Canadian Journal of Surgery最新文献

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A 25-year retrospective of Canadian plastic surgery research and its influence: a bibliometric study. 加拿大整形外科研究25年回顾及其影响:文献计量学研究。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-07-15 Print Date: 2025-07-01 DOI: 10.1503/cjs.012024
Daniel Josué Guerra Ordaz, Peter Tai, Antoine Lalonde, Magdalena Cordoba, Éolie Delisle, Sophie Nguyen, Rocío Branes, Maryam Mozafarinia, Carlos Cordoba
{"title":"A 25-year retrospective of Canadian plastic surgery research and its influence: a bibliometric study.","authors":"Daniel Josué Guerra Ordaz, Peter Tai, Antoine Lalonde, Magdalena Cordoba, Éolie Delisle, Sophie Nguyen, Rocío Branes, Maryam Mozafarinia, Carlos Cordoba","doi":"10.1503/cjs.012024","DOIUrl":"10.1503/cjs.012024","url":null,"abstract":"<p><strong>Background: </strong>Bibliometric analysis is a research tool for evaluating and analyzing scholarly output and impact within a specific domain. This study aimed to assess the quantity and quality of plastic surgery research conducted by Canadian-affiliated authors from 1999 to 2023.</p><p><strong>Methods: </strong>We conducted a comprehensive bibliometric analysis using the Web of Science Core Collection to retrieve data from 60 leading plastic surgery journals, focusing on original articles and reviews published between 1999 and 2023. The InCites Benchmarking & Analytics platform evaluated the publications' quantity and quality. Quality assessment employed 2 key metrics:: category-normalized citation impact (CNCI) and the percentage of publications in the top quartile of journals (%Q1) based on impact factors. We used VOSviewer to map collaborative relationships among universities over various periods.</p><p><strong>Results: </strong>Canada ranked as the 11th leading contributor globally, with 4446 publications. Nationally, the University of Toronto accounted for more than 30% of Canadian contributions. In terms of quality, Canada led with a CNCI of 1.09 and 21% of publications in the %Q1. Within Canada, McMaster University had the highest CNCI at 1.33, while Dalhousie University ranked highest in %Q1 at 32.3%. Our VOSviewer map of institutional collaborations revealed increased cooperation between Canadian universities and international institutions over the last 25 years.</p><p><strong>Conclusion: </strong>Over the last 25 years, the trajectory of Canadian plastic surgery literature has been characterized by continuous expansion while maintaining high quality. Efforts should be made to continue to increase the quality and quantity of Canadian research while sustaining international collaborations.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 4","pages":"E296-E304"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279391/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641888","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}
引用次数: 0
Association between preoperative proton pump inhibitor use and postoperative infectious and renal complications following major elective surgery. 术前使用质子泵抑制剂与重大择期手术后感染和肾脏并发症的关系。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-07-15 Print Date: 2025-07-01 DOI: 10.1503/cjs.010224
Luc Dubois, J Andrew McClure, Philip M Jones, Marko Mrkobrada, Suzanne Flier, Blayne Welk, Kelly Vogt
{"title":"Association between preoperative proton pump inhibitor use and postoperative infectious and renal complications following major elective surgery.","authors":"Luc Dubois, J Andrew McClure, Philip M Jones, Marko Mrkobrada, Suzanne Flier, Blayne Welk, Kelly Vogt","doi":"10.1503/cjs.010224","DOIUrl":"10.1503/cjs.010224","url":null,"abstract":"<p><strong>Background: </strong>Use of poton pump inhibitors (PPIs) is associated with increased risk of <i>Clostridioides difficile</i>-associated colitis, pneumonia, and acute kidney injury. Their effect on postoperative complications is unknown. The objective of this study was to investigate the association between PPIs and the risk of <i>C. difficile</i>-associated colitis, pneumonia, and acute kidney injury following elective surgery.</p><p><strong>Methods: </strong>In this population-based, matched cohort study, we identified patients who had filled a PPI prescription within 90 days before major elective surgery (2010-2019). Study outcomes included <i>C. difficile</i>-associated colitis, pneumonia, acute kidney injury, gastrointestinal bleeding, and death within 90 days of surgery. We matched patients 1-to-1 on the basis of age, sex, procedure, date of surgery, and a propensity score predicting PPI exposure. We used logistic regression to evaluate between-group differences.</p><p><strong>Results: </strong>Of 313 163 patients, 89 047 (28.4%) used PPIs; of those, 79 681 were successfully matched to patients who did not use PPIs. The risk of the composite outcome (acute kidney injury, pneumonia, <i>C. difficile</i>-associated colitis, and death) among the patients who used PPIs was slightly higher than among the patients who did not use PPIs (10.6% v. 10.2 4%), and was driven primarily by a higher rate of pneumonia among those who used PPIs (4.0% v. 3.7%). There was a lower rate of gastrointestinal bleeding among the patients who used PPIs (1.6% v. 1.8%). The risk of pneumonia was most pronounced in the subgroup undergoing hip and knee replacement (odds ratio 1.21, 95% confidence interval 1.08-1.36; <i>p</i> = 0.001). There were no significant differences between groups with regard to rates of <i>C. difficile</i>-associated colitis or acute kidney injury.</p><p><strong>Conclusion: </strong>We found that preoperative PPI use was associated with higher rates of pneumonia, particularly among patients undergoing hip and knee replacement surgery, and lower rates of gastrointestinal bleeding. Patients taking a PPI before surgery should be targeted for therapies aimed at reducing pneumonia risk, such as aggressive chest physiotherapy, following their operation.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 4","pages":"E305-E312"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279390/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641889","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}
引用次数: 0
Traumatic primary pulmonary thrombosis: injury and treatment patterns of a distinct clinical entity. 创伤性原发性肺血栓形成:损伤和治疗模式的一个独特的临床实体。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-07-15 Print Date: 2025-07-01 DOI: 10.1503/cjs.007124
Jovana Momic, Laura Allen, Kelly Vogt, Daniele Wiseman, Bradley Moffat
{"title":"Traumatic primary pulmonary thrombosis: injury and treatment patterns of a distinct clinical entity.","authors":"Jovana Momic, Laura Allen, Kelly Vogt, Daniele Wiseman, Bradley Moffat","doi":"10.1503/cjs.007124","DOIUrl":"10.1503/cjs.007124","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, pulmonary thrombi following trauma were believed to occur secondary to embolization from deep vein thrombosis (DVT). However, computed tomography (CT) during initial trauma resuscitation has identified pulmonary thrombi, which raises the possibility of primary pulmonary thrombosis as a distinct clinical entity. This study identifies cases of pulmonary thrombosis identified immediately after trauma and describes associated injury patterns and treatments.</p><p><strong>Methods: </strong>We conducted a retrospective review of the trauma and radiology registries at a Canadian level-1 trauma centre from January 2010 to April 2021. A chart review identified patients with pulmonary thrombi on initial CT. We extracted and analyzed patient demographic characteristics, mechanism of injury, summary of injuries, treatments, and outcomes.</p><p><strong>Results: </strong>A total of 24 patients (15 male, 9 female; mean age 54, standard deviation [SD] 18.6, yr) met the inclusion criteria. All patients experienced blunt trauma (mean Injury Severity Score 23.5, SD 9.5). Rib fractures (<i>n</i> = 11, 46%), pneumohemothorax (<i>n</i> = 7, 29%), and spinal fractures (<i>n</i> = 8, 33%) were common. Four patients had a concomitant DVT, and 10 patients did not undergo assessment for DVT; 10 patients were identified as having primary pulmonary thrombosis. Treatment was started in 18 patients (75%): 9 patients were treated with dalteparin, 2 with dalteparin and inferior vena cava (IVC) filter, 6 with IVC filter in isolation, and 1 with IVC filter and intravenous heparin. Five patients (21%) died from their injuries.</p><p><strong>Conclusion: </strong>Early pulmonary thrombosis was associated with chest injuries, often without DVT. These findings challenge the traditionally held view of DVT embolization as the cause of pulmonary thrombosis immediately following trauma and suggest that primary pulmonary thrombosis is a distinct clinical entity.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 4","pages":"E289-E295"},"PeriodicalIF":2.2,"publicationDate":"2025-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12279389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144641890","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}
引用次数: 0
Enhanced Recovery After Surgery and next-day discharge after laparoscopic Roux-en-Y gastric bypass. 增强术后恢复和腹腔镜Roux-en-Y胃旁路术后次日出院。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-07-10 Print Date: 2025-07-01 DOI: 10.1503/cjs.012923
Krista Hardy, Caleb Leung, Jonathan Seto, Simon Tewes, Wenjing He, Ashley Vergis
{"title":"Enhanced Recovery After Surgery and next-day discharge after laparoscopic Roux-en-Y gastric bypass.","authors":"Krista Hardy, Caleb Leung, Jonathan Seto, Simon Tewes, Wenjing He, Ashley Vergis","doi":"10.1503/cjs.012923","DOIUrl":"10.1503/cjs.012923","url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common bariatric procedure, but patients often experience extended inpatient stays. Given that Enhanced Recovery After Surgery (ERAS) protocols aim to expedite recovery and discharge, we sought to evaluate the impact of introducing an overnight short-stay unit with ERAS protocols, along with transfer protocols for patients requiring prolonged care.</p><p><strong>Methods: </strong>We retrospectively reviewed prospectively collected data on LRYGBs performed between November 2017 and December 2020. Postoperative evaluations were conducted 16-21 hours after surgery. Patients were educated about potential complications and required to stay within 1 hour of a tertiary centre for 7 days. We analyzed descriptive outcomes including length of stay (LOS), 30-day emergency department (ED) presentations, and 7-day and 30-day readmissions.</p><p><strong>Results: </strong>Among the 439 patients, the postoperative day 1 discharge rate was 94.8%, and the day 2 discharge rate was 1.8%. A small proportion of patients (2.7%) required transfer for anticipated prolonged LOS, primarily for delayed intra-abdominal hemorrhage requiring reoperation (66.7%) and as a precautionary measure for technically challenging procedures (16.7%). Two brief admissions to the intensive care unit occurred, with no deaths. Overall, 45 (10.3%) patients presented to the ED within 30 days, 12 (2.7%) patients were readmitted within 7 days, and 18 (4.1%) patients were readmitted within 30 days. Gastrointestinal intolerance was the most common reason for readmission.</p><p><strong>Conclusion: </strong>An ERAS protocol for LRYGB enabled safe next-day discharge for 94.8% of patients. Rates of ED presentation and readmission aligned with existing literature, supporting the feasibility of next-day discharge for appropriately selected patients. These findings contribute to the evidence base for optimizing postoperative care and enhancing patient outcomes in bariatric surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 4","pages":"E274-E280"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263330/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607458","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}
引用次数: 0
Testing the precautionary principle: a scoping review comparing potable tap and sterile water for irrigation in colonoscopy. 检验预防原则:结肠镜检查中用于灌溉的自来水和无菌水的范围审查比较。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-07-10 Print Date: 2025-07-01 DOI: 10.1503/cjs.012724
Hilalion San Ahn, Alexie Leclerc, Jennifer Shamess, Jordi Pardo, Catherine Dube, Alaa Rostom, Natalia Calo, Kednapa Thavorn, Daniel I McIsaac, David Smith, Husein Moloo
{"title":"Testing the precautionary principle: a scoping review comparing potable tap and sterile water for irrigation in colonoscopy.","authors":"Hilalion San Ahn, Alexie Leclerc, Jennifer Shamess, Jordi Pardo, Catherine Dube, Alaa Rostom, Natalia Calo, Kednapa Thavorn, Daniel I McIsaac, David Smith, Husein Moloo","doi":"10.1503/cjs.012724","DOIUrl":"10.1503/cjs.012724","url":null,"abstract":"<p><strong>Background: </strong>Most guidelines recommend use of sterile water in single-use plastic bottles for irrigation in colonoscopy, a recommendation extrapolated from case reports of infection linked to endoscopic retrograde cholangiopancreatography. Our objective was to identify evidence exploring the impact of tap versus sterile water in colonoscopy on patient, health care resource, and environmental outcomes.</p><p><strong>Methods: </strong>We performed a scoping review and included any study examining the effects of irrigation source during colonoscopy. A health information specialist searched Embase, MEDLINE, CINAHL, and Web of Science from inception to March 2024 using Peer Review of Electronic Search Strategies standards. Two reviewers performed screening and data extraction using a standardized form. We conducted a quantitative analysis of patient outcomes.</p><p><strong>Results: </strong>Of 335 identified articles, we included 3. All were prospective studies published between 1996 and 2002. Overall, 137 colonoscopies and 38 flexible sigmoidoscopies were reported. Two studies compared sterile versus tap water, with 7 of 118 (6%) and 35 of 327 (11%) positive water cultures, respectively. There were no clinical adverse events. One study compared tap water at warm versus room temperature and measured patient pain scores (2/10 and 4/10, respectively). Infectious complications were not reported.</p><p><strong>Conclusion: </strong>There is limited evidence to support either tap or sterile water in irrigation for colonoscopy, but potable tap water may be a safe choice and is environmentally and economically more beneficial than sterile water. In the context of the climate crisis and increasing economic health care burden, tap water in reusable bottles should be strongly considered for irrigation in colonoscopy. <b>Registration:</b> Open Science Framework Registry, https://osf.io/8dgck.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 4","pages":"E281-E288"},"PeriodicalIF":2.2,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12263332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144607459","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}
引用次数: 0
Gender representation in professorship and research productivity across all surgical specialties in Canadian academic institutions. 加拿大学术机构中所有外科专业教授职位和研究生产力的性别代表。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-06-18 Print Date: 2025-05-01 DOI: 10.1503/cjs.015723
Stuti M Tanya, Anne Xuan-Lan Nguyen, Maxine Joly-Chevrier, Daiana Roxana Pur, Sanjay Sharma, Fiona Costello, Femida Kherani, Vincent Quoc-Huy Trinh, Isabelle Hardy, Leonardo Lando
{"title":"Gender representation in professorship and research productivity across all surgical specialties in Canadian academic institutions.","authors":"Stuti M Tanya, Anne Xuan-Lan Nguyen, Maxine Joly-Chevrier, Daiana Roxana Pur, Sanjay Sharma, Fiona Costello, Femida Kherani, Vincent Quoc-Huy Trinh, Isabelle Hardy, Leonardo Lando","doi":"10.1503/cjs.015723","DOIUrl":"10.1503/cjs.015723","url":null,"abstract":"<p><strong>Background: </strong>Disparate gender representation among Canadian academic surgeons is documented; however, the association of academic rank with research productivity across all surgical specialties is not well understood. Our objective was to assess differences in gender representation by academic rank and research productivity metrics for surgical specialties in Canadian academic centres.</p><p><strong>Methods: </strong>This retrospective, cross-sectional, comparative study used online public databases in 2021. Data sources included the Canadian Resident Matching Service program descriptions, College of Physicians and Surgeons databases, the Scopus platform, and professional websites. Gender distribution by academic rank, research productivity metrics, institution, and surgical specialty were tested for a 0.5 proportion rate. We used a generalized logistic regression model adjusting for confounders to assess gender association with ordinally ranked academic rank. We defined significance by <i>p</i> < 0.05 with reported 95% confidence intervals.</p><p><strong>Results: </strong>We assessed 10 surgical specialties across 17 Canadian academic institutions. Women surgeons were underrepresented in 16 out of 17 centres (<i>p</i> < 0.001), comprising the majority in only obstetrics-gynecology (<i>p</i> < 0.001). Women were also less represented as assistant (37%), associate (27%), and full professors (18%) (<i>p</i> < 0.001), with lower mean <i>h</i>-index (6.4, <i>p</i> < 0.001), years active in research (11.5, <i>p</i> < 0.001), number of publications (18, <i>p</i> < 0.001), and <i>m</i>-quotient (0.42, <i>p</i> < 0.001). Multivariate analysis showed that men were more likely to be represented in senior professorship regardless of research productivity, institution, and specialty determinants (odds ratio 1.30-1.33, <i>p</i> = 0.001-0.024).</p><p><strong>Conclusion: </strong>Women surgeons were underrepresented across all academic ranks, were less likely to achieve senior professorship, and had lower research productivity metrics.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 3","pages":"E253-E264"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180920/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324590","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}
引用次数: 0
Evidence Based Reviews in Surgery: a critical appraisal of whole blood resuscitation in injured patients. 外科循证回顾:对受伤患者全血复苏的关键评价。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-06-18 Print Date: 2025-05-01 DOI: 10.1503/cjs.009924
Brodie Nolan, Morgan Schellenberg, Chad G Ball, Kelly N Vogt, Jordan Nantais
{"title":"Evidence Based Reviews in Surgery: a critical appraisal of whole blood resuscitation in injured patients.","authors":"Brodie Nolan, Morgan Schellenberg, Chad G Ball, Kelly N Vogt, Jordan Nantais","doi":"10.1503/cjs.009924","DOIUrl":"10.1503/cjs.009924","url":null,"abstract":"<p><p><b>Summary</b>Although blood transfusion as a clinical practice dates back several centuries, the optimal approach remains controversial. In the last decade there has been renewed interest in whole blood transfusion over component therapy for trauma patients. A recent multicentre prospective study assessed the impact of whole blood resuscitation on survival among injured patients in hemorrhagic shock presenting to trauma centres in the United States. We have undertaken an Evidence Based Review in Surgery of that study to appraise how its authors tackled an important clinical question with increasing relevance in modern trauma practice: What is the role of whole blood in trauma resuscitation?</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 3","pages":"E271-E273"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324589","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}
引用次数: 0
High- versus low-intensity knowledge translation interventions for surgeons and rates of local tumour recurrence after rectal cancer surgery: an Ontario study. 高强度与低强度知识转化干预对外科医生和直肠癌术后局部肿瘤复发率的影响:安大略省的一项研究。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-06-18 Print Date: 2025-05-01 DOI: 10.1503/cjs.012424
Marko Simunovic, Christine Fahim, Vanja Grubac, David R Urbach, Greg Pond, Erin Kennedy, Nancy N Baxter
{"title":"High- versus low-intensity knowledge translation interventions for surgeons and rates of local tumour recurrence after rectal cancer surgery: an Ontario study.","authors":"Marko Simunovic, Christine Fahim, Vanja Grubac, David R Urbach, Greg Pond, Erin Kennedy, Nancy N Baxter","doi":"10.1503/cjs.012424","DOIUrl":"10.1503/cjs.012424","url":null,"abstract":"<p><strong>Background: </strong>Given that diagnostic, neoadjuvant treatment, and surgical approaches to rectal cancer have changed markedly in the last 25 years, knowledge translation (KT) may be useful to optimize rectal cancer surgery and improve patient outcomes. We sought to evaluate the impact of surgeon-directed KT to improve the quality of rectal cancer surgery on local tumour recurrence in Ontario.</p><p><strong>Methods: </strong>Ontario's 14 health regions were previously categorized into 2 high-intensity and 12 low-intensity KT regions, based on KT methods (e.g., theory, audit, feedback), applied from 2006 to 2012 to improve the quality of rectal cancer surgery. In the high-intensity regions, efforts encouraged preoperative magnetic resonance imaging, appropriate radiation, and optimal surgical technique. We abstracted hospital chart data from across Ontario for a random sample of cases from 2010 to 2012 based on the respective population of a region and the relative hospital case volume within their region. The main study outcome was local tumour recurrence.</p><p><strong>Results: </strong>In the high-intensity and low-intensity KT regions, we reviewed data from 523 (48.6%) and 557 (51.4%) patients, respectively. Descriptive variables (e.g., age, sex, tumour stage) were similar between groups. In the high- and low-intensity regions, the proportion of patients with a permanent stoma was 31.4% and 26.4% (<i>p</i> = 0.08), the proportion with positive radial margins was 8.0% and 6.1% (<i>p</i> = 0.2), and the proportion with local tumour recurrence was 6.3% and 5.2% (<i>p</i> = 0.2), respectively. The adjusted risk of time to local recurrence was similar in the high- and low-intensity KT regions (hazard ratio 0.72, 95% confidence interval 0.50-1.05).</p><p><strong>Conclusion: </strong>The use of resource-intense methods was not associated with improved patient outcomes, including local tumour recurrence. New approaches are needed to optimize the population-level quality of rectal cancer surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 3","pages":"E245-E252"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180919/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324591","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}
引用次数: 0
Changes in opioid distribution and chronic opioid users following outpatient orthopedic surgery: a pre-post intervention study. 门诊骨科手术后阿片类药物分布和慢性阿片类药物使用者的变化:干预前后研究
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-06-18 Print Date: 2025-05-01 DOI: 10.1503/cjs.000325
Riley Hemstock, Sheila McRae, Ian Laxdal, Thomas Mutter, Kevin Friesen, Heather J Prior, Jason Old, Gregory Stranges, Devin Lemmex, James Dubberley, Jonathan Marsh, Robert Longstaffe, Peter MacDonald, Jarret Woodmass
{"title":"Changes in opioid distribution and chronic opioid users following outpatient orthopedic surgery: a pre-post intervention study.","authors":"Riley Hemstock, Sheila McRae, Ian Laxdal, Thomas Mutter, Kevin Friesen, Heather J Prior, Jason Old, Gregory Stranges, Devin Lemmex, James Dubberley, Jonathan Marsh, Robert Longstaffe, Peter MacDonald, Jarret Woodmass","doi":"10.1503/cjs.000325","DOIUrl":"10.1503/cjs.000325","url":null,"abstract":"<p><strong>Background: </strong>Outpatient overprescribing of opioids in the postoperative period contributes to the opioid epidemic. Given that patient education and evidence-informed prescription protocols have reduced postoperative opioid use in small, randomized trials, we sought to evaluate the effectiveness of a multimodal opioid reduction protocol, implemented institution-wide at an outpatient Canadian orthopedic surgery centre.</p><p><strong>Methods: </strong>In this pre-post intervention study, we used deidentified health administrative data from a provincial data repository to identify all opioid-naive patients who underwent outpatient shoulder or knee surgery at a single institution between 2013 and 2022. An opioid restriction protocol was implemented in 2019, including an educational pamphlet, perioperative verbal education, and a standardized postoperative analgesic prescription. Outcomes analyzed included dispensed morphine milligram equivalents (MME) per patient within 180 days of surgery and chronic opioid use, defined as opioids dispensed 180-270 days after surgery. Prescriptions dispensed from any provider were included.</p><p><strong>Results: </strong>We included 8244 patients preintervention and 2205 patients postintervention in the analyses. The average MME dispensed per patient decreased by 18% (57.8 MME, 95% confidence interval 45.0-70.6). The proportion of patients who filled opioid prescriptions beyond 180 days after surgery decreased from 4.8% to 2.6% (<i>p</i> < 0.001). These findings remained consistent after adjustment for age, sex, socioeconomic status, mental health, and medical comorbidity in multivariable regression analyses.</p><p><strong>Conclusion: </strong>The volume of opioids dispensed and the number of chronic opioid users were significantly reduced among patients who underwent outpatient orthopedic surgery after the institution-wide implementation of a multimodal postoperative opioid reduction protocol.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 3","pages":"E265-E270"},"PeriodicalIF":2.2,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144324588","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}
引用次数: 0
Rural surgical and obstetric facility-level outcomes for index procedures: a retrospective cohort study (2016-2021). 农村外科和产科设施水平的指数手术结果:一项回顾性队列研究(2016-2021)。
IF 2.2 4区 医学
Canadian Journal of Surgery Pub Date : 2025-06-10 Print Date: 2025-05-01 DOI: 10.1503/cjs.003423
Jude Kornelsen, Gal Av-Gay, Anshu Parajulee, Nancy Humber, Sean Ebert, Tom Skinner, Kathrin Stoll
{"title":"Rural surgical and obstetric facility-level outcomes for index procedures: a retrospective cohort study (2016-2021).","authors":"Jude Kornelsen, Gal Av-Gay, Anshu Parajulee, Nancy Humber, Sean Ebert, Tom Skinner, Kathrin Stoll","doi":"10.1503/cjs.003423","DOIUrl":"10.1503/cjs.003423","url":null,"abstract":"<p><strong>Background: </strong>Many rural communities have lost local access to procedural care, and although rural surgical services have endured in some regions, questions regarding quality and safety of care have persisted. Using retrospective observational data, we sought to compare adverse outcomes of the most common surgical procedures performed at rural facilities in British Columbia and outcomes by provider specialty. Our objective was to show whether the efficacy of surgical care at rural facilities is comparable to that of larger referral facilities and whether family physicians with enhanced surgical skills (FPESS) have outcomes comparable to those of specialists at referral facilities for low-morbidity patients.</p><p><strong>Methods: </strong>We included patients who had a colonoscopy, hernia repair, appendectomy, or cesarean delivery at 1 of 7 rural hospitals in BC that participated in the Rural Surgical and Obstetrics Networks of BC and corresponding referral facilities between 2016 and 2021. To control for differences in the acuity of patients between facility types, we risk stratified data by patient comorbidity level, in addition to adjusting for other demographic differences using multivariable Firth logistic regression analysis. We also compared the outcomes of FPESS with those of regional specialists for low-acuity patients in a similar manner. We calculated adjusted odds ratios (ORs), used tests of noninferiority to obtain <i>p</i> values for the adjusted ORs, and calculated E-values to estimate the extent to which our findings could be due to other unmeasured confounding.</p><p><strong>Results: </strong>Most surgical procedures at rural hospitals were performed by FPESS (<i>n</i> = 4403, 34.9%) and visiting general surgeons (<i>n</i> = 7317, 57.9%). We found that the quality of care at rural facilities was at least equivalent to the quality at referral facilities in rural BC for colonoscopy, hernia repair, and appendectomy, and that FPESS had outcomes at least equivalent to those of specialists for low-acuity patients.</p><p><strong>Conclusion: </strong>Our findings provide evidence in favour of the efficacy of rural procedural care at BC facilities, and although these results are not inherently generalizable to other populations, we believe they illustrate the potential for high-quality rural care for low-acuity procedures in similar settings. These findings are an important step toward documenting rural-specific outcomes and creating attendant benchmarks for rural practice.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"68 3","pages":"E221-E234"},"PeriodicalIF":2.2,"publicationDate":"2025-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12169910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144265314","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}
引用次数: 0
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