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Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
RESEARCH ARTICLE

Delivering complex surgical services: lessons learned from the evolution of a specialised pelvic exenteration centre

Kilian G. M. Brown A B C D , Kate E. McBride B C , Teresa Anderson B C and Michael J. Solomon A B C D *
+ Author Affiliations
- Author Affiliations

A Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.

B Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Sydney, NSW, Australia.

C Institute of Academic Surgery (IAS), Royal Prince Alfred Hospital, Sydney, NSW, Australia.

D Faculty of Medicine and Health, Central Clinical School, The University of Sydney, Sydney, NSW, Australia.

* Correspondence to: professor.solomon@sydney.edu.au

Australian Health Review 47(6) 735-740 https://doi.org/10.1071/AH23186
Submitted: 15 September 2023  Accepted: 15 November 2023  Published: 30 November 2023

© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Pelvic exenteration (PE) is a potentially curative, ultra-radical surgical procedure for the treatment of advanced pelvic tumours, which involves surgical resection of multiple pelvic organs. Delivering such a complex low-volume, high-cost surgical program presents a number of unique health management challenges, and requires an organisation-wide approach involving both clinical and administrative teams. In contrast to the United Kingdom and France, where PE services have been historically decentralised, a centralised approach was developed early on in Australia and New Zealand (ANZ) with referral of these complex patients to a small number of quaternary centres. The PE program at the authors’ institution was established in 1994 and has since evolved into the highest volume PE centre in the ANZ region and the largest single institution experience globally. These achievements have required navigation of specific funding and management issues, supported from inception by a proactive and collaborative relationship with hospital administration and management. The comprehensive state-wide quaternary referral model that has been developed has subsequently been successfully applied to other complex surgical services at the authors’ institution, as well as by more recently established PE centres in Australia. This article aims to summarise the authors’ experience with establishing and expanding this service and the lessons learned from a health management perspective.

Keywords: centralisation, clinical pathways, pelvic exenteration, surgical services.

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