Canadian Journal of Surgery最新文献

{"title":"The near extinction of the RAPTOR: a cautionary tale.","authors":"Andrew W Kirkpatrick, Eric Herget, Shane Smith, Paul B McBeth, Paul Duffy, Mark Nutley, Chad G Ball","doi":"10.1503/cjs.009926","DOIUrl":"10.1503/cjs.009926","url":null,"abstract":"<p><p>SummaryTrauma hybrid operating rooms (THORs) integrate diagnostic imaging with open surgical capabilities to provide both surgical and interventional radiology procedures, such as may be required by exsanguinating patients, in a single physical location. The world's first trauma program-designed THOR, designated the Resuscitation with Angiography, Percutaneous Treatments, and Operative Repair (RAPTOR) suite, opened in Calgary in 2013. It was considered to be paradigm shifting at the time; however, the physical space has become largely obsolete and is now disfavoured by key multidisciplinary users who are essential to RAPTOR functionality. Many health care systems worldwide are considering building such THORs, and lessons learned from early adopters may be invaluable to other planners. We critically evaluated the physical, operational, and administrative components of our RAPTOR experience in the context of the published literature. While the concept has great merit in saving lives, future-proofing such resources is critical.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E433-E435"},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Socioeconomic status and loss to follow-up after orthopedic trauma surgery.","authors":"Yvonne Tan, Mina Tohidi, Imran Syed, Jeff Yach","doi":"10.1503/cjs.021225","DOIUrl":"https://doi.org/10.1503/cjs.021225","url":null,"abstract":"<p><strong>Background: </strong>Follow-up after surgery is important, to monitor patient recovery and to identify potential complications. Our primary objective was to determine the association between patient socioeconomic status and loss to follow-up after orthopedic trauma surgery.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of patients aged 18 to 75 years who underwent orthopedic trauma surgery at a trauma centre in Ontario between January 2022 and December 2023. Patient socioeconomic status was determined by linking postal code with Material and Social Deprivation Index and presented as quintiles. We measured clinic follow-up attendance for 6 months after index surgery. We used logistic regression modelling to estimate the association between material deprivation quintiles and loss to follow-up, accounting for baseline patients and perioperative factors.</p><p><strong>Results: </strong>The study cohort included 1764 patients. Approximately 1 in 4 patients missed at least 1 follow-up appointment in the 6 months after surgery. Odds of missed follow-up with no return were 83% higher in patients in the most deprived quintile, compared with patients who were least deprived (odds ratio 1.83, 95% confidence interval 1.09 to 3.08). Younger age and higher American Society of Anesthesiologists Physical Status score were associated with increased odds of loss to follow-up. Geographic distance to hospital was not independently associated with loss to follow-up.</p><p><strong>Conclusion: </strong>Loss to follow-up is common after orthopedic trauma surgery, and the risk is higher in patients who are most socioeconomically disadvantaged. Innovative solutions should address the needs of specific patient groups to optimize patient access to appropriate, timely follow-up after orthopedic trauma surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E425-E432"},"PeriodicalIF":2.0,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149179588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rate of complications with hip and knee arthroplasties performed at a private hospital in Canada.","authors":"Pascal-André Vendittoli, Gautier Beckers, Marc-Olivier Kiss, Vincent Massé, Martin Lavigne","doi":"10.1503/cjs.018625","DOIUrl":"10.1503/cjs.018625","url":null,"abstract":"<p><strong>Background: </strong>Canada's publicly funded health care systems offer limited scope for private delivery of medically necessary surgery, but in Quebec, private hospitals are permitted to perform hip and knee arthroplasty. Given the paucity of outcome data from Canadian private facilities performing joint replacements, we sought to provide evidence on complications to inform the ongoing discussion about the role of private hospitals in Canada's surgical landscape.</p><p><strong>Methods: </strong>We prospectively collected complications and adverse events for all primary hip and knee arthroplasties performed at the Duval Clinic, a private hip and knee arthroplasty hospital, between January 2022 and December 2024. All patients were managed under an Enhanced Recovery After Surgery pathway. We classified complications as medical or orthopedic and analyzed these by type of procedure, year of occurrence, and need for hospitalization or reoperation.</p><p><strong>Results: </strong>During the study period, 3111 patients received 3379 arthroplasties (2843 unilateral and 268 bilateral). We observed a total of 190 (5.62%) medical and orthopedic adverse events or complications. Twenty-one patients (0.68%) required transfer to a public hospital after surgery for further management of a postoperative complication. Thirty-two (1.03%) patients visited an emergency department after surgery for an unexpected problem. Twenty-five (0.74%) patients underwent reoperation for an orthopedic complication, 7 of which were performed at the private hospital.</p><p><strong>Conclusion: </strong>Arthroplasty performed in a high-volume, accredited, private hip and knee arthroplasty hospital can achieve low complication rates. Transparent reporting of surgical safety in both public and private facilities is essential to guide patient choice and health policy.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E414-E424"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Wait times for degenerative lumbar spine consultation and surgery: a repeated cross-sectional analysis of the Canadian Spine Outcomes and Research Network.","authors":"Michael Bond, John Street, Charles G Fisher, Raphaële Charest-Morin, Edward Abraham, Andrew Nataraj, Bernard Larue, Supriya Singh, Michael H Weber, R Andrew Glennie, Adrienne Kelly, Michael G Johnson, Sean Christie, Najmedden Attabib, Travis Marion, Eugene Wai, Hassan Chaudry, Henry Ahn, Jérome Paquet, Hamilton Hall, Christopher S Bailey, Kenneth C Thomas, Neil Manson, Y Raja Rampersaud, Greg McIntosh, Nicolas Dea, Jason M Sutherland","doi":"10.1503/cjs.001823","DOIUrl":"10.1503/cjs.001823","url":null,"abstract":"<p><strong>Background: </strong>Lumbar spine pathology is an increasingly common condition that often requires timely access to specialist spinal surgeons, but prolonged wait times for specialist care are a serious problem in Canada. We sought to compare contemporaneous wait times for spinal surgical consultation across Canada.</p><p><strong>Methods: </strong>In this observational study, we used data from the Canadian Spine Outcome and Research Network from between 2015 and 2019. We defined wait times for spinal surgical care as the time between the date of primary care referral and surgery. We used simple linear regression to determine the average change in wait time per year. We calculated the percentage of patients meeting wait time targets for surgical intervention, set as the Canadian Institute for Health Information benchmark (< 182 days).</p><p><strong>Results: </strong>We included 3963 surgical patients. The median wait was 92 (interquartile range [IQR] 35 to 221) days between referral and consultation and 92 (IQR 41 to 165) days between booking and surgery, with a cumulative median wait time of 272 (IQR 137 to 483) days between referral and surgery. The cumulative wait time increased gradually over the 5-year study period, with an average increase of 25 days per year. The percentage of participants who did not meet the wait time benchmark was almost 30% in 2019.</p><p><strong>Conclusion: </strong>Patients requiring operative spinal care waited almost 1 year from primary care referral to surgical management for disabling lumbar conditions. Evidence-based strategies are needed to reduce wait times and improve access to care.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E393-E401"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632765/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Value of long-term systematic follow-up for complication detection after hip and knee arthroplasty: a 17-year retrospective cohort study.","authors":"Antoine Arsenault, Nathan Riel, Alex Tardif, Sonia Bédard, Annie Deshaies","doi":"10.1503/cjs.021725","DOIUrl":"10.1503/cjs.021725","url":null,"abstract":"<p><strong>Background: </strong>Long-term systematic follow-up after arthroplasty is widely practised; however, little to no evidence shows benefit from long-term surveillance in asymptomatic patients. The objective of this study was to assess the utility of long-term systematic follow-up in detecting arthroplasty complications requiring surgical intervention.</p><p><strong>Methods: </strong>We conducted a single-centre retrospective cohort study of patients who underwent revision surgery between 2003 and 2020 for complications occurring more than 12 months after primary total hip, total knee, or unicompartmental knee arthroplasty. We identified patients using institutional records. We classified complications based on whether they were first detected during systematic (scheduled) or nonsystematic (unscheduled or symptom-driven) follow-up. The primary outcome was the number of complications detected in each group. Secondary outcomes included time to complication detection and the number of symptomatic versus asymptomatic complications. We compared groups using Student <i>t</i> tests, Mann-Whitney <i>U</i> tests and χ² tests.</p><p><strong>Results: </strong>Among 633 revision surgeries, 74 met inclusion criteria. Of these, 52 (70.3%) complications were detected during nonsystematic follow-up. Since 2003, only 2 (2.7%) complications presented as asymptomatic. Median time to detection was slightly shorter with systematic follow-up (39.0 v. 53.5 mo, <i>p</i> = 0.45).</p><p><strong>Conclusion: </strong>Long-term systematic follow-up has limited effectiveness in detecting complications requiring revision surgery. In light of these findings, and consistent with recent studies reporting similar results, there is a pressing need to develop alternative follow-up strategies that will both improve quality of care and reduce the burden of current follow-up strategies.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E408-E413"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079807","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does ChatGPT provide safe and reliable patient information related to hip and knee arthroplasty?","authors":"Joëlle Deschênes-Bilodeau, Peter Staunton, Charles Desgagné, John Antoniou","doi":"10.1503/cjs.018325","DOIUrl":"10.1503/cjs.018325","url":null,"abstract":"<p><strong>Background: </strong>Patients have been resorting to online content as their main source of medical knowledge, notably on orthopedic interventions. However, Web-based research findings present a reverse correlation between quality of content and popularity. We sought to evaluate whether ChatGPT could provide an alternative and safe source of medical information for arthroplasty patients.</p><p><strong>Methods: </strong>We gave 5 commonly Googled questions related to hip and knee arthroplasty to board-certified arthroplasty surgeons, fellows, and orthopedic surgery residents, as well as to ChatGPT 4.0. We anonymized all answers, which were then analyzed by an independent board-certified arthroplasty surgeon. We scored the answers for accuracy of content (6-point Likert scale) and completeness (3-point Likert scale), then compared the performance of all groups.</p><p><strong>Results: </strong>Among human responders, the mean accuracy grade was 75% (standard deviation [SD] 17%), with a mean completeness grade of 69% (SD 22%). The fellows represented the strongest subgroup, with 75% of their answers scored above 5/6 for accuracy (mean 82%, SD 16%). We found that all human-generated answers had a statistically significant correlation between accuracy and completeness. ChatGPT had a mean accuracy grade of 93% (SD 12%), with a mean completeness of 93% (SD 14%).</p><p><strong>Conclusion: </strong>ChatGPT appears to be a safe tool for patients to access general arthroplasty information online. It outperformed all human responders on both accuracy and completeness of answers. The strongest human responder group was the arthroplasty fellows. Further work is required to clarify the tool's performance against other easily accessible online patient information sources.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E402-E407"},"PeriodicalIF":2.0,"publicationDate":"2026-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13632767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149079819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What trauma from commercial vehicle crashes is telling us.","authors":"Edward J Harvey, Chad G Ball","doi":"10.1503/cjs.018426","DOIUrl":"10.1503/cjs.018426","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E377-E378"},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ce que nous apprennent les traumas causés par des collisions mettant en cause des véhicules commerciaux.","authors":"Edward J Harvey, Chad G Ball","doi":"10.1503/cjs.018826","DOIUrl":"10.1503/cjs.018826","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E379-E380"},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Delays in presentation, severity of illness, and adverse surgical outcomes among patients transferred from Nunavik for acute care surgery.","authors":"Jeongyoon Jenny Moon, Devangi Patel, Tiffany Paradis, Faiz Ahmad Khan, Tarek Razek, Jeremy Grushka, Nathalie Boulanger, Larry Watt, Alexandra Vivier, Greg Clark, Paola Fata, Dan Deckelbaum, Kosar Khwaja, Atif Jastaniah, Evan G Wong","doi":"10.1503/cjs.005425","DOIUrl":"10.1503/cjs.005425","url":null,"abstract":"<p><strong>Background: </strong>Providing acute care surgery (ACS) to Nunavik, Quebec, is highly challenging because of health care infrastructure and access issues, with geographic distances and delays in transport translating to suboptimal care, particularly for acute surgical conditions requiring timely intervention. The main objective of this study was to identify clinical predictors of poor surgical outcomes in patients transferred from Nunavik to a tertiary care centre for operative ACS conditions.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study at the Montreal General Hospital (MGH), the main tertiary care centre providing ACS care to Nunavik. We included all adult patients who were transferred from Nunavik to the MGH and underwent a surgical intervention for an ACS condition between 2015 and 2020. The outcome of interest was the occurrence of a postoperative complication, as defined by the Clavien-Dindo classification.</p><p><strong>Results: </strong>In total, 177 patients were transferred from Nunavik to the MGH and underwent a surgical intervention for an ACS pathology during the study period. The mean age was 40.0 (standard deviation 16.7) years, and half the patients (<i>n</i> = 90, 50.8%) were female. The most common ACS pathology was acute cholecystitis (<i>n</i> = 65, 36.7%), followed by acute appendicitis (<i>n</i> = 51, 28.8%) and biliary pancreatitis (<i>n</i> = 13, 7.3%). Forty-six (26.0%) patients had a postoperative complication of Clavien-Dindo grade 1 or higher. On univariate analysis comparing patients who experienced complications to those who did not, we observed significant differences in age, sex, Emergency Surgical Score (ESS), delays in operative intervention, proportion of open surgical interventions, proportion of intraoperative perforations, admissions to the intensive care unit, and hospital length of stay. On multivariable logistic regression, male sex (odds ratio [OR] 2.75, 95% confidence interval [CI] 1.22 to 6.17), higher ESS (OR 1.28, 95% CI 1.03 to 1.59), higher American Society of Anesthesiologists (ASA) score (OR 2.28, 95% CI 1.23 to 4.24), and longer delays in presentation (OR 1.07, 95% CI 1.01 to 1.14) were predictive of postoperative complications.</p><p><strong>Conclusion: </strong>Delays in presentation and severity of illness on arrival are associated with worse postoperative outcomes for patients with ACS conditions transferred from Nunavik to an urban tertiary care centre. Identifying these predictors of poor postoperative course will help shape future quality improvement initiatives, which should focus on point-of-care resuscitation, improved transport logistics and resources, and ultimately improved access to on-site surgical care.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E382-E392"},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hadley Williams and the development of modern surgery at the University of Western Ontario.","authors":"Vivian C McAlister","doi":"10.1503/cjs.010826","DOIUrl":"10.1503/cjs.010826","url":null,"abstract":"<p><p>SummaryHenry Thomas Hadley Williams, known professionally as Hadley Williams, was a surgeon and teacher whose career illustrates the transformation of surgery in Canada from a craft learned by apprenticeship to a university and hospital discipline. Born in Devon, England, in 1864 and educated in southwestern Ontario, Williams returned to Britain for advanced surgical training and became a Fellow of the Royal College of Surgeons of England in 1899. In 1911 he succeeded John Wishart, the University of Western Ontario's first professor of clinical surgery, and consolidated a pre-Flexner surgical inheritance within the post-Flexner university. His own papers on suprapubic cystostomy, peripheral nerve injury, internal fixation, and perforated gastroduodenal ulcer show a practical surgeon concerned with infection, tissue handling, anatomic repair, timing, and functional recovery. His career at Victoria Hospital, St. Joseph's Hospital, and the University of Western Ontario (rebranded Western University in 2012) places him within the first generation of organized North American specialist surgery and helps explain how modern surgical standards took local institutional form in Canada.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 5","pages":"E372-E376"},"PeriodicalIF":2.0,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13614837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149023935","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}