Julien Dartus, Patrick Devos, Bogdan A Matache, Luc Bédard, Stéphane Pelet, Etienne L Belzile
{"title":"The impact of Canadian-produced research on the global orthopedic literature: a bibliometric analysis.","authors":"Julien Dartus, Patrick Devos, Bogdan A Matache, Luc Bédard, Stéphane Pelet, Etienne L Belzile","doi":"10.1503/cjs.007022","DOIUrl":"10.1503/cjs.007022","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the quality and impact of Canadian-produced research relative to that of other developed nations. The purpose of this study was to determine the contribution of Canadian authors to the orthopedic literature globally and nationally as well as Canada's research productivity in orthopedics. We hypothesized that Canada ranks among the most impactful countries in terms of orthopedic research productivity.</p><p><strong>Methods: </strong>We performed a bibliometric analysis to identify articles published between 2001 and 2020 in the category of orthopedics. We identified Canada's global rank in terms of overall productivity and assessed the contributions of individual Canadian authors. We also examined the quality of publications as determined by category normalized citation impact (CNCI) and publication in the top quartile of journals (%Q1) in terms of impact factor. In addition, we calculated the percentage of Canadian publications that were in orthopedics.</p><p><strong>Results: </strong>We identified 10 821 orthopedic publications from 2001 to 2020. Canada placed sixth globally in terms of productivity in orthopedic research. The annual productivity of Canadian orthopedic researchers increased over the study period by a factor of 3.2. In terms of research quality, with a %Q1 of 36.5% and a CNCI of 1.22, Canada outperformed Asian countries and the United States; the latter country had a %Q1 of 35.3% and a CNCI of 1.14 over the study period.</p><p><strong>Conclusion: </strong>The body of Canadian orthopedic literature has grown consistently over the past 20 years. Despite the overall leadership of the United States and other developed nations such as China and Japan, Canada ranks among the most influential countries in terms of the quality and quantity of orthopedic research.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E583-E595"},"PeriodicalIF":2.5,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10713202/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138497935","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":"Challenges and opportunities in providing high-quality surgical care in Canada.","authors":"David Pace, Steven Quigley, Lesley Johnston","doi":"10.1503/cjs.009723","DOIUrl":"10.1503/cjs.009723","url":null,"abstract":"<p><p>SummaryThe provision of surgical care in Canada requires substantial improvement. In this commentary, we use the US Institute of Medicine's framework for assessing the quality of health care to explore system-wide challenges that affect surgical outcomes in Canada. Challenges include surgical wait times, long travel times for surgery, human resource constraints, equitable access to surgery, limited collection of data about the surgical pathway, a lack of transparency in the reporting of surgical outcomes and a lack of incentives for hospital systems to achieve high-quality outcomes. We propose solutions supported by available literature to help overcome some of these challenges.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E602-E604"},"PeriodicalIF":2.5,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10713200/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138497933","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}
Kristen I Barton, Nicholas J Steiner, Kevin R Boldt, Olawale A Sogbein, Stephen M Tsioros, Lyndsay Somerville, James L Howard, Brent A Lanting
{"title":"Major complications after total hip arthroplasty with the direct anterior approach at a high-volume Ontario tertiary care centre.","authors":"Kristen I Barton, Nicholas J Steiner, Kevin R Boldt, Olawale A Sogbein, Stephen M Tsioros, Lyndsay Somerville, James L Howard, Brent A Lanting","doi":"10.1503/cjs.005223","DOIUrl":"10.1503/cjs.005223","url":null,"abstract":"BACKGROUND The rate of major surgical complications for high-volume orthopedic surgeons using the direct anterior approach (DAA) in Ontario, Canada, is not known. The purpose of this study was to investigate the rate of major surgical complications after total hip arthroplasty (THA) using DAA performed by experienced orthopedic surgeons at a high-volume tertiary care centre in Ontario. METHODS We conducted a retrospective cohort review of primary THA through DAA performed by 2 experienced fellowship-trained surgeons at an academic hospital in London, Ontario, between Jan. 1, 2012, and May 1, 2019. We excluded the first 100 cases to allow for surgeon learning curves. We recorded major surgical complications (intraoperative events, postoperative periprosthetic fractures, dislocation requiring closed or open reduction, implant failure [aseptic loosening or subsidence], early (< 6 wk) deep wound infection requiring irrigation and débridement, late (≥ 6 wk) deep wound infection requiring irrigation and débridement, and wound complications [wound dehiscence, stitch abscess, erythema, hematoma or seroma]) within 1 year of THA. RESULTS A total of 875 primary DAA THA procedures were included. The rates of surgical complications were 0.9% for intraoperative events, 1.5% for postoperative periprosthetic fractures, 0.8% for implant failure, 0.7% for early deep wound infection, 0.1% for late deep wound infection and 3.2% for wound complications; there were no cases of dislocation. The rate of revision for implant failure within 1 year was 0.1%. Male sex was associated with a greater risk of implant failure (p = 0.01), and having a higher body mass index was associated with both increased rates of infection (p < 0.01) and having a wound complication (p < 0.01). CONCLUSION Intraoperative events, postoperative periprosthetic fractures, implant failure, deep wound infection and wound complications accounted for the major surgical complications within 1 year of THA through DAA. The low revision rate suggests that DAA is a safe approach for THA.","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E596-E601"},"PeriodicalIF":2.5,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10713201/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138497934","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":"Author response to \"The Yukon data are incorrect\".","authors":"Michael H Chaikof","doi":"10.1503/cjs.98973","DOIUrl":"10.1503/cjs.98973","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E581"},"PeriodicalIF":2.5,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138450979","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}
Allyson Kis, Tarek Razek, Jeremy Grushka, Nathalie Boulanger, Larry Watt, Dan Deckelbaum, Kosar Khwaja, Paola Fata, Evan G Wong
{"title":"Surgical, trauma and telehealth capacity in Indigenous communities in Northern Quebec: a cross-sectional survey.","authors":"Allyson Kis, Tarek Razek, Jeremy Grushka, Nathalie Boulanger, Larry Watt, Dan Deckelbaum, Kosar Khwaja, Paola Fata, Evan G Wong","doi":"10.1503/cjs.013822","DOIUrl":"10.1503/cjs.013822","url":null,"abstract":"<p><strong>Background: </strong>Delivering trauma and surgical care to Northern Quebec presents unique challenges owing to the region's remoteness, extreme weather and limited transport; the expansion of telehealth could help address these difficulties. We aimed to evaluate current surgical, trauma and telemedicine capacity in Nunavik, Quebec.</p><p><strong>Methods: </strong>We used validated assessment tools, including the Personnel, Infrastructure, Procedures, Equipment and Supplies survey, the International Assessment of Capacity for Trauma index and the Maryland Health Care Commission Telemedicine Readiness tool to evaluate surgical, trauma and telemedicine capacity, respectively. We adapted these tools to the Northern Quebec context through discussions with local leadership. Data were collected in 2 regional hospitals - the Ungava Tulattavik Health Centre (UTHC) and the Inuulitsivik Health Centre (IHC) - and 12 Centres locaux de services communautaires (CLSCs; local community services centres) in 6 villages along the Hudson Bay coast and 6 villages along the Ungava Bay coast through iterative discussions with 4 chief nurses from each regional hospital and set of CLSCs; resources were confirmed through on-site evaluation by the respondents. We performed a descriptive analysis of the data.</p><p><strong>Results: </strong>Surgical capacity was highest in the IHC (6.76) and lowest in the Ungava Bay CLSCs (5.52). Personnel (0%-0%) and procedures (13%-33%) were the least available resources. Trauma capacity was highest in the IHC (7.25) and lowest in the Hudson Bay CLSCs (5.58). Although equipment (90%-100%) and supplies (100%-100%) were readily available, personnel (0%-0%) and procedures (25%-56%) were lacking. The UTHC was most prepared for telehealth (67.80%), and the Ungava Bay CLSCs achieved a lower score (51.13%). Underdeveloped telehealth criteria included funding, administrative support, quality improvement and physical spaces (all 33%-67%).</p><p><strong>Conclusion: </strong>Acute care capacity in Nunavik appears heterogeneous, with readily available equipment and supplies, but a lack of personnel capable of performing lifesaving procedures. To address the need for telemedicine, future initiatives should focus on improving funding, administrative support, physical spaces and quality-improvement initiatives.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E572-E579"},"PeriodicalIF":2.5,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138450982","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}
Samrat Ray, Chaya Shwaartz, Blayne Amir Sayed, Gonzalo Sapisochin, Anand Ghanekar, Ian McGilvray, Mark Cattral, Leslie Lilly, Nazia Selzner, Cynthia Tsien, Mamatha Bhat, Elmar Jaeckel, Markus Selzner, Trevor W Reichman
{"title":"Should advanced donor age be a deterrent in the utilization of grafts from donation after cardiac death in deceased donor liver transplantation? The Toronto experience.","authors":"Samrat Ray, Chaya Shwaartz, Blayne Amir Sayed, Gonzalo Sapisochin, Anand Ghanekar, Ian McGilvray, Mark Cattral, Leslie Lilly, Nazia Selzner, Cynthia Tsien, Mamatha Bhat, Elmar Jaeckel, Markus Selzner, Trevor W Reichman","doi":"10.1503/cjs.001123","DOIUrl":"10.1503/cjs.001123","url":null,"abstract":"<p><strong>Background: </strong>Advanced donor age paired with donation after cardiac death (DCD) increases the risk of transplantation, precluding widespread use of grafts from such donors worldwide. Our aim was to analyze outcomes of liver transplantation using grafts from older DCD donors and donation after brain death (DBD) donors.</p><p><strong>Methods: </strong>Patients who underwent liver transplantation using grafts from deceased donors between January 2016 and December 2021 were included in the study. Short-and long-term outcomes were analyzed for 4 groups of patients: those who received DCD and DBD grafts from younger (< 50 yr) and older (≥ 50 yr) donors.</p><p><strong>Results: </strong>Of the 807 patients included in the analysis, 44.7% (<i>n</i> = 361) of grafts were received from older donors, with grafts for older DCD donors comprising 4.7% of the total cohort (<i>n</i> = 38). Patients who received grafts from older donors had a lower incidence of biliary strictures than those who received grafts from younger donors (7.9% v. 20.0% for DCD donation, <i>p</i> = 0.14, and 4.9% v. 6.8% for DBD donation, <i>p</i> = 0.34), with a significantly lower incidence of ischemic-type biliary strictures in patients who received grafts from older versus younger DCD donors (2.6% v. 18.0%, <i>p</i> = 0.04). There was no difference in 1- and 3-year graft survival rates among patients who received grafts from older and younger DCD donors (92.1% v. 90.8% and 80.2% v. 80.9%, respectively) and those who received grafts from older and younger DBD donors (90.1% v. 93.2% and 85.3% v. 84.4%, respectively) (<i>p</i> = 0.85). Pretransplantation admission to the intensive care unit (hazard ratio [HR] 9.041, <i>p</i> < 0.001) and nonalcoholic steatohepatitis (HR 2.197, <i>p</i> = 0.02) were found to significantly affect survival of grafts from older donors.</p><p><strong>Conclusion: </strong>Donor age alone should not be the criterion to determine the acceptability of grafts in liver transplantation. With careful selection criteria, older DCD donors could make a valuable contribution to expanding the liver donor pool, with grafts that produce comparable results to those obtained with standard-criteria grafts.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E561-E571"},"PeriodicalIF":2.5,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699285/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138450981","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":"The Yukon data are incorrect.","authors":"Alexander J Poole","doi":"10.1503/cjs.98868","DOIUrl":"10.1503/cjs.98868","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E580"},"PeriodicalIF":2.5,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699284/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138450983","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":"Correction to: \"Surgical sexism in Canada: structural bias in reimbursement of surgical care for women\".","authors":"","doi":"10.1503/cjs.015423","DOIUrl":"10.1503/cjs.015423","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E582"},"PeriodicalIF":2.5,"publicationDate":"2023-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10699283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138450980","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}
Eryck Moskven, Daniel Banaszek, Eric C Sayre, Aleksandra Gara, Elizabeth Bryce, Titus Wong, Tamir Ailon, Raphaële Charest-Morin, Nicolas Dea, Marcel F Dvorak, Charles G Fisher, Brian K Kwon, Scott Paquette, John T Street
{"title":"Effectiveness of prophylactic intranasal photodynamic disinfection therapy and chlorhexidine gluconate body wipes for surgical site infection prophylaxis in adult spine surgery.","authors":"Eryck Moskven, Daniel Banaszek, Eric C Sayre, Aleksandra Gara, Elizabeth Bryce, Titus Wong, Tamir Ailon, Raphaële Charest-Morin, Nicolas Dea, Marcel F Dvorak, Charles G Fisher, Brian K Kwon, Scott Paquette, John T Street","doi":"10.1503/cjs.016922","DOIUrl":"10.1503/cjs.016922","url":null,"abstract":"<p><strong>Background: </strong>Current measures to prevent spinal surgical site infection (SSI) lack compliance and lead to antimicrobial resistance. We aimed to examine the effectiveness of bundled preoperative intranasal photodynamic disinfection therapy (nPDT) and chlorhexidine gluconate (CHG) body wipes in the prophylaxis of spine SSIs in adults, as well as determine our institutional savings attributable to the use of this strategy and identify adverse events reported with nPDT-CHG.</p><p><strong>Methods: </strong>We performed a 14-year prospective observational interrupted time-series study in adult (age > 18 yr) patients undergoing emergent or elective spine surgery with 3 time-specific cohorts: before rollout of our institution's nPDT-CHG program (2006-2010), during rollout (2011-2014) and after rollout (2015-2019). We used unadjusted bivariate analysis to test for temporal changes across patient and surgical variables, and segmented regression to estimate the effect of nPDT-CHG on the annual SSI incidence rates per period. We used 2 models to estimate the cost of nPDT-CHG to prevent 1 additional SSI per year and the annual cumulative cost savings through SSI prevention.</p><p><strong>Results: </strong>Over the study period, 13 493 patients (mean 964 per year) underwent elective or emergent spine surgery. From 2006 to 2019, the mean age, mean Charlson Comorbidity Index (CCI) score and mean Spine Surgical Invasiveness Index (SSII) score increased from 48.4 to 58.1 years, from 1.7 to 2.6, and from 15.4 to 20.5, respectively (<i>p</i> < 0.001). Unadjusted analysis confirmed a significant decrease in the annual number (74.6 to 26.8) and incidence (7.98% to 2.67%) of SSIs with nPDT-CHG (<i>p</i> < 0.001). After adjustment for mean age, mean CCI score and mean SSII score, segmented regression showed an absolute reduction in the annual SSI incidence rate of 3.36% per year (<i>p</i> < 0.001). The estimated annual cost to prevent 1 additional SSI per year was about $1350-$1650, and the estimated annual cumulative cost savings were $2 484 856-$2 495 016. No adverse events were reported with nPDT-CHG.</p><p><strong>Conclusion: </strong>Preoperative nPDT-CHG administration is an effective prophylactic strategy for spinal SSIs, with significant cost savings. Given its rapid action, minimal risk of antimicrobial resistance, broad-spectrum activity and high compliance rate, preoperative nPDT-CHG decolonization should be the standard of care for all patients undergoing emergent or elective spine surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"66 6","pages":"E550-E560"},"PeriodicalIF":2.5,"publicationDate":"2023-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10664804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134648497","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}
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