Canadian Journal of Surgery最新文献

{"title":"UBC Reticulum: a province-wide network promoting surgical excellence and continuous improvement of general surgery in British Columbia.","authors":"Patricia Balmes,&nbsp;Hamish Hwang,&nbsp;S Morad Hameed","doi":"10.1503/cjs.004123","DOIUrl":"https://doi.org/10.1503/cjs.004123","url":null,"abstract":"<p><p>The University of British Columbia's (UBC) Division of General Surgery is a diverse group, including both academic and community surgeons. Since its launch in 2019, the UBC Reticulum website has been a transformative tool in engaging general surgeons, fellows, residents, students and researchers through its many features and user-created content, such as its messaging board, Netter, and Connect feature, which connects members based on their specialty, location, procedures and interests. Reticulum also serves as a valuable repository of educational resources and is instrumental in the division's goal of improving continuing medical education; the Reticulum mentorship grant program provides financial support for practising surgeons pursuing peer-mentorship projects. UBC Reticulum serves as a model for how to coordinate surgical education, research and quality improvement within diverse provincial divisions.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/eb/066E399.PMC10396344.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9934762","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":"Pourquoi la formation médicale est-elle si difficile à poursuivre?","authors":"Edward J Harvey,&nbsp;Chad G Ball","doi":"10.1503/cjs.010323","DOIUrl":"https://doi.org/10.1503/cjs.010323","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/eb/d8/066E449.PMC10473866.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10498717","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":"Sex and racial diversity in Canadian academic surgery.","authors":"Rahim H Valji,&nbsp;Yasmin Valji,&nbsp;Simon R Turner","doi":"10.1503/cjs.004522","DOIUrl":"https://doi.org/10.1503/cjs.004522","url":null,"abstract":"<p><p>To ensure equitable representation of women and BIPOC (Black, Indigenous, person of colour) individuals in surgical specialties, it is first necessary to understand the presence and extent of the disparities that exist. We explored the websites of the 17 Canadian faculties of medicine to examine sex and racial diversity in surgical specialties and in surgical leadership positions in Canada. We categorized faculty members of each department of surgery as either male or female and White or BIPOC. The relative percentage of female academic surgeons was very low compared with Canadian demographic data, and the relative percentage of BIPOC academic surgeons was similar to Canadian demographic data. Our observations suggest that actions must be taken to improve diversity and inclusion in surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/91/be/066E411.PMC10414780.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977599","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":"Patient, operative and pain management factors influencing inpatient compared with surgical day care mastectomy procedures at a community hospital.","authors":"Colin Davey,&nbsp;Leo Chen,&nbsp;Hamish Hwang","doi":"10.1503/cjs.010422","DOIUrl":"https://doi.org/10.1503/cjs.010422","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic highlighted the importance of maximizing same-day discharge after surgery to mitigate potential patient harms associated with inpatient admission and conserve valuable hospital resources. Adoption of same-day discharge after breast surgery, particularly mastectomy, has been slow despite recent research suggesting the physical and psychological benefits of same-day discharge after surgery. We sought to identify factors associated with inpatient compared with surgical day care mastectomy procedures at a community hospital in Vernon, British Columbia.</p><p><strong>Methods: </strong>We conducted a retrospective chart review of all patients who underwent a total mastectomy without reconstruction at Vernon Jubilee Hospital, a 196-bed community hospital, between April 2016 and March 2019. Patient characteristics, operative variables and pain management were compared between inpatient and surgical day care mastectomy procedures. We also compared 7-day readmission, reoperation and complications.</p><p><strong>Results: </strong>A total of 187 mastectomy patients were analyzed with 72 (38.5%) surgical day care procedures. Factors associated with inpatient procedures included longer operative time (66.1 min v. 53.5 min, <i>p</i> = 0.001), bilateral mastectomy (91% v. 9%, <i>p</i> = 0.01) and suspected or confirmed obstructive sleep apnea (32% v. 17%, <i>p</i> = 0.04). Preoperative acetaminophen (83% v. 17%, <i>p</i> < 0.001), multilevel intercostal block (83% v. 17%, <i>p</i> < 0.001) and a prescription for acetaminophen plus tramadol (58% v. 42%, <i>p</i> < 0.001) were associated with day care surgeries. There were no significant differences between the inpatient and surgical day care groups with respect to 7-day readmission, reoperation or postoperative complications.</p><p><strong>Conclusion: </strong>We found no significant differences in surgical outcomes between inpatients and those with same-day discharge after mastectomy procedures. These findings add to the growing body of evidence that surgical day care mastectomy procedures are safe in the community setting.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0a/7c/066E403.PMC10396345.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9934759","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":"Local tissue concentrations of cefazolin during total joint arthroplasty: a systematic review.","authors":"Matthew Mannarino,&nbsp;Julien Montreuil,&nbsp;Michael Tanzer,&nbsp;Adam Hart","doi":"10.1503/cjs.019621","DOIUrl":"https://doi.org/10.1503/cjs.019621","url":null,"abstract":"<p><strong>Background: </strong>Periprosthetic joint infections (PJI) following joint arthroplasty are now the leading cause of reoperation and are associated with serious morbidity to the patient, often requiring several staged operations and a prolonged course of parenteral antibiotics. Prophylactic administration of intravenous antibiotics before skin incision is arguably the most important measure to prevent PJI; however, the dose effectiveness of cefazolin in target tissue is not well known. We aimed to identify parameters affecting local tissue concentration (LTC) of cefazolin.</p><p><strong>Methods: </strong>We performed a literature search using the following keywords: \"orthopaedics,\" \"orthopedic,\" \"arthroplasty\" and \"cefazolin.\" We included studies that measured LTC of cefazolin from samples obtained during either a total knee or total hip arthroplasty.</p><p><strong>Results: </strong>Of the 332 records screened, we included 10 studies that described LTC of cefazolin. The included studies evaluated dosing (<i>n</i> = 7), procedure type (<i>n</i> = 3), body mass index (<i>n</i> = 1) and tourniquet utilization (<i>n</i> = 1).</p><p><strong>Conclusion: </strong>Few studies have measured LTC levels of antibiotics (or levels of cefazolin) to validate current recommendations for antibiotic prophylaxis in orthopedic surgery. With infection as the leading reason for early reoperation or revision surgery, the parameters affecting LTC during orthopedic procedures need to be further assessed.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/32/ab/066E415.PMC10414781.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9977604","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":"A prospective Canadian gastroesophageal cancer database: What have we learned?","authors":"Kieran Purich,&nbsp;Daniel Skubleny,&nbsp;Sunita Ghosh,&nbsp;Eric L R Bédard,&nbsp;Kenneth C Stewart,&nbsp;Scott T Johnson,&nbsp;Erika Haase,&nbsp;Michael McCall,&nbsp;Dan Schiller","doi":"10.1503/cjs.005122","DOIUrl":"https://doi.org/10.1503/cjs.005122","url":null,"abstract":"<p><strong>Background: </strong>Minimal literature exists on outcomes for Canadian patients with gastroesophageal adenocarcinoma (GEA). The objective of our study was to establish a prospective clinical database to evaluate demographic characteristics, presentation and outcomes of patients with GEA.</p><p><strong>Methods: </strong>Patients diagnosed with GEA were recruited from Jan. 30, 2017, to Aug. 30, 2020. Data collected included demographic characteristics, presentation, treatment and survival. A multivariable model for overall survival in patients treated with curative intent was created using sex, lymph node status, resection margin status, age and tumour location as variables.</p><p><strong>Results: </strong>A total of 122 patients with adenocarcinoma of the stomach or gastroesophageal junction were included. Median age was 65 years (interquartile range [IQR] 59-74), 70% of patients were male and 26% were born outside of Canada. Median follow-up time was 14.5 (IQR 8.0-31.0) months. Following staging computed tomography scanning, 88% of patients were deemed to have potentially resectable disease. Eighty-one (76%) received staging laparoscopy and 74 (61%) were treated with curativeintent surgery. Forty-six (62%) patients had nodal metastases. The median number of nodes harvested was 22 (IQR 18-30). The R0 resection margin rate was 82%. The 3-year overall survival for patients who received curative-intent treatment was 63% and 38% for all patients. On multivariable analysis, female sex (hazard ratio [HR] 3.88, <i>p</i> = 0.01), positive nodal status (HR 3.58, <i>p</i> = 0.02), positive margins (HR 3.11, <i>p</i> = 0.03) and tumour location (HR 3.00, <i>p</i> = 0.03) were associated with decreased overall survival.</p><p><strong>Conclusion: </strong>Many of the patients with GEA in this study presented with advanced disease, and only 61% were offered curative-intent surgery. A prospective multicentre national GEA database is now being established.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fa/a7/066E422.PMC10414783.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10349447","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":"Watchful waiting for large primary nonparasitic splenic cysts.","authors":"Élise Di Lena,&nbsp;Nadia Safa,&nbsp;Sid Rahman,&nbsp;Pepa Kaneva,&nbsp;Liane S Feldman","doi":"10.1503/cjs.010322","DOIUrl":"https://doi.org/10.1503/cjs.010322","url":null,"abstract":"<p><strong>Background: </strong>Primary nonparasitic splenic cysts (NPSC) are typically diagnosed incidentally. The management of large (≥ 5 cm) asymptomatic cysts remains controversial; there is a lack of evidence guiding management. The purpose of this study was to describe the outcomes of nonoperative management of large NPSC.</p><p><strong>Methods: </strong>Patients diagnosed with NPSC between January 2004 and December 2019 were identified at our academic institution. Adult patients with an NPSC of at least 5 cm who had at least 1 additional hospital visit were included. Data are presented as medians with interquartile ranges (IQR).</p><p><strong>Results: </strong>We identified 512 medical records that included the term splenic cyst during the study period. Sixty-eight of the patients had no reported cyst size, 410 had cysts smaller than 5 cm, 1 patient underwent an elective splenectomy at another institution and 12 patients were excluded for other reasons; 21 patients with cysts of at least 5 cm were included in the study. Eight symptomatic patients underwent surgery at our institution. Of these, 2 presented acutely: 1 with hemoperitoneum who required admission for transfusions and later underwent elective laparoscopic splenectomy and 1 with increasingly severe abdominal pain who underwent laparoscopic cyst unroofing. The remaining 6 symptomatic patients had elective surgery for pain (4 cyst unroofing, 1 total splenectomy, 1 partial splenectomy). Thirteen patients were asymptomatic (10 female, median age 49.2 [IQR 38.1 to 64.6] yr). Two of these patients chose to undergo elective surgery. The remaining 11 asymptomatic patients, with a median initial cyst size of 8.0 (IQR 5.3 to 10.8) cm, were followed for a median of 31.0 (IQR 23.5 to 71.0) months. There was no change in median cyst size (0 [IQR -1 to 0] cm), and none of these patients underwent intervention for their NPSC.</p><p><strong>Conclusion: </strong>Asymptomatic patients managed nonoperatively for large NPSC did not become symptomatic or require intervention during the study period. This supports watchful waiting with serial radiologic and clinical monitoring for asymptomatic large NPSC.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/47/79/066E390.PMC10396346.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9934764","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":"Association of age with death and withdrawal of life-sustaining therapy after severe traumatic brain injury.","authors":"Alexandre Tran,&nbsp;Victoria Saigle,&nbsp;Neraj Manhas,&nbsp;Lauralyn McIntyre,&nbsp;Alexis F Turgeon,&nbsp;François Lauzier,&nbsp;Michael Chassé,&nbsp;Colleen Golka,&nbsp;Scott J Millington,&nbsp;Kwadwo Kyeremanteng,&nbsp;Diana Ghinda,&nbsp;Howard Lesiuk,&nbsp;Salmaan Kanji,&nbsp;Jennifer Fairbairn,&nbsp;Tammy Lloyd,&nbsp;Shane W English","doi":"10.1503/cjs.013721","DOIUrl":"https://doi.org/10.1503/cjs.013721","url":null,"abstract":"<p><strong>Background: </strong>Compared to younger age, older age (≥ 65 yr) is associated with worse outcomes after severe traumatic brain injury (TBI). We sought to describe the association of older age with in-hospital death and aggressiveness of intervention.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study of adult (age ≥ 16 yr) patients with severe TBI admitted to a single academic tertiary care neurotrauma centre between January 2014 and December 2015. We collected data through chart review as well as from our institutional administrative database. We provided descriptive statistics and used multivariable logistic regression to evaluate the independent association of age with the primary outcome, in-hospital death. The secondary outcome was early withdrawal of life-sustaining therapy.</p><p><strong>Results: </strong>There were 126 adult patients (median age 67 yr [Q1-Q3, 33-80 yr]) with severe TBI during the study period who met our eligibility criteria. The most common mechanism was high-velocity blunt injury (55 patients [43.6%]). The median Marshall score was 4 (Q1-Q3, 2-6), and the median Injury Severity Score was 26 (Q1-Q3, 25-35). After controlling for confounders including clinical frailty, pre-existing comorbidity, injury severity, Marshall score and neurologic examination at admission, we observed that older patients were more likely than younger patients to die in hospital (odds ratio 5.10, 95% confidence interval 1.65-15.78). Older patients were also more likely to experience early withdrawal of life-sustaining therapy and less likely to receive invasive interventions.</p><p><strong>Conclusion: </strong>After controlling for confounding factors relevant to older patients, we observed that age was an important and independent predictor of in-hospital death and early withdrawal of life-sustaining therapy. The mechanism by which age influences clinical decision-making independent of global and neurologic injury severity, clinical frailty and comorbidities remains unclear.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/6e/26/066E348.PMC10322160.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800984","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":"Why are doctors so hard to educate?","authors":"Edward J Harvey,&nbsp;Chad G Ball","doi":"10.1503/cjs.009923","DOIUrl":"https://doi.org/10.1503/cjs.009923","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f5/5d/066E448.PMC10473867.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10498713","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":"Evidence-based treatment of Achilles tendon rupture.","authors":"Dan Cohen,&nbsp;Emilie Sandman,&nbsp;Neil Saran,&nbsp;Brad Petrisor,&nbsp;Mohit Bhandari,&nbsp;Andrea Veljkovic,&nbsp;Anna Leucht,&nbsp;Emilie-Ann Downey,&nbsp;Paul Martineau","doi":"10.1503/cjs.008321","DOIUrl":"https://doi.org/10.1503/cjs.008321","url":null,"abstract":"<p><p>The treatment of Achilles tendon rupture has recently seen a shift toward non-operative management, as supported by the literature, yet many surgeons continue to treat these injuries operatively. The evidence clearly supports non-operative management of these injuries except for Achilles insertional tears and for certain patient groups, such as athletic patients, for whom further research is warranted. This nonadherence to evidence-based treatment may be explained by patient preference, surgeon subspecialty, surgeon era of practice or other variables. Further research to understand the reasons behind this nonadherence would help to promote conformity in the surgical community across all specialties and adherence to evidence-based approaches.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/71/38/066E356.PMC10322157.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9800985","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}