Canadian Journal of Surgery最新文献

{"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":2.0,"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":2.0,"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":2.0,"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":2.0,"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}

{"title":"Environmental sustainability in the operating room: perspectives and practice patterns of general surgeons in Canada.","authors":"Odelle Ma, Valentin Mocanu, Carmen Ng, Madeleine Kruth, Andrea Lin, Kevin Verhoeff, Shahzeer Karmali, David Bigam","doi":"10.1503/cjs.012325","DOIUrl":"10.1503/cjs.012325","url":null,"abstract":"<p><p>As key contributors to surgical emissions and leaders in the operating room (OR) environment, surgeons are uniquely poised to address surgical sustainability. The University of Alberta conducted a survey to characterize Canadian general surgeons' attitudes on OR sustainability, identify practice patterns nationwide that contribute to the OR carbon footprint, and gather ideas on improving environmental sustainability within surgery. The survey completion rate was 19.8%, with a total of 270 responses. Most surgeons agreed that environmental sustainability in the OR is important and that there is room for improving sustainability in their surgical practices. Most surgeons routinely use disposable materials during an elective laparoscopic cholecystectomy. We identified 3 common perceived barriers to implementing sustainable practices: a lack of reusable options, poor quality of reusable alternatives, and restrictions from the administrative level. We suggest a variety of strategies for improving sustainability at the individual, institutional, and national levels.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E84-E89"},"PeriodicalIF":2.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218440","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":"Provincial agreements for pregnant and parenting orthopedic surgery residents: a call for a national residency guideline.","authors":"Laura J Morrison, Annalise G Abbott, Kristen I Barton, Pascale Thibaudeau, Laurie Hiemstra","doi":"10.1503/cjs.015623","DOIUrl":"10.1503/cjs.015623","url":null,"abstract":"<p><p>In Canada, orthopedic surgery residents who identify as women face unique challenges regarding family planning during training. We investigated provincial policies on pregnancy, parental leave, and return to work in 8 provinces across Canada. We also explored the British Orthopaedic Association (BOA) guideline as a potential model for improving support for Canadian orthopedic surgical residents during pregnancy, parental leave, and professional development. Our analysis reveals disparities in duty hours, parental leave benefits, and pregnancy-related restrictions. For instance, Quebec allows relief from call duties at 20 weeks' getation, while Manitoba, Nova Scotia, and Saskatchewan mandate waiting until 28 weeks. Duty-hour restrictions vary across provinces, with British Columbia setting a limit of 12-hour shifts and Quebec setting it at 8 hours. Pay during parental leave also varies, with top-ups ranging from 84% to 100%, inconsistently available to nonbirthing or adoptive parents. Current agreements fail to support informed family planning decisions and lack robust strategies for risk mitigation. We propose implementing a standardized national guideline based on the BOA model. This guideline would offer clear policies for trainees during pregnancy, parental leave, and return to work, along with strategies to minimize occupational hazards. Adoption of such a guideline would empower trainees, promote inclusivity, and encourage more women to consider careers in orthopedic surgery.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E97-E101"},"PeriodicalIF":2.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218646","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":"Assessing the fragility index of randomized controlled trials on carotid artery stenosis: a systematic review.","authors":"Eva Liu, Natalie Tilbury, Amy Zhou, Hsuan Ming Su, Braeden D Newton, Amit Persad, Uzair Ahmed, Lissa Ogieglo, Michael Kelly","doi":"10.1503/cjs.008525","DOIUrl":"10.1503/cjs.008525","url":null,"abstract":"<p><strong>Background: </strong>The fragility index (FI) measures the robustness of randomized controlled trials (RCTs) with dichotomous outcomes, calculated as the number of patients whose outcome would need to change for a significant result to become non-significant. Many RCTs have compared carotid endarterectomy (CEA) and carotid artery stenting (CAS), with variable results; thus, in this systematic review, we sought to explore the FI as a possible explanation for the variability in trial results between CEA and CAS.</p><p><strong>Methods: </strong>We conducted a search in MEDLINE (1946 to Apr. 22, 2024), Embase (1974 to Apr. 22, 2024), and PubMed (up to Apr. 22, 2024) for RCTs comparing CEA and CAS. We included RCTs with statistically significant results and dichotomous primary outcomes.</p><p><strong>Results: </strong>Our literature search identified 11 RCTs involving 5296 patients (<i>n</i> = 2640 CEA, <i>n</i> = 2656 CAS). All studies except 1 favoured CEA, with the exception favouring CAS. The median FI was 11 (interquartile range 2 to 22). Interestingly, 100% of the studies had loss to follow-up (LTFU) greater than its FI.</p><p><strong>Conclusion: </strong>A small number of events is required to change the findings of RCTs comparing CEA to CAS from statistically significant to statistically nonsignificant. All studies that reported LTFU had LTFU greater than its FI, calling into question the robustness of these results.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E90-E96"},"PeriodicalIF":2.0,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948451/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218425","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":"Les médecins mis à mal par François Legault.","authors":"Edward J Harvey","doi":"10.1503/cjs.003826","DOIUrl":"10.1503/cjs.003826","url":null,"abstract":"","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E104-E105"},"PeriodicalIF":2.2,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12948455/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146218408","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":"Surgical outcomes in nonagenarian versus octogenarian patients: a propensity-matched analysis with implications for shared decision-making.","authors":"Fahim Kanani, Eduard Khabarov, Andrey Chopen, Nir Messer, Narmin Zoabi, Alaa Zahalka, Mordechai Shimonov, Catia Dayan, Moshe Kamar","doi":"10.1503/cjs.009525","DOIUrl":"10.1503/cjs.009525","url":null,"abstract":"<p><strong>Background: </strong>Although surgical outcomes among octogenarian patients are well documented, evidence for nonagenarian patients is limited. We sought to compare surgical outcomes between these age groups to guide clinical decision-making.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study (2013 to 2023) with 1:1 propensity-score matching. We included patients aged 80 to 99 years who underwent general surgery. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 90-day and 1-year mortality, functional status at last follow-up, complications (Clavien-Dindo classification), and hospital readmissions.</p><p><strong>Results: </strong>From 700 screened patients aged 80 to 99 years who underwent general surgery, 174 met inclusion criteria (73 nonagenarian and 101 octogenarian patients), yielding 73 matched pairs for analysis. Nonagenarian patients had significantly higher 30-day mortality (26.0% v. 9.6%, <i>p</i> = 0.02), 90-day mortality (49.3% v. 23.3%, <i>p</i> = 0.002), and 1-year mortality (75.3% v. 39.7%, <i>p</i> < 0.001) than octogenarian patients. At last follow-up (median 11 to 12 mo), poor functional status was observed in 34.2% of nonagenarian versus 23.3% of octogenarian patients. Hospital readmissions within 30 days occurred in 42.5% of nonagenarian versus 21.9% of octogenarian patients (<i>p</i> = 0.002). Despite propensity matching, the Fried frailty phenotype remained significantly imbalanced between groups (standardized mean difference 0.714, <i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Nonagenarian patients face substantially worse surgical outcomes than octogenarian patients, with nearly triple the 30-day mortality and high rates of functional impairment among survivors. The persistent frailty imbalance despite matching suggests inherent selection bias in surgical nonagenarians. Unlike octogenarians, for whom selective surgery may be justified, these findings support careful consideration of nonoperative management as the default approach for nonagenarians, with surgery reserved for highly select cases after comprehensive geriatric assessment and thorough shared decision-making with the patient.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":"69 1","pages":"E71-E83"},"PeriodicalIF":2.0,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12880876/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146117905","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}