The Cholecystectomy As A Day Case (CAAD) Score: A Validated Score of Preoperative Predictors of Successful Day-Case Cholecystectomy Using the CholeS Data Set

Background Day-case surgery is associated with significant patient and cost benefits. However, only 43% of cholecystectomy patients are discharged home the same day. One hypothesis is day-case cholecystectomy rates, defined as patients discharged the same day as their operation, may be improved by better assessment of patients using standard preoperative variables. Methods Data were extracted from a prospectively collected data set of cholecystectomy patients from 166 UK and Irish hospitals (CholeS). Cholecystectomies performed as elective procedures were divided into main (75%) and validation (25%) data sets. Preoperative predictors were identified, and a risk score of failed day case was devised using multivariate logistic regression. Receiver operating curve analysis was used to validate the score in the validation data set. Results Of the 7426 elective cholecystectomies performed, 49% of these were discharged home the same day. Same-day discharge following cholecystectomy was less likely with older patients (OR 0.18, 95% CI 0.15–0.23), higher ASA scores (OR 0.19, 95% CI 0.15–0.23), complicated cholelithiasis (OR 0.38, 95% CI 0.31 to 0.48), male gender (OR 0.66, 95% CI 0.58–0.74), previous acute gallstone-related admissions (OR 0.54, 95% CI 0.48–0.60) and preoperative endoscopic intervention (OR 0.40, 95% CI 0.34–0.47). The CAAD score was developed using these variables. When applied to the validation subgroup, a CAAD score of ≤5 was associated with 80.8% successful day-case cholecystectomy compared with 19.2% associated with a CAAD score >5 (p < 0.001). Conclusions The CAAD score which utilises data readily available from clinic letters and electronic sources can predict same-day discharges following cholecystectomy

Health for all by the year 2000 - 1984 Sir Walter Murdoch Memorial Lecture

A lecture given by Professor Stephen R. Leeder, Chairman of the Undergraduate Education Committee and Professor of Community Medicine, Faculty of Medicine at University of Newcastle for the 1984 Sir Walter Murdoch Memorial Lecture held at Murdoch University. PLEASE NOTE: This recording is incomplete. This sound recording is part of the History of Murdoch University Collection

Excess mortality in the Hunter region of Australia

The Hunter region of New South Wales has experienced higher death rates than expected during the past two decades. To try to explain this phenomenon the excess mortality was analysed by sex, age, cause of death and local governmental area within the region. Apart from unusually high mortality from motor vehicle accidents amongst young males, the excess deaths were confined to the age groups 35-74 years in both sexes, occurred in the predominantly industrial and mining areas and were largely attributable to ischaemic heart disease and stroke (with deaths from cancers occurring at normal rates). These findings emphasise that any prevention programme aimed at reducing mortality should focus on vascular diseases and be directed towards those sections of the community identified at greatest potential risk