervention, ultimately reducing patient changeover times.

The effect of hypertension and diabetes on the degree of renal function deterioration after unilateral nephrectomy.

OBJECTIVE: • To quantify the effect of hypertension and diabetes - which have been identified as both initiating and progressing factors in chronic kidney disease (CKD), as well as predictors of long-term renal impairment in patients undergoing nephrectomy - on renal function after unilateral nephrectomy for malignancy. PATIENTS AND METHODS: • A retrospective analysis was carried out of 80 unilateral nephrectomies performed at the Wagga Wagga Base Hospital, Calvary Private Hospital and Austin Hospital from January 2007 to December 2009. • Prognostic variables were patient age, sex and the presence of hypertension or diabetes. • The percentage reduction in glomerular filtration rate (GFR) after nephrectomy was measured and compared between variables using a two-sample Student's t-test. RESULTS: • All patients who had diabetes also had hypertension. • Of the 80 patients, 22 (27.5%) fulfilled the criteria for CKD with a preoperative GFR < 60 mL/min. • Patients with hypertension and diabetes had a significantly greater percentage reduction in postoperative GFR (36 ± 2%) than those who had neither risk factor (23 ± 2%, P < 0.003). A similar finding was observed for patients with hypertension alone (32 ± 1%, P < 0.009). • The difference in postoperative GFR reduction between diabetics and those with hypertension alone was not statistically significant (P= 0.205). • The differential reduction in GFR in patients with CKD risk factors persisted at 3-12 months follow-up. CONCLUSIONS: • An increased percentage reduction in GFR is seen in patients with hypertension and diabetes undergoing unilateral nephrectomy for malignancy. • These data could be used to identify those patients who would benefit from early referral and subsequent intervention to delay the progression of CKD, as well as those for whom nephron-sparing surgery might be a more appropriate surgical option.