Shaani Singhal

Elective lumbar spine surgery is among the more frequently delayed orthopaedic procedures in the Australian public hospital system. The extent to which prolonged preoperative wait time affects the eventual postoperative response remains incompletely characterised. This prospective single-centre cohort study examined six-week postoperative outcomes in 23 patients (mean age 58.0 years; 52.2% male) undergoing elective lumbar spine surgery at an Australian public tertiary orthopaedic unit, with preoperative and postoperative assessments using the Visual Analog Scale (VAS), the Oswestry Disability Index (ODI), and the 36-Item Short Form Health Survey (SF-36). Median preoperative wait was 64 days (range 15–288). Paired analyses demonstrated large, statistically and clinically significant improvements across all outcome instruments: composite VAS decreased by 4.4 points (p<0.001), ODI by 20.6 percentage points (p=0.005), and SF-36 component summary scores by 7.4–7.5 T-score points (both p<0.05). At a 2-point VAS minimum clinically important difference threshold, 81% of patients achieved clinically meaningful improvement and none worsened. Longer preoperative wait time was consistently associated with smaller postoperative improvement across VAS (r = -0.43), ODI (r = -0.41), and SF-36 physical component summary (r = -0.39); individual tests did not reach statistical significance, but the consistency of direction and magnitude across three independent instruments suggests a real effect. These findings indicate that surgery delivers substantial benefit in this cohort, and provide hypothesis-generating evidence that prolonged wait time may attenuate that benefit. Confirmation in larger cohorts is required.

The natural history of back pain in patients awaiting elective lumbar spine surgery within a public healthcare system remains incompletely characterised. Understanding how pain evolves over the preoperative waiting period is relevant for resource allocation and the targeting of preoperative interventions. This prospective single-centre cohort study examined back pain trajectories over a six-month waiting period in 40 consecutive patients (mean age 64.7 years; 42.5% male) listed for elective lumbar spine surgery at an Australian public tertiary orthopaedic unit between October 2022 and October 2024. Pain severity was assessed using the Visual Analog Scale across motion, standing, and sitting domains and the 36-Item Short Form Health Survey at recruitment and at six months. Paired analysis demonstrated no statistically or clinically significant change in mean VAS scores across any domain, with mean changes of approximately 0.2 points in all domains and the composite (all p > 0.5). Using a 2-point minimum clinically important difference threshold, 70% of patients (28/40) had no meaningful change, 15% (6/40) improved, and 15% (6/40) worsened. SF-36 results triangulated this finding: no subscale or component summary score showed a statistically significant change over six months. These findings indicate that, contrary to the prevailing assumption, mean preoperative pain remains stable for most patients during a six-month wait, while a minority subgroup deteriorates. The results extend recent international evidence to the Australian public-system context and support a shift toward identifying and targeting patients at risk of meaningful preoperative deterioration rather than universal preoperative interventions.

"Introduction: Postoperative complications are an integral aspect of the surgical audit, being a surrogate marker of surgical quality. Despite demonstrated efficacy in most specialties, there is scarce validation of current systems in plastic and reconstructive surgery, let alone a system unique to the specialty. This review aims to establish the efficacy of current systems in plastic and reconstructive surgery and formulate a classification unique to our specialty. Methods: A PUBMED literature search was performed in January 2023 encompassing all available literature. Search terms included ‘classification’, ‘grading’, ‘postoperative complications’ and ‘adverse events’. Further additions through bibliographic linkage generated a total of 363 articles. Results: Twenty-four papers were related to PRS. Sixteen used current systems to describe postoperative complications, whereas eight papers used a system designed uniquely for PRS. The downfall of conventional systems is the simplicity of return to the operating theatre, constituting a single grade in the Clavien-Dindo Classification. Return to theatre has a broad scope for heterogeneity in plastic and reconstructive surgery, particularly in reconstructive patients. A modification of the Clavien-Dindo Classification is proposed. Conclusion: There is limited efficacy of current classification systems for postoperative complications in plastic and reconstructive surgery nor a well-validated system unique to the specialty. A modified system with a detailed emphasis on return to the theatre will be of value to plastic and reconstructive surgery and ideally correlate with important outcomes. This will be validated in a retrospective review of the complication audit from the developing institution."

Background: Learning curves can reflect a surgical trainee’s rate of progress and competence in acquiring new skills. The INSORB subdermal staple device has been well established to facilitate decreased closure time across various surgical procedures, with similar cosmesis, healing, and consistency as those of standard subdermal sutures. This study is unique, as it demonstrated an observable learning curve with this device when used by a junior surgeon. Methods: Sixty-six patients underwent a cosmetic procedure during the second half of 2019 under the care of a single plastic surgeon in Melbourne, Australia. This corresponded to 254 unique linear incisions. Subdermal closure was done either with interrupted 3-0 Monocryl sutures or with the INSORB device. The consultant closed the incisions on one side, with the contralateral incision closed by the assistant using the same closure method. Data were then compared retrospectively, and closure times were compared over the ensuing 6 months. Results: Overall, consultant closure speed is 25% faster than assistant speed. When using 3-0 Monocryl, the difference is 33%, whereas the difference is reduced to 21% when using the INSORB. Furthermore, a mild learning curve could be appreciated with the assistant’s use of the INSORB over the comparatively short 6-month study period. Conclusions: In addition to improved speed, cost, outcome, and ergonomics, subdermal absorbable staples may also garner a faster learning curve than standard closure with 3-0 Monocryl. This study supported the learning curve of a surgical device as another innovative benefit and an important aspect of developing surgical technology.