Renal transplantation is well established as a life-altering and liberating intervention for patients who are dialysis-dependent. However, obesity is often a barrier to transplantation, and is associated with an increased risk of graft failure and other complications. A retrospective analysis was performed at a single quaternary centre, covering 5 years of patients referred to a state-wide public Bariatric service for special consideration of weight-loss surgery as an adjunct to being listed for renal transplantation. Of the 16 patients referred, 13 opted to proceed, and 12 have undergone weight-reduction surgery. 75% (9/12) have gone on to successful renal transplantation, and the remaining 25% are listed awaiting an appropriate donor. 83.3% (10/12) successfully met their weight target within 12 months of their surgery with a mean BMI reduction of 13.39±4.19, which is comparable to non-dialysis cohorts in the literature, while the remaining two patients both had a BMI reduction >11 and underwent successful transplantation. Within the overall cohort of patients, only one had a notable morbidity event within 30 days of bariatric surgery or their transplant. This suggests that weight-loss surgery in the context of dialysis and potential renal transplantation may see significant benefit without an unacceptable level of risk.

Iron deficiency anaemia (IDA) is common yet often under-investigated in surgical inpatients, contributing to delayed recovery, transfusion risk, and missed gastrointestinal malignancy. This study examined the prevalence, investigation, and follow-up outcomes of IDA among acute general surgical admissions. A retrospective audit was conducted for all Acute Surgical Unit admissions between January–March 2025. Demographics, haemoglobin, iron studies and endoscopy results were extracted from electronic records. Anaemia was defined using WHO thresholds and IDA as anaemia with ferritin <30 µg/L or transferrin saturation <20%. Patients were excluded if medically unsuitable for endoscopy, post-trauma, pregnant or recently scoped. Descriptive statistics and chi-square testing were performed. Of 866 admissions, 842 patients had bloods available. Anaemia occurred in 174 patients (20%), with 70 meeting biochemical criteria for IDA (8%). IDA patients were older than the total cohort (median 68.5 vs 48 years). Forty patients were appropriate for endoscopic investigation; 20 (50%) were referred, but only 13 procedures occurred within 6 months. Clinically significant pathology was identified in 11/13 cases (85%), including adenomatous polyps (15%) and malignancy (5%). Anaemia severity was not associated with likelihood of referral. IDA was prevalent and frequently under-investigated. Endoscopic yield was high, suggesting missed opportunity for diagnosis and intervention. Routine iron studies for anaemic patients and Direct-to-Scope pathways may improve detection of significant pathology. References World Health Organization 2019, Anaemia. Goddard AF et al. Gut. 2011.

Purpose: Symptomatic Established Rectus Diastasis (SERD) of parity is reported to be associated with decreased health-related quality of life and body-image satisfaction. Correction of rectus diastasis with abdominoplasty (with muscle plication) has been shown to improve quality of life in patient reported outcome measures (PROMs) research. However, the impact of rectus diastasis and surgical correction on women’s body-image and health-related quality of life compared to normative values using the BODY-Q has not been previously demonstrated. Methods: This was a prospective study on Australian women over 18-years old with rectus diastasis of parity undergoing abdominoplasty with diastasis repair. Women with an inter-rectus distance of >30mm confirmed on ultrasound and symptoms such as back pain and/or urinary incontinence were included. The BODY-Q instrument was administered online pre-op and then at least 6-months post-op and means were compared. Pre- and post-op scores were also compared to published normative values for women matched for age and BMI. Ethical approval from SAC HREC. Results: 117 women underwent abdominoplasty for SERD. BODY-Q scores were significantly higher after surgery than pre-op values for all scales (p<0.001). Pre-op BODY-Q scores for all scales were significantly worse than normative values (p<0.001) except for social function, which was similar. Post-op, BODY-Q scores for all scales were significantly better than normative values (p<0.001), except for physical and sexual function which were similar to normative. Conclusions: Women with SERD demonstrate significantly worse body-image satisfaction and health-related quality of life compared to normative populations of women. Surgical correction with abdominoplasty results in statistically significant and clinically meaningful improvements in health-related quality of life measured by the BODY-Q, to the level of normative populations of women.

Purpose There is much debate regarding the acceptable surgical margin for HCC resection. emerging evidence suggests that narrower margins and even R1 resections provide comparable oncological results for resection of HCC. We seek to compare survival outcomes following liver resection for HCC between patient based on their margin status. Methodology This retrospective cohort study examines patients that underwent primary liver resection for HCC in a tertiary referral centre in Western Australia between 2010 and 2025. Variables were analysed by plotting Kaplan-Meier survival curves, univariate analysis using Cox regression and by creating multivariate Cox models to identify independent predictors of survival. Results 107 patients underwent liver resection for HCC during the study period. 89 (83.18%), 12(11.21%) and 6 (5.61%) patients had R0, R1 and R2 resections respectively. 61 (57.01%) of patients were cirrhotic. 23 (21.29%) of patients underwent a major hepatectomy. 45 (42.06%) patients had recurrence of HCC during the period of study. 36 (33.64%) patients died during the period of the study. Multivariate analysis demonstrated that patients experiencing an R2 resection have significantly decreased disease free survival (HR: 2.90, CI: 1.14 – 7.41, p: 0.026) and overall survival (HR: 3.34, CI: 1.15 – 9.70, p: 0.027). There was no difference in disease free or overall survival between patients with R0 and R1 resections. Cirrhosis, BCLC stage and patients undergoing a major resection were not found to be significant predictors of survival. Conclusion Patients that experience R2 resections have a significantly poorer survival following HCC resection. We identified no difference in outcome when comparing R0 to R1 resections. Acceptance of R1 resections as a reasonable surgical outcome could enable a parenchymal sparing approach in HCC resection and allow patients with borderline remnant liver volume to access potentially curative resection.

Purpose: Non-technical errors (NTEs) contribute substantially to patient harm. Emergency general surgery is common, complex, and high-risk for NTEs, yet the incidence and characteristics of fatal NTEs remain unclear. This study aimed to characterise the incidence, clinical phase, team responsibility, and behavioural drivers of fatal NTEs in emergency general surgery to inform future non-technical skills (NTS) improvement strategies. Methods: A retrospective cohort study of all emergency general surgical mortalities with an adverse event or area of concern from the Australian and New Zealand Audit of Surgical Mortality (ANZASM) from 2012–2019 was conducted. Cases were independently assessed by two reviewers using a validated tool, with disagreements resolved by a third reviewer. Results: Fatal NTEs occurred in 790/1164 (67.9%) deaths, with a total of 1053 errors. Situational awareness errors were most common (518/1053, 49.3%), followed by decision-making (431/1053, 40.9%). Most errors arose from few recurrent behaviours: for situational awareness, failure to recognise clinical signs (92/518, 17.8%), failure to appreciate illness severity (75/518, 14.5%), missed diagnosis (73/518, 14.1%); for decision-making, failure to initiate appropriate intervention/investigation (99/431, 23%), incorrect operation (71/431, 16.5%). Error distribution differed across clinical phases (χ²=1325, p<0.01), with 947/1053 (89.9%) occurring outside the operating theatre. Surgical teams were responsible for 652/888 (73.4%) single-team and 109/116 (94%) multi-team errors; non-surgical teams for 235/888 (26.5%) single-team and 112/116 (96.6%) multi-team errors. Conclusions: Fatal NTEs mainly occurred outside the operating theatre, involved both surgical and non-surgical teams, and arose from few recurrent behaviours. These findings reveal a mismatch between traditional NTS improvement efforts and the contexts in which fatal NTEs occur, identifying actionable targets for future interventions.

Purpose of Study To investigate risk prediction tools for emergency laparotomy (EL) in older adults ≥65-years-old in a tertiary Acute Surgical Unit. Methods Patients who underwent EL between April 2021 and April 2022 had baseline characteristics and Clinical Frailty Scale (CFS) prospectively collected; Charlson’s Comorbidity Index (CCI), National Exploratory Laparotomy Audit (NELA), Physiological and Operative Severity (P-Possum), National Surgical Quality Improvement Program (NSQIP) scores, and clinical outcomes retrospectively collected. Binary logistics regression was adjusted for age, CFS and CCI. Results Of 114 patients undergoing EL, average age 76.7±7.6 years old, 46.5% (n=53) were not frail (CFS 1-3), 41.2% (n=47) mildly frail (CFS 4-5), 12.3% (n=14) severely frail (CFS ≥5); 4.4% (n=5) mildly, 34.2% (n=39) moderately, 61.4% (n=70) severely comorbid. 30-day and 1-year mortality were 10.5% (n=12) and 16.7% (n=19) respectively. Before adjustment, NELA was associated with 1.05 (95% CI, 1.02-1.10, p=0.007) and 1.08 (95% CI, 1.04-1.12, p<0.001), P-Possum 1.02 (95% CI, 1.00-1.05, p=0.061) and 1.04 (95% CI, 1.02-1.07, p=0.001), NSQIP-mortality 1.06 (95% CI, 1.02-1.10, p=0.007) and 1.06 (95% CI, 1.02-1.10, p=0.006) times 30-day and 1-year mortality respectively. After multivariable adjustment, NELA and P-Possum were not associated with 30-day mortality. Increments in NSQIP-mortality was associated with 1.05 times 30-day mortality (95% CI, 1.01-1.10, p=0.029). Increments in NELA was associated with 1.06 (95% CI, 1.02-1.11, p=0.005), P-Possum 1.03 (95% CI, 1.01-1.07, p=0.021) and NSQIP-mortality 1.05 (95% CI, 1.01-1.10, p=0.030) 1-year mortality respectively. Conclusion For EL in older adults with frailty and comorbidity, NSQIP provides complementary prediction for short-term mortality. NELA, P-Possum and NSQIP provide risk-prediction for mid-term mortality.