Canadian Journal of Surgery最新文献

{"title":"Implementation of and findings from a regional shoulder replacement registry.","authors":"Jarret Woodmass, Sarah Harris, Sheila McRae, Christiaan H Righolt, Peter MacDonald, Eric Bohm","doi":"10.1503/cjs.014624","DOIUrl":"10.1503/cjs.014624","url":null,"abstract":"<p><strong>Background: </strong>There is currently no national total shoulder arthroplasty (TSA) database in Canada. As a first step toward a national registry, a regional shoulder database was initiated in 2017. In this study, we describe the implementation of and initial findings from the shoulder database and patient-reported outcomes program.</p><p><strong>Methods: </strong>The registry is intended to capture all shoulder arthroplasty procedures in the province of Manitoba and includes surgeon-reported operative details and data on patient-reported outcome measures (PROMs). Every surgeon submits data. We included primary and revision procedures performed since 2017 in the retrospective case series study. We assessed registry coverage by the rate of return of surgeon-completed operative forms and patient-reported outcomes questionnaires, respectively. We determined the incidence of revision by the number of primary procedures linked to a revision within 1 year of surgery.</p><p><strong>Results: </strong>A total of 1044 TSA procedures occurred during the study period. Overall, 65.0% were anatomic (<i>n</i> = 679) and 35.0% were reverse TSA procedures (<i>n</i> = 365). Of the 1044 surgeries that took place, the capture rate was 92.0% (<i>n</i> = 960) for operative data. The capture rate for PROM questionnaires was 78.6% preoperatively and 65.8% postoperatively. Four primary procedures were linked with a revision within 1 year of surgery (0.4%). The most frequent diagnosis reported was degenerative arthritis (<i>n</i> = 558/817). High satisfaction (<i>n</i> = 569/636) and improved joint-specific and general quality-of-life PROMs were reported at 1 year.</p><p><strong>Conclusion: </strong>The provincial shoulder database demonstrates the early stages of a registry, which contains useful, granular data and is an opportunity to fill an important gap in Canadian arthroplasty data.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E137-E145"},"PeriodicalIF":2.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590254","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":"Where are orthopedic surgery graduates practising? A critical look at the last 30 years in Ontario.","authors":"Silvio Ndoja, Holly S Howe, Steven R Papp, Emil H Schemitsch, Brent A Lanting","doi":"10.1503/cjs.011525","DOIUrl":"10.1503/cjs.011525","url":null,"abstract":"<p><strong>Background: </strong>There has been considerable discussion regarding the demand for orthopedic surgery care and simultaneously the lack of employment opportunities for new graduates. We sought to understand the practice patterns and locations of orthopedic surgeons trained in Ontario.</p><p><strong>Methods: </strong>We invited 618 surgeons trained between 1992 and 2020 to participate in a survey investigating their current practice location, practice patterns, available resources, and reasons for emigration if practising outside of Canada.</p><p><strong>Results: </strong>A total of 253 surgeons responded (40.9%), with 242 full responses. Emigration out of Canada and number of fellowships did not change with time; however, those who graduated more recently were more likely to leave out of necessity rather than interest. Graduates of the University of Ottawa were more likely to work in the United States and more likely to settle farthest from their school if they stayed in Ontario. Graduates of the University of Toronto were more likely to work within 50 km of their training program than graduates of other schools. Most surgeons described themselves as specialists (community or academic), with very few self-described generalists (12%).</p><p><strong>Conclusion: </strong>We found an effect of school on the probability of leaving Canada, with surgeons who graduated more recently leaving out of necessity. This suggests that more recent graduates believe there are not enough opportunities, with graduates of the University of Ottawa being the hardest hit. We also found that almost no one viewed themselves as a generalist, which suggests a re-evaluation of the goals of residency education.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E155-E163"},"PeriodicalIF":2.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590278","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 effect of obesity on revision total knee arthroplasty: a retrospective cohort study.","authors":"Mohamad Nassereddine, Richard McCalden, Lyndsay Somerville, Jackie Marsh, Edward M Vasarhelyi","doi":"10.1503/cjs.003525","DOIUrl":"10.1503/cjs.003525","url":null,"abstract":"<p><strong>Background: </strong>Obesity has been linked to higher rates of postoperative complications, delayed wound healing, reoperation, and re-revision rate following revision total knee arthroplasty (RTKA). This study examined the impact of obesity across various weight classes on RTKA outcomes: healthy weight (body mass index [BMI] < 25); overweight (BMI 25 to 29.9); class I obesity (BMI 30 to 34.9); class II obesity (BMI 35 to 39.9); class III, type 1 obesity (BMI 40 to 44.9); class III, type 2 obesity (BMI 45 to 49.9); and severe class III obesity (BMI ≥ 50).</p><p><strong>Methods: </strong>We retrospectively reviewed an institutional database of patients who underwent RTKA over a period of 15 years. Data on demographics, re-revision rate, RTKA survivorship, postoperative complications, mortality rate, readmissions, 90-day costs, and functional outcomes were collected. Comparisons among BMI groups were made with Kruskal-Wallis tests for non-normal data and χ² and Fisher exact tests for categorical data.</p><p><strong>Results: </strong>A total of 550 patients were included in the study, categorized into 7 BMI groups. The overall re-revision rate was 17%, with the BMI 45 to 49.9 (hazard ratio [HR] 2.4, <i>p</i> = 0.028) and BMI ≥ 50 (HR 2.8, <i>p</i> = 0.007) groups experiencing the highest risk. Implant survival in these groups declined to 70% at 4 years and 40% at 10 years, which was significantly lower than in patients with a lower BMI (<i>p</i> = 0.001). Secondary outcomes revealed that a BMI ≥ 50 was associated with higher 90-day readmission, superficial and deep infection rates, and increased 90-day costs (all <i>p</i> < 0.05), whereas functional improvements following RTKA were comparable across BMI groups (all <i>p</i> > 0.05).</p><p><strong>Conclusion: </strong>A BMI of 45 to 49.9 and ≥ 50 are risk factors for re-revision, postoperative infection, and readmission rates and increase the 90-day costs associated with RTKA.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E146-E154"},"PeriodicalIF":2.2,"publicationDate":"2026-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13053093/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147590267","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":"Comparison of resident salary and living wage in Canada: a cross-sectional study.","authors":"Leyi Bellinda Yin, Stephanie Jiang, Ashlie Nadler, Justin Barr","doi":"10.1503/cjs.013025","DOIUrl":"10.1503/cjs.013025","url":null,"abstract":"<p><strong>Background: </strong>Medical training in Canada is a long and demanding process, often accompanied by substantial financial hardships. While resident salaries tend to exceed the average Canadian income, it remains unclear whether they sufficiently address the high burden of debt and elevated living costs, particularly in urban centres such as Toronto, Vancouver, and Montréal.</p><p><strong>Methods: </strong>This cross-sectional study evaluated the affordability of resident salaries across postgraduate year (PGY) 1 to PGY5 training programs for 2024-25 by comparing them to living wages. Salary-to-living wage ratios were calculated for single adults; single parents with 1 child; and dual-income, 2-children households.</p><p><strong>Results: </strong>Results from all 17 Canadian residency programs showed that residents consistently earn a living wage for single adults and dual-income, 2-children households. Single-parent residents were unable to earn a living wage until PGY2 in Calgary and Québec, and until PGY3 in Montréal.</p><p><strong>Conclusion: </strong>While most resident salaries met living wage benchmarks, some programs, including Calgary, Montréal, and Québec, fell short, forcing residents to cover the gap. Financial strain on residents persists because of high debt, limited time for cost-saving measures, and childcare costs. Residency salaries could be adjusted, with particular attention to regions with rising living expenses and family composition.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E130-E136"},"PeriodicalIF":2.2,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999224/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472797","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: Pre- and postsurgery measurements of continuous muscle compartment pressure in patients with extremity trauma.","authors":"","doi":"10.1503/cjs.005226","DOIUrl":"10.1503/cjs.005226","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E121"},"PeriodicalIF":2.2,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999223/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472782","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":"Clinical outcomes of revision arthroplasty with a modular taper fluted titanium stem for the treatment of Vancouver B2 and B3 periprosthetic femur fractures.","authors":"Jeremy Kubik, Margaret S Juryn, Sahil Kooner, Oleg Safir, Allan Gross, Paul Kuzyk","doi":"10.1503/cjs.011125","DOIUrl":"10.1503/cjs.011125","url":null,"abstract":"<p><strong>Background: </strong>Existing literature on Vancouver B2 and B3 periprosthetic fracture management with modular tapered fluted stems (MTFS) is limited by lack of patient-reported outcomes, small samples, and unseparated inclusion of multiple implant models. This study examines the outcomes of Vancouver B2 and B3 fractures treated with a single MTFS hip system, the Zimmer Modular Revision (ZMR), with a minimum 1-year follow-up.</p><p><strong>Methods: </strong>We conducted a retrospective review of all patients who received a femoral revision with a ZMR taper stem to treat a Vancouver B2 or B3 fracture at our centre between 2006 and 2020. The primary outcome was all-cause reoperation, with secondary outcomes including the Harris Hip Score (HHS), the Oxford Hip Score (OHS), stem subsidence, and mortality.</p><p><strong>Results: </strong>We included 44 patients (mean age 71.6 yr) in the final analysis, with a mean follow-up of 50.2 months. The all-cause reoperation rate was 11.9% (<i>n</i> = 5). Although there were 3 cases (7.1%) of stem subsidence, there were no cases in which stem revision was required. The mean HHS was 77.2 (standard deviation [SD] 10.6, range 47 to 91) and the mean OHS was 42.5 (SD 5.2, range 33 to 48).</p><p><strong>Conclusion: </strong>Management of Vancouver B2 and B3 periprosthetic femur fractures with the ZMR MFTS option resulted in an acceptable complication profile and good functional outcome with a minimum 1-year follow-up.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E122-E129"},"PeriodicalIF":2.2,"publicationDate":"2026-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12999225/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147472791","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":"Reinforcing the role of rural trauma laparotomy.","authors":"Richard C Chaulk, Laura Allen, Fran Priestap, Brad Moffat, W Robert Leeper, Neil Parry, Daryl Gray, Micheal Lewell, Alun Ackery, Kelly Vogt","doi":"10.1503/cjs.013325","DOIUrl":"10.1503/cjs.013325","url":null,"abstract":"<p><strong>Background: </strong>Hemodynamic instability due to abdominal injury in rural settings may necessitate damage-control laparotomy (DCL) before transferring patients to a lead trauma hospital (LTH) for care. Studies from the United States support performing DCL at rural hospitals (RHs), but data from Canada are lacking. This study compares outcomes between patients who received DCL at RHs and those treated directly at an LTH.</p><p><strong>Methods: </strong>A retrospective cohort study over 15 years evaluated patients transferred to our centre after receiving DCL at an RH, matched 1:1 with those who went directly to an LTH for similar injuries. The primary outcome was abdominal injury-specific complications. Data were compared using Student <i>t</i>, Mann-Whitney <i>U</i>, and Fisher exact tests.</p><p><strong>Results: </strong>We matched 21 patients transferred from RHs with 21 patients treated at our LTH. Injury types (blunt trauma: 81% v. 76%, <i>p</i> = 0.71) and Injury Severity Scores (median 34 v. 41, <i>p</i> = 0.37) were similar in the RH and LTH groups. Abdominal complications were common (21.4%), but no significant difference was found between the RH and LTH groups (28.6% v. 14.3%, <i>p</i> = 0.08). Secondary outcomes, including death (14.3% v. 28.6%, <i>p</i> = 0.26), open abdomen duration (1.0 d v. 0 d, <i>p</i> = 0.25), admission to the intensive care unit (95.2% v. 81.0%, <i>p</i> = 0.15), and hospital stay (16.0 d v. 17.0 d, <i>p</i> = 0.48) were comparable between the RH and LTH groups.</p><p><strong>Conclusion: </strong>Though uncommon, DCL performed at RHs is not associated with higher morbidity or mortality rates. Collaboration between LTHs and RHs in select cases should be encouraged. Future research should focus on identifying ideal candidates, trauma system barriers, and ways to support this practice in rural settings.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E108-E113"},"PeriodicalIF":2.2,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965662/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347544","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":"Building stronger trauma systems in Canada.","authors":"Jeremy Grushka, David Mulder, Avery Nathens, Andrew Beckett","doi":"10.1503/cjs.004226-l","DOIUrl":"10.1503/cjs.004226-l","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E106-E107"},"PeriodicalIF":2.2,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965663/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347563","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":"Stimulant drug misuse in patients presenting to level 1 trauma centres: a retrospective analysis of 80 000 patients in Canada and the United States.","authors":"Caroline Cristofaro, Ellie B Pinsker, Timothy R Daniels, Amit Atrey, Amir Khoshbin, Mansur Halai","doi":"10.1503/cjs.010024","DOIUrl":"10.1503/cjs.010024","url":null,"abstract":"<p><strong>Background: </strong>Despite increasing global misuse of stimulant drugs, there is a paucity of literature regarding stimulant use among trauma patients. The primary aim of this study was to assess hospital mortality among patients with stimulant intoxication who presented to level 1 trauma centres in Canada and the United States. Secondary outcomes included emergency department mortality, hospital length of stay, and admission to the intensive care unit (ICU).</p><p><strong>Methods: </strong>This is a retrospective analysis of data from the Trauma Quality Improvement Program, including patients presenting emergently to participating level 1 trauma centres from January 2017 to December 2018. We included patients aged 19 to 88 years who had positive toxicology to stimulant drugs or negative toxicology to all drugs. We adjusted for patient demographic factors in the analysis.</p><p><strong>Results: </strong>We included 89 130 patients, with 10 017 patients (11.2%) having a positive screen for stimulants. The mean age in the stimulants cohort was 42.0 years, with a 75.9% male preponderance and mean Injury Severity Score of 9. The control cohort was older, with a mean age of 55 years, and a smaller proportion of males (63.0%, <i>p</i> < 0.001). We found no significant differences between emergency department mortality and length of stay in the ICU after we adjusted for confounders. Patients with stimulants in their system were predicted to spend 1.11 (95% confidence interval 1.09 to 1.13) times as many days in hospital as controls, after we accounted for confounders.</p><p><strong>Conclusion: </strong>Stimulant misuse is a relevant issue in the trauma population, associated with increased hospital length of stay, but no significant difference in mortality. By addressing stimulant intoxication in trauma patients, health care providers can work toward improving patient outcomes and reducing the associated health care burden.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 2","pages":"E114-E120"},"PeriodicalIF":2.2,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12965664/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147347528","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":"Legault took aim at Quebec physicians.","authors":"Edward J Harvey","doi":"10.1503/cjs.003126","DOIUrl":"10.1503/cjs.003126","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E102-E103"},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948458/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218458","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}